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

Retrospective study on the comparison of out-of-hospital and in-hospital sudden cardiovascular death: An italian experience

A retrospective study of forensic autopsies was carried out in the time interval January 2007 to December 2012 at the Forensic Pathology Service, Catania, south Italy, with a reference population of 3 000 000 inhabitants. During the study period, 1346 forensic autopsies were performed, including 223 (16.57%) sudden/unexpected deaths. Among the latter, 116 fulfilled the criteria of out-of-hospital (Group A) and 107 were in-hospital (Group B) sudden/unexpected deaths with suspected medical malpractice and/or a professional liability claim. In Group A, coronary artery disease was the most common cause of death (N=67; 57.65 %), followed by cardiomyopathies (N=19, 16.38%) and myocarditis (N= 6; 17%). In Group B, coronary artery disease (N=32, 29.91%), post-procedural or post-surgical complications (N=30, 28.04%), pulmonary thromboembolism (N= 17; 15.89%) and aortic dissection (N=7, 6.54%) were the main causes of death

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

An unusual fatal case of overdose of Vinblastine and review of literature

The pharmacological treatment of neoplasia is based on the use of chemotherapeutic substances. Chemotherapeutic agents can cause acute and chronic toxicity even at therapeutic doses. For this reason their overdose puts a patientâs life at severe risk. This work presents an unusual fatal case of overdose subsequent to an accidental massive administration of Vinblastine (90 mg instead of 9 mg), slow bolus (five minutes), to a 33-year-old woman who suffered from Hodgkinâs Lymphoma. The administration of the massive dose was due to a transcription error of the therapeutic treatment plan and miscommunication between the health professionals which caused the use of the wrong dose. The forensic investigation showed the systemic macroscopic and histological changes due to the toxic effect of Vinblastine on the body, by offering a realistic example of the microscopic tissue changes caused by the antineoplastic agent to different organs. Such evidence shows the importance of being very accurate when writing the therapeutic treatment plans and of counting on adequately-trained health care staff

THE ROLE OF DEXTROMETHORPHAN IN EIGHT FATAL OVERDOSES: IS IT SOLELY A CUTTING SUBSTANCE FOR HEROIN OR COULD IT BE SOMETHING MORE?

The Authors evaluate the role of dextromethorphan as heroin adulterant. From December 2010 through April 2013, in our Laboratory of Forensic Toxicology of University of Catania, eight fatal overdose of heroin cut with dextromethorphan were observed. Our first case (December 2010) was the earliest report in Italy. For these reasons we focused our interest on this cutting substance, studying its pharmacological interaction with the depressive morphine action on central nervous system

Molecular Characterization of Acinetobacter Isolates Collected in Intensive Care Units of Six Hospitals in Florence, Italy, during a 3-Year Surveillance Program: a Population Structure Analysis▿

The strain diversity and the population structure of nosocomial Acinetobacter isolated from patients admitted to different hospitals in Florence, Italy, during a 3-year surveillance program, were investigated by amplified fragment length polymorphism (AFLP). The majority of isolates (84.5%) were identified as A. baumannii, confirming this species as the most common hospital Acinetobacter. Three very distinct A. baumannii clonal groups (A1, A2, and A3) were defined. The A1 isolates appeared to be genetically related to the well-characterized European EU II clone. A2 was responsible for three outbreaks which occurred in two intensive care units. Space/time population dynamic analysis showed that A1 and A2 were successful nosocomial clones. Most of the A. baumannnii isolates were imipenem resistant. The genetic determinants of carbapenem resistance were investigated by multiplex PCR, showing that resistance, independently of hospital origin, period of isolation, or clonal group, was associated with the presence of a bla OXA-58-like gene and with ISAba2 and ISAba3 elements flanking this gene. bla OXA-58 appeared to be horizontally transferred. This study showed that the high discriminatory power of AFLP is useful for identification and typing of nosocomial Acinetobacter isolates. Moreover the use of AFLP in a real-time surveillance program allowed us the recognition of clinically relevant and widespread clones and their monitoring in hospital settings. The correlation between clone diffusion, imipenem resistance, and the presence of the blaOXA-58-like gene is discussed

The professional training oe residents in legal medicine in clinical risk management state of the art and proposals for the new ministerail training plan

The clinical risk management as a tool to improve the quality and appropriateness of health services, in recent years has proved to conquer a central position in the politics of Clinical Governance. The main reason behind this rise is the need to contain the increasing litigation in the Jield of medical liability through instruments able to assess the risk profile oj health services and in the meantime to get toolsJor prevention / correction of critical issues. Another reason is the introduction of high insurance deductibles (sometimesgreater than One million euros) and the retirement oj many insurance companies in the market of medical malpractice that hasforced many hospitals (somewhere even entire Regions) lo activate schemes for self-management of claims. In this context an essential role is played by the legal medical examiner oj the hospital; therefore, it is mandatory to guarantee the acquisition of theoretical and practical principlesjrom the beginning of the professional training in legal medicine. This should led up to a highest co-operation among the professionals involved in the clinical risk management and, consequently, to an improvement of the effectiveness and efficiency of the whole health system. 1 his paper shows the state of the art of the Italian professional training in legal medicine with regard to the Jield of clinical risk management through the analysis of the main existing rules and a survey distributed to 29 Italian Schools of Specialization of Legal Medicine. Our results have demonstrated a lack of attention of ministerial training plans to the issue of clinical risk management, especially in terms oj practical activities; we have also noticed a heterogeneous pattern in the survey. According to these results, the A uthors suggest to insert specific formative objectives in the ministerial training plans that should be rewritten in order to conform them to the reduction from S to 4 training years in many medical specialties provided by the laws n. 128/2013 andn. 114/2014