Diagnostics

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14 pages, 7101 KiB

Open AccessArticle

Immunohistochemical and Morphometric Analysis of Lung Tissue in Fatal COVID-19

by Ioana-Andreea Gheban-Roșca, Bogdan-Alexandru Gheban, Bogdan Pop, Daniela-Cristina Mironescu, Vasile Costel Siserman, Elena Mihaela Jianu, Tudor Drugan and Sorana D. Bolboacă

Diagnostics 2024, 14(9), 914; https://doi.org/10.3390/diagnostics14090914 - 27 Apr 2024

Viewed by 1737

Abstract

The primary targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the lungs are type I pneumocytes, macrophages, and endothelial cells. We aimed to identify lung cells targeted by SARS-CoV-2 using viral nucleocapsid protein staining and morphometric features on patients with fatal [...] Read more.

The primary targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the lungs are type I pneumocytes, macrophages, and endothelial cells. We aimed to identify lung cells targeted by SARS-CoV-2 using viral nucleocapsid protein staining and morphometric features on patients with fatal COVID-19. We conducted a retrospective analysis of fifty-one autopsy cases of individuals who tested positive for SARS-CoV-2. Demographic and clinical information were collected from forensic reports, and lung tissue was examined for microscopic lesions and the presence of specific cell types. Half of the evaluated cohort were older than 71 years, and the majority were male (74.5%). In total, 24 patients presented diffuse alveolar damage (DAD), and 50.9% had comorbidities (56.9% obesity, 33.3% hypertension, 15.7% diabetes mellitus). Immunohistochemical analysis showed a similar pattern of infected macrophages, infected type I pneumocytes, and endothelial cells, regardless of the presence of DAD (p > 0.5). The immunohistochemical reactivity score (IRS) was predominantly moderate but without significant differences between patients with and without DAD (p = 0.633 IRS for type I pneumocytes, p = 0.773 IRS for macrophage, and p = 0.737 for IRS endothelium). The nucleus/cytoplasm ratio shows lower values in patients with DAD (median: 0.29 vs. 0.35), but the difference only reaches a tendency for statistical significance (p = 0.083). Our study confirms the presence of infected macrophages, type I pneumocytes, and endothelial cells with a similar pattern in patients with and without diffuse alveolar damage. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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14 pages, 3888 KiB

Open AccessArticle

Cardiac SARS-CoV-2 Infection, Involvement of Cytokines in Postmortem Immunohistochemical Study

by Letizia Alfieri, Lorenzo Franceschetti, Paolo Frisoni, Omar Bonato, Davide Radaelli, Diana Bonuccelli, Stefano D’Errico and Margherita Neri

Diagnostics 2024, 14(8), 787; https://doi.org/10.3390/diagnostics14080787 - 9 Apr 2024

Cited by 3 | Viewed by 1303

Abstract

In the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, significant attention was given to pulmonary manifestations. However, cardiac involvement is increasingly recognized as a critical factor influencing the prognosis, leading to myocardial damage, heart failure, acute coronary syndromes, potentially lethal [...] Read more.

In the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, significant attention was given to pulmonary manifestations. However, cardiac involvement is increasingly recognized as a critical factor influencing the prognosis, leading to myocardial damage, heart failure, acute coronary syndromes, potentially lethal arrhythmic events, and sudden cardiac death. Despite these findings, there is a lack of studies detailing the necroscopic, macroscopic, and microscopic cardiac changes associated with SARS-CoV-2. This study aimed to investigate the presence of SARS-CoV-2 viral proteins in cardiac tissue using immunohistochemical techniques to assess viral tropism. The analysis of cardiac tissue samples from deceased subjects, in different stages of conservation, confirmed to be positive for SARS-CoV-2 via reverse transcriptase-polymerase chain reaction (RT-PCR), showed immunopositivity for the SARS-CoV-2-NP viral antigen in 33% of cases. Notably, the presence of leukocyte infiltrates sufficient for diagnosing lymphocytic myocarditis was not observed. The central proinflammatory cytokines involved in the pathogenetic mechanism of coronavirus disease 19 (COVID-19) were researched using the immunohistochemical method. A significant increase in cytokine expression was detected, indicating myocardial involvement and dysfunction during SARS-CoV-2 infection. These findings suggest that the immunohistochemical detection of SARS-CoV-2 viral antigens and inflammatory cytokine expression in cardiac tissue could be crucial for a proper forensic assessment of the cause of death, even in sudden cardiac death. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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15 pages, 2986 KiB

