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Prof. Dr. Davide Lonati
ICS Maugeri IRCCS

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Case reports
Published: 20 April 2021
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Chemical burns are a risk in domestic and occupational accidents due to the common use of caustic agents. Long-term sequelae are normally due to the amount of skin and underlying tissues damaged. We describe a case of work-related chemical burns with unusual evolution in guttate psoriasis. A 36 years-old man was admitted to the Emergency Department (ED) three-hours after a work accident. During the cleaning of an industrial hydraulic system, a jet of hydrochloric acid 20% injured his face and upper limbs. At ED admission, he presented first and second-degree skin burns on the frontal region, on the scalp, on the right forearm, and earlobe. Plastic surgery management consisted in wound topical dressing with silver sulfadiazine and paraffin gauze twice a week for one month. Forty-eight hours after the latter topical treatment (45-days after the work accident), in the same anatomical regions of the previous burn scars, he developed a skin reaction with itchy erythema. The application of topical products was suspended without improvement, excluding an allergic reaction. Within few days, a generalized guttate psoriasis was evident on the whole body. Despite many prevention actions, work-related burns are a relatively common cause of hospitalization and may involve up to 80% of patients admitted to a burn unit. Guttate psoriasis has not been described as a sequelae of chemical burns. In our case, the others most frequent factors causing guttate psoriasis have been ruled out. Considering the temporal link between the development of guttate psoriasis and the work accident, hydrochloric acid skin burns might have promoted the systemic inflammatory mediators’ mechanism involved in the development of guttate psoriasis lesion’s after the dermal injury.

ACS Style

Azzurra Schicchi; Marco M Tresoldi; Valeria M Petrolini; Davide Lonati; Maria Perrone; Carlo A Locatelli. Guttate psoriasis: a case of unusual evolution of an occupation-related skin chemical burns. 2021, 112, 168 -170.

AMA Style

Azzurra Schicchi, Marco M Tresoldi, Valeria M Petrolini, Davide Lonati, Maria Perrone, Carlo A Locatelli. Guttate psoriasis: a case of unusual evolution of an occupation-related skin chemical burns. . 2021; 112 (2):168-170.

Chicago/Turabian Style

Azzurra Schicchi; Marco M Tresoldi; Valeria M Petrolini; Davide Lonati; Maria Perrone; Carlo A Locatelli. 2021. "Guttate psoriasis: a case of unusual evolution of an occupation-related skin chemical burns." 112, no. 2: 168-170.

Letter to the editor
Published: 02 December 2020 in Clinical Toxicology
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ACS Style

Bruno Mégarbane; Mark Zammit; Davide Lonati. Management of caustic ingestion: the time has come for consensus guidelines. Clinical Toxicology 2020, 59, 765 -766.

AMA Style

Bruno Mégarbane, Mark Zammit, Davide Lonati. Management of caustic ingestion: the time has come for consensus guidelines. Clinical Toxicology. 2020; 59 (8):765-766.

Chicago/Turabian Style

Bruno Mégarbane; Mark Zammit; Davide Lonati. 2020. "Management of caustic ingestion: the time has come for consensus guidelines." Clinical Toxicology 59, no. 8: 765-766.

Original article
Published: 11 November 2020 in British Journal of Clinical Pharmacology
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Aim To study the predictive factors for the development of clinical manifestations in poisoning due to the erroneous taking of low‐dose methotrexate (MTX). Methods A retrospective observational study was performed. Only cases of erroneous administration in non‐oncologic outpatients were included (July 2008–March 2020). Results Forty‐one cases were included. It was the first‐time of methotrexate taking for all patients. In 36 cases, patients took MTX daily instead of weekly. In the other 5 patients, methotrexate was sold instead of methylergometrine. Clinical manifestations were absent in 12/41 patients (29.3%). All the 29 (70.7%) symptomatic patients recognized the medication error when developed clinical manifestations: dermatological, hematological and gastrointestinal symptoms. Statistical results showed that symptomatic patients were older, received a higher amount of total dose and were treated longer. Moreover, the probability of being symptomatic increases as function of the age and of the total dose. Asymptomatic patients were treated with folinic acid (30 mg/m2/day) for 5 days. Symptomatic patients were treated with folinic acid together with treatments for the specific clinical manifestations. No patients were treated with glucarpidase. All patients fully recovered. Conclusions When MTX is prescribed for the first time, it is important to clearly communicate with patients in order to avoid therapeutic errors. In our experience, the age, the total taken dose and the number of days of assumption are predictive for the presence/absence of clinical manifestations. These parameters must be evaluated together in order to identify patients needing a maximal starting treatment with folinic acid and a closer monitoring.

ACS Style

Azzurra Schicchi; Giulia Scaravaggi; Valeria M. Petrolini; Alberto Malovini; Davide Lonati; Marta Crevani; Eleonora Buscaglia; Carlo A. Locatelli. Poisoning related to therapeutic error in prolonged low‐dose methotrexate treatment. British Journal of Clinical Pharmacology 2020, 87, 2385 -2391.

