Toxicological investigations in a fatal and non-fatal accident due to hydrogen sulphide (H2S)poisoning

2019

Hydrogen sulphide (H2S) is one of the most toxic natural gas and represents a not rare cause of fatal events in workplaces. We report here a serious accidental poisoning by hydrogen sulphide inhalation involving six sailors. Three of them died while the other three survived and were transported to the emergency room. No greenish discolouration of the body, that could be a feature of these type of deaths, was observed at autopsy. Given that blood and/or urine H2S detection does not allow to discriminate if it is related to inhalation or to putrefactive processes, the determination of thiosulphate, H2S main metabolite, is decisive. The succession of fatal events reported here can be rebuilt b…

Caspase 9 and Caspase 3 Immunohistochemical Pattern in Skeletal and Cardiac Muscles at Different Times after Death: An Experimental Study on PMI Esti…

2021

(1) Background: The estimation of the post mortem interval (PMI) is a challenge for forensic pathologists because data emerging from methods commonly applied are not always conclusive, since several conditions exist that may affect the reliability of these parameters. Thus, new approaches have been proposed to overcome such a limit. In recent years, several studies have been performed on proteins analyzing their expression/degradation patterns in relation to the progressing of the post mortem interval. (2) Methods: The immunoreactivity patterns of two apoptosis mediators—Caspase 9 and Caspase 3—have been tested in order to evaluate their potential role as markers of the post mortem interval…

Forensic tools for the diagnosis of electrocution death: Case study and literature review

2018

Diagnosis of death by electrocution may be difficult when electric marking is not visible or unclear. Accordingly, the body of a man who appeared to have died from accidental electrocution was carefully forensically analysed. Macroscopic and microscopic analysis of the current mark was carried out using a variable-pressure scanning electron microscope equipped with energy dispersive X-ray microanalyser to highlight skin metallisation, indicating the presence of iron and zinc. The histological findings of electrocution myocardial damage were supported by the results of biochemical analysis which demonstrated the creatine kinase-MB and cardiac troponin I elevation. The effects of electric cu…

Unusual attempted suicide or covered attempted homicide? A neck stabbing case report and review of literature.

2020

A medico-legal consult is frequently required in a clinical context in order to assess the eventual compatibility of specific wounds with a self- or hetero-infliction. Accordingly, the case of a 52-year-old man with a single, penetrating stab wound of the neck, reported as self-inflicted, is here presented. The forensic aspects, taken into account in order to determine the self- or hetero-infliction nature of the wound, are further discussed and compared to cases described in the literature.

Killing methods in Sicilian Mafia families

2019

The Sicilian Mafia is a criminal organisation founded in Sicily which is an island south of the Italian mainland in the Mediterranean Sea. Until recently, this organization was responsible for many murders and bombings. However, recently, based on the investigations known as the “Mare Nostrum” operation, the Supreme Court convicted 67 people and sent them to prison. Some defendants were found guilty of as many as 39 murders. This article reviews the forensic analysis that was used when investigating responsibility for these Mafia murders. Our review is based on the court documents and the ballistic investigations which were carried out to evaluate the reliability of “repented” or “pentiti”…

An unusual case of sudden cardiac death during sexual intercourse

2018

The most common cause of sudden death during sexual intercourse in adults is heart disease, and it is usually the male, whereas the death of the woman is unusual. Generally, in these cases, death occurs as a result of cardiovascular disease. The authors report an unusual case of the sudden death of a young woman during sexual intercourse. The post-mortem investigations (autopsy, cardiac nuclear magnetic resonance and cardiac histology) demonstrated a previously undiagnosed arrhythmogenic right ventricular cardiomyopathy. The terminal cause of death was a malignant arrhythmia from arrhythmogenic right ventricular cardiomyopathy. This is the first report of a case in which sexual activity ca…

Analysis on sarcoglycans expression as markers of septic cardiomyopathy in sepsis-related death

