Increasing diversion of prescribed benzodiazepines and Z-drugs to new psychoactive substances.

ABSTRACT: Over the last few years reports have indicated an increase in the number, type and availability of new psychoactive substances belonging to the benzodiazepine class. These molecules may pose high risks to users, since the majority have never undergone clinical trials or tests so their pharmacology and toxicology is largely unknown. However the new drug scenario emerging from the COVID-19 global pandemic seems to play a role in increasing the diversion of prescribed benzodiazepines and Z-drug. A brief presentation of this phenomenon is hereby presented. The awareness and response activities at national and international levels related to this issue should be enforced.

Commentary - Heroin purity and adulteration: an updated snapshot from the Italian Early Warning System.

Not Available.

Hepatotoxicity of paracetamol and related fatalities.

Paracetamol, also known as acetaminophen, is the most commonly used antipyretic and pain reliever and since 1955 it is available over-the-counter as a single formulation or in combination with other substances and, as indicated by the World Health Organization, it can be used in all the three steps of pain intensity. Paracetamol toxicity is one of the most common causes of poisoning worldwide. While paracetamol is described as relatively nontoxic when administered in therapeutic doses, it is known to cause toxicity when taken in a single or repeated high dose, or after chronic ingestion. Repeated supratherapeutic misuse, non-intentional misuse, and intentional ingestion may all result in hepatic toxicity, the main cause of acute liver failure (ALF) in the United States and Europe. Since paracetamol is responsible for nearly half of the cases in the US of acute liver failure and remains the leading cause of liver transplantation, continued awareness promotion, education and research should be constantly undertaken. We herein review the literature on paracetamol toxicity with particular attention to aspects of liver damage and related fatalities.

Choroidal findings in the course of idiopathic serous pigment epithelium detachment detected by indocyanine green videoangiography.

PURPOSE: To analyze the choroidal alterations associated with idiopathic serous pigment epithelium detachment. METHODS: Twenty-five consecutive patients affected by idiopathic serous pigment epithelium detachment underwent ophthalmoscopy, fluorescein angiography, and indocyanine green videoangiography. RESULTS: On indocyanine green videoangiography an early, complete, and homogeneous filling of the pigment epithelium detachment was always observed. In the late phases, the indocyanine green pattern depended on the size of the detachment. An idiopathic serous pigment epithelium detachment larger than the diameter of one optic disk was still hyperfluorescent in the late phases of indocyanine green videoangiography and was surrounded by a ring of brighter hyperfluorescence. An idiopathic serous pigment epithelium detachment smaller than the diameter of one optic disk usually could be visualized in the late phases as a hypofluorescent area surrounded by a hyperfluorescent ring. In 30 eyes (83.3%), choroidal hyperpermeability was observed. An irregular dilatation of the choroidal veins at the site or within an area the size of one disk diameter from the detachments could be visualized on indocyanine green videoangiography in 12 of 36 affected eyes (33.3%); in three cases an active focus of central serous chorioretinopathy with subretinal leakage developed in the follow-up period. CONCLUSION: The observation that pigment epithelium detachments frequently are associated with choroidal leakage and venous dilatation supports the hypothesis that an idiopathic serous pigment epithelium detachment is a variant of central serous chorioretinopathy. Moreover, the choroidal permeability alterations detected by indocyanine green videoangiography would support the theory of Gass that idiopathic serous pigment epithelium detachments could be caused by exudation of fluids from the choroidal vessels.

Bilateral Acanthamoeba keratitis in a gas-permeable contact lens wearer.

Acanthamoeba keratitis is an uncommon but potentially devastating complication of contact lens wear that has been reported with increasing frequency since its first description in 1974. We describe a case of bilateral Acanthamoeba keratitis, which occurred in a 24-year-old man, wearing gas-permeable contact lenses. This is to our knowledge the first case of Acanthamoeba keratitis reported in Italy, and the fourth bilateral case reported in the literature. Medical therapy (carried out after the first week by a different institution, due to the absence of essential antiamebic drugs on the Italian market) was effective in stopping the progression of the disease.

Choroidal filling in age-related macular degeneration: indocyanine green angiographic findings.

We studied the choroidal filling patterns in 145 patients with age-related macular degeneration (AMD), looking for a correlation with choroidal neovascularization (CNV). We found a correspondence in 71% of cases between the site of the CNV and watershed areas and in 59% of cases between the CNV and areas of 'delayed choroidal filling'. These data support the hypothesis of a relationship between areas of presumed choroidal ischemia and evolution of AMD complicated with CNV.

Neuroradiological examinations in optic neuropathies.

The advantages and limits of both CT and NMR imaging of optic nerve lesions are outlined and some examples are produced. Advantages of CT scanning are high resolution, multiplane reconstruction, quickness of examination, reliability, whereas the limits are the presence of artifacts from contiguous bone structures, the use of enhancement media and radiation damage. NMR is superior to CT scanning for detection of soft tissue lesions and possibility of multiplane scanning, but duration and high costs of the examination and some artifacts caused by ocular movements are limits to be taken into account. Both the techniques provide useful complementary information for the diagnosis of orbital lesions involving the optic nerve.

[R-(+)-alpha-methylbenzylimidazol-5-carboxylate (etomidate), a new anesthetic of ophthalmological importance]. / L'R-(+)-alfametil-benzil-imidazolo-5-carbossilato (etomidate) nuovo anestetico di interesse oftalmologico.

Data showing that a new i.v. anaesthetic, R-(+)-alphamethyl-benzyl-imidazol-5-carboxylate (Etomidate), leads to an approximately 3.3 mmHg fall in ocular pressure below the baseline are presented. The drug was also accompanied by a 14.1 mmHg and 12 beats/min decrease in A.P. and heart rate respectively. Further work on the various effects of this anaesthetic is required, since the paper is limited to its investigation in the induction stage.