1
|
Terranova C, Cestonaro C, Cinquetti A, Trevissoi F, Favretto D, Viel G, Aprile A. Sex differences and driving impairment related to psychoactive substances. Traffic Inj Prev 2024; 25:553-561. [PMID: 38497827 DOI: 10.1080/15389588.2024.2325607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE The first aim of the study was to identify sex differences in the use of psychoactive substances among subjects with a previous driving under the influence (DUI) episode. The secondary objective was to propose specific strategies for medico-legal improvements. METHODS This was a retrospective observational study that took place between June 1, 2019, and August 31, 2023. It was conducted on DUI subjects examined for reinstatement of their driver's license using an integrated medico-legal and toxicological approach. Ethyl glucuronide (EtG) and illicit psychoactive substances were determined from hair samples. We performed descriptive statistical analyses for the entire sample as well as separately by sex. Additionally, we conducted binary logistic regression analyses separately for males and females to identify protective/risk factors associated with previous road accidents and judgments of unfitness to drive due to excessive alcohol consumption (EtG ≥ 30 pg/mg). RESULTS The study included 2,221 subjects, comprising 1,970 men and 251 women. Men exhibited a higher prevalence of tobacco, alcohol, and illicit psychoactive substance use. Women were more frequently co-users of alcohol and psychoactive substances and involved in road accidents at the time of DUI. Among the men, being married or having a partner was found to be a protective factor concerning past traffic accidents. For both sexes, a DUI episode with a blood alcohol concentration (BAC) exceeding 1.5 g/L or the co-ingestion of alcohol and drugs was identified as a risk factor for road accident involvement. For men, smoking more than 20 cigarettes per day and, for women, having a DUI episode with a BAC over 1.5 g/L were the main factors indicating unfitness to drive, as determined through high hair EtG levels (> 30 pg/mg). Women with a previous history of road accidents were less likely to have EtG levels of 30 pg/mg or more. CONCLUSIONS The study confirmed sex differences in subjects with a previous DUI episode. A BAC exceeding 1.5 g/L or the simultaneous use of alcohol and drugs at the time of DUI necessitate careful assessment of both men and women seeking driver's license reinstatement. In women, a BAC exceeding 1.5 g/L is considered a risk factor for a subsequent judgment of unfitness to drive. The medico-legal assessment should also involve a thorough investigation of smoking habits in men, as these habits could be related to an increased risk of excessive alcohol consumption.
Collapse
Affiliation(s)
- Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Clara Cestonaro
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federica Trevissoi
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
2
|
Trevissoi F, Franchetti G, Fais P, Gabbin A, Giovannini E, Martini N, Sech M, Todesco G, Pizzi M, De Conti G, Giraudo C, Viel G, Cecchetto G. Detection of butterfly fractures of long bones through multi-slice computed tomography and micro-computed tomography. Leg Med (Tokyo) 2024; 67:102394. [PMID: 38217997 DOI: 10.1016/j.legalmed.2024.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Motor-vehicle accidents often result in lower limb injuries with biosseous fractures. The present study aimed at comparing multi-slice computed tomography (MS-CT), micro-computed tomography (micro-CT) and external fractography for the analyses of experimentally produced biosseus leg fractures. Briefly, 48 human legs amputated for medical reasons were defleshed and then experimentally fractured using a 3-point dynamic bending model (70,6 J of impact energy at the middle of the anterior surface of the tibia) producing 38 biosseous and 10 mono-osseous fractures with a total of 86 fractured bones. External fractography detected 63 (73,2%) "butterfly" fractures (24 (27,9%) complete and 39 (45,3%) incomplete), 14 (16,3%) "oblique" fractures, 6 (7,0%) "comminuted" fractures and 3 (3,5%) "transverse" fractures. Forty-three (43) of the 48 included legs displayed at least one butterfly fracture located at the tibia or fibula. MS-CT correctly detected and classified 16 complete and 20 incomplete butterfly fractures, failing to properly classify 27 fractures; 19 of these misclassifications led to an interpretative error on the trauma direction (i.e., 16 incomplete butterfly fractures classified as oblique fractures and 3 incomplete butterfly fractures classified as transverse). Micro-CT correctly detected and classified 22 complete and 37 incomplete butterfly fractures, failing to properly classify 4 fractures; two of these misclassifications led to an interpretative error on the trauma direction (i.e., two incomplete butterfly fractures classified as oblique fractures). Although further studies evaluating a wider number of fractures and fracture patterns are required to drive any definitive conclusions, this preliminary experimental investigation showed that MS-CT and micro-CT represent useful tools for reconstructing the morphology of leg fractures and could be crucial for trauma analysis in the forensic context. MS-CT could be used as a screening tool, micro-CT as second level analysis and external/internal fractography as third level, confirmatory analysis.
Collapse
Affiliation(s)
- Federica Trevissoi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Giorgia Franchetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Andrea Gabbin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Nicolò Martini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Maria Sech
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Giorgia Todesco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Marco Pizzi
- Radiology Unit, University-Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Giorgio De Conti
- Radiology Unit, University-Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Radiology, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100, Padova, Italy.
| |
Collapse
|
3
|
Secco L, Padalino P, Franceschetto L, Viero A, Pizzi M, De Conti G, Viel G, Fais P, Giraudo C, Cecchetto G. Micro-CT evaluation of morphological degenerative features of sterno-clavicular joint for age-at-death estimation in forensic anthropology - A qualitative analysis. Leg Med (Tokyo) 2024; 67:102374. [PMID: 38157674 DOI: 10.1016/j.legalmed.2023.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
The analysis of the sternoclavicular joint holds significant importance in forensic anthropology, especially through the evaluation of medial clavicular ossification stage, which, however, is helpful only in subjects younger than 30 years of age. Given this limitation, the aim of the present work was to examine, through micro-CT, the surface of sternoclavicular joints of deceased individuals across various age groups, aiming to identify age-related degenerative changes applicable to age estimation in adults over 30 years old. A total of 41 deceased subjects were categorized into three age groups (20-39 years; 40-59 years; ≥60 years) for the analysis. Degenerative morphological features on both clavicular and sternal articular surfaces, including topography, porosity, and presence of osteophytes, were evaluated using a composite scoring system based on a modified "Falys-Prangle method.", which assigns to each parameter specific score ranges: 1-3 for surface topography (smooth, slightly irregular, markedly irregular), 1-6 for porosity (absent, micro- and macroporosity for <50 % or >50 % of surface, surface breakdown), 1-3 for osteophytes (absent, present, not evaluable). The findings revealed a positive correlation between degenerative morphological features and age for both clavicular (rs = 0.719) and sternal articular surfaces (rs = 0.750). Additionally, the combined assessment of the clavicle and sternum, or the evaluation of the clavicle alone, exhibited better differentiation among the three age groups. The micro-CT evaluation of degenerative alterations affecting the sternoclavicular joint proves to be a reliable and efficient method for age estimation in adults.
Collapse
Affiliation(s)
- Laura Secco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Pasquale Padalino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Lisa Franceschetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Alessia Viero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Marco Pizzi
- Radiology Unit, University-Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Giorgio De Conti
- Radiology Unit, University-Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Chiara Giraudo
- Radiology Unit, University-Hospital of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| |
Collapse
|
4
|
Cestonaro C, Terranova C, Carollo M, Russo A, Rosa-Rizzotto M, Viel G, Favretto D, Aprile A. Hair toxicological analysis of infants and their mothers: a 5-year retrospective study focusing on cocaine. Int J Legal Med 2024:10.1007/s00414-024-03180-9. [PMID: 38400921 DOI: 10.1007/s00414-024-03180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
Prenatal and infant exposure to drugs of abuse is an emerging social and public health problem affecting children health and which may relate to child abuse and neglect. Exposure to drugs of abuse may occur through different routes, including intrauterine, breastfeeding, accidental intake, passive inhalation, and intentional administration. Currently, cases of suspected exposure can be investigated by hair toxicological analysis, the interpretation of which is, however, often difficult, leading to consequent difficulties in the management of such cases. In order to provide a contribution in terms of interpretation of the analytical results, this study aimed to search for the possible existence of elements, from a toxicological point of view, indicative towards the route of exposure. A retrospective study was performed on cases of suspected exposure to drugs of abuse in children aged 0-1 year, evaluated at a University Hospital between 2018 and 2022. Data of children hair toxicological analysis were analyzed and then compared with those of their mothers, when available; 41.6% children tested positive for cocaine. The study found a significant correlation between cocaine and benzoylecgonine concentrations, and a benzoylecgonine/cocaine ratio that tends to decrease as the age of children increases. From the comparison with mothers, a child/mother cocaine concentration ratio lower than 1 was found in all cases of hair sampled within the first week of life, and a ratio greater than or equal to 1 in all cases in which the sampling was performed later. These results, if confirmed in a larger cohort, could represent a contribution in the interpretation of cases of infant exposure to drugs of abuse and be integrated in the context of their multidisciplinary evaluation.
