Bipolar Spectrum Symptoms in Patients with Fibromyalgia: A Dimensional Psychometric Evaluation of 120 Patients

Background: Fibromyalgia Syndrome (FMS) is characterized by chronic widespread pain, fatigue, unrefreshing sleep and cognitive dysfunction. Depressive and manic symptoms are often reported in FMS patients' history. The aim of this study was to evaluate the prevalence of bipolar spectrum symptoms (BSS) and to correlate these with quality of life (QoL) scores and antidepressant treatment. Methods: From October 2017 to July 2018, a battery of QoL questionnaires (FIQ, PSQI and SF-12) was administered to 120 FMS patients after a clinical examination. The MOODS-SR lifetime questionnaire was then remotely administered to the patients included in the study. Results: The presence of depressive and manic lifetime symptoms was found, in line with the results of the available literature. A correlation was found between the history of depressive symptoms and the severity of FIQ and SF-12 scores. Despite a low statistical strength, a trend toward a correlation between a history of manic symptoms and SNRI treatment was detected. Conclusions: The correlation between the MOOD-depressive domains and poor QoL is in line with the available literature. Further studies are needed to corroborate these findings and to elucidate the relationship between manic symptoms and SNRI treatment

Extended Treatment with Micron-Size Oral Palmitoylethanolamide (PEA) in Chronic Pain: A Systematic Review and Meta-Analysis

Palmitoylethanolamide (PEA) emerged over the years as a promising approach in the management of chronic pain. Despite the fact that the efficacy of micron-size PEA formulations appears to be time-dependent, the optimal timing has not yet been elucidated. This systematic review and meta-analysis aim to estimate the possible advantage of an extended treatment in the relief of chronic pain. The literature search was conducted consulting scientific databases, to identify clinical trials in which micron-size PEA was administered for at least 60 days, and pain assessed by the Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS). Nine studies matched the required criteria, for a total of 742 patients involved. The meta-analysis showed a statistically and clinically significant pain intensity reduction after 60 days of micron-size PEA supplementation, compared to 30 days (1.36 points, p < 0.01). The secondary analysis revealed a weighted NRS/VAS score decrease of 2.08 points within the first month of treatment. These two obtained scores corresponded to a 35.1% pain intensity reduction within the first month, followed by a further 35.4% during the second month. Overall, these results confirm the clinically relevant and time-depended pain-relieving effect of micron-size PEA and therefore the advantage of an extended treatment, especially in patient with incomplete pain management

Infortunio Lavorativo e Concause Tossicologiche: risultati di una indagine preliminare in collaborazione con I.N.A.I.L. \u2013 Regione Veneto

