Rossella Snenghi

Shortened telomeres in individuals with abuse in alcohol consumption

Alcohol abuse leads to earlier onset of aging‐related diseases, including cancer at multiple sites. Shorter telomere length (TL) in peripheral blood leucocytes (PBLs), a marker of biological aging, has been associated with alcohol‐related cancer risks. Whether alcohol abusers exhibit accelerated biological aging, as reflected in PBL‐TL, has never been examined. To investigated the effect of alcohol abuse on PBL‐TL and its interaction with alcohol metabolic genotypes, we examined 200 drunk‐driving traffic offenders diagnosed as alcohol abusers as per the Diagnostic and Statistical Manual of Mental Disorders [DSM‐IV‐TR] and enrolled in a probation program, and 257 social drinkers (controls). We assessed alcohol intake using self‐reported drink‐units/day and conventional alcohol abuse biomarkers (serum γ‐glutamyltrasferase [GGT] and mean corpuscular volume of erythrocytes [MCV]). We used multivariable models to compute TL geometric means (GM) adjusted for age, smoking, BMI, diet, job at elevated risk of accident, genotoxic exposures. TL was nearly halved in alcohol abusers compared with controls (GMs 0.42 vs. 0.87 relative T/S ratio; p < 0.0001) and decreased in relation with increasing drink‐units/day (p‐trend = 0.003). Individuals drinking >4 drink‐units/day had substantially shorter TL than those drinking ≤4 drink‐units/day (GMs 0.48 vs. 0.61 T/S, p = 0.002). Carriers of the common ADH1B*1/*1 (rs1229984) genotype were more likely to be abusers (p = 0.008), reported higher drink‐units/day (p = 0.0003), and exhibited shorter TL (p < 0.0001). The rs698 ADH1C and rs671 ALDH2 polymorphisms were not associated with TL. The decrease in PBL‐TL modulated by the alcohol metabolic genotype ADH1B*1/*1 may represent a novel mechanism potentially related to alcohol carcinogenesis in alcohol abusers.

Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe

The preservation of uniqueness and the enhancement of the value of evidence in legal medicine is based on the implementation and development of a “quality management system,” which includes a continuous education of specialists, the introduction and application of guidelines and protocols, as well as mechanisms of internal quality control. This ongoing process shows differences with regard to various fields of knowledge such as forensic genetics, toxicology, forensic pathology or forensic psychiatry, especially if different European countries are compared. To get an overview on the development of legal medicine in different European countries, a questionnaire was developed and sent to representatives of 42 European countries to verify the existence of bio-medicolegal guidelines and protocols. A National Society of Legal Medicine is established in 27 out of 32 countries (84%) which could be included in the final analyses. In 25 countries (78%), a specialisation is necessary as a prerequisite of inclusion in a national register, and 30 of the countries (94%) have guidelines in at least one field of legal medicine. The most common guidelines concern forensic pathology (in the fields of professional qualification and sudden death), forensic toxicology (driving under the influence of drugs and substance testing) and forensic genetics (paternity testing and personal identification). The findings of this study show that comparison is possible and can be a basis for further consensus in the European medicolegal community. The process of harmonisation of the medicolegal autopsy rules in Europe initiated in 1990 was a first step on this way. Further consensus is necessary and might be gained by developing European guidelines for each field within the subdisciplines, based on a standard European Guideline Format.

Fatal asthma; is it still an epidemic?

BackgroundAsthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors.MethodsA web search including key words related to fatal asthma in Italy between 2013 and 2015 has been performed. Concerning the cases that occurred in Veneto, subjects’ clinical records have been evaluated and details about concomitant weather conditions, pollutants and pollen count have been collected.ResultsTwenty-three cases of asthma deaths were found in Italy; 16 of them (69%) occurred in the Veneto Region. A prevalence of male and young age was observed. Most of patients were atopic, died in the night-time hours and during the weekends. The possible risk factors identified were the sensitization to alternaria, previous near fatal asthma attacks and the incorrect treatment of the disease. Weather condition did not appear to be related to the fatal exacerbations, whereas among the pollutants only ozone was detected over the accepted limits. Smoking habits, possible drug abuse and concomitant complementary therapies might be regarded as further risk factors.DiscussionAlthough not free from potential biases, our web search and further investigations highlight an increasing asthma mortality trend, similarly to what other observatories report. The analysis of available clinical data suggests that the lack of treatment more than a severe asthma phenotype characterizes the fatal events.ConclusionsAsthma mortality still represents a critical issue in the management of the disease, particularly in youngsters. Once more the inadequate treatment and the lack of adherence seem to be not only related to the uncontrolled asthma but also to asthma mortality.

