Three cases of scombroid syndrome in Italy: clinical and preventive considerations.

Background: Foodborne diseases are common sources of morbidity and mortality worldwide. Scombroid syndrome represents a particular condition since it is not directly related to the ingestion of spoiled food but is determined by high levels of histamine, a chemical mediator naturally produced within the human body under particular conditions. In these cases, histamine is formed as a result of the bacterial activity from histidine, an amino acid present at high levels in some fish species. The resulting symptomatology can range from mild symptoms such as headache and skin rash to more severe manifestations such as hypotension and coronary spasms. Reference regulations in Italy set maximum levels of histamine in food at 200 mg/kg. Cases description: The cases described involve a family of three who, following the ingestion of a tuna dish, started to exhibit symptoms typical of an allergic reaction. In one case, hypotension, tachycardia, and electrocardiographic changes in the ST-tract suggestive of myocardial ischemia also appeared with negative myocardionecrosis enzyme dosage. All three cases experienced complete remission of symptoms in the absence of sequelae. Histamine concentrations in fish sampled three days later were 169 mg/kg. Conclusion: The cases described emphasize the importance of proper differential diagnosis as well as the importance of implementing specific controls in food hygiene.

An unusual case of death using a compacting machine.

ABSTRACT: In the large series of forensic injury, death from accidental me-chanical asphyxiation in adults is rare and is usually secondary to suffocation, aspiration, strangulation caused by entrapment of clothing in machinery (deaths at work) or asphyxiation in the course of erotic maneuvers. Compression asphyxia is a form of violent mechanical asphyxia in which the asphyxiated insult is produced by means of a compression and constriction mechanism of the thoracic cage. The authors report an unusual case of asphyxiated death from chest com-pression resulting from the action of a compacting machine, which occurred in a person who had fallen asleep in a waste bin.

LAW n.219/17: Reflecting on shared care plan.

INTRODUCTION: The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility. MATERIALS AND METHODS: This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient. RESULT: The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give. CONCLUSION: In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.

Assessing individual risk for AMD with genetic counseling, family history, and genetic testing.

PurposeThe goal was to develop a simple model for predicting the individual risk profile for age-related macular degeneration (AMD) on the basis of genetic information, disease family history, and smoking habits.Patients and methodsThe study enrolled 151 AMD patients following specific clinical and environmental inclusion criteria: age >55 years, positive family history for AMD, presence of at least one first-degree relative affected by AMD, and smoking habits. All of the samples were genotyped for rs1061170 (CFH) and rs10490924 (ARMS2) with a TaqMan assay, using a 7500 Fast Real Time PCR device. Statistical analysis was subsequently employed to calculate the real individual risk (OR) based on the genetic data (ORgn), family history (ORf), and smoking habits (ORsm).Results and conclusionThe combination of ORgn, ORf, and ORsm allowed the calculation of the Ort that represented the realistic individual risk for developing AMD. In this report, we present a computational model for the estimation of the individual risk for AMD. Moreover, we show that the average distribution of risk alleles in the general population and the knowledge of parents' genotype can be decisive to assess the real disease risk. In this contest, genetic counseling is crucial to provide the patients with an understanding of their individual risk and the availability for preventive actions.

Sustainability of prevention practices at the workplace: safety, simplification, productivity and effectiveness.

Traditional full-time employment has evolved into various types of occupational situations, and, nowadays, new work organization strategies have been developed. Previously overlooked risk factors have emerged, such as traffic accidents while commuting or during work hours, poor work organization, and detrimental lifestyles (like alcohol and substance abuse, although recent statistics seem to show a declining trend for the latter). The global scenario shows greater attention to occupational risks, but also, to the reduced degree of protection. Moreover, the elevated costs, the unacceptably high fatal accident rates in some sectors, the complexity of the prevention systems, the lack of prevention training, the inadequate controls (despite the numerous independent supervisory bodies) and the obsolescence of certain precepts, call for a prompt review of the regulatory system. This is especially needed for general simplification, streamlining certification bodies and minimizing references to other provisions in the legislation that make it difficult for Italian and foreign workers to read and understand the rules "without legal interpreters". "New" occupational diseases and occupational risk factors have also been reported in addition to pollution. There are concerns for continued economic and social destabilization, unemployment, commuting, temporary and precarious contracts. All of these contribute to the lack of wellbeing in the working population. Thus, the timing, duration, and types of prevention training should be carefully assessed, making prevention more appealing by evaluating costs and benefits with a widespread use of indicators that make appropriate actions for health promotion "visible", thus encouraging awareness. Although reducing prevention is never justified, it should still be "sustainable" economically in order to avoid waste of resources. It is also essential to have laws which are easily and consistently interpreted and to work on the ethics of employers and employees to ensure that they conform to the standards of other European countries that currently operate with greater effectiveness and lower costs.

Elemental analysis of histological specimens: a method to unmask nano asbestos fibers.

There is recent mounting evidence that nanoparticles may have enhanced toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method for unmask asbestos nanofibers from Formalin-Fixed, Paraffin-Embedded tissue. There is an increasing amount of evidence that nanoparticles may enhance toxicological potential in comparison to the same material in the bulk form. The aim of this study was to develop a new method to unmask asbestos nanofibers from Formalin-Fixed Paraffin-Embedded (FFPE) tissue. For the first time, in this study we applied Energy Dispersive X-ray (EDX) microanalysis through transmission electron microscopy to demonstrate the presence of asbestos nanofibers in histological specimens of patients with possible occupational exposure to asbestos. The diagnostic protocol was applied to 10 randomly selected lung cancer patients with no history of previous asbestos exposure. We detected asbestos nanofibers in close contact with lung cancer cells in two lung cancer patients with previous possible occupational exposure to asbestos. We were also able to identify the specific asbestos iso-type, which in one of the cases was the same rare variety used in the workplace of the affected patient. By contrast, asbestos nanofibers were not detected in lung cancer patients with no history of occupational asbestos exposure. The proposed technique can represent a potential useful tool for linking the disease to previous workplace exposure in uncertain cases. Furthermore, Formalin-Fixed Paraffin-Embedded (FFPE) tissues stored in the pathology departments might be re-evaluated for possible etiological attribution to asbestos in the case of plausible exposure. Since diseases acquired through occupational exposure to asbestos are generally covered by workers' insurance in most countries, the application of the protocol used in this study may have also relevant social and economic implications.

The protection of individuals affected with Specific Learning Disorders in the Italian Legislation.

Specific Learning Disorders (SLDs) affect specific abilities in individuals with an otherwise normal academic development. Among Italian School population, their reported prevalence is between 2.5% and 3.5%. Dysfunctions at the base of these disorders interfere with the normal acquisition process of reading, writing and/or mathematical abilities, leading to various degrees of adjustment difficulties in the affected individuals. The aim of this study was to assess the support that Italian Government offers to its citizens affected with SLDs, with a particular focus on assistance during the school-age years, particularly through the introduction of the Law 170/2010 and successive guidelines, supplementing the existing regulations to offer more efficient means and legal instruments aimed at achieving earlier diagnoses.

An insight into the occurrence of suicides in jails of an Italian region.

The objective of this study is to explore the personal and environmental causes of suicides in jails of an Italian region, by evaluating the extent of the phenomenon, in order to devise strategies for prevention. The examined documentation deals with all cases of suicide among detainees in the 14 prisons of the region Lazio between 01/01/2008 and 31/12/2014. The factors considered for evaluation concerns the are socio-demographics (age, gender, nationality) as well as legal aspects, prison characteristics (type of crime, judicial state) and method used for the suicide. The results show that the method to commit suicide in prisoners of Lazio is hanged. Suicides occur especially in Italian prisoners. Most prison inmates commit suicide less than one year before the end of the detention period. Since the majority of risk factors for suicide are present before the subject enters prison, it is not easy to observe and check the prisoners once they are in jail. The evaluation of the prisoners should be done during the phase when they first enter the jail and not after the intervening variables associated with the detention have had their effects. This suggests that further studies are necessary to better understand the phenomenon and evaluate the possibility to introduce effective preventive measures.

Ebola virus disease outbreak: what's going on.

The current West African Ebola Virus Disease (EVD) outbreak was confirmed in March, 2014, and after months of slow, fragmented responses, the EVD has been recognized as a public health emergency of international concern. The early diagnosis of the disease is difficult without laboratory testing, because its symptoms can be seen in many other infections. In the wake of international agencies advices, the Italian Ministry of Health, on October 1, 2014, released to the Healthcare Professional Workers (HPWs) the Protocol about the management of cases and contacts within the national territory. Due to the increasing number of humanitarian groups and HPWs involved in the field, the probability to have new cases of contamination is higher than ever. Proven specific treatments against EVD are not yet available, however, a variety of compounds have been under testing. The most effective are select monoclonal antibodies that have a high neutralizing potential against epitopes of Ebola Virus. For facing the matter, it is important a comprehensive approach according to the recommendations proposed by the international agencies because no single institution or country has all the capacities to respond to a new and emerging infectious disease.

