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

Effects of add-on ultramicronized n-palmitol ethanol amide in patients suffering of migraine with aura. a pilot study

Background: Palmitoyl ethanol amide (PEA) is an endogenously produced substance showing anti-nociceptive effect through both receptor and non-receptor mediated effects at the level of different cellular and tissue sites. This study showed the results of a single blind study that was conducted to evaluate both the safety and the efficacy of ultramicronized PEA (umPEA; 1,200 mg/day) for up 90 days in patients suffering of Migraine with Aura (MA) treated with NSAIDs. Methods: A total of 20 patients, 8 male (33-56-years, average 41.4 ± 7.8) and 12 female (19-61-years, average 38.5 ± 11.9) with MA were admitted to our observation and diagnosed according to ICHD-3 criteria, they received umPEA (1,200 mg/day) in combination with NSAIDs for up to 90 days. They were revaluated at 30, 60, and 90 days after treatment. Results: umPEA administration induced a statistically significant and time dependent pain relief. In particular, these effects were evident at 60 days (male P = 0.01189; female P = < 0.01) and they lasted until the end of the study (male P = 0.0066; female P = 0.01473). Conclusion: Although further studies are needed, our findings indicate that in patients suffering of MA treatment with umPEA had good efficacy and safety which candidate this compound as a therapeutic tool in pain migraine management

Crohn's Disease Imaging: A Review

Crohn's disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract, which can involve almost any segment from the mouth to the anus. Typically, Crohn's lesions attain segmental and asynchronous distribution with varying levels of seriousness, although the sites most frequently involved are the terminal ileum and the proximal colon. A single gold standard for the diagnosis of CD is not available and the diagnosis of CD is confirmed by clinical evaluation and a combination of endoscopic, histological, radiological, and/or biochemical investigations. In recent years, many studies have been performed to investigate the diagnostic potential of less invasive and more patient-friendly imaging modalities in the evaluation of Crohn's disease including conventional enteroclysis, ultrasonography, color-power Doppler, contrast-enhanced ultrasonography, multidetector CT enteroclysis, MRI enteroclysis, and 99mTc-HMPAO-labeled leukocyte scintigraphy. The potential diagnostic role of each imaging modality has to be considered in different clinical degrees of the disease, because there is no single imaging technique that allows a correct diagnosis and may be performed with similar results in every institution. The aim of this paper is to point out the advantages and limitations of the various imaging techniques in patients with suspected or proven Crohn's disease

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

Traumatic brain injury: A forensic approach: A literature review

Traumatic brain injury (TBI) is the principal cause of invalidity and death in the population under 45 years of age worldwide. This mini-review aims to systematize the forensic approach in neuropathological studies, highlighting the proper elements to be noted during external, radiological, autoptical, and histological examinations with particular attention paid to immunohistochemistry and molecular biology. In the light of the results of this mini-review, an accurate forensic approach can be considered mandatory in the examination of suspected TBI with medico-legal importance, in order to gather all the possible evidence to corroborate the diagnosis of a lesion that may have caused, or contributed to, death. From this point of view, only the use of an evidence-based protocol can reach a suitable diagnosis, especially in those cases in which there are other neuropathological conditions (ischemia, neurodegeneration, neuro-inflammation, dementia) that may have played a role in death. This is even more relevant when corpses, in an advanced state of decomposition, are studied, where the radiological, macroscopic and histological analyses fail to give meaningful answers. In these cases, immune-histochemical and molecular biology diagnostics are of fundamental importance and a forensic neuropathologist has to know them. Particularly, MiRNAs are promising biomarkers for TBI both for brain damage identification and for medico-legal aspects, even if further investigations are required to validate the first experimental studies. In the same way, the genetic substrate should be examined during any forensic examination, considering its importance in the outcome of TBI

Forensic textile damage analysis: Practical issues and methodological perspectives

Clothing damage analysis is an important tool for forensic investigations and, even it is a niche field, it is gaining interest. Moreover, the attention is shifting from evaluating just the “biological” traces found on the clothes to the modifications that clothes themselves undergo in the context of a specific traumatic dynamic. The Authors analyze a case of the investigation on a hole in the jacket worn by the victim when he was attacked, performed through optical microscope and morphological and elemental SEM/EDX analysis, to determine the origin of this texture damage to verify a witness story

Risk management and recommendations for the prevention of fatal foreign body aspiration: Four cases aged 1.5 to 3 years and mini-review of the literature

(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications

The Italian consensus to virtual colonoscopy

OBJECTIVES: To produce an informed consent for CT colonography (CTC), to be diffused by the Italian Society of Radiology, aimed to make patients and referring physicians aware of CTC examination protocol, advantages and disadvantages, limits and potential related risks. MATERIALS AND METHODS: Delphi method was used to create a consensus among experts on an informed consent for CTC. The overall agreement among different consulted specialists was evaluated and ranked using the Cronbach's correlation coefficient (α) at two time points: after the first and the second 'round' of consultation. RESULTS: The Cronbach index was 0.84 at the end of the first round and 0.93 at the end of the second round. The number of disagreements dropped from an overall of 11-5, from the first to the second round. CONCLUSIONS: The experts were able to produce an informed consent for CTC, hoping that this may be the beginning of a process focused on implementation of quality standards in CTC

Covid-19 pandemic and equal access to vaccines

The COVID-19 pandemic has evidenced the chronic inequality that exists between populations and communities as regards global healthcare. Vaccination, an appropriate tool for the prevention of infection, should be guaranteed by means of proportionate interventions to defeat such inequality in populations and communities affected by a higher risk of infection. Equitable criteria of justice should be identified and applied with respect to access to vaccination and to the order in which it should be administered. This article analyzes, as regards the worldwide distribution of anti-COVID-19 vaccines, the various ways the principle of equity has been construed and applied or even overlooked. The main obstacle to equal access to vaccines is vaccine nationalism. The perception of equity varies with the differing reference values adopted. Adequate response to needs appears to be the principal rule for achieving the criterion of equity in line with distributive justice. Priorities must be set equitably based on rational parameters in accordance with current needs. The entire process must be governed by transparency, from parameter identification to implementation. The issue of equal access to vaccination affects the entire world population, necessitating specific protective interventions. In light of this, the World Health Organization (WHO) has devised the COVAX plan to ensure that even the poorest nations of the world receive the vaccine; certain initiatives are also supported by the European Union (EU). This pandemic has brought to the fore the need to build a culture of equitable relationships both in each country's own domain and with the rest of the world