The aging process in prison: pathologies and health conditions in old inmates. An epidemiological research in Italy.

BACKGROUND AND AIMS: Elderly may suffer from different pathologies during their detention in jail because of their age. Conditions in jails were tough and adapting to that life could be problematic for the elder population. This article aimed to analyse the pathologies and health conditions in a sample of elder inmates from Italy. METHODS: The sample was composed by 94 elderly inmates. The research is multicentric. We selected jails from the cities of Bari, Taranto, Foggia, Lecce, Brescia, Bergamo, Cremona and Mantua. The study was conducted by interviewing the prisoners over 60 years of age, in the period between September and December 2017. RESULTS: 64% of the sample was in a "Not Optimal" health status. Most of pathologies were Cardiac pathologies (23.4%), Diabetes (12.8 %) and Surgery (9.6%). Statistically significant differences were found for heart disease (p=0.02) and Neoplasia (p=0.025) in the prison of Bari compared to all the other prisons. Statistically significant differences were found for Hypertension in Foggia and Taranto prisons compared to all the other (p=0.023). Furthermore, 18.1% of inmates ended up having an addiction. CONCLUSIONS: Our analysis showed that in our sample physical problems were more frequent than psychological one. In fact, in spite of in the literature there was a high prevalence of mental health problems among elderly inmates, we did not find this result. However, stress conditions may increase the risk of pathologies: for example, being in jail and adapt to new hard environment may increase the risk of getting sick. Heart disease pathologies and diabetes were very common in our sample as confirmed by the literature.

How should living entomological samples be stored?

Sampling and storing insect evidence alive are important tasks in forensic entomology as it can impact survival and growth rates. To investigate the effect of cooling and storing of insect evidence before its arrival in the laboratory, samples of all three larval stages of the blow fly species Lucilia sericata and Calliphora vicina were analyzed. A first group was stored at room temperature and a second one in a refrigerator (~ 5 °C) for 16 h, all without air, supply of food, and sawdust. Afterwards, they were kept at 6-8 °C in a Styrofoam box for 8 h, simulating a transport situation. Mortality rate (MR) was calculated and 25% of the surviving larvae were killed and measured to check for interim growth. The remaining alive specimens were reared at 25 °C until adult's eclosion for estimating a possible storage impact on survival during later development. The results were then compared with a control which was not temporarily stored and chilled but left feeding in boxes with an air-permeable lid on food substrate at 25 °C.A 24-h temporary storage stopped the larval growth in comparison with the control especially in early larval stages in both species. A high MR of up to 100% for third instar (L3) larvae stored both at room temperature and in a cold environment without air supply was found. Oxygen supply can reduce significantly the MR at least for L3 larvae of L. sericata. Findings provide scientific evidence for the recommendation to store larval samples at cold temperatures with both oxygen and food supply. The high MR for samples of the last larval stage clearly shows the need for a fast delivery after sampling and a more sophisticated storage procedure like, e.g., providing air supply. Storing live samples at room temperature without air access should be avoided.

Entomotoxicology in burnt bodies: a case of maternal filicide-suicide by fire.

One of the most common methods of maternal filicide is by fire. In this case study, a 40-year-old female and her children were found completely burned in a burnt out car. All bodies showed a degree of destruction by fire consisting to a level 3 of the Crow-Glassman Scale (CGS) and early stage of insect activity. Toxicological analyses were performed on soft tissues and body fluids still available. The results were positive for diazepam and its metabolites only for children with blood concentrations consistent with therapeutic doses of benzodiazepines. Home video surveillance cameras confirmed sedation prior to death recording the mother while administering some drops of sedative drugs in a soft drink to the children just a couple of hours before setting fire to the car. Based on autopsy findings, all victims were still alive at the time of fire. The cause of death was determined as carbon monoxide poisoning and fatal thermal injuries by fire. This case study has a special focus on the entomotoxicology and the potential role of insects in death investigations of burnt bodies, supposed to be an inadequate substratum for insect colonization. It demonstrates that in burnt bodies, arthropod colonization can be quite immediate after fire is extinguished. Toxicological analyses performed on larvae actively feeding on the children's bodies were positive for diazepam and its metabolites in small amount compared with blood concentrations, whereas the larvae collected from the mother's body were totally negative. These data, according to the autopsy findings and the toxicological results from the victim's blood and tissues, supported the suspect of a non-lethal sedation prior to death, which is a common behaviour in maternal filicide.

[Parricide, abuse and emotional processes: a review starting from some paradigmatic cases]. / Parricidio, abusi e processi emozionali: una rassegna partendo da alcuni casi paradigmatici.

