Routine Autopsy Research Articles

Whole-exome sequencing to identify causative variants in juvenile sudden cardiac death

BackgroundJuvenile sudden cardiac death (SCD) remains unexplained in approximately 40% of cases, leading to a significant emotional burden for the victims’ families and society. Comprehensive investigations are essential to uncover its elusive causes and enable cascade family screening. This study aimed to enhance the identification of likely causative variants in juvenile SCD cases (age ≤ 50 years), particularly when autopsy findings are inconclusive.ResultsAutopsy revealed diagnostic structural abnormalities in 46%, non-diagnostic findings in 23%, and structurally normal hearts in 31% of cases. Whole-exome sequencing (WES), refined through a customized virtual gene panel was used to identify variants. These variants were then evaluated using a multidisciplinary approach and a structured variant prioritization scheme. Our extended approach identified likely causative variants in 69% of cases, outperforming the diagnostic yields of both the cardio panel and standard susceptibility gene analysis (50% and 16%, respectively). The extended cardio panel achieved an 80% diagnostic yield in cases with structurally normal hearts, demonstrating its efficacy in challenging scenarios. Notably, half of the positive cases harboured a single variant, while the remainder had two or more variants.ConclusionThis study highlights the efficacy of a multidisciplinary approach employing WES and a tailored virtual gene panel to elucidate the aetiology of juvenile SCD. The findings support the expansion of genetic testing using tailored gene panels and prioritization schemes as part of routine autopsy evaluations to improve the identification of causative variants and potentially facilitate early diagnosis in first-degree relatives.

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.

Histopathological and Immunohistochemical Studies on Endocrine Glands of Dogs with Special Emphasis on the Immunoexpression of β-cells of the Pancreas

The aim of this study to evaluate the histopathological, histochemical and immunohistochemical changes of the endocrine glands namely, thyroid, pancreas and adrenal gland in dogs submitted to routine necropsy. A total number of 45 endocrine samples were collected from 15 carcasses of dogs received at Department of Veterinary Pathology, Madras Veterinary College, Chennai- 600 007 were chosen for the present study, namely thyroid, pancreas and adrenal gland. The tissue samples were collected in 10% neutral buffered formalin. Tissues were processed after 48 hours as per recommended procedure and 3 µm thickness sections were made and stained with haematoxylin and eosin for histopathological evaluation. The special stains like Masson’s trichrome and Picrosirius red were used to assess the extent of replacement with collagen fibers. Immunohistochmical protocol was followed as per the manufactured recommendation (Pathnsitu, USA).The histopathological changes recorded in the pancreas included vacuolar changes (2/15), necrosis (2/15), periductular fibrosis (1/15), perivascular fibrosis (1/15), congestion (5/15), hemorrhages (3/15) and inflammatory changes (1/15) while in the adrenal glands included diffuse cortical hyperplasia (4/15) succeeded by nodular hyperplasia (3/15), adrenalitis (2/15), hyperaemia (2/15), hemorrhages (1/15) and atrophy (1/15). Histopathological examination of thyroid revealed atrophy of follicles suggesting thyroiditis (3/15), presence of follicular epithelial cells which were found separated from the basement membrane with cellular debris in the lumen indicating necrosis (2/15) and presence of large cystic gaps with eosinophilic proteinaceous material consistent with cystadenoma(2/15). The remaining samples showed hemorrhages (2/15), perivascular fibrosis (1/15) and congestion (2/15). However no histological alterations were noticed in 3 cases (3/15). Immunohistochemistry revealed that pancytokeratin was expressed by all epithelial cells including ducts. The expression of insulin was noticed in all the cases indicating that no reduction of â cells in all the above said pathological conditions.

