Malpractice claims related to recurrent laryngeal nerve injury: Forensic remarks regarding 15 cases

Abstract Malpractice claims concerning recurrent laryngeal nerve (RLN) injuries are often related to thyroid surgery, but they can also involve surgeons of different specialties. Our survey was made considering expert opinions on claims for medical malpractice evaluated at Brescia Institute of Forensic Medicine in Italy during the period 1992–2012. Fifteen cases concerned RLN injury. Malpractice was identified in 10 cases, according to the following conditions: low pre and intra-operative risk of nerve injury, no documentation showing that the nerve was isolated and preserved despite the existence of potential risk factors. An accurate, well written and complete surgical report is the main tool for the expert examination in malpractice claims

Infected chronic ischemic wound topically treated with a multi-strain probiotic formulation: A novel tailored treatment strategy

Background A wide debate is ongoing regarding the role of cutaneous dysbiosis in the pathogenesis and evolution of difficult-to-treat chronic wounds. Nowadays, probiotic treatment considered as an useful tool to counteract dysbiosis but the evidence in regard to their therapeutic use in the setting of difficult-to-treat cutaneous ulcers is still poor. Aim: clinical report An 83-year-old woman suffering a critical limb ischemia and an infected difficult-to-treat ulcerated cutaneous lesion of the right leg, was complementary treated with local application of a mixture of probiotic bacteria. Methods Microbiological and metabolomic analysis were conducted on wound swabs obtained before and after bacteriotherapy. Results During the treatment course, a progressive healing of the lesion was observed with microbiological resolution of the polymicrobial infection of the wound. Metabolomic analysis showed a significant difference in the local concentration of propionate, 2-hydroxyisovalerate, 2-oxoisocaproate, 2,3-butanediol, putrescine, thymine, and trimethylamine before and after bacteriotherapy. Conclusion The microbiological and metabolomic results seem to confirm the usefulness of complementary probiotic treatment in difficult-to-treat infected wounds. Further investigations are needed to confirm these preliminary findings

Infected chronic ischemic wound topically treated with a multi-strain probiotic formulation: A novel tailored treatment strategy

Background A wide debate is ongoing regarding the role of cutaneous dysbiosis in the pathogenesis and evolution of difficult-to-treat chronic wounds. Nowadays, probiotic treatment considered as an useful tool to counteract dysbiosis but the evidence in regard to their therapeutic use in the setting of difficult-to-treat cutaneous ulcers is still poor. Aim: clinical report An 83-year-old woman suffering a critical limb ischemia and an infected difficult-to-treat ulcerated cutaneous lesion of the right leg, was complementary treated with local application of a mixture of probiotic bacteria. Methods Microbiological and metabolomic analysis were conducted on wound swabs obtained before and after bacteriotherapy. Results During the treatment course, a progressive healing of the lesion was observed with microbiological resolution of the polymicrobial infection of the wound. Metabolomic analysis showed a significant difference in the local concentration of propionate, 2-hydroxyisovalerate, 2-oxoisocaproate, 2,3-butanediol, putrescine, thymine, and trimethylamine before and after bacteriotherapy. Conclusion The microbiological and metabolomic results seem to confirm the usefulness of complementary probiotic treatment in difficult-to-treat infected wounds. Further investigations are needed to confirm these preliminary findings

Targeting microbiome: an alternative strategy for fighting SARS-CoV-2 infection

Respiratory and gastrointestinal symptoms are the predominant clinical manifestations of the coronavirus disease 2019 (COVID-19). Infecting intestinal epithelial cells, the severe acute respiratory syndrome coronavirus-2 may impact on host's microbiota and gut inflammation. It is well established that an imbalanced intestinal microbiome can affect pulmonary function, modulating the host immune response ("gut-lung axis"). While effective vaccines and targeted drugs are being tested, alternative pathophysiology-based options to prevent and treat COVID-19 infection must be considered on top of the limited evidence-based therapy currently available. Addressing intestinal dysbiosis with a probiotic supplement may, therefore, be a sensible option to be evaluated, in addition to current best available medical treatments. Herein, we summed up pathophysiologic assumptions and current evidence regarding bacteriotherapy administration in preventing and treating COVID-19 pneumonia

