GLI EFFETTI DELL’ACAMPROSATO SULLA RIMODULAZIONE DELLA TRASMISSIONE GLUTAMMATERGICA ECCITATORIA ED IL SUO IMPIEGO NEL TRATTAMENTO DEL CRAVING DA ALCOLISMO NEL TERRITORIO DELL’A.S.P. 1 AG

Secondo l’OMS definiamo l’alcolismo quel disturbo a genesi multifattoriale (bio-psico-sociale) associato all’assunzione episodica e/o cronica di bevande alcoliche con presenza o meno di dipendenza capace di determinare una sofferenza multidimensionale che si manifesta in maniera diversa da Soggetto a Soggetto. L’assunzione cronica di alcol modifica la normale attività neuronale attraverso il potenziamento dell’attività inibitoria del GABA e l’inibizione dell’effetto eccitatorio del Glutammato che induce il neuro-adattamento attraverso una over-espressione dei recettori del glutammato in modo da ripristinare l’equilibrio del sistema in presenza di alcol. Quando l’assunzione di alcol viene interrotta l’attività neuronale è caratterizzata sia da un aumento dell’eccitabilità dei recettori del glutammato sia dall’attività dei recettori NMDA che rappresenta invece la causa dei caratteristici sintomi dell’astinenza: le convulsioni. L’Acamprosato è un neuro modulatore specifico per il trattamento della dipendenza da alcol determinando il ripristino dell’equilibrio della trasmissione glutammatergica e l’inibizione dell’attività del glutammato agendo su due recettori: NMDA e mGluR5 rispettivamente ionotropico e metabotropico. Contrastando l’iperattività glutammatergica l’Acamprosato riduce il craving negativo e conseguenzialmente diminuisce l’incidenza, la severità e la frequenza delle ricadute. Nello studio clinico effettuato sono stati osservati 30 Pazienti reclutati nel territorio dell’A.S.P.1 di Agrigento suddivisi rispettivamente : > 9 Pazienti di cui 2 donne e 7 uomini presso il Ser.T di Sciacca, > 6 Pazienti di cui 1 donna e 5 uomini presso il Ser.T di Ribera, > 7 Pazienti di cui 2 donne e 5 uomini presso il Ser.T di Agrigento, > 8 Pazienti di cui 4 donne e 4 uomini presso il Ser.T di Canicattì. Riportiamo i dati di alcuni Pazienti reclutati e seguiti ambulatorialmente presso i Ser.T che erano già stati sottoposti a precedenti trattamenti farmacologici con GHB: * 4 Pazienti sui 30 – pari al 13,33% - esito negativo, * 9 Pazienti sui 30 – pari al 30 % - esito positivo, *17 Pazienti sui 30 – pari al 56,67 % - si sottoponevano per la prima volta alla terapia con Acamprosato. Ciascun Paziente è stato valutato mediante 2 questionari: OCDS (Obsessive Compulsive Drinking Scale) costituito da 14 item e SHORT SLEEP INDEX composto da 4 item. Tutti sono stati sottoposti a controlli seriati nel tempo che così abbiamo identificato: – T0 – prima dell’assunzione di Acamprosato; il primo follow –up al 4° mese – T1 - ed all’8 mese – T2 - il secondo. Per quanto riguarda la valutazione del craving si è osservato al T0 una percentuale dell’86,67% ricovero ed una del 13,33% ambulatoriale. Dove per ricovero si intende la percentuale di Pazienti che, rispondendo alle domande del test, ha totalizzato un punteggio relativo al craving >22, valore che richiede un monitoraggio costante da parte del Medico Responsabile del Ser.T e contemporaneamente anche di un maggiore supporto psicologico. Con il termine ambulatoriale si indicano tutti quei Pazienti il cui grado di craving risulta al di sotto dei valori considerati a “rischio ricadute” e tali da permettere al Paziente di proseguire un trattamento esclusivamente diurno ma che prevede comunque l’adeguato supporto psicologico all’interno del Ser.T. Al termine dell’odierno lavoro ed alla luce dei risultati ottenuti è innegabile l’efficacia dell’Acamprosato nel mantenimento dell’astinenza nei Soggetti dipendenti dall’alcol. Efficacia che si è manifestata riducendo il rischio di ricadute da un lato e, dall’altro per i ridotti effetti indesiderati registrati (la diarrea – il prurito) e per la notevole riduzione del craving negativo. Possiamo pertanto concludere dicendo che l’Acamprosato, associato ad un opportuno supporto psicologico, può senza dubbio rappresentare la terapia d’elezione che, certamente, in un futuro prossimo, sarà completata da altri supporti farmacologici-psicologici o altro per la riduzione/annientamento del problema: dipendenza dall’alcol

Intracranial halo pin penetration causing brain injury secondary to poor halo care technique: a case report and literature review

This is a case report of intra cranial penetration by halo pins resulting in cerebritis and fits secondary to incorrect halo care by the patient and his family. Halo pin penetration into the skull with brain injury is itself a rare incident. Previously documented case reports were in patients with a previous cranioplasties and they were highlight the fact that halo not to be used in cranioplasty patients. Cranial penetration of the halo pins has generally been secondary to a fall/medical condition as epilepsy. This incident how ever highlights the fact the halo care itself along with proper techniques used for tightening the halo pins by the carer plays a crucial role in preventing complications such as this

New insights into the role of androgen and oestrogen receptors in molecular apocrine breast tumours

Two recent studies on a rare androgen-dependent form of breast cancer have shed light on the biology of luminal tumours and reinforced the view that interfering with androgen signalling may have a place in the therapy of some forms of breast cancer

