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Highlights • SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and multiple organ failure until death. • Myocarditis, acute myocardial infarction, arrhythmias thromboembolism, and disseminated intravascular coagulation (DIC) are the main complications in patients with cardiovascular comorbidities. • SARSCoV-2 can worsen the clinical status of patients with comorbidities especially pre-existing cardiovascular diseases and this may interfere with therapies., A novel coronavirus SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) with cardiovascular and multiple organ failure till death. The main mechanisms of virus internalization and interaction with the host are down-regulation or upregulation of the ACE2 receptor, the surface glycoprotein competition mechanism for the binding of porphyrin to iron in heme formation as well as interference with the immune system. The interference on renin–angiotensin–aldosterone system (RAAS) activation, heme formation, and the immune response is responsible for infection diffusion, endothelial dysfunction, vasoconstriction, oxidative damage and releasing of inflammatory mediators. The main pathological findings are bilateral interstitial pneumonia with diffuse alveolar damage (DAD). Because ACE receptor is also present in the endothelium of other districts as well as in different cell types, and as porphyrins are transporters in the blood and other biological liquids of iron forming heme, which is important in the assembly of the hemoglobin, myoglobin and the cytochromes, multiorgan damage occurs both primitive and secondary to lung damage. More relevantly, myocarditis, acute myocardial infarction, thromboembolism, and disseminated intravasal coagulation (DIC) are described as complications in patients with poor outcome. Here, we investigated the role of SARSCoV-2 on the cardiovascular system and in patients with cardiovascular comorbidities, and possible drug interference on the heart.

Objectives: To evaluate autoptic histopathological findings of arrhythmogenic ventricular cardiomyopathy (AVC) as major cause of sudden cardiac death (SCD) in young adults. Background: According to Heart Rhythm Society (HRS)’s international consensus, histological criteria for AVC diagnosis include a progressive myocardial atrophy of the right ventricle characterized by a transmural fatty or fibrofatty replacement in a segmental or diffuse pattern (residual myocytes

Cerebral tissues in human remains are rare archaeological discoveries. These tissues are typically saponified, meaning that their triglycerides have been converted to glycerol and fatty acid salts, or soap. In c.e. 79, a volcanic hot ash avalanche rapidly killed the inhabitants of Pompeii and Herculaneum. In the 1960s, at the Collegium Augustalium in Herculaneum, a human victim of the avalanche was found lying on a wooden bed, buried by volcanic ash. In this victim’s skull, we discovered apparent brain remains that were vitrified instead of saponified.

Background Pulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time. Methods Pulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values. Results The 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h. Conclusions After a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death. Clinical trial number NCT03887819. Trial registration The trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was “Retrospectively registered”.

Peripartum cardiomyopathy (PPCM), a rare and potentially fatal disease, occurs in young, previously healthy pregnant women in the last stages of pregnancy and up to 5-6 months after delivery. Since its etiology is multifactorial, diagnosis is generally made via exclusion of all other causes. We here describe three cases of three young women who died suddenly and unexpectedly after giving birth by Cesarean section (C-section). These cases were brought to our attention after malpractice claims had been brought against the hospitals’ health professionals. In all three reported cases, the cardiac function suddenly and unexpectedly worsened within a few hours after C-section. Strikingly, all three women had unremarkable clinical histories. Prior to postpartum complications, they had experienced uncomplicated gestation and had given birth to healthy full-term newborns. Therefore, since in none of these cases could the women’s uneventful clinical history have foreshadowed exitus, the hospital physicians attributed their deaths to sudden cardiac arrest. The macroscopic and microscopic histological findings ruled out any other condition that might have led to the women’s sudden and unexpected deaths; the toxicological test results were all negative and no surgical anomalies were found. After painstakingly analyzing the medical and clinical data reported in the women’s medical charts, together with the histological data emerging after autopsy, in agreement with the literature, we concluded that all three women had died of peripartum cardiomyopathy. Lastly, our three cases suggest that among the various forensic methods used to determine the causes of death, the histological approach remains the gold standard for identifying the causes of death especially in previously healthy individuals who die suddenly and unexpectedly.