Underlying Substance Abuse Problems in Drunk Drivers

Objectives: The aim of this study was to investigate polydrug use in drunk drivers. Methods: The experimental study was conducted on 2,072 drunk drivers undergoing a driving license reissue protocol at the Department of Legal Medicine of Padova University Hospital in the period between January 2011 and December 2012. The study protocol involved anamnesis, clinical examination, toxicological history, and toxicological analyses on multiple biological samples. Results: One thousand eight hundred seventy-seven subjects (90.6%) were assessed as fit to drive, and 195 (9.5%) were declared unfit. Among those unfit, 32 subjects (1.6%) were declared unfit due to recent use of an illicit drug (time span < 6 months), 23 (1.1%) spontaneously interrupted the protocol before its end, and 140 (6.8%) completed the assessment. Ineligibility to drive after completeness of the protocol was established in 1.2% of cases for alcohol disorders and in 5.7% of cases for illicit drug abuse; only one subject was included in both subgroups. Cocaine was the most widely used substance, followed by cannabis, opiates, and psychotropic pharmaceutical drugs. Conclusions: The application of the protocol presented in this study allowed the identification of underlying polydrug use in drunk drivers. The study led to the identification of 6.8% unfit subjects on the basis of alcohol disorders and/or drug abuse, compared to 1.2% of identifiable unfitness if the protocol were limited to the mere assessment of alcohol consumption. The frequent association of alcohol and cocaine is different from other patterns of use in North Europe countries.

Alcohol drinking, mean corpuscular volume of erythrocytes, and alcohol metabolic genotypes in drunk drivers.

Regular and irregular abuse of alcohol are global health priorities associated with diseases at multiple sites, including cancer. Mechanisms of diseases induced by alcohol are closely related to its metabolism. Among conventional markers of alcohol abuse, the mean corpuscular volume (MCV) of erythrocytes is prognostic of alcohol-related cancer and its predictivity increases when combined with functional polymorphisms of alcohol dehydrogenase (ADH1B [rs1229984] and ADH1C [rs698]) and the mitochondrial aldehyde dehydrogenase (ALDH2 [rs671]). Whether these genetic variants can influence abuse in alcohol drinking and MCV has never been examined in drunk-driving traffic offenders. We examined 149 drunk drivers, diagnosed as alcohol abusers according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition Text Revision (DSM-IV-TR) and enrolled in a probation program, and 257 social drinkers (controls), all Caucasian males. Alcohol intake was assessed according to self-reported drink-units/d and MCV unadjusted and adjusted for age, smoking, and body mass index. Multivariable models were used to compute MCV adjusted means. Genotype analyses were performed by PCR on DNA from blood. The adjusted MCV mean was higher in drunk-driving abusers than in controls (92 vs. 91fL; P<.0001) and increased with the number of drink-units/d in both abusers and controls (P-trend=.0316 and .0089) already at intermediate quantities (0-1 vs. 2-4 drink-units/d: P=.054 and .024). Carriers of the common ADH1B*1/*1 (rs1229984) genotype were more likely to be drunk-driving abusers (P=.008), reported higher drink-units/d (P=.0126), and had larger MCV (P=.035). The rs698 ADH1C and rs671 ALDH2 polymorphisms were not associated with MCV. ADH1B*1/*1 polymorphism is significantly associated with being a drunk-driving abuser, higher alcohol drinking, and MCV enlargement. This suggests that drunk drivers with augmented MCV modulated by the alcohol metabolic ADH1B*1/*1 genotype may be at higher risk of driving incapability and of alcohol-related cancer.

Fatality due to fentanyl-cocaine intoxication resulting in a fall

SummaryThis is the first report of fatal intoxication by fentanyl and cocaine outside the USA. The case involved a fall caused by toxic psychosis. The circumstantial, clinical, anatomical, histopathological and toxicological framework is interpreted.ZusammenfassungDieses ist der erste Bericht über eine tödliche Intoxikation durch Fentanyl und Kokain außerhalb der USA. Der Bericht betrifft einen Fall, der durch eine toxische Psychose verursacht wurde. Die Umstände, die klinischen Daten, das anatomisch-pathologische und toxikologische Gesamtmuster werden interpretiert.

