Publications by authors named "Alessio Asmundo"

26 Publications

  • Page 1 of 1

Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations.

Med Sci Law 2021 Jan;61(1_suppl):141-145

Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.

The trend for medical malpractice claims has increased in recent years, both in the USA and in Europe. Although diagnostic radiology is not considered a high-risk field, malpractice claims in this area follow this general trend. The most common legal action taken against radiologists includes failure to diagnose, poor communication between physicians, failure to supervise technologists properly and improper procedures. Recently, the Italian Civil Supreme Court delivered a judgment (Cass. Civ., N.10158-18) regarding the liability of radiologists, stating that in radiological practice, a correct and timely execution of the diagnostic investigation is required. By contrast, the same judgment states that requesting further clinical consultations and/or the execution of in-depth diagnostic examinations are not within their duties. Considering this judgment, we report two cases of radiologist malpractice and related responsibility for negligent conduct regarding the diagnosis of thoracic aortic dissection and the prevention and management of acute aortic syndrome.
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http://dx.doi.org/10.1177/0025802420977977DOI Listing
January 2021

Electrosurgical unit: Iatrogenic injuries and medico-legal aspect. Italian legal rules, experience and article review.

Ann Med Surg (Lond) 2021 Feb 4;62:26-30. Epub 2021 Jan 4.

Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, A.O.U. "G. Martino" Via Consolare Valeria n. 1, 98124, Messina, Italy.

Background: The use of the electrosurgical unit (ESU) is well-established in the surgical practice. The Authors, to better understand the genesis of injuries connected to the use of electrosurgical instruments, conducted an in-depth literature review pertaining to this topic.

Materials And Method: Using the most important medical databases, a research of experimental studies in the last 20 years was conducted.

Results: The analysis of the mechanisms responsible for the lesions showed that high energy devices remain as the most common cause of injury. Adverse events are mainly given by thermal injuries; cases of electromagnetic interference are also described in patients with pacemakers or sacral nerve stimulator and spinal stimulators as well as cases of fire of the endotracheal tube in the course of tracheostomy for the use of the electrosurgical unit in an environment with a high concentration of oxygen or anesthetic gases. Also reported in the literature are individual cases of fires caused by sparks from the electrosurgical handpiece also for the use of disinfectants and/or in relation to surgical drapes.

Conclusion: In order to clearly define the medical-legal aspects, focusing on the professional responsibility of the surgical and nursing staff, the authors' attention was brought to the need for an effective prevention plan that highlights not only the importance of an accurate procedural knowledge in order to safety use the electrosurgical instruments, but also the need for a system that monitors any complications or adverse events resulting from the use of such instruments.
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http://dx.doi.org/10.1016/j.amsu.2020.12.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808912PMC
February 2021

Narrative review of proving the causal link of recurrent laryngeal nerve injury and thyroidectomy: a medico legal appraisal.

Gland Surg 2020 Oct;9(5):1564-1572

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.

The recurrent laryngeal nerve (RLN) injuries are frequent complications related to thyroid surgery determining patient complaints and malpractice litigations. In the present work, the authors provide a brief review on the peculiarities of RLN injuries associated with thyroidectomy to highlight the various aspects of medicolegal assessment of causal link between surgery and nerve damage. The characteristics of thyroid disease, the anatomical peculiarities of surgery site and the nerve identification and preservation are factors that mostly influence the liability admission or rejection. In this context, the clinical records are fundamental, representing the most important probative tool. The possibility of having a set of information collected by clinical records, which allows for analysis and comparison to be made regarding the adherence to standards for thyroid surgery, is essential to set any medico-legal deliberation. However, the medicolegal evaluation can be very difficult. The practitioners involved in the medicolegal analysis of patient complaints related to this thyroidectomy complication need an in-depth knowledge of surgical technique, damage prevention activities and related clinical picture. To this must be added an adequate competence in the evaluation of the causal link (relation between the event and the injury and between that injury and the temporary/permanent impairment) based on the rigorous application of the medicolegal method.
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http://dx.doi.org/10.21037/gs-20-203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667053PMC
October 2020

Membrane Attack Complex in Myocardial Ischemia/Reperfusion Injury: A Systematic Review for Post Mortem Applications.

