The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Purpose: Chronic asthenia (CA) is complained by some patients that have undergone thyroid surgery. We evaluate its impact in patients undergoing unilateral or bilateral thyroidectomy, the trend during a 1-year follow-up, and the possible risk factors. Methods: A prospective, cohort study was carried out on 263 patients scheduled for thyroidectomy from 2012 and 2014. Exclusion criteria were as follows: Gravesâ disease, malignancies requiring radioiodine therapy, post-surgical hypoparathyroidism, laryngeal nerve palsy, abnormal pre- and post-operative thyroid hormone levels, and BMI outside the normal range. Demographics; smoking and alcoholism addiction; cardiac, pulmonary, renal, and hepatic failure; diabetes; anxiety; and depression were recorded. The Brief Fatigue Inventory (BFI) was used to evaluate CA and its possible association with these comorbidities 6 and 12 months after thyroidectomy. Results: One hundred seventy-seven patients underwent total thyroidectomy (TT), 54 hemithyroidectomy (HT). Thirty-two patients were not recorded because of the onset of exclusion criteria. In the 6 months after thyroidectomy, in the TT group, 64 patients (36.16%) reported an impairment in the BFI score and only 1 in the TL group. The mean BFI score changed from 1.663(±1.191) to 2.16 (±11.148) in the TT group, from 1.584 (±1.371) to 1.171 (±1.093) in the TL group (pÂ&nbsp

La qualità della formazione medica nel distance learning

This study arises from the desire of investigate the perceived effectiveness and critical issues of distance learning, which has been adopted by universities during the SARS-CoV-2 pandemic. An anonymous survey was distributed among Italian medical students, trying to reach the largest part of them via the communication channels of SISM – Segretariato Italiano Studenti in Medicina – APS. 1,489 students from 40 universities have filled in the survey. 75% of the sample attended distance lectures, whereas 11% took part to Problem or Case Based Learning activities. Most of the reported criticism was due to organizational or logistic issues rather than technological ones. Half of the sample has not perceived any variations relating to the interaction with the teachers, whereas most of the interviewed people perceives a decreased interaction with classmates as an affectingly factor on their learning. 48% of the sample reports a greater distractibility and 38% a greater tiredness in comparison with face-to-face teaching. The essential lesson methods to set up an effective distance learning (e.g. e-learning) were probed through collected data and scientific literature. The main outcome has been acknowledging that the roles of the learner and the teacher in the process of distance learning differ from the equivalent roles in face-to-face learning. Therefore, redefining lesson methods and broadly curricular contents is required in order to organize an effective distance learning.Il presente studio nasce dalla volontà di rispondere a quesiti inerenti all’efficacia percepita e alle criticità del distance learning adottato dagli atenei italiani in risposta alla pandemia SARS-CoV-2. È stata distribuita una survey anonima agli studenti di Medicina e Chirurgia, cercando di raggiungerne un campione il più rappresentativo possibile tramite i canali di comunicazione del SISM - Segretariato Italiano Studenti in Medicina - APS. La survey è stata compilata da 1.489 persone afferenti a 40 atenei differenti. Il 75% del campione ha partecipato a lezioni frontali a distanza, mentre solo l’11% ha preso parte ad attività di Problem o Case Based Learning. La maggior parte dei problemi riscontrati dagli studenti è stata di natura organizzativa e logistica più che tecnologica. La metà del campione non ha rilevato variazioni nell’interazione con il docente, mentre la maggior parte percepisce una diminuzione nell'interazione con i compagni. Il 48% del campione accusa una maggiore distraibilità e il 38% una maggiore stanchezza. Tramite le fonti e i dati raccolti sono state indagate le metodiche imprescindibili per l’organizzazione di un distance learning efficace, come l’e-learning, nel quale le figure dei docenti e dei discenti assumono nuovi ruoli, con l’acquisizione di una maggiore autonomia da parte dei secondi. In conclusione, affinché il distance learning possa essere efficace è necessaria – in particolare in un contesto di Medical Education – una ridefinizione delle modalità di lezione e, più in generale, del contenuto dei curricula italiani

Coronary computed tomography angiography in acute chest pain: a sustainable model with remote support

Purpose: To propose a sustainable model of coronary computed tomography angiography (CCTA) use in acute coronary syndrome (ACS) in emergency department (ED) using a partially based teleradiology reporting model. We also analyzed impact of the protocol on short- and long-term patient's outcome. Methods: During a 12-month period, 104 consecutive patients admitted to the ED for acute chest pain (ACP) with low-to-intermediate risk of ACS were selected and underwent CCTA. Medical reporting was based on a model combining on-site physician and a remote radiologist supported by a web client-based teleradiology system, covering a 24/7 service. CCTA findings were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up. Results: CCTA ruled-out CAD in 76 patients (73.1%). Moderate (7.7%) to severe (19.2%) CAD was identified in 28 patients who were directly referred to functional tests or invasive angiography. The mean discharge time was 10.8 ± 5.8 h; patients with absent to mild disease were safely and quickly discharged. Remote reporting using a teleradiology platform was performed in 82/104 cases (78.9%), with slight impact on patient's discharge time (10.4 ± 5.6 vs. 12.1 ± 6.1 h, p: 0.24). MACEs at 6-month and at 5-year follow-up were 0.96% (n = 1/104) and 15.5% (n = 14/90). Conclusion: CCTA assessment of patients with ACP enables to quickly rule-out ACS, avoiding waste of time and resources, to identify patients with obstructive CAD which should be referred to subsequent tests and to stratify the risk of MACEs at short and long time. A partial teleradiology based 24/7 CCTA service is feasible and sustainable, even in small ED

mGluR5 PAMs rescue cortical and behavioural defects in a mouse model of CDKL5 deficiency disorder

Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) is a devastating rare neurodevelopmental disease without a cure, caused by mutations of the serine/threonine kinase CDKL5 highly expressed in the forebrain. CDD is characterized by early-onset seizures, severe intellectual disabilities, autistic-like traits, sensorimotor and cortical visual impairments (CVI). The lack of an effective therapeutic strategy for CDD urgently demands the identification of novel druggable targets potentially relevant for CDD pathophysiology. To this aim, we studied Class I metabotropic glutamate receptors 5 (mGluR5) because of their important role in the neuropathological signs produced by the lack of CDKL5 in-vivo, such as defective synaptogenesis, dendritic spines formation/maturation, synaptic transmission and plasticity. Importantly, mGluR5 function strictly depends on the correct expression of the postsynaptic protein Homer1bc that we previously found atypical in the cerebral cortex of Cdkl5-/y mice. In this study, we reveal that CDKL5 loss tampers with (i) the binding strength of Homer1bc-mGluR5 complexes, (ii) the synaptic localization of mGluR5 and (iii) the mGluR5-mediated enhancement of NMDA-induced neuronal responses. Importantly, we showed that the stimulation of mGluR5 activity by administering in mice specific positive-allosteric-modulators (PAMs), i.e., 3-Cyano-N-(1,3-diphenyl-1H-pyrazol-5-yl)benzamide (CDPPB) or RO6807794, corrected the synaptic, functional and behavioral defects shown by Cdkl5-/y mice. Notably, in the visual cortex of 2 CDD patients we found changes in synaptic organization that recapitulate those of mutant CDKL5 mice, including the reduced expression of mGluR5, suggesting that these receptors represent a promising therapeutic target for CDD

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria