Background: Starvation represents a specific pathological entity characterized by severe nutritional deprivation leading to multi-organ failure. Despite its forensic relevance, a comprehensive synthesis of autopsy findings remains lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched from inception to June 2025 using a pre-specified Boolean query. Eligible studies included case reports, case series and cohort investigations reporting post-mortem evidence of starvation or starvation-related malnutrition. Data extracted encompassed demographic, contextual, macroscopic, histological, and ancillary findings. Results: Fourteen studies were included, comprising 20 individual cases and two population-based cohorts (totaling 1647 deaths). Most cases (75%) involved children, predominantly victims of domestic neglect; adults accounted for 25%, mainly due to anorexia nervosa or voluntary fasting. Six cadavers were severely decomposed or mummified. Across studies, consistent autopsy findings included extreme emaciation, near-total loss of subcutaneous and visceral fat, empty gastrointestinal tract, and diffuse organ atrophy, especially of the liver, heart, thymus, and pancreas. Histology revealed hepatic steatosis, myocardial fibrosis, thymic involution and gelatinous transformation of adipose tissue. Ancillary methods (dual-energy X-ray absorptiometry, stable isotope and anthropological analyses) confirmed malnutrition in decomposed or skeletonized remains. Conclusions: This review delineates the morphological and histopathological hallmarks of starvation and suggests the possible diagnostic value of ancillary techniques in advanced decomposition. The predominance of neglect-related pediatric cases underscores starvation as a forensic indicator of social and caregiving failure. Establishing reproducible morphological and histological indicators may improve the consistency of forensic diagnosis and strengthen the evidentiary basis for determining starvation as a cause of death.

Epiduroscopy is a minimally invasive procedure that is used in pain therapy to treat lumbar and root pain that is resistant to medical and infiltrative therapies. The indications for periduroscopy are partly shared with those of spinal cord stimulation (SCS): failed back surgery syndrome (FBSS) and stenosis of the vertebral canal in particular. The costs and risks of periduroscopy are considerably lower than those of SCS. The purpose of this study is to evaluate the clinical and economic advantages of integrating periduroscopy as a step prior to SCS for patients with severe lumbar or radicular pain that is unresponsive to pharmacological and infiltrative treatments. Patients were enrolled if they had FBSS and spinal stenosis with indications for SCS and accepted periduroscopy treatment before the possible SCS trial. Patients were followed up for 24 months with evaluations of clinical data on the day after the procedure and at one and 24 months. The pain trend, satisfaction with the periduroscopy procedure, and the incidence of SCS implants in the study period were analyzed. A total of 106 patients were enrolled. Immediately after the procedure and in the first month, the reduction of pain and the level of patient satisfaction were high, but they were drastically reduced at 24 months with a progressive reappearance of symptoms that substantially overlapped with the pre-surgery levels. At 24 months, 48% of the patients underwent a neurostimulation trial, and a significant percentage of them were able to avoid the implantation of an SCS. Periduroscopy appears to be rational as a step prior to SCS in terms of the improvement of pain symptoms in the short term, the definitive results in a significant percentage of patients, and the significant economic savings for the health system.

Background: The communication of bad news in healthcare is a critical factor in patient care and workplace safety. Ineffective communication can contribute to emotional distress and aggression toward healthcare professionals. Despite its importance, many professionals lack the necessary training to manage these conversations effectively, increasing the risk of conflict. This study investigates the relationship between communication breakdowns and workplace violence in healthcare settings. Methods: This retrospective observational study analyzed incident reporting data from two major Local Healthcare Authorities in Southern Italy (2019–2023). Reports of aggression toward healthcare professionals were categorized by type (verbal or physical), triggering event, location, severity, and aggressor identity. Chi-square tests and linear regression models were used to identify trends and associations. Results: A total of 248 reported incidents were analyzed, with 85.1% classified as verbal aggression and 14.9% as physical aggression. The primary trigger was disagreement over clinical management (57.4%), followed by perceived delays in care (25.5%) and denial of assistance by family members (11.7%). Most incidents occurred in community-based healthcare services (42.6%) and emergency departments (25.5%). Family members were the primary perpetrators of physical assaults (64.3%), while patients were responsible for most verbal aggression (55.3%). Conclusions: Poor communication strategies contribute to workplace violence. Improving healthcare professionals’ communication skills through structured training, implementing conflict management strategies, and strengthening security measures in high-risk areas are crucial for reducing aggression. Future research should explore additional risk factors and assess the effectiveness of targeted interventions.