S Sblano

Bio: S Sblano is an academic researcher from University of Bari. The author has contributed to research in topics: Poison control & Diffuse axonal injury. The author has an hindex of 4, co-authored 5 publications receiving 48 citations.

A case of suicide by ingestion of caffeine.

Abstract: Intentional or unintentional caffeine abuse due to excessive intake of beverages or energy drinks containing caffeine is relatively frequent. However, death due to caffeine intoxication is rare and case reports of fatalities from caffeine toxicity are relatively infrequent. In this report, we describe an autopsy case involving a 31 year-old man who intentionally took a large amount of caffeine tablets in the form of a weight loss supplement as part of a suicide plan. Caffeine femoral blood concentration (170 mg/l) was within the toxic and potentially lethal ranges reported in the literature in similar cases. Postmortem biochemistry results suggested depressed glomerular filtration rate and pre-renal failure at the time of death but failed to reveal myoglobinuria, glycosuria, ketonuria or ketonemia. Based on the absence of pathological findings at autopsy and the high blood caffeine level, death was attributed to acute caffeine toxicity. The case emphasizes the usefulness of performing exhaustive toxicology and searching for all potentially relevant information in order to formulate appropriate hypotheses concerning the cause and manner of death.

Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009

Abstract: Introduction. In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences. Material and Methods. A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at “Policlinico of Bari” from 1990 to 2009. Results. All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms); 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on); 116 uncertain discrepant diagnoses; 82 unclear diagnoses. Conclusions. The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.

An immunohistochemical study of pulmonary surfactant apoprotein A (SP-A) in forensic autopsy materials

Abstract: SP-A is the most prevalent protein component of pulmonary surfactant which is essential to maintain alveolar stability. SP-A can be detected by immunohistochemistry and in such form it has been previously reported as a useful tool to distinguish aspyxial deaths from other hypoxic cases. The present immunohistochemical study shows the SP-A staining distribution among a selected forensic material to evaluate the effect of fluid accumulation in the lung interstitium and alveoli commonly related to pulmonary edema. A total of 48 cases were examined histologically and immuno-histochemically based on the presence/absence of pulmonary edema and survival time: 10 cases of acute cardiac deaths (ACDs) in which death occurred rapidly, in a few minutes from the beginning of the symptoms and without signs of pulmonary edema, 18 cases of drowning (12 in saltwater and 6 cases in freshwater), 20 cases of narcotic deaths (6 by cocaine and 14 by opiates) with gross pulmonary edema. The results suggest that edema fluid can produce some kind of molecular alterations of SP-A affecting immunostaining expression. The results show also that SP-A immunostaining patterns alone do not meet the requirements for general diagnostic use and cannot differentiate among fatalities. The SP-A expression needs to be preferably associated with the presence and intensity of histological signs according to suspected cause of death as well as type and amount of edema fluid commonly related to cardiac and/or respiratory failure (cardiogenic and non-cardiogenic pulmonary edema).

Stress‐Related Temporary Hearing Loss—Evaluation of Bio‐Humoral Parameters: Forensic and Criminological Applications

Abstract: The body-alarm reaction results from the activation of hypothalamic-pituitary-adrenal axis, which can lead to physio-psychological phenomena such as an exclusion/occlusion of the sense of hearing. One hypothesis to explain this alteration consists in a hydromechanical dysfunction of the internal ear attributable to antidiuretic hormone. In this study, we evaluated the perception of acoustic stimuli administered in stressful conditions in 14 phobic patients and in 20 healthy subjects, in order to assess the influence of stress on perceiving capabilities. We also measured the concentration of salivary cortisol and IL-1β and neurovegetative parameters to objectivise and quantify the physiological reactions. Our results show a worse perception of the frequencies of the human voice under stress; these findings could have a dual value: in the legal field, concerning criminal liability, and on the operative context, regarding the efficiency of verbal communication among law enforcement officers in situations inducing intense emotional stress.

β-App immunoreactivity as diagnostic tool of Diffuse Axonal Injury (DAI)

Abstract: The Diffuse Axonal Injury (DAI) is a frequent result of traumatic brain deceleration forces and can be investigated with immunohistochemistry for the β-amyloid precursor protein (β-APP). The aim of this study is to contribute to the discussion on the role of such important histopathological finding as routinely diagnostic tool in forensic setting, such as the reconstruction of the traumatic event or of the severity of the injury and the survival time. On these bases 20 cases of blunt head injuries were studied detecting focal haemorrhages, the distribution and pattern of β-APP axonal immunoreactivity in the corpus callosum and upper brainstem. β-APP axonal immunoreactivity was found in 13 cases, 6 of which stained in both the examined sites, while the remaining 7 were positive only in one site. Haemorrhages were present in 10 cases: for 8 cases only in one of the evaluated areas, for 5 cases in the same area with axonal β-APP immunoreactivity. β-APP staining was observed in cases with a survival of at least 1-2 hours. The results remark that for a complete assessment of blunt head injuries, particularly those without head gross damage or suffering for minimal external injury, an appropriate evaluation of the central brain regions can be strongly supported by microscopic findings such as small haemorrhages and axonal β-APP immunoreactivity. They can provide reliable information concerning the survival time and the degree of mechanical forces that developed during the traumatic event, especially in cases in which the circumstantial data are contradictory or unknown by pathologist.

