A phenobarbital overdose: a case report

Background: Phenobarbital is a long-acting barbiturate, responsible for many cases of poisoning, from unintentional overdose or attempted suicide. We report a case of phenobarbital overdose in a patient with history of depression. Patients and Methods: A 60 year old woman was admitted to our Internal Medicine Unit for drowsiness, irritability, difficulties in the maintenance of an upright position, dysphasia and weakness. She was suffering from depression and epilepsy and treated with phenobarbital 150 mg/die. Results: At the admittance, she had high fever and neck stiffness; phenobarbital serum levels were 71.2 mcg/ml (3 times u.n.l.); aminotransferases were 12-17u.n.l. Arterial blood pressure was 80/50 mmHg. An inflammatory meningeal process was excluded by lumbar puncture; a brain and spinal cord CT scan excluded spine bone lesions and ischemic stroke. In the suspect of an overdose, a protocol of urine alkalinization was applied resulting in a reduction of phenobarbital levels below the therapeutic range in about 6 days, with state of consciousness, cognitive and behavioral functions improvement. A rapid normalization in aminotransferases levels was noted and serology for hepatitis viruses (HAV, HBV, CMV, EBV, HSV) resulted negative. Conclusions: In our patient phenobarbital was responsible for stupor, hypotension, hypertonicity and aminotransferases elevation, whereas fever was due to a concomitant pulmonary inflammatory process resolved after antibiotic therapy. Despite the use of these drugs has been progressively reduced, the number overdose reports remains still hig

Non-invasive assessment of liver steatosis and fibrosis in HIV/HCV- and HCV- infected patients

Background. Conflicting data have been reported on the prevalence of liver steatosis, its risk factors and its relationship with fibrosis in patients with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection or with HCV mono-infection. Aim. The study aims were to assess steatosis prevalence and its risk factors in both HCV groups. We also evaluated whether steatosis was linked with advanced fibrosis. Sixty-eight HIV/HCV co-infected and 69 HCV mono-infected patients were consecutively enrolled. They underwent liver ultrasonography and transient elastography. Bright liver echo-pattern was used to diagnose steatosis; advanced fibrosis was defined as liver stiffness ≥ 9.5 kPa and FIB-4 values ≥ 3.25. The optimal stiffness cut-off according to FIB-4 ≥ 3.25 was evaluated by ROC analysis. Results. No significant difference was found in steatosis-prevalence between mono- and co-infected patients (46.3 vs. 51.4%). Steatosis was associated with triglycerides and impaired fasting glucose/diabetes in HCV mono-infected, with lipodystrophy, metabolic syndrome, total-cholesterol and triglycerides in co-infected patients. Stiffness ≥ 9.5 was significantly more frequent in co-infection (P < 0.003). Advanced fibrosis wasn't significantly associated with steatosis. The area under the ROC curve was 0.85 (95% CI 0.79-0.9). On multivariate analysis steatosis was associated with triglycerides in both HCV mono- and co-infected groups (P < 0.02; P < 0.03). Conclusion. Although steatosis was common in both HCV mono- and co-infected patients, it was not linked with advanced fibrosis. Triglycerides were independent predictors of steatosis in either of the HCV-groups. Dietary interventions and lifestyle changes should be proposed to prevent metabolic risk factors

MODIFICAZIONI ECOGRAFICHE DELLA LINFADENOPATIA DELL’ILO EPATICO DOPO ERADICAZIONE DELL’HCV CON DIRECT-ACTING ANTIVIRALS

A) Valutare le modificazioni ecografiche (US) dei linfonodi (LN) dell’ilo epatico in pazienti con epatopatia cronica (EC) correlata al virus dell’epatite C (HCV) e Sustained Virological Responders (SVR) alla terapia con i Direct-Acting Antivirals (DAAs); B) rilevare i fattori predittivi correlati con la scomparsa di LN. Abbiamo studiato 177 pazienti, trattati con DAAs, arruolati consecutivamente tra il Gennaio 2015 e il Dicembre 2016, con un follow-up dell’SVR di 24 mesi (SVR24) a Dicembre 2018; erano esclusi i pazienti con storia o insorgenza di epatocarcinoma nel follow-up. I LN erano definiti ingranditi (LN+) se il diametro maggiore era &gt;1 cm. Al baseline (BL) registravamo: età, sesso, BMI, markers HBV, HCV e genotipo, uso di alcol; valutavamo al BL, a 12 mesi (SVR12) e a 24 mesi: test di funzione epatica, HCV-RNA, liver stiffness (Fibroscan), diametri US di vena porta e milza. La prevalenza di LN+ al BL era 49.8%, il diametro 2.1±0.6 cm, in LN+ vs LN- le transaminasi erano più elevate (P&lt;0.05). A SVR12 la prevalenza di LN+ era 32.2 %; in LN+ vs LNs (pazienti in cui erano scomparsi) dei parametri studiati solo l’età era maggiore (P&lt;0.05). Il diametro dei LN+ a SVR12 era 1.8±0.4 cm, ridotto rispetto al BL (P&lt;0.05). A SVR24 la prevalenza di LN+ era 29.3 % inferiore vs BL (P&lt;0.001), solo l’età si confermava maggiore vs LNs (P&lt;0.03). Il diametro di LN+ era 1.7±0.5 minore che al BL (P&lt;0.05), sovrapponibile a SVR12 (P=ns). Nelle EC da HCV è frequente il rilievo US di LN all’ilo epatico, considerati indice di grading e staging istologici epatici più severi ed espressione del linfotropismo virale. Alla luce di questi presupposti i LN dovrebbero scomparire dopo l’eradicazione dell’infezione HCV, a questo proposito gli studi dopo terapia con Interferone sono contrastanti. Nel nostro studio LN+ al BL correla con AST e ALT confermando la relazione con l’attività necro-infiammatoria epatica. A SVR24 la prevalenza di LN+ è del 29.4% significativamente ridotta che al BL. IL diametro dei LN+ residui diminuisce a SVR12 per poi stabilizzarsi. La causa della persistenza di LN è controversa, l’assenza di relazione tra LN+ residui ed indici di funzione e fibrosi epatica ci fa ipotizzare che non dipenda più dall’attività della malattia epatica, ma da altre variabili, una potrebbe essere la diversa attività immunologica instauratasi dopo l’eradicazione virale, a conferma di ciò va ricordato che nel 20 % dei soggetti sani è possibile rilevare LN all’ilo epatico (J.Hepatol.2003;39:807), dato questo simile al nostro 29.4 %

