Multiple nail gun injuries: suicide or homicide?

Nail gun injuries are a forensic problem; it can be difficult to distinguish self-inflicted injuries from accident and homicide instances. This kind of injuries shares some characteristics with both gunshot and puncture wounds. We describe a peculiar case of a man who committed suicide driving nails into his skull using a pneumatic nail gun. Entrance wounds were found on both temporal regions of the head. Reviewing scientific literature, this is the first case in Italy reporting the macroscopic data of bilateral head and brain nail gun injuries during an autopsy. Circumstantial elements were not sufficient to clarify if these lesions were self-inflicted, inflicted by accident, or else. Radiological examination can be helpful to show the exact location of the nails, but it has also its own limitations. We firmly believe that autopsy, especially the head section, is crucial to identify the nature and the extension of these lesions, thus giving us much more information about the mechanism of death and the circumstances in which it occurred.

Reverse engineering in forensic investigations: a new approach to bite mark analysis

The study of bite marks provides crucial elements that contribute towards identifying the biter. In many cases, it assumes importance when bite marks are detected on the body of a victim of violence, but it could also be relevant when the bite marks are seen on food substances at the crime scene. In both circumstances, comparing the bite marks with a suspect's dentition can be decisive in confirming or excluding the culpability. In this case report, a bun (bread roll) with the sign of a bite was found at the crime scene. We report a pilot study using 3D reproduction of the bite mark on the bun and dental models of the alleged biter and the victim. A reverse engineering process was used to obtain digital 3D models of the bitten bun and the dental models by taking numerous photographs and stitching them together using a software called Metashape by Agisoft. The last step was to compare the bitemark to the two dental models, evaluating the spatial distance, the degree of overlap, and the degree of interpenetration. The results confirmed the usefulness of reverse engineering in forensic investigations showing the compatibility between the victim's teeth and the bite mark on the bun.

The Effects of the COVID-19 Pandemic on Vaccination Hesitancy: A Viewpoint

Vaccination hesitancy is considered by the World Health Organization as a danger to global health. In recent years, vaccine hesitancy rates to COVID-19 have been studied worldwide. In our study, we aim to provide an overview of the concept of vaccine hesitancy, with regard to the post-COVID era, and to provide prevention and management strategies. A search of the international literature until March 2023 was conducted in the PubMed database. The 5723 papers found were divided into two groups: prior to the COVID-19 era and from 2021 onward. Papers about the vaccine hesitation phenomenon are becoming more common during the SARS-CoV-2 pandemic and following the marketing that the vaccine companies have carried out on the different types of COVID-19 vaccines. It is advisable that healthcare authorities, at the national and international level, as well as healthcare professionals, at the local level, should promote a series of activities to reduce the vaccine hesitancy rate.

Lethal event in diving with self-contained underwater breathing apparatus: A forensic study

Introduction

In fatal accidents during scuba diving, it is necessary to differentiate a death from primary drowning from a secondary drowning death that is primarily due to other etiopathogenetic factors. The inhalation of water can only be the end point of a series of events capable of causing the diver's exitus. This study aims to demonstrate that even low-risk heart disease in daily life become potentially fatal during scuba diving.

Methods

In this case series, we describe all cases of deaths in the course of diving that came to the observation of the Forensic Institute of the University Bari over 20 years (2000-2020). A judicial autopsy was performed on all subjects, with ancillary execution of histological and toxicological investigations.

Results

The results of the medicolegal investigations carried out in the complex identified heart failure with acute myocardial infarction as the cause of death in four cases characterized by severe myocardiocoronarosclerosis, a primary drowning in a subject without previous pathological substrate in one case, and a terminal atrial fibrillation induced by acute dynamic heart failure due to functional overload of the right ventricle in one case.

Conclusion

Our study demonstrates that lethal events during diving are often related to the presence of unrecognized or subclinical cardiovascular diseases. Such deaths could be prevented and avoided if a greater regulatory sensitivity to preventing and controlling diving was encouraged, considering both the inherent risks of this activity and the possible unrecognized or underestimated pathologies.

'Compressed Baby Head': A New 'Abusive Head Trauma' Entity?

