Two-Year Cohort Study of SARS-CoV-2, Verona, Italy, 2020‒2022.

We performed a follow-up of a previously reported SARS-CoV-2 prevalence study (April‒May 2020) in Verona, Italy. Through May 2022, only <1.1% of the city population had never been infected or vaccinated; 8.8% was the officially reported percentage. Limiting protection measures and vaccination boosters to elderly and frail persons seems justified.

Dual-Energy CT for Detecting Painful Knee Prosthesis Loosening.

Background Dual-energy CT (DECT) is an alternative to radiography and single-energy CT (SECT) for detecting prosthesis-related complications. Purpose To compare the diagnostic performance of DECT, SECT, and radiography for knee prosthesis loosening, with use of surgery or imaging follow-up reference standards. Materials and Methods In this prospective single-center study from December 2018 to June 2021, participants with unilateral painful knee prostheses underwent radiographic, SECT, and DECT imaging. Five blinded readers, four radiologists, and one orthopedic surgeon evaluated the images. Prosthesis loosening was diagnosed by a periprosthetic lucent zone greater than 2 mm. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of each method were determined and compared with use of a multireader multicase analysis. Results There were 92 study participants (mean age ± SD, 70 years ± 9.4; 67 women) evaluated. Tibial and femoral loosening were diagnosed in 47 and 24 participants, respectively. For the tibia, mean sensitivity and specificity for arthroplasty loosening were 88% and 91%, respectively, for DECT, 73% and 78% for SECT, and 68% and 81% for radiography. For the tibia, DECT demonstrated similar diagnostic performance (AUC, 0.90) to SECT (AUC: 0.90 vs AUC: 0.87, respectively; P = .13) but was superior to radiography (AUC: 0.90 vs AUC: 0.82; P = .002). Overall diagnostic performance of DECT (AUC, 0.87) for the femur was superior to both SECT and radiography (P < .001). Conclusion Dual-energy CT had generally better diagnostic performance in detecting loosening of tibial and femoral components after total knee arthroplasty compared with single-energy CT or radiography. Clinical trial registration no. 2942 © RSNA, 2022.

Use of Heavy Silicon Oil as Intraocular Tamponade for Inferior Retinal Detachment Complicated by Proliferative Vitreoretinopathy: A Multicentric Experience.

INTRODUCTION: This is a multicentric study on the use of heavy silicon oil (HSO) as an intraocular tamponade for inferior retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). METHODS: 139 eyes treated for RD with PVR were included in the study. 10 (7.2%) were affected by primary RD with inferior PVR, while 129 (92.8%) were affected by recurrent RD with inferior PVR. 102 eyes (73.9%) had received a silicon oil (SO) tamponade in a previous intervention prior to receiving HSO. Mean follow-up was 36.5 (standard deviation = 32.3) months. RESULTS: The median interval between HSO injection and removal was 4 months (interquartile range: 3). At the time of HSO removal, the retina was attached in 120 eyes (87.6%), whereas in 17 eyes (12.4%), it had re-detached while the HSO was in situ. 32 eyes (23.2%) showed recurrent RD. A subsequent RD relapse was observed in 14.2% of cases with no RD at the time of HSO removal, and in 88.2% if an RD was present at the time of HSO removal. Advancing age showed a positive association with retinal attachment at the end of follow-up, while the risk of RD relapse at the end of the follow-up showed a significant negative association with HSO tamponade duration and with the use of SO rather than air or gas as post-HSO tamponade materials. Mean best corrected visual acuity was 1.1 logarithm of minimum angle of resolution at all follow-up time points. 56 cases (40.3%) needed treatment for elevated intraocular pressure (IOP), with which no clinically relevant variables were associated during follow-up. CONCLUSION: HSO represents a safe and effective tamponade in cases of inferior RD with PVR. The presence of RD at the time of HSO removal is a negative prognostic factor for the development of a subsequent RD relapse. According to our findings, in cases of RD at the time of HSO removal, a short-term tamponade should definitely be avoided, in favor of SO. Special attention must be paid to the risk of IOP elevation, and patients should be closely monitored.

Laparoscopic colorectal resection for deep infiltrating endometriosis: can we reliably predict anastomotic leakage and major postoperative complications in the early postoperative period?

