Abdominal-Pelvic Actinomycosis Mimicking Malignant Neoplasm

Abdominal-pelvic actinomycosis is often mistaken for other conditions, presenting a preoperative diagnostic challenge. In a 46-year-old female, computed tomography showed an abdominal-pelvic retroperitoneal mass extending from the lower pole of the right kidney to the lower pelvis. The patient had a 3-year history of intrauterine device. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly. The resection of retroperitoneal mass, distal ileum appendicectomy, right hemicolectomy, and right salpingo-oophorectomy was performed. The postoperative period was uneventful. Penicillin therapy was given for six months without any complication. The retroperitoneal mass measured 4.5 × 3.5 × 3 cm, surrounded adjacent organs and histologically showed inflammatory granulomatous tissue, agglomeration of filaments, and sulfur granules of Actinomyces, with positive reaction with periodic acid Schiff. Right tubo-ovarian abscess was present. Abdominalpelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intrauterine device

The rapid spread of SARS-COV-2 Omicron variant in Italy reflected early through wastewater surveillance

The SARS-CoV-2 Omicron variant emerged in South Africa in November 2021, and has later been identified worldwide, raising serious concerns. A real-time RT-PCR assay was designed for the rapid screening of the Omicron variant, targeting characteristic mutations of the spike gene. The assay was used to test 737 sewage samples collected throughout Italy (19/21 Regions) between 11 November and 25 December 2021, with the aim of assessing the spread of the Omicron variant in the country. Positive samples were also tested with a real-time RT-PCR developed by the European Commission, Joint Research Centre (JRC), and through nested RT-PCR followed by Sanger sequencing. Overall, 115 samples tested positive for Omicron SARS-CoV-2 variant. The first occurrence was detected on 7 December, in Veneto, North Italy. Later on, the variant spread extremely fast in three weeks, with prevalence of positive wastewater samples rising from 1.0% (1/104 samples) in the week 5-11 December, to 17.5% (25/143 samples) in the week 12-18, to 65.9% (89/135 samples) in the week 19-25, in line with the increase in cases of infection with the Omicron variant observed during December in Italy. Similarly, the number of Regions/Autonomous Provinces in which the variant was detected increased from one in the first week, to 11 in the second, and to 17 in the last one. The presence of the Omicron variant was confirmed by the JRC real-time RT-PCR in 79.1% (91/115) of the positive samples, and by Sanger sequencing in 66% (64/97) of PCR amplicons. In conclusion, we designed an RT-qPCR assay capable to detect the Omicron variant, which can be successfully used for the purpose of wastewater-based epidemiology. We also described the history of the introduction and diffusion of the Omicron variant in the Italian population and territory, confirming the effectiveness of sewage monitoring as a powerful surveillance tool

