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Introduction. Water intoxication is a well-recognized cause of symptomatic hyponatremia, whose often fatal consequences are described in a wide variety of conditions such as psychiatric disorders, metabolic dysfunctions, child abuse, drug abuse and several medical procedures. The case. We here report a rare case of a 67-year-old woman with severe acute hyponatremia due to an excessive voluntary water intake – 14 litres in two days – following a chiropractic prescription. The patient developed sudden severe symptoms, including water retention, sensory alteration, altered mental status and tonic-clonic seizures. She was thus admitted to the Intensive Care Unit with a diagnosis of coma due to electrolyte alterations following water intoxication. Conclusion. The evaluation, in the present case, of the medicolegal implications related to malpractice involving a practitioner of Complementary and Alternative Medicine, led to the admission of a professional liability of the chiropractor.

Italy is the European country with the second highest number of novel Coronavirus disease 19 (COVID-19) deaths. Several factors interfered with the spread of this phenomenon, both clinical, political, and bioethical. In this scenario, where the need for care goes far beyond the capacity of a health system able to cope with it, what should be the criteria for an equitable distribution of the available resources? The mass quarantine required physical distancing in order to limit the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and contextually created additional problems for the organization Italian National Health Service. The delicate ethical questions posed by the current emergency are beginning to unveil some proposals for solutions in literature, which, although still insufficient for understandable reasons, is increasing.

Gastrointestinal discomfort (GD), which often includes gastroesophageal reflux disease (GERD), is a common disorder in healthy adults affecting 40% of the worldwide population. The symptoms related to GD can have a negative impact on the quality of life (QoL). Current treatments for GERD are associated with side effects. We conducted a randomized double-blind placebo-controlled trial to assess the effect of a standardized extract of Opuntia ficus-indica L. cladodes and Olea europaea L. leaves on the symptoms and QoL of healthy adults with GD. One hundred healthy participants with GD were enrolled in the study and divided into two groups: 60 participants taking verum (400 mg/day) and 40 taking the placebo for 8 weeks. The Gastrointestinal Quality of Life index (GIQLI) and GERD Symptom Assessment Scale (GSAS) questionnaires were administered at the beginning of the study and after 4 and 8 weeks. The group treated with verum experienced a statistically significant improvement of GIQLI and GSAS scores (p .001). Moreover, the effect size measured revealed a clinical significance. A day-dependent improvement of symptoms was also observed. The standardized extract represents a fast, effective, and well-tolerated treatment for improving symptoms related to GD and GERD.

Tick-borne encephalitis (TBE) is an important viral infection of the central nervous system with high morbidity and mortality. With the increase of tourism TBE is becoming a problem also outside endemic regions. Italy is considered a country with low incidence of TBE and geographically restricted to the central and north eastern part of the country. In the south of Italy there is no evidence of disease presence, but neither is there much evidence of its absence. We report our experience about a lethal case of meningoencephalitis with a single-phase clinical course of the disease likely due to TBEV infection in a 13-year-old man. This is the first report of an autochthonous case of TBE in Sicily, region in the in Southern Italy.

Background. Cannabidiol (CBD) is a major chemical compound present in Cannabis sativa. CBD is a nonpsychotomimetic substance, and it is considered one of the most promising candidates for the treatment of psychiatric disorders. Objective. The aim of this review is to illustrate the state of art about scientific research and the evidence of effectiveness of CBD in psychiatric patients. Methods. This review collects the main scientific findings on the potential role of CBD in the psychiatric field, and results of clinical trials carried out on psychiatric patients are commented. A research was conducted in the PUBMED, SCOPUS, and ScienceDirect databases using combinations of the words cannabidiol, psychiatry, and neuropsychiatric. Results. Preclinical and clinical studies on potential role of CBD in psychiatry were collected and further discussed. We found four clinical studies describing the effects of CBD in psychiatric patients: two studies about schizophrenic patients and the other two studies carried out on CBD effects in patients affected by generalized social anxiety disorder (SAD). Conclusion. Results from these studies are promising and suggest that CBD may have a role in the development of new therapeutic strategies in mental diseases, and they justify an in-depth commitment in this field. However, clinical evidence we show for CBD in psychiatric patients is instead still poor and limited to schizophrenia and anxiety, and it needs to be implemented with further studies carried out on psychiatric patients. © 2019 Gioacchino Calapai et al.

ntroduction: Authors have carried out a survey to evaluate the appropriateness of the caesarean deliveries performed in a hospital of Sicily (Italy) during 2013. The choices of these surgeries have been compared with italian and sicilian guidelines. Materials: EpiInfo 7.1.4 software (CDC - Atlanta - USA) was used to perform the statistical data analysis (chi-square test). Results: We analyzed a total of 818 medical records related to 50.61% of spontaneous deliveries, :06% induced labor, and 46.33% of cesarean deliveries. Medical records showed that in 32.7% the caesarean section were justified by emergency conditions, whereas in 15.89% the choice was not quite justified according to guidelines parameters. In 39.57% the choice of caesarean delivery is not adequately justified either because the 5.04% is indicated as the reason the request of the woman, and because in 34.53% are not present in the medical record elements sufficient justification as incomplete or absent. Conclusions: More significant results lead to the conclusion that it's important focusing the attention to multiple social and sanitary strategies aimed at not only reducing health care spending but especially encouraging health professionals and pregnant women towards greater responsability in the choices of caesarean delivery for aspects of clinical risk and legal liability.

Gli autori segnalano un caso di propria osservazione riguardante il decesso di giovane uomo, sportivo, con anamnesi familiare e patologica negativa per patologie cardiache, coinvolto in incidente stradale autonomo; la cui causa del decesso veniva inizialmente attribuita (sulla scorta della sola ispezione cadaverica effettuata dal medico del 118 intervenuto sul luogo) ai gravi effetti contusivi cerebrali connessi al trauma cranico. Il successivo esame autoptico, disposto dall’A.G., completato dagli esami di laboratorio, consentiva di individuare la sussistenza di una ampia sostituzione fibro-adiposa del miocardio del ventricolo destro, comprendete la porzione epicardica e gli strati intermedi della parete, in soggetto con riscontro positivo per alcool all’esame tossicologico di screening. Le risultanze del caso in questione confermano l’importanza delle indagini medico-legali quale presupposto fondamentale per la valutazione del nesso causale, anche talora al fine di avere contezza del determinismo dell’evento che ha avuto il suo epilogo nel decesso. Ne deriva, in definitiva, la rilevanza della disciplina medico legale, talora anche a scopo clinico-preventivo in relazione alla potenziale sussistenza di patologie sconosciute di carattere familiare.

The Authors conducted a fact-finding survey among the health operators in some Sicilian and calabrian hospitals, hèreby eitending it to include doctors in training - in light of D.Lgs. 368/99 - and heilth operatórs in the area o in consideration oflaw42|9.T\esurveywas'aimedatdeterminingthedegree ofawarenessofthetypeofinsurancecoveràgeand/orcontraclsandlnlicies(>, "claims made") signed by the respective services, as well as about the protection supplied to health operators by the same insurance contracts.