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Background/aims The aim of this study is to share autopsy findings of COVID-19-positive cases and autopsy algorithms for safely handling of suspicious bodies during this pandemic. Methods COVID-19-positive cases of Istanbul Morgue Department were retrospectively analyzed. Sampling indications for PCR tests in suspicious deaths, macroscopic and microscopic findings obtained in cases with positive PCR tests were evaluated. Results In the morgue department, 345(25.8%) of overall 1336 autopsy cases were tested for COVID-19. PCR test was found positive in 26 cases. Limited autopsy procedure was performed in 7 cases, while the cause of death was determined by external examination in the remaining 19 cases. Male-to-female ratio was found 3.3:1 and mean age was 60.0 ± 13.6 among all PCR-positive cases. Cause of death was determined as viral pneumonia in fully autopsied cases. Most common findings were sticky gelatinous fluid in cavities and firm and swollen lungs, varying degrees of consolidation. In microscopy, diffuse alveolar epithelial damage, type-II pneumocyte hyperplasia, hyaline membrane formation, fibrinous exudate, and fibrinous plaques in the alveoli were the most common findings. Conclusions In COVID-19 autopsies, pulmonary findings were found to be prominent and the main pathology was pneumonia. Older age and findings of chronic diseases indicate that the cases were in the multirisk group in terms of COVID-19 mortality.

Background The identification of bacterial species in the soil can be used for the differentiation of soil samples and physical evidence. This study aims to evaluate the importance of identifying microorganisms in the soil for forensic sciences. The study covered 20 regions identified and marked outside the settlement areas within the boundaries of Istanbul. Methodology Big and wide soil and forest areas were preferred. Four types of physical evidence samples were collected from the identified areas at the end of the first, second, and third months and then analyzed. The collected samples were physically embedded in the soil. In this study, 10 g of soil sample and four pieces of physical evidence (fabric, rubber, metal, and wood), sized 5 × 5 cm and buried 20-30 cm deep in the soil, contaminated with soil were collected for analysis and stored in sterile conditions. The microbiological identification analyses were conducted at the end of the predefined period and in the predefined order using first phenotypic (e.g., microscopic and macroscopic), followed by culture methods using advanced diagnostic analyses, such as API and matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Results In the soil samples and the physical evidence samples collected, 83% bacteria and 17% fungus were identified. A database was set up for the study findings. Conclusions The presence of microorganisms in the soil and physical evidence samples contaminated with soil, which is crucial in the evaluation of criminal cases, was determined using microbiological analysis.

Objective The aim of this study is to define epidemiologic differences and the most common pathologies that cause nontraumatic sudden, natural death in people in the age group of 18-35 years. Identifying causes of sudden death in this age group is important for determining approaches for prevention. Methods We performed a descriptive statistical methodology, analysis, and interpretation using demographic and autopsy data of sudden deaths. A total of 4034 autopsies were reviewed and 66 cases of sudden death were included in this study. Results We identified 58 (87.9%) subjects in whom the adjudicated cause of death was of potential cardiac etiology. The most common cause of sudden young adult death was ischemic heart disease associated with the atherosclerotic coronary artery (n=24, 36.3%), followed by ischemic heart disease associated with nonatherosclerotic coronary artery disease and dissecting aortic aneurysm. Conclusion We put forth that the main cause of sudden young adult death was cardiac (87.9%) in origin. Of these cardiac causes, ischemic etiology associated with atherosclerosis was the main reason for sudden young adult deaths. In order to reduce the incidence of sudden young adult deaths, major efforts should be directed to prevent atherosclerosis in this age group.