Diagnostics (Basel) 2020 Nov 2;10(11). Epub 2020 Nov 2.

Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria 1, 98125 Messina, Italy.

The complement system has a significant role in myocardial ischemia/reperfusion injury, being responsible for cell lysis and amplification of inflammatory response. In this context, several studies highlight that terminal complement complex C5b-9, also known as the membrane attack complex (MAC), is a significant contributor. The MAC functions were studied by many researchers analyzing the characteristics of its activation in myocardial infarction. Here, a systematic literature review was reported to evaluate the principal features, advantages, and limits (regarding the application) of complement components and MAC in post mortem settings to perform the diagnosis of myocardial ischemia/infarction. The review was performed according to specific inclusion and exclusion criteria, and a total of 26 studies were identified. Several methods studied MAC, and each study contributes to defining better how and when it affects the myocardial damage in ischemic/reperfusion injury. The articles were discussed, focusing on the specificity, sensibility, and post mortem stability of MAC as a marker of myocardial ischemia/infarction, supporting the usefulness in routine post mortem investigations.
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http://dx.doi.org/10.3390/diagnostics10110898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692679PMC
November 2020

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression.

Diagnostics (Basel) 2020 Aug 9;10(8). Epub 2020 Aug 9.

Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.

(1) Background: The current outbreak of COVID-19 infection is an ongoing challenge and a major threat to public health that requires surveillance, prompt diagnosis, as well as research efforts to understand the viral pathogenesis. Despite this, to date, very few studies have been performed concerning autoptic specimens. Therefore, this study aimed: (i) to reiterate the importance of the autoptic examination, the only method able to precisely define the cause of death; (ii) to provide a complete post-mortem histological and immunohistochemical investigation pattern capable of diagnosing death from COVID-19 infection. (2) Methods: In this paper, the lung examination of two subjects who died from COVID-19 are discussed, comparing the obtained data with those of the control, a newborn who died from pneumonia in the same pandemic period. (3) Results: The results of the present study suggest that COVID-19 infection can cause different forms of acute respiratory distress syndrome (ARDS), due to diffuse alveolar damage and diffuse endothelial damage. Nevertheless, different patterns of cellular and cytokine expression are associated with anti-COVID-19 antibody positivity, compared to the control case. Moreover, in both case studies, it is interesting to note that COVID-19, ACE2 and FVIII positivity was detected in the same fields. (4) Conclusions: COVID-19 infection has been initially classified as exclusively interstitial pneumonia with varying degrees of severity. Subsequently, vascular biomarkers showed that it can also be considered a vascular disease. The data on Factor VIII discussed in this paper, although preliminary and limited in number, seem to suggest that the thrombogenicity of Sars-CoV2 infection might be linked to widespread endothelial damage. In this way, it would be very important to investigate the pro-coagulative substrate both in all subjects who died and in COVID-19 survivors. This is because it may be hypothesized that the different patterns with which the pathology is expressed could depend on different individual susceptibility to infection or a different personal genetic-clinical background. In light of these findings, it would be important to perform more post-mortem investigations in order to clarify all aspects of the vascular hypothesis in the COVID-19 infection.
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http://dx.doi.org/10.3390/diagnostics10080575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460315PMC
August 2020

Anabolic-androgenic steroids and brain injury: miRNA evaluation in users compared to cocaine abusers and elderly people.

Aging (Albany NY) 2020 08 3;12(15):15314-15327. Epub 2020 Aug 3.

Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95121, Italy.

