Clinica Terapeutica最新文献

{"title":"A rare case of suicide by ingestion of muriatic acid: analysis of the medico-legal evidences.","authors":"M A Sacco, S Gualtieri, M C Verrina, A P Tarallo, P Tarzia, P Ricci, I Aquila","doi":"10.7417/CT.2025.5181","DOIUrl":"10.7417/CT.2025.5181","url":null,"abstract":"<p><strong>Abstract: </strong>Caustic substances are highly corrosive and dangerous, causing protein denaturation and tissue necrosis by altering pH upon contact. Common examples include muriatic acid, caustic soda, and ammonia. This case study details a 44-year-old man who ingested muriatic acid in a suicide attempt, leading to widespread esophageal and gastric ulcerations, tissue necrosis, pulmonary consolidations, and blood-stream infections (Klebsiella Pneumoniae, Acinetobacter Baumanii complex). Despite medical interventions, the patient died. An autopsy was performed and it revealed extensive multi-organ hemorrhages and systemic damage. The findings highlight the rapid and fatal systemic effects of caustic ingestion, underscoring the importance of immediate emergency care, including esophagogastroduodenoscopy and gastric lavage, to mitigate absorption and systemic impact.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination plays a fundamental role in healthcare personal health and safety.","authors":"G La Torre","doi":"10.7417/CT.2025.5215","DOIUrl":"10.7417/CT.2025.5215","url":null,"abstract":"<p><strong>Abstract: </strong>Since vaccines are able to reduce the risk for HCWs of getting sick and contribute to stop the spread of microorganisms to others, in this paper a review has been made for comparing the recommendations for HCWs' vaccination in three different counties, Australia, Italy and USA. The results show that, while there is a perfect agreement for the recommended vaccinations for HCWs in these countries, the epidemiological situations of these countries testifies the extreme heterogeneity for the vaccinations indicated in specific circumstances.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"253-254"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microscopic and macroscopic findings in cocaine and crack airways injuries: a literature review.","authors":"A Ghamlouch, S De Simone, F Dimattia, B Treves, G Napoletano, A Maiese, L di Mauro, C Trignano, F Del Duca","doi":"10.7417/CT.2025.5193","DOIUrl":"10.7417/CT.2025.5193","url":null,"abstract":"<p><strong>Abstract: </strong>Cocaine inhalation - and its popular derivative known as crack cocaine - is linked to numerous complications and organ damage, well-recognized in scientific literature, including airway injuries. Airways damage is probably due both to thermal damage by hot vapor and micro-inhalation of crystals, leading to foreign body trauma and inflammation. A brief description of findings is helpful to health professionals - including forensic pathologist - to achieve the correct diagnosis. Our study is of a review of the literature with the aim of investigating the anatomical and pathological basis of damage of upper airways in cocaine crack chronic users. For this purpose, scientific studies that explore the correlation between symptoms related to airway injuries and the corresponding macroscopic and microscopic organ damage in chronic cocaine and crack users were reviewed. Results from 11 studies were reported, involving patients with a history of pharyngodynia, dysphagia, dysphonia, foreign body sensation, and respiratory difficulties. Diagnoses were confirmed through direct or indirect laryngoscopy, with the use of a fiberoptic bronchoscope or flexible endoscope. Macroscopic findings documented edema and inflammation of the epiglottis, false vocal cords, aryepiglottic folds, arytenoid cartilages, and piriform sinuses, and the presence of white plaques and pseudomembranes. Microscopic findings documented inflammatory tissue and necrosis, in one case squamous metaplasia. Our results showed that it is possible to find macroscopic and microscopic lesion in chronic abusers' upper airways and it lays the foundation for future studies in the investigation of the injuries mentioned in post-mortem examinations.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"83-88"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Gender Dysphoria in Italy: Reflections on Triptorelin, Consent, and Care.","authors":"M Lippi, F Orsini, F Damato, R Rinaldi","doi":"10.7417/CT.2025.5186","DOIUrl":"10.7417/CT.2025.5186","url":null,"abstract":"<p><strong>Abstract: </strong>Since 2018, the Italian National Committee for Bioethics (CNB) has endorsed the off-label use of triptorelin, a gonadotropin-releasing hormone agonist (GnRHa), for managing adolescent gender dysphoria (GD). Administered to suppress puberty, triptorelin provides adolescents time to explore their gender identity without the distress of developing secondary sexual characteristics. However, concerns persist regarding its long-term effects on bone density, brain development, and fertility. Ethical debates focus on the validity of informed consent in minors, given their cognitive and emotional immaturity, and the critical role of families in decision-making. The Italian medical-psychiatric model, requiring a formal GD diagnosis and multidisciplinary over-sight, contrasts with the autonomy-centered informed consent model used elsewhere. This paper advocates for a hybrid approach, integrating strengths of both models to ensure safe, accessible, and individualized care. Further research is essential to clarify the efficacy and risks of triptorelin, ensuring evidence-based, fully informed decisions for adolescents with GD.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"44-47"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in the Service of Medicine: Current Solutions and Future Perspectives, Opportunities, and Challenges.","authors":"S Marinelli, L De Paola, M Stark, G Montanari Vergallo","doi":"10.7417/CT.2025.5192","DOIUrl":"10.7417/CT.2025.5192","url":null,"abstract":"<p><strong>Objective: </strong>This article aims to identify the opportunities and risks of Artificial Intelligence tools (AIT) applied to clinical practice, while also reflecting on their impact on the doctor-patient relationship.