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Background and aimsFast-track care have been proved to reduce the short-term risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short- and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management.MethodsProspective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017. All patients underwent fast-track care within 24 h of admission. The primary outcome was defined as the first stroke recurrence at 90 days, 12 and 60 months after TIA. Stroke incidence with 95% confidence interval (CI) at each timepoint was calculated using Poisson regression. Predictors of stroke recurrence were evaluated with Cox regression analysis. The number needed to treat (NNT) of fast-track care in preventing 90-day stroke recurrence in respect to the estimates based on baseline ABCD2 score was also calculated.ResultsWe enrolled 1,035 patients (54.2% males). Stroke incidence was low throughout the follow-up with rates of 2.2% [95% CI 1.4–3.3%] at 90 days, 2.9% [95% CI 1.9–4.2%] at 12 months and 7.1% [95% CI 5.4–9.0%] at 60 months. Multiple TIA, speech disturbances and presence of ischemic lesion at neuroimaging predicted stroke recurrence at each timepoint. Male sex and increasing age predicted 90-day and 60-month stroke risk, respectively. Hypertension was associated with higher 12-month and 60-month stroke risk. No specific TIA etiology predicted higher stroke risk throughout the follow-up. The NNT for fast-track care in preventing 90-day stroke was 14.5 [95% CI 11.3–20.4] in the overall cohort and 6.8 [95% CI 4.6–13.5] in patients with baseline ABCD2 of 6 to 7.ConclusionOur findings support the effectiveness of fast-track care in preventing both short- and long-term stroke recurrence after TIA. Particular effort should be made to identify and monitor patients with baseline predictors of higher stroke risk, which may vary according to follow-up duration.

This paper aimed to analyse the spatio-temporal patterns of the diffusion of SARS-CoV-2, the virus causing coronavirus 2019 (COVID-19, in the city of Bologna, the capital and largest city of the Emilia-Romagna Region in northern Italy. The study took place from February 1st, 2020 to November 20th, 2021 and accounted for space, sociodemographic characteristics and health conditions of the resident population. A second goal was to derive a model for the level of risk of being infected by SARS-CoV-2 and to identify and measure the place-specific factors associated with the disease and its determinants. Spatial heterogeneity was tested by comparing global Poisson regression (GPR) and local geographically weighted Poisson regression (GWPR) models. The key findings were that different city areas were impacted differently during the first three epidemic waves. The area-to-area influence was estimated to exert its effect over an area with 4.7 km radius. Spatio-temporal heterogeneity patterns were found to be independent of the sociodemographic and the clinical characteristics of the resident population. Significant single-individual risk factors for detected SARS-CoV-2 infection cases were old age, hypertension, diabetes and co-morbidities. More specifically, in the global model, the average SARS-CoV-2 infection rate decreased 0.93-fold in the 21–65 years age group compared to the >65 years age group, whereas hypertension, diabetes, and any other co-morbidities (present vs absent), increased 1.28-, 1.39- and 1.15-fold, respectively. The local GWPR model had a better fit better than GPR. Due to the global geographical distribution of the pandemic, local estimates are essential for mitigating or strengthening security measures.

Carolina Bologna,1 Antonio Cozzolino,1 Andrea Ferraro,1 MariaVittoria Guerra,1 Anna Guida,1 Marina Lugarà,1 Maria Gabriella Coppola,1 Paolo Tirelli,1 Marilena Sicignano,1 Pasquale Madonna,1 Pierpaolo Di Micco2 1UOC Medicina Generale Ospedale del Mare ASL Na 1, Naples, Italy; 2UOC Medicina Interna Fatebenefratelli, Naples, ItalyCorrespondence: Carolina Bologna, Tel +393473002271, Email carolina.bologna@libero.itBackground: Waldenstrom’s disease is characterized by the presence of pathological changes in the B lymphocytes that are in the last stages of maturation. One characteristic of WM is the production of an abnormal high amount of IgM and hyper viscosity syndrome. The MW gets worse, symptoms such as fatigue, weight loss, night sweats, fever, recurrent infections and swollen lymph nodes develop in patients who have a known history of MGUS. In this clinical case, our patient without history of MGUS, presents for the first time for medical observation only for ascites and the presence of an interportocaval lymph node package. An atypical presentation of the disease that makes us reflect on the difficulty of making a diagnosis in the elderly patient and on pathogenetic hypotheses of ascites not yet explored.Case Presentation: Seventy-three-year-old patient, hospitalized for the onset of ascites with sloping edema, diffuse left pulmonary opacification. At the ultrasound check, cava and portal vessels patent and of regular caliber, however with inversion of flow in correspondence with the right branch and of the door to the hilum, with a subdiaphragmatic retrocaval focus with a maximum diameter of about 3 cm, which cannot be better viewed. CT scan of the abdomen with confirmation of the presence of an interportocaval lymph node package. After evidence of the electrophoretic protein picture of a double component, probably monoclonal with positive urinary immunofixation for free K chains. IgM dosage equal to 2190 mg. Serum immunofixation practice that confirms the diagnosis of type B lymphoproliferative syndrome as per Waldenstrom’s disease, confirmed by bone marrow aspiration with morphological and flow cytometric study. Immediately begin chemotherapy with Bendamustine 120 mg. After 4 weeks of therapy with the reduction of IgM values, the patient no longer presented ascites.Conclusion: This case has an unusual presentation of this disease and we could shed a new light on the possible pathogenesis of portal hypertension in Waldenstrom’disease.Keywords: ascites, portal hypertension, Waldenstrom’s disease, elderly