Aim: The aim of this paper is to survey the COVID-19 research articles in Q1 ranked high SJR index journals according to the SCImago journal rank indicator. Material and Method: The study was carried out on the website named "https://www.scimagojr.com". The search was conducted by selecting the criteria “medicine”, “pathology and forensic medicine”, “all regions/countries”, “journals”, and the “2020” as the year. Only 50 scientific journals met these criteria. COVID-19-related and unrelated research articles published in these journals were manually scanned. Review articles, book reviews, conferences, commentaries, case reports, mini reviews, short communications, letters to the editor were not included in the study. COVID-19 related research articles were divided into groups in terms of antemortem and postmortem type of the study by reviewing the abstract of the studies and also grouped according to the country of first author and countries of all authors. Results: A total of 3906 research articles published in 50 journals with Q1 SJR index over 0.887 were investigated. Of these 3906 research articles, 40 of them were related to COVID-19. 31 of these 40 COVID-19 related research articles were antemortem and 9 were postmortem studies. Among these 40 COVID-19 related scientific articles, the first author of publications belonged to 12 countries. United States, Australia, China, and Italy were found to be the most productive countries for published research articles on COVID-19 in selected high SJR index journals. The United States was the country with the highest number of first authors with 15 articles. China was the country with the highest number of multinational author list research articles. Conclusion: We believe that the number and content of studies conducted in these high-quality scientific journals on COVID-19 make important contributions and understanding in the fields of disease transmission, disease prevention, course and severity of symptoms, pathophysiology, molecular characteristics, and treatment approach processes.

Background/Aim: The most common cause of death in COVID-19 is acute respiratory distress syndrome. Diffuse alveolar damage is the histological characteristic and counterpart of acute respiratory distress syndrome. Histopathological findings, accompanied by immunohistochemical findings, can provide valuable information in the pathogenesis of Covid-19. We aimed to investigate the histopathological findings by supporting our results with immunohistochemical staining in SARS-CoV-2 positive autopsies.Methods: A total of 101 autopsy cases with positive postmortem SARS-CoV-2 rt-PCR tests between May 2020-May 2021 were investigated in this retrospective cohort study. Cases with negative postmortem swab samples on rt-PCR and those with severe autolysis were excluded from the study. Pathological changes in the lung were examined with hematoxylin and eosin-stained preparations. Immunohistochemical assay with pancytokeratin, TTF-1, IL-6, CD68, CD3, CD8, and antibodies against the SARS-CoV-2 nucleocapsid protein were also performed for further evaluation. Results: Diffuse alveolar damage findings were present in 58 (61.7%) out of 94 cases in our study. Seventeen (18.1%) showed findings compatible with the exudative phase, 37 (39.3%) were in the proliferative phase, and 4 (4.3%) were in the fibrotic phase of diffuse alveolar damage. Pulmonary perivascular lymphocytic infiltrates contained more CD3 (+) T lymphocytes than CD8 (+) T lymphocytes, immunohistochemically. Conclusion: The finding of more CD3 positive T lymphocytes than the CD8 positive T lymphocytes in the perivascular lymphocytic infiltrate correlates with the hypothesis of the direct destruction of CD8 (+) T lymphocytes or through impairment of cellular immunity by SARS-CoV-2 induced mediators. Detection of immunohistochemical staining with IL-6 in COVID-19 supports the cytokine storm mentioned in the previous studies and the role of IL-6 in cytokine storm in SARS-CoV-2 infection. The limited number of immunohistochemical studies on SARS-CoV-2 increases the importance of our study, which evaluates IL-6, CD3, and CD8 expressions at the tissue level. Autopsy research is important and contributes to the development of protective, diagnostic, and therapeutic modalities.

Sarcina ventriculi is a gram-positive anaerobic coccus with characteristic tetrad morphology. Sarcina ventriculiis identified by light microscopy with features of basophilic staining, cuboidal shape, tetrad morphology, and refractile nature. There have been very few case reports of Sarcina ventriculi reported in the literature. We present a case of a 53-year-old male, with gastric ulcer perforation where peritonitis was incidentally found to harbor Sarcina ventriculi in postmortem histopathological examination. Most of the cases exhibit abdominal pain, nausea, vomiting and delayed gastric emptying. It has also fatal life-threatening complications, such as gastric perforation and emphysematous gastritis. The histopathological examination has a key role for identification of the bacteria. The pathologist must always keep it in mind these bacteria as a cause of gastric ulcer perforation in the differential diagnosis. We want to present a case of a 53-year-old male gastric ulcer perforation who was found dead in his bed.

Pneumocystis jiroveci is the most common and serious opportunistic infection in acquired immune deficiency syndrome patients. It is detected in approximately 80% of human immunodeficiency virus (HIV) infected individuals. In this paper, we present a case of pneumocystic jiroveci pneumonia in a 32-year-old HIV-infected patient who committed suicide. We also present histopathological findings in the lung and aim to draw attention to suicidal tendency in HIV-infected individuals.