Especially in oncology and in critical care, the provision of medical care can require therapeutic choices that could go beyond the patient’s will or intentions of the protection of his health, with the possible adoption of medical behaviors interpreted as unreasonable obstinacy or, at the opposite extreme, as euthanasia. In some cases, the demand for obstinate therapeutic services could come from the patient or from his relatives, in which case the dilemma arises for the health professional between rejecting such a request, in respect of their professional autonomy, or abiding by it for fear of a professional care responsibility for therapeutic abandonment. We analyzed and commented on emblematic clinical cases brought to court for alleged wrong medical conduct due to breach of the prohibition of unreasonable obstinacy. In healthcare it is impossible to fix a general rule defining any therapeutic act as appropriate, because on one hand there are technical assessments of medical competence, and on the other the perception of the patient and of his family members of the usefulness of the health care provided, which may be in contrast. The medical act cannot make treatments that are inappropriate for the needs of care or even be unreasonable; conversely, before the request by the patient or by his family members for disproportionate health services in relation to the results they may give in practice, in compliance with the legislative and deontological provisions, the doctor can refuse them, thus safeguarding both his decision-making autonomy and, therefore, his professional dignity. Significance for public healthThe aim of our research is to contribute to identify the technical parameters and the ethical and deontological aspects useful to qualify a treatment as obstinate, to ensure on the one hand a treatment process that does not exceed the patient's requests or expectations (especially if unexpressed), and on the other hand to protect health workers from charges of professional liability for overtreatment damages, while avoiding attitudes of defensive medicine. Reference to the current code of Italian medical deontology is helpful in making therapeutic choices. It recommends the physician not to undertake diagnostic procedures and therapeutic interventions that are clinically inappropriate and ethically disproportionate and against the current laws, according to which the patient cannot demand healthcare treatments contrary to the law, deontology and good clinical-care practices.

The increase in the number of people who choose to have medical procedures done to improve their appearance may be due to changed social and cultural factors in modern society, as well to the ease of access and affordable costs of these cosmetic treatments. Today, two elements legitimate recourse to this type of treatment: the broad definition of health accepted by the law and the scientific community, and the provision of meticulous information to the entitled party previous to obtaining his or her consent. In Italy, while current case-law views treatments exclusively for cosmetic purposes as unnecessary, if not even superfluous, it nonetheless demands that providers inform clients about the actual improvement that can be expected, as well as the risks of worsening their current esthetic conditions.

Finding traumatic lesions on ancient skeletal remains offers a unique opportunity to investigate the circumstances surrounding the time of death. Here we present the unique find of a late 17th, early 18th century young male from Southern Italy with eight traumatic skull lesions. A detailed anthropological examination using X-ray and 3D CT scanning techniques was conducted in order to evaluate traumatic extent, direction and degree of severity of each skull injury. The nature, number and timing of repair of the traumata suggest that they were intentional blows inflicted in battle. Gross and radiographic evidence shows that the individual survived long after one of these traumata, most likely suffered in a previous battle. Shape, size and location, as well as different orientation and implied trajectory of the multiple wounds, suggest that they were produced by a heavy, sharp cutting weapon. The perimortem aspect of most of the traumata revealed them to be contemporary injuries, suffered in a final assault by a heavy sword during a face-to-face combat. The largest and deepest fracture penetrating the skull cavity possibly resulting in traumatic brain injury was here suggested as the fatal one, even if the victim may have survived for several days prior to death.

Dental treatments, as well as simple anatomical and functional repair work, can also be for aesthetic purposes. This is because the anatomical area concerned, i.e. the oral cavity, has a great power of attraction. Aesthetic treatments in general – in particular dental treatments – have been on the rise in recent years, and this has also meant an increase in claims due to patient dissatisfaction with the results obtained. Numerous laws have been introduced that emphasise the need for comprehensive prior information in order to acquire valid consent. This has resulted in the elimination of the distinction between the obligation of means and obligation of result, with achievement of the normally expected result required in any case.

In Italy, Law 194 of 22 May 1978 provides for and regulates the voluntary termination of pregnancy (VTP). Medical abortion became popular nationwide after Mifepristone (RU-486) was authorized for the market by AIFA (Italian Drug Agency) in July 2009. We searched articles in medical literature database with these terms: “medical abortion”, “RU486”, “surgical abortion”. We also searched laws and judgments concerning abortion in national legal databases. Ministerial guidelines were searched on official website of Italian Ministry of Health. We found many medical studies about medical and surgical abortion. We found also ministerial and regional guidelines, which were analyzed. From the point of view of legal medicine, the issues related to abortion with the pharmacological method consist in verifying compatibility and consistency with the safety principles and the parameters imposed by Law n. 194 of 1978, using off-label Misoprostol, what inpatient care should be used and informed consent. The doctor’s job is to provide the patient with comprehensive and clear information about how the procedure will be performed, any complications and the time period needed for both procedures.