Collapse
Affiliation(s)
- Clara Cestonaro
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo Carollo
- Clinical Pharmacology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessia Russo
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Melissa Rosa-Rizzotto
- Child Abuse and Neglect Crisis Unit, Paediatrics Department, Padua University Teaching Hospital, Padua, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
5
|
Franchetti G, Cestonaro C, Giordano R, Callegari E, Giraudo C, Viel G, Cecchetto G. Severe starvation and restraint in a 47-year-old woman: Clinical, autopsy and histopathological evidence of abuse and neglect. Forensic Sci Int 2024; 355:111941. [PMID: 38290228 DOI: 10.1016/j.forsciint.2024.111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
The recognition of abuse and/or neglect still represents a challenge for both clinicians and forensic pathologists. Whereas abusive behaviors have been largely described among pediatric and elderly populations, adults' abuse and neglect is less frequently encountered, and therefore investigated. We report a case of a middle-aged woman without any known organic or psychiatric disorders who died of a multiple organ failure (MOF) due to extreme cachexia and bed-resting syndrome. The integration of all clinical, autopsy and histopathological data highlighted a picture of severe malnutrition, restraint, and widespread traumatic injuries related to abuse and neglect. We believe that the case here presented could be useful for both clinicians and forensic pathologists as it underlines once again the importance of collecting and integrating all medical evidence (both in the ante- and post-mortem settings) for reconstructing the most probable pathophysiology of disorders and injuries, comparing that reconstruction with the allegations of the caregivers, and thus identifying any potential abuse and/or neglect behaviors.
Collapse
Affiliation(s)
- Giorgia Franchetti
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| | - Clara Cestonaro
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Renzo Giordano
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Enrica Callegari
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, Via Giustiniani 2, 35121 Padova, Italy
| | - Guido Viel
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Giovanni Cecchetto
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| |
Collapse
|
6
|
Angiola F, Franchetti G, Cestonaro C, Agnolucci J, Giordano R, Viel G. Dying at home during the SARS-CoV-2 endemic: The importance of defining the exact mechanism of death. Leg Med (Tokyo) 2024; 66:102361. [PMID: 38039658 DOI: 10.1016/j.legalmed.2023.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Coronavirus Disease 2019 (COVID-19) has become endemic in Europe thanks to the presence of less deadly and more infectious variants and to the existence of a significant portion of unvaccinated people among the general population. SARS-Cov-2 related deaths are probably going to fade in the next years, but Covid-19 should still be considered a potential cause of death in the out-of-hospital setting in the next future. MATERIAL AND METHODS Three (3) cases of unexpected death at home are here presented. Each case has been investigated with the same methodological approach: death scene investigation (DSI), complete autopsy with histology, immunohistochemistry, RNA in situ hybridization for SARS-CoV-2 spike protein in lung tissue, toxicology and microbiology. RESULTS AND DISCUSSION All three cases had a COVID + post-mortem nasopharyngeal swab. Histology and immunohistochemistry revealed a SARS-CoV-2 lung involvement in only two of the cases (Cases 2 and 3), while a septic bacterial pneumonia was found in Case 1, where RNA-in situ hybridization for viral spike protein showed no reactivity in pneumocytes. The integration of all postmortem evidence allowed to attribute a different role of SARS-Cov-2 in the determinism of the death. CONCLUSION In the current post-pandemic context, SARS-CoV-2 remains a possible cause of death when investigating out-of-hospital unexpected deaths. Since a positive post-mortem swab does not automatically imply a COVID-19-related death, histology and immunohistochemistry are helpful for identifying SARS-CoV-2 lung involvement and, therefore, its potential active role in the determinism of death.
Collapse
Affiliation(s)
- Francesco Angiola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giorgia Franchetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Clara Cestonaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Jacopo Agnolucci
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Renzo Giordano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy.
| |
Collapse
|
7
|
Callegari E, Agnolucci J, Angiola F, Fais P, Giorgetti A, Giraudo C, Viel G, Cecchetto G. The Precision, Inter-Rater Reliability, and Accuracy of a Handheld Scanner Equipped with a Light Detection and Ranging Sensor in Measuring Parts of the Body-A Preliminary Validation Study. Sensors (Basel) 2024; 24:500. [PMID: 38257593 PMCID: PMC10820714 DOI: 10.3390/s24020500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Anthropometric measurements play a crucial role in medico-legal practices. Actually, several scanning technologies are employed in post-mortem investigations for forensic anthropological measurements. This study aims to evaluate the precision, inter-rater reliability, and accuracy of a handheld scanner in measuring various body parts. METHODS Three independent raters measured seven longitudinal distances using an iPad Pro equipped with a LiDAR sensor and specific software. These measurements were statistically compared to manual measurements conducted by an operator using a laser level and a meterstick (considered the gold standard). RESULTS The Friedman test revealed minimal intra-rater variability in digital measurements. Inter-rater variability analysis yielded an ICC = 1, signifying high agreement among the three independent raters. Additionally, the accuracy of digital measurements displayed errors below 1.5%. CONCLUSIONS Preliminary findings demonstrate that the pairing of LiDAR technology with the Polycam app (ver. 3.2.11) and subsequent digital measurements with the MeshLab software (ver. 2022.02) exhibits high precision, inter-rater agreement, and accuracy. Handheld scanners show potential in forensic anthropology due to their simplicity, affordability, and portability. However, further validation studies under real-world conditions are essential to establish the reliability and effectiveness of handheld scanners in medico-legal settings.
Collapse
Affiliation(s)
- Enrica Callegari
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Jacopo Agnolucci
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Francesco Angiola
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (P.F.); (A.G.)
| | - Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (P.F.); (A.G.)
| | - Chiara Giraudo
- Unit of Radiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35100 Padova, Italy;
| | - Guido Viel
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| | - Giovanni Cecchetto
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy; (E.C.); (J.A.); (F.A.); (G.V.)
| |
Collapse
|
8
|
Perilli M, Toselli F, Franceschetto L, Cinquetti A, Ceretta A, Cecchetto G, Viel G. Phosphatidylethanol (PEth) in Blood as a Marker of Unhealthy Alcohol Use: A Systematic Review with Novel Molecular Insights. Int J Mol Sci 2023; 24:12175. [PMID: 37569551 PMCID: PMC10418704 DOI: 10.3390/ijms241512175] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Alcohol Use Disorders Identification Test (AUDIT) and its short form, the AUDIT-C, the main clinical instruments used to identify unhealthy drinking behaviors, are influenced by memory bias and under-reporting. In recent years, phosphatidylethanol (PEth) in blood has emerged as a marker of unhealthy alcohol use. This systematic review aims to investigate the molecular characteristics of PEth and summarize the last ten years of published literature and its use compared to structured questionnaires. A systematic search was performed, adhering to PRISMA guidelines, through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science. The inclusion criteria were as follows: PEth was used for detecting unhealthy alcohol consumption in the general population and quantified in blood through liquid chromatography coupled to mass spectrometry, with full texts in the English language. Quality assessment was performed using the JBI critical appraisal checklist. Twelve papers were included (0.79% of total retrieved records), comprising nine cross-sectional studies and three cohort studies. All studies stratified alcohol exposure and quantified PEth 16:0/18:1 through liquid chromatography coupled to mass spectrometry (LC-MS) in liquid blood or dried blood spots (DBS) with lower limits of quantitation (LLOQ) ranging from 1.7 ng/mL to 20 ng/mL. A correlation between blood PEth level and the amount of alcohol ingested in the previous two weeks was generally observed. PEth interpretative cut-offs varied greatly among the included records, ranging from 4.2 ng/mL to 250 ng/mL, with sensitivity and specificity in the ranges of 58-100% and 64-100%, respectively. Although the biomarker seems promising, further research elucidating the variability in PEth formation and degradation, as well as the molecular mechanisms behind that variability, are necessary.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy; (M.P.); (F.T.); (L.F.); (A.C.); (A.C.); (G.C.)
| |
Collapse
|
9
|
Piva E, Fais P, Ioime P, Forcato M, Viel G, Cecchetto G, Pascali JP. Per- and polyfluoroalkyl substances (PFAS) presence in food: Comparison among fresh, frozen and ready-to-eat vegetables. Food Chem 2023; 410:135415. [PMID: 36652797 DOI: 10.1016/j.foodchem.2023.135415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
There is a worldwide discussion to provide safety limits in food for per- and polyfluoroalkyl substances (PFAS), a group of persistent contaminants associated to human disease. Processed food is more at risk of containing increased amounts of PFAS as a consequence of intentionally or non-intentionally contamination during manipulation and packaging. Among food products, also vegetables can be submitted to industrial manipulation; therefore, a different PFAS content correlated to the level of vegetables processing is conceivable. This study assessed the amount and type of PFAS present in fresh, frozen and ready-to-eat vegetables. Differences have been observed between the three groups of samples in the average PFAS content; the difference between ready-to eat and frozen vegetables resulted statistically significative. Organic vegetables displayed a lower total amount of PFAS respect to the traditional counterpart. The impact of industrial manipulation remains to be cleared, but pesticides use during cultivation could be considered a source of PFAS contamination.
