Similarity, analogy, compatibility, identification: personal identification in forensic practice.

Background: Personal identification is a forensic procedure of recognizing a subject, whether corpse or living, based on a set of parameters and evidence. Spreading of video surveillance cameras has changed forensic application in identification. Indeed, there has been a shift from the evaluation of universally recognized anthropometric parameters to the spasmodic search for individual traits and/or characteristics that could be safely attributed to a single subject. Case Series: Authors analyzed two different cases of personal identification with the analysis and processing of images extracted from video surveillance systems. The first case involved two individuals suspected of throwing an ordnance into the relevant space of a public building. The second case involved a subject suspected of committing a robbery against a commercial establishment. Conclusion: In the field of personal identification focused on images processing extracted from video surveillance systems, as in the cases presented by the authors, there are lot of critical issues and limitations, which could undermine data. Correct personal identification can be achieved by comparing the clearly visible and objectively recognizable somatophysical and physiognomic characteristics of the offender with those of the suspects. So how compatible are two subjects compared? Compatibility and identification are two very different con-cepts. It is not necessarily the case that full compatibility is equivalent to personal identification. It is not necessarily the case that the absence of morphological similarity is equivalent to identification exclusion.

"When something goes wrong".

Background: Aspiration of food or liquids can result in suffocation, evolving in coughing, difficulty breathing and forced exhalation. Asphyxia occurs when the aspirated material occludes the upper airways, either in the proximal or distal tract, resulting in the inability to breathe. The risk of asphyxiation death, is increased if a person makes sudden movements while eating, walks or runs while eating, or even becomes distracted or frightened. It is higher in individuals with neurological diseases, intellectual disability (ID), cognitive impairment, psychiatric pathologies or their pharmacological treatments and people carrying additional physiological impairments, which can cause oral dysfunction and dysphagia. Protective mechanisms may sometimes lack or fail to expel food fragments stuck in the airways, which completely obstruct them. Case series: The authors present some peculiar cases of subjects who died from food bolus choking, namely a case of mozzarella-cheese clogging in a young subject (25 years old) undergoing rehabilitation treatment following a stroke; a 38-year-old man with middle-grade mental retardation died from first airway food bolus (mush of bread) clogging; a 26-year-old subject with epilepsy died from tripe clogging in the course of a seizure; a 38-year-old subject in psychiatric treatment for depressive disorder who died from clogging with octopus tentacles. Conclusion: Food bolus clogging asphyctic deaths generally occur in subjects with psychic/neurological pathologies, resulting in altered deglutition mechanisms or lack of protective reflexes. Foodstuff, especially if large or viscous, obstruct the proximal or distal airways, leading to acute respiratory failure and death. Autopsy is diriment in ascertain the cause of death.

Interrupted aortic arch: from a singular forensic case to clinical and diagnostic cue.

Background: Abnormalities of aortic arch include variables related to structure, location, anatomical relationships and collateral vessels. This group includes the malformation known as "interrupted aortic arch". During fetal life, oxygenated blood is provided by materno-fetal circulation and own fetal circulation. Case report.: This work discuss of female fetus born without any vital signs at 38th week by 34-years-old primigravida affected by gestational diabetes and anemia gravidarum. Pregnancy was regular. Labor and cardiotocographic tracings were regular, natural delivery; however, at the time of umbilical cord severing the baby went into cardiocirculatory arrest. Autopsy findings were: - hypertrophied right ventricle; - no morphological changes in interventricular septum, - ascending aorta physiologically arose from the left ventricle; after the emergence of the left subclavian artery and the anonymous trunk, it suddenly stopped at cul de sac. Thoracic tract arose as a collateral branch of the pulmonary artery. In addition, Botallo duct was patent. Thus, the diagnosis of death was interruption of aortic arch resulting in cardiogenic shock and irreversible cardiovascular collapse. Conclusion: In filed case, newborn presented "type B" interruption. Interruption manifests itself between left common carotid artery and the left subclavian artery. Descending aorta arose from the pulmonary trunk. So that, in this case, right ventricle provided systemic circulation. At delivery, with the severing of the umbilical cord and physiological closure of the Botallo ductus, acute right heart failure and shock occurred. This work aims to be a cue for scientific community, in order to assist clinical and diagnostic knowledge using autopsy data with expost perspective.

Psychosis in cocaine intoxication.

