L’UTILIZZO IN MEDICINA LEGALE DELLA MISURAZIONEDELLA SALUTE DEL MINORE SECONDO ICF-CY: ESEMPLIFICA-ZIONE CASISTICA

The evaluation of minors within welfare contest requires an adequate multidisciplinary and interdisciplinary approach to clinical and psycho-social order. There are many evaluation’s instruments, but in the medico legal context particularly useful is the evaluation according to the guidelines of the World Health Organization, in the recent codification ICF, International Classification of Functioning, Disability and Health [1] version YC (Children and Youth) [2]. The use of minor measurement according to ICF-CY is here reported in a child’s health experience with neuropsychiatric disorders. The system ICF-CY offers a revolutionary new model that relates biological, psychological and social …

Cervical necrotizing fasciitis and descending necrotizing mediastinitis in a patient affected by neglected peritonsillar abscess: a case of medical negligence.

Abstract We report a case of fatal cervical necrotizing fasciitis (CNF) and descending necrotizing mediastinitis (DNM) due to primary peritonsillar abscess in 60-year-old male patient with no history or evidence of immunocompromising disorders. The patient was treated with antibiotic and corticosteroid drugs but he developed mediastinitis and septic shock and died of multiple organ failure six days later from recovery in hospital. After a clinical, diagnostic and therapeutical consideration of the cervical necrotizing fasciitis and some related risks of a delayed diagnosis and treatment, the authors analysed the clinical history of the patient and of the medical conduct pointing out profess…

Torture and Maltreatment in Prison: A Medico-Legal Perspective

The maltreatment and torture of prisoners constitute a global problem. Methods of maltreatment are classified as the psychological and the physical, and physical methods inevitably lead to psychological sequelae. Our review offers an analysis from the medico-legal perspective of the literature on the torture and physical and sexual abuse experienced by prisoners and their psychological sequelae and aims to investigate the medico-legal issues of investigating maltreatment in prison so as to suggest methodologies and updated approaches for dealing with such cases in a forensic context. We performed a comprehensive literature search of peer-reviewed publications (articles and reviews), researc…

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

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…

Fetal and perinatal desths: drugs exposure duruing pregancy

The presentation of this review will focus attention on the area of pediatric forensic medicine and the importance of through investigation of these deaths not only for the appropriate classification of the cause adn manner of deaths, but for complete documentation of toxicological data and pathological findings wich may provide essential informations about the circumstances surrounding the death and possible contributory mechanism.

A CASE OF SUDDEN DEATH FOR CARDIAC HEMANGIOMA IN CHILD.

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

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…

La (indimostrata) relazione causale tra Thimerosal ed autismo infantile: revisione della letteratura scientifica e osservazione casistica

Il consenso informato nella responsabilità professionale

L’INFORMAZIONE E LA FORMAZIONE DEL SANITARIO NELLE INFEZIONI NOSOCOMIALI: LA NOSTRA ESPERIENZA

Gli Autori riportano i risultati ottenuti dalla somministrazione di un questionario, nel contesto siciliano dei Policlinici Universitari di Palermo e Messina, a sanitari operanti nel campo della terapia intensiva, selezionando e analizzando i quesiti maggiormente implicati nelle tematiche inerenti il clinical risk management delle IN, individuandone specifiche carenze a carico dei singoli professionisti e della struttura ospedaliera. È stato evidenziato che, sebbene siano già presenti specifici protocolli, nonché linee guida in materia, essi non trovano ancora un adeguato spazio nella realtà quotidiana di gestione del malato a causa di una generale inadeguatezza dell’informazione e della fo…

Modalità di stesura di perizia in campo ecofragico ostetrico

Gli autori approfondiscono la criteriologia medico legale in tema di accertamento della responsabilità PROFESSIONALE nel settore ecografico ostetrico. in particolare vengono richiamati i fondamenti normativi e dottrinari della consulenza tecnica medico legale

Fibrodisplasia arteriosa misconosciuta ad esito letale. Descrizione casistica e rivisitazione della letteratura

gli autori presentano due casi di displasia fibromuscolare (DFM) oggetto di indagine giudiziaria per ipotizzata responsabilità professionale nell'operato dei sanitari all'esordio clinico e nell'approccio chirurgico. Viene sottolineata la necessità di una rapida risoluzione chirurgica in ambiente specialistico e l'importanza delle linee guida che devono essere rispettate nell'approccio al pziente

Incesto e ciclo dell'abuso. Aspetti clinici e medico legali

l'incesto è un fenomeno ben conosciuto, che si concretizza in una relazione sessuale tra parnti ascendenti, discendenti o affini in linea retta. da un'analisi statistico-epidemiologica è emerso che, in molti casi, il giovane abusato in famiglia diventa a sua volta, da adulto, abusante, generando ed alimentando il cosiddetto ciclo dell'abuso. in tale ottica si riporta un caso giunto all'osservazione delgi Autori, i quali partndo dalla vicenda in esame, hanno poi analizato i profili psico-patologici sia delle vittime che degli abusanti

Quando bisogna discostarsi dalle linee guida? I casi problematici nella prassi odontoiatrica

Obiettivi Delineare vantaggi e limiti delle linee guida e dei riferimenti alle buone pratiche nella valutazione della condotta professionale dell’odontoiatra. Definire tipologie di pazienti e contesti operativi nei quali esse non risultano applicabili. Quest’obiettivo è coerente con i recenti sviluppi giurisprudenziali della Corte di Cassazione a Sezioni Unite del dicembre 2017 in tema di colpa e responsabilità dei sanitari. Materiali e metodi Si analizzano i riferimenti contenuti nella Legge 24/2017; quindi, in riferimento alla metodologia della responsabilità medico/odontoiatrica, si individuano i contesti della pratica clinica nei quali è più opportuno cercare di sviluppare buone pratich…

Refertazione in ecografia ostetrica e profili di responsabilità.

From 1997 to 2007: Modified Approach to Sexual Assault in Our Experience

The Infanticide: Some Forensic and Ethical Issues

Forensic investigation and clinical treatment of infanticide mother is occasion to reflect about this crime, related to social stigma. The forensic-psychiatric assessment must be anchored on authentic and meaningful clinical relationship to criminal mother, without misinterpretation and controtransferal dynamics, such as emotional reactions of mistrust and stigmatization toward the offender, which prevent the evaluator from a correct psychological and psychopathological comprehension. Otherwise, diachronic, multidisciplinary diagnostic evaluation may lead to strategies for treatment and rehabilitation, which can bring the patient to regain his dignity, his working capacities and social role…

Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries

The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that con…

An Overview on the Use of miRNAs as Possible Forensic Biomarkers for the Diagnosis of Traumatic Brain Injury

Determining the cause of death is one of the main goals of forensic pathology. However, conditions can occur in which common approaches—external inspection, autopsy, histology, etc.—might not be conclusive. With the advancement of molecular biology, several investigative techniques have been developed over the years, and the application as approaches complementary to routine procedures has proved useful in these cases. In this context, microRNA (miRNA) profiling has attracted increasing interest due to these molecules’ ability to regulate physiological and pathological processes. The evidence of differential miRNA expression in both animal models and human samples of traumatic brain injury …

Sudden death in adolescence caused by cardiac haemangioma

Primary tumors of the heart in infants and children are rare. The types of heart tumors in pediatric age groups are generally different from those in adults. Cardiac myxoma is by far the most common tumor in adults, but in infants and adolescents the prevalent tumor of the heart is rhabdomyoma. Among benign cardiac tumors, cardiac hemangiomas are rare and often diagnosed post-mortem due to the lack of specific clinical symptoms and signs. We report a case of sudden death due to cardiac hemangioma in an apparently healthy 15-year-old adolescent. The autopsy revealed a cardiac hemangioma located at the apex of the heart; the histopathological examination showed the tumor was a mixed capillary…

Behavioural and pharmacological characterization of a novel cannabimimetic adamantane-derived indole, APICA, in C57BL/6J mice

The novel adamantane derivative APICA (N-(adamtan-1-yl)-1-pentyl-1H-indole-3-carboxamide) was recently identified as a cannabimimetic indole of abuse (1, 2). Despite its novel structure, APICA recalls cannabimimetic indoles, such as representative member JWH-018. The emerging abuse problem, together with the paucity of information about the bioactivity of APICA (3) emphasize the need for further evaluation of the in vivo pharmacology of this novel indole-derived compound. In the present study, the effects of APICA (0 - 1 - 3 mg/Kg, i.p.) were tested in C57BL/6J mice, in a battery of tests that are sensitive to the effects of psychoactive cannabinoids, including body temperature; locomotor a…

An unusual case of seat belt syndrome

Seat belt syndrome refers to a constellation of injuries associated with sudden increase in intra-abdominal pressure in vehicle occupants wearing seat-belts; this work aimes to stress a particular pattern of perineal lesions in a rear passenger wearing seat belt.