Collapse
Affiliation(s)
- Elena Piva
- dtoLABS, Via Pozzuoli, 13C/13D, 30038 Spinea (VE), Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Pasquale Ioime
- dtoLABS, Via Pozzuoli, 13C/13D, 30038 Spinea (VE), Italy
| | - Mattia Forcato
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Falloppio 50, 35127 Padova, Italy
| | - Guido Viel
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Falloppio 50, 35127 Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Falloppio 50, 35127 Padova, Italy
| | - Jennifer P Pascali
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Via Falloppio 50, 35127 Padova, Italy
| |
Collapse
|
10
|
Cecchetto G, De Leo D, Pancheri A, Franchetti G, Proto S, Cocchio S, Furlan P, Corlianò P, Baldo V, Viel G, Feltrin G. Organ procurement requiring the authorization of the judicial authority. An epidemiological investigation in the Veneto region (Italy). Leg Med (Tokyo) 2023; 61:102218. [PMID: 36796174 DOI: 10.1016/j.legalmed.2023.102218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND When death occurs through a mechanism requiring a forensic investigation, consent for organ harvesting must be sought from the Judicial Authority (JA). AIM To perform a retrospective study of potential organ donors in the Veneto region over a six-year period (2012-2017), analysing any differences between cases in which the JA approved or denied organ harvesting. MATERIAL AND METHODS Both non-heart beating (NHB) and heart beating (HB) donors were included. For HB cases, personal and clinical data were collected. To evaluate the correlation between the JA response and the circumstantial and clinical data a logistic multivariate analysis was performed, estimating the adjusted odds ratios (adjORs). RESULTS Between 2012 and 2017, 17,662 organ and/or tissue donors were included, of which 16,418 were NHB donors and 1,244 HB-donors. Among the 1,244 HB-donors, JA authorization was asked in 200 cases (16.1%), approved in 154 cases (77.0%), limited in 7 cases (3.5%) and denied in 39 cases (19.5%). The JA denied the authorization for organ harvesting in 53,3% of cases with hospitalizations of less than 1 day and in 9,4% of cases with hospitalization exceeding one week [adjOR(95%CI) = 10.67 (1.92-59.22)]. The performance of an autopsy was linked to a higher chance of denied outcome from the JA [adjOR(95%CI): 3.45 (1.42-8.39)]. CONCLUSIONS Improvements in the communication between organ procurement organizations and the JA through efficient protocols furnishing detailed information on the cause of death might lead to a better procurement process with an increase in the number of transplanted organs.
Collapse
Affiliation(s)
- Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| | - Domenico De Leo
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Anna Pancheri
- Department of Diagnostics and Public Health - Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Giorgia Franchetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Sara Proto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Patrizia Furlan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Pantaleo Corlianò
- Regional Centre for Transplant Coordination of Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Legal Medicine and Toxicology, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Giuseppe Feltrin
- Regional Centre for Transplant Coordination of Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
| |
Collapse
|
11
|
Franceschetto L, Perilli M, Cinquetti A, Giraudo C, Gardi M, Cecchetto G, Viel G. Phosphatidylethanol in Maternal or Neonatal Blood to Detect Alcohol Exposure during Pregnancy: A Systematic Review. Life (Basel) 2022; 12:life12101528. [PMID: 36294962 PMCID: PMC9604963 DOI: 10.3390/life12101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy, even at low doses, may damage the fetus. Pregnant women tend to underreport their alcohol consumption generating the need for sensitive and specific biomarkers, among which PEth has emerged due to its high specificity and possibility to be measured in both maternal and neonatal blood. The aim of this study is to systematically review the latest 20 years of literature for depicting the state of the art, the limitations, and the prospects of PEth for estimating alcohol consumption during pregnancy. MATERIALS AND METHODS A systematic search, adhering to PRISMA guidelines, of the latest 20 years of literature through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science, with time limits 1 January 2002-1 March 2022, was performed. The inclusion criteria were as follows: PEth used for detecting alcohol consumption during pregnancy, quantified in blood through liquid chromatography coupled to mass spectrometry, and full texts in the English language. Opinion papers, editorials, and narrative reviews were excluded. RESULTS Sixteen (16) papers were included in the present review (0.81% of total retrieved records). All the included records were original articles, of which there were seven prospective cohort/longitudinal studies, six cross-sectional studies, two observational-descriptive studies, and one retrospective study. All studies assayed PEth in at least one biological matrix; seven (7) studies quantified PEth in maternal blood, seven studies in newborn blood, and only two studies in both maternal and neonatal blood. In several included papers, PEth proved more sensitive than self-reports for identifying pregnant women with an active alcohol intake with the diagnostic efficiency improving with the increase of the maternal alcohol intake. CONCLUSIONS Further studies, performed on wider and well-stratified populations, are needed to drive any definitive conclusion. PEth is a promising marker for monitoring alcohol use in pregnancy; however, at the present time, its use is still limited mainly by the absence of a globally agreed interpretative cut-off, the paucity of data regarding its specificity/sensitivity, and the lack of standardization on the diagnostic efficiency of the different isoforms.
Collapse
Affiliation(s)
- Lisa Franceschetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Matteo Perilli
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy
| | - Mario Gardi
- Unit of Urology, Sant’Antonio Hospital, University Hospital of Padua, 35100 Padua, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| |
Collapse
|
12
|
Franchetti G, Viel G, Fais P, Fichera G, Cecchin D, Cecchetto G, Giraudo C. Forensic applications of micro-computed tomography: a systematic review. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose
The aim of this systematic review was to provide a comprehensive overview of micro-CT current applications in forensic pathology, anthropology, odontology, and neonatology.
Methods
A bibliographic research on the electronic databases Pubmed and Scopus was conducted in the time frame 01/01/2001–31/12/2021 without any language restrictions and applying the following free-text search strategy: “(micro-computed tomography OR micro-CT) AND (forensic OR legal)”. The following inclusion criteria were used: (A) English language; (B) Application of micro-CT to biological and/or non-biological materials to address at least one forensic issue (e.g., age estimation, identification of post-mortem interval). The papers selected by three independent investigators have been then classified according to the investigated materials.
Results
The bibliographic search provided 651 records, duplicates excluded. After screening for title and/or abstracts, according to criteria A and B, 157 full-text papers were evaluated for eligibility. Ninety-three papers, mostly (64) published between 2017 and 2021, were included; considering that two papers investigated several materials, an overall amount of 99 classifiable items was counted when referring to the materials investigated. It emerged that bones and cartilages (54.55%), followed by teeth (13.13%), were the most frequently analyzed materials. Moreover, micro-CT allowed the collection of structural, qualitative and/or quantitative information also for soft tissues, fetuses, insects, and foreign materials.
Conclusion
Forensic applications of micro-CT progressively increased in the last 5 years with very promising results. According to this evidence, we might expect in the near future a shift of its use from research purposes to clinical forensic cases.
Collapse
|
13
|
Viero A, Biehler-Gomez L, Messina C, Cappella A, Giannoukos K, Viel G, Tagliaro F, Cattaneo C. Utility of micro-CT for dating post-cranial fractures of known post-traumatic ages through 3D measurements of the trabecular inner morphology. Sci Rep 2022; 12:10543. [PMID: 35732857 DOI: 10.1038/s41598-022-14530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/08/2022] [Indexed: 11/09/2022] Open
Abstract
Fracture dating is an issue at the forefront of forensic sciences. While dating fracture is crucial to understanding and verifying the chronology of events in cases of abuse and violent death, its application is the subject of considerable discussion in the scientific community, filled with limitations and difficulties. Current methods for fracture dating are mainly based on a qualitative assessment through macroscopy, microscopy, and imaging and subject to variations depending on the experience of the observer. In this paper, we investigated the potential of quantifiable micro-CT analysis for fracture dating. Five histomorphometric parameters commonly used for the study of the 3D bone trabecular microarchitecture with micro-CT were calculated based on nine fractures of known post-traumatic ages, including the degree of anisotropy, connectivity density, bone volume fraction, trabecular thickness, and trabecular separation. As a result, trends in the evolution of the microarchitecture of the bone relative to age of the callus could be identified, in particular concerning anisotropy, trabecular separation and connectivity density, consistent with the healing bone process. The findings obtained in this pilot study encourage further research in quantifiable parameters of the bone microarchitecture as they could represent useful features for the construction of objective models for fracture dating.
Collapse
Affiliation(s)
- Alessia Viero
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.,Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10, 37134, Verona, Italy.,Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| | - Lucie Biehler-Gomez
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy.
