Practice of percutaneous needle autopsy; a descriptive study reporting experiences from Uganda

BACKGROUND: Percutaneous needle autopsy can overcome a number of barriers that limit the use of complete autopsies. We performed blind-and ultrasound guided needle autopsies in HIV-infected adults in Uganda. In this study we describe in detail the methods we used, the ability of both procedures to obtain sufficient tissue for further examination and the learning curve of the operators over time. METHODS: If written informed consent was granted from the next of kin, we first performed a blind needle autopsy, puncturing brain, heart, lungs, liver, spleen and kidneys using predefined surface marking points. We then performed an ultrasound guided needle autopsy puncturing heart, liver, spleen and kidneys. The number of attempts, expected success and duration of the procedure were noted. A pathologist read the slides and indicated if the target tissue was present and of sufficient quality for pathological review. We report the predicted and true success rates, compare the yield of blind to ultrasound guided needle biopsies and evaluate the failure rate over time. RESULTS: Two operators performed 96 blind needle autopsies and 95 ultrasound guided needle autopsies. For blind needle biopsies true success rates varied from 56-99% and predicted success rates from 89-99%. For ultrasound guided needle biopsies true success rates varied from 72-100% and predicted success rates from 84-98%. Ultrasound guidance led to a significantly higher success rate in heart and left kidney. A learning curve was observed over time with decreasing failure rates with increasing experience and a shorter duration of the needle autopsy. CONCLUSION: Needle autopsy can successfully obtain tissue for further pathological review in the vast majority of cases, with a decrease in failure rate with increasing experience of the operator. The benefit of ultrasound guidance will depend on the population, the disease and organ of interest and the local circumstances. Our results justify further evaluation of needle autopsies as a method to establish a cause of death

HIV Suppresses Cervical Neutrophil Infiltration in Women with Normal or Abnormal Pap Smears

Human immunodeficiency virus (HIV) infection of CD4+ T cells results in a weakened immune system due to decreased white blood cells, particularly multi-lobed neutrophils (neutropenia) and other granulocytes.1 The purpose of this study was to determine whether a correlation exists between HPV/HIV status and presence of neutrophils. To test this, we used a computer software program (QuPath) to analyze neutrophil infiltration seen in pap smears of both HIV+ and HIV- patients from samples collected in Tanzania from three different sites: Bagamoyo, Chalinze, and Dar es Salaam. The software was used to quantify neutrophils per image based on the size and shape of the nuclei. For each sample, three slide images were taken and the average neutrophil count was determined through QuPath and compared to data about sample HIV and HPV status from a previous study. Results showed that HIV+ patients had significantly lower neutrophil counts, regardless of HPV type and cytology grade based on the Bethesda system. Therefore, we concluded that cervical neutrophil infiltration is suppressed in HIV+ samples for both normal and abnormal pap smears. 1. Shi, X. et al. Neutropenia during HIV infection: adverse consequences and remedies. Int Rev Immunol 33, 511-536 (2014)