Publications by authors named "Francesco De Ferrari"

23 Publications

  • Page 1 of 1

Streptococcus Pneumoniae Detection Long Time After Death in a Fatal Case of Waterhouse-Friderichsen Syndrome.

Am J Forensic Med Pathol 2017 Mar;38(1):18-20

From the *Forensic Medicine Unit, Section of Public Health and Human Sciences, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, and †Microbiology Section, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.

We report a fatal case of Waterhouse-Friderichsen syndrome in a 64-year-old man. The diagnosis, suspected during the autopsy (performed 63 hours after death), was confirmed through the successful detection of Streptococcus pneumoniae DNA and antigens in samples (blood and liver) collected during the autopsy. These results conformed with blood cultures performed antemortem, which became available only the day after the autopsy. The case underlines the need to collect biological material (liver and blood samples) during autopsy for microbiological investigations, although the collection is performed a long time after the death, suggesting that a liver sample works for DNA and liver and blood work for Streptococcus pneumoniae antigen detection.
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http://dx.doi.org/10.1097/PAF.0000000000000284DOI Listing
March 2017

Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.

Monaldi Arch Chest Dis 2016 06 22;84(1-2):25. Epub 2016 Jun 22.

University of Brescia.

Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation.
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http://dx.doi.org/10.4081/monaldi.2015.25DOI Listing
June 2016

Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.

Monaldi Arch Chest Dis 2016 06 22;84(1-2):25. Epub 2016 Jun 22.

University of Brescia.

Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation.
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http://dx.doi.org/10.4081/monaldi.2015.25DOI Listing
June 2016

REDUCTION OF VITREOUS PROSTAGLANDIN E2 LEVELS AFTER TOPICAL ADMINISTRATION OF INDOMETHACIN 0.5%, BROMFENAC 0.09%, AND NEPAFENAC 0.1.

Retina 2016 Jun;36(6):1227-31

*Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; †Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Legal Medicine, University of Brescia, Brescia, Italy; and ‡Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.

Purpose: To assess vitreous concentrations of nonsteroidal anti-inflammatory drugs (NSAIDs) and prostaglandin E2 (PGE2) in patients treated with NSAIDs before vitrectomy for macular pucker.

Methods: A prospective, investigator-masked, randomized study was performed in 64 patients scheduled to undergo vitrectomy. The patients were randomized 1:1:1:1 to receive indomethacin 0.5%, bromfenac 0.09%, nepafenac 0.1%, or placebo three times a day. NSAIDs and PGE2 levels were evaluated in vitreous samples collected at the beginning of surgery.

Results: Mean (SD) vitreous concentrations of the study drugs were 503.13 (241.1) pg/mL for indomethacin, 302.5 (91.03) pg/mL for bromfenac, and 284.38 (128.2) pg/mL for nepafenac. Mean (SD) vitreous PGE2 levels were 247.9 (140.9) pg/mL for indomethacin, 322.12 (228.1) pg/mL for bromfenac, 448.8 (261.1) pg/mL for nepafenac, and 1,133 (323.9) pg/mL for placebo. All three NSAIDs reduced vitreous PGE2 levels to a statistically significant extent, without a significant difference among them.

Conclusion: All assessed NSAIDs penetrated the vitreous and lowered basal PGE2 levels. A greater penetration was associated with pseudophakic eyes. The important inhibition of prostaglandins in the retina may have a clinical effect on the management of inflammatory retina diseases.
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http://dx.doi.org/10.1097/IAE.0000000000000860DOI Listing
June 2016

Ethyl glucuronide in vitreous humor and blood postmortem specimens: analysis by liquid chromatography-electrospray tandem mass spectrometry and interpreting results of neo-formation of ethanol.

Ann Ist Super Sanita 2015 ;51(1):19-27

Introduction: The determination of ethyl glucuronide (EtG), a stable and sensitive marker that is specific to alcohol intake, finds many applications both in the forensic toxicology and clinical fields.

Aim: The aim of the study is to examine the possibility of using a cadaveric biological matrix, vitreous humor (VH), to determine EtG as a marker of recent ethanol use.

Methods: The blood, taken from the femoral vein, and the VH were obtained from 63 autopsy cases. Analysis of the EtG was performed using an LC/MS/MS system. Analyses of the ethanol and putrefaction biomarkers, such as acetaldehyde and n-propanol, were performed using the HS-GC/FID technique in both the matrices.

