Acute pancreatitis caused by methimazole/carbimazole assumption: a case-series

The World Health Organization (WHO) has listed 525 different drugs, that can lead to acute pancreatitis cases, as a medication side-effect. Among them, methimazole (MMI also known as thiamazole, the active form of carbimazole [CBZ]) was included. We reported case reports of patients with overall features compatible with acute pancreatitis episodes following and presumably triggered by the exposure to MMI and its prodrug CBZ. A systematic search was performed on MEDLINE (PubMed). We included case reports of patients with overall features compatible with acute pancreatitis episodes following and presumably triggered by the exposure to MMI and its prodrug CBZ Data extraction and analysis were undertaken in duplicate. We identified 7 case reports. Most patients were female, and one patient was male. Mean age at baseline ranged from 18 to 80 years old. The average time, that elapses between the initiation of the therapy with MMI/CBZ and the onset of typical clinical signs and symptoms pathognomonic of acute pancreatitis, was 2-3 weeks. Based on the data derived from these case reports, it could be considered the possibility of a potential association between MMI/CBZ exposure. Evidence is, however, limited and requires more studies of high quality to confirm this association.

The Dedalo Project, a Community-based Prevention Program for the Promotion of Healthy Behaviors in Adult Population: Model Description and Target Population Assessment

Noncommunicable diseases (NCDs) are the leading global cause of death. The Italian National Prevention Plan (INPP) highlights the importance of health promotion and NCD prevention while avoiding health inequalities. In line with the INPP guidelines, we initiated a multicomponent community-based intervention program, named the Dedalo project, to promote healthy and active aging among population living around the Vercelli’s municipality, Italy. A cross-sectional analysis, that used the baseline data of a longitudinal study of the project, evaluated the program’s ability to enroll participants participants who represent the socioeconomic conditions present in the municipality. To this end, we compared the main social characteristics and behaviors of 40–74-year-old subjects (n = 155), who had attended at least one Dedalo activity, to those of same age individuals (n = 124) randomly extracted from the general population. We found that most participants were women (81.3%) and had a higher SES compared to the general population. Furthermore, they were healthier—OR 0.52, 95% CI 0.31–0.87 for self-reported diseases—and displayed healthier behaviors—OR 0.20, 95% CI 0.08–0.46 for smokers; 0.32 95%, CI 0.16–0.64 for fruit/vegetable consumers; and 0.36 95% CI 0.20–0.64 for sweet beverages consumers. Overall, our initial evaluation indicates that the Dedalo project has so far struggled to enroll individuals with low SES, men with any SES, and subjects displaying unhealthy behaviors, thereby failing to meet the INPP goal of preventing NCDs while avoiding health disparities. Thus, efforts should be made to ensure that this community-based intervention program can effectively reach all the target population, in particular those individuals most exposed to behavioral risk factors.

Suicide presentation and the risk at the time of the mandatory quarantine for the SARS-Cov-2 pandemic: medico-legal and forensic aspects

Introduction

COVID-19 pandemic is the most important health emergency of the 21st century. Since the high number of infected people and as there is still no specific therapy worldwide, the pandemic has been countered through the application of prevention measures based on social distancing and home isolation. These elements are known risk factors for the development of various psychiatric conditions. From a forensic point of view, these pathologies are related to a high suicide rate.

Objectives

It is no coincidence that during the previous pandemics that have occurred in history there has been a significant increase in suicides. By this work, we therefore want to highlight the psychological consequences of a pandemic and the importance of preventive strategies.

Methods

It is important to focus not only on physical well-being but also on the psychological aspects that the pandemic produces in the daily life of each individual

Results

If the infecting agent causes the death of millions of people around the world, the socio-economic context that is created indirectly determines as many deaths.

Conclusions

Therefore it is necessary to underline how it is advisable to implement preventive measures in order to significantly reduce deaths from suicide, a problem with an important impact in the social and forensic fields.

