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Nichols, Casey M. "Stellar Autopsy." Bowling Green State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1395100975.
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Start, Roger David. "Attitudes towards autopsy." Thesis, University of Sheffield, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285544.
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Rodrigues, César Augusto Cardoso. "Touchless autopsy report." Master's thesis, Faculdade de Ciências e Tecnologia, 2013. http://hdl.handle.net/10362/11041.
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Dissertação para obtenção do Grau de Mestre em Engenharia BiomédicaThis dissertation is a response to the most uncomfortable tasks in the medical examiners work, the tasks required to prepare an autopsy report. This is one of their biggest and most frequent limitations. The new technological tools of person-machine interface in the market motivated the realization of this project. This project is developed in Java, and allows a medical examiner to perform an autopsy report without requiring physical contact with the computer. Thus, this work has the following advantages: it does not require that the medical examiner removes his gloves whenever he needs to make an annotation, also, there is no need to transcribe information from paper format to a digital format, furthermore, it makes the process of developing the autopsy report simple having less likelihood of contaminate the material. This application was designed and developed in order to facilitate their use through voice commands, using the Java Speech and gestures detected by Leap Motion. The application operation is very satisfactory and was a source of enthusiasm to the medical examiners that accompanied the project, since this work has created a useful tool for their daily work.
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Kelly, Gavin. "Ammianus Marcellinus : autopsy, allusion, exemplum." Thesis, University of Oxford, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395223.
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Santos, José Henrique Catarino. "Suicide study : a psychological autopsy." Master's thesis, Faculdade de Ciências Médicas, 2014. http://hdl.handle.net/10362/12162.
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RESUMO: O'suicídio'é'atualmente'um'problema'de'saúde'pública.'Estimarse'que'um'milhão'de'pessoas'
morra'anualmente'devido'ao'suicídio.'De'acordo'com'diversas'agências'e'organizações'estimar 'que'ocorram'entre'20'a'40'tentativas'de'suicídio'por'cada'suicídio'consumado.'Os'custos'associados'ao'suicídio,'quer'humanos'quer'económicos'são'enormes'e'estendemrse'à'família,'emprego,'economia'e'finanças.'Os'números'oficiais'do'suicídio'em'Portugal'indicam'uma'taxa ligeiramente'acima'dos'10'por' cada'100'000'habitantes'mas' comportando' regiões'onde' são'observadas' taxas' muito' elevadas,' como' no' Sudoeste' de' Portugal' onde' se' observam particularmente taxas 3'vezes'acima'da'média'nacional.'
Investigámos' o' fenómeno' com' os' objetivos' de' validar' a' técnica' de' autópsia' psicológica' em' contexto' comunitário' nunca' realizado' em' Portugal,' e' dar' um' contributo' para' uma'
compreensão'mais'alargada'deste'problema'de'saúde'pública,'especialmente'nesta'região'de'
Odemira.' A' autópsia' psicológica' consiste' em' reunir' detalhadamente' informação' sobre' a'personalidade' e' vida' de' alguém' que' morreu' em' circunstâncias' equívocas' (por' suicídio,' homicídio' ou' acidente)'recorrendo'ainda'a'registos'e'documentação,'bem'como'procedendo'a entrevistas' com' familiares,' colegas' ou' amigos.' Foi' feita' uma' adaptação' de' uma' entrevista'
semirestruturada' para' o' efeito.' Foram' recrutados' 2' grupos' de' participantes:' um' grupo' de familiares de pessoas que cometeram'suicídio'(n=30)'e'um'grupo'de'familiares'de'pessoas'que morreram de causas' naturais' (n=24).' O' estudo' decorreu' em' 3' momentos' com' sessões' de'
apresentação' (i),' sessões' de' preparação' (ii)' e' entrevistas' para' recolha' de' informação' e'monitorização.''
Os' principais' resultados'mostram' que' existiram' dificuldades' na' obtenção' da' informação' a'partir' dos' entrevistados,' a'maioria' dos' suicidas' eram'homens' acima' dos' 40' anos' de' idade,'
afetados' por' lesões' graves' ou' doenças' graves' ' no' período' adulto' embora' apresentassem'condições' válidas' para' trabalhar,' reformados,' vivendo' em' família,' com' traços' de'personalidade' amargurados,' tristes' ou' pessimistas,' com' escassas' atividades' nos' tempos' de'
lazer,' sem' problemas' somáticos' significativos' ou' perturbações'mentais' que' comunicaram' a intenção de morrer previamente'e'provenientes'de'famílias'sem'dificuldades'económicas'ou'relações'familiares'desadequadas.'
Tendo'em'conta'a'literatura,'algumas'das'características'parecem'ser'muito'particulares'desta'população.'Aparentemente'o'suicídio'poderá'ter'implicações'genéticas'que'deveriam'ser'tidas'em'conta'em'futuras'investigações.'
A'integração'da'saúde'mental'nos'cuidados'de'saúde'primários'afigurarse'urgente'tendo'em'
conta' que' a' escassez' de' profissionais' de' saúde'mental' é' enorme' numa' parte' do' país' onde'ocorre' o'maior'número'de' suicídios.'Mudar'de'modelo'e'reorganizar'os' serviços'de' forma'a' poder' dar' uma' resposta' ao' défice' de' tratamento' de' saúde' mental' e' ter' em' conta' os'
determinantes'sociais'da'saúde'para'fazer'face'ao'isolamento'é'fundamental.' ---------------ABSTRACT: Suicide' is,'nowadays,' a'public'health'problem.'A'million'dies' annually'by' suicide'worldwide.'
According'to'several'agencies'and'organizations'an'estimation'of'20'to'40'suicide'attempts'is advanced for each complete' suicide. Associated'costs'to'suicide,'both'human'and'economic,'are' huge' and' spread' on' family,' jobs,' economy,' and' finances.' Official' available' figures' for'
suicide' in' Portugal' indicate' a' rate' slightly' over' 10' for' each' 100' 000' inhabitants,' but' with'regions'where'one' can' actually' find'extremely'high' rates,' like' for' instance' in' the'Southwest'
part' of' the' country,' where' are' regularly' found' rates' 3' times' higher,' when' compared' to'national'average.''
We' have' investigated' the' phenomenon' aiming' to' validate' the' technique' of' psychological'autopsy' in' a' community' context' never' explored' before' in' Portugal' and' to' contribute' for' a'
wider' understanding' of' this' public' health' problem,' especially' in' this' region' of' Odemira.'
Psychological'autopsy'consists'into'a'detailed'gathering'of'information'about'the'personality'and' life' of' someone' died' in' equivocal' circumstances' (suicide,' homicide,' accident),' registries and other'documentation'as'well'as'interviews'with'family'members,'corworkers'and'friends.'
An' adaptation' of' a' semirstructured' interview' was' made.' Two' groups' of' participants' were'recruited: a'group of'relatives'of'people'committing'suicide'(n=30),'and'a'group'of'relatives'of'people' whose' death' was' after' natural' causes' (n=24).' Study' was'made' in' 3'moments' with'presentation'sessions;'(i)'preparation'sessions;'(ii)'interviewing'data'collection'and'monitoring' iii).''
Main'results'showed'difficulties'to'obtain'information'from'interviewees,'most'suicides'were' from males over 40 years old, affected'by'serious'illness'or'severe'injury'in'adulthood'but'valid'to'work,'retired,'living'in'family,'with'bitterness,'sad'or'pessimistic'as'personality'traits,'with'few' leisure' activities,' without' significant' health' somatic' problems' or' mental' disorders,'communicating'intention'to'die'previously,'coming'from'families'with'no'indication'of'financial'distress'or'inadequate'family'relationship.'
Taking'into'account'the'literature'it'looks'like'some'features'seem'to'be'quiet'particular'from'this'population.'Apparently'one'might'say'that'suicide'could'have'genetic'implications'which'further'research'should'account'in'the'future.'
Integration' of'mental' health' into' primary' care' is' urgent' once' the' scarcity' of'mental' health'
professionals' is' enormous' in' a' part' of' the' country' where' most' suicides' occur.' Scaling' up services must go in order'to'address'to'treatment'gap'and'social'determinants'of'health'should'be'taken'into'account'to'face'isolation.'
Results' show' that' the' profile' of' the' suicidal' in' the' region' of' Odemira' is' particular' and'implications' of' genetics' should' be' taken' into' account.' Moreover' much' can' be' done' in'organization' of' services' in' the' region' where' we' performed' the' present' study' in' order' to'address'to'treatment'gap'for'mental'disorders'and'to'the'social'determinants'of'health.
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Roussel, Benjamin. "Autopsy of a quantum electrical current." Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1285/document.
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Les expériences de physique quantique ont atteint un niveau de contrôle permettant de préparer avec précision l'état quantique de nombreux systèmes physiques. Cela a mené à la naissance de l'optique quantique électronique, un sujet émergent qui vise à préparer, manipuler et caractériser l'état de courants électriques contenant quelques excitations électroniques se propageant dans un conducteur quantique ballistique. Ceci est un défi conséquent qui se heurte à la difficulté de caractériser un état quantique à N corps.Le sujet de cette thèse sera le développement de méthodes de traitement du signal quantique permettant d'accéder à une connaissance partielle d'un tel état pour des courants électriques quantiques. Une première méthode consiste à les analyser à nombre d'excitations fixé au travers des cohérences électroniques. Pour cela, nous élaborons une analyse de la cohérence à un électron en termes d'atomes de signaux électroniques. En combinant cela au protocole de tomographie par interférometrie HOM, nous présentons la première autopsie, fonction d'onde par fonction d'onde, d'un courant électrique quantique.Une autre approche consiste à examiner des indicateurs sondant directement l'état à N corps. Nous étudions le rayonnement émis par un conducteur quantique ainsi que la décohérence électronique d'une excitation à un électron. Ensuite nous analysons la distribution de probabilité de la chaleur dissipée par un système quantique mésoscopique. Dans ce cadre, nous développons une théorie de l'effet Joule en régime quantique et à explorons comment celle-ci pourrait permettre de sonder l'état à N corpsQuantum physics experiments have reached a level of precision and control that allows quantum state engineering for many systems. This has led to the birth of electron quantum optics, an emerging field which aims at generating, manipulating and characterizing quantum electrical currents built from few-electron excitations propagating within ballistic quantum conductors. This is challenging since it is generically impossible in practice to fully characterize the many-body state of a beam containing indistinguishable electrons. The thesis presents new quantum signal processing approaches for accessing, at least partially, to the quantum many-body state of quantum electrical currents.A first approach is to access such a state at few-particle levels through electronic coherences. We will thus present a new representation of single-electron coherence in terms of electronic "atoms of signal". Combining this signal processing algorithm to HOM tomography enables us to present the first autopsy, wavefunction by wavefunction, of an experimental electrical quantum current. Another method is to look for indicators giving information directly at the many-body level. We will investigate the radiation emitted by a quantum conductor and address the problem of decoherence of a general single-electron excitation. Finally, we will look at the heat deposited by a mesoscopic quantum system, leading to a quantum version of Joule heating and discuss how it gives an insight on the many-body state of the electron fluid
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Victor, J. Charles. "Ontario organ growth standards for perinatal autopsy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0013/MQ42109.pdf.
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Wahl, Kimberly Anne. "Ontario organ growth standards for perinatal autopsy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ42110.pdf.
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Innes, David Findlay. "The value of the autopsy in clinical medicine." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26604.
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The main purpose of this study was to assess the value of the autopsy in clinical medicine today. This has been achieved by analysing several variables. Clinical diagnostic accuracy was determined by assessing the concordance/discrepancy of clinical and autopsy diagnoses. In addition, several variables were assessed, namely whether or not the size of the hospital, type of ward, autopsy rate, age of the patient, and degree of confidence with which the clinical diagnosis was made had any bearing on the accuracy of the diagnosis. The impact of the newer diagnostic tests on clinical diagnosis was also assessed to confirm or refute the widely held opinion amongst clinicians that diagnostic advances have indeed reduced the need for autopsies. The attitudes of pathology registrars and consultants towards the autopsy were analysed, using a questionnaire proposed by Stubbs et al.
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Al-Omair, Noura. "Role of autopsy in sudden natural deaths in adults." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/16243.
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The aim of this study was to determine the extent to which the cause of death in sudden natural death in adults could be ascertained without autopsy, based on information provided in the police report, and to evaluate any degree of error between that and the officially certified cause of death. Two methods were carried out: 1. A questionnaire-based retrospective survey of sudden natural deaths distributed to practitioners. The predicted cause of death was compared with the actual cause of death as determined after autopsy. The difference between the two causes of death was classified into 'no difference', minor and major difference according to the classification scheme developed for this study. 2. A prospective study of adult sudden natural deaths referred by the procurators fiscal in Lothian and Borders to the department during 2009 and 2010. The police reports were reviewed and a cause of death was ascribed by the author. This cause was compared with the actual cause of death in the final autopsy report and any difference assessed according to the classification scheme. In the view of the retrospective study results, it is possible to determine the cause of death which is with no or minor difference to that determined by autopsy if, in addition to provide sufficient information regarding deceased’s medical history and circumstances of death, the participants are given the option to select which cases should undergo external examination only. The prospective study results indicate that in certain circumstances the cause of death could be ascribed correctly based on the available information prior to autopsy. Causes of death such as ischaemic heart disease, hypertensive heart disease and alcohol related death are more frequently ascribed correctly. However, ischaemic and hypertensive heart disease were over-predicted. Results indicate that there are criteria to select which cases might be subject to a "view and grant" procedure with no significant loss of accuracy. The implications of the study for the development of medico-legal services are considered with specific reference to Kuwait.