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Annalisa Cappella
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Laboratorio Di Morfologia Umana Applicata, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Konstantinos Giannoukos
- Elettra-Sincrotrone Trieste S.C.P.A., SYRMEP Group, AREA Science Park, Strada Statale 14, 34149, Basovizza, Trieste, Italy
| | - Guido Viel
- Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Franco Tagliaro
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10, 37134, Verona, Italy.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russia
| | - Cristina Cattaneo
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
| |
Collapse
|
14
|
Cinquetti A, Franchetti G, Fichera G, Giraudo C, Viel G, Cecchetto G. Entrapment within an ottoman storage bed: an unusual accidental asphyxial death. Forensic Sci Med Pathol 2022; 18:176-181. [PMID: 35320454 PMCID: PMC9106607 DOI: 10.1007/s12024-022-00473-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/14/2022]
Abstract
Herein, we present an uncommon forensic case of death by asphyxia. The victim was a woman whose body at death scene investigation (DSI) was discovered beside an ottoman storage bed. According to the rescue team, who had moved the body before our arrival, the body was originally found in the prone position and stuck with the neck, thorax and arms within the bed. Examination of the body showed hypostasis that was mainly distributed to the face and the lower chest while sparing the neck and the upper chest. The face was markedly swollen, and the eyes were congested with blood. Dissection and histology revealed pulmonary oedema and emphysema of both lungs. Integrating circumstantial, radiology and autopsy data, it was established that the victim, while trapped between the mattress and the edge of the ottoman storage bed, died by mechanical asphyxia due to cervical-thoracic compression and postural asphyxia acting simultaneously.
Collapse
Affiliation(s)
- Alessandro Cinquetti
- Legal Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giorgia Franchetti
- Legal Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giulia Fichera
- Pediatric Radiology Unit, Padova University Hospital, Via Giustiniani 2, 35121 Padova, Italy
| | - Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine – DIMED, Via Giustiniani 2, 35121 Padova, Italy
| | - Guido Viel
- Legal Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giovanni Cecchetto
- Legal Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| |
Collapse
|
15
|
Fassina G, Rigato S, Fassan M, Rotter G, Sanavio M, Cecchetto G, Viel G. A case of lethal varicose vein rupture caused by massive leiomyoma. Forensic Sci Int 2021; 328:111039. [PMID: 34624735 DOI: 10.1016/j.forsciint.2021.111039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Varicose veins are a common and benign disease, especially affecting the lower limbs of the elderly. This pathology can exhibit several complications, which in the majority of cases do not require medical treatment; life-threatening conditions are possible but extremely rare. We present here a suspected murder case in which a woman was found dead in her home with a large amount of blood soiling the floor and the furniture of her house. Death scene investigation (DSI) with body inspection and bloodstain pattern analysis (BPA) were not exhaustive in excluding a homicide, and the prosecutor asked for a forensic autopsy. During the dissection, a uterine neoplasia, which altered the lower limb venous system, was detected, thus allowing to reconstruct the physio-pathological mechanism of the formation and rupture of the varicose vein.
Collapse
Affiliation(s)
- Giacomo Fassina
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padua, Padua, Italy.
| | - Selene Rigato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Medicine, Pathology, University of Padua, Padua, Italy
| | - Gabriele Rotter
- Polizia di Stato, Gabinetto Regionale di Polizia Scientifica per la Calabria, Reggio Calabria, Italy
| | - Matteo Sanavio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padua, Padua, Italy
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padua, Padua, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Legal Medicine, University of Padua, Padua, Italy
| |
Collapse
|
16
|
Politi C, Gabbin A, Cecchetto G, Montisci M, Viel G, Pascali JP. A case study on MDMA. Two fatal cases involving young adults. AUST J FORENSIC SCI 2021. [DOI: 10.1080/00450618.2021.1921267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caterina Politi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Gabbin
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Montisci
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Guido Viel
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Jennifer P. Pascali
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
17
|
Buja A, Fonzo M, Sperotto M, De Battisti E, Baldovin T, Cocchio S, Furlan P, Saia M, Scapellato ML, Viel G, Baldo V, Bertoncello C. Education level and hospitalization for ambulatory care sensitive conditions: an education approach is required. Eur J Public Health 2021; 30:207-212. [PMID: 31321416 DOI: 10.1093/eurpub/ckz122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies in several different countries and settings suggest that ambulatory care-sensitive conditions (ACSCs)-related hospitalizations could be associated more with socioeconomic variables than with the quality of primary healthcare services. The aim of the present study was to analyze the potential links between education levels or other social determinants and ACSC-related hospitalization rates. METHODS We analyzed a total of 467 504 records of ordinary discharges after acute hospitalization in 2015-16 for patients 20-74 years old residing in the Veneto Region. We calculated the prevention quality indicators (PQIs) developed by the Agency for Healthcare Research and Quality. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were estimated with a set of Poisson regressions to measure the relative risk by sociodemographic level. RESULTS Hospitalizations for ACSCs accounted for 3.9% of all hospital admissions (18 436 discharges), and the crude hospitalization rate for ACSCs among 20- to 74-year-olds was 26.6 per 10 000 inhabitants (95% CI, 25.8-27.4). For all conditions, we found a significant association with formal education. In the case of the overall composite PQI#90, e.g. poorly educated people (primary school or no schooling) were at significantly higher risk of hospitalization for ACSCs than the better educated (RR, 4.50; 95% CI, 4.13-4.91). CONCLUSIONS Currently available administrative data regarding ACSCs may be used effectively for reveal equity issues in the provision of health care. Our results indicate that an educational approach inside Primary Health Care could address the extra risk for preventable healthcare demands associated with poorly educated patients.
Collapse
Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Marco Fonzo
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Milena Sperotto
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Elisa De Battisti
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Tatjana Baldovin
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Silvia Cocchio
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Patrizia Furlan
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Mario Saia
- ULSS 6 Euganea, Veneto Region, Padova, Italy
| | - Maria Luisa Scapellato
- Department of Cardiological, Thoracic and Vascular Sciences, Occupational Medicine Unit, University of Padua, Padova, Italy
| | - Guido Viel
- Department of Cardiological, Thoracic and Vascular Sciences, Legal Medicine Unit, University of Padua, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Chiara Bertoncello
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| |
Collapse
|
18
|
Giorgetti A, Pascali J, Montisci M, Amico I, Bonvicini B, Fais P, Viero A, Giorgetti R, Cecchetto G, Viel G. The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis. Metabolites 2021; 11:metabo11030189. [PMID: 33810163 PMCID: PMC8004630 DOI: 10.3390/metabo11030189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p < 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (<600 ng/mL) might lead to death in the presence of the above conditions/diseases.
Collapse
Affiliation(s)
- Arianna Giorgetti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.G.); (P.F.)
| | - Jennifer Pascali
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Massimo Montisci
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Irene Amico
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Barbara Bonvicini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.G.); (P.F.)
| | - Alessia Viero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, via Conca 71, 60126 Ancona, Italy;
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (J.P.); (M.M.); (I.A.); (B.B.); (A.V.); (G.C.)
- Correspondence:
| |
Collapse
|
19
|
Bonvicini B, Cecchi R, Parisi SG, Masotti V, Viero A, Cecchetto G, Terranova C, Viel G, Montisci M. Legal scenarios in the coronavirus time: Medico legal implications in the aspects of governance. Leg Med (Tokyo) 2020; 48:101832. [PMID: 33373948 PMCID: PMC7837105 DOI: 10.1016/j.legalmed.2020.101832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Along with rising levels of the infection around the world, the state of emergency prompted by the COVID-19 pandemic has also been having a heavy legal impact. The situation is posing important criminal challenges, as well as an ocean of social and public health issues around the world. It has not only directly affected constitutionally-guaranteed rights and individual freedoms, but also brought to the fore certain types of criminal offence that had previously been of little practical importance, such as the crime of 'maliciously or unintentionally causing an epidemic'. Different countries and states have introduced policies to manage the emergency at different times and in different ways. The measures adopted have been the object of much criticism, also raising questions of constitutional legitimacy in countries like Italy. The present contribution begins with a brief outline of the different international scenarios. Then we examine some of the medicolegal aspects of criminal offences previously envisaged and newly introduced since the arrival of the pandemic. We suggest the need for a sort of 'code of public health laws for the time of coronavirus', that could also be applied to other public health emergencies, pandemic or otherwise. The idea is to give operators in the sector and the general population the opportunity to identify clear and simple rules to follow in the current complex global situation. We need a new, appropriate interpretation of the 'boundaries' of our individual rights in relation to the need to safeguard the wider community and its more vulnerable members.
Collapse
Affiliation(s)
- Barbara Bonvicini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Rossana Cecchi
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | | | - Alessia Viero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Claudio Terranova
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Montisci
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| |
Collapse
|
20
|
Pascali JP, Fais P, Viel G, Cecchetto G, Montisci M. Correction to: Is old stuff back? A fatal case of ethyl chloride sniffing. Egypt J Forensic Sci 2020. [DOI: 10.1186/s41935-020-00199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
Collapse
|
21
|
De Matteis M, Giorgetti A, Viel G, Giraudo C, Terranova C, Lupi A, Fais P, Puggioni A, Cecchetto G, Montisci M. Correction to: Homicide and concealment of the corpse. Autopsy case series and review of the literature. Int J Legal Med 2020; 135:1115. [PMID: 32556491 DOI: 10.1007/s00414-020-02345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maria De Matteis
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy
| | - Arianna Giorgetti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy.
| | - Chiara Giraudo
- Institute of Radiology, Department of Medicine (DiMED), University-Hospital Padova, Via Giustiniani 2, Padova, Italy
| | - Claudio Terranova
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy
| | - Amalia Lupi
- Institute of Radiology, Department of Medicine (DiMED), University-Hospital Padova, Via Giustiniani 2, Padova, Italy
| | - Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandra Puggioni
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio, 50, Padova, Italy
| |
Collapse
|
22
|
Abstract
Regrettably, after a first moment of appreciation and praise of the citizens for healthcare personnel facing COVID 19 pandemia, numerous episodes of actions taken against them on the issue of their legal liability followed. Impelling is to start an argumentation on this problem that aims to establish a shared conduct in dealing with them. The authors propose a basis for discussion on which to begin a constructive debate.
