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Objective: To investigate variation in ancient DNA recovery of Brucella melitensis, the causative agent of brucellosis, from multiple tissues belonging to one individual MATERIALS: 14 samples were analyzed from the mummified remains of the Blessed Sante, a 14 th century Franciscan friar from central Italy, with macroscopic diagnosis of probable brucellosis., Methods: Shotgun sequencing data from was examined to determine the presence of Brucella DNA., Results: Three of the 14 samples contained authentic ancient DNA, identified as belonging to B. melitensis. A genome (23.81X depth coverage, 0.98 breadth coverage) was recovered from a kidney stone. Nine of the samples contained reads classified as B. melitensis (7-169), but for many the data quality was insufficient to withstand our identification and authentication criteria., Conclusions: We identified significant variation in the preservation and abundance of B. melitensis DNA present across multiple tissues, with calcified nodules yielding the highest number of authenticated reads. This shows how greatly sample selection can impact pathogen identification., Significance: Our results demonstrate variation in the preservation and recovery of pathogen DNA across tissues. This study highlights the importance of sample selection in the reconstruction of infectious disease burden and highlights the importance of a holistic approach to identifying disease., Limitations: Study focuses on pathogen recovery in a single individual., Suggestions for Further Research: Further analysis of how sampling impacts aDNA recovery will improve pathogen aDNA recovery and advance our understanding of disease in past peoples., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017., Materials: Skeletal remains of a well-preserved skeleton dating to the 12th-13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy)., Methods: Macroscopic and radiographic imaging., Results: Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55-75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints., Conclusions: A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy., Significance: This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas., Limitations: Small sample size limits discussion of the scope of the disease in antiquity., Suggestions for Further Research: This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This paper provides a critical literature review concerning paleopathological evidence of multiple myeloma discovered both in the Old and in the New World. A critical assessment of the bioarchaeological and paleopathological documentary sources permitted to identify a total of 25 ascertained cases of multiple myeloma from different geographical areas in the world ranging from Prehistoric times up to the Contemporary age. The distribution of multiple myeloma findings in past times shows that the majority of cases have been discovered in the Old World (n = 18) and extend back to the Middle Ages, while the evidences in the New World (n = 7) seems to date back to the pre-Columbian era. The demographic profile suggests a sex ratio of 1.3:1, while 91.7% of affected individuals (n = 24) are adults. This critical review also discusses the diagnostic criteria and methodological issues commonly attempted in paleo-oncological research, with particular regard to the differential diagnosis of multiple myeloma. As such, the main focus of this work is to present a comprehensive and exhaustive scrutiny of the skeletal manifestations identified as multiple myeloma in order to improve the accuracy of diagnoses within the field of paleopathology., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Ancient neoplasms diagnosed in the soft tissues of mummies are limited to 18 cases so far, with only 5 malignant tumors. The apparent paucity of neoplasms in ancient populations is sometimes attributed to shorter life spans and fewer oncogenic substances in the environment. However, this paucity may also be a result of the scarcity of autopsies of mummies, together with technical difficulties in detecting neoplastic lesions in mummified tissues. An exception, and example of the benefits of thorough systematic analysis, is the small sample of 10 Renaissance mummies from Naples (15th-16th centuries), in which 3 cases of cancer were found. In order to increase detection of soft tissue tumors, it is imperative that mummies undergo systematic autopsies and histological examinations performed by skilled paleopathologists. This review of the known ancient soft tissue neoplasms demonstrates the state of histology of malignant and benign soft tissue neoplasms in mummies, and the potential for further study. The limitations of paleopathological diagnosis will be discussed and an argument will be made for the use of autopsies and histological analysis on mummified human remains., (Copyright © 2017 Elsevier Inc. All rights reserved.)

During the archaeological excavations conducted in the 13th century cemetery of the Church of Sant'Agostino in Poggibonsi (Tuscany, Italy), a skull with evidence of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. To treat this wound, the patient underwent surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed, and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval authors, whose texts were available in the 13th century. This case represents rare Middle Ages evidence of neurosurgery used to treat a bone injury., (Copyright © 2017 Elsevier Inc. All rights reserved.)

During the late Middle Ages and the Renaissance autopsy started to be practised for medico-legal purposes in order to investigate the causes of death. The other reason for dissecting a body was embalming, a diffused custom typical of the elitarian classes. The exploration of the Medici tombs in the Basilica of San Lorenzo in Florence offered the opportunity to investigate the practice of autopsy on these aristocratic personages of the Renaissance and Early Modern Age. A total of 25 currently skeletonized individuals, almost all of whom formerly artificial mummies, were exhumed. Accurate examination of the skeletons revealed evident signs of autoptic practices such as horizontal and oblique craniotomies, longitudinal and transversal cuts of the sternum, and sectioning of the sternal extremities of the ribs. In this group, women were treated differently to men at autopsy, as only men underwent craniotomy; autopsy and embalming were carried out also for the illegitimate members of the family and for subaldults. The extremely rich documentary archives of the Medici family confirm that the corpses were in several cases submitted to autopsy. The present study offers important direct information on the 16-18th century autoptic practices that the court surgeons in Florence performed on the members of the elite class., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Archaeological excavations carried out at the castle of Monte di Croce near Florence brought to light a small cemetery complex belonging to the castle church, dated back to the 11th-12th centuries. An elite stone tomb contained the skeletal remains of a male aged 35-45 years with obvious pathology of the right tibia. The proximal metaphysis and the upper half of the diaphysis appear massively enlarged as a result of severe chronic periostitis. A transverse section illustrates complete obliteration of the medullary cavity by new spongy bone, with some large cavitations. The primary, but completely remodeled tibial shaft is still recognizable. This finding and the strong sclerotic reaction with some central cavitations rule out any form of bone tumor and indicate a chronic inflammatory disease. The morphological and radiological picture and the tibial localization suggest a diagnosis of chronic sclerosing osteomyelitis of Garré, a rare form of chronic osteomyelitis characterized by an intense periosteal reaction with little or no suppuration., (Copyright © 2015. Published by Elsevier Inc.)

