Death Verification Research Articles

Recent progress of methods for cuproptosis detection.

Varying from other identified cell death pathways, cuproptosis is a new type of regulated cell death characterized by excess Cu ions, abnormal aggregation of lipoylated proteins in TCA cycle, loss of Fe-S cluster proteins, upregulation of HSP70, leading to proteotoxic and oxidative stress. Cuproptosis is highly concerned by scientific community and as the field of cuproptosis further develops, remarkable progress has been made in the verification and mechanism of cuproptosis, and methods used to detect cuproptosis have been continuously improved. According to the characteristic changes of cuproptosis, techniques based on cell death verification, Cu content, morphology, molecular biology of protein levels of cuproptosis-related molecules and biochemical pathways of cuproptosis-related enzyme activity and metabolites of oxidative stress, lipoic acid, TCA cycle, Fe-S cluster proteins, oxidative phosphorylation, cell respiration intensity have been subject to cuproptosis verification and research. In order to further deepen the understanding of detecting cuproptosis, the principle and application of common cuproptosis detection methods are reviewed and categorized in cellular phenomena and molecular mechanism in terms of cell death, Cu content, morphology, molecular biology, biochemical pathways with a flow chart. All the indicating results have been displayed in response to the markers of cuproptosis, their advantages and limitations are summaried, and comparison of cuproptosis and ferroptosis detection is performed in this study. Our collection of methods for cuproptosis detection will provide a great basis for cuproptosis verification and research in the future.

Microplastics in the Olfactory Bulb of the Human Brain

Microplastic (MP) pollution is an emerging environmental and health concern. While MPs have been detected in various human tissues, their presence in the human brain has not been documented, raising important questions about potential neurotoxic effects and the mechanisms by which MPs might reach brain tissues. To determine the presence of MPs in the human olfactory bulb and to analyze their characteristics such as size, morphology, color, and polymeric composition. This case series study used a cross-sectional design involving the analysis of olfactory bulb tissues obtained from deceased individuals during routine coroner autopsies. The sampling procedures were conducted at São Paulo City Death Verification Service, with laboratory analysis carried out at the Brazilian Synchrotron Light Laboratory (LNLS). Participants included 15 adult individuals who had been residents of São Paulo for more than 5 years and underwent coroner autopsies. Exclusion criteria included previous neurosurgical interventions. Data analysis was performed in April 2024. The primary exposure assessed was the presence of MPs in the olfactory bulb, analyzed through direct tissue examination and digested tissue filtration followed by micro-Fourier transform infrared spectroscopy. The main outcomes were the identification and characterization of MPs within the olfactory bulb, including their size, morphology, color, and polymeric composition. The median age of the 15 deceased individuals was 69.5 years, ranging from 33 to 100 years, with 12 males and 3 females. MPs were detected in the olfactory bulbs of 8 out of 15 individuals. A total of 16 synthetic polymer particles and fibers were identified, with 75% being particles and 25% being fibers. The most common polymer detected was polypropylene (43.8%). Sizes of MPs ranged from 5.5 μm to 26.4 μm for particles, and the mean fiber length was 21.4 μm. Polymeric materials were absent in procedural blank and negative control filters, indicating minimal contamination risk. This case series provides evidence of MPs found in the human olfactory bulb, suggesting a potential pathway for the translocation of MPs to the brain. The findings underscore the need for further research on the health implications of MP exposure, particularly concerning neurotoxicity and the potential for MPs to bypass the blood-brain barrier.

