Search

Abstract Since early 2021, peculiar Volcano-Tectonic (VT) seismic sequences with very short inter-event times have become increasingly frequent and evident in the Campi Flegrei caldera (Italy), which has been experiencing a long-term unrest since 2005. During the same period the ground deformation (uplift), seismicity and gas emission that characterize the current unrest showed an acceleration. Within this type of seismic sequence, we identify burst-like swarms, characterized by inter-event times so short that they are often not easily recognizable. Here we show that these sequences are located in an area encompassing the main hydrothermal field and a zone affected by a geodetic anomaly (a region that uplifts less rapidly than the surroundings), which became evident in 2021. This type of seismicity has been associated with phreatic explosions and critical phases of unrest in other volcanoes and currently characterizes the state of activity of Campi Flegrei caldera.

Abstract The COVIVAX study assessed the association between COVID-19 vaccination and the risk of common neurological disorders in a multicenter case-control design. Vaccination exposure was compared between individuals with a first diagnosis of a neurological disorder (cases) and age- and sex-matched controls. A total of 624 participants were enrolled, and after random 1:1 matching 265 cases and 265 matched controls (total 530 participants) were included in the analyses. The most frequent neurological diagnosis in cases were stroke (60.4%), multiple sclerosis (11.3%) and seizures (6.4%). The proportion of vaccinated participants was 72.1% among cases and 79.6% among controls. A protective role of vaccination on the risk of developing a new neurological disorder was detected in the unadjusted analysis (OR 0.50; 95% CI 0.29–0.86; p = 0.0114). After adjustment for confounders, the number of vaccination doses received was associated with a reduced risk of developing new neurological disorders for participants aged over 60 years ( p = 0.0472; OR 0.14, 95% CI 0.03–0.68), with pre-existing comorbidities (p = 0.0122; OR 0.04, 95% CI 0.01–0.99) and for stroke (p = 0.0232; OR 0.04, 95% CI 0.02–0.97). The COVIVAX study provided no warning sign regarding an increase in the risk of developing new neurological disorders following COVID-19 vaccination of any type or doses. A potentially protective effect of multiple doses of COVID-19 vaccines against the risk of stroke in people aged over 60 needs to be confirmed by further studies.

Abstract Emerging infectious diseases are of major concern to animal and human health. Recent emergence of high pathogenicity avian influenza virus (HPAIV) (H5N1 clade 2.3.4.4b) led to substantial global mortality across a range of host species. Co-occurring species showed marked differences in mortality, generating an urgent need for better epidemiological understanding within affected populations. We therefore tested for antibodies, indicative of previous exposure and recovery, and for active viral infection in apparently healthy individuals (n = 350) across five co-occurring seabird species on the Isle of May, Scotland, during 2023, following H5N1 HPAIV associated mortality in the preceding summer. Antibody prevalence to AIV subtypes varied substantially between species, ranging from 1.1% in European shags (Gulosus aristotelis) (to H5) to 78.7% in black-legged kittiwakes (Rissa tridactyla) (to H16 or both H13 and H16), and between 31 and 41% for three auk species (H5, H16 or both). At least 20.4% of auks had antibodies to an as yet unidentified subtype, suggesting further subtypes circulating in the population. We found low levels of active, but asymptomatic, AIV infection in individuals (1.6–4.5%), but excluded this as H5N1. Our results emphasise the importance of testing healthy individuals to understand the prevalence of co-circulating AIV subtypes in wild populations, and the potential for future reassortment events which could alter virus behaviour and impact.

