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Cases of poisoning have been analyzed with the aim of estimating both the incidence and the seriousness of such xenobiotic effects, the major determinant agents, and the related antidotes used in hospital departments. From 2009 to November 2012, a survey of the availability of antidotes in the emergency room services was carried out in all hospital pharmacies under the Palermo Health Authority: Policlinico Paolo Giaccone, ARNAS Civico di Cristina Benefratelli, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello. Figures show that the majority of poisoning events were caused by the use/abuse of drugs, especially psychopharmaceuticals, alcohol and narcotic substances. This overdose of medical drugs and its various causes is a cause for concern and highlights the fact that this tendency has not regressed over the years. Doctors and pharmacists should raise patients’ awareness about how to use drugs correctly, and make adequate information available to all patients in order to, first, reduce the risks, and second, reduce the cost of treatment for intoxication.

BACKGROUND Metabolic Syndrome (MetS), currently defined as slight differences in the criteria of diagnosis – depending on which authority is quoted [i.e.: NCEP-ATP III (National Cholesterol Education Program/Adult Treatment Panel III); WHO (World Health Organization); IDF (International Diabetes Federation); AACE (American Association of Clinical Endocrinologists)], designates a cluster of metabolic risk factors that come together in a single individual, leading to cardiovascular disease. MetS is quite common, approximately 20-30% of the population in industrialized countries being affected. However, most of epidemiological data regarding MetS are derived from populations consisting mostly of middle-aged and younger subjects. AIM OF THE STUDY To assess the prevalence of the MetS in Internal Medicine wards and to determine its related comorbidities, including other clinical forms of atherosclerotic disease such as CHD risk equivalents. METHODS Our study was performed in patients admitted in Internal Medicine wards and selected as a randomization list in 12 Emilia Romagna-Marche FADOI centers. 1.316 patients were registered. According to explicit inclusion/exclusion criteria, we studied overall 902 participants (50.6% men, mean of age: 71-73 years). RESULTS According to NCEP-ATP III and IDF criteria the prevalence of MetS was 45.3% (IC 95%: 41.6-49.1) and 38.6% (IC 95%: 34.9-42.3), respectively. Patients with MetS presented a higher significant rate of ALT increase, syncope, atrial fibrillation, COPD, unstable angina, chronic kidney disease, cancer, valvular heart disease, peripheral arterial disease and carotid plaques. A strong association between IDF-MetS and congestive heart failure was observed, suggesting a role of central obesity as an independent risk factor in the elderly. DISCUSSION World-wide populations are becoming older. Aging and MetS are two conditions that represent an important part of health-care spending. Trunkal fatness increases in old age, potentially increasing existing abdominal fatness prevalent during middle age which is already related to increased size, cardiovascular disease and the metabolic syndrome. In this study we sought to assess the high impact of MetS in Internal Medicine wards, confirming its significant relationships to many comorbidities among older adults. CONCLUSIONS Our study emphasizes the importance of MetS and related diseases, pointing out the emerging problem of its real impact on management of these complex patients. Further research is needed to define the optimal body composition for older adults and to identify interventions that reduce morbidity and healthcare costs of MetS for this age group.

BACKGROUND Scurvy disease is a condition due to deficiency of ascorbid acid (vitamin C) and it is characterized by weakness, anemia, appearance of mucocutaneous hemorrhages and induration of muscles in the legs. We report a case of a young man living in the island of Sicily, Italy. CASE REPORT A 17 years old man was admitted to our hospital for the appearance of diffused cutaneous manifestations. Cause the perception of being overweight, he began autonomously a diet and he didn’t take any fruit or vegetables for several months. At admission we observed the presence of severe muscular hypotrophy associated to hematomas subcutaneous of thorax, trunk and legs. Blood examination showed a mild anemia and the reduction of serum proteins. Coagulation patterns and electrocardiography were normal. Tomography showed the presence of pericardial and pelvic effusion. Transthoracic echocardiography revealed the reduction in wall thickness and a moderate anterior and posterior pericardial effusion with normal systolic and diastolic function. The blood level of vitamin C was considerably lower than normal range. Definitive diagnosis was “scurvy disease”. We start treatment with ascorbic acid at maximum dose combined with hypercaloric diet. Cutaneous lesions resolved in two weeks. After five months, with normalization of ascorbic acid level and complete disappearance of cutaneous manifestations, we repeated echocardiography showing a significantly increasing left ventricular wall thickness and the reduction in pericardial effusion. CONCLUSIONS Scurvy disease is extremely rare in Sicily where citrus fruit cultivations are extensive and typical of the island. Scurvy disease is historically linked to the era of great maritime expeditions, but it still occurs in developed countries and re-emerging in Western countries. In this case we observed a combination of cutaneous and cardiac findings probably due to combined malnutrition and vitamin C deficiency.

