The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks

BACKGROUND: The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS: Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS: Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS: During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible

Genetic Analysis of Ten Gonosomal STR Loci in an Italian Population Using the Elucigene QSTR-XY Amplification Kit

n/

The Prevalence of Benzodiazepine Use among Italian Drivers in 15,988 Cases of Driving License Regranting from 2015 to 2023: Risks and Implications for Driving Fitness

The use of benzodiazepines is strongly associated with an increased risk of traffic accidents due to their side effects of sedation and drowsiness, which can significantly impair driving performance. the main aim of our study was to investigate the trend of benzodiazepine use over nine years (2015-2023) in a population of 15,988 subjects who had their license suspended for driving under the influence (DUI) of alcohol or drugs. among the 15,988 users accessed to our laboratory, 924 tested positive for at least one benzodiazepine. an increase in the number of positive-testing users was observed in the period 2015-2018, followed by a slight decrease in 2019. overall, the trend of benzodiazepine use was stable over the next four years (2020-2023), with the highest incidence in 2022. the most common benzodiazepines, and/or metabolites, found in urine samples were alpha-OH-alprazolam (28.66%; n = 366) and oxazepam (27.25%; n = 348). Several cases of mixed positivity were observed in the study population. the main substances taken with benzodiazepines were cocaine and Delta 9-tetrahydrocannabinol. Our findings suggest that people taking benzodiazepines should be monitored, as these have a relevant impact on driving ability in addition to significant interindividual differences in the behavioral effects of benzodiazepines on driving performance

Carbohydrate-Deficient Transferrin (CDT) as a Biomarker of Alcohol Abuse: A Retrospective Study of the Italian Drinking Trend among Drivers from 2016 to 2022

alcohol abuse is still one of the leading causes of death worldwide. early diagnosis of alcohol abuse enables preventive intervention on the effects and risks associated with its consumption. carbohydrate-deficient transferrin (CDT) is one of the most reliable biomarkers of chronic alcohol misuse. we retrospectively studied a population of 12,624 subjects who had their driving license suspended for driving under the influence of alcohol or drugs from 2016 to 2022. the analytical determination of CDT was performed following a certified high-performance liquid chromatography (HPLC) method. data were split by year, age and gender. the majority of subjects with positive ÍT were male, although the trend of positivity was similar between males and females. a steady increase in both the number of tests performed and the number of positives was observed over the years. patients aged 41-50 years had the highest prevalence, followed by 51-60, 31-40 and 18-30 years. CDT continues to be a steady marker for diagnosis of alcohol abuse in the majority of cases. data emerging from our study are in line with the increasing national trends on traffic accidents, injuries and deaths related to alcohol and drug DUI (driving under the influence), requiring the implementation of preventive measures to limit this ever-growing phenomenon

The medieval population of Leopoli-Cencelle (Viterbo, Latium) : dietary reconstruction through stable isotope analysis from bone proteins

The Medieval period in Europe was a time of unprecedented social complexity and significant social and political change that had an impact on human diets. The present study aims to use stable isotope analysis from bone proteins to explore the diets of humans (n = 76) and fauna (n = 5) from the Medieval town of Leopoli-Cencelle (VT, Italy). The town was occupied between the 9th–15th centuries CE, however, the analysed remains date to the Late Medieval period (12th–15th centuries CE). Historical sources provide some information about the inhabitants of this community: the majority of the population was represented by craftsmen and traders, but farmers and shepherds were also present. To date, no biomolecular data regarding this community have been published. The results indicated an increase of 3–5‰ in δ15N values of humans compared to animals, reflecting a high trophic-level. The δ13C results indicated that animal and human diet was mainly based on C3 terrestrial resources, although three humans possessed an isotopic signature indicative of C4 plant consumption. No statistically significant differences between sexes or age groups (adults vs juveniles) were detected. The isotopic results were further placed in their regional and chronological context, adding valuable data to our understanding of diet and food distribution during the Medieval period in Italy

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)

Informed consent. Legal obligation or cornerstone of the care relationship?

: The topic of informed consent has become increasingly important in recent decades, both in the ethical-deontological field and as a duty of law. The review covered all sentences issued by the 13th section of the Civil Court of Rome during the period January 2016-December 2020. During this period, 156 judgments were found in which a breach of consent was required; in 24 of these, specific liability was proven, and the corresponding compensation liquidated. Moreover, 80% of the cases concerned the lack of information provided. The most involved branches were those related to surgical areas: general surgery, plastic surgery and aesthetic medicine and orthopaedics. The total amount of compensation paid was EUR 287,144.59. The research carried out has highlighted how, in a broad jurisprudential context, the damage caused by the violation of the right related to informed consent is considered, and how it impacts on the economic compensation of damages. Additionally, it showed that the areas most affected by the information deficit are those related to the performance of surgical activities, which are characterized by greater invasiveness and a higher risk of adverse events. The data reported underline the exigency to consider informed consent not as a mere documentary allegation but as an essential moment in the construction of a valid therapeutic alliance, which is also useful for avoiding unnecessary litigation that is becoming increasingly burdensome for healthcare systems all over the world

