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Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients. This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes. We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments. The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress. [ABSTRACT FROM AUTHOR]

Despite the wealth of documented case studies, systematic approaches to correlate landslide characteristics with the damage they cause to bridges are rare. The correlation is challenging due to the complexity of landslides, which can vary in movement types, volume, velocities, materials, and orientations. Additionally, the lack of universally applicable models to forecast bridge responses in case of landslide interaction adds complexity. Recognizing the urgency of addressing this challenge, various countries, including Italy, have introduced guidelines and strategies to manage infrastructure risks and enhance safety. Efforts are underway to develop practical tools for authorities and infrastructure managers, encompassing factors influencing bridge response, especially under the action of natural hazards. This article presents a database of landslide-bridge interactions in Italy, developed under the FABRE Consortium. The database was compiled by analysing 382 bridges across 12 Italian regions. The article explores correlations between landslide characteristics and risk classification for bridges, defined as "Landslide Class of Attention" (L-CoA). The analysis shows that landslide volume is directly correlated with L-CoA severity, with larger volumes leading to higher classifications. Very slow-moving landslides are prevalent in high-risk L-CoA categories, suggesting they are associated with significant volumes and severe consequences. Complete interference between landslides and infrastructure poses the highest risk, while partial interference also contributes significantly. Combined landslides tend to result in more severe L-CoA classifications. The findings underscore the importance of better understanding the interactions between landslides and bridges, to develop predictive models and mitigate the risks posed by landslides to infrastructure in Italy and beyond. [ABSTRACT FROM AUTHOR]

Sydenham's Chorea (SC) is a neuropsychiatric disorder and a major manifestation of acute rheumatic fever. The erroneous assumption that SC is a benign and self-limiting disease, has led to a lack of high-quality scientific evidence of the therapeutical and prognostic features of SC. We retrospectively analyzed the medical records of patients <18-years old with SC in 17 Italian pediatric centers. Recorded data included clinical, instrumental and laboratory parameters. Prognostic risk factors including treatment regimens were assessed with univariate and multivariate sub-analysis. We included 171 patients with SC. 66% had generalized chorea, and 34% hemichorea. 81% had carditis (subclinical in 65%). Additional neurological symptoms were reported in 60% of the patients, mainly dysarthria and dysgraphia. 51% had neuropsychiatric symptoms at onset, which persisted after 12 months in 10%. Among psychiatric manifestations, the most common was anxiety disorder/depression (77%). Neurological remission was reached by 93% of the patients at 6 months; 9% relapsed. Patients were treated as follows: 11% penicillin alone, 37% immunomodulatory therapy, 16% symptomatic drugs (i.e. anti-seizure medication, dopamine antagonists) and 37% both symptomatic and immunomodulatory treatment. Neurological outcome did not differ between groups. Patients receiving symptomatic drugs had a higher risk of relapse on multivariate analysis (p = 0.045). Treatment of SC was largely heterogeneous. Based on our results, immunomodulatory therapy did not show higher efficacy at medium term, although it was associated to a slightly lower risk of relapse compared to symptomatic therapy. Longitudinal studies are needed to assess specific risk factors and best treatment options. • SC is a post-streptococcal disease causing a typical movement and psychiatric disorder. • Evidence-based guidelines for SC are currently lacking. • Treatment heterogeneity was high in our national retrospective multicenter cohort. • Treatment with immunotherapy or symptomatic drugs did not differ in terms of outcome. • Use of symptomatic drugs was associated with a slight increased risk of relapse. [ABSTRACT FROM AUTHOR]

A working group was established to develop a core domain set (CDS) for Chronic Nonbacterial Osteomyelitis (CNO) and Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) following the OMERACT filter 2.1. A scoping review to identify disease-related manifestations was performed, followed by a special interest group (SIG) session at OMERACT2020 to begin the CNO/SAPHO CDS framework. Candidate items were identified from the scoping review and most fell under Life Impact and Pathophysiology Manifestation core areas. A SIG agreed on the need to develop a CDS for CNO and SAPHO (100%) and for children and adults (91%). Based on candidate items identified, qualitative research and Delphi surveys will be performed as next steps. [ABSTRACT FROM AUTHOR]