A firearm bullet lodged into the thoracic spinal canal without vertebral bone destruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Firearm injuries account for 13% to 17% of all spinal cord injuries, and are generally caused during warfare or assault with intent to kill. Spinal cord injuries caused by firearms are usually observed in patients aged 15 to 34 years old, and are especially common among men.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Iraqi man who was referred to our radiology department with lower limb paraplegia secondary to a gunshot wound. We performed 64-slice computerized tomography with two-dimensional and three-dimensional reconstruction of the thoracolumbar spine. On the two-dimensional and three-dimensional reconstructed axial images of the thoracolumbar spine, an intra-canalicular bullet nucleus was found at the mid-spinal cord at the T8 level, with no evidence of vertebral bone destruction.</p> <p>Conclusions</p> <p>To the best of our knowledge, there is only one previous report in the literature describing a case of a bullet nucleus lodged into the inferior epidural spinal canal without destruction of the vertebral bone. With the rise of violence worldwide the incidence of gunshot injuries continues to increase, and, thus, it is essential for radiologists to have a clear understanding of gunshot injuries and the findings on radiographic images.</p

The RICORDO approach to semantic interoperability for biomedical data and models: strategy, standards and solutions.

BACKGROUND: The practice and research of medicine generates considerable quantities of data and model resources (DMRs). Although in principle biomedical resources are re-usable, in practice few can currently be shared. In particular, the clinical communities in physiology and pharmacology research, as well as medical education, (i.e. PPME communities) are facing considerable operational and technical obstacles in sharing data and models. FINDINGS: We outline the efforts of the PPME communities to achieve automated semantic interoperability for clinical resource documentation in collaboration with the RICORDO project. Current community practices in resource documentation and knowledge management are overviewed. Furthermore, requirements and improvements sought by the PPME communities to current documentation practices are discussed. The RICORDO plan and effort in creating a representational framework and associated open software toolkit for the automated management of PPME metadata resources is also described. CONCLUSIONS: RICORDO is providing the PPME community with tools to effect, share and reason over clinical resource annotations. This work is contributing to the semantic interoperability of DMRs through ontology-based annotation by (i) supporting more effective navigation and re-use of clinical DMRs, as well as (ii) sustaining interoperability operations based on the criterion of biological similarity. Operations facilitated by RICORDO will range from automated dataset matching to model merging and managing complex simulation workflows. In effect, RICORDO is contributing to community standards for resource sharing and interoperability.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Genetic screening of Fabry patients with EcoTILLING and HRM technology

<p>Abstract</p> <p>Background</p> <p>Anderson-Fabry disease (FD) is caused by a deficit of the α-galactosidase A enzyme which leads to the accumulation of complex sphingolipids, especially globotriaosylceramide (Gb3), in all the cells of the body, causing the onset of a multi-systemic disease with poor prognosis in adulthood. In this article, we describe two alternative methods for screening the <it>GLA </it>gene which codes for the α-galactosidase A enzyme in subjects with probable FD in order to test analysis strategies which include or rely on initial pre-screening.</p> <p>Findings</p> <p>We analyzed 740 samples using EcoTILLING, comparing two mismatch-specific<ul/>endonucleases, CEL I and ENDO-1, while conducting a parallel screening of the same samples using HRM (High Resolution Melting). Afterwards, all samples were subjected to direct sequencing. Overall, we identified 12 different genetic variations: -10C>T, -12G>A, -30G>A, IVS2-76_80del5, D165H, C172Y, IVS4+16A>G, IVS4 +68 A>G, c.718_719delAA, D313Y, IVS6-22C>T, G395A. This was consistent with the high genetic heterogeneity found in FD patients and carriers. All of the mutations were detected by HRM, whereas 17% of the mutations were not found by EcoTILLING. The results obtained by EcoTILLING comparing the CEL I and ENDO-1 endonucleases were perfectly overlapping.</p> <p>Conclusion</p> <p>On the basis of its simplicity, flexibility, repeatability, and sensitivity, we believe that<ul/>HRM analysis of the <it>GLA </it>gene is a reliable presequencing screening tool. This method can be applied to any genomic feature to identify known and unknown genetic alterations, and it is ideal for conducting screening and population studies.</p

Review for the generalist: evaluation of low back pain in children and adolescents

Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population

Improving the outcome of patients with castration-resistant prostate cancer through rational drug development

Castration-resistant prostate cancer (CRPC) is now the second most common cause of male cancer-related mortality. Although docetaxel has recently been shown to extend the survival of patients with CRPC in two large randomised phase III studies, subsequent treatment options remain limited for these patients. A greater understanding of the molecular causes of castration resistance is allowing a more rational approach to the development of new drugs and many new agents are now in clinical development. Therapeutic targets include the adrenal steroid synthesis pathway, androgen receptor signalling, the epidermal growth factor receptor family, insulin growth factor-1 receptor, histone deacetylase, heat shock protein 90 and the tumour vasculature. Drugs against these targets are giving an insight into the molecular pathogenesis of this disease and promise to improve patient quality of life and survival. Finally, the recent discovery of chromosomal translocations resulting in the upregulation of one of at least 3 ETS genes (ERG, ETV1, ETV4) may lead to novel agents for the treatment of this disease

Personality, personnel selection, and job performance

Job Performance: The term job performance can either refer to the objective or subjective outcomes one achieves in a specific job (e.g., the profit of a sales persons, the number of publications of a scientist, the number of successful operations of a surgeon) or to work-related activities (e.g., writing an article, conducting specific surgical acts). In the majority of research on this topic, job performance as an outcome is used. Personnel selection: Personnel selection refers to the process of selecting the best employees for specific jobs. Introduction One major application of personality research is in the area of personnel selection. The key question in this area is to which extent personality can predict how well a candidate will perform on the job he or she is applying for. Most scholars in this area acknowledge that personality has predictive validity for job performance. In line with this, personality assessment is part of the selection procedure in many organizations