Traumatic injuries by conducted electrical weapons: Case report of self-injury to the hand during stun gun training

The use of non-lethal weapons has spread worldwide, being introduced as an alternative to firearms in many countries such as the United States or the United Kingdom. Among non-lethal weapons, conducted electrical weapons have been adopted worldwide, to control unruly suspected criminals or to neutralise violent situations. The stun gun belongs to this category and is the most widely available, with more than 140,000 units in use by police officers in the field in the US, and an additional 100,000 electrical stun guns owned by civilians worldwide. In Italy, the use of conducted electrical weapons by law enforcement has only recently been introduced, with private use and commercialisation still prohibited, mainly due to controversies related to the potential dangers of such devices.Before the official adoption, several experiments had to be carried out, with mechanisms that reproduced the ballistics of the stun gun. Here we present the case of a man who suffered a self-injury trauma to his hand during a ballistics exercise with a crossbow loaded with stun gun probes.

Post-mortem tetramorphism: Four morphological changes within the same corpse

Transformative processes generally occur singly and jointly involving the whole body. Rarely, they appear simultaneously as distinct transformative phenomena. The case study relates to a corpse found inside a storage tank in a rather unusual position, during the winter months. On external examination carried out at the crime scene, both legs and feet were out of the well bending over the storage tank and showing skeletonisation and tissue defects due to biting inflicted by the environmental macrofauna. The thighs were also skeletonised, inside the well but not immersed in the water, as was the torso which, however, was entirely corified. The colliquated shoulders, head and upper limbs were fully immersed into the water as well as the macerated hands. The corpse was exposed simultaneously to three different environmental conditions: the external setting with changes in temperature, rainfall and the action of the macro fauna, the unventilated and humid setting inside the tank, and lastly the stored water. The corpse, lying in a specific position and being exposed to different atmospheric conditions, underwent four post-mortem changes at the same time, making it challenging to estimate the time of death, based only on the available data and macroscopic findings.

The Effect of Physical Exercise during COVID-19 Lockdown

The COVID-19 pandemic has exerted an effect on the general population that went over every expectation. To explore the effect of physical exercise (PE) during the national lockdown in Italy, a survey was drawn up and administered to a sample composed of 208 subjects. The questionnaire comprised 81 multiple-choice items, including sociodemographic data, health-related questions, and assessment of physical exercise, satisfaction with life, depression, and personality. The purpose of this study is to explore the role of physical exercise during the outbreak following the present hypothesis: first, if a link exists between the time spent on physical exercise during the lockdown and the perceived health condition, depressive and somatic symptomatology, and life satisfaction; second, to find associations among the SF-12 component summaries and the other psychological outcomes; and finally, to explore how physical and psychological variables are predictive of PCS-12 and MCS-12. The results showed that both vigorous and moderate physical exercise was strongly correlated with psychological variables, with statistically significant negative correlations found between age and physical exercise. Additionally, significant positive correlations were observed between physical exercise and mental health indices, such as MCS-12 and SWLS, whereas negative correlations were found with BDI, PCS-12, and SOM-H. The correlation analysis also revealed that physical and individual mental health summaries were associated with psychological outcomes, with statistically significant negative correlations found between PCS-12 and MCS, PCS-12 and SOM-H, and MCS-12 and BDI scores. Regression analysis showed that physical activities and psychological status both had a direct influence on perceived mental and physical well-being during the lockdown, accounting for 56.7% and 35.5% of the variance, respectively. The p-values for the significant correlations ranged from <0.05 to <0.01. Overall, these findings highlight the importance of physical exercise and psychological well-being in maintaining good health during the pandemic.

Determining Breast Implant Prevalence: A Population Study of Italian Chest Radiographs

BACKGROUND

Current breast implant prevalence within the general population remains elusive. An accurate prevalence is critical to serve as the denominator for any assessment of breast implant-related complication. The purpose of this manuscript is to assess this prevalence in women aged 20-70 years in Italy.

MATERIALS AND METHODS

Eight reviewers, demonstrating a mean sensitivity of 87.0% and specificity of 97.0%, were recruited for retrospective identification of implants on chest radiographs from a tertiary academic hospital in a major urban setting. Three final reviewers were selected, and they assessed all eligible chest radiographs collected between January and December 2019. The hospital-based population was compared to epidemiological data at a local, regional and national level to demonstrate homogeneity of age structures using the phi correlation coefficient.

RESULTS

We identified 3,448 chest X-rays which yielded 140 implants, with an overall prevalence of 4.1% for women aged 20-70. Implants were bilateral in 76% of cases and unilateral in 24%. They were placed cosmetically in 47.1% cases and used for reconstruction in 52.9% cases. Phi correlation coefficient found no differences across hospital-based, local, regional and national populations.

CONCLUSION

A validated method was performed to estimate implant prevalence from an academic hospital in a major urban setting at 4.1% and was used to estimate national prevalence in Italy. The implications of this epidemiologic study may reach across national borders for improved understanding of breast implant epidemiology and in predicting the total number of patients within a given population that may be affected by device complications.

LEVEL OF EVIDENCE IV

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Informed Consent: Legal Obligation or Cornerstone of the Care Relationship?

