Since there are no specific manifestations indicating mechanical asphyxia, the medicolegal diagnosis is based on nonspecific signs. Consequently, the diagnosis would be facilitated by the search for specific markers in combination with macroscopic examination. This narrative review was conducted following a rigorous methodology. The selection was made through a systematic search of major academic databases, including PubMed, Scopus, Web of Science, and Google Scholar. The markers examined are ubiquitin, hypoxia-inducible factor (HIF), surfactant protein A, heat shock protein (HSP) 27, HSP 70, aquaporin 5, miRNAs, cytokines, and other proteins. Immunohistochemistry plays an essential role in forensic pathology, aiding the identification and localization of specific biomarkers for diagnosing various causes of death. In particular, with immunohistochemistry, it is possible to detect stress responses in tissues, such as the expression of HSPs, HIFs, and other biomarkers indicative of hypoxic or traumatic events that led to death.

BackgroundThe integration of artificial intelligence (AI) and robotics into disability care presents transformative opportunities while simultaneously raising pressing ethical concerns. Issues related to autonomy, human dignity, and equitable access require careful consideration, particularly as these technologies reshape the dynamics of care delivery and clinical relationships. PurposeDrawing on an interdisciplinary approach that synthesizes insights from bioethical literature, illustrative case studies, and expert perspectives from healthcare, law, and technology, this reflection examines the ethical landscape of AI-supported rehabilitation and assistance. Particular attention is given to risks such as algorithmic bias, over-reliance on automation, and the potential erosion of the human dimension in care. A biopsychosocial model serves as a guiding framework to analyze how technological systems intersect with the lived experiences of individuals with disabilities. Ethical tensions emerge around personalized care, transparency in decision-making, and the inclusivity of data and design processes.ConclusionsThe analysis emphasizes the need for governance models that embed ethical safeguards and promote fairness, while also encouraging participatory design involving patients, caregivers, and healthcare professionals. By situating technological developments within broader socio-political and clinical contexts, this reflection identifies pathways toward a more equitable and human-centered integration of AI. Recommendations include investment in inclusive datasets, the development of fairness-aware algorithms, and the establishment of regulatory mechanisms that align innovation with fundamental rights and principles of social justice in healthcare.

Background: Article 32 of the Italian Constitution guarantees the right to health for all citizens, including detainees. Prison populations face unique health challenges due to high-risk lifestyles, psychosocial stressors, and limited access to care. This study aimed to investigate the burden of chronic diseases and associated risk factors among male inmates in a central Italian prison. Methods: This cross-sectional study was conducted in accordance with STROBE guidelines at Giuseppe Pagliei Prison in Frosinone, Central Italy, from May 2022 to May 2023. A total of 477 adult male inmates underwent systematic clinical evaluations and medical record reviews. Demographic and health data were analyzed to determine the prevalence of chronic conditions and related risk factors. Results: Participants (mean age 47.3 ± 13.1 years; 69.6% Italian, 30.4% international, mainly Eastern European and African) presented on average 1.8 chronic conditions. The most frequent diagnoses were psychiatric disorders (19.9%), cardiovascular diseases (17.2%), and osteoarticular disorders (14.5%). Disease burden correlated with aging, unhealthy lifestyles, and incarceration-related stressors. Tobacco smoking was highly prevalent. Conclusions: Male inmates show a considerable and partly preventable burden of chronic disease. Broader policy measures, including alternative sentencing and community-based rehabilitation, may mitigate the health impact of imprisonment while ensuring public safety. Adequate prison healthcare remains a public health priority and a constitutional and human rights obligation.

BACKGROUND: In Italy, the Local Medical Legal Commission is responsible for evaluating the mental and physical capabilities of drivers whose licenses have been suspended by competent authorities. However, Italy lacks a standard procedure for conducting subsequent investigations after driver license suspensions due to driving under the influence of alcohol (DUIA) or drugsMETHODS: This study focuses on data from the first year of implementing a protocol validated by the Forensic Toxicology Laboratory of the University of Perugia. The study analyzed ethyl glucuronide (EtG) in hair samples for license renewal after DUIA suspension. It involved 664 subjects, with 83.58% males and 16.42% females. Most subjects were between 26-55 years old, with over 65 years being the least represented age group.RESULTS: The mean concentration of EtG was statistically significant different between females (mean value 21.05 pg/mg) and males (mean value 25.01 pg/mg). The highest EtG concentration was detected in subjects between 35-45 years, reaching 121 pg/mg. Many subjects who underwent EtG analysis were moderate drinkers: 554 subjects (81.93%) tested negative with an EtG value below 30 pg/mg, while 120 subjects (18.07%) had an EtG concentration over 30 pg/mg. Additionally, 77 subjects tested positive for drugs, with benzodiazepines being the most frequently detected drugs (41.45%).CONCLUSIONS: This study provides important descriptive information about the characteristics of the examined population and revealed that the regional protocol in use in Umbria is effective and able to distinguish chronic users through the dosage of the EtG in the keratin matrix, in striving for a national protocol in the future.

