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The SINERGIE (South Italian Network for Rational Guidelines and International Epidemiology) project is intended to set up a collaborative network comprising virologists, clinicians and public health officials dealing with patients affected by HCV disease in the Calabria Region. A prospective observational data-base of HCV infection will be developed and used for studies on HCV natural history, response to treatment, pharmaco-economics, disease complications, and HCV epidemiology (including phylogenetic analysis). With this approach, we aim at improving the identification and care of patients, focusing on upcoming research questions. The final objective is to assist in improving care delivery and inform Public Health Authorities on how to optimize resource allocation in this area. [ABSTRACT FROM AUTHOR]

Fat Embolism Syndrome (FES) is associated with multisystem dysfunction. It has a wide spectrum of presentation and severity. Our first report of FES in Duchenne Muscular Dystrophy (DMD), onset soon after injury was associated with an early and rapid death. Since then, we have reviewed 6 boys with DMD who developed FES and survived. The boys were between 13 and 19 years (mean 16.3), taking Deflazacort and were obese. All 6 boys had osteoporosis, straight spines, and good cardiac and pulmonary function. All 6 boys had a history of trauma: 4 falls (1 walking, 1 ceiling tract transfer and 2 from wheelchair seatbelt unfastened), 1 forward flexion injury at the beach and 1 arm trauma during transfer. Long-bone fractures occurred in 3 boys: 2 femoral and 1 radial. Using Gurd’s clinical criteria for FES, all 6 boys had 2 major FES criteria. All had CNS signs/symptoms, 5 of 6 had respiratory symptoms and the 6th had petechiae. All 6 boys had at least 2 minor criteria. All had tachycardia and 1 or more of retinal changes, thrombocytopenia, anemia and fever. The time between the trauma and onset of symptoms ranged from 30 min to 24 h (mean 11.5 h). On discharge, 5 of 6 boys had normal CNS function. Cardio-pulmonary function returned to baseline by 6 mos. The sixth boy had severe neurologic sequelae. He requires g-tube feeds, is fully dependent for care and does not speak. FES may be more common than previously recognized. In 5 of 6 cases reported here, the onset of symptoms was delayed compared to our previously reported cases with a fatal outcome. It is important for physicians and families to consider a diagnosis of FES when a boy with DMD presents with acute symptoms following trauma. All boys required early and intensive respiratory and cardiac support. Since all the injuries were accidental, education for accident prevention is critical. [ABSTRACT FROM AUTHOR]