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Anna Laura SANTUNIONE
Ricercatore Universitario
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze,sede Istituti Anatomici (area Policlinico)
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Pubblicazioni
2025
- Correlation between epicardial fat volume and postmortem radiological and autopsy findings in cases of sudden death: A pilot study
[Articolo su rivista]
Camatti, Jessika; Santunione, Anna Laura; Draisci, Stefano; Antonella, Drago; Amorico, Maria Grazia; Ligabue, Guido; Silingardi, Enrico; Torricelli, Pietro; Cecchi, Rossana
abstract
Epicardial fat volume (EFV) has recently been recognized as a good predictor of multivessel coronary artery disease, and the Coronary Artery Calcium Score (CACS) is a parameter that estimates the amount of calcium in the coronary tree. Both of these parameters can be assessed non-invasively by cardiac computed tomography. Previous studies have investigated a correlation between autopsy results and radiologically calculated EFV and CACS. The present study aims to investigate a correlation between EFV and other radiological (CACS and the presence of coronary artery opacification defects on Multi-Phase Post-Mortem Computed Tomography Angiography (MPMCTA)) and autoptic (presence of coronary stenosis) findings, in order to verify whether EFV can be considered a good predictor of radiological and autoptic coronary findings. A cohort of 21 subjects who died suddenly was examined. Firstly, MPMCTA was performed, then autopsy was carried out. EFV and CACS were radiologically calculated, the detection of opacification defects on MPMCTA was investigated and the presence of coronary stenoses on autopsy was assessed. 21 deceased individuals (51 ± 10,77 years; 19 men) were evaluated. Statistically significant correlations were found between levels of EFV > 125 mL (cut-off indicated for prognostic risk stratification) and CACS > 0 (signifying the presence of coronary calcifications), opacification defects on MPMCTA, and coronary stenosis on autopsy. The volume of the epicardial fat, detected radiologically, is a promising additional tool in the assessment and risk stratification for sudden death. Further research is needed to better explore the application of radiologically calculated EFV in cases of sudden death.
2025
- Emergency department crowding: An assessment of the potential impact of the See-and-Treat protocol for patient flow management at an Italian hospital
[Articolo su rivista]
Verzelloni, Pietro; Adani, Giorgia; Longo, Alessandro; Di Tella, Silvio; Santunione, Anna Laura; Vinceti, Marco; Filippini, Tommaso
abstract
Background: Crowding and patient flow management are among the most relevant issues for emergency departments (EDs). This results in delayed treatment, adverse outcomes and increased costs. For these reasons, nurse-independent treatment protocols were developed aimed at managing non-emergency patients outside EDs thus improving patient flow. Our objective was to assess the potential impact of the implementation of the “See-and-Treat” protocol on eligible patients and related healthcare costs at an Italian ED. Methods: We selected all minor access codes from 2022 at the ED of Sassuolo Hospital in Northern Italy. We only included subjects discharged to home, while we excluded those who required specialized medical care or had received “Fast-Track” treatment. We identify a list of medical conditions to identify subjects eligible for inclusion in the See-and-Treat protocol and calculate the related healthcare costs. Results: Of 40,906 individual ED admissions, 2,607 (6.4%) qualified for See-and-Treat management. Limb injuries and pain were the leading conditions at presentation. Through cost analysis, we found that implementation of the See-and-Treat protocol may result in savings over €100,000/year at Sassuolo Hospital, and over €7 million if projected to the entire Emilia-Romagna Region. Conclusions: Despite some limitations affecting protocol implementation, especially availability of highly-specialized and specifically-trained nurses, the study provided a foundation for a more comprehensive understanding of the implementation of the See-and-Treat protocol as a possible valid model with a view to both human and economic healthcare resources.
2025
- Experience based efficient approach for DNA-led identification of highly carbonized human remains
[Articolo su rivista]
Gianfreda, Denise; Corradini, Beatrice; Ferri, Gianmarco; Ferrari, Francesca; Borciani, Ilaria; Cecchi, Rossana; Santunione, Anna Laura
abstract
In case of severely burned bodies, victim identification by visual or fingerprints recognition is often prevented by altered body conditions. To overcome these circumstances, different techniques are available. Among these, the most reliable is molecular identification, especially in cases of detached body parts. However, DNA analysis of highly burned remains is a very challenging task. The high temperatures reached at the time of burning can lead to the complete destruction of the genetic material, making DNA typing arduous.
This work presented a successful identification through molecular analysis of 11 heavily carbonized victims assigned to the Institute of Legal Medicine of Modena (Italy) between June 2022 and June 2023: a helicopter crash, a femicide and two car accidents.
Post-mortem (PM) and ante-mortem (AM) data were compared, allowing victims’ identification and their quick return to relatives. Complete autosomal and Y chromosome STRs profiles were obtained for all the corpses. For the helicopter crash case, the utility of the DVI module implemented in the Familias software is shown as this aid the fast association of the seven victims involved with the familiar references available for identification.
The importance of the sampling strategy and the need of a systematic approach to select the most promising biological material for a more successful downstream DNA-based identification is also highlighted.
2025
- Fatal Waterhouse-Friderichsen Syndrome caused by Streptococcus pneumoniae in a vaccinated adult with traumatic splenectomy: A case report
[Articolo su rivista]
Santunione, A. L.; Camatti, J.; Zucchi, F.; Ferronato, C.; Ferrari, F.; Caramaschi, S.; Silingardi, E.; Cecchi, R.