The authors of this study tackle the complex subject of parricide, which is a rare and often brutal form of homicide. Parricide has a high emotional impact on public opinion and on our collective imagination, especially in light of the fact that the perpetrators are often minors.. Three striking cases of parricide, taken from various documented sources and judicial files from the "N. Fornelli" Juvenile Penal Institute (Bari, Italy), are presented here. A review of the literature on the topic has revealed differences between parricides committed by adults and those committed by minors. In the end, the complex issues underlying such an unusual crime are connected to abuses and maltreatment that minor perpetrators of parricide have suffered, especially the emotional processes that are activated.

Bodies in sequestered and non-sequestered aquatic environments: a comparative taphonomic study using decompositional scoring system.

The study of decomposition by using accumulated degree days (ADDs) has been suggested not only in terrestrial decay but also for water-related deaths. Previous studies have demonstrated that the accumulation of thermal energy as a function of the post-mortem submersion interval (PMSI) can be derived from a descriptive decompositional scoring system (DSS). In order to verify how useful can the total aquatic decomposition score (TADS) for ADD prediction be, a comparative taphonomic study has been performed between two series of bodies: 16 corpses found floating in shallower waters with a presumptive PMSI from 3 to 118 days and exposed to water temperatures (Tw) between 10.5 and 20.3 °C approximately equating from a minimum of 46 to 1.392 ADD; 52 bodies, all victims of a single shipwreck, found in sequestered environments and subjected to constant Tw of 4 °C for 210 days approximately equating to 840 ADD. The two series of bodies have revealed different stages of decay and a large DSS variability. In most of bodies, freshly formed adipocere was able to delay the appearance of later decompositional stages explaining why most of the bodies were in relatively good condition. Although promising, the accuracy of the TADS model can be affected by adipocere and animal activity. The TADS model suffers of the same limitations for ADD calculations as they can give a false perception of accuracy due to the complexity of integrating all changing factors affecting human decay in sequestered and non-sequestered marine environments (currents, animal activity, water temperatures, depth of submersion).

False accusations of sexual abuse as a mean of revenge in couple disputes.

OBJECTIVE: In forensic-psychiatric evaluations on a minor presumed victim of sexual abuse, one may come across "false positives" and "false negatives". The aim of this study was to examine the phenomenon of false sexual abuse as revenge by one ex-partner against the other, and to offer recommendations about how to avoid this risk. MATERIALS AND METHODS: The authors examined 75 technical consultations and expert testimonials in which intrafamilial sexual abuse of a minor was reported. RESULTS: Twenty two (30%) were found to be baseless and result of conflict, revenge of one partner upon the other. Of these 22, 5 involved men who accused their ex-wives and/or live-in partners. The remaining 17 cases involved charges by women against their ex- husbands, and/or live-in partners. CONCLUSIONS: Charges of abuse represent not only an instrument of protection of one's own children, but also a weapon of revenge against an ex-partner, putting these minors into the role of victims.

Forensic entomology: applications and limitations.

Forensic entomology is the science of collecting and analysing insect evidence to aid in forensic investigations. Its main application is in the determination of the minimum time since death in cases of suspicious death, either by estimating the age of the oldest necrophagous insects that developed on the corpse, or by analysing the insect species composition on the corpse. In addition, toxicological and molecular examinations of these insects may help reveal the cause of death or even the identity of a victim, by associating a larva with its last meal, for example, in cases where insect evidence is left at a scene after human remains have been deliberately removed. Some fly species can develop not only on corpses but on living bodies too, causing myiasis. Analysis of larvae in such cases can demonstrate the period of neglect of humans or animals. Without the appropriate professional collection of insect evidence, an accurate and convincing presentation of such evidence in court will be hampered or even impossible. The present paper describes the principles and methods of forensic entomology and the optimal techniques for collecting insect evidence.

Living donor kidney transplant: medicolegal and insurance aspects.

Kidney transplantation is quite a routine complex procedure, not without risks and consequences to the donor, the recipient, and the health care professionals. Kidney-related medical malpractice suits are growing rapidly, and for clinicians and surgeons, the risk of being sued can be only reduced by practicing high-quality medicine and by appropriately communicating with donors and recipients. Actually relevant guidelines are available including safety and quality assurance standards for procurements, preservation, processing, and distribution for organs to maximize their quality and thereby the rate of success of transplants and to minimize the risk of such a procedure. We also find it essential that practice of living donor kidney transplant is in line with the general rules of the Convention for the Protection of Human Rights and its Additional Protocol. In this article, financial incentives and insurance aspects related with living donors kidney transplants are also illustrated.

nm23 expression in malignant ascitic effusions of serous ovarian adenocarcinoma.

