The tongue protrusion in post-mortem fire.

Burned bodies raise relevant issues for forensic patologist and odontologist both for the identification and the cause of death and possible vital burning.. The tongue protrusion is regularly investigated for the death caused by strangulation or hanging, whilst seems to be overlooked in case of charred remains as the significance of this sign is still discussed. Different mechanims are hypothized in literature to explain the toungue protrusion both for vital and non-vital burning. This paper retrospectively evaluates some cases of carbonized corpses examined at the Forensic Pathology service of the University of Florence. The tongue protrusion shows a high occurrence both in vital (100%) and non-vital fires (66%). The involvement of a forensic odontologist in the cadaver examination result to be limited to one third of the cases. In two non-vital cases the tongue was described as protruded and clenched between the dental arches. The rigor of the genioglossus induced by the heat could explain the phenomenon. Further research on fire fatalities is required to analyze the tongue bleeding as a possible parameter to discriminate the vital by the non-vital tongue protrusion. Moreover, the mechanism at the origin of vital and non-vital tongue protrusion, the different position of the tongue (protruded from an open mouth, protruded and clenched between the dental arches, etc.) in different death circumstances, should be furtherly investigated with a meaningful collaboration between forensic pathologists and odontologists for a complete registration and interpretation of all the mouth originated evidence.

Newborn screening of inherited metabolic disorders: the Italian situation.

Starting from an international overview of the current status of screening programs, the present paper focuses on the legal situation in Italy and the great differences among Italian regions. Since the introduction of tandem mass spectrometry (MS/MS) in the ‘90s the paradigm “one spot-one disease” changed. Only recently, some regions issued legislative acts to promote expanded newborn screening with MS/MS. This approach raises medico-legal and ethical issues because a fast neonatal diagnosis of an inborn error of metabolism (IEM) could increase chances of an early treatment and reduce disabilities, therefore citizens ought to have the same access to care countrywide. Enacting a mandatory standard for a disease screening panel using MS/MS and a few centers specialized in diagnosis, treatment and follow-up of patients affected by IEM (inborn errors of metabolism) can reduce legal and ethical issues.