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Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on practical activities and didactic teaching of residents and fellows. This survey aimed to propose long-term changes for ophthalmology training based on the changes experienced by trainees and their perception of new training opportunities. Methods: An online survey was distributed to ophthalmology trainees in multiple countries. Descriptive statistics were used to analyse the data. Results: A total of 504 analyzable responses were collected from 32 different countries. The current impact of COVID-19 pandemic was described as “severe” by most trainees (55.2%); however, the future perspective was more optimistic as demonstrated by the greater number of responses reporting a presumed “moderate” (37.3%), “mild” (14.1%) or “slight” (4.2%) long-term impact. The vast majority of trainees reported a decrease ≥50% of clinical activity (76.4%) and >75% of surgical activity (74.6%). Although an initial gap in didactic teaching has been experienced by many (55.4%), regular web-based teaching was reportedly attended by 67.7% of the respondents. A strong agreement was found regarding the worthwhile role of web-based case-presentations in clinical training (91.7%), web-based discussion of edited surgical videos (85.7%) and simulation-based practice (86.9%) in surgical training. Conclusions: This survey, focusing on trainees’ perspective, strongly reinforces the need to promptly include new technology-based training tools, such as web-based teaching, virtual surgical simulators, and telementoring, in long-term reorganisation of ophthalmology training to ensure its continuity and effectiveness, which would remain available even in the face of another unpredictable crisis within the health system.

L’articolo fa un confronto tra le differenti forme urbane delle città del Nord Africa, in particolare quelle della Tunisia (Tunisi, Kairouan, Tozeur, Nefta). Tali città, distribuite tra il Nord ed il Sud del paese, esprimono, nelle loro medine, l’identità della forma urbana e ne dichiarano la modernità lungo i loro bordi. Tunisi, posta tra due laghi, costruisce la sua modernità con la città coloniale che, anche se con linguaggi diversi, evidenzia i temi del Mediterraneo. La città di Kairouan mantiene la sua identità nella grande moschea, luogo centrale di organizzazione urbana. Le città d’oasi, come Tozeur e Nefta, esprimono il loro rapporto col paesaggio ed evidenziano con le loro architetture i materiali usati.

OBJECTIVES: To evaluate electrophysiological findings among patients with vestibular migraine (VM) and to compare them with those of patients suffering from definite Ménière disease (MD) without migraine. MATERIALS and METHODS: Twenty-one consecutive patients suffering from VM were enrolled; all subjects were selected according to the criteria proposed by the Bàràny Society for Neuro-otology. Each patient underwent a careful otological and neurotological examination. After completing a questionnaire regarding migraine and vertigo complaints, they were assessed by audiometric testing, video head impulse test (vHIT), and elec-trocochleography (EcochG). Data were compared with those of 21 patients who fulfilled the criteria for definite MD. RESULTS: 52.38% of the patients with VM suffered from at least two episodes of migraine per week, with 42.85% of the subjects complaining of migraines lasting ≥24 hours. 57.14% of the patients reported at least four episodes of vertigo per month, whereas 61.9% suffered from symptoms of chronic unsteadiness. No significant difference (p=0.76) resulted from the comparison of vHIT gain between patients with VM and MD. Eleven out of 21 patients (52.38%) with definite MD presented at least one ear with SP/AP >0.4, differently from patients with VM who exhibited SP/AP values suggestive of endolymphatic hydrops (EH) in only three cases (14.28%). CONCLUSION: The present study found a higher proportion of abnormal EcochG in MD than in VM (p=0.02) without any significant difference in the vHIT gain. On the basis of our findings, the identification of EH in some patients with VM cannot be definitely related to the same pathway that triggers MD symptoms. Future research may help in better understanding whether abnormal EcochG findings can predict the occurrence of MD among patients with VM.

