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Alprazolam is a psychoactive triazolo-benzodiazepine, commonly prescribed for the treatment of anxiety disorders and considered safe due to its high therapeutic index. It is frequently detected in polydrug-related deaths but there are very few cases of fatal intoxication by alprazolam not in combination with alcohol or other drugs. A fatal poisoning by alprazolam in a 60-years old male physician has been reported. At autopsy, no evidence of traumatic injuries or diseases was observed except for signs of bronchopneumonia and slight hypertrophy of the left ventricle. Alprazolam and its major metabolite (α-hydroxyalprazolam) were detected in biological samples through liquid chromatography-tandem mass spectrometry (LC-MS/MS). High concentrations of alprazolam and α-hydroxyalprazolam were found, respectively, in femoral blood 0.45 and 0.03 mg/L, urine 2.12 and 0.42 mg/L, bile 1.33 and 0.56 mg/L, liver 3.81 and 0.28 mg/L. Alprazolam alone was also detected in vitreous humour (0.19 mg/L) and in stomach content (0.34 mg/L). No conclusive information confirmed the hypothesis of 25 a suicidal ingestion of alprazolam. However, an alprazolam drug-related death was assessed based on the pre-existing cardiovascular and respiratory defects. The high levels of alprazolam several times greater than the therapeutic range contributed to death due to its respiratory and central nervous system-depressant effects.

Background: Diagnostic criteria for electrocution related death are still a challenge in forensic pathology and it seems that the electrical mark is the only reliable evidence. Methods: A comparison of histological and morphological findings of skin and internal organs from an autopsy series of electrocution deaths with those mostly reported in literature as representative for electrocution. Results: The morphological changes of heart, brain and other main internal organs are still unspecific. Organ’s damage observed in electrocution deaths shows a wide variability, not reliable for a certain diagnosis of electrocution. The electrical mark is still the golden standard for diagnosis of electrocution. Conclusions: In electrocution related deaths, pathological findings of the main internal organs are not enough evidence to support with certainty a post-mortem diagnosis that a victim suffered an electrical damage. Although the organ histological changes are undoubtedly the starting point for a better understanding of the fatal even, the diagnosis of death from electrical damage is still a dark and unsolved chapter. The electrical mark still represents a fundamental indicator above all in the medical-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases.

(1) Background: All deaths that occurred in a hospital of Southern Italy (&ldquo, San Giuseppe Moscati&rdquo, Hospital of Avellino) with medium jurisdiction (up to 425,000 citizens approximately) in the period from 9 March to 4 May 2020 were analyzed. The primary endpoint of the study was to analyze the causes of death in the period study. Secondary endpoints included: (1) the assessment of overall mortality in the emergency period compared with the same period of the past years (2018&ndash, 2019) in the jurisdiction area, (2) the assessment of the amounts of deaths with positive and negative reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal and oropharyngeal swabs, (3) the frequency of clinical and radiological features consistent with Covid-19 infection in negative RT-PCR cases. (2) Methods: Patients&rsquo, information and laboratory data were collected through the computerized medical record system (My Hospital, Italy) used for the clinical management of all referring patients. Epidemiological, clinical, and radiological data were reviewed along with the results of nasopharyngeal and oropharyngeal swabs. (3) Results: From 9 March to 4 May 2020, 140 deaths (87 males, 53 females) from all causes occurred in total at &ldquo, Hospital, of which 32 deaths were Covid-19 related. (4) Conclusions: The excess of mortality could be higher than the one reported in the official epidemiological surveys. False negative cases can have a distorting effect on the assessment of the real mortality rate and the excess mortality. Furthermore, many who died from Covid-19 were likely never tested or they had false negative RT-PCR results. Other victims probably died from causes indirectly related to Covid-19.

Isolated right atrial rupture after nonpenetrating blunt chest trauma is rare, and very few cases have been reported in the literature. Isolated right atrial rupture is a diagnostic challenge in these patients, who are mostly victims of motor vehicle collisions. The clinical presentation is heterogeneous and can vary depending on rupture location and size. The anatomical sites mostly involved are the appendage and the free wall followed by the superior and inferior vena cava junctions. The present case study shows a fatal isolated rupture of the right atrial appendage in a victim of a motor vehicle collision. At the emergency room, a computed tomography scan revealed a severe pericardial blood effusion, and pericardiocentesis was promptly performed. Unfortunately, the patient suddenly worsened just before cardiac surgery. Autopsy findings showed a cardiac tamponade due to a linear laceration 1.8 cm in length on the right atrial appendage. No other relevant injuries were observed. A prompt diagnosis of isolated right atrial rupture can be crucial for victims of blunt chest trauma with unexplained hypotension or hemodynamic instability to improve their chances of survival. Medicolegal issues can be raised mainly related to delayed diagnosis. Once a cardiac rupture is suspected, the injury repair is essential to achieve the best outcome.

Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.

Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending in a terminal bulbous (telson) containing paired venom glands and the stinger. There are 19 known families of scorpions and more than 2200 species, of which about 50 from the families of Buthidae, Hemiscorpiidae and Scorpionidae are harmful to humans. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins and organic compounds, thereby having neurologic, cardiovascular, hematologic and renal side effects, in addition to local effects such as redness, pain, burning and swelling. When the sting is fatal, the mechanism of death is often related to cardiotoxicity with terminal pulmonary edema. However, the cholinergic excess or the neuromuscular excitation can provoke respiratory failure. Sometimes, death is due to an anaphylactic reaction to the envenoming. The purpose of this literature review is to evaluate the autopsy findings in scorpion sting-related deaths in order to better understand the pathophysiological mechanisms underlying them, thus helping pathologists in defining the correct diagnosis.

iatrogenic splenic injury is a recognized complication in diagnostic and therapeutic procedures performed on the gut (e.g., colonoscopy, colon surgery). however, iatrogenic splenic injury following other types of medical and surgical interventions have also been described in the literature. Spleen injury after chest tube insertion is a very rare event that must be investigated to assess medical error and liability. We present the case of a 68-year-old woman who underwent to thoracentesis for a pleural effusion. about 20 hours after, blood tests showed a marked decrease in the hemoglobin concentration (7.0 g/dL) and hematocrit (21%). repeat abdominal ultrasonography showed a perisplenic hematoma and hemoperitoneum, and an emergency splenectomy was performed. The patient was admitted to the intensive care unit. her clinical condition subsequently worsened, particularly her renal and cardiac function, and she died 6 days after surgery. As in this case iatrogenic lesions represent a field of interest for the forensic pathologist. The medicolegal investigation in such situations aims to assess the presence of elements compatible with profiles of professional responsibility of personnel involved in diagnostic and therapeutic procedures. In our case, the autopsy provided useful data to evaluate the pathophysiological processes underlying the splenic lesion.