Collapse
Affiliation(s)
| | - Guido Viel
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Rossana Cecchi
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Massimo Montisci
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| |
Collapse
|
23
|
Giraudo C, Montisci M, Giorgetti A, Martinuzzo L, Bisceglia M, Moschi S, Fais P, Weber M, Quaia E, Viel G, Cecchetto G. Intra-class and inter-class tool discrimination through micro-CT analysis of false starts on bone. Int J Legal Med 2019; 134:1023-1032. [PMID: 31522297 DOI: 10.1007/s00414-019-02157-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
Micro-CT has successfully been applied to the characterization of false starts (FSs) and, among several parameters, kerf width seems to correlate to the tool blade. The aim of the present study was to evaluate the diagnostic value of micro-CT for the differentiation of saw marks produced by different classes of saws and by saws belonging to the same class and differing only in number of teeth per inches (TPI). A morphological and morphometric analysis of 84 marks, produced by 6 saws belonging to 3 morphological classes, was performed. In the experimental cohort, for each parameter, statistically significant differences in intra- and inter-class analysis were searched for and cut-offs were established. The diagnostic accuracy of cut-offs was assessed through statistical analyses on the validation cohort. The morphological assessment did not allow to differentiate saws differing only in TPI. Angle 1 and top kerf width, respectively for cross-cut and rip-cut saws with alternating set, allowed a good discrimination between FSs produced by tools belonging to the same morphological class. High positive predictive values were found in intra-class analyses, while results in inter-class analyses were less encouraging. In cases of dismemberment, a micro-CT-based analysis of FSs is strongly suggested as a part of a multistep and multimodal methodology of assessment, which includes scanning electron microscopy and stereomicroscopy. A morphological assessment should be followed by an experimental trial and by a morphometric analysis. Further studies are needed to evaluate hampering factors, such as damage by physico-chemical agents.
Collapse
Affiliation(s)
- Chiara Giraudo
- Institute of Radiology, Department of Medicine-DIMED, University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Arianna Giorgetti
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Lisa Martinuzzo
- Institute of Radiology, Department of Medicine-DIMED, University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Marco Bisceglia
- Unit of Forensic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Sofia Moschi
- Institute of Radiology, Department of Medicine-DIMED, University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences (DIMEC), Institute of Legal Medicine, University of Bologna, Bologna, Italy
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy.
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| |
Collapse
|
24
|
Pascali JP, Viel G, Cecchetto G, Pigaiani N, Vanin S, Montisci M, Fais P. The Red Swamp Crayfish
Procambarus Clarkii
(the Louisiana Crayfish) as a Particular Scavenger on a Human Corpse. J Forensic Sci 2019; 65:323-326. [DOI: 10.1111/1556-4029.14145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer P. Pascali
- Forensic Toxicology Unit Department of Health Sciences University of Florence Largo Brambilla 3 50134 Florence Italy
| | - Guido Viel
- Section of Legal Medicine Department of Cardiac Thoracic and Vascular Sciences University of Padova Via Falloppio 50 35121 Padova Italy
| | - Giovanni Cecchetto
- Section of Legal Medicine Department of Cardiac Thoracic and Vascular Sciences University of Padova Via Falloppio 50 35121 Padova Italy
| | - Nicola Pigaiani
- Unit of Forensic Medicine Department of Diagnostics and Public Health University of Verona P.le L.A. Scuro 1037134 Verona Italy
| | - Stefano Vanin
- School of Applied Sciences University of Huddersfield Queensgate HD1 3DH Huddersfield U.K
| | - Massimo Montisci
- Section of Legal Medicine Department of Cardiac Thoracic and Vascular Sciences University of Padova Via Falloppio 50 35121 Padova Italy
| | - Paolo Fais
- Unit of Legal Medicine Department of Medical and Surgical Sciences University of Bologna Via Irnerio 49 40126 Bologna Italy
| |
Collapse
|
25
|
|
26
|
Giorgetti A, Nalesso A, Cecchetto G, Pizzi M, Bellan A, Viel G, Montisci M. Two fatal intoxications by colchicine taken for saffron. Clinical, medico-legal and forensic toxicological implications. Leg Med (Tokyo) 2019; 38:64-68. [PMID: 30991227 DOI: 10.1016/j.legalmed.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/11/2019] [Accepted: 04/10/2019] [Indexed: 11/16/2022]
Abstract
Although fatal colchicine intoxications are rare and mostly related to suicidal intake or accidental overdose, other hypotheses should be considered when dealing with colchicine poisoning. We present a case of double, acute, and subacute, fatal colchicine intoxication in a married couple. The 70-year-old male victim suddenly died after vomiting and diarrhea. The next day his wife showed aggravating gastrointestinal symptoms and was hospitalized with a diagnosis of septic shock. A complete postmortem examination on the man was performed, together with histopathological analysis. Toxicological examination performed through liquid chromatography coupled to mass spectrometry revealed a colchicine blood peripheral concentration of 33 ng/mL. A few days after hospitalization, the woman showed a colchicine plasma concentration of 32 ng/mL. Despite veno-venous hemofiltration, she ultimately died of septic shock and multi-organ failure. Death scene investigation revealed that, a few days before the death of the male victim, the couple had collected wild saffron and had eaten a presumed saffron risotto. The integrated analysis of circumstantial, clinical, postmortem and toxicological data allowed to establish that the couple had died of a fatal accidental intoxication due to the ingestion of natural colchicine, mistaken for saffron. The death of the male was deemed caused by acute cardiovascular collapse induced by acute intoxication, while the female had suffered a subacute poisoning by antimitotic agent, resulting in immunosuppression and systemic infection. Toxicological analyses, promptly performed on the man for forensic purposes, directed the investigations and suggested the clinical diagnosis on the woman.
Collapse
Affiliation(s)
- Arianna Giorgetti
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Alessandro Nalesso
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Marco Pizzi
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Bellan
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy.
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| |
Collapse
|
27
|
Visentin S, Massaro L, Viel G, Cecchetto G, Montisci M. Suicide identification during on-site inspection. Proposal and application of an interpretative method for death scene investigation. Forensic Sci Int 2019; 297:148-155. [DOI: 10.1016/j.forsciint.2019.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
|
28
|
Fais P, Pascali JP, Mazzotti MC, Viel G, Palazzo C, Cecchetto G, Montisci M, Pelotti S. Possible fatal hyperthermia involving drug abuse in a vehicle: case series. Forensic Sci Int 2018; 292:e20-e24. [PMID: 30318181 DOI: 10.1016/j.forsciint.2018.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Major interplaying causes of heat stroke (HS) and fatal hyperthermia are climate, physical activity, artificial extreme ambient temperatures, confinement in a small compartment, and effects of drugs and chemicals, combined with predispositions and complications. A common and unfortunate cause of HS is vehicular hyperthermia (VH) death. Hyperthermia in a vehicle is a type of environmental thermal disorder, involving victim's susceptibility, confinement with restraint, and possible influences of drugs and poisons, including exhaust gas containing complex fumes, carbon dioxide and monoxide. Whereas VH typically occurs when babies or young children are being left unattended in parked vehicles in direct sunlight, it has been reported only anecdotally for adult subjects. Three cases of adult fatal VH will be herein presented. In each presented case the corpse was found enclosed in a vehicle on spring/summer days. During crime scene investigation (CSI) psychoactive substances were found near to the corpses leading to the suspect of a suicidal fatal drug intoxication. Basing on this misleading suspect in Case 2 and 3 a forensic expert was not charged for the CSI and a fatal VH was not suspected nor properly investigated. Later, a comprehensive autopsy, including biochemical and toxicological analyses, excluded a death related to natural causes, fatal intoxications, ketoacidosis and traumas. On the other hand, the reconstruction of the temperature, the humidity, the heat index and the related risk of HS allowed the diagnosis of fatal VH in all the reported cases. In particular, death occurred because of the long-lasting stay into a hot parked vehicle which was facilitated from self-administration of psychoactive drugs with related neuro-depression. This case series confirms that a comprehensive CSI followed by an autopsy including histology, biochemical and toxicological analysis remains mandatory in cases of forensic interest, as well as when a corpse is found enclosed in a vehicle. Anyway, sometimes the diagnosis of heat-related fatalities remains a medley of investigative and medicolegal observations.
