Covid patients died in Campania, the first autopsy: “The infection causes a maxi thrombosis”

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Covid-19: the first autopsy on a full-blown case in Campania was carried out yesterday in Giugliano. In the new structure of the ASL Napoli 2 north, in fact, in the last two months, 10 necroscopic examinations have already been performed on suspected Covid patients, always in the context of investigations ordered by the judicial authority against any other investigation of the kind carried out so far in Campania, also due to the unavailability of the autopsy rooms of the Federico II University whose morgue function would be attributed to the Municipality.

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RESEARCH
Autopsies, in the deaths caused by a new disease such as Covid, are essential to understand the origin of the deaths and dissolve still unsolved clinical issues. Fragmentary data came from some autopsies (about fifty) conducted mainly between Bergamo and Brescia during the acute phase of the epidemic and which confirmed the suspicions of many resuscitators and infectious disease specialists who saw an unexpected clinical picture at the patient’s bed. That is, not so much a viral pneumonia, however severe, as announced by China, but a systemic, vasculitic and thromboembolic disease on a hyperinflammatory basis that became lethal despite the reanimative interventionsthe. A pulmonary pathology but extended to the kidneys, heart and also the brain. Clinicians from Cotugno and other Covid centers immediately sensed this picture and resorted to a course correction in treatments (heparin, cortisone and other biological anti-inflammatory drugs such as Tocilizumab). Having an autoptic response available is very useful for developing more targeted and effective treatments.

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THE SECTOR ROOMS
The Giuglianese structure is the only one in Campania to meet the structural, organizational and technological requirements necessary to perform the autoptic examination on patients with Covid 19 infection but has no research function. The requests all came in the context of investigations by the Public Prosecutors of Naples, North Naples and Benevento. The body of a full-fledged Covid 19 patient is expected in the next few hours. Forensic doctors in these cases are asked to evaluate anatomopathological lesions to determine the cause of death. When the assessment takes place 72 hours after death, the virus can no longer be found with the swab. In Giugliano, the team led by Maurizio Municinò, in some of the suspected cases, and in the acclaimed one, verified the presence at a macroscopic level of pulmonary fibrotic lesions and vascular coagulations (thrombi) attributable precisely to the infection. In one case, lung areas were highlighted with very marked colors, which also qualify as thrombotic areas. For all the autopsies carried out, the anatomopathological diagnosis of the organs and tissues taken is awaited.

THE MANAGER
«The Giugliano Center for Legal Medicine – he underlines Antonio d’Amore, manager of the Asl Napoli 2 Nord – was inaugurated last November and we begin to understand its full value. He is the only one in Campania to be one of the few in Italy capable of responding to the stringent prescriptions of the Ministry of Health regarding autopsies on Covid patients. In addition to the agreements with the Prosecutor of Naples and North Naples, we have closed agreements with Benevento and we are in dialogue with the Prosecutors of Avellino and Torre Annunziata for similar agreements ». The structure of Giugliano has a sector room with decontamination showers, negative pressure ventilation system and filtration system for the outgoing air, the CT, cold rooms. Facilities that qualify it as the only one in Campania as a third level center. For the old rooms of the university hospital, however, the Municipality, University and Public Prosecutor of Naples are expected to define the procedure for the necessary work to adapt to research activities.

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