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Giussy Barbara,1,2 Valentina Albertini,3 Veronica Maria Tagi,4 Lidia Maggioni,5 Maria Carlotta Gorio,6 Cristina Cattaneo,5 Fabio Parazzini,2 Elena Ricci,2 Laura Buggio,1 Alessandra Kustermann1 1Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 3Department of Emergencies, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 4Department of Paediatrics, University of Chieti, Chieti, Italy; 5Department of Biomedical Science, Legal Medicine Section, University of Milan, Milan, Italy; 6Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milan, Milan, ItalyCorrespondence: Laura Buggio, Gynecological Unit and SVSeD, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12, Milan, 20122, Italy, Tel +39 02 5503 2917, Fax +39 02 50320264, Email buggiolaura@gmail.comIntroduction: Sexual violence against young girls is a pervasive multifaceted phenomenon which embraces several different forced sexual acts, including attempted and/or completed rape, sexual coercion and harassment, and sexual contact with force or threat of force. The aim of this study is to evaluate the characteristics of sexual violence in adolescent girls, by a retrospective analysis of 731 consecutive cases of sexually abused girls.Materials and Methods: We analyzed demographic characteristics, risk factors for rape, and the eventual subsequent presence and type of ano-genital lesions.Results: We found that sexual violence with penetration was perpetrated in 591 (80%) cases. Vulnerability factors related with a major risk of rape were age > 17 years old and consumption of alcohol and/or other drugs. About 196 (55%) victims had at a least one genital lesion.Conclusion: A prompt identification of red flags of sexual violence may help physicians in suspecting and managing cases of sexual assault in adolescent girls, even in the absence of typical lesions.Keywords: sexual violence, gender violence, rape, adolescent, genital lesions

Abstract Background Major depressive disorder (MDD) patients not responding to two or more different antidepressant treatments are currently considered to suffer from treatment resistant depression (TRD). Recently, intranasal esketamine has been approved by both the American Food and Drug Administration and European Medicines Agency for TRD and, more recently, in moderate to severe episode of MDD, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitute a psychiatric emergency. There is currently no indication for obsessive–compulsive disorder (OCD) although recently published studies have already shown a rapid and significant reduction of OCD-like symptoms following ketamine administration. The etiology of OCD has not yet been fully elucidated but there is a growing evidence that glutamate signaling dysfunction in the cortico-striatal–thalamo-cortical circuitry plays an essential role. This case report exemplifies possible clinical effects of esketamine on both depressive and OCD symptoms. Case presentation We present the case of a 39-year-old man suffering from TRD. During the first evaluation at our clinic, he also reported the presence of OCD spectrum symptoms, causing him to perform time-consuming mental rituals due to pathological doubts regarding the relationship with his wife as well as intrusive thoughts regarding his mental conditions. He underwent psychometric evaluations, therapeutic drug monitoring analysis, and pharmacogenomic tests. The overall results helped to explain patient’s treatment-resistance. Moreover, we observed a significant reduction in both depressive and OCD symptoms after administration of esketamine. Conclusion This case underlines the importance of pharmacogenomic tests in profiling TRD patients and confirms the possible use of esketamine in the treatment of comorbid OCD.