1,721,020 research outputs found
Expanding frontiers of risk management: care safety in nursing home during COVID-19 pandemic
Full text linkNursing homes provide long-term care and have residential-oriented hospitalizations characterized by medical, nursing, and social-care treatments for a typically geriatric population. In the current emergency phase, the problem of infections in residential structures for the elderly is taking on considerable importance in relation to the significant prevalence rates of COVID-19
A technical report from the Italian SARS-CoV-2 outbreak. Postmortem sampling and autopsy investigation in cases of suspected or probable COVID-19
Full text linkSARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a coronavirus responsible for COVID-19 (coronavirus disease 2019) which resulted in a cluster of cases of pneumonia that originated in China around 31 December 2019 and has subsequently spread across the globe. Currently, COVID-19 represents a health emergency worldwide, leading, in severe cases, to pneumonia, severe acute respiratory syndrome, multiorgan dysfunction or failure, and death. In the context of limited scientific knowledge
and evidence of SARS-CoV-2 infection, guidance is becoming increasingly necessary for pathologists who have to perform postmortem investigations on COVID-19 cases. The aim of the present report is to share a procedure applicable to cases of COVID-19-related death, particularly in cases of death without medical intervention and in the absence of an ascertained SARSCoV-2 infection and/or COVID-19 diagnosis, therefore providing support for diagnostic activity in the present COVID-19 pandemic. For this purpose, a standard operating procedure for correct swab collection, autopsy investigation and tissue sampling is provided
Fatal food-induced anaphylaxis: Determination of tryptase and specific IgE on cadaveric blood samples. What else for a better methodological standard?
Full text linkPost-mortem investigation in cases of fatal anaphylaxis is required to provide clarifications on the presence of macroscopic pathological changes, histological features, and immunohistochemical positivity suggestive of the diagnosis, on biochemical evidence of anaphylaxis and on the presence of serological data indicative of the allergen responsible for the anaphylactic reaction. We describe the case of a 16-year-old boy with a medical history of allergic asthma, celiac disease, and known food-induced allergy for fish, fresh milk, peanuts, hazelnuts, walnuts, apples, kiwis, and peaches. Acute onset of dyspnea followed by cyanosis of the lips and respiratory failure was described immediately after having an ice cream sandwich. Unsuccessful rescues were immediately attempted with oral administration of betamethasone, intramuscular injection of adrenaline, and cardiopulmonary resuscitation. A complete post-mortem examination was performed. Serum dosage of mast cell beta-tryptase from femoral blood detecting serum values of 41.4 mg/l. Determination of specific IgE on cadaveric blood samples confirmed the anamnestic data related to sensitization for several food allergens, including cod parvalbumin, tropomyosin, brazil nut, omega-5-gliadin of foods derived from wheat and gluten. The cause of death was identified in a cardiorespiratory failure due to anaphylactic shock in a poly-allergic subject and anaphylaxis was ascribed to the wheat contained in the ice cream sandwich eaten immediately before the onset of respiratory symptoms. The need is to implement an interdisciplinary approach capable to ascertain the sensitivity and specificity of the diagnostic tests currently in use as well as to evaluate the possibility of introducing new biomarkers in practice
Stem Cell Research and Clinical Translation: A Roadmap about Good Clinical Practice and Patient Care
Full text linkThe latest research achievements in the field of stem cells led in 2016 to the publication of “Guidelines for Stem Cell Research and Clinical Translation” by the International Society for Stem Cell Research (ISSCR). Updating the topics covered in previous publications, the new recommendations offer interesting ethical and scientific insights. Under the common principles of research integrity, protection of patient’s welfare, respect for the research subjects, transparency and social justice, the centrality of good clinical practice, and informed consent in research and translational medicine is supported. The guidelines implement the abovementioned publications, requiring rigor in all areas of research, promoting the validity of the scientific activity results and emphasizing the need for an accurate and efficient public communication. This paper aims to analyze the aforementioned guidelines in order to provide a valid interpretive tool for experts. In particular, a research activity focused on the bioethical, scientific, and social implications of the new recommendations is carried out in order to provide food for thought. Finally, as an emerging issue of potential impact of current guidelines, an overview on implications of compensation for egg donation is offered
Supporting Decision Making in Intensive Care: Ethical Principles for Managing Access to Care During the COVID-19 Pandemic
Full text linkThe pandemic from Covid-19 causes a health threat for many countries and requires an internationally coordinated response due to the high spread of the infection. the current local and international situation gives rise to logistical and ethical considerations regarding the imbalance between needs for assistance and availability of health resources in the continuation of the emergency. a shortage condition will require healthcare professionals to choose between patients who will have access to respiratory support and those who will have to continue without. the sharing of criterie for the introduction of patients to the different therapeutic paths is fundamental to prevent the onset of ethical issues. the present paper analyzes the critical issues related to the scarcity of healthcare resources and the limitation of access to intensive care with the aim of proposing ethically sustainable principles for the management of the current pandemic situatio
A very unusual accidental mechanical asphyxia of choking with a whole solea solea