Disclosure

No significant relationships.

The impact of the covid-19 pandemic on the risk of social stigma

Introduction

Social stigma indicates a process of negative connotation of a person which results in discrimination. The victim of stigma experiences a condition of social exclusion that negatively affects his relationships. The COVID-19 pandemic has spread the fear of being “contaminated”, which has led to the discrimination of a part of population.

Objectives

The purpose of this work is to analyze which people have suffered from stigma due to the COVID-19 pandemic by examining the negative effects on their health during this period.

Methods

A literature review of peer-reviewed articles was performed on Pubmed NCBI database by inserting the keywords: stigma and COVID-19 in the period 2020-2021.

Results

The data showed that the categories most at risk were positive patients and their families; healthcare workers in COVID-19 wards; Asian people. Discrimination has included avoidance attitudes, physical or verbal abuse, hypersurveillance in public places. Negative effects on victims included anxiety, depression, feelings of rejection and shame, self-harm and suicide. COVID-19 patients attempted to hide the disease by avoiding access to hospital; health personnel developed risk of burnout; Asian restaurants experienced a drop in reservations, even after quarantine period.

Conclusions

Social stigma is a public health problem and greater efforts are mandatory to reduce it including correct information, with the help of social and mass media; social interventions aimed at generating empathy; avoiding the use of negative language focused on stereotypes that could generate fear or discrimination. Such interventions are crucial to reduce discrimination in such a fragile period as COVID-19 pandemic.

Disclosure

No significant relationships.

“Second victims” in Covid-19 pandemic: A cross-sectional study among medical doctors of the Catanzaro Hospital

Introduction

Medical errors are a serious public health problem. The COVID-19 pandemic has caused further stress to doctors with the increase in patient mortality, the lack of definite guideline and growing work demands. In this scenario, the patient is not the only victim of the medical error. The “second victim” (SV) is defined as a health worker who was involved in an unforeseen and negative event for the patient, who suffers physically and psychologically, because he was traumatized by his own mistake and/or by the injuries caused to the patient. The SV phenomenon prevalence varies from 10.4% up to 43.3%.

Objectives

The aim of this study is to evaluate the second victim phenomenon during the COVID-19 pandemic among medical doctors of the Catanzaro University Hospital (Italy).

Methods

A cross-sectional study will be conducted by administering an anonymous questionnaire to the Catanzaro University Hospital medical doctors using SurveyMonkey software. Descriptive analysis will be performed.

Results

The data collection is ongoing. Currently, 300 subjects are included in the sample.

Conclusions

The second victim phenomenon has a negative impact on doctors, colleagues and patients. It is important to aid health workers involved in an adverse event by activating support networks and adopting appropriate strategies in order that the event is a source of learning and not of demotivation.

Disclosure

No significant relationships.

KAMBO: NATURAL DRUG OR POTENTIAL TOXIC AGENT? A LITERATURE REVIEW OF ACUTE POISONING CASES

Kambo is the name of a natural substance derived from the glandular secretions of the amphibian Phyllomedusa bicolor, a species native to regions in South America. The communities living in these areas administer the substance generally transdermally during rituals for religious-purifying purposes, producing small skin burns. The scientific literature has reported some cases of intoxication following the use of Kambo but this aspect is still poorly understood. In fact, no shared therapy protocols exist for these events nor any real legislation on Kambo. The purpose of this work was to examine all cases of acute intoxication resulting from the administration of Kambo and published over the last 10 years, illustrating clinical signs, laboratory findings, instrumental tests, and therapy. The several cases identified in our review confirm that acute Kambo intoxication can occur, with serious and life-threatening effects. We developed a protocol aimed at the early diagnosis of cases of suspected acute intoxication by creating a treatment algorithm. The study aims to investigate the pathophysiology of these events in humans, proposing a protocol for the diagnosis and treatment of these cases that can be used by healthcare professionals.

