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Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach.

Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, Lorenzoni C, Lacerda MV, Palhares A, Rodríguez-Carunchio L, Martínez MJ, Vila J, Bassat Q, Menéndez C, Ordi J - PLoS ONE (2015)

Bottom Line: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain.A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses.This procedure could improve the determination of CoD in developing countries.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.

ABSTRACT

Background and aims: Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings.

Methods: A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles.

Results: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs.

Conclusions: A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.

No MeSH data available.


Related in: MedlinePlus

Procedures for the collection of cerebrospinal fluid (A), peripheral blood (B), liver (C), lung (D), spleen (E), and the central nervous system biopsy (F) (designed by Xabier Sagasta).
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pone.0132057.g001: Procedures for the collection of cerebrospinal fluid (A), peripheral blood (B), liver (C), lung (D), spleen (E), and the central nervous system biopsy (F) (designed by Xabier Sagasta).

Mentions: The type and main characteristics of the different needles used in the MIA procedure for each particular biopsy, the sites of puncture and the number of samples to be obtained are summarized in Table 1 and illustrated in Fig 1. The sampling process starts with the collection of CSF by occipital puncture, reaching the cisterna magna (Fig 1A). Up to 5 mL of CSF are collected in a 10 mL sterile tube and two aliquots of 2 mL each are stored in Eppendorf Safe-Lock Tubes at -80°C. Then, 20 mL of blood are extracted by puncture of the subclavian vein through a supraclavicular or infraclavicular approach (Fig 1B). If less than 20 mL of blood are obtained with this approach, intracardiac blood is targeted through a heart puncture at the left 5th intercostal space. Ten mL of blood are collected in an EDTA-containing tube, 10 mL in an aerobic adult or pediatric blood culture bottle (BACTEC), and four large drops of blood are placed onto a Whatman 903 filter (GE Healthcare Bio-Sciences, Pittsburgh, PA, USA). If other fluids (pleural effusion or ascites) are detected in the US scan, 20 mL are collected. After the body fluids have been collected, specimens of the major organs are taken.


Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach.

Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, Lorenzoni C, Lacerda MV, Palhares A, Rodríguez-Carunchio L, Martínez MJ, Vila J, Bassat Q, Menéndez C, Ordi J - PLoS ONE (2015)

Procedures for the collection of cerebrospinal fluid (A), peripheral blood (B), liver (C), lung (D), spleen (E), and the central nervous system biopsy (F) (designed by Xabier Sagasta).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488344&req=5

pone.0132057.g001: Procedures for the collection of cerebrospinal fluid (A), peripheral blood (B), liver (C), lung (D), spleen (E), and the central nervous system biopsy (F) (designed by Xabier Sagasta).
Mentions: The type and main characteristics of the different needles used in the MIA procedure for each particular biopsy, the sites of puncture and the number of samples to be obtained are summarized in Table 1 and illustrated in Fig 1. The sampling process starts with the collection of CSF by occipital puncture, reaching the cisterna magna (Fig 1A). Up to 5 mL of CSF are collected in a 10 mL sterile tube and two aliquots of 2 mL each are stored in Eppendorf Safe-Lock Tubes at -80°C. Then, 20 mL of blood are extracted by puncture of the subclavian vein through a supraclavicular or infraclavicular approach (Fig 1B). If less than 20 mL of blood are obtained with this approach, intracardiac blood is targeted through a heart puncture at the left 5th intercostal space. Ten mL of blood are collected in an EDTA-containing tube, 10 mL in an aerobic adult or pediatric blood culture bottle (BACTEC), and four large drops of blood are placed onto a Whatman 903 filter (GE Healthcare Bio-Sciences, Pittsburgh, PA, USA). If other fluids (pleural effusion or ascites) are detected in the US scan, 20 mL are collected. After the body fluids have been collected, specimens of the major organs are taken.

Bottom Line: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain.A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses.This procedure could improve the determination of CoD in developing countries.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.

ABSTRACT

Background and aims: Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings.

Methods: A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles.

Results: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs.

Conclusions: A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.

No MeSH data available.


Related in: MedlinePlus