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remitting relapsing carbamazepine overdosage mimicking vertebrobasilar transient ischemic attacks

The objective of this article is to describe an atypical, remitting-relapsing presentation of carbamazepine toxicity due to its interaction with nebivolol. The method we use is a case report of an elderly epileptic patient in treatment with antiepileptic drugs (AEDs) and antihypertensive drugs, manifesting transient neurological symptoms in association with high blood pressure values. The case report is of a 72-year-old male by forty years of age had tonicclonic seizures related to the presence of a cerebral arteriovenous malformation. Seizures had been successfully controlled for many years by the same dosage of carbamazepine and lamotrigine, and recently total serum carbamazepine levels resulted within the "therapeutic range." He had also a history of controlled essential hypertension, but lately he manifested a scarce control of his blood pressure values. Few days after a modification of his antihypertensive therapy, the patient had two transient episodes of dysarthria, ataxia, and dizziness. At the emergency department, his blood pressure values were 190/110 mmHg, ECG and routine blood tests were normal, and a brain CT did not show acute lesions; about two hours later, his neurological examination was normal. Morning fasting carbamazepine serum levels were "normal" too; therefore, his symptoms were initially interpreted as vertebrobasilar transient ischemic attacks. However, the recurrence of similar episodes despite the normalization of his blood pressure suggested a carbamazepine intoxication. Indeed, its dosage resulted too high just in occasion of one of his attacks. A moderate reduction of carbamazepine was followed by cessation of toxicity. This case reminds us to be aware of adverse consequences of other drugs in patients assuming carbamazepine: in this case, its toxicity was consequential to a likely metabolic interaction with nebivolol

Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure

Objective Asbestos is a known human carcinogen, with evidence for malignant mesothelioma (MM), cancers of lung, ovary, larynx and possibly other organs. MM rates are predicted to increase with a power of time since first exposure (TSFE), but the possible long-term attenuation of the trend is debated. The asbestos ban enforced in Italy in 1992 gives an opportunity to measure long-term cancer risk in formerly exposed workers. Methods Pool of 43 previously studied Italian asbestos cohorts (asbestos cement, rolling stock, shipbuilding), with mortality follow-up updated to 2010. SMRs were computed for the 1970–2010 period, for the major causes, with consideration of duration and TSFE, using reference rates by age, sex, region and calendar period. Results The study included 51 801 subjects (5741 women): 55.9% alive, 42.6% died (cause known for 95%) and 1.5% lost to follow-up. Mortality was significantly increased for all deaths (SMR: men: 1.05, 95% CI 1.03 to 1.06; women: 1.17, 95% CI to 1.12 to 1.22), all malignancies combined (SMR: men: 1.17, 95% CI to 1.14 to 1.20; women: 1.33, 95% CI 1.24 to 1.43), pleural and peritoneal malignancies (SMR: men: 13.28 and 4.77, 95% CI 12.24 to 14.37 and 4.00 to 5.64; women: 28.44 and 6.75, 95% CI 23.83 to 33.69 and 4.70 to 9.39), lung (SMR: men: 1.26, 95% CI 1.21 to 1.31; women: 1.43, 95% CI 1.13 to 1.78) and ovarian cancer (SMR=1.38, 95% CI 1.00 to 1.87) and asbestosis (SMR: men: 300.7, 95% CI 270.7 to 333.2; women: 389.6, 95% CI 290.1 to 512.3). Pleural cancer rate increased during the first 40 years of TSFE and reached a plateau after. Discussion The study confirmed the increased risk for cancer of the lung, ovary, pleura and peritoneum but not of the larynx and the digestive tract. Pleural cancer mortality reached a plateau at long TSFE, coherently with recent reports

Grapevine (Vitis vinifera L.) varietal assortment and evolution in the Marche region (central Italy)