Hashish e principio attivo: considerazioni medico-legali su una casistica

Riassunto L’hashish è una sostanza stupefacente psicotropa che deriva dalla pianta appartenente alla famiglia delle Cannabaceae della specie Cannabis sativa. Le proprietà farmacologiche della Cannabis sativa sono dovute al suo composto principale, il delta9-tetraidrocannabinolo (THC), che agisce sui neuroni dopaminergici e provoca effetti psicoattivi. L’hashish si ricava dalla resina estratta dalle foglie della pianta e contiene il THC in una percentuale che va dal 6 al 15%. I campioni di stupefacente analizzati presso il laboratorio dell’Agenzia Regionale Protezione Ambiente Lazio (ARPALazio) nel triennio 2007-2009 e risultati positivi per hashish sono stati il 54,10% dell’intera attività di laboratorio inerente agli stupefacenti eseguita dall’ARPA Lazio. La quantità di principio attivo è tra il 6 e l’8% per il triennio 2007-2009. I casi in cui è stato superato il limite di 500 mg, fissato dal Decreto del Presidente della Repubblica del 9 ottobre 1990 n. 309 e relativo al possesso per uso personale depenalizzato, sono stati il 5,81%. Tale percentuale non conferma l’esistenza di grossi traffici internazionali, piuttosto di “piccoli spacciatori e/o consumatori”. Questo si spiega considerando che, se la quota di THC è sempre bassa, saranno pochi anche i casi eccedenti il limite consentito. Inoltre, se la quantità di THC nel campione si aggira intorno al 6-8%, il resto del preparato è costituito da altre sostanze come contaminanti, sostanze da taglio e adulteranti. Questi ultimi alterano i risultati degli esami per la droga effettuati in laboratorio, nascondendo il contenuto di THC e rimandando a tecniche più sofisticate per la sua ricerca. Le haschich est un stupéfiant psychotrope dérivé d’une plante de la famille des Cannabaceae de l’espèce Cannabis sativa. Les propriétés pharmacologiques du Cannabis sativa sont dues à son composé principal, le delta-9-tétrahydrocannabinol (THC) qui agit sur les neurones dopaminergiques et provoque des effets psychoactifs. Le haschich est fait à partir de l’extraction d’une résine présente dans les feuilles de la plante et contient le THC (6-15 %). Les échantillons de stupéfiant positifs au haschich analysés par le laboratoire de l’Agence Régionale de la Protection de l’Environnement du Latium (ARPALazio), entre 2007 et 2009, ont été de 54,1 % sur toute l’activité d’analyse de stupéfiants faite par l’Agence. La quantité de principe actif détectée, dans la même période, a été de 6-8 %. Les cas dans lesquels le seuil de 500 mg a été franchi ont été de 5,81% (ce seuil a été fixé par le Décret du Président de la République du 9 octobre 1990, n°309, relatif à la possession pour l’usage personnel dépénalisé). Ce pourcentage ne confirme pas l’existence de grands trafics internationaux, mais plutôt la présence de « petits dealers et/ou consommateurs ». Cette situation peut être expliquée considérant que, si le volume de THC est bas, les cas au-delà du seuil permis seront peu nombreux. En outre, si la quantité de THC dans l’échantillon est de 6-8 %, le reste du mélange est constitué d’autres substances comme les contaminants, les produits de coupage et autres substances altérantes. Ces derniers altèrent les résultats des tests de laboratoire car ils cachent le THC et obligeant à l’utilisation de techniques plus sofistiquées pour le détecter. The pharmacological properties of cannabis sativa are due to its main ingredient, delta9tetrahydrocannabiol (THC) which affects dopaminergic neurons thus causing psychoactive effects. Hashish is derived from the resin extracted from the leaves of the plant and contains THC in a percentage from 6 to 15%. The drug samples analyzed at the Laboratorio della Agenzia Regionale Protezione Ambiente Lazio (ARPALazio) in a three year time 2007-2009 were hashish for 54,10% out of the whole analyze drug sampling. The amount of the main active ingredient is between 6 and 8% for the three year time analysis 2007-2009. The cases exceeding the threshold amount of 500 mg as established by the Decreto del Presidente della Repubblica of 9th October 1990 n.309 relating to the unpunishable possession for private personal use were 5,81%. This percentage does not confirm the existence of big international drug trafficking but of “small drug dealers and/or consumers”. This can be explained by considering that if the amount of THC is always low, also the cases exceeding the allowed threshold quantity will be few. Furthermore, if the amount of THC in the sample is between 6-8%, the rest of the substance is made up of other elements such as contaminants, cutting agents and adulterants which alter the laboratory test drug results by hiding the THC contents that will be traced only through more sophisticated techniques