The skeleton of a 9- to 10-year-old child showing a case of skull malformation due to premature bilateral closure of the coronal suture was encountered during the excavation of a Sardinian plague cemetery ("Lo Quarter") dating to the 1582-1583 Alghero plague outbreak. The skull is deformed, with increased bi-parietal diameter, marked frontal and parietal bosses, shallow orbits, and a palpable ridge perpendicular to the coronal suture. Digitate impressions are observable on both fronto-parietal regions of the skull's inner table. Since the splanchnocranium has not preserved, it is impossible to verify if facial anomalies might have been present. Although the cranial appearance might be reminiscent of different genetic syndromes, the absence of obvious hand and feet anomalies is a hallmark for non-syndromic brachycephaly., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Clinical reports for Eleonora of Toledo (1522-1562), the wife of Cosimo I de' Medici, imply that during her 28th year she developed pulmonary tuberculosis, which was complicated by an attack of pernicious malaria, killing her at age 40. Eleonora's autopsy indicated that she had severe lung lesions consistent with chronic pulmonary infection. To clarify her disease status, we performed paleomolecular investigations. Our results identified ancient DNA from the Mycobacterium tuberculosis complex (MTB), along with Leishmania infantum (VL). Our data are of particular interest since in Tuscany the endemic foci of L. infantum are widely distributed and overlapped with those of malaria prior to its eradication. Although we can only speculate about Eleonora's true state of health, this clear evidence of long-term co-infection with MTB and VL is of major medical and biological interest since the co-evolution of the two pathogens and host-pathogen interactions in co-infected individuals are still not fully understood., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We report a case of osteochondritis dissecans in the patella of Francesco de' Medici, Prince of Capistrano, who lived from 1594 to 1614. He was known to play Florentine kick ball, a precursor of Rugby and American football, and speculate that trauma from this activity may have led to the lesion., (Copyright 2009 Elsevier B.V. All rights reserved.)

Aims: To evaluate the prevalence, incidence and clinical relevance of bacterial infection in predominantly non-alcoholic cirrhotic patients hospitalised for decompensation., Patients/methods: A total of 405 consecutive admissions in 361 patients (249 males and 112 females; 66 Child-Pugh class B and 295 class C) were analysed. Blood, urine, ascitic and pleural fluid cultures were performed within the first 24 hours, during hospitalisation whenever infection was suspected, and again before discharge., Results: Over a one year period, 150 (34%) bacterial infections (89 community- and 61 hospital-acquired) involving urinary tract (41%), ascites (23%), blood (21%) and respiratory tract (17%) were diagnosed. The prevalence of bacterial peritonitis was 12%. Infections were asymptomatic in 69 cases (46%) and 130 (87%) involved a single site. Enteric flora accounted for 62% of infections, Escherichia Coli being the most frequent pathogen (25%). Community-acquired infections were associated with more advanced liver disease (Child-Pugh mean score 10.2+/-2.1 versus 9.5+/-1.9, p<0.05), renal failure (p<0.05), and high white blood cell count (p<0.01). Hospital-acquired infections occurred more frequently in patients admitted for gastrointestinal bleeding (p<0.05). The in-hospital mortality was significantly higher in infected than in non-infected patients (15% versus 7%, p<0.05), and infection emerged as an independent variable affecting survival. Moreover bacterial infection accounted for a significantly prolonged hospital stay., Conclusions: Bacterial infection, regardless of the aetiology, is a severe complication of decompensated cirrhosis, and, although frequently asymptomatic, accounts for both longer hospital stay and increased mortality.

Background/aims: Hepatitis C virus (HCV) easily undergoes genomic changes, thus accounting for the presence of different genotypes, with different geographic distributions and different outcomes of chronic hepatitis. Type 1b is frequently found in advanced diseases; however, since this genotype is the most prevalent in older patients, the association with advanced age and severity of the disease is confounding. The aim of this study was to assess changes in the prevalence of HCV genotypes by surveying a large population of chronic hepatitis C patients in Northern Italy, and to assess if the high prevalence of genotype 1b in older patients with advanced diseases simply reflects the duration of HCV infection, rather than intrinsic biological properties of HCV., Methods: We studied 1368 HCV-RNA positive patients, with histologically proven chronic hepatitis. Drug addiction, blood transfusions and sporadically acquired infections represented the risk factors., Results: Genotype 1b, the most prevalent isolate, and genotype 2a were associated with older age, cirrhosis, sporadically-acquired infections and blood transfusion, while types 1a, 3a, and 4 were associated with younger age, chronic persistent hepatitis and drug addiction. Patients with a history of transfusions were divided into four groups depending on the period of transfusion. The prevalence of genotype 1b decreased with time. Type 3a appeared only after 1979., Conclusion: The severity of chronic hepatitis C could be related more to the duration of the infection rather than to the intrinsic pathogenicity of HCV genotypes.