AMA Style

Azzurra Schicchi, Giulia Scaravaggi, Valeria M. Petrolini, Alberto Malovini, Davide Lonati, Marta Crevani, Eleonora Buscaglia, Carlo A. Locatelli. Poisoning related to therapeutic error in prolonged low‐dose methotrexate treatment. British Journal of Clinical Pharmacology. 2020; 87 (5):2385-2391.

Chicago/Turabian Style

Azzurra Schicchi; Giulia Scaravaggi; Valeria M. Petrolini; Alberto Malovini; Davide Lonati; Marta Crevani; Eleonora Buscaglia; Carlo A. Locatelli. 2020. "Poisoning related to therapeutic error in prolonged low‐dose methotrexate treatment." British Journal of Clinical Pharmacology 87, no. 5: 2385-2391.

Letter to the editor
Published: 07 August 2020 in Clinical Toxicology
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ACS Style

Francesca Grulli; Davide Lonati; Anna Ronchi; Francesca Perotti; Arsenio Spinillo; Carlo A. Locatelli. Authors' reply to Comment on Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman. Clinical Toxicology 2020, 59, 84 -85.

AMA Style

Francesca Grulli, Davide Lonati, Anna Ronchi, Francesca Perotti, Arsenio Spinillo, Carlo A. Locatelli. Authors' reply to Comment on Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman. Clinical Toxicology. 2020; 59 (1):84-85.

Chicago/Turabian Style

Francesca Grulli; Davide Lonati; Anna Ronchi; Francesca Perotti; Arsenio Spinillo; Carlo A. Locatelli. 2020. "Authors' reply to Comment on Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman." Clinical Toxicology 59, no. 1: 84-85.

Review
Published: 07 August 2020 in Toxins
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Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.

ACS Style

Davide Lonati; Azzurra Schicchi; Marta Crevani; Eleonora Buscaglia; Giulia Scaravaggi; Francesca Maida; Marco Cirronis; Valeria Margherita Petrolini; Carlo Alessandro Locatelli. Foodborne Botulism: Clinical Diagnosis and Medical Treatment. Toxins 2020, 12, 509 .

AMA Style

Davide Lonati, Azzurra Schicchi, Marta Crevani, Eleonora Buscaglia, Giulia Scaravaggi, Francesca Maida, Marco Cirronis, Valeria Margherita Petrolini, Carlo Alessandro Locatelli. Foodborne Botulism: Clinical Diagnosis and Medical Treatment. Toxins. 2020; 12 (8):509.

Chicago/Turabian Style

Davide Lonati; Azzurra Schicchi; Marta Crevani; Eleonora Buscaglia; Giulia Scaravaggi; Francesca Maida; Marco Cirronis; Valeria Margherita Petrolini; Carlo Alessandro Locatelli. 2020. "Foodborne Botulism: Clinical Diagnosis and Medical Treatment." Toxins 12, no. 8: 509.

Letter to the editor
Published: 27 April 2020 in Clinical Toxicology
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ACS Style

Francesca Grulli; Davide Lonati; Anna Ronchi; Francesca Perotti; Arsenio Spinillo; Carlo A. Locatelli. Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman. Clinical Toxicology 2020, 59, 72 -73.

AMA Style

Francesca Grulli, Davide Lonati, Anna Ronchi, Francesca Perotti, Arsenio Spinillo, Carlo A. Locatelli. Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman. Clinical Toxicology. 2020; 59 (1):72-73.

Chicago/Turabian Style

Francesca Grulli; Davide Lonati; Anna Ronchi; Francesca Perotti; Arsenio Spinillo; Carlo A. Locatelli. 2020. "Management of high concentrations of cobalt and chromium in blood due to metal-on-metal hip arthroplasty in a pregnant woman." Clinical Toxicology 59, no. 1: 72-73.

Journal article
Published: 10 October 2018 in Toxicology Letters
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A method for the quantitation of α-fluoro-β-alanine (AFBA), the main metabolite of capecitabine (Cape) and 5-fluoruracil (5-FU), is described. Among antineoplastic drugs (ADs), 5-FU and Cape (the new oral prodrug) are the most commonly applied drugs in cancer therapy. The main objective of this study was to develop a reliable method that would be easy to run on a reversed-phase UHPLC system coupled to tandem mass spectrometry. AFBA was derivatized with Sanger's reagent to ensure complete yield of a stable 2,4 dinitrophenil-α-fluoro-β-alanine derivative. This method was based on the use of a mixed-mode anion exchange solid phase extraction enabling urinary extracts to be clear of endogenous interferences affecting quantitative results. The assay was validated in human urine according to FDA criteria with the use of a labeled internal standard (β-alanine-d4) to minimize experimental error. Good accuracy and precision were demonstrated by determining spiked urine QC samples in four consecutive days. The recovery of AFBA was between 70.0 and 82.6%, with a matrix effect that was 12.8% to 18.5%. The lower limit of quantitation (LOQ) was 0.5 ng/mL with a coefficient of variation of 5.3%. This assay was successfully applied to determine the levels of this metabolite in a large number of urine samples taken from personnel who were occupationally exposed to ADs.