As an opportunistic pathogen with high mortality rates, Cytomegalovirus (CMV) may lead to fatal disseminated CMV infection of the premature and newborn; thus necessitating the demonstration of CMV-DNA with clinical history and/or histopathological findings of CMV infection and defining other bacterial and viral infection agents with real-time polymerase chain reaction (RT-PCR) in udden unexpected death in infancy (SUDI) cases as we aimed in this study. 314 (144 female, 170 male) SUDI cases were prospectively investigated from January 2013 to January 2015 in Istanbul Forensic Medicine Institution. The study includes 87 tissue samples of 39 cases for post-mortem histopathological examination of interstitial pneumonia, myocarditis, meningitis, encephalitis, hepatitis, colitis or tubulointerstitial nephritis and/or accompanying chronic sialadenitis. CMV-DNA was found positive in 35 (40.2%) salivary gland, 19 (21.8%) lung, 1 (1.1%) tonsil, and 1 (1.1%) brain tissues. CMV sialadenitis and/or CMV pneumonia associated with other viral and/or bacterial agents were detected in 23 (60%) of 39 infant cases. The demonstration of CMV-DNA would significantly clarify the cause of death and collection of epidemiological data in SUDI cases with clinical history and histopathological findings of CMV infection accompanying chronic CMV sialadenitis. Furthermore, CMV suppresses the immune system, and may predispose to other bacterial and/or viral infections in these cases. Post-mortem molecular investigations are useful in explaining cause of death in SUDI with a suspicion of infection in forensic autopsies., Highlights • CMV may lead to fatal disseminated CMV infection of the premature and newborn. • Our study is the first comprehensive study investigating CMV infections in SUDI. • CMV suppresses the immune system, and may predispose to other infections. • Postmortem molecular investigations are useful in explaining cause of death in SUDI.

Background: Human bocavirus (HBoV) is a virus belonging to the Parvoviridae family, which has been newly discovered to be associated with respiratory tract infections in children. There are many reports worldwide on the endemicity of this virus. Since it is relatively new, it is not routinely detected in clinical laboratory investigations. Case Report: We demonstrated that HBoV infection caused the death of a 5-month-old girl with a history of high fever and wheezing. Human bocavirus (HBoV 1/2/3/4) was found in a nasopharyngeal swab, paraffin-embedded lung tissue and stool samples by multiplex PCR methods using postmortem microbiological analysis. Conclusion: This case suggests that lower respiratory tract infections due to HBoV may cause severe and life-threatening diseases. Postmortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. To our knowledge, this report is the first document of a HBoV postmortem case in Turkey

Cryptococcus neoformans is a highly mortal opportunistic yeast causing pneumonia and meningoencephalitis in cases with HIV infection. In rare cases, it causes systemic infections, spreading to organs like the spleen, liver, and kidneys. In this paper we present the post-mortem evaluation results of a systemic cryptococcal infection in a HIV-positive case found dead at home. A 30-year-old, 167 cm tall, 57 kg Chinese man found dead at home was sent to the Morgue Department for autopsy. In the anogenital region, multiple papular lesions,which were found 1 cm in diameter, off-white, having hard consistency, and raising from surface, were found. In autopsy, edema was found in the brain and cerebellum and cerebellar tonsils were prominent. The brain weighed 1561 g. Right lung was found 943 g and left lung 800 g in weight. Yeast growth was observed in the aerobic cultures of CSF, lung and spleent issue. The yeast form was defined as C. neoformans with API 32 C and Maldi-T of method. In addition, Serratia marcescens grew in blood and lung tissue culture. Plenty of gram-negative bacilli were seen in the Gram stain of tissue smear. In the post mortem histopathological examination of the tissues, histiocytic-pneumonia caused by cryptococcus and bacterial bronchopneumonia findings were seen in lungs and the parenchyma of the brain, and other organs were reported to be widely in vaded with cryptococcus. HIV-RNA was found positive in high quantitation in the blood sample of the case. HIVpositive immunocompromised people often die due to opportunistic infections. Our case died due to pneumonia infection caused by C. neoformans and secondary infection with S. marcescens and meningo encephalitis caused by systemic cryptococcus infection. Therefore, AIDS and related opportunistic infections should be strongly considered in cases where there is death of a foreign person at home with unknown clinical data and stories.

Metastatic bladder tumors constitute