José Verocay (Paysandú, 1876-Teplitz Bohemia, 1927) fue un médico anatomopatólogo uruguayo de reconocimiento internacional, quién en 1910 describió, por primera vez, las estructuras que más tarde fueran nombradas como “cuerpos de Verocay”, consideradas de fundamental importancia en el diagnóstico de Schwannoma (a pesar de no ser exclusivos del mismo). Su formación personal y científi ca se desarrolló en Europa en la Universidad Carolina de Praga, culminando con el máximo cargo académico posible de obtener en sus condiciones, el Privat Dozent (1910). Luego de su exilio, en 1919 como regresa a Uruguay donde obtiene el cargo de Profesor de Anatomía Patológica en la Escuela de Odontología (1925). Ese mismo año aspira al cargo de Profesor de Anatomía Patológica de la Facultad de Medicina, cargo al cuál no accede generando una gran controversia entre médicos y estudiantes. En 1927 debido al deterioro de su salud, decide viajar a Viena en pos de su cura, en Uruguay se le realiza un Homenaje público a iniciativa de los estudiantes de odontología de la época, en el Salón de Actos de la Facultad de Medicina, en donde por aquellos años se formaban los futuros odontólogos. Allí los propios estudiantes lo proclaman: “Maestro insigne de la generación médica actual”, “Profesor por derecho propio de la Juventud médica”. Fallece en Eichwald, distrito de Teplitz, Bohemia, en 1927, con 51 años de edad. Este artículo busca ser un breve repaso de su trayectoria académica en el Uruguay y en el mundo.

According to the COVID-19 lockdown and successive reopening a number of facts can be analysed. The main effects have been detected on: mobility and environment, and specifically on traffic, environmental data and parking. The mobility reduction has been assessed to be quite coherent with respect to what has been described by Google Global mobility report. On the other hand, in this paper a number of additional aspects have been put in evidence providing detailed aspects on mobility and parking that allowed us to better analyse the impact of the reopening on an eventual revamping of the infection, also taking into account of the Rt index. To this end, the collected data from the field have been compared from those of Google and some considerations with respect to the Imperial college Report 20 have been derived. For the pollutant aspects, a relevant reduction on most of them has been measured and rationales are reported. The solution has exploited the Snap4City IOT smart city infrastructure and data collector and Dashboard in place in Tuscany.

Isabella Berardelli,1 Maria Carmela Bloise,2 Matteo Bologna,2,3 Antonella Conte,2,3 Maurizio Pompili,1 Dorian A Lamis,4 Massimo Pasquini,2 Giovanni Fabbrini2,3 1Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, 2Department Human Neurosciences, Sapienza University of Rome, Rome, 3Neuromed Institute (IRCCS), Pozzilli (IS), Italy; 4Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA Objective: The aim of the current study was to evaluate whether cognitive behavioral group therapy has a positive impact on psychiatric, and motor and non-motor symptoms in Parkinson’s disease (PD).Methods: We assigned 20 PD patients with a diagnosis of psychiatric disorder to either a 12-week cognitive behavioral therapy (CBT) group or a psychoeducational protocol. For the neurological examination, we administered the Unified Parkinson’s Disease Rating Scale and the non-motor symptoms scale. The severity of psychiatric symptoms was assessed by means of the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Brief Psychiatric Rating Scale, and the Clinical Global Impressions.Results: Cognitive behavioral group therapy was effective in treating depression and anxiety symptoms as well as reducing the severity of non-motor symptoms in PD patients; whereas, no changes were observed in PD patients treated with the psychoeducational protocol.Conclusion: CBT offered in a group format should be considered in addition to standard drug therapy in PD patients. Keywords: Parkinson’s disease, cognitive behavioral group therapy, psychoeducation, motor symptoms, non-motor symptoms

Knowledge of scientific inquiry (SI) is considered essential to the development of an individual's Scientific Literacy (SL) and therefore, SI is included in many international science education reform documents. Two previous large scale international studies assessed the SI understandings of students entering middle school and secondary students at the end of their formal K-12 science education. The purpose of this international project was to use the VASI-E to collect data on what primary level students have learned about SI in their first few years of school. This study adds to previous research to bridge the landscape of SI understandings now with representation from primary, middle and high school samples. A total of 4,238 students from 35 countries/regions spanning six continents participated in the study. The results show that globally, primary students are not adequately informed about SI for their age group. However, when compared with the students in the previous international studies (grades seven and 12), the primary students' understandings were surprisingly closer to the levels of understanding of SI of the secondary school students than those in the seventh grade study.