Background: Cocaine overdose is a condition in which an increase in blood pressure, heart rate and depth of breath is observed. Cocaine consumption also causes a wide and well-known neuropsychiatric symptomatology that is characterized by incomprehensible behavior, confused and disordered thoughts, and paranoia. Cocaine addiction is a worldwide public health problem, which has somatic, psychological, psychiatric, socio-economic, and judicial complications. Case series: This work shows three cases in which cocaine poisoning and overdose caused a psychotic and extremely violent behavior in the hours leading up to the death of the subjects. Conclusion: The aim of this brief case series is to suggest some diagnostic criteria for the correct definition of this psychosis in order to make an early diagnosis crucial to prevent deaths related to it.

The Communicative-Relational Operating Model of the Italian National Institute of Health for an Effective Telephone Intervention in Public Health, Structured on Basic Counselling Skills.

Introduction: Communication has a crucial role in public health, because it becomes an essential component of prevention; it is also a proactive tool in health promotion. From a planning perspective, it is appropriate to use communication means that can help the bidirectional communication process, such as face-to-face communication and telephone communication. Materials and methods: In relation to this, the Italian National Institute of Health has developed the "Modello Operativo Comunicativo-Relazionale" (the "Communicative-Relational Operating Model"). It is based on the fundamental skills of the counselling, this gives a protocol to the health professionals that is replicable and organized and it allows health professionals to carry out a telephone communication that is efficient with the user through technical-scientific and communication-relational skills. The goal is to answer in a customized way to the various users' health needs. The Operating Model was created by experts of the National AIDS and Sexually Transmitted Infections Helpline of the Operational Unit of Psycho-Socio-Behavioural Research, Communication, Training, of the Infectious Diseases Department. Later, the Operating Model was proposed to the experts of the Helplines in the National Centre on Addictions and Doping and the National Helpline of the National Centre for Rare Diseases in the National Institute of Health that integrated this method into their telephone approach. Results: The Operating Model illustrated above was applied to several helplines of the National Institute of Health as an example of correct scientific information, updated and customized on sexual transmitted infections, addictions and rare diseases. Conclusions: This article aims to illustrate the Operating Model, the theoretical prerequisites that subtend it and its possible application in the different public health structures that use the telephone for a profes-sional relationship with their users.

Protective effect of sex steroid hormones on morphological and cellular outcomes after neonatal hypoxia-ischemia: A meta-analysis of preclinical studies.

Sex steroid hormones play an important role in fetal development, brain functioning and neuronal protection. Growing evidence highlights the positive effects of these hormones against brain damage induced by neonatal hypoxia-ischemia (HI). This systematic review with meta-analysis aims to verify the efficacy of sex steroid hormones in preventing HI-induced brain damage in rodent models. The protocol was registered at PROSPERO and a total of 22 articles were included. Moderate to large effects were observed in HI animals treated with sex steroid hormones in reducing cerebral infarction size and cell death, increasing neuronal survival, and mitigating neuroinflammatory responses and astrocyte reactivity. A small effect was evidenced for cognitive function, but no significant effect for motor function; moreover, a high degree of heterogeneity was observed. In summary, data suggest that sex steroid hormones, such as progesterone and 17ß estradiol, improve morphological and cellular outcomes following neonatal HI. Further research is paramount to examine neurological function during HI recovery and standardization of methodological aspects is imperative to reduce the risk of spurious findings.

The tubercular disease in immigrants without documents: new diagnostic settings adopted in Milan, Italy.

The tubercular disease (TB) is "the disease of poverty and people in need", spread in the poorest countries and among the less wealthy people of the western world (immigrants). In Italy the health authority has recently defined precise diagnostic and therapeutic patterns for TB. The social and health Association Naga in Milan with the Regional Reference Centre for TB, designed a screening system. In Naga's surgery all the undocumented immigrants, coming to Italy from countries with high TB incidence (> 100/100000) and high immigration rates, are screened by a questionnaire created by the Swiss Lung League; the suspect cases are sent to a designed centre for a second level of investigation. The use of this form allows to set a first selection based on the patients' anamnestic history, thus avoiding the intradermal reaction that, due to its low selectivity, could cause a 4 times higher crowding of the designed secondary centers.

A scalable method for O-antigen purification applied to various Salmonella serovars.

The surface lipopolysaccharide of gram-negative bacteria is both a virulence factor and a B cell antigen. Antibodies against O-antigen of lipopolysaccharide may confer protection against infection, and O-antigen conjugates have been designed against multiple pathogens. Here, we describe a simplified methodology for extraction and purification of the O-antigen core portion of Salmonella lipopolysaccharide, suitable for large-scale production. Lipopolysaccharide extraction and delipidation are performed by acetic acid hydrolysis of whole bacterial culture and can take place directly in a bioreactor, without previous isolation and inactivation of bacteria. Further O-antigen core purification consists of rapid filtration and precipitation steps, without using enzymes or hazardous chemicals. The process was successfully applied to various Salmonella enterica serovars (Paratyphi A, Typhimurium, and Enteritidis), obtaining good yields of high-quality material, suitable for conjugate vaccine preparations.

