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Sacco MA, Galassi FM, Varotto E, Landini L, Gualtieri S, Mazzuca W, Ricci P, Chiaravalloti G, Aquila I. A Multidisciplinary Approach to a Complex Fatal Attack Due to a Pack of Maremma Sheepdogs: Is It Always an Accident? Cureus 2024; 16:e56911. [PMID: 38659560 PMCID: PMC11042836 DOI: 10.7759/cureus.56911] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Deaths due to dog attacks are a worldwide issue. Fatal dog attacks may occur in various environments, including the dog owner's property. A lot of difficulties emerge when the attack involves a pack of dogs, of different species and sizes. In this case, it becomes much more difficult for forensic investigators to evaluate the event, especially regarding the identification of the dog or dogs that caused the death as well as the identification of the owner and the reconstruction of the dynamics for forensic purposes. In this paper, we analyze a specific case of an attack by a herd of Maremma sheepdogs. A crime scene investigation has been carried out. In the first phase of this case, the victim interacted with dogs that had non-aggressive attitudes. Then, after an escape attempt, she was assaulted by about 20 Maremma dogs of different sizes, leading to multiple injuries all over her body. The greatest difficulty was precisely that of reconstructing the dynamics due to the numerous injuries and dogs involved in the attack. The dynamics were divided into several stages following the analysis of the injuries found on the victim. This case study highlights how the forensic multidisciplinary approach has made it possible to precisely reconstruct the event. The analysis of the dogs' state of malnutrition and their suddenly aggressive attitude towards the victim revealed profiles of responsibility of the owner attributable to improper management and training of the animals to defend their property.
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Affiliation(s)
- Matteo Antonio Sacco
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Francesco Maria Galassi
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, POL
| | - Elena Varotto
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, AUS
| | - Laura Landini
- Forensic Anthropology, Forensic Anthropology, Paleopathology and Bioarchaeology (FAPAB) Research Center, Avola, ITA
| | - Saverio Gualtieri
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Wandamaria Mazzuca
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Pietrantonio Ricci
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | | | - Isabella Aquila
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, Magna Graecia University of Catanzaro, Catanzaro, ITA
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Sacco MA, Gualtieri S, Ricci P, Aquila I. The Risk of Suicide in the Post-COVID-19 Emergency Era: Psychological and Forensic Implications. Cureus 2023; 15:e49081. [PMID: 38125261 PMCID: PMC10731125 DOI: 10.7759/cureus.49081] [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] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
The emergence of the coronavirus disease 2019 (COVID-19) pandemic brought numerous challenges, including the management of psychological and psychiatric disorders, leading to an increased risk of suicide. At the end of the COVID-19 emergency, we wonder what the impact of the pandemic has been, and still is, on the state of public mental health with respect to the phenomenon of suicide. Therefore, this review aims to explore the psychological and forensic aspects of suicide in the post-COVID-19 emergency era. The paper will delve into the various psychiatric disorders associated in the literature with COVID-19, the risk factors for suicide during the pandemic, and measures that can be taken to prevent suicide in the post-COVID-19 era. Additionally, the paper will look at how forensic experts investigate suicide cases due to COVID-19 and the legal implications of suicide due to the pandemic. The findings of this study will provide insights into the psychological and forensic aspects of suicide in the post-COVID era, and emphasize interventions and policy development to address this growing public health concern.
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Affiliation(s)
- Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Saverio Gualtieri
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
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Sacco MA, Ricci C, Fragomeni G, Bonetta CF, Cordasco F, Gualtieri S, Cavalcanti B, Ricci P, Aquila I. Reconstruction of Trauma Dynamics Due to Ligature Strangulation by Using a Dynamometer: A Technical Report. Cureus 2023; 15:e48982. [PMID: 38111449 PMCID: PMC10726159 DOI: 10.7759/cureus.48982] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Asphyxiation caused by violence, particularly through ligature strangulation, necessitates the application of a force that is characterized by a point of application, direction, and intensity. These properties can be quantified through the use of a dynamometer, which is composed of a graduated scale and a spring. In this particular study, an experimental model utilizing a dynamometer was employed to aid in the diagnosis and analysis of the dynamics of violent trauma resulting from homicidal ligature strangulation. The experimental model was applied to an attempted murder case involving strangulation. The primary challenge in this case was to establish the attempted murder scientifically, as the offender claimed that there had been no intent to kill, but instead an attempt to frighten the victim. To prove his assertion, the assailant emphasized the absence of strangulation injuries on the victim's neck. To investigate, a crane scale dynamometer was fixed on a cable and placed on a manikin's neck. The potential measurable combinations with the dynamometer were then compared to witness accounts and the injuries found on the victim. The utilization of a dynamometer in our case permitted the diagnosis and verification of a trauma that was undoubtedly caused by violent asphyxiation via strangulation. The information yielded by the dynamometer was subsequently submitted as scientific evidence in Court, serving to substantiate the intent to commit homicide and substantiate the credibility of the victim's testimony.
