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Background. The use of radiological approaches in forensic investigations is rapidly emerging as an alternative to traditional autopsies. Here, we present the experience of the Sicilian and Calabrian forensic medical departments over the past five years, highlighting the application of PMCT to support autopsies in cases involving gunshot wound victims. Materials and Methods. From January 2020 to March 2024, thirty cadavers who died from gunshot wounds underwent total body PMCT examinations followed by autopsies. The examinations included multi-planar and 3D reconstructions. Data collected for each subject included gender, age, mode of death, type of weapon, number of shots, body sites affected, and presence of retained bullets. A team of two radiologists and two forensic physicians evaluated the images and compared them with the autopsy findings. Conclusion. PMCT and 3D reconstruction enabled evaluation of entry wounds, fracture margins, injury sites, fragments, and anatomical trajectories. The results from PMCT were compared with autopsy findings in terms of entry wounds, wound channels, foreign bodies, organ and skeletal injuries, and causes of death. PMCT showed concordance with autopsy findings in determining the cause of death in all cases. The speed, non-invasiveness, and ability to manipulate and reconstruct data make PMCT an ideal technique for supporting forensic investigations and autopsies. PMCT is highly reliable for accurately identifying lethal wounds and determining the cause of death. It excels at tracking wound paths, distinguishing entrance and exit wounds, locating retained bullets, and detecting fragmentation and dispersion of ballistic components. [ABSTRACT FROM AUTHOR]

Background: The use of radiological approaches in forensic investigations is rapidly emerging as an alternative to traditional autopsies. Here, we present the experience of the Sicilian and Calabrian forensic medical departments over the past five years, highlighting the application of PMCT to support autopsies in cases involving gunshot wound victims., Materials and Methods: From January 2020 to March 2024, thirty cadavers who died from gunshot wounds underwent total body PMCT examinations followed by autopsies. The examinations included multi-planar and 3D reconstructions. Data collected for each subject included gender, age, mode of death, type of weapon, number of shots, body sites affected, and presence of retained bullets. A team of two radiologists and two forensic physicians evaluated the images and compared them with the autopsy findings., Conclusion: PMCT and 3D reconstruction enabled evaluation of entry wounds, fracture margins, injury sites, fragments, and anatomical trajectories. The results from PMCT were compared with autopsy findings in terms of entry wounds, wound channels, foreign bodies, organ and skeletal injuries, and causes of death. PMCT showed concordance with autopsy findings in determining the cause of death in all cases. The speed, non-invasiveness, and ability to manipulate and reconstruct data make PMCT an ideal technique for supporting forensic investigations and autopsies. PMCT is highly reliable for accurately identifying lethal wounds and determining the cause of death. It excels at tracking wound paths, distinguishing entrance and exit wounds, locating retained bullets, and detecting fragmentation and dispersion of ballistic components.

Fabry disease is a rare X-linked lysosomal storage disorder due to pathogenic variants of the galactosidase alpha (GLA) gene, leading to a deficiency of alpha-galactosidase A. The inadequate enzymatic activity leads to progressive glycosphingolipids accumulation within tissues and subsequent multi-systemic dysfunction, with predominant involvement of heart, kidney, and nervous system. Two subtypes are recognized: the classic type and the late-onset type. We here describe the clinical characteristics of a patient with late-onset Fabry disease carrying a not previously identified GLA gene variant. This 50-year-old man came to hospital because of an acute ischemic stroke. He also complained of acroparesthesia and had angiokeratomas in the nape and the back. Blood alpha-galactosidase A activity was low, plasmatic lyso-Gb3 level was borderline, cardiac MRI showed cardiac fibrosis, brain MRI documented cerebrovascular disease, and skin biopsy revealed small fiber neuropathy without globotriaosylceramide-3 skin deposits. Genetic study by means of targeted next-generation sequencing analysis disclosed a missense substitution c.1139C>T (p.Pro380Leu) in the GLA gene. We suggest that this novel variant should be considered as pathogenic and associated with a late-onset variant of Fabry disease with a predominant neurological phenotype., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Chimeric antigen receptor (CAR)-T-cell therapy is a new treatment for patients with hematologic malignancies in which other therapies have failed., Areas Covered: The review provides an overview for recognizing and managing the most acute toxicities related to CAR-T cells., Expert Opinion: The development of immune-mediated toxicities is a common challenge of CAR-T therapy. The mechanism that determines this toxicity is still unclear, although an unfavorable tumor microenvironment and a pro-inflammatory state put patients at risk. The monitoring, diagnosis, and treatment of post-CAR-T toxicities must be determined and based on international guidelines and internal clinical practice. It is urgent to identify biomarkers that can identify patients at greater risk of developing complications. The adoption of consistent grading criteria is necessary to improve toxicity management strategies continually. The first-line therapy consists of supportive care and treatment with tocilizumab or corticosteroids. An early start of cytokine blockade therapies could mitigate toxicity. The plan will include cytokine release prophylaxis, a risk-adapted treatment, prevention of on-target/off-tumor effect, and a switch on/off CAR-T approach.

The aim of this study was to determine the prevalence of extended-spectrum β-lactamases (ESBLs)- and carbapenemase-producing fermentative Gram-negative bacteria (FGNB) in a University Hospital in Southern Italy. These bacteria have the potential to disseminate bacterial resistance in healthcare settings and cause untreatable and prolonged infections associated with high rates of mortality. A retrospective observational study was carried out in a University Hospital in Sicily from January to December 2019. A total of 1046 FGNB were recovered from different clinical samples among which 40%, 15% and 37% were, respectively, MDR, carbapenemase and ESBL producers. Antibiotic resistance profile of FGNB against the first-line drugs was remarkably high. K. pneumoniae (57%) followed by E. coli (27%) were found here as the major sources of ESBL producers. The highest proportion of ESBL producers was from ICU ward (72%), and were isolated from urine samples (63.6%) followed by blood samples (54%). Carbapenemase production among the FGNB in our study was about 0.9%, which is more than twice than the prevalence rate reported by the European Antimicrobial Resistance Surveillance Network (ECDC) (0.4%). To our knowledge, this is the first report on the prevalence of ESBL and carbapenemase-producing FGNB in this region. Our data clearly indicate the importance of implementing antibiotic stewardship strategies in our region to reduce the unnecessary use of antibiotics.