51 research outputs found
Assisted suicide: article 17 of the Italian Code of Medical Ethics follows in the footsteps of the Italian Constitutional Court's landmark ruling
Less than a year ago, on September 25th 2019, the Italian Constitutional Court issued a landmark decision on assistance in dying, thus setting a long-awaited standard in terms of regulating
assisted suicide1
. The ruling related to the case of Fabiano Antoniani, also known as DJ Fabo, a
man in his forties who had made a pondered, steadfast decision to receive assistance in dying at
a Swiss euthanasia clinic in 2017.
Fabiano was left blind and tetraplegic in the aftermath of a catastrophic road accident in
2014. His death has since become the subject of heated debate in a country, such as Italy, where
euthanasia, whether active (i.e., doctors actively causing the patient’s death) or passive (the
self-administration by the patient of lethal drugs to end his or her life, the way Fabiano ended
his), is adamantly opposed by the Catholic Church.
Italy’s Constitutional Court has made it clear that euthanasia should be permitted by law in
certain circumstances, including those in which a patient’s irreversible condition was “causing
physical and psychological suffering that he or she considers intolerable”.
The court’s ruling was centered around assisted dying and the “legal framework concerning
end of life [situations]”. A request had in fact been made by a Milan court to provide a clear
interpretation of the law in the trial against pro-euthanasia politician, activist and campaigner
Marco Cappato, who had actively helped Antoniani with his journey to a Swiss clinic which provides assisted suicide
Synthetic cathinones related fatalities: an update
Synthetic cathinones, more commonly known as "bath salts", are synthetic drugs chemically related to cathinone, a psychostimulant found in the khat plant. They are the first most consumed products among new psychoactive substances, which cause psychostimulant and hallucinogenic effects determining a number of fatalities worldwide. In this paper, we have systematically reviewed cases of synthetic cathinones-related fatalities analytically confirmed, which have occurred in the last few years.OBJECTIVE: Synthetic cathinones,
more commonly known as “bath salts”, are synthetic
drugs chemically related to cathinone, a
psychostimulant found in the khat plant. They are
the first most consumed products among new
psychoactive substances, which cause psychostimulant
and hallucinogenic effects determining
a number of fatalities worldwide. In this paper, we
have systematically reviewed cases of synthetic
cathinones-related fatalities analytically confirmed,
which have occurred in the last few years.
MATERIALS AND METHODS: Relevant scientific
articles were identified in Medline, Cochrane
Central, Scopus, Web of Science and Institutional/
government websites up to November 2017
using the following keywords: synthetic cathinones,
mephedrone, methylenedioxypyrovalerone,
MDPV, methylone, ethylone, buthylone, fatal
intoxication, fatalities and death.
RESULTS: In total, 20 citations met the criteria
for inclusion, representing several fatal cases
with analytically confirmed synthetic cathinones
in biological sample/s of the deceased. The
death was attributed to hyperthermia, hypertension,
cardiac arrest and more in general to the
classic serotonin syndrome. Only rarely did the
concentration of the parent drug causing fatality
overcome the value of 1 mg/L in post-mortem
biological fluids.
CONCLUSIONS: Abuse of synthetic cathinones
still represents a serious public health issue.
Systematic clinical studies on both the animal
and human model are lacking; therefore, the
only available data are from the users who experience
the possible hazardous consequences.