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Martin, Elizabeth E. M. Eng Massachusetts Institute of Technology. "Determining patterns of cancer drug resistance from autopsy patients." Thesis, Massachusetts Institute of Technology, 2020. https://hdl.handle.net/1721.1/129922.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, February, 2020Cataloged from student-submitted PDF of thesis.
Includes bibliographical references (pages 97-102).
Determining patterns of drug resistance is fundamentally required for improving clinical outcome of cancer treatment. The ability to study multiple samples from different metastatic sites of the same patient is a clinically and analytically challenging task, which has become possible with the advent of "rapid" autopsy procedures (<10 hours from death) conducted on cancer patients through the Massachusetts General Hospital (MGH) Rapid Autopsy Program. The dataset of whole-exome, whole genome and transcriptome sequencing data from advanced cancer samples uniquely captures genomic and transcriptomic information from multiple lesions of the same patient for advanced study of how resistance develops on the systemic level. Additionally, previously collected cell-free DNA samples enable the establishment of both a spatial and temporal picture of cancer drug resistance and progression.
Using RNA expression and pathway analysis, we can also identify unique transcriptional programs and differentially expressed genes between distinct clones within one patient as well as compare genetically similar clones across patents. This thesis integrates genomic and transcriptomic data through advanced clonal reconstruction methods, as well as clinical information such as cancer type, treatment history, and lesion location and response to investigate how the patient developed resistance to anti-cancer therapy. This thesis concentrates on findings in two cohorts of rapid autopsy patients: ER+ metastatic breast cancer, with a focus on patients treated with a CDK4/6 inhibitor, and cholangiocarcinoma, with a focus on patients with FGFR2-fusions treated with an FGFR-inhibitor.
In the ER+ breast cancer cohort, we identified multiple known and potentially novel resistance mechanisms in separate branches of the phylogenetic tree, often converging on distinct mutations in the same resistance genes. In cholangiocarcinoma, we found high levels of inter- and intra-tumoral heterogeneity in several patients, with a convergence on FGFR2 activating mutations as a form of resistance to FGFR-inhibitor therapy. The richness of the rapid autopsy dataset allows us to develop a fuller picture of convergent resistance mechanisms to therapy in cancer.
by Elizabeth E. Martin.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Quarrie, Karisha Claudia. "Correlation of post mortem LODOX digital radiological images with histopathological findings at autopsy : a prospective autopsy study at the Tygerberg Forensic Pathology Service Facility." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96682.
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Thesis (MMed)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which was adapted for medical usage. The LODOX has an established role in the field of Forensic Pathology where it shows high sensitivity and specificity for the detection of skeletal pathology and foreign bodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has not been reported and this study aims to review the radio-pathological correlation and the applicability of LODOX as a viable screening tool in the detection of lung pathology in post mortem cases. Methods: We prospectively reviewed cases which were referred for medico-legal autopsy between November 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town, South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as well as macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959. The macroscopic and microscopic variables were considered the “gold standard” when compared with the results of the LODOX. The sensitivity, specificity, positive and negative predictive values were assessed. Results: One hundred and fifty nine cases (159) were included in the study. The most common radiographic patterns reported were the presence of ground glass opacities and consolidation. Overall, low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopic pathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) was noted. These values were lower than that reported for pneumonia using conventional X-rays. Additionally, these LODOX patterns have a high probability of representing oedema or autolytic/decomposition change. Pneumothorax was the most common pleural pathology detected on LODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with the variables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions in our cohort was low. In general, LODOX predictions were better at excluding pathology which was not present rather than confirming pathology which was present. Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothorax but currently has limited value as a “stand alone” test in the field of Forensic Pathology. However the continued use of the LODOX as an adjunct examination, as well as prospective study of its applicability, is advised.
AFRIKAANSE OPSOMMING: Agtergrond: Die LODOX Statscan is ‘n heel-liggaam digitale X-straal skandeer apparaat wat aangepas is vir mediese gebruik. Die LODOX het ‘n gevestigde rol in Geregtelike Patologie, waar dit ‘n hoë sensitiwiteit en spesifisiteit het in die opsporing van skeletale patologie en vreemde voorwerpe. Die rol van die skandeerder in die opspoor van sagte weefsel patologie in die longe van volwassenes is nog nie gerapporteer nie, en hierdie studie ondersoek die radio-patologiese korrelasie en toepaslikheid van LODOX as ‘n doeltreffende siftingsmeganisme om long patologie op te spoor in post-mortale gevalle. Metode: Gevalle wat verwys is na die Tygerberg Geregtelike Patologie Diens lykshuis in Kaapstad, Suid-Afrika vir medies-geregtelike outopsies tussen November 2012 en Maart 2013, is prospektief geëvalueer. Alle gevalle wat die voorgeskrewe insluitingskriteria nagekom het, het LODOX skandering asook makroskopiese en mikroskopiese ondersoek van die longe ondergaan, soos toegelaat deur die Wet op Geregtelike Doodsondersoeke Nr 58 van 1959. Die makroskopiese en mikroskopiese veranderlikes is beskou as die “goud standaard” in vergelyking met die resultate van die LODOX. Die sensitiwiteit, spesifisiteit, positiewe en negatiewe voorspellingswaardes is beoordeel. Resultate: Eenhonderd-nege-en-vyftig gevalle (159) is ingesluit in die studie. Die algemeenste radiografiese pattroon wat gerapporteer is, was die teenwoordigheid van gemaalde glas opasiteit en konsolidasie. In geheel is lae to matige sensitiwiteit van hierdie LODOX beelde waargeneem in die voorspelling van pneumoniese mikroskopiese patologie (edeem, akute en chroniese ontsteking, en eienskappe van diffuse alveolêre skade). Hierdie waardes was laer as die wat gerapporteer is vir pneumonie met konvensionele X-strale. Verder het hierdie LODOX beelde ‘n hoë waarskynlikheid om edeem en/of outolise/ontbinding uit te beeld. Pneumotoraks was die algemeenste pleurale patologie wat waargeneem is met die LODOX, maar outopsie korrelasie kon nie gedoen word nie. Swak tot geen korrelasie is gemerk vir die veranderlikes kaviteit, maligne tumor en brongi-ektase, maar die prevalensie van hierdie toestande in ons kohort was laag. Oor die algemeen was LODOX voorspellings beter om patologie wat nie teenwoordig is nie, uit te skakel, eerder as om patologie wat teenwoordig is, te bevestig. Gevolgtrekking: The LODOX is ‘n uitstekende bewysstuk in die aantoon van ‘n pneumotoraks, maar huidiglik het dit beperkte waarde as onafhanklike toets in die veld van Geregtelike Patologie. Desnieteenstaande word die verdere gebruik van LODOX as bydraende ondersoek, sowel as die prospektiewe studie van sy toepaslikheid aanbeveel.
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Ahern, Liam Thomas. "The Poet’s Eye: Autopsy and Authority in Early Greek Poetry." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13510.
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Traditionally associated with the intellectual revolution of the 6th and 5th centuries B.C. and especially a hallmark of the historiographical authors Herodotus and Thucydides, earlier engagements with the concept of autopsy are often seen as self-explanatory and responding to a basic human sensibility, that is, “I have seen it for myself and therefore know it”. This thesis instead engages with poetic autopsy on its own terms. I examine the rhetorical function of autopsy, its role in the creation of authority and legitimacy. I enquire, in some ways, into the cultural contingency of autopsy, but only in so far as it reveals the structures of authority in and around early Greek poetry. Divided into two chapters, this thesis takes a holistic view towards the study of Greek poetry, taking into account not only the texts as we have them, but also their surrounding apparatus. The first chapter looks at the rhetorical strategies of poetic language in regards to autoptic claims, both by the narrator and by figures internal to the text. The second chapter considers the world outside the text through an analysis of paratexts and what I have termed extratext (that is performance context, biographical works, local tradition and early reception). I consider how these theatres of poetic representation lead to new readings of autopsy in the corpus at hand. I ultimately argue for a reassessment of the heritage of historiography and a more complex reading of the rhetorical place of epistemological thought in early Greek poetry.
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Carvalho, Marianne de Vasconcelos 1982. "Histopathological and immunohistochemical analysis of oral Kaposi sarcoma and thyroid gland in AIDS = Estudo histopatológico e imunoistoquímico de sarcoma de Kaposi oral e glândula tireóide de pacientes com Aids." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288413.
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Orientador: Pablo Agustin VargasTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A síndrome da imunodeficiência adquirida (AIDS) é causada pelo vírus da imunodeficiência humana (HIV). A infecção já acometeu mais de 60 milhões de pessoas em todo o mundo e 25 milhões de mortes. Apesar dos progressos que a comunidade internacional obteve, a AIDS ainda é uma epidemia global e constitui um dos principais problemas de saúde pública mundial. À luz dessa afirmação, este trabalho se fundamenta na abordagem das manifestações dos pacientes com AIDS, dando foco a dois tópicos relativamente distintos, porém de bastante relevância. O primeiro deles se baseia na descrição inédita da diversidade morfológica do sarcoma de Kaposi oral (SKO), o qual é umas das manifestações mais comuns associadas ao HIV, com frequente envolvimento oral. Realizamos um estudo retrospectivo de 135 casos de SKO presentes nos arquivos da Universidade de Pretoria, África do Sul. Após a revisão histológica, o SKO foi classificado em 7 categorias com base no padrão predominante de crescimento, tais como: sólido, limfangioma-like, telangiectásico, desmoplásico, linfangiectatico, equimótico e anaplásico. O significado prognóstico dessas variantes ainda precisará ser determinado, e o reconhecimento da diversidade morfológica do SKO é essencial para evitar erros diagnósticos. Em relação ao segundo capítulo, analisamos 100 tireoides obtidas de autópsias de pacientes com AIDS do Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo. Os casos foram analisados sistematicamente, a fim de determinar a frequência e as principais patologias presentes nesta glândula. Micobacteriose foi à infecção mais frequente, seguida por citomegalovírus (CMV) e criptococose. Envolvimento da glândula tiróide ocorreu geralmente como uma parte da disseminação da doença. Os médicos devem ter atenção especial para a detecção de sinais precoces de doenças na tireoide, que podem ser confundidos com sintomas gerais de manifestações da AIDS
Abstract: The acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). The infection has affected more than 60 million people around the world and over 25 million deaths. Despite the progress of the international community, AIDS is still a global epidemic and is a considerable public health problem worldwide. Due to this, this work is based on the approach of the manifestations of AIDS patients, focusing to two relatively distinct topics, but too much relevant. The first description is based on the unpublished morphological diversity oral Kaposi's sarcoma (OKS), which is one of the most common HIV manifestations, with frequent oral involvement. We performed a retrospective study of 135 cases of OKS retrieved from the archives of the University Of Pretoria, South Africa. After histological review, the OKSs were classified into 7 categories based on the predominant pattern of growth, such as solid, lymphangioma-like, telangiectatic, desmoplastic, lymphangiectatic, ecchymotic, and anaplastic. Although the prognostic significance of these variants is yet to be determined, the appreciation and recognition of such morphologic diversity remains essential in distinguishing these lesions from possible mimickers. Regarding the second chapter, we analyzed 100 thyroid obtained from autopsies of patients with AIDS, Department of Pathology, Faculty of Medicine, University of São Paulo. The cases were systematically analyzed in order to determine the frequency and the main pathological features of the gland. Mycobacteriosis infection was the most frequent, followed by cytomegalovirus (CMV) and cryptococcosis. Involvement of the thyroid gland usually occurred as a part of dissemination of the disease. Physicians should pay special attention to the early signs of thyroid disease, which can be misdiagnosed with symptoms of general manifestations of AIDS
Doutorado
Patologia
Doutora em Estomatopatologia
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Abboud, Sherine. "Susceptibility genes in ischemic stroke and intracranial atherosclerosis: clinical and autopsy studies." Doctoral thesis, Universite Libre de Bruxelles, 2009. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210290.
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Stroke is the third leading cause of death and the most common cause of disability in the world. To relieve the heavy burden of stroke, we need to understand the mechanisms that will form the basis of improved prevention and treatment. Epidemiological studies have found evidence for a genetic influence on the common form of stroke. However the genetic of stroke is still in its infancy. Subclinical intracranial atherosclerosis is sometime a predisposing factor for ischemic stroke (IS). This study was carried out to elucidate genetic factors influencing the complex phenotype of IS and subclinical intracranial atherosclerosis.In the Belgium Stroke Study (BSS), we collected 237 middle-aged (45-60 yrs) patients with small vessel occlusion (SVO) or large vessel atherosclerosis (LVA) IS, according to the Acute Stroke Treatment (TOAST) criteria, 326 ethnicity and gender matched subjects were used as controls. We tested variants in cholesterol-related candidate genes (sterol regulatory element binding protein, SREBP, SREBP-cleavage activating protein, SCAP, Apolipoprotein E, APOE, and Proprotein convertase subtilisin/kexin type 9, PCSKA) for association with IS. Significant gene-IS associations were further tested in a Finnish autopsy collection of 1004 cases with a quantitative assessment of atherosclerosis in the circle of Willis.
