Use of Lucilia species for forensic investigations in Southern Europe.

The aim of this study was to highlight the importance of evaluating entomological evidence in forensic investigations on a regional scale. To evaluate climatic, geographical and environmental influences on the selection of carrion-breeding fauna in Northern Italy and consequently on inferred forensic data (post-mortem intervals and post-mortem transfer), we present details of six indoor-outdoor cases. Results show that the most abundant species was Lucilia sericata, together with other fly species of entomo-forensic interest, belonging to the Calliphoridae and Sarcophagidae families. In particular, for the first time in Italy, we report finding Phormia regina, Lucilia ampullacea, Lucilia caesar and Sarcophaga (Pandelleana) protuberans on fresh cadavers. The active period of L. sericata in Northern Italy, according to previous findings in Southern Europe, revealing clearcut differences with phenologies in Northern Europe, has important consequences in estimating the period (season, months) of death in cases of long post-mortem intervals (several months or years) if empty puparia of this fly are found. According to our results, the distribution of L. sericata in areas with urban sprawl, like Northern Italian regions, cannot be used to evaluate post-mortem transfer from an urban area to a rural one.

Fatal toxic epidermal necrolysis in autoimmune polyglandular syndrome type I.

Autoimmune polyglandular syndrome Type I (APS I) is a disorder defined by the presence of at least two of the following diseases: Addison's disease, hypoparathyroidism, and chronic mucocutaneous candidiasis. We present the case of a 45-yr-old woman, affected by APS I, in chronic treatment with betamethasone. She was referred to a Division of General Medicine for jaundice, ascites and peripheral edema attributed to worsening of pre-existing autoimmune chronic hepatitis. During hospitalization, the following drugs were given: Amoxicillin/Clavulanic acid and Levofloxacin for bronchopneumonia, Furosemide and Canreonate for renal impairment, Pantoprazole for gastric protection, and Itraconazole for oral candidiasis. After about a month, she developed widespread, sheet-like, epidermal detachment, with painful lesions of the conjunctiva, lips and mouth. Toxic epidermal necrolysis (TEN) was diagnosed, and the patient was transferred to a Burn Center, where she died 10 days after the first onset of cutaneous rash. Autoptic and histopathological findings (epidermal necrosis and detachment, lymphomonocytic infiltration of the dermis) confirmed the clinical diagnosis. TEN is a usually drug-induced cutaneous inflammatory disorder characterized by extensive epidermal detachment and frequent mucosal involvement. It has also been associated with immuno-mediated disorders (HIV infection, graft-vs-host disease, systemic lupus erythematosus, mixed essential cryoglobulinemia), in keeping with immuno-mediated pathogenesis. We present, to our knowledge, the first report of TEN in a patient with APS I, and suggest that some pathogenetic mechanisms of APS I are shared with TEN. We stress how such a disease can occur in an autoimmune syndrome, even during corticosteroid treatment.

[Alcohol, drugs, pharmacologic agents, and street safety]. / Alcol, droga, farmaci e sicurezza stradale.

Deaths due to road accidents during weekends have become a worrying phenomenon in Italy. With the aim of highlighting the role of psychotropic substances (alcohol, drugs of abuse) in causing road accidents, a survey based on clinical and chemico-toxicological analyses has been carried out on car drivers in the Veneto region during night weekends since 1994. Rapid clinical screening was carried out on 7952 drivers. 1399 of these, suspected to be under the influence of psychotropic substances, were subjected to complete clinical and toxicological ascertainment involving the following procedures: a) anamnesis, aiming at evidence of possible current or past use of psychotropic substances; b) objective clinical examination, aiming at finding evidence of recent (signs of acute or chronic intoxication) or past use (signs of withdrawal or associated organic pathologies) of psychotropic substances; c) double sampling of blood and urine and chemico-toxicological analysis using immunochemical, GC-HS and GC/MS-SIM techniques. As well as many data of social and behavioural interest, processing of results demonstrated that: a) 56.7% of the drivers examined had consumed alcoholic beverages; b) 30.4% had BACs higher than the threshold permitted in Italy (80 mg/100 ml); c) 15.7% of drivers were found to be under the influence of drugs of abuse or psychoactive drugs; d) the most frequently found substances were (in order): cannabinoids, stimulants (cocaine, amphetamines), opiates.