Open AccessArticle

Pathological Findings in Hanging: Is the Traditional Knowledge Correct?

by Graziano Domenico Luigi Crudele, Alberto Amadasi, Lorenzo Franceschetti and Cristina Cattaneo

Diagnostics 2024, 14(3), 318; https://doi.org/10.3390/diagnostics14030318 - 1 Feb 2024

Viewed by 1490

Abstract

Background: In forensic pathology, asphyxia presents a problem as frequently as it is thorny and challenging. Some knowledge in forensic pathology is still considered to be traditionally acquired and is not critically assessed with modern statistical or technical tools. In this study, we [...] Read more.

Background: In forensic pathology, asphyxia presents a problem as frequently as it is thorny and challenging. Some knowledge in forensic pathology is still considered to be traditionally acquired and is not critically assessed with modern statistical or technical tools. In this study, we seek to examine the injuries that are considered to be typical of cases of hanging (neck lesions, haemorrhages, and pleural and epicardial petechiae). Methods: We evaluated whether there was, indeed, a statistically significant association between these injuries and deaths from hanging as compared to non-hanging deaths. We collected 399 cases (32 deaths by hanging and 367 cases of non-hangings), built contingency tables and performed chi-square tests for each variable (lesion) examined; we also analysed this association in various subgroups of the sample (according to sex, age and weight ranges). Results: Our results did not deviate from the expected outcome based on traditional knowledge, although they do provide a more detailed demonstration and clarification of traditional knowledge regarding this topic. Conclusions: These findings provide valuable insights for future discussion, examination and deepening of knowledge that is traditionally accepted but often undersupported in the literature. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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Review

Jump to: Research, Other

11 pages, 1190 KiB

Open AccessReview

Fentanyl and Sudden Death—A Postmortem Perspective for Diagnosing and Predicting Risk

by Ines Strenja, Elizabeta Dadić-Hero, Manuela Perković and Ivan Šoša

Diagnostics 2024, 14(17), 1995; https://doi.org/10.3390/diagnostics14171995 - 9 Sep 2024

Viewed by 893

Abstract

Sudden, unexpected deaths are extremely difficult for families, especially when the victim is a child. Most sudden deaths occur due to cardiovascular issues, and a smaller number (approximately one-quarter) are attributed to other causes, such as epilepsy. The medicinal and non-medicinal use of [...] Read more.

Sudden, unexpected deaths are extremely difficult for families, especially when the victim is a child. Most sudden deaths occur due to cardiovascular issues, and a smaller number (approximately one-quarter) are attributed to other causes, such as epilepsy. The medicinal and non-medicinal use of the synthetic opioid fentanyl, which can cause breathing problems, is frequently involved in these deaths. It is also being found more often in autopsies of sudden death cases, and the number of overdose deaths from illicit drugs containing fentanyl is increasing. There are cases in which it is mixed with other drugs. A gene known as the KCNH2 gene or human ether-a-go-go-related gene (hERG), involved in the heart’s electrical activity, can be related to abnormal heart rhythms. This gene, along with others, may play a role in sudden deaths related to fentanyl use. In response, we have examined the scientific literature on genetic variations in the KCNH2 gene that can cause sudden death, the impact of fentanyl on this process, and the potential benefits of genetic testing for the victims to offer genetic counseling for their family members. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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Other

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5 pages, 5650 KiB

Open AccessInteresting Images

Postmortem Detection of “Clinically Undiagnosed” Diffuse Large B-Cell Lymphoma: Gross and Microscopic Findings

by Vincenzo Cianci, Daniela Sapienza, Giovanni Bartoloni, Alessio Cianci, Annalisa Cracò, Fausto Omero, Patrizia Gualniera, Alessio Asmundo and Cristina Mondello

Diagnostics 2024, 14(17), 1901; https://doi.org/10.3390/diagnostics14171901 - 29 Aug 2024

Viewed by 466

Abstract

Diffuse large B-cell lymphoma is considered the most found non-Hodgkin lymphoma in adults. Diffuse large B-cell lymphoma, which also occurs in sporadic forms, is associated with some pathological conditions, including human immunodeficiency virus infection, especially if it progresses to AIDS. The authors report [...] Read more.

