MORTALITY OF HOSPITALIZED PATIENTS WITH SARS-COV-2 INFECTION IN UNIVERSITY TERTIARY CARE OF ITALY

This study on the mortality trends in hospitalized patients at the University tertiary care Hospital “P. Giaccone” in Palermo (Italy) affected by the SARS-CoV-2 analyses clinical information from necroscopy medical record and death certificates in order to: 1) discern patients who died due to COVID-19 (understood as the immediate cause of death, reported in death certificates, the course of the disease documented within a causal chain (immediate and underlying cause) and patients who died of other diseases with SARS-CoV-2 infection as a comorbidity; 2)evaluate the pre-existing conditions of SARS-CoV-2 positive patients and their influence on the mortality rate with reference to the Charlson Comorbidity Index; 3)compare variables concerning patients who died at the University Hospital of Palermo, with data from the National Institute of Health during the analyzed period, in order to strengthen or refute the hypotheses of other studies or to bring in new findings. The results of this retrospective study confirm, in public health terms, the importance of proper certification of cause of death, complete with indications of comorbidities and complications, as it is of fundamental value from both an epidemiological and medico-legal point of view

VALIDITY AND CREDIBILITY OF A CHILD’S TESTIMONY OF SEXUAL ABUSE: A CASE REPORT

The allegation by a child victim of sexual abuse is, in many cases, the most important evidence of wrongdoing, especially in absence of medical or physical evidence or confes-sions of guilt. The Rorschach inkblot test is a projective personality assessment technique used to evaluate child witnesses. We report a case of three girls allegedly abused by the father, in which the psychometric evaluation with the Rorschach test did not give credibility to the testimony of the chil-dren. When interrogating a minor, it is very difficult to distinguish between a true and a lie. Indeed, many different elements can affect the dialogue, such as the child’s age, the events being discussed, interrogation environment, factors linked to the interviewer, etc. Therefore, it is possible errors of evaluation, misunderstandings or confusion happen fre-quently. The aim of this case report is to highlight that employment of methodologies and criteria recognised by the scientific community could simplify the acquisition and assessment of information from a minor

Child abuse in a medical setting: Case illustrations of two variants of munchausen sindrome by proxy

Munchausen syndrome is a complex type of abuse, which is often underdiagnosed or misdiagnosed in clinical practice, and has harmful consequences for children. Its relationship with child abuse, of which it is a variety, must be recognized in clinical and forensic practice. The authors report herein two observed cases of different types of Münchausen syndrome by proxy (MSbP). The first, is the most severe form of MSbP, with induced, true illness and related pathological symptoms into victim. The second case is a moderate form, much more complex to detect, in which a perpetrator parent simulates and aggravates the childâs illness. Adequate training of health professionals and investigators is essential in revealing cases of MSbP. Diagnosis must be based on the study of the different forms of âabuseâ and the knowledge of clinical protocols used to validate any suspected behaviour which could be potentially harmful to the child. Moreover, a lack of training may lead to misleading interpretations of medical history interpretation and fallacious conclusions. Our study aims to review the features that are to be considered in a suspected case of MSbP, in accordance with a recently updated consensus statement by the Committee on Child Abuse and Neglect from the American Academy of Pediatrics

SUDDEN UNEXPLAINED JUVENILE DEATH AND THE ROLE OF MEDICOLEGAL INVESTIGATION: UPDATE ON MOLECULAR AUTOPSY

In the past few years, contributions of molecular biology assays to the investigation of sudden juvenile death have permitted to clarify some of the pathogenetic aspects of sud-den arrhythmic death, opening the way to preventive action on victims’ relatives. We reviewed literature on the genetics of sudden juvenile death, and on molecular biol-ogy assays performed on autoptic samples. Biological investigation permits the detection of genetic mutations underlying the suscep-tibility to sudden cardiac death of individuals with rare inherited forms of arrhythmia (Long QT Syndrome, Brugada Syndrome, Lev’s disease etc.) through the analysis of criti-cal sequences codifying for ion channel subunits (HERG, KvLQT1, MinK, Mirp1, SCN5A, KCNQ1, KCNH2, KCNE1, KCNE2).The main objective of post-mortem investigation in sudden juvenile death is the detection of treatable monogenic inherited disorders, in order to prevent further deaths among the relatives of the deceased patient

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

ANTITHROMBOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECYSTECTOMY

Pulmonary thromboembolism is a common cause of in-hospital death. In moderate or high risk patients undergoing laparotomy, acute and long-term mortality can be effec-tively reduced with an appropriate prophylactic drug treatment, while in low-risk patients undergoing laparoscopy, the correlation between the thromboembolism risk and the pro-cedure itself, as well as potential benefits of thromboprophylaxis are, at present, unclear. Here we report the case of E., a 49-year-old woman with patent foramen ovale, consid-ered to be at low risk of thromboembolism, who experienced a sudden cardiopulmonary arrest following a laparoscopic cholecystectomy and died four days later. . The purpose of this case report is to highlight the necessity of continuing large sample studies on the correlation between laparoscopic surgery and thromboembolism in low-risk patients