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

New trends of substance abuse during COVID-19 pandemic: an international perspective

In the late 2019, an epidemic of cases with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has spread from China to the rest of the world, resulting in a global pandemic (COronaVIrus Disease 19, COVID-19 pandemic). Starting from the first months of 2020, several restrictions have been imposed by governments to face the public health threat, impacting the usual patterns of drug abuse throughout the world (1). The temporary border closure affected the usual illicit drug route of shipping from country to country, resulting in scarcity of classic street drugs (2). Moreover, restrictive measures internationally adopted by several countries made necessary to close all the usual recreational settings in which stimulants drugs are commonly abused. On the contrary, since in house drugs abuse became the most feasible option, other private encounters might have caught on, such as chemsex (3). In particular this phenomenon, which originated mainly in the large cities of Northern Europe, has gradually spread across the continent and is now a worrying reality in western European countries. Other rising trends of substance abuse include cognitive enhancers and new psychoactive substances (4, 5). Furthermore, the consequent social isolation and the likely limited access to detoxification centers caused additional psychological distress, pushing drug addicts toward alternative psychotropic drugs, possibly through illegal online marketplaces. An international overview of the new trends of drug abuse during the current COVID-19 pandemic and the related health risks are hereby discussed, taking into consideration different points of view

Aerothermodynamic radiation studies

We have built and made operational a 6 in. electric arc driven shock tube which alloys us to study the non-equilibrium radiation and kinetics of low pressure (0.1 to 1 torr) gases processed by 6 to 12 km/s shock waves. The diagnostic system allows simultaneous monitoring of shock radiation temporal histories by a bank of up to six radiometers, and spectral histories with two optical multi-channel analyzers. A data set of eight shots was assembled, comprising shocks in N2 and air at pressures between 0.1 and 1 torr and velocities of 6 to 12 km/s. Spectrally resolved data was taken in both the non-equilibrium and equilibrium shock regions on all shots. The present data appear to be the first spectrally resolved shock radiation measurements in N2 performed at 12 km/s. The data base was partially analyzed with salient features identified

Cognitive enhancing drugs: a future challenge for the workplace?

In medical practice, cognitive enhancers (also called nootropics) are defined as therapeutic drugs treating specific cognition impairments in patients with attention deficit hyperactivity disorder, Alzheimer’s disease, stroke schizophrenia or aging. However, the non-medical use of cognitive enhancers with the aim of increasing mental alertness and concentration, improving memory, fighting wakefulness and boosting energy has been spreading worldwide2. In this concern, scarce investigations have been carried out on the possible risks of chronic non-medical use of nootropics, and these risks seem to be largely overlooked, especially among students3. Considering the ever more competitive nature of modern societies, which also reverberates into workplaces, cognitive enhancers are reasonably expected to become even more common over time4. Nonetheless, long-term consequences are as yet unknown. Cognitive enhancers, used by healthy individuals, are widely known as nootropics: they consist of drugs, supplements and other substances that are allegedly known to improve cognitive function, particularly executive functions, and to strengthen memory, creativity or even motivation. Pharmaceutical substances and compounds known as ‘cognitive-enhancers’ allegedly boost mental performance and the ability to focus and keep concentration. In broader terms, such drugs are often claimed to heighten and foster the acquisition of motor capabilities and affective skills (i.e., one’s ability to deal with anxiety stemming from performing certain work tasks or eliciting feelings of trust and affiliation). It is worth noting, however, that no drugs are licensed by medical authorities to be recommended and prescribed as ‘cognitive enhancers’. Thus, the definition of ‘performance-enhancing drug’ is usually linked to the off-label use of drugs prescribed for specific medical conditions. These substances are usually stimulants that preferentially target the catecholamines of the prefrontal cortex of the brain to induce their effects5. Historically, amphetamines have been the first drugs used off-label for the purpose of fostering memory consolidation and increasing concentration6. Since these substances are legally controlled as drugs of abuse, they can only be obtained on illegal markets. This purchase channel is also used to obtain methylphenidate, which is undoubtedly the most misused drug as cognitive enhancer5,7. Mostly prescribed for treating Attention Deficit Hyperactive disorder (ADHD) and narcolepsy, methylphenidate has been scheduled as an illegal drug in many countries for its abuse liability and side effects, resulting in a rapid expansion of methylphenidate legal analogs onto the drug market. Alternative prescription drugs for the treatment of narcolepsy and ADHD, such as modafinil and armodafinil, are also used as cognitive enhancers8. Finally, two last drugs should be mentioned among nootropics: atomoxetine, a selective nor-adrenaline reuptake inhibitor licensed for the treatment of children with methylphenidate-resistant ADHD or undergoing methylphenidate side effects9, and donepezil, a second-generation acetylcholinesterase inhibitor licensed for the treatment of mild to moderately severe symptoms of Alzheimer-related dementia10. At the same time, there has been renewed interest in older prescription drugs (e.g., beta blockers, to decrease performance anxiety) and illicit psychostimulants (e.g., cocaine, amphetamines), sometimes in different forms or doses. Whereas there is still little consensus on the actual effectiveness and nature of the cognitive benefits of the above-mentioned drugs in healthy subjects13, their use to enhance the level of performance in specific workplaces has been reported for decades14. In fact, cognitive enhancement has been a mainstay of military research in the US since the Second World War with the use of amphetamines, modafinil and other cognitive enhancers in the most recent military operations (e.g., Vietnam war, Korean war, operations Desert Shield and Desert Storm in Iraq, later sustained military operations in the Middle East)15,16. Whereas the military use of cognitive enhancers has been known for many years, not only in the US but internationally. More recent studies reported that other occupations present a high prevalence of use: medical doctors and health professionals (e.g., surgeons, surgical technicians’ anesthetists), transportation workers (e.g., truck drivers, car drivers, taxi drivers), financial traders, clinical investigators, research managers and lawyers. Finally, the increase of precarious and part-time home works has been recently associated to psychological discomfort and an increase in prescriptions of psychotropic drugs, and a rise in the misuse of cognitive enhancers can be hypothesized17-19. Another important factor to be taken into account is the role of the internet as a source of information through web forums and as a way of obtaining those substances. Such dynamics also constitute a cultural shift in the way drugs are obtained and consumed: they are anonymously received and safer than street drugs trafficking, although the actual composition and nature of the substances cannot be precisely ascertained. This latter fact creates a gap of information on the diagnosis of misuse in cases of possible intoxications and fatalities, since neither analytical screening nor confirmation methodologies are currently available for documenting exposure to those profuse and chemically diverse substances. In addition, apart from intoxications and fatalities, it has to be reminded that several of these substances present a potential for abuse liability and abstinence symptoms, which, instead of improving work pressure and overload, can worsen the environmental situation. In conclusion, we wish to draw the attention of the whole scientific community and policy makers to the increasing importance of the misuse of cognitive enhancers, and to improve public awareness of the phenomenon and contextual political strategies to stop this incoming threat for the health of current and future worker