The aim of this study was to evaluate nm23 expression as detected in malignant cells of neoplastic ascites and to verify its relationship with the presence of tissue nm23 and p53 in primitive neoplasia. Using an immunocytochemical assay with a specific anti-nm23 polyclonal antibody, nm23 expression was evaluated in ascitic effusions of 45 patients with ovarian serous adenocarcinoma and ascites in normal and/or hyperplastic mesothelial cells from 37 women with various neoplasms (12 ovarian neoplasms) free of malignant cells as controls. nm23 and p53 tissue expression was also detected in 21 corresponding tumor samples, including 11 bilateral lesions. nm23 was expressed in 57% of malignant effusions compared to 43% in controls: the two groups were not correlated. nm23 in effusions agreed with tissue expression (p=0.02) but a direct correlation was not demonstrated. The incidence of nm23 was more frequent in stage III than in stage IV disease (p=0.08) and was associated with mutated p53 expression (p=0.01). Using the Wilcoxon test for unpaired data, a higher incidence (p=0.05) of p53-positive tumors in bilateral cancers was found while a higher expression of nm23 in effusions of patients with monolateral lesions was observed (p=0.08). The presence of p53 was correlated with that of nm23 in both cytologic (p=0.005) and histological samples (p=0.01). Our findings, together with the diversity in biological behaviour present in various tumors, suggest that nm23 is a family of genes with differing biological functions which act as tumor-specific inhibiting factors within a complex process also involving other genes. Due to the analogies and correlations between nm23 and p53, the role of nm23 as a potential predictive factor of response to chemotherapy and in DNA repair is emphasized.

Factors affecting decomposition and Diptera colonization.

Understanding the process of corpse decomposition is basic to establishing the postmortem interval (PMI) in any death investigation even using insect evidence. The sequence of postmortem changes in soft tissues usually gives an idea of how long an individual has been dead. However, modification of the decomposition process can considerably alter the estimate of the time of death. A body after death is sometimes subject to depredation by various types of animals among which insects can have a predominant role in the breakdown of the corpse thus, accelerating the decomposition rate. The interference of the insect community in the decomposition process has been investigated by several experimental studies using animal models and very few contributions directly on cadavers. Several of the most frequent factors affecting PMI estimates such as temperature, burial depth and access of the body to insects are fully reviewed. On account of their activity and world wide distribution, Diptera are the insects of greatest forensic interest. The knowledge of factors inhibiting or favouring colonization and Diptera development is a necessary pre-requisite for estimating the PMI using entomological data.

Entomotoxicology.

Entomotoxicology is a relatively new branch of forensic entomology. The potential use of insects for detecting drugs and other toxins in decomposing tissues has been widely demonstrated. In death investigations, Diptera and other arthropods can be reliable alternate specimens for toxicological analyses in the absence of tissues and fluids normally taken for such purposes. Entomotoxicology also investigates the effects caused by drugs and toxins on arthropod development in order to assist the forensic postmortem interval estimates. However, several remarks on the limitations of entomotoxicology have been highlighted recently. In this paper, the implications for the practice of this forensic procedure are fully reviewed.

The forensic entomologist in the context of the forensic pathologist's role.

An adequate death investigation requires the combined efforts and cooperation of experts in different disciplines: crime scene technicians, death investigators, forensic pathologists, anthropologists, entomologists, other medical and non-medical professionals. These front-line experts play a crucial role in every death investigation process. The forensic pathologist normally has the legal authority to take charge of the dead body at a death scene and his primary functions are the exterior and interior examination of the cadaver by analyzing the extent of antemortem injuries and the postmortem changes and the recovery of physical evidence. He is responsible for determining how, when and why of any death which is the result of violence, suspicious or unexplained circumstances or a death which is sudden or unattended, defending and explaining the reasons for making these diagnoses in a courtroom. The forensic entomologist can provide invaluable aid in death cases where human remains are colonized by insects and in the overall investigation. His principal role is to identify the arthropods associated with such cases and to analyze entomological data for interpreting insect evidence. He is responsible for determining the period of insect activity according to all the variables affecting insect invasion of remains and their development. The major goal of medico-criminal entomology is to contribute to the determination of the time, cause, manner and place of the investigated death (especially on badly decomposed corpses or skeletonized human remains) with the support of all the elements which can be inferred from the study of insects found on the cadaver or nearby. The application of techniques devised recently in forensic entomology can allow experts in the field to collect strong entomological evidence and provide useful information not only in a death investigation including movement or storage of the remains following death, time of dismemberment, postmortem artifacts on the body but also at the scene, and even more in child neglect, sexual molestation and identification of suspects. As the role of the forensic entomologist at the death scene, at the autopsy and in the laboratory is defined and well known, this paper focuses on the difficulties that could arise if forensic pathologists and entomologists are uncertain about the procedures that they have to follow, do not realize the value of objective findings or fail to evaluate them. Although every forensic case presents a slightly different set of circumstances and has to be tackled individually, the forensic pathologist should work with the forensic entomologist from the visual observations of the cadaver on the scene, through the collection of arthropods and temperature data at the death scene and at the autopsy, up to the final report with the interpretation of entomological and other biological evidence.

