TELEMEDICINE DURING THE COVID-19 PANDEMIC: EXPERIENCE FROM AN ITALIAN OUTPATIENT CLINIC FOR MOVEMENT DISORDERS

Patients with chronic diseases such as Parkinson’s disease need periodic medical examinations. During the COVID-19 pandemic non-emergent medical visits were impossible. To ensure continuity of health care, telemedicine has been demonstrated to be a potential and useful tool

Saltwater contamination in the lowlying coastland of the Venice Lagoon, Italy

TIle southem portion ofthe Venice coastland includes a very precarious environment. Due to an elevation down to 4 m below msl, ilie Venice Lagoon atld Adriatic Sea proximity, and the encroachment of seawater from ilie mouth of the river network up to 20 km inland, salt contamination of land atld groundwater is a severe problem that is seriously affecting the farmland productivity. An interdisciplinary multi-scale research is ongoing with the aim of understanding ilie contamination process, quantifying the effect of ilie saltwater intrusion of the crop production, and proposing possible mitigation strategies. A 21-ha representative basin has been selected and deeply monitored from the hydrogeological atld agricultural points of view. It has been clearly outlined that in the upper 5 to 10 m mainly the lowpermeable soils are contaminated by salt. Conversely, fresh to brackish waters are located in the sandy elongated paleo-channels. This is likely due to the origin of the area which was a salty marshlatld since one century ago. The freshwater supplied for almost 100 years by the rainfall and leakage from the river and chatlnel beds has been able to reduce ilie salt concentration only in the highly permeable deposits

Pain Modulation after Oromucosal Cannabinoid Spray (SATIVEX®) in Patients with Multiple Sclerosis: A Study with Quantitative Sensory Testing and Laser-Evoked Potentials

Background. Delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) (nabiximols or Sativex®) is an oromucosal spray formulation containing THC and CBD at an approximately 1:1 fixed ratio. Its administration for the treatment of pain in patients with multiple sclerosis (MS) has been established. MS patients generally complain of different kinds of pain, including spasticity-related and neuropathic pain. In this study, we compared and evaluated pain modulation and thermal/pain threshold of MS patients before and after THC/CBD administration. Methods. 19 MS patients underwent clinical examination, numerical rating scale (NRS), quantitative sensory testing (QST), and laser-evoked potentials (LEPs) before and after 1 month of therapy. Psychophysiological and neurophysiological data were compared to sex- and age-matched controls. Results. Patients reported a significant reduction in pain. We found statistically significant differences in LEP parameters between patients and controls but no significant change in LEP measures after THC/CBD therapy. Cold and heat detection thresholds were altered in patients but did not change after THC/CBD therapy. There was a significant increase in cold pain threshold by hand stimulation and a significant reduction in abnormal cold perception thresholds. Conclusions. Our results indicate that Sativex® therapy provides pain relief in MS patients and suggest that it might modulate peripheral cold-sensitive TRP channels

3D groundwater flow and deformation modelling of Madrid aquifer

A novel methodological approach to calibrate and validate three-dimensional (3D) finite element (FE) groundwater flow and geomechanical models has been implemented using Advanced Differential Interferometric SAR (A-DInSAR) data. In particular, we show how A-DInSAR data can be effectively used to (1) constrain the model set-up in evaluating the areal influence of the wellfield and (2) characterise the aquifer system, specifically the storage coefficient values, which represents a fundamental step in managing groundwater resources. The procedure has been tested to reconstruct the surface vertical and horizontal movements caused by the Manzanares-Jarama wellfield located northwest of Madrid (Spain). The wellfield was used to supply freshwater during major droughts over the period between 1994 and 2010. Previous A-DInSAR outcomes obtained by ERS-1/2 and ENVISAT acquisitions clearly revealed the seasonality of the land displacements associated to the withdrawal and recovery cycles that characterized the wellfield development. A time-lag of about one month, which is in the order of the time span between two SAR acquisitions, between the hydraulic head changes and the displacements has been detected in this site by a wavelet analysis of A-DInSAR and piezometer time series. The negligible delay between the forcing factor and the system response and the complete subsidence recovery when piezometric head recovers supported the understanding of a minor role played by the pore pressure propagation within clay layers and the almost perfectly elastic behavior of the system (viscosity is negligible), respectively. The developed geomechanical model satisfactorily reproduces the pumping-induced deformations with a Root Mean Square Error (RMSE) between observed and simulated land displacements in the order of 0.1-0.3 mm. The results give insights about the approach benefits in deeply understanding the spatio-temporal aquifer-system response to the management of this strategic water resource for Madrid.The activity has been developed within the scientific collaboration established in the framework of the UNESCO Land Subsidence International Initiative (LaSII - https://www.landsubsidence-unesco.org/). The research was funded by University of Pavia in the framework of a research grant award “assegno di tipo A premiale” for research activities at the Dept. of Earth and Environmental Sciences, within the research project entitled “Sustainable groundwater resources management by integrating A-DInSAR derived monitoring and flow modeling results” assigned to Roberta Bonì in March 2019. This research was partially funded by the Spanish Ministry of Economy, Industry and Competitiveness (MINECO), the State Agency of Research (AEI), and the European Funds for Regional Development (FEDER) under project TEC2017-85244-C2-1-P

Understanding the dynamic behaviour for the Madrid aquifer (Spain): insights from the integration of A-DInSAR and 3-D groundwater flow and geomechanical models

