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Article ; Online: The presence of thrombus in spontaneous coronary artery dissection: A systematic review of autopsy findings.

Jaspan, Vita N / Rapkiewicz, Amy V / Reynolds, Harmony R

American heart journal plus : cardiology research and practice

2022 Volume 15, Page(s) 100135

Abstract: Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. There is no consensus on optimal treatment, though a conservative approach including antiplatelet agents is commonly used. We ... ...

Abstract	Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. There is no consensus on optimal treatment, though a conservative approach including antiplatelet agents is commonly used. We hypothesized that most cases of SCAD would not demonstrate true lumen thrombus in the dissected artery, suggesting that anti-platelet agents might not have a role in the treatment of SCAD. Methods: We conducted a systematic review of the published literature through March 2022 to identify pathology images from individuals who died of SCAD. The images were independently reviewed by a pathologist to assess for the presence of thrombus and inflammatory cells. Results: We identified 40 cases from 34 publications with available pathology images and found only one case of true lumen thrombus. Additionally, we found that 53% of cases involved eosinophilic inflammation. Conclusion: The role of antiplatelet agents in the treatment of SCAD should be re-evaluated. Further studies are needed to better understand the significance and treatment implications of eosinophilic inflammation.
Language	English
Publishing date	2022-04-22
Publishing country	United States
Document type	Journal Article
ISSN	2666-6022
ISSN (online)	2666-6022
DOI	10.1016/j.ahjo.2022.100135
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Article ; Online: New York University Long Island School of Medicine.

Ayala, Gladys M / Rapkiewicz, Amy V / Carsons, Steven E / Shelov, Steven P

Academic medicine : journal of the Association of American Medical Colleges

2021 Volume 95, Issue 9S A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools, Page(s) S353–S357

Language	English
Publishing date	2021-02-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	96192-9
ISSN	1938-808X ; 1040-2446
ISSN (online)	1938-808X
ISSN	1040-2446
DOI	10.1097/ACM.0000000000003481
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Article ; Online: A Large Postmortem Database of COVID-19 Patients Can Inform Disease Research and Public Policy Decision Making.

Hooper, Jody E / Sanchez, Harry / Litovsky, Silvio / Lu, Zhen Arthur / Gabrielson, Edward W / Padera, Robert F / Steffensen, Thora / Solomon, Isaac H / Gilbert, Andrea / Threlkeld, Kirsten J / Rapkiewicz, Amy V / Harper, Holly / Kapp, Meghan E / Schwerdt, Mary K / Mount, Sharon / Wang, Yiwen / Lu, Rong / Williamson, Alex K

Archives of pathology & laboratory medicine

2024

Abstract: Context.—: Autopsies performed on COVID-19 patients have provided critical information about SARS-CoV-2's tropism, mechanisms of tissue injury, and the spectrum of disease.: Objective.—: To provide an updated database of postmortem disease in COVID- ... ...

Abstract	Context.—: Autopsies performed on COVID-19 patients have provided critical information about SARS-CoV-2's tropism, mechanisms of tissue injury, and the spectrum of disease. Objective.—: To provide an updated database of postmortem disease in COVID-19 patients, assess relationships among clinical and pathologic variables, evaluate the accuracy of death certification, and correlate disease variables to causes of death. Design.—: The 272 postmortem examinations reported in this paper were submitted by 14 pathologists from 9 medical or forensic institutions across the United States. The study spans the eras of the 3 principal COVID-19 strains and incorporates surveyed demographic, clinical, and postmortem data from decedents infected with SARS-CoV-2, including primary and contributing causes of death. It is the largest database of its kind to date. Results.—: Demographics of the decedents reported here correspond well to national statistics. Primary causes of death as determined by autopsy and official death certificates were significantly correlated. When specifically cited disease conditions found at autopsy were correlated with COVID-19 versus non-COVID-19 death, only lung findings characteristic of SARS-CoV-2 infection or the absence of lung findings were significantly associated. Conclusions.—: Changes in hospitalization and disease likely stem from longer lifespans after COVID-19 diagnosis and alteration in treatment approaches. Although Omicron variants preferentially replicate in the upper airways, autopsied patients who died of COVID-19 in that time period showed the same lung damage as earlier decedents. Most importantly, findings suggest that there are still unelucidated risk factors for death from COVID-19 including possibly genetic susceptibility.
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	194119-7
ISSN	1543-2165 ; 0363-0153 ; 0096-8528 ; 0003-9985
ISSN (online)	1543-2165
ISSN	0363-0153 ; 0096-8528 ; 0003-9985
DOI	10.5858/arpa.2023-0380-OA
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Article ; Online: The OSPE.

