Approccio metodologico in tema di violenze sessuali: esperienza operativa della cattedra di medicina legale dell’Università di Catanzaro

The Law no. 66 of the 15th February 1996 has made sexual violence a crime against the person. Under this Law, the relationship between the offender and the person injured at the time of the aggression becomes central. The seriousness of the offence also derives from the violation of the personal liberty of the victim and the violation of his/her most intimate person, his/her dignity and physical or mental well-being. Sexual violence against a minor is considered an aggravating circumstance. The multipurpose survey conducted by ISTAT in 2002 on the safety of citizens and thus also on the “harassment and sexual violence” suffered by women aged between 14 and 59, showed that around 53,000 women in Italy have suffered rape or attempted rape in any given year, and that over 95% of rapes or attempted rapes go unreported. The perpetrators are mostly family members and friends, known to the victims. This is in contrast to the 2,543 complaints that the police have filed with the Judicial Authorities in the same period. The situation became more evident after the ISTAT analysis of 2006 on “Violence and abuse against women” aged between 16 and 70, which suggests that 1 million (4.8%) of them have been victims of rape or attempted rape during their lifetimes. Partners carry out physical violence (12%) above all, while sexual violence is largely carried out by a non-partner (20.4%); in cases of rape or attempted rape, no real differences have been observed between partners and non-partners (2.4% and 2.9% respectively). Rapes are, for the most part, reported when the violent act has been committed by a stranger. The cases studied, as shown in the past, confirm the statistical observations: the phenomenon is submerged and little known. Our experience indicates that the inadequacy of the samples collected and documented, as well as the lack of coordination between the police and specialists, may be among the reasons leading to the inefficiency of genetic-forensic tests, necessary to identify the aggressor’s profile. Reports relative to the use and abuse of drugs and / or psychotropic substances are insufficient, and updates on sexually transmitted diseases or pregnancy associated with criminal action are lacking. We are aware that the phenomenon can be effectively dealt with through the use of dedicated staff and trained specialists, thereby obviating the problem of improvisation, unfortunately still present. This has taken place through the promotion of an anti-violence centre at the Magna Graecia University of Catanzaro, as well as in other Italian cities, and with the formation of a multidisciplinary team of professionals whose aim is to formulate and implement guidelines, constantly updated according to the latest technical and scientific developments, as well as the training of specialists in the clinical and medico-legal management of the victims of sexual assaults.La legge n 66 del 15 febbraio 1996 ha ascritto il reato di violenza sessuale tra i delitti contro la persona. Con questa norma assume un ruolo centrale la relazione tra soggetto agente e persona offesa al momento del fatto. La gravità dell’offesa deriva anche dalla lesione della libertà personale della vittima e dalla violazione della sua intimità, dignità ed integrità fisica o psichica. Tra le circostanze aggravanti si annovera la violenza sessuale nei confronti di un minorenne. L’indagine multiscopo condotta dall’ISTAT nel 2002 sulla sicurezza dei cittadini e quindi anche sulle molestie e le violenze sessuali subite dalle donne di età compresa tra i 14 e i 59 anni ha dimostrato che circa 53.000 donne in Italia hanno subito stupro o tentato stupro in un anno, e che oltre il 95% degli stupri o dei tentati stupri non viene denunciato. Gli autori delle violenze sono soprattutto persone note alle vittime come familiari ed amici. Tutto ciò è in contrasto con le 2543 denuncie che le forze di polizia hanno sporto all’Autorità Giudiziaria nello stesso periodo. La situazione è diventata più evidente dopo l’indagine ISTAT del 2006 sulla violenza e i maltrattamenti contro le donne di età compresa tra 16 e 70 anni, in cui si evince che 1 milione (4,8%) di esse è stata vittima di uno stupro o di un tentativo di stupro nel corso della loro vita. Il partner concretizza soprattutto violenza fisica (12%), mentre la violenza sessuale è attuata soprattutto da un non partner (20,4%); in casi di stupro o di tentato stupro non sono state osservate differenze significative tra partner e non partner (2,4-2,9%). Gli stupri sono denunciati in massima parte quando l’azione violenta è stata commessa da uno sconosciuto. Lo studio dei casi, come già in passato evidenziato, conferma quanto rilevano le statistiche: Il fenomeno per molti aspetti risulta sommerso e poco conosciuto. L’esperienza, realizzata nei casi di violenza sessuale pervenuti alla nostra osservazione, indica che l’inidoneità dei campioni raccolti e conservati, così come la mancata coordinazione tra le forze di polizia e gli specialisti, possono essere tra i motivi che determinano la perdita di efficacia delle indagini genetico–forensi, necessarie ad individuare il profilo dell’aggressore. Insufficienti sono le notizie sull’uso ed abuso di sostanze stupefacenti e/o psicotrope e assenti sono le notizie sulla diffusione di malattie sessualmente trasmesse o su eventuali gravidanze associate all’azione delittuosa. Siamo consapevoli che il fenomeno può essere contrastato con l’impiego di personale dedicato e in possesso di una formazione specialistica, rimediando così al problema dell’improvvisazione, purtroppo ancora presente. Ciò ha condotto alla promozione della creazione di un Centro Antiviolenze anche presso il Policlinico dell’Università Magna Graecia di Catanzaro, così come in altre realtà italiane, e nella formazione di un gruppo multidisciplinare di professionisti e ricercatori finalizzato alla redazione ed implementazione di linee guida sempre aggiornate ed in sintonia con le più recenti evoluzioni tecnico-scientifiche, nonché per la formazione di personale specializzato nel management clinico e medico legale delle vittime di reati sessuali

