No abstract

A gap was observed between the number of crimes reported to the judicial authorities (tip of the iceberg) and the estimated prevalence of the phenomenon in the literature. There is a need both to create a network of protection for the elderly involving medical and judicial specialists and to train healthcare professionals to better recognise and report cases of maltreatment.

The SARS-CoV-2 pandemic involved several changes and difficulties in the work of forensic pathologists. Postmortem nasopharyngeal swabs for the diagnosis of the SARS-CoV-2 infection are recommended before an autopsy examination by the Centers for Disease Control and Prevention.Autopsy examinations must not be performed for SARS-CoV-2 infection cases when airborne infection isolation rooms or other suitable spaces are unavailable. However, it has not yet been reported whether the presence of SARS-CoV-2 at a low viral load may be enough to infect and disseminate the contagion.Here, we report the case of a 67-year-old man found dead at home on November 9, 2020, and transferred immediately after to the Genova District Mortuary. As the first postmortem molecular nasopharyngeal swab resulted positive, a weekly sampling was carried until February 4, 2021. All the molecular tests were positive for SARS-CoV-2, including the last swab performed 87 days after the arrival of the corpse at the morgue. Virus isolation conducted on VERO E6 cells revealed no cytopathic effect indicating no viral replication as early as 18 days after the corpse's arrival at the morgue and until January 2021.Our findings suggest that the presence of the genome of SARS-CoV-2 at low viral load should not be considered a sign of an active infection but a trace of a remaining viral genome from a previous infection. Then, if the virus shows no replication activity, its molecular detection should not constitute a threat to public health. Further studies are required to establish the infection's potential and its correlation with viral load.

Sudden death due to massive hemorrhage after a mini-invasive ambulatory diagnostic procedure is extremely rare. Fine-needle aspiration (FNA) of thyroid nodules is very safe, displaying a low rate of complications, all of which mild and often self-limiting. In few cases do these complications necessitate surgical decompression, and rarely does FNA of a thyroid nodule lead to the death of the patient.We report a case of sudden death caused by respiratory insufficiency after compression of the vascular and nervous structures of the neck and obstruction of the upper airways by hemorrhages dissecting the thyroidal and perithyroidal tissues in a 78-year-old woman. These hemorrhages were the result of vascular lacerations caused during diagnostic FNA of a nodule suspected of malignancy. In such cases, it is important to conduct a complete autopsy and histological analysis to ascertain the origin of massive hemorrhage involving the structures of the neck and to attribute the cause of death to the aforementioned procedure. The forensic pathologist must bear in mind that even extremely small damage, such as that produced by a fine needle, may cause a fatal hemorrhage in subjects with a subverted anatomo-pathological picture (such as, for example, the massive fibrosis of an organ).

Rationale: Only a few cases of accidental deaths due to speargun injuries are reported in the literature. Murder or suicide cases are even rarer. Patient concerns: A 59-year-old male with a history of major depression and previous suicide attempts, was found, still alive and conscious, with a spear in his mouth and a fishing speargun a few meters away. The spear then penetrated the cranium and crossed the entire left cerebral hemisphere. Diagnoses: The patient underwent a retrograde removal of the spear. During the surgery, there was a massive encephalic bleeding. After about 2 days of coma, brain death was confirmed. An autopsy was performed to determine the cause of death. Interventions: The scalp presented hemorrhagic infiltrates in the left parieto-temporal region. There were an acute subdural hematoma and subarachnoid hemorrhage. At the opening of the lateral ventricles a massive fronto-parieto-temporal hematoma was evident. The skull base had a massive hemorrhagic infiltration and a circular fracture of about 0.5 cm in diameter, due to the penetration of the spear. The hard palate showed a circular solution of continuity with net margins whose diameter was consistent with the size of the spear. Outcomes: The cause of death was attributed to the traumatic cranial-encephalic lesions due to the speargun shot in the mouth. Lessons: The investigation into unusual cases of death constitutes a complex matter and requires a careful evaluation on the part of the forensic pathologist. A differential diagnosis may be necessary in order to rule out simulated suicide/homicide. In this particular case, the analysis of the scene of the self-suppression event and available circumstantial information, the evaluation of clinical data, the complete autopsy and the comparison between the injuries of the victim and the characteristics of the weapon used led to the confirmation of the suicidal nature of the death.