Collapse
Affiliation(s)
- Paolo Fais
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, 40126 Bologna, Italy.
| | - Jennifer Paola Pascali
- Forensic Toxicology Division, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Carla Mazzotti
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, 40126 Bologna, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121 Padova, Italy
| | - Chiara Palazzo
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, 40126 Bologna, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121 Padova, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121 Padova, Italy
| | - Susi Pelotti
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, 40126 Bologna, Italy
| |
Collapse
|
29
|
Fais P, Mazzotti MC, Montisci M, Palazzo C, Leone O, Cecchetto G, Viel G, Pelotti S. Post-mortem thermal angiography: a pilot study on swine coronary circulation. Int J Legal Med 2018; 133:571-581. [PMID: 30218174 DOI: 10.1007/s00414-018-1935-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Thermal imaging (TI) allows the detection of thermal patterns emitted from objects as a function of their temperature in the long-infrared spectrum and produces visible images displaying temperature differences. The aim of this pilot study was to test TI to visualize the coronary circulation of swine hearts. Thirty swine hearts were prepared for ex situ coronarography, and thermal images were acquired through a FlirOne thermal camera (FLIR Systems®) paired with a Google Android Smartphone. Coronary arteries were cannulated, namely the anterior interventricular artery, the circumflex branch of the left coronary artery, and the right coronary artery. The heart was cooled, and contrast medium (CM) consisting of distilled water heated to 40 °C was injected in a coronary vessel, while thermal images were captured. These steps were repeated for each coronary vessel and under experimentally simulated coronary heart disease. Thermal imaging coronarography (TIC) allowed a clear representation of the morphology and course of the coronary vessels and of experimentally simulated coronary heart disease, moreover, demonstrated to be easy to perform during or after autopsies on ex situ hearts, non-destructive, reproducible, and cheap. On the basis of these preliminary results, TIC might allow a subsequent more focused and comprehensive cardiopathological examination of the heart, which remains mandatory for the definitive diagnosis of coronary heart disease. Although these preliminary results seem encouraging, further systematic studies on human hearts, both normal and pathological, are necessary for estimating the sensitivity and specificity of the proposed method and to draw any definitive conclusion.
Collapse
Affiliation(s)
- Paolo Fais
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Maria Carla Mazzotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Chiara Palazzo
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy.
| | - Susi Pelotti
- DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126, Bologna, Italy
| |
Collapse
|
30
|
Ramos LWF, Rossi G, Nery B, Elly E, Ferreira MV, Souza CF, Viel G. P2851Abnormalities on a preoperative electrocardiogram do not predict postoperative outcomes after moderate/high-risk non-cardiac surgery: a evaluation of combined hypertensive and diabetic patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L W F Ramos
- Brazilian Institute for Cancer Control, Sao Paulo, Brazil
| | - G Rossi
- Universitary Center São Camilo, São Paulo, Brazil
| | - B Nery
- Universitary Center São Camilo, São Paulo, Brazil
| | - E Elly
- Brazilian Institute for Cancer Control, Sao Paulo, Brazil
| | | | - C F Souza
- Brazilian Institute for Cancer Control, Sao Paulo, Brazil
| | - G Viel
- Brazilian Institute for Cancer Control, Sao Paulo, Brazil
| |
Collapse
|
31
|
De Matteis M, Cecchetto G, Munari G, Balsamo L, Paola Gardiman M, Giordano R, Viel G, Fassan M. Circulating miRNAs expression profiling in drug-resistant epilepsy: Up-regulation of miR-301a-3p in a case of sudden unexpected death. Leg Med (Tokyo) 2018; 33:5. [PMID: 29689454 DOI: 10.1016/j.legalmed.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Maria De Matteis
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padua, Padua, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padua, Padua, Italy
| | - Giada Munari
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Laura Balsamo
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Marina Paola Gardiman
- Padua University Hospital, Surgical Pathology Unit, Via Giustiniani 2, 35121 Padua, Italy
| | - Renzo Giordano
- ULSS 13 - Dolo Hospital, Surgical Pathology Unit, Dolo (Venice), Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padua, Via Falloppio 50, 35121 Padua, Italy.
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| |
Collapse
|
32
|
Fais P, Viero A, Viel G, Giordano R, Raniero D, Kusstatscher S, Giraudo C, Cecchetto G, Montisci M. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges. Int J Legal Med 2018; 132:1357-1366. [PMID: 29627916 DOI: 10.1007/s00414-018-1838-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/27/2018] [Indexed: 12/19/2022]
Abstract
Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error.
Collapse
Affiliation(s)
- Paolo Fais
- Department of Medical and Surgical Sciences (DIMEC), Institute of Legal Medicine, University of Bologna, Bologna, Italy
| | - Alessia Viero
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy.
| | - Renzo Giordano
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Dario Raniero
- Department of Public Health and Community Medicine, Unit of Forensic Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | | | - Chiara Giraudo
- Institute of Radiology, Department of Medicine (DiMED), University-Hospital Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Via Falloppio 50, 35128, Padova, Italy
| |
Collapse
|
33
|
Pelletti G, Cecchetto G, Viero A, De Matteis M, Viel G, Montisci M. Traumatic fatal aortic rupture in motorcycle drivers. Forensic Sci Int 2017; 281:121-126. [PMID: 29127893 DOI: 10.1016/j.forsciint.2017.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/09/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
Traumatic fatal aortic rupture (FAR) is a common finding in victims of motor vehicle crashes (MVC), but its aetiology and mechanisms of production remain an issue of major concern, above all in motorcyclists. This study reports a series of cases obtained from a retrospective analysis of traumatic FARs occurring in motorcycle drivers, with the aim of defining the injury patterns and correlating them with the mechanisms of FAR production. Circumstantial, autopsy and histology data were collected through a retrospective analysis of post mortem examinations performed at the Institute of Legal Medicine of the University of Padova between 2014 and 2016. Among 151 traffic related victims, 8 were motorcycle drivers and displayed traumatic FAR and were thus included in the study. In 7 cases, the presence of abdominal/thoracic injuries suggested that the external compression due to the accident was at least a concurrent cause of FAR, being the predominant mechanism of aortic injury in 4 cases, through the "osseous pinch" or the "waterhammer effect" mechanisms. Our study highlights the well-known role of "preventative forensic pathology", which has become routinary in traffic medicine since many years, also for defining the points of impact and the injury patterns of motorcyclists sustaining traumatic FAR, thereby facilitating the development of new prevention strategies and devices. Further studies, however, are needed in order to widen the investigated population and to estimate the real number of victims for which traumatic FAR might hypothetically be prevented with specific countermeasures.
Collapse
Affiliation(s)
- Guido Pelletti
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy.
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Alessia Viero
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Maria De Matteis
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| |
Collapse
|
34
|
Pelletti G, Cecchetto G, Viero A, Fais P, Weber M, Miotto D, Montisci M, Viel G, Giraudo C. Accuracy, precision and inter-rater reliability of micro-CT analysis of false starts on bones. A preliminary validation study. Leg Med (Tokyo) 2017; 29:38-43. [DOI: 10.1016/j.legalmed.2017.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/05/2017] [Indexed: 12/28/2022]
|
35
|
Ferrara SD, Viel G. [Personalized medicine and medical malpractice.]. G Ital Med Lav Ergon 2017; 39:186-189. [PMID: 29916586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/09/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The manuscript deals with personalized medicine and medical liability in Europe and Italy, addressing the importance of synergistic collaboration between clinical and medico-legal professionals in order to appropriately investigate medical errors and prevent any future adverse event. METHODS Following a rapid epidemiological overview of mala praxis in Europe, the manuscript presents and discusses the International Guidelines developed and adopted by the International Academy of Legal Medicine (IALM), which guide the work of the medical experts under both criminal and/or civil law. RESULTS Finally, the manuscript proposes the indispensability of a quality assurance and accreditation system for clinical and medico-legal reports along with a shared and integrated methodology for managing health claims in order to prevent adverse events.
Collapse
Affiliation(s)
- Santo Davide Ferrara
- Ordinario di Medicina Legale, Direttore, Dipartimento di Medicina Legale, del Lavoro, Igiene e Sanità Pubblica, Università-Azienda Ospedaliera di Padova
| | - Guido Viel
- Associato di Medicina Legale, Dipartimento di Medicina Legale, del Lavoro, Igiene e Sanità Pubblica, Università-Azienda Ospedaliera di Padova
| |
Collapse
|
36
|
Fais P, Pigaiani N, Cecchetto G, Montisci M, Gottardo R, Viel G, Pascali JP, Tagliaro F. “Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation. J Forensic Sci 2017; 62:1671-1673. [DOI: 10.1111/1556-4029.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Fais
- Department of Medical and Surgical Sciences - Unit of Legal Medicine; University of Bologna; Via Irnerio 49 40126 Bologna Italy
| | - Nicola Pigaiani
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Rossella Gottardo
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
| | - Guido Viel
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Jennifer Paola Pascali
- Forensic Toxicology Division; Department of Health Science; University of Florence; Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
| |
Collapse
|
37
|
Boscolo-Berto R, Montisci M, Secco S, D'Elia C, Snenghi R, Viel G, Ferrara SD. Association Between Financial Conflicts of Interests and Supportive Opinions for Erectile Dysfunction Treatment. J Bioeth Inq 2016; 13:439-448. [PMID: 27416979 DOI: 10.1007/s11673-016-9732-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/18/2016] [Indexed: 06/06/2023]
Abstract
A conflict of interest (COI) is a situation in which a person has competing loyalties or interests that make it difficult to fulfil his or her duties impartially. Conflict of interest is not categorically improper in itself but requires proper management. A SCOPUS literature search was performed for publications on the efficacy/safety of Phospho-Di-Esterase Inhibitors (PDEIs) for treating erectile dysfunction. A categorization tool (CoOpCaT) was used to review and classify the publications as supportive/not-supportive for the discussed active ingredient and reporting or not reporting a COI for that specific drug or for the remaining PDEIs (i.e. competitors). Multivariable binary logistic regression was performed. In the 419 selected records the prevalence of supportive opinions was higher when a COI for the index label was declared. The CoOpCaT showed good internal consistency, discriminative validity and intra/inter-rater agreement. The strongest predictor for a supportive opinion was the total number of financial COIs for the index label. A mild protective effect of the total number of financial COIs for any competitor label was noted. Financial COIs have frequently been associated with bias, and the measures currently adopted to restrain it lack effectiveness. Some evidence for monitoring and/or compensating this bias is reported here, but the ultimate solution remains distant.