While we could not detect any significant association between polymorphisms in the SREBP and SCAP genes and IS, we found evidence for association at the APOE and PCSK9 loci. The APOE &949;4+ genotype was related to a more severe intracranial atherosclerosis score in men, and within the most common APOE &949;3/&949;3 genotype group a higher risk of IS was associated with the G-allele at the -219G/T promoter polymorphisms. At PCSK9, the minor allele (G) of the tagging E670G polymorphism appeared as a significant predictor of LVA (OR = 3.52, 95% CI 1.25-9.85; p = 0.017). Accordingly, in the Finnish autopsy series, G-allele carriers tended to have more severe allele copy number-dependent (p=0.095) atherosclerosis in the circle of Willis and in its branches.
Our findings in this unique combination of clinical and autopsy data suggest a multifaceted role of apoE on the risk of cerebrovascular diseases. The APOE &949;4+ genotype did not predict the risk of IS, but was associated with severity of subclinical intracranial atherosclerosis in men. In contrast, the promoter variants affecting apoE expression were significant predictors of IS, suggesting that quantitative rather than qualitative variation of apoE is related to IS independently of subclinical intracranial atherosclerosis. Furthermore, we demonstrated that PCSK9 associates with the risk of LVA stroke subtype, and suggest that the risk is related to the severity of the underlying intracranial atherosclerosis.
Atherogenesis is considered as an active, inflammatory process, interleukin (IL)-18 a proinflammatory cytokine, is thought to play a central role in the development of atherosclerosis and more specifically in plaque rupture. We genotyped four haplotype tagging polymorphisms at the IL18 gene in the BSS and the Finnish autopsy series. The minor alleles of the IL18 -607 and +127 polymorphisms, as well as the haplotype carrying both minor alleles, associated with IS after adjustment for all cardiovascular risk factors. No association was seen with the development of subclinical intracranial atherosclerosis. Our findings suggest that variation in the IL18 gene influences the acute atherosclerotic IS event, but not the previous development of subclinical intracranial atherosclerosis, suggesting a causal role of IL18 in the vulnerability of cerebral arterial atherosclerotic plaques to acute rupture and subsequent thrombosis.
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished
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Slyvka, Nataliia Oleksyivna, O. V. Besedynska, V. O. Samsonyuk, and Igor Antonovych Plesh. "WERNICKE’S ENCEPHALOPATHY AS A CAUSE OF DEATH IN ALCOHOL ADDICTS: AUTOPSY STUDY." Thesis, Материалы научной конференции студентов-медиков с международным участием. - Актуальные проблемы современной медицинской науки. - Самарканд, 27 мая 2016 г, 2016. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/11619.
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Slyvka, N. O., O. V. Besedynska, V. O. Samsonyuk, and Igor Antonovych Plesh. "WERNICKE’S ENCEPHALOPATHY AS A CAUSE OF DEATH IN ALCOHOL ADDICTS: AUTOPSY STUDY." Thesis, Материалы научной конференции студентов-медиков с международным участием. - Актуальные проблемы современной медицинской науки. - Самарканд, 27 мая 2016 г, 2016. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/11717.
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Ighodaro, Eseosa T. "STUDYING VASCULAR MORPHOLOGIES IN THE AGED HUMAN BRAIN USING LARGE AUTOPSY DATASETS." UKnowledge, 2018. https://uknowledge.uky.edu/neurobio_etds/19.
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Cerebrovascular disease is a major cause of dementia in elderly individuals, especially Black/African Americans. Within my dissertation, we focused on two vascular morphologies that affect small vessels: brain arteriolosclerosis (B-ASC) and multi-vascular profiles (MVPs). B-ASC is characterized by degenerative thickening of the wall of brain arterioles. The risk factors, cognitive sequelae, and co-pathologies of B-ASC are not fully understood. To address this, we used multimodal data from the National Alzheimer’s Coordinating Center, Alzheimer’s Disease Neuroimaging Initiative, and brain-banked tissue samples from the University of Kentucky Alzheimer’s Disease Center (UK-ADC) brain repository. We analyzed two age at death groups separately: < 80 years and ≥ 80 years. Hypertension was a risk factor in the < 80 years at death group. In addition, an ABCC9 gene variant (rs704180), previously associated with aging-related hippocampal sclerosis, was associated with B-ASC in the ≥ 80 years at death group. With respect to cognition as determined by test scores, severe B-ASC was associated with worse global cognition in both age groups. With brain-banked tissue samples, we described B-ASC’s relationship to hippocampal sclerosis of aging (HS-Aging), a pathology characterized by neuronal cell loss in the hippocampal region not due to Alzheimer’s disease. We also studied MVPs, which are characterized by multiple small vessel lumens within a single vascular (Virchow-Robin) space. Little information exists on the frequency, risk factors, and co-pathologies of MVPs. Therefore, we used samples and data from the UK-ADC, University of Kentucky pathology department, and University of Pittsburgh pathology department to address this information. We only found MVPs to be correlated with age. Lastly, given the high prevalence of cerebrovascular disease and dementia in Black/African Americans, we discussed the challenges and considerations for studying Blacks/African Americans in these contexts.
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Zackrisson, Anna-Lena. "Pharmacogenetics from a Forensic Perspective : CYP2D6 and CYP2C19 genotype distributions in autopsy cases." Doctoral thesis, Linköpings universitet, Klinisk farmakologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17936.
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In Sweden about 550 individuals die every year due to drug intoxication. A challenge for the forensic toxicologist is to determine whether or not the analytical results can explain intoxication as a cause of death. The most common drugs found among intoxication cases are psychiatric drugs and analgesics. Many of these drugs are metabolised by CYP-enzymes such as CYP2D6 and CYP2C19. Genetic variations, polymorphisms, in the genes coding for these enzymes can lead to an inactive enzyme resulting in poor metabolism, which can lead to adverse drug reactions, even with fatal outcome. The CYP2D6 gene can be multiplied, which can lead to an ultra-rapid metabolism if the alleles are active. Another polymorphism, in the CYP2C19 gene, can also lead to an ultra-rapid metabolism. This increased metabolism can result in insufficient drug plasma concentration and, with that, failed treatment. Alternately, if the drug is a pro-drug and has to be activated by these enzymes, it can lead to a high amount of active metabolites. There is a large inter-individual variation of these polymorphisms and also a large variation between different populations. Additional information about an individual’s pharmacogenetics may possibly facilitate the interpretation of the postmortem result and contribute to solve the “toxicological puzzle”. The general aim of this thesis was to study if genetic variation in the drug metabolising enzymes, CYP2D6 and CYP2C19 can contribute to fatal intoxication. Reliable and rapid SNP and CNV assays suitable for forensic samples using PCR and pyrosequencing were developed for CYP2D6 and genotype frequencies in a Swedish population were shown to be in concordance with earlier published data. SNP assays were established for polymorphisms in the CYP2C19 gene. Genotype distributions in fatal intoxication cases were compared with Swedish blood donors and significant difference between the materials were established. The allele CYP2D6*4 was found to be less frequent among the intoxication cases, as compared with the blood donors. No differences in CYP2C19 genotype frequencies were found between the materials. These findings are the opposite of our hypothesis that we expected to find an increased number of individuals carrying genetic variations, leading to poor metabolism among fatal intoxication cases. However, we are convinced that information concerning an individual’s genotype can be of importance in specific intoxication cases. Further studies are required to illuminate this question. Two further autopsy materials were studied; suicide cases (intoxications excluded) and natural death cases. A significant increased number of individuals carrying more than two active CYP2D6 alleles among the suicide cases were found compared to natural death cases. Furthermore, we found some significant differences between the materials when the individuals in each material were grouped according to how many active CYP2D6 alleles they carry in combination with the CYP2C19 genotype, which was divided into six subgroups. We do not currently have any explanation for the differences between the materials.
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Lumadue, Richard Thomas Lumsden D. Barry. "History and demise of The University Foundation in St. Augustine, Florida an institutional autopsy /." [Denton, Tex.] : University of North Texas, 2007. http://digital.library.unt.edu/permalink/meta-dc-3646.
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Al-Kandari, Nadiah M. J. "A forensic study of unnatural deaths in Kuwait : epidemiological, virtual autopsy and DNA investigations." Thesis, University of Central Lancashire, 2012. http://clok.uclan.ac.uk/6583/.
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Forensic science is growing rapidly in the world today. During the past decade, medico-legal investigations have been highly expanded to include all areas of forensic science. The present study investigated three important aspects of forensic biology. First, this present project investigated, a total number of 5,703 reported medico-legal cases diagnosed as un-natural deaths by The Forensic Department in Kuwait, during the year 2003-2009. The results show that accidental, homicidal and suicidal deaths accounted for 86%, 8% and 6%, respectively. The results showed that most people who died of unnatural deaths were more predominant in the age group 20-29 years (third decade). Road Traffic Accidents accounted for 65% of accidental deaths, and 4% out of them were related to alcohol consumption. The results also illustrated that the highest rate of homicide in Kuwait was due to stab wound injuries (38%) compared to the lower rate of homicidal pattern for infanticides (3%). Similarly, the study showed that the most common method of suicide in Kuwait was death by hanging and this accounted for (60%). This study further demonstrated the effectiveness of virtual autopsy technique as a new tool in forensic investigations to determine various un-natural death causes. A total of thirty (30) male forensic cadavers were employed in this project. The cases were RTA (11), firearm injuries (10), drowning (4), head injuries (3) and lastly strangulation (2). All these cases were compared to the findings of traditional autopsy. The results show similar findings for virtopsy compared to traditional autopsy. This study clearly revealed that virtopsy could be an effective alternative in certain situation, being noninvasive and rapid. The present project also investigated 28 samples of human blood, saliva or semen. The experiments were done at four different temperatures (55°C, 37°C, 24°C and 4°C) and four different humidity ranges (41%, 55%, 58% and 61%), respectively. The results showed that, DNA quantity in blood, saliva and semen samples remained more or less the same at temperatures of 4°C, 24°C and 37°C compared to values for day one with all other days. In contrast, when the temperature was raised to 55 °C, the DNA started to degrade with time until it reached zero at day 12 for saliva and day 15 for blood, but not for semen. The results clearly show that DNA in saliva and blood samples is extremely sensitive to heat compared to semen. In conclusion, the study reveals the different causes of unnatural deaths, the value of virtual autopsy and the need for early DNA measurement in Kuwait.
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Ward, Kevin. "Examining the Use of Psychological Autopsy Interviews in a Case of Suspected Youth Suicide." Antioch University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1274390550.
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Lumadue, Richard Thomas. "History and Demise of The University Foundation in St. Augustine, Florida: An Institutional Autopsy." Thesis, University of North Texas, 2007. https://digital.library.unt.edu/ark:/67531/metadc3646/.
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This is an historical study of an institution of higher education that existed in St. Augustine, Florida from 1942-1949. The name of the institution was The University Foundation, founded by George J. Apel, Jr. This institution had several higher education divisions functioning under its umbrella. These divisions were the St. Augustine Junior College, the Graduate Division, the American Theological Seminary and the University Extension College with evening courses and Home Study courses for vacation study. The information collected for this study was accomplished primarily by the process of studying archives and conducting personal interviews. Since this is a qualitative research study, the collected information was processed through the use of multiple data-collection methods, data sources and analyses which insured the validity of the findings of the study. This process is known as information triangulation. The results of this study provide answers to the circumstances and identities of the key players which led to the formation of The University Foundation. Issues relating to the mission, revenue streams, faculty, curricula, and the ultimate demise of The University Foundation were also addressed in this study. Recommendations are included for higher education administrators, faculty, researchers, fund-raisers, and others whose efforts may be directed toward the launching and operation of new Christian institutions of higher learning.
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Vecchiatti, Stella Maria Pedrossian. "O iodo aumenta e antecipa a incidência de tireoidites em camundongos não obesos diabéticos (NOD): estudo histológico e ultra-estrutural." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-06042010-144602/.