2018

The post-mortem assessment of sepsis-related death can be carry out by many methods recently suggested as microbiological and biochemical investigations. In these cases, the cause of death is a multiple organ dysfunction due to a dysregulated inflammatory response occurring after the failure of infection control process. It was highlighted also that the heart can be a target organ in sepsis which determines the so-called septic cardiomyopathy characterized by myocardial depression. Several mechanisms to explain the pathophysiology of septic cardiomyopathy were suggested, but very few studies about the structural alterations of cardiac cells responsible for myocardial depression were carried…

An Insight into the Role of Postmortem Immunohistochemistry in the Comprehension of the Inflammatory Pathophysiology of COVID-19 Disease and Vaccine-…

2021

On 11 March 2020, the World Health Organization (WHO) declared a pandemic due to the spread of COVID-19 from Wuhan, China, causing high mortality rates all over the world. The related disease, which mainly affects the lungs, is responsible for the onset of Diffuse Alveolar Damage (DAD) and a hypercoagulability state, frequently leading to Severe Acute Respiratory Syndrome (SARS) and multiorgan failure, particularly in old and severe-critically ill patients. In order to find effective therapeutic strategies, many efforts have been made aiming to shed light on the pathophysiology of COVID-19 disease. Moreover, following the late advent of vaccination campaigns, the need for the comprehension …

Unexpected death for Takayasu aortitis associated with coronary ostial stenosis: case report.

2015

The differential diagnosis of vasculitis is often a difficult task due to the frequent morphological similarities that various vasculitic syndromes express when the heart is the target organ. The more the lesions are limited to the arterial tree with absent or almost silent coronary events, the less specific the anatomical and clinical frameworks. To create a series of clinical records and on the basis of these assumptions, the authors report a case concerning the sudden death of a 43-year-old woman which occurred while an ergonometric test was being carried out 28 days after the onset of the symptoms. A subsequent postmortem investigation/autopsy enabled us to detect a granulomatous aortit…

Immunohistochemical study on dystrophin expression in CAD-related sudden cardiac death: a marker of early myocardial ischaemia

2018

The aims of this study were to assess if dystrophin can be a tool for the forensic evaluation of sudden cardiac death due to coronary atherosclerotic disease (CAD) and particularly if it can be a marker of early myocardial ischaemia. Then in this investigation, the dystrophin was compared to C5b-9 and fibronectin to analyze if there are some differences in the expression of these proteins. Two groups of CAD-related sudden cardiac death, respectively the group 1 with gross and/or histological evidence and the group 2 with no specific histological signs of myocardial ischaemia were used. A third group formed by cases of acute mechanical asphyxiation was used as a control. The immunohistochemi…

Pathological Findings in COVID-19 as a Tool to Define SARS-CoV-2 Pathogenesis. A Systematic Review

2021

Introduction: The World Health Organization declared the COVID-19 pandemic in March 2020. COVID-19 still represents a worldwide health emergency, which causesa severe disease that has led to the death of many patients. The pathophysiological mechanism of SARS-CoV-2 determining the tissue damage is not clear and autopsycan be auseful tool to improve the knowledge of this infection and, thus, it can help achieve a timely diagnosis and develop an appropriate therapy. This is an overview of the main post-mortem findings reporting data on the infection effects on several organs.Methods: A systematic literature search was conducted in the PubMed database searching for articles from 1 January to A…

Forensic microbiology applications: A systematic review.

2019

Abstract According to the Human Microbiome Project (HMP), a healthy human body contains ten times more microbes than human cells. Microbial communities colonize different organs of the body, playing fundamental roles both in human health and disease. Despite the vast scientific knowledge of the role of microbial communities in a living body, little is known at present about microbial changes occurring after death, thus leading many authors to investigate the composition of the thanatomicrobiome and its potential applications in the forensic field. The aim of the following review is to provide a general overview of the advances of postmortem microbiology research, mainly focusing on the role…

The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience

2021

AbstractIn this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuri…

Hanging disguised as bondage: accidental or suicidal death?

