Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease has been described to possibly be associated with ocular surface disturbances. However, whether the virus could invade ocular tissues still remains elusive. In the present study, we tried to investigate the post-mortem presence of SARS-CoV-2 RNA in corneal epithelium gathered by patients with an ante-mortem confirmed diagnosis of Coronavirus disease-19 (COVID-19). Cadavers with an ante-mortem confirmed diagnosis of moderate to severe COVID-19 were examined. Clinical and demographic features were retrieved from hospital patients’ notes. For each cadaver, corneal scrapings, conjunctival swabs (CS) and nasopharyngeal swabs (NPS) were collected to perform real-time reverse transcriptase polymerase chain reaction ((RT)-PCR) for SARS-CoV-2. Fourteen consecutive cadavers with an ante-mortem confirmed diagnosis of moderate to severe COVID-19 were examined. The last NPS performed ante-mortem confirmed SARS-CoV-2 infection in 12/14 (85.7%) patients. The mean death-to-swab time (DtS) was 3.15 ± 0.5 (2.10–5.1) h. The post-mortem NPS and CS found positive for SARS-CoV-2 RNA were 9/14 (64.3%) and 3/28 (10.7%), respectively. None of the corneal epithelium scrapes tested positive to RT-PCR for SARS-CoV-2 RNA. These data promote the SARS-CoV-2 as not able to contaminate the post-mortem corneal epithelium, while it can persist in different other structures of the ocular surface (i.e., the conjunctiva). It is reasonable to assume that such a contamination can occur ante-mortem too.

Background: Our study analysed the outpatient activity of the onco-hematology Complex Operative Unit (UOC) of Tor Vergata Hospital, Rome coronavirus disease 2019 (Covid-19) center, where, as a result of the sudden and unexpected emergency, healthcare services were provided through telemedicine procedures that can be considered very close to Telehealth. Aim of the study: our retrospective study aimed to assess the widespread use of telemedicine in terms of feasibility and safety related to adverse events, a crucial experience which will make it possible to predict any effective use of such a method in patients with hematological disorders even after the end of the Covid-19 emergency. Materials and methods: At the Day Hospital clinic, from 8 March to 31 May 2020, an outpatient group received 3828 medical teleconsultations and 11,484 additional contacts following the first examination; each patient examined through the telematic method required an average of three supplementary contacts via e-mail or telephone. Results: The follow-up lasted 145 days, and all the events that occurred were monitored. In total, we recorded 16 clinical adverse events, 5 of which classified as major events, and 11 as minor events. Conclusion: The 3828 telematic clinical examinations and the 11,484 additional contacts following the first examination carried out by the onco-haematology UOC of Tor Vergata Hospital, proved how telemedicine, albeit in its basic form, was a key tool in facing the sanitary emergency caused by the sudden spread of Covid-19. An experience that can be considered reliable enough to be replicated in possible post-Covid-19 emergencies. From a medical forensic point of view, the main issues to consider are informed consent, personal data management and professional responsibility profiles.

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.

The aim of this study was to investigate the persistence of SARS-CoV-2 in post-mortem swabs of subjects who died from SARS-CoV-2 infection. The presence of the virus was evaluated post-mortem from airways of 27 SARS-CoV-2 positive patients at three different time points (T1 2 h; T2 12 h; T3 24 h) by real-time PCR. Detection of antibodies to SARS-CoV-2 was performed by Maglumi 2019-nCoV IgM/IgG chemiluminescence assay. SARS-CoV-2 viral RNA was still detectable in 70.3% of cases within 2 h after death and in 66,6% of cases up to 24 h after death. Our data showed an increase of the viral load in 78,6% of positive individuals 24 h post-mortem (T3) in comparison to that evaluated 2 h after death (T1). Noteworthy, we detected a positive T3 post-mortem swab (24 h after death) from 4 subjects who were negative at T1 (2 h after death). The results of our study may have an important value in the management of deceased subjects not only with a suspected or confirmed diagnosis of SARS-CoV-2, but also for unspecified causes and in the absence of clinical documentation or medical assistance.

Nowadays, it is vital to have new, complete, and rapid methods to screen and follow pharmacotoxicological and forensic cases. In this context, an important role is undoubtedly played by liquid chromatography-tandem mass spectrometry (LC-MS/MS) thanks to its advanced features. This instrument configuration can offer comprehensive and complete analysis and is a very potent analytical tool in the hands of analysts for the correct identification and quantification of analytes. The present review paper discusses the applications of LC-MS/MS in pharmacotoxicological cases because it is impossible to ignore the importance of this powerful instrument for the rapid development of pharmacological and forensic advanced research in recent years. On one hand, pharmacology is fundamental for drug monitoring and helping people to find the so-called “personal therapy” or “personalized therapy”. On the other hand, toxicological and forensic LC-MS/MS represents the most critical instrument configuration applied to the screening and research of drugs and illicit drugs, giving critical support to law enforcement. Often the two areas are stackable, and for this reason, many methods include analytes attributable to both fields of application. In this manuscript, drugs and illicit drugs were divided in separate sections, with particular attention paid in the first section to therapeutic drug monitoring (TDM) and clinical approaches with a focus on central nervous system (CNS). The second section is focused on the methods developed in recent years for the determination of illicit drugs, often in combination with CNS drugs. All references considered herein cover the last 3 years, except for some specific and peculiar applications for which some more dated but still recent articles have been considered.