MACROCEPHALY FROM A NORMAL VARIANT TO A THREATENING CONDITION. A SINGLE CENTER RETROSPECTIVE STUDY ON 189 SUBJECTS

Introduction: Macrocephaly, defined as a head circumference more than two standard deviations from the normal distribution, is among the most frequently requested neuropediatric consultations. Materials: we conducted a retrospective study on 189 subjects with macrocephaly, from birth to 18 years old, enrolled from October 2001 to December 2019, for diagnostic definition and/or neurodevelopmental assessment. Brain sonography has been performed in all infants and CT or MR in selected patients. Results: macrocephaly was prevalent in males (62.4%), a head circumference >3SD (8.5%) has been associated with a neurodevelopmental impairment. A genetic and/or concomitant malformation were present in 11.1% of the sample. A male prevalence for impaired outcome has been ascertained. Conclusions: early identification of pathological macrocephaly is necessary to plan a possible treatment, an individualized and multidisciplinary follow up and an effective genetic counseling

The Importance of Participation in Regeneration of Peripheral Urban Spaces: the Experience of “Serpentone Reload”

Suburbs are often very contradictory places. Despite great part of urban population live there, these parts of cities are mostly considered as degradation places. The topic of suburbs regeneration is relevant today. Nevertheless, often expensive interventions implemented by local authorities fail to regenerate their public spaces, increasing the degradation condition. This paper presents the experience of “Serpentone reload”, a workshop based on participatory reactivation of abandoned or underused spaces and buildings in "Cocuzzo/Serpentone" neighbourhood in Potenza (Basilicata, Italy). The workshop particularly focused on the reuse of the "Ship", an underground building with a park coverage completed in 2010 and designed by the firm Archea. The "Ship" has been forgotten and not used for long time, not only by the neighbourhood, but by the whole citizenship, because it has been perceived as an extraneous element and the result of an imposition from the top, definitely not the outcome of shared choices. During the workshop, the "Ship" (“Nave” in Italian language) has become an art centre called N.Av.E. (New Expressive Adventures – Nuove Avventure Espressive in Italian), a place capable to host temporary events (expositions, lectures, theatre and dance performance, movies projection, etc.). Such a choice has allowed the neighbourhood and the city to take back that “object” so hated as ignored. The experience is particularly significant, because it shows how low cost interventions, realized with citizens involvement and participation, could contribute to the regeneration of peripheral urban areas more than expensive and complex imposed interventions, which often do not take into account dwellers real needs and expectations

Effect of transport length and genotype on tonic immobility, blood parameters and carcass contamination of free-range reared chickens

The aim of the present study was to investigate the effect of transport on welfare traits, several haematological parameters and carcase hygiene in two different chicken genotypes (fast- and slow-growing strains) reared under free-range conditions. For this aim, two hundred male chicks, 100 from fast-growing (Ross 308, R) and 100 from slow-growing (Naked Neck, NN) strain were farmed. At the end of the rearing period, at 81 days of age, 56 birds/strain were randomly selected for slaughtering and submitted to two different pre-slaughter conditions: no transport (0h) or 4 hours of transport (4h). Tonic immobility (TI), blood parameters and carcase hygiene traits were determined. Strain and transport significantly affected TI of birds. Both experimental factors and their interaction significantly affected plasma creatine kinase, alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase. Cholesterol and triglycerides were not different between the experimental groups, whereas glucose decreased after 4 hours of transport in both strains. A significant difference between groups for the heterophils/lymphocytes ratio after transport was also observed, with NN being higher than Ross. Concerning the oxidative stress, we observed a higher ROS production in NN chickens. The carcase microbial characteristics showed a higher level of contamination after the transport (total viable counts), but not concerning the Enterobacteriaceae counts

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo