Contribution to the floristic knowledge of eastern Irpinia and Vulture-Melfese area (Campania and Basilicata, southern Italy)

In order to improve the floristic knowledge of the Italian territory, we report the inventory of the taxa collected during the annual field trip of the working group for Floristics, Systematics and Evolution of the Italian Botanical Society held in 2015 in eastern Irpinia and Vulture-Melfese area (South Italy). The investigated territories are located in southern Apennines, along the border between the Campania and Basilicata administrative regions. These areas are scarcely known in terms of vascular flora. The floristic samplings were performed in 19 sites selected as representative of the local environmental diversity as regards to climate, litho-morphology and land-use. The research led to the identification of 4,137 specimens of vascular plants, belonging to 815 species and subspecies, 399 genera, and 85 families. Among these taxa, 42 were endemic to Italy, 38 were included in the IUCN Red List of the Italian Flora, 28 were alien and 5 were cryptogenic in Campania and/ or Basilicata administrative regions. Two taxa, Aquilegia coerulea (casual alien, native to North America) and Lolium ×boucheanum (native), were found to be new for Italy. On the basis of the available floristic literature the first one is also to be considered new for the European flora. At regional scale, we have found 18 taxa new for the Campania and 15 new for the Basilicata region. Finally, 10 taxa were confirmed for Campania. Data obtained during this study, confirmed the important role of a collaborative approach among botanists and the great relevance of these territories for plant diversity

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effects of topiramate in patients with cerebellar tremor

Purpose: To evaluate the safety and potential beneficial effect of topiramate (TPM) as monotherapy or adjunctive therapy to carbamazepine (CBZ) in patients with cerebellar tremor. Methods: Nine patients with cerebellar tremor participated a 4-week, open-label, prospective-controlled trial. TPM was given as monotherapy (n=7 cases), or in combination with CBZ (n=2 cases), at dosages ranging from 25 mg twice daily to 100 mg twice daily. The severity of tremor was assessed clinically on a 0–4 scale, by tremograms, by the Patients Global Impressions Scale, and by a “free writing” task at baseline and after 4 weeks. Results: TPM was discontinued in four patients due to adverse effects (sedation=2; cognitive IMPAIRMENT=2; increased AGGRESSIVENESS=2; ASTHENIA=1). During TPM, all patients improved. The mean tremor amplitude, compared with the baseline period, was reduced from 20% to 75%. After TPM, mean clinical scores of postural tremor and kinetic tremor decreased from 2.1±0.8 to 0.9±0.9 and from 2.1±1 to 1.4±1 (P<.05), respectively. All patients with head tremor improved. Writing, eating, and drawing were improved with TPM. Four patients chose to keep taking the drug. Conclusions: Our study indicates that TPM may be useful for the management of cerebellar tremors. A prospective placebo-controlled trial of TPM in this kind of tremor is warranted. TPM dosages should be titrated slowly to avoid the potential side effects of the drug. The range and the frequency of adverse events might limit the clinical usefulness of TPM

Evidence of early childhood as the susceptibility period in multiple sclerosis: space-time cluster analysis in a Sardinian population

The authors analyzed the natural history of multiple sclerosis (MS) before onset to identify the period of susceptibility and exogenous factors that might play a role in causing the disease. Space-time cluster analysis was performed among northern Sardinians, a genetically stable Italian population that showed an increasing risk of MS between 1965 and 1999. Residence changes from birth to clinical onset were recorded for all MS patients with clinical onset between 1965 and 1999 in the province of Sassari. Closeness in space and time was defined as living in the same municipality and differing in year of birth by 1, 2, or 5 years. Analyses were performed for the period from birth to age 25 years or MS onset and in demographic and clinical subgroups. Clustering was substantial in early childhood. Clustering was most marked in the most recent cases, among women, and among patients with early age at onset, a relapsing-remitting course, and in the eastern subarea. No clustering was found when closeness in time was defined as a fixed number of years before onset, which argues against a fixed latency period. Early childhood seemed to be a period of increased susceptibility to MS. This evidence and the increasing incidence of MS in northern Sardinia are compatible with a change in environmental exposure

Topiramate in patients with cerebellar tremor: a controlled trial

Previous studies have suggested that carbamazepine (CBZ) may be a valuable drug in cerebellar tremors. Our preliminary findings indicate that the novel anticonvulsant topiramate may also be useful in this kind of tremor

Sardinia, a high-risk area for multiple sclerosis: a prevalence and incidence study in the district of Alghero

Findings from small descriptive studies carried out in the last few years in Sardinia suggest that this region is now of high rather than medium risk for multiple sclerosis. It is uncertain whether this high prevalence reflects a different approach in case finding over time or a true change in disease occurrence. We report the results of a prevalence and incidence survey conducted in the district of Alghero, a community of 78,000 people in northwest Sardinia. Based on data from 31 patients, the average annual incidence for the period 1971 through 1980 was 4.1 per 100,000. On December 31, 1980, the prevalence rate was 59 per 100,000. The results support the view that Sardinia is now a high-risk area for multiple sclerosis, and further suggest a rise in the occurrence of the disease in recent years

Multiple sclerosis epidemiology in Sardinia: evidence for a true increasing risk

Objectives To update prevalence and incidence rates of MS among Sardinians. Materials and methods The present work is a "spider" kind of population based survey, conducted over the interval 1968-97, on patients with MS (Poser criteria) living in the province of Sassari, Northern Sardinia (454,904 population). Results A crude total prevalence rate of 144.4 per 100,000, an onset-adjusted prevalence rate of 149.7 per 100,000 and an average annual incidence rate of 8.2 for the period 1993-7 were found. Conclusion Repeated epidemiological assessments of MS in Sardinia over decades have shown that the island is at high risk for MS. The present work highlights that MS incidence in Sardinia has been increasing over time. Although a substantial and widely spread improvement in MS case ascertainment can be postulated as the reason for such observations, a comparison between our data and those recently reported from a more industrialized province in Northern Italy seems to prove an at least partially real increase in MS risk among Sardinians and favours the hypothesis of a MS "Sardinian focus" as related to its latitude