Congenital heart diseases (CHDs) and forensic investigations: Searching for the cause of death.

Congenital Heart Diseases (CHDs) are a group of structural abnormalities or defects of the heart that are present at birth. CHDs could be connected to sudden death (SD), defined by the WHO (World Health Organization) as "death occurring within 24 h after the onset of the symptoms" in an apparently "healthy" subject. These conditions can range from relatively mild defects to severe, life-threatening anomalies. The prevalence of CHDs varies across populations, but they affect millions of individuals worldwide. This article aims to discuss the post-mortem investigation of death related to CHDs, exploring the forensic approach, current methodologies, challenges, and potential advancements in this challenging field. A further goal of this article is to provide a guide for understanding these complex diseases, highlighting the pivotal role of autopsy, histopathology, and genetic investigations in defining the cause of death, and providing evidence about the translational use of autopsy reports. Forensic investigations play a crucial role in understanding the complexities of CHDs and determining the cause of death accurately. Through collaboration between medical professionals and forensic experts, meticulous examinations, and analysis of evidence, valuable insights can be gained. These insights not only provide closure to the families affected but also contribute to the prevention of future tragedies.

Respect for bioethical principles and human rights in prisons: a systematic review on the state of the art.

BACKGROUND: Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health. METHODS: A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review. RESULTS: Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners' access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights. CONCLUSIONS: Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons.

Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis.

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people's willingness to seek medical care and the subsequent effects on patients' prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23-May 4, 2020-COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.

Metabolic syndrome and prostatic disease: potentially role of polyphenols in preventive strategies. A review.

Benign prostatic hyperplasia and prostate cancer are two common urological diseases of the elderly. Scientific community has always looked for a link that could explain the correlation between the two diseases and the role of chronic inflammation in the pathogenesis of BPH and PCa. As shown by the reports of the two diseases relationship with oxidative stress and metabolic syndrome, the use of compounds with antioxidant action could therefore affect both the symptoms and their onset. Polyphenols appear to act not only against oxidative stress but also at different levels. The aim of this review is to evaluate the role of the most important polyphenols on these two urological diseases. As antioxidants these compounds seems to have a direct action on the cell cycle and hormone function, important for both prostate cancer and BPH. Despite a large number of articles about the relationship of the polyphenols with prostate cancer, very little evidence exists for BPH. Additional clinical trials or meta-analysis are necessary on this topic.

Metabolic syndrome and prostatic disease: potentially role of polyphenols in preventive strategies. A review

ABSTRACT Benign prostatic hyperplasia and prostate cancer are two common urological diseases of the elderly. Scientific community has always looked for a link that could explain the correlation between the two diseases and the role of chronic inflammation in the pathogenesis of BPH and PCa. As shown by the reports of the two diseases relationship with oxidative stress and metabolic syndrome, the use of compounds with antioxidant action could therefore affect both the symptoms and their onset. Polyphenols appear to act not only against oxidative stress but also at different levels. The aim of this review is to evaluate the role of the most important polyphenols on these two urological diseases. As antioxidants these compounds seems to have a direct action on the cell cycle and hormone function, important for both prostate cancer and BPH. Despite a large number of articles about the relationship of the polyphenols with prostate cancer, very little evidence exists for BPH. Additional clinical trials or meta-analysis are necessary on this topic.

Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: new insights from an Italian cross-sectional study.

PURPOSE: To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) assessed by the fatty liver index (FLI), in lower urinary tract symptoms (LUTS) patients and to estimate its ability in predicting LUTS. METHODS: We performed a cross-sectional analysis of 448 consecutive patients affected by LUTS. LUTS were evaluated using the IPSS questionnaire and metabolic syndrome (MetS) criteria (by International Diabetes Federation). FLI, prostate volume (PV), serum prostate-specific antigen, total testosterone (TT) and homeostasis model assessment (HOMA) index were evaluated. A value of FLI ≥40 was set to predict NAFLD. Patients were divided into Group A (FLI <40) and Group B (FLI ≥40). Odds ratios (OR) for having moderate-severe LUTS were calculated. Logistic regression model was fitted adjusting for confounding factors. RESULTS: Group B showed higher prevalence of MetS, IR, moderate-severe LUTS and ED, higher IPSS, IPSS-storage, IPSS-voiding, total prostate volume, insulin, HOMA and lower TT and IIEF-5. Univariate logistic regression analysis demonstrated that continuous FLI (OR = 1.03, p < 0.05) and FLI ≥40 (OR = 2.41, p < 0.01) significantly increase the risk of moderate-severe LUTS. Continuous FLI (OR = 1.12, p < 0.01) and FLI ≥40 (OR = 5.39, p < 0.01) were independent predictors of moderate-severe LUTS at the multivariate logistic regression analysis, after adjusting for confounding factors. Subjects with MetS and FLI ≥40 had 2.0-fold the risk of moderate-severe LUTS (OR = 2.10, p < 0.01). CONCLUSIONS: Non-alcoholic fatty liver disease (NAFLD) subjects have higher risk of LUTS. The presence of FLI ≥40 can be used to predict subjects at high risk of LUTS.