Commentary – CRISPR-based techniques: Cas9, Cas13 and their applications in the era of COVID-19

The CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)/ Cas9 (CRISPR-associated protein 9) system enables scientists to edit diverse genome types with relative ease, with the aim – in the near future – to prevent future human beings from developing genetic diseases. The new opportunities arising from the system are broad-ranging and revolutionary, but such prospects have also been the cause for alarm throughout the international scientific community. The authors have laid out a review of the trials carried out so far in terms of genome editing, for the ultimate purpose of weighing implications and criticisms. We feel that possible valuable alternatives, such as induced pluripotent stem cells should not be overlooked

Macro Asset Allocation with Social Impact Investments

Using a unique dataset of 50 listed companies that meet the majority of the OECD requirements for social impact investments, we construct a social impact finance stock index and investigate how investing in social impact firms can contribute to portfolio risk-return performance. We build portfolios with three different methodologies (naïve, Markowitz mean-variance optimization, GARCH-copula model), and we study the performance in terms of returns, Sharpe ratio, utility, and forecast premium based on a constant relative risk aversion function for investors with different levels of risk aversion. Consistent with the idea that social impact investment can improve portfolio risk-return performance, the results of our macro asset allocation analysis show the importance of a large fraction of investor portfolios’ stake committed to social impact investments

Does episiotomy always equate violence in obstetrics? Routine and selective episiotomy in obstetric practice and legal questions

OBJECTIVE: The study’s main goal is to figure out whether episiotomy, a widely applied invasive procedure, may constitute a determining factor of liability for practitioners according to the standards of obstetric violence. MATERIALS AND METHODS: The authors have aimed to analyze laws and documentation issued on the matter by sovereign states, statements and remarks from International health organizations, in addition to scientific article available on the main search engines (PubMed, Scopus, Google Scholar) and legal databases (Lexis, Justia). RESULTS: The body of research has highlighted the existence of a wide-ranging agreement as to routine episiotomy, deemed to be a scientifically unfounded procedure, and which should, therefore, be avoided. By virtue of that, routine episiotomy might easily give rise to charges and liability for doctors and midwives alike; likewise to claims may stem from a failure to perform an episiotomy when it was actually needed. CONCLUSIONS: Unlike routine episiotomy, selective episiotomy is far more unlikely to cause charges of obstetric violence against operators. Unfortunately, the criteria in order to establish when a selective episiotomy is indicated are far from consistent and would require an additional effort on the part of scientific societies towards a more clearly defined and shared description

Intrapartum sonography of fetal head in second stage of labor with neuraxial analgesia: a literature review and possible medicolegal aftermath

Intrapartum ultrasound (IU) is a valid support to obstetric management of fetal head progression in the second stage of labor in nulliparous with neuraxial labor analgesia (NLA). Nulliparous with NLA may have a prolonged the second stage of labor. The aim of this literature review was to evaluate the mode of delivery, as well as maternal and fetal morbidities associated with missed progression of fetal head detected with IU in the second stage of labor in nulliparous women with NLA.MATERIALS AND METHODS: The literature review was performed using PubMed, Cochrane, Medline, EMBASE, Scopus, Google Scholar and book chapters searches to identify relevant articles from 2001 to 2019, evaluating the mode of delivery and morbidities of the second stage of labor. Search terms used were “Intrapartum ultrasound”, “dystocia”, “prolonged labor”, “neuraxial analgesia”, “persistent occiput posterior position”, “asynclitism”, “second stage of labor”, “medico-legal aftermath”. Prolonged second stage was defined as three hours and more. Retrospective case series of women with prolonged second stage of labor with NLA were identified. The primary outcome was the incidence of operative vaginal delivery (OVD) and cesarean delivery (CS). RESULTS: The use of NLA may determine a prolonged second stage of labor (PSSL). IU when compared to the traditional vaginal digital examination (VDE) demonstrated the highest degree of diagnostic accuracy. CONCLUSIONS: The use of IU during NLA can aid in the diagnosis of fetal head progression, station or malposition and malrotation, alerts obstetrician on the possibility of dystocic labor, indicating to stop the drug administration in NLA and shift to OVD or CS. Extending the second stage of labor beyond current American College of Obstetricians and Gynecologists (ACOG) recommendations is beneficial. The ISUOG guidelines recommended the clinical application of IU to diagnose the persistent occiput posterior position (POPP) and asynclitism (A) in dystocic labor and produce photographic evidence of the case. Maternal and neonatal complications, medicolegal consequences and litigation can decrease if the IU device is used as good practice