Ernesto d’Aloja

Supine Hypotensive Syndrome as the Probable Cause of Both Maternal and Fetal Death

Abstract:  Supine hypotensive syndrome is characterized by severe supine hypotension in late pregnancy, whose clinical presentation ranges from minimal cardiovascular alterations to severe shock, resulting from inferior vena cava compression by gravid uterus. We report a case of a 41‐year‐old 39‐week‐pregnant woman found dead supine. Autopsy revealed the following: cyanosis of the limbs; congestion of the jugular and subclavian veins; abundant abdominal subcutaneous fatty tissue; uterus displacing intestine and diaphragm; collapsed inferior vena cava; both femoral veins dilated and filled with blood; edematous and congested lungs; and placenta 790 g, fetus 3475 g, amniotic fluid 800 cm3. The diagnosis of supine hypotensive syndrome as the probable cause of death is supported by the position of the body and autopsy findings. This syndrome can be considered as the first stage of the physio‐pathological mechanism that led to death in the case presented herein and should be considered by pathologists as a cause of sudden death.

Can Urine Metabolomics Be Helpful in Differentiating Neuropathic and Nociceptive Pain? A Proof-of-Concept Study

The diagnosis of pain nature is a troublesome task and a wrong attribution often leads to an increase of costs and to avoidable pharmaceutical adverse reactions. An objective and specific approach to achieve this diagnosis is highly desirable. The aim of this work was to investigate urine samples collected from patients suffering from pain of different nature by a metabolomics approach based on 1H NMR spectroscopy and multivariate statistical analysis. We performed a prospective study on 74 subjects: 37 suffering from pain (12 with nociceptive and 25 with neuropathic pain), and 37 controls not suffering from any kind of chronic pain. The application of discriminant analysis on the urine spectral profiles allowed us to classify these two types of pain with high sensibility and specificity. Although the classification relies on the global urine metabolic profile, the individual contribution in discriminating neuropathic pain patients of metabolites such as choline and phosphocholine, taurine and alanine, suggests potential lesions to the nervous system. To the best of our knowledge, this is the first time that a urine metabolomics profile is used to classify these two kinds of pain. This methodology, although based on a limited sample, may constitute the basis for a new helpful tool in the clinical diagnosis.

Post-Mortem Corneal Thickness Measurements with a Portable Optical Coherence Tomography System: a Reliability Study.

The purpose of this study was to determine the repeatability and reproducibility of post-mortem central corneal thickness (CCT) measurements by using a real-time, portable optical coherence tomography (OCT) system on an animal model, and to prospectively evaluate the time-course of post-mortem changes in CCT. Forty-six ocular globes of sheep (Ovis aries) were analyzed with a portable spectral-domain OCT device by two operators at different postmortem intervals (PMIs) as follows: immediately (i.e. within 10 minutes), at the 30th minute, at the 1st, 6th, 12th, 24th and 48th hour, and later (up to the 96th hour). The coefficient of repeatability ranged from 0.3% to 3.5%, and coefficients of reproducibility ranged from 0.2% to 3.7% in the central region of the cornea. The intraclass correlation coefficients were particularly high at different PMIs, thus confirming good measurement reliability with the portable OCT. The average CCT decreased immediately and then increased thereafter, with two peaks at 6 and 24 hours after death. Our results suggest that portable OCT is a reliable tool for monitoring CCT variations after death and may be useful in characterizing corneas before explantation, detecting quantitative variations during post-mortem corneal degeneration or assessing changes in CCT for forensic implications.

The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy

Introduction/Objective: The aim was to measure the lifetime prevalence of panic disorder (PD) in an Italian community sample, and to estimate the burden attributable to PD in compromising the quality of life (QoL) of people diagnosed with it. Methods: Community survey was conducted on a sample of 4,999 randomly selected adult subjects. Instruments used were semi-structured clinical interview Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians and allowing diagnosis according to Diagnostic and Statistical Manual of Mental Disorder (4th ed.; DSM-IV); Short Form Health Survey (SF-12). Results: The lifetime prevalence of PD was 3.6% (4.4% in females, 2.5% in males; p = .002). People with PD had a lower SF-12 score than the standardized community sample (35.5 ± 6.5 vs. 38.4 ± 5.9; p < .0001) with a mean difference (attributable burden) of 2.9 ± 0.7, that is, lower than PD with agoraphobia (AP; 4.2 ± 2.4). Wilson Disease (WD), Multiple Sclerosis, Major Depressive Disorder and Eating Disorders (ED) show a higher attributable burden in impaired QoL than PD, while the attributable burden of PD with AP is not lower than in ED and WD. Conclusions: The burden attributable to the impairment of QoL following a lifetime diagnosis of PD was found to be not so great compared to the impairment caused by Major Depressive Disorder (MDD) or neurological conditions. The comorbidity of PD with AP worsens QoL significantly.

A Case of Suicidal Suffocation Simulating Homicide

Abstract:  This case concerns an unusual suicidal plastic bag suffocation. An elderly white man was found dead and partially disrobed in his apartment lying supine on a sofa with a plastic bag closed by a rope over the head and the upper and lower extremities tightly tied with two other ropes, the end of both arranged into slipknots (self‐rescue mechanism). Police investigations found no pornography in the apartment, and circumstantial data alleged no psychiatric disorders or suicidal intentions. The autopsy excluded signs of struggle and sexual intercourse as well as any type of injury or physical illness. Chemical analyses on the peripheral blood excluded acute drugs and/or alcohol intoxication. A differential diagnosis of the manner of death was performed, including scenarios of accidental autoerotic asphyxiation, homicide during either sexual activity or ritualistic, elderly suicide. The collected data most strongly supported the hypothesis of a suicidal asphyxiation simulating homicide to devolve a life insurance to the victim’s sons because of economic difficulties.

