Drowning under drug influence is scarcely reported, especially in relation to lung weight in drug-free or drug-positivity drowning. A novel drowning index is proposed in order to easily compare some factors (drug exposure, fresh/salty water, gender, age, post-mortem interval) acting on drowning deaths. Autopsies and toxicological analyses were performed in 48 drowning cases. Ultra-high-performance liquid chromatography-tandem mass spectrometry for drugs of abuse and headspace-gas chromatography-mass spectrometry GC-MS for volatile substances resulted in positive on 13 cases. The drug-positive group was compared to the drug-free group thanks to a novel drowning index [(lungs plus pleural effusion) / height]. Salty/freshwater, sex, and age influence were studied in the two groups to detect their influence on the novel drowning index. Bromazepam, ethanol, lorazepam, lormetazepam, ethanol plus cocaine were quantified in 13/48 drowning cases. In the univariate analysis, the variables associated with low drowning index were female gender (p = 0.010), freshwater drowned (p = 0.012), and benzodiazepine assumption (p = 0.012). Drowning under ethanol effect compared to drug-free cases did not obtain significant associations. In the multivariate analysis, only the male gender (β = -0.378, p = 0.005) and salty water (β = 0.369, p = 0.006) were independent parameters associated with higher DI (adjusted R2 = 0.241). Comparison between groups of drowning can take advantage of an integrated drowning index that, thanks to its sensibility, can register differences induced by the type of water & intake of exogenous substances & age/sex.

BackgroundThe COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many sexually transmitted infection (STI) clinics to book appointments by telephone. In this work, we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients.MethodsFrom January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage. Symptoms suggestive of STIs were further classified into four syndromic presentations: cutaneous neoformations, genital and oral ulcers, anogenital discharge, and finally other dermatological manifestations. All other clinical pictures were properly managed and eventually referred to other centers and not considered in the analysis. During the following medical examinations, the concordance between presumptive syndromic diagnosis and confirmed clinical diagnosis were recorded. Cohen k test was used to assess concordance.ResultsAccording to the Cohen k test, a good concordance between telephone presumptive diagnoses and medical clinical assessment was found (73.79% with a k = 0.611), whereas only a scarcely acceptable concordance between expected and real waiting time was established (75.51%, k = 0.34).ConclusionsConcordance between nursing syndromic diagnosis and syndromic medically confirmed diagnosis is good from a clinical point of view but there is a limitation when considering a public health perspective. An optimal training of nurses may improve the method of telephone triage. For future ongoing emergencies, the implementation of telemedicine with accurate patient management systems is mandatory.

(1) Background: The current outbreak of COVID-19 infection is an ongoing challenge and a major threat to public health that requires surveillance, prompt diagnosis, as well as research efforts to understand the viral pathogenesis. Despite this, to date, very few studies have been performed concerning autoptic specimens. Therefore, this study aimed: (i) to reiterate the importance of the autoptic examination, the only method able to precisely define the cause of death; (ii) to provide a complete post-mortem histological and immunohistochemical investigation pattern capable of diagnosing death from COVID-19 infection. (2) Methods: In this paper, the lung examination of two subjects who died from COVID-19 are discussed, comparing the obtained data with those of the control, a newborn who died from pneumonia in the same pandemic period. (3) Results: The results of the present study suggest that COVID-19 infection can cause different forms of acute respiratory distress syndrome (ARDS), due to diffuse alveolar damage and diffuse endothelial damage. Nevertheless, different patterns of cellular and cytokine expression are associated with anti-COVID-19 antibody positivity, compared to the control case. Moreover, in both case studies, it is interesting to note that COVID-19, ACE2 and FVIII positivity was detected in the same fields. (4) Conclusions: COVID-19 infection has been initially classified as exclusively interstitial pneumonia with varying degrees of severity. Subsequently, vascular biomarkers showed that it can also be considered a vascular disease. The data on Factor VIII discussed in this paper, although preliminary and limited in number, seem to suggest that the thrombogenicity of Sars-CoV2 infection might be linked to widespread endothelial damage. In this way, it would be very important to investigate the pro-coagulative substrate both in all subjects who died and in COVID-19 survivors. This is because it may be hypothesized that the different patterns with which the pathology is expressed could depend on different individual susceptibility to infection or a different personal genetic-clinical background. In light of these findings, it would be important to perform more post-mortem investigations in order to clarify all aspects of the vascular hypothesis in the COVID-19 infection.

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.

Four pre-exposure prophylaxis (PrEP) users with gastrointestinal disorders (sleeve gastrectomy, terminal ileitis, celiac disease, or chronic diarrhea) and receiving oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) were included. Despite self-reported high adherence, trough plasma tenofovir concentrations (after supervised intake) were significantly lower in these patients than in PrEP recipients without gastrointestinal disorders (21 ± 9.1 versus 138 ± 85 ng/ml). PrEP users with gastrointestinal disorders may need increased TDF doses or alternative prophylactic measures.

Prion diseases are neurodegenerative disorders which are caused by an accumulation of the abnormal, misfolded prion protein known as scrapie prion protein (PrP Sc ). These disorders are unique as they occur as sporadic, genetic and acquired forms. Sporadic Creutzfeldt-Jakob Disease (CJD) is the most common human prion disease, accounting for approximately 85–90% of cases, whereas autosomal dominant genetic forms, due to mutations in the prion protein gene ( PRNP ), account for 10–15% of cases. Genetic forms show a striking variability in their clinical and neuropathological picture and can sometimes mimic other neurodegenerative diseases. We report a novel PRNP mutation (V189I) in four CJD patients from three unrelated pedigrees. In three patients, the clinical features were typical for CJD and the diagnosis was pathologically confirmed, while the fourth patient presented with a complex phenotype including rapidly progressive dementia, behavioral abnormalities, ataxia and extrapyramidal features, and the diagnosis was probable CJD by current criteria, on the basis of PrP Sc detection in CSF by Real Time Quaking-Induced Conversion assay. In all the three patients with autopsy findings, the neuropathological analysis revealed diffuse synaptic type deposition of proteinase K-resistant prion protein (PrP res ), and type 1 PrP res was identified in the brain by western blot analysis. So, the histopathological and biochemical profile associated with the V189I mutation was indistinguishable from the MM1/MV1 subtype of sporadic CJD. Our findings support a pathogenic role for the V189I PRNP variant, confirm the heterogeneity of the clinical phenotypes associated to PRNP mutations and highlight the importance of PrP Sc detection assays as diagnostic tools to unveil prion diseases presenting with atypical phenotypes.