Death by Facial and Skull Injuries of a Motorcyclist Wearing a Full-Face Helmet: Case Report and Literature Review

We describe a case of death by facial and skull fractures with brain injuries of a motorcyclist wearing a full-face helmet. A 40-year-old man driving a high-powered motorcycle crashed violently into the rear of a stopped car. The main results from the autopsy revealed the deformation of the left orbito-zygomatic and fronto-temporoparietal regions corresponding to bone fractures with laceration at the left temporal lobe. The CT scan of the helmet revealed the detachment of the energy-absorbing liner. Moreover an impact speed of 93 Km/h resulted from the analysis of accident dynamics. We analysed the literature regarding the effectiveness of full-face helmets in reducing the risk of fatality and we sought the factors that may have deleted the protection offered. The lesions causing death were due to high speed and probably the inadequacy of the helmet

Peculiar and Unusual Drowning in Waste Oil from Motor Vehicles: Case Report

Drowning is one of the most frequent causes of accidental or suicidal death, and more rarely it is associated with a homicide. Cases of drowning in water or in the sea are common. The authors report an unusual and peculiar case of drowning, that of a woman who accidentally fell inside a collection tank of waste oil of motor vehicles

Immunohistochemical detection of early myocardial infarction: a systematic review

The postmortem diagnosis of early myocardial infarction is a challenge for forensic pathologists because the routine histology is neither specific. Many authors have suggested the use of the immunohistochemistry to fill the gaps in the histological diagnosis of early myocardial infarction. This review aims to analyse advances of immunohistochemical detection of early cardiac damage due to ischaemia. To this purpose, we reviewed experimental studies that investigated immunohistochemical markers and their estimated timing of expression. The review was performed according to specific inclusion and exclusion criteria, and a total of 23 studies assessing the immunohistochemical markers for the diagnosis and timing of early myocardial infarction were identified. The literature review highlights that the analysed markers are complement components, others being inflammatory mediators, cardiac cell proteins, plasma proteins, stress or hypoxia-induced factors and proteins associated with heart failure. All studies demonstrate the effectiveness of the tested markers in the early detection of myocardial infarction in both animal and human samples

Sudden death in water: Diagnostic challenges

The authors report a case of sudden death in a breath-holding diver and highlight the forensic diagnostic difficulties in opining the cause of sudden death in water. The autopsy showed increased thickness of the left ventricular wall with a distinct pattern of concentric hypertrophy, evident particularly in the subaortic interventricular septum. Histological examination revealed diffuse interstitial fibrosis and associated findings of multifocal myocyte disarray especially evident in the subaortic interventricular septum. The analysis and discussion of this case made it possible to attribute sudden death to a lethal arrhythmia following myocyte disarray and hypoxia caused by breath-holding, the triggering factor of apnea. This case demonstrates the importance of a thorough forensic investigation, particularly in histological terms, in subjects found dead in water, in order to ascertain the real cause of death, which may not be always ascribable to drowning

Forensic tools for the diagnosis of electrocution death: Case study and literature review

Diagnosis of death by electrocution may be difficult when electric marking is not visible or unclear. Accordingly, the body of a man who appeared to have died from accidental electrocution was carefully forensically analysed. Macroscopic and microscopic analysis of the current mark was carried out using a variable-pressure scanning electron microscope equipped with energy dispersive X-ray microanalyser to highlight skin metallisation, indicating the presence of iron and zinc. The histological findings of electrocution myocardial damage were supported by the results of biochemical analysis which demonstrated the creatine kinase-MB and cardiac troponin I elevation. The effects of electric current flow were also highlighted by perforations of endothelial surface of a pulmonary artery using scanning electron microscope, and all the results were analysed by the main tools suggested in the literature

An unusual case of sudden cardiac death during sexual intercourse

The most common cause of sudden death during sexual intercourse in adults is heart disease, and it is usually the male, whereas the death of the woman is unusual. Generally, in these cases, death occurs as a result of cardiovascular disease. The authors report an unusual case of the sudden death of a young woman during sexual intercourse. The post-mortem investigations (autopsy, cardiac nuclear magnetic resonance and cardiac histology) demonstrated a previously undiagnosed arrhythmogenic right ventricular cardiomyopathy. The terminal cause of death was a malignant arrhythmia from arrhythmogenic right ventricular cardiomyopathy. This is the first report of a case in which sexual activity can be regarded as the triggering factor combined with cardiac disease to the woman's death