The topic of informed consent has become increasingly important in recent decades, both in the ethical-deontological field and as a duty of law. The review covered all sentences issued by the 13th section of the Civil Court of Rome during the period January 2016-December 2020. During this period, 156 judgments were found in which a breach of consent was required; in 24 of these, specific liability was proven, and the corresponding compensation liquidated. Moreover, 80% of the cases concerned the lack of information provided. The most involved branches were those related to surgical areas: general surgery, plastic surgery and aesthetic medicine and orthopaedics. The total amount of compensation paid was EUR 287,144.59. The research carried out has highlighted how, in a broad jurisprudential context, the damage caused by the violation of the right related to informed consent is considered, and how it impacts on the economic compensation of damages. Additionally, it showed that the areas most affected by the information deficit are those related to the performance of surgical activities, which are characterized by greater invasiveness and a higher risk of adverse events. The data reported underline the exigency to consider informed consent not as a mere documentary allegation but as an essential moment in the construction of a valid therapeutic alliance, which is also useful for avoiding unnecessary litigation that is becoming increasingly burdensome for healthcare systems all over the world.

Forensic applications of hyperspectral imaging technique: a narrative review

Hyperspectral imaging (HSI) collects and processes information from the entire electromagnetic spectrum to obtain the spectrum of each pixel in the image of a scene, with the aim of finding objects and identifying materials. It is a non-contact, non-destructive technology that can be used without modifying or altering the analysed target. Forensic analysis and crime scene investigations are two of the most investigated fields of application, being able to detect and analyse many types of evidence.In this paper we analysed the most commonly reported forensic science applications.The literature indicates that the fields in which HSI appears most promising are the analysis of blood traces, document forgery, gunshot residues and the identification of fingerprints.

Tandem bullets: case report and ballistic analysis

Background

In forensic ballistics, the phenomenon of tandem bullets occurs when two or more bullets are ejected from the barrel of a firearm in a single shot. The injuries caused by these bullets have been described in the literature and include several possibilities, whose severity seems to be especially related to the mass increase of the exploded cartridges and to the distance at which the shots are fired, as a result of the sudden drop in kinetic energy that occurs.

Case presentation

We report the case of a subject hit by a tandem bullet, during an attempted robbery, describing the injury reported in relation to the ballistic analysis of the case and examining the dynamics in which this circumstance occurred.

Conclusions

The ballistic analysis conducted in our case confirmed that the harmful potential of “tandem bullets” is inversely correlated to the mass of the fired bullets. In our case, the exploded shot, consisting of two 38 Special caliber bullets fused together, hit the body of the subject involved with minimal kinetic energy and penetrating potential. We believe that further ballistic studies should be conducted on a cadaveric model by exploiting cadaveric donation programs for scientific research purposes, in order to investigate the wide spectrum of possible injuries that can occur, also simulating the effects of unjacketed tandem bullets.

Medico-Legal Aspects of Hospital-Acquired Infections: 5-Years of Judgements of the Civil Court of Rome

Introduction: Healthcare-associated infections (HAIs) represent a risk to patients’ health, as well as being an issue of worldwide relevance in terms of public health and increased healthcare costs. The occurrence of a complication causally related to the development of an infection contracted during a hospital stay, or in any event during a healthcare activity, may represent a source of liability for the healthcare facility itself and, therefore, lead to compensation for the injured patient. The aim of this research is to analyze the phenomenon of professional liability related to HAIs, to emphasize its economic and juridical aspects and, at the same time, highlight the clinical-managerial issues deserving attention, in order to guarantee the safety of care for patients. Methods: The retrospective review concerned all the judgments regarding HAIs drawn up by the Judges of the Civil Court of Rome, published between January 2016 and December 2020. Results: In the five-year period considered, 140 verdicts were issued in which the liability for which compensation was sought was related to the occurrence of healthcare-related infections. Convictions were recognized in 62.8%. The most involved branches were those related to the surgical areas: orthopedics, heart surgery, and general surgery. The three most frequently isolated organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The total amount of compensation paid was EUR 21.243.184,43. Conclusions: The study showed how the analysis of the juridical and medico legal aspects of HAIs may represent not only a helpful tool for healthcare performance assessment, but also a data source usable in clinical risk management and in the implementation of patient safety.

Legionella and Air Transport: A Study of Environmental Contamination

Introduction: There is growing interest in the public health and transport sectors in research into exposure to biological hazards, considering not only the risks arising from inter-human contagion, but also those related to exposure to the flight environment itself. The aim of this paper is to report data from an investigation into the water and air-conditioning systems of commercial aircraft for the presence of Legionella contamination, with a total of 645 water samples taken during the period 2007−2021. Methods: The investigation involved 126 aircraft of six different commercial aircraft types: MD80, Airbus A320 F, Embraer 175/190, AIRBUS A330, Boeing 767 and Boeing 777. Water samples were taken from the water systems (toilet taps, galley and boilers). Each sample was preliminarily subjected to an evaluation of the following parameters: temperature, pH and residual chlorine. The ScanVit® Legionella kit was used for bacteria detection and enumeration. Results: Samples were considered positive if the number of colony-forming units/liter (CFU/L) was >100. For the entire observation period, 45% of the investigated aircraft tested positive. Regarding the overall number of samples analyzed, 68.4% (441/645) were below 100 CFU/L, and thus within the limits allowed by the Italian Guidelines. Conclusions: Water system contamination with Legionella in the air transport field is a real public health issue that should not be underestimated given the heavy passenger traffic. Infection should be considered an occupational risk to which crew members are exposed.