BACKGROUND

Child abuse represents an important issue in the medico-legal and social context. In the last few decades, various aspects and mechanisms have been identified in child abuse case studies; however, constant research is needed in the field. With this paper, the authors will present a case of a new entity of Abusive Head Trauma that has come to the attention of medico-legal experts.

DISCUSSION

The trauma analysis performed on the cranio-encephalic district of the baby revealed quite peculiar lesions that led the authors to exclude that the injuries had been solely caused by violent shaking of the baby's head, as suggested by Shaken Baby Syndrome. Instead, the authors hypothesised that another lesion mechanism had been added to this one, namely latero-lateral cranial compression. The comprehensive and exhaustive analysis of the case led the authors to present a new possible entity in child abuse trauma, namely 'Compressed Baby Head'.

CONCLUSIONS

To the best of our knowledge, in the current literature, no similar clinical cases have ever been described. Thus, the case's uniqueness deserves to be brought to the attention of experts and the entire scientific community, as well as medical personnel, paediatricians, and reanimators. These professional figures are the first individuals who may encounter complex clinical cases such as the one presented in this paper; thus, they need to know how to properly manage the case and ensure protection for the abused infants and children.

Requests for Compensation in Cases Involving Patients' Falls in Healthcare Settings: A Retrospective Analysis

Falls are the most frequent adverse events recorded in healthcare facilities. By employing a multifaceted strategy to ensure prevention interventions that are specific to the patient type and environmental risk management, risk factor evaluation may help to reduce falls in the hospital setting. Patient falls are one of the main causes of lawsuits against hospitals, which has led to the development of validated instruments that are beneficial in treating the patient after the incident and effective in minimizing the frequency of falls. The aim of our study is to evaluate compensation claims asserting healthcare culpability in situations where a patient fell in a hospital setting. The collected data relate to judgments issued in Italy until December 2022 regarding 30 episodes of falls that occurred between 2003 and 2018. Our research revealed that approximately 50% of Italian healthcare organizations lose the case in court when a patient falls in a hospital setting and dies or is injured. In half of these cases, the failure of the medical staff to use protective equipment against falls is what led to the court's acceptance of the compensation claim. In order to improve the quality of healthcare services, fall prevention techniques must continue to be implemented.

Analysis of Italian requests for compensation in cases of responsibility for healthcare-related infections: A retrospective study

Introduction

The aim of this study was to examine the type of compensation claims for alleged medical malpractice in the field of healthcare-related infections in Italy.

Methods

It was analyzed which was the most frequent clinical context, the characteristics of the disputes established, which were the alleged damages most often complained of, which were the possibly censurable behaviors of the health professionals, and which were the reasons for acceptance or rejection of the request for compensation.

Results

In 90.2%, the issue questioned regarded surgical site infections. The most common pathogens involved were coagulase-negative Staphylococci (34.1%) and Staphylococcus aureus (24.4%). The lack or non-adherence to protocols of prophylaxis and/or prevention of healthcare-related infections was the most reported cause of acceptance of the request of compensation.

Discussion

According to our data, a stronger effort should be made in terms of risk management perspective in order to ensure the develop and application of protocols for prevention of Gram-positive healthcare-related infections and strengthen infection control and antimicrobial stewardship programs.

Cerebral venous sinus thrombosis after COVID-19 vaccination and congenital deficiency of coagulation factors: Is there a correlation?

In January 2020, SARS-COV-2 infection spread worldwide and was declared "pandemic" by WHO. Because of the high contagiousness of the virus and devastating effects of the epidemic on public health, numerous efforts have been made to develop suitable vaccines to prevent the infection. Among the side effects developed by patients who undergone vaccination, there are common symptoms but also more serious reactions such as the thrombosis syndromes. This paper presents two cases of thrombosis temporally associated with live-vectored Covid vaccination similar to vaccine-induced thrombocytopenia (VITT) in patients with inherited thrombophilia (respectively, the deficiency of protein S and a Factor II mutation). The clinical manifestation caused by VITT is characterized by widespread thrombosis especially affecting intracranial venous sinus, which may cause massive bleeding and intracranial hemorrhage. Although this condition is widely described in literature, there is no evident correlation between this side effect and inherited condition of thrombophilia. The authors suggest that the presence of inherited thrombophilia should be better investigated and, if necessary, screened during the anamnestic data collection before the vaccine administration, leading the healthcare professional to choose the appropriate vaccine to the patient.