Nowadays, organ transplantation is considered an established medical practice that, every year, improves the quality of life of thousands of patients. However, the increasing demands for kidney transplantation are in contrast with the global lack of organs. The imbalance between supply and demand for organs has created the basis for a highly profitable black market, placing illicit organ trafficking in the broader context of human trafficking. Currently, thanks to the advancements of the analytical techniques used in laboratories, forensic genetics is able to discriminate the geographical origin of genetically distinct populations. The recent availability of genetic data regarding many populations of the world and the concomitant development of technologies and methodologies that are appropriate for the study of panels of STRs and SNPs are fundamental resources in this direction. This type of analyses, together with the creation of missing person DNA databases, may be used in cases of dubious origin of organs or in transplantation cases in which clear and comprehensive medical records of patients and donors are not available. It can also establish a scientific tool useful to contrast the illegal traffic of human kidneys. In this article, we will discuss biological and ethical aspects of this interesting perspective.

Polydrug use is a serious health and social problem worldwide. Treatment remains a challenge because it requires planning based on estimates of the nature and extent of drug consumption and the characteristics of the population in need. To this end, 103 subjects, who voluntarily asked to begin rehabilitation treatment, were monitored through hair analysis to investigate the nature and extent of their polydrug use. A factor analysis was carried out to delineate polydrug user profiles based on the following variables: age, sex, type of illicit drug use, type of prescription drug misuse, and amount of alcohol consumption. Twenty-three percent of subjects tested positive to more than one illicit drug (mainly cocaine), 44% to unprescribed drugs (mainly benzodiazepines), and 66% were hard drinkers. The profiles of drug users outlined included “single drug cocaine user”, and “single drug opiate user”. Moreover, a particularly problematic profile of cocaine users, common between genders and age groups, who combine high levels of alcohol and unprescribed benzodiazepines and opiates, emerged (“hard polydrug abusers”). From a treatment policy perspective, these findings support the importance of preventive analysis before rehabilitation treatment begins in order to identify different patterns of drug abusers to implement personalized multidisciplinary measures.

AIM:To clarify the role of the ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), in monitoring alcohol consumption. METHOD:We recruited 7 female and 17 male volunteers who were instructed to consume a quantity of beer (containing 48 gm ethanol) with food in one session. We examined urinary excretion of EtG and EtS over time and looked for correlations between the concentrations of the metabolites EtG and EtS. RESULTS:EtG concentrations in urine varied between 0.026 and 430.372 μg/ml with average values between 11.85 μg/ml (SD 19.75), 30 min after alcohol intake, and 100.39 μg/ml (SD 101.34), 4.5 h after alcohol intake. EtS urinary concentration ranged from 0.006 to 101.432 μg/ml with average values between 4.77 μg/ml (SD 5.42), 30 min after alcohol intake, and 30.14 μg/ml (SD 27.20), 4.5 h after alcohol intake. Spearman's test showed that urinary EtG and EtS correlated significantly at several time points. CONCLUSION:The great interindividual variability in their excretion suggests caution in the use of urinary measurement of these metabolites in forensic investigations.

Introduction: Drug checking as a part of drug harm-reduction strategies represents an essential aspect of public health policies. It focuses on rapid identification of drugs that individuals intend to use during night events, in order to implement health-protective behaviors. Chemical drug analysis techniques vary considerably, from simple colorimetric reagents to advanced forensic methods such as gas chromatography/mass spectrometry (GC/MS). Materials and Methods: In 2019, drug-check services were offered at some night events in Umbria (Central Italy). One hundred and twenty attendees directly delivered unidentified substances to a harm-reduction worker, who collected a few milligrams of the substances on ceramic plates and added a drop of colorimetric reagent. Multiple reagents were used to increase the diagnostic capacity of a substance, which may react with a specific drug or a few drugs. Later, a fraction of the samples was analyzed by GC/MS. The concordance of the results obtained using these two methodologies and the intended behaviors of consumers after being informed of the test result was evaluated. Results: We analyzed 120 samples by colorimetric test: 32 MDMA, 25 ketamine, 10 amphetamine, 11 cocaine, 8 heroin, and 4 LSD samples. The results were inconclusive for 29 samples. The GS/MS analysis confirmed MDMA in 84%, ketamine in 78%, amphetamine in 91%, cocaine in 92%, heroin in 88%, and LSD in 100% of the samples. The results of samples with inconclusive results were as follows: 2, MDMA; 7, ketamine; 2, amphetamine; 2, cocaine; 2, heroin; 2, mephedrone; 6, mixes; 1, debris; and 5, adulterants as the main component. Twenty-one of 29 participants reported that they had no intention of consuming the unidentified substance. Discussion: The high percentage of individuals who claimed no intention of consuming the unidentified drugs indicates that drug checking is viable as a part of drug harm-reduction strategies. Overall, colorimetric reagents showed a good performance with regard to samples being unadulterated (LSD) or minimal in quantity, but failed to identify mixtures of substances and the adulterants present in them. Therefore, the use of more discriminatory on-site methods such as Raman or infrared spectrometry is strongly recommended.

