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Nittari G, Gibelli F, Bailo P, Sirignano A, Ricci G. Factors affecting mental health of seafarers on board merchant ships: a systematic review. Rev Environ Health 2024; 39:151-160. [PMID: 36302371 DOI: 10.1515/reveh-2021-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Merchant ships represent a peculiar working environment with several challenges and risks. The specific situation on board of ships may affect the mental health of seafarers more remarkably than ashore workers. CONTENT A systematic review of the literature has been carried out to identify the main causes of mood disorders among seafarers and the impact that these disorders have on their health. This review has analyzed the scientific literature published between January 2006 and December 2021 using the search engines PubMed, Web of Science (WoS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). SUMMARY Social isolation, distance from families, fatigue, stress and long work shifts represent the main causes of mood disorders among seafarers. OUTLOOK Strategies aimed at improving conditions of cohabitation on board, and a greater consideration of these problems are key for improving the mental health of workers at sea.
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Affiliation(s)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Marche, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Marche, Italy
| | | | - Giovanna Ricci
- School of Law, University of Camerino, Camerino, Marche, Italy
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Sirignano P, Piffaretti G, Ceruti S, Orso M, Picozzi M, Ricci G, Sirignano A, Taurino M. Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study. J Cardiovasc Surg (Torino) 2024:S0021-9509.23.12906-5. [PMID: 38319647 DOI: 10.23736/s0021-9509.23.12906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Società Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS A questionnaire consisting of 26 statements was developed, validated by an 18-member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when ≥70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS Two-hundred-forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first-round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital, Rome, Italy -
- Department of General and Specialistic Surgery, Sapienza University, Rome, Italy -
| | - Gabriele Piffaretti
- Vascular Surgery, ASS T Settelaghi University Teaching Hospital, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia Ceruti
- Research Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche "Togo Rosati", Perugia, Italy
| | - Mario Picozzi
- Research Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Giovanna Ricci
- School of Civil Law, University of Camerino, Camerino, Italy
| | | | - Maurizio Taurino
- Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital, Rome, Italy
- Department of Molecular and Clinical Medicine, Sapienza University, Rome, Italy
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Bailo P, Gibelli F, Celletti A, Caraffa A, Sirignano A, Ricci G. The contributing factors to suicide in Italian prisons: An 11-year analysis (2010-2020). Crim Behav Ment Health 2023; 33:441-454. [PMID: 38081794 DOI: 10.1002/cbm.2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Suicide is a leading cause of death globally, with approximately 800,000 deaths annually and accounting for 1.5% of all deaths. Risk factors are multifaceted, encompassing individual factors (such as genetics, family history and mental illnesses) and environmental factors (such as economic conditions, social support and life events). In prisons, suicide rates are markedly higher than in the general population, particularly in Italy, where the prisoner suicide rate is approximately 20 times that of the non-incarcerated population. There is, however, little research on suicide in Italian prisons. AIMS To analyse the characteristics of all people who died by suicide in Italian prisons between 2010 and 2020. METHODS We carried out a records-based cohort study analysing official data from the Italian Ministry of Justice on prison suicides between 2010 and 2020. The data were cross-referenced and, when required, supplemented with information from Ristretti Orizzonti, a journal specialising in health and living conditions in prisons, as well as from the website of ISTAT (Italian National Statistical Institute), newspapers, radio broadcasts and news agencies. RESULTS Factors associated with an increased risk of suicide in prisons were nighttime periods, the months of June, July and October, a relatively brief duration of detention (<6 months), having been convicted of murder, male gender, being about 40 years old, having access to hanging materials and being interned (i.e. subjected to the execution of custodial security measures) or awaiting trial. Prison overcrowding was not a risk factor for suicide. CONCLUSION Our findings hold substantial implications for suicide prevention in Italian prisons as they suggest both characteristics of individuals and characteristics of the institutions that could be taken as risk indicators. This knowledge can inform the development of targeted interventions to manage both individual and environmental factors better, leading to improved prison conditions and reduced suicide rates. Furthermore, our research establishes a foundation for more systematic and in-depth investigations that could further improve suicide prevention strategies in Italian prisons, ultimately influencing policy changes in both practice and research, including perhaps establishing a national database on every completed suicide in prisons.
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Affiliation(s)
- Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
| | - Asaea Celletti
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
| | - Anna Caraffa
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino (MC), Camerino, Italy
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Ricci G, Gibelli F, Sirignano A. Three-Dimensional Bioprinting of Human Organs and Tissues: Bioethical and Medico-Legal Implications Examined through a Scoping Review. Bioengineering (Basel) 2023; 10:1052. [PMID: 37760154 PMCID: PMC10525297 DOI: 10.3390/bioengineering10091052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Three-dimensional bioprinting is a rapidly evolving technology that holds the promise of addressing the increasing demand for organs, tissues, and personalized medicine. By employing computer-aided design and manufacturing processes, 3D bioprinting allows for the precise deposition of living cells, biomaterials, and biochemicals to create functional human tissues and organs. The potential applications of this technology are vast, including drug testing and development, disease modeling, regenerative medicine, and ultimately, organ transplantation. However, as with any groundbreaking technology, 3D bioprinting presents several ethical, legal, and regulatory concerns that warrant careful consideration. As the technology progresses towards clinical applications, it is essential to address these challenges and establish appropriate frameworks to guide the responsible development of 3D bioprinting. This article, utilizing the Arksey and O'Malley scoping review model, is designed to scrutinize the bioethical implications, legal and regulatory challenges, and medico-legal issues that are intertwined with this rapidly evolving technology.
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Affiliation(s)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, IT-62032 Macerata, Italy; (G.R.); (A.S.)
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Ricci G, Gibelli F, Bailo P, Caraffa AM, Nittari G, Sirignano A. Informed Consent in Paediatric Telemedicine: Challenge or Opportunity? A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11101430. [PMID: 37239716 DOI: 10.3390/healthcare11101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The fundamental importance of informed consent as a prerequisite for the lawfulness of the medical act is an indisputable cornerstone of clinical practice. However, the provision of effective information and the collection of informed consent presents important critical issues in the underage patient, even considering that in general terms he or she does not have the power to directly express consent, which must be provided by parents or legal guardians. These critical issues are amplified in the context of telemedicine. The present study aims, through a scoping review of the literature of the past 10 years, to outline the operational practices adopted in the collection of informed consent from children in the context of telemedicine and to identify solutions devised to address the critical issues related to the provision of adequate information to the child in this particular care setting. The results of the research show that the activity of delivering adequate information to the child, itself complex, is made even more complex by the particular setting of telemedicine, which, however, could be effectively exploited to facilitate communication with the child patient.
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Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Anna Maria Caraffa
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
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Campanozzi LL, Gibelli F, Bailo P, Nittari G, Sirignano A, Ricci G. The role of digital literacy in achieving health equity in the third millennium society: A literature review. Front Public Health 2023; 11:1109323. [PMID: 36891330 PMCID: PMC9986277 DOI: 10.3389/fpubh.2023.1109323] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Healthcare in the third millennium is largely delivered through systems involving the use of the technological devices and services, foremost among them telemedicine. For the adequate delivery of digital medicine services, however, it is necessary for users to be digitally literate, that is, able to consciously make use of technology. In order to understand how relevant digital literacy is in determining the effectiveness of e-Health services, we performed a traditional literature review on 3 major databases by combining the terms "Digital Literacy" and "Computer Literacy" with the terms "Telemedicine" and "Telehealth". Starting from an initial library of 1,077 papers, we selected 38 articles. At the outcome of the search, we found that digital literacy is a pivotal element in conditioning the effectiveness of telemedicine and digital medicine services in general, however, with some limitations.