2294 Improving communication and documentation in patients receiving end of life care

Abstract Introduction Improvement project in response to several bereavement meetings with families reporting concerns with communication and care received during their loved ones’ end of life care (EOLC). Methods Retrospective review of 79 inpatients documentation who died between August 2021–March 2022 in comparison against the Royal College of Physicians National Care of the dying audit to identify targets for intervention. Survey of 22 members of ward staff between (January–March 23) including medical, nursing, and allied health professionals to understand confidence, clinical knowledge and available resources to care for EOL patients and families. Results Retrospective audit showed 13.9% of families expressed concerns about EOLC received. Discussions held of the potential for progression into EOLC were 82.4% of cases and that of approaching the terminal phase of life 83.5%, which is similar to the national findings of 83% and 79% respectively. There was an absence in offering holistic support to families and patients like food vouchers, parking permits, and referral to chaplaincy team at only 27.8% cases. This theme was seen in the staff survey, with 16.5% of staff suggesting offering parking permits and 15.2% suggesting food vouchers. The survey also highlighted the relative lack of confidence of allied health professionals 5.9/10 vs the remaining team average of 8.1/10 when providing EOLC. Conclusions The audit and survey identified gaps in patient care and communication for our ward staff. To improve quality of care, teaching sessions in collaboration with palliative care team are set to start for ward staff. To improve communication, two proformas were developed; one tackles patient and family communication preferences in cases of acute health deterioration. Another proforma aims to standardise death verification documentation across the trust. These are first cycle interventions to help improve patients and families holistic.

UNRAVELING GENDER DISPARITIES AND PROGNOSTIC INSIGHTS IN MODERATE AORTIC STENOSIS: A RETROSPECTIVE STUDY

Abstract Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries, associated with reduced survival if severe AS remains untreated. Recent reports note unfavorable outcomes in moderate AS (mAS) patients, challenging optimal intervention timing. Variations in pathophysiology linked to sex differences, involving sex hormones, activation of the renin–angiotensin–aldosterone system, and dysregulation in collagen synthesis, have been observed. Yet, limited data exists on sex–specific differences in mAS outcomes. This single–center, retrospective study included 150 patients (median age 79±13 years, female sex 48%) diagnosed with mAS who underwent comprehensive echocardiography in IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico of Milan from July 2022 to October 2023. Clinical data, encompassing demographics details and therapy, were obtained via record reviews and phone interviews. Death verification relied on the ‘Sistema Informativo Socio–Sanitario Regione Lombardia’ database. Echocardiographic records were digitally stored and post–processed by four independent investigators using Medimatic ComPACS workstation. Men were significantly younger than women (75±10 vs 79±9.7 years, p= 0.016). They exhibited lower left ventricular (LV) ejection fraction, larger LV end–systolic volume and stroke volume compared to women (54±7 vs 59±10%; p=0.028. 55±36 vs 31±13 ml; p<0.001. 83±18 vs 75±18 ml; p=0.030). Men had significantly smaller aortic valve (AV) area index to body surface area (BSA) (0.6±0.09 vs 0.7±0.1 cmq/mq; p<0.001) and lower doppler velocity index (0.32±0.07 vs 0.38±0.11; p<0.001) than women. Coronary artery disease and smoking were more frequent in men (53.3 vs 46.7%; p=0,002. 52.6 vs 47.4%; p<0.001). In survival analysis, 15% of women and 30.8% of men experienced events, with male gender independently associated with the composite outcome (all–cause mortality and AV replacement) over a mean follow–up time of 200 ± 133 days, showing a median survival of 244±16 vs 255±15 days for females (p–value=0.025). In multivariable analysis including relevant clinical variables (hemoglobin and AV index to BSA), male sex remained independently associated with the composite outcome (hazard ratio 2,01; CI 1.0–4.17; p=0.05). Women diagnosed with mAS exhibited a lower incidence of AV replacement and all–cause mortality. These findings may suggest the existence of different clinical and echocardiographic phenotypes among patients with AS.

Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital.

The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.

Mortalidade perinatal: análise de necropsias médico-legais no período de 2018 a 2022

OBJECTIVES: characterize the sociodemographic profile of the study population; analyze the cause of death described in the report; identify the events that contributed to the death; evaluate the quality of the completion of the Death Certificate (DC) and verify the prenatal follow-up of these children. METHODS: cross-sectional study, using secondary data from necropsy reports performed at the Criciúma and Tubarãos Death Verification Services. Individuals with death between 22 weeks of gestation and the sixth day of life were included, excluding those with more than 50% of the report without completion. The information present in the DC, necropsy reports and complementary tests were evaluated. RESULTS: a total of 212 necropsy reports were evaluated. Among these, 51,4% corresponded to females and 87,7% were caucasians. The majority (85.5%) of the cases analyzed were fetal deaths, with complications of the placenta, umbilical cord and membranes (ICD P02) being the main cause with 73,1% of the cases. There was a lack of completion of intermediate causes in 84,4%, and significant conditions that contributed to death in 98,5% of the reports. Regarding prenatal care, 89.6% underwent follow-up. CONCLUSION: it is emphasized that perinatal mortality is a crucial indicator for prenatal evaluation and factors related to mother and pregnancy. This is because it will be through epidemiological information related to it that public resources will be distributed, in order to reduce the diseases and improve health indicators.

