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

被引:91
作者
Castillo, Paola [1 ]
Ussene, Esperanca [2 ]
Ismail, Mamudo R. [2 ]
Jordao, Dercio [2 ]
Lovane, Lucilia [2 ]
Carrilho, Carla [2 ]
Lorenzoni, Cesaltina [2 ]
Lacerda, Marcus V. [3 ]
Palhares, Antonio [3 ]
Rodriguez-Carunchio, Leonardo [6 ]
Martinez, Miguel J. [1 ,5 ]
Vila, Jordi [1 ,5 ]
Bassat, Quique [1 ,4 ]
Menendez, Clara [1 ,4 ]
Ordi, Jaume [1 ,6 ]
机构
[1] Univ Barcelona, Hosp Clin, Barcelona Ctr Int Hlth Res CRESIB, ISGlobal, Barcelona, Spain
[2] Maputo Cent Hosp, Dept Pathol, Maputo, Mozambique
[3] Fundacao Med Trop Dr Heitor Viera Dourado, Manaus, Amazonas, Brazil
[4] CISM, Maputo, Mozambique
[5] Univ Barcelona, Hosp Clin, Dept Microbiol, Barcelona, Spain
[6] Univ Barcelona, Hosp Clin, Dept Pathol, Barcelona, Spain
关键词
VERBAL AUTOPSY; PLASMODIUM-FALCIPARUM; CLINICAL-DIAGNOSIS; NEEDLE AUTOPSY; GLOBAL HEALTH; POSTMORTEM; MORTALITY; MALARIA; SEQUESTRATION; FEASIBILITY;
D O I
10.1371/journal.pone.0132057
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
070301 [无机化学]; 070403 [天体物理学]; 070507 [自然资源与国土空间规划学]; 090105 [作物生产系统与生态工程];
摘要
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.
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页数:13
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