Anabolic-androgenic steroids (AASs) can be used to treat both hormonal diseases and other pathologies characterized by muscle loss (aging, cancer, and AIDS). Even if the adverse effects related to the misuse of AASs have been well studied in different systems and apparatuses, knowledge about brain damage is poor.In this scenario, this experimental study aimed to analyze the role of several microRNAs (miRNAs) in brain damage after AAS misuse, to better comprehend the underlying mechanisms. The research hypothesis at the base of this experimental study is that the chronic use of AASs may be associated to brain damage with a dysregulation of these miRNAs. Moreover, miRNA expression values were compared among three different groups, "AAS" group, "Cocaine" group and "Aging" group, in order to define if AAS brain damage can be compared with the brain impairment linked to aging and/or cocaine assumption.This experimental study revealed that the tested miRNAs (hsa-miR-21-5p, hsa-miR-34a-5p, hsa-miR-124-5p, hsa-miR-132-3p, and hsa-miR-144-3p) were overexpressed in all enrolled groups. In the light of the presented results, the identification of specific circulating and/or tissue biomarkers is challenging for the scientific community. Further studies with larger samples are needed to confirm these interesting findings.
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http://dx.doi.org/10.18632/aging.103512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467388PMC
August 2020

Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature.

Int J Environ Res Public Health 2020 06 30;17(13). Epub 2020 Jun 30.

Forensic Medicine, Department of Law, Magna Grecia, University of Catanzaro, 81100 Catanzaro, Italy.

(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: "foreign body aspiration," "infant choking, 1.5 to 3 years," "food and foreign body aspiration," "common household," "prevention of foreign body aspiration," "guidelines," "recommendations," "training of caregivers (parents, educators)," "resuscitation," "Heimlich maneuver," and "disengagement of the upper airways." We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.
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http://dx.doi.org/10.3390/ijerph17134700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369691PMC
June 2020

Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review.

J Clin Med 2020 Jun 28;9(7). Epub 2020 Jun 28.

Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.

The severe acute respiratory syndrome (SARS)-CoV-2 was identified for the first time in China, in December 2019. Confirmed cases of COVID-19 have been reported around the world; indeed, this infection has been declared a pandemic. Consequently, the scientific community is working hard to gain useful information about the history of this virus, its transmission, diagnosis, clinical features, radiological findings, research and development of candidate therapeutics as well as vaccines. This review aims to analyze the diagnostic techniques used to ascertain the COVID-19 infection, critically reviewing positive points and criticism for forensic implications, obviously including autopsy. Finally, this review proposes a practical workflow to be applied in the management of corpses during this outbreak of the COVID-19 infection, which could be useful in cases of future infectious disease emergencies. Analyzing the diagnostic methods, to date, virus nucleic acid RT-PCR represents the standard method used to ascertain the COVID-19 infection in living subjects and corpses, even if this technique has several criticisms: mainly, the staff should be highly specialized, working in high-throughput settings, able to handle high workloads and aware of health risks and the importance of the results. Thus, IgG/IgM serological tests have been developed, overcoming RT-qPCR duration, costs, and management, not requiring highly trained personnel. Nevertheless, serological tests present problems; the WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. Furthermore, nothing has yet been published regarding the possibility of applying these methods during post-mortem investigations. In light of this scenario, in this review, we suggest a flow chart for the pathologist called on to ascertain the cause of death of a subject with historical and clinical findings of COVID-19 status or without any anamnestic, diagnostic, or exposure information. Indeed, the literature data confirmed the analytical vulnerabilities of the kits used for laboratory diagnosis of COVID-19, particularly during postmortem examinations. For these reasons, autopsy remains the gold standard method to ascertain the exact cause of death (from or with COVID-19 infection, or other causes), to consequently provide real data for statistical evaluations and to take necessary measures to contain the risks of the infection. Moreover, performing autopsies could provide information on the pathogenesis of the COVID-19 infection with obvious therapeutic implications.
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http://dx.doi.org/10.3390/jcm9072026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409028PMC
June 2020

Short-Term Physiological Effects of a Very Low-Calorie Ketogenic Diet: Effects on Adiponectin Levels and Inflammatory States.

