First Surveillance of Violence againstWomen during COVID-19 Lockdown: Experience from “Niguarda” Hospital in Milan, Italy

Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries

The frequency of polidrug use in a driving population in Rome

In Italy the illicit substances routinely tested are cannabinoids, cocaine, opiates, amphetamines / methamphetamine, MDMA and similar but these substances are not the most use in our country. In particular, the consumption of ketamine represents an emerging problem. Ketamine is a anesthetic with hallucinogenic and dissociative effects and these are the ones sought for the voluptuary pur-pose, while the amnesic effect are exploited for drug facilitated sexual assault. Our study was car-ried out to assess the positivity for the illicit substances routinely tested and also for ketamine in a population of 182 patients arrived at the emergency room of the Hospital “San Camillo Forlanini” of Rome, for which have been required toxicological tests on the basis of Articles 186 and 187 of the New Highway Code. The choice of this kind of population allows to have an accurate and reliable epidemiological data about the real diffusion of voluptuary use of drugs. The study examines 182 samples subjected to routine toxicological investigations in the period be-tween October 2011 and August 2012. The Authors have researched the presence of ethanol, cannabinoids, cocaine, opiates, amphetamines and benzodiazepines with the use of “ADVIA Chemistry Systems ”, while the ketamine is tested by a single-phase tests on urine [Sure Screen Diagnostic (Di. Ra.Lab)] with a cut-off level of this method is 1000ng/ml. During this period we have considered 182 patients (males 78%, females 22%). The mean age was 34 years (standard deviation 13, minimum 15, maximum 80). Most of the admission were during the last days of the week (Thursday 17%, Friday 15%, Saturday 15% and Sunday 17%). With re-spect to the clinical needs of subjects admitted, 42% were admitted with a red code. Considering a single substance analysis, 46 subjects resulted positive to alcohol (25%), 38 to can-nabinoids (21%), 24 to opioids (13%), 20 to cocaine (11%), 19 to benzodiapezine (10%) and 7 to ketamine (4%). Among those who resulted positive to at least one substance (95, 52% of the sample) 55 subjects re-sulted positive to one substance (58%), 27 to two substances (28%) and 13 to three or more substances (13%). Poly-use was evaluated with an indicator previously proposed by Fabi et al in 2013. This resulted in a polydrug-use score equal to 2.93 (standard deviation 1.7, minimum 1.5, maximum 9.25)

New Psychoactive Substances: Evolution in the Exchange of Information and Innovative Legal Responses in the European Union

Abstract: At the end of 2019, the European Monitoring Centre for Drugs and Drug Addiction was monitoring around 790 new psychoactive substances, more than twice the total number of controlled substances under the United Nations Conventions. These substances, which are not subject to international drug controls, include a wide range of molecules, including the assortment of drugs such as synthetic cannabinoids, stimulants, opiates, and benzodiazepines. Most of them are sold as “legal” substitutes for illicit drugs, while others are intended for small groups willing to experiment with them in order to know their possible new effects. At the national level, various measures have been taken to control new substances and many European countries have responded with specific legislationinfavorofconsumersafetyandbyextendingoradaptingexistingdruglawstoincorporate the new psychoactive substances. Moreover, since 1997, an early warning system has been created in Europe for identifying and responding quickly to the risks of new psychoactive substances. In order toestablishaquickerandmoreeffectivesystemtoaddressthecriminalactivitiesassociatedwithnew dangerous psychoactive substances, the European legal framework has considerably changed over the years

Intention to be vaccinated for COVID-19 among Italian nurses during the pandemic

Background: While the COVID-19 pandemic has spread globally, health systems are overwhelmed by both direct and indirect mortality from other treatable conditions. COVID-19 vaccination was crucial to preventing and eliminating the disease, so vaccine development for COVID-19 was fast-tracked worldwide. Despite the fact that vaccination is commonly recognized as the most effective approach, according to the World Health Organization (WHO), vaccine hesitancy is a global health issue. Methods: We conducted a cross-sectional online survey of nurses in four different regions in Italy between 20 and 28 December 2020 to obtain data on the acceptance of the upcoming COVID-19 vaccination in order to plan specific interventions to increase the rate of vaccine coverage. Results: A total of 531 out of the 5000 nurses invited completed the online questionnaire. Most of the nurses enrolled in the study (73.4%) were female. Among the nurses, 91.5% intended to accept vaccination, whereas 2.3% were opposed and 6.2% were undecided. Female sex and confidence in vaccine efficacy represent the main predictors of vaccine intention among the study population using a logistic regression model, while other factors including vaccine safety concerns (side effects) were non-significant. Conclusions: Despite the availability of a safe and effective vaccine, intention to be vaccinated was suboptimal among nurses in our sample. We also found a significant number of people undecided as to whether to accept the vaccine. Contrary to expectations, concerns about the safety of the vaccine were not found to affect the acceptance rate; nurses’ perception of vaccine efficacy and female sex were the main influencing factors on attitudes toward vaccination in our sample. Since the success of the COVID-19 immunization plan depends on the uptake rate, these findings are of great interest for public health policies. Interventions aimed at increasing employee awareness of vaccination efficacy should be promoted among nurses in order to increase the number of vaccinated people

