Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses.

Objective: To evaluate the efficacy and safety of GHB for treatment of AWS and prevention of relapse Thirteen randomised controlled trials involving 648 participants were included in this review. Eleven of these were conducted in Italy. However, there is not enough reliable evidence from the research that has been done to date to be confident of a difference between GHB and placebo, or to determine reliably if GHB is more or less effective than other drugs for the treatment of alcohol withdrawl or the prevention of relapses. Six trials with a total of 286 participants evaluated the effectiveness of GHB in reducing withdrawal syndrome. These compared the drug with a variety of other interventions, making it impossible to use them all in a single analysis. One study suggests that GHB might reduce withdrawal symptoms more than a placebo, but this is based on a very small number of patients. No strong differences were observed between GHB and benzodiazepines or Clomethiazole. In the other comparisons, the differences were not statistically significant. Seven trials involving 362 participants tested the use of GHB to treat alcohol dependence or prevent relapses if a person was already detoxified (mid-term outcomes). These included several different comparisons, so each analysis was able to include only one or two trials; and the trials were generally small (range 17 to 98 participants). GHB did appear to be better than Naltrexone and Disulfiram in maintaining abstinence and preventing craving, based on two trials and one trial respectively for these comparisons. The most consistently reported side effect of GHB was dizziness and vertigo, with this being more common at higher doses. The findings of this review should be considered alongside concerns that have been raised about GHB regarding the risk of developing addiction, and the misuse or abuse of the drug, suggesting to use GHB only under strict medical surveillance

Historical Landslides Reactivated by Earthquake in the NW Apennines (northern Italy)

The results of a multidisciplinary research on historical landslides reactivated by earthquakes in the NW Apennines (Italy) are discussed. Investigations have led to the collection of 12 landslides reactivated by seismic shocks ranging from 3.3 to 6.5 magnitude. The rock-types involved are weak rocks, lithologically and/or structurally complex (flysch, clay shale and debris). In the study cases, earthquakes are considered as a triggering cause of reactivation of landslides controlled by rainfall

Prospective analysis of pain and pain management in an emergency department

BACKGROUND AND AIM OF THE WORK: The aim of pain management in the Emergency Department (ED) is to temporarily optimize patient quality of life by reducing acute discomfort. The goals of this study were to evaluate the intensity and location of pain experienced by patients in the ED, the time to analgesia administration in the ED, and the patient's satisfaction so to identify potential useful interventions to improve pain management. METHODS: We prospectively collected data on the intensity of pain experienced by 137 patients during their ED stays using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Patients were further stratified by pain intensity according to three categories, and by cause of pain. RESULTS: NRS pain measurements were higher than VAS measurements. Patients who took pain medication within a few hours before their ED visit had a higher mean VAS score at arrival in comparison to patients who did not. Patients treated with pain medications, compared to the non-treated, had more pain at arrival; abdominal pain was treated earlier than non-abdominal pain, whereas no difference in timing of medication administration was noted between traumatic and non-traumatic pain. Among the hospitalized patients, the chest was the most common location of pain; these patients had lower NRS scores than non-hospitalized patients. Patients with mild to moderate pain were more satisfied then those with severe pain. CONCLUSIONS: The discrepancy between NRS and VAS scores suggests that pain intensity cannot be determined accurately according to pain scale data alone but should also incorporate clinical judgment