Results: In 17 cases, both ethanol and EtG were absent in both matrices.Nineteen cases presented ethanol in blood from 0.05 to 0.30 g/L, EtG-Blood concentration from 0.02 to 3.27 mg/L, and EtG-VH concentration from 0.01 mg/L to 2.88 mg/L. Thirteen cases presented ethanol in blood > 0.05 g/L but EtG concentration in blood and VH lower than 0.01 mg/L, are part of these 8 samples presented acetic aldehyde and n- propanol in blood or VH, means identification of putrefaction indicators. Fourteen cases presented ethanol in blood > 0.46 and EtG concentration in blood and VH higher than 0.01 mg/L.

Conclusions: The determination of EtG in biological material is important in those cases where the intake of ethanol appears doubtful, as it allows us to exclude the possibility of any post-mortem formation of ethanol.
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http://dx.doi.org/10.4415/ANN_15_01_05DOI Listing
December 2016

An autopsy study of sudden cardiac death in persons aged 1-40 years in Brescia (Italy).

J Cardiovasc Med (Hagerstown) 2016 Jun;17(6):446-53

Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Public Health and Human Sciences, Forensic Medicine Unit, University of Brescia, Brescia, Italy.

Introduction: Sudden cardiac death (SCD), above all when occurring in young people, remains a major clinical problem. We have analysed the clinical and post mortem findings of patients who were evaluated for SCD.

Methods And Results: We have analysed 54 cases of SCD which occurred in patients aged below 40 years during the period 1993-2012 and were studied at the Institute of Forensic Medicine of Brescia. The following variables were considered: sex, age, medical history, autopsy findings with special reference to macroscopic and histological evaluation of the heart and toxicological investigation. In all cases, we also performed the dissection of the cardiac conduction tissue with subsequent serial sampling and careful microscopic evaluation.Most SCD patients were men (76%), with a mean age of 27 years. The results of post mortem investigations have identified the following abnormalities: coronary artery disease (18.5%), arrhythmogenic right ventricular dysplasia (11.1%), hypertrophic obstructive cardiomyopathy (9.2%), severe valvular heart disease (7.4%) and myocarditis (7.4%). A case of persistence of the inter-atrial communication with cardiomegaly and right and left ventricular hypertrophy was also reported. Examination of the cardiac conduction tissue showed abnormalities in 12 cases (22.2%), in whom the heart was structurally normal at macroscopic examination. Despite all the investigations carried out, any pathogenic substrate that could have justified death was not found in 12 cases (22.2%).

Conclusion: Our study underlines the value of an accurate routine post mortem investigation that may show an otherwise unsuspected structural heart disease. The serial study of the conduction tissue may provide pathologic substrates that may be responsible for the arrhythmic cause of death. A meaningful percentage of cases (22%) had no evidence of any abnormality. Genetic testing can be indicated in these cases.
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http://dx.doi.org/10.2459/JCM.0000000000000234DOI Listing
June 2016

Hydranencephaly in a case of suspected infanticide.

Med Sci Law 2015 Apr 16;55(2):82-5. Epub 2014 Jun 16.

Università degli Studi di Brescia, Italy.

An abandoned fetus with suspicious skin injuries was found dead, lying on the grass of a garden, near a private house. Suspecting infanticide, the prosecutor ordered a medico-legal autopsy. The cause of death was identified as a congenital malformation of the central nervous system such as hydranencephaly, and infanticide was excluded.
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http://dx.doi.org/10.1177/0025802414536153DOI Listing
April 2015

Hydranencephaly in a case of suspected infanticide.

Med Sci Law 2015 Apr 16;55(2):82-5. Epub 2014 Jun 16.

Università degli Studi di Brescia, Italy.

An abandoned fetus with suspicious skin injuries was found dead, lying on the grass of a garden, near a private house. Suspecting infanticide, the prosecutor ordered a medico-legal autopsy. The cause of death was identified as a congenital malformation of the central nervous system such as hydranencephaly, and infanticide was excluded.
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http://dx.doi.org/10.1177/0025802414536153DOI Listing
April 2015

Hydranencephaly in a case of suspected infanticide.

Med Sci Law 2015 Apr 16;55(2):82-5. Epub 2014 Jun 16.

