Use of minimally invasive autopsy during the COVID-19 pandemic and its possibilities in the context of developing countries

Melo, Deborah Nunes de; Coelho, Tânia Mara Silva; Lima, Giovanna Rolim Pinheiro; Fernandes, Carolina Gomes; Alves, Bruno Cavalcante Fales de Brito; Araújo, Fernanda Montenegro de Carvalho; Monteiro, Raimundo Nonato Farias; Ordï, Jaume; Saldiva, Paulo; Cavalcanti, Luciano Pamplona de Góes

doi:10.1371/journal.pntd.0009629

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…Although it is well-known that autopsy represents the gold standard method for understanding the pathophysiological aspects of unknown diseases [ 50 , 125 ], during the COVID-19 pandemic there have been undoubted delays in performing autopsies on subjects who died with/from COVID-19. Taking a cautious approach to limit the risk of spreading the infection, only minimally invasive autopsies were initially performed [ 126 ]. Several weeks later, full autopsies were performed again, playing a vital role in understanding the pathophysiology of the SARS-CoV-2 infection [ 48 , 77 , 78 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

et al. 2022

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During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.

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Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

et al. 2022

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“…Postmortem investigation rates remain scarce worldwide as do scientific contributions and, in this regard, reluctance to perform autopsies based on fear of disease transmission, lack of adequate facilities and strict procedures and regulations imposed by governments have been defined by the scientific community as the ‘lockdown of science’. Cultural barriers and the reluctance of families to provide informed consent are additional factors contributing to the decline in autopsy numbers 30…”

Section: Discussionmentioning

confidence: 99%

“…Cultural barriers and the reluctance of families to provide informed consent are additional factors contributing to the decline in autopsy numbers. 30 …”

Section: Discussionmentioning

confidence: 99%

New autopsy technique in COVID-19 positive dead bodies: opening the thoracic cavity with an outlook to reduce aerosol spread

2022

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AimsAfter the advent of the COVID-19 pandemic, most countries have modified some of their health-related regulations. However, this has not been in the case of the postmortem of deceased because it has a legal aspect. Thus, the healthcare providers knowingly or unknowingly faced the threat of COVID-19 exposure from those dead bodies. To introduce an autopsy technique that reduces the droplet spreads, especially in those mortuaries where the biosafety mechanism is not highly equipped.MethodsThe validity of the new incision was achieved through the calculation of the Scale Content Validity Index (SCVI) taking inputs from 17 forensic specialists. The subjects for the new technique were selected from the patients who were RTPCR positive for COVID-19 or clinically or radiologically showing features of COVID-19.ResultsThe dissection procedure was finalised by achieving the SCVI at 0.92. The chest cavity was approached through the abdominal cavity by opening the diaphragm and dissecting out the contents of the chest using a long blade knife.ConclusionsThe advantage of this approach is that the autopsy surgeon and pathologists do not have to open the chest cavity by dissecting the Sternum, and hence the chance of droplet infection becomes almost nil. This technique is complete, simple, less time-consuming and conducive for sample collection, and even reduces the possibility of body fluid seepage following a postmortem examination

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“…Plural autopsy investigations were postponed, compromising the very best of the autopsy technique due to the intervening degradation processes, and others were never performed with the assignment of a generic cause of death [ 9 ]. This situation has caused and is still causing problems of a clinical–epidemiological nature due to the lack of certain data to allow the optimal study of the pandemic phenomenon and monitoring of other morbid conditions [ 10 ]. In addition, there have been further problems in the courts for the attribution of medical malpractice in the absence of a certified cause of death, which has not made it possible to identify those responsible or to exonerate the intervening health care providers.…”

Section: Introductionmentioning

confidence: 99%

Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review

Bailo

Gibelli

Ricci

et al. 2022

IJERPH

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Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The COVID-19 pandemic and its associated difficulties in terms of implementing autopsy examinations have made the need for alternative means of determining causes of death even more evident. One of the most interesting alternatives to the conventional autopsy is the verbal autopsy, a tool that originated in Africa and Asia in the 1950s and consists of a structured interview with the deceased’s family members concerning the symptoms manifested by the person and the circumstances of death. In the early 1990s, the first doubts emerged about the validity of verbal autopsies, especially about the real reliability of the cause of death identified through this tool. The objective of the review was to identify studies that had assayed the validity of verbal autopsies through a rigorous comparison of the results that emerged from it with the results of conventional autopsies. When starting from an initial pool of 256 articles, only 2 articles were selected for final review. These are the only two original research articles in which a verbal autopsy validation process was performed by employing the full diagnostic autopsy as the gold standard. The two papers reached opposite conclusions, one suggesting adequate validity of verbal autopsy in defining the cause of death and the other casting serious doubts on the real applicability of this tool. Verbal autopsy undoubtedly has extraordinary potential, especially in the area of health and demographic surveillance, even considering the implementation that could result from the use of artificial intelligence and deep learning. However, at present, there appears to be a lack of solid data to support the robust reliability of this tool in defining causes of death.

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Use of minimally invasive autopsy during the COVID-19 pandemic and its possibilities in the context of developing countries

Cited by 6 publications

References 17 publications

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

New autopsy technique in COVID-19 positive dead bodies: opening the thoracic cavity with an outlook to reduce aerosol spread

Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review

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