Analytical methodologies for the identification
of parent compounds and eventual metabolites
both in ante-mortem and post-mortem cases
need to be developed and validated. Analytical
data should be shared through different communication
platforms with the aim of stopping this
serious health threat for drug users
Hepatotoxicity induced by greater celandine (Chelidonium majus L.): a review of the literature
The available literature assessing Chelidonium majus L. (CM) hepatotoxicity potential, and its risk to benefit assessment has been reviewed in this paper. Identification of significant scientific literature was performed via the following research databases: Cochrane Central, Google Scholar, EMBASE, Medline, Science Direct, Scopus, Web of Science, using the following keywords: "Chelidonium majus", "greater celandine", "Hepatotoxicity", "Liver" "Injury", "Toxicity" individually investigated and then again in association. CM named also greater celandine, swallow-wort, or bai-qu-cai (Chinese), has been used for a long time in traditional Chinese medicine and phytotherapy. Its extracts have been claimed to display a wide variety of biological activities: antimicrobial, anti-inflammatory, spasmolytic, antineoplastic, hepatoprotective, and analgesic. Moreover, herbal medicine suggests this plant have numerous additional effects which have not yet been scientifically evaluated, such as antitussive, diuretic, and eye-regenerative. However, despite its claimed hepatoprotective effects, several hepatotoxicity cases have been reported to be probably or highly probably connected with CM exposure, after their evaluation through liver-targeted causality assessment methods. CM hepatotoxicity has been defined as a distinct form of herb-induced liver injury (HILI), due to an idiosyncratic reaction of the metabolic type. This evidence has to be considered in relationship with the absence of considerable benefits of CM therapy. Therefore, the risk to benefit ratio of the use of herbal products containing greater celandine can actually be considered as negative
The importance of disclosing the conflict of interest (CoI) in the era of open access publishing
In pharmacological and biomedical sciences, most of the principle donators are progressively demanding open access as a condition in economical support, something which has already become common in various other areas1.
The expression “open access” has been used since 2002: first in the Budapest Open Access Initiative
(February 2002), then in the Bethesda Statement on Open Access Publishing (June 2003) and finally in
the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (October 2003).
Open access was initially intended for scholarly journal manuscripts in order to provide an unrestricted
online access to them. However, even though this term first appeared in the 2000s, free on-line access
to journal manuscripts had started at least 10 years previousl
Advance healthcare directives: moving towards a universally recognized right
Advance healthcare directives (AD) are still intensively animating debates in Europe and
worldwide, leading to the enactment of different laws, according to the diverse legal, sociocultural,
religious and philosophical traditions of each society1
.
After a long complicated seemingly ever-lasting process, on the 14th of December 2017 the Italian
Parliament finally approved the Law on “Informed consent and Advance healthcare directives”
putting Italy on the same level as other European countries, which have previously regulated this
complicated matter2
.
The most controversial point of the law is represented by AD. Section 4 states that everyone
able to make a proper judgment, regarding any possible future inability to self-determine, can,
through AD, express their beliefs and preferences concerning health treatments, consent or refusal
to any diagnostic or therapeutic choice, including artificial nutrition and hydration. One can also
indicate a person of trust to represent him/her in the relationships with doctors and hospitals2
.
Furthermore, the same provision specifies that the doctor is obliged to respect the AD, unless:
a) the patient requests a treatment opposing the law or medical deontology, or b) the AD is clearly
incongruous, or c) new and unpredictable therapies have come into force. Therefore, ADs are
binding; conscientious objection is not foreseen.
The reference of the law to medical deontology finds its rationale in section 38 of the Italian
Code of Medical Ethics, updated in May 2014, where the requirements that AD must meet are
stated3
.
With this new law2
Italy conforms to the orientation of the other main European countries,
obliging the respect of ADs, even if the limits are slightly different, France4
, Germany5
, Spain6
and
England7
they are binding.