Abstract Objective Localized scleroderma is a skin fibrosing disorder that, if untreated, may result in severe disability. The purpose of this systematic review is to compare the present evidence concerning the effectiveness of Methotrexate versus phototherapy, alone or associated with Psoralen, in childhood localized scleroderma. Method A systematic search between January 1996 and May 2017 was performed to identify studies investigating the efficacy of Methotrexate (MTX) or phototherapy (UVA) for treating localized scleroderma with onset ≤18 years. Due to a lack of validated clinical criteria, four clinical response criteria were used to assess the treatment efficacy as primary outcome. We determined a combined estimate of the proportion of children responding to MTX and UVA. Results A total of 19 studies was included (8 MTX; 11 UVA). In the methotrexate group, 193 children were included in the analysis; in the phototherapy group, a total of 48 treated children. For both groups age, disease subtype, glucocorticoids (GCs) use, and side effects of treatment were also analyzed. The meta-analysis suggested that UVA and MTX protocols have both a favorable effect in active lesions of childhood localized scleroderma. However, MTX resulted significantly superior to UVA, with or without Psoralen. Conclusion Our study supports the combination of MTX and GCs in patients with a high risk of complication. Phototherapy with UVA1 could represent a therapeutic option in patients with limited scleroderma, where lesions do not cross joints and they do not lead to potential cosmetic changes. [ABSTRACT FROM AUTHOR]

Many natural phenomena (rock or snow avalanches, and debris flows) as well as industrial processes are characterized by the flow of solid particles. A key issue in the development of a numerical tool for the study of this problem is the implementation of a suitable constitutive model, capable of capturing the complex rheological behaviour of the granular material in a wide range of strain rates. At the micro-scale level, the grains interacts by enduring frictional contacts or by nearly instantaneous collisions. The first mechanism prevails at low shear rates, when the material behaves like a solid (quasi-static conditions); the latter prevails at high shear rates, when it behaves like a fluid or a granular gas (collisional conditions). This paper presents a new constitutive model able to describe the behaviour of granular materials from quasi-static to collisional conditions and the transition in between. The stress tensor is assumed to be the sum of a quasi-static and a collisional contribution: the former one is modelled by adopting an elasto-plastic model incorporating the critical state concept, whereas the latter stems from the kinetic theory of granular gases. The features of the constitutive model are illustrated with a volume element test; moreover the model has been implemented in the MPM code Anura3D and applied to the simulation of triaxial tests. [ABSTRACT FROM AUTHOR]

Contact between bodies is one of the most challenging problems to solve, especially when combined with large deformations. For MPM, several methods have been developed to simulate frictional contact, i.e. shear stress is proportional to the normal stress via a friction coefficient; however, for cohesive soils under undrained conditions the interface shear stress is more likely a function of the undrained shear strength and independent of the normal stress (adhesive contact). This paper presents the extension of one of the most widely used contact algorithms in MPM for adhesive contact. This enhanced formulation is validated with a sliding block benchmark and applied to the simulation of cone penetration testing (CPT) in clay. CPT is an in situ test commonly used in geoengineering to determine the subsoil's stratigraphy and to estimate soil parameters. It is shown that the adhesion at the cone-soil interface affects significantly the measured cone resistance. Numerical results are compared with available analytical and experimental studies, showing the effectiveness of the proposed method to describe undrained penetration in clay. [ABSTRACT FROM AUTHOR]

Flows of granular materials are among the most destructive of all landslide phenomena. The assessment of the potential damage caused by the granular flow and the design of protection structures require the knowledge of the landslide-structure interaction. Numerical simulations of these phenomena are very complex because large displacements, soil-structure interaction and complex non-linear soil behavior have to be considered. A key issue in the simulation of these phenomena is the definition of a constitutive model able to describe the granular material response under a wide range of strain rates. This study examines and compares the results obtained by different constitutive models, namely the elastic perfectly plastic model with Mohr-Coulomb failure criterion, and the viscoplastic model with Drucker-Prager yielding condition. To this aim, we consider a finite volume of granular material instantaneously released from the top of an inclined channel; the material flows downslope and bumps a rigid wall on which the forces are measured. [ABSTRACT FROM AUTHOR]