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Affiliation(s)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
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Bailo P, Gibelli F, Ricci G, Sirignano A. Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review. Int J Environ Res Public Health 2022; 19:11749. [PMID: 36142022 PMCID: PMC9517079 DOI: 10.3390/ijerph191811749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The COVID-19 pandemic and its associated difficulties in terms of implementing autopsy examinations have made the need for alternative means of determining causes of death even more evident. One of the most interesting alternatives to the conventional autopsy is the verbal autopsy, a tool that originated in Africa and Asia in the 1950s and consists of a structured interview with the deceased's family members concerning the symptoms manifested by the person and the circumstances of death. In the early 1990s, the first doubts emerged about the validity of verbal autopsies, especially about the real reliability of the cause of death identified through this tool. The objective of the review was to identify studies that had assayed the validity of verbal autopsies through a rigorous comparison of the results that emerged from it with the results of conventional autopsies. When starting from an initial pool of 256 articles, only 2 articles were selected for final review. These are the only two original research articles in which a verbal autopsy validation process was performed by employing the full diagnostic autopsy as the gold standard. The two papers reached opposite conclusions, one suggesting adequate validity of verbal autopsy in defining the cause of death and the other casting serious doubts on the real applicability of this tool. Verbal autopsy undoubtedly has extraordinary potential, especially in the area of health and demographic surveillance, even considering the implementation that could result from the use of artificial intelligence and deep learning. However, at present, there appears to be a lack of solid data to support the robust reliability of this tool in defining causes of death.
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Malaca S, Busardò FP, Nittari G, Sirignano A, Ricci G. Fourth Generation of Synthetic Cannabinoid Receptor Agonists: A Review on the Latest Insights. Curr Pharm Des 2022; 28:2603-2617. [PMID: 34781870 DOI: 10.2174/1381612827666211115170521] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over the past few years, an emerging number of new psychoactive substances (NPSs) entered the illicit market. NPSs are designed to resemble the effects of classical drugs of abuse, reinforcing their effects and duration. Among the most abused NPS, synthetic cannabinoids are cannabinoid receptor agonists (SCRAs) that mimic the effect of the main psychotropic phytocannabinoid Δ9-tetrahydrocannabinol (THC). METHODS We herein reviewed the international literature to provide available information on the newest SCRAs generation. RESULTS Compared to the previous SCRAs generations, the structures of the last generation result in increased affinity for and efficacy at cannabinoid CB1 receptors, which are thought to be mainly responsible for the psychoactive effects of THC and its analogues. Accordingly, these more potent cannabimimetic effects may increase the number of adverse reactions such as neurological disorders (e.g., psychosis, agitation, irritability, paranoia, confusion, and anxiety), psychiatric episodes (e.g., hallucinations, delusions, self-harm), other physical conditions (e.g., tachycardia, hypertension, arrhythmia, chest pain, nausea, vomiting, and fever) and deaths. In the last decade, more than a hundred SCRAs from different chemical classes emerged on the illicit web market. SCRAs have been thoroughly studied: they were physico-chemically characterized, and pharmaco-toxicological characteristics were investigated. The last SCRAs generations include increasingly potent and toxic compounds, posing a potential health threat to consumers. CONCLUSION From November 2017 to February 2021, at least 20 new "fourth-generation" SCRAs were formally reported to international drug agencies. Our understanding of the neurotoxicity of these compounds is still limited due to the lack of global data, but their potency and their toxicity are likely higher than those of the previous generations.
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Affiliation(s)
- Sara Malaca
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Francesco P Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
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Pesel G, Ricci G, Gibelli F, Sirignano A. Electronic unified therapy record as a clinical risk management tool in the Italian healthcare system. Front Public Health 2022; 10:919543. [PMID: 35991051 PMCID: PMC9381968 DOI: 10.3389/fpubh.2022.919543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 01/09/2023] Open
Abstract
Digitization of health records is still struggling to take hold in the Italian healthcare context, where medical records are still largely kept manually on paper. Besides being anachronistic, this practice is particularly critical if applied to the drug chart. Poor handwriting and transcription errors can generate medication errors and thus represent a potential source of adverse events. In the present study, we attempt to test the hypothesis that the application of a computerized medical record model may represent a useful tool for managing clinical risk and medical expenditure. We shall do so through the analysis of the preliminary results of the application of such a model in two private hospitals in Northern Italy. The results, although preliminary, are encouraging. Among the benefits of digitizing drug records, we recorded a greater accuracy and adequacy of prescriptions, a reduction in the overall workload for nurses (no longer required to manually transcribe the list of drugs from one chart to another), as well as an optimization of the management of drug stocks by hospital pharmacies. The results in terms of clinical risk reduction will be monitored through a prospective cohort study that will take place in the coming months.
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Affiliation(s)
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
- *Correspondence: Filippo Gibelli
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
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Ricci G, Gibelli F, Sirignano A. Editorial - From ruling No. 242/2019 of the Constitutional Court to the Italian law on medically assisted death: a complex transition. Eur Rev Med Pharmacol Sci 2022; 26:4546-4549. [PMID: 35856342 DOI: 10.26355/eurrev_202207_29174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- G Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy.
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Varì MR, Ricci G, Cavallo M, Pichini S, Sirignano A, Graziano S. Ketamine: from prescription anaesthetic to New Psychoactive Substance. Curr Pharm Des 2022; 28:1213-1220. [PMID: 35538799 DOI: 10.2174/1381612828666220510115209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022]
Abstract
Discovered in the United States of America (USA) in the 1960s, ketamine was introduced as an anaesthetic drug to specifically replace phencyclidine. Briefly, the substance moved from the medical world to recreational users, since it was discovered that intense psychedelic experiences were obtained with dosages lower than those prescribed for anesthesia. At the end of the 90's, circulated in London nightclubs as a drug itself and as counterfeit 3,4-methylenedioxymethamphetamine tablets. In 1997, the Drug Enforcement Administration (DEA) alerted the United States (US) government to the increasing diffusion of ketamine in American 'clubs', and in 1999, the substance was added to Schedule III of drugs controlled by federal authorities. In 2002, ketamine epidemics moved to Europe, and the European Monitoring Centre for Drugs and Drug Addiction carried out a risk assessment monitoring of the phenomenon. An estimated ninety-nine percent of all global ketamine seizures occurred in Asia. Its growing popularity is due to the fact that this new psychoactive substance is cheaper than other stimulants such as MDMA that the amount used for recreational purposes does not cause respiratory depression and its legal use as a drug makes it widely available for a diversion towards illicit markets. Nevertheless, acute intoxication and several deaths have been related to exclusive ketamine use both in Europe and internationally. Since 2015, there has been and increasing rise of the illicit ketamine market and currently the drug is being used with unprecedented peaks and a consequent significant increase in seizures and clinical cases worldwide.
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Affiliation(s)
- Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marco Cavallo
- Central Directorate for Antidrug Services, Rome, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
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Carlier J, Berardinelli D, Montanari E, Sirignano A, Di Trana A, Busardò FP. 3F-α-pyrrolydinovalerophenone (3F-α-PVP) in vitro human metabolism: Multiple in silico predictions to assist in LC-HRMS/MS analysis and targeted/untargeted data mining. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1193:123162. [PMID: 35180546 DOI: 10.1016/j.jchromb.2022.123162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
Synthetic cathinones (SCs) constitute a heterogenous class of new psychoactive substances (NPS), structurally related to cathinone. SCs represent the widest NPS class, second to synthetic cannabinoids, accounting for approximately 160 different analogues with substitution at the phenyl group, the amine group, or the alkyl chain. In 2020, α-pyrrolidonophenone analogues were the most trafficked SCs, and were involved in many fatalities and intoxication cases. In particular, 3F-α-pyrrolidinovalerophenone (3F-α-PVP) was the cause of the highest number of SC-related fatal intoxications in Sweden in 2018. Minor structural modifications are used to avoid legal controls and analytical detection, but may also induce different toxicological profile. Therefore, the identification of specific markers of consumption is essential to discriminate SCs in clinical and forensic toxicology. In this study, we assessed 3F-α-PVP metabolic profile. 3F-α-PVP was incubated with 10-donor-pooled human hepatocytes, LC-HRMS/MS analysis, and software-assisted data mining. This well-established workflow was completed by in silico metabolite predictions using three different freeware. Ten metabolites were identified after 3 h incubation, including hydrogenated, hydroxylated, oxidated, and N-dealkylated metabolites. A total of 51 phase I and II metabolites were predicted, among which 7 were detected in the incubations. We suggest 3F-α-PVP N-butanoic acid, 3F-α-PVP pentanol, and 3F-α-PVP 2-ketopyrrolidinyl-pentanol as specific biomarkers of 3F-α-PVP consumption. This is the first time that an N-ethanoic acid is detected in the metabolic pathway of a pyrrolidine SC, demonstrating the importance of a dual targeted/untargeted data mining strategy.
