Postmortem diagnostics of assumed suicidal food anaphylaxis in prison: a unique case of anaphylactic death due to peach ingestion.

Suicidal ingestion of food which the victim is aware they are allergic to is an exceptional occurrence in the forensic field. To the best of our knowledge, no cases of suicidal food anaphylaxis have been reported to date. Therefore we present the first case described in the literature. A 30-year-old prisoner was found dead inside his cell with the remains of a peach remains next to his body, and a handwritten farewell note in his pocket. The autopsy revealed only non-specific findings, while laboratory investigations (serological, toxicological, histological, and immunohistochemical) played a pivotal role in determing the cause and manner of death. In particular, a high titer of both total and specific IgE antibodies was detected, as well as an increase of the tryptase level in cadaveric blood. Moreover, a massive concentration of salicylates was measured in the gastric contents. Microscopically, cellular residues characterized by a vegetal structure were observed in the gastric contents and elements suggestive of mast cells were detected in the glottis, lungs, and myocardium. The immunohistochemical investigation with anti-CD117 and anti-tryptase antibodies showed positivity for mast cells, some of which appeared degranulated. Such findings were entirely consistent with an acute systemic anaphylactic reaction triggered by allergy. Therefore, the prisoner's death was attributed to self-induced food anaphylaxis caused by the ingestion of peaches. This conclusion was achieved based only on circumstantial data, anamnestic information, autopsy findings, and multiple laboratory results. This integrated approach should be used to pursue a post-mortem diagnosis of anaphylaxis.

Uncommon suicide methods in the detention regime in Milan (1993-2019): Forensic contribution on autopsy cases.

We analysed the recorded cases of suicides committed other than by hanging in prison in Milan. A retrospective analysis was conducted on 25,512 autopsies performed from 1993 to 2019, selecting all the suicides in prison but our attention was focused solely on cases where an alternative mode to hanging was used. From a total of 97 suicide events in prison, 15 were consistent with the established search criteria: 6 victims died from plastic bag suffocation, 4 by direct inhalation of butane gas, 2 associated plastic bag suffocation to inhalation of butane gas, one committed suicide with an edged weapon, one by self-burning and, finally, one by voluntary ingestion of a food to which he was allergic, with the intent of inducing an anaphylactic shock. Our analysis has shown that the landscape of prison suicides is diverse, not limited solely to hanging. Therefore, it is necessary for the forensic scientific community to raise awareness of potentially unusual suicide methods in prisons and, in the same way, for the Penitentiary Administration to put adequate preventive measures and strategies in place.

Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993-2017) : Suicides and natural deaths in prison.

We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan's three detention facilities. These deaths were divided into two types: natural deaths (n=135; 59.5%) and violent deaths (n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.

Comparison between prostitutes' and general women's homicides: The experience of the bureau of legal medicine of Milan and Hinterland over 26 years.

We present a retrospective study of prostitutes' homicide in the Milanese area over a 26-year period (1993-2018), and compare the results with general women's homicides: 294 women were killed of whom 71 were prostitutes. In the general population, the type-victim is an Italian woman aged between 31 and 40 years suffering from no particular pathologies or drug dependence. Prostitutes are 10 years younger, mostly Italian, suffering from pathologies probably related to their activities. Prostitutes remain at high risk of violence, due to gaps in the crime prevention system.