Ethyl Glucuronide and Ethyl Sulphate in Urine: Caution in their use as markers of recent alcohol use

AIM

To clarify the role of the ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), in monitoring alcohol consumption.

METHOD

We recruited 7 female and 17 male volunteers who were instructed to consume a quantity of beer (containing 48 gm ethanol) with food in one session. We examined urinary excretion of EtG and EtS over time and looked for correlations between the concentrations of the metabolites EtG and EtS.

RESULTS

EtG concentrations in urine varied between 0.026 and 430.372 μg/ml with average values between 11.85 μg/ml (SD 19.75), 30 min after alcohol intake, and 100.39 μg/ml (SD 101.34), 4.5 h after alcohol intake. EtS urinary concentration ranged from 0.006 to 101.432 μg/ml with average values between 4.77 μg/ml (SD 5.42), 30 min after alcohol intake, and 30.14 μg/ml (SD 27.20), 4.5 h after alcohol intake. Spearman's test showed that urinary EtG and EtS correlated significantly at several time points.

CONCLUSION

The great interindividual variability in their excretion suggests caution in the use of urinary measurement of these metabolites in forensic investigations.

Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair

Background

Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months.

Material

A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation.

Results

Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542).

Conclusion

The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.

Is it possible to identify the inguinal nerves during hernioplasty? A systematic review of the literature and meta-analysis of cadaveric and surgical studies

Purpose

Patients who undergo inguinal hernioplasty may suffer from persistent postoperative pain due to inguinal nerve injuries. The aim of this systematic review and meta-analysis was to provide comprehensive data on the prevalence (identification rates), anatomical characteristics, and ethnic variations of the ilioinguinal (IIN), the iliohypogastric (IHN) and the genital branch of the genitofemoral (GNF) nerves.

Methods

The systematic literature search was conducted using the PubMed, Scopus and Web of Science databases.

Results

A total of 26 articles (5265 half-body examinations) were included in this study. The identification rate of the IIN was 94.4% (95% CI 89.5–97.9) using a random-effects model. Unweighted multiple regression analysis showed that study sample size (β = − 0.74, p = .036) was the only statistically significant predictor of lower prevalence. The identification rates of the IHN and GNF was 86.7% (95% CI 78.3%–93.3%) and 69.1% (95% CI 53.1%–83.0%) using a random-effects model, respectively. For those outcomes, a visual analysis of funnel and Doi plots indicated irregularity and provided evidence that larger studies tended to have lower identification rates. In terms of the synthesis of anatomical reference points, there was a large and statistically significant amount of heterogeneity for most outcomes.

Conclusions

The identification rates of the inguinal nerves in our study were lower than reported in literature. The lowest was found for GNF, suggesting that this nerve was the most difficult to identify. Knowledge regarding the anatomy of the inguinal nerves can facilitate their proper identification and reduce the risk of iatrogenic injury and postoperative pain.

"OKKIO alla salute 2014" results from the Tuscan sample

BACKGROUND

The prevalence of overweight and obesity among children is rapidly increasing in many countries. For this reason we decided to investigate the eating habits of 8-9 years old Tuscany children, by paying attention to the frequency of their meals per day and to their food choices, also in relation to children's Body Mass Index (BMI) classes. In addition, we considered some environmental factors that could affect children eating behaviors, such as parents' BMI.

METHODS

Data from the 2014 Tuscany nutritional surveillance system (part of the national periodical survey) and collected from children, parents and teachers, have been linked to study of children's eating habits. Logistic regression analyses were used to investigate the association between incorrect dietary habits and the potential predictors of overweight and obesity.

RESULTS

More than half of the 2,163 children (68.64% overall, 67.61% females, 69.56% males) reported to have eaten an appropriate breakfast in the morning, while 5.9% skipped breakfast and only 33.5% of children ate an appropriate mid-morning snack. Logistic regression showed that having breakfast and especially an adequate breakfast are protective factors against obesity (OR 0.57, p<0.01; OR 0.84; p=0.03 respectively).

CONCLUSION

In Tuscany Region, unhealthy dietary habits are common among children. The identified deficiencies may be a harbinger of future public health problems.

Suicide behaviour and arsenic levels in drinking water: a possible association?: A review of the literature about the effects of arsenic contamination in drinking water on suicides

BACKGROUND

A considerable part of the global population is exposed to arsenic-contaminated drinking water which is the main source of inorganic arsenic(As) exposure in humans. Arsenic exposure interferes with the action of enzymes, essential cations, and transcriptional events in cells throughout the body, and a multitude of multisystemic non-cancer effects might ensue. The aim of our review was to evaluate the effects of arsenic contamination in drinking water on suicides rates.

METHODS

A systematic literature search (English written literature) was conducted in electronic databases MEDLINE, SCOPUS. Evidences dating from 1999 till 2016 have been collected. A manual search of reference lists of included studies and review articles was successively performed. All references of the retrieved studies were also reviewed to avoid missing relevant publications. The key search terms included: "arsenic AND water AND suicide".

RESULTS

The literature search yielded 13 publications, but we identified 2 manuscripts available for this systematic review. The 2 studies included in the review, were published in 2015 and in 2017 and settled in Italy and Hungary. The levels of arsenic in the waters ranged from 0.016 μg/l to >50 μg/l. The findings of the two studies are conflicting, in fact Pompili et al. reported an apparently beneficial effect of arsenic on suicides rates, with an inverse correlation of arsenic concentration and local suicide rates, in contrast to a positive correlation with natural-cause mortality rates.

CONCLUSIONS

Our review led to conflicting results, so the diatribe about the real effects of arsenic intake of suicidal behaviors is still open. Therefore, we encourage other colleagues to conduct further studies in other locations in order to have more reliable results.