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As tireoidites auto-imunes são afecções endocrinológicas relativamente comuns. Há uma noção entre os clínicos de que a incidência das mesmas tem aumentado nos últimos anos. Este aumento foi documentado em algumas regiões no mundo, mas ainda há controvérsias se o mesmo ocorre no nosso país. Apesar de ser alvo de intensos e exaustivos estudos, a fisiopatologia das tireoidites auto-imunes bem como a identidade do fator desencadeante inicial da auto-imunidade permanecem obscuros e fatores genéticos, ambientais, medicamentosos e nutricionais (por exemplo, iodo) têm sido responsabilizados como causas do incremento da freqüência da auto-imunidade tireoidiana. O Iodo tem sido implicado, como responsável pelo aumento de incidência em diferentes populações após sua introdução para prevenção de bócio endêmico. Na literatura as tireoidites são definidas e classificadas de diferentes formas e há diversidade de metodologias para avaliação de material cirúrgico e de necropsias o que dificulta o estudo comparativo em diferentes séries. Para verificar se houve incremento da freqüência de tireoidites em nossa área estudamos retrospectivamente os laudos de 5 anos de necropsias realizadas no SVO da FMUSP e comparamos com levantamento anterior realizado na mesma instituição. Os infiltrados linfocitários foram marcados para CD4, CD8, CD20 e CD68. A participação da apoptose foi analisada pela técnica do TUNEL e marcação de caspase 3. Camundongos NOD (Não Obesos Diabéticos) foram submetidos à sobrecarga oral de iodo por 60 e 90 dias com o objetivo de avaliar o papel do iodo nas alterações histolopatológicas da tireóide e para criar um modelo experimental para o estudo da fisiopatologia da tireoidite autoimune.. Resultados: A freqüência de tireoidite em nosso estudo de necropsias aumentou 58 vezes em relação ao estudo anterior (2,3% e 0,04%, respectivamente). À imunohistoquímica, os casos classificados inicialmente como tireoidite linfocítica e tireoidite de Hashimoto mostraram padrão semelhante de infiltrados sugerindo serem as duas condições estágios evolutivos da mesma doença. A apoptose foi marcante nos casos estudados demonstrando ter papel importante na fisiopatologia da tireoidite auto-imune. Nos camundongos NOD o iodo antecipou e aumentou a prevalência de tireoidites. Nas duas tireóides estudadas à microscopia eletrônica encontramos lesões mitocondriais e do retículo endoplasmático rugoso que não foram vistas em nossos controles. Conclusão: Temos um incremento real da prevalência de tireoidites em necropsias realizadas em nossa instituição. O padrão histopatológico das tireoidites auto-imunes estudadas sugere que a tireoidite dita linfocítica poderia corresponder à fase inicial do processo auto-imune que levaria à tireoidite de Hashimoto. O iodo foi o fator desencadeante e que aumentou e antecipou a incidência de tireoidite em nosso estudo experimental.Autoimmune thyroiditis are relatively common endocrine diseases. There is a common perception among clinicians that its incidence has been increasing in recent years. Such an increase has been documented in a number of regions worldwide; it remains controversial, however, whether the frequency of thyroiditis is increasing in our country. Despite of being a subject of intense and exhaustive studies, the pathophysiology of auto-immune thyroiditis as well as the identity of the factor that triggers the initial autoimmunity have remained undetermined and genetics, environmental factors, drugs and, nutrition (e.g., iodine) have been implicated in the increase of frequency of thyroid autoimmunity. The iodine has been hold responsible for the increase in the incidence of autoimmune thyroiditis in different populations after its introduction in iodine-defficient regions as a prophylaxis for endemic goiter. There is a myriad of different definitions and classifications for thyroiditis. There is also a great diversity in methods used in the assessment of surgical specimens and necropsy materials. Such a diversity of classification systems and study protocols creates a barrier for comparison of data from different series/studies. In order to verify whether an increase in frequency of thyroids is occurring in our population we retrospectively analyzed the report of necropsies performed in a period of five years in the service of death verification of University of Sao Paulo School of Medicine and compared to a published study performed previously at the same institution. Lymphocytic infiltrations were labeled with antiserum against CD4, CD8, CD20 e CD68. The involvement of apoptosis was assessed by TUNEL and caspase 3 labeling. NOD (Non Obese Diabetic) mice were exposed with high dose oral iodine for 60 or 90 days in order to evaluate the role of iodine in the genesis of histopathological derangements of thyroid and to create an experimental model for the study of autoimmune thyroiditis. Results: In this study, we found a 58-fold increase in the frequency of thyroiditis in comparison to the study performed previously (2,3% e 0,04%, respectively). Cases categorized initially as lymphocytic thyroiditis showed a cell infiltrate that labeled by immunohistochemistry in a similar way as the infiltrates of cases classified as Hashimotos thyroiditis which suggests that these entities might be different stages of a same disease. All cases displayed strong labeling for apoptosis markers demonstrating its important role in the pathophysiology of autoimmune thyroiditis. Iodine anticipated and increased the frequency of thyroiditis in NOD mice. In both thyroids studied with electron microscopy, we found mitochondrial and rough endoplasmic reticulum lesions that were not seen on control thyroids. Conclusion: there is an actual increase in thyroiditis prevalence in necropsies performed at our institution. The histological pattern of autoimmune thyroiditis we studied suggests that the sol called lymphocytic thyroiditis might be the initial stage of an autoimmune process that would eventually lead to Hashimotos thyroiditis. The iodine was the triggering factor which increased and anticipated the incidence of thyroiditis in our experimental study.
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Khaw, Fu-Meng. "Osseointegration of hydroxyapatite coated femoral prostheses : a clinicopathological and biomechanical study of human autopsy retrieved implants." Thesis, University of Newcastle upon Tyne, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289162.
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Vergnano, S. "Verbal autopsy for stillbirth and neonatal deaths : comparing population cause specific mortality fraction using two methods." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1349291/.
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Background: Every year 3.2 million infants are stillborn and 3.6 million die within the first month. Up to 98% of these deaths occur in countries with inadequate or non-existent vital registration systems, where cause of death data are sparse and mostly derived from verbal autopsies (VA). It has been advocated that VA are included in routine national statistics. This thesis proposes and compares the strengths and limitations of methodologies to collect and interpret VA data for stillbirths and neonatal deaths. Methods: Data were derived from three research areas in Malawi, Nepal and Mumbai. The development of classifications, diagnostic algorithms and questionnaires for VA, suitable for physician review interpretation is described. A probabilistic method to analyse all age deaths (InterVA) was adapted for stillbirths and neonatal deaths. Cause specific mortality fractions were compared using physicians’ review and InterVA. Results: Neonatal mortality rate in Malawi was 25/1000 livebirths (LB), in Nepal 31/1000 LB and in Mumbai 16/1000 LB. A total of 922 VA including both live and stillbirths were analysed to establish causes of death. Stillbirths accounted for 44-54% of deaths. Of neonatal deaths, in Malawi the majority were attributed to severe infections according to physician review (55%) and InterVA (46%); in Nepal (43%) and Mumbai (61%) perinatal asphyxia was most common according to InterVA. In Nepal however, physician review ascribed the majority of neonatal deaths to severe infections (50%). Kappa statistics for individual agreement comparing both methods was 0.60 (CI 0.567-0.702) in Malawi, 0.62(CI 0.59- 0.65) in Nepal and 0.48(0.40 - 0.50) in Mumbai. Discussion: Different VA interpretation methods exist, however standardised procedures are necessary for international comparison. The role of physician review in interpreting VA is changing while computerised methods are becoming more widespread. The modified InterVA model provides a rapid and consistent method to establish causes of stillbirths and neonatal deaths, however it requires further refinements and ultimately a validation study using a comparison other than physician review.
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Muthuphei, Mufandilani Nelson. "Causes of perinatal deaths in Ga-Rankuwa Hospital Obstetrics Unit : an autopsy study of 100 cases." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26632.
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Introduction: Perinatal mortality is regarded as an indicator of the social status and obstetrical care within a given community. The developed world has witnessed a dramatic decline in perinatal mortality as standards of living improved. Unfortunately, this turn of events has not been seen in the Third World where mortality remains very high. When improved perinatal autopsy techniques are applied the causes of perinatal deaths are readily appreciated. No previous autopsy study has been conducted at our hospital. The application of new techniques has stimulated the present study, which is also intended to monitor current and future clinical practice. Problem formulation: What are the common causes of death in the perinatal period at Ga-Rankuwa Hospital? Aims of the study: a. To assess the common causes of fetal and neonatal deaths at our hospital. b. To determine those causes which are preventable and propose specific obstetric interventions. c. To obtain a baseline for future studies along the same line. d. To lay a foundation for clinicopathologic discussion with clinical colleagues. Research Methodology: An autopsy study is to be conducted on each and every stillbirth and neonatal death that occurs during the period of study. The technique will be discussed in detail in Chapter 3.
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Vera, Montecinos América. "Proteomic profile in postmortem brain in chronic schizopfrenia." Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/673434.
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Schizophrenia is a complex psychiatric disorder involving dysregulation of multiple pathways. In the last decades, the cortico-cerebellar-thalamo-cortical circuit has been proposed to play a key role in cognitive impairments in schizophrenia. The cerebellum is a brain area that forms part of this circuit that modulates synaptic responses of cortical regions, it has been proposed to play an important role in schizophrenia pathophysiology. Furthermore, the cerebellum, in connection with the dorsolateral prefrontal cortex, is involved in executive and working memory function. Thus, we hypothesized that the altered proteomic profile in the brain participates in the molecular network dysfunction in chronic schizophrenia. In this doctoral thesis we aimed to compare the proteomic profile in the postmortem cerebellar cortex and the prefrontal cortex of individuals with chronic schizophrenia by using (i) mass spectrometry, (ii) bioinformatic analyses to identify altered molecular networks, (iii) two double-hit schizophrenia murine models induced by maternal deprivation combined with an additional stressor for the hit proteins from the altered network in the cerebellum, (iv) immunohistochemistry techniques and (v) 3D projection analysis for unexplored candidate hits in human cerebellum.
First, we performed a pilot proteomic analysis on postmortem human cerebellar tissue from patients with schizophrenia (n=4) and control (n=4) subjects in a pool design using differential isotope peptide labelling followed by liquid chromatography tandem mass spectrometry (LC-MS/MS). Our results showed 1412 quantified proteins and 99 significantly altered proteins. 11 candidate proteins were selected as the most robust candidates from the enriched biological functions comprising cell communication/signal transduction in schizophrenia. In this study we report 68 new proteins altered in schizophrenia. In our individual proteomic study of the cerebellum, we analysed 12 cerebellar samples of subjects with schizophrenia and 14 healthy control individuals using one-shot liquid- tandem mass spectrometry. We identified a proteomic signature composed of 2578 identified proteins and 1474 quantified proteins with 250 significantly dysregulated proteins. This study reported 167 new proteins that are altered in the cerebellum in schizophrenia. Moreover, our study allowed us to identify the proteome profile and molecular networks altered in the cerebellum in chronic schizophrenia. Hierarchical clustering allowed schizophrenia subjects to be segregated from controls. Furthermore, our analyses showed that the 250 altered proteins could be under the transcriptional control of only11 transcription factors. The pathways regulated by these 11 transcription factors were related to transport, signalling, inflammation, and apoptosis.
Our network generation analysis in the cerebellum showed two well-defined networks. The network generated from the up-regulated proteins showed a mixed module with enriched pathway interactions. This module consisted of proteins from vesicle-mediated transport and axon guidance pathways. In the axon guidance pathway, CLASP1 was a hit protein that we further studied in two independent double-hit murine models for schizophrenia. Our results showed CLASP1 to be down-regulated in the murine model of maternal deprivation combined with social isolation, while our proteomic study showed it to be up- regulated. The second network was formed by two modules generated from proteins that were found to be down-regulated in the cerebellum: an energy module and a neutrophil degranulation module. The energy module was well defined in our analysis, with NDUFB9 found to be a down-regulated hit protein in our proteomic study and in the double-hit murine model of maternal deprivation combined with social isolation. The second module was neutrophil degranulation. METTL7A was found to be a hit protein in this pathway. In our study, we found . and METTL7A was found to be consistently down-regulated both in schizophrenia subjects and murine models for schizophrenia. We demonstrated for the first time the expression of METTL7A in Bergmann glia cells in the human cerebellum. We also detected METTL7A in one of its canonical localizations, in lipid droplets in white matter cells.
The prefrontal cortex analysis revealed 4407 identified proteins, 1989 quantified proteins and 43 significantly altered proteins. The enriched pathways were mainly related to the immune system. The network generated from the enriched pathway showed a mixed module with interactions between MHC class II antigen presentation, membrane trafficking, Golgi-to-ER retrograde transport, Nef-mediated CD8 down-regulation and the immune system.
Together, the results presented in this Thesis suggest an imbalance in the immune system in two brain regions, the cerebellum and the prefrontal cortex. This suggests that the nervous system could be susceptible to an imbalance in the immune system in schizophrenia subjects. Moreover, the vesicle-mediated transport pathway was found to be altered in both the cerebellum and the prefrontal cortex, two brain areas that participate in the cortico-cerebellar thalamo-cortical circuit. This result suggests a possible alteration in synaptic efficacy and communication between these areas in schizophrenia.
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Canovas, Thorsell Roberto. "Integritet av IT-forensiska verktyg för automatisk analys." Thesis, Högskolan i Skövde, Institutionen för informationsteknologi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-20166.
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IT-relaterad brottslighet ökar lavinartat och Polismyndigheten står inför nya utmaningar i att identifiera gärningsmän. Allt mer mjukvaror och tjänster blir automatiserade och det gäller även mjukvarorna som Polismyndigheten använder sig av. En av utmaningarna är den oerhörda mängd data som måste processas och analyseras i undersökningar och då förutsätts det att verktygen presenterar data med bibehållen integritet. Verktygen som används är nästan alltid tredjepartsmjukvara och då är det viktigt att rätt data plockas ut och att datan är korrekt. Denna studie har som mål att jämföra två mjukvaror i hur de identifierar och presenterar data. Studien görs i samverkan med Polismyndigheten vid Regionalt IT-brottscentrum Väst – Skövde och hoppas inbringa nya insikter och kunskaper i de verktyg som jämförelsen grundas på och med hjälp av kunskaperna kunna värdesätta integriteten hos verktygen. Resultatet som framträder i studien är att verktygen presenterar data med bibehållen integritet.Cybercrime is on the rise in society and the Swedish Police is facing new challenges in identifying criminals. More tools and services are becoming automated, and this also applies to the tools that the Swedish Police uses. One of the challenges is the enormous amount of data that must be processed and analyzed during investigations. The tools used are always third-party programs and IT-forensics needs to rely on the organization that makes the software. This study aims to evaluate two different tools in how they identify and present artifacts. The study is conducted in collaboration with the Police Authority at the Regional IT Crime Center West - Skövde and hopes to bring new insights and knowledge into the tools on which the comparison is based on and with the help of the knowledge be able to value the integrity of the tools. The result that the study presents is that the tools are presenting data with preserved integrity.
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Wagner, Manuela. "Maligne Tumoren als Zufallsbefunde bei klinischen Obduktionen - Eine retrospektive Untersuchung am Obduktionsgut des Institutes für Pathologie des Universitätsklinikums Leipzig." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-124575.
