In amara attesa: il suicidio in gravidanza

The finding of an old post-mortem report concerning the suicide of a pregnant woman in the archive of The Institute of Legal Medicine of the University of Milan, offered the opportunity to research similar cases. Despite the fact that the above mentioned archive contains as many as 95.000 reports, no other cases were found, supporting the conclusions of scientific literature on the rarity of this phenomenon. The matter has however been the subject of a number of studies and the Authors analyse them in detail. With regard to the cases, they had to “resort” to articles published on several newspapers between 1980 and 2009, and could thus review 16 cases of suicide and 10 cases of attempted suicide during pregnancy, analyzing the age of the victim, her marital status, the month of gestation, how the victim attempted/committed suicide, comparing data with the ones available in other scientific publications.Il reperimento, fra i verbali autoptici della Sezione di Medicina Legale dell’Università di Milano, di un vecchio caso di suicidio da parte di una donna gravida ha offerto l’occasione per una ricerca di analoghi casi. In realtà, nonostante l’archivio citato contenga ben 95.000 verbali, non sono stati trovati altri casi, il che conforta le conclusioni della Letteratura scientifica circa la rarità del fenomeno. Le ricerche in materia non sono comunque assenti, e gli Autori le analizzano in dettaglio. Quanto ai casi, hanno “ripiegato” sugli articoli apparsi in diverse testate giornalistiche dal 1980 al 2009, e hanno così potuto esaminare 16 casi di suicidio e 10 di tentato suicidio in gravidanza, analizzando età dell’autrice, stato civile, mese di gestazione, modalità lesive, confrontando i dati con quelli presentati nelle altre pubblicazioni scientifiche

Minorenni vittime di omicidio a Milano (Italia): 1993-2017

This study aims to examine the phenomenon of homicide with victims under 18 years-old in a wide and multiethnic metropolitanarea in the north of Italy. We’re dealing with a type of crime that generates a widespread alarm and a common concern.The data analysis, approached with a multidisciplinary strategy, presented in this paper is based on forensic reports of the Instituteof Legal Medicine of the University of Milan, to provide a detailed framework of the homicides of minors that took place inthe territorial jurisdiction of Milan and Monza Prosecutor’s Office between 1993 and 2017. Quantitative and qualitative analysiswere conducted regarding victims’ socio-demographic characteristics (gender, age, nationality), weapons used, places and modalityof body discovery, murderers, motives of the killing and type of relationship between offenders and victims. Purpose of thispaper is to compare the present set of data with the ones provided by the international literature, as well as make some criminologicalobservations on this matter with a view to preventing the phenomenon. To this end, some representative case studieshave been added, their characteristics and also the relationships between offender and victim have been discussed.Questo studio esamina il fenomeno dell'omicidio con vittime di età inferiore ai 18 anni in una vasta e multietnica area metropolitanadel nord Italia, un tipo di crimine che genera allarme e preoccupazione. L'analisi dei dati, affrontata con una metodologia multidisciplinare,è basata sui verbali autoptici dell'Istituto di Medicina Legale dell'Università di Milano, al fine di fornire un quadro dettagliatodegli omicidi con vittima minorenne che si sono verificati nella giurisdizione territoriale della Procura di Milano e Monzatra il 1993 e il 2017. Sono state condotte analisi quantitative e qualitative sulle vittime, quali le caratteristiche socio-demografiche(genere, età, nazionalità), le armi utilizzate, i luoghi e le modalità di rinvenimento del corpo, le caratteristiche dell’omicida, i motividell'uccisione e il tipo di relazione tra criminale e vittima. Scopo di questo studio è confrontare l'attuale insieme di dati con quelliforniti dalla letteratura internazionale, nonché porre alcune considerazioni di carattere preventivo. A tal fine, sono stati presentatianche alcuni casi studio rappresentativi, discutendone le caratteristiche peculiari e le relazioni tra l'autore del reato e la vittima

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

Effects of intracellular/dissolved ratios of microcystin-LR onto its ultrafiltration removal