ACS Style

Cristina Sottani; Elena Grignani; Laura Zaratin; Donatella Santorelli; Emanuele Studioso; Davide Lonati; Carlo A. Locatelli; Ornella Pastoris; Sara Negri; Danilo Cottica. A new, sensitive and versatile assay for quantitative determination of α-fluoro-β-alanine (AFBA) in human urine by using the reversed-phase ultrahigh performance-tandem mass spectrometry (rp-UHPLC–MS/MS) system. Toxicology Letters 2018, 298, 164 -170.

AMA Style

Cristina Sottani, Elena Grignani, Laura Zaratin, Donatella Santorelli, Emanuele Studioso, Davide Lonati, Carlo A. Locatelli, Ornella Pastoris, Sara Negri, Danilo Cottica. A new, sensitive and versatile assay for quantitative determination of α-fluoro-β-alanine (AFBA) in human urine by using the reversed-phase ultrahigh performance-tandem mass spectrometry (rp-UHPLC–MS/MS) system. Toxicology Letters. 2018; 298 ():164-170.

Chicago/Turabian Style

Cristina Sottani; Elena Grignani; Laura Zaratin; Donatella Santorelli; Emanuele Studioso; Davide Lonati; Carlo A. Locatelli; Ornella Pastoris; Sara Negri; Danilo Cottica. 2018. "A new, sensitive and versatile assay for quantitative determination of α-fluoro-β-alanine (AFBA) in human urine by using the reversed-phase ultrahigh performance-tandem mass spectrometry (rp-UHPLC–MS/MS) system." Toxicology Letters 298, no. : 164-170.

Journal article
Published: 29 June 2018 in Scientific Reports
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Medically relevant cases of snakebite in Europe are predominately caused by European vipers of the genus Vipera. Systemic envenoming by European vipers can cause severe pathology in humans and different clinical manifestations are associated with different members of this genus. The most representative vipers in Europe are V. aspis and V. berus and neurological symptoms have been reported in humans envenomed by the former but not by the latter species. In this study we determined the toxicological profile of V. aspis and V. berus venoms in vivo in mice and we tested the effectiveness of two antivenoms, commonly used as antidotes, in counteracting the specific activities of the two venoms. We found that V. aspis, but not V. berus, is neurotoxic and that this effect is due to the degeneration of peripheral nerve terminals at the NMJ and is not neutralized by the two tested antisera. Differently, V. berus causes a haemorrhagic effect, which is efficiently contrasted by the same antivenoms. These results indicate that the effectiveness of different antisera is strongly influenced by the variable composition of the venoms and reinforce the arguments supporting the use polyvalent antivenoms.

ACS Style

Giulia Zanetti; Elisa Duregotti; Carlo Alessandro Locatelli; Andrea Giampreti; Davide Lonati; Ornella Rossetto; Marco Pirazzini. Variability in venom composition of European viper subspecies limits the cross-effectiveness of antivenoms. Scientific Reports 2018, 8, 1 -9.

AMA Style

Giulia Zanetti, Elisa Duregotti, Carlo Alessandro Locatelli, Andrea Giampreti, Davide Lonati, Ornella Rossetto, Marco Pirazzini. Variability in venom composition of European viper subspecies limits the cross-effectiveness of antivenoms. Scientific Reports. 2018; 8 (1):1-9.

Chicago/Turabian Style

Giulia Zanetti; Elisa Duregotti; Carlo Alessandro Locatelli; Andrea Giampreti; Davide Lonati; Ornella Rossetto; Marco Pirazzini. 2018. "Variability in venom composition of European viper subspecies limits the cross-effectiveness of antivenoms." Scientific Reports 8, no. 1: 1-9.

Case reports
Published: 01 May 2018 in Journal of Addiction Medicine
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Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders. We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-D-aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens. This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.

ACS Style

Matteo Caloro; Giuseppa Calabrò; Eleonora de Pisa; Enrico Rosini; Georgios D. Kotzalidis; Davide Lonati; Carlo Alessandro Locatelli; Pietro Papa; Fabrizio Schifano; Paolo Girardi. Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder. Journal of Addiction Medicine 2018, 12, 247 -251.

AMA Style

Matteo Caloro, Giuseppa Calabrò, Eleonora de Pisa, Enrico Rosini, Georgios D. Kotzalidis, Davide Lonati, Carlo Alessandro Locatelli, Pietro Papa, Fabrizio Schifano, Paolo Girardi. Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder. Journal of Addiction Medicine. 2018; 12 (3):247-251.

Chicago/Turabian Style

Matteo Caloro; Giuseppa Calabrò; Eleonora de Pisa; Enrico Rosini; Georgios D. Kotzalidis; Davide Lonati; Carlo Alessandro Locatelli; Pietro Papa; Fabrizio Schifano; Paolo Girardi. 2018. "Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder." Journal of Addiction Medicine 12, no. 3: 247-251.