Considerazioni sulla cocaina: presentazione ed analisi di una casistica

L’uso di cocaina costituisce un serio pericolo per la salute ed il nostro Paese ha previsto una dettagliata normativa in materia con il DPR 309/90, modificato a seguito del referendum del 1993 con il quale è stato depenalizzato il possesso di droga finalizzato all’uso personale, riconosciuto sulla base di specifiche dosi al momento del sequestro. Nel caso della cocaina, per la quale il limite da non superare per riconoscersi come utilizzatore e non spacciatore è rappresentato dal limite di 750 mg di principio attivo, particolare importanza ai fini dei pericoli per la salute riveste la quantità di adulterante contenuto nella dose. Il lavoro propone alcune considerazioni in merito alla prevalenza di adulteranti nel mercato degli stupefacenti in particolare per la cocaina nel territorio regionale laziale attraverso un report dell’attività di laboratorio dell’Agenzia Regionale Protezione Ambientale del Lazio, al fine di trarre utili considerazioni anche in merito al trattamento del paziente in uno stato di intossicazione. L’usage de cocaïne représente un danger pour la santé et notre pays a prévu une norme détaillée en la matière, le DPR n° 309/90, modifié suite à un référendum abrogatif en 1993 qui a dépénalisé la détention de drogue pour usage personnel (ce dernier est reconnu sur la base de la quantité de drogue au moment de la saisie). En ce qui concerne la cocaïne, la limite à ne pas dépasser pour être reconnu comme utilisateur et non comme dealer est 750 mg de principe actif ; en outre, la quantité de substance altérant la dose est particulièrement importante. Cette étude propose des considérations sur la prévalence de substances qui altèrent les doses sur le marché des stupéfiants, en particulier en ce qui concerne la cocaïne dans la région du Latium à travers l’analyse des activités du laboratoire de l’Agence Régionale de la Protection de l’Environnement du Latium, afin de développer des considérations utiles aussi au traitement du patient intoxiqué. Cocaine consumption represents a serious danger for human health and our Country has provided a detailed set of rules to this regard by DPR 309/90 amended after the referendum of 1993 which decriminalizes the possession of drug for personal use according to established amounts during confiscation. As far as cocaine is concerned the established limited quantity is 750 mg of main active ingredient (so as to be considered consumer and not drug-dealer). What is particularly important is the amount of adulterants contained in the drug dose, which is particularly dangerous and harmful. This study proposes some considerations about the prevalence of adulterants in drug-trafficking in particularly in cocaine in Lazio region through the laboratory sampling tests of the Agenzia Regionale Protezione Ambiente del Lazio, in order to draw useful considerations regarding the treatment of intoxicated patients

Hashish e principio attivo: considerazioni medico-legali su una casistica / Haschich et principe actif : considérations médico-légales à partir d’une liste de cas / Hashish and its active ingredient: forensic-medical considerations from a case-record

Le haschich est un stupéfiant psychotrope dérivé d’une plante de la famille des Cannabaceae de l’esp��ce Cannabis sativa. Les propriétés pharmacologiques du Cannabis sativa sont dues à son composé principal, le delta-9-tétrahydrocannabinol (THC) qui agit sur les neurones dopaminergiques et provoque des effets psychoactifs. Le haschich est fait à partir de l’extraction d’une résine présente dans les feuilles de la plante et contient le THC (6-15 %).Les échantillons de stupéfiant positifs au haschich analysés par le laboratoire de l’Agence Régionale de la Protection de l’Environnement du Latium (ARPALazio), entre 2007 et 2009, ont été de 54,1 % sur toute l’activité d’analyse de stupéfiants faite par l’Agence. La quantité de principe actif détectée, dans la même période, a été de 6-8 %. Les cas dans lesquels le seuil de 500 mg a été franchi ont été de 5,81% (ce seuil a été fixé par le Décret du Président de la République du 9 octobre 1990, n°309, relatif à la possession pour l’usage personnel dépénalisé). Ce pourcentage ne confirme pas l’existence de grands trafics internationaux, mais plutôt la présence de « petits dealers et/ou consommateurs ».Cette situation peut être expliquée considérant que, si le volume de THC est bas, les cas au-delà du seuil permis seront peu nombreux. En outre, si la quantité de THC dans l’échantillon est de 6-8 %, le reste du mélange est constitué d’autres substances comme les contaminants, les produits de coupage et autres substances altérantes. Ces derniers altèrent les résultats des tests de laboratoire car ils cachent le THC et obligeant à l’utilisation de techniques plus sofistiquées pour le détecter.The pharmacological properties of cannabis sativa are due to its main ingredient, delta9tetrahydrocannabiol (THC) which affects dopaminergic neurons thus causing psychoactive effects. Hashish is derived from the resin extracted from the leaves of the plant and contains THC in a percentage from 6 to 15%. The drug samples analyzed at the Laboratorio della Agenzia Regionale Protezione Ambiente Lazio (ARPALazio) in a three year time 2007-2009 were hashish for 54,10% out of the whole analyze drug sampling.The amount of the main active ingredient is between 6 and 8% for the three year time analysis 2007-2009. The cases exceeding the threshold amount of 500 mg as established by the Decreto del Presidente della Repubblica of 9th October 1990 n.309 relating to the unpunishable possession for private personal use were 5,81%. This percentage does not confirm the existence of big international drug trafficking but of “small drug dealers and/or consumers”.This can be explained by considering that if the amount of THC is always low, also the cases exceeding the allowed threshold quantity will be few. Furthermore, if the amount of THC in the sample is between 6-8%, the rest of the substance is made up of other elements such as contaminants, cutting agents and adulterants which alter the laboratory test drug results by hiding the THC contents that will be traced only through more sophisticated techniques