Although penalties for violating Italy's laws on driving under the influence of drugs (DUID) are very strict, no national protocol is enforced in order to assess possible offences in traffic accidents and routine traffic patrols.We describe two protocols that were applied to assess 298 cases of potentially impaired drivers out of 1653 stopped in Perugia, a town in Central Italy.One protocol was the D.O.S. carried out by means of oral fluid and urine and blood for confirmatory analysis.The other "SALIVA" uses only oral fluid collected during the road checkpoints.Psychoactive drugs were present in about 30% of the suspected drivers under both protocols, with cannabis being most often detected.The number of drivers who were sanctioned for DUID was significantly higher under the SALIVA protocol.Because non-standardized procedures showed critical issues, it is necessary to harmonize DUID national protocols.Toxicological screening and confirmatory tests, with standard analytic procedures, should be developed.

From 22 March until 18 May 2020, a complete lockdown in Italy was ordered as a countermeasure against the COVID-19 pandemic. Social isolation measures affect some populations more than others, and people with drug and/or alcohol disorders (SUDs) are more likely to be adversely affected. This study presents, for the first time, laboratory data on the use of alcohol and drugs in a high-risk population during Italy's first wave of the COVID-19 pandemic. Thirty subjects with SUDs were monitored for the use of illicit drugs and alcohol every 3 months before, during and after the lockdown, by hair analysis. The number of samples positive for heroin, cocaine, MDMA and cannabis fell considerably during the lockdown and then resumed to pre-lockdown levels when the period of confinement was over. Interestingly, the consumption of benzodiazepines and alcohol followed the opposite trend; both the number of benzodiazepine-positive samples and the level of alcohol consumption increased and remained high, even at the end of the lockdown. The confinement measures produced significant changes in drug/alcohol use patterns, with a shift toward the use of substances that were more easily accessible, used as self-medication for negative feelings, and used to alleviate the effects of abstinence from drugs that were no longer readily available.

Background: Considering the lack of universally accepted visual requirements for driving and for defining various grades of visual disability, the aim of this study is to propose a new method that provides a numerical score resulting from a combined assessment of the visual field and visual acuity loss obtained using a digital technology visor. Methods: This study presents a new system for calculating the percentage of visual disability by combining binocular visual acuity and binocular visual field assessments. A new Global Vision Evaluation System digital technology visor uses standardized, reproducible criteria to produce well-defined, numerically expressed test results. Through a specific algorithm, the device produces a numerical value expressing the percentage of visual disability. Results: Eighty-six subjects with various types of visual impairment underwent visual acuity and visual field test examinations carried out employing both traditional methods and the new digital visor. The two methods provided homogeneously similar results regarding the positioning of the subjects on the visual disability scale. Conclusions: The new digital visor seems to be a valid method to ensure that visual disability assessments are more homogeneous and reliable, and that, consequently, the resources available for this purpose are more fairly distributed.

The COVID-19 (Coronavirus Disease-19) is the most urgent health emergency worldwide and all professionals are called to give support in the diagnosis and treatment of patients affected by this disease. The Scientific Society of Hospital Legal Medicine of the National Health System (COMLAS) and the Italian Society of Anatomical Pathology and Cytology (SIAPEC) produced this document with the intent of offering a technical support to professional involved in the autoptic activities during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic infection.

Brain death is identified with the irreversible cessation of all brain functions. The medical procedures for diagnosis of death are well defined and regulated by Italian laws that give the opportunity to procure organs and tissues1 at the end of observation according to the guidelines of the transplant procurement management.2 Nowadays, there is still a considerable variability in the procurement of organs between different hospitals, which is explained by the different knowledge of the procedure, both technical and non-technical skills, which include the ability of physicians to work together. The simulation technique recreates a scenario that allows successes and mistakes to be experienced, to receive feedback and to gain confidence in a secure environment.3 We used a simulation manikin (SimMan 3G, Laerdal Medical Corporation), a monitor for displaying vital parameters, a screen for displaying instrumental tests (blood gases, electroencephalogram, imaging) and equipment commonly used in practice resuscitation. From the adjacent ‘control room’ where the technical simulation and tutoring took place, it was possible to supervise the simulation scenario, setting the vital parameters and ‘reactions’ of the manikin in relation to stimulation needs through a special simulation software. The simulation scenario reproposed a clinical case (different for each group of residents) of a frequent abutment pathology in clinical practice. An evaluation commission (or …