Abstract Background Rimegepant, a novel oral calcitonin gene-related peptide receptor antagonist, has been recently approved for the acute migraine treatment. While its efficacy was confirmed in randomized clinical trials, no data is available regarding real-life effectiveness and tolerability. GAINER, a prospective, multicentric study, aimed to evaluate rimegepant effectiveness and tolerability in the real-world setting. Methods Our study involved 16 headache centers across Italy. The main outcomes were: i) 2 h pain freedom, and ii) occurrence of treatment-emergent adverse events after administration. Participants were instructed to treat one migraine attack with rimegepant 75 mg orally disintegrating tablet. Using an ad hoc diary, participants prospectively collected migraine attack features at baseline and every 30 min after rimegepant administration, up to 2 h post dose. A 24 h follow up was also collected. Results We enrolled 103 participants with migraine (74.8% female, mean age 44.4 [42.0 – 46.7] years, 24.3% with chronic migraine of whom 44.0% presented a concomitant diagnosis of medication overuse headache). The number of previously failed preventive classes was 2.7 [2.3 – 3.2]. Participants presented a mean of 9.6 [8.2 – 10.9] monthly migraine days at baseline. At rimegepant intake, 40.8% of patients rated migraine intensity as severe. Pain freedom 2 h post dose was reported in 44.7% (46/103) of individuals. Pain freedom 2 h post dose was not influenced by baseline pain severity (p = 0.316), but it was associated with timing of intake (p = 0.032) with a higher rate of 2 h pain freedom when rimegepant was taken within 1 h from pain onset. Mild adverse events were reported in 15.5% total attacks (16/103), predominantly fatigue (n = 6), gastrointestinal symptoms (n = 6), somnolence (n = 4), and transient cognitive difficulties (n = 3). Tolerability was rated as good-to-excellent in 85.4% cases (88/103). Conclusions Our data confirms rimegepant effectiveness and safety in the acute migraine treatment in a real-world setting in a cohort of participants that includes subjects with episodic or chronic migraine, medication overuse and a high number of prior preventive treatment failures. Trial registration The study was preregistered on clinicaltrial.gov, NCT05903027.

Rangers safeguard the balance between humans and nature by protecting and managing biodiversity and natural resources. The challenging working conditions that rangers face make them vulnerable to wildlife attacks and exposure to zoonotic and vector-borne diseases. Despite all of these work-related challenges and threats to their health, a vast majority of rangers lack access to adequate medical treatment facilities. This research has used data from the one of the largest and most comprehensive surveys of rangers across multiple countries, collected as part of the Global Ranger Perception Survey, to examine the relationship between the precarious working conditions of rangers and their health outcomes. By comparing data from the 2020 World Malaria Report, our study highlights the severe malaria burden carried by rangers around the world. Malaria prevalence in rangers working in Central Africa, East Africa, and South America was estimated to be four times higher than in the general population. The results of this study are valuable because they show that rangers are a vulnerable, high-risk population of professionals and their working conditions are highly associated with their respective health outcomes. The research also makes it imperative that improving working conditions is essential for maintaining a professional ranger workforce that protects the planet’s natural areas and biodiversity.

There is not a welfare protocol for horses reared for meat production in semi-extensive systems. The aims of the study were to develop a specific welfare protocol suitable to be applied at pasture and on stable; and to evaluate whether the welfare items were influenced by the farming system (pasture vs stable). 52 non-animal-based measures (N-ABMs) and 14 animal-based measures (ABMs), classified into 6 thematic areas (training, feeding, facilities, ABMs, biosecurity, health management) were selected by a focus group. The protocol was applied on a total of 429 Catria horses located across 26 pastures during the warm seasons and on 7 stables during the cold seasons. Differences obtained within each horse-unit were calculated by using the diversity index (VARNC) and the distance from the ideal (dfi) index. Chi-square test was used for comparing the relative frequencies (%) of the answers (pasture vs stable). Most the welfare items were classified as adequate in both pasture and stable, yet differences were found within ‘training’ (p = 0.02) and ‘feeding’ (p