Usefulness of minimally invasive autopsy in the diagnosis of arboviruses to increase the sensitivity of the Epidemiological Surveillance System in Ceará, Brazil.

To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Training was provided to medical pathologists on MIA. A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance. A protocol was developed to perform minimally invasive autopsies (MIAs) in Death Verification Services (SVO), capable of expanding the system's capacity to identify a greater number of deaths suspected to be due to arboviruses. The experience suggests that in-service trained health professionals are able to perform MIA, and that use of this technique in SVOs has been shown to be capable of increasing the system's sensitivity in detecting deaths of interest to public health. Trained professionals will be able to collect biological material in hospitals, through MIA, in cases of interest for health surveillance and when family members do not allow a complete conventional autopsy to be performed.

Evaluation of locus coeruleus changes during aging by post‐mortem brain MRI contrast

AbstractBackgroundNeuropathological studies have pointed to the importance of neurodegeneration in the locus coeruleus (LC) as a possible early biomarker of Alzheimer’s Disease (AD). The aim of this study is to explore a non‐invasive MRI technique to evaluate normal and pathological changes in the LC during aging.MethodsSubjects were recruited from our Capital’s Death Verification Service. After obtaining written consent from family members, 24 individuals (55‐94 yrs) were submitted for post‐mortem brain in situ MRI with a 7T scanner. Post‐mortem interval ranged from 7 to 20 hours and body temperature varied from 14.8°C to 26°C. MRI protocol included acquisition of multi‐echo gradient‐echo axial images with 2 mm thickness and 0.4 mm in‐plane resolution. LC signal intensity was evaluated from a single gradient‐echo image presenting the brightest signal for the LC. In the same slice normalized values for the left and right LC were quantified (LNV and RNV) by selecting a ROI on the brightest spot of the LC (one‐pixel sized) and dividing it by the signal intensity measured in the left and right pons, respectively (ROI of approx. 50mm2) (Figure1). Subject’s Clinical Dementia Rating (CDR) was obtained by interviewing a close family member. A two‐tailed paired t‐test was performed between the RNV and the LNV, and dependence with age was analyzed by Pearson correlation.ResultsCDR was 0 (n = 17); 0,5 (n = 2); 1 (n = 1), 2 (n = 1), and 3 (n = 3). LNV was higher than RNV (t(23) = 3.9; p< 0.001 (Figure2). The mean of LNV and RNV (MNV) was higher in individuals with CDR = 0 than in subjects with CDR >0, but subjects with CDR>0 were also significantly elder, and there was a significant effect of age on the MNV (r = ‐ 0,49, p = 0,015), Figure 3.ConclusionMRI LC contrast was able to depict LC changes as a function of age, whereby subjects with symptons seemed to present lower LC intensity. The left LC was consistently brighter than the right LC endorsing results observed in other studies (Betts et al.2019 https://doi.org/10.1016/j.dadm.2019.02.001). Future histopathological analysis will help to elucidate the origin for this signal difference.

A106‘FY1 for a day’ an immersive programme to prepare final year medical students for foundation training