Disease management of type 2 diabetes: a follow-up analysis in a sanitary district of Sicily.

AIM: The aim of this paper was to analyze the Disease management of type 2 diabetes in a sanitary district of the Sicily Region (Italy). METHODS: In a population of 9 698 subjects, we selected patients with known type 2 diabetes: a cohort of 385 subjects, (206 women and 179 men) following up for one year. Prevalence of type 2 diabetes in the analyzed population was 3.97%. A great lot of cohort was on a diet. RESULTS: After one year, a per cent reduction of obese and overweight subjects was observed. No differences were observed for Body Mass Index (BMI) at the beginning and at the end of the study. After one year, through educational meetings with the doctor, a significant increase of knowledge on the patient's conditions and on the diabetes complications was verified, but our data showed persistent poor attention by doctors. The poor knowledge of patients led to a difficult disease management. After one year, a great lot of cohort used antistroke and cardiovascular disease therapy, reducing significantly the cardiovascular disease risk. However, our study also highlights a gap between the therapeutic guidelines and the actual treatment, with wide variability in the delivery of secondary prevention. CONCLUSION. Our study showed that a persevering warning and a constant adjournment of doctors improves the disease management, reducing complications risk in type 2 diabetes patients.

Capsule endoscopy of the small bowel in the clinical practice: outpatient management is feasible and cheaper.

AIM: Four Italian regions have cost coding for outpatient capsule-endoscopy. Elsewhere it is performed in ordinary hospital admission. To identify, in a cohort of patients of a Gastroenterology Unit, those feasible for outpatient versus inpatient treatment; to analyze costs distribution in both management areas. METHODS: We retrospectively analysed 100 clinical records of admissions to A.O. San-Carlo-Borromeo, Milan between 2005-2008. Hospitalization criteria (at least 3): 1) occult/obscure gastrointestinal bleeding; 2) hemoglobin ≤ 8 gr/dL; 3) indication for blood transfusions; 4) urgent hospital admission. RESULTS: A total of 62 patients had urgent admission, 60 blood transfusions, 81 underwent EGD and colonoscopy, 8 enteroscopy and 5 surgery. Mean haemoglobin value was 8.67 g/dL. Capsule-endoscopy was positive in 70, uncertain in 8, negative in 22. Positive cases: 33 angiodyplasia, 18 ulcers/erosions, 13 polyps/masses, 5 overt bleeding, 1 celiac disease. 47/100 were appropriate as outpatient, saving 432 days of hospital stays. Admission coding was grouped into 7 DRGs (overall expense: 98,366 Euros). Considering EGD/colonoscopy outpatient costs and 1.100 euros as estimated value for capsule-endoscopy, the total expense could be 53.919. CONCLUSION: Outpatient capsule-endoscopy small bowel examination is feasible in half of the cases. It is cost saving, (about 45.000 Euros/100 patients), reducing inappropriate hospital stays.

Validation of an extraction and gas chromatography-mass spectrometry quantification method for cocaine, methadone, and morphine in postmortem adipose tissue.

Adipose tissue is a complex biological matrix that necessitates several pre-analytical preparation steps to separate drugs and metabolites from the lipophilic matrix. A novel, sensitive, and specific gas chromatographic-mass spectrometric (GC-MS) method for the determination of cocaine (metabolites), methadone, and morphine in postmortem adipose tissue was developed, optimized, and validated. The method involves the aqueous acid extraction of analytes, alkalinization of the extract, solid-phase extraction with chloroform, and derivatization with BSTFA before GC-MS analysis. Deuterated compounds were used as internal standards for determination and quantification of analytes. Limits of detection were 0.005 microg/g for cocaine and cocaethylene, 0.02 microg/g for benzoylecgonine, 0.01 microg/g for ecgoninemethylester, 0.005 microg/g for methadone, and 0.01 microg/g for morphine. Linearity ranged from 0.1 to 1.000 microg/g for all analytes. Intra- and interday accuracy ranged from 70.6 to 105%, and intra- and interday precisions were less than 8.2% and 8.6%, respectively, for all analytes. The method showed a good recovery.

[Analysis of type 2 diabetes disease management: cross-study of a sanitary district]. / Analisi del disease management del diabete di tipo 2: uno studio trasversale su un distretto sanitario.