Diffuse large B-cell lymphoma is considered the most found non-Hodgkin lymphoma in adults. Diffuse large B-cell lymphoma, which also occurs in sporadic forms, is associated with some pathological conditions, including human immunodeficiency virus infection, especially if it progresses to AIDS. The authors report the case of a 45-year-old man with AIDS in whom a postmortem diagnosis of diffuse large B-cell lymphoma was performed. The proposed images document extensive pluri-visceral involvement, already visible macroscopically, and subsequently confirmed through histological examination. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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8 pages, 1659 KiB

Open AccessCase Report

Femicide Circumstances and Harmfulness: Case Report and Focusing Review

by Chiara Stassi, Marco La Mantia, Giuseppe Francesco Lo Re, Valentina Martines, Stefania Zerbo, Giuseppe Davide Albano, Ginevra Malta and Antonina Argo

Diagnostics 2024, 14(13), 1360; https://doi.org/10.3390/diagnostics14131360 - 26 Jun 2024

Cited by 1 | Viewed by 1223

Abstract

(1) Background: Femicide is an increasing phenomenon consisting of the murder of a woman for gender-related reasons. Despite the enactment of new laws aimed at controlling the phenomenon by toughening the penalties and introducing aggravating circumstances, there is an increasing trend that testifies [...] Read more.

(1) Background: Femicide is an increasing phenomenon consisting of the murder of a woman for gender-related reasons. Despite the enactment of new laws aimed at controlling the phenomenon by toughening the penalties and introducing aggravating circumstances, there is an increasing trend that testifies to the persistence of a flaw in the actual measures. (2) Case Presentation. We report the case of the murder of a 32-year-old woman—perpetrated by an ex-husband who refused to accept the end of the marriage—the analysis of which allowed us to frame the case as femicide. (3) Discussion. Despite global awareness of this phenomenon, the identification of risk factors to predict and prevent femicide is of utmost importance. This can be achieved by a multidisciplinary approach involving police officers, legal professionals, hospitals, governmental and nongovernmental organizations, and medico-legal departments aimed at promoting standardized methodologies. (4) Conclusions. We evaluate the contribution of forensic investigations to the identification of key elements that can help frame the murder of a woman as a femicide. Considering the devastating consequences for children who witness this kind of violence within the domestic setting, the planning of more impactful preventive actions is, thus, mandatory to minimize effects on public health. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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10 pages, 17429 KiB

Open AccessCase Report

Delayed Traumatic Rupture of the Spleen in a Patient with Mantle Cell Non-Hodgkin Lymphoma after an In-Hospital Fall: A Fatal Case

by Giuseppe Davide Albano, Stefania Zerbo, Mario Spanò, Nello Grassi, Emiliano Maresi, Ada Maria Florena and Antonina Argo

Diagnostics 2024, 14(12), 1254; https://doi.org/10.3390/diagnostics14121254 - 14 Jun 2024

Viewed by 850

Abstract

Splenic rupture and hematoma are significant complications that can occur in patients with non-Hodgkin lymphoma (NHL). Understanding these associated complications is essential for optimal patient management and enhanced patient outcomes. Histopathological and immunohistochemical analyses are crucial in diagnosing NHL and assessing splenic involvement. [...] Read more.

Splenic rupture and hematoma are significant complications that can occur in patients with non-Hodgkin lymphoma (NHL). Understanding these associated complications is essential for optimal patient management and enhanced patient outcomes. Histopathological and immunohistochemical analyses are crucial in diagnosing NHL and assessing splenic involvement. In this study, a judicial autopsy had been requested by the Prosecutor’s Office for a malpractice claim due to a fall in the hospital. In the Emergency Department, a 72-year-old man fell from a gurney and reported sustaining a wound to his forehead. No other symptoms were reported. A face and brain CT scan showed no abnormalities. Nine days after discharge, the patient presented with abdominal pain. An abdominal CT revealed splenic rupture and hemoperitoneum. The patient underwent open splenectomy but showed signs of hemodynamic shock and subsequently died. The evidence from the autopsy allowed us to diagnose mantle cell non-Hodgkin lymphoma with spleen involvement, previously unknown. Histopathological and immunohistochemical analyses were performed to assess the diagnosis of splenic rupture and estimate its timing. The findings strongly suggest that the splenic rupture was associated with the patient’s fall and the pre-existing malignancy. This case highlights the importance of considering an underlying hematological malignancy when investigating delayed splenic rupture. An immunohistochemical study of spleen samples allowed the timing of splenic hematoma and rupture to be assessed, leading to the establishment of a causal relationship with trauma. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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16 pages, 752 KiB