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Auf der Basis der Obduktionsprotokolle der Jahre 2000-2009 des Institutes für Pathologie des Universitätsklinikums Leipzig wurden die Häufigkeiten und Verteilungen maligner Tumoren sowie der zu Lebzeiten nicht bekannten malignen Tumoren untersucht.
Bei insgesamt 4592 durchgeführten Sektionen wurden in 263 Fällen zu Lebzeiten nicht bekannte maligne Tumoren diagnostiziert. Dies entsprach 5,7% des gesamten Sektionsgutes bzw. 20,2% aller nachgewiesenen Malignome.
Nach Analyse der pTNM-Klassifikation wurden 70,9% der Malignome in den Tumorkategorien pT1 und pT2 erfasst. In 24,7% der Fälle traten Lymphknotenmetastasen, in 19,4% Fernmetastasen auf.
23,2% der postmortal entdeckten Malignome waren todesursächlich. Über die Hälfte der Obduzierten mit klinisch nicht bekannten Tumoren waren 70 Jahre oder älter.
Die häufigsten klinisch nicht bekannten malignen Tumoren waren die Prostatakarzinome (23,9%), die kolorektalen Karzinome (16,3%), die Nierentumoren (13,0%), die Lungenkarzinome (12,7%) sowie die Leberkarzinome (6,5%).
Patienten mit synchronen Doppel- beziehungsweise Dreifachtumoren traten bei 1,8% des Sektionsgutes auf. Der Anteil nicht erkannter maligner Tumoren an den Mehrfachmalignomen betrug 41,7%.
Diese Sektionsanalyse bestätigte, dass auch im 21. Jahrhundert trotz der rasanten Entwicklungen in Medizin und Technik weiterhin maligne Tumoren erst bei der Autopsie festgestellt werden.
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Cyr, Jason. "L’échec du rêve américain : Volkswagen Blues, Une histoire américaine, On the Road et Detroit: An American Autopsy." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/57886.
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This thesis investigates the failure of the American Dream through historical contexts, in particular that pertaining to African-American history, as well as by way of a corpus comprised of four main books, two by Québécois authors and two by American authors. These books include the following: Volkswagen Blues by Jacques Poulin, On the Road by Jack Kerouac, Une histoire américaine by Jacques Godbout and Detroit: An American Autopsy by Charlie LeDuff. Throughout the analysis conducted within this thesis, the failure of the American Dream was the main focus of discussion, both within literature and historically. The first part of the thesis is dedicated to the definition of the American Dream and who may achieve it. In general, anyone may accomplish it, however, whites, both historically and contemporarily, tend to have a better chance of doing so. The thesis then takes a historical look at the failure of the American Dream, specifically by way of the inequalities exemplified throughout African-American history from the 18th century to the present in comparison to the mistreatments of Québécois at the hands of Anglophone Canada. The next part takes a look at the failure of the American Dream from a literary point of view, demonstrating how the United States may at first glance seem to exemplify the realization of the American Dream. However, after further analysis, this American Dream turns out to be a failure due to many factors including government corruption, corporate greed and racial inequality. It was concluded that whether someone will achieve the American Dream depends on who is asked as well as their cultural, racial, social, economic, and historical backgrounds among other factors. In the end, the question one must ask oneself is the following: Does the concept of the American Dream still exist today?Arts, Faculty of
French, Hispanic, and Italian Studies, Department of
Graduate
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Cavanagh, Jonathan T. O. "Suicide and undetermined death in South East Scotland : a case-control study using the psychological autopsy method." Thesis, University of Edinburgh, 2000. http://hdl.handle.net/1842/27769.
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Mental disorders are major risk factors for suicide. Not all those who suffer from them kill themselves. Additional information is required to differentiate higher from lesser risk patients. Retrospective case-control comparisons were made of cases of suicide/undetermined death with living controls using psychological autopsy in South East Scotland. Cases and controls were matched for age, sex and mental disorder. Informants were those closest to cases and controls. The subjects were 45 cases of suicide/undetermined death and 40 living controls. Cases and controls did not differ in any significant way with respect to severity of mental disorder. The main factors independently associated with undetermined death or suicide were:- a history of deliberate self harm (adjusted OR 4.1) physical ill health (adjusted OR 7.8) treatment of whatever kind by mental health services (adjusted OR 0.01). Other antecedents associated with increased risk (criminal record, involvement with police, financial problems and failure to vote) and those associated with decreased risk (contact with a doctor and in-patient care) did not exert effects after controlling for confounding. Controls were receiving more care of whatever kind. Treatment of mental disorder comorbid with physical illness and a history of deliberate self harm may be especially important. Factors which separate those with mental disorder at high risk from those at lesser risk relate to care levels provided, which may be a function of engagement by and with health services. The role of mental health professionals is beneficial in suicide prevention. The focusing of that role toward engaging alienated or "difficult" patients should be addressed.
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Churchwright, Kelly K. "Policy Autopsy: A Failure of Regulatory Oversight to Ensure Least Restrictive Environment in Ohio’s Electronic Charter Schools." Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1542989313356733.
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Mondamert, Leslie. "Seawater desalination, autopsy and cleaning of reverse osmosis membranes recovered from full-scale plants and pilot units." Poitiers, 2010. http://www.theses.fr/2010POIT2264.
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Gondak, Rogério de Oliveira 1978. "Analysis of dendritic cells in tongue, cervical lymph nodes and palatine tonsils of autopsied patients with acquired immunodeficiency syndrome = Análise das células dendríticas na língua, linfonodos cervicais e tonsilas palatinas de pacientes autopsiados com Síndrome da Imunodeficiência Adquirida." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288428.
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Orientadores: Pablo Agustin Vargas, Luiz Paulo KowalskiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Na infecção pelo HIV, as células dendríticas (CDs) podem desempenhar vários papéis, incluindo a provável captação inicial do HIV, transporte para os linfonodos, e posterior transferência para células T, desempenhando um importante papel no sistema imune. As manifestações orais observadas em pacientes infectados pelo HIV, incluindo aquelas associadas ao HSV-1 podem estar diretamente relacionadas à injúria das CDs. A proposta deste estudo foi identificar e quantificar as CDs intersticiais na língua de pacientes autopsiados com AIDS e portadores de infecção herpética lingual (n=10), pacientes com AIDS e sem lesões linguais (n=10) e pacientes sem AIDS e sem lesões linguais (n=10) por meio de reações imunoistoquímicas. Além disso, investigamos a população de CDs nos linfonodos e tonsilas palatinas de pacientes com AIDS (n=32) e sem AIDS (n=21). Nos tecidos linguais, foram utilizados os anticorpos contra CD1a e CD83 para identificação das CDs e o anticorpo contra HSV-1 para detecção do vírus da herpes simples tipo 1. Nos linfonodos e tonsilas palatinas foi utilizados além dos anticorpos contra CD1a e CD83, o anticorpo contra fator XIIIa. Para a quantificação das CDs nos tecidos linguais foi utilizado análise histomorfométrica convencional e nos tecidos linfóides foi aplicado o método analítico Positive Pixel Count (software Image Scope). Os resultados mostraram uma intensa depleção na população de CDs em tecidos linguais e linfóides de pacientes com AIDS e a infecção lingual pelo HSV-1 não potencializou a redução de CDs
Abstract: During HIV infection, dendritic cells (DCs) may play several roles, including the probable initial uptake of HIV, transport to the lymph nodes, and subsequent transfer to T cells. Oral opportunistic infections observed in HIV-infected patients, including those associated with HSV-1 may be directly related to injury of DCs. The purpose of this study was to identify and quantify the interstitial DCs in the tongue of autopsied patients with AIDS and lingual herpes (n = 10), AIDS patients with normal tongues (n = 10) and non-AIDS patients with normal tongues (n = 10) by immunohistochemistry. Furthermore, we investigated the DCs population in lymph nodes and palatine tonsils of AIDS patients (n = 32) and non-AIDS patients (n = 21). CD1a and CD83 antibodies were carried out to identify DCs in lingual tissues and HSV-1 antibody for detection of herpes simplex virus type 1. In lymphoid tissues, CD1a, CD83 and factor XIIIa antibodies were carried out to identify DCs. Interstitial DCs were measured by conventional histomorphometry whereas the lymphoid DCs were measured by Positive Pixel Count Algorithm method using ImageScope software. The results showed a decreased population of DCs in lingual and lymphoid tissues of AIDS patients independently of the presence of concomitant infection by HSV-1
Doutorado
Patologia
Doutor em Estomatopatologia
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Ben, Taher Mohamed. "Detecting the cause of death in infants and children : whole body post-mortem computed tomography compared to autopsy." Thesis, University of Sheffield, 2019. http://etheses.whiterose.ac.uk/22429/.
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Post-mortem investigation is a sensitive issue that needs to be studied in order to address the many issues that surround this topic. This thesis is divided into 7 chapters. Chapter One is a review of the literature, providing information about identifying the causes of death in children, autopsy protocols and the acceptability of post-mortem investigations among the public. Chapter Two determined the reaction towards post-mortem procedures among Muslims and non-Muslims in Libya and in the UK. Muslims were found to have a significant preference for post-mortem imaging compared to autopsy except in homicidal cases. Chapter Three is a systematic review of the literature which identified 3 papers totalling 262 patients and showed overall agreement between post-mortem CT and conventional autopsy of 51%. Chapter Four is an evaluation of the performance of PMCT compared to conventional autopsy in identifying the cause of death in 54 infants and children. Conventional autopsy detected significantly more abnormalities than PMCT and proved to be superior to PMCT for identifying organ' soft tissue abnormalities. PMCT however was superior at identifying skeletal pathology. Chapter Five investigated whether longitudinal changes in organ Hounsfield units (HU) and total body air volume (TBAV) can provide an estimate of post-mortem interval (PMI) in eight euthanised lambs. TBAV increased by 14 cm3 (p < 0.001) for each additional post-mortem day with an intercept of 116 cm3 (p < 0.001). There was clear and progressive decrease in tissue densities and increase in TBAV in individual cases over time. Chapter Six is a pilot study to determine whether PMCT can be used to estimate PMI in 51 infants and children by measuring HU of selected organs. Results suggest that further investigation of the reliability of using HU of the kidney and spleen to estimate PMI is warranted. Chapter Seven provides an overview, discussion and concludes this thesis.
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Hale, Aaron. "In search of peace an autopsy of the political dimensions of violence in the Democratic Republic of Congo /." [Gainesville, Fla.] : University of Florida, 2009. http://purl.fcla.edu/fcla/etd/UFE0024248.
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Croda, Julio Henrique Rosa. "Patogênese da síndrome pulmonar hemorrágica na leptospirose humana." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-25032009-131328/.