Collapse
Affiliation(s)
- Rafael Boscolo-Berto
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Legal Medicine, University Hospital of Padova, Via Falloppio 50, Padova, 35121, Italy.
| | - Massimo Montisci
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Legal Medicine, University Hospital of Padova, Via Falloppio 50, Padova, 35121, Italy
| | - Silvia Secco
- Department of Urology, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, Milano, 20162, Italy
| | - Carolina D'Elia
- Department of Urology, University of Verona, Piazzale Scuro 10, Verona, 37134, Italy
| | - Rosella Snenghi
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Legal Medicine, University Hospital of Padova, Via Falloppio 50, Padova, 35121, Italy
| | - Guido Viel
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Legal Medicine, University Hospital of Padova, Via Falloppio 50, Padova, 35121, Italy
| | - Santo Davide Ferrara
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Legal Medicine, University Hospital of Padova, Via Falloppio 50, Padova, 35121, Italy
| |
Collapse
|
38
|
Fais P, Cecchetto G, Boscolo-Berto R, Toniolo M, Viel G, Miotto D, Montisci M, Tagliaro F, Giraudo C. Morphometric analysis of stab wounds by MSCT and MRI after the instillation of contrast medium. Radiol Med 2016; 121:494-501. [PMID: 26747042 DOI: 10.1007/s11547-015-0612-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyze the morphology and depth of stab wounds experimentally produced on human legs amputated for medical reasons using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) after the instillation of a single contrast medium solution (CMS). MATERIALS AND METHODS For morphological analysis, MSCT and MRI scans were performed before and after the instillation of CMS into the wound cavity. Depth measurements were performed on the sagittal view only after CMS instillation. Subsequently, each wound was dissected using the layer-by-layer technique and the depth was measured by a ruler. One-way between-groups pairwise analysis of variance (ANOVA) and Bland-Altman plot analysis were used for comparing radiological and anatomical measurements. RESULTS Unenhanced MSCT images did not identify the wound channels, whereas unenhanced MRI evidenced the wound cavity in 50 % of cases. After the instillation of CMS, both MSCT and MRI depicted the wound channel in all the investigated stabbings, although the morphology of the cavity was irregular and did not resemble the shape of the blade. The radiological measurements of the wounds' depth, after the application of CMS, exhibited a high level of agreement (about 95 % at Bland-Altman plot analysis) with the anatomical measurements at dissection. A similar systematic underestimation, however, has been evidenced for MSCT (average 11.4 %; 95 % CI 7-17) and MRI (average 9.6 %; 95 % CI 6-13) data after the instillation of CMS with respect to wound dissection measurements. CONCLUSION MSCT and MRI after the instillation of CMS can be used for depicting the morphometric features of stab wounds, although depth measurements are affected by a slight systematic underestimation compared to layer-by-layer dissection.
Collapse
Affiliation(s)
- Paolo Fais
- Legal Medicine, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padua, Italy
| | - Rafael Boscolo-Berto
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padua, Italy
| | - Matteo Toniolo
- Institute of Radiology, University-Hospital of Padova, Via Giustiniani 3, 35121, Padua, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padua, Italy
| | - Diego Miotto
- Institute of Radiology, University-Hospital of Padova, Via Giustiniani 3, 35121, Padua, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, University-Hospital of Padova, Via Falloppio 50, 35121, Padua, Italy
| | - Franco Tagliaro
- Legal Medicine, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy
| | - Chiara Giraudo
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
39
|
Ferrara SD, Baccino E, Boscolo-Berto R, Comandè G, Domenici R, Hernandez-Cueto C, Gulmen MK, Mendelson G, Montisci M, Norelli GA, Pinchi V, Ranavaya M, Shokry DA, Sterzik V, Vermylen Y, Vieira DN, Viel G, Zoja R. Padova Charter on personal injury and damage under civil-tort law. Int J Legal Med 2015; 130:1-12. [DOI: 10.1007/s00414-015-1244-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022]
|
40
|
Viero A, Cecchetto G, Boscolo-Berto R, Viel G, Montisci M. Suicidal Smothering by Rubber Latex Gloves and Handkerchief. J Forensic Sci 2015; 61:268-70. [PMID: 26248524 DOI: 10.1111/1556-4029.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
Abstract
Asphyxial deaths are common in forensic practice, being sustained by a variety of mechanisms that cause an oxygen deficiency to the brain. Several classification models have been proposed in the literature, the most recent one being that of the International Network for Forensic Research Group (INFOR). This report describes an unusual case of suffocation where the obstruction of the airways was caused by a gag formed of three latex gloves and a handkerchief. The manner of death (differential diagnosis between homicide and suicide) and the different alternatives of classification are discussed.
Collapse
Affiliation(s)
- Alessia Viero
- Legal Medicine and Toxicology, Department of Cardiological, Thoracic and Vascular Sciences, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, Department of Cardiological, Thoracic and Vascular Sciences, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Rafael Boscolo-Berto
- Legal Medicine and Toxicology, Department of Cardiological, Thoracic and Vascular Sciences, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiological, Thoracic and Vascular Sciences, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, Department of Cardiological, Thoracic and Vascular Sciences, University-Hospital of Padova, Via Falloppio, 50, 35121, Padova, Italy
| |
Collapse
|
41
|
Iacobone M, Citton M, Scarpa M, Viel G, Boscaro M, Nitti D. Systematic review of surgical treatment of subclinical Cushing's syndrome. Br J Surg 2015; 102:318-30. [PMID: 25640696 DOI: 10.1002/bjs.9742] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/23/2014] [Accepted: 11/11/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Subclinical Cushing's syndrome (SCS) is a condition of biochemical cortisol excess without the classical clinical features of overt hypercortisolism; it may be associated with some consequences of metabolic syndrome. The most appropriate treatment remains controversial. This study aimed to assess the outcomes of adrenalectomy for SCS. METHODS A systematic review was performed. MEDLINE, Embase and Cochrane Databases (1980-2013) were searched for studies reporting the outcomes of unilateral adrenalectomy with respect to hypertension, diabetes, dyslipidaemia, obesity and osteoporosis in patients with SCS. Studies with a questionable diagnosis of SCS, bilateral adrenal involvement and insufficient data were excluded. RESULTS Of the 105 papers screened, seven were selected; there were six retrospective studies and one randomized clinical trial, including 230 patients. Data analysis was limited by heterogeneity in definition of SCS and endpoints. Hypercortisolism was cured in all operated patients. Laparoscopy was the preferred approach, with a morbidity rate of 0·8 per cent. A beneficial effect of surgery on blood pressure, glucometabolic control and obesity was evident in all studies, with cure or improvement in 72, 46 and 39 per cent of patients respectively, compared with conservative management. The results for lipid metabolism were equivocal, because of a decrease in triglyceridaemia but discordant effects on cholesterol metabolism among the different studies. No beneficial effects on osteoporosis were found. CONCLUSION Laparoscopic adrenalectomy seems to be beneficial in reversing several metabolic effects of hypercortisolism, with a low morbidity rate. However, the heterogeneity and low quality of the available studies preclude definitive recommendations.
Collapse
Affiliation(s)
- M Iacobone
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padua, Italy
| | | | | | | | | | | |
Collapse
|
42
|
Viero A, Giraudo C, Cecchetto G, Muscovich C, Favretto D, Puglisi M, Fais P, Viel G. An unusual case of "dyadic-death" with a single gunshot. Forensic Sci Int 2014; 244:e1-5. [PMID: 25194714 DOI: 10.1016/j.forsciint.2014.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
Abstract
The terms "dyadic death" or "murder-suicide" refer to an incident where an individual commits homicide and then takes his or her own life. These events are generally committed by men within the family network, using firearms or sharp force instruments, and make up a relatively small proportion of homicides overall. Herein, we present the application of post-mortem multislice computed tomography (CT) and micro-CT analysis to an unusual case of dyadic death, where a 38-year-old man fired a single gunshot to his own right temple, killing himself and his 50-year-old wife, lying on the bed beside him. The integration of radiological, autoptic and histological data allowed us to reconstruct the trajectory of the gunshot, the most probable dynamics of the event, and to classify the incident as a "suicide-homicide", because the female victim died a few minutes later than her husband and murderer.