The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study

INTRODUCTION: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. METHODS: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. RESULTS: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. CONCLUSIONS: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

A Five-Year Survey for Plastic Surgery Malpractice Claims in Rome, Italy

(1) Introduction: Medical malpractice claims against both health institutions and physicians are a crucial topic in Italy, as well as in other countries, particularly regarding civil proceedings. Our study reports an analysis of all of the malpractice judgments concerning plastic surgery decided in the Civil Court of Rome between 2012 and 2016. (2) Methods: the database of the Observatory Project on Medical Responsibility (ORMe) was analyzed, which collects all of the judgments of the Civil Court of Rome, that is, the first instance district court. Therefore, neither the jurisprudence of the second level court nor that of the Supreme Court was taken into account. (3) Results: 144 judgments concerning plastic surgery were delivered in the five-year period of 2012–2016 (corresponding to 10.6% of total professional liability verdicts of the Civil Court of Rome in the same period). In 101/144 cases (70.14%), the claim was accepted. A total of €4,727,579.00 was paid in compensation for plastic surgery malpractice claims, with a range from a minimum amount of €1555.96 to a maximum amount of €1,425,155.00 and an average compensation of €46,807.71 per claim that was significantly lower compared to other surgical disciplines. (4) Conclusions: Our data confirm that the analyzed branch has a high litigation rate, with a prevalence of convictions for cosmetic procedures over reconstructive ones, both for malpractice and for violation of the informed consent. Plastic surgery is also confirmed among those branches in which the professionals are more frequently sued compared to health institutions

MEDICO-LEGAL AND TRAUMATOLOGICAL ASPECTS OF ORBITAL FRACTURES: A CASE REPORT

Orbital fractures account for 10-25% of all facial fractures. The etiology of such injuries can be traced to: acts of violence (36%), motor vehicle accidents (32%), falls (18%), sports injuries (11%), occupational accidents (3%) and gunshot wounds (2%). In 30% of cases, orbital fractures are associated with intraocular complications, 11-15% of which are serious ophthalmic emergencies that may cause reduced visual acuity. In this paper, we report the case of a motorcyclist who was treated for complex facial fractures (orbital, sphenoid, ethmoid and zygomaticomaxillary complex fractures involving the mastoid air cells and nasal conchae as well as the septum, nasal fractures and fractures in the pterygoid plates). After an initial diagnostic assessment, the doctors determined that the most critical damage was caused by the trauma inflicted to the left orbital walls. An open reduction was therefore carried out on this injury about a month later. The trauma had caused, on the one hand, a marked alteration of the patient’s facial appearance, and on the other hand, at a functional level, the onset of diplopia. This article analyses the long-term effects of orbital fractures on the patients’ physical fitness, considering the specific experience from the clinical case reported

Acute liver failure caused by paracetamol toxicity: A case report

This was a case of acute liver failure caused by paracetamol toxicity. The patient was a 54-year-old woman who self-medicated with paracetamol to treat a fever. She was admitted to hospital after 3 days of nausea, vomiting, and jaundice. After excluding viral hepatitis, diagnosis leaned towards hepatitis secondary to paracetamol, which was later confirmed by serum paracetamol levels (69.4 mg/L). Despite acetylcysteine therapy, the patient died after a few hours. Upon macroscopic examination at autopsy, diffuse congestion of the hepatic parenchyma with alterations to the normal structure and diffuse parenchymal necrosis were observed. Upon microscopic examination of hepatic tissue, features of hepatic centrilobular necrosis were present. From data reported in the literature, findings obtained from the clinical history and the anatomopathological evidence suggested that the death of the patient was attributable to accidental paracetamol poisoning

Un caso di resezione della prima filiera delle ossa del carpo: aspetti valutativi

The authors, inspired by a case received their observation in terms of “insurance policy” (proximal row carpectomy), they highlight how the forensic medicine – and not just evaluation – must be constantly attentive to the evolution and the progress of other branches of medicine in order to make judgments more appropriate and responsive to the needs of the law. Finally, the emphasis, as has already been pointed out many times before, on the profound differences that may characterize the same evaluative disability in most areas of medical-legal response