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Affiliation(s)
- Jeremy Carlier
- Marche Polytechnic University, Department of Excellence of Biomedical Sciences and Public Health, Section of Legal Medicine, Unit of Forensic Toxicology, via Tronto 10, 60126, Ancona AN, Italy; Sapienza University of Rome, Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Section of Legal Medicine, Unit of Forensic Toxicology, Viale Regina Elena 336, 00161, Rome RM, Italy
| | - Diletta Berardinelli
- Marche Polytechnic University, Department of Excellence of Biomedical Sciences and Public Health, Section of Legal Medicine, Unit of Forensic Toxicology, via Tronto 10, 60126, Ancona AN, Italy
| | - Eva Montanari
- Department of Legal medicine, Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Ascanio Sirignano
- University of Camerino, Department of Legal Medicine, School of Law, Via Andrea D'Accorso, 16, 62032, Camerino (MC), Italy
| | - Annagiulia Di Trana
- Marche Polytechnic University, Department of Excellence of Biomedical Sciences and Public Health, Section of Legal Medicine, Unit of Forensic Toxicology, via Tronto 10, 60126, Ancona AN, Italy.
| | - Francesco P Busardò
- Marche Polytechnic University, Department of Excellence of Biomedical Sciences and Public Health, Section of Legal Medicine, Unit of Forensic Toxicology, via Tronto 10, 60126, Ancona AN, Italy
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Gibelli F, Ricci G, Sirignano A, De Leo D. COVID-19 Compulsory Vaccination: Legal and Bioethical Controversies. Front Med (Lausanne) 2022; 9:821522. [PMID: 35187005 PMCID: PMC8847256 DOI: 10.3389/fmed.2022.821522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
The imposition of compulsory health treatments has always been a subject of animated legal and bioethical debate. What is at stake are two opposing interests that are in their own way protected by international treaties and constitutional provisions: the right to individual self-determination and the duty to defend and preserve collective safety. The global health crisis related to the COVID-19 pandemic has placed the issue of the legitimacy of imposing compulsory vaccination at the center of the multifaceted debate on pandemic health policies. Indonesia, Tajikistan, Turkmenistan, and the Federated States of Micronesia are currently the only four countries in the world where the COVID-19 vaccine is mandatory for all citizens. Italy was the first country in the European Union to introduce this obligation, effective from 8 January 2022 by virtue of the decree-law approved on 5 January 2022, which imposed vaccination compulsory for everyone over the age of 50. Similar paths have been undertaken by Greece and Austria, where the obligation will start respectively on 16 January 2022 (for citizens aged over 60) and 1 February 2022 (for citizens of all ages). However, in many civilized countries, “selective” forms of compulsory vaccination, i.e., aimed at specific categories of individuals, especially healthcare professionals, are already provided for. The present work aims to offer a concise and as much as possible exhaustive overview of the main ethical and legal issues related to compulsory COVID-19 vaccination, with reference to both the Italian and the international context, mainly European.
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Affiliation(s)
- Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
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Ricci G, Busardò F, Gibelli F, Sirignano A, Brunetti P. Evaluating the risk of toxicity and adverse drug interactions involving recreational GHB use and prescribed drugs. Expert Opin Drug Metab Toxicol 2022; 17:1445-1454. [DOI: 10.1080/17425255.2021.2029404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Francesco Busardò
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
| | - Filippo Gibelli
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Via Andrea D’Accorso 16, 62032 Camerino, Italy
| | - Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Marche Polytechnic University of Ancona, Via Tronto 10, 60126 Ancona, Italy
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Zaami S, Sirignano A, García-Algar Ó, Marinelli E. COVID-19 pandemic, substance use disorders and body image issues, a worrisome correlation. Eur Rev Med Pharmacol Sci 2022; 26:291-297. [PMID: 35049007 DOI: 10.26355/eurrev_202201_27780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The SARS-CoV-2 pandemic has profoundly affected the social fabric and the economic and health care viability and functioning of most countries. Aside from its deeply destructive impact on health care systems and national economies, the pandemic has jeopardized people's emotional and psychological well-being as well. The authors aimed to shed a light on how the pandemic has been affecting patients with addiction issues and body dysmorphic disorder (BDD), which is characterized by negative thoughts about appearance and body misperceptions. People with body dysmorphic disorder are in fact at increased risk of developing substance use disorders, and such a destructive association has only been made more severe by pandemic-related restrictions, emotional distress and anxiety, as well as longer exposure to social media and online interactions. This is a major cause for concern, because substance use worsens symptoms of BDD and contributes to unfavorable treatment outcomes.
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Affiliation(s)
- S Zaami
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy.
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Bailo P, Gibelli F, Blandino A, Piccinini A, Ricci G, Sirignano A, Zoja R. Telemedicine Applications in the Era of COVID-19: Telesurgery Issues. Int J Environ Res Public Health 2021; 19:ijerph19010323. [PMID: 35010581 PMCID: PMC8751214 DOI: 10.3390/ijerph19010323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 06/01/2023]
Abstract
Telemedicine allows for the effective delivery of health care to patients at a distance through the application of information technology to the field of medicine. This is optimal during the COVID-19 pandemic to reduce interpersonal contact to mitigate contagion. Among the possible Telemedicine applications, there is Telesurgery, which involves more and more surgical specialties thanks to the numerous benefits in quality and cost containment. In the growing field of Telesurgery, its technical and legal implications must be considered. In this study, a traditional review of the scientific literature was carried out to identify the most relevant issues of interest in Telesurgery. The problematic legal aspects identified are mainly related to the difference in legislation between different geographical areas, which is critical in the case of malpractice. In addition, there is the possibility of a malicious hacker attack on the transmitted data stream either to steal sensitive data or to harm the patient. Finally, there are inherent difficulties with the technology used, such as latency issues in data transmission. All these critical issues are currently not adequately addressed by current legislation. Therefore, one can only hope for a legislative action to allow Telesurgery to be used safely.
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Affiliation(s)
- Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Andrea Piccinini
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy; (F.G.); (G.R.); (A.S.)
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy; (A.B.); (A.P.); (R.Z.)
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Nittari G, Marino P, Gibelli F, Sossai P, Sirignano A, Ricci G. Role of meteorological factors in the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic in Italy. Eur Rev Med Pharmacol Sci 2021; 25:7135-7143. [PMID: 34859879 DOI: 10.26355/eurrev_202111_27267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the evolutionary dynamics of the Coronavirus disease 2019 (COVID-19) pandemic in the coming months is a matter of great importance and urgency for governments worldwide, making fundamental decisions based on what is known about the transmission mechanisms of the virus and its survival in the environment. The present study aimed to evaluate the impact of demographic variables, solar radiation and relative humidity on the spread of the COVID-19 pandemic of the various regions in Italy. MATERIALS AND METHODS The retrospective longitudinal study was conducted, and data used in this study was obtained from the Italian Health Ministry. Descriptive statistics included mean, frequency, and percentage, and results presented by graphs were calculated. RESULTS The infection trend was investigated by comparing it with the demographic situation and the irradiation indices of solar ultraviolet light that are detected with the changing seasons. The present study reported that the geographic areas with higher population density and lower solar radiation during the autumn and winter months were most affected by SARS-CoV-2. CONCLUSIONS The analysis carried out can provide a predictive model for the future phases of the COVID-19 pandemic in Italy, regardless of the adoption of lockdown measures and behavioral factors.
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Affiliation(s)
- G Nittari
- School of Pharmacy and Health Products, Telemedicine and Telepharmacy Center, University of Camerino, Camerino, MC, Italy.