Collapse
Affiliation(s)
- Alessia Viero
- Department of Cardiological, Thoracic and Vascular Sciences, Institute of Legal Medicine, Via Falloppio, 50, 35121 Padova, Italy
| | - Chiara Giraudo
- Department of Medicine-DIMED, Radiology Section, Via Giustiniani, 2, 35121 Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiological, Thoracic and Vascular Sciences, Institute of Legal Medicine, Via Falloppio, 50, 35121 Padova, Italy
| | | | - Donata Favretto
- Department of Cardiological, Thoracic and Vascular Sciences, Institute of Legal Medicine, Via Falloppio, 50, 35121 Padova, Italy
| | - Massimo Puglisi
- Medico Legal Expert of the State Police Office, "Questura di Padova", Piazzetta G. Palatucci, 5, 35123 Padova, Italy
| | - Paolo Fais
- Unit of Forensic Medicine, Department of Public Health and Community, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Guido Viel
- Department of Cardiological, Thoracic and Vascular Sciences, Institute of Legal Medicine, Via Falloppio, 50, 35121 Padova, Italy.
| |
Collapse
|
43
|
Montisci M, Corradin M, Giacomelli L, Viel G, Cecchetto G, Ferrara SD. Can immunohistochemistry quantification of Cathepsin-D be useful in the differential diagnosis between vital and post-mortem wounds in humans? Med Sci Law 2014; 54:151-157. [PMID: 24166688 DOI: 10.1177/0025802413504909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Markers of skin wound vitality and the research methodology used for their determination are still matters of debate in forensic pathology. Cathepsin-D, a lysosomal enzyme, is the most expressed cathepsin in human skin, and although it seems to have the necessary requirements to be utilized as a vitality marker, past research has provided no definitive and clear response on its potential usefulness. Immunohistochemistry with monoclonal antibodies and image analysis has been employed to detect and quantify the expression of Cathepsin-D in human skin wounds. We analyzed skin fragments obtained from 20 living individuals (group A) and 20 persons deceased from natural causes (group B). For each case, five skin fragments were withdrawn at 0', 5', 10', 30', and 90' after abdominal incision. Once the samples were formalin-fixed and paraffin-embedded, we analyzed the expression of Cathepsin-D through the quantification of the immunohistochemistry signal by image analysis. Immunoreactivity was displayed in Pixels of positive area measured by image analysis and converted in micrometer squares. The average levels of Cathepsin-D were higher in group B than in group A, except in three cases which showed a lower expression, with a statistically significant difference of Cathepsin-D expression between the two groups (p < 0.0001). Group B showed unvaried levels among the progressive samples and group A revealed an increasing predominant trend at 30'. Due to the high levels of expression of Cathepsin-D found in the post-mortem injuries, our study definitively excludes any usefulness of immunohistochemistry quantification of this enzyme in the differentiation between vital and post-mortem injuries.
Collapse
|
44
|
Ferrara SD, Viel G. Functional ‘-omics’ in intrauterine growth restriction: novel insights into child development. Expert Rev Proteomics 2014; 9:355-7. [DOI: 10.1586/epr.12.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
45
|
Viel G, Boscolo-Berto R, Cecchetto G, Fais P, Nalesso A, Ferrara SD. Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis. Int J Mol Sci 2012. [PMID: 23203094 PMCID: PMC3509610 DOI: 10.3390/ijms131114788] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The present paper aims at a systematic review of the current knowledge on phosphatidylethanol (PEth) in blood as a direct marker of chronic alcohol use and abuse. In March 2012, the search through “MeSH” and “free-text” protocols in the databases Medline/PubMed, SCOPUS, Web of Science, and Ovid/Embase, combining the terms phosphatidylethanol and alcohol, provided 444 records, 58 of which fulfilled the inclusion criteria and were used to summarize the current evidence on the formation, distribution and degradation of PEth in human blood: (1), the presence and distribution of different PEth molecular species (2), the most diffused analytical methods devoted to PEth identification and quantization (3), the clinical efficiency of total PEth quantification as a marker of chronic excessive drinking (4), and the potential utility of this marker for identifying binge drinking behaviors (5). Twelve papers were included in the meta-analysis and the mean (M) and 95% confidence interval (CI) of total PEth concentrations in social drinkers (DAI ≤ 60 g/die; M = 0.288 μM; CI 0.208–0.367 μM) and heavy drinkers (DAI > 60 g/die; M = 3.897 μM; CI 2.404–5.391 μM) were calculated. The present analysis demonstrates a good clinical efficiency of PEth for detecting chronic heavy drinking.
Collapse
Affiliation(s)
- Guido Viel
- Authors to whom correspondence should be addressed; E-Mails: (G.V.); (R.B.-B.); Tel.: +39-049-827-2230; Fax: +39-049-663155
| | - Rafael Boscolo-Berto
- Authors to whom correspondence should be addressed; E-Mails: (G.V.); (R.B.-B.); Tel.: +39-049-827-2230; Fax: +39-049-663155
| | | | | | | | | |
Collapse
|
46
|
Acanfora L, Rampon M, Filippeschi M, Marchi M, Montisci M, Viel G, Cosmi E. An inflatable ergonomic 3-chamber fundal pressure belt to assist vaginal delivery. Int J Gynaecol Obstet 2012; 120:78-81. [PMID: 23083494 DOI: 10.1016/j.ijgo.2012.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/19/2012] [Accepted: 09/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate whether Baby-guard-a new medical device with an ergonomic 3-chamber inflatable abdominal belt-can reduce complications associated with vaginal delivery. METHODS A randomized controlled single-blind prospective study of 80 pregnant women delivering at term was conducted at San Giuseppe Hospital, Empoli, Italy. In the study group (n=40), the abdominal belt was inflated to optimal therapeutic pressures. In the control group (n=40), the abdominal belt was inflated to minimal, non-therapeutic pressures. Factors relating to maternal, fetal, and labor complications during vaginal delivery were evaluated. RESULTS Compared with the control group, women in the study group experienced a lower incidence of perineal and cervical lacerations (P<0.001); reduced use of the Kristeller maneuver (P<0.001); shorter duration of the second stage of labor (P<0.001); less psychologic and physical fatigue (P<0.001); fewer maternal requests for cesarean delivery during labor (P<0.001); fewer vacuum extractions (P<0.01); and fewer cesarean deliveries (P<0.02). No neonatal intensive care unit admissions were recorded in the study group versus 7 in the control group (P<0.012). CONCLUSION Use of the ergonomic 3-chamber inflatable abdominal belt system reduced the incidence of risks associated with vaginal labor. Clinical trials.gov identifier: NCT01566331.
Collapse
Affiliation(s)
- Luisa Acanfora
- Department of Physiology, University of Florence, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
47
|
Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y. Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2012; 16:431-43. [PMID: 22055895 DOI: 10.1016/j.smrv.2011.09.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 09/08/2011] [Accepted: 09/09/2011] [Indexed: 10/15/2022]
|
48
|
Boscolo-Berto R, Raduazzo DI, Cecchetto G, Viel G. Urethral catheterization in men with artificial urinary sphincter: clinical and legal implications. Urol J 2012; 9:611-613. [PMID: 22903486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Rafael Boscolo-Berto
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy.
| | | | | | | |
Collapse
|
49
|
Cecchetto G, Viel G, Boscolo-Berto R, Fais P, Snenghi R, Zuin A. Iatrogenic perforation of a pulmonary angiomatoid lesion: histopathological study and review of the literature. Med Sci Law 2012; 52:47-49. [PMID: 22399031 DOI: 10.1258/msl.2011.011026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Percutaneous tube thoracostomy (PTT) remains the most widely performed procedure to manage blunt or penetrating chest traumas. This life-saving manoeuvre can be frequently associated with complications. We present the case of a 76-year-old man, admitted to a peripheral hospital after a car accident and treated by PTT, who died shortly after the withdrawal of the chest tube. At autopsy, the victim was found to be affected by an extensive haemothorax resulting from the perforation of a subpleural angiomatoid lesion. The histopathological characteristics and the pathogenesis of the iatrogenic injury involving the vascular abnormality, along with its causal role in determining the fatal haemothorax, are critically discussed under both clinical and forensic points of view.
Collapse
Affiliation(s)
- Giovanni Cecchetto
- Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | | |
Collapse
|
50
|
Boscolo-Berto R, Viel G, Raduazzo DI, Cecchetto G, Artibani W. Male infertility after transpelvic gunshot wound injury: a case of clinical and forensic relevance. Urol J 2012; 9:714-717. [PMID: 23235979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Rafael Boscolo-Berto
- Department of Oncological and Surgical Sciences, Urology Clinic; Department of Environmental Medicine and Public Health, Section of Legal Medicine and Forensic Pathology, University of Padova, Italy.
| | | | | | | | | |
Collapse
|