We wish to draw the attention of the whole medical scientific community to this matter,
advocating for an open dialogue to discuss the ethical and medical issues concerning AD, thereby
facilitating the improvement and implementation of guidelines and policies to safeguard patients
together with healthcare providers1
. There has been considerable progress in addressing all the
ethical issues regarding AD and as a consequence of the constant innovation in medical science and
an increase in life expectancy we can demand more research into this topic
Suitability of miRNA assessment in postmortem interval estimation
OBJECTIVE: The aim of this review was to explore recent pieces of evidence focused on the use of miRNAs for PMI estimation both in humans and animal experiments, with particular interest on the best miRNAs to use as reference/target markers in different tissues or biological fluids. MiRNAs are innovative biomarkers used in clinical and research field: they appear very attractive, being introduced in forensic research scenarios even for PMI estimation.MATERIALS AND METHODS: Data from PubMed and Scopus were analyzed from January 2013 to August 2020. Based on inclusion/exclusion criteria, high-quality articles have been selected to become the subject of this review.RESULTS: A total of 737 papers were found but, after titles/abstracts screening for inclusion criteria and a full-text careful selection, 33 papers were deeply studied. After the exclusion of 19 papers, 15 articles remained. Eight papers dealt with animals (mice/rats), two both with animals and humans (for method validation previously built), while 5 exclusively with humans. Myocardium (6/15) and brain (6/15) were the most studied tissues. respectively in mice/rats and humans. PMI considered was up to 7.5 days in mouse studies and less than 3 days in human models.CONCLUSIONS: Because of their significant stability in both early and long PMI, miRNAs are the cleverest reference markers to be used. Temperature and environmental conditions influence mostly mRNA, while miRNAs are less susceptible to them. The best miRNA to choose depends on its tissue specificity, i.e., miR-9 and miR-125 in brain or miR-1 and miR-133 in skeletal muscle/heart
Assessment of the stability of exogenous gamma hydroxybutyric acid (GHB) in stored blood and urine specimens
OBJECTIVE: The aim of this work
is to test the stability of exogenous GHB in whole
blood and urine samples collected from living and
deceased GHB free-users, spiked with known
concentrations of GHB and stored at different
temperatures (–20°C, 4°C and 20°C) up to 4 weeks.
MATERIALS AND METHODS: GHB was added
to GHB-free ante-mortem blood and urine samples
at the concentration of 5 and 10 mg/L, respectively
whereas in post-mortem blood and urine specimens at 50 and 10 mg/L respectively. All samples
were stored at three different temperatures: –20°C,
4°C and 20°C and extracted and analyzed at three
days, 1 week, 2 weeks, 3 and 4 weeks in duplicate.
No preservatives were added. GHB was quantified
by GC-MS after LLE according to a previously published method.
RESULTS: Post-mortem blood specimens
showed a reduction of GHB levels higher than 10%
only after a period of 4 weeks of storage for samples kept at +4°C and +20°C, whereas samples
stored at –20°C showed a mean reduction of 8.7%.
In post-mortem urine samples, there was a mean
reduction of GHB levels higher than 20% at all storage temperatures, after 4 weeks of storage. Antemortem blood samples showed a reduction of GHB
levels lower than 10% only after 3 days of storage
at –20°C and at +4°C (samples stored at +20°C
showed a mean reduction of 10.4%). After 4 weeks
of storage, there was a mean reduction of GHB
concentrations higher than 20% at all storage temperatures. Ante-mortem urine samples showed a
reduction of GHB levels higher than 10% after just
3 days of storage for samples kept at all tested temperatures. After 4 weeks of storage, there was a
mean reduction of GHB concentrations higher than
25% at all storage temperatures.
CONCLUSIONS: According to our findings, it
would be useful to perform GHB analysis both in
blood and urine specimens within 3 days of
sampling and the specimens should be stored at
–20°C or 4°C in order to avoid instability issues
GHB concentration in breast milk of narcoleptic women treated with sodium oxybate. How important it is to be careful when interpreting values
Total tryptase or β-tryptase in post mortem settings: Which is to be preferred?
Dear Editor,
We have read with attention and interest the Tsea et al.
manuscript [1] entitled “Post mortem tryptase cut-off level for
anaphylactic death” where a 5-year retrospective study has
compared totaltryptase levels in the femoral blood of 9 anaphylactic
deaths and 45 controls. A cut-off of 53.8 mg/L was identified for total
post mortem tryptase in femoral blood with a sensitivity of 89% and
specificity of 93% through a receiver-operating characteristic (ROC)
curve analysis to diagnose anaphylaxis
- …