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Background. In the evolving field of forensic medicine, artificial intelligence (AI) technologies may revolutionize traditional autopsy practices by enhancing the precision and efficiency of postmortem examinations. Methods. A review of the literature was carried out on the Pub-med and Scopus search engines by inserting the keywords "artificial intelligence" AND "forensic" AND ("autopsy" OR "crime scene management" OR "forensic odontology" OR "post mortem interval" OR "forensic anthropology" OR "forensic sciences"). The works that analyzed the applications of artificial intelligence in the forensic and autopsy field were analyzed. Conclusion. The results showed the application of different forms of artificial intelligence such as machine learning, deep learning, robotics, artificial neural networks. Various applications are therefore possible in the autopsy field including forensic identification, analysis of radiological data through Virtopsy, estimation of the weapon used through analysis of firearm damage with ballistics, estimation of the Post-Mortem Interval (PMI), forensic toxicology. Al's potential to aid in the precise identification of causes of death, estimation of postmortem intervals. With forensic pathologists facing the constant challenge of making accurate diagnoses under pressure, AI applications can offer much-needed support by reducing subjective judgment and the inherent human error due to fatigue. Therefore, the integration of AI into autopsies, while promising in terms of efficiency and accuracy, demands a careful balance between technological advancement and ethical responsibility to ensure trust and integrity in forensic practices. [ABSTRACT FROM AUTHOR]

Background. Sudden infant death syndrome (SIDS) is a tragic and devastating condition whose causes remain largely unknown. Recent studies have shown that the composition of a child's gut flora can play a significant role in the development of SIDS. Methods. This work aims to research those factors that influence the composition of the intestinal flora, the role they have in the development of SIDS and the new strategies for preventing SIDS showing a new interpretation through a detailed review of the literature. The gut in physiological conditions is mainly composed of Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria, but when there is the presence of dysbiotic or different microbial communities, the onset of the disease is more likely as an altered microbial community can lead to an interruption of the gut-brain axis and an increased risk of SIDS. Conclusions. All this implies that the composition of the microbiome can be modified to reduce the risk of sudden death in newborns. The results of the literature provide valuable information on the potential role of the intestinal microbiome in SIDS even if not all mechanisms are yet clear, especially in the mechanisms of death. Therefore, it is necessary in cases of SIDS when carrying out an autopsy to also investigate this area; to this end, we suggest a questionnaire to be administered to family members to understand the eating habits of the newborn and the family and integrate with microbiological investigations to explore every possible hypothesis. [ABSTRACT FROM AUTHOR]

Background. The voluntary interruption of pregnancy (VIP) remains one of the most contentious issues worldwide, subject to different legal frameworks and cultural interpretations. Access to VIP is considered a fundamental right for women, recognized by international organizations such as the World Health Organization (WHO) and supported by the United Nations. It is estimated that 40-50 million abortions are performed each year, of which about 75% are in developing countries. IVG is legal in only 25 countries, while in the others, it is severely restricted or illegal, leading to an increase in risky and illegal practices. Methods. We consulted government and ministerial websites in European countries to gather data on current abortion laws. In addition, scientific articles and legislative documents compare regulations across some countries, especially from 2020 to today, analyzing differences, similarities and implications. Percentage data on the number of abortions in several European countries, including Italy, were analyzed. Conclusion. Our analysis revealed significant differences in abortion laws between European countries. In many countries, abortion is allowed at the request of the woman within a certain gestational age limit, which typically ranges between 10 and 24 weeks. However, in some countries, the restrictions are much stricter, with limitations making access to legal abortion very difficult or impossible. In conclusion, the Italian experience highlights the importance of considering local sociocultural dynamics in shaping IVG policies and highlights the need for an evidence-based approach to guarantee women right to reproductive health internationally, surrounding reproductive rights, gender equality, and public health policy. [ABSTRACT FROM AUTHOR]

Background. Gender gap is a neologism that identifies the disparity between social and professional conditions experienced by females compared to males. The disparity increases as one ascends the academic hierarchy. In recent years, the debate has expanded, and more options have been planned for the elimination of the current gender gap. Methods. This research was conducted by examining the landscape of the gender gap, particularly in the academic forensic medicine field. Our analysis involved reviewing papers published between 2006 and 2024, identified through electronic database searches (PubMed). The search terms used were: "gender gap" AND "academic" AND "medicine" AND "leadership." In total, we analyzed 85 papers. Additionally, we examined data from forensic medicine residency programs. Conclusions. The representation of women in medicine is well-known. Despite the increasing number of women in leadership positions in medicine, they still lag significantly behind men. These data highlight a situation that could be seen as grounds for an accusation of "academic abuse". In the Italian forensic residency programs, less than 20% are led by women, and among these, not all hold the rank of full professor. Although a certain rebalancing is already underway, the gap is still significant. There are already regulations obliging local authorities to promote gender equality in councils, companies, and institutions under their jurisdiction. It would be desirable to consider minimum quotas for female participation in university competitions. This would be a first step toward eliminating the gender gap in academic and forensic medical fields. [ABSTRACT FROM AUTHOR]

