Search

obesity is one of the most prevalent diseases all over the world. Because of its high social impact, the broadest possible approach on several levels - and not limited only to clinical aspect - is needed to better understand and face the challenges obesity poses to public health.to analyse, through the main evidence, the social impact of weight excess in the general population and the actions aimed at mitigating its negative effects.narrative review.data obtained from the sources included in the study were gathered and analyzed in five macroareas: Health Inequality, Society, Work, Impact on Social Medicine (focused on the Italian model), and Social Costs.each category showed a bilateral relationship with obesity having a significant impact for the community.for each field, various actions should be taken at institutional level. Many recommendations and actions have already been taken worldwide, but they alone seem to be not enough. This work points out that, in order to combat obesity and bring about a slowdown of this pandemic, the entire scientific community and institutions must work together to identify and design programmes that are truly effective.

The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility.This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient.The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give.In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.

Malignant hyperthermia manifests clinically as a hypermetabolic crisis when a malignant hyperthermia-susceptible individual is exposed to a volatile anesthetic such as halothane, isoflurane, enflurane, sevoflurane, or desflurane or depolarizing muscular blockers such as succinylcholine. The condition shows autosomal dominant inheritance with reduced penetrance, and is mostly associated with mutations resulting in abnormal ryanodine receptor type 1 or, more rarely, dihydropyridine receptors. Exposure to triggering agents may lead to unregulated passage of calcium from the sarcoplasmic reticulum into the intracellular space, resulting in an acute malignant hyperthermia crisis. Mortality from malignant hyperthermia in the United States was 16.9% in 2001 and 6.5% in 2005, but it is characterized by high morbidity. Therapy is based on suspension of the triggering agent and administration of dantrolene. Diagnosis is possible by biopsy using in vitro contraction tests or DNA screening for malignant hyperthermia. The authors present a case of malignant hyperthermia during myocardial revascularization through off-pump coronary artery bypass graft.

Short half-life benzodiazepines like midazolam are used as premedication to relieve intra-partum pain, and are known to have no adverse effects to the newborn. However, such short-acting drugs are known to induce paradoxical reactions when their concentration is abnormally elevated respect to the age of the subject. In a 1 day-old newborn, admitted to the Cardiology Unit of the “Bambino Gesù” Children Hospital of Rome due to a prenatal diagnosis of tetralogy of Fallot, a paradoxical reaction with a spontaneous resolution was observed. The analysis of urines, performed by gas chromatography/mass spectrometry after a drug screening, showed the presence of the active metabolite 1-hydroxymidazolam at 9.7 µg/mL with no detectable trace of its precursor midazolam and of the alternative metabolite 4-hydroxymidazolam. On the basis of these evidences, we speculated that 1-hydroxymidazolam, produced by the mother’s liver enzymes, passed to the newborn whose reduced volume of distribution (for the shunted circulation) favoured the onset of such a reaction. Hence, the toxicological approach should be carried out on both mother and child wherever the clinical picture may appear unexplainable or does not match with the other findings collected.

Specific Learning Disorders (SLDs) affect specific abilities in individuals with an otherwise normal academic development. Among Italian School population, their reported prevalence is between 2.5% and 3.5%. Dysfunctions at the base of these disorders interfere with the normal acquisition process of reading, writing and/or mathematical abilities, leading to various degrees of adjustment difficulties in the affected individuals. The aim of this study was to assess the support that Italian Government offers to its citizens affected with SLDs, with a particular focus on assistance during the school-age years, particularly through the introduction of the Law 170/2010 and successive guidelines, supplementing the existing regulations to offer more efficient means and legal instruments aimed at achieving earlier diagnoses.