An atypical gunshot suicide: a case report and a literature overview.

Background: Gunshot suicides are more common in those people who live in countries with greater cultural accessibility of firearms and whose weapon's availability and use are easier. In the case of suicide by firearm, the most typical site of the entrance hole is represented by the temple, the forehead or the submental region, while only in a smaller percentage of cases is intra-oral. Case report: We present a particular case of suicide of an 85-year-old man, using a single-charge, short-barrelled firearm. The shot was fired on contact, with the entrance hole located at the tongue. The bullet remained held inside the body and there was no exit hole on the skin. A rigorous and multidisciplinary methodological approach was adopted, including an accurate judicial inspection of the environment, an anamnestic collection, an autoptic procedure completed by macroscopic and microscopic examination of the entrance hole and internal organs, and a radiological examination. Conclusions: In cases of gunshot suicide involving the intra-oral region, the tongue is rarely affected. Normally, the victim points the weapon upwards and the bullet follows this direction. When the entrance hole is on an atypical site, and different from the skin, and the trajectory are inusual, the interpretation of the dynamic of the event is more complex. So, it is essential to conduct a complete investigation, including the information of the forensic examination, with the data emerged in autopsy, radiological and histological examination.

Loss of chance: the uncertainty of the event or the uncertainty of the conduct? Case Series and Medicolegal Considerations.

Background: The concept of damages for loss of chance originated in France in 1877 and was adapted to healthcare in 1962. In Italy, it was first introduced in healthcare liability in 2004, with Civil Court of Cassation decision No. 4400. Italian jurisprudence recognizes the loss of chance as an independent, legally and economically assessable damage, distinct from the actual outcome lost. The landmark St. Martin Judgments of 2019 further established that such damages can be claimed if they involve appreciable, serious, and consistent values. This requires proving a causal link between the conduct and the lost chance, based on established civil law criteria. Case report: 1) a 71-year-old man whose lung carcinoma was not diagnosed in time, leading to a significant reduction in survival chances. 2) a woman whose breast cancer diagnosis was delayed, resulting in a more advanced stage and decreased survival prospects. Discussion: In medical professional liability, the Supreme Court requires a high probability or certainty of causation for recognizing the causal link between wrongful conduct and damage. The assessment involves proving both the causal link and the reasonable probability of a lost opportunity's realization. Hypothetical damage is insufficient for compensation. Conclusions: The compensability of loss of chance relies on proving the causal link between the negligent act and the uncertain event, where the impact on the patient's non-pecuniary sphere is significant. Medicolegal practice faces challenges in distinguishing between causality and damage, which can lead to confusion between biological damage and damage from loss of opportunity.

The legislative position of the Osteopath in Italy after the Decree of the Ministry of Universities and Research of 29 November 2023, in agreement with the Minister of Health: implications in terms of professional responsibility and current shortcomings.

Background: At the end of a long definition and legislative process (Law No.3 of 11 January 2018 and DPR No 131 of 2021), started under the thrust of the European directives, with the Decree of the Ministry of Universities and Research of 29 November 2023, in agreement with the Minister of Health, osteopathy in Italy has become a healthcare profession in all respects. Materials and Methods: In order to understand the current legislative and professional position of the Osteopath, research of the original definitions and the history of the profession has been carried out, assessing an overview of the current situations among EU countries. Therefore, an analysis of the current Italian legislation has been carried out in a medical-legal key, with a critical eye aimed above all at assessing the current shortcomings. Conclusions: The inclusion of osteopathy as a healthcare profession in Italy is a significant step towards the regulation and recognition of this practice, implying considerable innovations both in terms of access to the profession, both in the field of the professional health responsibility. Even if with the Decree of 29 November 2023, a significant step forward has been made, further regulatory and control measures are needed to ensure the quality, safety, and effectiveness of osteopathic treatments, as well as the protection of patients and the professionalism of operators.

Telemanagement and Radiology: current structure, opportunities and new horizons.

Background: Telemedicine is a method of providing remote services in compliance with data security, with a significant positive impact on healthcare, in which Teleradiology means the electronic transmission of radiographic images from one geographical area to another. In this context, the term "telemanagement" shows a real remote management of a diagnostic examination, concluded by the production of telereport and telediagnosis. Materials and Methods: On the basis of Italian position papers, National guidelines and current Laws, a careful analysis of multiple aspects was carried out, in order to understand the current obligations and application limits. Discussion and Conclusion.: Proper radiotelemanagement requires a shared operating protocol within the structure, which integrates verification and safety procedures, periodic checks and adequate resources. In addition, practical interface between the involved figures must be properly established. Then, guidelines highlight the "standard" radiological procedures that can be performed in the absence of the specialist: in ordinary hospitalization, it is allowed to perform Telemanagement procedures only within "standard" procedures; in emergency setting, the only limit is placed in case of administration of contrast agent. No provisions have been approved for teleradiological work in private settings. Finally, inter-company procedures are only provided for screening programs. In this context; potential negative implications are the risk of substitution of health professionals, as well as ethical issues related to data security, patient's consent and quality of the doctor-patient relationship. In an effort of optimism aimed at the future, we want to express our propensity towards a universe with lots of potential that, over time, will emerge in its concreteness.