Final year medical students are often anxious about commencing foundation training and feel underprepared for the practical responsibilities they are expected to conduct independently [1]. Consequently, a full day programme was created to facilitate immersive simulation of a typical working day of a Foundation Year 1 (FY1) doctor. Aim: To provide an enriching programme empowering final year medical students to experience the practical aspects of foundation training (including areas of expressed difficulty), whilst creating a safe and realistic learning environment and providing opportunities for interprofessional learning and near-peer teaching. Junior doctors from FY1s to Medical Registrars delivered the programme’s content. In the morning, three interprofessional simulation scenarios were delivered to the medical students and included nursing students for added realism. Each scenario reflected common ward-based and acute-setting situations that had minimal coverage in their undergraduate curricula. Afternoon stations were created to attenuate the medical students’ anxieties about the aspects of foundation training they perceived as difficult. Using a simulated ward, a mock handover was conducted. Students were then expected to complete the tasks of death verification, complex prescribing and female catheterization. The other stations simulated interpreting blood results, discussions with a microbiologist and requesting and discussing radiological imaging. During completion of all stations, the medical students carried and answered a bleep mimicking realistic distractions. Morning and afternoon debriefing occurred in small groups. Following programme completion, all the medical students ( ‘FY1 for a day’ is an effective and sustainable educational programme to potently prepare final year medical students for their foundation training whilst safeguarding psychological safety and fortifying multidisciplinary relationships. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Augmenting the United States transplant registry with external mortality data: A moving target ripe for further improvement

The Organ Procurement and Transplantation Network conducts a robust death verification process when augmenting the United States transplant registry with external sources of data. Process enhancements added over 35,000 externally verified deaths across waitlist candidates and transplant recipients for all organs beginning in April 2022. Ninety-four percent of added posttransplant deaths occurred beyond 5 years posttransplant, and over 74% occurred beyond 10 years. Deceased donor solid organ recipients transplanted from January 1, 2010, through October 31, 2020, were analyzed from January and July 2022 Organ Procurement and Transplantation Network Standard Transplant Analysis and Research and the Scientific Registry of Transplant Recipients Standard Analysis Files to quantify the impact of including vs excluding unverified deaths (not releasable to researchers) on posttransplant patient survival estimates. Across all organs, 1- and 5-year posttransplant survival rates were not substantially impacted; meaningful differences were observed in 10-year survival among kidney recipients. These findings bear important implications for anyone who utilized transplant registry data to examine long-term outcomes prior to the updated verification process. Users of transplant surveillance data should interpret results of long-term outcomes cautiously, particularly differences across subpopulations, and the transplant community should identify ways to improve data quality and minimize the reporting burden on transplant institutions.

Distribution of leptin receptors in the brain stem: possible route in the pathophysiology of neuromuscular control of airway resistance during sleep

IntroductionLeptin, a hormone related to satiety, has been studied because of its association with obesity and sleep apnea. The distribution of leptin receptors in the brain stem, and in the hypoglossal nucleus, has not yet been described. The stimulation of these muscles has been studied in the treatment of sleep apnea. Objectiveto detail the presence of leptin receptors in the nuclei of these nerves to enable studies of stimulation of this region through leptin. Methods: the brains of five cadavers, removed during necropsy, collected at the Death Verification Service were included. An informed consent was signed by a family member (wife, mother or son/daughter) who answered specific questionnaire concerning comorbities. Anthropometric measurements were recorded. The medulla oblongata and pons fragments were identified. Immunohistochemical staining analysis was performed to identify the location of the leptin receptors. ResultsIn the immunohistochemical analysis an intense staining signal of the brownish coloration of neurons was evidenced in the hypoglossal nerve nucleus, moderate in the olivary nucleus and mild in the dorsal nucleus of the vagus and trigeminal nucleus. In motor neurons, more intense brown pigmentation can be observed in the nucleus and cytoplasm when compared to sensory neurons. ConclusionThe immunoexpression of leptin receptor was demonstrated in the motor neurons of the human hypoglossal nucleus. These results may contribute to unravel details of the pathophysiology of neuromuscular control of airway collapse during sleep and to the development of new drugs capable of improving the neuromuscular tone of upper airway in apneic individuals.