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

In vitro evaluation on HeLa cells of protective mechanisms of probiotic lactobacilli against Candida clinical isolates

Aims: To characterize in vitro the ability of human Lactobacillus strains to inhibit the adhesion, to displace and to compete with clinically isolated Candida strains. Methods and Results: Three types of assays were performed to determine the inhibitory effect of Lactobacillus plantarum 319, Lactobacillus rhamnosus IMC 501, Lactobacillus paracasei IMC 502 and a specific probiotic combination (SYNBIO) on adhesion of Candida pathogens to HeLa cells: blockage by exclusion (lactobacilli and HeLa followed by pathogens), competition (lactobacilli, HeLa and pathogens together) and displacement (pathogens and HeLa followed by the addition of lactobacilli). Bacterial adhesion to HeLa was quantified by microscopy after May-Grunwald/Giemsa stain. The inhibition results highlight a significant (P < 0.05) competition of the considered probiotics against all the Candida strains. The results suggest that the probiotic strains used in this study could prevent colonization of the urogenital tract by relevant pathogens such as Candida strains through barrier and interference mechanisms (mainly displacement and competition), but the degree of inhibition of adhesion was bacterial strain-dependent. Conclusions: The results support the potential of these Lactobacillus probiotic strains as anti-infective agents in the vagina and encourage further studies about their capacity to prevent and manage urogenital tract infections in females. Significance and Impact of the Study: To optimize the defensive properties of the vaginal microbiota, improving the health of many women by probiotic intervention

Super-telomeres in transformed human fibroblasts

Telomere length maintenance is critical for organisms' long-term survival and cancer cell proliferation. Telomeres are kept within species-specific length ranges by the interplay between telomerase activity and telomeric chromatin organization. In this paper, we exploited telomerase immortalized human fibroblasts (cen3tel) that gradually underwent neoplastic transformation during culture propagation to study telomere composition and length regulation during the transformation process. Just after telomerase catalytic subunit (hTERT) expression, cen3tel telomeres shortened despite the presence of telomerase activity. At a later stage and concomitantly with transformation, cells started elongating telomeres, which reached a mean length greater than 100kb in about 900 population doublings. Super-telomeres were stable and compatible with cell growth and tumorigenesis. Telomere extension was associated with increasing levels of telomerase activity that were linked to the deregulation of endogenous telomerase RNA (hTERC) and exogenous telomerase reverse transcriptase (hTERT) expression. Notably, the increase in hTERC levels paralleled the increase in telomerase activity, suggesting that this subunit plays a role in regulating enzyme activity. Telomeres ranging in length between 10 and more than 100kb were maintained in an extendible state although TRF1 and TRF2 binding increased with telomere length. Super-telomeres neither influenced subtelomeric region global methylation nor the expression of the subtelomeric gene FRG1, attesting the lack of a clear-cut relationship between telomere length, subtelomeric DNA methylation and expression in human cells. The cellular levels of the telomeric proteins hTERT, TRF1, TRF2 and Hsp90 rose with transformation and were independent of telomere length, pointing to a role of these proteins in tumorigenesis

La sicurezza del paziente in ambiente ospedaliero e la responsabilità professionale dei vertici strategici

[Patient safety in the hospital setting and the professional responsibilities of top managers] The authors underline the evolution of legislation concerning the creation of Hospital Companies and the reasons for the implementation of clinical risk management activities, then analyse the responsibilities involving the top figures of the top hospital management. In particular, the authors highlight the obligation and responsibilities of the strategic apex of a Hospital Company and show that, sometimes, the technical consultants – who express a medical-legal advice – underestimate the responsibility of these figures. It is a management responsibility that determines the obvious and inevitable consequences on those who work in contact with the patient and who bear the obligations and responsibilities. In some cases, the responsibility of the top figures is indisputable and obvious, but there is no awareness about the possibility of the top management involvement within the assessment evaluation