Gli incidenti stradali e gli infortuni sul lavoro si collocano tra le pi\uf9 importanti cause di morte o di menomazione. A livello europeo l\u2019alcol \ue8 stato correlato al 25% delle morti su strada, causando la morte di circa 10.000 persone ogni anno. Relativamente agli infortuni sul lavoro, il trend dei sinistri sul lavoro, in costante calo negli anni recenti, trova ragionevolmente una concausa efficiente nell\u2019applicazione delle recenti norme sugli obblighi di accertamento dell\u2019idoneit\ue0 al lavoro anche in relazione al consumo di sostanze posti a carico del medico competente [D.Lgs 81/2008], tuttavia la reale percentuale di morti ed infortuni lavorativi alcol correlati risulta di fatto sconosciuta.In questo scenario, valutando i dati statistici pubblicati dall\u2019INAIL, risulta che una considerevole quota di infortuni sul lavoro (soprattutto mortali) \ue8 ricollegabile a sinistrosit\ue0 stradale. Da un punto di vista tossicologico, esiste un consenso generale ed una robusta base scientifica che supporta la correlazione tra impairment psico-attitudinale e concentrazioni ematiche di alcol. Risulta dunque evidente l\u2019interesse scientifico, medico ed assicurativo nell\u2019effettuare uno studio epidemiologico che vada ad indagare la prevalenza della \u201cguida sotto l\u2019effetto\u201d di alcol nei casi di sinistri stradali identificabili come infortuni lavorativi allo scopo di sviluppare adeguate politiche volte al contenimento di tale fenomeno.Il Laboratorio di Analitica Forense del Dipartimento di Diagnostica e Sanit\ue0 Pubblica dell\u2019Universit\ue0 degli Studi di Verona analizza, secondo le procedure della moderna tossicologia, i campioni ematici che pervengono dai Pronto Soccorsi di Verona e provincia di soggetti coinvolti in sinistro della strada con feriti. Questi dati sono stati interfacciati, attraverso uno specifico software, con il database dell\u2019INAIL allo scopo di estrapolare i sinistri stradali occorsi in occasione di lavoro. Sono stati analizzati con strumenti statistici dati quali mansione lavorativa, lesivit\ue0, sesso, giorno della settimane e orario del sinistro ed et\ue0 del conducente.Sono stati arruolati 8459 casi (occorsi dal 2006 al 2013) di sinistri stradali con feriti.I dati interfacciati con il database INAIL hanno dimostrato che il 7,5% dei sinistri stradali INAIL correlati si sono realizzati con una concentrazione ematica di alcol positiva, di cui oltre il 77% al di fuori dei limiti di legge. Dunque, sebbene la prevalenza dei guidatori \u201csotto l\u2019effetto\u201d fra gli infortuni lavorativi sia nettamente inferiore alla popolazione generale dei conducenti di veicoli, questa rappresenta indubbiamente un severo problema per la sicurezza stradale ed in ambito lavorativo.Road and occupational accidents are important causes of death or disability. In Europe alcohol has been linked to 25% of lethal road accidents, killing about 10,000 people each year. Although the trend of accidents at work has been steadily decreasing in recent years, reportedly because of the application of a law banning alcohol use in the workplace [D.Lgs 81/2008, L 131/2003], the real percentage of deaths and injuries in the workplace directly related to alcohol is unknown. Data collected from INAIL records demonstrate that a relevant part of the occupational accidents is represented by traffic injuries. There is a general consensus and a strong scientific base that supports the correlation between alcohol and impairment. On these grounds, it is of the highest interest in the scientific, medical and insurance fields, to study the blood alcohol concentration in cases of occupational road accidents, in order to develop adequate policies to hinder the phenomenon.The Laboratory of Forensic Analytical Department of Diagnostic and Public Health, University of Verona analyzes, according to the procedures of modern toxicology, blood sampled from drivers involved in a road traffic accident with injuries in the emergency units of the hospitals of Verona. In the present study toxicological data was interfaced through a specific software with the database of INAIL in order to extrapolate those accidents that occurred at work during work-related road transfers. Type of work, type of injuries, gender, day and time of occurrence, age of the driver, were considered as variables of interest and analysed by using statistical methods 8459 cases (occurred between 2006 and 2013) of drivers involved in a road traffic accident with injuries have been enrolled.Comparing our toxicological results to the corresponding data deduced from the INAIL database, a 7,5% of traffic accidents occurred in workers with a blood alcohol concentration above 0 g/L. On this sample, in the 77% of subjects the blood alcohol concentration was above the legal limit (0.5 g/L). Thus, although apparently with a much lower prevalence than in the general population, \u201cdriving under alcohol influence\u201d occurs also among professional drivers, representing a severe problem for the road and workplace safety

I delitti sessuali

A seguito di profonde modifiche culturali avvenute nella societ\ue0 del dopoguerra e di un dibattito parlamentare di durata ventennale, l\u2019introduzione della legge n. 66/1996 recante \u201cNorme contro la violenza sessuale\u201d ha determinato una radicale modifica dell\u2019inquadramento giuridico della fattispecie delittuosa nel Codice Penale. In questo capitolo vengono prese in considerazioni le modifiche di legge apportate e le procedure sanitarie adottate in caso di violenza sessuale

I delitti sessuali

A seguito di profonde modifiche culturali avvenute nella societ\ue0 del dopoguerra e di un dibattito parlamentare di durata ventennale, l\u2019introduzione della legge n. 66/1996 recante \u201cNorme contro la violenza sessuale\u201d ha determinato una radicale modifica dell\u2019inquadramento giuridico della fattispecie delittuosa nel Codice Penale. In questo capitolo vengono prese in considerazioni le modifiche di legge apportate e le procedure sanitarie adottate in caso di violenza sessuale

Two cases of multiple stab wounds: suicide or homicide?

Introduction. Multiple stab wounds in traumatic deaths usually indicate homicide. Nonetheless, a self-harming action should always be taken into consideration. Self-inflicted wounds tend to be in readily accessible regions of the body such as the anterior chest, neck and abdomen; sensitive areas are often spared. Hesitation wounds and no defence injuries are also typical of suicide. Materials and methods. Two cases of atypical suicide with a knife are reported. Homicide was initially suspected due to the amount and distribution of the injuries but, after investigation, the involvement of any other person could be excluded. Each case was subjected to a full medicolegal investigation with an autopsy and toxicological analyses. Background information was also reviewed. Results. Case 1: A 44-year-old male was found in an advanced stage of putrefaction on the floor of his flat. A lot of blood traces and a butterfly knife were found on the site. At autopsy, 14 stab wounds were identified to the anterior chest. Case 2: A 39-year-old male was found dead in his garage with a kitchen knife in his right hand. At autopsy, 25 stab wounds were identified to the neck and abdomen although only 14 were deeply penetrating. In both cases, there was a history of depression and there was no sign of forced entry or assault. Conclusions. The integration of circumstantial data, scene and autopsy findings, in particular with the study of the site, shape and direction of wounds are required to avoid misinterpretation of the manner of death

