Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy.
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy.
Front Biosci (Landmark Ed). 2022 Jun 7;27(6):182. doi: 10.31083/j.fbl2706182.
The purpose of this manuscript is to provide a comparative overview of the two global pandemics: the first on June 11th 2009 due to influenza A H1N1 (H1N1-09); the second and current pandemic caused by coronavirus 2019 (COVID-19) on March 11th 2020, focusing on how autopsy can contribute to the definition of cellular pathology, to clinical pathology and, more generally, to public health.
A systematic literature search selection was conducted on PubMed database on June 5, 2021, with this search strategy: (COVID-19) AND (H1N1 influenza) showing 101 results. The following inclusion criteria were selected: English language; published in a scholarly peer-reviewed journal; full-length articles were further elected. To further refine the research was to focus on the type of manuscript: review, systematic review, and meta-analysis. A critical appraisal of the collected studies was conducted, analyzing titles and abstracts, excluding the following topics: treatment, public health measures and perception of the general population or healthcare personnel about their quality of life. According to these procedures, 54 eligible studies were included in the present review.
Histopathological findings play a key role in understanding the pathophysiological mechanisms of diseases and, thus possible therapeutic approaches. The evidence on the thrombo-inflammatory mechanism underlying COVID-19 is growing to a much greater magnitude than the diffuse alveolar damage in common with H1N1-09; our study appears to be in line with these results. The prevailing scientific thinking to explain the morbidity and mortality of COVID-19 patients is that it elicits an exuberant immune reaction characterized by dysregulated cytokine production, known as a "cytokine storm".
The histological and immunohistochemical pattern demonstrated similarities and differences between the infectious manifestations of the two pathogens, which justify empirical therapeutic approaches, in the first phase of the COVID-19 pandemic. Therefore, the previous pandemic should have taught us to promote a culture of clinical and forensic autopsies in order to provide timely evidence from integration among autopsy and clinical data for early adopting adequate therapies.
本文旨在对 2009 年 6 月 11 日因甲型 H1N1（H1N1-09）引发的首次大流行和 2020 年 3 月 11 日因冠状病毒 2019（COVID-19）引发的当前大流行进行比较概述，重点介绍尸检如何有助于确定细胞病理学、临床病理学，更广泛地说，有助于公共卫生。
2021 年 6 月 5 日在 PubMed 数据库中进行了系统的文献搜索选择，使用了以下搜索策略：(COVID-19) AND (H1N1 流感)，显示了 101 个结果。选择了以下纳入标准：英语语言；发表在学术同行评议期刊上；进一步选择全文文章。为了进一步完善研究，将重点放在手稿类型上：综述、系统综述和荟萃分析。对收集的研究进行了批判性评估，分析了标题和摘要，排除了以下主题：治疗、公共卫生措施以及一般人群或医疗保健人员对其生活质量的看法。根据这些程序，本综述纳入了 54 项符合条件的研究。
组织病理学发现对于了解疾病的病理生理机制以及可能的治疗方法起着关键作用。关于 COVID-19 下的血栓炎症机制的证据比 H1N1-09 下的弥漫性肺泡损伤增长得更为广泛；我们的研究似乎与这些结果一致。目前解释 COVID-19 患者发病率和死亡率的主流科学思想是，它引发了一种过度的免疫反应，其特征是细胞因子产生失调，称为“细胞因子风暴”。
两种病原体的感染表现具有相似和不同之处，这证明了在 COVID-19 大流行的第一阶段，经验性治疗方法是合理的。因此，前一次大流行应该让我们认识到，要促进临床和法医尸检文化，以便从尸检和临床数据的整合中及时提供证据，从而尽早采用适当的治疗方法。
