Mario Gabbrielli

Molecular detection of Leptospira interrogans in human tissues and environmental samples in a lethal case of leptospirosis

A forensic case of suspected Leptospirosis with fatal course was resolved by the molecular detection of Leptospira interrogans in postmortem human tissues and in environmental samples. Polymerase chain reaction analysis and DNA sequencing confirmed the clinical diagnosis of Weil syndrome, and the death was considered to be an occupational accident with all the legal implications.

Death by electrocution: Histological technique for copper detection on the electric mark

The current observation of deaths by electrocution, both for domestic and work-related accidents as well as those in other contexts, has deepened the scope of investigation into electric marks, especially from the histological point of view. This is one of the few investigation tools that may lead to the diagnosis of death by electrocution in this distinct area, bearing in mind the diagnostic difficulties that this type of fatality presents. Our attention has been placed on the phenomenon of metallization. In particular, we focused on using the Timms method [1] to locate the copper deposits. The phenomenon of metallization, usually could be caused by the copper deposit, this happens due to the copper debris released onto the skin by the live conductor. To date, this technique has only been used in the pathological field. Nevertheless, we tried to assess its application in seven selected cases, after partially modifying the technique, comparing it with the most common staining detection techniques and analysing the specificity, sensitivity as well as the potential for its application in the routine.

Case report of a homicide by a shotgun loaded with unusual ammunition

Reported is the case of a man killed by a neighbor with a shotgun loaded with a unusual ammunition. The cartridge contained several shots chained together by metallic wires. Such ammunition has been used for hunting purposes but is now banned, so it can be handmade only. The joined pellets produce a wound with features that are different from those of a wound made by a regular load of pellets. Several interpretive problems are caused by the unknown number of pellets contained in the shell and the effects of the wire holding the shot together.

Report of a fatal case of pulmonary thromboembolism in a long-distance truck driver.

AbstractLong-distance truck drivers have been found to be associated with many medical problems because of their lifestyle and work environment. Many studies have revealed an increased risk in sexually transmitted infections, musculoskeletal disease, sleep disorders, hypertension, gastrointestinal disease, substance abuse and alcoholism, lung cancer, as well as human immunodeficiency virus infection. To our knowledge, there are no any articles about a fatal case of pulmonary thromboembolism. We report a case of a 45-year-old truck driver, who was found dead in his truck at a service station along the A1 motorway in Umbria, Italy. Autopsy findings revealed pulmonary thromboembolism as cause of death. Our report underlies that future actions must be addressed to provide health care access to this vulnerable, medically underserved population.

Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm ones self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.

The Usefulness of Cadaveric Fungi as an Investigation Tool.

To the Editor: In forensic pathology, it is common practice to date the postmortem interval (PMI) only as an approximation. Interval estimation is based on cadaveric phenomena, which are very dynamic and at the same difficult to quantify and reproduce experimentally, that is, cooling, hypostasis, rigor mortis, and postmortem changes. The important role that the chronology after death plays in order to assess the time of death and the continuous lack of objective evidence for this assessment prompted the interest of numerous scholars to study this subject in depth. Nevertheless, one of the possible contributions to establish the PMI might be provided by mycology. Regarding this topic, the article written by Menezes et al, “Cadaveric Fungi: Not Yet an Established Forensic Tool,” deals with the role of forensic mycology that cannot be used as an aid in determining the PMI and making an analysis about the use of microfungi to establish the time of death. The argument suggesting that forensic mycology is not useful as an investigation tool could be premature. The usefulness of fungi as a tool for postmortem investigation is demonstrated by a case report in 1982 published by van de Voorde and van Dijck. These scientists showed the correct approach, with rigorous scientific methods, establishing a time interval during which the death had occurred. They performed the isolation of microfungi, after letting them grow. Subsequently, they compared the stage of development of microfungi (under similar conditions of the crime scene) with the sample, properly frozen, taken during the crime scene inspections from the corpse. Thiswas the first application of forensic mycology to a murder investigation, and thanks to the mold, they established the time in which the death occurred. Conversely, Hitosugi et al have assessed, inaccurately, the PMI based on

Giant Diaphragmatic Lipoma: Two Autopsy Case Reports and Review of the Literature

Lipomas are common benign tumors most frequently found within the subcutaneous areas of the body. Deep‐seated lipomas are rare and tend to be larger than cutaneous ones. Lipomas are rarely seen in the thoracic cavity, and they are usually located in the mediastinum, bronchiole, and lungs. Diaphragmatic lipomas have been occasionally reported in the literature, the first being described by Clark et al. in 1886. The authors report two rare cases of giant diaphragmatic lipoma incidentally found during forensic autopsies. In the first case, a Caucasian 85‐year‐old woman burned to death with another passenger, after her methane‐fueled car collided with another car on a highway near Terni, Umbria, Italy. In the second case, a Caucasian 45‐year‐old man collapsed while walking through the countryside of Perugia. In either case, a large mass in the thorax was observed. The definitive pathologic diagnosis was giant intrathoracic diaphragmatic lipoma without evidence of malignancy. The authors also review the relevant literature and discuss differential diagnoses. These case reports contribute to the establishment of the actual incidence of diaphragmatic lipomas.

