Fat overload syndrome following intravenous lipid emulsion administration as antidote in suspected anesthetic intoxication: insights from a clinical and forensic case experience.

Abstract: Medication errors pose significant risks to patients' health, representing a relevant social and economic issue for the healthcare system. This study focuses on the life-threatening consequences of an overdose of intravenous lipid emulsion (ILE), used as an antidote for suspected bupivacaine intoxication in a young woman undergoing hip surgery. Shortly after administration of the local anesthetic, the woman experienced cardiac arrest and was admitted to the intensive care unit with severe respiratory failure, metabolic acidosis and deep coma. Despite medical intervention, her condition worsened, leading the medical team to administer ILE for suspected bupivacaine intoxication. The patient's condition did not improve and ultimately resulted in death. The autopsy highlighted a widespread presence of oily material in the vascular system, compatible with an overdose of ILE. At a checking, medical records reported a dose of ILE that was 4-fold higher than the recommended dose in this off-label indication. This case report highlights the important need for healthcare professionals to understand the risks of using ILE as an antidote. Adequate monitoring of these "sentinel events" and their critical evaluation can lead to the implementation of specific clinical risk management protocols to reduce the risk for the patient and contain healthcare costs.

Effect of hydrogen peroxide and hyaluronic acid in mouth rinse after third molar extraction: a triple-blind parallel randomized controlled clinical trial.

OBJECTIVE: The study aimed to investigate the potential beneficial role of hydrogen peroxide (H2O2) and hyaluronic acid (HA) combination formulation in socket healing after third molar surgery. Biomaterials, including mouthwash formulations, were hypothesized to contribute to improved socket healing and reduced post-operative complications. PATIENTS AND METHODS: A triple-blinded parallel randomized controlled clinical trial was conducted at a single-center dental hospital in Milan, Italy. The trial included 114 patients who underwent extraction of impacted, partially erupted, and completely erupted third molars. Patients were randomly assigned to three parallel groups: Group 1 (H2O2 and HA), Group 2 (placebo), and Group 3 (0.2% chlorhexidine). The trial was registered at ClinicalTrial.gov (registration number NCT04438434). The main outcome measures included various parameters related to socket healing, such as pain, inflammation, swelling, plaque index, bleeding index, granulation tissue, suppuration, re-epithelialization, bleeding upon palpation, odor, and taste alteration. Patients were followed up for 7 days. RESULTS: All 114 enrolled patients completed the study, with no dropouts or loss to follow-up. The mean age of patients in the three groups differed (H2O2 and HA: 30.9±14.9; placebo: 27.6±13.1; 0.2% chlorhexidine: 23.05±10.16). Significant reductions (p<0.001) in visual analog scale (VAS) pain levels and other outcome measures were observed in the H2O2 and HA group compared to the placebo group. These findings suggest a positive effect of the H2O2 and HA combination on socket healing after the third molar surgery. CONCLUSIONS: The study concludes that the combination of hydrogen peroxide and hyaluronic acid can be considered a potential mouthwash with beneficial effects on socket healing following third molar surgery. However, additional clinical trials are recommended to validate its effectiveness further and provide additional evidence supporting its use in clinical settings. CLINICALTRIAL: gov: NCT04438434.

Survey of Oral Hygiene Habits and Knowledge among School Children: a cross-sectional study from Italy.

AIM: This study is aimed to investigate the oral hygiene practice, knowledge and attitude of young adults, assessing their awareness about the impact of a certain "risk" behaviour on their oral and dental health. MATERIALS: This is a cross-sectional survey study conducted on 829 students (350 males and 479 females, mean age 13-20 years) attending high school in Milan and surrounding areas. They were asked to complete anonymous questionnaire during the first semester of the 2019-2020 school year, under the supervision of a teacher and/or an assigned interviewer. The questionnaire was created by "Laboratorio Adolescenza", in collaboration with the International Alliance of Responsible Drinking (IARD) Research Institute and the University of Milan. All of the data was compiled into table or graph form and analysed. CONCLUSION: There is a general awareness among Italian school children about the risks of bad oral habits, however, there is a need to improve the oral health knowledge, attitude and practices in the target population with emphasis on improvement of oral hygiene practices.

Headaches in Domestic Medicine by William Buchan.

In this paper, we consider the chapter on headaches contained in William Buchan's Domestic Medicine, a book that enjoyed great success during the second half of the eighteenth and the beginning of the nineteenth centuries, and belongs to the series of public education treatises that began with the publication of Avis au Peuple sur la Sante by Simon Andrè Tissot. In line with the ideals of the Enlightenment, Buchan's aim was to satisfy the needs of people who had no opportunity of consulting a physician by providing them with information about the symptoms and treatment of the most common diseases. One of the distinguishing characteristics of the book is the space dedicated to preventive medicine. In the chapter on headaches, as well as dealing extensively with their etiology, pathogenesis, clinical characteristics and treatment within the conceptual context of humoral medicine, the author also proposed a number of preventive measures that can still be considered fully acceptable today.

The role of CSF ventricular drainage in controlling intracranial hypertension in patients with brain lesions. Comparison of three methods. Preliminary results.

Results obtained with three different CSF ventricular drainage methods (intermittent with no outflow resistance, continuous against a positive pressure, continuous with pre-arranged positive pressure), were evaluated in fifty nine cases of traumatic cerebral lesions and spontaneous intracerebral hematomas with intracranial hypertension. Continuous CSF withdrawal gives better clinical results and is more effective in controlling intracranial pressure than intermittent drainage (50% vs 13% successes respectively). Results obtained with continuous drainage against a steady positive pressure and with a pre-arranged pressure ("tidal drainage") are almost similar. However an outflow resistance 3-5 mmHg higher than diastolic level of ICP represents a rational approach to the problem.