autopsy

Coronavirus disease 2019 (COVID-19) was identified in China in late December 2019 and led to a pandemic that resulted in millions of confirmed cases and deaths. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uses distinct receptors and co-receptors to enter host cells. Vimentin has emerged as a potential co-receptor for SARS-CoV-2 due to the high level of vimentin expression in testis tissue.

The present study investigated the link between vimentin expression level and SARS-CoV-2-induced orchitis.

In this case-control study, testis autopsy samples were collected immediately after the death of both COVID-19 cases and a control group that included individuals who died due to accidental causes. Gene expression and immunohistochemical assays were conducted to evaluate the level of vimentin expression, cell proliferation, and leukocyte infiltration.

A significant expression of vimentin and infiltration of immune cells (CD68+, CD38+, and CD138+) in the testicular tissue of COVID-19 cases, along with extensive immunoglobulin G precipitation and reduced inhibin expression (p = 0.001) were observed. Additionally, gene expression analysis revealed increased expression of vimentin and decreased expression of the proliferation markers Ki67 and proliferating cell nuclear antigen, suggesting that SARS-CoV-2 may disrupt spermatogenesis through immune responses and the arrest of cell proliferation.

There may be a strong link between vimentin expression and COVID-19-induced orchitis. Further studies are needed to confirm these findings. Considering some limitations, vimentin can be used as a biomarker option for testicular damage following COVID-19-induced orchitis.

The aim of this study was to analyze characteristic and pattern of road traffic injuries in this special aging group, as well to examine the relevance of certain injuries or risk factors to outliving the injuries.

This epidemiological, analytical, retrospective, autopsy study investigated the road traffic deaths for period between 2001 and 2022. The subjects were divided into two age groups, elderly (65 years and older) and middle aged (16-64 years old).

We included 213 (32%) elderly participants out of all 665 RTA subjects who died from sustained injuries or complications of the injuries. The majority of elderly subjects (61%) were pedestrians, and elderly participants in RTA were more likely to survive the injuries. The most common injuries among the elderly in all group of participants were chest injuries 81% (and among them, rib fractures were present in 76%). Cranio-cerebral injury is the most common cause of death in RTA subjects, singular (45%) or in combination with other causes. In the group of elderly RTA subjects complication of injury is represented in 36 subjects (17%), while as cause of death is represented in 22 subjects (10%). Elderly are less likely to have positive BAC, and even in cases when BAC was increased, the levels were on the lower scale.

More effort should be made to enhance road safety for elderly pedestrians, especially considering the expected rapid growth in the elderly population.

Nasal septoplasty is one of the most frequently performed surgical procedures with several common and uncommon complications. Although rare, intracranial adverse events of septorhinoplasty are life-threatening, and there are few case reports of fatal intracranial complications.

A healthy 47-year-old woman underwent septorhinoplasty, then had a decreased level of consciousness and finally died due to subarachnoid and intraventricular hemorrhage caused by a bone fragment isolated from the fractured sphenoid sinus.

The complication was attributed to the surgeon's carelessness, and he was considered liable for patient death due to medical negligence.

Surgeon experience in septoplasty surgery is essential, and meticulous attention to anatomical landmarks is paramount to prevent a serious outcome that may lead to patient death and surgeon conviction.

Methanol is a non-drinking type of alcohol used for industrial and automotive purposes. Methanol itself is not dangerous, but its harmful metabolites may cause the accumulation of acid in the blood, leading to metabolic acidosis, permanent blindness, and death. In this case report study, the case was a 28-year-old Nepalese man who was admitted in a semi-unconscious state to the emergency department. A working diagnosis of methanol poisoning was made. After more than two weeks, he succumbed to death due to a worsening cerebral infarction. At autopsy, extensive hemorrhagic infarction was observed, involving bilateral cerebral hemispheres. Well-defined subcortical hemorrhages leading to laminar necrosis were seen at the frontoparietal lobes. Cystic or lacunar necrosis was present at the basal ganglia. The brainstem showed the presence of duret hemorrhage. The man died approximately three weeks after the methanol ingestion. This case highlights the important pathological changes and accumulating effects of methanol in the brain.