Int J Mol Sci 2020 May 2;21(9). Epub 2020 May 2.

Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, 71100 Foggia, Italy.

Adipose tissue is a multifunctional organ involved in many physiological and metabolic processes through the production of adipokines and, in particular, adiponectin. Caloric restriction is one of the most important strategies against obesity today. The very low-calorie ketogenic diet (VLCKD) represents a type of caloric restriction with very or extremely low daily food energy consumption. This study aimed to investigate the physiological effects of a VLCKD on anthropometric and biochemical parameters such as adiponectin levels, as well as analyzing oligomeric profiles and cytokine serum levels in obese subjects before and after a VLCKD. Twenty obese subjects were enrolled. At baseline and after eight weeks of intervention, anthropometric and biochemical parameters, such as adiponectin levels, were recorded. Our findings showed a significant change in the anthropometric and biochemical parameters of these obese subjects before and after a VLCKD. We found a negative correlation between adiponectin and lipid profile, visceral adipose tissue (VAT), C-reactive protein (CRP), and pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), which confirmed the important involvement of adiponectin in metabolic and inflammatory diseases. We demonstrated the beneficial short-term effects of a VLCKD not only in the treatment of obesity but also in the establishment of obesity-correlated diseases.
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http://dx.doi.org/10.3390/ijms21093228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246656PMC
May 2020

The Role of a Good Quality Autopsy in Pediatric Malpractice Claim: A Case Report of an Unexpected Death in an Undiagnosed Thymoma.

Front Pediatr 2020 7;8:31. Epub 2020 Feb 7.

Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy.

Thymomas are extremely rare in the first 20 years of life, with different clinical presentations: from asymptomatic mediastinal masses to compressive and paraneoplastic syndromes. In pediatric population, the respiratory disorders have a higher incidence. The overall thymoma mortality rate is described as 40% and metastasized tumors are more aggressive. This case report describes a compressive syndrome caused by a thymoma in which symptoms were exacerbated by a concurrent pulmonary infection, thus leading an affected infant to sudden death despite medical treatment. In this case, patient's death occurred just before the differential diagnostic process got completed. Malpractice claim was based on the missing diagnosis as well as the suspect of inadequate provided care. Consequently, autopsy played a crucial post-mortem role to find out the cause of death, and to exclude any professional liability. Despite modern diagnostic techniques, autopsies are still the best available forensic tool. It is useful to remember that death is a fact of life, therefore not always preventable.
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http://dx.doi.org/10.3389/fped.2020.00031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026673PMC
February 2020

Feasibility Study of MRI Muscles Molecular Imaging in Evaluation of Early Post-Mortem Interval.

Sci Rep 2020 01 15;10(1):392. Epub 2020 Jan 15.

Department of Biomedical and Dental Sciences,and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy.

Estimating early postmortem interval (EPI) is a difficult task in daily forensic activity due to limitations of accurate and reliable methods. The aim of the present work is to describe a novel approach in the estimation of EPI based on quantitative magnetic resonance molecular imaging (qMRMI) using a pig phantom since post-mortem degradation of pig meat is similar to that of human muscles. On a pig phantom maintained at 20° degree, using a 1.5 T MRI scanner we performed 10 scans (every 4 hours) monitoring apparent diffusion coefficient (ADC), fractional anisotropy (FA) magnetization transfer ration (MTR), tractography and susceptibility weighted changes in muscles until 36 hours after death. Cooling of the phantom during the experiment was recorded. Histology was also obtained. Pearson's Test was carried out for time correlation between post-mortem interval and MRI data. We found a significative inverse correlation between ADC, FA, MT values and PMI. Our preliminary data shows that post-mortem qMRMI is a potential powerful tool in accurately determining EPI and is worth of further investigation.
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http://dx.doi.org/10.1038/s41598-019-57357-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962370PMC
January 2020

Experience of an Italian Hospital Claims Management Committee: A tool for extrajudicial litigations resolution.

