Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"
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Prevalence and Management of Complications of Laser Ablation for Benign Thyroid Nodules
No full textContext Percutaneous laser ablation (LA) is today regarded as a valuable therapy for symptomatic, benign solid (noncystic) thyroid nodules (STNs).Objective We assessed the prevalence of complications from LA for benign and STNs and their management.Methods We conducted a systematic review with meta-analysis of data from published studies on LA of STNs, in addition to author institutions. A random effects meta-analysis was performed on the prevalence rates.Results The literature search yielded 1351 studies, of which 38 studies were included, in addition to our institutional experience (4745 STNs in total). The overall quality of each included study was judged as fair. The prevalence of "overall" complications of LA was 23% ([CI, 17%-30%], I2 93.7%, 1208 of 4702 thyroid nodules [TNs]). The prevalence of "minor" complications of LA was 21% ([CI, 15%-27%], I2 93.7%, 1159 of 4702 TNs). The prevalence of "major" complications of LA was 2% ([CI, 1%-3%], I2 54.0%, 49 of 4745 TNs). Sensitivity analyses did not modify the results, except for dysphonia, whose pooled prevalence was higher when using local anesthesia (2%; CI, [1%-3%], I2 25.2; P = .010) or conscious sedation (2%; CI, [1%-4%], I2 27.2; P = .014). The pooled prevalence rate of local pain was 15% (CI, [12%-20%], I2 89.3). Local pain was transient and typically mild to moderate, sometimes severe, requiring analgesics for 1 to 5 days up to 1 month. The pooled prevalence rate of dysphonia was 2% (CI, [1%-2%], I2 30.3). All cases of dysphonia were transient except for one permanent case.Conclusion LA for benign and noncystic STNs can be considered a generally safe technique. Major complications are rare
The American College of Cardology/American Heart Association Heart Failure Staging System Highlights Diagnostic Delay and Predicts Outcome in Transthyretin Cardiac Amyloidosis
No full textObjective: To apply the American College of Cardiology (ACC) and American Heart Association (AHA) heart failure (HF) staging system to patients with transthyretin cardiac amyloidosis (TTR-CA) in order to assess diagnostic delay and evaluate prognosis. Patients and Methods: Consecutive patients with TTR-CA enrolled in an Italian registry were classified according to the ACC/AHA HF staging system at diagnosis. Outcome was assessed as all-cause mortality during a 3-year follow-up. Results: At diagnosis, of 549 patients with TTR-CA, 115 (20.9%) presented with HF stage B, 172 (31.3%) with stage C1, 198 (36.1%) with stage C2, and 64 (11.7%) with stage D. Patients with stages B, C1, C2, and D presented with hierarchically higher prevalence of left ventricular systolic impairment, advanced diastolic dysfunction, advanced New York Heart Association functional class, hospitalization for HF, and N-terminal pro–B-type natriuretic peptide values. At 3 years, the survival rate was 94% in patients with stage B HF, decreasing to 69% with stage C1, 43% with stage C2, and 17% with stage D. At multivariable analysis, considering stage B as the reference, risk increase for all-cause mortality was 4, 5, and 11 for stages C1, C2, and D, respectively. Conclusion: At diagnosis, almost half of patients with TTR-CA present with advanced stages of HF (C2 or D), suggesting marked diagnostic delay. The ACC/AHA HF staging system accurately stratifies prognosis and may be usefully added to the multiparametric evaluation of patients with TTR-CA
Pelvic Actinomycosis and Diagnostic Complexity: Case Report with Literature Review
No full textIntroduction: Actinomyces are commensal bacteria that colonize various sites in the human body. Under certain predisposing conditions, they can proliferate and cause granulomatous inflammation in different tissues. Pelvic actinomycosis is an extremely rare condition; its significance lies in the fact that it can be easily misdiagnosed as gynecological malignancy based on clinical manifestations and imaging findings. According to the literature, this type of inflammatory disease is a common mimic of ovarian cancer. Objective and methods: This paper aims to provide a comprehensive overview of the characteristics of pelvic actinomycosis through a literature review and the description of two cases collected between 2023 and 2024 at Azienda Ospedaliera Universitaria Santa Maria della Misericordia in Udine Italy
Eco-Body Lab – Il Corpo come Strumento di Inclusione e Sostenibilità