Mortality among children under 5 years is an important health indicator. Therefore, determining the most common causes and manners of death according to the postmortem data is necessary for designing intervention programs to reduce mortality.

This study aimed to evaluate the causes and manners of death in children aged under 5 years old in Tehran, Iran using autopsy findings.

This descriptive cross-sectional study was conducted on the data of all deaths among children aged under 5 years who were referred to the Legal Medicine Organization of Tehran, Iran, during January 2009-December 2019. The data were collected using the checklists of demographic characteristics, autopsy, toxicological findings, pathological findings, hospital records, and judicial documents, which were then analyzed.

Among 1750 children aged under 5 years old included in this study, 898 (51.3%) cases were male, and 997 (56.9%) were hospitalized. Most of the mortality cases occurred about two months after birth. The most common causes of death were found as congenital cardiovascular anomalies (14.7%), pneumonia (11.7%), and preterm labor (11%). Moreover, natural death (77.7%), accidental death (17.7%), homicide (2.7%), and unknown death (2%) were the major manners of death in these children.

Postmortem examination to determine the causes of unnatural death could help clinicians and policymakers to propose a suitable intervention for reducing the mortality rate in children under 5 years.

Death by hanging is a vital health hazard worldwide; it is classified as violent mechanical deaths resulting from asphyxia. The manner of death in hanging is suicide in the majority of the cases, and accidental hanging is less common, and homicidal hanging is still less common. The study was aimed towards analyzing sociodemographic patterns, precipitating factors for committing hanging at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India.

A retrospective study was conducted at the mortuary of VIMS, Ballari, Karnataka, India. From January 01, 2016, to December 31, 2020, 356 alleged hanging cases were brought to the mortuary for postmortem examination, and the cause of death was attributed to hanging. The necessary data were collected with the help of history, inquest reports, meticulous postmortem examination, etc. The results were obtained after tabulating and data analyzed with a cross-sectional study.

Of 356 cases of hanging, the majority of the cases were in the age group of 31-40 years (140 patients; i.e., 39.32%). Male preponderance was detected in 235(66%) cases, and most victims have married 199(56%) subjects. Concerning seasonal variation, we noted that the maximum number of suicides by hanging was reported in July to September 141(39.60%). Out of 356 hanging cases, 178(50%) were employed. The predisposing factor was Chronic illness in 136(38.20 %) cases, followed by financial stress and psychological problems in 120(33.70%) and 50(14.04%) cases, respectively. Most of the victims belonged to the Hindu religion, 290(82%) cases. Moreover, 320(90%) of cases had no suicide note.

Hanging is challenging to prevent due to numerous concomitant factors, but psychological counseling, economic support, and education can reduce the incidence of hanging.

Determining the cause of death among drug addicts in Residential Rehab Campuses (RRCs) is of paramount importance, since it may prevent and reduce morbidity and mortality rates. Therefore, the present study was done to investigate the cause of death among drug addicts in RRCs in Kahrizak Dissection Hall, Tehran Province, Iran, from September 2011 to September 2019.

In this descriptive cross-sectional study, a total number of 166 drug addicts, who had died in the RRCs located in Tehran, Iran were examined, and the findings were analyzed using the SPSS v. 26. Moreover, the Chi-square test was utilized to compare the results.

In this study, the most important causes of death, were infections, drug side effects, Myocardial Infarction (MI), and drowning, respectively. The highest frequency of death had occurred in the 31-40-year-old age group and was mostly observed in unmarried individuals. The most common causes of death were infection among the single and divorced ones and were MI for married cases. Toxicological results were generally negative in 60.84% of the cases. Also, 86.74% of the cases were non-pathological with regard to the brain tissue samples and 65.66% of the individuals had no pathological cardiac lesions. Besides, the most common microscopic findings of the lungs were associated with pulmonary edema. In the trauma group and also drug side effects and drowning groups, the most frequent pathological findings were pulmonary hemorrhage and pulmonary edema, respectively. As a whole, 69.87% of the deaths had occurred in the RRCs and 55.42% of them were assumed natural in terms of mode of occurrence.

The majority of the deaths in the RRCs should not have occurred if the given centers were authorized and the illegal centers were closed. Moreover, these centers should have proper management with the presence of resident physicians and trained medical staff as well as necessary medical equipment, proper nutrition, no access to drugs and other illicit substances, along with adherence to hygienic principles to minimize mortality rates among the drug addicts living in the RRCs.