Oral Bacteriotherapy Reduces the Occurrence of Chronic Fatigue in COVID-19 Patients

Long COVID refers to patients with symptoms as fatigue, “brain fog,” pain, suggesting the chronic involvement of the central nervous system (CNS) in COVID-19. The supplementation with probiotic (OB) would have a positive effect on metabolic homeostasis, negatively impacting the occurrence of symptoms related to the CNS after hospital discharge. On a total of 58 patients hospitalized for COVID-19, 24 (41.4%) received OB during hospitalization (OB+) while 34 (58.6%) taken only the standard treatment (OB–). Serum metabolomic profiling of patients has been performed at both hospital acceptance (T0) and discharge (T1). Six months after discharge, fatigue perceived by participants was assessed by administrating the Fatigue Assessment Scale. 70.7%of participants reported fatigue while 29.3%were negative for such condition. The OB+ group showed a significantly lower proportion of subjects reporting fatigue than the OB– one (p < 0.01). Furthermore, OB+ subjects were characterized by significantly increased concentrations of serum Arginine, Asparagine, Lactate opposite to lower levels of 3-Hydroxyisobutirate than those not treated with probiotics. Our results strongly suggest that in COVID-19, the administration of probiotics during hospitalization may prevent the development of chronic fatigue by impacting key metabolites involved in the utilization of glucose as well as in energy pathways

Sudden death due to a hypopharyngeal mass during sleep: a case report

It is not frequent to find during the autopsy a lymphoid hyperplasia located in the hypopharynx. The literature reports numerous cases characterized by the presence of a mass, non-malignant too, in this particular anatomical district; in these cases the neoformation plays an important role in explaining the cause of death through different asphyxial mechanisms. We present a case of a 44-year-old man, in apparent good health, who suddenly died during sleep. The autopsy revealed an hypopharyngeal lymphoid hyperplasia that can provide the asphyxial mechanisms as cause of death. Furthermore, the anatomical finding could be integrated by a circumstantial piece of evidence: the death occurring during sleep. Some studies, in fact, have highlighted the physio-pathological mechanisms to explain sleep-disordered breathing, particularly the muscular and neural changes involving the pharynx. The asphyxial mechanism was also studied by an immunoistochemical analysis with the anti-Human Surfactant Apoprotein-A (SP-A) antibody

La perte de chances dans le droit de la responsabilité médicale à travers un significatif arrêt de la Court de Cassation Italienne (Cass. Civ. Sez. III, 18/09/2008, n. 23846, Pres. Varrone)

Nous commentons un arrêt de la Cour de Cassation italienne concernant la perte de chance. Cet arrêt a reformé le jugement du tribunal et a affirmé des principes originaux, Nous pensons que cette decision peut interesser tous ceux qui s'occupent du dommage corporel, ainsi que les medecins legistes des pays francophones. La jurisprudence italienne qui concerne la perte de chance est relativement recente (Cass. civ.), sez. III, 4 mars 2004, n° 4400). De plus, au point de vue europeen, certaines questions juridiques relatives aux droits de l'homme en matière de santé et de bien-être peuvent concerner la résponsabilité médicale. In this article we discuss a decree of the Italian Court of Appeal concerning the loss of chance. This decree has reformed the judgement of the court and has affirmed original principles. We think that this decision may interest all those who are occupied with corporal damage, as well as legal doctors in French-speaking countries. The Italian jurisprudence concerning the loss of chance is relatively recent (Cass., 4 March 2004, n° 4400). Furthermore, in the European perspective, certain juridical questions about human rights as regards health and well-being may concern the medical responsibility