abstract
: Waterhouse-Friderichsen Syndrome (WFS) is a rare but life-threatening condition characterized by massive adrenal hemorrhage. WFS represents one of the features of the Overwhelming Post-Splenectomy Infection, which occurs any time after spleen removal and is recognized as the most serious complication in asplenic patients. We report a fatal case of WFS resulting from Streptococcus pneumoniae infection in a vaccinated and splenectomized patient. D.R., a 62-year-old man who had been splenectomized 20 years earlier following a traffic accident and had undergone Streptococcus Pneumoniae vaccination, had an acute febrile episode with chills at home, followed by vomiting. He died suddenly within 12 h of presentation. A multidisciplinary approach was adopted to resolve the case. Autopsy, histological, immunohistochemical, microbiological and toxicological examinations were performed. At autopsy, both adrenal glands presented increased volume and diffuse intraparenchimal hemorrhage. Postmortem bacteriological cultures of blood, cerebrospinal fluid and pericardial fluid showed S. pneumoniae, while serologic and molecular characterization demonstrated that the serotype responsible was serotype 23B, which was not included in the vaccination which D.R. underwent. Accordingly, the cause of death of D.R. was attributed to acute adrenal insufficiency due to Waterhouse-Friderichsen syndrome caused by Serotype 23B Streptococcus pneumoniae infection. In splenectomized patients with fever, accompanied by other nonspecific symptoms, the diagnosis of WFS should be considered, even if the subjects received the recommended vaccinations. The postmortem diagnosis of WFS requires a multidisciplinary approach, including macroscopic examination, histological analysis, and microbiologic investigations, so it is necessary to collect appropriate postmortem biological specimens for microbiological investigation.
2025
- Forensic age progression application in a morphological study of an Italian family: A case report
[Articolo su rivista]
Donato, Laura; Ubelaker, Douglas H; Bugelli, Valentina; Camatti, Jessika; Treglia, Michele; Santunione, Anna Laura; Marsella, Luigi Tonino; Cecchi, Rossana
abstract
: Processing a photo aimed at the aging of the person depicted is a delicate process. The technique performed in these cases, i.e. age progression, takes into consideration the physiognomic elements of the face and its variations over time. This study aims to deepen knowledge regarding the morphological similarities of the physiognomic traits found in two generations of an Italian family. Age progression is carried out on the two daughters to compare the result with their current appearance. Twelve photos were studied, depicting the members of an Italian family in close-up. Three photos of each member of the family were analysed, consisting of the father, mother, and two sisters (L. and E.). Facial features, such as shape of the face, eyes, eyebrows, nose and mouth were evaluated at age 1, 7 and 30. In addition, age progression technique was applied. Through the analysis of the images, facial features are studied to find similarities, and the problems encountered in studying the photos are discussed. Furthermore, the age progressions are obtained, and they do not show 100% accuracy. This study represents an analysis of age progression technique and explains how the provision of photographic documentation of family members can be important.
2025
- Socio-demographic and toxicological findings from autoptic cases in a Northern Italy community (2017-2022)
[Articolo su rivista]
Palazzoli, Federica; Filippini, Tommaso; Lavenia, Antonino; Balduini, Simone; Attanasi, Alessia; Verri, Patrizia; Vandelli, Daniele; Castagnetti, Valentina; Santunione, Anna Laura; Vinceti, Marco; Cecchi, Rossana
abstract
IntroductionThe overall trend in the use of licit and illicit substances is increasing. However, a few data on socio-demographic and toxicological findings in post-mortem cases are available.MethodsA retrospective study was conducted on autoptic cases evaluated in the Institute of Legal Medicine of the cities of Modena and Reggio Emilia in the period 2017-2022. Positivity to toxicological compounds and their relation with sociodemographic and forensic features were evaluated.ResultsA toxicological analysis was conducted in 504 cases out of 794 autopsies, finding 330 positive cases. An association was observed between positivity and increasing age, as well as manner of death. The most frequently observed classes of substances were benzodiazepine (41.2%), followed by alcohol (35.5%) and abuse drugs (24.8%). For every class of substances in at least half of the cases two or more classes were detected. As regards prescribed drugs, approximately 40% of cases assumed 2 or more drugs, while polypharmacy occurred in 6.1%.ConclusionsOlder age and specific causes of deaths appear to be associated with toxicological findings. In addition, co-assumption of licit and illicit substances emerged as a widespread phenomenon in our study population. Under a public health perspective, these data provide findings of relevance for preventive and therapeutic measures.
2025
- The age progression technique: Study and evaluation of the results
[Articolo su rivista]
Donato, L.; Cecchi, R.; Ubelaker, D. H.; Camatti, J.; Davis, M.; Santunione, A. L.; Treglia, M.; Marsella, L. T.
abstract
Age progression technique involves a reworking of the photo of a missing person in accordance with the guidelines drawn up by medical sciences on aging. Here we present the age progression of photos of individuals who are not missing persons, so the photos of their current appearance are available. The creation of age progressions in blind starting from photos of them as children made it possible to evaluate the effectiveness of the technique. The age progression was carried out based on a photo of Individual A and Individual B. First, the study of the facial features defined the morphology according to the standard classification, then reference images characterized by morphologies consistent with those of the original image were searched for. Thanks to Adobe Photoshop 2023 software, the creation of a collage was made. Finally, the result was compared with the current photo of the individual. The analysis of the two age progressions carried out gave different results. In the age progression of Individual A, the morphology of the facial features reveals similarities with slight errors in the comparison with his photo at 19 years old. Regarding the age progression of Individual B's face, doubts were raised regarding both skin tone and haircut. The positive and negative aspects found in these age progressions are of great importance in evaluating the accuracy of the results. Thanks to continuous practice, the age progression technique can be improved so that it can be a real support tool for the search for long-time missing persons.
2024
- Cardiovascular drugs and suicide death: Determination of carvedilol, amlodipine, doxazosin and diltiazem in two fatal cases
[Articolo su rivista]
Santunione, A. L.; Palazzoli, F.; Verri, P.; Vandelli, D.; Castagnetti, V.; Profeta, C.; Silingardi, E.
abstract
A number of medical conditions are identified as risk factors for suicide death; in particular, cardiovascular illnesses are recognized as a major suicide risk factor. In this case, self-poisoning is the common method of suicide and cardiovascular drugs are among the major medications associated with fatal overdose, with calcium channel blockers being one of the most common agents. The present study describes two different fatal suicide cases involving four cardiovascular drugs: carvedilol, doxazosin and amlodipine (case 1) and diltiazem (case 2). The concentrations of the target cardiovascular drugs in the different biological specimens (central and femoral blood, urine, liver, brain) are presented, giving information about the potentially fatal data and the distribution of the drugs in the body. The study led to the implementation of a fast, sensitive and simple method for the detection and quantification of the four commonly prescribed cardiovascular drugs in post-mortem specimens including fluids and tissues for forensic purposes. The method was fully validated. The toxicological results of the studied cases are discussed, along with the autopsy results, histopathological evidence, and circumstances of death. The toxicological findings presented in the study provide new data regarding cardiovascular drugs in different post-mortem specimens, which will contribute to the currently limited knowledge about the toxicological profile of cardiovascular drugs and their distribution.