Belovarac, Brendan J / Zabar, Sondra R / Warfield, Dana / Bannan, Michael A / Rapkiewicz, Amy V

American journal of clinical pathology

2020 Volume 155, Issue 3, Page(s) 324–332

Abstract: Objectives: Resident assessment tends to consist of multiple-choice examinations, even in nuanced areas, such as quality assurance. Internal medicine and many other specialties use objective structured clinical examinations, or OSCEs, to evaluate ... ...

Abstract	Objectives: Resident assessment tends to consist of multiple-choice examinations, even in nuanced areas, such as quality assurance. Internal medicine and many other specialties use objective structured clinical examinations, or OSCEs, to evaluate residents. We adapted the OSCE for pathology, termed the Objective Structured Pathology Examination (OSPE). Methods: The OSPE was used to evaluate first- and second-year residents over 2 years. The simulation included an anatomic pathology sign-out session, where the resident could be evaluated on diagnostic skills and knowledge of key information for cancer staging reports, as well as simulated frozen-section analysis, where the resident could be evaluated on communication skills with a "surgeon." The OSPE also included smaller cases with challenging quality issues, such as mismatched slides or gross description irregularities. All cases were scored based on the Pathology Milestones created by the Accreditation Council for Graduate Medical Education. Results: Using this OSPE, we were able to demonstrate that simulated experiences can be an appropriate tool for standardized evaluation of pathology residents. Conclusions: Yearly evaluation using the OSPE could be used to track the progress of both individual residents and the residency program as a whole, identifying problem areas for which further educational content can be developed.
MeSH term(s)	Accreditation/methods ; Accreditation/standards ; Clinical Competence/standards ; Education, Medical, Graduate/methods ; Education, Medical, Graduate/standards ; Humans ; Internship and Residency ; Pathology, Clinical/education ; Pathology, Clinical/standards ; Quality Assurance, Health Care/methods ; Quality Assurance, Health Care/standards
Language	English
Publishing date	2020-11-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2944-0
ISSN	1943-7722 ; 0002-9173
ISSN (online)	1943-7722
ISSN	0002-9173
DOI	10.1093/ajcp/aqaa143
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Article: COVID-19-Associated Large- and Medium-Sized-Vessel Pathology: A Case Series.

Chen, Stacey / Malas, Jad / Latson, Larry A / Narula, Navneet / Rapkiewicz, Amy V / Williams, David M / Pass, Harvey I / Galloway, Aubrey C / Smith, Deane E

Aorta (Stamford, Conn.)

2022 Volume 10, Issue 3, Page(s) 104–113

Abstract: Background: Coronavirus disease-19 (COVID-19) remains a public health crisis. The epidemiology of COVID-19-associated large- and medium-sized-vessel pathology is not well characterized. The aim of this study is to identify patients with possible COVID- ... ...

Abstract	Background: Coronavirus disease-19 (COVID-19) remains a public health crisis. The epidemiology of COVID-19-associated large- and medium-sized-vessel pathology is not well characterized. The aim of this study is to identify patients with possible COVID-19-associated large- and medium-sized-vessel pathology based on computed tomography (CT) imaging to provide insight into this rare, but potentially devastating, cardiovascular manifestation. Methods: This is a single-center retrospective review of patients with CT chest, abdomen, and/or pelvis concerning for large- and medium-vessel pathology and confirmed COVID-19 infection from March 1, 2020 to October 31, 2020. Results: During the study period, 6,553 CT reports were reviewed and pertinent imaging was identified in 139 patients. Of these, 8 patients (median age: 59 years, range 51-82) were COVID-19 positive. All patients had preexisting cardiovascular risk factors and three (37.5%) had an autoimmune disease. Four patients were never hospitalized for COVID-19. Among these, two presented to the hospital at a median of 39 days (range: 27-50) after their initial COVID-19 test with chest and back pain where imaging revealed extensive aortic pathology. One patient required surgical management for aortic pathology. All other patients were treated with expectant management and outpatient follow-up. Conclusion: The clinical and radiological presentations of COVID-19-associated large- and medium-vessel pathology are heterogeneous and can be a late finding after COVID-19 recovery. Close clinical follow-up and surveillance imaging for large- and medium-sized-vessel pathology may be warranted in COVID-19 patients.
Language	English
Publishing date	2022-11-01
Publishing country	Germany
Document type	Journal Article
ISSN	2325-4637
ISSN	2325-4637
DOI	10.1055/s-0042-1748960
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Article ; Online: Fatal Complications of Aesthetic Techniques: The Gluteal Region.

