Insulin pump therapy in children and adolescents with type 1 diabetes: the Italian viewpoint.

BACKGROUND AND AIM: A panel of experts of the Italian Society of Paediatric Endocrinology and Diabetology translated into Italian the international insulin pump therapy recommendations in children and adolescents with type 1 diabetes. METHODS: After an extensive review of the literature using evidence-based recommendations, several issues were taken into account, such as patient selection, advantages and disadvantages, instrument choice, insulin type, therapy planning and follow-up, emergencies, nutrition, particular occasions (like parties, holidays, sick days, travels), exercise, continuous glucose monitoring and integrated system, neonatal diabetes. The panel evaluated the cost-effectiveness of insulin pump therapy compared to multiple daily injection therapy, analysing the cost-benefit ratio. RESULTS: Some tweak was needed due to the Italian dietetic singularity, meal schedule, climate and lifestyle. Insulin pump therapy in neonatal diabetes is a new issue and no guidelines have been published yet for this age-group. Moreover, legal issues according to the Italian law have been added and are peculiarity of our recommendations. An "informed therapeutic agreement" between the patient and his/her family and the diabetic team has to be signed before starting insulin pump therapy. CONCLUSIONS: We think that nowadays the need for clinical guidelines is important and worth the effort that all countries develop faithful adaptation into their local languages taking into account specific contexts and local peculiarities, without making substantial modifications to the original text.

[Medical-legal evaluation of Brugada syndrome]. / La sindrome di Brugada in ambito valutativo medico-legale.

Brugada syndrome is a congenital arrhythmogenic disease, characterized by alterations in sodium channels in the absence of structural myocardial changes. It leads to ventricular electrical instability, causing arrhythmias with high risk of sudden cardiac death. Patients affected by Brugada syndrome show electrocardiographic alterations either at baseline or after stimulation. Symptomatology and electrocardiographic alterations are the most important prognostic elements. The only effective treatment is the implantation of an automatic implantable cardioverter-defibrillator, which dramatically reduces arrhythmic mortality. This device is used only in symptomatic patients for abortive sudden cardiac death or syncope with electrocardiographic alterations, whereas in most patients just a careful follow-up is required. In this article we evaluate the medical-legal aspects of patients with Brugada syndrome, in forensic pathology, social insurance, private insurance, medical professional liability and ability to work. First of all, we analyze the question of medical professional liability, mostly in case of a wrong identification of prognostic factors. Then we consider the medical-legal evaluation of Brugada syndrome in the field of social insurance, in relation to the clinical picture and particularly to the frequency of arrhythmic events. As far as private insurance is concerned, we dwell upon patients' insurability in the various types of policies, refundable medical expenses and evaluation of pathology in health insurance. Finally, we discuss the question of ability to work, with special regard to armed forces and police, whose committees do not provide a specific evaluation for Brugada syndrome by making identical use of automatic implantable cardioverter-defibrillators and pacemakers, thus ignoring the great clinical differences between these two devices.

Long persistence of rigor mortis at constant low temperature.

We studied the persistence of rigor mortis by using physical manipulation. We tested the mobility of the knee on 146 corpses kept under refrigeration at Torino's city mortuary at a constant temperature of +4 degrees C. We found a persistence of complete rigor lasting for 10 days in all the cadavers we kept under observation; and in one case, rigor lasted for 16 days. Between the 11th and the 17th days, a progressively increasing number of corpses showed a change from complete into partial rigor (characterized by partial bending of the articulation). After the 17th day, all the remaining corpses showed partial rigor and in the two cadavers that were kept under observation "à outrance" we found the absolute resolution of rigor mortis occurred on the 28th day. Our results prove that it is possible to find a persistence of rigor mortis that is much longer than the expected when environmental conditions resemble average outdoor winter temperatures in temperate zones. Therefore, this datum must be considered when a corpse is found in those environmental conditions so that when estimating the time of death, we are not misled by the long persistence of rigor mortis.