Leg Med (Tokyo) 2020 Feb 14;42:101657. Epub 2019 Dec 14.

Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.

Litigation related to medical liability has a great impact on Italian healthcare expenditure. Recently, many Italian Regions have adopted a "self-insurance system" and, in Sicilian Hospitals, were established the Claims Management Committees (CMC) to provide the direct management of claims. Here the experience of a Sicilian University Hospital CMC was described to analyze the claims features and their outcomes providing evidence on CMC usefulness. The analysis involved claims for compensation received during 4 years, using data obtained by a retrospective analysis of claims database created by Forensic Medicine Service. Claims data, obtained from the insurance broker, were used to perform the statistical comparison. During the examined period a total of 377 claims were received by CMC, respectively 63.6% for professional liability and 36.4% for other causes (damages not related to medical malpractice). The prevalence of complaints about malpractice regarded surgery. The CMC had expressed an opinion on 120 claims related to malpractice with the percentages of admission or rejection of liability respectively of 55% and 45%. The statistical analysis revealed a greater number of lawsuits in the Insurance system and, moreover, the CMC higher probability to reach the amicable settlement of litigations. CMC provides specific data on claims trend and economic expenditure, demonstrating its usefulness for analysis and monitoring the causes of patients/people damage. It is a tool for medical malpractice risk assessment and prevention. It can encourage the amicable settlement and prevention of civil action. It seems to be an efficient system to reduce the health liability costs.
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http://dx.doi.org/10.1016/j.legalmed.2019.101657DOI Listing
February 2020

Post-Mortem Immunohistochemical Evidence of β2-Adrenergic Receptor Expression in the Adrenal Gland.

Int J Mol Sci 2019 Jun 23;20(12). Epub 2019 Jun 23.

Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, 1, 98125 Messina, Italy.

The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal β2-adrenergic receptor (β2-AR), a receptor with high-affinity for catecholamines, with the aim to show which zones it is expressed in and how its expression differs in relation to the cause of death. The immunohistochemical study was performed on adrenal glands obtained from 48 forensic autopsies of subjects that died as a result of different pathogenic mechanisms using a mouse monoclonal β2-AR antibody. The results show that immunoreactivity for β2-AR was observed in all adrenal zones. Furthermore, immunoreactivity for β2-AR has shown variation in the localization and intensity of different patterns in relation to the original cause of death. To the best of our knowledge, this is the first study that demonstrates β2-AR expression in the human cortex and provides suggestions on the possible involvement of β2-AR in human cortex hormonal stimulation. In conclusion, the authors provide a possible explanation for the observed differences in expression in relation to the cause of death.
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http://dx.doi.org/10.3390/ijms20123065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628614PMC
June 2019

Cross-Country Comparative Analysis of Legislation and Court Rulings in Wrongful Birth Actions.

J Leg Med 2019 Jan-Mar;39(1):35-53

Negligent conduct by health care providers can result in medical malpractice injury sustained by parents denied their right to decide whether and when to have children. In this review of the international medicolegal literature, the authors present a comparative analysis of the law of medical negligence in this context and a discussion of the grounds for compensable injury resulting from medical error. The discussion is focused on the legal provisions for compensable injury awarded to the plaintiff (expectant mother, parents of the born child, and born child) and the types of injury various legal systems recognize in such cases. The aim of this article is to provide medical malpractice investigators and legal professionals with an overview of the birth cases.
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http://dx.doi.org/10.1080/01947648.2019.1596851DOI Listing
January 2020

Immunohistochemical study on dystrophin expression in CAD-related sudden cardiac death: a marker of early myocardial ischaemia.

Int J Legal Med 2018 Sep 7;132(5):1333-1339. Epub 2018 May 7.

Legal Medicine Section, Department for Health Promotion and Mother-Child Care, University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.