In the pandemic era of Coronavirus   disease 19 (COVID-19), one of the most important issues is the nature of real pathological events that occur during disease course in different parts of the body. There are several ways to know more about COVID-related histopathological events,such as tissue sampling which means biopsy from the tissues of either livepeople or necropsy/autopsy of people who died from COVID-19.

We conducted an original study for assessing histopathological findings of lung necropsy samples collected from 15 Iranian patients.The continuous variables were presented as mean and standard deviation, and for the qualitative data on histopathological findings, the percentage or qualitative scores (0 to +3) were used.

We found similar presentations of COVID-related histopathologic events regarding percentage and severity in pulmonary tissue, includinglymphocytic infiltrations, inflammatory infiltrations of septal and perivascular areas, desquamated type2 pneumocytes, hyaline membrane changes, fibrin material depositions, abnormal changes of alveolar capillaries, presence of megakaryocytes, PMN infiltrations, septal necrosis, microabscess formation and bacterial colony formation. Also, we found few interesting features which were not completely compatible with previous similar studies or newly reported by ours asa high percentage of anthracosis (86%: 13 patients) that was not clearly reported in other previous studies, also a lower percentage of microthrombotic vascular lung injuries (20%: 3 patients), and a higher percentage of viral cytopathic effects (27%: 4 patients).

This article suggests a greater need for evaluatingthe autopsy samples of COVID-19 patients to provide better management strategies and propose the question of whether anthracosismay be a mortality risk factor in COVID-19 patients.

Finding a sample of healthy tissue is a critical challenge in research studies. Non-pathological Tissue adjacent to the tumor (NAT) specimens is usually used as the control in several studies. However, little is known about the similarity of NAT to healthy tissues. Here, we compared the expression of Matrix Metalloproteinase 2 (MMP-2) and its inhibitor, Tissue Inhibitors of MMP (TIMP)-1 as extracellular matrix remodeling factors in NAT and autopsy lung tissue. RNA of 7 NAT and 6 Formalin-Fixed Paraffin-Embedded (FFPE) lung autopsies from healthy people as the control group was extracted, and cDNA was synthesized. The gene expression levels of MMP-2 and TIMP-1 were evaluated by real-time PCR. There were no significant differences in the expression of MMP-2, TIMP-1, or their ratio between the two groups. The results showed that NAT could be used as healthy controls in lung tissue studies for MMP-2 and TIMP-1.

Teratoma is a rare type of tumor that can contain fully developed tissues and organs, including hair, teeth, muscle, and bone. Teratomas are most common in the tailbone, ovaries, and testicles, but can occur elsewhere in the body. These tumors originate from all three embryonic germ layers: ectoderm, mesoderm, and endoderm. Nasopharyngeal teratomas are responsible for a high birth mortality rate from acute respiratory distress. We report a rare case of pharyngeal mass in a fetus with antenatal ultrasound and autopsy findings. A 31-year-old primigravid woman with history of insulin-dependent diabetes mellitus and treated hypothyroidism presented with severe polyhydarmnios, prenatal ultrasound revealed a heterogenous solid cystic mass in submandibular region with no vascularity on Doppler exam. The postmortem and pathologic examination confirmed the nasopharyngeal teratoma with extensive cervical extension. The aim of this study was updating current knowledge about this disease.

Cardiac tumors range from benign to high grade malignancies. The incidence of cardiac involvement either by primary, or secondary tumors during autopsy is reported to be extremely low. Extranodal NK/T-cell lymphoma (ENKTL), nasal type is an unusual type of lymphoma. The skin is the second most common site of involvement after the respiratory tract. We present a case of a 63-year-old male, who was recently diagnosed with ENKTL, nasal type, who received chemotherapy, and died without any evident cause. The corpse was referred for routine medicolegal examination. Macroscopical determination of the cause of death was not feasible and subsequent histopathological examination revealed heart infiltration by ENKTL that was found in vivo in cutaneous lesions. Similar infiltrations existed in the pancreatic tissue. To the best of our knowledge, myocardial infiltration of ENKTL, inducing severe myocardial lesions that eventually caused death, is rare, with limited cases reported in the literature.