Rapkiewicz, Amy V / Kenerson, Katherine / Hutchins, Kenneth D / Garavan, Fintan / Lew, Emma O / Shuman, Mark J

Journal of forensic sciences

2018 Volume 63, Issue 5, Page(s) 1406–1412

Abstract: Cosmetic procedures are common and utilize many techniques to obtain aesthetically good outcomes for patient satisfaction with acceptable safety standards. Cosmetic procedures that involve the gluteal region are becoming increasingly popular as various ... ...

Abstract	Cosmetic procedures are common and utilize many techniques to obtain aesthetically good outcomes for patient satisfaction with acceptable safety standards. Cosmetic procedures that involve the gluteal region are becoming increasingly popular as various procedures can target the gluteal region such as liposuction, tumescent liposuction, cosmetic filler injections, autologous fat transfer, depot drug delivery, and implants. Complications of cosmetic gluteal procedures can be localized or systemic with systemic complications being responsible for most deaths. These reported systemic complications include sepsis, thromboembolism, fat embolism with or without fat embolism syndrome, macroscopic fat embolism, anesthesia-related and blood volume abnormalities. We herein report 10 deaths due to elective gluteal cosmetic procedures. Autologous fat transfer (fat grafting, lipoinjection) following liposuction resulted in 8 of 10 fatal outcomes of the gluteal aesthetic procedures. A comprehensive discussion of gluteal anatomy, gluteal contouring procedures, and the approach to such cases is presented along with the autopsy findings of the reported cases.
MeSH term(s)	Adipose Tissue/transplantation ; Adult ; Buttocks ; Coroners and Medical Examiners ; Cosmetic Techniques/mortality ; Embolism, Fat/etiology ; Embolism, Fat/mortality ; Female ; Florida/epidemiology ; Humans ; Lipectomy/mortality ; Middle Aged ; Pulmonary Embolism/etiology ; Pulmonary Embolism/mortality ; Retrospective Studies ; Shock, Septic/etiology ; Shock, Septic/mortality ; Transplantation, Autologous
Language	English
Publishing date	2018-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	219216-0
ISSN	1556-4029 ; 0022-1198
ISSN (online)	1556-4029
ISSN	0022-1198
DOI	10.1111/1556-4029.13761
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Article ; Online: Fatal wounds sustained from "falling bullets": maintaining a high index of suspicion in a forensic setting.

Rapkiewicz, Amy V / Shuman, Mark J / Hutchins, Kenneth D

Journal of forensic sciences

2014 Volume 59, Issue 1, Page(s) 268–270

Abstract: Celebratory gunfire injuries from "falling bullets" occur when guns are fired into the air during celebrations without realizing that this can cause serious injuries or even fatalities. Fatal celebratory gunfire injury is an uncommonly reported event in ... ...

