Local Dermonecrosis with Generalized Urticaria Probably Due to Loxosceles rufescens Bite

BACKGROUND: The spiders of the Loxosceles genus, commonly denoted as “brown spiders” or “Mediterranean recluse” or “brown recluse,” belong to the spider family Sicariidae, suborder Labidognatha, order Araneida, class Arachnida, and phylum Arthropoda. This spider is widespread in Africa and South/Central America, but it is also distributed in North America, in the West Indies, in the Mediterranean Europe, and in China. CASE REPORT: Here, we report the case of a severe dermonecrotic loxoscelism identified in Southern Italy, probably due to the bite of Loxosceles rufescens. The patient was a women admitted at hospital ER because of a little skin erythema that evolved toward a severe necrosis and ulceration within 20 days. After clinical and laboratory data excluded other local and systemic diseases, she was treated with a systemic and local therapy using corticosteroids and antibiotics with the diagnosis of loxoscelism. The healing from the local skin lesion occurred within 2 months, but the local pain, weakness, and discomfort lasted for a long time. CONCLUSION: It is the fisrt time that a possible case of systemic loxoscelism with skin generalized urticaria is reported in Italy

Evaluation and Management of Patients with Methomyl Poisoning – A Case Report

The Apulian Poison Centre (PC) of Foggia, Italy, annually manages numerous consultations concerning certain or suspected poisonings from pesticides, starting at the same time a careful activity related to the risk assessment phase. The management of the exposure to pesticides and to other chemicals, and the alerting of the “National center for chemicals, cosmetics and consumer protection” at the Istituto Superiore di Sanità (ISS), actively contributes to the improvement of products quality and safety. Thus, leading to a reduction in the number of intoxications - and therefore of the accesses to the emergency services - allows greater protection for workers, bystanders, residents and consumers. The reported case of methomyl poisoning has been of fundamental importance both from the medical point of view and for the management of the intoxicated patient, both for the risk assessment actions, and for cooperation with the competent authorities, generating discussion points on the regulations in force between PCs and National Competent Authority. It follows that the feedback of intoxication in an emergency can lead to improvements in the management and risk mitigation measures in order to reach a greater protection of human, animal, and environmental health. In addition, the regulatory feedback deriving from these reports is an input to the increase product quality improvement (mixtures, labels, packaging, and risk communication) leading to a greater protection of potential exposed subjects. The importance of creating an information and management network that allows the optimization of the flow of information deriving from PCs arises. The actions taken are therefore described, both relating to the management of the emergency, and relating to the subsequent information flow and to the measures for containing the consequent risks

Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

A Report on Mushrooms Poisonings in 2018 at the Apulian Regional Poison Center: Mushrooms poisonings in 2018

BACKGROUND: The “Ospedali Riuniti’s Poison Center” (Foggia, Italy) provides a 24 h telephone consultation in clinical toxicology to the general public and health-care professionals, including drug information and assessment of the effects of commercial and industrial chemical substances, toxins but also plants and mushrooms. It participates in diagnosis and treatment of the exposure to toxins and toxicants, also throughout its ambulatory activity. METHODS: To report data on the epidemiology of mushroom poisoning in people contacting our Poison Center we made computerized queries and descriptive analyses of the medical records database of the mushroom poisoning in the poison center of Foggia from January 2018 to December 2018. RESULTS: A total of 69 mushroom poisonings cases were recorded in our poison center the period from January 2018 to December 2018. Our poison center serves all the Italian territory but most of the calls about mushrooms poisonings, in 2018, came from Apulia, Campania, and Basilicata, which are bordering regions of Italy. About 80.2 % of calls were made by the physicians (particularly, 73.9% by emergency room, 18.8% and 4.3% by hospital ward, and 1.4% both by a general practitioner and by the American Sign Language [“ASL”]) and 18.8% by the public. Cooked mushrooms were involved in all the cases (single and multiple species). The most frequent calls were made in the period between September 2018 and December 2018; in the other months, there were only sporadic cases. All were intentional exposures in adults (>18 years). CONCLUSIONS: Mushroom exposures and poisonings are an important problem in those regions of Italy where many people adventuring in mushroom’s research without any license. This fact has contributed substantially to morbidity due to mushroom poisoning. Our database is a valuable national resource for the collection and monitoring of Italian mushroom poisoning cases in 2018 but limited to the people who called our poison center, which is one of the nine poisons centers in Italy. And since in most cases, the mushroom’s species remains unknown, it is important to quickly recognize symptoms and most frequent species involved on the Italian territory, in particular in South Italy

The Solanaceous cystine-knot miniproteins are metallocarboxypeptidase inhibitors acting in stress defence and development.