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Gibelli F, Ricci G, Sirignano A, Turrina S, De Leo D. The Increasing Centrality of Robotic Technology in the Context of Nursing Care: Bioethical Implications Analyzed through a Scoping Review Approach. J Healthc Eng 2021; 2021:1478025. [PMID: 34493953 PMCID: PMC8418927 DOI: 10.1155/2021/1478025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/02/2021] [Accepted: 08/14/2021] [Indexed: 11/18/2022]
Abstract
At the dawn of the fourth industrial revolution, the healthcare industry is experiencing a momentous shift in the direction of increasingly pervasive technologization of care. If, up until the 2000s, imagining healthcare provided by robots was a purely futuristic fantasy, today, such a scenario is in fact a concrete reality, especially in some countries, such as Japan, where nursing care is largely delivered by assistive and social robots in both public and private healthcare settings, as well as in home care. This revolution in the context of care, already underway in many countries and destined to take place soon on a global scale, raises obvious ethical issues, related primarily to the progressive dehumanization of healthcare, a process which, moreover, has undergone an important acceleration following the outbreak of the COVID-19 pandemic, which has made it necessary to devise new systems to deliver healthcare services while minimizing interhuman contact. According to leading industry experts, nurses will be the primary users of healthcare robots in the short term. The aim of this study is to provide a general overview, through a scoping review approach, of the most relevant ethical issues that have emerged in the nursing care field in relation to the increasingly decisive role that service robots play in the provision of care. Specifically, through the adoption of the population-concept-context framework, we formulated this broad question: what are the most relevant ethical issues directly impacting clinical practice that arise in nursing care delivered by assistive and social robots? We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. The first two steps, formulating the main research question and carrying out the literature search, were performed based on the population-context-concept (PCC) framework suggested by the Joanna Briggs Institute. Starting from an initial quota of 2,328 scientific papers, we performed an initial screening through a computer system by eliminating duplicated and non-English language articles. The next step consisted of selection based on a reading of the titles and abstracts, adopting four precise exclusion criteria: articles related to a nonnursing environment, articles dealing with bioethical aspects in a marginal way, articles related to technological devices other than robots, and articles that did not treat the dynamics of human-robot relationships in depth. Of the 2,328 titles and abstracts screened, we included 14. The results of the 14 papers revealed the existence of nonnegligible difficulties in the integration of robotic systems within nursing, leading to a lively search for new theoretical ethical frameworks, in which robots can find a place; concurrent with this exploration are the frantic attempts to identify the best ethical design system applicable to robots who work alongside nurses in hospital wards. In the final part of the paper, we also proposed considerations about the Italian nursing context and the legal implications of nursing care provided by robots in light of the Italian legislative panorama. Regarding future perspectives, this paper offers insights regarding robot engagement strategies within nursing.
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Affiliation(s)
- Filippo Gibelli
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Stefania Turrina
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
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La Maida N, Mannocchi G, Giorgetti R, Sirignano A, Ricci G, Busardò FP. Optimization of a rapid sample pretreatment for the quantification of COCAINE and its main metabolites in hair through a new and validated GC-MS/MS method. J Pharm Biomed Anal 2021; 204:114282. [PMID: 34325248 DOI: 10.1016/j.jpba.2021.114282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
We developed and validated a new rapid and sensitive gas chromatography-tandem mass spectrometry method for the determination of cocaine and its metabolites benzoylecgonine, norcocaine, ecgonine methyl esther and cocaethylene in hair of consumers. Hair samples were firstly decontaminated with three subsequent dichloromethane washes, then incubated for one hour with M3® buffer to promote analytes solubilization and stabilization and finally solid phase extracted. All extracts were derivatized and injected into GC-MS/MS with electron impact ionization. Multiple Reaction Monitoring was used for the acquisition of characteristic analytes ion transitions reaching a high sensitivity 0.01 ng/mg COC and metabolites limit of quantification. The method was linear in the COC and metabolites calibration ranges (LLOQ-10 ng/mg and LLOQ-1 ng/mg, respectively). Intra-assay and inter-assay precision were always lower than 15 %, accuracy never exceeded ± 6.6 %. The main advantages of the presented method are the fast, simple and innovative pretreatment procedure together with the instrumental sensitivity that allowed to measure also less concentrated metabolites.
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Affiliation(s)
- Nunzia La Maida
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica Delle Marche" of Ancona, Via Tronto 71, 60124, Ancona, Italy.
| | | | - Raffaele Giorgetti
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica Delle Marche" of Ancona, Via Tronto 71, 60124, Ancona, Italy.
| | | | | | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica Delle Marche" of Ancona, Via Tronto 71, 60124, Ancona, Italy.
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20
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Lo Faro AF, Tini A, Gottardi M, Pirani F, Sirignano A, Giorgetti R, Busardò FP. Development and validation of a fast ultra-high-performance liquid chromatography tandem mass spectrometry method for determining carbonic anhydrase inhibitors and their metabolites in urine and hair. Drug Test Anal 2021; 13:1552-1560. [PMID: 33908166 PMCID: PMC8456811 DOI: 10.1002/dta.3055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
A new, rapid, sensitive, and comprehensive ultra‐high‐performance liquid chromatography tandem mass spectrometry (UHPLC–MS/MS) method for quantifying diuretics (acetazolamide, brinzolamide, dorzolamide, and their metabolites) in human urine and hair was developed and fully validated. Twenty‐five milligrams of hair were incubated with 500‐μl M3® buffer reagent at 100°C for 1 h for complete digestion. After cooling, 1‐μl supernatant was injected onto chromatography system. Urine samples were simply diluted before injection. The chromatographic run time was short (8 min) through a column with a mobile phase gradient. The method was linear (determination coefficients always higher than 0.99) from limit of quantification (LOQ) to 500 ng/ml in urine and from LOQ to 10 ng/mg in hair. LOQs ranged from 0.07 to 1.16 ng/ml in urine and from 0.02 to 0.15 ng/mg in hair. No significant ion suppression due to matrix effect was observed, and process efficiency was always higher than 80%. Intra‐ and inter‐assay precision was lower than 15%. The suitability of the methods was tested with six urine and hair specimens from patients treated with acetazolamide, dorzolamide, or brinzolamide for ocular diseases or systemic hypertension. Average urine concentrations were 266.32 ng/ml for dorzolamide and 47.61 ng/ml for N‐deethyl‐dorzolamide (n = 3), 109.27 ng/ml for brinzolamide and 1.02 ng/ml for O‐desmethyl‐brinzolamide (n = 2), and finally, 12.63 ng/ml for acetazolamide. Average hair concentrations were 5.94 ng/mg for dorzolamide and 0.048 ng/mg for N‐deethyl‐dorzolamide (n = 3), 3.26 ng/mg for brinzolamide (n = 2), and 2.3 ng/mg for acetazolamide (n = 1). The developed method was simple and fast both in the extraction procedures making it eligible in high‐throughput analysis for clinical forensic and doping purposes.
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Affiliation(s)
- Alfredo Fabrizio Lo Faro
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Anastasio Tini
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | | | - Filippo Pirani
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | | | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
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21
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Sirignano P, Galiero G, Sirignano A, Taurino M. Acute limb ischemia due to iliac thrombosis following laparoscopic surgery for hiatal hernia: Report from a medical malpractice litigation. Ann Med Surg (Lond) 2021; 67:102505. [PMID: 34188914 PMCID: PMC8220168 DOI: 10.1016/j.amsu.2021.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Aim of this paper is to report an unusual case of iliac artery acute thrombosis following a laparoscopic elective surgery for hiatal hernia repair and observed during a medical malpractice litigation. A 69-year-old woman submitted to laparoscopic hiatal hernia repair developed a lower limb ischemia in 5th postoperative day due to common iliac and popliteal arteries acute occlusion. Patient was urgently treated with iliac embolectomy with Fogarty's catheter, and femoral endarterectomy, followed on 1st post-operative day by external iliac artery stenting and multiple attempts of popliteal artery recanalization. After 4 years of follow-up, despite symptoms at rest were disappeared, a severe (<200 m) right limb claudication was still present. Although rare, retrospective studies and surveys report an incidence ranging from 0.04% to 0.5%, direct major vascular injuries are well-known potential complications of laparoscopic surgery. In the great majority of cases, iliac lesion become clinically evident as haemorrhagic lesions. This is the first case of acute limb ischemia due to laparoscopic surgery related iliac lesion evaluated during a medical malpractice litigation.
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Affiliation(s)
- Pasqualino Sirignano
- Department of Surgery "Paride Stefanini", "Sapienza" University of Rome, Italy, Vascular and Endovascular Surgery Division, Sant'Andrea Hospital of Rome, Italy
| | - Giuseppe Galiero
- Legal Medicine Unit, Department of Advanced Biomedical Sciences, School of Medicine, "Federico II", University of Naples, Italy
| | | | - Maurizio Taurino
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Italy, Vascular and Endovascular Surgery Division, Sant'Andrea Hospital of Rome, Italy
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22
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Nittari G, Battineni G, Messinetti M, Campanozzi L, Sirignano A. Critical reflections and solutions for health problems of Italian refugees. Clin Ter 2021; 172:158-162. [PMID: 33763677 DOI: 10.7417/ct.2021.2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In recent years, the flow of migrants and refugees to EU nations is recorded in high amounts. By travelling through ships or nonhygienic boats most of them tend to have a high amount of risk in getting health issues. However, getting proper healthcare is a funda-mental human right since refugees or migrants can actively contribute to the development of host countries and their native nationalities. Therefore, in this paper, we try to explore the common diseases that happened to migrants who travel to Italy in recent years. Methods We analyzed the Italian refugees' data provided by the Italian health ministry in the years 2013-16, and explore the key pathologies and their medical conditions. All the data correctly clas-sified and analyzed depending on their age, gender, and pathologies that they posses. Results From 2013 to 2016, in total, 455,912 refugees were trav-elled into Italy. 74% male, 12% female, and 14% of minor refugees were recorded during this period. In pathologies, rashes or skin dis-eases (scabies) were happening in often and after scabies pregnancy issues were observed on a considerable scale. Similarly, brain-related problems and surgeries were recorded at the lowest in number. Conclusion In 2015, about 12% of all workers in the EU nationali-ties were migrants. As of this, it is highly recommended in the provision of proper health facilities to them without making any judgments. This paper is aiming to provide prevention methodologies that are in high demand for health care of refugees and migrants.
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Affiliation(s)
- G Nittari
- Telemedicine and Tele pharmacy Centre, School of Medicinal and Health products sciences, University of Camerino
| | - G Battineni
- Telemedicine and Tele pharmacy Centre, School of Medicinal and Health products sciences, University of Camerino
| | - M Messinetti
- School of Law, Medico-Legal Section, University of Camerino
| | - L Campanozzi
- Institute of Philosophy of Scientific and Technological Practice, Campus Bio-Medico University, Rome, Italy
| | - A Sirignano
- School of Law, Medico-Legal Section, University of Camerino
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Battineni G, Nittari G, Sirignano A, Amenta F. Are telemedicine systems effective healthcare solutions during the COVID-19 pandemic? J Taibah Univ Med Sci 2021; 16:305-306. [PMID: 33753981 PMCID: PMC7969856 DOI: 10.1016/j.jtumed.2021.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gopi Battineni
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Giulio Nittari
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Legal Medicine Division, School of Law, University of Camerino, Camerino, Italy
| | - Francesco Amenta
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
- Research Department, International Radio Medical Centre (C.I.R.M.), Rome, Italy
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Nittari G, Sagaro GG, Feola A, Scipioni M, Ricci G, Sirignano A. First Surveillance of Violence against Women during COVID-19 Lockdown: Experience from "Niguarda" Hospital in Milan, Italy. Int J Environ Res Public Health 2021; 18:ijerph18073801. [PMID: 33917305 PMCID: PMC8038697 DOI: 10.3390/ijerph18073801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Abstract
Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries.
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Affiliation(s)
- Giulio Nittari
- Telemedicine and Telepharmacy Center, University of Camerino, 9-62032 Camerino, Italy;
- Correspondence: ; Tel.: +39-0737-401726
| | - Getu Gamo Sagaro
- Telemedicine and Telepharmacy Center, University of Camerino, 9-62032 Camerino, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5-80138 Naples, Italy;
| | - Mattia Scipioni
- School of Law, University of Camerino, Via A. D’Accorso, 16-62032 Camerino, Italy; (M.S.); (G.R.); (A.S.)
| | - Giovanna Ricci
- School of Law, University of Camerino, Via A. D’Accorso, 16-62032 Camerino, Italy; (M.S.); (G.R.); (A.S.)
| | - Ascanio Sirignano
- School of Law, University of Camerino, Via A. D’Accorso, 16-62032 Camerino, Italy; (M.S.); (G.R.); (A.S.)
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Di Trana A, Busardò FP, Ricci G, Sirignano A. Commentary: Tele-COVID-19: does it improve the provision of health services? Eur Rev Med Pharmacol Sci 2021; 25:2152-2153. [PMID: 33660835 DOI: 10.26355/eurrev_202102_25121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A Di Trana
- Department of Excellence of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy.
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Zaami S, Minutillo A, Sirignano A, Marinelli E. Effects of Appearance- and Performance-Enhancing Drugs on Personality Traits. Front Psychiatry 2021; 12:730167. [PMID: 34630182 PMCID: PMC8497711 DOI: 10.3389/fpsyt.2021.730167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/20/2021] [Indexed: 01/18/2023] Open
Abstract
Appearance- and performance-enhancing drugs (APEDs) are commonly used by adolescents and young adults in an effort to improve not only athletic performance but also physical and mental efficiency and sexual appearance. The rationale for using these drugs is grounded in the perceived importance of external appearance, the quest for health and youth, and the urge to boost one's sexual performances. Although APED users tend to be quite moderate overall, some specific subpopulations can display pathological use associated with high-risk behaviors. A wide and diverse range of APEDs is now easily accessible to almost anyone through backdoor online avenues. Common APEDs include anabolic-androgenic steroids, non-steroidal anabolics, anorectics, diuretics and ergo/thermogenics, nootropics or "cognition enhancers," licit and illicit psychostimulants, and finally, sexual enhancers. The use of APEDs appears linked to several psychopathological disorders of unclear prevalence, e.g., body image disorders and eating disorders, perfectionism, but also depression and loneliness. The role of personality traits related to APED use has been investigated in adolescents and young adults, in elite and amateur athletes, and in chemsexers and associated with the above-reported personality traits. The studies herein analyzed show that APED consumption in the general population is quickly growing into a public health concern. It is therefore essential to launch prevention and intervention projects aimed at promoting safe instrumental use of the body, not only in sports disciplines but also among the general population, and to promote psychological aid procedures for people with substance use issues, depression and anxiety, and body image disorders.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
| | - Adele Minutillo
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Ascanio Sirignano
- School of Law, Medico-Legal Section, University of Camerino, Camerino, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
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Ricci G, Pallotta G, Sirignano A, Amenta F, Nittari G. Consequences of COVID-19 Outbreak in Italy: Medical Responsibilities and Governmental Measures. Front Public Health 2020; 8:588852. [PMID: 33364225 PMCID: PMC7752765 DOI: 10.3389/fpubh.2020.588852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has shocked the world causing more victims than the latest global epidemics such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2003, and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012. Italy has been one of the most affected countries, and it had to deal with an already weak economic condition and cuts to public health services due to budgetary requirements from the last decade—something that made the situation even more dramatic. Deaths have exceeded 600.000 worldwide. During the emergency, regulatory measures were taken to counter the situation. This study highlights the main anti-COVID-19 government measures to support doctors and healthcare professionals, and it analyzes how to respond to the many requests complaining about neglectful healthcare professionals during the spread of the infection. For all those healthcare workers who died on duty, a compensation plan is assumed through a solidarity fund. The same solution cannot be granted to all patients, given the difficulty in assessing the responsibility of the doctor not only during an emergency but with insufficient instruments to cope with it as well.