Testing the specificity of the diatom test : search for false-positives

The diatom test is widely used by forensic pathologists as proof of drowning, notwithstanding some criticisms mainly concerningthe occurrence of false-positive results (presence of diatoms in the tissues of subjects who died from causes other thandrowning). The aim of the present study was to verify the claimed inaccuracy of the method caused by an excessive rate of falsepositives related to inadvertent exposure to diatoms of the general population. The study was carried out to investigate thepresence of diatoms in the tissues (lungs and sternum) of subjects who died from causes other than drowning. Two groups ofcadavers that underwent an autopsy at the Institute of Forensic Medicine of the University of Verona were included in the study.Group A comprised 45 individuals who died from causes other than drowning, whereas Group B comprised 20 bodies which hadbeen recovered from water. The extraction of the diatoms was performed by incubation of samples in nitric acid for 48 hours at608C. The analysis of the samples from Group A showed the absence of diatoms in both lung and sternum samples. In Group B alllung samples showed the presence of diatoms, whereas only six sternum samples were shown to contain diatoms. The differencebetween Groups A and B was statistically highly significant. The absence of diatoms in the samples collected from Group Afalsified the hypothesis that false-positive results from the diatom test may occur due to diatoms entering living bodies throughthe respiratory and/or digestive tracts via air, water or food, supporting the validity of the diatom test as proof of drowning

Incomplete decapitation in suicidal vehicle-assisted ligature strangulation: A case report and a review of the literature

Vehicle-assisted ligature strangulation is an extremely rare suicide method. We report a case of a 43-year-old man who secured one end of a nylon rope to a tree and the other end around his neck, then got inside his vehicle and stepped on the gas, leading to an incomplete decapitation. A sharply demarcated encircling ligature mark was found upon external examination, along with a deep laceration in the anterior region of the neck. The severance plane passed between the third and fourth cervical vertebrae, with diffuse haemorrhagic infiltration of the cervical muscles, in accordance with autopsy findings reported in the literature. The lung histological examination described a large amount of red blood cells and pulmonary oedema. A review of the literature concerning suicidal vehicle-assisted ligature strangulation cases allowed us to investigate some common autopsy findings, as well as the rope features relevant to the beheading

Vehicle-assisted ligature strangulation: case report of a bizarre suicide method and literature review

Introduction. Vehicle-assisted ligature strangulation is an extremely rare suicide method. We report a case of a 43-year-old man who attached one end of a nylon rope to a tree, fastened the other end around his neck and started his vehicle, leading to an incomplete decapitation. The rope was not found during crime scene investigation; hence policemen wrongly assumed it was a homicide. Materials and methods. We performed a literature review of all the studies published on the major scientific search engines: only 14 cases of this unusual suicide method are described in literature and only one of which involved an incomplete decapitation. We analysed all available cases regarding victim’s gender, possible decapitation, rope features (material, length, thickness) and its eventual breaking. Results. 93,3% of victims were male. Complete decapitation occurred in 6 cases, incomplete decapitation in 2 cases, decapitation was absent in 7 cases. Length and thickness of the ropes were extremely variable. The materials included metal, nylon, and hemp. In both cases of partial decapitation, and in 4 out of 7 cases in which decapitation was not described, the rope was broken. Considering the cases in which complete decapitation occurred, none of the ropes broke. Conclusions. Vehicle-assisted ligature strangulation is almost exclusively chosen by men, careful on-site inspection should be performed, to rule out other manners of death; rope features should be noted to compare them to the ligature mark and the possible decapitation since longer and more resistant ropes are more commonly associated to complete decapitation

CO related deaths: a Verona case series. When COoperation becomes compulsory

Introduction. Carbon monoxide (CO) poisoning is a significant concern in forensic medicine, as it often presents unique challenges in terms of diagnosis, investigation, and determination of the cause of death. CO is a colourless, odourless, and tasteless gas that can be lethal when inhaled in high concentrations. It binds strongly to haemoglobin, forming carboxyhaemoglobin (COHb), which reduces the oxygen-carrying capacity of the blood, leading to tissue hypoxia and ultimately death. Materials and methods. Circumstantial data, medical history information, autopsy findings, and toxicological analysis results related to 24 CO poisoning cases at the Institute of Legal Medicine in Verona were collected and analysed. The data were examined in an integrated manner to identify correlations and common patterns. A comparison was also made with the data available in the literature. Results. The male gender was confirmed to be the most frequently involved. COHb levels were found to be less than 50% in 6 cases. Three individuals had concurrent cardiovascular pathologies, while 11 subjects tested positive for various substances, including alcohol, benzodiazepines, and morphine. In most cases, the manner of fatal intoxication was accidental, although 6 suicides and 1 homicide were reported. Conclusions. The Verona case series demonstrates that deaths due to CO poisoning require a multidisciplinary approach. The integration of diverse expertise is essential for assessing the manner of death. This approach enables a comprehensive evaluation of the available data, aids in distinguishing between accidental, suicidal, and homicidal deaths, and ensures accurate and reliable forensic conclusions