Protection of Prisoners with Mental Health Disorders in Italy: Lights and Shadows after the Abolition of Judicial Psychiatric Hospitals

In Italy, a person suffering from a mental disorder who commits a crime will be given a custodial security order and serve the period of admission at a Residenza per la esecuzione delle misure di sicurezza (REMS) (Residence for the Execution of Security Measures, hereinafter "REMS"). These institutions have been established recently and though equipped with the necessary safety measures, the focus is on psychiatric therapy. Despite being present on a national scale, access is very limited in terms of capacity. Immediate remedial measures are needed, so much so that the European Court of Human Rights recently condemned Italy for this very reason. This article, through a review of the constitutive principles of these institutions, shows how they have very positive aspects such as the attention to necessary psychotherapy in order to protect the right to health and the real taking charge of the fragility of the subjects; however, it is seen how there are many negative aspects linked above all to the scarce availability of places in these structures. The article provides suggestions on a more comprehensive strategy for facilities for detainees with mental disorders

Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review

The severe acute respiratory syndrome (SARS)-CoV-2 was identified for the first time in China, in December 2019. Confirmed cases of COVID-19 have been reported around the world; indeed, this infection has been declared a pandemic. Consequently, the scientific community is working hard to gain useful information about the history of this virus, its transmission, diagnosis, clinical features, radiological findings, research and development of candidate therapeutics as well as vaccines. This review aims to analyze the diagnostic techniques used to ascertain the COVID-19 infection, critically reviewing positive points and criticism for forensic implications, obviously including autopsy. Finally, this review proposes a practical workflow to be applied in the management of corpses during this outbreak of the COVID-19 infection, which could be useful in cases of future infectious disease emergencies. Analyzing the diagnostic methods, to date, virus nucleic acid RT-PCR represents the standard method used to ascertain the COVID-19 infection in living subjects and corpses, even if this technique has several criticisms: mainly, the staff should be highly specialized, working in high-throughput settings, able to handle high workloads and aware of health risks and the importance of the results. Thus, IgG/IgM serological tests have been developed, overcoming RT-qPCR duration, costs, and management, not requiring highly trained personnel. Nevertheless, serological tests present problems; the WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. Furthermore, nothing has yet been published regarding the possibility of applying these methods during post-mortem investigations. In light of this scenario, in this review, we suggest a flow chart for the pathologist called on to ascertain the cause of death of a subject with historical and clinical findings of COVID-19 status or without any anamnestic, diagnostic, or exposure information. Indeed, the literature data confirmed the analytical vulnerabilities of the kits used for laboratory diagnosis of COVID-19, particularly during postmortem examinations. For these reasons, autopsy remains the gold standard method to ascertain the exact cause of death (from or with COVID-19 infection, or other causes), to consequently provide real data for statistical evaluations and to take necessary measures to contain the risks of the infection. Moreover, performing autopsies could provide information on the pathogenesis of the COVID-19 infection with obvious therapeutic implications

Physical activity has numerous beneficial effects on metabolic and inflammatory processes

Obesity is a long-term multifactorial chronic disease, characterized by energy imbalance, due to an excess of caloric intake compared to energy expenditure and deregulation of other metabolic parameters, as, altered lipid profile, increased insulin resistance and chronic pro-inflammatory state. A healthy lifestyle, characterized by hypocaloric diet and physical activity, is important to reduce a chronic inflammation, oxidative stress and metabolic disorders typical of obesity. It is well known that the chronic inflammation state and oxidative stress are responsible for the aging and development of many diseases, such as cancer. In the light of these evidences, the aim of this study is to analyse body composition, metabolic profile and oxidative stress levels in obese patients subjected to a physical activity program before and after weight loss. We analysed the glycaemic and lipid profile, body composition such as visceral adipose tissue (VAT), fat mass (FM), and the dROMs serum levels via the Fenton's reaction. We found that in obese patients before physical activity intervention there are higher levels in dROMs serum levels, altered glycaemic and lipid profile and body composition compared to obese patients after physical activity intervention. In conclusion, the physical activity has numerous beneficial effects in obesity, modulating not only metabolic profile but also inflammatory and oxidative stress response

