The Multidisciplinary Approach for the Diagnosis of Laryngohyoid Lesions: a Systematic Literature Review and Meta-Analysis.

Background: The diagnosis of neck lesions remains a medico-legal diagnostic challenge because of the complexity of the anatomical relationship of the neck's organs and their anthropometric morphological variability. We compared the multidisciplinary approach using autopsy and postmortem computed tomography (PMCT), postmortem fine preparation (PMFP), postmortem micro-computed tomography (micro-CT), and postmortem magnetic resonance (PMMR) with the performance of a single diagnostic method among them evaluating the significance of different results. The multidisciplinary approach significantly reduced the number of unidentified neck lesions. The analysis demonstrates the need to better define the scan protocols and compose forensic guidelines for radiological application. The results of this study point out the need to compare the different diagnostic approaches in deceased subjects to better define the radiological scan protocol based on a multidisciplinary approach, including autopsy and radiological methods and the radiological scan protocols. Methods: We performed a systematic electronic search of retrospective scientific articles in PubMed, the Scopus database, and the Cochrane Library. The following combinations of words were used: "hyoid fracture"; "comparison between PMCT AND autopsy"; "hyoid fracture PMCT AND autopsy"; "hyoid bone fracture AND forensic imaging"; "hyoid fracture AND PMCT"; "neck fracture PMCT AND autopsy"; "laryngohyoid lesions"; "postmortem CT AND autopsy in strangulation"; "postmortem AND strangulation Signs "; "strangulation virtopsy"; and "strangulation AND MRI". We selected 16 articles that were published between March 2003 and June 2020. We conducted a meta-analysis with R software to evaluate the rates. We obtained related confidence intervals and a forest plot. Results: Thyroid cartilage damages were significantly more common than hyoid bone fractures (61.7% vs 42.2%) in a sample of 128 subjects. The synergic uses of autopsy/PMCT, autopsy/PMFP, autopsy/microCT, and autopsy/PMMR revealed significantly higher rates than a single investigation. We analyzed the PMCT scan data. The scan parameters evaluated were as follows: row, scan sample, reconstruction, kernel, slice thickness, kVp, and mAs. A lack of uniformity in the application of the protocol was observed. Conclusion: Further studies are needed to better define the radiological scan protocols and to draw guidelines to identify the appropriate radiological methods in relation to the specific case.

Telehealth modulation and new proposals during the Covid-19 pandemic: a literature review.

Abstract: The Covid-19 pandemic has completely modified the Healthcare organization. This review aims to analyze the evolution of the different Telemedicine areas during pandemic. Electronic Health Records allows accelerating the study of patients suffering from Covid-19 disease, supporting their clinical assistance. The decreasing rehabilitation programs have determined a deterioration of the patient quality of life. Teleradiology was necessary to discard the increased requests and dab the shortage of staff, and to guarantee the interaction between specialist and patient. Telecardiology was fundamental determining a reduced of secondary mortality for cardiological complications of the infection. Teledermatology has permitted an early identification of the patients affected through diagnoses of cutaneous signs, reducing clinical visits. Telelegal-medicine changed through a law, that was introduced allowing a remarkable use of videoconferencing in the different stages of judicial and extrajudicial process. The digital consultations and home drug delivery were implemented in telepharmacy area. Artificial Intelligence allows an early diagnosis of the infection, monitoring the treatment through an intelligent platform. Robotic assisted telemedicine minimizes the risk of exposure allowing the disinfection of the places, drugs and meals delivery, the measurement of vital signs. Mobile Health facilitated the collection and the automatic transfer of the patient's parameters. Telemedicine would constitute still today as complementary but not substitutive to the traditional medicine. During the pandemic telemedicine has resulted important to guarantee continuity cures. Radiology and Dermatology showed a major telemedicine application.

Pre-operative leukocytosis: a potential poor prognosis risk factor in cardiac device implantation: a case report.

INTRODUCTION: Despite the benefits of the implantation of cardiac rhythm management devices cardiac implantable electronic device (CIED) infection is an emerging problem New debate emerged about the unclear role of the pre-operative alteration of pro-inflammatory parameters, such as leukocytosis, in the development CIED infection and/or heart failure, and its consequent impact on the timing of ICD implantation/reimplantation. CASE REPORT: A 65 years old patient with a history of Diabetes Mellitus (DM) type II, ventricular and supraventricular arrhythmias, chronic myocardial ischemia, heart failure was admitted to hospital. Healthcare workers opted for ICD implantation despite the presence of a persistent leukocytosis with normothermia. Five days later the implantation, patient showed fever and heart failure; blood culture resulted positive for Staphylococcus Aureus. Patient died for sepsis syndrome due to a cardiac device-related infection after a few days, despite the device extraction. DISCUSSION: Cardiac device implantation remains a necessary surgi-cal procedure in order to reduce sudden cardiac death's rate in patients with heart failure. Leukocytosis is a new potential poor prognosis risk factor. The relationship between pro-inflammatory markers', such as CRP and white blood cell count, and device implantation is still not entirely clear. Pro-inflammatory markers could facilitate an infection development; recent study hypothesized that these markers could promote the development of heart failure. CONCLUSION: Leukocytosis could represent a poor prognosis risk factor favoring the development of CIED infection and/or heart failure.