Subarachnoid hemorrhage during sexual activity after sildenafil intake: an accidental association?

We report and describe an autopsy case of a man dead for rupture of cerebral artery aneurysm with subsequent subarachnoid hemorrhage after sexual intercourse. Toxicologic analysis demonstrated that he had consumed sildenafil (Viagra). Although subarachnoid hemorrhage has been reported to be associated with sexual intercourse, it is not among the known adverse effects of sildenafil. However, sildenafil has been found to interact with vascular physiology via multiple mechanisms and in most of the vascular districts of the human body. This case provides an example of a very rare association between this drug and a fatal pathologic event and deserves to be added to the existing clinical knowledge about sildenafil and the pathophysiology of the events involved. This knowledge may be helpful in orienting further investigation into the mechanisms of action of sildenafil and their clinical implications.

Working and Environmental Factors on Job Burnout: A Cross-sectional Study Among Nurses

Background: Burnout is a problem that impacts on the staff management costs and on the patient care quality. Objective: This work aimed to investigate some psychosocial factors related to burnout. Specifically, we explored the sample characteristics for moderate/high emotional exhaustion, cynicism and professional inefficacy, as well as the relationship between both working and environmental variables and burnout. Method: A cross-sectional study involving 307 nurses from one Italian hospital was carried out. A self-reported questionnaire was used to collect data. Data analysis was performed by using SPSS 19.0. Results: The results showed that there was a significant difference between nurses with low and moderate/high burnout in all the three components in almost all the examined organizational variables. In addition, we found that the aspects of working life had a significant impact on the three dimensions of burnout. Conclusions: The findings of this study not only can provide useful basis for future research in the field, but also can offer practical suggestions for improving nursing practice and promote effective workplace, thus reducing the risk burnout among nurses.

Is the quickness of resuscitation after hypoxia influenced by the oxygen concentration? Metabolomics in piglets resuscitated with different oxygen concentrations

Perinatal asphyxia is one of the leading causes of morbidity and mortality in the neonatal period. There is an on-going debate in the literature concerning the correct oxygen concentration to be used during neonatal resuscitation. Aim of this study was to investigate whether different metabolic profiles occurred according to oxygen concentration administered and quickness of resuscitation. We tested the hypothesis that the metabolic profile may be affected by the response to the different oxygen concentration and influenced the different time of recovery. Forty male Landrace/Large newborn piglets were the subjects of the present study. As a consequence of the different time of resuscitation, a metabolomics analysis between the two classes of reoxygenated piglets with the slowest and fastest recovery was carried out: first group (4 piglets) RT 68 minutes. In addition, 1 H-NMR metabolomics study was performed showing different metabolic profiles between the two groups. The most significant metabolites were: N-phenylacetylglycine, acetoacetate, methanol, glucose, sarcosine, succinate, dimethylamine and alanine. Our results seem to indicate that the rapidity of resuscitation is influenced by the oxygen concentration. Proceedings of the 9 th International Workshop on Neonatology · Cagliari (Italy) · October 23 rd -26 th , 2013 · Learned lessons, changing practice and cutting-edge research

Neither Freedom nor Autonomy Without Beneficence

Tarbell, and Hylek. Administrative, technical, and material support: Tarbell, Henault, and Hylek. Study supervision: Tarbell and Hylek. Financial Disclosure: None reported. Funding/Support: This work was supported by a grant from the American Medical Association Women Physicians’ Congress Joan F. Giambalvo Memorial Scholarship Fund. Role of the Sponsor: The funding source played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Additional Contributions: Rebecca Starr and Brenda Vega contributed in data collection.

Morphological analysis of corneal findings modifications after death: A preliminary OCT study on an animal model

&NA; The aim of this work was to describe, for the first time, the morphological modifications, in a three‐dimensional mode, of the central cornea at different intervals since death. The study design involved the analysis of 30 eyes (15 heads) of female, adult sheep (>2 years) sacrificed at a local slaughterhouse. The eyes, after animal decapitation, were examined in situ, without enucleation. Ocular globes were stored at well‐known temperature (within a range of 12–22 °C) and humidity (within a range of 50–60%). The instrumental analysis was executed using a portable spectral‐domain OCT (SD‐OCT) system (iVue SD‐OCT, Optovue Inc, Fremont, CA) calibrated to the corneal mode. OCT imaging was performed at different time‐points since death. Pachymetric map, morphological and ultrastructural analysis (epithelium, stroma, and endothelium), were performed for each time‐point. After an initial thinning of tissues and an enhancement of epithelial reflectivity, stromal thickness increased from the 2nd up to the 6th hour. Subsequently, a new trend incorneal thinning was observed in association with the appearance ofone or more demarcation lines between the anterior andposterior stroma. After the 12th hour, a recurrence of corneal swelling was detected in association with thedelamination of stromal tissue. Since the 24th hour, the epithelium disappeared in 50% of cases and the anterior chamberdepth progressively decreased. At the 48th hour, various ocular structures showed the onset of putrefaction processes, such as theappearance of hyper‐reflective dots in anterior chamber, iridocorneal contact, and the massive vacuolization of theposterior stroma until the total delamination. The portable OCT system is a useful approach for in situ postmortem corneal examination, and it may be potentially applied for the selection of donor cornea in transplantology and for the determination of post‐mortem intervals in forensic medicine.