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A leptospirose é uma zoonose de alta morbidade em humanos e um importante problema de saúde pública. Causada por bactérias do gênero Leptospira, a doença apresenta diversas formas clínicas e é especialmente importante em países em desenvolvimento. Síndrome pulmonar hemorrágica é a maior causa de óbito em pacientes com formas severas da doença. Os mecanismos patogênicos relacionados à síndrome pulmonar hemorrágica na leptospirose humana são desconhecidos. Com o objetivo de avaliar estes mecanismos patogênicos, 30 necrópsias (tecido pulmonar) de pacientes com síndrome pulmonar hemorrágica na leptospirose e 7 controles foram avaliados. Para determinar a participação os mecanismos patogênicos envolvidos, experimentos de histologia e imunohistoquímica (IgM, IgG, IgA, and C3) foram realizados em amostras de tecidos pulmonares, bem como dosagem sérica de auto-anticorpos específicos (anticardiolipina e anti-membrana basal) de amostras pareadas de soros de pacientes com leptospirose com e sem síndrome hemorrágica pulmonar e de indivíduos doadores de banco de sangue. Nos achados patológicos, os pacientes com síndrome hemorrágica pulmonar na leptospirose diferem dos controles com hemorragia pulmonar em alguns aspectos: moderada ou intensa presença de macrófagos na luz alveolar (97% versus 29%, respectivamente; p < 0.01); presença de membrana hialina na superficie alveolar (100% versus 0% respectivamente; p < 0.01); intensa necrose e regeneração de pneumócitos II (100% versus 0%, respectivamente; p < 0.01); e presença de plasmócitos no septo aveolar (80% versus 29%; p < 0.02). Nenhuma diferença estatisticamente significativa foi observada em relação ao número de outras células no septo alveolar. Leptospiras intactas foram raramente observadas. A detecção de antígeno de leptospira não foi correlacionada com a intensidade de hemorragia pulmonar. Em nenhum dos tecidos pulmonares estudados foi evidenciado alterações microscópicas sugestivas de coagulação intravascular disseminada. Deposição de imunoglobulina foi detectada na superfície alveolar de 18 de 30 pacientes com síndrome pulmonar hemorrágica na leptospirose. Três padrões de marcação de imunoglobulina e complemento foram observados em tecido pulmonar de pacientes com hemorragia pulmonar e leptospirose: (A) marcação linear delicada, como uma membrana, recobrindo a superfície luminal alveolar de pneumócitos I e II; (MF) marcação multifocal, aleatória ao longo do septo; e (I) marcação fraca granular, focal, intra-alveolar. Não houve diferenças significativas na concentração de auto-anticorpos contra membrana basal nos diferentes grupos estudados. Observamos diferenças significativas nos títulos de anticorpos IgM anticardiolipina entre a primeira e segunda amostra, nos pacientes com e sem hemorragia pulmonar (p<0.01 e p=0.04, respectivamente). Aumento significativo nos títulos de anticorpos anti-cardiolipina da classe IgG, bem como na relação IgG/IgM, foi observado apenas nos pacientes com hemorragia pulmonar (p=0.01 e p=0.01). Nós concluímos que o comprometimento pulmonar na leptospirose humana grave ocorre principalmente sob a forma de uma pneumopatia hemorrágica com características peculiares, cujo quadro morfológico difere de outras hemorragias pulmonares. Caracteriza-se pela deposição linear de imunoglobulina (IgM, IgG e IgA) e complemento(C3) na superfície luminal alveolar de pneumócitos I e II e multifocal nos septos alveolares. Associa-se à intensa necrose de pneumócitos I e II, regeneração de pneumócitos II, além de inflamação septal e alveolarLeptospirosis is a zoonotic disease that is a cause of high morbidity and mortality in humans and is an important public health problem. Caused by bacteria of Leptospira genus, this disease presents diverse clinical manifestations and is especially important in developing countries. Leptospirosis pulmonary hemorrhage syndrome is the major cause of death in patients with the severe form of leptospirosis. The pathogenic mechanisms of this syndrome are unknown. With the purpose of identifying these pathogenic mechanisms, 30 necropsies (pulmonary samples) from patients with leptospirosis pulmonary hemorrhage syndrome and seven controls were evaluated. . To determine whether the immune system is involved, histology and immunohistochemistry (IgM, IgG, IgA, and C3) experiments were performed on lung tissue samples, as well sera measurements of autoantibodies (against the basal membrane and anti-cardiolipin) were performed in leptospirosis patients with and without pulmonary hemorrhage syndrome (in paired samples) and in healthy donors from a blood bank. We found that patients with leptospirosis pulmonary hemorrhage syndrome differed from control pulmonary hemorrhage patients in several features: the presence of moderate to high levels of macrophages in the alveolar space (77% versus 29%, respectively; p = 0.02), the presence of the focal hyaline membrane on alveolar surface (100% versus 0%; p < 0.01), extensive necrosis and regeneration of pneumocyte II cells (100% versus 0%; p < 0.01) and the presence of plasma cells in the alveolar septum (77% versus 29%, respectively; p =0.02). No statistically significant differences were observed in the number of others cells in the alveolar septae. Intact leptospires were rarely detected. Leptospiral antigen was not correlated with the intensity of the lesions. None of the patients showed microscopic evidence for disseminated intravascular coagulation. Immunoglobulin deposits were detected on the alveolar surface of 18/30 leptospirosis patients with pulmonary hemorrhage. Three staining patterns were observed for the immunoglobulins and C3 in the lung tissues of leptospirosis patients with pulmonary hemorrhage syndrom: (A) delicate linear staining adjacent to the alveolar surface, like a membrane covering the luminal surface of type I and II pneumocyte cells; (MF) random, multifocal staining along the alveolar septum; and (I) weak, focal intra-alveolar granular staining.. We were not able to show any significant difference in autoantibodies concentration in the different groups. We found significant difference between the titles of anticardiolipin IgM antibodies in the first and second sera sample from leptospirosis patients with and without pulmonary hemorrhage (p<0.01 e p=0.04, respectively). The increased in the titles of anti-cardiolipin IgG antibodies, as well IgG/IgM ratio was observed only in patients with pulmonary hemorrhage(p=0.01 and p=0.01). We concluded that the pulmonary involvement on severe human leptospirosis have particular characteristics, which the morphologic aspect differ from the others causes of lung hemorrhage. It was distinguished by linear deposition of immunoglobulin and complement (C3C) on the luminal alveolar surface of pneumocyte I and II cells. This event was associated with pneumocyte I and II cells necrosis, pneumocyte II regeneration and septal and alveolar inflammation
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Rinne, Katy. "Analyse der Autopsiefälle mit kongenitalem Vitium im Kindersektionsgut der Charité von 1952 bis 1996." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2000. http://dx.doi.org/10.18452/14483.
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ANALYSE VON 1.990 AUTOPSIEFÄLLEN MIT ANGEBORENEM HERZFEHLER IM KINDERSEKTIONSGUT DER CHARITÈ VON 1952 BIS 1996 Die vorliegende Arbeit basiert auf dem retrospektiven Studium der Befunde aller Kinder unter 16 Jahren, der Totgeburten und Schwangerschaftsbeendigungen, die von 1952 bis 1996 an der Charité, Medizinische Fakultät der Humboldt-Universität zu Berlin, autopsiert wurden. Alle Berichte, in denen ein angeborener Herzfehler vorlag, wurden eingesehen. Die Zielstellung bestand darin, Veränderungen und Trends in der Häufigkeit der kongenitalen Vitien, im Sterbealter, im klinischen Verlauf (operative oder interventionelle Therapie) und in den Todesursachen, zum einen in Abhängigkeit von der Art des Herzfehlers und des weiteren vom Zeitabschnitt innerhalb der 45 Jahre, zu untersuchen. Die genannten Aspekte wurden in einer dafür erstellten Datenbank erfaßt. Insgesamt fanden sich unter den 11.261 Sektionen 1.990 Fälle mit einem angeborenen Herzfehler, dies entspricht einer Häufigkeit von 17,7%. Diese Gruppe setzte sich zusammen aus 1.774 Lebendgeborenen, 138 Totgeburten und 78 Schwangerschaftsbeendigungen. 76,7% aller Kinder verstarben im Säuglingsalter. In der zeitlichen Betrachtung variierte die Altersstruktur deutlich, beeinflußt von der Entwicklung der Interventionskardiologie und Kinderherzchirurgie an der Charité. Von den 1.774 Lebendgeborenen hatten 699 Kinder (39,4%) eine invasive Therapie (chirurgisch/ katheterinterventionell) erhalten. Innerhalb der 45 Jahre zeigte sich ein signifikanter Anstieg im Anteil der operierten Kinder. Deren Häufigkeit wiederum war deutlich abhängig vom zugrundeliegenden Herzfehler. In der detaillierten Analyse der operativen Therapie stellte sich die Wandlung der Herzchirurgie von den extrakardialen Palliationsoperationen als Ersteingriff zu den heutigen Korrekturoperationen und komplexen Palliationen dar. Von allen operierten Kindern verstarben 631 (90,3%) perioperativ. Bei den Todesursachen im natürlichen Verlauf lag in 41,6% eine dekompensierte chronische Herzinsuffizienz vor, in 26,8% eine Komplikation des Herzfehlers (thrombembolische Ereignisse, hypoxische Hirnschädigung, Endokarditis). 10% der Kinder wiesen letale extrakardiale Fehlbildungen auf. In 21,6% der Fälle stand die Todesursache nicht im Zusammenhang mit dem Herzfehler. Zusammenfassend ließ sich in dieser Arbeit klar demonstrieren, wie sehr sich die Fortschritte in der Diagnostik und Therapie der angeborenen Herzfehler auf die Befunde in einem Sektionsgut auswirken. Ausgehend davon kann deren kritische Einschätzung zur Qualitätssicherung der klinischen Entwicklungen beitragen.ANALYSIS OF 1.990 AUTOPSY CASES WITH CONGENITAL HEART DISEASE AT THE CHARITÈ-HOSPITAL BETWEEN 1952 TO 1996 In a retrospective review we have examined the reports of all children under the age of 16 years, stillbirth and terminated pregnancies that underwent a post-mortem at the Charité Hospital between 1952 to 1996. Specifically we were interested in the cases with congenital heart malformations. We wanted to find out about changes in the frequency of congenital heart disease, the age of these patients, their clinical history (kind of interventional or surgical therapy) and the cause of death depending on the kind of cardiac defect and the time over the period of 45 years. All criterias were registered in a database and analysed for statistical significance. In the series of 11.261 autopsies we found 1.990 cases with a congenital heart malformation (medium frequency of 17,7%). The group consists of 1.774 liveborn children, 138 stillbirths and 78 cases of abortion. 76,7% of all liveborn children died within the first year. Depending on time this age differed significantly according to the innovations in cardiac surgery and interventional procedures. Of all 1.774 liveborn cases 699 children (39,4%) had an invasive (surgical/interventional) procedure. Over the time period there was a significant increase in the percentage of operated children. Their frequency again was clearly depending on the kind of cardiac defect. In the detailed analysis of the kind of therapy we could show the development of cardiac surgery from palliative extracardiac procedures at the beginning to corrective and more complex palliations nowadays. 631 (90,3%) of all operated children died perioperatively whereas the others died from left heart failure in 41,6%, in 26,8% a serious complication of the cardiac defect (arterial embolism, cerebral hypoxia, endocarditis) was the cause, in 10,0% a lethal extracardiac congenital malformation was present and in 21,6% the cause of death was not related to the cardiac defect. From the results of the study we could conclude that the criterias in a post-mortem series depend enormously on the present clinical situation concerning the kind cardiac defect and the kind of therapy according to the development of cardiac surgery and interventional procedures. There are further current studies necessary in order to evaluate recent clinical questions using autopsy results.
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Kwong, Tse-hin Glenn, and 鄺子憲. "An autopsy-based epidemiological study of road traffic fatalities in Hong Kong: crash type, injury severity andprospects for intervention." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31228252.
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Hlahla, Mmachuene I. "Discrepancies between antemortem computed tomography scan and autopsy findings of traumatic intracranial haemorrrhage at Pietersburg Hospital forensic pathology Department." Thesis, University of Limpopo, 2019. http://hdl.handle.net/10386/3050.
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Thesis (MMED. (Forensic Medicine)) --University of Limpopo, 2019Traumatic intracranial haemorrhages are common, carry a high mortality rate and are therefore commonly known in the practice of forensic pathology as unnatural deaths. Studies have demonstrated a significant decrease in mortality rate among patients who received surgical interventions compared to patients who were treated medically. Missed or mis-diagnoses, which may be apparent during an autopsy procedure, present possible missed treatment opportunities. Aim/objective and methods The study investigated the discrepancy rate and discrepancy pattern of diagnosis between antemortem brain computed tomography (CT) scan findings and autopsy findings in deceased patients with traumatic intracranial haemorrhage (TIH). A quantitative retrospective descriptive study was conducted based on bodies presented with TIH at Pietersburg Hospital Forensic Pathology Department. A total of consecutive 85 cases with antemortem CT (ACT) scan findings were compared to autopsy findings using percentage agreement and Cohen’s kappa statistics. Results and conclusion There was a fair overall agreement (k=0.38) with overall discrepancy rate of 24.74%, ranging from 9.41% to 34.12% for individual TIH between ACT scan and autopsy findings. Subarachnoid haemorrhage had the lowest agreement between the ACT scan and autopsy findings for TIH. Patient and doctor factors associated with the discrepancies were assessed. Those associated factors, if addressed, may have a positive impact on patient outcome. As far as the debate on non-invasive autopsy procedure is concerned, as a result of existing discrepancy rate, we conclude that ACT should not be used alone in the determination of cause of death but may be used in conjunction with autopsy findings.
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Fottrell, Edward F. "Dying to count : mortality surveillance methods in resource-poor settings." Doctoral thesis, Umeå : Univ, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1544.
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Gondak, Rogério de Oliveira 1978. "Avaliação das células de Langerhans na língua de pacientes autopsiados com AIDS em estágio avançado." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288417.