An unusual case of sudden cardiac death during sexual intercourse

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…

Self-inflicted long bone fractures for insurance fraud.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to defin…

Focus on Liability of Residences for Elderly and Sick People: A Case Series and Medico-Legal Issues

Residences for elderly and sick people, self-sufficient or dependent, are varied. To date, the liability profiles of these structures are not clearly delineated, and increasingly often, their operating and organization criteria are entrusted to subnational, regional, or local regulations. Among the various deficits, there is the keeping of a complete and detailed documentation/diary of the patient, the lack of which can generate medico-legal problems. In this paper, we present three cases of guests in residences for a dependent person brought to the attention of the Institute of Forensic Medicine of the University Hospital of Palermo due to criminal proceedings, where the lack of existing d…

Il consenso informato in cardiologia interventistica

Lo scenario della responsabilità nel dolore toracico: illustrazione casistica

From Undetectable Equals Untransmittable (U=U) to Breastfeeding: Is the Jump Short?

Background: Vertical transmission of HIV infection may occur during pregnancy, at childbirth or through breastfeeding. Recommendations on the safety of breastfeeding of HIV-infected women on effective antiretroviral treatment are not univocal among international guidelines (WHO 2010, EACS 2017, DHHS 2017), leaving space for variability at the patient’s level. Methods: We collected clinical, laboratory and outcome data from 13 HIV-infected pregnant women who, between March 2017 and June 2021, elected to breastfeed their children against specific medical advice. All mothers were on antiretroviral therapy with darunavir or raltegravir plus emtricitabine/tenofovir disoproxil and remained HIV-RN…

Radiology for Postmortem

Thanatology deals with the study of early and postmortem changes in relation to the estimation of the time since death. These normal postmortem changes depend on internal and external factors, such as body temperature, preexisting conditions, underlying disease or injury, and the postmortem interval.

Il dolore toracico e le insidie medico legali.

Aspetti medico legali dei "nuovi" biomarkers dell'abuso cronico di alcool in vivente e cadavere

gli Autori analizzano gli aspetti medico legali dei "nuovi" biomarkers dell'abuso cronico di alcool in vivente e cadavere. Fra questi, l'utilizzo del dosaggio della CDT, potrebbe trovare una importante valenza in tema di accertamenti idoneativi alla guida in soggetti assuntori periodici o cronici di alcool

SINDROME COMPARTIMENTALE (su un caso di omessa diagnosi)

Occupational Diseases: Asbestosis and Mesothelioma in Forensic Practice

Diagnosis of occupational diseases, a strong collaboration between radiologic and clinical features with related occupational history and literature supporting, and an association between the exposure and the disease process are requested. Further pathological findings emerging at biopsy or autopsy, which are considered ancillary examination techniques, may assist in the judgment related to causal chain reconstruction.

Homicide with post mortem dismemberment of the victim

Interpretation of Diagnostic Imaging for Medicolegal Issues

Forensic radiology is a relative recently emergent part of forensic medicine characterized by the application of radiological methods in criminal investigations, such as the forensic M.E’s radiological reports in civil or penal matters for judicial technical advice. The various imaging modalities like X-rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasonography can be used depending on various forms of cases and their requirements in routine investigations.

SUDDEN UNEXPLAINED JUVENILE DEATH AND THE ROLE OF MEDICOLEGAL INVESTIGATION: UPDATE ON MOLECULAR AUTOPSY

In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives. We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples. Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subuni…

The violence of men against women: Medico-legal and psychological issues

Violence against women breaches women’s human rights and is a global public health issue that can cause devastating life-long damage. This study considers the characters of victims, abusers and traumatic bonding in heterosexual couples from a medico-legal and psycological standpoint. After considering the devastating effects on women’s health, and with the objective of preventing future violence, it illustrates the weaknesses and strengths of new Italian guidelines related to violence against women in emergency departments including the use of “Brief Risk Assessment for IPV in the Emergency Department – DA5”.

Informed consent and minors: hiv testing in italian legislation.

Linee guida per la valutazione del Parkinson in ambito di invalidità civile.

Il welfare in Italia.

Case Report: Unusual Clinical Presentation of a Rare Cardiac Inflammatory Myofibroblastic Tumor in Children: The Differential Diagnosis With Pediatric Emergencies

Introduction: There are still no guidelines about pediatric cardiac cancers. The purpose of this work is to provide new scientific data facilitating the differential diagnosis of a rare cardiac tumor with an unusual presentation, such as the cardiac inflammatory myofibroblastic tumor (IMT).Case Presentation: A 3-year-old male child presented with several symptoms including unconsciousness, vomiting, and drowsiness. A clinical and neurological examination revealed a unilateral (right) motor delay and positive unilateral Babinski sign. Electrocardiogram (ECG) was normal.Diagnostic Assessment: The total body computed tomography (CT) scans showed hypodensity in the left temporal–parietal lobe, …

INFORMAZIONE E COMUNICAZIONE IN ECOGRAFIA OSTETRICA

Daphne II Project case report: a 3 years-old baby girl sexually abused from a young of 14 in a domestic extrafamily context

Lethal rupture of post-traumatic aneurysm of the vertebral artery case report.

Abstract Traumatic aneurysms or dissections of the vertebral artery have been reported in patients who have suffered minor craniofacial injuries in traffic accidents. A case is reported of ruptured traumatic vertebral artery aneurysm due to closed head injury without without penetrating injuries or skull fractures. The macroscopic and histological findings relevant to the vertebral wall were compatible with post-traumatic aneurysm; the rupture of the wall was assumed to be caused by sepsis and local infiltration of inflammatory cells.

La nutrizione artificiale: l'assistenza palliativa domiciliare. aspetti bioetici e possibili profili di responsabilità professionale

Gli Autori esaminano gli apsetti salienti della quetione bioetica della nutrizione artificiale, facendo riferimento anche ai più recenti casi di spospensione dlla NA e approfondiscono gli correlati ad evntuali profili di responsabilità professionale

RESPONSABILITA' PROFESSIONALE IN CARDIOLOGIA: DISCUSSIONE DI DUE CASI DI RESPONSABILITA' DA CONDOTTA OMISSIVA PER IMPLICAZIONI DI ORDINE PENALISTICO.

Pitfalls on Postmortem Imaging: The Need of Blending Conventional and Virtual Autopsy on Burnt-Charred Body

Joining forensic traditional autopsy and CT-MR postmortem virtual approach may assist forensic experts in adequate reconstruction of cause, manner, and way of death, significantly to find evidence of found wound/fracture and relative interpretation. Evaluation of criminal burning is often a difficult challenge in the view of misinterpretation of wound/fracture victims and usually poor case history of this criminal offense. In this scenario, a strong collaboration between imaging and classical forensic techniques is helpful.

Postmortem Imaging in Sudden Adult Death

Several definitions of “sudden and unexpected death” exist. The World Health Organization definition is of natural death within 24 h from the onset of symptoms, but this is much too long for many clinicians and pathologists; some will only accept death within 1 h from the onset of illness. If the event was not witnessed, sudden death is defined as the interval between the time the subject was last seen and the time the body was found within 6 h.

Medico legal procedures related to sexual assault: a 10-year retrospective experience of a Daphne protocol application

Background: Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged as confirmed by the literature. Italian law n.96, 1996, foreseeing norms regarding rape and sexual abuse, finally gave significant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II program to support victims of rape and abuse, and the Violence and Operative Healthcare Networks (Ve.R.S.O.) project started at the Policlinico “P. Giaccone” University Hospital of Palermo in 2006. Aim: data analysis emerging from 10 years experience of Daphne protocol utilization for the management of sexual assault victims. Methods:…

Clinical risk management delle infezioni nosocomiali: profili di responsabilità

L’oggetto del rapporto obbligatorio tra paziente e struttura sanitaria rientra nella complessa prestazione di assistenza sanitaria. Il rapporto, nonché la responsabilità, tra ospedale e paziente, è di natura contrattuale e ad esso si fa riferimento sia in caso di inadempimento delle obbligazioni direttamente a carico della struttura (ex art. 1218 c.c.), sia in caso Di inadempimento delle prestazioni medico-professionale del sanitario (ex art. 1228 c.c.). Un’obbligazione importante a cui risponde la struttura ospedaliera è quella di garantire l’utilizzo di locali idonei sotto il profilo igienico, in quanto essa è l’ente responsabile delle infezioni nosocomiali dovute ad agenti patogeni event…

Minori autori di reati sessuali: un’analisi prelimiare sui casi giudicati dal tribunale per i minorenni di Palermo negli anni 2005-2009

L’allarme sociale in ordine agli abusi sessuali sui minori è accresciuto negli anni unitamente alla consapevolezza dell’importanza della tutela del minore e del valore fondamentale delle sue relazioni nel corso dello sviluppo. Il presente studio intende essere un contributo di conoscenza su una specifica categoria di abusanti: i minorenni. Uno studio delle peculiarità di tale fenomeno è premessa indispensabile per predisporre idonee ed efficaci strategie di trattamento. Al fine di identificare il numero e le caratteristiche dei minori abusanti si è proceduto a consultare i fascicoli del Tribunale per i Minorenni di Palermo relativi ad un periodo compreso fra il 2005 e il 2009. Tale indagine…

Forensic investigation in aircraft accident with the aid of CT (MSCT), and Magnetic Resonance Imaging (MRI): our experience

The autors report their experience in a case of air disaster in which a Tuninter airlines ATR 72 fallen down into the sea near Capo Gallo coast (Palermo, Italy) with 39 persons on board, resulting in six-teen victims. In the present contribute the authors argued the causes of the death and analysed patternes of injuries sustained by passengers involved in the fatal airplane accident using the conventional autopsy combined with postmortem Multi Slice Computed Tomography (MSCT) examination.