BACKGROUND: Anastomotic leakage (AL) and major complications after colorectal resection for deep infiltrating endometriosis (DIE) have a remarkable impact on patient outcomes. The aim of this study is to assess the predictive value of C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBCs) and the Dutch Leakage Score (DLS) as reliable markers in the early diagnosis of AL and major complications after laparoscopic colorectal resection for DIE. METHODS: 262 consecutive women undergoing laparoscopic colorectal resection for DIE between September 2017 and September 2018 were prospectively enrolled. WBCs, CRP, PCT and DLS were recorded at baseline and on postoperative day (POD) 2, 3 and 6 then statistically analyzed as predictors of AL and severe postoperative complications. RESULTS: The AL rate was 3.2%. The major morbidity rate was 11.2%. No postoperative mortality was recorded. The postoperative trend of DLS and serum levels of CRP and PCT, but not WBCs, were significantly higher in women developing AL and severe complications. DLS had better sensitivity and specificity than biomarkers on all postoperative days as a predictor of AL and major complications. CRP and PCT have a low positive predictive value (PPV) and a high negative predictive value (NPV) for AL and major complications on POD3 and POD6. The risk of malnutrition was significantly related to AL. CONCLUSIONS: The combination of DLS as a standardized postoperative clinical monitoring system and CRP and PCT as serum biomarkers, allows the exclusion of AL and major complications in the early postoperative period after laparoscopic colorectal resection for DIE, thus ensuring a safe patient discharge.

Heat can treat: long-term follow-up results after uterine-sparing treatment of adenomyosis with radiofrequency thermal ablation in 60 hysterectomy candidate patients.

BACKGROUND: Adenomyosis may induce pelvic pain, abnormal uterine bleeding or bulk symptoms. If hormonal treatment proves ineffective or contraindicated, hysterectomy may be necessary. For patients who desire to conserve the uterus despite severe symptomatology, uterine-sparing techniques have been introduced. Radiofrequency thermal ablation (RFA) consists of the local application of high temperature to eliminate diseased tissue, applied recently for adenomyosis treatment. The objective of the study was to analyze the efficacy of RFA for avoiding hysterectomy in patients with adenomyosis-related symptoms. METHODS: This is a single-center, retrospective cohort study performed in a referral center for endometriosis. The study population consisted of all consecutive patients who underwent Radiofrequency thermal ablation (RFA) treatment as an alternative to hysterectomy for adenomyosis between March 2011 and June 2019 in our institution. RFA was performed using laparoscopic access. To evaluate the impact of RFA treatment on symptoms, follow-up findings were compared to preoperative symptomatology using the ten-point visual analog scale (VAS) for pain assessment. RESULTS: Sixty patients were included in the study, 39 of them (65%), underwent a concomitant surgery for endometriosis in association to RFA. On a long-term follow-up (mean 56 months (range 10-115, SD 29), hysterectomy was performed in 8 patients (13%). The mean VAS score before vs after surgery was 7.4 vs 3.3 for dysmenorrhea, 3.7 vs 0.3 for dyschezia, 4.7 vs 0.7 for dyspareunia, and 4.0 vs 1.4 for chronic pelvic pain, being significantly reduced after RFA for all these pain components (p < 0.0001 in every case). Thirty-one patients (52%) suffered from AUB before RFA, this symptom persisted in 10 patients (16%) during follow-up (p < 0.001). Bulk symptoms were present in 16 patients (27%) and disappeared after RFA in all cases. CONCLUSIONS: RFA allows for hysterectomy avoidance in most cases. It leads to marked improvements in pain symptomatology, uterine bleeding and bulk symptoms.

Temporal variation of optical coherence tomography biomarkers as predictors of anti-VEGF treatment outcomes in diabetic macular edema.