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Affiliation(s)
- Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Cristoforo Ricci
- Department of Jurisprudence, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Gionata Fragomeni
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Carlo Filippo Bonetta
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Fabrizio Cordasco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Saverio Gualtieri
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Berardo Cavalcanti
- Department of Forensic Medicine, Forensic Medical Office, Corso Mazzini Giuseppe, Cosenza, ITA
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
| | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, ITA
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Aquila I, Sacco MA, Gorniak J, Rouse M, Gualtieri S, Cordasco F, Tarallo AP, Raffaele R, Ricci P. Unexplained and Unexpected Pediatric Deaths: Forensic Review and New Perspectives. Diagnostics (Basel) 2023; 13:3111. [PMID: 37835854 PMCID: PMC10572571 DOI: 10.3390/diagnostics13193111] [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: 08/14/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Unexplained and unexpected pediatric deaths are a major challenge in global healthcare. The role of the forensic pathologist is crucial in determining the cause and manner of death in these cases, although to date, there are many limitations in post-mortem diagnosis. The role of the autopsy and related forensic investigations become a fundamental tool to investigate and give an explanation for an unacceptable event, considering the young age of the victims. From this point of view, even today, it is necessary that this phenomenon is correctly recorded through standardized systems and universally accepted methods. Furthermore, it is essential that scientific research on this topic is increased through the implementation of universally accepted operating protocols recognizing real risk factors in order to prevent such events. The purpose of the study is to offer a review of the state of the art about unexplained pediatric death and, above all, to propose an international reporting platform, extending proper investigations not only to judicial cases but also to all the other cases of unexpected pediatric death.
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Affiliation(s)
- Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Jan Gorniak
- Clark County Office of Coroner Medical Examiner, 1704 Pinto Lane, Las Vegas, NV 89106, USA; (J.G.); (M.R.)
| | - Melanie Rouse
- Clark County Office of Coroner Medical Examiner, 1704 Pinto Lane, Las Vegas, NV 89106, USA; (J.G.); (M.R.)
| | - Saverio Gualtieri
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Fabrizio Cordasco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Alessandro Pasquale Tarallo
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Roberto Raffaele
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (F.C.); (A.P.T.); (R.R.); (P.R.)
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Sacco MA, Gualtieri S, Verrina MC, Ricci P, Aquila I. Sudden Death of a Young Man Due to Massive Haemoptysis Associated With Pulmonary Tuberculosis: A Rare Case. Cureus 2023; 15:e47635. [PMID: 38021513 PMCID: PMC10668203 DOI: 10.7759/cureus.47635] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Asphyxia includes a large number of possible causes and mechanisms, such as infectious diseases of the lungs. Among these, tuberculosis (TB) is one of the main infectious causes of death worldwide. The burden of TB is very high, by virtue of antibiotic resistance and the risk of other concomitant infections, such as HIV. A major problem is related to the omitted diagnosis of TB infection which, in some cases, may remain completely unknown to the patient, with a significant increase in mortality and morbidity risk. There has been a decrease in the reported cases of sudden death due to TB, especially that associated with hemoptysis and aspiration of blood. In this report, we describe a case of sudden death that occurred in a young male in the workplace, under unclear circumstances. The autopsy detected acute asphyxia due to a massive pulmonary hemorrhage in the individual, who was apparently suffering from TB. The autopsy proved to be essential for understanding the cause of death and investigating the adequacy of the health surveillance measures carried out on the individual.
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Affiliation(s)
- Matteo Antonio Sacco
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Saverio Gualtieri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Maria Cristina Verrina
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Pietrantonio Ricci
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, ITA
| | - Isabella Aquila
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, ITA
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Sacco MA, Gualtieri S, Tarda L, Ricci P, Aquila I. Clinical and Forensic Investigation Protocols for Diagnosing Abusive Head Trauma: A Literature Review. Diagnostics (Basel) 2023; 13:3093. [PMID: 37835835 PMCID: PMC10572508 DOI: 10.3390/diagnostics13193093] [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: 08/27/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Abusive head trauma (AHT) represents a very serious global public health problem. Prevention of these episodes is essential to reduce the morbidity and mortality of this phenomenon. All healthcare professionals should be able to recognize the signs of abuse. However, diagnosis is very complex as the signs are often blurred and cannot be recognized with certainty without carrying out adequate instrumental investigations. It has been calculated that approximately one-third of AHT cases remain undetected and require more than one medical visit to be correctly interpreted and diagnosed. On the other hand, the literature has recently also emphasized the problems related to possible false diagnoses of abuse and the numerous family and personal repercussions that follow from this issue. For these reasons, correct and timely recognition is essential to avoid the risk of recurrence of AHT and to start proper forensic investigations, in order to identify the offender or exonerate a suspect. The present work explores the most recent evidence of recent years in the field of AHT diagnostics through a literature review. The purpose of this article is to provide forensic pathologists with clear tools for diagnosis based on the literature. To this end, the review suggests clinical and forensic protocols aimed at the timely diagnosis of AHT in order to prevent abuse from remaining undetected.
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Affiliation(s)
| | | | | | | | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (L.T.); (P.R.)
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7
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Sacco MA, Gualtieri S, Calanna L, Ricci P, Aquila I. Exploring the Potential of Proteome Analysis as a Promising Tool for Evaluation of Sudden Cardiac Death (SCD) in Forensic Settings: A Literature Review. Int J Mol Sci 2023; 24:14351. [PMID: 37762655 PMCID: PMC10531952 DOI: 10.3390/ijms241814351] [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: 08/27/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Sudden cardiac death (SCD) represents a global emergency, with a high number of cases affecting all age groups every year. The prevention of these fatal events requires an accurate knowledge of etiology and pathogenesis, which can vary. Autopsy is an indispensable tool in cases of SCD for diagnostic purposes, as well as for judicial and preventive purposes for family members. Despite the completion of all routine post-mortem investigations, it is often complicated for the forensic pathologist to define the triggering cause of these events. The study of the proteome is proving to be extremely promising in the field of human cardiovascular disease. This paper aims to offer a literature review on the study of the proteome in post-mortem cadaveric biological samples obtained from SCD cases. The aim of this work is to outline the state of the art of the scientific advances that protein analysis can offer in the diagnosis of SCD and the limits that various studies have traced up to now. In conclusion, the work defines the future perspectives of this field in SCD, suggesting strategies to overcome the reported limits and improve the diagnostics of these events.
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Affiliation(s)
| | | | | | | | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.A.S.); (S.G.); (L.C.); (P.R.)
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Sacco MA, Cordasco F, Abenavoli L, Lavano A, Gallotta G, Garofalo E, Bruni A, Scalise C, Gualtieri S, Tarallo AP, Aquila VR, Ricci P, Aquila I. The Role of Autopsy and Post-Mortem Investigations in Falling Traumas in the Hospital Environment. Diagnostics (Basel) 2022; 12:diagnostics12123168. [PMID: 36553175 PMCID: PMC9777541 DOI: 10.3390/diagnostics12123168] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/03/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Falls in a hospital setting are a global public health problem. Despite the production of sensors and various preventive tools to reduce the risk, falls remain a dangerous event with a significant impact on the morbidity and mortality of patients. Despite numerous prevention strategies, falling in the hospital are not always investigated and the autopsy is not always performed in these cases, so it is often not known whether the death is related to the fall or to other causes, inevitably affecting the assessment of any profiles of medical liability for health personnel or for the hospital in the accident. We describe three cases of falls that occurred in different hospitals, in which the autopsy allowed to diagnose with certainty the extent of the trauma and to reconstruct its dynamics. Along with the circumstantial and documentary analyses, deficiencies both in the trauma diagnostics and in the application of the safety measures on the patients were showed. Together with the description of our cases, we propose the post-mortem investigations of these events, both for judicial and risk management purposes.
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Affiliation(s)
- Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Fabrizio Cordasco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Angelo Lavano
- Unit of Neurosurgery, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Giovanni Gallotta
- Department of Clinical and Experimental Medicine, Federico II University, 80138 Naples, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Carmen Scalise
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Saverio Gualtieri
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Alessandro Pasquale Tarallo
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Valerio Riccardo Aquila
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-09613647304; Fax: +39-09613647560
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Morello F, Nazerian P, Mueller C, Soeiro A, Leidel B, Salvadeo S, Giachino F, Vanni S, Grimm K, Tavares De Oliveira M, Veglio M, Gualtieri S, Grifoni S, Lupia E. P6021Rule-out of acute aortic syndrome by integration of the aortic dissection detection risk score plus d-dimer: preliminary data from the ADvISED prospective multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6021] [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: 11/13/2022] Open
Affiliation(s)
- F. Morello
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - C. Mueller
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | - A. Soeiro
- University of São Paulo, Heart Institute, Emergency Care Unit, São Paulo, Brazil
| | - B.A. Leidel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Emergency Medicine, Berlin, Germany
| | - S. Salvadeo
- Policlinic Foundation San Matteo IRCCS, Emergency Medicine, Pavia, Italy
| | - F. Giachino
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | - S. Vanni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - K. Grimm
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | | | - M.G. Veglio
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - S. Grifoni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - E. Lupia
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
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Zanobetti M, Coppa A, Nazerian P, Grifoni S, Scorpiniti M, Innocenti F, Conti A, Bigiarini S, Gualtieri S, Casula C, Ticali PF, Pini R. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. Eur J Trauma Emerg Surg 2015; 44:805-810. [PMID: 26683569 DOI: 10.1007/s00068-015-0620-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. METHODS A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs). RESULTS Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. CONCLUSION According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.
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Affiliation(s)
- M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - A Coppa
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P Nazerian
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Grifoni
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - M Scorpiniti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - F Innocenti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - A Conti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Bigiarini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Gualtieri
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - C Casula
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P F Ticali
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - R Pini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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11
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Iarussi D, Gualtieri S, Tedesco MA, Iacono A. [Cardiovascular toxic effects of drugs not used in cardiology]. Cardiologia 1995; 40:105-11. [PMID: 8998701] [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: 02/03/2023]
Affiliation(s)
- D Iarussi
- Cattedra di Cardiologia, Seconda Università degli Studi, Napoli
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Nave C, Giasi A, Lucca P, Cice G, Gualtieri S, Albanese G, D'Amato S, Iacono A. [Infectious endocarditis in dentistry practice: recent controversies and modes of the use of antibiotic prophylaxis]. Cardiologia 1994; 39:777-82. [PMID: 7736477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.
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Affiliation(s)
- C Nave
- Cattedra di Cardiologia, Università degli Studi, Napoli
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13
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Tedesco M, Iarussi D, Ratti G, Gualtieri S, Irace L, Romano A, Guadagno I, Coppolino P, Iacono A. Doxorubicin cardiotoxicity assessed with vectorcardiographic and echocardiographic techniques. J Electrocardiol 1993. [DOI: 10.1016/0022-0736(93)90029-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Pisacane C, Iarussi D, Buono S, Gualtieri S, Coppolino P, Iacono A. [Clinical usefulness of quantitative two-dimensional echocardiographic analysis of segmental kinesis of the left ventricle in monitoring of patients with neoplasms treated with anthracyclines]. G Ital Cardiol 1991; 21:1259-67. [PMID: 1818000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To determine whether serial quantitative two-dimensional echocardiographic analysis of left ventricular wall motion could be effective in selecting patients in whom anthracycline treatment must be stopped, 26 patients (18 M and 8 F, mean age 10 +/- 3, range 6 to 16 years) with malignancy, receiving doxorubicin or daunomycin were followed up. Left ventricular regional wall motion abnormalities were detected in 11 patients (42%), while left ventricular ejection fraction at rest (although progressively decreased from baseline value [63 +/- 2 vs 55 +/- 2%; p = 0.0001]) was still in normal range. The following distribution of left ventricular contraction abnormalities was noted: septal, anteroseptal and posteroseptal akinesis with posterior wall hypokinesis in one patient; septal, anteroseptal and posteroseptal akinesis with anterolateral free-wall hypokinesis in another; septal, anteroseptal and posteroseptal hypokinesis in four; lateral and posterolateral free-wall hypokinesis in one; septal, anteroseptal, posteroseptal and posterior hypokinesis in four. The drug was discontinued in only two patients with akinesis, since we regarded this contraction abnormality as a predictive index of more serious and extensive myocardial damage. We began to detect hypokinesis when cumulative doses of doxorubicin or daunorubicin were 155-420 mg/m2 and 270-285 mg/m2 respectively, while akinesis was seen at doses of 395 mg/m2 of body-surface area for doxorubicin and 575 mg/m2 for daunorubicin. Follow-up examination was conducted six months after the last dose of anthracycline, and improvement or recovery of left ventricular regional wall motion abnormalities was noted in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Pisacane
- Istituto Medico-Chirurgico di Cardiologia, Universitá Degli Studi di Napoli Federico II
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15
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Sinforiani E, Trucco M, Pacchetti C, Gualtieri S. [Evaluation of the effects of citicoline in chronic cerebrovascular diseases]. Minerva Med 1986; 77:51-7. [PMID: 3511406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A double-blind random block trial was carried out on 58 patients suffering from chronic cerebrovascular diseases as defined by the "Ad Hoc Committee, Paris 1980". The trial was carried out to assess the effects of citicoline on chronic cerebrovascular disease. Particular attention was paid to the selection of the assessment tools (neuropsychological and psychological tests). Citicoline treatment brought about an improvement in awareness and perceptive-motor faculties. This effect can be attributed to an overall drug action on neural energy metabolism.
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Moglia A, Sinforiani E, Zandrini C, Gualtieri S, Corsico R, Arrigo A. Activity of Oxiracetam in Patients with Organic Brain Syndrome. Clin Neuropharmacol 1986. [DOI: 10.1097/00002826-198609003-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Sinforiani E, Trucco M, Cavallini A, Gualtieri S, Verri AP, Spignoli G. [Reversibility of cognitive disorders among chronic alcoholics in phases of withdrawal. Effect of arginine pyroglutamate]. Minerva Psichiatr 1985; 26:339-46. [PMID: 3912647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Aiello C, Groothold G, Gualtieri S, Irace L, Marini IL, Perna B, Romano A. Haemodynamic effects of indenolol at rest and after a submaximal workload in essential hypertension. Eur J Clin Pharmacol 1985; 28:501-5. [PMID: 3899670 DOI: 10.1007/bf00544058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The effect of indenolol on heart rate and blood pressure at rest and after submaximal workload has been studied in 19 patients with established essential hypertension. A stepwise increase from moderate to submaximal exercise was chosen to mimic challenges normally occurring in daily life. After 4 weeks of once a day indenolol therapy a significant, gradual reduction in the following cardiovascular parameters was observed: heart rate at rest fell by 20%, 30% after exercise and 31% after recovery; systolic blood pressure showed a fall of 15% at rest, 19% after workload and 14% after recovery; the reduction in diastolic blood pressure was 15% at rest, 11% after exercise and 12% after recovery. The rate-pressure product was decreased by 32% at rest, 43% after exercise and 42% after recovery. It is concluded that the most important pharmacological effect of indenolol is the significant decrease in myocardial oxygen demand. In patients with essential hypertension indenolol not only produces a definite antihypertensive effect, but it also increases workload tolerance and decreases subjective symptoms during physical activity. Compliance was good and no severe side effects were observed.
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Iarussi D, Bordi B, Vitale P, Gualtieri S, Pisacane C, Tommasino C, Iaccarino G. [Left ventricular function in subjects with porphyria cutanea tarda]. Cardiologia 1984; 29:387-94. [PMID: 6239638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Iarussi D, Gualtieri S, Coppolino P, Fulgione C, Battaglia S. [Disappearance of a left intraventricular thrombus documented by bidimensional echocardiography]. Cardiologia 1983; 28:353-7. [PMID: 6687174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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21
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Iarussi D, Gualtieri S, Caso P, Aiello C, Ferrante MR, Raucci D, Jacono A. [Ventricular extrasystoles: useful pathological phenomenon in clinical medicine]. Recenti Prog Med 1980; 68:150-88. [PMID: 6154303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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