Human and insect mitochondrial DNA analysis from maggots.

During the course of our forensic investigations, we have encountered situations where it would have been useful to have evidence, other than direct contact between the two, for concluding that a carrion-fly maggot developed on a particular human victim. If a maggot collected during a death investigation did not develop on the victim, then its age is not relevant to estimating the postmortem interval. In this study we demonstrate that mitochondrial DNA (mtDNA) sequence data can be obtained from the dissected gut of a maggot that had fed on human tissue. These data can be used to identify both the human corpse upon which the maggot had been feeding and the species of the maggot itself.

Determination of postmortem interval from old skeletal remains by image analysis of luminol test results.

The luminol test is routinely used in forensic serology to locate blood traces and identify blood stains not visible to the naked eye; its sensitivity is reported as ranging from 1:100,000 to 1:5,000,000. To evaluate the possibility of correlating the postmortem interval with blood remnants in bone tissue, the luminol test was performed on 80 femurs with a known time of death, grouped in five classes. Powdered bone (30 mg) was recovered from compact tissue of the mid-shaft of each femur and was treated with 0.1 mL of Luminol solution (Sirchie Finger Print Laboratories, Inc.). The reactions were observed in a dark room and filmed by a TV camera equipped with a recording tape. An intense chemiluminescence was observed after a few seconds in all 20 femurs with a PMI ranging from 1 month to 3 years. On the 20 femurs with a PMI ranging from 10-15 years, a clear chemiluminescence was visible with the naked eye in 80% of the sample. Among the 20 femurs with a PMI ranging from 25 to 35 years, a weaker chemiluminescence appeared in 7 femurs (33% of the sample). In the 10 femurs with a PMI ranging from 50 to 60 years, a faint reaction was observed only in a single femur. In none of the ten femurs with a PMI over 80 years was chemiluminescence observed. The image of each reaction was computerized and analyzed for gray scale. The results of image analysis show a possible quantitative relationship between the PMI and luminol chemiluminescence in powdered bone.

Sex determination by discriminant analysis of patella measurements.

The authors have analyzed 80 skeletons (40 males and 40 females) from the collection at the Institute of Legal Medicine of the University of Bari belonging to a known contemporary Southern Italian population; time of death was around 1970 and ages ranged from 25 to 80 years. Seven measurements taken on 80 intact, undeformed right patellae (max height, max width, thickness, height and width of the external facies articularis, height and width of the internal facies articularis) were used to determine sex by multivariate discriminant analysis. One function associating two parameters (max width and thickness) obtained the highest value of correct sex determination with a rate of 83.3%; other functions showed a higher percentage of misclassification (up to 17.5%). This study tests the success rate of correct sex prediction based exclusively on patellar dimensions. The discriminant factors carried out by statistical analysis may aid the forensic anthropologist when no other human skeletal remains suitable for sex determination are available.

Three case studies in forensic entomology from southern Italy.

Three cases of forensic interest regarding the estimation of postmortem interval (PMI) by entomological data are presented. The three cases concerning criminal investigations were performed in Southern Italy by the Entomological Laboratory of the Institute of Forensic Medicine at the University of Bari. For each case the authors present a detailed description of the remains as observed at the crime scene and a description of the arthropods collected from the remains. The PMI estimation was based on comparison of data from autopsy reports (rate of decay), local environmental conditions (temperature, humidity, rainfall) and development times for the immature stages of each species of local arthropod and succession patterns. The collection of insects was performed at the discovery site and during autopsy procedures. In the first case a PMI of 5 to 8 days was established based on the presence of adult specimens of Saprinus aeneus (family Histeridae), and mature larvae of Chrysomya albiceps and Sarcophaga carnaria (3rd instar). In the second case, on the charred remains of a corpse, larvae of Sarcophaga haemorrhoidalis (3rd instar) and Protophormia terraenovae (2nd instar) were observed in different developmental stages, as indicated, giving a PMI of 3 to 4 days based on entomological data. In the third case a PMI of 36 to 48 hours was defined from the evidence of Calliphora vicina 2nd instar on the two burnt bodies. In all cases the entomological evidence alone led to conclusions on PMI.