Mercury in liver and feathers of some birds of prey in Rio de Janeiro State, Brazil: Preliminary results

Birds of prey at higher trophic levels are particularly vulnerable to mercury pollution and can serve as indicators of trace elements in different ecosystems. Thus, the aim of this study was to evaluate the presence of mercury in feathers and livers in some birds of prey that occur in the State of Rio de Janeiro, Brazil. Eleven livers were collected from birds of pray during routine necropsies performed at the Rio de Janeiro Zoological Garden, and the feathers from animals in rehabilitation/release process. The results showed mercury concentrations ranged from 0.5 mg / kg to 1.3074 mg / kg in livers and from 0.3376 mg / kg to 3.000 mg / kg in feathers. Liver samples can be collected through invasive methods like biopsies, which involve anesthesia and handling of the bird, or during routine necropsies in zoological collections, breeding grounds, and from deceased birds found in the field, especially those affected by trampling or firearm injuries. Alternatively, analyzing feathers for mercury provides a practical, cost-effective, and non-invasive method that avoids risking harm to the bird's physical well-being.

The influence of fixing condition on myoglobin stainability of striated muscle as a tool for forensic diagnosis

It is reported that immunostaining of Myoglobin (Mb) is useful for forensic diagnosis. In this study, we investigated the condition of fixation of striated muscle in 10 % neutral-buffered formalin to obtain appropriate stationarity of Mb in immunostaining. Firstly, criteria for staining intensity and definition of the stainability of examined were determined for sheep muscle tissue. Sheep myocardial tissue was fixed using 10 % neutral-buffered formalin under the 21 different conditions based on combinations of the following: three ratios of volume of formalin (mL) to weight of myocardium (g) (RFM) of 1, 4 or 9, 7 durations of fixation (DF) of 0.5, 3 or 6 h, and 1, 2, 5 or 7 days. Secondly, detection of Mb diffused form skeletal muscle from autopsy cases into formalin during fixation were confirmed by ELISA. Finally, the evaluation of stainability of Mb of striated muscle in routine autopsy examinations was confirmed using sheep staining intensity standards. From this experimental investigation, it has been demonstrated that the most suitable formalin fixation condition for using Mb staining in forensic diagnosis is RFM4 with a fixation time of at least DF 3 h up to 1 day. It was evident that staining intensity decreases with fixation durations exceeding 2 days, irrespective of the RFM. Thus, the fixation time was deemed the most influential factor affecting the staining properties of Mb staining in skeletal muscle tissue. When conducting Mb staining using striated muscle as an evaluation sample, particular attention should be paid to the fixation time.

A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria

Introduction: It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from the superior mesenteric artery (SMA), can supply the liver in 1.5–4.0% of cases. Computed tomography (CT) angiography is a highly accurate method for identifying arterial anomalies, which may remain undetected until the time of surgery, leading to unexpected complications. Case presentation: A 53-year-old male exhibiting symptoms of decreased appetite, weight loss, vomiting, and altered sclera, urine, and stool colour, underwent a contrast-enhanced CT scan revealing biliary tract dilatation and pancreatic abnormalities, leading to a pancreaticoduodenectomy. During the surgery, an uncommon arterial finding—CHA from SMA—was noted. Pancreatic cancer was confirmed. The patient was discharged a week post-surgery without issues, emphasizing perioperative care progress. Discussion: The authors’ study focused on the detection conditions of the same hepatic artery anomaly in eight cases reported between 2017 and 2023. In two of them the anomaly was discovered in cadaver by routine autopsy. In three cases, this variation was identified before the surgery, but in three other cases it wasn’t detected until the surgical procedure. In the authors’ case, due to multiple reasons, the anomaly remained undetectable until the surgery. Conclusion: This study underscores the importance of thorough preoperative evaluation to grasp vascular variations for better patient care. Also, a noteworthy observation in our case is that the surgeon identified an expanded hepatic vessel, prompting further investigation into this anomaly.

