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Zuccarello P, Carnazza G, Salerno M, Esposito M, Cosentino S, Giorlandino A, Sessa F, Pomara C, Barbera N. Forensic investigation on a combined death by food aspiration and acute escitalopram intoxication occurred to a psychiatric subject in a nursing home. Int J Legal Med 2024:10.1007/s00414-024-03168-5. [PMID: 38321300 DOI: 10.1007/s00414-024-03168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer's, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action.
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Affiliation(s)
- P Zuccarello
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy.
| | - G Carnazza
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - M Salerno
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - M Esposito
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - S Cosentino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - A Giorlandino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - F Sessa
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - C Pomara
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - N Barbera
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
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Zuccarello P, Carnazza G, Giorlandino A, Cosentino S, Arcifa V, Barbera N. Lethal vortioxetine poisoning? A forensic investigation. Leg Med (Tokyo) 2023; 65:102314. [PMID: 37607460 DOI: 10.1016/j.legalmed.2023.102314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023]
Abstract
Vortioxetine is an antidepressant recently licensed in the US and EU for the treatment of major depressive disorder. No fatalities from vortioxetine overdose have been reported, yet. Two cases of attempted suicide are described in the literature, although no toxicological analyzes were conducted. Vortioxetine concentrations found in blood and organs in a case of a probable acute lethal intoxication are reported here. A 65-year-old woman was found on the floor behind her bed with no vital signs. The woman was recently on vortioxetine 10 mg/day for major depression, anxiety, and psychotic attacks. Vortioxetine was quantified in blood, brain, liver, kidney, and lung samples by LC-MS/MS. Vortioxetine concentrations were: 1.197 ng/ml in the blood, 804 ng/g in the brain, 8.992 ng/g in the lung, 1.389 ng/g in the liver, 292 in the kidney. No other substance was found. In the case reported here, the blood concentration was approximately 35-135 times higher than the antemortem therapeutic value. Histological examination showed signs of a probable sudden cardiac death following to arrhythmia, with no evidence of myocardial infarction. The present case indicate that blood concentrations close to 1,000 ng/mL could lead to death, involving probably to a cardiac toxicity.
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Affiliation(s)
- P Zuccarello
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy.
| | - G Carnazza
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - A Giorlandino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - S Cosentino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - V Arcifa
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - N Barbera
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
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Genovese MG, Cavallotti GP, Bocchini R, Carnazza G, Scaglione D, Ceccopieri D. [Radiologic evaluation of ileal reservoirs. Our experience]. MINERVA CHIR 1990; 45:241-5. [PMID: 2165578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A radiological investigation was performed in 25 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. Radiology was of great value in the demonstration of post-operative complications.
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Affiliation(s)
- M G Genovese
- Servizio di Radiodiagnostica, Ospedale Mauriziano Torino
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Cavallotti GP, Genovese MG, Carnazza G, Bocchini R, Marangella MM. [Radiological characteristics of primary hyperoxaluria with oxalosis]. Minerva Med 1989; 80:1125-8. [PMID: 2812471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Oxalosis is a rare disorder, in which there are widely and evenly spread deposits of oxalate crystals in the kidneys with progressive renal failure. An inborn error of metabolism is the cause of oxalosis. The incidence of this disease in boys and girls is practically equal. Most patients do not survive their 20th year. In our case there were changes in the skeleton and extensive deposits of oxalates in the kidneys.
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Affiliation(s)
- G P Cavallotti
- Servizio di Radiodiagnostica, Ospedale Mauriziano Umberto I, Torino
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Carnazza G, Cavallotti GP, Genovese MG, Sordo L, Taricco MT. [Nontraumatic lesions of the knee revealed by standard radiographic examination]. Minerva Med 1987; 78:1857-62. [PMID: 3431732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Examination of a series of knee arthrographies and CAT scans reveals the importance of certain signs of "lesions" that are revealed by simple standard radiography.
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Affiliation(s)
- G Carnazza
- Servizio di Radiodiagnostica, Ospedale Mauriziano Umberto I, Torino
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Genovese MG, Carnazza G, Cavallotti GP, Violante R. [Fibromatosis of the mesenterium]. Minerva Med 1987; 78:1481-4. [PMID: 3670694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A rare case of mesenteric fibromatosis observed in a 58 year old woman, repeatedly operated in the abdominal area, with a mesogastric-hypochondriac hard-elastic mass, is presented. Being the cause of the affection still unknown, an abnormal proliferation of fibrous tissue induced from chemical-physical injuries is considered at the basis of the clinical entity.
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Affiliation(s)
- M G Genovese
- Istituto di Radiodiagnostica, Ospedale Mauriziano Umberto I, Torino
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Taricco MT, Gortan L, Carnazza G, Genovese MG, Benincasa A. [Considerations on a rare case of C.R.E.S.T. syndrome]. Minerva Med 1984; 75:1965-7. [PMID: 6483254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A rare case of C.R.E.S.T. syndrome with evident pulmonary interstitial fibrosis is presented.
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Genovese MG, Benincasa A, Bosio C, Carnazza G. [Radiological studies of a case of post-traumatic intraparenchymal renal hematoma]. Minerva Urol 1983; 35:221-5. [PMID: 6656734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bianchi SD, Carnazza G, Mecozzi B, Murialdo G. [Radiotransparent lesions of the jaw]. Minerva Stomatol 1982; 31:799-808. [PMID: 6962345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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