SUSPECTED CHILD ABUSE: UNUSUAL DEATH IN WESTERN COUNTRY. SUICIDE OR HOMICIDE?

This case report describes a particular case of carbonized corpse, found in his burnt-out car in an isolated Palermo’s west suburban zone. The goal of this case report is to describe the shame and the social stigma related with suspicious of pedophilia and how it led a man to suicide by fire, considering that is an unusual way to die in western countries

Penile Enhancement Procedures: Urological And Ethicolegal Issues

Phalloplasty procedures for most men requiring penile augmentation surgery are cos-metic procedures; generally the patients have a normal-sized and fully functional penis but they think that their penis is too small. There are not well defined indications for penile enhancement surgery and, except for the treatment of “micropenis”, there are not established guidelines and the outcome measures for success are still unclear. All penile enhancement techniques often do not reach the expected result and the grade of pa-tient’s satisfaction is frequently poor. Phalloplasty procedures for psychological dys-morfism are not approved by any scientific society and the majority of these procedures are …

aspetti bioetici, deontologici e legali della terapia antalgica

COVID-19 Vaccination in Pediatric Population: A Necessity or Obstruction to the Protection of the Right to Health? Biojuridical Perspective.

One of the most recently debated topics worldwide is the mass vaccination of children against coronavirus disease 2019 (COVID-19). Next, the risk/benefit ratio of COVID-19 vaccination and infection in children are compared. Nonetheless, the real question in this debate is as follows: Does the vaccine represent a necessary tool or is it an obstacle in protecting the right to health? From a public health point of view, the Supreme Court of Nova Scotia, in Canada, recommends COVID-19 vaccination in the pediatric population. Based on Article 25 of the Draft Articles on State responsibility, vaccination can be considered a social act necessary for protecting the individual's right to health. The…

The relevance of Scientific evidences in Criminal Investigations of mafia's crime: the experience of "Capaci Bloodshed" and the Murder of the judge Giovanni Falcone

Violence and Abuse: Battered Child

Battered child is a crucial social and medical issue, which represents a major cause of morbidity and mortality among children. The ‘child abuse syndrome’ is a clinical condition in young children who have received serious physical abuse, and should be considered in any child exhibiting evidence of fracture of any bone, subdural haematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. A clinical-radiological-forensic collaboration is crucial for its identification.

Additional file 1: of Unsolved questions and preferred solution about living will

Questionnaire administered to health care professionals. Legend: tools and items of Questionnaire. (DOC 170 kb)

Morte improvvisa giovanile inspiegata e ruolo dell'indagine medico-legale: aggiornamento dell'autopsia molecolare

Can Immunohistochemical stains aid torule out pitfalls in suffucation death?

Rare occurrence of Whipple Disease in a young female patient with a fatal outcome

Abstract Whipple Disease is a rare chronic multi-systemic disease caused by the ubiquitous environmental Gram-positive bacterium Tropheryma whipplei . It can be fatal if untreated. Here we describe the fatal outcome in a 27-year-old Caucasian female patient with a three-month history of persistent fever, anemia, weight loss and diarrhea. The final resolution of the diagnostic process was only reached after the patient’s death thanks to autopsy. The case depicted is a classic Whipple Disease histologically characterized by digestive involvement based on positive periodic acid-Schiff (PAS) staining and immunohistochemical analysis for T. whipplei and systemic involvement (pericarditis, brain …

Death of a 23-year-old man from cardiac conduction system injury through a blunt chest impact after a car accident.

Abstract Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent causes of cardiac contusion resulting from a direct blow to the chest. Myocardial contusion is difficult to diagnose; the clinical presentation varies greatly, ranging from a lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. The authors report a case of death due to a cardiac conduction system injury from a blunt chest impact following a car accident. The autopsy showed no external signs of thoracic trauma, no evident rib or sternum fractures. A small sub-endoc…

Cardiovascular Implantable Electronic Device Infection and New Insights About Correlation Between Pro-inflammatory Markers and Heart Failure: A Systematic Literature Review and Meta-Analysis

Introduction: Surgical approaches to treat patients with abnormal pro-inflammatory parameters remain controversial, and the debate on the correlation between hematological parameter alteration in cardiac implantable electronic device (CIED) infection and the increase in mortality continues.Methods: We performed a systematic review using the PubMed, Scopus, and Cochrane Library databases. Twenty-two articles from May 2007 to April 2020 were selected and divided according to the following topics: prevalence of microbes in patients with CIED infection; characteristics of patients with CIED infection; comparison between patients who underwent and did not undergo replantation after device extrac…

Juvenile sudden cardiac death due to congenital coronary ostial valve-like ridges: A case report and literature review

Coronary artery anomalies are a heterogeneous group of congenital disorders affecting the coronary pattern with a characteristic (origin, number, number of hosts, course, etc.). They are rarely found in the population. We report the case of a 21-year-old male who died from sudden cardiac death caused by an isolated coronary ostial obstruction, secondary to a rare anomaly, the presence of a valve-like ridge consisting of a small fold in the Valsalva aortic sinus. The study provides a brief literature review on the pathophysiology, diagnosis, and clinical and medico-legal issues in coronary artery anomaly cases that may be helpful in forensic practice when dealing with sudden cardiac death i…

AN INTERVIEW STUDY OF THE AWARENESS AND UNDERSTANDING OF CHILD ABUSE AND NEGLECT IN THE EMERGENCY ROOM.

APPROPRIATENESS OF CESAREAN SECTION IN A HOSPITAL OF SICILY (ITALY): STATISTIC EVIDENCES AND MEDIC LEGAL CONSIDERATIONS

ntroduction: Authors have carried out a survey to evaluate the appropriateness of the caesarean deliveries performed in a hospital of Sicily (Italy) during 2013. The choices of these surgeries have been compared with italian and sicilian guidelines. Materials: EpiInfo 7.1.4 software (CDC - Atlanta - USA) was used to perform the statistical data analysis (chi-square test). Results: We analyzed a total of 818 medical records related to 50.61% of spontaneous deliveries, :06% induced labor, and 46.33% of cesarean deliveries. Medical records showed that in 32.7% the caesarean section were justified by emergency conditions, whereas in 15.89% the choice was not quite justified according to guideli…

Can immunohistochemical stains aid to rule out pitfalls in suffocation deaths ?

La ricerca sulle cellule staminali al banco di prova

Role of MDCT virtopsy in valuation of burned bodies and its comparison with traditional autopsy

Aims and objectives Methods and materials Results Conclusion Personal information References

GHB: farmaco, sostanza d’abuso e droga da stupro: diverse tipologie di uso, differenti problematiche analitico-forensi

L’acido gamma-idrossibutirrico (GHB) è un neurotrasmettitore con effetti gaba-mimetici; si tratta di un composto endogeno, ma notoriamente usato per le applicazioni terapeutiche come anestetico per via endovenosa, come sedativo e per il trattamento della narcolessia. Dagli anni ‘80 è comune sostanza usata come doping, quindi emerge come droga da “tempo libero” nei rave-party; più recentemente, i supposti effetti afrodisiaci e la reale capacità di induzione di amnesia retrograda ne hanno indotto l’utilizzazione quale sostanza in grado di ridurre la capacità di resistenza della vittima di uno stupro annoverandola tra le cosiddette “date rape drugs” (Drug facilitated sexual assault, DFSA), e c…

Incest: Medical-Legal perspectives

Toxicological problems related to drugs with particular reference to chemical precursor

the author analyze the toxicological problems related to drugs with particular reference to chemical precursor

Medicina legale orientata per problemi

L’area delle discipline medico-legali vive oggi un rinnovato interesse, sia per gli aspetti di approfondimento dottrinario di tematiche che si pongono a ponte tra scienza e diritto, sia per quanto attiene l’innovazione tecnologica delle scienze biomediche e il loro avanzamento applicativo; sembra così aprirsi un’era di estremo e sempre più diffuso interesse verso questa disciplina di studio, unitaria nel metodo (la metodologia medico legale ) e nell’approccio ( res medica sub specie iuris ), pur nella sua svariata congerie applicativa. Questo libro, utilizzando lo strumento pedagogico dell’apprendere per problemi, si rivolge sia allo studente universitario di area sanitaria sia al medico gi…

