Lethal nitrous oxide (N2O) intoxication during surgery: the contribution of immunohistochemistry in identifying the cause of death: a case report.

BACKGROUND: Nitrous oxide (N2O) is a gas used in medicine for its analgesic, anxiolytic and amnesic properties. It is a drug considered safe if adequately administered. In the literature, accidental N2O-related deaths are rare. They are mostly related to inhalation of this substance for recreational and autoerotic purposes; rarely are reported deaths due to incorrect administration of medical gas in anesthesia. The diagnosis of death from acute N2O intoxication is complex and is generally an exclusion diagnosis: the macroscopic and microscopic post-mortem signs are entirely nonspecific. Furthermore, the circumstantial data are not always supportive and can even be confusing, mainly if the death occurred inside a hospital. CASE PRESENTATION: We describe a particular case of death from acute nitrous oxide poisoning in a hospital environment, of a Caucasian male of 72-years-old. The intoxication occurred during a minimally invasive vascular surgery due to an incorrect assembly of the supply lines of medical gases (O2 and N2O). The identification of the cause of death resulted from the analysis of circumstantial data, macroscopic and microscopic autoptic findings, and immunohistochemical investigations based on the search for antibodies anti E-selectin, P-selectin, and HIF 1-α. CONCLUSION: Although not pathognomonic of asphyxiation by N2O, the latter molecules are a valid and early marker of hypoxic insult. Therefore, in concert with all other findings, it may constitute valid support for the forensic pathologist to ascertain the cause of death in case of suspected intoxication by N2O.

Cannabis regulatory system in European Union countries, forensic concept of "doping dose" and medico-legal implications.

Cannabis is the most widely used illicit psychoactive substance in the world. In recent years, in many European Union countries, there has been a decriminalisation of the use and personal possession of cannabis for recreational purposes. There has been a spread of medical cannabis, as well as marketing of cannabis products at low concentrations of delta-9-tetrahydrocannabinol (Delta-9-THC), the major chemical to which cannabis owes its psychotropic effect. The percentage limit of this substance, only recently set by the European Court of Justice, must be distinguished from the "doping dose" of Delta-9-THC, namely, the dose which causes psychotropic effect in the consumer. Our study analyses and summarises the regulations in the countries of the European Union on the penalisation of recreational cannabis, the legalisation of medical cannabis and limits on percentage of THC imposed locally. Based on the analysis of a recent judgment of the Italian Supreme Court of Cassation, we discuss the importance of the role of the forensic toxicologist in the scientific definition of "doping dose". The distinction between the doping dose of THC and the percentage of THC contained in the marketed cannabis product is vital when establishing fair punishment in the event of a crime.

The Importance of the International Community in Protecting the Right to Abortion: The Cases of Malta and of the US Supreme Court.

According to the World Health Organization (WHO), abortion is often necessary and is not a criminalizable medical act. Unfortunately, despite the global trend in recent years tending towards liberalization of abortion as a fundamental right of women in certain circumstances, it is still not guaranteed in all countries of the world in the same way. Moreover, the abortion debate is often characterized by unscientific opinions based on political and/or religious ideologies. Recently, a European episode has rekindled the debate on abortion: in Malta, a tourist was unable to have an abortion, with consequent risks, even serious ones, on her health. In addition, even in the United States a Supreme Court ruling created a considerable stir: the Roe v. Wade (1973) ruling that had legalized abortion at the federal level was revoked. After the ruling of the Supreme Court, each state of the USA can decide for itself whether and how to legalize abortion. These recent international developments are particularly worrying and make even more evident the need for abortion to be protected at an international level as an inalienable and fundamental human right, and therefore not to be limited.

Informal caregivers in Italy: the 'phantom zone' of welfare.

Medical progress and the consequent gradual ageing of the population increase the number of people in Europe who require continuous care, as they suffer from chronic diseases or senility. This demand is disproportionate if compared to the economic resources of health systems and is, therefore, heavily supported by the activity of the so-called "informal caregivers". With our article we propose to depict the current scenario in Italy, dwelling on the safeguards, to date, aimed at informal caregivers, which are insufficient to correct the criticalities associated with the burdensome assistance provided by such figures. Such critical issues result in a real risk for the health of informal caregivers and their loved ones and require urgent action by the health system. If it is true that health welfare is not able to protect the increasing number of people who are not self-sufficient, it is necessary to invest at least on specific measures to preserve the health and skills of those who are at the forefront of this hidden welfare. (www.actabiomedica.it).