Objective. Artificial intelligence (AI) is the ability of a computer machine to display human capabilities such as reasoning, learning, planning, and creativity. Such processing technology receives the data (already prepared or collected), processes them, using models and algorithms, and answers questions about forecasting and decision-making. AI systems are also able to adapt their behavior by analyzing the effects of previous actions and working then autonomously. Artificial intelligence is already present in our lives, even if it often goes unnoticed (shopping networked, home automation, vehicles). Even in the medical field, artificial intelligence can be used to analyze large amounts of medical data and discover matches and patterns to improve diagnosis and prevention. In forensic medicine, the applications of AI are numerous and are becoming more and more valuable. Method. A systematic review was conducted, selecting the articles in one of the most widely used electronic databases (PubMed). The research was conducted using the keywords “AI forensic” and “machine learning forensic”. The research process included about 2000 Articles published from 1990 to the present. Results. We have focused on the most common fields of use and have been then 6 macro-topics were identified and analyzed. Specifically, articles were analyzed concerning the application of AI in forensic pathology (main area), toxicology, radiology, Personal identification, forensic anthropology, and forensic psychiatry. Conclusion. The aim of the study is to evaluate the current applications of AI in forensic medicine for each field of use, trying to grasp future and more usable applications and underline their limitations. [ABSTRACT FROM AUTHOR]

Introduction. Prisoners are at risk of developing vitamin D deficiency due to their lacking exposure to sunlight. So far, there are no published studies evaluating blood levels of vitamin D in relation to the health status of inmates and the quality of the Italian prison system Aim. To investigate vitamin D status and its determinants in a cohort of prisoners. Subject and Methods. One hundred and seventy-two (172) prison inmates (males, n=159, age 47± 11.3 years; females, n=13, age 43.91±12.18 years) of three penitentiaries in the province of Salerno. Vitamin D deficiency, insufficiency and sufficiency were respectively defined as a 25(OH)D level <20 ng/mL; from 20 to 30 ng/mL, >30 ng/mL. Results. In our group, Vitamin D deficiency occurs in 77.32% of the prisoners with 32.55% of the cases having severe insufficiency. Prisoners with higher BMI show lower circulating vitamin D levels (p<0.001). No significant relationship was found with the du-ration of detention (Pearson R: 0.01). Conclusion. In this cohort of inmates the vitamin D status is determined by BMI, but not by the duration of the detention. [ABSTRACT FROM AUTHOR]

Law n. 40/2004 regulated Medically Assisted Procreation (MAP) in Italy. The case described in this article is part of the many judicial cases that have affected this legislation. Following the marital separation process, the former husband withdrew consent to the implantation of already formed embryos in the uterus of his former wife who turned to the judiciary to obtain permission to initiate such a procedure. This paper consists of an analysis of this judicial process and deals with medical-legal and bioethical issues. In contrast to what is stated in Law n. 40/2004, the subsequent Law n. 219/2017 about informed consent, establishes the general principle of the withdrawal of consent until the healthcare procedure is carried out. Another issue concerns the difficult balance between the guarantee of personal freedom and the embryo's life protection, considering that although the embryo is already formed, it is not a person yet. In light of the existence of previous conflicting judicial sentences, the careful and separate assessment of the case under discussion, together with potential future events, is essential to reach a balanced conclusion, that can resolve disputes in the Italian constantly changing society. [ABSTRACT FROM AUTHOR]

Voluntary interruption of pregnancy (VIP) in Italy is regulated by Law no. 194/1978. Its monitoring is carried out by the VIP Epidemiological Surveillance System, which periodically analyses the results of questionnaires compiled by the territorial healthcare structures and sent by each Region. The latest report, covering the years 2019 and 2020, highlights the adequacy of preventive and proactive strategies, an improvement in the quality and effectiveness of the service offered. Furthermore, considering the COVID-19 pandemic, the reorganization of the IVG application guidelines showed a considerable adaptation to the emergency context through measures such as the increase in pharmacological procedures compared to surgical procedures. The interpretation of the data shows that in Italy there is one of the lowest VIP rates in Europe, reflecting the effectiveness of campaigns that promote responsible procreation. Further implementations should be extended to the foreign population, which still shows a mediumhigh VIP rate. The efficiency of the service offered resulted to be high. The latter was assessed considering the waiting period required for the performance of the VIP procedure. Furthermore, the high percentage of conscientious objectors does not harm the healthcare service. The estimates show an adequate territorial coverage by the authorized structures compared to the female population of fertile age. In conclusion, the central action of planning, organization, and monitoring finds a valid ally in the territorial management entrusted to the Regions. The analyzed report reflects even more margins of efficiency and adequacy when considered within the particular historical context of the pandemic by COVID-19. [ABSTRACT FROM AUTHOR]