No full textL'integrazione tra Embodied Education, sostenibilità e inclusione rappresenta una frontiera innovativa nella didattica moderna, unendo il corpo e la mente nell'apprendimento e promuovendo un ambiente educativo più equo e consapevole. Questo studio sperimentale ha l'obiettivo di esplorare come l'apprendimento basato sull'esperienza corporea possa sensibi-lizzare gli studenti sugli obiettivi di sviluppo sostenibile dell'Agenda 2030 e favorire pratiche inclusive all'interno delle scuole. Il progetto, della durata di sei mesi, coinvolge un campione di 100 studenti della scuola secondaria di primo grado, con un focus particolare su studenti con bisogni educativi speciali (BES), provenienti da background migratorio o so-cio-economicamente svantaggiati, e studenti con eccellenze scolastiche. Tali gruppi, spesso marginalizzati, sono posti al centro del progetto per garantire che l'inclusione e la sostenibilità diventino pratiche comuni e condivise tra tutti gli studenti. L'approccio metodologico adot-tato è di tipo quali-quantitativo, utilizzando strumenti validati per misurare l'inclusione, il benessere e la consapevolezza ecologica degli studenti, al fine di valutare gli effetti dell'ap-proccio integrato sulla loro crescita personale e sociale. I risultati attesi includono un mi-glioramento dell'inclusione sociale, una maggiore consapevolezza riguardo alle problematiche ambientali e un arricchimento dell'esperienza educativa complessiva
Spatial Effects in Sustainable Financing: Evidence from Italian SMEs
No full textSustainable financing plays a crucial role in supporting firms’ ecological transition. This study investigates the determinants of access to green funds and the amount received by Small and Medium Enterprises (SMEs) in Italy, focusing on the characteristics of firms that obtain public financing for sustainability projects. Given the potential influence of industry sectors and spatial proximity on financing dynamics, we explore the existence of spillover effects arising from both group/sectoral belonging and geographical location, conceptualized as inter-firm networks. To test this hypothesis, we first compute indicators of spatial association, and then estimate a Spatial Autoregressive (SAR) model. We find significant spillover effects in both spatial and networked dimensions. Therefore, our results suggest that sectoral structure, firm connectivity, and spatial proximity all contribute to amplifying the diffusion of sustainable financing, with important implications for policies supporting corporate sustainability
Prognostic Value of Malnutrition, Frailty, and Physical Performance in Transthyretin Cardiac Amyloidosis: Insights From a Prospective Multicenter Cohort Study
No full textBACKGROUND: The prevalence of transthyretin cardiac amyloidosis among older adults (often octogenarians) is increasing. We aimed to determine whether age and geriatric syndromes bear any impact on the management and outcomes in transthyretin cardiac amyloidosis and assess the risk of ageism. METHODS: In a prospective, multicenter cohort study, 256 patients diagnosed with transthyretin cardiac amyloidosis from March 2021 to March 2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre stage). Key CGA domains included disability, malnutrition, depression, frailty, Short Physical Performance Battery, and cumulative deficits (sum of the single CGA items). Associations of these measures with disease-modifying therapy and overall mortality were analyzed. RESULTS: Median age was 82 years (men: n=223 [87%]; variant: n=19 [7.4%]); 129 (50.3%) patients received disease modifiers. Those ≥85 years had significantly lower odds of receiving disease-modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.9 (interquartile range, 1.0–2.3) years, 45 (17.6%) patients died. After adjustment for National Amyloidosis Centre stage, diuretics and disease modifiers, CGA domains of disability, malnutrition, Short Physical Performance Battery, frailty, and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved National Amyloidosis Centre prognostic accuracy. CONCLUSIONS: In a national prospective cohort of patients with transthyretin cardiac amyloidosis, older age was associated with lower prescription of disease modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Because some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes
Ethics in Psychiatry
No full textThe United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) is an international human rights treaty, which sets out the fundamental human rights for persons with disabilities. Issued in 2006, the Convention aims to promote, protect, and ensure the full and equal enjoyment of all human rights and fundamental freedoms by persons with disabilities and proposes a paradigm shift from “substitute decision-making” to “supported decision-making”. Alongside the CRPD, a committee of the UN produced the General Comment no. 1, in which some of the articles are addressed in detail, and strict interpretations of the articles are provided, fueling a hot debate in the psychiatric community. The present chapter offers a summary of the strengths and the limitations surrounding the convention and its interpretations
Correction: Thymic hyperplasia is accurate to detect new-onset Graves' hyperthyroidism and resolves after restoring euthyroidism
No full textIn the original version of this article, the author’s name Reginelli Alfonso was incorrectly written as Regginelli Alfonso