The cystine-knot proteins identified in Solanaceous species are a group of small proteins (≤50 aa long in the mature form) characterized by a peculiar three dimensional structure called cystine-knot, which possess inhibitory activity against metallocarboxypeptidase. Their unique structural scaffold is due to the presence of three intertwined disulfide bonds conferring resistance to high T, extreme pH and proteolysis. Another characteristic of the cystine-knot miniproteins is the presence at the N terminus of a signal peptide for secretion. Studies on potato, tomato and tobacco cystine-knot metallocarboxypeptidase inihbitors (MCPI) demonstrated their responsiveness to various type of abiotic stresses. Moreover, the over-expression of a potato MCPI conferred resistance to the herbivor Chilo suppressalis and the fungus Magnaporthe oryzae in transgenic rice, suggesting a function in the plant response to biotic stress. More recently, it was shown that altering the expression pattern of two tomato cystine-knot metallocarboxypeptidase inhibitor (TCMPs) during flower and fruit development can result in early fruit production. To shed light on the role of these proteins in reproductive development, we have undertaken a yeast two hybrid analysis to detect interactive partners. One of the identified interactors belongs to the B-box zinc finger protein family which comprises Zn finger transcription factors with regulatory roles in different developmental processes and B-box proteins lacking the transcriptional regulation domain. TCMPs interact with a BBX protein of the second type whose principal function in A.thaliana is to interfere with the formation of protein complexes that regulate flowering. Our results indicate that the overexpression of TCMPs favours the sympodial termination in tomato and its ectopic overexpression in A. thaliana induces early flowering and increases FT expression, thus suggesting that TCMP might modulate the activity of flowering regulatory multiprotein complexe

Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy

{TCMP}-2 affects tomato flowering and interacts with {BBX}16, a homolog of the arabidopsis B-box {MiP}1b

Flowering and fruiting are processes subject to complex control by environmental and endogenous signals. Endogenous signals comprise, besides classical phytohormones, also signaling peptides and miniproteins. Tomato cystine-knot miniproteins (TCMPs), which belong to a Solanaceous-specific group of Cys-rich protein family, have been recently involved in fruit development. TCMP-1 and TCMP-2 display a highly modulated expression pattern during flower and fruit development. A previous study reported that a change in the ratio of the two TCMPs affects the timing of fruit production. In this work, to investigate TCMP-2 mode of action, we searched for its interacting partners. One of the interactors identified by a yeast two hybrid screen, was the B-box domain-containing protein 16 (SlBBX16), whose closest homolog is the Arabidopsis microProtein 1b implicated in flowering time control. We demonstrated the possibility for the two proteins to interact in vivo in tobacco epidermal cells. Arabidopsis plants ectopically overexpressing the TCMP-2 exhibited an increased level of FLOWERING LOCUS T (FT) mRNA and anticipated flowering. Similarly, in previously generated transgenic tomato plants with increased TCMP-2 expression in flower buds, we observed an augmented expression of SINGLE-FLOWER TRUSS gene, the tomato ortholog of FT, whereas the expression of the antiflorigen SELF-PRUNING was unchanged. Consistently, these transgenic plants showed alterations in the flowering pattern, with an accelerated termination of the sympodial units. Overall, our study reveals a novel function for TCMP-2 as regulatory factor that might integrate, thanks to its capacity to interact with SlBBX16, into the signaling pathways that control flowering, and converge toward florigen regulation

Esposizione a sostanze e miscele pericolose: risultati preliminari del progetto pilota multicentrico basato su dati provenienti da centri antiveleni

RIASSUNTO - La sorveglianza delle esposizioni derivanti da sostanze e miscele pericolose contenute nei prodotti immessi in commercio, che possono o meno scaturire in un’intossicazione, è un’attività fondamentale per orientare le azioni di prevenzione (Evidence Based Prevention) e per verificarne la rispondenza ai requisiti previsti dalle normative europee, in particolare su classificazione, etichettatura e imballaggio (Regolamento (CE) n. 1272/2008 - CLP). Il Centro Nazionale Sostanze Chimiche Prodotti Cosmetici e Protezione del Consumatore dell’ISS in collaborazione con alcuni Centri Antiveleni italiani, ha condotto uno studio pilota per valutare se l’utilizzo congiunto dei dati sulle consulenze medico-tossicologiche gestite da queste strutture possa costituire un adeguato sistema di sorveglianza anche in rapporto ai differenti sistemi di codifica delle informazioni adottati.SUMMARY (Exposure to dangerous substances and mixtures: preliminary results of the multicenter pilot project based on data from poison control centers) - The surveillance of exposures (with or without poisoning) deriving from dangerous substances and mixtures contained in the products placed on the market is a fundamental activity to guide actions of prevention (Evidence Based Prevention) and to verify their compliance with the requisites established by the European regulations, in particular on classification, labeling and packaging (Regulation (EC) no. 1272/2008 - CLP). The National Center for Chemicals, Cosmetics and Consumer Protection at the Italian National Institute of Health, in collaboration with some Italian Poison Control Centers, conducted a pilot study to assess whether the joint use of data on the medical advices managed by these structures could constitute an adequate surveillance system also in relation to the different adopted coding systems of the information