PURPOSE: To report a longitudinal analysis of specific optical coherence tomography (OCT) features in eyes with diabetic macular edema (DME) treated with anti-VEGF. METHODS: A total of 133 eyes of 103 consecutive patients with center-involving DME were included in the study. The eyes were treated between August 2008 and April 2019 with three monthly intravitreal anti-VEGF injections, either with or without prompt or deferred laser, followed by pro re nata (PRN) re-treatment. The following OCT biomarkers were evaluated: subfoveal neuroretinal detachment (SND) (defined as present (SND+) or absent (SND-)), hyperreflective retinal foci (HRF) number (defined as: absent/few(HRF-) or moderate/many (HRF+)), external limiting membrane (ELM) integrity, central macular thickness (CMT), and central retinal thickness (CRT). Changes in SND status and in the number of HRF were evaluated at each DME recurrence throughout the follow-up(FU) period. Mutual correlation among OCT biomarkers and their relationship with visual and anatomic outcomes were assessed both at baseline and over the FU period. RESULTS: The mean FU was 71.2 months (SD 28.4; min. 12-max. 111). At baseline, the prevalence of SRD+ was 27.8% and a high number of HRF were detected in 41.4% of the eyes. A significant reduction in the number of HRF, CMT, CRT, and in the prevalence of SND was recorded in the post-loading phase (p-value <0.0001). In DME recurrences, the presence of SND+ and HRF+ was significantly more frequent in eyes with baseline SND+ and HRF+ compared to eyes presenting baseline SND- and HRF- (p-value <0.0001). No role of SND (p-value: 0.926) and HRF (p-value: 0.281) as baseline predictors of visual and anatomic outcomes was demonstrated, while a worse visual outcome was significantly correlated with a higher incidence of relapsing SND+ (p-value <0.0001) and HRF+ (p-value <0.0028) throughout the FU period. CONCLUSION: In this study, SND and HRF were frequently present in DME recurrences with the same pattern exhibited at baseline, suggesting that these OCT biomarkers may characterize a specific pattern of DME that repeats over time. Moreover, the results suggested that the persistence and recurrence of SND and HRF may account for a decrease in visual function more than the baseline prevalence of these biomarkers. Further studies are required to confirm these findings.

Poor performance of screening questionnaires for obstructive sleep apnea in male commercial drivers.

PURPOSE: Screening commercial drivers (CDs) for obstructive sleep apnea (OSA) reduces the risk of motor vehicle accidents. We evaluated the accuracy of standard OSA questionnaires in a cohort of CDs. STUDY DESIGN AND METHODS: We enrolled consecutive male CDs at 10 discrete transportation companies during their yearly scheduled occupational health visit. The CDs had their anthropometric measures taken; completed the Berlin, STOP, STOP-BANG, OSAS-TTI, SACS, EUROSAS, and ARES questionnaires; and underwent a home sleep apnea test (HSAT) for the determination of their respiratory events index (REI). We assessed the questionnaires' ability to predict OSA (REI ≥ 5 events/h) and moderate-to-severe OSA (REI ≥ 15 events/h). RESULTS: Among 315 CDs recruited, 243 (77%) completed the study protocol, while 72 subjects were excluded for inadequate HSAT quality. The demographics and clinical data were comparable in both the included and excluded subjects. The included CDs had a median age of 50 years (interquartile range (IQR) 25-70) and a mean body mass index of 27 ± 4 kg/m2. One hundred and seventy-one subjects (71%) had OSA, and 68 (28%) had moderate-to-severe OSA. A receiver operating characteristic curve of the questionnaires were 0.51-0.71 for predicting OSA and 0.51-0.66 for moderate-to-severe OSA. The STOP-BANG questionnaire had an unsatisfactory positive predictive value, while all of the other questionnaires had an inadequate negative predictive value. CONCLUSIONS: Standard OSA questionnaires are not suited for screening among CDs. The use of the HSAT could provide an objective evaluation of for OSA in this special population.

Management of vertebral compression fractures: the role of dual-energy CT in clinical practice.