</p><p><strong>Materials and methods: </strong>The authors conducted a systematic literature review following the PRISMA guidelines, selecting the period from 2019 to October 2024. Academic databases PubMed and Scopus were drawn upon by using the keywords and searchstrings \"artificial intelligence\", \"healthcare\", \"informed consent\", and \"doctor-patient relationship\" in titles, abstracts, and keywords.</p><p><strong>Results and discussion: </strong>AIT has proven useful in significantly reducing the time spent on bureaucratic tasks and minimizing errors compared to traditional medicine. However, their effectiveness is highly influenced by the quantity and quality of data used for training. Additionally, there is an issue with the transparency of the decision-making process because AIT and even their programmers are unable to explain their diagnostic and therapeutic recommendations. Therefore, human supervision of AI work is essential.</p><p><strong>Conclusions: </strong>The potential risks of AI for patient safety and personal data security necessitate that governments urge those involved in the production of AI tools to adhere to specific ethical standards developed with the participation of all stakeholders, including patients.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the hands of the robot to the courtroom.","authors":"G Mercuri, E Mustè, E Galluccio, N Nicolotti, P Refolo, G Vetrugno, A Oliva","doi":"10.7417/CT.2025.5190","DOIUrl":"10.7417/CT.2025.5190","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate the implications of robotic surgery on clinical risk and litigation at the Fondazione Policlinico \"A. Gemelli\" (FPG) to identify potential strategies to reduce future cases of controversies.</p><p><strong>Materials and methods: </strong>We examined claims related to robotic surgeries performed at FPG from 2015 to 2024. The complication rate for each procedure was evaluated and compared to that of laparoscopic procedures. Subsequently, trends in litigation related to robotic-assisted surgery were analysed, taking into account findings from international literature on the topic.</p><p><strong>Results: </strong>Our data demonstrate a 27% increase in claims, mainly involving Gynecology, Urology, and General Surgery. The primary causes of legal disputes were related to surgical errors and the need for additional procedures. The complication rate was higher in laparoscopic procedures compared to those performed with robotic assistance.</p><p><strong>Conclusions: </strong>The number of claims analysed shows a growing trend, although robotic surgery represents a small proportion of the total number of procedures performed. This finding should encourage healthcare facilities to adopt appropriate tools for assessing and monitoring risks associated with robot-assisted procedures. These tools will help strengthen the skills and training of healthcare workers, as well as improve doctor-patient communication, thus promoting a reduction in claims and an overall improvement in the healthcare experience.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"66-69"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of neuroprotective role of benfotiamine in Alzheimer's disease model: A randomized control study.","authors":"B Mallika, K Sudha, A Massand, B V Murlimanju, G Sonal, M P Neelam, K Sowndarya","doi":"10.7417/CT.2025.5195","DOIUrl":"10.7417/CT.2025.5195","url":null,"abstract":"<p><strong>Background: </strong>Thiamine deficiency mimics the features of Alzheimer's disease (AD) like cognitive impairment, amyloid and tau deposition. There is growing evidence that links AD with aluminium. The study aims to explore the effect of benfotiamine (BFT), a lipid soluble thiamine derivative, on aluminium induced AD rat model.</p><p><strong>Materials and methods: </strong>All the rats except control group were administered AlCl3 for one month to induce dementia. Positive control group received donepezil; BFT groups received 50 and 300 mg/kg b.w. /day for last 15 days. Morris water maze test was performed to assess learning and memory. Histological changes were studied in C3 region of hippocampus. Acetylcholine esterase (AChE), malondialdehyde, reduced glutathione, nitric oxide, hyperphosphorylated tau proteins and caspase 8 were estimated in brain homogenate.</p><p><strong>Results: </strong>AlCl3 impaired learning and memory significantly and increased AChE, caspase 8, tau proteins. The decrease in NO level was highly significant (p<0.001) in BFT treated rats compared to control. Lower dose of BFT had profound influence on augmenting GSH levels (p=0.012). Further, higher dose of BFT improved learning and memory significantly in AD model (p=0.009) and was more effective in preventing taupathy, apoptosis and neuronal damage by acting as a potent antioxidant.</p><p><strong>Conclusion: </strong>It can be concluded that oral supplementation of 300mg /kg b.w. /day of BFT may reverse AD pathological processes and improve dementia. However, the need of thiamine supplementation in elderly persons to delay or halt the cognitive loss and eventual dementia needs validation by clinical trial.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"127-135"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of hospital triage in the context of trauma patients.","authors":"G De Gabriele, E Macorano, A Cristalli, A Colucci, S Di Trani, A Marzaioli, F Mele, F Introna","doi":"10.7417/CT.2025.5183","DOIUrl":"10.7417/CT.2025.5183","url":null,"abstract":"<p><strong>Background: </strong>In the field of emergency medicine, the question of how to ensure that patients receive the care they require in a timely manner has been a topic of debate for approximately 30 years throughout Europe. This is due to the fact that, as a result of advances in medical science and technology, it is now possible to assess the criticality of a patient's condition with greater accuracy than was previously possible.