Free access to emergency oral contraceptives (EOCs) in the European Union: A regulatory vacuum to be filled.

BACKGROUND: According to the World Health Organization (WHO), any woman in childbearing age who have decided not to take permanently an oral contraceptive but who are sexually active has the right to access emergency contraception (EC). Despite this, in many European countries there are no specific laws governing the criteria for access to emergency oral contraceptives (EOCs) for girls under 18, especially about the need for third party consent. This normative vacuum is dangerous as it risks creating confusion and entrusting the management of the fundamental right of self-determination to the discretion of others. Moreover, in European Union (EU) countries, there is an inequality in terms of access to contraceptive supplies, reimbursement criteria and the availability of information online. OBJECTIVE: Our article compares the criteria for access to EOCs (Ulipristal Acetate-UPA and Levonorgestrel-LNG) in the various EU countries to highlight possible disparities and consequent inequalities. METHODS: Government and ministerial websites, European agencies websites, and Contraceptive Use by Method 2019 (WHO) have been consulted. RESULTS: There are some differences between the various European countries that could configure inequality in EU countries. CONCLUSIONS: It would be appropriate a definitive levelling of the legislation of the European Union on emergency contraception associated with massive information and awareness campaigns.

Can vaccine adherence against Sars-CoV-2 become a criterion for access to medical care?

Vaccine hesitancy and anti-vax movements are increasing globally. Covid-19 pandemic has caused and causes emergency situations where available resources do not always meet the need for community care.In this article, the authors analyse the bioethical and medico-legal implications of the possibility - in conditions of scarcity of resources - of selecting patients who must have access to medical care based on vaccination against Sars-CoV-2.

Compulsory vaccination against SARS-CoV-2 in health care professionals in Italy: Bioethical-legal issues.

On 17 March 2022, the Italian Council of Ministers, by means of Press Release No. 67, sanctioned the extension of the vaccine obligation against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for health workers until 31 December 2022. Healthcare workers who do not demonstrate that they have adequate vaccination coverage will be suspended from work and will not be paid. Recently, the Council of Administrative Justice of Sicily has identified possible contrasts between the vaccine obligation of health professionals and numerous constitutional principles, paving the way for an interesting bioethical-legal debate on the subject. The aim of this article is to examine the possible profiles of unconstitutionality of the measure of the Italian Government and to identify medico-legal and bioethical issues potentially related to the vaccine obligation for health professionals in a context of resolution of the emergency phase related to the coronavirus disease 2019 (COVID-19) pandemic.

Role of forensic medicine in addressing the war crimes: Perspective from Russia-Ukraine conflict during the COVID-19 pandemic.

The International Criminal Court has recently opened an investigation into the international crimes committed on Ukrainian territory. The ongoing Russian-Ukrainian war is a tragic opportunity for a necessary critical and scientific reading of the Rome Statute. In our work, we aim to critically analyse the contents of the International Criminal Court's Rome Statute, with particular attention to the definition and listing of war crimes. Our objective is to assess whether the content of the Rome Statute and the Geneva Convention is useful to provide a correct and complete orientation of the medico-legal work in the context of war. We believe, in fact, that the forensic pathologists, and forensic experts in general, are the only professional figures specialised in providing scientific evidence of crimes compatible with war crimes. Their timely intervention and the standardisation of their work - in association with a review of the deficient content found in the Rome Statute - is essential in order to allow the prosecution of international crimes, already potentially undermined by the slowdowns associated with the COVID-19 pandemic that is the backdrop to the current conflict.

Pharmacological History of Missing Subjects: Perspective of a Correction Factor to Aid in the Study of Bone Remains.