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Affiliation(s)
- Giovanna Ricci
- Scuola di Giurisprudenza, Università di Camerino, Camerino, Italy
| | - Graziano Pallotta
- Scuola di Scienze del Farmaco e dei Prodotti della Salute, Università di Camerino, Camerino, Italy
| | | | - Francesco Amenta
- Scuola di Scienze del Farmaco e dei Prodotti della Salute, Università di Camerino, Camerino, Italy
| | - Giulio Nittari
- Scuola di Scienze del Farmaco e dei Prodotti della Salute, Università di Camerino, Camerino, Italy
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Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A, Amenta F, Ricci G. Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed J E Health 2020; 26:1427-1437. [PMID: 32049608 PMCID: PMC7757597 DOI: 10.1089/tmj.2019.0158] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/07/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including "Telemedicine," "Ethics," "Malpractice," "Telemedicine and Ethics," "Telemedicine and Informed consent," and "telemedicine and malpractice." Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.
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Affiliation(s)
- Giulio Nittari
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Ravjyot Khuman
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Simone Baldoni
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Graziano Pallotta
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Gopi Battineni
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Department of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Health Science Products, University of Camerino, Camerino, Italy
| | - Giovanna Ricci
- Department of Legal Medicine, School of Law, University of Camerino, Camerino, Italy
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Tambone V, Boudreau D, Ciccozzi M, Sanders K, Campanozzi LL, Wathuta J, Violante L, Cauda R, Petrini C, Abbate A, Alloni R, Argemi J, Argemí Renom J, De Benedictis A, Galerneau F, García-Sánchez E, Ghilardi G, Hafler JP, Linden M, Marcos A, Onetti Muda A, Pandolfi M, Pelaccia T, Picozzi M, Revello RO, Ricci G, Rohrbaugh R, Rossi P, Sirignano A, Spagnolo AG, Stammers T, Velázquez L, Agazzi E, Mercurio M. Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic. Front Public Health 2020; 8:284. [PMID: 32612972 PMCID: PMC7308475 DOI: 10.3389/fpubh.2020.00284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Donald Boudreau
- Department of Medicine, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Massimo Ciccozzi
- Research Unit of Medical Statistic and Molecular Epidemiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen Sanders
- Department of Business, Law and Society, St Mary's University, London, United Kingdom
| | - Laura Leondina Campanozzi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Jane Wathuta
- Institute for Family Studies & Ethics, Strathmore University, Nairobi, Kenya
| | | | - Roberto Cauda
- Section of Infection Diseases, Department of Healthcare Surveillance and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Petrini
- Bioethics Unit, Italian National Institute of Health, Rome, Italy
| | - Antonio Abbate
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Rossana Alloni
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - Josepmaria Argemi
- Division of Medicine, Gastroenterology and Hepatology Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Josep Argemí Renom
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna De Benedictis
- Hospital Clinical Direction, Campus Bio-Medico University of Rome, Rome, Italy
| | - France Galerneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Emilio García-Sánchez
- Department of Political Sciences, Ethics and Sociology, University CEU Cardenal Herrera, Valencia, Spain
| | - Giampaolo Ghilardi
- Institute of Philosophy of Scientific and Technological Practice (FAST), Campus Bio-Medico University of Rome, Rome, Italy
| | - Janet Palmer Hafler
- Teaching and Learning Center, Yale University School of Medicine, New Haven, CT, United States
| | - Magdalena Linden
- Department of Medicine, Solna, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Alfredo Marcos
- Department of Philosophy, Universidad de Valladolid, Valladolid, Spain
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Pandolfi
- Fondazione Leonardo, Civiltà delle Macchine, Rome, Italy
| | - Thierry Pelaccia
- Prehospital Emergency Medical Service (SAMU 67), Strasbourg University Hospital, Strasbourg, France
| | - Mario Picozzi
- Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Ruben Oscar Revello
- Instituto de Bioética de la Facultad de Ciencias Médica, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Robert Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Patrizio Rossi
- Central Medical Department, National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | | | - Trevor Stammers
- Centre for Bioethics and Emerging Technologies, Institute of Theology, St Mary's University, London, United Kingdom
| | - Lourdes Velázquez
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Evandro Agazzi
- Interdisciplinary Bioethics Center, Universidad Panamericana, Mexico City, Mexico
| | - Mark Mercurio
- Program for Biomedical Ethics, Yale University School of Medicine, New Haven, CT, United States
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Ricci G, Tomassoni D, Pirillo I, Sirignano A, Sciotti M, Zaami S, Grappasonni I. Obesity in the European region: social aspects, epidemiology and preventive strategies. Eur Rev Med Pharmacol Sci 2019; 22:6930-6939. [PMID: 30402859 DOI: 10.26355/eurrev_201810_16163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obesity related to metabolic syndrome is gaining an increasing importance as the main risk factor for diseases and disability in the European region. We herein review the increasing trend of obesity and overweight in males and females from Europe, preventive programs addressed to children, youngsters, adult population and subjects with particular diseases which can profit from healthy nutrition. The main feature is that some European countries have implemented programs on World Health Organization (WHO) proposals, while some others have focused attention only on some aspects. Based on the reported obesity increase over the last twenty years, prevention programs seem to have been ineffective. Most likely, the effects will be observed later on. In this concern, it will be fundamental to continue and finance the countries of the European region, where those programs have been extensively applied, to obtain even better results in terms of obesity prevention.
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Affiliation(s)
- G Ricci
- School of Law, University of Camerino, Camerino (MC), Italy.
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Busardò FP, Gottardi M, Tini A, Minutillo A, Sirignano A, Marinelli E, Zaami S. Replacing GHB with GBL in Recreational Settings: A New Trend in Chemsex. Curr Drug Metab 2019; 19:1080-1085. [PMID: 30251602 DOI: 10.2174/1389200219666180925090834] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recently, Gamma-hydroxybutyrate (GHB) consumption in the recreational setting has been replaced by that of its prodrug Gamma-butyrolactone (GBL), cheaper and easier to obtain due to several legal industrial applications. OBJECTIVE The aim of the present paper was to report the most authoritative literature on the pharmacology and toxicology of GBL, dependence and abuse potential and the related public health issues together with the results of the analyses of several illicit liquid preparations containing GHB/GBL generally sold as "G". METHOD International literature concerning "Gamma-butyrolactone", "GBL" "toxicology", "pharmacology", "abuse", "dependence" and "GHB has been reviewed and liquid preparations containing GHB/GBL analysed by ultra-high performance liquid chromatography coupled to the tandem mass spectrometry validated methodology. RESULTS GBL for recreational purposes is orally administered in liquid form and rapidly transformed into GHB by lactonase enzymes present in the blood. As GBL shows a higher lipophilicity than GHB, it is absorbed more quickly, its bioavailability is higher and its effects are faster than those of GHB. Studies on rodents have shown that GBL has a low acute toxicity and only central nervous system depression has been highlighted. GBL abuse potential broadly mimics that of GHB, taking into account that it exerts its effects on the only after conversion into GHB. The analysis of 30 illicit preparations generally sold as "G" highlighted the presence of GBL in all of them at a mean concentration of 760.7 ±91.46 mg/mL (range: 588.5 - 899.3 mg/mL). CONCLUSION GBL currently represents a growing public health issue since the substance is relatively cheaper and easier to obtain than GHB. Improvement and implementation of laws and policies to place GBL under control are needed to limit its diffusion, the eventual health threat for users and its non -negligible abuse liability and dependence risk.
