[Fatigue-related risk: what are the consequences for professionals and health-care organizations?]. / Rischio fatigue-related quali ricadute per i professionisti e le organizzazioni sanitarie?

Many studies have investigated the influence of fatigue on healthcare professionals' safety and clinical performances, showing associations between prolonged work shifts, sleep deprivation and both injuries and errors. Even in the absence of conclusive evidence, after the death of a girl under the care of two fatigued residents, New York State promulgated in 1989 rules to cap residents' duty hours, afterwards adopted by the Accrediting Council for Graduate Medical Education. Italian data on fatigue-related medical errors are still lacking, and no legal cases have raised public awareness of this topic. The authors explored medical-legal issues potentially arising from cases of fatigue-related errors, and proposed two interventions from a risk management perspective: 1. review of events reported through the incident reporting system in which at least one contributing factor was fatigue-related, and 2: root cause analysis of events and accidents reported during night shifts.

Determining the time of death by morphological and immunohistochemical evaluation of collagen fibers in postmortem gingival tissues.

The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1-3 days; mid post mortem interval, 4-6 days; long post mortem interval, 7-9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.

[Eosinophilic gastroenteritis. Report of a clinical case]. / La gastroenterite eosinofila. Descrizione di un caso clinico

An unusual case of eosinophilic gastroenteritis is described, together with its differential diagnosis from allergic enteropathy. Numerous biopsies and other instrumental examinations pointed to small intestine as the only site and eosinophilic enteritis as a suitable classification. Disappearance of the clinical symptoms was obtained with corticosteroid management in the space of 6 months.