The aims of this study were to assess if dystrophin can be a tool for the forensic evaluation of sudden cardiac death due to coronary atherosclerotic disease (CAD) and particularly if it can be a marker of early myocardial ischaemia. Then in this investigation, the dystrophin was compared to C5b-9 and fibronectin to analyze if there are some differences in the expression of these proteins. Two groups of CAD-related sudden cardiac death, respectively the group 1 with gross and/or histological evidence and the group 2 with no specific histological signs of myocardial ischaemia were used. A third group formed by cases of acute mechanical asphyxiation was used as a control. The immunohistochemical staining by dystrophin, C5b-9 and fibronectin antibodies was performed. Loss of sarcolemmal dystrophin was observed in different degrees according to more or less significant histological evidence of myocardial ischaemia. Moreover, the comparison between loss of dystrophin expression and fibronectin positivity showed significant differences in group 2. The results suggested that dystrophin can be used in forensic diagnosis of CAD-related sudden cardiac death and as marker of early myocardial ischaemia.
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http://dx.doi.org/10.1007/s00414-018-1843-3DOI Listing
September 2018

Analysis on sarcoglycans expression as markers of septic cardiomyopathy in sepsis-related death.

Int J Legal Med 2018 Nov 11;132(6):1685-1692. Epub 2018 Apr 11.

Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy.

The post-mortem assessment of sepsis-related death can be carry out by many methods recently suggested as microbiological and biochemical investigations. In these cases, the cause of death is a multiple organ dysfunction due to a dysregulated inflammatory response occurring after the failure of infection control process. It was highlighted also that the heart can be a target organ in sepsis which determines the so-called septic cardiomyopathy characterized by myocardial depression. Several mechanisms to explain the pathophysiology of septic cardiomyopathy were suggested, but very few studies about the structural alterations of cardiac cells responsible for myocardial depression were carried out. The aim of this study was to evaluate whether sarcoglycans (SG) were involved in septic cardiac damage analyzing their expression in sepsis-related deaths and, particularly, if these proteins can be used as markers of septic myocardial dysfunction. Cases of septic-related death confirmed by clinical and autopsy records were investigated and compared to a control group of traumatic deaths. Indirect immunofluorescence analysis was performed to analyze α-SG, β-SG, δ-SG, ζ-SG, ε-SG, and γ-SG. Decrease of fluorescence staining pattern for all tested sarcoglycans was observed in the septic-related deaths compared to normal fluorescence staining pattern of control group. These results provide new findings about the myocytes structural alterations due to sepsis and suggest that these proteins could be used in forensic assessment of septic cardiomyopathy.
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http://dx.doi.org/10.1007/s00414-018-1840-6DOI Listing
November 2018

Post mortem CT of intrahepatic gas distribution in twenty-seven victims of a flood: Patterns and timing.

Leg Med (Tokyo) 2017 Nov 21;29:18-21. Epub 2017 Sep 21.

Department of Biomedical Sciences, Dental and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Italy.

We reported the results of post mortem computed tomography of the liver in 27 subjects dead simultaneously during a flood. The aim of our work was to identify the different patterns of post mortem intrahepatic gas distribution and the timing of its appearance. Although post mortem CT is the method of choice for the evaluation of gas distribution, controversies exist about the first site of appearance of intrahepatic gas (portal veins versus hepatic veins) as well as the timing and steps of intrahepatic gas spreading. In each subject we performed thin slice CT scanner (Somatom Definition, Siemens) and post processing of native CT images with Minimum Intensity Projection technique. Our results show that the first site of appearance of intrahepatic gas is portal veins. Gas in hepatic veins was never seen without the presence of the gas in portal vein. Gaseous cysts in hepatic parenchyma represent a further and usually more tardive pattern of intrahepatic gas distribution. In addition, we demonstrated that differences in timing of gas spreading was statistically significative for exclusive presence of portal veins gas before 48h as well as for complete substitution of hepatic parenchyma by cysts 64h after death. In conclusion, our work shows that the CT study of postmortem intrahepatic gas distribution could be a useful complementary tool both in demonstrating the mechanism of intrahepatic gas spreading and in estimating post mortem interval.
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http://dx.doi.org/10.1016/j.legalmed.2017.09.002DOI Listing
November 2017

Traumatic dental injury.