Substance abuse is among the main causes of preventable diseases and premature deaths worldwide. Despite legal efforts to prevent substance abuse, it has increased and imposed significant economic costs on societies. This analytical cross-sectional study aimed to explore the rate of substance abuse-induced mortality in the provinces of Iran, in 2017. We elaborated an evaluation structure to identify nationwide different substance abuse-related mortality rates.

We employed the retrospective data extracted from autopsy, forensic medicine examination, and demographic characteristics from the recordings in the Iranian Legal Medicine Organization (ILMO). Stata and ArcGIS were applied for data analysis.

Nationwide, 3089 substance abuse-related deaths were recorded in the ILMO; the incidence rate was 38.17 per million subjects. The deaths mostly occurred in the 30-39 age group and males accounted for 90% of cases. The provinces of Kermanshah, Lorestan, Fars, Hamadan, and Semnan reported significantly higher rates, compared with the provinces of Mazandaran, West-Azerbaijan, and Golestan with the lowest mortality rates per million (74.72, 69.81, 63.42, 61.70, 58.53 vs. 10.82, 12.11, 14.30, respectively). Mortality rates due to the abuse of methadone (20.29), morphine (12.34), amphetamine (5.32), methamphetamine (7.05), codeine (4.21), tramadol (5.96), benzodiazepine (1.47), and diphenoxylate (0.05) were calculated per million populations of Iran.

The obtained data suggested that preventive interventions should focus on the 20-40 age group. Methadone, morphine, and methamphetamine were associated with the highest mortality, compared to other substances; thus, they require effective treatment and preventive programs. Iranian Drug Control Headquarters, police department, and policymakers should act more efficiently regarding a preventive strategic plan in this respect.

This study aimed to report an unusual presentation of an advanced gastric adenocarcinoma. Leptomeningeal carcinomatosis is a rare event in gastric adenocarcinoma. It is much more uncommon as the primary manifestation in post-mortem evaluation of the cause of death in a patient presenting with headache and neurological signs and symptoms. Herein, we discuss our experience with a case of gastric adenocarcinoma, who was diagnosed after death, presenting with neurological signs and symptoms of leptomeningeal carcinomatosis. A 52-year-old gentleman presented with intractable headache and neck pain as well as vertigo. His physical examination showed only decreased deep tendon reflexes. He died after a short period of coma. Post-mortem evaluation showed numerous signet ring cells in the subarachnoid space as well as gastric malignant ulcer. In patients with intractable headache with no identifiable cause, meningeal involvement and infiltration should be considered as the probable underlying cause. Radiologic findings are not significant; however, lumbar puncture can be diagnostic.

The scientific evidence concerning pathogenesis and immunopathology of the coronavirus disease 2019 (COVID-19) is rapidly evolving in the literature. To evaluate the different tissues obtained by biopsy and autopsy from five patients who expired from severe COVID-19 in our medical center.

This retrospective study reviewed five patients with severe COVID-19, confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and imaging, to determine the potential correlations between histologic findings with patient outcome.

Diffuse alveolar damage (DAD) and micro-thrombosis were the most common histologic finding in the lung tissues (4 of 5 cases), and immunohistochemical (IHC) findings (3 of 4 cases) suggested perivascular aggregation and diffuse infiltration of alveolar walls by CD4+ and CD8+ T lymphocytes. Two of five cases had mild predominantly perivascular lymphocytic infiltration, single cell myocardial necrosis and variable interstitial edema in myocardial samples. Hypertrophic cardiac myocytes, representing hypertensive cardiomyopathy was seen in one patient and CD4+ and CD8+ T lymphocytes were detected on IHC in two cases. In renal samples, acute tubular necrosis was observed in 3 of 5 cases, while chronic tubulointerstitial nephritis, crescent formation and small vessel fibrin thrombi were observed in 1 of 5 samples. Sinusoidal dilation, mild to moderate chronic portal inflammation and mild mixed macro- and micro-vesicular steatosis were detected in all liver samples.

Our observations suggest that clinical pathology findings on autopsy tissue samples could shed more light on the pathogenesis, and consequently the management, of patients with severe COVID-19

Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death