Within the framework of a programme aimed at monitoring the impact of fish farming on the marine biota, we have had the opportunity to study the effect of the organic enrichment caused by the fish farm on meiofauna abundances and Kinorhyncha communities’ structure over two farming cycles. Up to now, studies on kinorhynchs have focussed mostly on the taxonomy, biogeography, and the ultrastructure, and, more recently, on the phylogenetic aspects of the taxon. Only few studies have dealt with the ecology of these creatures and studies focusing on the response of these animals to disturbances of anthropogenic origin are rare. The study took place in the Western Mediterranean and fauna was investigated based on three replicate cores collected from eight sites: one beneath the farm, four along a transect with increasing distances from the farm, and three control sites. Density data from beneath the cage and the three control sites was analysed within a beyond-B.A.C.I. (Before-After, Control-Impact) with asymmetrical sampling design, while a Before-After approach was used to analyse data from other sites. The latter approach was applied also to investigate the environmental variables from all the surveyed sites. Overall, 21 major meiofaunal groups were found in the area, with total densities ranging from 595 to 6818 ind/10 cm 2 . We recorded a variation of the densities of several taxa after each cycle. In particular, we observed a significant increase of the total meiofauna and nematodes abundances, and a marked decrease of kinorhynchs diversity and density at the sites beneath and near the farming ‘Cage’. Conversely, kinorhynch density increased at sites far from the farm. Kinorhynchs were present with ten species, including a representative of the rare genus Condyloderes , and densities up to more than 245 ind./10 cm 2 . Analyses indicate that kinorhynchs are particularly sensitive to sulfides. Accumulation of organic matter and high concentration of sulfides caused a marked reduction or even the disappearance of kinorhynchs. If confirmed by additional studies, the nematodes/kinorhynchs ratio could be used as simple and useful tool for the assessment of organic enrichment in marine environments, especially in muddy bottoms. [ABSTRACT FROM AUTHOR]

The air puff is a dynamic contactless tonometer test used in ophthalmology clinical practice to assess the biomechanical properties of the human cornea and the intraocular pressure due to the filling fluids of the eye. The test is controversial, since the dynamic response of the cornea is governed by the interaction of several factors which cannot be discerned within a single measurement. In this study we describe a numerical model of the air puff tests, and perform a parametric analysis on the major action parameters (jet pressure and intraocular pressure) to assess their relevance on the mechanical response of a patient-specific cornea. The particular cornea considered here has been treated with laser reprofiling to correct myopia, and the parametric study has been conducted on both the preoperative and postoperative geometries. The material properties of the cornea have been obtained by means of an identification procedure that compares the static biomechanical response of preoperative and postoperative corneas under the physiological IOP. The parametric study on the intraocular pressure suggests that the displacement of the cornea׳s apex can be a reliable indicator for tonometry, and the one on the air jet pressure predicts the outcomes of two or more distinct measurements on the same cornea, which can be used in inverse procedures to estimate the material properties of the tissue. [ABSTRACT FROM AUTHOR]

Objective To examine, separately, in children and adults with autoimmune chronic uveitis (ACU), the evidence regarding the effectiveness and the safety of switching to a non-anti-TNF biologic modifier immunosuppressant treatment (NTT) currently available in clinical practice. Methods A systematic search between January 2000 and April 2014 was conducted using EMBASE, Ovid MEDLINE, Evidence Based Medicine Reviews—ACP Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of NTT as a biologic modifier immunosuppressant medication for ACU, refractory to topical and/or systemic steroid therapy, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria. We determined a combined estimate of the proportion of subjects responding to NTT. Results We initially identified 526 articles, of which 89 were potentially eligible. From the selection process, a total of 10 retrospective chart reviews and a randomized single-blind controlled study, providing a total of 12 children and 34 adults, were deemed eligible: 3 articles looked at rituximab, 3 at abatacept, 3 at tocilizumab, and the remaining 1 at alemtuzumab and the other at anakinra. Before the NTT treatment, all the eligible subjects received several combinations of one or more DMARDs and at least one anti-TNF strategy. With the exclusion of 7 adults enrolled in the RCT, 8 of 12 children and 18 of 27 adults responded to NTT treatment: 0.66 was the combined estimate of the proportion of subjects improving on NTT treatment in children (95% CI: 0.46−0.99) and in adults (95% CI: 0.49–0.84). Further statistical comparison between different NTT strategies was not possible due to the small sample size. Conclusion Although randomized controlled trials are needed, the available evidence suggests the clinical use of a NTT strategy in selected categories of ACU, refractory to previous course of immunosuppressive treatment, DMARDs, as well as anti-TNFα, in adults as well as children. [ABSTRACT FROM AUTHOR]

