Age estimation in children and young adolescents for forensic purposes using fourth cervical vertebra (C4).

The aim of this study was to evaluate the applicability of using the growth of the body of C4 vertebra for the estimation of age in children and young adolescents. We used the fact that the proportions between the radiologic projections of the posterior and anterior sides of the C4 vertebral body, which forms a trapezoidal shape, differ with age: in younger individuals, the posterior side is higher, whereas in older individuals, the projections of the sides of the vertebral body form a rectangular shape with the two sides equal or with the anterior side slightly higher. Cephalograms of 444 Italian subjects (214 female and 230 male individuals) aged between 5 and 15 years and with no obvious development abnormalities were analyzed. The projections of the anterior side (a) and of the posterior side (b) of each C4 body were measured, and their ratio (Vba), as a value of the C4 body development, was used for age estimation. Distribution of the Vba suggested that it does not change after 13 years in female and 14 years in male subjects. Consequently, we restricted our analysis of the Vba growing model until 14 years in both sexes. We used a Bayesian calibration method to estimate chronological age as function of Vba as a predicting variable. The intra- and inter-observer agreement was satisfactory, using intra-class correlation coefficient of Vba on 30 randomly selected cephalograms. The mean absolute errors were 1.34 years (standard deviation 0.95) and 1.01 years (standard deviation 0.71), and the mean inter-quartile ranges of the calibrating distribution were 2.32 years (standard deviation 0.25) in male and 1.72 years (standard deviation 0.39) in female individuals, respectively. The slopes of the regression of the estimated age error to chronological age were 0.02 in male and 0.06 in female individuals, where both values did not result significantly different from 0 (p > 0.12). In conclusion, although our Bayesian calibration method might not really outperform the classical regression models in the precision of its estimates, it appears to be more robust, to greatly reduce the typical bias inherent in the regression model approach, and to have the ability to incorporate multiple predictors.

Efficacy and tolerability of tapentadol prolonged release in the elderly and fragile patient: an observational study.

The article "Efficacy and tolerability of tapentadol prolonged release in the elderly and fragile patient: an observational study, M. Zampi published in Eur Rev Med Pharmacol Sci 2019; 23 (4 Suppl): 45-50. DOI: 10.26355/eurrev_201911_19371. PMID: 31755084" has been withdrawn from the authors. This article has been withdrawn. The Publisher apologizes for any inconvenience this may cause.

Efficacy and tolerability of tapentadol prolonged release in the elderly and fragile patient: an observational study.

OBJECTIVE: The incidence of chronic pain increases with age and comorbidities, a particularly relevant issue in the elderly over the age of 80 years. Thus, the choice of the best analgesic treatment is difficult to make. The therapeutic priority in elderly patients is to favor the least invasive route of administration, and the minimum effective dose, with a gradual and slow up-titration, if needed. Tapentadol with its dual mechanism of action, combining synergistically a reduced load (<40% that of strong opioids) of µ-opioid receptor agonism (MOR) with noradrenaline reuptake inhibition (NRI), can be an interesting analgesic option for geriatric patients, because of its easy manageability, the lower rate of adverse effects, the good level of analgesia, and the ability of improving the overall quality of life of elderly patients. PATIENTS AND METHODS: A total of 49 elderly patients (>80 years) with chronic pain from different etiologies received tapentadol PR daily over 8 weeks. RESULTS: At the end of the study, responders to treatment were 43% (20/47 patients). Compared with baseline, pain intensity, both at rest and during loading, decreased by 60% and by 55%, respectively (p<0.0001). Tolerability was high throughout the study period, with 92% of patients grading it either good or excellent during follow-up. In total, 16 episodes of side effects were reported, with five considered severe and leading to therapy discontinuation. Ten cases of therapy discontinuation occurred, most of them (five patients, 10%) due to the ineffectiveness of analgesic treatment. CONCLUSIONS: Tapentadol PR, adequately titrated according to patients' need, are safe and effective to control pain in most elderly patients.

Hair analysis in order to evaluate drug abuse in driver's license regranting procedures.

In Italy, driving under the influence of drugs determines the suspension of the offender's driver's license. To regain the license the person must be drug free during an observation period. People whose license has been revoked or suspended can obtain, or re-obtain their driver's license subject to the judgment of a medical commission. The exclusion of illicit drug use is determined by means of toxicological analysis, mainly on urine or hair matrices. We reported the results of several years of experience of the forensic toxicology laboratory of the University of Macerata in the use of hair analysis for the assessment of past exposure to drugs in people suspected of driving under the influence of drugs. From 2004 to 2013, 8612 hair samples, were analyzed for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ(9)-THC) using gas chromatography/mass spectrometry (GC/MS) method. We used a cutoff (SoHT or national guidelines) to determine the positive data, regardless of the hair sample concentrations. 1213 samples resulted positive, 71.7% were positive for cocaine and metabolites, 19.8% for morphine and metabolites, 8.5% for Δ(9)-THC. We also studied the timeframe of the abuse, as well as gender and age distribution of positive subjects. Moreover, we analyzed the possible deterrent effect of the hair analysis on driving under the influence of psychoactive substances.

[Topical pharmacologic approach with 5% lidocaine medicated plaster in the treatment of localized neuropathic pain]. / Approccio farmacologico topico con lidocaina cerotto 5% nel trattamento del dolore neuropatico localizzato.

The treatment of neuropathic pain is a medical challenge. The responsiveness to the different classes of drugs is often unsatisfactory and frequently associated to a wide range of side effects. International guidelines suggest for the "localized" neuropathic pain the topical treatment with 5% lidocaine medicated plaster, alone or associated to systemic drugs, as the first choice since its favorable efficacy and tolerability profile. Many clinical experiences support the rationale for using 5% lidocaine medicated plaster in different kinds of localized neuropathic pain, such as postherpetic and trigeminal neuralgia, compressive syndromes, painful diabetic polyneuropathy and pain secondary to trauma or surgical interventions. This paper reports a series of clinical cases whose heterogeneity suggests the wide burden of applicability of the topical 5% lidocaine, either alone and associated to systemic drugs. All the described conditions were characterized by a highly intense pain, not adequately controlled by actual medications, which improved after the use of topical lidocaine. The good response to lidocaine allowed the reduction, of even the withdrawal, of concurrent drugs and improved the patients' quality of life.

[Poisons and men: historical, legal and toxicological aspects]. / Il veleno e l'uomo: aspetti storici, giuridici e tossicologici.

Humanity has always practised the poisoning. At first, magic and mistery characterized this ritual. Then, thanks to a more careful legislation and to empirical research it became subject of toxicology.