Journal article
Published: 28 February 2018 in Toxins
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Ciguatera fish poisoning (CFP) is the most prevalent non-bacterial food-borne form of poisoning in French Polynesia, which results from the consumption of coral reef fish naturally contaminated with ciguatoxins produced by dinoflagellates in the genus Gambierdiscus. Since the early 2000s, this French territory has also witnessed the emergence of atypical forms of ciguatera, known as ciguatera shellfish poisoning (CSP), associated with the consumption of marine invertebrates. In June 2014, nine tourists simultaneously developed a major and persistent poisoning syndrome following the consumption of the gastropod Tectus niloticus collected in Anaho, a secluded bay of Nuku Hiva Island (Marquesas Archipelago, French Polynesia). The unusual nature and severity of this event prompted a multidisciplinary investigation in order to characterize the etiology and document the short/long-term health consequences of this mass-poisoning event. This paper presents the results of clinical investigations based on hospital medical records, medical follow-up conducted six and 20 months post-poisoning, including a case description. This study is the first to describe the medical signature of T. niloticus poisoning in French Polynesia and contributed to alerting local authorities about the potential health hazards associated with the consumption of this gastropod, which is highly prized by local communities in Pacific island countries and territories.

ACS Style

Clémence Mahana Iti Gatti; Davide Lonati; Hélène Taiana Darius; Arturo Zancan; Mélanie Roué; Azzurra Schicchi; Carlo Alessandro Locatelli; Mireille Chinain. Tectus niloticus (Tegulidae, Gastropod) as a Novel Vector of Ciguatera Poisoning: Clinical Characterization and Follow-Up of a Mass Poisoning Event in Nuku Hiva Island (French Polynesia). Toxins 2018, 10, 102 .

AMA Style

Clémence Mahana Iti Gatti, Davide Lonati, Hélène Taiana Darius, Arturo Zancan, Mélanie Roué, Azzurra Schicchi, Carlo Alessandro Locatelli, Mireille Chinain. Tectus niloticus (Tegulidae, Gastropod) as a Novel Vector of Ciguatera Poisoning: Clinical Characterization and Follow-Up of a Mass Poisoning Event in Nuku Hiva Island (French Polynesia). Toxins. 2018; 10 (3):102.

Chicago/Turabian Style

Clémence Mahana Iti Gatti; Davide Lonati; Hélène Taiana Darius; Arturo Zancan; Mélanie Roué; Azzurra Schicchi; Carlo Alessandro Locatelli; Mireille Chinain. 2018. "Tectus niloticus (Tegulidae, Gastropod) as a Novel Vector of Ciguatera Poisoning: Clinical Characterization and Follow-Up of a Mass Poisoning Event in Nuku Hiva Island (French Polynesia)." Toxins 10, no. 3: 102.

Case reports
Published: 02 August 2017 in Undersea and Hyperbaric Medicine
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ACS Style

Vincenzo Zanon; Antonio Morri; Davide Lonati; Antonio Paoli; Enrico Mario Camporesi; Gerardo Bosco. HBO₂ in snake envenomation (atrox albinus rattlesnake): a case report in a human. Undersea and Hyperbaric Medicine 2017, 43, 473 -476.

AMA Style

Vincenzo Zanon, Antonio Morri, Davide Lonati, Antonio Paoli, Enrico Mario Camporesi, Gerardo Bosco. HBO₂ in snake envenomation (atrox albinus rattlesnake): a case report in a human. Undersea and Hyperbaric Medicine. 2017; 43 (4):473-476.

Chicago/Turabian Style

Vincenzo Zanon; Antonio Morri; Davide Lonati; Antonio Paoli; Enrico Mario Camporesi; Gerardo Bosco. 2017. "HBO₂ in snake envenomation (atrox albinus rattlesnake): a case report in a human." Undersea and Hyperbaric Medicine 43, no. 4: 473-476.

Case reports
Published: 26 June 2017 in Clinical Toxicology
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Ingestion of elemental mercury (Hg0) is considered non-toxic. After massive ingestion, local intestinal complications may develop: retention within appendix is quite frequent but treatment is debated. We describe a case of intentional ingestion of Hg0 requiring multi-step decontamination and prophylactic appendectomy. Case detail: A 19-year-old woman was admitted to ED for abdominal pain. History revealed ingestion of large amount of Hg0 as suicide attempt. To prevent absorption, facilitate elimination, and avoid complications a conservative approach was started. Due to inefficacy of initial maneuvers colonoscopy with irrigation/aspiration was performed, repeated whole bowel irrigation was continued and second colonoscopy was performed to clean residual metal. Abdominal plain films confirmed the presence of retained mercury within the appendix in asymptomatic patient. To reduce risk of appendicitis, potential perforation, and possibly systemic toxicity, a prophylactic laparoscopic appendectomy was performed at day 5 with removal of all retained mercury without peritoneal spillage. Highest mercury concentration was 22.7 mcg/L in serum (1-4.5 mcg/L) and 5.1 mcg/L in urine (0.1-5 mcg/L). After ingestion, metal retention in appendix is quite frequent. Evidence about optimal treatment are different and based on case reports. A multi-step approach with multidisciplinary evaluation tailored to the patient is suggested.

ACS Style

Andrea Michielan; Azzurra Schicchi; Roberto Cappuccio; Davide Lonati; Francesca Lamboglia; Alessandra Vitalba; Alessandro Caroli; Marta Crevani; Carlo A. Locatelli; Giorgio Betetto. Intentional ingestion of elemental mercury requiring multi-step decontamination and prophylactic appendectomy: a case report and treatment proposal. Clinical Toxicology 2017, 56, 69 -73.