Germline mutations of signal transducer and activator of transcription 3 (STAT3) are responsible for 2 distinct human diseases: autosomal-dominant hyper-IgE syndrome (AD-HIES) caused by STAT3 loss-of-function mutations and STAT3 gain-of-function disease. So far, these entities have been regarded as antithetic, with AD-HIES mainly associated with characteristic infections and a connective tissue phenotype and STAT3 gain-of-function characterized by lymphoproliferation and poly-autoimmunity. The R335W substitution in the DNA-binding domain of STAT3 was initially described in 2 patients with typical AD-HIES, but paradoxically, recent functional analysis demonstrated a gain-of-function effect of this variant. A patient with Sjögren syndrome and features of AD-HIES with this mutation is described and the molecular consequences are further characterized. This study provides a clinical and immunological description of the patient. STAT phosphorylation in primary patient cells was studied and A4 cells transfected with the patient allele were used to study phosphorylation kinetics, transcriptional activity, and target-gene induction. The hybrid clinical features of the patient were associated with normal T H 17 cells. Enhanced and prolonged STAT3 phosphorylation, an increased STAT3 driven luciferase reporter activity upon IL-6 stimulation, but reduced IL-6–induced SOCS3 production were all observed. The germline R335W-STAT3 variant displays a mixed behavior in vitro that mainly shows gain-of-function, but also loss-of-function features. This is matched by an ambiguous clinical and immunological phenotype that dismantles the classical antithetic dualism of gain- versus loss-of-function. Germline STAT3 mutation–related disease represents a pathological spectrum with the p.R335W associated phenotype locating between the 2 recognized clinical disease patterns. [ABSTRACT FROM AUTHOR]

Objective To summarize the evidence regarding the effectiveness of switching to a second anti-TNFα treatment in children with autoimmune chronic uveitis (ACU), refractory to the first course of anti-TNFα treatment. Methods We conducted a systematic literature review between January 2000 and May 2013 to investigate the efficacy of a second anti-TNFα agent in the treatment of ACU in children (≤16 years) refractory to a first course of a single anti-TNFα treatment, topical and/or systemic steroid therapy and at least one DMARD. The primary outcome measure was the improvement of intraocular inflammation, as defined by the SUN working group criteria, at 6 (±2) months of treatment. Results Among 1086 identified articles, 128 were scrutinized: 10 observational studies, 6 on adalimumab (ADA), 3 on infliximab (INF), and 1 on both, were deemed eligible. Study cohort included 40 children (ADA = 34 and INF = 6), median age 8 years (range 3-16). Nine were males, 28 females (gender not reported in 3), 39/40 were affected by JIA. Seventeen children received etanercept: 11 were switched to ADA, the remaining 6 to INF. All 23 children who previously received INF were switched to ADA. Altogether, 30 children (24 on ADA, 6 on INF) of 40 responded to treatment: 0.75 (95% CI: 0.51-100) was the combined estimate of the proportion of subjects improving. Conclusions Despite the fact that no RCT is available and the number of cases is small, this review provides evidence that switching to a second anti-TNFα agent results in improvement of ocular activity for the 75% treated children [ABSTRACT FROM AUTHOR]