BACKGROUND Inspired by a series of newspaper articles, the authors consider the different semantic meaning of the Italian word “malasanità” and the English word “malpractice”. They feel that many cases of “malasanità” are rarely due to technical problems, which are rarely proven in a trial, but mainly to the ethical problems. They claim that ethics lead human behaviour particularly in healthcare, as can be seen in the loving care of the patients. Patients take free medical service as granted and appreciate the personal behaviour and the empathy of the doctors. Today the practice of informed consent is the failure of the relationship between physician and patient. Medicine should be humanized not through technical improvements, but through ethics. AIM OF THE PAPER By the analysis of single cases the healthcare operator’s behaviour and actions are studied, as well as the authentic humanity of the professionals called to help other people. CONCLUSIONS When dealing with a single case, the media use the word “malasanità” globally, as if the whole healthcare system was responsible. The authors, criticizing both the terminology and the interpretation, prefer to proceed to the analysis of the single case, without ignoring however the many lacks and faults that occurred during the hospitalization.

Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin + clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have beneficial effects on health-care costs.

Introduction: There are few data on the prevalence of depression among acute patients with comorbidities. The current study aimed to determine the prevalence of depressive symptoms in hospitalized patients admitted to Internal Medicine Units and the correlation between these symptoms and comorbidities and disability indexes. Materials and methods: All consecutive patients admitted to 26 Internal Medicine Units of the Italian National Public Health System in Sicily, Italy, from September 2001 to March 2002 were screened. Within 24 hours of admission, patients were administered the Geriatric Depression Scale (GDS), Mini-Mental State Examination, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Charlson’s Comorbidity Index. Results: 1,947 subjects were included in the analyses. Of the patients, 509 (26.1%) showed depressive symptoms (indicated by GDS score > 15). Depression was significantly associated (univariate analyses) with hypertension (OR 1.45; CI 95% 1.18-1.79), diabetes (OR 1.48, CI 95% 1.17-1.87), cerebrovascular disease (OR 1.50, CI 95% 1.08-2.07), cirrhosis (OR 1.49, CI 95% 1.01- 2.19), ADL score (OR 0.72: CI 95% 0.63-0.82), and IADL score (OR 0.83; CI 95% 0.78-0.87), but not with Charlson’s Comorbidity Index (OR 1.04; CI 95% 0.98-1.10). Multivariate analysis showed that independent predictive factors for depression were age (OR 1.02, CI 95% 1.01-1.02), female gender (OR 2.29, CI 95% 1.83 - 2.87), and IADL score (OR 0.86, CI 95% 0.81 - 0.93). Conclusions: The data suggest that depressive symptoms are not linked to worse clinical conditions but are associated with the loss of autonomy in Instrumental Activities of Daily Living.

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Introduction Proton pump inhibitors (PPIs) are highly prescribed drugs in Italy and in particular in the Sicilian region but little is known about their use in the hospital setting.Materials and methods PPI utilization and related costs were reviewed retrospectively by examining the pharmaceutical records of drug dispensation to the various wards of the Policlinico Universitario P. Giaccone of Palermo in 2010. Differences in the prescribing rates and drug preferences among the different clinical wards were analyzed.Results A total of 20,420 patients were hospitalized at the Policlinico of Palermo in 2010. Overall, the consumption of PPIs was 120 DDD/100 bed-days for the year 2010 with a total cost of 42,780 euros. Omeprazole and esomeprazole were the most commonly prescribed molecules accounting for over 70% of all prescriptions: nevertheless, wide differences in drug choices were noted even within the same ward. As expected, greater utilization rates were registered in the Internal Medicine and General Surgery departments. In particular, the highest consumption was observed in the Oncology, Geriatry and Obesity Surgery wards, with about 250 DDD/100 bed-days. All wards reported intravenous PPI administration suggesting some inappropriate use.Discussion From our data, PPIs appear to be moderately over-used at the Policlinico of Palermo. This practice may lead to the inappropriate continuation of therapy in primary care, further increasing costs and risks of adverse events. A survey evaluating in more detail the appropriateness of prescriptions is advisable.