Changes to legal forensic inspections in Sicily during Covid-19

Our institute, in collaboration with the Public Prosecutor’s Office, arranges for cadaveric inspections during a judicial inspection, jointly with the police. With the advent of the Covid-19 pandemic, operating methods have changed. Specifically, we now discuss the cases individually before attending to guarantee the health of operators and citizens

Referto/rapporto e denunce sanitarie obbligatorie

Le linee guida ed il loro valore nel contesto medico legale

Negli ultimi decenni, vi è stata una crescente ricerca di interventi efficaci per migliorare la prognosi dello stroke e numerose linee guida sono state prodotte in tal senso. Ciò ha comportato ultimamente, rispetto al passato, un incremento della sopravvivenza del 10% ed un aumento di soggetti che ha superato la malattia senza riportare gravi disabilità permanenti (paralisi, perdita della parola, della visione, della memoria, ecc.) con una percentuale all’incirca identica. E’ da sottolineare che, a differenza di quanto avviene per altre malattie, dove l’attenzione per migliorare la qualità delle cure è rivolta a promuovere l’uso di singoli farmaci o interventi terapeutici, nell’ictus gli sf…

LA CARTELLA CLINICA NELL’ATTUALE CONTESTO DELLA PRIVACY

Coronary artery anomalies and juvenile sudden cardiac death

Cartella clinica

Forensic microbiology applications: A systematic review.

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…

Alcol e applicazioni tossicologico-forensi: criticità giuridiche

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

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…

A possible biomarker for methadone related deaths

Abstract Methadone (MTH) concentrations in those dying of MTH toxicity totally overlap concentrations where the presence of MTH is only an incidental finding, making it very difficult to make distinctions in actual cases. A biomarker, be it anatomical or biochemical for MTH toxicity is badly needed, particularly if that markers were known to disrupt effective ventilation. Because the brainstem houses the regulatory centers for cardiorespiratory-control enters, it would seem to be the most likely anatomical site to seek abnormalities in cardiorespiratory control. Objective To locate and describe the cells of nucleus of the solitary tract (TS)(NTS) in human brainstem and determine if neuronal…

Augmented Reality Gamification for Human Anatomy

This paper focuses on the use of Augmented Reality technologies in relation to the introduction of game design elements to support university medical students in their learning activities during a human anatomy laboratory. In particular, the solution we propose will provide educational contents visually connected to the physical organ, giving also the opportunity to handle a 3D physical model that is a perfect reproduction of a real human organ.

LA MEDICINA: DUE COMPONENTI, MOLTE VARIANTI.

Asthmatic bronchial lesions in drug addicted

IMMIGRAZIONE CLANDESTINA NELLA SICILIA OCCIDENTALE. ESPERIENZE MEDICO-LEGALI SU UN NAUFRAGIO COLLETTIVO

Psychological support and psychotherapy via digital devices in Covid-19 emergency time: Some critical issues

The Covid-19 pandemic and the resulting fear, quarantine and lockdown measures implemented in Italy and other countries to contain the risk of contagion have seriously impacted the mental health of a large number of people. The need to offer psychological and psychotherapeutic support to these people, while respecting the government’s pressing calls to “stay home”, have led many psychologists and psychotherapists, both in the public and private sectors, to provide their professional services via teleconference, telephone, smartphone, etc. The aim of this work is to highlight some critical issues related to the sudden switch from the traditional method of providing psychological services to…

La prevenzione del rischio clinico nel trattamento della calcolosi urinaria. Illustrazione casistica

Linee guida in ortodonzia e attuale valutazione dei profili di responsabilità

Alla luce della nuova legge entrata in vigore in Italia, si discute il valore protettivo delle linee guida in ortodonzia sotto il profilo medico-legale. OBJECTIVES. In view of the Italian law recently come into force, this study aims at discussing the protective value of orthodontic guidelines in terms of legal medicine. MATERIALS AND METHODS. A review of orthodontic guidelines was conducted, including general orthodontic guidelines as well as specific guidelines for clinical and surgical cases. RESULTS AND CONCLUSIONS. Orthodontic practices envisaging professional liability include diagnosis, prevention, interception, care planning and treatment of all types of malocclusion (even when asso…

Il dolore cronico: profili di responsabilità medico legale

Utility of post mortem MRI in definition of thrombus in aneurismatic coronary arteries due to incomplete Kawasaki Disease in infants

Abstract Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents in childhood. The characteristic coronary arterial lesion is an aneurysm, which may lead to thrombosis, dilatation, stenosis, and occlusion. Such an aneurysm is typically calcified and generally develops five or more years after the onset of acute KD. It becomes more noticeable after ten years. KD is sometimes difficult to diagnose because of the limited clinical features, especially in infants younger than 6 months old, where the clinical presentations often do not fulfill the diagnostic criteria for KD. We report a case of Incomplete Kawasaki…

Postmortem Computed Tomography: From Acquisition to Reporting

PMCT in a noninvasive, fast, and quite available method which coroners and forensic experts tend to use more and more often, especially when a crime is suspected. PMCT proved to be an excellent tool for detection and assessment of bone fracture injuries due to sharp trauma and bullet trajectories.

Sexual Abuse-Current Medico-legal, Forensic and Psychiatric Aspects

Abstract Violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. There are many obstacles especially when sexual abuses have to be evaluated. These problems are present both when victims of sexual abuse are evaluated and when sex offenders are dealt with, especially when the offenders are juvenile sex offenders (JSO). These issues give cause for great concern about prognosis, and the resulting psychosocial implications, and call for a special effort from the scientific community in identifying appropriate prevention and treatment methods. This chapter is divided into two parts. The first part deals with the forensic and psychiatric features,…

La persona nel diritto civile

Idoneità all'attività sportiva e doping: profili di responsabilità professionale.

Alcohol and Nicotine Use among Adolescents: An Observational Study in a Sicilian Cohort of High School Students

In recent years, the mode of alcoholic intake known as binge drinking (BD) has become a common practice, especially among adolescents who, due to socio-environmental motives, tend to reach a rapid state of drunkenness. This drunkeness leads to alterations in brain areas responsible for executive functions and cognitive processes, as well as to the genesis of factors that predispose to lasting addiction. Likewise, nicotine leads to a comparable degree of addiction. On this basis, the aim of this research was to evaluate, on a cohort of 349 high school students (15–17 years old) in the province of Palermo, the following: (I) the drinking model of alcoholic beverages; (II) the use of nic…

ASPETTI PENALISTICI DELLA MANCATA DIAGNOSI DI MALFORMAZIONE FETALE

L'accertamento ecografico in ostetricia costituisce uno dei temi salienti del campo della responsabilità professionale del ginecologo, sovente foriero di responsabilità professionale. L'autore pone in rilevo i possibili scenari di responsabilità professionale con particolare attenzione alla omessa diagnosi di malformazioni fetali.

Percorsi di integrazione e modello operativo della rete anti-violenza: esperienza del progetto Daphne

Unexpected Traumatic Carotid Artery Lesion

Dal paternalismo ippocratico alla medicina difensiva: Eticità del consenso informato in psichiatria

La figura del medico nella storia ha attraversato il tempo e le criticità culturali determinando l’evoluzione della scelta terapeutica nella pratica clinica del quotidiano. Il tema del rapporto medico paziente è un tema classico, che vede la contrapposizione, in sintesi, fra tre distinti modelli: un modello tutorio paternalistico, che è il modello classico, risalente alla tradizione ippocratica e cattolica, improntato sulla figura del medico benefattore e onnidecidente; un modello basato sul moderno concetto di alleanza terapeutica e un modello incentrato sulla piena libertà di autodeterminazione del malato e sulla concezione personalistica dei diritti del paziente1. Se scaviamo all’origine…

La nutrizione artificiale: l'assistenza palliativa domiciliare. Aspetti bioetici e possobili profili di responsabilità professionale

Segreto Professionale e diritto alla privacy

OBIETTIVI DEL CAPITOLO • Definire i concetti di “segreto professionale” e “diritto alla privacy” • Esaminare le norme del Codice deontologico e le norme giuridiche di riferimento • Acquisire la consapevolezza del valore etico della riservatezza nella condotta sanitaria • Fornire una Scheda sinottica di consultazione rapida

Complicanze neurogene iatrogene in esito ad erronea esecuzione di tecnica di riduzione secondo weber di frattura del gomito.