Lung tissue expression of epithelial injury markers is associated with acute lung injury severity but does not discriminate sepsis from ARDS

BackgroundAcute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients, and diffuse alveolar damage (DAD) is considered its histological hallmark. Sepsis is one of the most common aetiology of ARDS with the highest case-fatality rate. Identifying ARDS patients and differentiate them from other causes of acute respiratory failure remains a challenge. To address this, many studies have focused on identifying biomarkers that can help assess lung epithelial injury. However, there is scarce information available regarding the tissue expression of these markers. Evaluating the expression of elafin, RAGE, and SP-D in lung tissue offers a potential bridge between serological markers and the underlying histopathological changes. Therefore, we hypothesize that the expression of epithelial injury markers varies between sepsis and ARDS as well as according to its severity.MethodsWe compared the post-mortem lung tissue expression of the epithelial injury markers RAGE, SP-D, and elafin of patients that died of sepsis, ARDS, and controls that died from non-pulmonary causes. Lung tissue was collected during routine autopsy and protein expression was assessed by immunohistochemistry. We also assessed the lung injury by a semi-quantitative analysis.ResultsWe observed that all features of DAD were milder in septic group compared to ARDS group. Elafin tissue expression was increased and SP-D was decreased in the sepsis and ARDS groups. Severe ARDS expressed higher levels of elafin and RAGE, and they were negatively correlated with PaO2/FiO2 ratio, and positively correlated with bronchopneumonia percentage and hyaline membrane score. RAGE tissue expression was negatively correlated with mechanical ventilation duration in both ARDS and septic groups. In septic patients, elafin was positively correlated with ICU admission length, SP-D was positively correlated with serum lactate and RAGE was correlated with C-reactive protein.ConclusionsLung tissue expression of elafin and RAGE, but not SP-D, is associated with ARDS severity, but does not discriminate sepsis patients from ARDS patients.

Position and Length of Appendix among Delhi Population-An Autopsy Based Study

Vermiform appendix reportedly shows lots of variations in its position and length among different individuals. The signs and symptoms presented by acute appendicitis requiring medical or surgical intervention may vary accordingly. Hence, medical practitioners should have a fair knowledge of such variations to diagnose the underlying pathology. Knowledge about variations in the position and length of the appendix is also equally important for its removal through minimally invasive surgery. The present study was conducted at Lady Hardinge Medical College, New Delhi from October 2018 to March 2020 to observe the variations in position and length of appendix in the dead bodies brought for routine medico-legal autopsies. Among 200 randomly selected deceased individuals, males were 88.5% whereas females were 11.5%. Maximum numbers of individuals were found in the age group 31–40 years (23%), followed by 41–50 years (22.5%) and then 21–30 years (22%). The mean age of the individuals was 43 ± 14.98 years, with an age range varied from 14 to 90 years. Position of the appendix was found pre-ileal in 6.5%, post-ileal in 10%, promonteric in 12%, pelvic in 21%, retro-caecal in 27.5%, para-colic in 13.5%, sub-caecal in 6.5% and others in 3% cases. Retro-caecal position was the most common position in the present study. The mean length of the vermiform appendix was found to be in the range of 0–5 cm in 10.5%, 5–10 cm in 63%, 10–15. cm in 21.5%, 15–20 cm in 4.5%, and more than 20 cm in 0.5% cases. The mean (average) length of the vermiform appendix was 8.4 ± 3.07 cm, with a range varied from 4.2 cm to 21.1 cm. The position of the appendix could not be related to the sex and age of the individual or to the length of the appendix.