2024
- Forensic & Legal Medicine in Italy
[Capitolo/Saggio]
Santunione, Anna Laura; Bugelli, Valentina; Cecchi, Rossana
abstract
In this chapter we will present the forensic and legal medicine in Italy: the postgraduate training path, the characteristics of the specialization school and its training objectives, and the mandatory activities that must be certified in the trainee's pathway in order to obtain the title of specialist. We will also discuss the various fields of activity in which the forensic doctor can work in Italy, not only in the forensic field, but also in the field of civil liability, diagnostic activities, medico-legal activities for the Italian National Health Service and in the field of social security, social assistance and insurance.
2024
- Forensic species identification: practical guide for animal and plant DNA analysis
[Articolo su rivista]
Corradini, Beatrice; Gianfreda, Denise; Ferri, Gianmarco; Ferrari, Francesca; Borciani, Ilaria; Santunione, Anna Laura; Cecchi, Rossana
abstract
: The importance of non-human DNA in the forensic field has increased greatly in recent years, together with the type of applications. The molecular species identification of animal and botanical material may be crucial both for wildlife trafficking and crime scene investigation. However, especially for forensic botany, several challenges slow down the implementation of the discipline in the routine.Although the importance of molecular analysis of animal origin samples is widely recognized and the same value is acknowledged to the botanical counterpart, the latter does not find the same degree of application.The availability of molecular methods, especially useful in cases where the material is fragmented, scarce or spoiled preventing the morphological identification, is not well known. This work is intended to reaffirm the relevance of non-human forensic genetics (NHFG), highlighting differences, benefits and pitfalls of the current most common molecular analysis workflow for animal and botanical samples, giving a practical guide. A flowchart describing the analysis paths, divided in three major working areas (inspection and sampling, molecular analysis, data processing and interpretation), is provided. More real casework examples of the utility of non-human evidence in forensic investigations should be shared by the scientific community, especially for plants. Moreover, concrete efforts to encourage initiatives in order to promote quality and standardization in the NHFG field are also needed.
2024
- Predictive value of coronary artery calcium score on radiological and autoptic findings in cases of sudden death
[Articolo su rivista]
Camatti, Jessika; Santunione, Anna Laura; Draisci, Stefano; Antonella, Drago; Amorico, Maria Grazia; Ligabue, Guido; Silingardi, Enrico; Torricelli, Pietro; Cecchi, Rossana
abstract
Calcium Artery Coronary Score (CACS) is a noninvasive examination of the coronary arteries in which the amount of calcium is calculated using cardiac Computed Tomography. The role of postmortem imaging in sudden death has been the subject of increasing interest in recent years, and previous studies have proposed a possible correlation between CACS and autopsy findings. The present study aims to establish a correlation between CACS, the presence of coronary artery opacification defects on Multi-Phase Post-Mortem Computed Tomography Angiography (MPMCTA), and the presence of coronary stenosis at autopsy, in order to verify whether CACS confirms its predictive value in terms of cardiac risk and can guide the decision to perform or not to perform MPMCTA. A cohort of 24 subjects who died suddenly was examined. Firstly, MPMCTA was performed, then autopsy was carried out. CACS was calculated, the detection of opacification defects on MPMCTA was investigated and the presence of coronary stenoses on autopsy was described. 24 deceased individuals (53 years +/- 11.7; 20 men) were evaluated. CACS has a positive predictive value of 0.78 and a negative predictive value of 0.73 in assessing the presence of radiological coronary artery opacification defects. The positive predictive value on stenosis relief is 0.88, while the negative predictive value on the same relief is 0.73. CACS is an appropriate additional tool in the evaluation of sudden death cases. Our results provided an encouraging contribution to the systematic application of CACS in cases of sudden death.
2023
- Cannabinoid Stability in Postmortem Brain Samples Stored at Different Temperatures
[Articolo su rivista]
Santunione, A L; Palazzoli, F; Verri, P; Vandelli, D; Chiapelli, F; Silingardi, E
abstract
Drug stability is an important concern of forensic toxicological testing, particularly postmortem samples that may be stored for an extensive period of time before analysis. In postmortem toxicology, the complex assessment of analyte stability in biological matrices can profoundly impact the interpretation of toxicological results and the outcome of forensic casework. The aim of this work is to assess the stability of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH), and 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid glucuronide (THCCOOH-glucuronide) in brain stored at three different temperatures (4°C, -20°C and -70°C) up to over 12 months (390 days) in order to establish the best storage condition for preventing potential drug degradation during the storage period. Brain is suitable and useful for xenobiotic concentrations and a valuable specimen in the interpretation of postmortem toxicological results. In our study, pooled brain specimens were spiked at low and high concentrations to evaluate the change in concentration over time. Stable compounds were quantified within ±20% of the target concentration (the mean concentration resulting from the initial analysis). According to stability criteria, our preliminary findings revealed that all the cannabinoids studied are stable in frozen brain samples (-20°C and -70°C) for over 12 months: all the analytes' concentrations remained unaffected during storage over time, the analytical variation staying within ±20%. On the contrary, under refrigeration conditions (4°C), 11-OH-THC, THCCOOH and THCCOOH-glucuronide were instable. Authentic brain samples, collected from eight cases during the autopsy, were analyzed and the stability was evaluated. This study provided new data on cannabinoid stability in brain. The stability of the brain samples, both in spiked samples and authentical caseworks, highlights the importance of the brain as a valid testing matrix when retesting is required after a long period of time or when laboratories are faced with backlog.
