Objective Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population. Study Design Retrospective study. Setting Primary health care facility. Methods The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study. Results A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported. Conclusions Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.

Aim: We examined evidence on infective and noninfective endocarditis obtained from a database of 50,403 clinical autopsies performed at an Italian general hospital between January 1983 and December 2006. Materials and Methods: Out of 814 endocarditis cases, 409 were of infective endocarditis (IE) and 405 non-infective (NIE). The median age at the time of death was 78 years for those with IE and 83 for those with NIE. Data were collected on gender, clinical history, comorbidities, kind of affected valve (nonprosthetic/mechanical/biological), pathological features of endocarditis, endocarditis complications and microbiological agents. Results: The diagnosis of IE was frequently missed and these conditions were often complicated by cardiovascular events. IE was more common among patients with prior valve infection or cardiovascular surgery, while malignancies were frequent comorbidities of NIE. Conclusion: In general, we found several data that differ from those generally present in the scientific literature, and this could be explained by the fact that data on IE and NIE are generally obtained from surgical and clinical databases, while we analysed only autoptic cases.Endocarditis is a common clinical problem characterized by lesions known as vegetations, and is defined as inflammation of the endocardium that mainly, but not exclusively, affects the heart valve leaflets. Historically, endocarditis is classified as infective (IE) and non-infective (NIE) on the basis of whether or not it is caused by infections.NIE can be caused by mechanical stress, chemical agents, immunological factors (Libman-Sacks, post-rheumatic disease, hypereosinophilic syndrome, or systemic lupus erythaematosus), or directly by turbulent blood flow that may mechanically damage the endocardium (non-bacterial thrombotic endocarditis). Moreover, it can be associated with hypercoagulable states or malignancies (nonbacterial thrombotic/marantic endocarditis).From a clinical point of view, NIE and IE have similar signs and symptoms and it is difficult to differentiate between them. Furthermore, they are associated with a consistent risk of misdiagnosis: For example, it is not rare that the hypothesis of health-care associated IE is neglected among elderly patients with multiple comorbidities because of the low specificity of usual clinical presentation (1). The diagnosis can also be completely missed, and in these cases, cardiac and extra-cardiac complications of both IE and NIE can be responsible for unexpected sudden death (2-4).These considerations help to explain why endocarditis is often diagnosed only at autopsy. However, a missed diagnosis of endocarditis is not always due to medical errors: For example, in several cases, the first clinical manifestation of NIE is a lethal stroke or severe systemic embolization, and thus the diagnosis is necessarily made only at autopsy (3).In general, pathologists have a paramount role in this field; even when endocarditis is not the cause of death, it can provide crucial information and hints to the exami...

AKB48 is a designer drug belonging to the indazole synthetic cannabinoids class, illegally sold as herbal blend, incense, or research chemicals for their psychoactive cannabis-like effects. In the present study, we investigated the in vivo pharmacological and behavioral effects of AKB48 in male rats and measured the pharmacodynamic effects of AKB48 and simultaneously determined its plasma pharmacokinetic. AKB48 at low doses preferentially stimulated dopamine release in the nucleus accumbens shell (0.25 mg/kg) and impaired visual sensorimotor responses (0.3 mg/kg) without affecting acoustic and tactile reflexes, which are reduced only to the highest dose tested (3 mg/kg). Increasing doses (0.5 mg/kg) of AKB48 impaired place preference and induced hypolocomotion in rats. At the highest dose (3 mg/kg), AKB48 induced hypothermia, analgesia, and catalepsy; inhibited the startle/pre-pulse inhibition test; and caused cardiorespiratory changes characterized by bradycardia and mild bradipnea and SpO2 reduction. All behavioral and neurochemical effects were fully prevented by the selective CB1 receptor antagonist/inverse agonist AM251. AKB48 plasma concentrations rose linearly with increasing dose and were correlated with changes in the somatosensory, hypothermic, analgesic, and cataleptic responses in rats. For the first time, this study shows the pharmacological and behavioral effects of AKB48 in rats, correlating them to the plasma levels of the synthetic cannabinoid.Chemical Compound Studied in This Article: AKB48 (PubChem CID: 57404063); AM251 (PubChem CID: 2125).

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