Fusobacterium necrophorum predomina na microbiota do abscesso dentário mandibular em Blastocerus dichotomus

ABSTRACT: Dental abscess in ruminants is an acute polymicrobial infection, usually resulting from periodontal disease or endodontic infection, with consequences for animal health and welfare. The present study aimed to describe the bacterial microbiota of dental abscesses in Blastocerus dichotomus. Biological material from mandibular dental abscesses, punctured with a sterile syringe and needle during routine veterinary curative procedures or necropsies, was collected from three ex-situ marsh deer. Bacteria were identified using high-throughput sequencing of the 16S ribosomal RNA gene. The three specimens had the presence of facial bulging, and two died because of severe emaciation with a history of progressive weight loss. Bacteroides (38.6%), Fusobacterium (36.65%), and Porphyromonas (7.49%) represented the most abundant genera and Fusobacterium necrophorum (35.69%), Porphyromonas levii (3.12%) and Porphyromonas gulae (1.78%) were among the ten most represented species in the microbiota of mandibular abscess in Blastocerus dichotomus. These molecular findings demonstrate a broader diversity of species in the polymicrobial nature of dental abscesses in B. dichotomus than was previously reported when culture-dependent methods were used in the diagnosis.

Draft genome sequences of two Salmonella Uzaramo isolates from poultry in South Africa.

Salmonella enterica is a zoonotic pathogen and a leading cause of foodborne gastroenteritis in humans. Here, we report the draft genome sequences of two Salmonella Uzaramo isolates, which were isolated from poultry organs during routine post-mortem examination in South Africa. Currently, whole-genome sequences on Salmonella Uzaramo are scanty.

Postmortem Computed Tomography: A Supplant Technique to Autopsy for Firearm Injuries in the Head

Background: Autopsy is more time-consuming if the bullet/bullets are lodged at the difficult-to-access sites of the head, especially maxillofacial regions. The procedure of suturing the deceased becomes even more difficult after the retrieval of bullets post-dissection of facial tissues. The altered aesthetics psychologically and emotionally disturb the already bereaved next of kin. The authors explored the utility of PMCT and propose a methodology of targeted dissection/minimally invasive approach to retrieve the bullet. The authors discussed the feasibility to conclude the cause of death in cases of single/multiple firearm injuries to the head using PMCT alone. Methods: The authors evaluated three cases of firearm deaths at a distance lesser than close range to the head. The deceased was subjected to PMCT scanning using a 16-slice Multi-Slice CT spiral scanner and findings were analyzed using the Vitrea software v.6.9.1 with the slice thickness ranging from 0.5mm to 5mm. A routine conventional autopsy was conducted post-scanning. Two of the three cases were suicide and succumbed to a single firearm injury while the third case was a homicide due to multiple firearm injuries. Conclusion: PMCT alone can be utilized and relied upon in deaths due to a single shot to the head and suggests a combined methodology of PMCT evaluation and minimally invasive approach in cases of multiple firearm injuries for better correlation of wound track. Lastly, PMCT helped in a targeted approach to reach the in situ bullets more precisely than any other radiological technique which upholds the humanitarian forensic aspect.

Mortality Attributed to Central and Peripheral Nervous System Disorders: A Five-years Comprehensive Review from Turkey

Objective: This study aims to provide a comprehensive overview of deaths related to central and peripheral nervous system (CNS and PNS, respectively) disorders in Turkey over a 5-year period. The objective is to identify patterns in mortality rates, investigate regional prevalence, and analyze demographic factors contributing to fatal outcomes. Additionally, we aim to critique existing data collection methodologies. Materials and Methods: Utilizing cross-sectional analysis, data were obtained from the Turkish Statistical Institute (TUIK). Mortality rates were calculated using population estimates from the TUIK, with age- and sex-specific rates, and age-standardized rates (ASRs) derived from the world standard population. Causes of death were classified according to the World Health Organization's International Classification of Diseases, Tenth Revision (ICD-10). Results: The data revealed distinct patterns in mortality rates for CNS and PNS disorders from 2018 to 2022, with significant variations between male and female populations. A prominent upward trend in deaths attributed to CNS and PNS diseases was observed after 2018, despite a decline in the population growth rate. The highest mortality rates were particularly notable in 2020 and 2021. Conclusion: This study identified a significant increase in deaths related to CNS and PNS disorders amid the backdrop of the COVID-19 pandemic. A potential correlation between COVID-19 and the prevalence of neurological disorders has been suggested. With potential underdiagnosis due to the absence of routine post-mortem diagnostic autopsies, this study underscores the need for improved diagnostic capabilities and medical practices.