Penetrating Ocular Trauma with Retained Intraocular Foreign Body: Management, Follow-up and Medico-legal Evaluation.

Ocular trauma is the leading cause of acquired monocular blindness, accounting for 1.97-6% of such cases. Particularly, penetrating ocular injuries are among the most common eye injuries with this kind of outcome. Early diagnosis and prompt management are crucial to avoid complications, and the especially dreaded enucleation. In this article, the authors describe the clinical management, and evaluate the visual and anatomical results obtained in a case of ocular injury with retained intraocular foreign body (IOFB) in a 20-year old female patient. The course of treatment involved a combination of penetrating keratoplasty with a temporary keratoprosthesis, phacoemulsification with intraocular lens implantation and pars plana vitrectomy. At three years from the initial injury, the patient was able to count fingers at 30 centimetres and anatomical restitutio ad integrum of the globe had been achieved.

Biological hazards and healthcare-associated infections in Italian healthcare facilities: some considerations on inspections and accountability.

Healthcare-associated infections are a major clinical and public health problem that involve, in a variety of ways, healthcare professionals, hospital administrators and, above all, patients. In Italy, the incidence of infectious complications generally varies from 5-10% (hospitalized patients) to 1% (home care patients); 5-10% of such infections manifest epidemically, and infections caused by antibiotic-resistant microorganisms are becoming more and more common, with a mortality rate of 20-30%. Moreover, any "preventable deaths or serious injuries" attributable to a (concrete) causality resulting from a breach of rules, laws and regulations, as well as imprudence, incompetence or negligence by the operators will determine a possibility of a penal prosecution for manslaughter or grievous bodily harm, and also generate expenses for civil procedures and insurance compensation. The adoption of company policies covering appropriate risk assessment, epidemiological monitoring, implementation of guidelines, procedures and protocols, activity of the Hospital Infections Committee and proper communication between managers and facilities, training of healthcare personnel and medical surveillance of employees can help reduce the adverse phenomena of healthcare-associated infections.

Sleep disorders and driving licence: the current Italian legislation and medico-legal issues.

Road traffic accidents (RTA) are a serious issue in all industrialized countries and have dramatic social and healthcare-related implications. Fatigue (sleepiness) is the principal identifiable and preventable cause of road traffic accidents. Obstructive sleep apnoea syndrome (OSAS) and narcolepsy are two of the leading causes of excessive daytime sleepiness. In this article, the authors analyze the current Italian legislation regarding driving licence issuance and fitness to drive, in order to evaluate the potential implications of sleep disorders, particularly OSAS and narcolepsy. In European Legislation and in Italy, OSAS and narcolepsy are not included among the illnesses or invalidating conditions that limit the fitness to drive for driving licence issuance purposes. In fact, they are not included in the Annex III of the European Council Directive 91/439/EEC of the 29th of July 1991 on driving licences. Some Countries of the European Union (Belgium, France, Finland, Great Britain, the Netherlands, Spain and Sweden) had implemented the 91/439/EEC Directive with national restrictions on driving licence issuance policies in case of OSAS and narcolepsy. Given the well-established scientific evidence available, in Italy, the lack of legislation regulating the assessment of the psychophysical requisites for the issuance and renewal of driving licences of individuals affected by sleep disorders seems extremely worrying. Furthermore, the current lack of legal obligation in Italy for healthcare facilities to disclose such diagnoses to the organs responsible for issuing driving licences (such as the Motorizzazione Civile - the Department of motor vehicles) remains the subject of heated debate.

Environmental tobacco smoke: health policy and focus on Italian legislation.

