The Influence of the COVID‑19 Pandemic Emergency on Alcohol Use: A Focus on a Cohort of Sicilian Workers

The period between the beginning and the end of the COVID‑19 pandemic emergency generated a general state of stress, affecting both the mental state and physical well‑being of the gen‑ eral population. Stress is the body’s reaction to events or stimuli perceived as potentially harmful or distressing. Particularly when prolonged over time, it can promote the consumption of different psychotropic substances such as alcohol, and thus the genesis of various pathologies. Therefore, our research aimed to evaluate the differences in alcohol consumption in a cohort of 640 video work‑ ers who carried out activities in smart working, subjects particularly exposed to stressful situations due to the stringent rules of protection and prevention implemented during the pandemic. Further‑ more, based on the results obtained from the administration of the AUDIT‑C, we wanted to analyse the different modes of alcohol consumption (low, moderate, high, severe) to understand whether there is a difference in the amount of alcohol consumed that could predispose individuals to health problems. To this end, we administered the AUDIT‑C questionnaire in two periods (T0 and T1 ), co‑ inciding with annual occupational health specialist visits. The results of the present research showed an increase in the number of subjects consuming alcohol (p = 0.0005) and in their AUDIT‑C scores (p < 0.0001) over the period considered. A significant decrease in subgroups who drink in a low‑risk (p = 0.0049) mode and an increase in those with high (p = 0.00012) and severe risk (p = 0.0002) were also detected. In addition, comparing the male and female populations, it emerged that males have drinking patterns that lead to a higher (p = 0.0067) health risk of experiencing alcohol‑related diseases than female drinking patterns. Although this study provides further evidence of the negative impact of the stress generated by the pandemic emergency on alcohol consumption, the influence of many other factors cannot be ruled out. Further research is needed to better understand the relationship between the pandemic and alcohol consumption, including the underlying factors and mechanisms driving changes in drinking behaviour, as well as potential interventions and support strategies to address alcohol‑related harm during and after the pandemic

The analysis of SUDEP forensic autopsies leading to preventable events

Introduction: The diagnosis of unexpected death by excluding non-natural causes, particularly in subjects with epilepsy, is a topic of interest and it is difficult to identify in the forensic field. Health professionals sometimes are faced with cases of sudden death, generally in young adults with a long history of epilepsy that require, for judicial purposes, an explanation in terms of cause and means to determine the death. SUDEP is an entity diagnosed by the exclusion of other causes that may have led to death, and then for forensic purposes, it requires particular attention and knowledge, and there is difficulty in identifying it. Our contribution aims to illustrate the scientific community pathological findings, medical history, and circumstantial evidence of four cases of sudden death in epileptic subjects. Method: We illustrated four cases of judicial autopsies from the Institute of Forensic Medicine of Palermo, Italy; the purpose was to exclude the criminal intervention in determining the death as non-natural. The study of victims’ medical history, the toxicological investigations, and the autopsy findings analyzed both from macroscopic and microscopic aspects have made it possible to highlight some findings that can be traced back to SUDEP despite the small sample of subjects studied. Results: These presented findings of four SUDEP cases could help forensic pathologists in recognizing this entity, by highlighting its characteristics, and allowing for a pathological classification, also in relation to the use of drugs for epilepsy treatment and circumstances of death. Discussion: To obtain a definite diagnosis of SUDEP, a complex investigation process is required in a multidisciplinary approach. Considering the literature review with criticism, it could allow health professionals to select the characteristics of epileptic patients at risk of sudden death. Processing human behaviors, molecular and histopathological findings of the autopsies, but also the physiological, and pathological human body system functions thanks to Artificial Intelligence, could be the key to explaining SUDEP mechanisms and the future results to prevent it

Evaluation of Correlation between Sleep and Psychiatric Disorders in a Population of Night Shift Workers: A Pilot Study

Background: Insomnia is the perception of inadequate, insufficient or non-restorative sleep. Of all sleep-related disorders, insomnia is the most common. It is important to remember that the sleep-wake cycle also plays a central role in the genesis of anxiety and depression. The aim of our study is to evaluate the association between sleep disturbances and anxiety and depression in a group of workers of both sexes who perform night shift work. Methods: Information on sleep disorders was collected by administering the Insomnia Severity Index (ISI) questionnaire. Statistical analysis was conducted using the Chi-square test to assess whether there were any differences between sex for those who were healthy or who were diagnosed with psychiatric disorders. Results: The results showed that there was a good percentage of subjects with insomnia problems, impairing normal daily activities and promoting the onset of fatigue, daytime sleepiness, cognitive performance deficits and mood disorders. Conclusion: We highlighted how anxious and depressive anxiety disorders are more pronounced in people who suffer from altered sleep-wake rhythms. Further research in this direction could prove to be fundamental for understanding the genesis of the onset of other disorders as well

EtG Quantification in Hair and Different Reference Cut-Offs in Relation to Various Pathologies: A Scoping Review