Since description of autopsy findings and an indication of fatal concentrations related to overdoses from synthetic cathinones are rare, we reviewed the literature using three different search engines including articles from 2010 to 2019. Fifty-two resulted in line with our inclusion criteria providing information about 142 subjects, treated as individual cases. From our analysis most cathinones related deaths derived from polydrug abuse. In very few cases, death could be ascribed exclusively to the use of synthetic cathinones, namely mephedrone (4-MMC), butylone (Bk-MBDB), methylone, alpha-pyrrolidinopentiophenone (alpha-PVP), 3,4-dimethylmethcathinone (3,4-DMMC), 3',4'-Methylenedioxy-alpha-pyrrolidinobutiophenone (MDPBP), alpha-propyloaminopentiophenone (N-PP), 4-methylethcathinone (4-MEC) and 4'-methyl-alpha-pyrrolidinohexiophenone (MPHP), with blood concentrations generally higher than 0.5 mg/l in blood. Toxicological knowledge of these substances remains scarce and any contribution would prove fundamental in reconstructing their toxicity profile.

Prader-Willi syndrome is a rare disease linked to chromosome 15, with morpho-functional features which place patients' lives at risk. We present the case of a 4-year-old boy affected by Prader-Willi syndrome, who died, in apparent good health, as reported by his mother, except for a common cold, diagnosed by a doctor few days before his death. Some months before, he was admitted to hospital with infectious pneumonia which was successfully treated. Forensic pathologist who performed the autopsy attributed the cause of death to respiratory insufficiency caused by acute inflammation on chronically impaired lungs. The reported case serves as a reminder to never underestimate the presence of mild respiratory and infectious symptoms in children affected by Prader-Willi Syndrome.

Introduction In recent years, there has been an increase in the non-medical use of psychoactive prescription drugs including pregabalin (PGB). Studies have shown that multiple drug users and patients in methadone treatment programs administered PGB at high dosages in order to achieve euphoria, reduce withdrawal symptoms, or potentiate the effects of methadone. For these reasons, accurate toxicological monitoring is required for these high-risk individuals. Materials and Methods The present study investigated whether PGB could be detected in the hair samples of 250 patients with a history of opiate dependency, and under toxicological surveillance assess their compliance with methadone maintenance therapy. Results Opiates were found in 54/250 of all hair samples, while cannabis was present in 74/250 patients, cocaine was detected in 21/250 patients, and benzodiazepines without prescription were identified in 49/250 patients. As expected, methadone was present in all 250 patients (100%). PGB without prescription was found in the hair samples of 35/250 patients (14%). Of these, 91.43% were male, 48.57% were <30 y old, and 45.71% were between ages 30 and 50 y. There were no apparent associations among PGB use, daily methadone dosage, and duration of methadone maintenance therapy. Psychiatric comorbidities were present in 25.71% of the patients abusing PGB. Anxiety (55.56%) and depression (33.33%) were the most prevalent psychiatric disorders. Discussion Most of the patients taking PGB (57.14%) used other drugs (especially opiates) concurrently. The utility of hair analysis is explained by easy and rapid sample collection and the ability of the hair to reflect long-term drug use and incorporate drug metabolites. The findings of this study suggested that PGB has significant potential for abuse by high-risk populations such as opioid users and patients with dual diagnosis. These risks are particularly high in cases of poly-drug use and drug intake that are not in compliance with prescription guidelines.

Postmortem diagnosis of anaphylaxis remains a challenge for pathologists due to the complexity of pathogenetic factors and the absence of pathognomonic data. We describe the case of a 57-year-old man where the combination of autopsy findings, immunohistochemical investigation, laboratory examinations with serum tryptase dosage, supported by anamnestic-circumstantial data, provided the necessary elements for postmortem diagnosis of fatal respiratory arrest due to anaphylactic shock caused by a hornet sting. In addition we illustrate the results of a literature review of the last ten years in which cases subjects died from anaphylactic shock caused by an insect sting.

The authors report a case of a man who developed stroke symptoms a few days after a road accident on his motorcycle. Radiographic examinations revealed the presence of bilateral dissection of the extracranial internal carotid arteries with signs of involvement of the brain parenchyma.The location, timing, and presentation lead to the conclusion that the carotid lesions were secondary to the motorcycle collision; in particular, we suppose that it is due to the pressure exerted by the helmet strap worn. Although helmets have undoubtedly prevented serious injuries, this report highlights that the helmets themselves may cause injuries, especially to cervical soft tissues and vessels.