Rapid Diagnostic of Streptococcus suis in Necropsy Samples of Pigs by thrA-Based Loop-Mediated Isothermal Amplification Assay.

Streptococcus (S.) suis presents a serious threat to the pig industry as well as food safety and public health. Although several LAMP assays have been developed for the identification of S. suis, no universal assay is so far available for the field-suitable examination of clinical pig specimens. Based on the thrA housekeeping gene, a new loop-mediated isothermal amplification (LAMP) assay was developed and validated for the detection of S. suis in the brain and joints of pigs. For this LAMP assay, two different methods for the extraction of DNA from brain and joint swabs were compared. Using the LPTV boiling method, the detection limit of LAMP was 1.08 CFU/reaction, while the detection limit was 53.8 CFU/reaction using a commercial DNA extraction kit. The detection limits of thrA-LAMP in combination with the LPTV boiling method were 104-105 CFU/swab in the presence of brain tissue and 103-104 CFU/swab in the presence of joint tissue. The diagnostic quality criteria of LAMP were determined by the examination of 49 brain swabs and 34 joint swabs obtained during routine diagnostic necropsies. Applying the LPTV boiling method to brain swabs, the sensitivity, specificity, and positive and negative predictive values of thrA-LAMP were 88.0, 95.8, 95.7, and 88.5% using cultural investigation as a reference method, and 76.7, 100, 100, and 73.1% using real-time PCR as a reference method. Based on these results, the thrA-LAMP assay combined with the LPTV boiling method is suitable for rapid detection of S. suis from brain swabs.

Analysis of Exhumations Carried Out in Three Divisions of Sindh

Aim: To determine the causes of death on exhumation in three divisions of Sindh, Pakistan Study Design: Cross-sectional Place and Duration of Study: Department of Pathology, Chandka Medical College, Larkana Methods: 131 exhumations carried over 1 year were included in the study. In accordance with protocol, the graves were first identified and body was removed from it. Routine autopsy was carried out. Written consent for obtaining data was taken from the relatives present and a standard proforma was used to note findings. Samples for histopathology were also taken and cause of death was evaluated. After taking relevant information, the bodies were buried in accordance with the religious and cultural norms of the relatives. Data was entered and analyzed using SPSS 22.0. Results: Males were more commonly exhumed. 21-40 years age group was most commonly involved. Most exhumations were carried out in Larkana. Most common weapon used was forced blunt trauma. Almost all bodies were at different stages of decomposition. We then observed the type of weapon/medium used. All 131 cases were of unnatural death. We observed that the most common weapon used was a hard blunt object (n=41; 31.29%), water causing drowning (n=34; 25.95%), sharp forced trauma (n=21; 16.03%) and strangulation (n=19:14.50%) were commonly used. Whereas, the least commonly used were firearms (n=16; 12.21%). According to our observation, 57.25% (n=75) were partially decomposed, 40.45% (n=53) had advanced decomposition whereas 2.29% (n=3) had no decomposition at all. Practical Implication: Analysis of exhumations is crucial for uncovering forensic evidence, resolving criminal cases, and providing closure to families. It helps ascertain causes of death, identify potential foul play, and contribute to the justice system's integrity. Additionally, exhumation analysis aids in refining investigative techniques and advancing forensic science. Conclusion: We recommend exhumation when required be carried out in females as well. We also recommend early exhumation in cases of suspected foul-play. Our data may help in future planning of policies regarding exhumation. Keywords: Exhumation; 3 Divisions of Sindh; Decomposition, Causes of Death, Drowning, Firearm Injuries, Weapon