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Affiliation(s)
- Francesco Paolo Busardò
- Section of Legal Medicine, Department of Excellence - Biomedical Sciences and Public Health. University "Politecnica delle Marche" of Ancona, Italy
| | | | - Anastasio Tini
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, V.Le Regina Elena 336, 00161, Rome, Italy
| | - Adele Minutillo
- National Centre on Drug Addiction and Doping, Istituto Superiore di Sanita, Rome, Italy
| | | | - Enrico Marinelli
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, V.Le Regina Elena 336, 00161, Rome, Italy
| | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, V.Le Regina Elena 336, 00161, Rome, Italy
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Pirillo I, Amenta F, Sirignano A, Ricci G. Cross-border healthcare: Implementation of Directive 2011/24/EU and National Contact Point in Italy. Travel Med Infect Dis 2017. [PMID: 28645864 DOI: 10.1016/j.tmaid.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Isabel Pirillo
- Centre of Telemedicine and Telepharmacy, University of Camerino, Italy.
| | - Francesco Amenta
- Centre of Telemedicine and Telepharmacy, University of Camerino, Italy
| | | | - Giovanna Ricci
- School of Law, Legal Medicine Section University of Camerino, Italy
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Ricci G, Pirillo I, Tomassoni D, Sirignano A, Grappasonni I. Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates. Clin Exp Hypertens 2017; 39:8-16. [PMID: 28071980 DOI: 10.1080/10641963.2016.1210629] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metabolic syndrome (MetS) is a common and complex disorder combining hypertension, obesity, dyslipidemia, and insulin resistance. MetS represents a risk factor for changes in cognitive functions in older age, and several studies have suggested that MetS may be linked to dementia. This article reviews the main evidences about the relationship between MetS and neurodegenerative disease. Starting from an epidemiological point of view, the article analyzes medico-social aspects related to MetS, considering the reduction of work capacity and the condition of disability that it involves. Some authors affirm that on the basis of current Italian legislation, it is possible to consider the syndrome as a disability. This is because all the diseases that make up MetS are high-risk clinical pathological conditions. For these reasons, a joint action is required to contain the incidence of MetS, the high social costs, and the loss of productivity related to the syndrome. In conclusion, healthcare initiatives could be adopted in order to increase the understanding of the pathogenic contributions of each element on MetS and how they can be modified. These actions will be useful to reduce healthcare costs and can lead to more effective prevention of metabolic disease, thus promoting good health. ABBREVIATIONS MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps.
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Affiliation(s)
- Giovanna Ricci
- a School of Law , University of Camerino , Camerino , Italy
| | - Isabel Pirillo
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
| | - Daniele Tomassoni
- c School of Biosciences and Veterinary Medicine , University of Camerino , Camerino , Italy
| | - Ascanio Sirignano
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
| | - Iolanda Grappasonni
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
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Ciccozzi M, Menga R, Ricci G, Vitali MA, Angeletti S, Sirignano A, Tambone V. Critical review of sham surgery clinical trials: Confounding factors analysis. Ann Med Surg (Lond) 2016; 12:21-26. [PMID: 27872745 PMCID: PMC5109256 DOI: 10.1016/j.amsu.2016.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Sham surgery (placebo surgery) is an intervention that omits the step thought to be therapeutically necessary. In surgical clinical trials, sham surgery serves an analogous purpose to placebo drugs, neutralizing biases such as the placebo effect. A critical review was performed to study the statistical relevance of the clinical trials about sham surgery in the light of potential confounding factors. MATERIALS AND METHODS For the critical review 52 articles were included. The possible confounding factors have been studied using a structured interpretative research form designed by the authors. This form includes the following ten confounding factors: I), lack of homogeneity among inclusion/exclusion criteria. II), false double blind. III), lack of post-surgery double blind. IV), power of the study. V), sample characteristics. VI), lost patients to Follow-up. VII), gender distribution. VIII), age equilibrium. IX), lack of psychological patient evaluation. X), lack of psychiatric patient evaluation. In most of the studies, at least one confounding factor was present. RESULTS The analysis of the confounding factors showed that they could influence the reliability of the surgical placebo effects. CONCLUSIONS The validity of sham surgery should be reconsidered.
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Affiliation(s)
- Massimo Ciccozzi
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, 00161 Rome, Italy; Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
| | - Rosa Menga
- Faculty of Medicine, Campus Bio-Medico University of Rome, Italy
| | - Giovanna Ricci
- School of Law, University of Camerino, 62032 Camerino, Italy
| | | | - Silvia Angeletti
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
| | - Ascanio Sirignano
- School of Medical Sciences and Health Products, University of Camerino, 62032 Camerino, Italy
| | - Vittoradolfo Tambone
- Institute of Philosophy of Scientific and Technological Practice, University Campus Bio-Medico of Rome, Italy
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Ricci G, Cannovo N, Sirignano A. MEDICALLY ASSISTED PROCREATION, A DISCUSSION STILL OPEN IN ITALY. Med Law 2015; 34:487-496. [PMID: 30759947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article analyses the current situation of medically assisted reproduction in Italy after the issuance of Law 40 in 2004. This law is actually completely different from its first version. In fact, the controversial points, like reproduction for couples with genetic diseases, prohibition of heterologous fertilization, cryoconservation of embryos, obligation to perform just one and simultaneous implant of all the embryos produced, are definitively not in force today. This new situation can be explained not only by rules issued by Italian courts but, in particular, by changes introduced by the European Court of Human Rights and by questions of constitutional legitimacy raised by some Italian Courts. After ten years from the issue of this law, Italy has returned to the pre-existing situation. The old law was only full of prohibitions. Now, heterologous fertilization is possible and this article gives a picture of the present situation in hospitals for assisted procreation in Italy.
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Setacci C, Sirignano A, Ricci G, Spagnolo AG, Pugliese F, Speziale F. A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction. J Cardiovasc Surg (Torino) 2015; 56:607-615. [PMID: 25216219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico-legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre-existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly.
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Affiliation(s)
- C Setacci
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy -
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Ricci G, Delbon P, Conti A, Sirignano A. [Literature review and state of the art of the Italian law on medically assisted reproduction]. Clin Ter 2015; 166:e234-41. [PMID: 26152636 DOI: 10.7417/ct.2015.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article analyzes the current situation of medically assisted reproduction in Italy after the promulgation of Law 40 in 2004. This law is actually completely different from the origin version. The controversial points like reproduction for couples who bear genetic diseases, prohibition of heterologous fertilization, cryoconservation of the embryos, obligation to perform just one and contemporaneous implant of all the embryos produced, are today definitively erased. This new situation is due to the jurisprudence of the Italian Courts but especially to the changes introduced by the European Court of Human Rights and by the questions of constitutionality raised by some Italian Courts. After analysis of the legislation, the views of various authors are compared, and the weaknesses and strong points of the law are considered from the point of view of legal medicine, science and bioethics. After ten years of operation of this law Italy has returned to a situation that existed before the law. In fact the old law was only full of prohibitions. Now is possible to do heterologous fertilization and this article photographs the current situation of hospitals for assisted procreation in Italy. The work also comments on procreative tourism, a direct consequence of this law, and on the status of women, who must be the subject and not the object of the legislation.