No full textThe case here reported involves a schizophrenic 19-year-old girl under treatment with clotiapine, which was well tolerated except for a moderate dry mouth. The woman ingested a whole sole (Solea solea), which caused a very rapid death by choking. A complete autopsy was performed 24 h later, as well as histological and toxicological analysis. At autopsy, the sole was wedged in the esophagus causing a choking ab extrinseco. The fish had a length of 18 cm and a maximum width of 6 cm, weighing 188.7 g. Toxicological analysis detected 0.57 mg/L of clotiapine in blood, which falls within the therapeutic range. The peculiarity of this case is represented by two factors: one is the choking by fish and the second was the adverse affect caused by clotiapine, which induced a condition of dry mouth making the act of swallowing even more difficult, thereby contributing to a very rapid mechanical asphyxia and the death of the young woman
La consulenza tecnica d’Ufficio in tema di transessualismo alla luce del D.Lgs n. 150 del 2011: il contributo non sempre richiesto della medicina legale
Full text linkA seguito delle modifiche apportate alla Legge n. 164/1982 dal Decreto Legislativo n. 150/2011, che non prevede più espressamente il richiamo alla possibilità di espletare una consulenza tecnica d’ufficio per lo studio delle condizioni psico-sessuali del soggetto transessuale, parte della dottrina medico-legale ha sollevato obiezioni circa il possibile restringimento delle indagini tecnico-peritali e quindi dell’apporto della disciplina medico-legale e psichiatrico-forense nei casi di rettificazione di attribuzione anagrafica del sesso. Partendo da tale assunto, gli autori hanno affrontato la tematica relativa alla consulenza tecnica di ufficio in tema di transessualismo, analizzando in particolare le professionalità richieste e la metodologia peritale da adottare nell’ambito della c.t.u. Al fine di tutelare maggiormente la salute psico-fisica del soggetto transessuale, è stata sottolineata l’importanza di un approccio multidisciplinare e, quindi, la necessità della nomina di un collegio peritale costituito da: uno specialista in Medicina Legale ed uno in Psichiatria. Al tempo stesso, è emerso come in realtà in alcuni Tribunali Italiani già prima della modifica legislativa fosse consuetudine basare il giudizio anche soltanto sulla documentazione allegata dall’istante e rilasciata dai vari centri autorizzati.Following the amendments made to the Law no. 164/1982, Legislative Decree no. 150/2011,
which no longer expressly provides the possibility of carrying out a technical consultancy for the
study of psycho-sexual conditions of the transsexual subject, part of Legal-Medicine interpretation
has questioned the possible narrowing of technical-expert surveys and therefore the contribution of
Legal Medicine and Mental-Forensic disciplines in cases of rectification of sex registry attribution.
Starting from this assumption, the authors addressed the issue concerning the technical consultancy
on the subject of transsexualism, focusing on the skills required and on the expert's methodology to
be adopted in the c.t.u. field. In order to better protect the mental and physical health of transsexual
subject, the importance of a multidisciplinary approach, and so the need of the appointment of an
expert panel composed by one specialist in Forensic Medicine and one in Psychiatry have been
stressed. At the same time, it emerged that in fact in some Italian Courts, already before the
legislative amendment, was customary to base the judgment even only on the documentation
attached by the applicant and released from various authorized centers
The Importance of the International Community in Protecting the Right to Abortion: The Cases of Malta and of the US Supreme Court
No full textAccording to the World Health Organization (WHO), abortion is often necessary and is not a criminalizable medical act. Unfortunately, despite the global trend in recent years tending towards liberalization of abortion as a fundamental right of women in certain circumstances, it is still not guaranteed in all countries of the world in the same way. Moreover, the abortion debate is often characterized by unscientific opinions based on political and/or religious ideologies. Recently, a European episode has rekindled the debate on abortion: in Malta, a tourist was unable to have an abortion, with consequent risks, even serious ones, on her health. In addition, even in the United States a Supreme Court ruling created a considerable stir: the Roe v. Wade (1973) ruling that had legalized abortion at the federal level was revoked. After the ruling of the Supreme Court, each state of the USA can decide for itself whether and how to legalize abortion. These recent international developments are particularly worrying and make even more evident the need for abortion to be protected at an international level as an inalienable and fundamental human right, and therefore not to be limited
NBOMe: new potent hallucinogens - pharmacology, analytical methods, toxicities, fatalities: a review
Full text link– OBJECTIVE: NBOMe is a class of
emerging new psychoactive substances that
has recently gained prominence in the drug
abuse market. NBOMes are N-2-methoxy-benzyl
substituted 2C class of hallucinogens, currently
being marked online as “research chemicals”
under various names: N-bomb, Smiles, Solaris,
and Cimbi. This article reviews available literature
on the pharmacology; the analytical methods
currently used for the detection and quantification
of NBOMe in biological matrices and
blotters, together with intoxication cases and
NBOMe-related fatalities.
MATERIALS AND METHODS: Relevant scientific
articles were identified from Medline,
Cochrane Central, Scopus, Web of Science, Science
Direct, EMBASE and Google Scholar,
through June 2015 using the following keywords:
“NBOMe”, “Nbomb”, “Smiles”, “intoxication”,
“toxicity” “fatalities”, “death”, “pharmacology”,
“5-HT2A receptor”, “analysis” and “analytical
methods”. The main key word “NBOMe”
was individually searched in association to
each of the others.
RESULTS: The review of the literature allowed
us to identify 43 citations on pharmacology, analytical
methods and NBOMe-related toxicities
and fatalities.
CONCLUSIONS: The high potency of NBOMes
(potent agonists of 5-HT2A receptor) has led to
several severe intoxications, overdose and traumatic
fatalities; thus, their increase raises significant
public health concerns. Moreover, due to
the high potency and ease of synthesis, it is likely
that their recreational use will become more
widespread in the future. The publication of new
data, case reports and evaluation of the NBOMes
metabolites is necessary in order to improve
knowledge and awareness within the forensic
community
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