Gianmarco Troiano

Drugs and psychoactive substances in the Tiber River

Wastewater analysis is a direct and objective method used to measure human consumption of illicit drugs. In the last few years these have become a new class of environmental contaminants. The aim of our study was the identification of drugs in Tiber River waters. We collected 20 water samples from May to June 2012, at six points of the river: at the source, near Perugia, near Rome and at the mouth. Samples were analysed using gas chromatography with a mass detector. Basic analytes were extracted using the method of Varian Certify. For acidic analytes we proceed to direct extraction using organic solvents. The most detected drug was ecstasy. We also identified traces of methadone, morphine, heroine, methylamphetamine and tetrahydrocannabinol (THC). The highest concentration of cocaine was found near Perugia with a peak in the weekend (4744 ng/ml). Psychoactive substances had constant concentrations in the week. Ecstasy (MDMA) was the most detected drug. The most interesting finding was the increased concentration of cocaine and heroin in waters near Perugia showing the alarming phenomenon of weekend use of these substances.

A 10 year post-mortem analysis of keratin matrix in Perugia (Italy): focus on cocaine involvement in several types of death

Abstract The use of keratin matrix, in detecting drug consumption, offers compelling advantages compared to other conventional biological matrices used for these types of investigation, and provides important information to surveys which are characterised by a general underestimation, especially in Italy. In our study we collected and analysed 424 hair samples from corpses autopsied in Perugia from January 2001 to December 2011 in order to detect traces of drugs and especially of cocaine, and evaluate their involvement in several types of death. Hair samples were analysed by gas chromatography–mass spectrometry in the Laboratory of Forensic Toxicology of the Department of Legal Medicine of the University of Perugia: 232 samples derived from cases of overdose deaths; 192 were connected to different causes of death. The average concentration of cocaine in the keratin matrix samples was of 3.74 ng/mg in people who died from overdose, 3.09 ng/mg in people who died from other causes. In 232 cases of overdose deaths, 135 were positive for cocaine (accounting for 58.18% of total); in 192 deaths from other causes, 39 were positive for cocaine (accounting for 20.31% of the total). Our study demonstrated the crucial role of cocaine in overdose deaths and in other deaths, as is well known in other research.

Quality of life in refugees and asylum seekers in Italy: A pilot study

Interest in measuring the Health Related Quality of Life (HRQoL) of the immigrants increased in recent years in Italy as in other countries. Our purpose was to evaluate the HRQoL of refugees welcomed in Tuscany using the SF-36 questionnaire. We collected 114 questionnaires from 2011 to 2015. Our samples was constituted by 98 males and 16 females, coming from different regions of the world; the mean age was 27.4. Statistical analysis showed that gender, length of stay and educational qualification are not associated with a poorer HRQoL. Instead, elderly refugees showed lower scores; refugees from African region reported a better HRQoL than the others, and there are also differences between refugees welcomed in different cities of Tuscany. Our purpose is to continue this study enlarging the sample size and the geographical coverage, in order to have a more interesting description of the health perception of refugees welcomed in Italy.

Emoji: What does the scientific literature say about them?-A new way to communicate in the 21th century

ABSTRACT Communication is really complex and beyond the verbal communication, it involves the transmission of abstract and concrete information using both verbal and nonverbal symbols. In June-July 2017 we performed a systematic search in the electronic database PubMed in order to better understand the impact of “emoji” in the scientific community. We considered eligible for the systematic review original articles, letters, brief reports, short communications web articles (written in English, French, Italian or Spanish) without any temporal limit and using the keyword “emoji” The literature search yielded 5 publications. The studies were published between 2015 and 2017. Two authors tried to associate emoji to specific feelings. Huesch et al. analyzed 1.7 million unique interactions and stories associated with breast cancer screening keywords generated on Facebook. Skiba in his short communication describes the history of emoji and proposed to develop a set of emoji that could be used to improve the management of their patients’ health. Bourzac in her short communication, says that at the first-ever Emojicon in California, a group of science enthusiasts and designers worked on proposals for several new science-themed emoji, in order to better express themselves. Although the scientific literature about emoji is very few, their psychological and emotional significance is very fascinating, and they could have an interesting application in public health to improve the physician–patient interaction.

Hair testing for cocaine in living men: an epidemiological study on hair samples collected for various medico-legal purposes

Abstract The collection and analysis of hair samples offers higher chances of identifying people addicted to drugs than urine samples. In our study we propose hair analysis as a useful epidemiological indicator to identify the extent of cocaine use in different medico-legal situations: currently the epidemiological trends of substance abuse are estimated indirectly, mainly through large-scale surveys or through medical and crime statistics that may be too generic. We conducted a cross-sectional study, analysing hair samples, collected for various medico-legal purposes, from living men belonging to different categories, in order to complete a previous study conducted in 2016. Of 104 samples collected for different purposes, 55 were positive for drugs (52.88% of total) and, in this group, positivity for cocaine was found in 28 cases (26.92% of total), with a mean concentration of 4.58 ng/mg of hair, and a mean concentration of 0.75 ng/mg of hair of its major metabolite (benzoylecgonine). This datum is in line with the Italian Superior Health Institute reports, which declared a reduction in the use of cannabis and benzodiazepines, but a notable increase in cocaine use. Despite its limitations, this study adds further information to the previous one conducted in the same context, and furnishes an interesting picture of the phenomenon of cocaine addiction in Italy.