In forensic anthropology, bone mineral density and the estimation of the dating of fractures based on the degree of progress of healing processes are important parameters of study on bone remains. With our article we aim, on the one hand, to highlight the importance that these parameters have in the reconstruction of the biological profile of the subject, as well as the time and the cause of death; on the other hand, we aim to limit their variability according to the medical substances and/or abuse assumed during life by the subject. The aim of this article is to encourage the introduction of the pharmacological history of missing persons as a new correction factor for the study of bone remains, possibly based on new scientific studies that allow us to establish with greater specificity the effect that certain pharmacological therapies produce on bone mass and the speed of remodeling.

Violation of the right to abortion at the time of the war in Ukraine.

Abortion is still a controversial medical practice. One country where it is not possible to have an abortion freely is Poland. During the war between Russia and Ukraine, many Ukrainian women became pregnant due to rape. These women, refugees in Poland, have asked for an abortion; however, under Polish law, it is not possible to have an abortion if the rape has not yet been legally recognized. This situation is causing a very serious violation of the fundamental rights to the health and self-determination of Ukrainian women. It will be necessary to implement all possible international measures to allow these women to abort freely.

Unusual suicide with an electric Jigsaw: A case report and literature review.

Fatal injuries caused by power saws are rare. In most cases, they are accidental and non-voluntary. Even rarer are suicides carried out using power saws, with no previously reported cases of suicide by electric jigsaw. We report a case of suicide by electric jigsaw of a young obese woman suffering from major depression with psychotic features. The peculiarity of our case - compared to those known in the scientific literature - concerns not only the means used for suicide, but also the results of psychological autopsy and the characteristics of the fatal injury. In fact, the autopsy showed a large wound on the anterior and lateral region of the neck with preservation of the integrity of the large vessels of the neck. The cause of death was attributed to haemorrhagic shock due to slow bleeding of small and medium calibre neck vessels, with blood aspiration.

Binge-eating episode as a direct cause of death in a young individual without eating disorder.

Binge eating is characterised by the ingestion of large quantities of food in a short time. Cases in the literature deal exclusively with gastric perforation in people with a history of anorexia nervosa, binge eating disorder or bulimia nervosa.We report the case of a young woman with no previous diagnosis of mental illness and a history of only two binge-eating episodes that occurred a few years earlier. She died suddenly during a binge-eating episode from stomach rupture resulting from a single perforation of the stomach with leakage of food material within the abdominal cavity. There was no sign of gastric necrosis or peritonitis. The deceased died quickly.Our case, which appears unique in the literature, shows that there is a risk of death even in people with no diagnosis of eating disorders and a history of only few and isolated binge-eating episodes. Physicians should carefully investigate a patient's history to assess any risks.

Accidental identification of peritoneal encapsulation during an autopsy after a car accident.

Peritoneal encapsulation is a rare congenital pathological condition. Typical of this pathology is the presence of an accessory peritoneal flap that encloses the entire mass of the small intestine. Subjects with this condition often do not show symptoms and, in most cases, finding of it is accidental. We report a case of peritoneal encapsulation, not previously identified and found during an autopsy; the deceased, positive for HIV and affected by a Kaposi's sarcoma, died following a road accident. Unlike other cases in the literature, the peritoneum encapsulated all abdominal organs and not only small intestines. Notwithstanding, there were no signs of intestinal ischaemia or intestinal obstruction.

Abortion in Europe: Recent legislative changes and risk of inequality.

BACKGROUND: Induced abortion is a medical practice that has always been much discussed all over the world. Abortion is allowed in most European countries at the request of the woman with limitations that are imposed mainly by the gestational age. However, there are legislative differences between European countries which impose stringent limits on the use of induced abortion. OBJECTIVE: This article analyzes the European legislation on abortion, with a particular focus on countries in which there have been recent legislative changes in recent years, and the possible consequent risk of inequality among European women. METHODS: Government and ministerial websites of the countries analyzed have been consulted to investigate abortion laws in Europe. In addition, the Global Abortion Policies Database of the World Health Organization was also consulted for a regulatory comparison. RESULTS: The differences between the various European countries are considerable. Although guaranteed by most legislation, abortion remains a fragile right in some European countries. CONCLUSION: Different legislation in the various countries of Europe causes difficulties for women who want to have an abortion but who reside in states where there are strict limits to abortion. In addressing the issue of induced abortion, we must not forget that the center of this practice is the woman. For this reason, it is essential to apply a reasoning based on respect for women's rights: freedom, health, and self-determination.