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Affiliation(s)
- G Ricci
- Cattedra di Medicina Legale, Scuola di Giurisprudenza, Università degli Studi di Camerino, Camerino
| | - P Delbon
- Centro di Studio e di Ricerca di Bioetica dell'Università degli Studi di Brescia (con il contributo della Fondazione Poliambulanza) Dipartimento di Specialità Medico Chirurgiche, Scienze Radiologiche e Sanità Pubblica - Sezione di Sanità Pubblica e Scienze Umane - Medicina Legale, Brescia
| | - A Conti
- Centro di Studio e di Ricerca di Bioetica dell'Università degli Studi di Brescia (con il contributo della Fondazione Poliambulanza) Dipartimento di Specialità Medico Chirurgiche, Scienze Radiologiche e Sanità Pubblica - Sezione di Sanità Pubblica e Scienze Umane - Medicina Legale, Brescia
| | - A Sirignano
- Scuola di Scienze del Farmaco e dei Prodotti della Salute, Università degli Studi di Camerino, Camerino, Italia
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Ziello AR, Fasanaro AM, Petrelli C, Ricci G, Sirignano A, Amenta F. Sea piracy sequelae: assessment according to the Diagnostic and Statistical Manual of Mental Disorders-5. Int Marit Health 2014; 65:230-4. [PMID: 25522708 DOI: 10.5603/imh.2014.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our previous studies have investigated the psychological consequences of kidnapping in a group of Italian seafarers assaulted by sea pirates and held in captivity and in their family members by the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-4. These studies have shown that both the victims and the family members showed significant psychological disturbances, corresponding to a chronic Post-Traumatic Stress Disorder (PTSD), in the victims, and a pattern of anxiety and depression in their family members. After publication of these studies, an updated edition of the DSM became available, namely, the DSM-5. The DSM-5 redefines some diagnostic criteria, including those related to the PTSD. This work was focused on the re-evaluation of the results of our previous studies in the light of the DSM-5 diagnostic criteria. MATERIALS AND METHODS Sixteen Italians including 4 kidnapped seafarers and 12 family members were examined by a semi-structured interview followed by Clinician-Administered PTSD Scale (CAPS-DX) and the Cognitive Behaviour al Assessment (CBA 2.0) for victims and by State-Trait Anxiety Inventory (STAI) X-1 and X-2 of CBA 2.0 and the Hamilton Depression Rating Scale (HDRS) for family members. Data already obtained were reviewed and re-analysed according to the DSM-5 criteria and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). RESULTS The use of the CAPS-5 did not modify the diagnosis for the victims' group: 3 of 4 had a PTSD diagnosis performed through the CAPS-5. Seven of 12 family members had PTSD diagnosis performed through the CAPS-5, with negative cognitions and mood symptoms being those obtaining the highest score. CONCLUSIONS Using DSM-5 criteria, the diagnosis of PTSD in the direct victims of piracy was confirmed. The same diagnosis could apply to a group of their family members. Besides anxiety and fear, in fact, we found in 7 out 12 subjects the presence of symptoms included by the DSM-5 in the PTSD spectrum. These symptoms were: avoidance, negative alterations in mood and cognition, blame of self or others. The use of updated diagnostic criteria may enable more correct assessment of the consequences of piracy acts. This may be also useful for establishing proper compensations for the damage suffered by seafarers, depending on the degree of disability resulting from the criminal acts they suffered.
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Affiliation(s)
- Antonio Rosario Ziello
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Camerino, Italy.
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Sirignano P, Setacci F, Galzerano G, Sirignano A, Fineschi V, Setacci C. What is the present situation of vascular surgery? Considerations and reflections based on real practice. J Cardiovasc Surg (Torino) 2013; 54:633-637. [PMID: 24002393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
"For the best vascular care to every patient, every day" is the goal of our practice, but is it a possible goal? Where are we now? The general idea is that we are pursuing the right way. The evolution of our discipline in the last two decades has been extraordinary and we reaffirm that we are the leaders in diagnose and treatment of the arterial pathology. Unfortunately, we can find some cases in which reality has to be faced as hardly as it can be, remembering us that we still have to go further with our job. The delay in the diagnose and treatment could lead to a permanent deficit and a money loss for the national health system due to prolonged hospitalization, multiple re-hospitalizations, loss of working capacity. This must be avoided. We strongly suggest that a vascular surgeon should be present in all the Emergency Room and should be routinely involved in the management of patients. The routine use of dedicated interdisciplinary protocols should be strongly advocated. Vascular surgery, as medical specialty, should be recognized as single specialty in all countries and as "peculiar" by the National Authority as well as Neurosurgery and Cardiac Surgery.
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Affiliation(s)
- P Sirignano
- Vascular and Endovascular Surgery Unit Department of Medical, Surgical and Neurological Sciences School of Medicine, University of Siena, Siena, Italy.
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Sirignano P, Setacci F, Galzerano G, Sirignano A, Setacci C. Claimants in vascular surgery. J Cardiovasc Surg (Torino) 2012; 53:715-717. [PMID: 23138647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Litigation concerning medical activities is constantly increasing, as society becomes more and more "protective" of citizens who may have suffered any wrong due to malpractice. However, we should bear in mind that the percentage of claims liquidated is minimal. METHODS From January 2009 to December 2011, 63 claims involving vascular procedures were analyzed. The rate of claimants receiving payment was very low: only 8 of the 63 (12.7%) claims having been settled. The most important thing we noted was that in 5 of the 8 claims settled the key element that defined the sentence was time: time to take a decision, to perform a diagnostic examination, to decide on a surgical procedure. RESULTS We have sought to assess the role of the "time factor" in the occurrence of errors in a surgical specialty considered at high risk of litigation such as vascular surgery. This analysis of our experience over the past three years has shown that the central element in the genesis of the error was the erroneous timing of intervention. It interesting to note that, in contrast to what might be expected, time-related errors are much more common in cases treated electively than in urgent or emergency cases. CONCLUSION Our experience demonstrates that the "time factor" plays a primary role in the genesis of errors in vascular surgery. This delay in deciding and acting probably depends on the fact that the vascular surgeon was the patient's first contact in only one of the cases examined. This should emphasize the need to equip all emergency departments with a Vascular Surgery Unit.
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Affiliation(s)
- P Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Siena, Siena, Italy.
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Conti A, Delbon P, Sirignano A. Informed consent when taking genetic decisions. Med Law 2004; 23:337-353. [PMID: 15270473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Developments in genetics with diagnostic, pre-symptomatic and predictive testing involve significant changes in the decision-making process, because of the complexity of genetic information and the difficulty related to understanding the causes and mechanism of genetic diseases, ethical, psychological and social implications (psychological stress, anxiety, discrimination in employment and assurance, difficulties in interpersonal relationship), and indirect involvement of third parties. When taking genetic decisions, the patient should receive all the information about the objective and the type of the test, the hypothetical risk, the possibility of obtaining unexpected results, possible psycho-physical repercussion, and means of support for the long time that might pass between the diagnostic predictions and the possible onset of the disease: genetic counseling is a complex but essential operation for acquiring the informed consent of the patient. The outlined peculiarities of the process for informed consent in genetics requires the adequate training of medical personnel to manage the relationship with the patient in these complex cases.
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Affiliation(s)
- A Conti
- Centre for Bioethics Research, Forensic Medicine Department, Brescia University, Italy
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42
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Kempton JB, Sirignano A, DeGaetano DH, Yates PJ, Rowe WF. Comparison of fingernail striation patterns in identical twins. J Forensic Sci 1992; 37:1534-40. [PMID: 1453167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The fingernail ridge patterns of a pair of identical twins were compared to each other, their parents, and an unrelated subject. The patterns of the twins' nails showed regions of strong similarity but were distinguishable from one another. Fewer similarities were found when comparing the nails to those of the parents and the unrelated control. The twins were shown to be monozygotic by means of DNA profiling. This therefore represents the first demonstration of unique fingernail ridge patterns in subjects shown conclusively to be identical twins. When the fingernail ridge patterns were examined with a scanning electron microscope, the backscattered electron (BEI) images were found to have superior contrast when compared to the secondary electron (SEI) images.
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Affiliation(s)
- J B Kempton
- Department of Forensic Sciences, George Washington University, Washington, DC
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Digilio G, Multari G, Werner B, Ballati G, Lemmo M, Sirignano A, Iacobini M, Roggini M, Cozzi F. Intestinal obstruction at the onset of acute lymphoblastic leukemia in a child. Am J Pediatr Hematol Oncol 1990; 12:187-9. [PMID: 2378413 DOI: 10.1097/00043426-199022000-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.
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Affiliation(s)
- G Digilio
- Third Department of Pediatrics, Policlinico Umberto I, University of Rome La Sapienza, Italy
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Vidal B, Sirignano A, Puricelli C, Da Col P, Meriggi A, Feruglio GA. [Computed x-ray tomography of heterotopic cardiac transplant]. Radiol Med 1984; 70:546-8. [PMID: 6398882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Vidal B, Sirignano A, Pessina F. [Computerized tomography and echography in a case of portal hypertension]. Radiol Med 1983; 69:63-5. [PMID: 6828794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sirignano A, Pessina F, Barozzi L. [Hernia of epiploic contents through the foramen of Morgagni (tomodensitometric diagnosis)]. Radiol Med 1982; 68:907-8. [PMID: 7163535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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