A multispecialty trauma team must provide care for pelvic gunshot wounds (PGW) due to the high risk of associated morbidity and mortality, the high density of organs that might be wounded within the pelvis, and the potential consequences of these complicated injuries. We present a case of a 59-year-old woman hemodynamically stable with firearm injury to the left buttock. CT examination showed free air in the peritoneal cavity and in the retroperitoneum and a focal contrast extravasation within the uterine fundus. The patient underwent urgent laparotomy that revealed triple bowel perforation (sigmoid colon, medium rectum, ileum) and a laceration of the posterior and anterior uterine wall at level of the cervix with no signs of active bleeding. The bullet was lodged above the peritoneal reflection, in the right pelvis, and it was removed, and handed over to the judicial authority. The perforated bowel segments were resected with Hartmann's procedure and ileal anastomosis. The uterine laceration was repaired. Although all the viscera and the structures along the trajectory can be harmed, pelvic gunshot wounds have the potential to inflict serious injury. Nongravid uterine traumas are a unique occurrence, and proper care requires an understanding of lesion grading. Finding the gynecological lesion in female patients is essential to receiving the best care and protecting the reproductive system.

Abstract Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.

Abstract Background Paracetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted. Methods The survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted. Results The results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness. Conclusions Both the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

BackgroundLaryngopharyngeal reflux (LPR) is defined as an extraesophageal reflux of gastroduodenal contents to the laryngopharynx, affecting the upper aerodigestive tract. There is currently no standardized treatment protocol for LPR. The use of proton pump inhibitors (PPIs) is widely established in common practice and derives from the standard approach of using PPIs to treat patients with gastroesophageal reflux disease (GERD). However, as PPIs may not be effective on all types of reflux, the aim of our study was to evaluate the effectiveness of dietary changes and mucosal protectants, alone or in combination, in LPR treatment.MethodsThis multicenter randomized controlled trial included 48 patients divided into three groups: dietary modifications only, mucosal protectors only, and a combination of both. The patients’ responses were assessed over 1 month using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS), along with measurements of salivary and nasal pepsin concentration and rhinomanometry.ResultsSignificant improvements were observed in RSI and RFS scores across all groups. The group receiving combined dietary modifications and mucosal protectors showed the most substantial benefits. Additionally, a notable reduction in salivary and nasal pepsin concentrations and nasal resistances was observed, particularly in patients combining dietary modifications and mucosal protectors.ConclusionThe study showed that combined dietary modifications and mucosal protects strategies effectively manage LPR symptoms, offering a potential therapeutic approach.

IntroductionIn 2018, the National Cancer Institute of Naples has launched the GLUBREAST Trial to verify the efficacy of cyanoacrylate sealing glue to prevent or reduce seroma after axillary dissection in breast surgery. The glue is a synthetic sealant (N-Butyl-2-CyanoAcrylate+Metacryloxisulfolane) biocompatible, CE approved for internal human uses and surgical procedures. The assumed mechanism of action in breast surgery is that the glue would create a seal coating in the operative field to occlude lymphatic leaks and limit seroma formation.Materials and methodsThe trial included 180 patients scheduled for breast-conserving surgery or for radical modified mastectomy without reconstruction. Out of 180 patients, 91 were randomized to receive suction drain and sealant glue after axillary dissection (Experimental Arm), whereas 89 patients (Control Arm) received suction drain without glue.StatisticsA multivariable mixed effect model on presence of liquid drained and volume drained was calculated. Stratified models by visits were performed.ResultsThe trial ended in June 2022. Older age was associated with a higher volume of seroma drained per day (β 0.30; 95% CI: 0.00–0.60). A 5-U increase in body mass index was associated with higher daily drained seroma volume in patients who underwent breast-conserving surgery (β 5.0; 95% CI: 0.62–9.4), but not in patients who underwent mastectomy (β 2.5; 95% CI: −3.6–8.6). We did not find statistically significant differences in presence of liquid drained and volume drained among the study groups. An advantage for the Experimental Arm was observed from third and fourth to fifth outpatient visits without reaching a statistical significance (p=0.069 and p=0.072, respectively); so far, 5% of patients in the Experimental Group had clinical benefit from the glue.ConclusionsThe vast majority of data in the literature come from case series, and surgeons need a higher level of evidence to drive surgical decision-making and choose proper devices to increase patient quality of life. The GLUBREAST randomized trial tested the efficacy of cyanoacrylate sealing glue to prevent postoperative seroma in breast surgery. Although only a small number of patients benefited from sealant application, we regret to say this trial has some limitation, i.e., the prolonged presence of suction drain. Further research is warranted to better clarify the benefit of cyanoacrylate glue in breast surgery.