2020

The concept of autoerotic asphyxiation refers to the use of devices or substances intended to enhance one's arousal by inducing cerebral hypoxia, which can involuntarily lead to death. Although in most cases death occurs accidentally, it is nonetheless true that the same devices might be used by the practitioners in order to attempt suicide. The case of a 34-year-old practitioner of autoerotic asphyxiation found dead in his apartment with bondage-like ligatures and masking is reported here. The case raised some issues concerning the accidental or suicidal nature of the act. The aspects taken into account in the management of the case are discussed, along with a compared approach to the data…

Ustioni da elettrobisturi: contributo casistico e considerazioni medico-legali

2016

[Electrosurgery burns: case series and medico-legal issues] In general and specialist surgical practice the use of the electrosurgical unit is consolidated for minimally invasive interventions, due to the ability to control the bleeding of the operative field and the interaction between the cutting and coagulative mechanisms. The authors take inspiration from four cases of personal observation, related to thermal injury produced by electrosurgery, to conduct a brief review of the literature on this issue and present some medical and legal aspects derived from their expert’s observation, in terms of healthcare liability. The authors underline the importance of an accurate knowledge of the pr…

Caspase 9 and Caspase 3 Immunohistochemical Reactivity Pattern in Skeletal and Cardiac Muscle at Different Times After Death: A New Tool for Postmort…

Learning Overview: After attending this presentation, attendees will understand the importance of the identification of new markers that could be used as possible PMI indicators, especially in contexts in which the reliance on the classic thanatochronological triad—livor, rigor, and algor mortis—is not conclusive. Impact on the Forensic Science Community: This presentation will impact the forensic science community by highlighting the relationship between the activation pattern of caspases 9 and 3 on skeletal and cardiac muscle samples and PMI. The determination of the amount of time elapsed from one’s death to the recovery of the body—the so-called PMI—has always relied on the evaluation o…

La sicurezza del paziente in ambiente ospedaliero e la responsabilità professionale dei vertici strategici

2016

[Patient safety in the hospital setting and the professional responsibilities of top managers] The authors underline the evolution of legislation concerning the creation of Hospital Companies and the reasons for the implementation of clinical risk management activities, then analyse the responsibilities involving the top figures of the top hospital management. In particular, the authors highlight the obligation and responsibilities of the strategic apex of a Hospital Company and show that, sometimes, the technical consultants – who express a medical-legal advice – underestimate the responsibility of these figures. It is a management responsibility that determines the obvious and inevitable …

Death by Facial and Skull Injuries of a Motorcyclist Wearing a Full-Face Helmet: Case Report and Literature Review

2016

We describe a case of death by facial and skull fractures with brain injuries of a motorcyclist wearing a full-face helmet. A 40-year-old man driving a high-powered motorcycle crashed violently into the rear of a stopped car. The main results from the autopsy revealed the deformation of the left orbito-zygomatic and fronto-temporoparietal regions corresponding to bone fractures with laceration at the left temporal lobe. The CT scan of the helmet revealed the detachment of the energy-absorbing liner. Moreover an impact speed of 93 Km/h resulted from the analysis of accident dynamics. We analysed the literature regarding the effectiveness of full-face helmets in reducing the risk of fatality …

Dystrophin and metalloproteinase 9 in myocardial ischemia: A post-mortem immunohistochemical study

2021

The presented study evaluated the expression of dystrophin and MMP-9 in cases of sudden cardiac death (SCD) due to coronary atherosclerotic disease (CAD) in order to analyze the characteristics and the chronology of their expression, providing evidence on the possible role in post-mortem diagnosis of myocardial ischemia. The expression of these proteins was also compared to C5b-9 complex and fibronectin expression to evaluate any differences. Two groups of CAD-related SCD, respectively group 1 with gross and/or histological evidence and group 2 with no specific histological signs of myocardial ischemia, were used. A third group formed by cases of acute mechanical asphyxiation was used as a …