Microcystins (MCs) are toxic secondary metabolites produced by cyanobacteria, often present in eutrophic waters. Since the need of drinking exploitation of eutrophic lakes and reservoirs is increasing worldwide, effective and economic methods to remove cyanobacteria and MCs in the potable treatment of eutrophic water are required. Since traditional treatments present significant drawbacks in this process, the membrane pressure-driven filtration is emerging as a possible option; furthermore, being its cost mainly related to pore size, the use of low density membranes, and specifically Ultrafiltration (UF), seems the most appropriate solution. UF can effectively remove cyanobacteria biomass by size exclusion, but a certain capacity to remove significant amounts of microcystins, despite the fact that MC molecules are smaller than UF membrane pores, was also observed, This is due to the mechanisms governing the ratios of MC presence in intracellular and dissolved forms, or to possible adsorption of MCs by inorganic colloids or natural organic matter contained in the water, or to adsorption on the membrane itself. The ratio between intracellular and dissolved IvICs is mainly considered related to the release of MCs by cyanobacterial cells under stress conditions, or during their senescent stages. Nevertheless, on-field statistical studies assume the possibility of further unknown mechanisms, since the release mechanisms alone seem not clearly related to any ecological or climatic conditions. While the highest cyanobacteria proliferation happens in highly eutrophic water bodies, the highest concentration of dissolved MCs seems to happen mainly in oligotrophic or mesotrophic waters. In this study, we present the results of several laboratory and pilot plant experiments, aimed to deepen the knowledge of the mechanisms governing the migration of Microcystin-LR (MC- LR) from dissolved to particulate-bound phase and vice versa, and their effect over the UF removal of microcystins. Firstly, we analysed the presence of MC-LR, in filtered water after 3 months of pure culture of Microcystfs Aeruginosa and different cycles of freezing, showing an increase of dissolved MC- LR due to cell break deriving from the refrigeration cycles. Secondly, we performed tests of filtration in a pilot ultrafiltration plant equipped with a polysulfone membrane, using samples of demineralised water and raw water from an eutrophic lake (Massaciuccoli lake, Tuscany, Italy), both spiked with MC-LR. The lake water was characterized for presence of inorganic and organic compounds, as well as colonies of microorganisms, including total cyanobacteria. The UF filtration tests resulted in significantly different residuals of MC-LR. Specifically, the raw lake water spiked with MC-LR resulted in a higher MC-LR removal efficiency. The results of the experiments allowed to discuss the role of the absorption-release process over the efficiency of the ultrafiltration process, and the role of MC-LR release by cyanobacteria cells under stress conditions so as to allow the exploration of non-conventional operation rules aimed to maximize the removal of Iv1Cs by UF

Altered body water distribution in subjects with juvenile rheumatoid arthritis and its effects on the measurement of water compartments from bioelectric impedance

Objective: To assess the reliability of bioelectric impedance analysis (BIA) for predicting total body water (TBW) and extracellular water (ECW) in children affected by juvenile rheumatoid arthritis (JRA). Subjects: Thirty-nine children affected by JRA and 23 healthy children of similar age (11.0 +/- 3.6, range 3.0-19.0 y) were recruited for the study. Methods: TBW and ECW were measured by deuterium oxide and bromide dilution, respectively. Bioelectric impedance (Z) was measured at frequencies of 5, 50 and 100 kHz. The prediction of TBW and ECW from BIA was based on the impedance index (ZI = height(2)/Z, cm(2)/Omega). Results: TBW standardized per kg of body weight and ECW standardized per litre of TBW were significantly higher in JRA as compared to control patients (59.7 +/- 2.4 vs 57.7 +/- 2.7% and 44.5 +/- 4.6 vs 38.1 +/- 7.9%, with P < 0.005 and P < 0.0001, respectively). Moreover, intracellular water standardized per litre of TBW was significantly lower in JRA than in control subjects (55.5 +/- 4.6 vs 62.5 +/- 8.1, with P < 0.0001). In both controls and patients, the use of ZI at 5 kHz offered the more accurate prediction of ECW. However, the use of ZI at 100 kHz did not offer a better prediction of TBW as compared to its value of 50 kHz. Control-generated formulae for predicting water compartments from BIA [TBW = 0.716 x ZI at 100kHz-1.504, r = 0.934, s.e.e. = 2.2 l; ECW = 0.430 x ZI(5)-3.652, r = 0.869, s.e.e. = 1.7 l] underestimated TBW and ECW in JRA patients. However, population-specific formulae [TBW (1) = 0.766 x ZI at 100 kHz-0.053, r = 0.939, s.e.e. = 2.8 l; ECW (1) = 0.399 x ZI at 5 kHz-0.283, r = 0.886, s.e.e. 1.7 l] allowed an accurate prediction of TBW and ECW in JRA patients, taking into account their altered body water distribution. Conclusions: Altered water distribution impedes the use of formulae developed on healthy children to predict TBW and ECW from BIA and JRA patients. It is hypothesized that chronic inflammation and subclinical malnutrition may be responsible for the altered body water distribution of JRA patients. Traditional body composition models may require adjustments for use in JRA children due to their altered body hydration and water distribution. Sponsorship: The study was supported by MURST (Ministero Universita Ricerca Scientifica e Technologica) '60%' grants. Descriptors: juvenile rheumatoid arthritis, body composition, total body water, extracellular water, bioelectric impedance analysi