A SURVEY ON THE CAUSES OF RESURRECTION OF DEFUNCT “LAZARUS PHENOMENON” FROM ACUPUNCTURE PERSPECTIVE

Background and Objective: Every year in the world, a significant number of people who have passed a way for different reasons, revive. In many of these cases, medical science has no answer for the phenomenon. This study investigates the causes of temporary death and revival from acupuncture perspective. Methods: This research is a descriptive study done in 2017. The samples are chosen among individuals in the world whose resurrection has been reported by the media. A check list was prepared by consulting the experts which contains age, gender, cause of death, death duration, cause of revival, place of revival, consciousness after death and governmental verification of death. Data were reported using SPSS (19) software. Results: Death caused by heart disease and accidents is 20 (17.4 %) for each. 20 (17.4%) of the individuals who have resurrected were between the ages 20 to 40. Death duration was 24 hours for 17 people (14.8 %) and 1 to 30 minutes in 14 cases (12.2 %). Place of revival was hospital in 27 cases (23.5 %), morgue in 23 cases (20 %), autopsy lab in 6 cases (5.2 %) and tomb in 31 cases (27 %). 17 individuals (14.8 %) were conscious about their death before revival. Conclusions: It seems that major changes should be made in death prevention and specification in the world medical system. Correct recognition between temporary and permanent death can save many of the dead. Acupuncture points GV26 and Ki1 may have good impact on revival. More researches in this area can provide basic solutions for health policy determiners in the world.

Trends in mortality among ART-treated HIV-infected adults in the Asia-Pacific region between 1999 and 2017: results from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) of IeDEA Asia-Pacific.

IntroductionAIDS‐related deaths in people living with HIV/AIDS have been decreasing in number since the introduction of combination antiretroviral treatment (cART). However, data on recent causes of death in the Asia‐Pacific region are limited. Hence, we analysed and compared AIDS‐related and non‐AIDS–related mortality in high‐ and low‐income settings in the region.MethodsPatients from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) receiving cART between 1999 and 2017 were included. Causes of death verification were based on review of the standardized Cause of Death (CoDe) form designed by the D:A:D group. Cohorts were grouped as AHOD (all high‐income sites), TAHOD‐high (high/upper‐middle income countries) and TAHOD‐low (lower‐middle income countries). TAHOD sites were split into high/upper‐middle income and lower‐middle income country settings based on World Bank classifications. Competing risk regression was used to analyse factors associated with AIDS and non‐AIDS–related mortality.ResultsOf 10,386 patients, 522 died; 187 from AIDS‐related and 335 from non‐AIDS–related causes. The overall incidence rate of deaths during follow‐up was 0.28 per 100 person‐years (/100 PYS) for AIDS and 0.51/100 PYS for non‐AIDS. Analysis indicated that the incidence rate of non‐AIDS mortality decreased from 0.78/100 PYS to 0.37/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). Similarly, incidence rates of AIDS‐related deaths decreased from 0.51/100 PYS to 0.09/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). More recent years of follow‐up were associated with reduced hazard for non‐AIDS mortality (2008 to 2012: aSHR (adjusted sub‐hazard ratio) 0.72, 95% confidence interval (CI) 0.54 to 0.96, p = 0.027; 2013 to 2017: aSHR 0.64, 95% CI 0.47 to 0.87, p = 0.004) compared to years 2003 to 2007. The AHOD cohort had almost twice the hazard of non‐AIDS mortality compared to TAHOD‐low (lower‐middle income sites) (aSHR 1.72, 95% CI, 1.20 to 2.46, p = 0.003); there were no differences between cohorts for AIDS‐related mortality (p = 0.834).ConclusionAIDS and non‐AIDS–related mortality rates have decreased over the past years in the Asia‐Pacific region. There is a greater risk for non‐AIDS–associated deaths in the AHOD cohort compared to lower‐middle income settings in TAHOD.

Quality of data on causes of death in southern Brazil: the importance of garbage causes.

The study objective was to analyze the quality of data on causes of death in southern Brazil. Mortality Information System (SIM - Sistema de Informações sobre Mortalidade) data were used to evaluate the occurrence of Garbage Causes (GC) in death certificates (DCs) of residents of South states and their capitals between 2015 and 2016. The GC of each state were compared to the other states and grouped by severity level (N1 to N4, according to decreasing potential impact on mortality profile). We evaluated the N1 and N2 GC in the 0-74 years, in accordance with local of occurrence and attesting professional. The occurrence of GC ranged from 29 to 31% among the three states, below the national average (34%). The GC of levels N1 and N2 were similar between states and heterogeneous between capitals. Most deaths were in-hospital, between 55%-64% of N1 and N2 GC occurred in the states and 39%-55% in the capitals. As for home deaths, this number ranged between 25%-31% and 25%-40%, respectively. More than 30% of the attesting professionals (except in Florianópolis) were declared as "others" in the corresponding DC field. Physicians from the Forensic Medical Institute (IML) and Death Verification Service (SVO) attested 15 to 24% of N1 and N2 GC in the states and 33 to 66% in the state capitals. The improvement of mortality data should involve strategies aimed at hospital physicians, in accordance with the volume of deaths and the IML and SVO services in addition to support for the emission of home DC, due to the importance in generating more severe GC.