Investigation of injuries sustained from falls down stairs

Interpretation of injuries sustained from fatal falls involving stairs is a challenge encountered by death investigation teams regularly. The high incidence of this occurrence is because stairs are a common entity in society. Without a medical evaluation of an individual's injuries, it is difficult to determine whether a fall from stairs contributed to how the individual died. The purpose of this study is to characterize the injuries of individuals that were sustained from a confirmed fatal fall involving stairs within our jurisdiction (Ontario, Canada) during 2014–2020. In a retrospective cross-sectional observation study, we examined 159 cases using both postmortem imaging and routine autopsy approaches. Our findings showed the head was the most common anatomical region injured. The most common injuries observed in the head included skull fracture(s) (most commonly the temporal, parietal and occipital bones), subarachnoid hemorrhages, and brain contusions. Anatomical regions less commonly injured included the extremities, thorax, and pelvis. This study identified an association between the presence of intracranial hemorrhage and those 65-years-old and younger; brain injury in the absence of pre-existing medical conditions; and brain injury for individuals that had a blood alcohol concentration between 0 and 80mg/100 mL. Extracranial skeletal trauma, as defined by skeletal trauma apart from the head region, was observed in 62% of cases. Extracranial skeletal trauma was also found to be strongly associated with individuals over 65-years-old. Overall, our study affirms that traumatic head injury is the primary cause of death from falls down stairs. Also, we provide information on rare injuries from falls down stairs, and indirectly, identify which body locations appear protected from injury during falls. These findings may aid in the interpretation of whether injuries in this setting are compatible with accidental or non-accidental trauma.

Necrotizing plasma cell-rich aortitis and sudden cardiac death: Late sequelae of COVID-19?

The ongoing epidemic caused by the coronavirus SARS-CoV-2 is characterized by a variety of pathologic processes within the syndrome of COVID-19. Usually beginning as an upper respiratory infection with potential progression to a pneumonitis, many cases of COVID-19 that show minimal signs or symptoms initially may develop adverse systemic sequelae later, such as widespread thrombo-embolic phenomena, systemic inflammatory disorders (especially in children), or vasculitis. Here, we present a patient who suffered a sudden cardiac death following persistent SARS-CoV-2 viral positivity for four-and-one-half months after a mild clinical viral course. At routine autopsy, a remarkable plasma cell-rich necrotizing aortitis was uncovered. The aortic intima displayed diffuse, circumferential ongoing chronic intimal edema, inflammation, and neo-vascularization. The plasma cell-rich inflammatory process also involved the origin of the left main coronary artery (LM) causing a coronary arteritis accompanied by subacute, stenosing intimal vascular smooth muscle cell (VSMC) proliferation resulting in acute myocardial necrosis as a cause of death. A similar vasculitis and plaque were noted during the routine autopsy at the ostium of the celiac artery; vasculitis was not found systemically or in smaller caliber vessels. Through a variety of techniques including extensive histopathologic and immunohistochemical characterization, immunostaining localization of viral antigen, and transmission electron microscopy we present highly suggestive evidence that this unique necrotizing, plasma cell-rich aortitis is a rare sequela of COVID-19.

Dirofilaria immitis Identified in Galapagos Sea Lions (Zalophus wollebaeki): A Wildlife Health and Conservation Concern.

The Galapagos sea lion (Zalophus wollebaeki), an endemic and endangered pinniped, faces an increasing threat due to infectious diseases related to domestic animals. Dirofilaria immitis, the parasite responsible for canine heartworm disease, is one such threat, as canine infections on the archipelago have been documented. We used a canine heartworm antigen test kit to analyze the blood from 25 juvenile Galapagos sea lions for D. immitis. Two (8%) sea lions tested positive for D. immitis antigen. Using morphologic and genetic assessments, we evaluated 20 filarial-like worms collected from within the heart of an adult male Galapagos sea lion during a previous routine postmortem examination. The intracardiac worms were morphologically consistent with adult D. immitis, and sequence analysis of targeted PCR amplicons confirmed their identity. This is the first report of D. immitis infection in Galapagos sea lions, which could become a major health problem for these pinnipeds. Further studies are necessary to confirm the level of threat from this parasite; however, widespread adoption of routine heartworm testing, prevention, and treatment in the canine population, and the control of mosquitos, could potentially reduce the disease impact on this endangered pinniped species.