An unusual fatal case of overdose of Vinblastine and review of literature

2017

The pharmacological treatment of neoplasia is based on the use of chemotherapeutic substances. Chemotherapeutic agents can cause acute and chronic toxicity even at therapeutic doses. For this reason their overdose puts a patient’s life at severe risk. This work presents an unusual fatal case of overdose subsequent to an accidental massive administration of Vinblastine (90 mg instead of 9 mg), slow bolus (five minutes), to a 33-year-old woman who suffered from Hodgkin’s Lymphoma. The administration of the massive dose was due to a transcription error of the therapeutic treatment plan and miscommunication between the health professionals which caused the use of the wrong dose. The foren…

Intraosseous gas distribution as a marker of postmortem interval

2020

Abstract The postmortem interval is probably the most important puzzle piece in clarifying the circumstances in case of death occurred in unknown conditions. Over the years, radio-imaging modalities have proved their worth in forensic field, providing additional and significant improvements and findings. CT-scan is characterized by wide availability, fast scan times and sustainable healthcare costs. Detection of gas, hemorrhage and bone fractures are points of strength of CT-scan. A reliable evaluation of the post-mortem interval is interesting in the victims of a mass disaster, also following a natural disaster, for the individuation of responsibility in the efficiency of the help and assi…

Membrane Attack Complex in Myocardial Ischemia/Reperfusion Injury: A Systematic Review for Post Mortem Applications

2020

The complement system has a significant role in myocardial ischemia/reperfusion injury, being responsible for cell lysis and amplification of inflammatory response. In this context, several studies highlight that terminal complement complex C5b-9, also known as the membrane attack complex (MAC), is a significant contributor. The MAC functions were studied by many researchers analyzing the characteristics of its activation in myocardial infarction. Here, a systematic literature review was reported to evaluate the principal features, advantages, and limits (regarding the application) of complement components and MAC in post mortem settings to perform the diagnosis of myocardial ischemia/infar…

Peculiar and Unusual Drowning in Waste Oil from Motor Vehicles: Case Report

2016

Drowning is one of the most frequent causes of accidental or suicidal death, and more rarely it is associated with a homicide. Cases of drowning in water or in the sea are common. The authors report an unusual and peculiar case of drowning, that of a woman who accidentally fell inside a collection tank of waste oil of motor vehicles.

Investigation of the skin lesions in lightning strike death

2021

Lightning strike-related deaths are unusual, and the victim bodies can present different lesions due to the different injury mechanisms associated with this event. Since the post mortem assessment can be challenging, the evaluation of the characteristics of the skin lesions becomes fundamental to reconstruct the event. Due to the paucity of literature on this topic, the authors report the case of a 59-year-old man found dead near his home after a thunderstorm. Initially considered a murder by gunshot, the autopsy revealed the typical lightning strike lesions, also known as Lichtenberg figures. The adequate interpretation of the autopsy data and the histological evidences allowed to reconstr…

La tutela assicurativa della responsabilità professionale

2010

The Authors conducted a fact-finding survey among the health operators in some Sicilian and calabrian hospitals, hèreby eitending it to include doctors in training - in light of D.Lgs. 368/99 - and heilth operatórs in the area o in consideration oflaw42|9.T\esurveywas'aimedatdeterminingthedegree ofawarenessofthetypeofinsurancecoveràgeand/orcontraclsandlnlicies(>, "claims made") signed by the respective services, as well as about the protection supplied to health operators by the same insurance contracts.

ustione corneale durante intervento di facoemulsificazione: contributo casistico e considerazioni medico-legali

2014

[Corneal burn during phacoemulsification surgery: case report and medico-legal considerations] The authors report a case of severe corneal burn, occured a few seconds later the beginning of the surgical procedure of phacoemulsification on a 63 years old woman affected by cataract. The authors analyzed the case as a result of claims for damage to the surgeons and the hospital by the patient. In terms of assessment of responsibility, medico-legal investigation is aimed at identifying whether the responsibility of the event of damage to the patient is to be attributed to the negligent conduct of the surgeon or to defects or damage to the equipment used by the same. The authors underline the im…