Università degli Studi di Brescia, Italy.

An abandoned fetus with suspicious skin injuries was found dead, lying on the grass of a garden, near a private house. Suspecting infanticide, the prosecutor ordered a medico-legal autopsy. The cause of death was identified as a congenital malformation of the central nervous system such as hydranencephaly, and infanticide was excluded.
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http://dx.doi.org/10.1177/0025802414536153DOI Listing
April 2015

Hydranencephaly in a case of suspected infanticide.

Med Sci Law 2015 Apr 16;55(2):82-5. Epub 2014 Jun 16.

Università degli Studi di Brescia, Italy.

An abandoned fetus with suspicious skin injuries was found dead, lying on the grass of a garden, near a private house. Suspecting infanticide, the prosecutor ordered a medico-legal autopsy. The cause of death was identified as a congenital malformation of the central nervous system such as hydranencephaly, and infanticide was excluded.
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http://dx.doi.org/10.1177/0025802414536153DOI Listing
April 2015

Homicide by blunt trauma in Brescia county (northern Italy) between 1982 and 2012.

Am J Forensic Med Pathol 2014 Mar;35(1):62-7

From the Istituto di Medicina Legale, Università degli Studi di Brescia, Brescia, Italy.

Blunt force injuries are produced by a variety of objects, including hands and feet (which is human strength) and many different weapons. Some of these objects produce distinctive patterns of injury of potential evidentiary value. This article presents a series of 53 homicides by blunt trauma along the period from 1982 to 2012, representing 16% of all homicides treated by the University Institute of Forensic Medicine in Brescia (northern Italy). Fifty-seven percent (30 cases) of the victims were male. The mean age of the victims was 47.9 years. The weapon most frequently involved was human strength. Not surprisingly, head trauma was the most common cause of death (66%). Forty-seven percent (25 cases) of the victims survived their assaults for varying periods. Homicides due to blunt trauma are still a relevant challenge for the forensic pathologist, who must obtain a complete and accurate history of the crime (including details regarding the crime scene), interpret patterns of injury and other findings at autopsy, and correlate all of the findings to make an accurate ruling of the cause and manner of death.
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http://dx.doi.org/10.1097/PAF.0000000000000080DOI Listing
March 2014

Age-at-death estimation in Caucasian females from the morphological analysis of the sternal end of the fourth rib.

Leg Med (Tokyo) 2013 Jan 9;15(1):47-9. Epub 2012 Aug 9.

Istituto di Medicina Legale, Università degli Studi di Brescia, Piazzale Spedali Civili 1, Brescia, Italy.

The morphology evaluation of the sternal end of the fourth rib through the İşcan's "phases method" is considered one of the most reliable method for age-at-death estimation of corpses of unknown identity. This study aims to develop a component model for age estimation alternative to İşcan's method. A numerical score, ranging from 3 to 9, was assigned based on the morphology of surface (S), antero/posterior walls (W) and articular margins (M) of the sternal end of the fourth rib in 71 white female corpse. For each component a regression formula was determined. The best correlation between end rib morphology and age-at-death was obtained through the formula of multiple regression with two independent variables (articular surface and antero/posterior walls): Age (years)=6.37(S)+5.33(W)-17.15±3.3.
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http://dx.doi.org/10.1016/j.legalmed.2012.07.002DOI Listing
January 2013

HIV-positive status and preservation of privacy: a recent decision from the Italian Data Protection Authority on the procedure of gathering personal patient data in the dental office.

J Med Ethics 2012 Jun 7;38(6):386-8. Epub 2012 Feb 7.

Centre of Bioethics Research (with contribution of FondazionePoliambulanza), Forensic Science Department, University of Brescia, Italy.

The processing of sensitive information in the health field is subject to rigorous standards that guarantee the protection of information confidentiality. Recently, the Italian Data Protection Authority (Garante per la Protezione dei Dati Personali) stated their formal opinion on a standard procedure in dental offices involving the submission of a questionnaire that includes the patient's health status. HIV infection status is included on the form. The Authority has stated that all health data collection must be in accordance with the current Italian normative framework for personal data protection and respect the patient's freedom. This freedom allows the patient to decide, in a conscious and responsible way, whether to share health information with health personnel without experiencing any prejudice in the provision of healthcare requested. Moreover, data collection must be relevant and cannot exceed the principles of treatment goals with reference to the specific care of the concerned person. However, the need for recording information regarding HIV infection at the first appointment, regardless of the clinical intervention or therapeutic plan that needs to be conducted, should not alter the standard protection measures of the healthcare staff. In fact, these measures are adopted for every patient.
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http://dx.doi.org/10.1136/medethics-2011-100014DOI Listing
June 2012

Agalactorrhoea following reductive mastoplasty: a case of permanent impairment evaluation.