Keratoconus is an eye condition caused by localized thinning of the corneal tissue, which leads to a characteristic cone-shaped protrusion of the cornea. We investigate the mechanical behavior of keratoconus and suspect keratoconus corneas versus healthy corneas by using patient-specific finite element models. Patient-specific geometries of the corneas are obtained from diagnostic images provided by corneal topographer, transformed into solid models, and discretized in hexahedral elements. For the diseased corneas, a suitable reduction of the stiffness is applied within a limited region of the cornea around the conus. After the identification of the stress-free configuration, the models are used to simulate pressurization tests up to 40 mmHg. The material parameters have been estimated within the stress-free configuration identification procedure. As expected, numerical results reveal a more compliant behavior for the diseased corneas in terms of apex displacement plots as a function of the intraocular pressure, with diseased corneas experiencing up to 44% increase in apex displacement compared to healthy corneas. The maps of the stress confirm, for the diseased corneas, a marked increase of the maximum tensile stress, on both anterior and posterior surfaces, to be ascribed mainly to the reduction of the corneal thickness. Stress maps also show, for keratoconus corneas, a marked increase of the ratio between posterior and anterior tensile stress in the conus. Numerical analyses are used to construct the refractive power maps, revealing clearly that the maximum dioptric power in keratoconus corneas is at the center of the cone-shape rather than at the apex. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: This study aims to analyse the risk of cardiovascular events in a local cohort of patients with type 2 diabetes, and to evaluate the prognostic accuracy of four algorithms used to estimate cardiovascular risk: the Framingham study, United Kingdom Prospective Diabetes Study (UKPDS), Riskard study and Progetto Cuore. Method and results: We analysed clinical charts of the Diabetes Clinics of Modena for the period 1991–95. Patients in the age range of 35–65 with type 2 diabetes and no previous cardiovascular disease were eligible. The incidence of new cardiovascular disease was compared with estimated rates deriving from the different functions. A stratification was obtained in subgroups at different cardiovascular risk, allowing comparison between the algorithms. A total of 1532 patients were eligible; women presented a worse cardiovascular risk profile. An absolute 10-year rate of cardiovascular events of 14.9% was observed. Comparing patients with events with event-free subjects, we found significant differences in systolic blood pressure, age at visit, smoking, high-density lipoprotein (HDL)-cholesterol, duration of diabetes, glycosylated haemoglobin (HbA1c) and co-morbidities. Comparing the estimated risk rate according to the different functions, Italian algorithms were more consistent with observed data; however, Progetto Cuore and Riskard show underestimation of events when applied to females. Conclusions: Estimation of cardiovascular risk is dependent on the algorithm adopted and on the baseline risk of the reference cohort. Functions designed for a specific population, including risk variables peculiar for diabetes, should be adopted to increase the performance of such functions which is clearly unsatisfactory at present. [Copyright &y& Elsevier]

Abstract: Sediment from harbors of the Emilia-Romagna (Northern Adriatic Sea) were dredged and dumped in four disposal areas characterized by muddy bottoms. The long-term effects of the dumping on macrozoobenthic communities were investigated before and after 6month, 8month, 2years and 4years. The disposal of dredged material did not influence the granulometry and %TOC in the sediment, and no alterations in the structure of the macrobenthic communities were observed in the four areas. The lack of impact could be ascribed to the environmental characteristics and precautionary measures taken to minimize the effects of the dumping. It appears that: (1) the communities of the dumping areas are well adapted to unstable environments; (2) the sediments were disposed gradually and homogeneously over relatively large areas; Other factors that help to reduce the impact of sediment disposal are the low concentrations of contaminants in dredged materials and the similarity of sediment in the dredged and disposal areas. Off-shore discharge appears a sustainable strategy for the management of uncontaminated dredged sediments from the Northern Adriatic Sea harbors. [Copyright &y& Elsevier]

Abstract: Sands for the nourishment of beaches along the Emilia-Romagna coast (northern Adriatic Sea) were dredged from an offshore area characterised by relict sands formed during the last Adriatic post-glacial transgression. The short-term effects of the sand extraction on macrozoobenthic communities were investigated before, during and 1, 6 and 12 months after dredging at three impacted stations and seven control stations. Sand extraction activities did not significantly influence the granulometry and %TOC in the sediment but caused almost complete defaunation at dredging stations. Yet, just 12 months after the extraction, the recolonisation of communities at the impacted stations was at an advanced stage. Unlike other studies on the effects of extraction of marine sand, no significant settlement of opportunistic species was observed. The limited impact of the sand extraction operation on the physical characteristics of the sediment and hydrological-sedimentary characteristics in the relict sand area should aid its rapid recovery and the restoration of the original community in a short period of time (2–4 years after dredging). [Copyright &y& Elsevier]