•

The use of Kambo has spread for distribution worldwide through numerous websites.

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The literature review confirmed that acute Kambo intoxication include possible side effects.

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Intoxication may affect various systems with laboratory or instrumental alterations.

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Intoxication may be reversible if promptly diagnosed and treated.

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An algorithm with adequate triage can support diagnosis and treatment.

Methimazole Treatment and Risk of Acute Pancreatitis: A Population-based Cohort Study

CONTEXT

A warning has been recently issued by the European Medicine Agency (EMA) regarding a potential increased risk of acute pancreatitis (AP) in methimazole (MMI) users.

OBJECTIVE

To investigate the association between MMI and the diagnosis of AP in a population-based study.

MATERIALS AND METHODS

A retrospective analysis of administrative health databases was conducted (2013-2018). Relevant data were obtained from: (1) inhabitants registry, (2) hospital discharge records (ICD-9-CM 577.0), and (3) drug claims registry (ATC H03BB02). We evaluated AP risk in MMI users in 18 months of treatment, stratifying results by trimester. Poisson regression was used to estimate the age- and sex-adjusted rate ratios (RR), and the relative 95% confidence intervals (CI), comparing rates of AP between MMI users and nonusers. The absolute risk of AP in MMI users was also calculated.

RESULTS

A total of 23 087 new users of MMI were identified. Among them, 61 hospitalizations occurred during the study period. An increase in AP risk was evident during the first 3 trimesters of therapy (RR 3.40 [95% CI: 2.12-5.48]; RR 2.40 [95% CI: 1.36-4.23]; RR 2.80 [95% CI: 1.66-4.73]), but disappeared thereafter. The AP absolute risk in MMI users during the first 18 months of treatment was less than 0.4% in all sex and age classes.

CONCLUSIONS

Our results support the EMA warning, suggesting an increased risk of AP associated with MMI use. However, such an increase seems limited to the first months of MMI treatment. Moreover, in absolute terms, the probability of AP is low among patients, well below 1%.

Is Caloric Restriction Associated with Better Healthy Aging Outcomes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Global dietary patterns have gradually shifted toward a 'western type' with progressive increases in rates of metabolic imbalance. Recently, animal and human studies have revealed positive effects of caloric restriction (CR) on many health domains, giving new knowledge for prevention of ill and health promotion; Methods: We conducted a systematic review (SR) of randomized controlled trials (RCTs) investigating the role of CR on health status in adults. A meta-analysis was performed on anthropometric, cardiovascular and metabolic outcomes; Results: A total of 29 articles were retrieved including data from eight RCTs. All included RCTs were at low risk for performance bias related to objective outcomes. Collectively, articles included 704 subjects. Among the 334 subjects subjected to CR, the compliance with the intervention appeared generally high. Meta-analyses proved benefit of CR on reduction of body weight, BMI, fat mass, total cholesterol, while a minor impact was shown for LDL, fasting glucose and insulin levels. No effect emerged for HDL and blood pressure after CR. Data were insufficient for other hormone variables in relation to meta-analysis of CR effects; Conclusion: CR is a nutritional pattern linked to improved cardiometabolic status. However, evidence is limited on the multidimensional aspects of health and requires more studies of high quality to identify the precise impact of CR on health status and longevity.

The silent deaths of the elderly in long-term care facilities during the Covid-19 pandemic: The role of forensic pathology

The Covid-19 pandemic is currently a major global public health problem. We know that the elderly and people with chronic diseases contract the infection more easily and they develop clinically more serious and often lethal forms. To date, the reasons for this have been generically attributed to old age and underlying diseases. Most Covid-19 deaths occurred in long-term care facilities because the residents are elderly people with chronic illness living in close contact. Therefore, facilities have become epidemic outbreaks. Forensic knowledge is very limited because an autopsy is rarely performed. Post-mortem investigations can help increase knowledge about Covid-19 and identify any undiagnosed pathologies in life. Therefore, forensic investigations play a role in protecting a frail population. Autopsies should be encouraged on elderly people who died of Covid-19.

