Cocaine contamination in pubic hair: Analysis of the decontamination method

Abstract Even if pubic hair represents a reliable and widely accepted alternative hair matrix to identify drug abusers, it might produce false positive results due to external contamination. The aim of this study was to verify whether the external contamination of pubic hair with cocaine could influence the discrimination between active users and false positive subjects. The analysis was performed on in vivo and in vitro samples; the contamination was carried out by rubbing pubic hair with cocaine hydrochloride contaminated hands for three consecutive days. Five days after the beginning of the contamination, the pubic hair was collected and analysed at different times for two months. Data from our studies show that all in vivo samples yielded false positives; the in vitro samples were negative only for 10 days and then yielded false positives

Fulminant ischemic colitis with a fatal outcome after cocaine snorting: Case report and literature review

Abstract Snorting represents the most common route of administration for recreational powdered cocaine, and it is considered less dangerous than other routes of intake (i.e., intravenous; crack inhalation; etc.). A case of fulminant ischemic colitis with a fatal outcome, which occurred in a 19-year-old man after cocaine snorting, is presented in this report. Although several cases are reported in the literature, no one has involved people aged less than 20 years. The young man showed unspecific symptoms, which began about 2 h after the cocaine intake and the physicians were unable to make the diagnosis. This report may assist doctors treating young men who have consumed cocaine to consider this possible complication in all young adults (teenagers) in the presence of unspecific symptoms

The Mediterranean shipwreck of April 18 2015: challenges in the postmortem examination of the victims

Background and Aims. On the 18th of April 2015, one of the largest shipwrecks in the Mediterranean sea occurred with around 800 gone missing. Among European indifference and inactivity, the Italian Government created a task force, through the will of the Commissioner’s Office of Missing Persons, the Italian Navy, the Prefecture of Siracusa, the Police, the Military Red Cross and the University of Milano flanked by the Universities of Catania, Palermo and Messina and other 10 Universities for the recovery and the identification of these victims in a challenging scenario where collection of post-mortem and ante-mortem data is very difficult respectively because of the conditions of the bodies and the political situation of the countries of provenance of the victims as well as the dispersal of their relatives and loved ones all over the world. According to the DVI protocols, identification relies mainly upon primary (genetic, fingerprint, teeth) criteria, but previous experience on the Lampedusa disaster has proven that such criteria may not guarantee high success rates. Personal descriptors of faces (ante-mortem photographs) are becoming more and more important. Materials and Methods. Since July 2015, 69 body bags bodies have been recovered around the wreck e and 458 body bags inside the boat; these were recovered by the Italian Navy and brought to a Naval area near Siracusa where a morgue was set up. Here PM examination on all bodies was performed and a biological profile was created through detailed pathological, anthropological odontological and radiological examination of the remains along with sampling for DNA analysis. 3D scans of the face or crania also were performed. Results. Preservation of the bodies varied from decomposed bodies, partial skeletonization of the extremities to complete skeletonization (with lack of the skull). Over 550 bodies were recovered along with many commingled remains. Preservation of bodies varied from partial skeletonization of the extremities (41%) to complete skeletonization (23%). All bodies so far belong to males. Conclusions. The humanitarian disposition of countries, politicians and scientists is a fundamental prerequisite for identifying victims of these disasters. Because of the difference in type of AM data available in such cases, autopsy procotols and identification strategies may need to vary

THE IMPORTANCE OF THE NURSING FOLDER INTRODUCTION AND ITS FORENSIC VALUE.

In this paper, the authors seek to outline the medico-legal aspects of the nursing folder and the requirement for precision in its compilation in terms of content, requirements, management and filing. This article also discusses the importance of the introduction of the nursing folder and emphasizes its status as a public document. The passing of Law n. 42/1999 was fundamental in empowering the nursing profession and marking the passage from “auxiliary health care profession‖ to “health care profession‖

ASSESSMENT OF TOXICITY DUE TO INTRAVENOUS ADMINISTRATION OF HEROIN CUT WITH CAFFEINE IN A CHRONIC CITALOPRAM CONSUMER.

This article presents the case of a 26 year old male heroin addict and chronic user of high doses of citalopram, who was found dead at his home. Toxicological analysis showed that the young man was in a state of chronic citalopram intoxication. The low opioid concentration detected excluded heroin overdose as the cause of death. The heroin used by the man was characterized by a low percentage of opiates (heroin 0.1%, acetylcodeine 0.8%; 6-MAM 1.19%, codeine 0.2%) and a high percentage of cutting substances (caffeine 38%, acetaminophen 29%). The pathogenetic mechanism underlying the man’s death was reconstructed through the integrated evaluation of analytical and pathological data together with consideration of the toxic effects of intravenous injection of heroin cut with a significant amount of caffeine (although non-lethal) in the presence of high citalopram concentrations