Age estimation from dry bone measurements: evidence from a sample of soldiers exiled in two concentration camps in Bari

The mandible undergoes remodelling and morphological alterations throughout the life of an individual, and it is subjected to sex- and age-related structural changes. Personal identification from skeletal remains represents one of the most difficult challenges for a forensic anthropologist. The study of mandibular morphology is an important aid in determining the sex and age of skeletal remains. The objective of this study was to evaluate the age-related changes of three mandibular dimensions through dry bone measurements: bigonial width, ramus height and gonial angle. A total of 93 skeletal remains were included in this study, from a group of soldiers of Yugoslav origin who lived in two concentration camps in Bari (southern Italy) during World War II. These are included in the collection of the Forensic Anthropology Laboratory of the Institute of Forensic Medicine of Bari. The measurements were recorded after comprehensive examination by a forensic anthropologist and a forensic odonto-stomatologist. The data obtained were analysed statistically using a bivariate test and a multivariate linear regression model, using the Statal 13MP software. The results indicate that the bigonial width and gonial angle vary significantly according to age. In conclusion, this study confirms that the mandible is useful for age estimation in the identification of skeletal remains using these specific mandibular measurements when performed on dry bone without radiological distortion.

Effects of a constant dose rate of terbutaline on circadian peak expiratory flow, heart rate and systolic arterial pressure in patients with asthma exacerbation

The purpose of this study was to investigate the effect of a constant infusion rate of terbutaline on circadian bronchial peak expiratory flow rate (PEFR), heart rate and arterial pressure in patients with asthma exacerbation. Fifteen hospitalized asthmatic patients (6 females and 9 males, mean age 43.3 years, mean weight 67.0 kg) were included in this study. In order to reach the desired plasma concentrations of terbutaline immediately, a pharmacokinetic simulation was done. Based on the predicted values thus obtained, an initial 5-min bolus dose of 2.94 micrograms/kg was given to all patients at 7 a.m., i.e. at the beginning of the study. Over the following 24 h (7 a.m. to 7 a.m.), 33 micrograms/kg of terbutaline was infused intravenously at a constant rate with an electric pump. Since severe acute asthma requires corticosteroids, a 40-mg injection of methylprednisolone was given to all patients at 7 a.m. PEFR, heart rate, systolic arterial pressure, side effects and plasma terbutaline levels were recorded at 7 and 10 a.m., 1, 4, 7 and 11 p.m., and 3 and 7 a.m. the following morning. Terbutaline had a significant favorable effect on asthma exacerbation but no circadian rhythm was found in PEFR. Although terbutaline was infused at a constant rate, plasma levels depended on circadian variations.

Unequal day-night terbutaline i.v. dosing in acute severe asthma: effect on nocturnal bronchial patency, heart rate, and arterial pressure

Our study investigated the differential effects of continuous or unequal day-night terbutaline dosing on circadian bronchial patency, heart rate, and arterial pressure in severe acute asthma. Forty-five hospitalized asthmatic patients (19 women and 26 men, mean age 45.4 years, mean weight 63.5 kg) were included in this multicenter study. Three groups of patients (corresponding to three dosing schedules) were randomized; the three groups were comparable, since no statistically significant difference was detected in the age, weight, or peak expiratory flow values at the beginning of the study. In order to reach immediately the concentrations of terbutaline corresponding to the desired unequal day-night concentrations, a theoretical pharmacokinetic simulation was done to predict the outcome in terms of the plasma concentrations after the three dosing regimens; the results of this simulation allowed us to calculate the initial bolus dose to be given over 5 min to groups A, B, and C, i.e., 1.47, 2.94, and 4.41 micrograms/kg, respectively. This bolus was given to all patients at 0700 h, the beginning of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immediate and secondary prognosis of suffocation fits from post-tuberculous respiratory insufficiencies (author's transl)]

Prognosis for an immediate future and up to one year of decompensation periods was comparable both in chronic bronchitic patients and in ancient tuberculous ones. The latter can be divided in two groups, "amputated" and "non-amputated", according to the main kind of sequellae, pleural and/or parenchymatous. The immediate future is identical and then, the prognosis of the "amputated" which was rather more favourable at one year progressively worsens to reach that of "non-amputated" patients.