The first hydrogeological mapping of Ischia Island at the 1:10,000 scale is presented and discussed. The ‘Map of the geohydrologic units of Ischia Island’ and the accompanying hydrostratigraphic sequence at a basin scale are based on the most recent geological maps and data from the CAR.G Project, and on new volcanological and hydrogeological surveys and studies. Data sources include the database stored by the INGV, Sezione di Napoli, Osservatorio Vesuviano and field investigations, including a survey of the springs and thermo-mineral springs which has been neglected up to now. In total 130 volcanostratigraphic units and 18 geohydrologic units were recognized; the distribution of fumaroles sites was enhanced, and 60 springs/thermal springs were identified/rediscovered. The proposed hydrogeological map provides an overview of the volcano-tectonic evolution of Ischia Island and upgrades the hydrogeological model, becoming a catalyst for the effort to acquire better data and to manage natural both resources and risks.

Study region: In this study, we compared the spatiotemporal evolution of rainfall trends in E-OBS and ERA5 to those detected using historical rainfall series recorded by ground-based networks in Southern Italy. In particular, the study is applied to the Campania, Basilicata, Apulia, Calabria and Sicily regions (84,000 km2 in total) on seasonal and annual scales. Study focus: Meteorological gridded datasets at large spatial scales are widely used in many hydroclimatic applications as they provide long and spatially homogeneous records. Regional trend analyses based on these data need to be treated with caution due to some potential limitations at relevant hydrological scales, such as the coarse spatial resolution and the spatio-temporal inhomogeneity of the underlying data. Gradual trends and abrupt change points were studied on rainfall data from 1979 to 2019. New hydrological insights for the region: Both gridded datasets capture the major trends in observed rainfall, with a predominance of positive values driven by changes in September-November. Overall, ERA5 returns flatter results compared to E-OBS, with the former comparing well with observations in Sicily and Apulia, while the latter is performing well in Campania and partially in Calabria and Basilicata. Most statistically significant trends are associated with discontinuities in the early 2000s, and this is well captured by both ground and gridded datasets. The general behavior in inter-annual variability trends in Southern Italy is captured by both datasets, with ERA5 also detecting regional patterns.

Per- and polyfluoroalkyl substances (PFASs) are carbon–fluorine compounds with widespread industrial and domestic use, posing potential toxicological risks to humans and ecosystems. Several analytical methods have been developed to assess the occurrence of PFASs in the environment, but a standardized method, applicable to all matrices, is still lacking. This paper reviews the extraction and chromatographic detection methods for PFAS assessment in environmental samples, considering parameters such as the LOD, LOQ, and recoveries. Solid phase extraction (SPE) is commonly used, showing high recovery rates for water, soil, and sediment samples using HBL and WAX polymeric sorbents (85–100% and 93–111.5%, respectively). LC-MS has demonstrated low LODs and LOQs in seawater (0.01–0.08 ng L−1; 0.03–0.24 ng L−1), marine sediment (0.002–0.018 ng g−1; 0.004–0.054 ng g−1), and dust (0.08–0.68 pg g−1; 0.26–2.25 pg g−1), indicating its sensitivity when detecting trace PFAS levels. Evaluating PFASs is crucial for the development of future removal strategies and risk assessments. Potential solutions including the use of PFAS substitutes and innovative adsorption techniques for their adsorption could present promise in reducing their environmental presence.