CC BY 4.0Ethyl glucuronide (EtG) is a non-volatile, non-oxidative, hydrophilic, and stable ethanol phase II metabolite. EtG is produced through ethanol glucuronidation by UDP-glucuronosyltransferase (UGT), a phase II enzyme. EtG can be extracted from different biological matrices, including keratin ones, such as hair or nails. The purpose of this scoping review is to describe the relationship between EtG levels in hair and some of the most common and frequent pathological conditions and verify whether different reference cut-offs in relation to various pathologies have been identified in the scientific literature. In fact, in-depth knowledge of the influence of pathologies, such as diabetes mellitus, hepatic and renal dysfunction, on EtG production and its storage in keratin matrices would allow a more appropriate interpretation of obtained data and rule out false positives or false negatives. This scoping review is based on bibliographic research carried out on PubMed regarding the quantification of EtG in hair of subjects affected by different pathological conditions. According to the scientific literature, the main and most common pathologies that can affect the concentration of EtG in hair are liver and kidney diseases and diabetes. The EtG quantification analytical data should be interpreted carefully as they may have a great impact in both forensic and clinical contexts

PHARMACOLOGICAL MANAGEMENT OF THE POLYTRAUMA PATIENT. ON ANALGESIC THERAPY GUIDELINES

In consideration of the constant, if not increasing number of polytrauma patients arriving in emergency rooms, the pharmacological treatment of pain is a topic that is always under observation and innovation. Even more important is the global management of pain in the polytrauma patient, i.e. its treatment in the phases even after hospitalisation. The existence of pharmacotherapeutic protocols is today an aid for the physician in order to act in the most appropriate way in the shortest possible time. This brief commentary is intended to be a practical guide to the analgesic treatment of the polytrauma patient, in the light of the most recent scientific evidence

Guidelines and Current Assessment of Health Care Responsibility in Italy

Clinical guidelines are a potential tool for improving the effectiveness and quality of healthcare, decreasing variability in clinical practice, and preventing adverse events. In the purview of Law no. 24/2017, adherence to national guidelines can lead to a reduction in medical malpractice claims and the practice of so-called “defensive medicine”. The law has assigned a central role to the guidelines, establishing the National Institute of Health through the new Italian National Center for Clinical Excellence, Quality, and Security (CNEC) as the methodological guarantor in the process of national guideline development. Here we discuss the issue of professional liability as recently outlined by the Gelli-Bianco Law (no. 24/2017), taking into account the clinical significance and medicolegal value of the guidelines

The risk of the ‘prison-emptying’ effect in Italy due to the Covid-19 pandemic

People who live and work or are detained inside restricted communities (including prisons) need to be considered as they are at a high risk of becoming infected with Covid-19 during this pandemic.1 InItaly, the spread of Covid-19 has provoked numerous riots within the prisons and local detention centres, and there is a consequent increase in requests for inmates to be released and detained at hom

WORK ACTIVITIES AT INCREASED RISK OF TRAUMATIC INJURIES: AN INTEGRATED PREVENTIVE APPROACH

Included in the scope of workplace safety is that relating to potential accidents, i.e. the harmful consequences for human health crossed with the work environment factor. In the study of the determinism of these accidental events, it is important to achieve a biomechanical balance between two main elements: the human and the work environment (consisting of the physical, chemical and environmental factors, i.e. the equipment and what generates its use). Considering the most recent statistically recorded incidents, our analysis has focused on the accident sphere proper, where an imbalance in the above-mentioned binomial triggers the activation of multiple disciplines that actively and pro-actively study the event and assess its sequelae, in all possible facets (economic, engineering, clinical, medical-legal)

Long-Term COVID: Case Report and Methodological Proposals for Return to Work

Almost two years after the beginning of the SARS-CoV-2 pandemic, the knowledge of which in the infectious and therapeutic spheres is constantly evolving, attention paid to the medicolegal aspects linked to this emergency phenomenon has mainly focused on the liability implications falling on healthcare personnel. With regard to the medicolegal assessment of the outcomes of COVID-19 illness, although it is a procedure that is commonly used, and although references in the assessment tables in force have been adhered to, a specific assessment protocol has not been standardized that takes into account, from an objective point of view, the degree of severity of the long-term residual outcomes and their impact on the social and working lives of subjects. This shortcoming appears to be attributable to the immediate need to categorize the results of COVID-19, but, in our opinion, it deserves an in-depth study and protocols to enable evaluation committees to draw up an assessment as precisely as possible and that is free of gaps, which could be the subject of legal disputes. The aim of the present work, in light of a worldwide problem, is to arrive at specific and univocal evaluation criteria for COVID-19 disease outcomes, applicable in different operational contexts of reemployment

CONGENITAL NEUROBLASTOMA: A RARE CASE OF PLURIVISCERAL METASTATIC DISSEMINATION

Neuroblastoma is one of the most common neonatal tumors. It involves children in early infancy and originates from neural crest cells of the adrenal gland medulla or sympathetic glia. We report an unusual case of congenital poorly differentiated neuroblastoma with multiple metastases in the brain and cerebellum. The biophysical profile showed a prominent polyhydramnios at 25.3 weeks of gestation; meantime, the mother was diagnosed with gestational diabetes. The mass was detected during the third ultrasonographic examination at 31.4 weeks of gestation. The fetus lived only one day after birth and the postmortem examinations were performed subsequently. An autopsy was performed both to understand the causes of death and to identify any profiles of professional responsibility. The histological examination confirmed the diagnosis: a neoplasm arising from the lower right limb and pelvi