2023
- Capitolo 11 "La tutela della riservatezza, il segreto professionale ed il segreto d'ufficio. Il trattamento dei dati riservati"
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2023
- Capitolo 12 'Il referto e la denuncia di reato'
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2023
- Capitolo 13 "Riflessi medico legali della pandemia da SARS-CoV-2"
[Capitolo/Saggio]
Silingardi, E.; Santunione, A. L.
abstract
2023
- Capitolo 24 "I delitti contro l'incolumità pubblica"
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2023
- La documentazione sanitaria: la cartella clinica, le certificazioni mediche
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2022
- Gli esti della ricerca: parte II. Questionario per responsabili Residenze per anziani.
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
Lo scopo del progetto di ricerca "Covid-19, sicurezza sul lavoro e responsabilità. monitoraggio e implementazione di protocolli integrati anticontagio nella provincia di Modena (Protocovid)" è stato da un lato quello di condividere con enti locali, pubblici e privati i dati di un osservatorio a carattere multidisciplinare. In questo contesto si inseriscono una serie di questionari che sono stati appositamente confezionati e diffusi dal gruppo di ricerca a varie realtà aziendali della provincia di Modena. é stato inoltre somministrato uno speciale questionario alle strutture Residenziali per anziani della provincia di Modena
2021
- Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study
[Articolo su rivista]
Camatti, Jessika; Santunione, Anna Laura; Draisci, Stefano; Gangi, Bruno Giuliano; Bisceglia, Marco; Bini, Riccardo; Renzi, Riccardo; Silingardi, Enrico
abstract
While post-mortem angiography (PMA) is gradually establishing its role in Forensic Radiology, the available literature in Italy lacks a solid foundation, particularly regarding its use in criminal court proceedings. An illustrative example of multiphase post-mortem CT angiography (MPMCTA) is presented here to encourage the systematic implementation of PMA methods. To demonstrate concordance between MPMCTA and the reference standard (autopsy and histology) in a case of acute coronary thrombosis, we report a case where MPMCTA, autopsy, histological and toxicological analyses were performed on a previously healthy 51-year-old man. MPMCTA detected a right coronary artery filling defect that could be ascribed to coronary thrombosis, which was later confirmed by autopsy and histological examinations.
2021
- Post-mortem distribution of mephedrone and its metabolites in body fluids and organ tissues of an intoxication case
[Articolo su rivista]
Palazzoli, F.; Santunione, A. L.; Verri, P.; Vandelli, D.; Silingardi, E.
abstract
New psychoactive substances (NPS) are substances that continue to appear on the drug market to bypass controlled substance legislation. Mephedrone or 4-methylmethcathinone is becoming the most popular new psychoactive substance among youth as a recreational drug. The present study describes the optimization and validation of a sensitive method that combined clean up procedure and LC–MS/MS technique designed to simultaneously determine the presence of Mephedrone and its two metabolites (normephedrone as active metabolite and dyhidromephedrone) in post-mortem specimens (body fluids and organ tissues). To date, this is the first determination of Mephedrone metabolites in post-mortem specimens. The validated method was applied to a fatal Mephedrone intoxication case. The distribution of the three analytes in different post-mortem matrices was presented. The toxicological results of the studied case are discussed, along with autopsy, histopathological evidence and crime-scene information. The toxicological results presented in the study provide new data relative to mephedrone and the distribution of its metabolites in post-mortem specimens. In our opinion, the metabolite concentration database must be developed because the metabolites may be linked to toxicity. The pattern of parent drug and its metabolites can be helpful in the interpretation of fatal cases involving mephedrone, which will contribute to the currently limited knowledge about mephedrone and metabolites concentrations.
2020
- Cannabinoids Determination in Brain: A Supplemental Helpful in Postmortem Evaluation
[Articolo su rivista]
Palazzoli, F; Santunione, A L; Marchesi, F; Verri, P; Vandelli, D; Licata, M; Silingardi, E
abstract
The scientific interest in Cannabis has been documented by a wide literature but postmortem studies and interpretations of autopsy findings are lacking or limited to few cases, few matrices analyzed or a small number of analytes. The present study describes the development and full in-house validation of a sensitive and simple method based on an optimized rapid clean up procedure combined with a robust and highly sensitive LC-MS-MS technique, designed to simultaneous determination of Delta9-tetrahydrocannabinol (THC), cannabidiol (CBD), 11-hydroxy-Delta9-tetrahydrocannabinol (11-OH-THC), 11-nor-Delta9-tetrahydrocannabinol-carboxylic acid (THC-COOH) and 11-nor-Delta9-tetrahydrocannabinol-carboxylic acid-glucuronated (THC-COOH-glucuronide) in postmortem samples: central blood (CB), femoral blood (FB) and brain tissue (BR). The developed method was validated and applied to 24 postmortem cases involving cannabinoids. In this study, we presented a full optimization and validation of target analyses for each matrix. The procedure had proven to be reliable and accurate. This study adds new data, particularly about the cannabinoids concentrations in BR samples. Combined pattern (CB, FB, BR) can be used in the interpretation of postmortem cases, proving and strengthening the assessments made on blood data. BR matrix in a helpful supplement in the investigation of the role of cannabinoids as crucial or contributory factor in leading to death.
2019
- Cap. 6: La Documentazione sanitaria: la cartella clinica, le certificazioni mediche in 'Medicina legale. Per studenti e medici di medicina generale'
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 10: 'La tutela della riservatezza . il segreto professionale e il segreto d'ufficio. il trattamento dei dati riservati'. In Medicina legale per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 11 'Il referto e la denuncia di reato'. In Medicina legale. Per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Silingardi, E.
abstract
2019
- Capitolo 22: I delitti contro l'incolumità pubblica. In Medicina legale. Per studenti e medici di medicina generale
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2019
- Capitolo 23 'Il delitto di doping'. In Medicina legale. Per studenti e medici di medicina generale
[Capitolo/Saggio]
Licata, M.; Santunione, A. L.; Tagliaro, F.
abstract
2019
- "I delitti contro l'incolumità pubblica" in Medicina legale per i corsi di laurea a orientamento giuridico e triennali
[Capitolo/Saggio]
Santunione, A. L.; Licata, M.; Silingardi, E.