Serum tryptase, Immunoglobuline E assay and circumstantial data are fundamental tools for the post-mortem diagnosis of food anaphylaxis: a case report and literature review

Introduction. The most recent literature suggests that postmortem diagnosis of anaphylaxis remains a significant challenge for pathologists. Even with autopsy examination, the diagnosis of anaphylactic shock is difficult due to the complexity of the pathogenetic factors and the lack of pathognomonic data. Case presentation. The authors present a case of death for anaphylactic shock after food ingestion. Laboratory examinations carried out on blood taken from femoral arteries, approximately 5 hours after death, showed a value of 120 ng/ L of tryptase (n.v. <11.4 ng/ L) . Examination aimed at detecting IgE confirmed the existence of milk proteins allergy. Autopsy findings were suggestive of sudden death of cardiovascular origin, characterized by multi-organ congestion, petechiae and tracheal and bronchial foam. Conclusions. The combination of autopsy findings with serum tryptase and immunoglobuline E assay, histological preparations and anamnestic-circumstantial data provided the necessary elements for the postmortem diagnosis of anaphylactic shock caused by milk proteins ingestion.

Access to social security benefits among multiple sclerosis patients in Italy: A cross-sectional study.

BACKGROUND Knowledge concerning the predictors of social security benefits and the proportion of Multiple Sclerosis (MS) patients receiving these benefits is very limited. OBJECTIVE To estimate the likelihood of receiving social security benefits for Italian MS patients. METHODS From September 2014 to November 2015, we interviewed MS outpatients from two Italian MS clinics to collect information regarding their personal data, clinical and working history, and access to social security benefits. We performed both univariate and multivariable analyses to evaluate the predictors for receiving social security benefits. RESULTS We interviewed 297 patients, with a mean age of 49.5 (± 10.7) years; 71.4% were females. About 73% of patients had a relapsing-remitting (RR) course and the median EDSS score was 2.5 (IQR 1.5-6). About 75% of MS patients received a full exemption from co-payments, while the proportions of people who enjoyed each of the other social security benefits were lower, ranging from 8.8% (car adaptation) to 32% (disable badge). At multivariable analysis, the probability of obtaining each of the benefits was significantly associated with the EDSS score: walking aids (OR 3.9), care allowance (OR 3.6), disabled badge (OR 2.4), exemption from co-payment (OR 1.6) and allowed off work permit (OR 1.7). Only the probability of obtaining an allowed off work permit was also influenced by comorbidities (OR 2.9) and a higher education (OR 2.2). CONCLUSION Except for full exemption from co-payments, the proportions of MS patients who enjoyed social security benefits seem to be limited in our study sample. The EDSS score is the strongest predictor of the probability of receiving all the benefits. Only a small proportion of patients received care allowance and working permits, probably because such benefits are only granted to people with a high level of disability. On the other hand, the low proportion of patients who enjoyed fiscal benefits for home and car adaptations could have been influenced by the way such benefits are granted in our country.

La responsabilità dello psichiatra

This paper evaluates forensic duties and liabilities for psychiatrists, based on the current literature and based on our experience over several years of forensic medicine practice, involving both criminal and civil cases. We evaluated different scenarios, including cases of patients dangerous to themselves or others. We highlighted the importance to keep adequate and detailed clinical records, both in the inpatient and outpatient setting, given the absence of other objective items (e.g., laboratory records or other instrumental assessments) that may be of help for the judge and his/her counselors.This paper evaluates forensic duties and liabilities for psychiatrists, based on the current literature and based on our experience over several years of forensic medicine practice, involving both criminal and civil cases. We evaluated different scenarios, including cases of patients dangerous to themselves or others. We highlighted the importance to keep adequate and detailed clinical records, both in the inpatient and outpatient setting, given the absence of other objective items (e.g., laboratory records or other instrumental assessments) that may be of help for the judge and his/her counselors.