Abstract	Celebratory gunfire injuries from "falling bullets" occur when guns are fired into the air during celebrations without realizing that this can cause serious injuries or even fatalities. Fatal celebratory gunfire injury is an uncommonly reported event in the continental United States. Our electronic database was queried for homicides occurring within days of July 4th and December 31st over a 14-year period. We describe two cases of fatal gunfire injury due to celebratory gunfire occurring during New Year's Eve in Southern Florida. The relevant literature is reviewed. These case reports illustrate that fatal gunfire injuries sustained from "falling bullets" may pose as an unexpected mimic to sudden natural deaths especially in patients with prior medical history. A high index of suspicion to recognize such injury is required particularly during holidays.
MeSH term(s)	Adult ; Aged ; Anniversaries and Special Events ; Aorta/injuries ; Aorta/pathology ; Databases, Factual ; Florida/epidemiology ; Forensic Ballistics ; Forensic Pathology ; Head Injuries, Penetrating/pathology ; Homicide ; Humans ; Male ; Neck Injuries/pathology ; Wounds, Gunshot/pathology
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	219216-0
ISSN	1556-4029 ; 0022-1198
ISSN (online)	1556-4029
ISSN	0022-1198
DOI	10.1111/1556-4029.12258
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Article: COVID-19-Associated Large- and Medium-Sized-Vessel Pathology: A Case Series

Chen, Stacey / Malas, Jad / Latson, Larry A. / Narula, Navneet / Rapkiewicz, Amy V. / Williams, David M. / Pass, Harvey I. / Galloway, Aubrey C. / Smith, Deane E.

AORTA

2022 Volume 10, Issue 03, Page(s) 104–113

Abstract	Background: Coronavirus disease-19 (COVID-19) remains a public health crisis. The epidemiology of COVID-19-associated large- and medium-sized-vessel pathology is not well characterized. The aim of this study is to identify patients with possible COVID-19-associated large- and medium-sized-vessel pathology based on computed tomography (CT) imaging to provide insight into this rare, but potentially devastating, cardiovascular manifestation. Methods: This is a single-center retrospective review of patients with CT chest, abdomen, and/or pelvis concerning for large- and medium-vessel pathology and confirmed COVID-19 infection from March 1, 2020 to October 31, 2020. Results: During the study period, 6,553 CT reports were reviewed and pertinent imaging was identified in 139 patients. Of these, 8 patients (median age: 59 years, range 51–82) were COVID-19 positive. All patients had preexisting cardiovascular risk factors and three (37.5%) had an autoimmune disease. Four patients were never hospitalized for COVID-19. Among these, two presented to the hospital at a median of 39 days (range: 27–50) after their initial COVID-19 test with chest and back pain where imaging revealed extensive aortic pathology. One patient required surgical management for aortic pathology. All other patients were treated with expectant management and outpatient follow-up. Conclusion: The clinical and radiological presentations of COVID-19-associated large- and medium-vessel pathology are heterogeneous and can be a late finding after COVID-19 recovery. Close clinical follow-up and surveillance imaging for large- and medium-sized-vessel pathology may be warranted in COVID-19 patients.
Keywords	COVID-19 ; aortitis ; large-vessel vasculitis ; medium-vessel vasculitis
Language	English
Publishing date	2022-06-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2325-4637
ISSN (online)	2325-4637
DOI	10.1055/s-0042-1748960
Database	Thieme publisher's database

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Article ; Online: Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series.

Rapkiewicz, Amy V / Mai, Xingchen / Carsons, Steven E / Pittaluga, Stefania / Kleiner, David E / Berger, Jeffrey S / Thomas, Sarun / Adler, Nicole M / Charytan, David M / Gasmi, Billel / Hochman, Judith S / Reynolds, Harmony R

EClinicalMedicine

2020 Volume 24, Page(s) 100434

Abstract: Background: There is increasing recognition of a prothrombotic state in COVID-19. Post-mortem examination can provide important mechanistic insights.: Methods: We present a COVID-19 autopsy series including findings in lungs, heart, kidneys, liver, ... ...