AMA Style

Andrea Michielan, Azzurra Schicchi, Roberto Cappuccio, Davide Lonati, Francesca Lamboglia, Alessandra Vitalba, Alessandro Caroli, Marta Crevani, Carlo A. Locatelli, Giorgio Betetto. Intentional ingestion of elemental mercury requiring multi-step decontamination and prophylactic appendectomy: a case report and treatment proposal. Clinical Toxicology. 2017; 56 (1):69-73.

Chicago/Turabian Style

Andrea Michielan; Azzurra Schicchi; Roberto Cappuccio; Davide Lonati; Francesca Lamboglia; Alessandra Vitalba; Alessandro Caroli; Marta Crevani; Carlo A. Locatelli; Giorgio Betetto. 2017. "Intentional ingestion of elemental mercury requiring multi-step decontamination and prophylactic appendectomy: a case report and treatment proposal." Clinical Toxicology 56, no. 1: 69-73.

Journal article
Published: 15 June 2017 in Eurosurveillance
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Botulism is a rare but severe neuroparalytic disease caused by botulinum toxins. Because of its high potential impact on public health, botulism is a closely monitored communicable disease in Europe. In Italy, which has one of the highest incidence rates in Europe (0.03 cases per 100,000 population), botulism is monitored through a case-based passive surveillance system: the front-line physician who diagnoses a suspected case must notify the Local Health Units immediately, and the Ministry of Health's office within 12 hours. From 1986 to 2015, 466 confirmed cases of botulism were recorded in Italy (of 1,257 suspected cases). Of these, 421 were food-borne (the most frequently seen form of botulism due to the consumption of improperly home-canned foods), 36 were infant botulism, which accounts for ca 50% of all these types of cases registered in Europe, six were wound-related and three were due to adult intestinal colonisation. This scenario suggests that stronger efforts should be made towards raising public awareness of the risk of food-borne botulism, especially with respect to home-preserved foods, as well as improving the training of front-line medical personnel, to ensure that a quick and accurate diagnosis of botulism can be made.

ACS Style

Fabrizio Anniballi; Bruna Auricchio; Alfonsina Fiore; Davide Lonati; Carlo Alessandro Locatelli; Florigio Lista; Silvia Fillo; Giuseppina Mandarino; Dario De Medici. Botulism in Italy, 1986 to 2015. Eurosurveillance 2017, 22, 30550 .

AMA Style

Fabrizio Anniballi, Bruna Auricchio, Alfonsina Fiore, Davide Lonati, Carlo Alessandro Locatelli, Florigio Lista, Silvia Fillo, Giuseppina Mandarino, Dario De Medici. Botulism in Italy, 1986 to 2015. Eurosurveillance. 2017; 22 (24):30550.

Chicago/Turabian Style

Fabrizio Anniballi; Bruna Auricchio; Alfonsina Fiore; Davide Lonati; Carlo Alessandro Locatelli; Florigio Lista; Silvia Fillo; Giuseppina Mandarino; Dario De Medici. 2017. "Botulism in Italy, 1986 to 2015." Eurosurveillance 22, no. 24: 30550.

Review
Published: 28 March 2017 in Clinical Toxicology
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European viper bite is relatively uncommon but can cause serious envenoming, particularly swelling and hemorrhage spreading from limb to trunk that can cause long term disability. Systemic features are relatively mild compared to many other venomous species. Moderate-to-severe envenoming requires antivenom, which is given many hundreds of times each year across the continent. Several Vipera spp antivenoms are produced in Europe, but there is little comparative information available for the antivenoms and none is licensed with the European Medicines Agency. We aimed to collect descriptive data on European viper antivenoms and assess their relative effectiveness. A systematic review of articles relating to antivenom in Europe was performed using the Medline medical database. The following keywords "Europ*" or the individual names of each European country and "antiven*" or "immun*" or "envenom*" and "snake" or "viper*" or "adder" were used. Articles published between 1 January 1996 and 11 March 2016 pertaining to clinical outcome, including case reports, were selected. Referenced articles in the indexed articles were explored for suitability and included if they met any of the criteria: specific antivenom used, route of antivenom administration, adverse reactions to antivenom therapy and length of hospital admission. All accepted abstracts from EAPCCT conferences since 2000 were searched and abstracts relating to Vipera spp envenoming were assessed for suitability. We extracted data on study type, safety and effectiveness. We sought information on antivenoms from manufacturers and individual patient data from authors of publications. Since individual patient data were only rarely available, we compared median length of stay between case series reporting each antivenom. We identified 40 papers and six published abstracts, and one unpublished paper that reported clinical cases and case series of envenomed patients treated with antivenom. No publication reported randomized controlled trials comparing any European Vipera antivenom with either placebo or another antivenom. 25 reports were of retrospective hospital- (n = 13) or poison center-based (n = 12) case series including five or more patients; a further 12 reports were either case reports or case series with less than five patients and one paper was a limited literature review. An additional nine papers reported prospective data; seven collected data remotely through poison service telephone communication with the attending physicians. Antivenoms available in Europe: Eight antivenoms are available for European Vipera spp envenoming; a material safety data sheet providing information on manufacture was available for seven. Six are raised against V. berus or V. ammodytes venom; the seventh is raised against a mixture of V. ammodytes, V. aspis and V. berus venom and the eighth is raised against V. ammodytes, Macrovipera lebetina and Montivipera xanthina venom. Six manufacturers recommended intramuscular administration while two recommended intravenous administration. No randomized control trials comparing the effectiveness of antivenoms were identified. Pre-clinical data: We found two papers presenting comparative preclinical data. Clinical data: Clinical studies were predominantly retrospective and contained clinical data on antivenom used in 2602 patients; where the antivenom was identified (n = 2174), 2061 (94.8%) received Zagreb, ViperFAV or ViperaTAb antivenoms. There were few published data on the other antivenoms. Repeated use of antivenom: Repeat doses were reported in 230/1491 of cases (15.4%) where this information was recorded. Outcome and length of hospital stay: Intravenous administration of antivenom was associated with shorter length of hospital stay (median length of hospital stay in studies of intravenous ViperFAV or ViperaTAb ranged from 1 to 4.8 days versus 2 to 18 days for intramuscular Bulbio or Zagreb antivenoms). Antivenom versus no antivenom: Some small studies demonstrated no difference in the length of hospital stay in patients with equivalent envenomation grading who either did or did not receive antivenom. Adverse events: Adverse reactions were reported in 37 of 2408 cases (1.5%) including seven cases of anaphylaxis. There are very limited pre-clinical comparative data and no randomised controlled trials assessing effectiveness of the antivenoms against different Vipera species. Most descriptive data suggest the efficacy of Zagreb, ViperFAV and ViperaTAb antivenoms by the intravenous route but not intramuscular route, although this is level D evidence. Reported adverse reactions were rare, suggesting that the modern intravenous antivenoms are of good quality. Better and more systematic data, including perhaps randomized controlled trials comparing different antivenoms, are required for the many hundreds of antivenom administrations that occur annually across Europe.