Worldwide tobacco smoking kills nearly 6 million people each year, including more than 600,000 non-smokers who die from smoke exposure. Environmental tobacco smoke (ETS, also called secondhand smoke, involuntary smoke, or passive smoke) is the combination of sidestream smoke, the smoke given off by a burning tobacco product and mainstream smoke, the smoke exhaled by smokers. People may be exposed to ETS in homes, cars, workplaces, and public places, such as bars, restaurants, and recreational settings. In addition, there is another type of smoke which until now has not been recognized: the so-called thirdhand smoke, that comes from the reaction of mainstream smoke and environmental nitrous acid (HNO2) making carcinogenic tobacco-specific nitrosamines (TSNAs). The effects of ETS on human health are well-known, passive smoking is harmful to those who breathe the toxins and it is a serious problem for public health. The smoking ban in Italy had reduced ETS pollution, as in the United States and in other countries all over the world. However, the implementation of comprehensive legislation on smoking policy will necessitate other tobacco control measures for its successful fulfillment: increased media awareness, telephone smoking cessation helplines and smoking cessation support services could be an opportunity to ensure awareness, comprehension and support to those who want to quit smoking. The effectiveness of legislative efforts will also depend on successful enforcement of smoking bans and compliance with the legislation. This review summarizes the evidences about the effect of ETS and provides an overview of smoke-free laws and policies.

Clinical and psychosocial correlates of post-herpetic neuralgia.

Post-herpetic neuralgia is the most challenging and debilitating complication of herpes zoster in the immunocompetent host. Because the effect of treatment is disappointing once the syndrome has developed, it is important to know which factors predict post-herpetic neuralgia occurrence to facilitate selection of herpes zoster patients with a higher risk of developing neuralgia and undertake preventative strategies. The present study aimed at identifying demographic, clinical and psychosocial correlates of post-herpetic neuralgia in a sample of 219 immunocompetent patients, who were examined by dermatologists in private practice in Italy and who completed a questionnaire designed to evaluate their clinical and psychosocial profile at the time of clinical diagnosis of herpes zoster and at a follow-up visit 6 months later. In a univariate analysis, post-herpetic neuralgia was associated significantly with older age, longer duration of prodromal pain, greater acute pain intensity, greater extent of rash, presence of abnormal sensations and use of systemic antiviral therapy. Compared to the values at herpes zoster onset, at the follow-up visit patients with post-herpetic neuralgia presented with similar high mean scores of pain intensity, anxiety and depression and greatly reduced quality of life, whereas patients without neuralgia presented with improved scores. In a multivariate model, older age, greater acute pain intensity, greater extent of rash and longer duration of prodromal pain were independently associated with post-herpetic neuralgia. The results of this study may help physicians to identify patients with a higher risk of developing post-herpetic neuralgia and undertaking preventative strategies.

[The association of asbestos and cigarette smoke in lung cancer. Note 2]. / L'associaione asbesto-fumo di sigaretta nel cancro polmona- re. Nota 2.

This work follows up the previous edited in the year 2004, and deals with the still serious and discussed problem of work risks even though the use of asbestos has been forbidden since 10 years, and the tobacco's smoke since one year. The Authors discuss the question related to the genetic point of view as a first and multiplying action caused at the some time by the tobacco's smoke and asbestos dust in the working places. This work report an up-to-date list of law about environmental prevention.

[Topical notes about work diseases rules]. / Nuovo elenco delle malattie professionali a denuncia obbligatoria.

The Authors explain the text of the Decree April 27 2004 related to the new list of work diseases to be reported as by law enacted, instead of the previous Decree April 18 1973. The Decree follows up the latest UE Recommendation 2003/670 in order to bring up to date the European list of work diseases. The Authors examine several topical points of this decree, wishing for Italy a new up to date list for work diseases as from the last DPR April 13, 1994 no 336.

[Child labour]. / Il lavoro minorile.

The authors emphasize the violation of children's and adolescents' rights as a result of the exploitation of child labour. Besides the legal aspect, they pointed out the medical features related to the delicate growing process of the child in the phases of development and adaptation of the main organs to hard work. Currently the problem is being supervised by those states that recognize the right for minors to be protected against any kind of physical, mental, spiritual and moral risk.

[Pregnancy and work]. / Gravidanza e lavoro.

In the last decades there has been an increase of women's presence in the working field. That has been a consequence of the use of an advanced technology, of a different organization of work, of the rules about men/women equality, as wellas of the women's emancipation. As a result women have been exposed to a greater amount of risks both for their health and for their reproductive function. In this work, we highlighted the pathogenic effects resulting from the interaction of different substances present in the working place with the female organism, with special interest in the effects on pregnancy. Furthermore, we laid stress on the rules and on the guidelines that safeguard women's right to work as well as their right to be mothers both at a national and at an european level.