Abstract	Background: There is increasing recognition of a prothrombotic state in COVID-19. Post-mortem examination can provide important mechanistic insights. Methods: We present a COVID-19 autopsy series including findings in lungs, heart, kidneys, liver, and bone, from a New York academic medical center. Findings: In seven patients (four female), regardless of anticoagulation status, all autopsies demonstrated platelet-rich thrombi in the pulmonary, hepatic, renal, and cardiac microvasculature. Megakaryocytes were seen in higher than usual numbers in the lungs and heart. Two cases had thrombi in the large pulmonary arteries, where casts conformed to the anatomic location. Thrombi in the IVC were not found, but the deep leg veins were not dissected. Two cases had cardiac venous thrombosis with one case exhibiting septal myocardial infarction associated with intramyocardial venous thrombosis, without atherosclerosis. One case had focal acute lymphocyte-predominant inflammation in the myocardium with no virions found in cardiomyocytes. Otherwise, cardiac histopathological changes were limited to minimal epicardial inflammation ( Interpretation: In this series of seven COVID-19 autopsies, thrombosis was a prominent feature in multiple organs, in some cases despite full anticoagulation and regardless of timing of the disease course, suggesting that thrombosis plays a role very early in the disease process. The finding of megakaryocytes and platelet-rich thrombi in the lungs, heart and kidneys suggests a role in thrombosis. Funding: None.
Keywords	covid19
Language	English
Publishing date	2020-06-25
Publishing country	England
Document type	Journal Article
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2020.100434
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Article ; Online: Identification of Immunohistochemical Reagents for In Situ Protein Expression Analysis of Coronavirus-associated Changes in Human Tissues.

Szabolcs, Matthias / Sauter, Jennifer L / Frosina, Denise / Geronimo, Jerica A / Hernandez, Enmily / Selbs, Elena / Rapkiewicz, Amy V / Rekhtman, Natasha / Baine, Marina K / Jäger, Elke / Travis, William D / Jungbluth, Achim A

Applied immunohistochemistry & molecular morphology : AIMM

2020 Volume 29, Issue 1, Page(s) 5–12

Abstract: We studied the suitability of commercially available monoclonal antibodies (mAbs) for the immunohistochemical (IHC) detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in standard archival specimens. Antibodies were screened on ... ...

Abstract	We studied the suitability of commercially available monoclonal antibodies (mAbs) for the immunohistochemical (IHC) detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in standard archival specimens. Antibodies were screened on HEK293 cells transfected with viral nucleoprotein, S1 subunit and S2 subunit of spike protein and on untransfected cells, as well as a panel of normal tissue. Lung tissue with presence of SARS-CoV2 confirmed by in situ hybridization (ISH) was also used. A total of 7 mAbs were tested: (1) mAb 001 (Sino Biological, 40143-R001), (2) mAb 007 (Sino Biological, 40150-R007), (3) mAb 019 (Sino Biological, 40143-R019), (4) mAb 1A9 (GeneTex, GTX632604), (5) mAb ABM19C9 (Abeomics, 10-10007), (6) FIPV3-70 (Santa Cruz, SC-65653), and (7) mAb 6F10 (BioVision, A2060). Only 2 mAbs, clone 001 to the nucleoprotein and clone 1A9 to the S2 subunit spike protein displayed specific immunoreactivity. Both clones showed strong staining in the acute phase of COVID-19 pneumonia, mostly in areas of acute diffuse alveolar damage, but were not completely congruent. Viral protein was also found in kidney tubules, endothelia of multiple organs and a nasal swab of a patient with persistent SARS-CoV2 infection. The other tested reagents were either poorly reactive or demonstrated nonspecific staining in tissues and lesions not infected by SARS-CoV2. Our study demonstrates that rigid specificity testing is mandatory for the evaluation of mAbs to SARS-CoV2 and that clones 001 to nucleoprotein and 1A9 to S2 subunit spike protein are useful for the in situ detection of SARS-CoV2.
MeSH term(s)	Antibodies, Monoclonal/immunology ; Antibodies, Viral/immunology ; COVID-19/immunology ; COVID-19/virology ; Endothelium/virology ; HEK293 Cells ; Humans ; Immunohistochemistry ; Indicators and Reagents ; Kidney Tubules/virology ; Lung/virology ; Nucleocapsid Proteins/analysis ; Nucleocapsid Proteins/immunology ; SARS-CoV-2/immunology ; Spike Glycoprotein, Coronavirus/analysis ; Spike Glycoprotein, Coronavirus/immunology
Chemical Substances	Antibodies, Monoclonal ; Antibodies, Viral ; Indicators and Reagents ; Nucleocapsid Proteins ; Spike Glycoprotein, Coronavirus ; spike protein, SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-10-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473273-7
ISSN	1533-4058 ; 1062-3345 ; 1541-2016
ISSN (online)	1533-4058
ISSN	1062-3345 ; 1541-2016
DOI	10.1097/PAI.0000000000000878
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