Caffeine: Cognitive and Physical Performance Enhancer or Psychoactive Drug?

Abstract: Caffeine use is increasing worldwide. The underlying motivations are mainly concentration and memory enhancement and physical performance improvement. Coffee and caffeine-containing products affect the cardiovascular system, with their positive inotropic and chronotropic effects, and the central nervous system, with their locomotor activity stimulation and anxiogenic-like effects. Thus, it is of interest to examine whether these effects could be detrimental for health. Furthermore, caffeine abuse and dependence are becoming more and more common and can lead to caffeine intoxication, which puts individuals at risk for premature and unnatural death. The present review summarizes the main findings concerning caffeine's mechanisms of action (focusing on adenosine antagonism, intracellular calcium mobilization, and phosphodiesterases inhibition), use, abuse, dependence, intoxication, and lethal effects. It also suggests that the concepts of toxic and lethal doses are relative, since doses below the toxic and/or lethal range may play a causal role in intoxication or death. This could be due to caffeine's interaction with other substances or to the individuals' preexisting metabolism alterations or diseases.

The clinical toxicology of caffeine: A review and case study.

Abstract: Caffeine is a widely recognized psychostimulant compound with a long history of consumption by humans. While it has received a significant amount of attention there is still much to be learned with respect to its toxicology in humans, especially in cases of overdose. A review of the history of consumption and the clinical toxicology of caffeine including clinical features, pharmacokinetics, toxicokinetics, a thorough examination of mechanism of action and management/treatment strategies are undertaken. While higher (i.e., several grams) quantities of caffeine are known to cause toxicity and potentially lethality, cases of mainly younger individuals who have experienced severe side effects and death despite consuming doses not otherwise known to cause such harm is troubling and deserves further study. An attempted case reconstruction is performed in an effort to shed light on this issue with a focus on the pharmacokinetics and pharmacodynamics of caffeine.

Stress and tinnitus

Abstract: Emotional stress is a constant companion of tinnitus patients, since this phantom sound can unfortunately be a very effective stressor. However, the mechanism of stress contribution to the onset or progression of tinnitus remains unknown. Here, we review the pathways induced by emotional stress and the outcome of their induction: corticosteroid-dependent changes in gene expression, epigenetic modulations, and impact of stress on neuronal plasticity and neurotransmission. Using clinical examples, we demonstrate the presence of emotional stress among tinnitus patients and we present methods to measure the degree of stress. The evidence causally linking emotional stress with tinnitus is still indirect—the main difficulty lies in the inaccessibility of human auditory tissues and the inability to directly measure tinnitus-induced psychological distress in animal models. However, we believe that translational research is the future way of filling this gap, finding the answers, and thereby improving both the diagnosis and treatment of tinnitus patients.

Caffeine-Related Deaths: Manner of Deaths and Categories at Risk

Abstract: Caffeine is the most widely consumed psychoactive compound worldwide. It is mostly found in coffee, tea, energizing drinks and in some drugs. However, it has become really easy to obtain pure caffeine (powder or tablets) on the Internet markets. Mechanisms of action are dose-dependent. Serious toxicities such as seizure and cardiac arrhythmias, seen with caffeine plasma concentrations of 15 mg/L or higher, have caused poisoning or, rarely, death; otherwise concentrations of 3–6 mg/kg are considered safe. Caffeine concentrations of 80–100 mg/L are considered lethal. The aim of this systematic review, performed following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement for the identification and selection of studies, is to review fatal cases in which caffeine has been recognized as the only cause of death in order to identify potential categories at risk. A total of 92 cases have been identified. These events happened more frequently in infants, psychiatric patients, and athletes. Although caffeine intoxication is relatively uncommon, raising awareness about its lethal consequences could be useful for both clinicians and pathologists to identify possible unrecognized cases and prevent related severe health conditions and deaths.

Occurrence, fate, persistence and remediation of caffeine: a review

Abstract: Pharmaceutical and personal care products (PPCPs) have gained attention in recent years due to their continuous discharge in natural waters. Their persistence in the environment has impacted flora, fauna and human being worldwide. One of the most common PPCPs is caffeine (1, 3, 7-trimethylxanthine) which acts as a stimulant to the central nervous system in humans and is found in nature in about 60 plant species, especially in coffee, tea and cacao plants. Here we discuss the evidence with respect to caffeine occurrence, its persistence and remediation in light of increasing knowledge and the impact of caffeine on the environment. Daily intake of caffeine around the world is found to increase due to the frequent introduction of new caffeinated beverages as well as increased consumption of coffee, tea and carbonated soft drinks, which has led to increase in its concentration in water bodies including agricultural soil. The caffeine concentration in different water system, studied by various authors is also described. Diverse effects of the use of caffeine on several organisms including humans are also briefly presented. Therefore, urgent attention for the removal of caffeine and its derivatives is the need of the hour. Various methods described in literature for caffeine degradation/removal is also presented. Another widely used technique in environmental remediation is molecular imprinting (MIP); however, only few MIPs have been demonstrated for caffeine which is also discussed. Regular monitoring can be useful to control toxic effects of caffeine. Graphical abstract.