Effects of single dose of gamma-hydroxybutyric acid and lorazepam on psychomotor performance and subjective feelings in healthy volunteers.

OBJECTIVE: This study investigated the possible effects of gamma-hydroxybutyric acid (GHB) on human psychomotor performance and subjective feelings important for the safety of skilled performance. METHODS: Twelve healthy volunteers, six males and six females, aged 22-36 years, participated as subjects. Drugs and placebo were administered according to a single-dose, double-blind, balanced, four-way, crossover design. Treatments were separated by a wash-out period of 1 week and consisted of placebo, lorazepam 0.03 mg x kg(-1), GHB 12.5 mg x kg(-1) and GHB 25 mg x kg(-1). Subjects' psychomotor performance was assessed at baseline and at 15, 60, 120 and 180 min after treatment. Mood was assessed using 16 visual analogue scales, before treatment and 120 min later. Psychomotor performance was measured using the following tests: Critical Flicker Fusion. Response Competition Test, Critical Tracking Task, Choice Reaction Time and Visual Vigilance Task. RESULTS: GHB at both doses had no effects on attention, vigilance, alertness, short-term memory or psychomotor co-ordination (delta-placebo, P > 0.05); calmness increased with the lower dose and contentedness decreased significantly at both doses (delta-baseline, P < 0.05); adverse effects were limited to slight subjective feelings of dizziness and dullness, which disappeared 30-60 min after administration of the dose. Lorazepam caused impairment of psychometric functions. CONCLUSION: After single therapeutic doses, GHB does not induce changes in psychomotor performance and therefore the drug does not influence the ability to drive or work. However, repeated reports of the abuse potential of GHB and its usefulness in treating ethyl alcohol addiction indicate that it may play an "agonist-like" role, which means that it should only used under close medical supervision.

Opiate-related death: morphometric study of neurons from the dorsal motor nucleus of the vagus nerve.

The aim of this work is to verify the presence of objectively observable morphological alterations caused by the direct action of opiates on brain structures controlling respiration in cases of drug-related deaths. A computer-assisted morphometric study was carried out on the Dorsal Motor Nucleus of the Vagus Nerve (DMNV) in seven subjects (four of whom died of drug overdose, and 3 controls). Serial sections 10-15 microns thick were stained according to Nissl. The sections were then examined under the optical microscope and 200 fields per subject were digitalized. The resulting images, regarding at least 700 neurons per subject were segmented using a semi-automatic procedure and analysed by the Optilab software. The data obtained were subjected to cluster analysis to identify the neuron classes in the DMNV. Each subject was characterized with a vector of percentages indicating the fraction of neurons falling in each of these classes. Discriminant analysis was then applied to verify to what extent the variables discriminated between the two populations. Results indicated that: the statistical methods adopted have a good power of discrimination; in subjects who died of opiate overdose, the neurons are distributed to a greater extent in classes composed of smaller neurons than in controls.

Low blood alcohol concentrations and driving impairment. A review of experimental studies and international legislation.

While noting that there is no international scientific or legislative uniformity in blood alcohol concentration (BAC) levels admissible for driving motor vehicles, the authors analyse problems concerning the effects of low levels of ethyl alcohol on driving ability. A summary of the international literature on this subject reveals: the existence of contrasting assumptions, with scientific evidence clearly demonstrating altered psychomotor functions; the need to adopt sufficiently complex psychometric tests to reveal the effects of low BACs; the need to improve standardization of experimental studies on man-machine interaction; the need to investigate the following areas: tolerance to alcohol; low BACs with inexperienced, infrequent drinkers and chronic, heavy drinkers; hangover effects; alcohol-gender-age interactions, and specific effects on young drivers; alcohol-drug combinations. The analysis of legislation and enforcement policies also reveals the need for: re-evaluation of the international legal BAC threshold and standardization of procedures for ascertaining the degree of driving disability; further scientific research to compare and evaluate selected legislative initiatives currently in place in most states; to identify the best strategies and procedures to detect and arrest impaired drivers; to determine the optimum random testing rate to maximize deterrent effects in the workplace at minimal cost; to design innovative and comprehensive approaches to rehabilitation programs needed for subgroups of offenders and of workers; to study the effectiveness of new legislations and policies.