ASL Roma

This systematic review aims to evaluate the impact of multimedia education compared to standard approaches for people with central venous access devices for long-term use. We systematically searched PubMed, Embase, and CINAHL Complete until January 2025. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Ten studies were identified (832 patients), including six randomized controlled trials and four quasi-experimental studies. Seven multimedia educational programs used asynchronous methods (e.g. pre-recorded videos or presentations), while three employed synchronous approaches (e.g. tele-visits or virtual communities). Five studies assessed short-term knowledge, with two showing significant improvements and three reporting no differences. Skill acquisition improved in two studies. Cumulative catheter complications decreased in two studies, though findings on specific issues were mixed. These findings suggest potential benefits of multimedia education in patient care, but methodological limitations and study variability render the evidence inconclusive, underscoring the need for high-quality research.

Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20-25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3-T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population.

The Mediterranean Diet (MD) has been associated with reduced inflammation and improved immune regulation, suggesting a potential protective role against autoimmune diseases. This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate. A total of 9 high-quality studies were included. No significant associations were found between high vs. low MD adherence and the incidence of rheumatoid arthritis (RR = 0.99, 95% CI: 0.97-1.01), lupus (HR = 0.97, 95% CI: 0.91-1.03), Crohn's disease (RR = 0.95, 95% CI: 0.84-1.07), or ulcerative colitis (RR = 1.02, 95% CI: 0.97-1.08). A significant inverse association was observed for multiple sclerosis (RR = 0.91, 95% CI: 0.85-0.98) and for Sjögren's syndrome (OR = 0.81, 95% CI: 0.66-0.99). However, the certainty of evidence for all outcomes was rated as low. Promising associations were observed for multiple sclerosis and Sjögren's syndrome, although current evidence does not support a consistent protective effect of the MD across several other autoimmune diseases. Further longitudinal research is needed to confirm these findings and explore underlying mechanisms. Meanwhile, the promotion of MD adherence remains justified within broader public health strategies for chronic disease prevention.

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual-Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results.

IntroductionLong COVID (LC) has been associated with hypothalamic–pituitary–adrenal (HPA) axis dysfunction, although findings from blood cortisol measurements remain inconsistent. We hypothesized that LC patients exhibit a disrupted diurnal cortisol rhythm and that salivary cortisol (SC) profiling may provide a more accurate assessment of HPA activity.MethodsThis prospective, single-center, case–control study was conducted at a Long COVID clinic in Rome between February 2023 and March 2024 and included 96 participants evaluated at least 28 days after confirmed SARS-CoV-2 infection. LC was defined as one or more new or persistent symptoms and classified as severe when four or more of the following were present: fatigue, cognitive impairment, exercise intolerance, dyspnea, arthralgia, or dysautonomia. SC was measured at 8:00 AM, 3:00 PM, and 11:00 PM.ResultsThe cohort (mean age 58.1 ± 14.8 years; 60% female; all White) included 83 LC patients (80% moderate, 20% severe) and 13 asymptomatic post-COVID (APC) individuals. Compared with healthy controls, both LC and APC groups showed reduced morning SC (p<0.01), flattened diurnal variation, and elevated evening SC, indicating loss of the normal morning peak and nocturnal decline. Blood cortisol levels did not differ among groups, but LC patients had higher ACTH than APC (26 pg/mL vs 13 pg/mL; p<0.01), suggesting compensatory HPA activation. One LC patient (1.2%) was diagnosed with adrenal insufficiency.DiscussionThese exploratory findings suggest a disrupted circadian cortisol rhythm in individuals after COVID-19, with altered HPA axis dynamics that may be associated with disease severity.

Despite national and international guidelines on Helicobacter pylori management, limited evidence exists on how these recommendations are applied in routine clinical practice. This nationwide survey, conducted by the Italian Association of Hospital Gastroenterologists and Endoscopists and the Italian Federation of General Practitioners (FIMMG), aimed to identify the empirical first- and second-line treatments most commonly recommended in Italy. Members of societies were invited via email to anonymously complete an original 20-item questionnaire. Ten therapeutic regimens were proposed, with treatment durations classified as 7, 10, or 14 days. Respondents reported the type of proton-pump inhibitor (PPI) used, total daily dose (mg/day), and whether probiotics and/or lactoferrin were recommended. PPI doses were standardized according to acid inhibition potency and categorized as low, standard, or high. Among the 1262 respondents [358 gastroenterologists (GEs) and 904 general practitioners (GPs)], the first-line regimen most frequently prescribed was the triple therapy with PPI, clarithromycin and amoxicillin (35.2%; 12% of GEs vs. 44.4% of GPs; P < 0.0001), followed by bismuth quadruple therapy - three-in-one capsule (BQT-TSC: 31.2%; 51.4 vs. 23.3%, P < 0.001), and sequential therapy (21.7%; 26.8 vs. 19.7%, P < 0.001). For second-line, BQT-TSC was the most prescribed regimen (53.1%; GEs versus GSs: not statistically significant). 10-day courses and low-dose PPIs predominated, and approximately 1/3 of respondents recommended probiotics. Empirical regimen selection, PPI dosing, and probiotic use frequently diverged from guideline recommendations. These findings highlight the need to align clinical practice with evidence-based standards to improve eradication rates, optimize cost-effectiveness, and preserve healthcare resources.