abstract
2019
- Il delitto di doping in Medicina legale per i corsi di laurea a orientamento giuridico e triennali
[Capitolo/Saggio]
Licata, M.; Santunione, A. L.; Tagliaro, F.
abstract
2018
- Multi-phase postmortem CT angiography (MPMCTA): experiences of the Forensic Radiology Unit in the University Hospital of Modena - Italy
[Poster]
Amorico, M. G.; Drago, A.; Procicchiani, D.; Tore, E.; Vecchio, S.; Santunione, A. L.; Dominguez, A.; Silingardi, E.; Torricelli, P.
abstract
The collaboration between forensic science and radiology has been lasting and proficuous, and both the disciplines now learn from and support each other. Since the first use of conventional radiology in forensic science, every new technology developed in clinical radiology has been gradually absorbed in the forensic use. Multi-phase postmortem CT angiography (MPMCTA) is increasingly being recognized as a valuable adjunct medico-legal tool to investigate the vessels of the head, thorax and abdomen. We present the expreriences of the Forensic Radiology Unit of the University of Modena and Reggio Emilia.
2018
- The role of ethyl glucuronide in supporting medico-legal investigations: Analysis of this biomarker in different postmortem specimens from 21 selected autopsy cases
[Articolo su rivista]
Santunione, Anna Laura; Verri, Patrizia; Marchesi, Filippo; Rustichelli, Cecilia; Palazzoli, Federica; Vandelli, Daniele; Licata, Manuela; Silingardi, Enrico
abstract
Ethanol determination in postmortem blood is one of the most frequently requested analyses in legal medicine and forensic toxicology. Ethyl glucuronide is a non-oxidative ethanol metabolite. It is also a useful marker of ante-mortem alcohol ingestion when ethanol itself has been completely eliminated from the body and could be considered in autopsy cases to obtain more reliable indications. The aim of the present study was to investigate the ethyl glucuronide distribution in postmortem specimens from autopsy cases found to be positive for ethanol. We presented 21 autopsy cases in which central blood, peripheral blood and liver samples were available. Specimens were analyzed for ethyl glucuronide by liquid chromatography tandem mass spectrometry; we also recorded postmortem interval, case history, cause of death, use of drugs, metabolic disorders if present, putrefaction if present, history of ethanol abuse and information about ethanol intake before death. Our aim was to evaluate and to compare the ethyl glucuronide levels in different matrices taken from the same subject in order to provide a better understanding of the interpretation of postmortem ethyl glucuronide concentrations.
2017
- L'imaging TC nella valutazione post-mortem delle vittime del territorio in EMilia
[Articolo su rivista]
Baldoni, F.; Procicchiani, Diego; Amorico, Mg.; Tidaro, R. Tata C.; Pizzirani, M.; Santunione, A. L.; Camatti, Jessika; Silingarsi, E.; Torricelli, P.
abstract
Lo sviluppo delle moderna tecniche di diagnostica per immagini ha portato ad una revisione delle consolidate metodologie nel campo dell'indagine medico-legale. In quest'ottica si inserisce ,l'adozione, oltre al tradizionale impiego di routinari rilievi radiografici, di modalità diagnostiche più sofisticate ed avanzate quali la TC multistrato (TCMS). Nella nostra esperienza la TCMS, adottata per lo studiodi pazienti deceduti in un mass disaster quale il terremoto che ha colpito l'Emilia nel 2012, insieme alla ricognizione esterna di cadavere effettuata dal patologo forense, si è dimostrata utile per lo studio, l'identificazione e la valutazione delle lesioni riportate dalle vittime in seguito al crollo di edifici industriali
2016
- A study of distribution of ethyl glucuronide in post-mortem matrices
[Abstract in Atti di Convegno]
Santunione, Anna Laura; Verri, Patrizia; Palazzoli, Federica; Marchesi, Filippo; Valdelli, D.; Licata, Manuela; Silingardi, Enrico
abstract
Background and aim. Ethanol determination in post-mortem blood is one of the most important and frequently requested analysis in legal medicine and forensic toxicology. Post-mortem ethanol formation is a well-known problem, so correct interpretation of ethanol detection in post-mortem samples can be difficult. Therefore determining whether a finding of ethanol is due to antemortem ingestion of alcohol or not is very relevant in order to solve medico-legal question regarding traffic or occupational accidents or to establish victime capacity of reaction. EtG is a non oxidative ethanol metabolite with many applications in forensic toxicology. In autopsy samples can be used to determine recent alcohol consumption if blood ethanol has already been eliminated (that explains for example a positivity to cocaetilene [CE]) but furthermore it is a marker of antemortem ethanol ingestion. Study aim was to investigate the EtG distribution in post-mortem matrices: EtG concentration in heart blood, femoral blood and liver has been determined by LC-MS/MS.
Material and methods. The samples were collected in autopsies of the Institute of Legal Medicine in Modena, Italy. We selected blood ethanol positive or blood CE positive autopsy cases in the period 2012-2015, during which all autopsy were also analyzed for EtG. In all cases we also recorded time frame between death and autopsy, case history, cause of death, putrefaction, if present. The analytical method used allowed the quantification of EtG in postmortem blood and liver. Among sample preparation, 200 mg of blood and 1 g of liver were added with physiological water, 200 mg supernatant was added to 10 µL internal standard solution (EtG-D5 1 ng/µL), 900 µL methanol. The methanol layer was transferred to Phenomenex PhreeTM Phospholipid Removal Tabbed 1 ml Tube. The cleaned methanol solution was taken to dryness and analysed by LC-MS/MS with negative ionization MRM mode.
Results and discussion. We analized 54 autopsy cases and in total 113 autopsy samples. The frame between death and autopsy ranged from 24 h to 9 days. Both heart blood and peripheral blood was obtained in 31 cases, in 28 cases also liver speciman was available, in 21 cases only central blood was obtained, in 2 cases only peripheral blood. In 41 cases EtG was positive. In these EtG positive cases heart blood concentrations ranged from 10 to 42000 ng/ml, femoral blood concentraion ranged from 10 to 4698 ng/ml, liver concentrations ranged from 394 to 40615 ng/g. Distribution data of EtG in tested specimens will be presented.
2015
- Estimation of the time of death through the analysis of clock miRNAs expression in blood and vitreous humor
[Articolo su rivista]
Corradini, Beatrice; Alu', Milena; Radheshi, Erjon; Gabbolini, Valentina; Ferrari, Francesca; Santunione, Anna Laura; Silingardi, Enrico
abstract
Estimation of the time since death is a practical task in daily forensic casework but available methods lack reliability especially in complex deaths and after long PM period. MirRNA analysis should be ideally an useful ancillary tool as it proved to be sensitive in forensics especially for body fluid identification.
Here we analyzed 10 miRNAs with a supposed role in circadian rhythms through an RT-qPCR assay in postmortem samples of blood (n = 12) and vitreous humor (n = 12) from individuals died in the day or at night, in order to find those with an oscillating pattern of variation. The expression stability of four endogenous controls was also tested to find the most suitable for normalization.SNORD95 proved to be the best and was used in both body fluids. Four miRNAs showed significant differential expression between individuals died at daytime and at nighttime, mir-106b and mir-96 in vitreal samples and mir-142-5p and mir-219 in blood. Results are preliminary and limited to the small sample set. Future studies on more samples and with additional markers are needed to further elucidate the role of miRNA profiling in postmortem contexts and how useful they would be as “chronobiomarkers” for time of death determination
2015
- Forensic botany II, DNA barcode for land plants: Which markers after the international agreement?
[Articolo su rivista]
Ferri, Gianmarco; Corradini, Beatrice; Ferrari, Francesca; Santunione, Anna Laura; Palazzoli, Federica; Alu', M. 2.
abstract
The ambitious idea of using a short piece of DNA for large-scale species identification (DNA barcoding) is already a powerful tool for scientists and the application of this standard technique seems promising in a range of fields including forensic genetics. While DNA barcoding enjoyed a remarkable success for animal identification through cytochrome c oxidase I (COI) analysis, the attempts to identify a single barcode for plants remained a vain hope for a longtime. From the beginning, the Consortium for the Barcode of Life (CBOL) showed a lack of agreement on a core plant barcode, reflecting the diversity of viewpoints. Different research groups advocated various markers with divergent set of criteria until the recent publication by the CBOL-Plant Working Group. After a four-year effort, in 2009 the International Team concluded to agree on standard markers promoting a multilocus solution (rbcL and matK), with 70-75% of discrimination to the species level. In 2009 our group firstly proposed the broad application of DNA barcoding principles as a tool for identification of trace botanical evidence through the analysis of two chloroplast loci (trnH-psbA and trnL-trnF) in plant species belonging to local flora. Difficulties and drawbacks that were encountered included a poor coverage of species in specific databases and the lack of authenticated reference sequences for the selected markers. Successful preliminary results were obtained providing an approach to progressively identify unknown plant specimens to a given taxonomic rank, usable by any non-specialist botanist or in case of a shortage of taxonomic expertise. Now we considered mandatory to update and to compare our previous findings with the new selected plastid markers (matK+rbcL), taking into account forensic requirements. Features of all the four loci (the two previously analyzed trnH-psbA+trnL-trnF and matK+rbcL) were compared singly and in multilocus solutions to assess the most suitable combination for forensic botany. Based on obtained results, we recommend the adoption of a two-locus combination with rbcL+trnH-psbA plastid markers, which currently best satisfies forensic needs for botanical species identification.
2015
- investigation of erthquake related deaths using post-mortem multi detector computed tomography
[Abstract in Atti di Convegno]
Santunione, Anna Laura; Perini, Andrea; Radheshi, Erjon; Amorico, Maria Grazia; Tata, Cristina; Torricelli, Pietro; Silingardi, Enrico
abstract
Purpose: Post-mortem Multi-Detector Computed Tomography (MDCT) is now recognized as a valuable adjunct medicolegal tool. Beside its application for identification purposes, MDCT is used to assist pathologists in determining cause of death. Compared to conventional radiography MDCT offers advantages in detecting blunt force injury, and can quickly provide a guide to lethal injuries. Therefore, the use of MDCT for earthquake-related deaths is an obvious choice, as blunt force injuries are common in such victims. The purpose of this study was to evaluate the impact of MDCT on the assessment of causes of death, in a case series of fatal injuries after the 2012 Modena earthquake.
Methods and materials: 12 medicolegal cases underwent full-body CT-scan and external examination. The circumstances of death were collected and reviewed. Conventional autopsy was not authorized by the local Prosecutor for all cases.
Results: In all cases, post-mortem MDCT and external examination revealed lesions consistent with fatal blunt force injuries, and the absence of contrary evidence that could support another cause of death. These findings together with the circumstantial data were sufficient to assess cause and manner of death.
Conclusions: The results of this study confirm that post-mortem MDCT provides an important contribution to determining cause of death, especially when autopsy is not performed. Therefore, radiologists with experience in post-mortem imaging are needed to support forensic pathologists in establishing causes of death, without necessarily having to perform conventional autopsy.
2014
- Modalità di presentazione del disagio psichico nei migranti: accessi in pronto soccorso e comportamenti suicidairi.
[Abstract in Atti di Convegno]
Pizzirani, Margherita; Reggianini, Corinna; Bettelli, Margherita; Santunione, Anna Laura; Ferrari, Silvia; Rigatelli, Marco; Silingardi, Enrico; Galliani, Ivan
abstract
Dall'analisi degli accessi al PS dei due ospedali di Modena di italiani e stranieri e il numero di suicidi, gli AA fanno alcune considerazioni sulla difficoltà di individuare un percorso di presa in carico psichiatrica per i pazienti migranti che nel 59% dei casi presentano disturbi apsecifici, suggestivi di somatizzazione.