Tutela della salute in carcere, durante la pandemia Covid-19

Being detained in jail is an acknowledged risk factor for physical and psychiatric morbidity. The impact of COVID-19 pandemicon the penitentiary system, already characterized by criticalities in terms of healthcare, including high infectious risk, has beenconsidered a source of further danger within the prison and for the community. This problem has been raised by several observers, in the absence of a shared approach between states. The Italian Government enacted a series of measures aimed at penitentiary structures, to contain and manage health and safety risks. General precautions for infections prevention have been used, including frequent hands washing and environmental cleaning and disinfection procedures. Physical distancing in jail is extremely challenging, and we deem that it was still impossible to apply it, despite the release of almost 8000 detainees, among those at greater health risk. Measures have been also ordered to limit external contacts with detainees, including a substantial or absolute suspension of visits from relatives, operators and lawyers, replaced by video meetings. Quarantine and isolation of suspect cases has also been ordered, including new prisoners. Despite unfavorable premises the analysis we did on available data indicates lower infection rate and lethality rate in prison than in general population. In this paper a synthetic framework of the sanitary problems in detention will be provided, then the data will be analyzed, providing possible interpretations potentially useful for the management of the pandemic at the community level. Infectious surveillance, compliance with sanitation standards, early treatment of suspected cases, lower mean age, efficacious isolation and quarantine strategies may explain the better outcomes in Italian penitentiary system, also in the impossibility to systematically apply physical distancing. La restrizione in ambiente intramurario è un noto fattore di rischio in termini di morbidità per patologie fisiche e psichiche. L’impatto di una pandemia quale la COVID-19 sul sistema penitenziario, caratterizzato da plurime criticità in termini di gestione sanitaria, rischia potenzialmente di determinare gravi effetti sulla salute di detenuti e operatori. A livello internazionale tale problematica è stata sollevata e descritta, in assenza di un approccio condiviso tra gli stati dell’Unione Europea. In Italia, uno dei paesi maggiormente colpiti in termini di contagi e mortalità, si è assistito all’applicazione di una serie di misure dirette alle strutture penitenziarie, atte al contenimento ed alla gestione dei rischi per la salute e la sicurezza. L’ambiente carcerario, tuttavia, notoriamente caratterizzato da sovraffollamento e gravato da fattori di rischio specifici, rende problematico adottare una serie di misure che sono state invece previste per la popolazione generale. Il distanziamento fisico in carcere è estremamente problematico, e riteniamo che sia stato impossibile applicarlo, nonostante il rilascio di quasi 8000 detenuti, tra quelli a maggior rischio per la salute. Sono state inoltre disposte misure per limitare i contatti esterni con i detenuti, compresa una sospensione sostanziale o assoluta delle visite di parenti, operatori e avvocati, sostituita da videoconferenze. Sono stati ordinati anche la quarantena e l'isolamento dei casi sospetti, compresi i nuovi detenuti. Nonostante tali sfavorevoli premesse, l’analisi dei dati da noi effettuata circa i contagi ed i decessi in carcere, sino al 1° maggio 2020, indicano un tasso di infezione paragonabile alla popolazione generale, ed un tasso di letalità significativamente inferiore. Nel presente lavoro, dopo aver fornito un inquadramento sintetico delle problematiche sanitarie in ambito detentivo, si discuteranno i dati fornendo possibili interpretazioni di potenziale utilità per la gestione a livello comunitario.&nbsp

Review of nutrient actions on age-related macular degeneration

The actions of nutrients and related compounds on age-related macular degeneration (AMD) are explained in this review. The findings from 80 studies published since 2003 on the association between diet and supplements in AMD were reviewed. Antioxidants and other nutrients with an effect on AMD susceptibility include carotenoids (lutein and zeaxanthin, β-carotene), vitamins (vitamin A, E, C, D, B), mineral supplements (zinc, copper, selenium), dietary fatty acids [monounsaturated fatty acids, polyunsaturated fatty acids (PUFA both omega-3 PUFA and omega-6 PUFA), saturated fatty acids and cholesterol], and dietary carbohydrates. The literature revealed that many of these antioxidants and nutrients exert a protective role by functioning synergistically. Specifically, the use of dietary supplements with targeted actions can provide minimal benefits on the onset or progression of AMD; however, this does not appear to be particularly beneficial in healthy people. Furthermore, some supplements or nutrients have demonstrated discordant effects on AMD in some studies. Since intake of dietary supplements, as well as exposure to damaging environmental factors, is largely dependent on population habits (including dietary practices) and geographical localization, an overall healthy diet appears to be the best strategy in reducing the risk of developing AMD. As of now, the precise mechanism of action of certain nutrients in AMD prevention remains unclear. Thus, future studies are required to examine the effects that nutrients have on AMD and to determine which factors are most strongly correlated with reducing the risk of AMD or preventing its progression