comment on shore et al association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes insights from the veterans administration cardiac care follow up clinical study diabetes care 2014 37 409 418

We read with great interest the recently published article by Shore et al. (1) that addresses the important issue of admission hyperglycemia during hospitalization for acute myocardial infarction (AMI). The authors measured the prevalence of admission hyperglycemia in a very large cohort of AMI patients without known diabetes and examined its association with new evidence of diabetes in the 6 months following hospitalization. Diagnostic codes for diabetes, outpatient prescriptions for glucose-lowering medications, and/or HbA1c ≥6.5% during or after the index hospitalization were used for

Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review

Background: Cannabis is the most consumed drug worldwide and number of users is increasing, particularly among youth. Moreover, cannabis potential therapeutic properties have renewed interest to make it available as a treatment for a variety of conditions. Albeit rarely, cannabis consumption has been associated with cardiovascular diseases such as arrhythmias, myocardial infarction (MI) and potentially sudden death. Case presentation: A 24-year-old woman presented to the emergency department sent by her cardiologist because of a recent finding of a 16 seconds asystole on the implantable loop recorder (ILR) she implanted 7 months before for recurrent syncopes. She declared that she is a heavy cannabis user (at least 5 cannabis-cigarette per day, not mixed up with tobacco, for no less than 12 years) and all syncopes occurred shortly after cannabis consumption. After a collective discussion with the heart team, syncope unit, electrophysiologists and toxicologist, we decided to implant a dual chamber pacemaker with a rate response algorithm due to the high risk of trauma of the syncopal episodes. 24 months follow-up period was uneventful. Conclusions: Cannabis cardiovascular effects are not well known and, although rare, among these we find ischemic episodes, tachyarrhythmias, symptomatic sinus bradycardia, sinus arrest, ventricular asystole and possibly death. Because of cannabis growing consumption both for medical and recreational purpose, cardiovascular diseases associated with cannabis use may become more and more frequent. In the light of the poor literature, we believe that cannabis may produce opposite adverse effects depending on the duration of the habit. Acute administration increases sympathetic tone and reduces parasympathetic tone; conversely, with chronic intake an opposite effect is observed: repetitive dosing decreases sympathetic activity and increases parasympathetic activity. Clinicians should be aware of the increased risk of cardiovascular complications associated with cannabis use and should investigate its consumption especially in young patients presenting with cardiac dysrhythmias

Post-Mortem Assessment and Evolutionary Role of the Autopsy

The Chapter is dedicated to the evolutionary role of autopsy, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines (like Radiology), involved in historic synergy in the post-mortem assessment, together with the mother discipline Forensic Pathology. A task sustainable through the utilization of the so-called advanced molecular autopsy, a convergence of different skills jointly makes use of the high dimensionality of data generated by new technologies requiring a data mining approach governed by improved bioinformatics and computational biology tools. The evolution of the scientific research and the increased accuracy of the various disciplines will be able to weigh the value of evidence, placed at the disposal of the justice system as truth and proof

Legal scenarios in the coronavirus time: Medico legal implications in the aspects of governance

Along with rising levels of the infection around the world, the state of emergency prompted by the COVID-19 pandemic has also been having a heavy legal impact. The situation is posing important criminal challenges, as well as an ocean of social and public health issues around the world. It has not only directly affected constitutionally-guaranteed rights and individual freedoms, but also brought to the fore certain types of criminal offence that had previously been of little practical importance, such as the crime of ‘maliciously or unintentionally causing an epidemic’. Different countries and states have introduced policies to manage the emergency at different times and in different ways. The measures adopted have been the object of much criticism, also raising questions of constitutional legitimacy in countries like Italy. The present contribution begins with a brief outline of the different international scenarios. Then we examine some of the medicolegal aspects of criminal offences previously envisaged and newly introduced since the arrival of the pandemic. We suggest the need for a sort of ‘code of public health laws for the time of coronavirus’, that could also be applied to other public health emergencies, pandemic or otherwise. The idea is to give operators in the sector and the general population the opportunity to identify clear and simple rules to follow in the current complex global situation. We need a new, appropriate interpretation of the ‘boundaries’ of our individual rights in relation to the need to safeguard the wider community and its more vulnerable members

Validation of a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) for the evaluation of coronary flow reserve Comparison with intracoronary Doppler flow wire

AbstractOBJECTIVESWe tested the hypothesis that coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD) as assessed by a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) is in agreement with CFR measurements assessed by intracoronary Doppler flow wire.BACKGROUNDContrast-enhanced transthoracic second harmonic echo Doppler is a novel noninvasive method to detect blood flow velocity and reserve in the LAD. However, it has not yet been validated versus a gold-standard method.METHODSTwenty-five patients undergoing CFR assessment in the LAD by Doppler flow wire were also evaluated by contrast-enhanced transthoracic Doppler to record blood flow in the distal LAD at rest and during hyperemia obtained by adenosine IV infusion. In five patients CFR was evaluated twice (before and after angioplasty).RESULTSAs a result of the combined use of IV contrast and second harmonic Doppler technology, feasibility in assessing coronary flow reserve equaled 100%. The agreement between the two methods was high. In fact, in all but five patients the maximum difference between the two CFR measurements was 0.38. Overall, the prediction (95%) interval of individual differences was −0.69 to +0.72. Reproducibility of CFR measurements was also high. The limits of the agreement (95%) between the two measurements were −0.32 to +0.32.CONCLUSIONSCoronary flow reserve in the LAD as assessed by contrast-enhanced transthoracic echo Doppler along with harmonic mode concurs very closely with Doppler flow wire CFR measurements. This new noninvasive method allows feasible, reliable and reproducible assessment of CFR in the LAD