Dispositional optimism as a correlate of decision-making styles in adolescence

Despite the numerous psychological areas in which optimism has been studied, including career planning, only a small amount of research has been done to investigate the relationship between optimism and decision-making styles. Consequently, we have investigated the role of dispositional optimism as a correlate of different decision-making styles, in particular, positive for effective styles and negative for ineffective ones (doubtfulness, procrastination, and delegation). Data were gathered through questionnaires administered to 803 Italian adolescents in their last 2 years of high schools with different fields of study, each at the beginning stages of planning for their professional future. A paper questionnaire was completed containing measures of dispositional optimism and career-related decision styles, during a vocational guidance intervention conducted at school. Data were analyzed using stepwise multiple regression. Results supported the proposed model by showing optimism to be a strong correlate of decision-making styles, thereby offering important intervention guidelines aimed at modifying unrealistically negative expectations regarding their future and helping students learn adaptive decision-making skills

GaSb-based solar cells for multi-junction integration on Si substrates

We report on the first single-junction GaSb solar cell epitaxially grown on a Si substrate. A control stand-alone GaSb solar cell was primarily fabricated, which demonstrated a 5.90% efficiency (AM1.5G). The preparation, growth and manufacturing procedures were then adapted to create the GaSb-on-Si solar cell. The hybrid device resulted in a degraded efficiency for which comparison between experimental and simulated data revealed dominant non-radiative recombination processes. Material and electrical characterization also highlighted the impact of anti-phase domains and boundaries and threading dislocation density on the shunt resistance of the cell. Nevertheless, the GaSb-on-Si cell performance is close to recent results on the integration of GaSb solar cells on GaAs, despite a much larger lattice mismatch (12% vs 8%). Routes for improvement, concerning the material quality and cell structure, are proposed. This work lays the foundations of a GaSb-based multi-junction solar cell monolithically integrated on Si

Construire sa vie (Life designing) : un paradigme pour l’orientation au 21e siècle

Ce texte est la traduction française de l’article publié dans le Journal of Vocational Behavior, 75(3) : Savickas, M. L., Nota, L., Rossier, J., Dauwalder, J.-P., Duarte, M. E., Guichard, J., Soresi, S., Van Esbroeck, R., & van Vianen, A. E. M., « Life designing: A paradigm for career construction in the 21st century » (239-250), © 2009, avec la permission de Elsevier. http://www.sciencedirect.com/science/journal/00018791 ***** La nouvelle organisation sociale du travail du début du 21e siècle pose une série de questions et lance de nombreux défis aux spécialistes de l’accompagnement en orientation professionnelle. Compte tenu de la mondialisation du conseil en orientation, c’est dans un cadre international que nous avons décidé d’aborder ces questions, puis de formuler des réponses potentiellement innovantes. Cette approche permet d’éviter les difficultés que soulève la création de modèles et de méthodes dans un pays donné en tentant ensuite de les exporter dans d’autres, où ils doivent être adaptés pour être utilisés. Cet article présente le premier résultat tangible de cette collaboration : un modèle et des méthodes d’accompagnement des personnes. Le modèle « Construire sa vie », destiné à des interventions d’accompagnement en orientation se fonde sur cinq présupposés concernant les personnes et leur vie professionnelle : des possibilités liées aux contextes, des processus dynamiques, une progression non linéaire, des perspectives multiples et des configurations individuelles. En partant de ces présupposés, nous avons bâti un modèle en contexte, se réclamant de l’épistémologie du constructionnisme social, reconnaissant en particulier que les connaissances et l’identité d’un individu sont le produit d’interactions sociales et que le sens est co-construit, via la médiation du discours. Le cadre général « construire sa vie » s’appuie sur les théories de la construction de soi (Guichard, 2005) et de la construction des parcours professionnels (Savickas, 2005), qui décrivent les conduites d’orientation et leurs développements. Ce cadre concerne toute la vie, il est holiste, tient compte des contextes et est préventif.At the beginning of the 21st century, a new social arrangement of work poses a series of questions and challenges to scholars who aim to help people develop their working lives. Given the globalization of career counseling, we decided to address these issues and then to formulate potentially innovative responses in an international forum. We used this approach to avoid the difficulties of creating models and methods in one country and then trying to export them to other countries where they would be adapted for use. This article presents the initial outcome of this collaboration, a counseling model and methods. The life-designing model for career intervention endorses five presuppositions about people and their work lives: contextual possibilities, dynamic processes, non-linear progression, multiple perspectives, and personal patterns. Thinking from these five presuppositions, we have crafted a contextualized model based on the epistemology of social constructionism, particularly recognizing that an individual’s knowledge and identity are the product of social interaction and that meaning is co-constructed through discourse. The life-design framework for counseling implements the theories of self-constructing (Guichard, 2005) and career construction (Savickas, 2005) that describe vocational behavior and its development. Thus, the framework is structured to be life-long, holistic, contextual, and preventive