The impact of the Covid-19 pandemic on domestic violence: The dark side of home isolation during quarantine

Domestic violence is a global public health problem. It takes many different forms and leads to significant physical and psychological consequences for the victim and the whole family. Situations that may prompt episodes of violence in the family include stress, emotional disappointment, economic factors, bad and cramped housing, and alcohol or drug abuse. How does the government's forced home isolation to contain Covid-19 infections impact on this type of abuse? Numerous articles have reported a decrease in reports of domestic violence since quarantine began but how reliable is these data? Is it a potential wake-up call for public institutions? We discuss the risks associated with quarantine measures during the pandemic and suggest the measures to prevent and improve the reporting of abuse cases.

Covid-19 emergency in prison: Current management and forensic perspectives

The Covid-19 pandemic is currently a major worldwide public health problem. Contagion within prisons and in other custodial settings will need to be addressed promptly, but the management of preventive measures will be difficult due to overcrowding and inmates and officers' close physical contact. There may also be less access to care than in community settings. Accordingly, prisons are particularly vulnerable to outbreaks of infection, and in addition to the likely greater risks of contagion attention must be paid to the psychological problems that the pandemic can have on the prison population. Riots and episodes of violence have already taken place in various prisons. With the inevitable restrictions on social contact and family meetings, prisoners who already are at increased risk of mental illness and suicide are more susceptible to adverse psychological repercussions. From a forensic point of view, therefore, we stress the need for the development of a strong support network by mental health workers for the prison population.

Multiple sclerosis and celiac disease: is there an increased risk?

Multiple sclerosis and celiac disease are both considered immune-mediated diseases. Recently, improved serological screening methods provided a higher prevalence of celiac disease (CD) in the general population worldwide and also demonstrated gastrointestinal symptoms may be lacking. The aim of this study was to determine the prevalence of (CD) in an unselected group of 95 adults with multiple sclerosis using transglutaminase antibodies. No patients showed pathological values. Different immune and genetic basis between the two diseases may represent crucial insights to explain our results.

Adhesion of mononuclear cells from multiple sclerosis patients to cerebral vessels in cryostat sections of normal human brain

Leukocyte extravasation across the blood-brain barrier is a critical event in the pathogenesis of multiple sclerosis (MS). This complex multistep process includes the adhesion of leukocytes to the endothelial cells of the central nervous system microvasculature. To investigate this phenomenon in MS, we developed a modified version of the frozen-section assay. Peripheral blood mononuclear cells (PBM) from 26 MS patients, 26 healthy controls and 10 patients with other inflammatory non- neurological diseases (OIND) were co-incubated with cryostat sections of normal brain white matter, immunohistochemically labelled with anti-CD45 antibody and counterstained with Giemsa stain. CD45-positive PBM adherent to transected microvasculature were counted with an automated image analyzer. MS patients showed an increased number of vessel-bound PBM (48.8 +/- 36.4) with respect to healthy controls (27.4 +/- 20.7, P = 0.01) and OIND patients (22.6 +/- 7.8, P = 0.01). Significant differences were also obtained counting the number of vessel-bound PBM as a percent of total vascular cells between MS patients (12.7 +/- 7.2%) and healthy controls (6.9 +/- 5.4%, P = 0.002) or OIND patients (7.4 +/- 4.4%, P = 0.03). We confirm that PBM from MS patients show an increased potential of binding to cerebral vessels. The frozen-section assay provides a unique tool to study in situ the molecular interactions of leukocytes with brain vascular structures.

Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests

We evaluated the risk of developing clinically definite multiple sclerosis (CDMS) after an acute attack of isolated optic neuritis (ON) in 112 patients, in relation to demographic and paraclinical findings. Patients were examined by brain MRI, CSF analysis, and multiple evoked potentials (EPs); 10 were lost to follow-up, and the other 102 were enrolled in a prospective study (follow-up duration 6. 3 +/- 2.2 years). Of these, 37 (36.3%) developed CDMS after a mean interval of 2.3 +/- 1.6 years. The risk of developing CDMS was 13% after 2 years, 30% after 4, 37% after 6, and 42% after 8 and 10 years. Gender, age, and season of ON onset did not affect the risk. MS occurred in 37 of 71 patients (52.1%) with one MRI lesion or more; no patient with a normal MRI developed the disease. MS developed more frequently in patients with intrathecal IgG synthesis than in those without (43% vs. 28%), but the difference was not statistically significant. Multiple EPs showed a slight predictive value only including somatosensory EPs of the lower limb. Multiple sclerosis was mild in most cases (EDSS 2.2 +/- 1.9). The EDSS was less than 4 in 32 cases (86%), between 4 and 6 in 2 (5%), higher than 6.5 in 3 (8%).

Peripheral benzodiazepine receptor expression on leukocytes and neutrophil function during anticonvulsant monotherapy

Epileptic patients on long-term therapy with a single anticonvulsant showed enhanced expression of peripheral benzodiazepine receptors (pBZrs) on neutrophils, monocytes and lymphocytes. N-Formyl-methionyl-leucyl-phenylalanine-induced chemotaxis was significantly impaired in neutrophils from patients on carbamazepine (p < 0.01 vs. controls). Neutrophils from patients on phenytoin had enhanced phorbol myristate acetate-stimulated O-2 production (p < 0. 01 vs. controls) and neutrophils from patients on valproic acid had impaired phagocytosis frequency and Staphylococcus aureus lethality index (p < 0.01 vs. controls). Overexpression of pBZrs on leukocytes may reflect the clinical response to anticonvulsants and may play a role in the immunological effects of some of these drugs.

Carbamazepine affects neutrophil function through an action on peripheral benzodiazepine receptors

The aims of this study were to assess the possible role of peripheral benzodiazepine receptors (pBZrs)1 in mediating the in vitro effects of carbamazepine (CBZ) on some neutrophil functions in healthy volunteers and to investigate neutrophil function and pBZr expression in patients with epilepsia on CBZ monotherapy for at least 1 year. In vitro CBZ (42-168 microM) concentration-dependently inhibited chemotaxis induced by N-formyl-methionyl-leucyl-phenylalanine (FMLP) or lipopolysaccharide (LPS)-activated human serum. CBZ did not affect random migration, phagocytosis index, phagocytosis frequency, NBT reduction frequency, C. albicans lethality index and resting superoxide production. The pBZr antagonist PK 11195 (1 microM, per se ineffective) reversed the inhibitory effect of CBZ on chemotaxis induced by endotoxin-activated serum or FMLP. The pBZr agonist Ro 5-4864 (10-100 microM) mimicked the effect of CBZ on chemotaxis induced by endotoxin-activated serum or FMLP and had no effect on the other parameters. Neutrophils from epileptic patients on chronic CBZ monotherapy had impaired FMLP- and serum-induced chemotaxis and enhanced expression of pBZrs on neutrophils. These data strongly suggest an involvement of pBZrs in mediating the in vitro effects of CBZ on chemotaxis; furthermore, impairment of the same neutrophil function parameters and overexpression of pBZrs in patients are consistent with the hypothesis of an in vivo interaction of CBZ with pBZrs.