Objectives. Proximal femur fractures (PFF) usually occur in geriatric patients and lead to high mortality and disability. This study aims to analyze the mortality rate at 30 days in over-65 -years hospitalized patients with proximal femur fractures, comparing the data collected from three public hospitals in Lazio Region, focusing on early surgery outcomes. Materials and Methods. They were gathered data from the Regional Program for the Evaluation of the Outcomes of Health Interventions (P.Re.Val.E.) dated 2019, managed by the Department of Epidemiology of the Regional Health Service of Lazio (DEP), concerning femur fractures' treatment and outcome in elderly patients. Three hospitals were selected (called A, B, or C), belonging to a specific Local Health Authority in Rome, and for each of them were identified some indicators (total number of hospitalizations, origin of the admissions, destination of patients, surgery within 48 hours or two days, 30-day mortality, number of hospitalizations). Results. In Hospital A, the mortality rate at 30 days (305 registered patients) was 2.6%, the lowest among the hospitals considered. In Hospital B, the total mortality at 30 days (254 registered patients) was 7.48%, above the regional average of 5.95%. In Hospital C, the mortality rate at 30 days (71 registered patients) was 4.23%, below the regional average. Conclusions. P.Re.Val.E. represents a fundamental tool to evaluate the work of the Local Health Authorities and the structures that are part of it. In particular, about proximal femoral fractures in over-65-years patients, the results of surgical treatment in 48 hours and the mortality rate at 30 days represent a reproducible index of quality of the healthcare system. However, other variables need to be considered in future studies, taking into account different features of various hospitals, even if they belong to the same Local Health Authority. [ABSTRACT FROM AUTHOR]

In the modern era, when prolonging life is not an option, the end-of-life discussions are unavoidably influenced by Neuroethics. Despite this, it is interestingly evident how the sentiments of a terminal patient of 1885 and a physician of 2020, are still comparable. This paper presents the arguments behind the so-called "Therapeutic Misconception" and the aim of palliative care to provide dying patients support. It is essential to address priorities of informed consent, signed before any remedy is provided. A key component of the newest Neuroscience research is the analysis of motivation and free will. So, it is necessary to comprehend if the patient struggles to feel at peace with these aspects of his "right to die": Is he free to choose or is he influenced by the doctors? Is this confusion an example of "Therapeutic Misconception"? Is his Informed Consent totally "Informed"? In order to broaden our understanding, we account for many critical situations, such as the mentally impaired Psychiatric patients or the famous Italian case of Eluana Englaro. In addition, we suggested some current approaches such as Artificial Intelligence, useful in preserving some cognitive functions the patient may have lost. Furthermore, research in this field is very critical and in some Catholic countries like Italy, people faced difficulties accepting the idea of the "Anticipated directives". In general, whatever the mental status and whatever the terminal state, the patients seem still far from handling their own auto-determination and their Consent, even if the ultimate goal is to die with dignity. [ABSTRACT FROM AUTHOR]

Although asphyxia related-death is a common occurrence in forensic setting, traditional autopsy with neck dissection is not always sufficient to gain information about potential injuries of the deep structures of the neck. In this case a 40 years-old white female was found unresponsive on the floor of her living room, in supine position with a widespread brownish area on her neck. A preliminary PMCT examination showed a fracture line within the hyoid bone. This finding was confirmed by the autopsy, which revealed soft tissue's haemorrhage ofthe sternocleidomastoid and sternohyoid muscles and a fracture of the right horn of the hyoid bone. A 3D reconstruction of the event showed the aggressor standing behind the victim while holding his arm around her neck. Our study demonstrates that, PMCT represent an effective aid to traditional examination techniques in order to visualize fractures. The former always requires to be associated with autoptic examination. [ABSTRACT FROM AUTHOR]

Spinal Epidural Abscess (SEA) is a rare pyogenic infection localized between dura mater and vertebral periostium. The development of SEA is associated with the presence of medical co-morbidities and risk factors that facilitate bacterial dissemination. It is possible distinguish two type of SEA: primary SEA due to pathogen hematogenous dissemination and secondary SEA resulting from direct inoculation of pathogen. This entity, very uncommon, shows a prevalence peak between the 5th and the 7th decade of life with predominance in males. The case is a 44 years old Caucasian man with chronic low back pain, treated with physiotherapy and anti-inflammatory drugs. Following an episode of acute severe exacerbation of pain, the patient underwent four session of dorsal and lumbo-sacral area mesotherapy. One month after the last session, the patient experienced acute sever lumbar pain, radiated to left lower limb and accompanied by fever and vomiting. During hospitalization, elevated levels of white blood cells and C Reactive Protein (CRP) were found. Moreover, a vertebral magnetic resonance imaging revealed the presence of intramedullary lesion. Furthermore, methicillin sensitive staphylococcus aureus was isolated from three blood cultures and antibiotic therapy was performed. In our case the patient had the typical SEA onset, without any specific risk factors excepting the execution of four session of mesotherapy. Aim of this study is to explain risk factors for the SEA development and to clarify how act as preventive measure, because also acupuncture can promote bacterial infection. [ABSTRACT FROM AUTHOR]

Law No 40/2004 regulates in Italy the matter of medically assisted procreation (MAP). Recently, the Tribunal of Capua Vetere expressed its position on the subject of informed consent in a case of MAP. In the specific case, a couple entered the preliminary stages of the PMA procedures, carrying out the fertilization of the ovum and the embryo production. Afterwards, the couple separated and the man denied consent to the continuation of the MAP. The woman, willing to proceed with the implantation, the woman made an urgent judicial appeal, obtaining the judge's permission to transfer the embryo to the uterus. This paper analyses the different bioethical positions on MAP's informed consent. In fact, on the one hand, the paper highlight what is set out in Law 219/2017 which provides for the possibility of the patient to revoke at any time the consent to the treatment given. On the other hand, it should be noted that Law 40/2004, willing to protect the embryo, establishes the irrevocability of the position of parental consent after fertilization. The judgment in question seems to favour this latter position, placing itself in the protection of the cryopreserved embryo and recalling the principle of entrustment following the fertilization of the egg. Nevertheless, the matter is controversial a consistent amount of legal developments are expected to arise in the next future. [ABSTRACT FROM AUTHOR]

Introduction. The AHRQ Quality Indicators (QIs) were created in order to both identify the performance and to track the improvement of patient safety. Patient Safety Indicator 12 (PSI12) is relative to the risk of Post Operatory Pulmonary Embolism or Deep Venous Thrombosis (PO DVT/PE). This pilot study has three main objectives. Firstly, to perform an analysis of the performance of different hospital wards by using administrative data; secondly, to analyze defects in the process that led to the occurrence of the adverse event; thirdly, reviewing the single PO DVT/PE. Methods. Data were extracted from a Hospital Information data flow (SIO) and compared to Clinical Discharge Record. PSI12 estimates were computed before and after the screening. Control Charts allowed the static analysis of performance between different hospital wards in 2014. The Ishikawa diagram was drawn for the analysis of the underlying causal process. Results. The number of PSI12 cases provided by DRGs through SIO data flow decreased from 45 to six after the comparison with the correspondent clinical records. Four clinical records provided full information allowing the analysis of process. The Ishikawa Diagram identified the defects in the process of prophylaxis that resulted into a PO DVT/PE. Discussion. The clinical records screening revealed a lower incidence of PO DVT/PE with respect to the DRGs statistics. Overall the PO DVT/PE occurrence in 2014 fell into the control limits, although the result could be undermined by the low quality of clinical records compilation. The failure in the prophylaxis procedure was imputable to pitfalls in the health care management and to the individual attitude towards patient safety procedures. In conclusion, the reliability and validity of administrative data in monitoring quality and safety are worthy to be explored in the context of further validation studies. [ABSTRACT FROM AUTHOR]

The freedom-restraining measures used during Involuntary Health Treatment (IHT) are highly criticized in the medical community. Physical restraint techniques are currently largely used worldwide in Psychiatry. The use of restraints against the patient's will can be considered a serious intrusion of basic human rights and even an act of violence against the patient. In all cases, the restraint should not lead to injuries or damage to the patient's health and should be implemented with a respect of the human rights and dignity. Generally, the use of restraint should be considered as a last resource, when all the other methods have failed. Since it represents the principal freedomlimitation measure, it should be constantly monitored by physicians who apply these methods. The case of a 58 years-old white male, affected by chronic schizoaffective disorder and cannabinoid dependence, was under involuntary medical treatment as a consequence of antisocial behavior. During the IHT he suffered firstly a pharmacological restraint and then a physical restraint in order to suppress a slight state of agitation. The patient was completely blocked to the bed for more than 80 hours and died after three days of hospitalization. The aim of this study is to evaluate the suitability of restrictive methods for psychiatric patients in order to establish specific rules to prevent abuse of restraint techniques and even to help physicians to treat psychiatric patients. [ABSTRACT FROM AUTHOR]