Volatile organic compounds: instrumental and canine detections link an individual to the crime scene

Background: Whenever a crime is committed, forensic personnel are requested to collect every kind of evidence to establish the relationship between the suspects and the crime. When any evidence is accidentally destroyed or not found, there is one type of latent evidence that is always deposited at the crime scene: unique human scent. Recently, the use of trained canines to detect selective human scent at a crime scene has increased. To consolidate this kind of evidence, it is essential to have an exact knowledge and an awareness of the chemical signature of the volatile compounds that could indicate the presence of the alleged offender at the crime scene. This experimental study aims to detect the volatile organic compounds (VOCs) released from subjects who handled scent-articles to imprint their odor on. After handling, each scent-article was wrapped in sterile and VOC-free cotton gauzes for 48 h for secondary transfer. VOCs were detected by headspace/solid-phase microextraction-gas chromatography/mass spectrometry (HS/SPME-GC/MS) and well-trained dogs, at different time points (up to 15 days). Furthermore, the possibility of further DNA detection after contact was also investigated to propose a novel approach able to identify a subject from this latent forensic trace. Results: Data show that inter-individual human scent composition includes different VOCs, but dogs were able to discriminate the individual who touched the object at the crime scene. The dog training procedure showed excellent sensitivity (between 99.48 and 100%) and specificity (between 60 and 100%), having a positive predictive value (PPV) ranging between 97.94 and 100% and a negative predictive value (NPV) ranging between 85.71 and 100%. Preliminary work on DNA analysis released after contact yielded positive results, even if further studies are necessary, expanding the same experimentation to a larger sample with the aim of obtaining a statistically significant result. Conclusion: Data show that human scent is a good source of VOCs and a good target for canine training. The well-trained dog represents a specialized biological device able to discriminate personal human odor from any contaminants in the mixture detected by instrumental analysis. Furthermore, this study proposes the use of human scent as a forensic latent trace for DNA profiling

Anabolic Androgenic Steroids: Searching New Molecular Biomarkers

Even if anabolic androgenic steroid (AAS) abuse is clearly associated with a wide spectrum of collateral effects, adolescents and athletes frequently use a large group of synthetic derivatives of testosterone, both for aesthetic uses and for improving performance. Over the last few years, the development of MicroRNA (miRNA) technologies has become an essential part of research projects and their role as potential molecular biomarkers is being investigated by the scientific community. The circulating miRNAs detection as a diagnostic or prognostic tool for the diagnosis and treatment of several diseases is very useful, because with a minimal quantity of sample (peripheral blood), miRNAs are very sensitive. Even more, miRNAs remain stable both at room temperature and during freeze-thaw cycles. These characteristics highlight the important role of miRNAs in the near future as new tools for anti-doping. The article provides a systematic review and meta-analysis on the role of miRNAs as new potential molecular biomarkers of AAS use/abuse. Particularly, this paper analyzed the “miRNA signature” use as biomarkers for health disorders, focusing on the organ damages which are related to ASS use/abuse. Moreover, this review aims to provide a future prospect for less invasive or non-invasive procedures for the detection of circulating miRNA biomarkers as doping assumption signaling

Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection \u2013 Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice.

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Pediatric and Fetal Autopsies

Pediatric autopsies are the most useful investigations to establish the circumstances and causes of death and to exclude child abuse. Photographic collection of autopsy is strongly recommended in all cases, to document external and internal abnormalities. All evisceration techniques allow an adequate visualization of malformations, but the Letulle method seems to be the most suitable one in pediatric autopsies. The examination of fetal annexes is an essential part of the autopsy in cases of fetal or perinatal death. As a minimum requirement for pediatric autopsies, histological sections that should be taken are \u2013 at least \u2013 one sample of each pulmonary lobe, multiple samples of the heart, skin, subcutaneous tissue, liver, kidney, thymus, brain, and diaphragm. Representative sections of placenta that include both decidual and fetal surfaces, and sections of cord and membrane roll are submitted for histological examination, too

Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance

The medico-legal term “sudden death (SD)” refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes

Health in Prison: Does Penitentiary Medicine in Italy Still Exist?

Despite the detailed legislative developments that have occurred within the context of prison medicine in Italy, problems of a management nature continue to affect prisoner health and management, which in turn impact the prison system’s ability to offer prisoners a real opportunity for rehabilitation. Certain behavioral aspects reported in prisons may alter and negatively impact the normal doctor-patient relationship, including elements that hinder the therapeutic alliance and impede proper clinical risk prevention and management. However, practical steps may be taken in connection with the analysis of flows and healthcare services that may enable prison administrations to bring about a true, modern restructure of the prison system