Minerva Stomatol 2016 Jun 16;65(3):158-63. Epub 2016 Feb 16.

Department of Biomedical Sciences and of Morphological and Functional Imaging, Università degli Studi di Messina, Messina, Italy -

Background: The aim of this study was to retrospectively evaluate the incidence of traumatic dental injury and consequential dental impairment following road traffic accidents and to examine the factors that can affect the monetary value of compensation for bodily injury payable pursuant to current insurance regulations.

Methods: From 2004 to 2014, 7233 persons involved in road traffic accidents in the province of Messina, eastern Sicily, were examined by insurance physicians to assess bodily injury damage. Data were collected from cases of traumatic dental injury causing malocclusion and temporomandibular joint dysfunction, either alone or concomitant with injuries to other parts of the body. Injury characteristics and consequential bodily injury damage were classified and the incidence calculated using Microsoft Excel software.

Results: The incidence of traumatic dental injuries was 3% of the total population (195 subjects - 127 males and 68 females); the majority of cases (56%) involved riders of two-wheeled vehicles. A high percentage of riders received injury to one or more teeth, i.e. fractures and dislocations, more frequently to the anterior teeth (68%) than the posterior teeth because of their position in the dental arch. Temporomandibular joint injuries were far fewer (8%) and resulted from either direct or indirect trauma associated with severe head and/or neck injury. The incidence of permanent bodily damage consequential to these injuries was fairly low.

Conclusions: Although the incidence of dental trauma following road traffic accidents is low, the monetary compensation for consequential dental impairment based on current insurance regulatory law is far from negligible.
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June 2016

Lethal Anaphylactic Reaction to Intravenous Gelatin in the Course of Surgery.

Am J Ther 2016 Nov/Dec;23(6):e1344-e1346

1Department of Biotechnology and Legal Medicine, Section of Legal Medicine, University of Palermo, Palermo, Italy; 2Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 3Operative Unit of Clinical Pharmacology, Azienda Ospedaliera Universitaria Policlinico "G. Martino," Messina, Italy; 4Operative Unit of Allergy and Clinical Immunology, Azienda Ospedaliera Universitaria Policlinico "G. Martino," Messina, Italy; 5Department of Biomedical Sciences and Morphological and Functional Images, Section of Morphological Forensic and Locomotor System, University of Messina, Messina, Italy; and 6Institute of Clinical Physiology (IFC), Consiglio Nazionale delle Ricerche (CNR), Messina Unit, Messina, Italy.

Plasma volume expanders (PVEs) are widely used to increase circulating blood volume. Gelatins used as PVEs are heterogeneous mixtures of polypeptides, usually prepared by hydrolysis of bovine collagen containing large amounts of proline and hydroxyproline residues. It has been shown that gelatins can cause anaphylactic reactions. We describe the case of a 73-year-old man who during surgery for intestinal obstruction presented a lethal anaphylactic reaction after the administration of a PVE containing gelatin lysate. The reaction occurred 10 minutes after the start of plasma expander infusion. Then, patient became comatose, and he died without awakening after 76 days. Necroptic aspects and histologic evaluation suggested the occurrence of anaphylactic reaction. According to pharmacovigilance algorithm, the causality relationship between PVE administration and adverse reaction has been considered as probable. We described a new lethal adverse reaction caused by PVEs containing gelatin. It is currently considered a very rare event, but we believe that it represents an important signal suggesting for a critical surveillance comprising a complete evaluation of individual's allergic susceptibility.
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http://dx.doi.org/10.1097/MJT.0000000000000235DOI Listing
March 2017

Glutathione S-transferase M1/T1 genotype and melanoma in a Southern Italian population: a case-control study.