Considerazioni sulla cocaina: presentazione ed analisi di una casistica / Considérations sur la cocaïne : présentation et analyse d’une liste de cas / Considerations about cocaine: analysis and presentation of a case-record

L’usage de cocaïne représente un danger pour la santé et notre pays a prévu une norme détaillée en la matière, le DPR n° 309/90, modifié suite à un référendum abrogatif en 1993 qui a dépénalisé la détention de drogue pour usage personnel (ce dernier est reconnu sur la base de la quantité de drogue au moment de la saisie). En ce qui concerne la cocaïne, la limite à ne pas dépasser pour être reconnu comme utilisateur et non comme dealer est 750 mg de principe actif ; en outre, la quantité de substance altérant la dose est particulièrement importante. Cette étude propose des considérations sur la prévalence de substances qui altèrent les doses sur le marché des stupéfiants, en particulier en ce qui concerne la cocaïne dans la région du Latium à travers l’analyse des activités du laboratoire de l’Agence Régionale de la Protection de l’Environnement du Latium, afin de développer des considérations utiles aussi au traitement du patient intoxiqué. Cocaine consumption represents a serious danger for human health and our Country has provided a detailed set of rules to this regard by DPR 309/90 amended after the referendum of 1993 which decriminalizes the possession of drug for personal use according to established amounts during confiscation. As far as cocaine is concerned the established limited quantity is 750 mg of main active ingredient (so as to be considered consumer and not drug-dealer). What is particularly important is the amount of adulterants contained in the drug dose, which is particularly dangerous and harmful.This study proposes some considerations about the prevalence of adulterants in drug-trafficking in particularly in cocaine in Lazio region through the laboratory sampling tests of the Agenzia Regionale Protezione Ambiente del Lazio, in order to draw useful considerations regarding the treatment of intoxicated patients

Bereavement after the suicide of a significant other

CONTEXT: It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors. AIMS: The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors. MATERIALS AND METHODS: Careful MedLine and PsycINFO searches for the period 1980-2013. RESULTS: The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide. CONCLUSION: Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors. PRACTICE IMPLICATIONS: It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions

CCR2+ monocytic myeloid-derived suppressor cells (M-MDSCs) inhibit collagen degradation and promote lung fibrosis by producing transforming growth factor-β1.

Monocytes infiltrating scar tissue are predominantly viewed as progenitor cells. Here, we show that tissue CCR2+ monocytes have specific immunosuppressive and profibrotic functions. CCR2+ monocytic cells are acutely recruited to the lung before the onset of silica-induced fibrosis in mice. These tissue monocytes are defined as monocytic myeloid-derived suppressor cells (M-MDSCs) because they significantly suppress T-lymphocyte proliferation in vitro. M-MDSCs collected from silica-treated mice also express transforming growth factor (TGF)-β1, which stimulates lung fibroblasts to release tissue inhibitor of metalloproteinase (TIMP)-1, an inhibitor of metalloproteinase collagenolytic activity. By using LysMCreCCR2loxP/loxP mice, we show that limiting CCR2+ M-MDSC accumulation reduces the pulmonary contents of TGF-β1, TIMP-1 and collagen after silica treatment. M-MDSCs do not differentiate into lung macrophages, granulocytes or fibrocytes during pulmonary fibrogenesis. Collectively, our data indicate that M-MDSCs contribute to lung fibrosis by specifically promoting a non-degrading collagen microenvironment. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd