Abstract
Autopsies are a major tool for medical learning, for studying disease mechanisms, for determining the causes of death in a given population, and for evaluating the quality of medical care. The modernization of the autopsy process has led to new modalities, associating imaging (TC, RNM, USG), Minimally Invasive Autopsy (MIA) and Verbal Autopsy (VA). In recent years, the Department of Pathology at FMUSP has conducted research projects that combine these methods, with different possibilities of application. The marked inequalities in the population of large cities are clearly associated with disease development. The association between inequality, urban space, and health has been established in terms of variations in morbidity and mortality across the territory. The present project aims to expand the scope of spatial health studies, incorporating a unique database in the world, made feasible by the large number of medical autopsies performed by the São Paulo Death Verification Service. The general objective of the present proposal is the use of autopsy as a tool for investigating essential topics in public health, through the evaluation of human tissue. We present three main specific objectives: 1) The morphological characterization of the long-term systemic effects of COVID-19, with a focus on lung and kidney disease, where the post-mortem tissues of individuals with a previous history of COVID-19 of different severity will enable to better understand of the pathophysiological and morphological processes of a disease of public importance; 2) The use of autopsy as a tool for assessing urban inequalities, where the city of São Paulo will be used as a "real world laboratory" for studying the vulnerability of the population to chronic illness, investigating spatial variability and the impact of the physical and socio-economic environment on the progression of highly prevalent chronic diseases. We intend to carry out a cartographic study to evaluate the quality of the diagnosis of neoplasms, care for the bedridden elderly, the prevalence of chronic kidney disease, the adequate management of diabetes mellitus, evaluate the role of traffic as a determinant of spatial variability in exposure to atmospheric pollution, and also investigate the role of pollution in the development of neurodegenerative diseases and neuroinflammation; 3) Validation of the new Verbal Autopsy instrument proposed by the World Health Organization (WHO) in 2022, using conventional autopsy as the gold standard. Once validated, this instrument will be used by any region in the world that needs VA to improve death records. (AU)
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