New Eurofever/PRINTO classification criteria (EPCC) for Familial Mediterranean Fever (FMF) and other recurrent fevers have been recently developed, together with the classification of the pathogenicity of MEFV variants. To evaluate the impact in real life of both the EPCC and INSAID pathogenicity classification of MEFV variants in the large international Eurofever FMF cohort. Baseline demographic, genetic and clinical data of FMF patients included in the Eurofever registry were evaluated. The EPCC and the 2018 INSAID classification for MEFV variants were applied in all eligible FMF patients. Since November 2009, clinical information was available for 1012 FMF (532 males/480 females, 827 children/185 adults) from 119 centres. Complete data were available for 887 patients in whom 623 (70.2%) satisfied EPCC (EPCC+), while 264 (29.8%) did not (EPCC−). The majority of the EPCC− patients (172, 65.1%) displayed negative or non-informative genetics (monoallelic or biallelic benign variants, monoallelic variant of unknown significance). At baseline, colchicine was used in most of EPCC+ patients (88%) and in a lower percentage of EPCC− patients (69%, p < 0.0001), who were treated in a higher proportion with steroid or NSAID on demand (p = 0.003 and 0.008, respectively). Four percent of patients received Anti-IL-1 treatment. The combination of EPCC and the 2018 INSAID classification of MEFV variants is able to identify two distinct groups of patients, which differ in clinical characteristics, therapeutic approach and response to treatment. EPCC+ patients displayed the typical features of FMF, while EPCC− patients had a more variable phenotype with a lower percentage of response to colchicine. [Display omitted]. • The application of Eurofever/PRINTO classification criteria (EPCC) defines two distinct groups of patients, which differ in clinical characteristic, therapeutic approach and response to treatment. • Patients fulfilling the EPCC displayed higher rate of response to colchicine, in comparison to EPCC− patients. • The negativity of EPCC and the presence of non-informative genetic test should alert the physicians for the possibility of an alternative diagnosis and treatment in the context of an inflammatory phenotype. [ABSTRACT FROM AUTHOR]

Echinococcosis is a parasitic zoonosis in which humans are involved as an intermediate host. It is a very common pathology in the areas of Eastern Europe and Asia, where the main activity is represented by pastoralism and animal breeding. In humans, the most frequently affected sites are the liver (60–70%) and lungs (20–30%), manifesting themselves with symptoms such as abdominal pain, coughing, dyspnea, hemoptysis, up to cases of anaphylactic shock. In Italy it is not a common disease with an incidence of 2:100.000 inhabitants, and it's extremely rare in pediatric population. In this work we presented a case of a 11-years male patient came for a persistent cough, to whom was found a giant cystic mass in the thorax. Serological tests confirmed the diagnosis of echinococcosis. Patient underwent to thoracotomy to remove the cyst and he begun the antiparasitic therapy. Post-operative outcome was good and the patient is, until now, free of problems. Echinococcosis is a challenging problem for a pediatric surgeon, especially in non-endemic area, not only because it is not a common disease in pediatric population, but also for the surgical management that can presents some difficulties and complications in the post-operative course. [ABSTRACT FROM AUTHOR]

The health emergency linked to the Sars-Cov-2 infection represented an absolutely new problem for all health professionals. In particular, the information regarding the spread of the virus in the pediatric field and its manifestations are still incomplete. In this paper we present a case of neonatal infection which, as far as we know, represents one of the few published cases and which occurred in a patient who came to our attention for acute abdomen from intestinal perforation. The perforation was caused by Meckel's diverticulum, an event considered infrequent in the first year of life and almost exceptional in the neonatal period. This case required particular management, putting pediatric surgeons in front of new and difficult to solve problems. New onset clinical events, such as this one described, represent an opportunity for sharing useful data for the creation of universal protocols for the management of patients with problems that are becoming common and of which little is known. [ABSTRACT FROM AUTHOR]

Objective: To review the clinical features of Cogan syndrome, a rare vasculitis characterized by systemic, ocular, and audiovestibular symptoms. Study design: Clinical records of patients with Cogan syndrome followed at 2 pediatric rheumatology institutions and those from a database search were reviewed. Data included clinical features at onset and during the disease course, treatments, and outcomes. Results: Twenty-three children with Cogan syndrome (15 males; mean age, 11.4 years [range, 4-18 years]) were included in the analysis. Eleven patients (47.8%) exhibited systemic features at disease onset, including fever, arthralgias-arthritis or myalgias, headache, and weight loss. Twenty-one patients (91.3%) had ocular symptoms, due mainly to interstitial keratitis, uveitis, or conjunctivitis/episcleritis. Vestibular symptoms (39.1%) included vertigo, vomiting, and dizziness. Auditory involvement (65.2%) consisted of sensorineural hearing loss, tinnitus, and deafness. Four patients had cardiac valve involvement, and 3 had skin manifestations. After a median 2 years of follow-up, 30.4% of the patients were in clinical remission, but all others had irreversible complications (deafness, 21.7%; sensorineural hearing loss, 13.0%; vestibular dysfunction, 4.3%; ocular complications, 13.0%; cardiac valve damage, 17.4%). Conclusion: Audiovestibular and ocular involvement have a major impact on prognosis in children with Cogan syndrome. [ABSTRACT FROM AUTHOR]