Medicina e nursing delle evidenze

Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy

Background: Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs. Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital. An Antimicrobial Stewardship (AMS) program was implemented to optimize antibiotic use, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, and reduce costs. Methods: The stewardship strategies were: antimicrobial oversight on “critical” antibiotics; the development of hospital guidelines on antibiotic selection with the production of a co…

Homicide or Suicide? Unusual Death of Man Suspected of Sexual Harassment in Family Context

COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis

IntroductionThe World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Two vaccine types were developed using two different technologies: viral vectors and mRNA. Thrombosis is one of the most severe and atypical adverse effects of vaccines. This study aimed to analyze published cases of thrombosis after COVID-19 vaccinations to identify patients’ features, potential pathophysiological mechanisms, timing of appearance of the adverse events, and other critical issues.Materials and MethodsWe performed a systematic electronic search of scientific articles regarding COVID-19 vaccine-related thrombosis and its complications on the PubMed (MEDLINE) d…

Biphasic pleural mesothelioma in a electrician working in a railway company: Case report and current trends in mesotheliomas in Italy

Background: Mesothelioma is an aggressive tumour that can involve the pleura, the peritoneum, and sometimes other mesothelia, such as the pericardium and the tunica vaginalis testis. Scientific communities have known for a long time the causal correlation between exposure to asbestos (work related or not) and the onset of the disease (in 75% - 90% of cases) and the increasing number of asbestos-correlated mesotheliomas expected in the next years. Case presentation: The authors present the case of an electrician, 66-year-old man, died for pleural mesothelioma, working in Palermo in the company of the Italian Railways for a period of about 20 years, exposed to asbestos. Frequently he disassem…

Anomalous Origin and Course of the Right Coronary Artery

Coronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery.1–4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes …

Valenza umana della cura (care) dei pazienti in SVP e ruolo dei caregivers

[Human value of care and caregivers' role in the management of permanent vegetative state (SVP) patients] As stated by the Royal College of Physicians, «patients who remain in a vegetative or minimally conscious state following profound brain injury present a complex array of clinical and ethical challenges to those who care for them». Patients in clinical condition of Permanent Vegetative State (SVP) are unaware of self and environment, enable of language comprehension or expression; they are able to survive along provided that we are able to ensure primary care, such as eating and hydration. With regard to this existential landmark, caregiver’s role is not only legally related, as guardia…

Immigrant death and human trafficking crimes. A report of August 28th 2015 tragedy in Mediterranean sea

Il consenso informato per l’effettuazione del test per la diagnosi da HIV: come comportarsi in caso di minori.

EtG Quantification in Hair and Different Reference Cut-Offs in Relation to Various Pathologies: A Scoping Review

Ethyl glucuronide (EtG) is a non-volatile, non-oxidative, hydrophilic, and stable ethanol phase II metabolite. EtG is produced through ethanol glucuronidation by UDP-glucuronosyltransferase (UGT), a phase II enzyme. EtG can be extracted from different biological matrices, including keratin ones, such as hair or nails. The purpose of this scoping review is to describe the relationship between EtG levels in hair and some of the most common and frequent pathological conditions and verify whether different reference cut-offs in relation to various pathologies have been identified in the scientific literature. In fact, in-depth knowledge of the influence of pathologies, such as diabetes mellitus…

Morti fetali e perinatali: esposizione gestazionale a sostanze d'abuso

The chaperone system in glioblastoma multiforme and derived cell lines: diagnostic and mechanistic implications.

BACKGROUND: Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor in adults. Novel treatments are needed to counteract the molecular mechanisms of GBM growth and drug resistance. The chaperone system (CS) members are typically cytoprotective but some, termed Hsp, can become pathogenic and participate in carcinogenesis, along with the vascular endothelial growth factor (VEGF), and we investigated them in GBM biopsies and derived cell lines. The objectives were to identify diagnostic-prognostic biomarkers and gather information for developing chaperonotherapy. METHODS: Cell lines from GBMs were established, characterized (morphology, growth characteristics, and sp…

La ricerca clinica tra scienza ed etica nella malattia di Parkinson.

Behavioural and pharmacological characterization of a novel cannabinomimetic adamantane-derived indole, APICA, and considerations on the possible misuse as a psychotropic spice abuse, in C57bl/6J mice

The novel adamantane derivative APICA (N-(adamantan-1-yl)-1-pentyl-1H-indole-3-carboxamide) was recently identified as a cannabinomimetic indole of abuse. Despite its novel structure, APICA recalls cannabinomimetic indoles, such as representative member JWH-018.In present study, the effects of APICA (1-3 mg/kg, i.p.) were tested in C57BL/6J mice, in the Tetrad task which includes the assessment of: body temperature; locomotor activity and behavioural reactivity; nociception; motor coordination; declarative memory. Furthermore, pre-treatment with the CB1 antagonist AM251 (3 mg/kg, i.p.) or the CB2 antagonist AM630 (3 mg/kg, i.p.) was carried out to characterize APICA activity.Our results sho…

Il dolore non toracico a genesi cardiaca nello scenario della responsabilità: illustrazione casistica

La modernità immutabile del codice di deontologia medica

[The new code of medical ethics and its immutable modernity] Abstract non presente. Si riporta l'inizio dell'editoriale: La riformulazione del Codice di Deontologia Medica (CDM) 2014 [1] e un’occasione per riflettere sugli emergenti confini della biomedicina e dell’impegno professionale, come evidenziati dalla attuale proposizione...

Imaging for Ballistic Trauma: Other Applications of Forensic Imaging in the Living

Firearms are mechanical instruments that allow launching remote specific bodies with mass (bullets) exploiting burst gas energy. The role of imaging for ballistic trauma is crucial in order to define the main characteristics for both judiciary and nonjudiciary purpose, which are the intracorporeal trajectory, the entrance and exit wounds, and the general characteristics of gunshot injuries.

Diagnosticabilità delle malformazioni fetali e “linee guida per le consulenze medico-legali in ecografia ostetrica” della Società Italiana di Ecografia ostetrico-goinecologica e metodologie biofisiche.

Un caso di disfonia severa provocata da una lesione monolaterale iatrogena del nervo laringeo ricorrente Considerazioni medicolegali

di un intervento di emitiroidectomia, a causa di una lesione del nervo laringeo ricorrente di sinistra, riferibile ad una condotta colposa del chirurgo. Vengono considerati i risvolti medicolegali, porgendo particolare attenzione alla questione relativa al risarcimento cui l’operatore sanitario è obbligato, nei confronti del soggetto danneggiato. Tale compenso è stabilito in rapporto alla menomazione della funzione fonatoria subita dalla persona lesa e, pertanto, si riferisce non solo all’alterazione dell’integrità psicofisica e alle eventuali ripercussioni esistenziali che una tale condizione può determinare sulla qualità della vita, ma finanche alle conseguenze economicamente valutabili d…

L’uso diffuso delle statine nell’era della prevenzione di massa della cardiopatia ischemica: occasione per riflettere sugli eventi avversi dei farmaci e sulla possibile responsabilità medica.

L'assistenza al paziente politraumatizzato e la responsabilità professionale dell'équipe sanitaria

Fibroelastosi endocardica congenita in coso di autopsia fetale per sospetta malpractice professionale. Caso clinico e revisione della letteratura

Gli Autori presentano il caso di una donna giunta alla 39,4 settimana di gestazione, regolarmente sottoposta ad esami clinici e strumentali che evidenziavano un decorso regolare della gravidanza eccetto oligoamnios. La paziente espletava il parto con feto nato vivo ma non vitale. L'esame esterno del cadavere evidenziava esclusivamente cianosi generalizzata. L'esame autoptico ha evidenziato cardiomegalia con incremento di tutte le cavità cardiache con rapporto cardio-toracico 6.5/8.5 ed un aspetto porcellanaceo delle pareti ventricolari di sinistra. All'istologia tale ispessimento era causato da fibroelastosi diffusa dell'endocardio associata a marcata miocitolisi colliquativa del miocardio …

Work's discomfort among the nurse profession; the burn-out syndrome

The health care assistance doesn't mean only a productive work based on technology use, but is also involving the woeker's identity, feelings and emotions, towards a satisfaction of relation with customer. Neverthless, the relation between health care worker and customer can harm wich is devoted to this relation. The burn-out is a pathological condition related to work set, characterized by three dimensions: emotional worn out, absence of personality and work implementation. The authors show the results of a study performed on 100 nurses and deputy professionals of two Sicilian hospitals, where a Maslach Burn-Out Inventory (MBI) test was supplied by two nurses coordinators.

Unsolved questions and preferred solution about living will

Abstract Background Ethical problems about end-of-life medicine include a variety of issues approached in different ways by physicians and, more recently, special emphasis to this kind of ethical issues and possible answers has done by Italian National Ethical Committee in the issue named “Deep and continuous palliative sedation in the imminence of Death” (January, 2016). The debate is very critical in Intensive Care Units and Cancer Wards, where health care professionals face-off with terminally-ill patients is an outright routine; the Authors investigated their medical knowledge and ethical perception about patient critical and terminal condition to discuss the most relevant conclusions. …

Office ecografia: l’ecografia come supporto alla visita ostetrico-ginecologica. il ruolo dell’ostetrica.