ACS Style

Thomas Lamb; Luc de Haro; Davide Lonati; Miran Brvar; Michael Eddleston. Antivenom for European Vipera species envenoming. Clinical Toxicology 2017, 55, 557 -568.

AMA Style

Thomas Lamb, Luc de Haro, Davide Lonati, Miran Brvar, Michael Eddleston. Antivenom for European Vipera species envenoming. Clinical Toxicology. 2017; 55 (6):557-568.

Chicago/Turabian Style

Thomas Lamb; Luc de Haro; Davide Lonati; Miran Brvar; Michael Eddleston. 2017. "Antivenom for European Vipera species envenoming." Clinical Toxicology 55, no. 6: 557-568.

Letter to the editor
Published: 08 February 2017 in Clinical Toxicology
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ACS Style

Antonella Valli; Davide Lonati; Carlo Alessandro Locatelli; Eleonora Buscaglia; Marcello Di Tuccio; Pietro Papa. Analytically diagnosed intoxication by 2-methoxphenidine and flubromazepam mimicking an ischemic cerebral disease. Clinical Toxicology 2017, 55, 611 -612.

AMA Style

Antonella Valli, Davide Lonati, Carlo Alessandro Locatelli, Eleonora Buscaglia, Marcello Di Tuccio, Pietro Papa. Analytically diagnosed intoxication by 2-methoxphenidine and flubromazepam mimicking an ischemic cerebral disease. Clinical Toxicology. 2017; 55 (6):611-612.

Chicago/Turabian Style

Antonella Valli; Davide Lonati; Carlo Alessandro Locatelli; Eleonora Buscaglia; Marcello Di Tuccio; Pietro Papa. 2017. "Analytically diagnosed intoxication by 2-methoxphenidine and flubromazepam mimicking an ischemic cerebral disease." Clinical Toxicology 55, no. 6: 611-612.

Journal article
Published: 30 December 2016 in QJM: An International Journal of Medicine
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Scorpion envenomation may represent a life-threatening condition and, specifically in tropical, subtropical and sub-Saharan area, will be considered a public health problem. We describe a case of a 25-year-old Caucasian woman, suffering from severe scorpion envenomation by Leirus Quinquestratius. The patient presented a catecholamine induced myocarditis and myocardial dysfunction. Our observations, obtained by repeated cardiac magnetic resonance (CMR) assessments (11 days; 3, 9 and 15 months), firstly revealed a possible irreversible and sub-clinical myocardial damage. CMR seems to be a useful tool to assess cardiac damage in scorpion envenomation, particularly in terms of prevention of irreversible myocardial damage and dilated cardiomyopathy delayed development.

ACS Style

D. Lonati; C.A. Locatelli; Sherif Sabri; G. Moro; Oronzo Catalano. Cardiac magnetic resonance study of scorpion toxic myocarditis. QJM: An International Journal of Medicine 2016, 110, 113 -114.

AMA Style

D. Lonati, C.A. Locatelli, Sherif Sabri, G. Moro, Oronzo Catalano. Cardiac magnetic resonance study of scorpion toxic myocarditis. QJM: An International Journal of Medicine. 2016; 110 (2):113-114.

Chicago/Turabian Style

D. Lonati; C.A. Locatelli; Sherif Sabri; G. Moro; Oronzo Catalano. 2016. "Cardiac magnetic resonance study of scorpion toxic myocarditis." QJM: An International Journal of Medicine 110, no. 2: 113-114.

Case reports
Published: 01 September 2016 in Addictive Behaviors
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This document is the Accepted Manuscript of the following article: Matteo Caloro, et al, ???Use of benzylglycinamide by a HIV-seropositive polysubstance user: The changing pattern of novel psychoactive substance use among youths???, Addictive Behaviors, Vol. 60, pp. 53-57, September 2016. Under embargo. Embargo end date: 6 April 2018. The Version of Record is available online at doi: https://doi.org/10.1016/j.addbeh.2016.03.032. ?? 2016 Elsevier Ltd. All rights reserved.A 24-year old woman with multisubstance use since the age of 13, including opioids and cocaine, and long-standing HIV/HCV seropositivity status, presented with psychosis, agitation, and insomnia at the emergency department of a university hospital. She had been abusive and physically aggressive frequently without specific reasons and was involved in criminal legal cases. She was hospitalized twice. During her first hospital stay she experienced a brief episode of detachment from her environment, similar to episodes reportedly suffered at home. Psychosis had developed following heavy polysubstance abuse. Her mother provided sachets containing benzylglycinamide, a substance with no known psychotropic effects, which were also present in the patient's urine. She was occasionally positive for cannabinoids. She used to buy various novel psychoactive substances (NPSs) from the internet and used experimentally various substances freely made available to her by drug suppliers/dealers. She was unable to explain clearly why she was taking any of the identified NPS. She stated she was taking benzylglycinamide to calm her when smoking synthetic cannabinoids. While it appears that benzylglycinamide is not likely to constitute a novel drug of abuse, her polysubstance use exemplifies trends in NPS use patterns among the youths in the Western world and should alert mental health workers as to the possible dangers of such behavior and its reflection on social behavior and psychopathology

ACS Style

Matteo Caloro; Giuseppa Calabrò; Georgios D. Kotzalidis; Ilaria Cuomo; John Martin Corkery; Alessandro Emiliano Vento; Luana Lionetto; Sergio De Filippis; Valentina Ranieri; Davide Lonati; Carlo Alessandro Locatelli; Eleonora De Pisa; Antonio Di Tommaso; Paolo Girardi; Fabrizio Schifano. Use of benzylglycinamide by a HIV-seropositive polysubstance user: The changing pattern of novel psychoactive substance use among youths. Addictive Behaviors 2016, 60, 53 -57.

AMA Style

Matteo Caloro, Giuseppa Calabrò, Georgios D. Kotzalidis, Ilaria Cuomo, John Martin Corkery, Alessandro Emiliano Vento, Luana Lionetto, Sergio De Filippis, Valentina Ranieri, Davide Lonati, Carlo Alessandro Locatelli, Eleonora De Pisa, Antonio Di Tommaso, Paolo Girardi, Fabrizio Schifano. Use of benzylglycinamide by a HIV-seropositive polysubstance user: The changing pattern of novel psychoactive substance use among youths. Addictive Behaviors. 2016; 60 ():53-57.

Chicago/Turabian Style

Matteo Caloro; Giuseppa Calabrò; Georgios D. Kotzalidis; Ilaria Cuomo; John Martin Corkery; Alessandro Emiliano Vento; Luana Lionetto; Sergio De Filippis; Valentina Ranieri; Davide Lonati; Carlo Alessandro Locatelli; Eleonora De Pisa; Antonio Di Tommaso; Paolo Girardi; Fabrizio Schifano. 2016. "Use of benzylglycinamide by a HIV-seropositive polysubstance user: The changing pattern of novel psychoactive substance use among youths." Addictive Behaviors 60, no. : 53-57.

Comparative study
Published: 01 July 2016 in Toxicology Letters
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Although nanosized-titanium dioxide particles (TiO2NPs)-containing products are constantly placed on the market, little is known about their possible impact on human health, even regarding to CNS effects. In this study, mechanistic pathways, by which TiO2NPs induce cellular damage and death, have been investigated in human (astrocytes-like) D384 cells and comparatively weighed against the effects produced by the bulk counterpart. Cellular signals evaluated by multiple set of in vitro tests after 24h exposure to TiO2NP concentrations (0.5-125μg/ml) were: ROS production, p-p53, p53, p21, Bax, Bcl-2 and caspase 3. TiO2 cellular uptake was also estimated by both light microscopy and ICP-MS. ROS were generated starting at 1.5μg/ml and further increased at the highest concentrations (≥31μg/ml). At the same low concentration, an increased expression of p-p53, p53, p21, Bax, and activated caspase3 were also observed. Parallely, Bcl-2 decreased along with TiO2NP concentration increase. Similar alterations were observed when testing TiO2 bulk: cellular checkpoint perturbations were associated with rising intracellular Ti. The present data demonstrated that low TiO2NP concentrations were capable, after 24h, to induce subtle cellular perturbation in D384 cells after a single cell treatment, supporting the evidence that both oxidative stress and apoptotic mechanisms may occur in this type of CNS cells.