14openInternationalItalian coauthor/editorItaly is one of the richest countries in terms of grapevine varietal assortment, and the Marche region in central Italy has an ancient winegrowing tradition. Increasing interest in autochthonous grapevine varieties prompted efforts to recover and identify local minor germplasm also in this region, and to search for pedigree relationships and determine the evolution of varietal assortment. In the present study this was done using nuclear and chloroplast microsatellite markers and SNP markers from the Vitis18kSNP chip. Eighteen new genotypes were found, of which seventeen belonged to well-known, less known and even unknown vines found to be specific to the Marche region. The rearranged pedigree highlighted the complex intertwining relationships between Marche varieties. Second-degree relationships were also derived. Some minor Marche varieties have increased the number of parent-offspring related members of Garganega, Sangiovese, Crepolino/Visparola and Sciaccarello, which are varieties already recognised as founders or recurrent parents of many Italian cultivars. Crepolino/Visparola was shown to be a key variety in the evolution of the Marche varietal assortment, having played the role of parent and grandparent, as explained by the presence of this genotype in the region in ancient times. Surprisingly, Semidano, a well-known Sardinian variety, played a clear role as parent or grandparent of three minor Marche varieties, testifying to its presence in central Italy in ancient times. Incrocio Bruni 54 was confirmed as an offspring of Sauvignon and Verdicchio, as declared by the breeder. The parentage of Lacrima was completed: this variety was found to be a spontaneous cross between Nera Rada and Aleatico. A dendrogram of genetic similarity clearly resembled the groups defined with the pedigree reconstruction and it gave an indication of the genetic similarity of the varieties excluded from the strictest parentage links.openCrespan, Manna; Migliaro, Daniele; Larger, Simone; Pindo, Massimo; Palmisano, Massimo; Manni, Alvise; Manni, Elisa; Polidori, Enzo; Sbaffi, Francesco; Silvestri, Quintilio; Silvestroni, Oriana; Velasco, Riccardo; Virgili, Settimio; Camilli, GiuseppeCrespan, M.; Migliaro, D.; Larger, S.; Pindo, M.; Palmisano, M.; Manni, A.; Manni, E.; Polidori, E.; Sbaffi, F.; Silvestri, Q.; Silvestroni, O.; Velasco, R.; Virgili, S.; Camilli, G

A Systematic Review and Meta-Analysis of Ginkgo biloba

Ginkgo biloba (Gb) has demonstrated antioxidant and vasoactive properties as well as clinical benefits in several conditions such as ischemia, epilepsy, and peripheral nerve damage. Additionally, Gb is supposed to act as potential cognitive enhancer in dementia. So far, several trials have been conducted to investigate the potential effectiveness of Gb in neuropsychiatric conditions. However, the results of these studies remain controversial. We conducted a systematic review and a meta-analysis of three randomised controlled trials in patients with schizophrenia and eight randomised controlled trials in patients with dementia. Gb treatment reduced positive symptoms in patients with schizophrenia and improved cognitive function and activities of daily living in patients with dementia. No effect of Gb on negative symptoms in schizophrenic patients was found. The general lack of evidence prevents drawing conclusions regarding Gb effectiveness in other neuropsychiatric conditions (i.e., autism, depression, anxiety, attention-deficit hyperactivity disorder, and addiction). Our data support the use of Gb in patients with dementia and as an adjunctive therapy in schizophrenic patients

Dinamiche temporali della mortalità per asbestosi in coorti di lavoratori del cemento- amianto in Italia

