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لا يوجد المزيد من العناصر في سلة التسوق الخاصة بك
Decidere in Medicina 2024/1
16.99 €
شامل للضريبة
Clinica, etica, giurisprudenza, sanità
Editorial
3 Society and money. Pathological gambling
Gino Lelli, Dipartimento di Studi Umanistici dell’Università degli Studi “Carlo Bo”, Urbino (PU)
Andrea Sorcinelli, Sociologo, Cagli (PU)
Abstract
Pathological gambling is an example of how money can most negatively affect human existence, leading the gambler to lose all other meaningful forms of society and the social, thus taking away meaning from his or her existence, to completely alienate himself or herself.
Actuality
7 Why are so few DATs deposited in the Italian database? Is it the fault of a lack of public awareness campaign or the effect of a poorly written rule?
Fabio Cembrani
Medico legale. Università degli Studi di Verona
Abstract
The Author analyzes the possible formalization paths of the anticipated will with regard to the care provided for by law no. 219/2017 identifying them in the advance treatment provisions (DAT) and in the shared care planning (advance care planning) of which it examines the merits and related defects. It proposes to invest better and more in shared care planning, indicating the advantages and opportunities that derive from its gradual formation within the care relationship.
Medication diary
11 Dapagliflozin in post-myocardial infarction wins only on cardiometabolic soft endpoints
Carlo Manfredi
Clinical pharmacologist Massa Carrara Italy
Abstract
The DAPA-MI trial showed that dapagliflozin use among patients with acute myocardial infarction without a history of diabetes mellitus or chronic heart failure (HF) has better cardiometabolic outcomes compared with placebo. Cardiovascular outcomes including hospitalization for HF were similar but patients on dapagliflozin were less likely to develop diabetes and experienced a weight loss of 1.65 kg over approximately 2 years of follow-up. This is despite approximately 75% of the population having an EF of <50% in the acute setting. Based on this trial, in an acute coronary syndrome population, the cardiovascular benefits appear limited.
Clinical case
15 A case of euglycemic diabetic acidosis: a challenge to the clinician
Matteo Caiti, Elisabetta Cenni, Alessandra Barreca, Paolo Moscatelli,
U.O. Medicina Interna. Ospedale Policlinico San Martino. Genova
Rodolfo Russo
U.O. Clinica Nefrologica. Ospedale Policlinico San Martino. Genova
Abstract
A diabetic woman currently in SGLT-2 inhibitor and insulin treatment presents to the ED with a severe ketoacidosis and altered mental state and coma. Her clinical assessment and laboratory tests help making the diagnosis of euglycemic diabetic acidosis. We then were able to correct the patient’s heavy acidemia with the administration of continuous intravenous short-acting insulin, crystalloid fluids, electrolytes and glucose solution.
Electrocardioquiz
Short QT syndrome
Bruno Tartaglino
Specialist in Cardiology Turin (Italy)
Abstract
What does the QT interval represent? How is QTc calculated? Upper and lower limits of the QT. What causes a shortened QT interval? What is short QT syndrome characterized by? What are the diagnostic criteria for short QT syndrome?
The radiologist's diagnoses
A delayed-effect microenema...
Silvia Grazioli
Radiology Spedali Civili Brescia P.O. Montichiari (Italy)
Abstract
The radiological investigations to search for intracavitary foreign bodies are frequent, with possible complications that can be serious, in some cases fatal. Rectal perforations from a foreign body may occur caused
by endoscopic or evacuation maneuvers, or caused by maneuvers for erotic, self-injurious or even criminal purposes. The author experienced an elderly woman who had been bedridden for a long time, resident in a nursing home. Previously hysterectomized and terminally ostomized, she has insulin-dependent diabetes mellitus, right hemiparesis due to multi-infarct encephalopathy, amputee of the left thigh due to wet gangrene, but rather lucid and cooperative. She reported secretion of material purulent mixed with fecal material from the rectum.
What do we know
33 How virus and bacteria may overcome our immunologic defenses. Lesson re-learned from COVID-19 (Part I)
Sandro Girotto, Sonia Zenari
Medico di Medicina Generale (MMG) Verona
Umberto De Conto, Francesco Cavasin
MMG Treviso
Enrico Peterle
MMG Venezia
Vito Bossone
MMG Padova
L. Attilio Boner
Prof. di Pediatria, Università di Verona
Ercole Concia
Prof. di Malattie Infettive e Parassitarie, Università di Verona
Abstract
COVID-19 pandemic taught us that the disease can be severe and characterized by significant immunopathology spurred by an exuberant, yet dysregulated, innate immune response with a poor adaptive response. A limited and delayed interferon I (IFN-I) and IFN-III response results in exacerbated proinflammatory cytokine production and in extensive cellular infiltrates in the respiratory tract, resulting in lung pathology. During the pandemic we had to recall to our mind that virus and bacteria may escape our immunity by means of immunological evasion, immune inertia, virus persistence and reactivation. Vaccines have been the major key for prevention of severe disease but also the modulation of the immune response played a major rule in severely compromised and fragile patients. It is biologically plausible to speculate that a healthy lifestyle with a diet rich in elements essential for optimal immune function could have been a prevention strategy to reduce the burden of the disease, both in terms of saved lives, pressure on health system and financial expenses.