Prospective analysis of pain and pain management in an emergency department

BACKGROUND AND AIM OF THE WORK: The aim of pain management in the Emergency Department (ED) is to temporarily optimize patient quality of life by reducing acute discomfort. The goals of this study were to evaluate the intensity and location of pain experienced by patients in the ED, the time to analgesia administration in the ED, and the patient's satisfaction so to identify potential useful interventions to improve pain management. METHODS: We prospectively collected data on the intensity of pain experienced by 137 patients during their ED stays using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Patients were further stratified by pain intensity according to three categories, and by cause of pain. RESULTS: NRS pain measurements were higher than VAS measurements. Patients who took pain medication within a few hours before their ED visit had a higher mean VAS score at arrival in comparison to patients who did not. Patients treated with pain medications, compared to the non-treated, had more pain at arrival; abdominal pain was treated earlier than non-abdominal pain, whereas no difference in timing of medication administration was noted between traumatic and non-traumatic pain. Among the hospitalized patients, the chest was the most common location of pain; these patients had lower NRS scores than non-hospitalized patients. Patients with mild to moderate pain were more satisfied then those with severe pain. CONCLUSIONS: The discrepancy between NRS and VAS scores suggests that pain intensity cannot be determined accurately according to pain scale data alone but should also incorporate clinical judgment

Additional Causes of Seismically-Related Landslides in the Northern Apennines, Italy

The results of a multidisciplinary research on the additional causes in historical landslides induced by earthquakes in the north-western sector of the Northern Apennines (Italy) are discussed. 18 well documented landslides induced by seismic shocks were identified. Up to 11 landslides were set in motion by a strong (6.5 magnitude) earthquake which struck the Tyrrhenian side of the Northern Apennines on September 7th 1920. Other landslides were triggered by earthquakes occurring from 1779 to 2003. These landslides were triggered by earthquakes ranging from 3.3 to 6.5 magnitude (IV to X MCS degrees). The earthquake-related landslides studied are mainly complex or slide-type movements. The rock types involved are prevalently calcareous flysch, clay shales and debris. Detailed studies on geology, hydrogeology, geomorphology, soil/rock mechanics and meteorology were carried out in each landslide area. According to the data collected during research, it comes out that earthquakes seem to be just the triggering cause for a great number of these landslides whereas the intrinsic causes mainly result from the amount of precipitation in the preceding periods (soil saturation conditions and build-up of pore-water pressures). Out of the 18 landslides investigated, earthquakes undoubtedly played a decisive role in 5 cases only. Also the lithological characteristics and weathering conditions of the bedrock appear to be extremely important since the five cases previously mentioned affected loose debris materials or weak rocks

The triggering factors in landslides induced by earthquakes in the Northern Apennines, Italy

Several cases of earthquake-related landslides occurring in the Northern Apennines (Italy) have been studied. A detailed analysis of all predisposing and triggering causes of mass wasting processes were taken into account, assessing the real importance of seismic shocks in the reactivation of landslide bodies

Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study

OBJECTIVES: To derive and validate a predictive algorithm integrating a nomogram-based prediction of the pretest probability of infection with a panel of serum biomarkers, which could robustly differentiate sepsis/septic shock from noninfectious systemic inflammatory response syndrome. DESIGN:Multicenter prospective study. SETTING: At emergency department admission in five University hospitals. PATIENTS:Nine-hundred forty-seven adults in inception cohort and 185 adults in validation cohort. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A nomogram, including age, Sequential Organ Failure Assessment score, recent antimicrobial therapy, hyperthermia, leukocytosis, and high C-reactive protein values, was built in order to take data from 716 infected patients and 120 patients with noninfectious systemic inflammatory response syndrome to predict pretest probability of infection. Then, the best combination of procalcitonin, soluble phospholipase A2 group IIA, presepsin, soluble interleukin-2 receptor \u3b1, and soluble triggering receptor expressed on myeloid cell-1 was applied in order to categorize patients as "likely" or "unlikely" to be infected. The predictive algorithm required only procalcitonin backed up with soluble phospholipase A2 group IIA determined in 29% of the patients to rule out sepsis/septic shock with a negative predictive value of 93%. In a validation cohort of 158 patients, predictive algorithm reached 100% of negative predictive value requiring biomarker measurements in 18% of the population. CONCLUSIONS: We have developed and validated a high-performing, reproducible, and parsimonious algorithm to assist emergency department physicians in distinguishing sepsis/septic shock from noninfectious systemic inflammatory response syndrom