2013
- Sudden death related to myocardial tubercolosis
[Capitolo/Saggio]
V., Gabbolini; Santunione, Anna Laura; Silingardi, Enrico
abstract
sudden cardiac death is defined as death due to cardiac causes, in youngh adults myocarditis is the major causes of sudden unexpected death. Cases of sudden death from previously undiagnosed MTB have rarely been reported in the literature, the most probable mechanism for sydden cardiac death is arrhythmias
2012
- Come una cattiva legge può condizionare la pratica medica. Studio sull'incidenza di gravidanze multiple in rapporto al numero di embrioni trasferiti in utero, in pazienti sottoposte a tecniche di PMA nel decennio 2000-2010
[Articolo su rivista]
Vecchio, S.; Santunione, Anna Laura; Silingardi, Enrico
abstract
the aim of this retrospective study is assessing the impact of the law 40/04 on the results of the tecniques of medically assisted procreation, with regard to the variation in the incidence of multiple pregnancies in relation to the number of enmbryos tranferred
2012
- Development of six-SNPs assay for forensic analysis in European population
[Abstract in Atti di Convegno]
Ferri, Gianmarco; Ferrari, F.; Corradini, B.; Santunione, Anna Laura; Alu', Milena
abstract
Y-chromosomal SNPs analysis show regional specificity useful in forensic investigation for
inferring the male genetic background of individuals and population and to predict biogeographical
origin of the donor of a crime scene sample. Due to its exclusively paternal inheritance, the
Y-chromosome has been extensively used in evolutionary and forensic genetics to investigate the
phylogeny and the history of population and their migration. A large scale parsimonious
phylogenetic tree representing worldwide Y-chromosome variation has been constructed and
comprises major haplogroups. The aim of this study was to set-up six multiplex assays based on
SNaPshot kit to identify markers inside major clades of European population. Specifically, we
design PCR and minisequencing primers targeting a total of 33 Y-mutations downstream R1*, I*,
J2*, G* and E1b1b1* haplogroups. The PCR fragments were chosen to get the shortest product
possible in order to improve the performance in degraded samples (amplicons principally ranging
from 56 bp to 140 bp). This assay based on a 6-multiplex PCR reaction is a suitable tool for
detecting the main European haplogroups in forensic casework and population study.
2012
- L'integrazione dell'analisi del capello nel trattamento terapeutico multidisciplinare di un soggetto con dipendenza combinata da alcol e cocaina
[Articolo su rivista]
Palazzoli, Federica; Santunione, Anna Laura; Vandelli, Daniele; S., Malak; C., Ferretti; Licata, Manuela
abstract
objective toxicology tests combined with self report data, are resulted an appropriate outcome measure. Furthermore comparing self reports and cocaine hair test, hair test result highly sensitive and specific in identifying past cocaine use.
2012
- Migrants presenting with suicidal behaviours at the A&E department in Modena
[Abstract in Rivista]
Ferrari, Silvia; Martire, L; Pizzirani, M; Reggianini, C; Rigatelli, Marco; Santunione, Anna Laura
abstract
Not available
2012
- pseudoaneurisma ventricolare sinistro e morte improvvisa
[Articolo su rivista]
Lusetti, M; Gabbolini, V.; Santunione, Anna Laura; Silingardi, Enrico
abstract
nel presente lavoro viene discusso il possibile meccanismo patogeneticodelle alterazioni strutturali riscontrate a livello della parete aneurismatica. vengono inoltre dettegliate le indagini anamnestiche e laboratoristiche necessarie a delibare correttamente questa tipologia casistica
2012
- Subaortic stenosis and sudden death
[Articolo su rivista]
Santunione, Anna Laura; M., Bettelli; G., Carosielli; E., D'Antone; M., Lusetti; Silingardi, Enrico
abstract
The Authors present a casuistic on sudden Death due to membranous subaortic stenosis. The problems on pathologic diagnosis and forensic implicatins are discussed
2012
- Suicidal migrants in Modena
[Abstract in Rivista]
Reggianini, Corinna; Martire, Lisa; Ferrari, Silvia; Pizzirani, Margherita; Santunione, Anna Laura; Rigatelli, Marco
abstract
Self-harm behaviours, including attempted and complete suicide, have been reported to be common among migrants. Data from our analysis confirm general epidemiologic features of suicide, with complete suicide by hanging more typical among adult males and self-harm behaviours by drug ingestion more typical among youg adult females.
2011
- Lateral saccular laryngeal cyst and unexpected asphyxial death
[Articolo su rivista]
Silingardi, Enrico; Sola, Naike; Santunione, Anna Laura; Trani, Nicoletta
abstract
We present the case of a 41-year-old man with a herniated saccular laryngeal cyst in the left cervical region who died unexpectedly at home from acute asphyxia. The laryngeal cyst manifested itself a few days before death under the form of an obvious palpable swelling in the cervical region.The autopsy showed, in the left cervical region, an oval-shaped mass originating on the wall of the larynx and herniated into the extralaryngeal region.The critical reduction of the laryngeal space originated from an intense edema of the laryngeal mucosa above the cysts, concurrent with a flogistic process of the cystic wall, with probable associated glottic laryngospasm mediated by the superior laryngeal nerve. The rapid evolution of edema was favored by the extreme relaxation of the connective of laryngeal mucosa in the supraglottic and aryepiglottic regions, and it explains the sudden death.The case is useful for delineating the problems related to the possible evolution of laryngeal cysts, the pathogenesis of asphyxial complications, the anatomo-pathological diagnosis and the medico-forensic aspects.
2009
- biobanche di tessuti a scopo di ricerca e consenso alla donazione di materiale biologico umano
[Abstract in Atti di Convegno]
Santunione, Anna Laura
abstract
I notevoli progressi della ricerca e della tecnologia biomedica hanno portato ad un crescente interesse verso le collezioni di materiale biologico umano. il consenso informato del donatore del materiale biologico assume un ruolo fondamentale, sia dal punto di vista giuridico che da quello etico, nella legittimazione all'utilizzo del materiale stesso.
2009
- il rifiuto anticipato dei trattamenti trasfusionali: la cassazione civile ancora in bilico tra un passato che non passa ed un futuro ipotetico
[Nota a Sentenza]
Silingardi, Enrico; Santunione, Anna Laura
abstract
commento alla sentenza 23676/2008 sul rifiuto alle trasfusioni di sangue dei pazienti testimoni di Geova
2009
- Unexpected intrauterine fetal death in parvovirus B19 fetal infection
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura; Rivasi, Francesco; Gasser, B; Zago, S; Garagnani, Lorella
abstract
The AA. presents 5 cases of maternal-fetal infection from parvovirus B19. The aspects anatomopathologic, diagnostic, clinical and professional liability are discussed
2008
- Spontaneous umbilical cord hematoma: An unusual cause of fetal mortality: A report of 3 cases and review of the literature
[Articolo su rivista]
Gualandri, G; Rivasi, Francesco; Santunione, Anna Laura; Silingardi, Enrico
abstract
Spontaneous hematoma of the umbilical cord represents a rare cause of fetal morbidity and mortality and the outcome is poor in half of the cases. There are many risk factors, such as infections, morphologic anomalies, alterations of the vessel walls, prolapses, twisting and traction of the cord, but in many cases the causes remain unknown. We present 3 cases of umbilical cord hematoma which took place at the end of the pregnancy and were followed by perinatal death of the fetus. In the 3 cases, which were autopsied including macroscopical and histopathologic examination of the placenta and the umbilical cord, a cordonal pathology was present; in all cases, there were alterations of the vascular wall, and in the third case inflammatory vasculopathy was found. In all 3 cases, the cause of death was attributed to acute anoxia due to the cordonal hematoma.
2007
- Chirurgia toracica: casistica e profili di rischio
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura; N., Trani
abstract
la chirurgia toracica non cardiaca concerne un esteso e delicatissimo ambito di strutture anatomiche ed una rilevante quota di patologie, tra le quali prevalgono, tanto per importanza quanto per incidenza statistica quelle di natura neoplastica. Nel contributo si prendono in esame i profili di responsabilità in ambito chirurgico-toracico
2007
- Gli avvelenamenti nel settorato medico-legale modenese 1994- 2004
[Articolo su rivista]
Licata, Manuela; Santunione, Anna Laura; Silingardi, Enrico; Beduschi, Giovanni
abstract
gli autori presentano un'analisi casistica riguardante le intossicazioni acute letali nel settorato modenese dal 1994-2004, confrontando i dati con una precedente analisi casistica effettuata a Modena nel periodo 1983-1993. ciò ha permesso di evidenziare le modificazioni del trend delle intossicazioni acute dovute alle singole sostanze e di registrare un cospicuo aumento delle intossicazioni acute da farmaci , preminentemente suicidiarie, accanto ad una scomparsa quasi totale delle morti da intossicazione acuta da CO
2007
- Lineamenti di medicina legale per il medico di medicina generale
[Monografia/Trattato scientifico]
S., Del Vecchio; G., Gualandri; S., Pelosi; Santunione, Anna Laura
abstract
manuale di medicina legale per l'esercizio professionale
2007
- Neurochirurgia: casistica e mappatura dei rischi
[Articolo su rivista]
Beduschi, Giovanni; Santunione, Anna Laura
abstract
gli autori analizzano una casistica relativa alla responsabilità professionale in ambito neurochirurgico, delineandone gli aspetti caratterizzanti
2007
- oculistica: casistica e mappatura dei rischi
[Articolo su rivista]
F., Fregni; N., Trani; Santunione, Anna Laura
abstract
gli autori analizzano una casistica relativa alla responsabilità professionale in ambito oculistico, delineandone gli aspetti caratterizzanti
2007
- otorinolaringoiatria: casistica e mappatura dei rischi
[Articolo su rivista]
G., Popoli; N., Trani; M., Trani; Santunione, Anna Laura
abstract
l'otorinolaringoiatra è uno specialista che come pochi altri riconosce nel suo bagaglio culturale competenze cliniche e chirurgiche. Tale peculiarità ha trovato pieno riscontro nella nostra esperienza caratterizzata da contenzioso conseguito all'attualizzarsi tanto di rischi propri dell'agire per c.d. medico, quanto da più numerosi rischi dell'agire chirurgico.
2006
- Aspetti di responsabilità nel settore del doping
[Capitolo/Saggio]
Silingardi, Enrico; Licata, Manuela; Santunione, Anna Laura
abstract
affronta la tematica della responsabilità medica nel settore del doping
2006
- Chirurgia Toracica video-assistita. Aspetti medico-legali
[Capitolo/Saggio]
Silingardi, Enrico; Santunione, Anna Laura
abstract
puntualizzazione dei aspetti di interesse medico-legale connessi alla chirurgia toracica video-assistita, in particolare responsabilità professionale e consenso informato
2006
- Per partum death at term pregnancy due to spontaneous cord hematoma.
[Articolo su rivista]
Gualandri, G; Rivasi, Francesco; Santunione, Anna Laura; Silingardi, E.
abstract
hematoma of the umbilical cord is rare but the outcome is poor in the half of the cases. spontaneous cord hematoma can present morphologically in a different manner so in all cases in which acute asphyxia is verified, it is necessary to proceed to an accurate study of the cord, in fact we feel that the diagnosis of spontaneous cord hematoma is understimated because a study wich multiple section in not performed routinely
2006
- Sudden death from tubercular myocarditis
[Articolo su rivista]
Silingardi, Enrico; Rivasi, Francesco; Santunione, Anna Laura; Garagnani, Lorella
abstract
Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.
2004
- Medicina generale: casistica e profili di rischio
[Articolo su rivista]
Beduschi, Giovanni; Popoli, G.; Trani, N.; Santunione, Anna Laura
abstract
gli autori analizzano una casistica di responsabilità professionale nel campo della medicina generale, delineandone le principali caratteristiche
2004
- omicidio dissimulato vs omicidio combinato. Problemi di diagnostica differenziale medico-legale
[Articolo su rivista]
Silingardi, Enrico; Santunione, Anna Laura
abstract
l'omicidio mediante asfissia ed abbruciamento è di osservazione infrequente in ambito medico-forense; gli autori riportano due casi di omicidio combinato, rivelati all'autopsia per asfissia (soffocamento e strangolamento) ed abbruciamento incompleto. i metodi medico-forensi, istopatologici e tossicologici, si sono rivelati utili nella determinazione e nella conferma delle cause di morte