Health jurisprudence
48 Attività medica extramuraria non autorizzata e conseguente danno erariale
Sergio Fucci
Giurista e bioeticista, già consigliere presso la Corte d’Appello di Milano
Abstract
The judgment under review reveals the risks that a physician employed by an ASL with an exclusive employment relationship assumes if, without having been specifically authorized, he or she carries out his or her professional activity in an extramural manner and without complying with the requirements imposed for intramural activity.
50 Ipotesi di responsabilità per la dedotta tardiva diagnosi di tumore pancreatico borderline resecabile
Sergio Fucci
Giurista e bioeticista, già consigliere presso la Corte d’Appello di Milano
Abstract
The judgment under review reveals the difficulties in ascertaining responsibility in a case of disputed manslaughter against a woman with borderline resectable pancreatic neoplasia and the importance of the contribution offered by the expert panel in cross-examination with the other experts.
52 Diritti fondamentali del paziente e suicidio medicalmente assistito
Sergio Fucci
Giurista e bioeticista, già consigliere presso la Corte d’Appello di Milano
Abstract
The Italian Parliament fails to legislate on the end of life, and jurisprudence is forced to deal with new cases that pose issues deemed unsolvable without first referring them to the Constitutional Court. It is necessary to verify whether there is room for its new intervention to expand the area of non-punishability beyond the boundaries established with sentence 242/2019.
Clinical pharmacology and pharmaco-economics
55 Due vaccini per la prevenzione della malattia delle basse vie aeree da virus respiratorio sinciziale
Carlo Manfredi
Farmacologo clinico, Massa Carrara
Abstract
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTD) in infants and young children and in the elderly ≥ 65 years of age. Two recombinant vaccines, Arexvy® and Abrysvo®, have been approved for prevention of lower respiratory tract disease (LRTD) caused by RSV in adults ≥60 years old. Abrysvo® is also approved for passive protection against LRTD caused by RSV from birth through 6 months of age following maternal immunization between 32 through 36 weeks gestation to protect their infants.
Topic of the year: From the emergency room to emergency and emergency medicine
63 Next coming Emergency Department. How ER used to be and how it is today
Filippo Manelli
U.O.C. Pronto Soccorso. ASST Bergamo Est (Seriate, BG)
Maria Sofia Cotelli
U.O.C. Neurologia. ASST Valcamonica (Esine, BS)
Abstract
In recent years, the issue related to the Emergency Department (ED) in its various expressions (admission, emergency-urgency, temporary observation, emergency medicine) has become increasingly relevant and topical. The recent SARS-COV2 pandemic has been a test case mainly for this sector, highlighting above all the structural, organizational and system limits of emergency care at the national, regional and local levels, in terms also of planning. Talking about PS in Italy is difficult primarily because there is a very wide variability of types and settings within the same service, to the point that it is impossible to draw a homogeneous picture representative of the system. However, the attempt to make an excursus of what was and what currently is the situation of EDs in Italy is an extremely difficult but necessary mission before describing in detail the various aspects of the subject.
Images
73 Tingling in a limb reveals a fatal clinical picture
Filippo Manelli, Stefano Alberti
U.O. Pronto Soccorso. ASST Bergamo Est Seriate (BG)
Mariachiara Michelini
U.O. Pronto Soccorso. ASST Valcamonica (Esine, BS)
Maria Sofia Cotelli
U.O. Neurologia. ASST Valcamonica (Esine, BS)
Abstract
A 22-year-old Caucasian youth admitted for first epileptic seizure characterized by tingling in the right upper limb and followed by loss of consciousness and tongue biting, in the absence of sphincter release. The findings appeared compatible with gliomatosis cerebri with diffuse infiltration of the parenchyma in the supratentorial site on the right and doubtful contralateral localization.
Learn from a question
29- 77 by Sossio Serra (Pronto Soccorso-Medicina d’urgenza - Ospedale M.Bufalini, Cesena (FC)) and Gemma C. Morabito (Dirigente medico Pronto Soccorso e OBI, Azienda Ospedaliera di Perugia)
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