Taglio cesareo su richiesta materna: aspetti clinici, etici e medico-legali

Negli ultimi anni si è assistito ad un aumento significativo del numero di parti espletati con taglio cesareo, pari circa al 25-30%. Inoltre è sempre più comune la “scelta” delle donne e dei loro partner sulla tipologia del parto. Nel 2004, infatti, i tagli cesarei richiesti dalle pazienti rappresentavano il 4-18% di tutti i cesarei ed il 14-22% di quelli programmati. La richiesta materna di taglio cesareo nasce da condizionamenti sociali, culturali e medici. La FIGO e la SOGC, nelle loro linee guida, concludono che il taglio cesareo su richiesta non è attualmente eticamente accettabile; per l’ACOG, invece, emerge una posizione più possibilista. Inoltre, il NCC-WHC ed il NIH ritengono accettabile una valutazione individualizzata della richiesta materna di taglio cesareo dopo un adeguato ed esauriente counselling. Sotto il profilo strettamente legale, la richiesta di taglio cesareo offre argomenti sia favorevoli che contrari. Questi ultimi tengono presente la facoltà di decidere secondo scienza e coscienza, l’interpretazione restrittiva dell’art. 5 c.c., che vieta al soggetto di disporre del proprio corpo, l’aumentato rischio del taglio cesareo in termini di morbilità e mortalità materna in confronto al parto vaginale. Per contro, la legittimità del ricorso al taglio cesareo su richiesta può essere sostenuta dal principio dell’autodeterminazione del soggetto nei riguardi della propria salute, non solo fisica ma anche psichica. Quindi qualsiasi intervento, in particolare il taglio cesareo su richiesta materna, deve essere preceduto da una attenta e adeguata informazione e un consenso informato per non sbagliare e rientrare nell’imprudenza

Depressione post-partum: valutazione clinica e medico-legale

Più dell’85% delle donne nel post-partum soffrono di disturbi dell’umore: nella maggior parte dei casi forme transitorie e lievi (“postpartum blues”), nel 15% forme più severe (“depressione propriamente detta”) che possono sfociare in “psicosi”. Il caso da noi riportato riguarda una donna di 21 anni che, dopo aver partorito con taglio cesareo per ipossia acuta fetale, in 7a giornata di puerperio riferisce che “c’è qualcosa che non va”: si dimostra particolarmente stanca, irritata, triste. Nei giorni successivi la sintomatologia si acuisce. Alla consulenza psichiatrica le viene diagnosticata “depressione post-partum moderata” e dopo una terapia per 6 mesi con paroxetina la prognosi è stata buona sia per la madre che per il neonato. I disturbi psichiatrici del post-partum rappresentano un importante problema di sanità pubblica, che può anche avere conseguenze negative sullo sviluppo fisico e comportamentale, oltre che poter mettere a rischio la vita del neonato (“infanticidio”). Le varie legislazioni europee infliggono una pena minore nei casi di infanticidio, e in Italia la legge che lo regolamenta è l’art. 578 del c.p., riformulato dalla legge n. 42 del 5/8/1981: “La madre che cagiona la morte del proprio neonato immediatamente dopo il parto, o del feto durante il parto, quando il fatto è determinato da condizioni di abbandono materiale e morale connessa al parto, è punita con la reclusione da 4 a 12 anni”. Data quindi la potenziale gravità di questo disturbo, è importante diagnosticarlo in fase precoce ed attuare delle misure terapeutiche appropriate, oltre che supporto psicologico

Post mortem concentrations of endogenous gamma hydroxybutyric acid (GHB) and in vitro formation in stored blood and urine samples

Gamma-hydroxybutyrate (GHB) is a central nervous system depressant, primarily used as a recreational drug of abuse with numerous names. It has also been involved in various instances of drug-facilitated sexual assault due to its potential incapacitating effects. The first aim of this paper is to measure the post-mortem concentration of endogenous GHB in whole blood and urine samples of 30 GHB free-users, who have been divided according to the post-mortem interval (PMI) in three groups (first group: 24-36h; second group: 37-72h; third group: 73-192h), trying to evaluate the role of PMI in affecting post mortem levels. Second, the Authors have evaluated the new formation of GHB in vitro in blood and urine samples of the three groups, which have been stored at -20°C, 4°C and 20°C over a period of one month. The concentrations were measured by GC-MS after liquid-liquid extraction according to the method validated and published by Elliot (For. Sci. Int., 2003). For urine samples, GHB concentrations were creatinine-normalized. In the first group the GHB mean concentration measured after autopsy was: 2.14mg/L (range 0.54-3.21mg/L) in blood and 3.90mg/g (range 0.60-4.81mg/g) in urine; in the second group it was: 5.13mg/L (range 1.11-9.60mg/L) in blood and 3.93mg/g (range 0.91-7.25mg/g) in urine; in the third group it was: 11.8mg/L (range 3.95-24.12mg/L) in blood and 9.83mg/g (range 3.67-21.90mg/g) in urine. The results obtained in blood and urine samples showed a statistically significant difference among groups (p<0.001) in the first analysis performed immediately after autopsy. Throughout the period of investigation up to 4 weeks, the comparison of storage temperatures within each group showed in blood and urine samples a mean difference at 20°C compared to -20°C not statistically significant at the 10% level. These findings allow us to affirm that the PMI strongly affects the post mortem production of GHB in blood and urine samples. Regarding the new formation of GHB in vitro both in blood and urine samples of the three groups, which have been stored at -20°C, 4°C and 20°C over a period of one month, although there was no significant increases of GHB levels throughout the period of investigation, the lowest increases were found both in blood and urine at -20°C, therefore we recommend the latter as optimal storage temperature