L'ETICA DELLA RESPONSABILITA' NELLA RICERCA SCIENTIFICA

Post-traumatic lethal carotid-cavernous fistula.

The authors report about an unexpected death by traumatic lesion of the internal carotid artery in a 30-year-old man who had fallen two metres. The man suffered a fracture of the left maxillary sinus and a fracture of the right orbit with bilateral haemorrhage of the maxillary sinus. Surgical treatment was performed with favorable outcome. Clinically, there were no neurological symptoms but about 60 days after his accident, the man died from uncontrolled epistaxis. He was submitted to the autopsy that show a linear fracture in the left side of the turcic sella and lesion of the left internal carotid artery with carotid-cavernous fistula.

Sindrome di Steven-Johnson/Lyell: aspetti eziopatogenetici e medio legali

gli autori analizzano gli aspetti etiopatogenetici e medio legali correlati alla Sindrome di Steven-Johnson/Lyll

Accertamento e trattamento sanitario obbligatorio

A novel LC–MS/MS analytical method for detection of articaine and mepivacaine in blood and its application to a preliminary pharmacokinetic study

Local anaesthetics (LAs) are commonly used in surgery, especially in dentistry. They cause a transitory inhibition of nerve signal due to the blockade of the voltage-gated sodium channels. LAs are administrated alone or with vasoconstriction agents, such as adrenaline. Toxicity of LAs is associated to neurological and cardiovascular alterations. Tachycardia, arrhythmia, tremors, tonic-clonic seizure and respiratory depression (at high doses) are the main symptoms of intoxication by LAs. Lidocaine, articaine and mepivacaine are among the most used anaesthetics. This study aimed to fully validated a new method for the simultaneous detection of articaine and mepivacaine in whole blood. Sample …

Evidence and witness of a child victim of sexual abuse in Italian penal process.

Detection of gamma-hydroxybutyrate in hair: Validation of GC–MS and LC–MS/MS methods and application to a real case

A gas chromatography-mass spectrometry (GC-MS) and a liquid chromatography tandem mass spectrometry (LC-MS/MS) method were validated for quantifying endogenous and exogenous hair concentrations of gamma-hydroxybutyrate (GHB). The GC-MS method is based on overnight extraction of 25 mg hair in NaOH at 56 °C, liquid/liquid extraction in ethylacetate and trimethylsylil derivatization; analysis is by electron ionization and single ion monitoring of three ions. The LC-MS/MS method entails a rapid digestion of 25 mg hair with NaOH at 75 °C for 40 min, liquid/liquid extraction in ethylacetate and reconstitution of the extract in the LC mobile phase; negative ion electrospray ionization and multiple…

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Abstract Background Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operati…

Circumcision and Sexually Transmitted Disease Prevention: Evidence and Reticence

Circumcision is one of the oldest surgical procedures and the most common surgical procedure performed on males. It is practiced for three main reasons: ritual or religious meanings, prophylactic hygienic purposes, and therapeutic indications. Male circumcision is advocated as an efficacious prevention strategy against sexually transmitted diseases. One of the main biological mechanisms responsible for the lower human immunodeficiency virus (HIV) infection rate in heterosexual circumcised men is the protective effect of keratinization of the glans. Moreover, male circumcision removes the inner part of the prepuce containing Langerhans cells that are targeted by HIV. Several observational st…

Certification of Death: External Postmortem Examination

La valutazione del danno biologico in implantoprotesi.

Sexual abuse and maltratment on child: protocols, cooperation strategies, daphne II - V.eR.S.O. (Violenza e reti sanitarie operative) Project- our experience

Possibili profili di responsabilità nelle fistole oro-sinusali iatrogene. illustrazione casistica

FEMALE GENITAL MUTILATIONS: GENITO-URINARY COMPLICATIONS AND ETHICAL-LEGAL ASPECTS

Many women in the world are still undergoing female genital mutilations (FGMs) even if in almost all the countries, the practice of FGM is illegal. The increase of immigration, particularly from African Countries, to Europe, and Italy too, led to consider this phenomenon with particular attention and skill. All the operators in health services need to know the different types of FGMs and the related complications and the psychological and sexual sequels. Urological complications, in particular, are not rare and the changing anatomy of the external genital apparatus can also make the catheter insertion sometimes difficult. This review analyzes the epidemiology of FGMs, the reasons why the p…

Conoscenze fondamentali della patologia forense per il sanitario non specialista in medicina legale

Governo clinico e sicurezza: il ruolo del medico legale.

La responsabilità professionale del cardiologo: il dialogo informato e la scelta terapeutica

Informazione,consenso e alleanza terapeutica in chirurgia orale ambulatoriale

lo sviluppo della odontoiatria amplia la possibilità di interventi di chirurgia orale anche in contesto ambulatoriale; questo impone una attenta valutazione dei rischi, delle possibili complicazioni e dei vantaggi per il paziente; queste informazioni devono essere effettivamente comprese dal paziente, affinchè si costruisca un valido consenso; questa modalità di comunicazione contribuisce alla fiducia posta nel sanitario e nell’équipe terapeutica, ed è alla base della alleanza terapeutica; sotto il profilo legale, si ritiene che l’informazione, ancor prima della realizzazione del contratto di cura, sia una obbligazione vincolante per il sanitario/i. Occorre dunque sviluppare sistematicament…

The risk of the 'prison-emptying' effect in Italy due to the Covid-19 pandemic.

People who live and work or are detained inside restricted communities (including prisons) need to be considered as they are at a high risk of becoming infected with Covid-19 during this pandemic.1 InItaly, the spread of Covid-19 has provoked numerous riots within the prisons and local detention centres, and there is a consequent increase in requests for inmates to be released and detained at home

Homicide or suicide? An unusual death of a man suspected of sexual harassment in family context

The authors describe a case of a man found carbonized in a burnt car. The man was suspected of sexual harassment in family context. Forensic exhamination helped to distinguish between homicide and suicide hypothesis.

The analysis of SUDEP forensic autopsies leading to preventable events

Introduction: The diagnosis of unexpected death by excluding non-natural causes, particularly in subjects with epilepsy, is a topic of interest and it is difficult to identify in the forensic field. Health professionals sometimes are faced with cases of sudden death, generally in young adults with a long history of epilepsy that require, for judicial purposes, an explanation in terms of cause and means to determine the death. SUDEP is an entity diagnosed by the exclusion of other causes that may have led to death, and then for forensic purposes, it requires particular attention and knowledge, and there is difficulty in identifying it. Our contribution aims to illustrate the scientific commu…

Pharmacogenetics and Forensic Toxicology: A New Step towards a Multidisciplinary Approach

Pharmacogenetics analyzes the individual behavior of DNA genes after the administration of a drug. Pharmacogenetic research has been implemented in recent years thanks to the improvement in genome sequencing techniques and molecular genetics. In addition to medical purposes, pharmacogenetics can constitute an important tool for clarifying the interpretation of toxicological data in post-mortem examinations, sometimes crucial for determining the cause and modality of death. The purpose of this systematic literature review is not only to raise awareness among the forensic community concerning pharmacogenetics, but also to provide a workflow for forensic toxicologists to follow in cases of unk…

La rilevanza medico-legale dei biofilms batterici nelle infezioni nosocomiali

Sexual abuse and maltreatment on child: protocols, cooperation strategies, Daphne II V.eR.S.O. project, our experience.

CARDIAC RUPTURE FOLLOWING BLUNT CHEST TRAUMA: REPORT OF TWO CASES.

An inusual catastrofic intra-abdominal hemorrhage caused by spontaneus segmental arterial mediolysis dissection

Postmortem Imaging in Drowning

The diagnosis of drowning is one of the most difficult in the field of forensic medicine since the autopsy findings are often not specific and the laboratory examinations are controversially appreciated by the scientific community. In a cadaver recovered from water, it is of utmost importance to differentiate antemortem and postmortem drowning. This chapter fully investigates biological/thanato-chemical, pathological and imaging findings which may guide the definitive diagnosis.

Aspetti medico legali dei “nuovi” biomarkers dell’abuso cronico di alcool in vivente e nel cadavere.

Ischemic hypoxic encephalopathy: The role of MRI of neonatal injury and medico-legal implication

Hypoxic ischemic encephalopathy is one of the major causes of neonatal death and neurological disability in the child, and represents the most common birth injury claim. Intrapartum asphyxia often leads to several long-term sequalae, such as cerebral palsy and/or developmental delay, epilepsy. Through the neuroimaging it's possible to identify and define the different lesioned pictures and provide useful elements to establish the moment in which the damage occurred; indeed, timing of injury is a key element in the legal arena. Magnetic resonance imaging (MRI) is emerging as one of the most important tools in identifying the etiologic of neonatal encephalopathy as well as in predicting long-…

A fatal case of a paint thinner ingestion: Comparison between toxicological and histological findings

Toluene and xylene are aromatic hydrocarbons commonly used as an industrial solvent for the manufacturing of pharmaceuticals, paints, and chemicals. The Occupational Safety and Health Administration has determined that toluene levels of 2000 parts per million (ppm) are considered dangerous to life and health. Several studies have examined the absorption of toluene and xylene following inhalation and oral ingestion in humans. Volatile organic compounds that are absorbed into the blood are distributed throughout the body; in particular, distribution of absorbed toluene and xylene in humans and rodents is characterized by preferential uptake in well-perfused and lipophil tissues such as the br…

Lie Detection: fMRI

Objective detection of deception was extensively studied, starting from polygraph to more modern techniques, the functional MR (fMRI), and they are based on neural (sympathetic) activation that is evoked in stressful conditions, such as lying. The role of fMRI in neurophysiology has been extensively developed and studied, and its principles lie in the correlation between the brain demand of energy during determined task and its supply. Although being extensively studied, its role for judiciary purpose presents many shortcomings.

