Chronic inflammatory demyelinating polyradiculoneuropathy: can a diagnosis be made in patients not fulfilling electrodiagnostic criteria?

OBJECTIVE: to identify the clinical and diagnostic investigations that may help supporting a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients not fulfilling the EFNS/PNS electrodiagnostic criteria. METHODS: we retrospectively reviewed the data from patients with a clinical diagnosis of CIDP included in a national database. RESULTS: we included 535 patients with a diagnosis of CIDP. This diagnosis fulfilled the EFNS/PNS criteria in 468 patients (87.2%) (definite in 430, probable in 33, possible in 3, while two had CISP). Sixty-seven patients had a medical history and clinical signs compatible with CIDP but electrodiagnostic studies did not fulfill the EFNS/PNS criteria for CIDP. These patients had similar clinical features and frequency of abnormal supportive criteria for the diagnosis of CIDP compared to patients fulfilling EFNS/PNS criteria. Two or more abnormal supportive criteria were present in 40 (61.2%) patients raising to 54 (80.6%) if we also included a history of a relapsing course as a possible supportive criteria. Increased cerebrospinal fluid proteins and response to immune therapy most frequently helped in supporting the diagnosis of CIDP. Response to therapy was similarly frequent in patients fulfilling or not EFNS/PNS criteria (87.3% versus 85.9%) CONCLUSIONS: Patients with a clinical diagnosis of CIDP had similar clinical findings, frequency of abnormal supportive criteria and response to therapy compared to patients fulfilling EFNS/PNS criteria. The presence of abnormal supportive criteria may help supporting the diagnosis of CIDP in patients with a medical history and clinical signs compatible with this diagnosis but non-diagnostic nerve conduction studies

Atypical CIDP: diagnostic criteria, progression and treatment response. Data from the Italian CIDP Database

OBJECTIVES: A few variants of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been described, but their frequency and evolution to typical CIDP remain unclear. To determine the frequency and characteristics of the CIDP variants, their possible evolution to typical CIDP, and treatment response. METHODS: We applied a set of diagnostic criteria to 460 patients included in a database of Italian patients with CIDP. Clinical characteristics and treatment response were reviewed for each patient. The Kaplan-Meier curve was used to estimate the progression rate from atypical to typical CIDP. RESULTS: At the time of inclusion, 376 (82%) patients had a diagnosis of typical CIDP while 84 (18%) had atypical CIDP, including 34 (7%) with distal acquired demyelinating symmetric neuropathy (DADS), 17 (4%) with purely motor, 17 (4%) with Lewis-Sumner syndrome (LSS) and 16 (3.5%) with purely sensory CIDP. Based on retrospective review of the symptoms and signs present at onset and for at least 1 year, 180 (39%) patients had an initial diagnosis compatible with atypical CIDP that in 96 (53%) patients evolved to typical CIDP. Mean disease duration was longer in patients evolving to typical CIDP than in those not evolving (p=0.0016). Patients with DADS and LSS had a less frequent response to immunoglobulin than those with typical CIDP, while patients with purely motor and sensory CIDP had a similar treatment response. CONCLUSIONS: The proportion of patients with atypical CIDP varies during the disease course. DADS and LSS have a less frequent response to intravenous immunoglobulin compared with typical CIDP, raising the possibility of a different underlying pathogenetic mechanism

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

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Tra passione e sopravvivenza. Prospettive, condizioni e aspettative dei lavoratori della conoscenza negli atenei italiani