AIM: We studied type 2 diabetes prevalence in the Sicilian country, and the disease management, trough the analysis of some indicators. METHODS: A cohort of 385 subjects with type 2 diabetes was selected in a sanitary district. Anamnestic, anthropometric, pharmacological data were recorded by a self-controlled software (Gipac-2). We used Student's t-test for statistical data analysis. RESULTS: The cohort of diabetic people represents 3.97% of the studied population in toto, 206 women and 179 men: only 2/3 of the studied people followed the therapeutic indications, using prevalently oral hypoglycemic therapy, with poor agreement to specialised centres for diabetes. Hypertension was present in 52.51% of men, in 68.21% of women; most of 50% of people, men and women, showed an obesity/overweight condition. The observations of eventual diabetes complications (eye, foot etc.) was poor by doctors: a 1/3 of patients had diabetes complications undefined. The disease management analysis showed the use of antiplatelet-adhesion drugs involved a half of the studied people; 55-60% of people agreed to diet restriction, no sex-related; the self-control of glucose blood value was present in 65-70% of subjects. The indicators analysis showed that only 40% of men and women performed a HbA1C measurement; 40-50% of people did not control blood pressure in 90 days, 65% did not perform a LDL measurement in one year, more than 70% did not perform a fundus oculi check up. CONCLUSION: The study confirms the incidence of diabetes similar to national and European standards. The disease management appears lacunose in half of the population, the use of indicators is limited; guidelines on chronic disease management and on prevention of complications are partially applied. The use of sensitization strategies of sanitary operators, trough formation periods, is very important in order to implement the chronic disease management.

Elective surgery for benign liver tumours.

BACKGROUND: Benign liver tumours (haemangioma, focal nodular hyperplasia, and hepatic adenoma) have different prevalence and prognosis. Spontaneous rupture and malignant transformation can complicate hepatic adenoma. Elective surgery is controversial, and indications are represented by uncertain diagnosis, presence of symptoms, and prevention of major complications. OBJECTIVES: To assess the beneficial and harmful effects of elective surgery of benign liver tumours. We identified 31 cases series. These were small (with less than 60 participants) and the types of tumours mixed. These studies reported no significant mortality, but in the six studies with mortality it ranged from 1% to 17%. SEARCH STRATEGY: The Cochrane Hepato-Biliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (searches in Issue 1, 2006), MEDLINE, EMBASE, CancerLit, and Science Citation Index Expanded (SCI-EXPANDED) (searched December 2005). A further search included the proceedings of major hepatological and surgical congresses (Annual Meetings of the American Association for the Study of the Liver (AASLD) and European Association for the Study of the Liver (EASL)), and examination of the references of relevant papers and reference lists of the identified studies. SELECTION CRITERIA: Randomised clinical trials in adult patients with benign liver tumours without indications for emergency surgery in which elective surgery (resection) versus no intervention or sham operation are compared. DATA COLLECTION AND ANALYSIS: All trials identified through searches were evaluated for eligibility for inclusion. We intended to extract relevant data in order to analyse the outcomes as per our published protocol using intention-to-treat analysis. MAIN RESULTS: We could not identify any randomised clinical trials. AUTHORS' CONCLUSIONS: We were unable to find evidence supporting or refuting elective surgery for patients with benign liver tumours. We need large, long-term randomised clinical trials with adequate methodology to assess the benefits and harms of elective surgery.

[Results of the evaluation of environmental technological risk of an Italian region (Puglia)]. / Risultati della valutazione del rischio tecnologico ambientale di una regione italiana (Puglia).

In order to plan a correct planning and a realization of interventions to support Regional Environmental Authority, results of "Technological Risk" methodology applied in a Italian region (Puglia) are reported. In this paper two main risk factors has been evaluated (high risk activities, areas with environmental crisis high risk) and determined indicators able to describe, in case of accident or anomalous event, potential interactions in the normal industrial process. Than has been described operative phases to consent risk factors evaluation and their evolution, considering also pressures on the environment identified by other issues. Some themes were in detail studied through territorial analysis and set of rules. This work enables to carry out a specific database for factories subject to "substantial risk" and finally was completed data processing with thematic maps and statistic analysis.

Eight isolated cases of KBG syndrome: a new hypothesis of study.

We report on eight cases of patients affected by KBG syndrome (KBG stands for the initials of the affected patients in the original report), a rare genetic disease, that we find only in 40 cases mentioned in the scientific literature. In this work we present the minimum diagnostic criteria of diagnosis due to identify the syndrome and a hypothesis of study for the research of the involved factors.