In vitro cytokine, sCD23 and IgG secretion in multiple sclerosis

Synthesis of IgG by peripheral blood mononuclear cells from patients with multiple sclerosis (MS) and with other neurological diseases and from healthy controls was induced by Pokeweed mitogen (PWM) in short-term cultures. As expected, MS patients produced more immunoglobulin (Ig) G and had a higher percentage of 'high responders' to PWM stimulation as compared to controls. Interleukin (IL)-4 was undetectable in all samples. IL-6 and tumor necrosis factor (TNF)-alpha synthesis was induced by PWM stimulation in all groups, but MS patients showed the most significant increase of both cytokines. Interestingly, only MS patients showed a significant increase of the soluble form of CD23 receptor (sCD23). Moreover, only sCD23 levels correlated with in vitro IgG production in MS patients. The levels of IL-6, TNF-alpha, sCD23 were greater in high responders compared to low responders in all groups. The mean value of each molecule, however, did not differ significantly among overall groups. A highly significant difference was reported for sCD23 in MS patients. We suggest that sCD23, also known as B cell growth factor, may play a role in the well-documented phenomenon of in vitro IgG hypersynthesis in MS patients, adding support to the concept of B cell up-regulation in the peripheral blood of these patients.

Erectile impotence in multiple sclerosis: a neurophysiological study

Pudendal evoked potentials, motor evoked potentials of the bulbocavernosus muscle to magnetic stimulation and bulbocavernosus reflex were recorded in 34 patients with multiple sclerosis (MS). Responses were delayed in 26, 20 and 3 cases respectively. No relationship was found between neurophysiological abnormalities and the presence or severity of erectile dysfunction, showing that these tests have little diagnostic usefulness in MS patients with impotence. Nocturnal penile tumescence was assessed in 14 cases: the test result was normal in 10 patients, including 3 severely paraplegic subjects.

Interleukin-2 receptor expression on blood monocytes of patients with multiple sclerosis

We studied the expression of class II MHC product (HLA DR) and IL-2 receptor on circulating monocytes (M phi) in MS patients, neurological and healthy controls, by double color flow cytometry. In all groups most M phi were DR+ without significant differences. More interesting, low percentages of IL-2+ M phi were detectable in healthy and neurological controls, whilst a few MS patients with active disease showed higher levels. This finding is in agreement with similar studies in other T-cell mediated diseases and with the report of rare IL-2+ macrophages in MS plaques. Although the actual role of IL-2+ M phi in the immune response still needs elucidation, our findings suggest their relevance to the pathological process of demyelinating disease.

Perineal motor potentials to magnetic stimulation, pudendal evoked potentials and perineal reflex in women

Motor potentials to transcranial and lumbar magnetic stimulation were recorded from the perineum in 14 healthy women. The response to transcranial stimulation presented an onset at 20.2 +/- 1.3 ms and a negative peak at 25.1 +/- 1.9 ms. Lumbar responses presented an onset at 5.1 +/- 0.8 ms, and the motor central conduction time measured 14.4 +/- 1.5 ms. Perineal reflex, cortical and lumbar pudendal evoked potentials were recorded after electrical stimulation of the labia minora. These tests are of possible clinical use in the evaluation of sphincter disturbances as they investigate the afferent and efferent pathways concerning pudendal nerve function.

Motor potentials of inferior orbicularis oculi muscle to transcranial magnetic stimulation. Comparison with responses to electrical peripheral stimulation of facial nerve

Magnetic stimulation at the vertex evoked a motor potential (MP) in the inferior orbicularis oculi muscle of 10 healthy subjects with an onset latency of 8-13 msec. Its amplitude increased and its latency decreased when the muscle was contracted: the latency measured 9.5 +/- 1.3 msec with an intensity of stimulation 10-15% above threshold in the contracted muscle. This MP is secondary to excitation of the motor cortex. With the coil placed over the occipital scalp and the same stimulation intensity, an MP was recorded with an onset latency at 4.5 +/- 0.6 msec. This response reflects the activation of the facial nerve root. The peripheral electrical stimulation of the facial nerve at the mandible angle elicited an MP with an onset latency at 3.5 +/- 0.4 msec. Most records showed the presence of late components at about 30 msec for all types of stimulation.

