Dataset Information

Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020.

ABSTRACT:

Background

Minimally invasive autopsies, also known as minimally invasive tissue sampling (MITS), have proven to be an alternative to complete diagnostic autopsies (CDAs) in places or situations where this procedure cannot be performed. During the coronavirus disease 2019 (COVID-19) pandemic, CDAs were suspended by March 2020 in Brazil to reduce biohazard. To contribute to the understanding of COVID-19 pathology, we have conducted ultrasound (US)-guided MITS as a strategy.

Methods

This case series study includes 80 autopsies performed in patients with COVID-19 confirmed by laboratorial tests. Different organs were sampled using a standardized MITS protocol. Tissues were submitted to histopathological analysis as well as immunohistochemical and molecular analysis and electron microscopy in selected cases.

Results

US-guided MITS proved to be a safe and highly accurate procedure; none of the personnel were infected, and accuracy ranged from 69.1% for kidney, up to 90.1% for lungs, and reaching 98.7% and 97.5% for liver and heart, respectively. US-guided MITS provided a systemic view of the disease, describing the most common pathological findings and identifying viral and other infectious agents using ancillary techniques, and also allowed COVID-19 diagnosis confirmation in 5% of the cases that were negative in premortem and postmortem nasopharyngeal/oropharyngeal swab real-time reverse-transcription polymerase chain reaction.

Conclusions

Our data showed that US-guided MITS has the capacity similar to CDA not only to identify but also to characterize emergent diseases.

SUBMITTER: Duarte-Neto AN

PROVIDER: S-EPMC8672862 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020.

Duarte-Neto Amaro Nunes AN Ferraz da Silva Luiz Fernando LF Monteiro Renata Aparecida de Almeida RAA Theodoro Filho Jair J Leite Thabata Larissa Luciano Ferreira TLLF de Moura Catia Sales CS Gomes-Gouvêa Michele Soares MS Pinho João Renato Rebellho JRR Kanamura Cristina Takami CT de Oliveria Ellen Pierre EP Bispo Kely Cristina Soares KCS Arruda Cássia C Dos Santos Aline Brito AB Aquino Flavia Cristina Gonçalves FCG Caldini Elia Garcia EG Mauad Thais T Saldiva Paulo Hilário Nascimento PHN Dolhnikoff Marisa M

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20211201 Suppl_5

<h4>Background</h4>Minimally invasive autopsies, also known as minimally invasive tissue sampling (MITS), have proven to be an alternative to complete diagnostic autopsies (CDAs) in places or situations where this procedure cannot be performed. During the coronavirus disease 2019 (COVID-19) pandemic, CDAs were suspended by March 2020 in Brazil to reduce biohazard. To contribute to the understanding of COVID-19 pathology, we have conducted ultrasound (US)-guided MITS as a strategy.<h4>Methods</h4 ...[more]

PMID: 34910174

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Project description:BackgroundContraceptive arm implants, such as Implanon NXT®/Nexplanon®, are reversible methods of birth control that have gained global popularity, with over 20 million worldwide users. While palpable implants can be easily removed, deep or non-palpable implants pose complications during extraction, often requiring open surgery. This ultrasound-guided removal technique offers a minimally invasive, safe, and effective alternative, providing real-time control over the implant and neurovascular structures. Our study aims to evaluate the effectiveness and challenges of this implant removal method.MethodsIn this retrospective observational study, all cases referred to our institution for ultrasound-guided removal of contraceptive implants, from June 2022 to December 2023, were reviewed. Our facility serves as a referral center for handling challenging implants. Twenty-nine women with contraceptive implants were referred for implant removal in this period of time. Thirty implants were sent for removal in total (one patient had a double implant). Data specific to the patients were collected: age and body mass index (BMI). Data specific to the implant were also collected: time since implant insertion (months), history of a previous removal attempt, type of implant (single or double rod), implant palpability, laterality of the implant, supra or subfascial location, success or failure of the ultrasound-guided removal procedure and presence of complications in the post-procedure. Statistical analysis was conducted to determine the relationship between the procedure success rate and these variables, and also between these variables and the supra or subfascial location of the implant.ResultsTwenty-six of the 30 implants (86.67%) were successfully removed with this fully ultrasound-guided technique. In cases where the implant could not be removed, there was a higher rate of subfascial implant location (75%), while in cases where the removal was successful, the rate of subfascial implant location was significantly lower at 19.23% (P=0.048). Patients whose implants could be removed had a median BMI of 23.71 kg/m2, which was higher than the BMI of patients whose implants could not be removed (20.82 kg/m2), with a P=0.022. No complications were registered.ConclusionsPercutaneous real-time ultrasound-guided implant removal is effective, safe and offers a minimally-invasive alternative to open surgery. The removal of subfascial implants is also feasible but more challenging, leading to a reduction of success rate in this group. These positive outcomes suggest its potential as a standard initial approach for deep contraceptive implant removal.

Project description:ObjectiveCurrently, there are no reliable biomarkers for predicting therapeutic response in patients with rheumatoid arthritis (RA). The synovium may unlock critical information for determining efficacy, since a reduction in the numbers of sublining synovial macrophages remains the most reproducible biomarker. Thus, a clinically actionable method for the collection of synovial tissue, which can be analyzed using high-throughput strategies, must become a reality. This study was undertaken to assess the feasibility of utilizing synovial biopsies as a precision medicine-based approach for patients with RA.MethodsRheumatologists at 6 US academic sites were trained in minimally invasive ultrasound-guided synovial tissue biopsy. Biopsy specimens obtained from patients with RA and synovial tissue from patients with osteoarthritis (OA) were subjected to histologic analysis, fluorescence-activated cell sorting, and RNA sequencing (RNA-seq). An optimized protocol for digesting synovial tissue was developed to generate high-quality RNA-seq libraries from isolated macrophage populations. Associations were determined between macrophage transcriptional profiles and clinical parameters in RA patients.ResultsPatients with RA reported minimal adverse effects in response to synovial biopsy. Comparable RNA quality was observed from synovial tissue and isolated macrophages between patients with RA and patients with OA. Whole tissue samples from patients with RA demonstrated a high degree of transcriptional heterogeneity. In contrast, the transcriptional profile of isolated RA synovial macrophages highlighted different subpopulations of patients and identified 6 novel transcriptional modules that were associated with disease activity and therapy.ConclusionPerformance of synovial tissue biopsies by rheumatologists in the US is feasible and generates high-quality samples for research. Through the use of cutting-edge technologies to analyze synovial biopsy specimens in conjunction with corresponding clinical information, a precision medicine-based approach for patients with RA is attainable.

Dataset Information

Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020.

Background

Methods

Results

Conclusions

Publications

Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020.

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