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

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

Orbital magnetism in axially deformed sodium clusters: From scissors mode to dia-para magnetic anisotropy

Low-energy orbital magnetic dipole excitations, known as scissors mode (SM), are studied in alkali metal clusters. Subsequent dynamic and static effects are explored. The treatment is based on a self-consistent microscopic approach using the jellium approximation for the ionic background and the Kohn-Sham mean field for the electrons. The microscopic origin of SM and its main features (structure of the mode in light and medium clusters, separation into low- and high-energy plasmons, coupling high-energy M1 scissors and E2 quadrupole plasmons, contributions of shape isomers, etc) are discussed. The scissors M1 strength acquires large values with increasing cluster size. The mode is responsible for the van Vleck paramagnetism of spin-saturated clusters. Quantum shell effects induce a fragile interplay between Langevin diamagnetism and van Vleck paramagnetism and lead to a remarkable dia-para anisotropy in magnetic susceptibility of particular light clusters. Finally, several routes for observing the SM experimentally are discussed.Comment: 21 pages, 7 figure

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

Erectile dysfunction in men with chronic obstructive pulmonary disease.

Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and medications. ED can have a significant impact on COPD men and consequently on their quality of life, which is usually already compromised. Given this situation, however, pneumologists usually do not properly care for the sexuality of COPD patients especially because men can be reluctant to talk about their intimate issues. The aim of this narrative review is to briefly summarize the evidence emerging from literature and to provide a wide point of view about sexual dysfunction in COPD men