ACS Style

Uliana De Simone; Davide Lonati; Anna Ronchi; Teresa Coccini. Brief exposure to nanosized and bulk titanium dioxide forms induces subtle changes in human D384 astrocytes. Toxicology Letters 2016, 254, 8 -21.

AMA Style

Uliana De Simone, Davide Lonati, Anna Ronchi, Teresa Coccini. Brief exposure to nanosized and bulk titanium dioxide forms induces subtle changes in human D384 astrocytes. Toxicology Letters. 2016; 254 ():8-21.

Chicago/Turabian Style

Uliana De Simone; Davide Lonati; Anna Ronchi; Teresa Coccini. 2016. "Brief exposure to nanosized and bulk titanium dioxide forms induces subtle changes in human D384 astrocytes." Toxicology Letters 254, no. : 8-21.

Journal article
Published: 06 April 2016 in Clinical Toxicology
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Marco Marano; Davide Lonati; Carlo Alessandro Locatelli; Mara Pisani. Letter in response to: “Hyperglycemia is a risk factor for high-grade envenomations after European viper bites (Vipera spp.) in children”. Clinical Toxicology 2016, 54, 539 -539.

AMA Style

Marco Marano, Davide Lonati, Carlo Alessandro Locatelli, Mara Pisani. Letter in response to: “Hyperglycemia is a risk factor for high-grade envenomations after European viper bites (Vipera spp.) in children”. Clinical Toxicology. 2016; 54 (6):539-539.

Chicago/Turabian Style

Marco Marano; Davide Lonati; Carlo Alessandro Locatelli; Mara Pisani. 2016. "Letter in response to: “Hyperglycemia is a risk factor for high-grade envenomations after European viper bites (Vipera spp.) in children”." Clinical Toxicology 54, no. 6: 539-539.

Comparative study
Published: 01 May 2015 in NeuroToxicology
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Although in the last few decades, titanium dioxide nanoparticles (TiO2NPs) have attracted extensive interest due to their use in wide range of applications, their influences on human health are still quite uncertain and less known. Evidence exists indicating TiO2NPs ability to enter the brain, thus representing a realistic risk factor for both chronic and accidental exposure with the consequent needs for more detailed investigation on CNS. A rapid and effective in vitro test strategy has been applied to determine the effects of TiO2NPs anatase isoform, on human glial (D384) and neuronal (SH-SY5Y) cell lines. Toxicity was assessed at different levels: mitochondrial function (by MTT), membrane integrity and cell morphology (by calcein AM/PI staining) after acute exposure (4-24-48h) at doses from 1.5 to 250μg/ml as well as growth and cell proliferation (by clonogenic test) after prolonged exposure (7-10 days) at sub-toxic concentrations (from 0.05 to 31μg/ml). The cytotoxic effects of TiO2NPs were compared with those caused by TiO2 bulk counterpart treatment. Acute TiO2NP exposure produced (i) dose- and time-dependent alterations of the mitochondrial function on D384 and SH-SY5Y cells starting at 31 and 15μg/ml doses, respectively, after 24h exposure. SH-SY5Y were slightly more sensitive than D384 cells; and (ii) cell membrane damage occurring at 125μg/ml after 24h exposure in both cerebral cells. Comparatively, the effects of TiO2 bulk were less pronounced than those induced by nanoparticles in both cerebral cell lines. Prolonged exposure indicated that the proliferative capacity (colony size) was compromised at the extremely low TiO2NP doses namely 1.5μg/ml and 0.1μg/ml for D384 and SH-SY5Y, respectively; cell sensitivity was still higher for SH-SY5Y compared to D384. Colony number decrease (15%) was also evidenced at ≥0.2μg/ml TiO2NP dose. Whereas, TiO2 bulk treatment affected cell morphology only. TiO2 internalization in SH-SY5Y and D384 cells was appreciated using light microscopy. These findings indicated, that (i) human cerebral SH-SY5Y and D384 cell lines exposed to TiO2NPs were affected not only after acute but even after prolonged exposure at particularly low doses (≥ 0.1μg/ml), (ii) these in vitro critical doses were comparable to literature brain Ti levels detected in lab animal intranasally administered with TiO2NP and associated to neurotoxic effects. In summary, the applied cell-based screening platform seems to provide effective means to initial evaluation of TiO2NP toxicity on CNS.

ACS Style

Teresa Coccini; Stefania Grandi; Davide Lonati; Carlo Locatelli; Uliana De Simone. Comparative cellular toxicity of titanium dioxide nanoparticles on human astrocyte and neuronal cells after acute and prolonged exposure. NeuroToxicology 2015, 48, 77 -89.

AMA Style

Teresa Coccini, Stefania Grandi, Davide Lonati, Carlo Locatelli, Uliana De Simone. Comparative cellular toxicity of titanium dioxide nanoparticles on human astrocyte and neuronal cells after acute and prolonged exposure. NeuroToxicology. 2015; 48 ():77-89.

Chicago/Turabian Style

Teresa Coccini; Stefania Grandi; Davide Lonati; Carlo Locatelli; Uliana De Simone. 2015. "Comparative cellular toxicity of titanium dioxide nanoparticles on human astrocyte and neuronal cells after acute and prolonged exposure." NeuroToxicology 48, no. : 77-89.