HS-SPME-GC/MS analysis in a fatal case of a paint thinner ingestion

CONGENITAL NEUROBLASTOMA: A RARE CASE OF PLURIVISCERAL METASTATIC DISSEMINATION

Neuroblastoma is one of the most common neonatal tumors. It involves children in early infancy and originates from neural crest cells of the adrenal gland medulla or sympathetic glia. We report an unusual case of congenital poorly differentiated neuroblastoma with multiple metastases in the brain and cerebellum. The biophysical profile showed a prominent polyhydramnios at 25.3 weeks of gestation; meantime, the mother was diagnosed with gestational diabetes. The mass was detected during the third ultrasonographic examination at 31.4 weeks of gestation. The fetus lived only one day after birth and the postmortem examinations were performed subsequently. An autopsy was performed both to unders…

A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series

The best evidence provided in the literature worldwide suggests the importance of harmonizing the investigation in drug-related fatalities. In this study, the application of a multidisciplinary approach in eight cases of drug-related deaths is presented. Although death scene findings could be highly suggestive of drug intoxication, external examination and toxicological screening test alone are insufficient. There are several variables, and it is not always easy to give the proper interpretation of the drug detection. A complete autopsy is necessary to correctly complete organ and tissues sampling for further histological and toxicological studies and obtain body fluids. The use of peripher…

Consenso all'atto medico ed autonomia di "grandi minori": il caso del test HIV

Gli Autori approfonsicono il tema dell'auonomia del consenso informato dei minori con particolare riferimento al consnenso per l'effettuazione del test per HIV. traendo spunto da quanto stabilito nella L. 135/90, gli Autori, si soffermano sul concetto di necessità medica, ipotizzando possibili circostanze in cui il medico, dinanzi alla volontà dl minore, possa sentirsi esonerato dall'acquisizione del consenso del genitore o del legale rappresentante, rafforzando l'obbligo della dovuta ed idonea informazione del paziente

Images in cardiovascular medicine. Anomalous origin and course of the right coronary artery.

Coronary anomalous origin from the wrong aortic sinus has been thought to be a risk factor for ischemia because of acute takeoff from the aorta and flow between the aorta and the pulmonary artery.1–4 A 30-year-old man suddenly died within an hour of waking. His clinical history revealed no evidence of any disease, and the postmortem toxicological examination was negative. Autopsy ruled out violent or natural noncardiac causes of death and revealed an underlying congenital heart disease, which was characterized by a congenital bicuspid aortic valve and an anomalous origin of the right coronary artery just above the median raphe of the anterior cusp

Il ruolo dell’odontoiatra nella medicina estetica: norme e indicazioni

Riassunto Obiettivi Scopo del lavoro e valutare al laureato in Odontoiatria e Protesi Dentaria se sia consentito attuare trattamenti di Medicina Estetica del volto prospettati per modulare gli effetti negativi dell’invecchiamento e, al contempo, analizzare i cambiamenti estetici delle strutture periorali associati all’eta. Materiali e metodi Vengono descritti sinteticamente quali trattamenti coinvolgono clinicamente la professione odontoiatrica, con particolare riguardo alle infiltrazioni di tossina botulinica e di filler o volumizzanti, con un cenno anche agli aspetti civilistici e assicurativi correlati a tali trattamenti. Risultati e conclusioni Nell’ultimo decennio si e registrato un im…

The Impact on Healthcare Workers of Italian Law n. 24/2017 “Gelli–Bianco” on Patient Safety and Medical Liability: A National Survey

Italian “Gelli–Bianco” law (law n. 24 enacted by the Italian Government on 8 March 2017) introduced innovative changes and regulations regarding patient safety and healthcare workers’ (HCWs) liability. We promoted a national survey to evaluate the effect of the law on HCWs. The questionnaire was edited and distributed using the free online tool “Google Forms” (Google LLC). The mode of administration chosen for the questionnaire was telematic self-completion. In particular, the questionnaire was sent to several portals of information, websites, in the scientific and medical sectors. Four hundred forty-five subjects participated in the survey. The differenc…

Profili di responsabilità professionale nella terapia antalgica

VALIDITY AND CREDIBILITY OF A CHILD’S TESTIMONY OF SEXUAL ABUSE: A CASE REPORT

The allegation by a child victim of sexual abuse is, in many cases, the most important evidence of wrongdoing, especially in absence of medical or physical evidence or confes-sions of guilt. The Rorschach inkblot test is a projective personality assessment technique used to evaluate child witnesses. We report a case of three girls allegedly abused by the father, in which the psychometric evaluation with the Rorschach test did not give credibility to the testimony of the chil-dren. When interrogating a minor, it is very difficult to distinguish between a true and a lie. Indeed, many different elements can affect the dialogue, such as the child’s age, the events being discussed, interrogation…

COVID-19 Pandemic: New Prevention and Protection Measures

As of the end of February 2021, more than 420,000,000 confirmed cases of COVID-19 have been reported worldwide, with 5,856,224 deaths. Transmission of the different genetically engineered variants of SARS-CoV-2, which have been isolated since the beginning of the pandemic, occurs from one infected person to another by the same means: the airborne route, indirect contact, and occasionally the fecal–oral route. Infection is asymptomatic or may present with flulike symptoms such as fever, cough, and mild to moderate and severe respiratory distress, requiring hospitalization and assisted ventilation support. To control the spread of COVID-19, the World Health Organization (WHO) and Centers for …

Role of virtopsy in the postmortem diagnosis of drowning

Aims and objectives Methods and materials Results Conclusion Personal information References

il danno alla persona

Origine e decorso anomalo della coronaria destra in un caso fatale di tromboembolismo polmonare post-operatorio

La rilevanza del tromboembolismo polmonare trova giustificazione nella sua grande incidenza, nei dati sulla mortalità e nella sua brusca modalità di insorgenza, che la rende trattabile durante la fase acuta. L'arma più efficace contro la TEP è la prevenzione e a tal fine sono state proposte numerose linee guida. Scopo del presente lavoro è illustrare un evento tromboembolico polmonare fatale determinatosi nonostante la somministrazione di una tromboprofilassi aderente alle più accreditate linee guida emanate sull'argomento. La particolare origine anomala della coronaria destra del soggetto, non nota in vita, ha certamente favorito il decesso. Gli Autori pertanto illustrano il ruolo causale …

Evidenze medico legali in tema di dolore toracico

Ethical and legal issues of end of life between past and future in the "globalized" european mediterranean culture: the Italian experience.

CONGENITAL NEUROBLASTOMA: A RARE CASE OF PLURIVISCERAL METASTATIC DISSEMINATION

Neuroblastoma is one of the most common neonatal tumors. It involves children in early infancy and originates from neural crest cells of the adrenal gland medulla or sympathetic glia. We report an unusual case of congenital poorly differentiated neuroblastoma with multiple metastases in the brain and cerebellum. The biophysical profile showed a prominent polyhydramnios at 25.3 weeks of gestation; meantime, the mother was diagnosed with gestational diabetes. The mass was detected during the third ultrasonographic examination at 31.4 weeks of gestation. The fetus lived only one day after birth and the postmortem examinations were performed subsequently. An autopsy was performed both to unders…

<p>Guidelines and Current Assessment of Health Care Responsibility in Italy</p>

Clinical guidelines are a potential tool for improving the effectiveness and quality of healthcare, decreasing variability in clinical practice, and preventing adverse events. In the purview of Law no. 24/2017, adherence to national guidelines can lead to a reduction in medical malpractice claims and the practice of so-called "defensive medicine". The law has assigned a central role to the guidelines, establishing the National Institute of Health through the new Italian National Center for Clinical Excellence, Quality, and Security (CNEC) as the methodological guarantor in the process of national guideline development. Here we discuss the issue of professional liability as recently outlined…

Attività clinica : colpa medica e responsabilità professionale

Psychological and medico-legal perspectives on electroconvulsive therapy and patient-centered care: A short review of cross-cutting issues

Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines,etc.From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in …

Gli strumenti di valutazione delle difficoltà persistenti a svolgere i compiti e le funzioni dell'età nel minore

La valutazione del minore in ambito previdenziale ed assistenziale richiede una adeguato apporto multidisciplinare ed approccio interdisciplinare, di ordine clinico e psico-sociale; gli strumenti operativi di cui la scienza medica può dotarsi sono molteplici, ma nel contesto medico legale è soprattutto la valutazione secondo le direttive dell’Organizzazione Mondiale della sanità, nella recente codifica ICF (Classificazione Internazionale del Funzionamento, della Disabilità e della salute, Erikson ed.2001) nella versione YC, a fornire gli odierni strumenti di valutazione a supporto delle Commissioni Medico Legali.

