Acute Pulmonary Embolism and Paradoxical Embolism in Patients with Patent Foramen Ovale: to Close or Not to Close…That is the Question!

Nowadays, the treatment of patent foramen ovale (PFO) after acute pulmonary embolism (PE) remains matter of speculation. Absence of both randomized trials and recommendations in current international guidelines complicate the decisions making in such patients. In the present manuscript we discuss about the reasons for which PFO should be closed after acute PE

One-Year Risk of myocarditis after COVID-19 infection: a systematic review and meta-analysis

Background: Acute myocarditis has been described as a relatively rare cardiovascular complication of COVID-19 infection. However, data regarding the risk of myocarditis during the post-acute phase of COVID-19 are scant. We assess the risk of incident myocarditis in COVID-19 survivors within one year from the index infection by a systematic review and meta-analysis of the available data. Methods: Data were obtained searching MEDLINE and Scopus for all studies published at any time up to September 1, 2022, and reporting the long-term risk of incident myocarditis in COVID-19 survivors. Myocarditis risk data were pooled using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI). Heterogeneity among studies was assessed using Higgins and Thomson I2 statistic. Results: Overall, 20.875.843 patients (mean age 56.1 years, 59.1% males) were included in this analysis. Of them, 1.245.167 survived to COVID-19 infection. Over a mean follow-up of 9.5 months, myocarditis occurred to 0.21 [95% CI: 0.13- 0.42) out of 1000 patients survived to COVID-19 infection compared to 0.09 [95% CI: 0.07-0.12] out of 1000 control subjects. Pooled analysis revealed that recovered COVID-19 patients presented an increased risk of incident myocarditis (HR: 5.16, 95% CI: 3.87-6.89, p<0.0001, I2=7.9%) within one year from the index infection. The sensitivity analysis confirmed yielded results. Conclusion: Our findings suggest that myocarditis represents a relatively rare but important post-acute COVID-19 sequelae

Acetyl-cholinesterase-inhibitors slow cognitive decline and decrease overall mortality in older patients with dementia

We evaluated the effect of Acetyl-cholinesterase-inhibitors (AChEIs) on cognitive decline and overall survival in a large sample of older patients with late onset Alzheimer's disease (LOAD), vascular dementia (VD) or Lewy body disease (LBD) from a real world setting. Patients with dementia enrolled between 2005 and 2020 by the "Alzheimer's Disease Research Centers" were analysed; the mean follow-up period was 7.9 years. A 1:1 propensity score matching was performed generating a cohort of 1.572 patients (786 treated [AChEIs +] and 786 not treated [AChEIs-] with AChEIs. The MMSE score was almost stable during the first 6 years of follow up in AChEIs + and then declined, while in AChEIs- it progressively declined so that at the end of follow-up (13.6 years) the average decrease in MMSE was 10.8 points in AChEIs- compared with 5.4 points in AChEIs + (p &lt; 0.001). This trend was driven by LOAD (Delta-MMSE:-10.8 vs. -5.7 points; p &lt; 0.001), although a similar effect was observed in VD (Delta-MMSE:-11.6 vs. -8.8; p &lt; 0.001). No effect on cognitive status was found in LBD. At multivariate Cox regression analysis (adjusted for age, gender, dependency level and depression) a strong association between AChEIs therapy and lower all-cause mortality was observed (H.R.:0.59; 95%CI: 0.53-0.66); this was confirmed also in analyses separately conducted in LOAD, VD and LBD. Among older people with dementia, treatment with AChEIs was associated with a slower cognitive decline and with reduced mortality, after a mean follow-up of almost eight years. Our data support the effectiveness of AChEIs in older patients affected by these types of dementia

Trends in age and sex-specific dilated cardiomyopathy mortality in Italy, 2005-2017

Aims: Data regarding the dilated cardiomyopathy (DCM)-related mortality and relative time trends in the Italian population remain scant. We sought to assess the DCM mortality rates and relative trends among the Italian population between 2005 and 2017. Methods: Annual death rates by sex and 5-year age group were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (95% CIs), also stratified by sex, were calculated using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in DCM-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. Results: In Italy, the DCM age-standardized annual mortality rate decreased from 4.99 (95% CI: 4.97-5.02) deaths per 100 000 to 2.51 (95% CI: 2.49-2.52) deaths per 100 000 population. Over the entire period, men had a higher DCM-related mortality rates than women. Moreover, the mortality rate increased with age, with a seemingly exponential distribution and showing a similar trend among men and women. Joinpoint regression analysis revealed a linear decrease in age-standardized DCM-related mortality from 2005 to 2017 [AAPC: -5.1% (95% CI: -5.9 to -4.3, P < 0.001)] in the entire Italian population. However, the decline was more pronounced among women [AAPC: -5.6 (95% CI: -6.4 to -4.8, P < 0.001)] compared with men [AAPC: -4.9 (95% CI: -5.8 to -4.1, P < 0.001)]. Conclusion: In Italy, the DCM-related mortality rates linearly declined from 2005 to 2017