Unexpected death for takayasu aortitis associated with coronary ostial stenosis

2015

The differential diagnosis of vasculitis is often a difficult task due to the frequent morphological similarities that various vasculitic syndromes express when the heart is the target organ. The more the lesions are limited to the arterial tree with absent or almost silent coronary events, the less specific the anatomical and clinical frameworks. To create a series of clinical records and on the basis of these assumptions, the authors report a case concerning the sudden death of a 43-year-old woman which occurred while an ergonometric test was being carried out 28 days after the onset of the symptoms. A subsequent postmortem investigation/autopsy enabled us to detect a granulomatous aortit…

Sudden death in water: Diagnostic challenges

2016

Abstract The authors report a case of sudden death in a breath-holding diver and highlight the forensic diagnostic difficulties in opining the cause of sudden death in water. The autopsy showed increased thickness of the left ventricular wall with a distinct pattern of concentric hypertrophy, evident particularly in the subaortic interventricular septum. Histological examination revealed diffuse interstitial fibrosis and associated findings of multifocal myocyte disarray especially evident in the subaortic interventricular septum. The analysis and discussion of this case made it possible to attribute sudden death to a lethal arrhythmia following myocyte disarray and hypoxia caused by breath…

Skull and Encephalic Injuries Caused by Beach Umbrellas: Case Reports and Review of Literature

2016

This study reports two unusual cases of skull-encephalic injuries in bathers that were caused by violent impacts with beach umbrellas. The first case concerned a 36-year-old man who, while lying on a sun bed, was struck on his left temple by a beach umbrella, which had been blown away by a gust of wind. The second case concerned a six-year-old child who was struck on the right temporal region while he was playing on the sand. Both subjects died. A review of the literature was carried out. Various skull and brain injuries caused by several objects were found, but no injuries caused by beach umbrellas were detected. There were only cases of injuries caused by normal umbrellas. These cases sho…

Fire in operating room: The adverse "never" event. Case report, mini-review and medico-legal considerations.

2020

Abstract The patient’s security and safety represent a topic of great importance for public health that led several healthcare organizations in many Countries to share documents to promote risk management and preventing adverse events. Surgical Fire (SF) is an infrequent adverse event generally occurring in the operating room (OR) and consisting of a fire that occurs in, on, or around a patient undergoing a medical or surgical procedure. Here a medico-legal case involving a 65-year-old woman reporting burns to the neck due to an SF during a thyroidectomy was described. A literature review was performed using Pubmed and Scopus databases, focusing on epidemiology, causes, prevention activitie…

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland

2019

The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal &beta

A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject

2019

Abstract Introduction: The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS. Patient concerns: After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) af…

Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

2020

To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to…

Allele frequencies distribution of 16 forensic STR loci in a Western Sicilian population sample

2017

Abstract The PowerPlex® ESI 17 Fast and ESX 17 Fast Systems represent faster cycling versions released by Promega® to follow the requirements of ENFSI and EDNAP groups’ for new STR genotyping systems in Europe. Allele frequencies and forensic parameters were estimated in a population sample of 120 unrelated healthy individuals living in Sicily (Western Sicilian population sample) using PowerPlex® ESI 17 Fast and PowerPlex® 17 Fast Systems. Full concordance of the results for both systems was observed. No significant deviation from Hardy-Weinberg equilibrium was detected. The observed heterozygosity changed from 0.85833 for FGA to 0.95 for TH01. The combined power of discrimination for the 1…

Immunohistochemical detection of early myocardial infarction: a systematic review

2017

The postmortem diagnosis of early myocardial infarction is a challenge for forensic pathologists because the routine histology is neither specific. Many authors have suggested the use of the immunohistochemistry to fill the gaps in the histological diagnosis of early myocardial infarction. This review aims to analyse advances of immunohistochemical detection of early cardiac damage due to ischaemia. To this purpose, we reviewed experimental studies that investigated immunohistochemical markers and their estimated timing of expression. The review was performed according to specific inclusion and exclusion criteria, and a total of 23 studies assessing the immunohistochemical markers for the d…