Med Sci Law 2011 ;51 Suppl 1:S37-8

Cattedra di Medicina Legale, Università degli Studi di Brescia, Brescia, Italy.

A woman of fertile age who had been suffering from agalactorrhoea since undergoing reductive mastoplasty was referred to us for forensic evaluation. As the impairment rating criteria listed within the main Italian assessment guidelines did not provide us with any helpful clues, we turned our attention to a selection of French, Spanish and Portuguese rating tables either legally binding or merely indicative in nature, to the barème (table) formulated by the CEREDOC (Confédération Européenne d'Experts en Evaluation et Réparation du Dommage Corporel) and to the American Medical Association guidelines, the only ones contemplating rating criteria specific for agalactorrhoea with an impairment score range of 0-5 percentage points. In light of the woman's young age and in subsequent consideration of the implications agalactorrhoea typically has both for nursing mothers and for their newborn babies, we estimated her physical impairment at five percentage points.
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http://dx.doi.org/10.1258/msl.2010.100050DOI Listing
January 2012

Age estimation from the rib by components method analysis in white males.

Am J Forensic Med Pathol 2010 Mar;31(1):27-33

Department of Forensic Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.

Changes at the sternal extremity of the fourth rib have already been established as reliable indicators of age at death. Still now, the Iscan "phase method," based on the morphologic changes at the sternal extremity of the fourth rib, is one of the best effective for age estimation at death. The present study was carried out to develop an alternative method considering the morphologic characteristics of articular surface (A), anterior/posterior walls (B), and superior/inferior edges (C) of the sternal extremity of the fourth rib. For each parameter a numerical score was assigned and some regression formulae was elaborated. The best correlation between morphologic characteristics and age was obtained through the formula Age = 10.43 (AB)(0.53). The sample consisted of sternal extremities of the fourth rib obtained at autopsy from 49 white males of known age.
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http://dx.doi.org/10.1097/paf.0b013e3181c0e7a5DOI Listing
March 2010

Age estimation from the rib by components method analysis in white males.

Am J Forensic Med Pathol 2010 Mar;31(1):27-33

Department of Forensic Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.

Changes at the sternal extremity of the fourth rib have already been established as reliable indicators of age at death. Still now, the Iscan "phase method," based on the morphologic changes at the sternal extremity of the fourth rib, is one of the best effective for age estimation at death. The present study was carried out to develop an alternative method considering the morphologic characteristics of articular surface (A), anterior/posterior walls (B), and superior/inferior edges (C) of the sternal extremity of the fourth rib. For each parameter a numerical score was assigned and some regression formulae was elaborated. The best correlation between morphologic characteristics and age was obtained through the formula Age = 10.43 (AB)(0.53). The sample consisted of sternal extremities of the fourth rib obtained at autopsy from 49 white males of known age.
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http://dx.doi.org/10.1097/paf.0b013e3181c0e7a5DOI Listing
March 2010

Population data for 15 autosomal STRs loci and 12 Y chromosome STRs loci in a population sample from the Sardinia island (Italy).

Leg Med (Tokyo) 2009 Jan 23;11(1):37-40. Epub 2008 Aug 23.

Department of Forensic Medicine, University of Brescia, Brescia, Italy.

One hundred twenty-five unrelated individuals (69 females and 56 males) from Sassari (Northern Sardinia) and Orgosolo (Central Sardinia) were typed for 15 STRs loci. The 56 males were typed for 12 Y chromosome STRs loci too. Frequency distribution is described.
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http://dx.doi.org/10.1016/j.legalmed.2008.06.003DOI Listing
January 2009

X-chromosome polymorphism on DXS8378, DXS7132, HPRTB and DXS7423 loci in 130 individuals from Brescia (northern Italy).

