Quetiapine is an antipsychotic drug introduced in 1997 for treating schizophrenia. Here, we present a case of quetiapine overdose associated with the death of a 50-55-year-old man. At autopsy, multiorgan congestion, and pulmonary and cerebral edema were present. Contraction band necrosis of myocardial cells was observed following histological studies. Blood, urine, bile, and gastric contents were analyzed, and a very high quetiapine concentration was determined in the samples. In addition, an incremental post-mortem ethanol blood concentration was observed. This phenomenon is probably caused by blood glucose fermentation because neither sodium nor potassium fluoride was added to the blood sample. In conclusion, our case demonstrated that high levels of quetiapine detected in postmortem blood specimen might indicate drug overdose to be the cause of death, especially in the presence of non-specific pathological findings. We emphasize the importance of the publication of data in cases of intoxication caused by drugs and the necessary updating of databases in forensic toxicology.
BACKGROUND: Body identification is an important activity in the forensic field both for ethical, juridical and civil reasons. It consists of a comparison between the biological data obtained from the body and the ante-mortem material of one or more unidentified deceased or missing person.METHODS: Radiographic images of the skull of 100 Italians people were analyzed through X-rays scans and a graphic software (Adobe Photoshop 6; Adobe, Mountain View, CA, USA). The images were digitalized and stored as computer files. The subjects were classified into 6 levels with 5 lobes and the data obtained were evaluated with statistical methods: the F-test was performed to verify the equality of the variance; the Pearson correlation coefficient was used for the evaluation of the variables that characterize the frontal sinus models, the Fisher’s Exact test and the χ2 test were used for the comparisons between groups and the t-test for the one between genders.RESULTS: The F-test was applied to verify the distribution of the asymmetry index between the two genders observing that P=0.284; Pearson correlation index showed that the correlations between right border and asymmetry index (inverse) and between right border and left border, between septa and left border, between septa and right border (direct) are significant.CONCLUSIONS: The main finding shown in the study is a statistically significant correlation between right edge and asymmetry index, between right edge and left edge, between septa and left edge and between septa and right edge. We can therefore affirm that the morphology, the presence of septa and the size of the area, are an excellent basis for personal identification, though the asymmetry index of the area of the frontal sinuses (easy to perform in daily practice) is in our opinion the method worthy of further investigation, so as to apply it methodologically homogeneously in forensic practice.
The social health insurance managed by INPS provides workers with compulsory insurance with an economic indemnity in the event of illness resulting in temporary and absolute incapacity for specific work (Article 6 of Law 138/43, Article 2110 of the Civil Code, Article 38 of the Constitution 1st paragraph, Art. 2 Law 33/80). For the first 3 days of illness, there is a deductible, referred to as a deficiency, the economic coverage of which is borne by the employer, according to the specific contractual provisions. The right to sickness allowance, therefore, runs from the 4th day, does not include Sundays and holidays and ceases upon expiry of the prognosis. To obtain the insurance benefit, the worker is obliged to transmit one or more medical certificates containing the diagnosis and clinical prognosis to INPS. The current disease certification analysis model is based on a statistical multivariate analysis technique (data mining), which makes it possible to report the most ‘at-risk’ certificates in terms of the prognosis adequacy, based on a probability indicator. The risk not only refers to cases of so-called suitability (i.e. of workers able to resume work due to termination of the indemnifiable illness) but also for cases of non-existence of illness or reduction of the forensic prognosis following a more favorable clinical course than expected. Data mining allows one to examine all active certificates at the time of analysis and, therefore, not just those recently received. With the help of the SAVIO system (system for the assignment of optimized visits), the combinations between available doctors and proposed visits are optimized, in full automation and maximum timeliness. To carry out the work, a further 286 visits were added to the ordinary budget of home check-ups available ex officio in the period 20/04/2017 - 10/05/2017. Medical checkups were carried out, as usual for office visits, only on non-holiday days. The study design envisaged an increase in the number of visits assigned to agricultural OTDs, compared to the standard required by data mining, equal to 286 additional visits in the reference period. The statistical analysis did not show significant differences between the percentages of eligible and confirmed in 2017 compared to 2016. The results of this study, although highlighting some methodological and analytical limitations, also present encouraging data that justify the launch of a more structured experimentation in the coming years. During the next trials, periodic checks should be provided to evaluate the study’s progress and, upon reaching its limit, stop it in the event of clear uneconomicity. The final assessment should be carried out in the first month of the following year and should include the use of an outcome indicator (output/outcome) that allows to evaluate the overall impact of the proposed operating model on the economic value of production.
Almost every country in the world is either experiencing the COVID-19 pandemic or being plagued by its repercussions. Times of crisis and national emergency situation can cause anxiety and stress in the general population. Such feelings can be aggravated in people suffering from addiction. Surface web and darknet markets, social media and secure encrypted communication applications now appear to play a more prominent role in the sourcing of drugs at a user level. The research community should be aware of the possibility that this virus may affect more severely particular populations, such as people with substance abuse disorders. It is reasonable to assume that lung function impairment can put people with drug addiction at risk of serious health complications. Moreover, the impacts of the current pandemic for people with drug use disorders can be indirect. They include reduced access to health care, putting thousands of lives at risk. Countless clinics providing syringe exchange services or daily addiction medication have closed or reduced their working hours. The absence of medical staff able to administer naloxone (life-saving drug) may increase the likelihood of opioid overdoses, with a potentially fatal outcome. To address this need, addiction treatment has become more flexible. These measures are important to make sure that the addiction treatment is conducted in a completely safe environment.