Lesions and pathogens found in pigs that died during the nursery period in five Danish farms

BackgroundDiagnosing and treatment of diseases in pigs are important to maintain animal welfare, food safety and productivity. At the same time antimicrobial resistance is increasing, and therefore, antibiotic treatment should be reserved for individuals with a bacterial infection. The aim of the study was to investigate gross and histological lesions and related pathogens in pigs that died during the nursery period in five Danish farms. In addition, high throughput, real-time qPCR monitoring of specific porcine pathogens in fecal sock and oral fluid samples were carried out to investigate the between-farm and between-batch variation in the occurrence of pathogens.ResultsTwenty-five batches of nursery pigs from five intensive, indoor herds were followed from weaning (approximately four weeks) to the end of nursery (seven to eight weeks post weaning). Gross and histological evaluation of 238 dead and 30 euthanized pigs showed the highest prevalence of lesions in the skin, respiratory system, gastrointestinal tract, and joints. Gross and histological diagnoses of lung and joint lesions agreed in 46.5% and 62.2% of selected pigs, respectively. Bacteriological detection of Escherichia coli, Streptococcus suis or Staphylococcus aureus infections in joints, lungs and livers was confirmed as genuine infection on immunohistochemical staining in 11 out of 70 tissue sections. The real-time qPCR analysis of pooled samples showed that most pathogens detected in feces and in oral fluid in general followed the same shedding patterns in consecutive batches within herds.ConclusionsGross assessment should be supplemented with a histopathological assessment especially when diagnosing lesions in the lungs and joints. Moreover, microbiological detection of pathogens should optimally be followed up by in situ identification to confirm causality. Furthermore, routine necropsies can reveal gastric lesions that may warrant a change in management. Real-time qPCR testing of fecal sock samples and oral fluid samples may be used to monitor the infections in the individual herd and testing one batch seems to have a good predictive value for subsequent batches within a herd. Overall, optimal diagnostic protocols will provide a more substantiated prescription of antibiotics.

Autopsy for Medical Diagnostics: Finding the Cause of Sudden Unexpected Death through Investigation of the Cardiac Conduction System by Serial Sections.

Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD-including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)-occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies.

Proteome alterations in human autopsy tissues in relation to time after death

Protein expression is a primary area of interest for routine histological diagnostics and tissue-based research projects, but the limitations of its post-mortem applicability remain largely unclear. On the other hand, tissue specimens obtained during autopsies can provide unique insight into advanced disease states, especially in cancer research. Therefore, we aimed to identify the maximum post-mortem interval (PMI) which is still suitable for characterizing protein expression patterns, to explore organ-specific differences in protein degradation, and to investigate whether certain proteins follow specific degradation kinetics. Therefore, the proteome of human tissue samples obtained during routine autopsies of deceased patients with accurate PMI (6, 12, 18, 24, 48, 72, 96 h) and without specific diseases that significantly affect tissue preservation, from lungs, kidneys and livers, was analyzed by liquid chromatography–tandem mass spectrometry (LC–MS/MS). For the kidney and liver, significant protein degradation became apparent at 48 h. For the lung, the proteome composition was rather static for up to 48 h and substantial protein degradation was detected only at 72 h suggesting that degradation kinetics appear to be organ specific. More detailed analyses suggested that proteins with similar post-mortem kinetics are not primarily shared in their biological functions. The overrepresentation of protein families with analogous structural motifs in the kidney indicates that structural features may be a common factor in determining similar postmortem stability. Our study demonstrates that a longer post-mortem period may have a significant impact on proteome composition, but sampling within 24 h may be appropriate, as degradation is within acceptable limits even in organs with faster autolysis.