Advanced Differential Interferometric Synthetic Aperture Radar (A-DInSAR) techniques and 3-D groundwater flow and geomechanical models are integrated to improve our knowledge about the Tertiary detritic aquifer of Madrid (TDAM). In particular, the attention is focused on the Manzanares-Jarama well field, located to the northwest of Madrid, which experienced five cycles of extensive groundwater withdrawal followed by natural recovery, to cope with the droughts occurred in summer 1995, 1999, 2002, 2006, and 2009. Piezometric records and A-DInSAR data acquired by ERS-1/2 and ENVISAT satellites during the periods 1992–2000 and 2002–2010, respectively, have been used to calibrate the groundwater flow and the geomechanical models. A time-lag of about one month between the hydraulic head changes and the displacements of the land surface has been detected by a joint wavelet analysis of A-DInSAR and piezometer head time series. Overall, the results show the effectiveness of the proposed integrated approach composed of A-DInSAR and 3-D geomechanical model to characterize the aquifer-system response during and after the groundwater withdrawal.This research has been supported by the Università degli Studi di Pavia (Assegno di tipo A premiale: “Sustainable groundwater resources management by integrating A-DInSAR derived monitoring and flow modeling results” assigned to Roberta Bonì in March 2019) and the Spanish Ministry of Economy, Industry and Competitiveness (MINECO), the State Agency of Research (AEI), and the European Funds for Regional Development (FEDER) (grant no. TEC2017-85244-C2-1-P)

Wavelet analysis of land subsidence time-series: Madrid Tertiary aquifer case study

Interpretation of land subsidence time-series to understand the evolution of the phenomenon and the existing relationships between triggers and measured displacements is a great challenge. Continuous wavelet transform (CWT) is a powerful signal processing method mainly suitable for the analysis of individual nonstationary time-series. CWT expands time-series into the time-frequency space allowing identification of localized nonstationary periodicities. Complementarily, Cross Wavelet Transform (XWT) and Wavelet Coherence (WTC) methods allow the comparison of two time-series that may be expected to be related in order to identify regions in the time-frequency domain that exhibit large common cross-power and wavelet coherence, respectively, and therefore are evocative of causality. In this work we use CWT, XWT and WTC to analyze piezometric and InSAR (interferometric synthetic aperture radar) time-series from the Tertiary aquifer of Madrid (Spain) to illustrate their capabilities for interpreting land subsidence and piezometric time-series information.This research has been supported by the Spanish Ministry of Economy and Competitiveness, the State Agency of Research and the European Funds for Regional Development (grant no. TEC2017-85244-C2-1-P)

Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey

Background: Functional neurological disorders (FND) are disabling medical conditions commonly seen in neurological practice. Neurologists play an essential role in managing FND, from establishing a diagnosis to coordination of multidisciplinary team-based treatment for patients. With this study, we investigated the knowledge and the clinical experience of Italian neurologists in managing patients with FND. Methods: Members of the Italian Society of Neurology were invited via e-mail to participate in this ad hoc online survey; 492 questionnaires were returned completed. Results: The term "Functional neurological disorders" in reference to FND was used more frequently than other psychological (e.g., psychogenic or conversion), or descriptive terms (e.g., non-organic or stress-related). When speaking with patients, the respondents stated that they preferred explaining symptoms based on abnormal functioning of the nervous system than discussing mental illness and that they would refer their patient to a psychologist rather than to a psychiatrist. Few considered that physiotherapy and psychiatric interventions are useful approaches to treating FND. Some believed that patients simulate their symptoms. Conclusions: Overall, the responses suggest that knowledge about scientific advances in FND is somewhat sparse. A psychiatric-centered view of FND opens the way to an approach in which neurobiological and psychological aspects constitute essential factors of the condition. In this context, professional education could improve understanding of FND and optimize patient management

Stroke management during the coronavirus disease 2019 (COVID-19) pandemic: experience from three regions of the north east of Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige)

Background: Efficiency of care chain response and hospital reactivity were and are challenged for stroke acute care management during the pandemic period of coronavirus disease 2019 (COVID-19) in North-Eastern Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige), counting 7,193,880 inhabitants (ISTAT), with consequences in acute treatment for patients with ischemic stroke. Methods: We conducted a retrospective data collection of patients admitted to stroke units eventually treated with thrombolysis and thrombectomy, ranging from January to May 2020 from the beginning to the end of the main first pandemic period of COVID-19 in Italy. The primary endpoint was the number of patients arriving to these stroke units, and secondary endpoints were the number of thrombolysis and/or thrombectomy. Chi-square analysis was used on all patients; furthermore, patients were divided into two cohorts (pre-lockdown and lockdown periods) and the Kruskal-Wallis test was used to test differences on admission and reperfusive therapies. Results: In total, 2536 patients were included in 22 centers. There was a significant decrease of admissions in April compared to January. Furthermore, we observed a significant decrease of thrombectomy during the lockdown period, while thrombolysis rate was unaffected in the same interval across all centers. Conclusions: Our study confirmed a decrease in admission rate of stroke patients in a large area of northern Italy during the lockdown period, especially during the first dramatic phase. Overall, there was no decrease in thrombolysis rate, confirming an effect of emergency care system for stroke patients. Instead, the significant decrease in thrombectomy rate during lockdown addresses some considerations of local and regional stroke networks during COVID-19 pandemic evolution

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