Venomous bites during pregnancy: the black widow spider (Latrodectus mactans)

Abstract The spider genus Latrodectus, commonly called “widow spider,” is found all over the world. Its venom contains α-latrotoxin, which leads to a massive presynaptic release of acetylcholine so, after a person has been bitten, crampy muscle spasms usually occur within an hour. There is a lack of information about spider bites and envenomation during pregnancy, so we performed a systematic review of the literature using the following MeSH-terms: “black widow spider pregnancy”; “black widow spider” AND “pregnancy”; “black widow spider pregnant”; “black widow spider AND pregnant”. The only restriction was the language: we included in the review articles in English, Italian, Spanish or French. The literature search yielded 26 results, but after the revision of the full texts, we identified 5 manuscripts to include in the review. They were American studies, published between 1979 and 2011. 28.25 years was the mean age of women when they were bitten, the gestational age ranged from 4 to 40 weeks, the left thigh, the right knee and the right breast were the most common sites of the bites. The most common symptoms were: spasms, local erythema, abdominal cramps, hypertension, anxiety, muscle rigidity. Patients were usually treated with benzodiazepines to allay the anxiety, with calcium gluconate, and in a limited number of cases (6.9%) with antivenin after a skin test to avoid anaphylactic reactions. No notable obstetric effects followed the bite: only in one case the authors described the onset of contractions and cervical dilatation which promptly arrested after treatment. Black widow spider bites have the potential to cause significant maternal morbidity and mortality. Acute risks to the fetus appear to be negligible in the short term if an appropriate therapy is promptly administered to the mother.

Ultrasound-guided embryo transfer: summary of the evidence and new perspectives: systematic review and meta-analysis

Despite the purported advantages of ultrasound guidance during embryo transfer, and the large number of clinical trials published on this topic, recommendations for the use of this technique in daily clinical practice are still under debate. We designed a meta-analysis based exclusively on evidence from published randomized controlled trials, with the aim of analysing the effect of trans-abdominal ultrasound guidance during embryo transfer versus clinical touch and of transvaginal ultrasound guidance (TV-US) versus the trans-abdominal approach on IVF outcomes. On the basis of 14 randomized trials, we found a moderate quality of evidence supporting the beneficial effects of transabdominal guidance during embryo transfer compared with conventional clinical touch in clinical pregnancy and ongoing or live birth rates. No significant differences were found in miscarriage and ectopic pregnancy rate, with low or very low quality of evidence, respectively. On the basis of three randomized trials, we found the quality of evidence supporting the equivalence of transvaginal versus transabdominal approach in clinical pregnancy and ongoing or live birth rates to be low. Finally, larger randomized controlled trials are necessary to explore the possible benefits of TV-US, three-dimensional ultrasound imaging modality, and uterine length measurement before transfer.

EFFECTS OF ANTICOAGULATION THERAPY WITH VITAMIN K ANTAGONISTS ON HOSPITALIZATIONS AND EMERGENCY ROOM ACCESSES IN GROSSETO (ITALY)

Introduction A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old). Methods In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012. We analyzed the admissions to hospital and the accesses to the emergency rooms (ERs) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis. Results 3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3%), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time. Conclusions Our study showed that VKAs are responsible of an increase of the accesses to ER and of the admissions to hospital. However, it would be interesting to enlarge the sample size including patients living in other provinces or in other regions, with a lower age and treated also with TSOACs, in order to evaluate the real cost-effectiveness of anticoagulant therapy.

Socioeconomic factors and mortality: evidences from an Italian study

ABSTRACT Background The importance of socioeconomic factors as health determinants is well known in literature. The aim of our study was to demonstrate the correlation between socio-economic factors and the health status of a population in areas with an identical health organization. Methods We collected (for the period 1990-2014) the standardized mortality rates in Tuscany (Italy) for each municipality. Linear regression was performed to establish the existence of an association between vulnerability index/unemployment rate and mortality. Results The linear regression with the vulnerability index as independent variable and the overall mortality rate for all causes as a dependent variable, showed that the 1991 vulnerability index correlates positively and with the total mortality rates from the 2000–2004 period. The second linear regression considers the unemployment index as the independent variable. The value of the 1991 index correlates positively and in a statistically significant way with the total mortality rates from 2000 to 2004 with a constant increase until 2010–2014. Conclusions Our evidences show that a strong, excellent and uniform regional healthcare system are not enough to ensure a uniform level of health among different communities. Socio-economic factors, represent important risk factors for health and could create differences in health state.

Human leukocyte antigen DQ2/DQ8 positivity in women with history of stillbirth

The aim of this study was to investigate the prevalence of human leukocyte antigens (HLA) DQ2 and DQ8 haplotypes, two common polymorphisms associate with celiac disease (CD), in women with previous stillbirth, but not affected by CD.