Leg Med (Tokyo) 2007 May 10;9(3):158-60. Epub 2007 Jan 10.

Department of Forensic Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.

One hundred and thirty unrelated individuals (80 females and 50 males) from Brescia (northern Italy) were typed for DXS8378, DXS7132, HPRTB and DXS7423 loci. Allele, genotype and haplotype frequencies were calculated. A comparison between our population data and others from Caucasians and Asians populations was performed.
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http://dx.doi.org/10.1016/j.legalmed.2006.11.001DOI Listing
May 2007

Population data for 12 Y-chromosome STRs in a sample from Brescia (northern Italy).

Forensic Sci Int 2005 Aug;152(1):83-7

Department of Forensic Medicine, University of Brescia, Brescia, Italy.

Twelve Y-chromosome STRs--DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS392, DYS393, DYS385, DYS437, DYS438, DYS439--were typed in a population sample (n=104) of unrelated males from Brescia (northern Italy). A total of 91 haplotypes were identified by the 12 Y-STR loci. The haplotype diversity (98.68%), discrimination capacity (87.50%) and gene diversity were calculated.
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http://dx.doi.org/10.1016/j.forsciint.2005.02.006DOI Listing
August 2005

[Recommendations for the use of iodinated contrast media and for magnetic resonance by injection route. Radiological and medico-legal considerations].

Radiol Med 2003 Nov-Dec;106(5-6):556-68

U.O. e Cattedra di Radiologia, Università degli Studi Magna Graecia, Catanzaro, Italy.

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February 2004

Identification of forensic samples by using an infrared-based automatic DNA sequencer.

Croat Med J 2003 Jun;44(3):299-305

Genetics and Molecular Medicine Unit, A. Meyer Hospital, University of Florence, A. Meyer Hospital, Via Luca Giordano 13, 50132 Florence, Italy.

We have recently introduced a new protocol for analyzing all core loci of the Federal Bureau of Investigation's (FBI) Combined DNA Index System (CODIS) with an infrared (IR) automatic DNA sequencer (LI-COR 4200). The amplicons were labeled with forward oligonucleotide primers, covalently linked to a new infrared fluorescent molecule (IRDye 800). The alleles were displayed as familiar autoradiogram-like images with real-time detection. This protocol was employed for paternity testing, population studies, and identification of degraded forensic samples. We extensively analyzed some simulated forensic samples and mixed stains (blood, semen, saliva, bones, and fixed archival embedded tissues), comparing the results with donor samples. Sensitivity studies were also performed for the four multiplex systems. Our results show the efficiency, reliability, and accuracy of the IR system for the analysis of forensic samples. We also compared the efficiency of the multiplex protocol with ultraviolet (UV) technology. Paternity tests, undegraded DNA samples, and real forensic samples were analyzed with this approach based on IR technology and with UV-based automatic sequencers in combination with commercially-available kits. The comparability of the results with the widespread UV methods suggests that it is possible to exchange data between laboratories using the same core group of markers but different primer sets and detection methods.
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June 2003

Mixed stains from sexual assault cases: autosomal or Y-chromosome short tandem repeats?

Croat Med J 2003 Jun;44(3):289-92

Institute of Forensic Medicine, University of Brescia, Italy.

We analyzed forensic DNA samples from four cases of sexual assault, using the Y-chromosome-specific human DNA markers and a panel of autosomal short tandem repeats (STRs). The presence of male contribution was evaluated by the analysis of the Amelogenin locus. A panel of tetrameric Y-STR (DYS19, DYS390, DYS391, DYS392, DYS385, DYS389I and II) was used in further analysis of samples, increasing the efficiency of the forensic genetic analyses. It was possible to identify a partial or full Y-profile of the rapists in different DNA mixtures when genetic profile could not be detected by autosomal STRs. However, in the case of male/male DNA mixture, only the victim's Y-profile could be obtained because the DNA of the offenders was present in low amounts. When the mixture contained different male/male proportion of DNA, only the full profile of the major component could be detected. In cases where male/female DNA mixed stains contained a sufficient amount of male DNA, the analysis of autosomal STRs was adequate enough to identify the full profile of the rapist. Our experience shows that the main advantage of the Y-STR approach is its ability to detect the male component in the mixed stains when the DNA of the male contributor is present only in a very small amount.
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June 2003