Negli ultimi quindici anni, i profondi mutamenti normativi (le Leggi 230/2005 e 240/2010) ed i drastici tagli alla spesa per l’università e la Ricerca hanno comportato che le rare ‘porte d’ingresso’ alle carriere accademiche, ancor più che in passato, si siano trasformate in vere proprie strettoie. I difficilissimi percorsi di ingresso e stabilizzazione nella carriera universitaria hanno inoltre prodotto una quantità notevole di lavoratori precari che lottano per rimanere nel mondo accademico, spesso in condizioni di forte isolamento lavorativo, di competizione reciproca, nonché con il rischio costante di un’espulsione (temporanea o definitiva) dal sistema accademico. Eppure, nonostante le notevoli e crescenti difficoltà, i precari dell’accademia sono determinati, svolgono con passione il loro lavoro (e, spesso, una parte del lavoro dei docenti ‘strutturati’), mettono in pratiche strategie di vita (sul piano economico, abitativo, arrivando anche alla sfera della genitorialità), strategie di resistenza e di sense making che consentono loro di seguire la loro aspirazione. A partire dai dati raccolti nell’indagine Ricercarsi, obiettivo del contributo è quindi quello di offrire uno spaccato delle condizioni di vita, di lavoro e delle prospettive future di questo eterogeneo aggregato di lavoratori della conoscenza.In the past fifteen years, radical normative changes (Laws 230/2005 and 240/2010) and cuts to university and research budgets have generated a reduction of the already limited “entrance gates” to academic careers. These difficulties in the path towards stabilisation have produced a high number of precarious researchers and academics, who fight to have a remunerated position in the academia, despite bad working conditions and the constant treat of expulsion from the academic system. Notwithstanding such difficulties, precarious researchers have kept attending to their jobs with devotion and continued to build up strategies and practices of resistance. Starting from the data collected during the survey “Ricercarsi” the aim of this paper is to focus on the life and working conditions of these heterogeneous aggregation of academic and knowledge workers. The main part of the present work will be strictly analytical; a section will be devoted to analyse the methodology, focusing on the participation and activation aspects related to the survey, that was meant to go beyond strictly “sampling” criteria, concentrating more on the reflexivity of the subject

Determinadi meccanismi di reazioni catalizzate da metallo-enzimi

Dottorato di Ricerca in Metodologie Chimiche Inorganiche,XXIII Ciclo,a.a.2009-2010Università della Calabri

L’università dei precari: la destrutturazione di un ruolo e le strategie individuali di risposta

Il presente contributo riprende, in maniera sintetica, i risultati ottenuti dall’indagine "Ricercarsi. Indagine sui percorsi di vita e lavoro del precariato universitario", realizzata con l’intento di fare luce sulle criticità del sistema accademico italiano, sull’accidentalità dei percorsi di carriera di chi (a vario titolo) occupa e ha occupato posizioni di preruolo nelle università, oltre che sulle aspettative e strategie messe in atto da questi attori. L’indagine, condotta attraverso una strategia di ricerca basata sull’approccio metodologico dei mixed methods, combina diverse metodologie, i cui risultati illustrano entità e forme del fenomeno della precarizzazione nell’università italiana

L’università dei precari: la destrutturazione di un ruolo e le strategie individuali di risposta

Il presente contributo riprende, in maniera sintetica, i risultati ottenuti dall’indagine Ricercarsi. Indagine sui percorsi di vita e lavoro del precariato universitario, realizzata con l’intento di fare luce sulle criticità del sistema accademico italiano, sull’accidentalità dei percorsi di carriera di chi (a vario titolo) occupa e ha occupato posizioni di pre-ruolo nelle università, oltre che sulle aspettative e strategie messe in atto da questi attori. L’indagine, condotta attraverso una strategia di ricerca basata sull’epistemologia dei mixed methods, combina diverse metodologie, i cui risultati sono brevemente presentati nei tre successivi paragrafi: 1) la concatenazione delle analisi dei dati amministrativi e un’analisi longitudinale delle carriere accademiche di chi ha avuto a vario titolo un contratto precario in un ateneo italiano tra il 2003 e il 2014 – che informano in merito all’entità del fenomeno della precarizzazione dell’università; 2) la survey on line, che ha raccolto, tra ottobre 2013 e aprile 2014, 1864 questionari, utilizzando un modello campionario non probabilistico a valanga – che informa invece sui percorsi professionali e di vita, sulle condizioni di lavoro, sulle aspettative e le prospettive del precariato universitario; 3) le storie di vita, raccolte attraverso 23 interviste in profondità diversificate per figura (ricercatore a tempo determinato, assegnista di ricerca, collaboratore occasionale, dottorando), per area disciplinare e per collocazione geografica e grandezza dell’ateneo degli intervistati – che “danno un volto” ai precari e alle precarie della ricerca in Italia