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Orientador: Pablo Agustin VargasDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A língua de pacientes com AIDS é acometida freqüentemente por infecções oportunistas e neoplasias. O objetivo deste estudo foi quantificar as células de Langerhans (CL) presentes em regiões lesionais e não lesionais na língua de pacientes autopsiados com AIDS em fase avançada, correlacionando a diminuição das CL com a presença de patologias infecciosas em diferentes regiões da língua (anterior, média, posterior e lateral) e comparar estes achados com a língua de pacientes HIV negativos. Foram utilizadas neste trabalho as línguas de 40 pacientes autopsiados com AIDS divididos em 04 grupos (10 com candidose lingual, 10 com herpes lingual, 10 com leucoplasia pilosa oral e 10 sem lesões em língua) e as línguas de 23 pacientes autopsiados (grupo controle) que morreram por outras patologias não associadas à AIDS e que não apresentaram patologias em língua. Realizamos estudo imunoistoquímico com os marcadores HLA-DR, CD1a e CD83 para identificar as CL e quantificá-las por meio de análise histomorfométrica. O índice de positividade foi obtido através da leitura de 7 campos seqüenciados orientados por ocular micrométrica. As células positivas foram contadas para cada um dos anticorpos nas quatro diferentes regiões da língua e os resultados expressos em células positivas por área de epitélio e por comprimento de membrana basal. O anticorpo HLA-DR mostrou a presença média das CL na língua dos pacientes com AIDS (LA=24,28/mm2 e 3,64/mm, LM=24,60/mm2 e 3,68/mm, LP=20,95/mm2 e 3,14/mm, LL=19,84/mm2 e 2,97/mm) e no grupo controle (LA=68,18/mm2 e 10,23/mm, LM=60,73/mm2 e 9,11/mm, LP=62,94/mm2 e 9,44/mm, LL=50,24/mm2 e 7,53/mm). O anticorpo CD1a mostrou a presença média das CL na língua dos pacientes com AIDS (LA=17,30/mm2 e 2,59/mm, LM=21,11/mm2 e 3,16/mm, LP=13,48/mm2 e 2,02/mm, LL=15,55/mm2 e 2,33/mm) e no grupo controle (LA=205,38/mm2 e 30,81/mm, LM=218,36/mm2 e 32,75/mm, LP=167,29/mm2 e 25,09/mm, LL=223,60/mm2 e 33,54/mm). O anticorpo CD83 mostrou a presença média das CL na língua dos pacientes com AIDS (LA=6,19/mm2 e 0,92/mm, LM=6,34/mm2 e 0,95/mm, LP=6,82/mm2 e 1,02/mm, LL=7,14/mm2 e 1,07/mm) e no grupo controle 68,18/mm2 e 10,23/mm, LM=68,46/mm2 e 10,27/mm, LP=69,28/mm2 e 10,39/mm, LL=63,49/mm2 e 9,52/mm), sendo que foram extremamente significantes as diferenças entre ambos os grupos em todas as regiões e anticorpos estudados (p<0,001). Portanto, podemos concluir que as CL estavam degeneradas e diminuídas em número em todas as regiões da língua e em todos os grupos com AIDS em relação ao grupo controle e as lesões infecciosas orais oportunistas não influenciaram na depleção das CL nas línguas
Abstract: The tongues of AIDS patients can be affected by opportunistic infections and neoplasms. Objectives: to quantify and compare the expression of Langerhans cells (LC) in lesional and non lesional areas in the tongue from patients with and without AIDS (control group), using autopsy material. Methods: we analysed the expression of CD1a, HLA-DR and CD83 using immunohistochemistry to identify and quantify LC in the tongues of AIDS patients (n=40), which were divided into 04 groups (10 lingual candidiasis, 10 lingual herpes, 10 oral hairy leukoplakia and 10 none lesions), and 23 tongues from HIV-negative controls. The immunoreactivity rate was obtained after reading at least seven fields sequenced driven ocular micrometer. The positive LC were detected in the lingual surface epithelium in four different regions (anterior, middle, posterior and lateral) and the results expressed as positive cells per area of epithelium and basement membrane length. Results: LC showed the following immunoreactivity for CD1a in the tongue of AIDS patients (LA=17.30/mm2 and 2.59/mm, LM=21.11/mm2 and 3.16/mm, LP=13.48/mm2 and 2.02/mm, LL=15.55/mm2 and 2.33/mm), and in the control group (LA=205.38/mm2 and 30.81/mm, LM=218.36/mm2 and 32.75/mm, LP=167.29/mm2 and 25.09/mm, LL=223.60/mm2 and 33.54/mm); HLA-DR (AIDS patients) (LA=24.28/mm2 and 3.64/mm, LM=24.60/mm2 and 3.68/mm, LP=20.95/mm2 and 3.14/mm, LL=19.84/mm2 and 2.97/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=60.73/mm2 and 9.11/mm, LP=62.94/mm2 and 9.44/mm, LL=50.24/mm2 and 7.53/mm); CD83 (AIDS patients) (LA=6.19/mm2 and 0.92/mm, LM=6.34/mm2 and 0.95/mm, LP=6.82/mm2 and 1.02/mm, LL=7.14/mm2 and 1.07/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=68.46/mm2 and 10.27/mm, LP=69.28/mm2 and 10.39/mm, LL=63.49/mm2 and 9.52/mm). The statistical analysis identified significant differences in the both groups and in all regions, and among the 3 antibodies (p<0.001). Conclusions: LC were degenerated and reduced in number in all regions of the tongue of AIDS patients in relation to the control group and the depletion of LC in the tongues of AIDS patients is not associated with oral opportunistic infections
Mestrado
Patologia
Mestre em Estomatopatologia
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Fraga, Andrea de Melo Alexandre 1968. "Óbitos por causas externas em menores de 18 anos na cidade de Campinas - SP." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308336.
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Orientador: Joaquim Murray Bustorff-SilvaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A doença trauma é considerada, mundialmente, a primeira causa de óbito na população entre um e 44 anos de idade. Entre as causas de trauma incluem-se os acidentes e a violência, correspondendo a causas externas intencionais ou não intencionais. Na infância, as principais causas externas que cursam com óbito em países desenvolvidos, estão relacionadas a acidentes de trânsito, seguidas por afogamento. O objetivo deste estudo retrospectivo baseado em laudos de necropsia foi descrever o perfil epidemiológico de óbitos por causas externas em menores de 18 anos de idade na cidade de Campinas, Brasil, no período entre 2001 e 2008. Entre os 2170 óbitos observados em menores de 18 anos, independente da causa, constatou-se que 530 foram por causas externas, com predomínio do sexo masculino, na proporção de 3.4:1. Houve um predomínio de óbitos no grupo etário de 10-17 anos (76%). O principal mecanismo observado foi ferimento por projétil de arma de fogo (FPAF - 47%). No período entre 2005-2008, houve uma diminuição no número de óbitos em consequência da redução dos homicídios. Outros mecanismos frequentes foram acidentes relacionados a trânsito (26%; sendo a maioria vítima de atropelamento - 57,2%) seguido por afogamento (10,4%). Asfixia/sufocação foi o mecanismo de morte em 72% dos casos com idade inferior a um ano; afogamento predominou entre 1-4 anos (30,8%); acidentes relacionados a trânsito foram frequentes nos grupos de 5-9 anos (56%) e de 10-14 anos (40,4%) e FPAF teve a maior incidência (68%) no grupo 14-17 anos. Cinquenta e um porcento dos óbitos ocorreram na própria cena e 15%, durante o atendimento pré hospitalar. Conclui-se que houve um predomínio de óbitos em crianças e adolescentes do sexo masculino, na faixa etária de 15-17 anos, principalmente por FPAF, sendo homicídio a intenção predominante
Abstract: Trauma disease is considered the first cause of death worldwide in the population from 1 to 44 years of age. Among trauma causes are accidents and violence, comprising intentional and non-intentional external causes. In childhood, in developed countries, the major external causes resulting in death are traffic accidents, followed by drowning. This retrospective study based in autopsy examinations describes the epidemiology profile of death by external causes in individuals younger than 18 years from 2001 to 2008 in Campinas city, Brazil. There were 2170 deaths of all causes in < 18 years, 530 of which were due to external causes, with male predominance 3.4:1. The age distribution reveled 76% of deaths in the group 10-17 years. The most predominant trauma mechanism was firearm injuries (47%), but there was a decrease of deaths in the period 2005-2008 in consequence of homicides reduction. Other frequent mechanisms were transport related injuries (138 - 26%; pedestrian struck in 57.2% of these deaths) and drowning (55 - 10.4%). Asphyxia/suffocation was the mechanism of injury in 72% of deaths in group < 1 year; drowning (30.8%) was predominant in group 1-4; transport related deaths were frequent in the groups 5-9 (56%) and 10-14 (40.4%); and firearm had the highest frequency (68%) in the group 14-17 years. 51% of deaths occurred at the scene and 15% at the pre-hospital care. In conclusion, there was predominance of death in children and adolescents males, between 15-17 years old, mainly by firearm mechanism, predominantly due to homicide intent
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
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Machado, Heloisa Novaes. "A necropsia perinatal no campo dos defeitos congênitos e do aconselhamento genético." Instituto Fernandes Figueira, 2012. https://www.arca.fiocruz.br/handle/icict/6457.
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Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil
Este estudo teve como propósito avaliar a contribuição dos achados morfológicos da necropsia perinatal de neomortos com defeitos congênitos (DC) no aconselhamento genético. Os DC são relevantes na morbimortalidade infantil e representam impacto desfavorável ao indivíduo no contexto de suas famílias e da sociedade. De um total de 196 necropsias realizadas no Departamento de Anatomia Patológica do Instituto Fernandes Figueira, FIOCRUZ-RJ, em um período de dois anos (março de 2007 a fevereiro de 2009), 143 casos (72,9%) apresentavam DC e, destes, 79 (55,2%) correspondiam a neomortos. Este grupo constituiu o material desta pesquisa. Foram revistos os prontuários médicos com o intuito de comparar os dados de ultrassonografia (USG) do 2º trimestre gestacional e os dados do campo 34 das Declarações de Nascido Vivo (DNV) com os achados morfológicos de necropsia. Foi feita uma análise estatística de concordância interobservador, entre os achados de necropsia, os dados de USG e os dados do campo 34 das DNV, sendo a necropsia considerada padrão-ouro. Os resultados obtidos mostraram que a necropsia é fundamental, acrescentando dados que podem modificar o diagnóstico final em 57,7% dos casos, confrontados com USG e em 55,3% dos casos, quando confrontados com o campo 34. Houve discordância total entre os dois parâmetros de confrontação e os achados de necropsia em 9% e 5,3%, respectivamente, para USG e campo 34. Os índices kappa foram 0,93 (USG) e 0,82(DNV), considerados excelentes na escala de concordância. Os achados morfológicos de necropsia também permitiram inserir os casos em categorias etiopatogênicas (classificação apresentada pelo Autor). Tais achados morfológicos, somados aos dados clínicos, laboratoriais e de imagem, permitiram a construção de hipóteses diagnósticas, no sentido de ampliar e refinar o aconselhamento genético. Em 52% do total de casos (22,8% correspondendo ao grupo malformação isolada; 17,8% ao grupo de disrupção e 11,3% ao grupo de displasias) este objetivo foi alcançado. Em cerca de 40% da totalidade dos casos (malformações múltiplas) uma hipótese diagnóstica foi proposta. Cerca de 8% do total de casos foram considerados indeterminados. Concluímos que os achados morfológicos da necropsia perinatal nos DC, obtidos de maneira sistematizada, com documentação fotográfica e radiológica, fornecem dados essenciais ao raciocínio clínico para a construção de hipóteses diagnósticas, influenciando o curso do aconselhamento genético. Esta seria uma medida efetiva, que possibilitaria a discussão dos casos por equipe multidisciplinar à distância, nos moldes daquelas realizadas no Instituto Fernandes Figueira, FIOCRUZ-RJ, lembrando sempre a orientação do Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC): “UM CASO NÃO DOCUMENTADO É UM CASO NÃO CONSULTADO”
The aim of this study was to assess the role of the perinatal autopsy of neonates with congenital defects (CDs) in genetic counseling. Such CDs are relevant to infantile morbidity and mortality, determining familial and social disadvantages. Of a total of 196 autopsies performed at the Department of Anatomical Pathology of the Instituto Fernandes Figueira, FIOCRUZ-RJ, during a period of two years (March 2007 to February 2009), CDs were identified in 143 (72.9%), of which, 79 (55.2%) corresponded to neonatal deaths, constituting the object of this research. The medical records were reviewed aiming at comparing both second gestational trimester ultrasound (US) reports and data from birth certificates (BCs) with autopsy morphological findings. A statistical analysis of interobserver agreement involving the autopsy findings, US reports and BC data was performed, autopsy being considered gold standard. The results obtained showed that autopsy is fundamental, providing additional information that could modify the final diagnosis in 57.7% of the cases, as compared with the US, and in 55.3% of the cases, as compared with the BCs. Total discrepancy was identified between both parameters of comparison (US and BCs) and the autopsy findings in 9% and 5.3% of the cases, respectively. The kappa coefficients for US and BCs were 0.93 and 0.82, respectively, considered excellent in the agreement rating. The autopsy morphological findings have also allowed the classification of the cases into etiopathogenetic categories (classification provided by the author). Those morphological findings, along with clinical, laboratory and imaging data, allowed the construction of diagnostic hypotheses to widen and refine genetic counseling. A diagnosis was established in 52% of the cases as follows: 22.8% corresponding to the group of isolated malformation; 17.8% to the group of disruption; and 11.3% to the group of dysplasias. In approximately 40% of the cases (multiple malformations), a diagnostic hypothesis was proposed, and in nearly 8% of the cases, the diagnosis was considered undetermined. In conclusion, the morphological findings of perinatal autopsy in cases of CDs, systematically obtained with photographic and radiological documentation, provide essential information to clinical reasoning for the construction of diagnostic hypothesis, influencing the course of genetic counseling. This might be an effective measure to enable the discussion of cases by multidisciplinary teams across distances, such as those performed at the Instituto Fernandes Figueira, FIOCRUZ-RJ. It is worth noting the following guidance provided by the Latin-American Collaborative Study of Congenital Malformations (ECLAMC): “AN UNDOCUMENTED CASE IS AN UNRECOVERABLE CASE”
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Karat, A. S. "An autopsy study exploring the spectrum of disease in individuals with advanced HIV in primary care clinics in South Africa." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4646134/.