Migraine vertigo (MV) and Ménière's disease (MD) share several signs and symptoms such as tinnitus, fullness, photophobia, phonophobia, headache and vertigo spells lasting hours.The aim of the present study was to prospectively observe patients with MV with a sporadic audiological symptom evaluated with clinical examination, Vestibular Evoked Myogenic Potentials (VEMPs), ECochG and v-HIT.The finding of VEMP asymmetry, according to our cut-off of 33% of difference between sides, resulted in 20 cases, of which 6 had asymmetry of both c-VEMPs and o-VEMPS, all with development of fluctuating hearing during follow-up. ECochG was positive for endolymphatic hydrops in 12 patients.The evolution of MV may have a variable course in which some patients may develop symptoms typical of MD. The two diseases may be contextually present at the same time configuring an overlapping syndrome, and asymmetric VEMPs might predict development of fluctuating hearing.Evoluzione dell’emicrania vestibolare in sindrome da sovrapposizione con la malattia di Ménière: ruolo prognostico degli esami strumentali.La vertigine emicranica e la malattia di Ménière condividono diversi segni e sintomi come acufeni, ovattamento auricolare, fonofobia, cefalea e crisi di vertigine della durata di ore.Lo scopo dello studio è stato quello di valutare prospetticamente i pazienti con vertigine emicranica e manifestazioni audiologiche sporadiche, mediante esame clinico, VEMPs, ECOchG, v-HIT.Il riscontro di asimmetria dei VEMPs, secondo il limite del 33% di differenza tra i due lati, si è avuto in 20 casi dei quali: 6 con asimmetria di ocular e cervical VEMPs e sviluppo di fluttuazione uditiva nel corso del follow-up. L’ECochG ha riscontrato un’idrope endolinfatica in 12 pazienti.L’evoluzione della vertigine emicranica durante la vita del paziente può avere un decorso variabile nel quale alcuni di essi possono sviluppare sintomi tipici della malattia di Meniere. Le due malattie possono essere contestualmente presenti configurando la sindrome da sovrapposizione e l’asimmetria di entrambi i VEMPs potrebbe predire lo sviluppo della fluttuazione uditiva.

Objectives: To analyse the possible presence of reduced cognitive efficiency in family caregivers of patients with prolonged disorders of consciousness (DOC). Subjects: The participants were 27 caregivers of 25 patients with DOC admitted to the severe brain injury units of the ICS Maugeri, Institutes of Telese Terme and Sciacca, Italy. Methods: We examined cognitive functions such as short- and long-term memory, executive functions and attention by means of standardized tests. We also assessed features of psychological distress such as anxiety, depression, psychophysiological symptoms, prolonged grief disorder, psychological burden and quality of life. All scores on neuropsychological tests were compared with those of the 15 matched control subjects. Results: Enrolled family caregivers showed high frequency of clinically relevant depressive symptoms and anxiety; half of them met the criteria for prolonged grief disorder. Caregivers achieved scores lower than the matched controls on tests for selective attention, verbal fluency and long-term spatial memory. Conclusions: Family caregivers’ burden is associated with a reduced efficiency of selected executive measures and visuospatial learning. These results emphasize the need for appropriate psychological and cognitive supporting therapies for family caregivers of patients with DOC, also considering their delicate involvement in clinical decision-making and in providing care.

Objectives The Italian project MATRICE aimed to assess how well cases of type 2 diabetes (T2DM), hypertension, ischaemic heart disease (IHD) and heart failure (HF) and their levels of severity can be automatically extracted from the Health Search/CSD Longitudinal Patient Database (HSD). From the medical records of the general practitioners (GP) who volunteered to participate, cases were extracted by algorithms based on diagnosis codes, keywords, drug prescriptions and results of diagnostic tests. A random sample of identified cases was validated by interviewing their GPs. Setting HSD is a database of primary care medical records. A panel of 12 GPs participated in this validation study. Participants 300 patients were sampled for each disease, except for HF, where 243 patients were assessed. Outcome measures The positive predictive value (PPV) was assessed for the presence/absence of each condition against the GP9s response to the questionnaire, and Cohen9s κ was calculated for agreement on the severity level. Results The PPV was 100% (99% to 100%) for T2DM and hypertension, 98% (96% to 100%) for IHD and 55% (49% to 61%) for HF. Cohen9s kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD. Conclusions This study shows that individuals with T2DM, hypertension or IHD can be validly identified in HSD by automated identification algorithms. Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions, but some misclassification occurs. For HF, further research is needed to refine the current algorithm.