0000000000975958
AUTHOR
Ginevra Malta
Evaluation of Correlation between Sleep and Psychiatric Disorders in a Population of Night Shift Workers: A Pilot Study
Background: Insomnia is the perception of inadequate, insufficient or non-restorative sleep. Of all sleep-related disorders, insomnia is the most common. It is important to remember that the sleep–wake cycle also plays a central role in the genesis of anxiety and depression. The aim of our study is to evaluate the association between sleep disturbances and anxiety and depression in a group of workers of both sexes who perform night shift work. Methods: Information on sleep disorders was collected by administering the Insomnia Severity Index (ISI) questionnaire. Statistical analysis was conducted using the Chi-square test to assess whether there were any differences between sex for those who…
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…
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”.
The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?
The Covid-19 pandemic caused a marked increase in admissions to intensive care units. The critically ill patients’ condition from the infection resulted in their deaths. The healthcare facilities have got into trouble because of the pandemic. In fact, they had to create additional beds in a very short time and to protect health workers with personal protective equipment. Healthcare professionals fear that there will be an increase in complaints and medico-legal malpractice claims and hence they have urged politicians to discuss this. The Italian Parliament recently debated the topic of medical liability and passed the Decree-Law no. 18 of 17 March 2020 (DL – so called Cura Italia) by which…
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…
Long-Term COVID: Case Report and Methodological Proposals for Return to Work
Almost two years after the beginning of the SARS-CoV-2 pandemic, the knowledge of which in the infectious and therapeutic spheres is constantly evolving, attention paid to the medicolegal aspects linked to this emergency phenomenon has mainly focused on the liability implications falling on healthcare personnel. With regard to the medicolegal assessment of the outcomes of COVID-19 illness, although it is a procedure that is commonly used, and although references in the assessment tables in force have been adhered to, a specific assessment protocol has not been standardized that takes into account, from an objective point of view, the degree of severity of the long-term residual outcomes and…
MALE VIOLENCE AGAINST WOMEN: INTEGRATION BETWEEN PSYCHOLOGICAL AND NEUROSCIENTIFIC DATA AND THEIR USE IN FORENSIC EVALUATION FOR THE JUDGMENTS
Human growth and development, starting from conception, are characterized by a progressive increase in body and organ dimensions, as well as specific functional maturity, under the influence of genetic as well as environmental and epigenetic determinants. Beyond a possible normal familial trait, increased fetal growth resulting in a large for gestational age newborn, isolated macrosomia or that associated with congenital malformation, can be attributable to both maternal metabolic and genetic pathology. Overgrowth syndromes are a heterogeneous group of diseases characterized by excessive tissue development often concomitant to neurodevelopmental involvement. Recently, an increased risk of f…
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
PHARMACOLOGICAL MANAGEMENT OF THE POLYTRAUMA PATIENT. ON ANALGESIC THERAPY GUIDELINES
In consideration of the constant, if not increasing number of polytrauma patients arriving in emergency rooms, the pharmacological treatment of pain is a topic that is always under observation and innovation. Even more important is the global management of pain in the polytrauma patient, i.e. its treatment in the phases even after hospitalisation. The existence of pharmacotherapeutic protocols is today an aid for the physician in order to act in the most appropriate way in the shortest possible time. This brief commentary is intended to be a practical guide to the analgesic treatment of the polytrauma patient, in the light of the most recent scientific evidence.
WORK ACTIVITIES AT INCREASED RISK OF TRAUMATIC INJURIES: AN INTEGRATED PREVENTIVE APPROACH
Included in the scope of workplace safety is that relating to potential accidents, i.e. the harmful consequences for human health crossed with the work environment factor. In the study of the determinism of these accidental events, it is important to achieve a biomechanical balance between two main elements: the human and the work environment (consisting of the physical, chemical and environmental factors, i.e. the equipment and what generates its use). Considering the most recent statistically recorded incidents, our analysis has focused on the accident sphere proper, where an imbalance in the above-mentioned binomial triggers the activation of multiple disciplines that actively and pro-ac…
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…
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…
Telemedicine during Covid-19 pandemic: Advantage or critical issue?
Telemedicine offers a support to traditional medicine, delivering clinical services when distance is a critical factor. Although this tool does not replace a medical examination, during Covid-19 pandemic, it reduces the spread of infection and avoids the need for a patient’s visit. It is useful in the management of chronic disorders or for patients undergoing palliative treatment. The University Hospital of Palermo has applied this in cases of chronic illness caring for patients who cannot stop their treatment, such as Department of Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal Medicine of Palermo, in particular, is also using telemedicine to manage medico-…
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
Cooking Particulate Matter: A Systematic Review on Nanoparticle Exposure in the Indoor Cooking Environment
Background: Cooking and fuel combustion in the indoor environment are major sources of respirable suspended particulate matter (RSPM), which is an excellent carrier of potentially harmful absorbed inorganic and organic compounds. Chronic exposure to RSPM can lead to acute pulmonary illness, asthma, cardiovascular disease, and lung cancer in people involved in cooking. Despite this, questions remain about the harmfulness of different particulate matter (PM) sources generated during cooking, and the factors influencing PM physico-chemical properties. The most reliable methods for sampling and analyzing cooking emissions remain only partially understood. Objectives: This review aims to compreh…
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…
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…
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…
The Influence of the COVID‑19 Pandemic Emergency on Alcohol Use: A Focus on a Cohort of Sicilian Workers
The period between the beginning and the end of the COVID-19 pandemic emergency generated a general state of stress, affecting both the mental state and physical well-being of the general population. Stress is the body’s reaction to events or stimuli perceived as potentially harmful or distressing. Particularly when prolonged over time, it can promote the consumption of different psychotropic substances such as alcohol, and thus the genesis of various pathologies. Therefore, our research aimed to evaluate the differences in alcohol consumption in a cohort of 640 video workers who carried out activities in smart working, subjects particularly exposed to stressful situations due to the string…
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…
Guidelines and Current Assessment of Health Care Responsibility in Italy
Stefania Zerbo, Ginevra Malta, Antonina Argo Department of Health Promotion, Maternal and Child Care, &ldquo;G. D&rsquo;Alessandro&rdquo;, Legal Medicine Section, University of Palermo, Palermo, ItalyCorrespondence: Stefania ZerboDepartment of Health Promotion, Maternal and Child Care, &ldquo;G. D&rsquo;Alessandro&rdquo;, 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…
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…
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…