ABSTRACT BACKGROUND Serum uric acid (SUA) has been associated with cardiovascular (CV) and all-cause mortality; however, its interpretation is influenced by renal function. The serum uric acid to creatinine ratio (SUA/sCr) has been proposed as a refined marker, integrating urate burden with renal excretory capacity. Evidence from real-world populations with preserved renal function remains limited. METHODS A retrospective observational analysis was performed using administrative and laboratory databases from nine Italian healthcare entities, covering more than 7.6 million individuals. Eligible subjects were 18–95 years old, with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m², serum creatinine (sCr) ≤1.8 mg/dL, and no prior urate-lowering therapy. The index date was defined as the first SUA measurement between January 2017 and March 2022. A total of 739,950 participants were stratified into quintiles of SUA/sCr ratio. Outcomes were two-year all-cause mortality and CV events, including ischemic heart disease, heart failure, cerebrovascular disease, and coronary revascularization. RESULTS All-cause mortality exhibited a U-shaped distribution, with the lowest risk in mid-quintiles and the highest in extreme quintiles (6.2% in quintile 1, 7.0% in quintile 5). Cardiovascular events showed a progressive increase, from 9.9% in quintile 1 to 11.6% in quintile 5. Sex-stratified analyses indicated higher absolute risks in men, whereas women demonstrated steeper relative increases across higher quintiles. In individuals with hyperuricemia, mortality and CV events rose consistently with increasing SUA/sCr values. CONCLUSIONS The SUA/sCr ratio is an independent predictor of short-term mortality and cardiovascular events in individuals with preserved renal function. Its incorporation into routine risk stratification may support earlier identification of high-risk patients, particularly those with elevated SUA. CLINICAL PERSPECTIVE What Is New? In this large, real-world study of nearly 740,000 adults with preserved renal function, the serum uric acid to serum creatinine (SUA/sCr) ratio emerged as a strong, independent predictor of two-year all-cause and cardiovascular mortality. The prognostic value of SUA/sCr was particularly evident in patients with hyperuricemia, where higher quintiles were associated with progressively increased risk of death and cardiovascular events. What Are the Clinical Implications? The SUA/sCr ratio, based on two inexpensive and widely available laboratory parameters, provides a practical tool for early cardiovascular risk stratification in patients without overt kidney disease.

PurposeTo compare the efficacy and safety of topical insulin and amniotic membrane extract eye drops (AMEED) in promoting healing of corneal persistent epithelial defects (PEDs) refractory to conventional therapy.Patients and MethodsThis retrospective comparative study included 27 eyes of 24 patients (mean age 61.0 ± 16.6 years) with PEDs treated with either topical insulin (1 IU/mL) or AMEED four times daily. Clinical outcomes included complete epithelial closure, rate of epithelialization, change in best-corrected visual acuity (BCVA), and occurrence of adverse events.ResultsOf 27 eyes, 18 received topical insulin and 9 received AMEED. The mean interval from diagnosis to treatment initiation was 93.4 ± 111.7 days in the AMEED group and 72.5 ± 56.1 days in the insulin group. Complete healing occurred in all eyes (100%) in the insulin group versus 44.4% in the AMEED group. The daily reduction in epithelial defect area during the first two weeks was significantly greater with insulin (P = 0.04). At final follow-up, BCVA improved significantly only in the insulin group (P = 0.006). No adverse reactions were observed in either group; one AMEED-treated eye required amniotic membrane transplantation.ConclusionTopical insulin and AMEED are both safe and effective for refractory PEDs, but insulin showed superior epithelial healing and visual recovery. Given its availability, low cost, and favorable safety profile, topical insulin may represent a practical alternative in the management of persistent epithelial defects.