Using scapular measurements in regression formulae for the estimation of stature.

There are very few papers in forensic literature in which scapular dimensions have been used for estimation of living stature. Allowing the forensic duty to estimate the living stature of skeletal remains, using intact or fragmented scapulae, the Authors have performed multiple regression analysis between the measurements taken from 80 scapula (40 male and 40 female) belonging to a skeletal collection with anthropometric known data. Seven parameters (max length, max breadth, max acrocoracoid distance, length of acromion, max length of coracoid, length of glenoid cavity, width of glenoid cavity) have been recorded. By statistical analysis multiple and linear regressions have been obtained. The results show that living stature may be determined by using regression formulae of single or associated parameters taken from whole or fragmented scapulae. In absence of intact or fragmented long limb bones, scapula sample can be reliably employed for the estimation of stature in forensic practice.

Sex determination by discriminant analysis of calcanei measurements.

Eight measurements taken on the right calcaneus (maximum length, load arm width, minimum width, height of calcaneus, body height, breadth of the facies articularis talaris posterior, breadth and height of the facies articularis cuboidea) of a known contemporary Southern Italian skeletal population (40 males and 40 females) were used to determine sex by multivariate discriminant analysis. Three functions revealed a correct sex-determination of 85%. These functions were obtained by the association of the following parameters: maximum length, load arm width and breadth of the facies art. talaris post. (function no. 1); maximum length and breadth of the facies art. talaris post. (function no. 2); maximum length and height of the facies art. cuboidea and breadth of the facies art. cuboidea (function no. 3). These results may aid the forensic anthropologist when no other remains, useful for skeletal sex determination, are available.

Antagonistic effects of FR 173657 on human, pig, rabbit, and guinea pig kinin receptors: an in vitro study.

The pharmacodynamic features of the new nonpeptide kinin B2 receptor antagonist FR 173657 were evaluated on pig, rabbit, guinea pig, and human native kinin B2 receptors. FR 173657 exerted high antagonistic activity in all preparations examined. In particular, it acts as a competitive antagonist in the rabbit jugular vein (pA2 8.9) and in the human umbilical vein (pA2 8.2) but as a noncompetitive antagonist in the pig coronary artery (pKB 9.2) and in the guinea pig ileum (pKB 9.2) stimulated with the selective B2 receptor agonist bradykinin (BK). In contrast, FR 173657 failed to antagonize the biological effects of the selective B1 receptor agonist LysdesArg9BK in the pig renal vein, rabbit aorta, and human umbilical vein, three kinin B1 receptor systems. Moreover, this compound was inactive against the effects induced by noradrenaline, 5-hydroxytryptamine, endothelin-1, angiotensin II, substance P, acetylcholine, and histamine in the B2 receptor preparations. Taken together, these results demonstrate that FR 173657 is the first potent nonpeptide B2 receptor antagonist with high affinity, selectivity, and specificity for kinin B2 receptors of different species, including man.

[Severe congenital thoracic-lumbar scoliosis in pregnancy. A case report and review of the literature]. / Scoliosi toraco-lombare congenita grave in gravidanza. Case-report e review della letteratura.

The authors describe a case report of a patient affected by congenital thoraco-lumbar scoliosis of a severe degree, aged 32, para 0, gravida 1. She was submitted to orthopedic surgery in childhood. Cesarean section was performed at the 37th week of amenorrhoea. Pregnancy in severe defects of the spine, though becoming more and more uncommon, can still be encountered. Severe congenital scoliosis is a clinical problem; it affects not only the size and shape of the pelvis, but also sometimes results in significant maternal cardiovascular and respiratory complication. The authors, reviewing the literature, evaluate the anatomical and functional (from a biomechanical point of view) derangement of the pelvis, the problem of vaginal delivery and the clinical and radiological assessment of the problem, especially evaluating the cardio-pulmonary function. In conclusion, pregnancy in patients with severe scoliosis can be managed successfully by close monitoring especially of the respiratory function. The decision of the route of delivery is related to clinical assessment and obstetric indications.