Study of central and peripheral motor conduction in normal subjects

Motor potentials to transcranial and cervical magnetic stimulation and F-wave were recorded in 37 arms of 25 normal subjects. Clockwise and anticlockwise cervical stimulation were performed over C5, C7 and T2 spinous processes. A significant correlation was found between height and measurements of central and peripheral motor conduction. Peripheral motor conduction measured by F-wave derived techniques (Kimura formula) was 0.5 msec higher as compared with responses to cervical magnetic stimulation. The site and current flow direction of cervical magnetic stimulation influenced the amplitude of responses but not their latency: responses were larger in the right arm when the centre of the coil was placed over the C5 spinous process and clockwise stimuli were used. The same results were obtained in the left arm when the coil was reversed.

Multimodality evoked potentials in amyotrophic lateral sclerosis

Visual, brainstem auditory and somatosensory evoked potentials to medial nerve stimulation were recorded in 27 patients affected by amyotrophic lateral sclerosis. VEP N75, P100, N140, N75-P100 latencies and P100 amplitude, BAEP I-III, III-V and I-V interpeak-latencies were within normal limits in all ALS patients. Somatosensory evoked potentials were abnormally delayed in 8 patients: in 3 arms because of a delayed N9-N13 latency, in 9 arms because of a delayed N13-N19 latency.

[Clinical, immunologic and electrophysiologic correlations in evaluating multiple sclerosis in relation to its development]

49 patients with multiple sclerosis (MS) were evaluated on several lines of investigation: clinical examination with disability rating scale, disease activity staging, multimodal evoked potentials and cerebrospinal fluid analysis. 24 patients were monthly re-examined and T-cell subsets were analysed in the peripheral blood. Evoked potentials were re-evaluated every 3 months in 24 patients. All paramethers were correlated in transversally and longitudinally during a 3 to 18 months follow-up. The results are discussed in the view of a methodological approach to a laboratory evaluation of disease evolution in its natural course and during therapeutic trials.

[Action of trazodone on pyramidal hypertension. Clinical study]

18 patients with severe stabilized pyramidal hypertonia were treated with Trazodone for a minimum period of 60 days with a daily oral dose of 200-300 mg. The reduction of hypertonia was assessed using the Ashworth Scale to evaluate symptoms and signs. On the whole 12 patients showed a clinical improvement; eight of them showed an improvement of at least 2 items on the Ashworth Scale. The reduction of hypertonia began on the 4-5th day of therapy, progressing until the 10-12th day of treatment and then remained constant. Tolerance was very good. Despite the low number of patients in the study the authors obtained good results suggesting that Trazodone should be studied further in this field.

A case of myasthenia gravis associated with optic neuritis

A case of myasthenia gravis is described in association with optic neuritis in which brain-stem auditory and somatosensory evoked potentials were normal. CSF contained alkaline oligoclonal IgG bands. Blood lymphocyte subpopulations showed a decreased number of T-suppressor cells.

[A case of Creutzfeldt-Jakob disease. Electroencephalographic and immunobiological aspects]

A case of Creutzfeld Jakob disease is described from an E.E.G. and immunological point of view. The E.E.G. data at various stages of the disease are described and the presence of intrathecally produced IgG antibodies is pointed out.

Multiple tests in the diagnosis of multiple sclerosis

Visual evoked potentials (VEPs), somatosensory evoked potentials (SEPs), E-UFA test and CSF isoelectrofocusing (IEF) were applied to 42 multiple sclerosis patients. VEPs were abnormal in 29 cases. SEPs in 31 cases, E-UFA in 30 cases, CSF IEF in 38 cases. At least two tests were abnormal in 41 out of 42 patients; 16 cases revealed pathological responses in three tests (38,1%), 15 in four of them (35,7%). The authors discuss the value of using several tests in the diagnosis of multiple sclerosis and emphasize their importance for the purpose of diagnostic classification.