Open AccessSystematic Review

Evaluation of Bitemark Analysis’s Potential Application in Forensic Identification: A Systematic Review

by Nikolaos Christoloukas, Anastasia Mitsea, Aliki Rontogianni, Evangelos Papadakis and Christos Angelopoulos

Diagnostics 2024, 14(11), 1180; https://doi.org/10.3390/diagnostics14111180 - 4 Jun 2024

Cited by 1 | Viewed by 1477

Abstract

Bitemark analysis involves the examination of both patterned injuries and contextual circumstances, combining morphological and positional data. Considering the uniqueness of human dentition, bitemarks caused by teeth on skin or impressions on flexible surfaces could assist in human identification. Aims: to investigate the [...] Read more.

Bitemark analysis involves the examination of both patterned injuries and contextual circumstances, combining morphological and positional data. Considering the uniqueness of human dentition, bitemarks caused by teeth on skin or impressions on flexible surfaces could assist in human identification. Aims: to investigate the available literature systematically and evaluate the scientific evidence published over the past decade concerning the potential application of bitemark analysis in forensic identification. Methods: Two researchers meticulously searched electronic databases from January 2012 to December 2023, including Scopus, PubMed, Web of Science, and the Cochrane Library. Adhering to the PRISMA statement guidelines, this review employed appropriate medical subject headings (MeSHs) and free-text synonyms. Strict inclusion and exclusion criteria were applied during article retrieval. Results: The findings yielded controversial outcomes. Approximately two-thirds of the articles concluded that bitemark analysis is useful in forensic identification, while the remaining articles did not report statistically significant outcomes and cautioned against relying solely on bitemark analysis for identification. Conclusions: The authors assert that bitemark analysis can be a reliable and complementary method for forensic identification, contingent upon the establishment and adoption of a universally accepted global protocol for data collection, processing, and interpretation. Undoubtedly, recent years have witnessed a notable increase in research focused on bitemark identification, driven by the goal of achieving quantitative, objective, reproducible, and accurate results. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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9 pages, 3425 KiB

Open AccessCase Report

Hyoid Bone Fracture Pattern Assessment in the Forensic Field: The Importance of Post Mortem Radiological Imaging

by Vincenzo Cianci, Cristina Mondello, Annalisa Cracò, Alessio Cianci, Antonio Bottari, Patrizia Gualniera, Michele Gaeta, Alessio Asmundo and Daniela Sapienza

Diagnostics 2024, 14(7), 674; https://doi.org/10.3390/diagnostics14070674 - 22 Mar 2024

Viewed by 1601

Abstract

Post mortem hyoid bone fracture findings may be attributable to various factors, including both the onset of acute mechanical asphyxia as it happens in manual strangulation and in charred corpses. In forensic practice, the discovery of corpses burned after death to hide their [...] Read more.

Post mortem hyoid bone fracture findings may be attributable to various factors, including both the onset of acute mechanical asphyxia as it happens in manual strangulation and in charred corpses. In forensic practice, the discovery of corpses burned after death to hide their real cause of death is not uncommon: in these cases, the diagnostic challenge is even greater, as the action of flames is capable of both masking previously generated lesions and/or generating new ones, as occurs for hyoid bone fractures. The case concerns a 76-year-old man found charred in his bedroom. Almost complete body charring made it impossible to evaluate any external damage. Post mortem computed tomography (PMCT) was performed, and an evident bilateral fracture of the greater horn of the hyoid bone was detected. Although the absence of typical charring signs had steered the diagnosis towards post mortem exposure to flames, PMCT proved to be very useful in increasing the accuracy in correctly determining the cause of death. In particular, making use of Maximum Intensity Projection (MIP) hyoid bone reconstructions, it was possible to measure the medial dislocation angle of the fracture fragments and then to establish the applied direction of force, which acted in a lateral–medial way. A manual strangulation diagnosis was confirmed. The increasing importance of performing post mortem radiological exams as a corollary for conventional autopsy has been further confirmed. Full article

(This article belongs to the Special Issue Updates on Forensic Pathology)

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