Gallbladder motility in obesity, diabetes mellitus and coeliac disease.

We reviewed data on gallbladder motility in obesity, diabetes and coeliac disease. In obesity, a condition characterised by increased risk of gallstone(s), decreased gallbladder motility has heterogeneously been reported as a consequence of the different type of meals used to induce gallbladder contraction, characteristics of the population studied, technique used, and proportion of patients with hyperinsulinaemia. Moreover, recent studies have evaluated the effect of dietary restriction on gallbladder motility in obese patients. A two- to three-fold increase in the risk of cholesterol gallstone(s) has been reported in diabetic patients, mainly in relation to obesity and hypertriglyceridaemia. Furthermore, decreased gallbladder motility has been described and attributed to other factors, including underlying autonomic neuropathy, reduced gallbladder sensitivity to cholecystokinin and/or reduced number of cholecystokinin receptors on the gallbladder wall. Impaired gallbladder motility has been reported also in patients with coeliac disease in relation to reduced secretion of enteric hormones and/or decreased gallbladder sensitivity to them. In particular, untreated coeliacs, when compared to controls, showed low postprandial cholecystokinin and increased fasting somatostatin levels. Interestingly, the correlation between fasting somatostatin levels and gallbladder size has clearly been confirmed in patients affected by somatostatinoma or treated with somatostatin or its analogues. Gallbladder motility can be affected by various clinical conditions, such as obesity, diabetes mellitus and coeliac disease.

Clinical course of pregnant women with chronic hepatitis C virus infection and risk of mother-to-child hepatitis C virus transmission.

As far as concerns chronic hepatitis C virus infection in pregnant women, different points remain to be elucidated, such as the clinical course, the rate of mother-to-child hepatitis C virus transmission and, in particular, its route and the possible risk factors. This review aimed to analyse current data on the prevalence of chronic hepatitis C virus infection in pregnant women and its relationship with risk factors, the rate of mother-to-child hepatitis C virus transmission and the factors possibly involved, particularly the maternal hepatitis C virus viral load and the human immunodeficiency virus coinfection, and the type of delivery and feeding. Finally, the appropriate timing for HCV-RNA testing in newborns has been reviewed.

Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women.

The prevalence and natural course of chronic hepatitis C virus (HCV) infection was evaluated in 15,250 consecutive pregnant women. The rate of HCV vertical and perinatal transmission was also assessed. The presence of anti-HCV was tested by means of EIA III and confirmed by recombinant immunoblot assay III. Alanine transaminase (ALT), anti-human immunodeficiency virus (HIV), and HCV-RNA were tested during the first month and third trimester of pregnancy, and 6 months after delivery; the same tests were made in all of the newborns of anti-HCV-positive mothers at birth (on cord blood samples) and then at 4-month intervals. Anti-HCV positivity was found in 370 cases (2.4%), 72% of whom were also HCV-RNA-positive. The proportion of women with hypertransaminases decreased from 56.4% at the first examination during the first month of pregnancy to 7.4% in the last trimester, and then increased again after delivery (54. 5%), without any concomitant changes in the proportion of those with viremia. The proportion of anti-HCV- and HCV-RNA-positive newborns was 5.1% after 1 year (8 of 155), all of whom had the same genotype as their mother. The rate of HCV transmission was not affected by the type of delivery or feeding, or the HIV status of the mother. The results of this large-scale study confirm previous data in smaller series concerning the prevalence of HCV infection in pregnant women, and strongly support the hypothesis of a favorable (possibly immunomediated) effect of pregnancy on liver cell necrosis in anti-HCV-positive women.

Immigration and health: the Italian National Focal Point experience.

This report is a description of the situation of migrant populations in Italy. It was written by a committed team of experts from public institutions, non-governmental organisations (NGO) and volunteer associations that for three years have been part of the Italian National Focal Point (NFP) within the European Project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention (the Netherlands) and financed by the European Commission DG/V. This year the Italian National Focal Point, co-ordinated by the Telefono Verde AIDS of the Istituto Superiore di Sanità, has produced a second report (the first one was published in 1998) on health issues related to migrant populations. Besides providing an updated picture on the presence of foreigners in Italy, such report illustrates the present legislative situation within the sanitary area and some interventions regarding prevention, treatment and rehabilitation provided by each structure in the Italian NFP to foreign citizens. The initiatives carried out during the year 1999 by public institutions, NGO and volunteer associations are also reported in order to detect the psycho-social-sanitary needs of immigrants and target prevention programmes to their particular and specific needs.