G Ital Dermatol Venereol 2016 Apr 14;151(2):140-4. Epub 2015 Jan 14.

Department of Clinical and Experimental Medicine - Dermatology, University of Messina, "G. Martino" Hospital, Messina, Italy -

Background: The aim of this study was to assess the frequency of GSTM1 and GSTT1 null genotype in melanoma patients and controls from Sicily and Calabria, two regions of Southern Italy never investigated on this issue before, that present a peculiar gene pool because of their geographical and historical characteristics.

Methods: One hundred and twelve Caucasian melanoma patients and 150 age- and sex-matched healthy controls were examined; their GSTM1/GSTT1 genotype was defined by polymerase chain reaction on a sample of oral mucosa cells obtained by buccal swabs.

Results: Odds ratio for melanoma was increased not significantly in case of fair hair/eye color, presence of many naevi or solar lentigines, or history of actinic keratosis, skin cancer or sunburns; frequencies of GSTM1 null, GSTT1 null and all their possible combinations were not significantly different between patients and controls.

Conclusions: Our results, in agreement with worldwide literature, show that melanoma is apparently independent from genetic lack of GSTM1/GSTT1. However, melanoma is notoriously linked to a history of sunburns, and GSTM1/GSTT1 null are a significant risk factor for sunburns. We describe a possible explanation of this apparent contradiction, taking into account the different roles of the multiple components of human skin in photoprotection, and their variable importance in different conditions of exposure to UV radiations. Simultaneous evaluation of a larger number of components of the antioxidant system, to assess their individual contribution to protection against melanoma, is advisable and should be considered in future studies. This could allow to better define risks for each patient and possibly to tailor preventive measures.
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April 2016

Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity.

BMC Res Notes 2011 Dec 17;4:544. Epub 2011 Dec 17.

Departmental Section of Legal Medicine, University of Messina, Messina, Italy.

Background: In recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage.

Methods: In order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers.

Results: Most of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law.

Conclusion: Italy must introduce a compulsory insurance system which could absorb, through a mechanism of "distribution of risk", the malpractice litigation and its costs. This will provide compensation in accidental cases where it wouldn't be possible to demonstrate carelessness, imprudence and/or lack of skill.
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http://dx.doi.org/10.1186/1756-0500-4-544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257210PMC
December 2011

Glutathione S-transferase M1/T1 gene polymorphisms and vitiligo in a Mediterranean population.

Pigment Cell Melanoma Res 2011 Aug 20;24(4):731-3. Epub 2011 Jun 20.

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http://dx.doi.org/10.1111/j.1755-148X.2011.00872.xDOI Listing
August 2011

Validation of a large Italian Database of 15 STR loci.

Forensic Sci Int 2006 Jan 22;156(2-3):266-8. Epub 2005 Apr 22.

Center of Statistical Genetics, SS Abetone e Brennero 2, 56127 Pisa, Italy.

Results from a collaborative exercise with proficiency testing conducted by 20 Italian laboratories on the 15 loci included in the Identifiler kit were analyzed by allele sharing methods and by standard population genetics tests. The validated database, including about 1500 subjects, was merged with that of a previous exercise conducted on nine loci, and the resulting allele frequencies, subdivided by Italian region, were published on-line.
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http://dx.doi.org/10.1016/j.forsciint.2005.03.001DOI Listing
January 2006

Analysis of penta D (15q) and penta E (21q) STR polymorphism in a southern Italian population sample.

J Forensic Sci 2004 Sep;49(5):1128-9

Forensic Genetic Laboratory, Department of Territorial Social Medicine, Section of Legal Medicine, University of Messina, Sicily, Italy.

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September 2004

Allele frequencies for eight STR loci in a population sample from Sicily (Italy).

J Forensic Sci 2002 Mar;47(2):408-9

Dipartimento di Medicina Sociale del Territorio, Università degli Studi di Messina, Italy.

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March 2002