The Impact of Covid-19 Pandemic on Child Abuse and Neglect (preprint)

Purpose: - Child abuse and neglect (CAN) is a worldwide issue due to its biological, psychological, and social effects. Research in this field is particularly useful to understand CAN aspects which are still unknown and to define updated intervention strategies. Until now, there are no clear indications about the possible effects determined by the SARS-CoV-2 pandemic on CAN. For these reasons, the authors of the present manuscript propose a study in which they compared quantitative and qualitative variables of pre-pandemic and pandemic cases evaluated at an Italian ambulatory specialized in diagnosis and management of CAN. The main aims were to: define if there was a reduction or an increase of cases referred for CAN during SARS-CoV-2 pandemic;evaluate if there were statistically significant differences of variables’ distributions between pre-pandemic and pandemic periods. Methods - The study included children 0 - 18 years of age who were referred to the specialized ambulatory during the first 13 months of the SARS-COV-2 pandemic in Italy: March 2020 - March 2021. As control group (Group B - GB), the authors chose children 0 - 18 years of age evaluated by the healthcare professionals of the same ambulatory from March 2018 to March 2019. Ages and main qualitative variables were compared between the two samples throughout statistical tests. Results - The analysis yielded no statistical differences for age distributions and for the most part of qualitative variables. The study pointed out a reduction of the distribution of the number of cases. Conclusions - In this study, the comparison of frequencies’ distribution of the most part of variables between pre and post pandemic samples did not differ. The most important result of the present analysis is that in the pandemic period the volume of observed CAN cases decreased. This allows us to confirm the indications of the scientific literature. We cannot exclude that the decrease was due to a negative impact of the pandemic on the child protection system. The afore-mentioned data will be useful to program corrective interventions, also for future pandemic and disasters.

Lungs' Microscopic Patterns of Vessels in Patients Deceased with or by SARS-CoV-2 Infection

Background: Even If Specific mechanisms are not completely understood, several studies highlighted Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) ability to alter vascular homeostasis. In the literature, multiple reports of microscopic pulmonary findings of vascular structures in patients deceased by or with SARS-Cov-2 infection are available. Nevertheless, the scientific literature lacks a systematic analysis of these findings. Methods: the authors realized a systematic review of the literature in order to identify common microscopic patterns representative of pulmonary vascular damage: useful data for pathologists in clinical and forensic settings. The research yielded 23 articles (79 total cases). Quali/quantitative analysis was carried out. Conclusion: the review allowed to identify vascular thrombosis (especially in lesser caliber vessels) as common microscopic pattern. The recurrence of this pattern was confirmed by scientific literature data which demonstrate SARS-CoV-2 ability to interfere with coagulation cascade. Other meaningful microscopic findings were also discussed, even if their low frequency in study population did not allow to define them as common.

Immunohistochemistry patterns of SARS-CoV-2 deaths in forensic autopsies.

SARS-CoV-2 infection was a leading cause of death in 2020 worldwide. It can evolve determining sudden dyspnea and death without hospitalization and/or a nasopharyngeal swab. These cases can need the intervention of forensic pathologists in order to identify causes of death and to clarify malpractice claims. For these reasons, it would be useful to identify immunohistochemistry patterns of SARS-CoV-2 deaths. Thus, the authors described immunohistochemistry findings of two Patients: perivascular recruitment of T-cells in lung parenchyma, massive activation of cytotoxic cells (especially in spleen's parenchyma), and diffuse platelet aggregation in medium/small vessels. In addition, they analyzed these data in the light of the scientific literature, pointing out meaningful immunohistochemistry patterns in order to better understand SARS-CoV-2 pathophysiology process and to clearly identify causes/contributing factors of death in forensic routine.

Dental autopsy recommendations in SARS-CoV-2 infected cases.

Unidentified human remains with unknown medical history can always pose biological hazards to forensic pathologists and odontologists, including hepatitis C, HIV infection, Middle East respiratory syndrome (MERS), hemorrhagic fever viruses such as Ebola, meningitis and now Sars-Cov2. The pandemic of the new coronavirus disease (COVID-19) has reached 185 Countries with an increasing number of deaths. Forensic pathologists and odontologists may find themselves having to perform an identification autopsy to confirmed or suspected Sars-Cov2 positive deaths. By respecting the entire set of universal precautions and recommendations the highlighted risks can be minimized, and best practice in human identification should always be a priority for human rights of the dead. The following article is a summary of the recommendations for conducting dental autopsies and management of suspected COVID-19 cases.