[Neurophysiological tests in the diagnosis of multiple sclerosis. Visual and somatosensory evoked potential studies]

Visual evoked potentials were recorded and found abnormal in 44 out of 57 multiple sclerosis (M.S.) patients (77%). Somatosensory evoked potentials were abnormal in 42 cases (73%). Both tests were abnormal in 56 out of 57 cases. The two tests have a complementary role in the assessment of M.S., showing a subclinical involvement of visual or sensory pathways in many cases. The high incidence of abnormal responses in patients with a short duration of the disease and in patients diagnosed as possible or probably M.S. suggests the aid of the tests in diagnosis of M.S.

[Exploration of the optic and somatosensory pathways with cerebral evoked potentials]

Visual and somatosensorial evoked potentials are the electrical response, recorded on the scalp, that follows the presentation of visual and sensorial stimuli. After briefly mentioning the technical premises enabling evoked responses to be obtained from EEC activity, some cases are reported (demyelining, degenerative, compressive, ischaemic, anoxic pathology) where visual or sensory evoked potentials presented changes, proof of the usefulness of these techniques for the purposes of clinical documentation or for diagnosis in different fields of DNS pathology.

[Multiple sclerosis: epidemiological research in the province of Varese]

Epidemiological research has been carried out on multiple sclerosis in the province of Varese. The index of prevalence of the disease at 31-12-1975 was 24.176%. The geomedical figures for the province are reported and a comparison made with similar research carried out in 1966. The clinical aspects of the disease are discussed in relation to a group of patients from other Italian provinces.

Erythrocyte electrophoretic mobility test for multiple sclerosis

A blood test for M.S., E-UFA test, was reviewed with statistical analysis. The test was positive in 18 out of 22 M.S. patients, negative in the controls and OND. The results confirm the validity of the test.

[Visual evoked potentials and the E-UFA test. Laboratory contribution to the diagnosis of multiple sclerosis]

Visual evoked potentials (VEPs) and electrophoretic mobility test of erythrocytes (E-UFA test) were compared in 50 multiple sclerosis (M.S.) patients as diagnostic tests. Abnormal VEPs were recorded in 35 patients. E-UFA test was found positive in 31 cases. With respect to Mc Alpine diagnostic criteria, 26 out of 33 definite M.S., 6 out of 9 probable M.S. and 3 out of 8 possible M.S. cases had abnormal VEPs. A positive response in E-UFA test was observed rispectively in 16, 8, 7 patients. Complessively 48 cases (96%) had an abnormal response to the one and/or to the other of the two tests, which apper complementar in early diagnosis of M.S.

Erythrocyte unsaturated fatty acid test (E-UFA test): a biological test to detect optic neuritis as initial feature of multiple sclerosis

Retrobulbar optic neuritis, though suspicious is not always considered as a possible onset of MS. For this reason we submitted to the E-UFA (erythrocyte unsaturated fatty acid) test, 41 subjects who suffered from one or several episodes of retrobulbar optic neuritis with no other neurological signs. The test was positive in 14 subjects (34, 1%).

[Biochemical aspects of lipid metabolism in multiple sclerosis]

The biochemical features of lipid metabolism in multiple sclerosis are discussed and the contribution made by work on the aetiopathogenesis of the disease is illustrated. Reference is made to diagnostic tests (E-UFA and MEM tests), whose premisses are based on lipid metabolism. A link between biochemical and immunological research in this field is put forward.

E-UFA test in multiple sclerosis

Field et al. have recently suggested a blood test for multiple sclerosis based on determination of the absolute electrophoretic mobility of erythrocytes alone and in the presence of linoleic acid (LA) or arachidonic acid (AA). We attempted to reinvestigate this phenomenon in an Italian population.

HLA typing on Italian multiple sclerosis population

Considerable evidence suggests the existence of significant differences of HLA distribution between M.S. patients and normal healthy subjects of the same population. In the present work we investigate whether the antigen DW2 may be a better marker for M.S. than the specificities at the loci A and B by means of in vitro one-way mixed lymphocyte cultures.