Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all inWestern countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error

Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges

Necrotizing fasciitis (NF) is a life-threatening infection of soft tissues spreading along the fasciae to the surrounding musculature, subcutaneous fat and overlying skin areas that can rapidly lead to septic shock and death. Due to the pandemic increase of medical malpractice lawsuits, above all in Western countries, the forensic pathologist is frequently asked to investigate post-mortem cases of NF in order to determine the cause of death and to identify any related negligence and/or medical error. Herein, we review the medical literature dealing with cases of NF in a post-mortem setting, present a case series of seven NF fatalities and discuss the main ante-mortem and post-mortem diagnostic challenges of both clinical and forensic interests. In particular, we address the following issues: (1) origin of soft tissue infections, (2) micro-organisms involved, (3) time of progression of the infection to NF, (4) clinical and histological staging of NF and (5) pros and cons of clinical and laboratory scores, specific forensic issues related to the reconstruction of the ideal medical conduct and the evaluation of the causal value/link of any eventual medical error. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature

Cytoprotective effects of colloidal bismuth subcitrate in patients with ulcer disease

Helicobacter pylori is capable of altering the structure of the mucus gel adhering to the surface of the gastric antral wall. Thirty patients (22 men and 8 women) with endoscopic evidence of active duodenal ulcer and histologically confirmed H pylori antral gastritis participated in this prospective study. The study objective was to evaluate the effects of 6 weeks of treatment with colloidal bismuth subcitrate (two 120-mg tablets twice daily) on peptic secretion and the gastric mucosal barrier. Samples of gastric juice were collected during endoscopy to measure pepsin levels. Also during endoscopy, four biopsies were taken (two antral and two from the body/fundus) for histological examination, H pylori detection, and the quantification of pepsinogen group A (PGA), gastrin, and pepsin in the tissues. All of the above parameters were repeated with endoscopy after 6 weeks of treatment. Ulcer healing was obtained in 26 (87%) of 30 patients after treatment. H pylori infection was cleared in 15 (50%) patients. No significant changes were detected in concentrations of pepsin in the gastric juice or concentrations of PGA, gastrin, or pepsin in the tissues. Mucus depletion was visibly lower after treatment, suggesting that colloidal bismuth subcitrate may alter the bacterial microenvironment, regenerating the quantity of mucus. © 1995

A Holistic Approach for Enhancing the Efficacy of Soil Microbial Inoculants in Agriculture: From Lab to Field Scale

Microbial inoculants can be an efficient tool to manage the soil and plant microbiomes providing direct beneficial effects, and for modulating native soil and plant-associated microbiota. However, the application of soil microbial inoculants as biofertilizers and biopesticides in agriculture is still limited by factors related to their formulation, application method, and the knowledge about the impact and interactions between microbial inoculants and native soil and plant host microbiomes. The review is thus describing and discussing three major aspects related to microbial-based product exploitation, namely: i) the discovery and screening of beneficial microbial strains; ii) the opportunities and challenges associated with strain multifunctional features; iii) the fermentation and formulation strategies also based on the use of wastes as growth substrates and the technical and regulatory challenges faced in their path to field application. All these issues are addressed in activities performed by the EXCALIBUR project (www.excaliburproject.eu), which aims to expand the current concept about microbiomes interactions, acknowledging their interactive network that can impact agricultural practices as well as on all living organisms within an ecosystem