Un approccio integrato contro la dispersione scolastica: L’orientamento prospettico progettuale

L'orientamento scolastico, essenziale per indirizzare le scelte educative e professionali degli studenti, è cruciale nella prevenzione della dispersione scolastica. A partire da un approfondimento teorico di teorie, metodi e strumenti dell’orientamento, il contributo propone la visione prospettica e progettuale (De Pieri, 2015; Crea, 2019) come risorsa per creare modelli promotori di sviluppo integrale degli studenti, capaci di pianificazione di percorsi che pongano al centro del processo l’individuo. Esperienze, contesto di appartenenza e risorse personali diventano vettori di gestione autonoma di anticipazione e indirizzo di scelte educative e professionali. Se orientare è educare (De Pieri, 2012), l’intento è di contribuire a definire un approccio integrato distante dai più tradizionali e direttivi modelli, per aiutare la persona a conseguire importanti traguardi di sviluppo e rispondere alla personale ricerca di senso.Educational guidance is pivotal for directing students' educational and professional choices and is essential in preventing school dropout. Beginning with a theoretical examination of the theories, methods, and tools of guidance, the contribution proposes a prospective and projective vision (De Pieri, 2015; Crea, 2019) as a resource to create models that promote the integral development of students, capable of planning pathways that place the individual at the center of the process. Experiences, the context of belonging, and personal resources become vectors for autonomous management of anticipation and the direction of educational and professional choices. If to guide is to educate (De Pieri, 2012), the intent is to foster a psychopedagogical approach that diverges from more traditional and directive models, to assist individuals in achieving significant developmental milestones and responding to their personal quest for meaning

Dyslipidaemia and mortality in COVID-19 patients - a meta-analysis

Background: The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. Aim: To assess the prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. Design: Systematic review and meta-Analysis. Methods: Preferred reporting items for systematic reviews and meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 31 January 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random-effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random-effect models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. Results: Of about 18 studies, enrolling 74 132 COVID-19 patients (mean age 70.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, P &lt; 0.0001), with high heterogeneity (I2 = 98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-Term death (OR: 1.69, 95% CI: 1.19-2.41, P = 0.003), with high heterogeneity (I2 = 88.7%). Due to publication bias, according to the Trim-And-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, P &lt; 0.0001 (one studies trimmed). Conclusion: Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-Term mortality risk

Teachers’ reflective awareness between implicit beliefs and educational strategies against school dropout

This contribution examines school dropout in its various forms from a systemic perspective, exploring the dynamics that contribute to its complexity. It investigates how teachers’ implicit beliefs, specifically regarding growth mindset and fixed mindset (Dweck, 2006), influence educational practices and evaluations within schools. Through a critical review of recent scientific literature and empirical studies in education, it underscores the role of teachers’ adaptive competence in preventing cognitive and emotional biases that can lead to school marginalization. The use of the Questionnaire of Perceptions of Competencies and Convictions (QPCC) is proposed to enhance teachers’ awareness of their implicit beliefs, crucial for fostering fair, inclusive, and dropout preventive learning environments.   La consapevolezza riflessiva del docente tra credenze implicite e strategie educative anti-dispersione. Questo contributo esamina il fenomeno della dispersione scolastica nelle sue varie forme da una prospettiva sistemica, esplorando le dinamiche che ne alimentano la complessità. Indaga come le credenze implicite degli insegnanti, in particolare riguardo al growth mindset e al fixed mindset (Dweck, 2006), influenzano le pratiche educative e valutative all’interno delle scuole. Attraverso una revisione critica della letteratura scientifica recente e degli studi empirici nel campo dell’educazione, si sottolinea il ruolo della competenza adattiva degli insegnanti nella prevenzione dei pregiudizi cognitivi ed emotivi che possono portare alla marginalizzazione scolastica. Si propone l’utilizzo del Questionario di Percezione delle proprie Competenze e Convinzioni (QPCC) per aumentare la consapevolezza degli insegnanti riguardo alle loro credenze implicite, fondamentale per promuovere ambienti di apprendimento equi, inclusivi e orientati alla prevenzione della dispersione scolastica