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

OBJECTIVES:An objective of clinical autopsies is to determine the final cause of death and the pathological changes that may have triggered it. Despite advances in Medicine, the level of discrepancy between clinical and autopsy diagnoses remains significant. The aim of this study was to compare the data obtained from autopsies carried out at the São Bernardo do Campo/SP Death Verification Section with clinical diagnostic hypotheses proposed during medical care.METHOD:This was a retrospective study involving the comparison of necroscopic reports issued by the São Bernardo do Campo/São Paulo Death Verification Section in 2014 and 2015 and the Cadaver Referral Guides completed by attending physicians prior to the necroscopic examination.RESULTS:A total of 465 cases were analyzed. In general, discrepancies between the clinical diagnostic hypothesis and the autopsy diagnosis occurred in 28% of the cases. A logistic regression model, with diagnostic discrepancy as a response variable and sex, age, duration of care, type of institution providing medical care and organ system as explanatory variables, was fit to the data; the results indicated that all explanatory variables with the exception of organ system are not significant (p>0.132).CONCLUSIONS:Discrepancies between clinical diagnostic hypotheses and autopsy diagnoses continue to occur, despite new developments in complementary examinations and therapies. The odds of a discrepancy when patients present with diseases of the cardiac system are greater than those when there are problems in the vascular, endocrine and neurological systems.

Trend in mortality due to ill-defined causes in the state of Tocantins and in its capital Palmas, Brazil, 1998-2014.

to evaluate the time trend of proportional mortality due to ill-defined causes, in Tocantins and Palmas, Brazil, 1998-2014. this was a time trend study using data from the Mortality Information System (SIM) and the Death Verification Service (SVO); we evaluated the time trend of this type of this mortality using Joinpoint Regression. between 1998 and 2014, proportional mortality from ill-defined causes fell 88.5% in Tocantins and 88.1% in Palmas; the trend test indicated statistically significant inflection points in 1998-2004 (-4.14; p=0.001) for Tocantins and in 1998-2000 (-7.92; p<0.005) for Palmas; a certain degree of stability was observed with effect from 2004. there was a significant decline in proportional mortality due to ill-defined causes in Tocantins; however, it is still necessary to intensify actions aimed at improving the quality of information on mortality in some municipalities.

Uniform and blinded cause of death verification of the NELSON lung cancer screening participants

Primary outcome of the Dutch-Belgian lung cancer screening trial (NELSON) is lung cancer-specific mortality. Accurate assessment of the cause of death (CoD) is crucial. As death certificates regarding the CoD can be inaccurate, a clinical expert committee (CEC) was formed to assign the CoD. In this study, the medical files of deceased lung cancer patients were reviewed and the outcomes were compared with official death certificates. The first 266 completed medical files of Dutch deceased participants who were diagnosed with lung cancer during the study or of those with lung cancer on the death certificate were selected and blinded towards arms and patients identity. The end product of the review process consisted of six possible categories which defined the graduation of certainty that lung cancer was the primary CoD. The percentage agreement and the Cohen’s kappa statistics between the two CEC-memberswere calculated. The sensitivity and specificity of the official death certificates were determined. The results indicated that, the overall concordance and the Cohen’s kappa between the CEC-memberswere 86.1% and 0.57(0.45–0.69, p<0.001), respectively. This level increased with the numbers of cases evaluated. The sensitivity and the specificity of the official death certificate were 92.6% and 98.8%; 6.5% cases were reclassified to lung cancer specific death, which is lower than in the National Lung Screening trial(22.0%). Concluding, each death should be reviewed by at least two members. So far, in the NELSON trial, possible biases related to lung cancer death seem relatively small.

Estudo Transversal dos Casos de Pancreatite Aguda Necropsiados no Instituto Médico Legal de Belo Horizonte, 2006–201

A pancreatite aguda é caracterizada pela inflamação do pâncreas, em que as lesões variam de edema intersticial a necrose do parênquima com hemorragia grave. A mortalidade é alta quando associada à falência multissistêmica. A pancreatite aguda pode ser causa de morte súbita e seu diagnóstico, em especial a forma necrotizante, é feito somente após a necropsia em até metade dos casos. Objetivos: Avaliar, retrospectivamente, as características epidemiológicas e patológicas das mortes por pancreatite aguda examinadas no Instituto Médico-Legal de Belo Horizonte (IML-BH). Materiais e métodos: Análise retrospectiva dos laudos de necropsia do IML-BH cuja causa da morte foi pancreatite aguda realizados no período de 2006 a 2012. Resultados: Houve predominância de homens e a maioria dos casos foi de pancreatite aguda hemorrágica, com o etilismo sendo a etiologia predominante. A média etária foi de 43 anos, com metade dos casos entre 40 e 60 anos. A maioria dos necropsiados foi encontrada morta no próprio domicílio. Houve relação estatística entre a faixa etária de 40 e 60 anos e a ocorrência de hematoma retroperitoneal. Complicações sistêmicas incluíram edema pulmonar e cerebral, derrame pleural e pneumonia. Conclusão: Apesar do principal papel da necropsia forense ser a investigação das causas externas de morte, este estudo confirma que há situações nas quais a Medicina Legal apresenta papel importante, em especial nas localidades que não dispõem de serviços de verificação de óbito, na avaliação de potencias causas de morte súbita, como a pancreatite aguda hemorrágica.

Avaliação da implantação dos Serviços de Verificação de Óbito em Pernambuco, 2012: estudo de casos múltiplos*

to evaluate the implementation of Death Verification Services in Pernambuco State, Brazil, in 2012. this was an implementation analysis evaluation study; we constructed a logical framework and judgement matrix were prepared; primary data (direct observation and interviews) and secondary data were used; assessment of the level of Death Verification Services implementation was based on outcome-related structure and process indicators which were compared with the logical framework. the Recife and Caruaru Death Verification Services were considered to have achieved Advanced Partial Implementation, consistent with the outcome indicators measured, reaching 89.0% and 82.0% of the expected values, respectively; the Information Collection and Nosological/Aetiological Diagnosis components were considered to Fully Implemented at the Recife and Caruaru Death Verification Services; whilst the Education and Research component was only considered to be Fully Implemented at the Recife Death Verification Services. level of implementation was similar at both services; the higher level of the Education and Research component at the Recife Death Verification Services reveals the importance of technical and academic cooperation.

AIDS and the pancreas in the HAART era: a cross sectional study

BackgroundsThe aim of this study is identify the main morphological patterns of the pancreas in AIDS patients in use of Higly Active Antiretorviral Therapy (HAART).MethodsWe conducted a cross sectional study in the year of 2010. The inclusion criteria were patients older than 18 years who died of AIDS with the use of HAART (2006–2009) and underwent to autopsy . They were compared with a group of 109 patients who died of AIDS in 1995 before the HAART therapy. All the autopsies were made in the Death Verification Service of São Paulo.ResultsThe HAART group presented pancreas abnormalities lighter than no HAART users. In the HAART group, histology shows: reduction of zymogen granules in the acinar cells (ZG) higher percentage of cases, “dysplasia-like” presents lower and pancreatic acinar atrophy, presents higher percentage of cases compared to no HAART group. The exocrine pancreas in treated patients was distinguished by the high level of atrophy, sharp reduction of zymogen granules and high level of apoptosis, reflecting degeneration and lower level of protein-caloric malnutrition.ConclusionsThe islets of Langerhans in HAART group were increased in number and volume and with high level of nuclear dysplasia. The antiviral therapy and a longer survival resulted in a higher atrophy and reduction of enzymes, increasing the apoptosis and generated important changes in the pancreatic islets, probably resulting in clinical laboratory repercussion.We found no evidence of pancreatic histopathological lesions secondary to antiretroviral therapy.