Introduzione Il cemento amianto è un settore lavorativo che ha comportato un’esposizione occupazionale ad elevate concentrazioni di fibre di amianto. Tra i dipendenti del cemento amianto si riporta la presenza di un certo numero di lavoratori affetti da asbestosi, una malattia polmonare occupazionale causata dall'inalazione e dalla deposizione di fibre di amianto nel tessuto polmonare, la cui progressione determina disabilità, insufficienza respiratoria e morte prematura. Nei paesi occidentali il tasso di mortalità per asbestosi è associato al passato consumo di amianto e segue dinamiche temporali correlate alla latenza. Obiettivi L’obiettivo dello studio è valutare le dinamiche temporali e i determinanti associati con la mortalità per asbestosi tra le 21 coorti osservate, costituite da lavoratori del cemento amianto esposti ad alte concentrazioni di fibre di amianto. Metodi La mortalità per asbestosi è stata analizzata in una coorte di 13076 addetti al cemento amianto (18.1% donne). Per ogni lavoratore è stata calcolata l’esposizione cumulativa sulla base della storia personale e i valori di esposizione diciascuna azienda per anno pesando per la diversa varietà mineralogica sulla base della frazione di amianto utilizzato (Hodgson e Darnton 2010). Sono state condotte tre diverse analisi, basate su Rapporti Standardizzati di Mortalità (RSM), modello Età- Periodo-Coorte (EPC) attraverso un modello di Poisson e analisi composizionale della mortalità per malattie asbesto correlate (tumore primitivo pleurico e peritoneale, tumore del polmone e asbestosi). In tutte e tre le analisi si è considerata l'esposizione cumulativa. Gli RSM sono stati calcolati utilizzando i tassi di mortalità di riferimento per regione, sesso, calendario e limitati al calcolo delle persone-anno ad eventi dopo il 1970. Risultati Le analisi si basano su 512117 anni-persona (388914 anni-persona dal 1970). La mortalità per asbestosi raggiunge valori elevati soprattutto tra le donne (uomini RSM: 508; donne: 1027). I valori dei RSM per asbestosi aumentano rapidamente all'aumentare dell'esposizione cumulativa e con il tempo trascorso dalla prima esposizione. L'analisi EPC riporta un chiaro contributo dell'età sulla mortalità con un andamento crescente a partire dai 60 anni ed con un picco di mortalità a 75-80 anni; i rischi relativi confermano l’associazione con esposizione cumulativa ed è un minore rischio tra le donne.Tra i lavoratori più pesantemente esposti, l'asbestosi diventa la prima causa di morte per malattie asbesto-correlate tra le persone più anziane. Conclusioni Si conferma che la mortalità da asbestosi è stata determinata principalmente dall'esposizione cumulativa. La differente composizione delle malattie asbesto correlate è attribuibile all'esposizione ad amianto e alla diversa abitudine al fumo tra generi. Come conseguenza del declino delle esposizioni dopo il 1980, il numero di morti per asbestosi è destinato a diminuire drasticamente nei prossimi decenni

Dinamiche temporali della mortalit\ue0 per asbestosi in coorti di lavoratori del cemento- amianto in Italia.

Introduzione Il cemento amianto \ue8 un settore lavorativo che ha comportato un\u2019esposizione occupazionale ad elevate concentrazioni di fibre di amianto. Tra i dipendenti del cemento amianto si riporta la presenza di un certo numero di lavoratori affetti da asbestosi, una malattia polmonare occupazionale causata dall'inalazione e dalla deposizione di fibre di amianto nel tessuto polmonare, la cui progressione determina disabilit\ue0, insufficienza respiratoria e morte prematura. Nei paesi occidentali il tasso di mortalit\ue0 per asbestosi \ue8 associato al passato consumo di amianto e segue dinamiche temporali correlate alla latenza. Obiettivi L\u2019obiettivo dello studio \ue8 valutare le dinamiche temporali e i determinanti associati con la mortalit\ue0 per asbestosi tra le 21 coorti osservate, costituite da lavoratori del cemento amianto esposti ad alte concentrazioni di fibre di amianto. Metodi La mortalit\ue0 per asbestosi \ue8 stata analizzata in una coorte di 13076 addetti al cemento amianto (18.1% donne). Per ogni lavoratore \ue8 stata calcolata l\u2019esposizione cumulativa sulla base della storia personale e i valori di esposizione di ciascuna azienda per anno pesando per la diversa variet\ue0 mineralogica sulla base della frazione di amianto utilizzato (Hodgson e Darnton 2010). Sono state condotte tre diverse analisi, basate su Rapporti Standardizzati di Mortalit\ue0 (RSM), modello Et\ue0- Periodo-Coorte (EPC) attraverso un modello di Poisson e analisi composizionale della mortalit\ue0 per malattie asbesto correlate (tumore primitivo pleurico e peritoneale, tumore del polmone e asbestosi). In tutte e tre le analisi si \ue8 considerata l'esposizione cumulativa. Gli RSM sono stati calcolati utilizzando i tassi di mortalit\ue0 di riferimento per regione, sesso, calendario e limitati al calcolo delle persone-anno ad eventi dopo il 1970. Risultati Le analisi si basano su 512117 anni-persona (388914 anni-persona dal 1970). La mortalit\ue0 per asbestosi raggiunge valori elevati soprattutto tra le donne (uomini RSM: 508; donne: 1027). I valori dei RSM per asbestosi aumentano rapidamente all'aumentare dell'esposizione cumulativa e con il tempo trascorso dalla prima esposizione. L'analisi EPC riporta un chiaro contributo dell'et\ue0 sulla mortalit\ue0 con un andamento crescente a partire dai 60 anni ed con un picco di mortalit\ue0 a 75-80 anni; i rischi relativi confermano l\u2019associazione con esposizione cumulativa ed \ue8 un minore rischio tra le donne.Tra i lavoratori pi\uf9 pesantemente esposti, l'asbestosi diventa la prima causa di morte per malattie asbesto-correlate tra le persone pi\uf9 anziane. Conclusioni Si conferma che la mortalit\ue0 da asbestosi \ue8 stata determinata principalmente dall'esposizione cumulativa. La differente composizione delle malattie asbesto correlate \ue8 attribuibile all'esposizione ad amianto e alla diversa abitudine al fumo tra generi. Come conseguenza del declino delle esposizioni dopo il 1980, il numero di morti per asbestosi \ue8 destinato a diminuire drasticamente nei prossimi decenni