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Background and methods: Tuberculosis (TB) remains the leading reported cause of mortality among HIV-positive individuals in low- and middle-income countries (LMIC), but disease prevalence and cause-specific mortality data are based on estimates; reliable data are needed to track progress towards targets for reductions in TB and HIV-related deaths. The aim of this work was to estimate disease prevalence and causes of death (CoD) among people dying after enrolment to three large studies of TB and HIV in South Africa. Literature was systematically reviewed for autopsy studies estimating disease prevalence in HIV-positive adults; studies validating verbal autopsy (VA) for HIV and TB deaths; and studies directly estimating CoD in HIV-positive adults in LMIC. Primary data were collected concerning HIV-positive decedents from three parent studies and HIV-negative controls. Minimally-invasive autopsy (MIA), involving tissue biopsy, fluid aspiration, and bronchoalveolar lavage was conducted in a subset of HIV-positive decedents. CoD were assigned, through structured review of clinical and research data (“reference-standard”) and VA data, collected using the World Health Organization (WHO) 2012 instrument and interpreted using physician-certified (PCVA) and computer-coded VA (CCVA) methods (InterVA-4 and SmartVA-Analyze). VA-assigned and reference-standard CoD were compared; agreement was measured at individual- and population-level. Results: MIA was conducted for 34 HIV-positive adults: 16 (47%) had evidence of TB at autopsy, 14/16 (88%) had evidence of extrapulmonary disease, and 6/16 (38%) had not been started on TB treatment; 23/34 (68%) had evidence of bacterial pneumonia and 20/34 (59%) had evidence of two or more concomitant infections. Most (94%) individuals who underwent MIA were assigned HIV-associated reference-standard CoD; this was underestimated by all three VA methods (PCVA 74% [chance-corrected concordance {CCC} 0.71], InterVA-4 47% [CCC 0.42], and SmartVA-Analyze 41% [CCC 0.31]). Reference-standard CoD were assigned, without MIA data, to 259 HIV-positive adults: 183 (71%) were assigned HIV-associated causes. Only the PCVA estimate was similar, at 80% (CCC 0.78); InterVA-4 and SmartVA-Analyze underestimated the HIV-associated mortality fraction (estimates 48% and 29%; CCC 0.48 and 0.20, respectively). An autopsy study exploring the spectrum of disease in individuals with advanced HIV in primary care clinics in South Africa Agreement between VA methods and the reference-standard was poor at individual level (overall CCC ≤0.22) and slightly better at population level (cause-specific mortality fraction [CSMF] accuracy 0.43–0.79). Only PCVA could estimate the HIV-associated TB mortality fraction, underestimating it when compared with a reference standard that included autopsy data (reference 41% vs. PCVA 32%; CCC 0.23) and overestimating it when compared with a reference standard without autopsy data (reference 27% vs. PCVA 42%; CCC 0.42). Among 356 HIV-positive and 103 HIV-negative adults with confirmed HIV status, the VA instrument was sensitive (84.3%) and specific (94.2%) in assigning HIV status; VA methods showed high specificity (all methods >89%) in assigning HIV-associated CoD; and both CCVA methods underestimated the likely true HIV-associated mortality fraction among confirmed HIV-positive decedents (InterVA-4 44.7% and SmartVA-Analyze 22.5%). Conclusions: TB remains a leading CoD among HIV-positive adults in LMIC. Changes are needed to disease classification systems and automated VA methods to allow for better estimation of HIV-associated mortality overall and mortality due to HIV-associated TB. Structured guidelines for assigning CoD in HIV-positive people in clinical settings and the use of MIA at sentinel surveillance sites may be useful additions to current methods.
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Führer, Amand-Gabriel [Verfasser], Andreas [Akademischer Betreuer] Stang, Hajo [Akademischer Betreuer] Zeeb, and Matthias [Akademischer Betreuer] Richter. "Verbal Autopsy und Mortalität erwachsener Frauen in West Wolega, Äthiopien / Amand-Gabriel Führer. Betreuer: Andreas Stang ; Hajo Zeeb ; Matthias Richter." Halle, Saale : Universitäts- und Landesbibliothek Sachsen-Anhalt, 2016. http://d-nb.info/1090786387/34.
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SHIBAMOTO, YUTA, YOSHIMASA MORI, MASAMI ASAI, TAKANOBU TORIYAMA, CHISA HASHIZUME, TAKAHIKO TSUGAWA, and TATSUYA KOBAYASHI. "Gamma Knife Radiosurgery of Brain Metastasis from Malignant Pleural Mesothelioma : Report of Three Cases with Autopsy Study in a Case." Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/19497.
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Chowdhury, Md Hafizur Rahman. "Neonatal deaths in a rural area of Bangladesh: an assessment of causes, predictors and health care seeking using verbal autopsy." Thesis, Curtin University, 2008. http://hdl.handle.net/20.500.11937/1526.
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Poor neonatal health is a major contributor to mortality in under-five children in developing countries, accounting for more than two thirds of all deaths in the first year of life, and for about half of all deaths in children under-five. A major constraint to effective neonatal survival programmes in developing countries, such as Bangladesh, has been the lack of accurate epidemiological data on neonatal deaths. The current study aimed to (1) describe the causes of neonatal death in a rural subdistrict of Bangladesh; (2) describe associated birth and obstetric characteristics of neonatal deaths; (3) describe the patterns of care-seeking practices during the fatal neonatal illness episode; (4) compare deaths and care-seeking patterns between the Maternal and Child Health and Family Planning (MCH-FP) service area of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and the adjoining government service area; (5) identify the predictors of neonatal deaths; and (6) assess the accuracy in assigning causes of death from verbal autopsy data by comparing physician review with medical assistant review and computer-based algorithm.This study was carried out during 2003 and 2004 in a demographic surveillance area in the Matlab rural sub-district of eastern Bangladesh. The surveillance system covers a population of ~220,000 and is maintained by ICDDR,B. Community health workers (CHRW) visit each household monthly to record vital demographic, morbidity and health care seeking data. Half of the surveillance population receives MCH-FP services from ICDRR,B (ICDDR,B service area) and the remaining half receives standard government services (government service area).Verbal autopsies, consisting of retrospective interviews with caregivers of recently deceased neonates about the circumstances leading to their death, were carried out by the staff trained in verbal autopsy. The interviews were held with the mothers of all deceased neonates (n=365) who had died during 2003 and 2004. The verbal autopsy data were then independently reviewed by three physicians and a medical assistant to assign a direct cause of death and an originating cause of death. A computer algorithm using evidence-based clinical signs and/or symptoms was also used for assigning cause of death. Agreement of at least two of the three physicians was used to determine direct causes of death. Diagnostic accuracy and reliability of medical assistant and algorithm in assigning direct cause of death were evaluated by comparing with the diagnoses provided by the physicians. Linked epidemiological data on all live births in the Matlab area during 2003 and 2004 were also analysed.There were 365 deaths among the 11,291 live births recorded during 2003 and 2004, yielding a neonatal mortality rate (NMR) of 32.3 per 1000 live births. The NMR was lower in the ICDDR,B area compared to the government area. Of all neonatal deaths, 37% occurred within 24 hours, 76% within three days, 84% within seven days, and the remaining 16% between eight and 28 days of birth.Five causes accounted for 85% of the deaths: birth asphyxia (45%), prematurity/low birth weight (LBW) (15%), sepsis/meningitis (12%), respiratory distress syndrome (7%), and pneumonia (6%). The majority of neonatal death cases were low birth weight (56%) and singleton births (82%). There were some differences in the distribution of causes of death between the ICDDR,B and government areas, the most notable being prematurity/LBW which was twice as common in the ICDDR,B area than in government area.Strikingly, more than a third (37%) of the deceased neonates had not been taken to any source of health care for the fatal illness episode, and another quarter (25%) sought care from traditional healers or from unqualified practitioners. Only 37% sought modern biomedical care from a doctor or paramedic.Among the 365 neonatal deaths, a much higher proportion (48.5%) of the deliveries occurred at a health facility in the ICDDR,B area, compared to 15.3% in the government area. Vaginal delivery was the commonest mode of delivery in both areas, with a higher proportion of caesarean sections in the ICDDR,B area (9.3%) compared with the comparison government area (1.6%).The verbal autopsy method appears to be highly effective in that agreement on a direct cause of death was reached by at least two physicians in 339 (93%) cases. Using the physician review as the gold standard, the medical assistant review of causes of death demonstrated a sensitivity ranging from 47.7% to 83.5% depending on the cause of death, a specificity ranging from 93.0% to 97.5%, and kappa values ranging from 0.51 to 0.77. Similarly, depending on the cause of death, algorithm demonstrated a sensitivity ranging from 35.6% to 77.4%, specificity ranging from 86.8% to 95.9%, and kappa values ranging from 0.24 to 0.69.Independent predictors of neonatal mortality included lack of maternal education, single parity, and lack of antenatal care (ANC) during the last trimester. Male sex of the neonate, multiple births, and facility-based delivery were also significantly associated with excess neonatal mortality.In conclusion, the study highlighted the central role of birth asphyxia, prematurity/LBW, and sepsis/meningitis in neonatal deaths, indicating that the core of interventional packages to prevent neonatal deaths in rural Bangladesh should incorporate these causes. Community awareness about early care seeking, skilled attendance at delivery, and training and integration into mainstream services of traditional/unqualified care practitioners are some of the approaches needed to reduce neonatal mortality further. Improving access to female education and antenatal care would also have beneficial effects on neonatal survival.This study revealed the value of both review by medical assistant and computerbasedalgorithm to reliably assign major causes of neonatal deaths from verbalautopsy data. Further research could be undertaken to develop optimal combinationsof the medical assistant and hierarchical algorithm for assigning major causes ofdeath in low-resource settings such as Matlab.
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Nascimento, Camila Fernandes. "Caracterização das alterações da proteína TDP-43 durante o envelhecimento normal: uma análise em cérebros humanos postmortem." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-18062015-114710/.
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INTRODUÇÃO: A proteína TDP-43 (Transactive DNA-binding protein 43) é o principal agregado proteico anormal verificado em casos de Degeneração Lobar Frontotemporal (DLFT) e Esclerose Lateral Amiotrófica (ELA). Apesar dos avanços na área, o papel da TDP-43 no envelhecimento normal ainda é pouco compreendido. A falta de indivíduos controles em estudos de associação clinicopatológica com tecido cerebral humano é resultado do alto custo da prática de autópsia mundialmente. O que é um diferencial do Brasil, onde essa prática é obrigatória em casos de morte natural sem causa definida. O Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento Cerebral (BEHGEEC) possui grande número de encéfalos de sujeitos sem déficit cognitivo com alta miscigenação étnica e variação de graus de escolaridade. O que possibilita estudos mais aprofundados sobre envelhecimento cerebral humano não-patológico. OBJETIVOS: (1) investigar de maneira sistemática a distribuição dos achados neuropatológicos da TDP-43 no envelhecimento humano normal; (2) caracterizar a distribuição dessa proteína em diferentes áreas encefálicas; (3) explorar associação de características, clínicas, sociodemográficas ou neuropatológicas com o aparecimento das inclusões de TDP-43. MÉTODOS: Foram incluídos participantes com idade acima de 50 anos e classificados clinicamente e anatomopatologicamente como normais. Reação imunoistoquímica contra a conformação anormal da TDP-43 foi realizada em três regiões cerebrais de interesse córtex temporal, amígdala e hipocampo. RESULTADOS: Os agregados de TDP-43 estavam presentes em 10,5% dos indivíduos estudados (n=323). A região mais frequentemente acometida foi a amígdala (85,3% dos casos). O acúmulo de TDP-43 foi associado à idade e raça (p=0,002). Análise de regressão logística demonstrou que indivíduos da raça asiática possuem maior chance de apresentar os agregados de TDP-43 do que caucasianos, independente dos fatores gênero, idade, estágio de Braak para emaranhados neurofibrilares e escolaridade (odds ratio=3,5: intervalo de confiança: 1,41-8,69, p=0,007). CONCLUSÕES: Os resultados sugerem que o acúmulo anormal de TDP-43 aumenta com o avanço da idade e que a amígdala é a região cerebral mais susceptível ao acúmulo desse tipo de inclusão. Como os idosos estudados são cognitivamente normais, sugerimos que indivíduos asiáticos estão protegidos contra os efeitos deletérios da proteína TDP-43 no cérebro. Futuros estudos de associação clinicopatológica e genética em populações de diferentes raças poderão contribuir para identificação de possíveis fatores de proteção contra a expressão clínica dos achados da proteína TDP-43BACKGROUND: Transactive DNA-binding protein 43 (TDP-43) is the major abnormal aggregate present in Frontotemporal Lobar Degeneration (FTLD) and Amyotrophic Lateral Slcerosis (ALS). Although all the efforts in research in this field, the role played by TDP-43 in normal aging is still unknown. The lack of normal controls in studies focusing on clinicopathological associations is a result of the high cost of autopsy practice worldwide. In Brazil, autopsy is mandatory by law in cases without a certificate. The Brain Bank of the Brazilian Aging Study Group (BBBASG) comprises a large number of cognitively normal elderly subjects highly ethnically admixtured and with broad education attainment. This allow us to further study the non-pathological process of the human aging brain. GOALS: (1) sistematically investigate the distrubution of neuropathological findings of TDP-43 in the normal human brain; (2) characterize the distribution of theses findings in different brain regions; (3) explore clinical, sociodemographics or neuropathological variables that could be associated with TDP-43 inclusion outcome. METHODS: We included participants over 50 years old previously classified cognitively and neuropathologically as normals. Imunnohistochemistry against abnormal form of TDP-43 was performed in three brain regions: temporal cortex, hippocampal formation and amygdala. RESULTS: TDP-43 aggregates were present in 10,5% of the study subjects (n=323). Amygdala was the most frequently affected brain region (85.3% of the cases). TDP-43 accumulation was associated with age at death and race (p=0.002). Logistic regression analysis showed that asians older adults have higher odds of presenting TDP-43 inclusions than caucasians, regardless of gender, age, Braak stage for neurofibrilarly tangles and education attainment (OD=3.5, CI: 1.41-8.69, p=0.007). CONCLUSIONS: Our results suggest that TDP-43 abnormal accumulation increases along aging process and the amygdala is the brain region most susceptible to these alterations. Because we studied cognitively normal elderlies, we suggest that Asians older adults are protected against deleterious effects of TDP-43 in the brain. Future clinicopathological and genetic studies in populations dwelling in different ethnical backgrounds may identify possible protecting factors against the clinical expression of TDP-43 neuropathological findings