Association between Serum Interleukin-6 Concentrations and Mortality in Older Adults: The Rancho Bernardo Study

Background: Interleukin-6 (IL-6) may have a protective role in acute liver disease but a detrimental effect in chronic liver disease. It is unknown whether IL-6 is associated with risk of liver-related mortality in humans. Aims: To determine if IL-6 is associated with an increased risk of all-cause, cardiovascular disease (CVD), cancer, and liverrelated mortality. Methods: A prospective cohort study included 1843 participants who attended a research visit in 1984–87. Multiple covariates were ascertained including serum IL-6. Multivariable-adjusted Cox proportional hazards regression analyses were used to examine the association between serum IL-6 as a continuous (log transformed) variable with all-cause, CVD, cancer, and liver-related mortality. Patients with prevalent CVD, cancer and liver disease were excluded for cause-specific mortality. Results: The mean (6 standard deviation) age and body-mass-index (BMI) of participants was 68 (610.6) years and 25 (63.7) Kg/m 2, respectively. During the 25,802 person-years of follow-up, the cumulative all-cause, CVD, cancer, and liverrelated mortality were 53.1 % (N = 978), 25.5%, 11.3%, and 1.3%, respectively. The median (6IQR) length of follow-up was 15.3610.6 years. In multivariable analyses, adjusted for age, sex, alcohol, BMI, diabetes, hypertension, total cholesterol, HDL, and smoking, one-SD increment in log-transformed serum IL-6 was associated with increased risk of all-cause, CVD, cancer, and liver-related mortality, with hazard ratios of 1.48 (95 % CI, 1.33–1.64), 1.38 (95 % CI, 1.16–1.65), 1.35 (95 % CI, 1.02–1.79)

Induction chemotherapy followed by concurrent standard radiotherapy and daily low-dose cisplatin in locally advanced non-small-cell lung cancer

Both induction chemotherapy and concurrent low-dose cisplatin have been shown to improve results of thoracic irradiation in the treatment of locally advanced non-small-cell lung cancer (NSCLC). This phase II study was designed to investigate activity and feasibility of a novel chemoradiation regimen consisting of induction chemotherapy followed by standard radiotherapy and concurrent daily low-dose cisplatin. Previously untreated patients with histologically/cytologically proven unresectable stage IIIA/B NSCLC were eligible. Induction chemotherapy consisted of vinblastine 5 mg m−2 intravenously (i.v.) on days 1, 8, 15, 22 and 29, and cisplatin 100 mg m−2 i.v. on days 1 and 22 followed by continuous radiotherapy (60 Gy in 30 fractions) given concurrently with daily cisplatin at a dose of 5 mg m−2 i.v. Thirty-two patients were enrolled. Major toxicity during induction chemotherapy was haematological: grade III–IV leukopenia was observed in 31% and grade II anaemia in 16% of the patients. The most common severe toxicity during concurrent chemoradiation consisted of grade III leukopenia (21% of the patients); grade III oesophagitis occurred in only two patients and pulmonary toxicity in one patient who died of this complication. Eighteen of 32 patients (56%, 95% CI 38–73%) had a major response (11 partial response, seven complete response). With a median follow-up of 38.4 months, the median survival was 12.5 months and the actuarial survival rates at 1, 2 and 3 years were 52%, 26% and 19% respectively. The median event-free survival was 8.3 months with a probability of 40%, 23% and 20% at 1, 2 and 3 years respectively. Induction chemotherapy followed by concurrent daily low-dose cisplatin and thoracic irradiation, in patients with locally advanced NSCLC, is active and feasible with minimal non-haematological toxicity. Long-term survival results are promising and appear to be similar to those of more toxic chemoradiation regimens, warranting further testing of this novel chemoradiation strategy. © 1999 Cancer Research Campaig