</p><p><strong>Case report: </strong>Authors analyzed a peculiar case occurred in a hospital in the South of Italy. A patient who had sustained multiple injuries underwent an understate in triage procedure, resulting in an unfavorable outcome. The assignment of a Code Red rather than a Code Blue would have resulted in the initiation of interventional care, including transfer to a hospital with the necessary resources for the subject's condition. This would have increased the likelihood of survival for the subject.</p><p><strong>Discussion: </strong>As illustrated by the presented case, inaccurate triage estimation by nursing staff can have dire consequences, as subsequent control levels are contingent upon the initial triage code assigned to a patient. This exemplifies the necessity for a unified national consensus on triage procedures in emergency departments, irrespective of hospital size.</p><p><strong>Conclusion: </strong>The subject matter is of significant national and international interest. A reformulation of the parameters governing access to emergency care would be necessary in order to significantly reduce the incidence of knowledge-based errors attributable to nurses who are sometimes compelled to work in conditions that are wholly unreliable3. The use of territorial structures located on the territory would be used to manage minor emergencies and appropriately treat patients in need of advanced care. It is possible to propose using local medicine to lessen the burden of emergency rooms, which are increasingly overcrowded with minor emergencies.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"34-35"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can appearance be deceiving? A Strange Case of Nasal AVM.","authors":"D A Cotroneo, I Russo, A Pallante, L Di Mauro, M Chisari","doi":"10.7417/CT.2025.5179","DOIUrl":"10.7417/CT.2025.5179","url":null,"abstract":"<p><strong>Abstract: </strong>Article 5 of Law No. 24/2017 regulates good clinical-assistance practices and guidelines aimed at improving the quality of healthcare services and enhancing patient protection. The aim of this study is to highlight the importance of the pre-existing condition of an individual who suffers harm from an unlawful act in order to achieve an accurate damage assessment. Specifically, when a pre-existing impairment affects the organ or system injured by the unlawful act, the principle of differential damage can be legitimately applied. This principle allows for the distinction between the damage directly caused by the unlawful act and the pre-existing condition, enabling a more precise evaluation of the harm suffered. A 40-year-old woman with a high-flow vascular malformation of the nasal apex, classified as Schobinger stage III/IV, was referred to our medical team. She underwent an arteriographic examination and an initial embolization attempt, followed by a second attempt, both performed without further diagnostic investigations and without any benefit. Seeking treatment elsewhere, she underwent subtotal resection of the nose, with the histological examination revealing \"ulcerated and infiltrating angiosarcoma of the nasal skin and striated muscle.\" She was then subjected to radiotherapy and chemotherapy. The failure to perform a biopsy necessitated a more destructive resection from both an anatomical and functional standpoint, as it was performed approximately one year later. The patient's prior condition played a crucial role in the assessment of damage: optimal medical-surgical treatment would still have resulted in significant permanent post-operative outcomes, including the loss of a large part of the nose (Class III). However, the greater biological damage resulting from the inadequate conduct of the medical staff caused significant aesthetic harm, culminating in the complete loss of the nose (Class IV). Therefore, she was recognized as having a permanent differential biological damage of 15%, representing greater damage starting from 20% (an outcome she would have experienced even with the best treatment) up to 35% of current biological damage, which is considered stabilized.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"14-18"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual abuse or traffic accidental trauma? Analysis of a case.","authors":"M Focardi, B Defraia, I Bianchi, V Gori, M Romanelli, G Ferretti, L Nanni, S Losi","doi":"10.7417/CT.2025.5176","DOIUrl":"10.7417/CT.2025.5176","url":null,"abstract":"<p><strong>Abstract: </strong>The authors present a complex case of a 5-year-old child who was involved in a traffic accident as a pedestrian hit by a car and reported widespread injuries mostly extrinsic at the anal level, suspected sexual abuse. As reflected in the literature (1), about 1 in 4 children are victims of abuse in their lifetime, and anogenital injuries are included in the clinical signs of suspected sexual abuse. In fact, we learn from the 2023 (2) update on the interpretation of clinical signs in cases of suspected child sexual abuse that a perianal laceration with exposure of the tissues underlying the dermis is suggestive of sexual abuse unless there is a plausible cause linking it to accidental trauma. In the present case, the medico-legal assessment and evaluation was carried out one month after the event and involved a forensic physician and pediatrician from the GAIA (Gruppo Abusi Infanzia e adolescenza) service at IRCCS Meyer. Anorectal or genital injury in children does not always have a clear and immediately well-framed diagnosis. It is essential that health care personnel consider various diagnostic hypotheses (sexual abuse, trauma, pathology, etc.) and be properly educated to manage and investigate such occurrences. In fact, even today, there is much confusion about how to frame these cases. Often sexual abuse is underdiagnosed while other times it is misdiagnosed, leading to dramatic consequences for both the child and the family.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}