LINEE GUIDA PER LA VALUTAZIONE DEL PARKINSON IN AMBITO DI INVALIDITA’ CIVILE

Progressive Isolated Hypoglossal Nerve Palsy and Sudden Asphyzial Death

Useful Evidence by Post-Mortem CT and Stereomicroscopy in Bone Injury: A Case Series from Forensic Practice

The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characte…

Violence against women in heterosexual couples: A review of psychological and medico-legal considerations.

Intimate partner violence against women (IPVAW) is the most pervasive violation of women’s rights worldwide, causing devastating lifelong damage. Victims can suffer physical, emotional or mental health problems, and experience detrimental effects in social, psychological and relational health with their families, especially children. Due to the complexity regarding violence against women in heterosexual couples, it is important to make a clear distinction between psychological and physical mistreatment, which also includes psychological violence. This differentiation is important in determining different emotional and psychological aspects of mistreatment in order to understand the reasons …

Malpractice medica. Un osservatorio per una prevenzione. Atti delle prime giornate di studio del GISDI. Napoli 12-13 marzo 2004

Guidelines and Current Assessment of Health Care Responsibility in Italy

Stefania Zerbo, Ginevra Malta, Antonina Argo Department of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, Legal Medicine Section, University of Palermo, Palermo, ItalyCorrespondence: Stefania ZerboDepartment of Health Promotion, Maternal and Child Care, “G. D’Alessandro”, Legal Medicine Section, University of Palermo, via del Vespro N. 129, Palermo 90127, ItalyTel +39 33 3725 0209Fax +39 09 1655 3203Email stefania.zerbo@unipa.itAbstract: Clinical guidelines are a potential tool for improving the effectiveness and quality of healthcare, decreasing variability in clinical practice, and preventing adverse events. In the…

Dentistry and Drug Adverse Events: Between Responsibilities and Regulations

The purpose of this paper is to renew interest and attention to the medical history, prescription, and/or use of drugs during dental practice. The work analyzes the issue of the use of drugs in dentistry from both a clinical and a medical–legal point of view. The laws governing the matter were also taken into consideration, relating them to the roles of prescriber and user that the dentist can acquire. Analysis of various aspects of this matter demonstrates that it is necessary for dentists to know the drugs and medical substances, their characteristics and properties, related effects, and interactions in order to use them appropriately and adequately. Knowledge of interferences, reac…

DOPING E RESPONSABILITA' PROFESSIONALE

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims. Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged, as confirmed by analyses and studies carried out at different levels and in different contexts. Internationally, different approaches are taken to the collection of forensic evi- dence and to the clinical and psychological treatment of alleged victims. Italian law n.96, 1996, foreseeing norms regarding rape and abuse, finally gave signifi- cant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II pro- gram to support victims of rape and abu…

Preventable fatal injury during rally race: a multidisciplinary approach

Abstract Introduction The motor vehicle crash (MVC) constitutes an important challenge for forensic pathology in order to identify the manner and cause of death. Our study focuses on a fatal accident during a rally race corresponding to MVC sub-category. Materials and method Postmortem computed tomography (PMCT) was performed before the conventional autopsy. Autoptic and PMCT data were compared. Data collection allowed analyzing biomechanical dynamics of the incident and post-traumatic injuries through qualitative-statistics and solicitation quantitative indices. Results Photo and circumstantial evidence analysis showed a wrong installation of double shoulder belt system of head and neck su…

Rischio clinico e sistemi di Incident Reporting a confronto: critesi ed ipotesi di miglioramento, quando funzionano e perché falliscono

gli Autori individuano alcune criticità del sistema di incident reporting attraverso un'analisi retrospettiva di esperienze nazionali ed internazionali, e, a conclusione, descrivono alcune possibili vie percorribili per il miglioramento del sistema.

Postmortem Imaging in Mass Disasters

The term “mass casualty” in the forensic field refers to a sudden tragic event involving a large number of people; such an event determines the need to perform a large number of autopsy exams, possibly in a short time. Mass casualties tend to involve emergencies that are unexpected and result in stressful situation when even those with no or scarce interest or experience could be called to play a role. Radiology could be helpful in the task of identifying victims, in cooperation with a multidisciplinary team, usually headed by a forensic specialist.

Pattern psicopatologici di giovani abusanti e modellizazione di un trattamento terapeutico riabilitativo precoce. Una ricerca nel distretto giudiziario minorile della Sicilia occidentale

La casistica di responsabilità professionale in ambito nefro-urologico esaminata alla luce dei principi di Clinical Risk Management

Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues

Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing …

Myocardial bridge pathology and preventable accidents during physical activity of healthy subjects: A case report and a literature review.

Myocardial bridging is a congenital coronary pathology described as a segment of coronary artery which courses through the myocardial wall under the muscle bridge. Although the prognosis of myocardial bridging is benign, sports medicine recognises myocardial bridging as a leading cause of sudden death among young basketball, football and soccer players. The authors report a case of a 42-year-old man who collapsed while playing football. He died notwithstanding prompt medical assistance and cardiopulmonary resuscitation. At autopsy, gross examination of the heart revealed the intramural course of the left anterior descending coronary artery to be 2 cm from its coronary ostial origin. Histol…

Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review

The upper cervical spine has unique anatomical features that distinguish it from the remainder of the cervical spine. Its motion segments make up a large amount of total cervical spine motion and, as a result,predispose it to a unique set of injuries. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to section of the spinal cord. The use of post mortem CT (PMCT), and the subsequent multi-planar and volume rendering reconstruction techniques can provide non-invasive, objective operator-independent imaging data set that may be further reviewed by other specialists. and can substantially add to forensic examinations of the skeleton, especial…

Informatica, web e telemedicina

Bioetica e Biopolitica della Medicina. La ricerca sulle cellule staminali al banco di Prova

In relazione alla frontiera della ricerca rappresentata dalle indagini sulle cellule staminali, gli Autori, analizzano le implicazioni valoriali di ordine bioetico alla luce di due posizioni etiche, etica della sacarlità della vita ed etica della qualità della vita, dalla cui discendono distinte poizioni valoriali on ovvie ricadute sulle sclete dle medico o del biologo ricercatore

Definizione di una mappa del rischio della specialità urologica

Overdose of Quetiapine—A Case Report with QT Prolongation

Quetiapine is an atypical antipsychotic drug used to treat bipolar disorder, schizophrenia, and major depressive disorder. Although several studies describe the adverse effects of intoxication with Quetiapine, only a few report an extreme overdose without comedications that lead to a life threat. We present a case of a 75-year-old male who tried to attempt suicide by ingesting 28 g of Quetiapine. During the management in the emergency department, both serum and urine samples were collected, allowing a complete pharmacokinetic analysis to be conducted, from the admission to the discharge.

Consenso informato

Homicide with post mortem dismemberment of the victim with previous amputation of right lower limb: Case report and review of the literature

The dismemberment of a corpse is comparatively rare in forensic medicine and usually performed with different types of sharp tools. The victim is always the victim of a homicide. Dismemberment usually occurs where the killing took place without prior planning by the perpetrator. We report a case of homicide with post mortem mutilation of the victim’s body with previous amputation of right lower limb in which the perpetrator was not identified. At autopsy, several fractures were detected on the cranial vault, and the cause of death was due to skull and brain injuries from multiple blunt force traumas.

A Fatal Case of a Paint Thinner Ingestion: Comparison Between Toxicological and Histological Findings

MATERNAL EXPOSURE TO STRESSFUL/TRAUMATIC EVENTS AND AUTISM SPECTRUM DISORDERS IN OFFSPRING: PRELIMINARY FINDINGS OF A CASE CONTROL PILOT STUDY.

The correlation between maternal exposure to stressful and traumatic events during pregnancy and autism spectrum disorder (ASD) in offspring has been studied in the literature. Fewer studies, however, have considered the mother's exposure to traumatic events during childhood. This work focuses on maternal exposure to these events in childhood and/or adulthood, relating it to autism spectrum disorder in offspring. A questionnaire was used to assess whether and to what type of event the mothers have been exposed, and to assess eventual peri-traumatic dissociation related to the traumatic event. The mothers involved in this study were recruited at the Child Neuropsychiatry Outpatient Clinic of…

FORENSIC INVESTIGATION IN AIR CRASH OF TUNINTER