Iatrogenic perforation of a pulmonary angiomatoid lesion: histopathological study and review of the literature

Percutaneous tube thoracostomy (PTT) remains the most widely performed procedure to manage blunt or penetrating chest traumas. This life-saving manoeuvre can be frequently associated with complications. We present the case of a 76-year-old man, admitted to a peripheral hospital after a car accident and treated by PTT, who died shortly after the withdrawal of the chest tube. At autopsy, the victim was found to be affected by an extensive haemothorax resulting from the perforation of a subpleural angiomatoid lesion. The histopathological characteristics and the pathogenesis of the iatrogenic injury involving the vascular abnormality, along with its causal role in determining the fatal haemothorax, are critically discussed under both clinical and forensic points of view.

The Dangerous Pattern of Concurrent Use of Alcohol and Cocaine Among Drunk-Drivers of Northeast Italy

Aim To estimate the prevalence of drug and polydrug use among drunk-drivers during the driving license regranting program, in order to assess the inclusion of toxicological tests on hair and urine samples in the systematic methodology in this category of subjects. Short summary A total of 2160 drunk-drivers were tested for alcohol and drugs during driving license regranting. Thirty-one subjects showed alcohol use, 212 illicit drug use and, among these, 131 were polydrug users. Nineteen different patterns of drug and polydrug use were found. Cocaine was detected in 165 subjects. Methods The study was performed on 2160 drunk-drivers examined at Legal Medicine and Toxicology Unit of the University of Padova, in a 3-year-period (2014-2017). The positivity for one or more illicit drugs in hair or urine samples was confirmed by LC/MS and GC/MS methods. Chi-square test, Fischers exact test and Cochran-Armitage Trend test were used to study the correlation between general characteristics of the examined sample and the presence of drug/polydrug use. Results Thirty-one subjects showed alcohol use, 212 illicit drug use and, among these, 131 were polydrug users. Nineteen different patterns of drug and polydrug use were found. Cocaine was detected in 165 subjects in whom 122 showed a concurrent use of alcohol and cocaine, identified through the detection of cocaethylene in hair samples. No significant association and/or trends between drug/polydrug use and the general characteristics of the sample were detected. Conclusions The results show that drug and polydrug use among drunk-drivers should be subjected to toxicological as well as alcohological monitoring, especially in the regranting procedure. The implementation of this procedure could improve the knowledge of dimensions of the issue, providing a powerful means for the reduction of phenomenon of driving under the influence of alcohol and drugs.

921 Falling TVS: is it a resolved problem?

Introduction A growing number of injuries and deaths from televisions falling from furniture are reported in literature although these are completely preventable injuries. Such injuries are ideal for a public education campaign targeting parents, health care workers, and television manufacturers. Methods We report 2 cases of trauma sustained from falling TV arrived to our Emergency Department. Results In these 2 cases there are no adult witnesses to the event, but they were alerted by a loud crashing sound of a falling TV. The death incidents occurred because TVs were on surfaces not suitable for TVs, a bookcase in the first case, and in the second case on a small table. The Glasgow Coma Scale score on admission was 3, in the first case and 8 in the second. The first baby, 2 years old, reported major traumatic brain injuries, and the impact force resulted in severe trauma and death. CT results revealed extended fracture parietal-occipital. In the second case the baby was playing with the TV’s electrical cords and remained blocked under the product resulting in crushing and compressing injuries: the entire dresser and television fell over and the television landed on the boy’s head. Discussion The kind of trauma sustained from a falling TV depends on the length of time the victim has been trapped under the TV, on the impact force, on the point where the victims were hit on the age, and on the weight and size of the TV. Conclusion As the incidents resulted from the instability of the furniture on which the TVs were set and that the same TV’s were not properly anchored and could fall onto the victims, it is to be noted that they can be prevented by simply anchoring TVs and furniture. Televisions should only be placed on furniture designed to hold them, such as stands or media centres or they should be anchored to the wall. Items that might tempt kids to climb should also be removed, such as toys and remote controls, from the top of the TV and furniture.

Erratum to: Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe

G. VielDepartment of Environmental Medicine and Public Health,Institute of Legal Medicine, University-Hospital of Padua,Via Falloppio, 50,35121 Padua, Italye-mail: santodavide.ferrara@unipd.itT. BajanowskiInstitute of Legal Medicine,University-Hospital Essen,Hufelandstrasse 55,45122 Essen, GermanyR. CecchiDepartment of Legal Medicine,University of Rome “La Sapienza”,Viale Regina Elena 336,00161 Rome, ItalyInt J Legal Med (2010) 124:671DOI 10.1007/s00414-010-0481-1