Thigh muscles injuries in professional soccer players: a one year longitudinal study

Thigh muscles indirect injuries are common finding in soccer and represent a critical challenge for teams medical staffs. Indirect injuries are classified on the basis of their site and their clinical and radiological findings, but the assessment of a precise prognosis remains a crucial point. Both ultrasound (US) and magnetic resonance (MR) represent effective techniques not only to detect indirect injuries but also to accurately determine severity, location, and, consequently, the prognosis. In this setting, our aim is to review imaging findings of professional athletes muscle tears at three time points (3 days, 2 weeks, and 4 weeks after the time of injury) and, further, to investigate the correlation between tears extent and lay-off time of the athletes. Combined US-MR assessment could be helpful in the management of thigh muscles indirect injuries providing accurate information about the site, the extent, and the healing proces

Muscle magnetic resonance imaging in myotonic dystrophy type 1 (DM1) : Refining muscle involvement and implications for clinical trials

Only a few studies have reported muscle imaging data on small cohorts of patients with myotonic dystrophy type 1 (DM1). We aimed to investigate the muscle involvement in a large cohort of patients in order to refine the pattern of muscle involvement, to better understand the pathophysiological mechanisms of muscle weakness, and to identify potential imaging biomarkers for disease activity and severity. One hundred and thirty-four DM1 patients underwent a cross-sectional muscle magnetic resonance imaging (MRI) study. Short tau inversion recovery (STIR) and T1 sequences in the lower and upper body were analyzed. Fat replacement, muscle atrophy and STIR positivity were evaluated using three different scales. Correlations between MRI scores, clinical features and genetic background were investigated. The most frequent pattern of muscle involvement in T1 consisted of fat replacement of the tongue, sternocleidomastoideus, paraspinalis, gluteus minimus, distal quadriceps and gastrocnemius medialis. Degree of fat replacement at MRI correlated with clinical severity and disease duration, but not with CTG expansion. Fat replacement was also detected in milder/asymptomatic patients. More than 80% of patients had STIR-positive signals in muscles. Most DM1 patients also showed a variable degree of muscle atrophy regardless of MRI signs of fat replacement. A subset of patients (20%) showed a 'marbled' muscle appearance. Muscle MRI is a sensitive biomarker of disease severity alsofor the milder spectrum of disease. STIR hyperintensity seems to precede fat replacement in T1. Beyond fat replacement, STIR positivity, muscle atrophy and a 'marbled' appearance suggest further mechanisms of muscle wasting and weakness in DM1, representing additional outcome measures and therapeutic targets for forthcoming clinical trials. We refined the pattern of muscle involvement in DM1 by upper and lower body muscle magnetic resonance imaging (MRI), identifying the most frequent pattern of fat replacement and confirming that muscle MRI is a sensitive biomarker of disease burden in DM1. We also observed: STIR-positive muscles in 80% of patients preceding fat replacement, muscle atrophy in muscles unreplaced by fat, and progeroid muscle appearance supporting a premature muscle senescence. Our findings provide novel insights into the pathophysiological mechanisms of muscle wasting and weakness in DM1, and could represent additional outcome measures and therapeutic targets for forthcoming clinical trials