PURPOSE: To evaluate the role of dual-energy computed tomography (DECT) in the management of vertebral compression fractures in clinical practice. MATERIALS AND METHODS: This retrospective IRB-approved study included 497 consecutive patients with suspected acute vertebral fractures, imaged either by DECT (group 1) or MRI (group 2) before vertebroplasty. The site, number and type of fractures at imaging findings, and clinical outcome based on any change in pain (DELTA-VAS), before (VAS-pre) and after treatment (VAS-post), were determined and compared. Two radiologists evaluated DECT and MRI images (15 and 5 years of experience, respectively), and inter-observer and intra-observer agreement were calculated using k statistics. RESULTS: Both in the control group (n = 124) and in the group of patients treated by vertebroplasty (n = 373), the clinical outcome was not influenced by the imaging approach adopted, with a DELTA-VAS of 5.45 and 6.42 in the DECT group and 5.12 and 6.65 in the MRI group (p = 0.326; p = 0.44). In the group of treated patients, sex, age, lumbar fractures, multiple fractures, previous fractures, Genant grade, involvement of anterior apex or superior endplates, and increased spinal curvatures were similar (p = ns); however, dorsal fractures were more prevalent in group 1 (p = 0.0197). Before treatment, the mean VAS-pre was 8.74 in group 1 (DECT) and 8.65 in group 2 (MRI) (p = 0.301), whereas after treatment, the mean VAS-post value was 2.32 in group 1 (p = 0.0001), and 2.00 in group 2 (p = 0.0001). The DELTA-VAS was 6.42 in the group of patients imaged using DECT and 6.65 in the group imaged using MRI (p = 0.326). Inter-observer and intra-observer agreement were 0.85 and 0.89 for DECT, and 0.88 and 0.91 for MRI, respectively. CONCLUSION: The outcome of vertebral compression fracture management was no different between the two groups of patients studied.

Prevalence of SARS-CoV-2, Verona, Italy, April-May 2020.

We used random sampling to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 infection in Verona, Italy. Of 1,515 participants, 2.6% tested positive by serologic assay and 0.7% by reverse transcription PCR. We used latent class analysis to estimate a 3.0% probability of infection and 2.0% death rate.

Diagnostic Performance of Dual-Energy CT for Detecting Painful Hip Prosthesis Loosening.

Background Revisions of hip prostheses are increasing, and conventional radiography (CR) is a primary tool for managing -complications. However, dual-energy CT (DECT) with virtual monoenergetic imaging is capable of reducing periprosthetic metal artifacts compared with standard CT. Purpose To compare the diagnostic performance of DECT and CR in detecting hip prosthesis loosening, using surgery as a reference for diagnosis. Materials and Methods This retrospective single-center study conducted between January 2018 and October 2020 included -consecutive patients with unilateral painful hip prostheses. Two independent readers (with 15 years and 4 years of experience) who were blinded to clinical findings evaluated CR and DECT images. At imaging, diagnosis of loosening prosthesis was made for -periprosthetic radiolucency greater than or equal to 2 mm wide or the presence of two or more secondary findings, including -periprosthetic osteolysis, angulation of the implant, fracture, or abnormal periosteal reaction. For each reader and for each imaging parameter, -sensitivity and specificity were calculated. The diagnostic performance of each imaging tool was compared by using the McNemar test. Interobserver agreements were calculated with Cohen κ statistics. Statistical software was used. Results Overall, 178 patients (mean age ± standard deviation, 74 years ± 20; 96 men) were included (121 undergoing surgery, 57 follow-up). Overall, 87 of 178 patients (49%) were diagnosed with a loosened prosthesis. DECT had higher sensitivity and specificity than CR for both reader 1 (94% [82 of 87 examinations; 95% CI: 87, 98] and 93% [85 of 91 examinations; 95% CI: 86, 97] vs 84% [73 of 87 examinations; 95% CI: 74, 91] and 91% [83 of 91 examinations; 95% CI: 83, 96], respectively; P < .001) and reader 2 (92% [80 of 87 examinations; 95% CI: 84, 97] and 95% [86 of 91 examinations; 95% CI: 88, 98] vs 80% [70 of 87 -examinations; 95% CI: 71, 88] and 91% [83 of 91 examinations; 95% CI: 83, 96], respectively; P = .001), with better interobserver agreement (κ, 0.88 [95% CI: 0.81, 0.95] vs 0.78 [95% CI: 0.69, 0.88]). Conclusion Dual-energy CT showed better diagnostic performance than conventional radiography in diagnosing hip prosthesis loosening. See also the editorial by Lutz in this issue. © RSNA, 2021.

Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile.

STUDY OBJECTIVE: To compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile. DESIGN: A single-center, retrospective cohort study. SETTING: Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy. PATIENTS: A total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle. INTERVENTIONS: After the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated. MEASUREMENTS AND MAIN RESULTS: The VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%-100%) and 100% (95% CI, 96.3%-100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%-99.5%) and 100% (95% CI, 75.3%-100%), respectively, with specificities of 100% (95% CI, 96.8%-100%) and 100% (95% CI, 96.6%-100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%-100%), 100% (95% CI, 39.8%-100%), and 100% (95% CI, 75.3%-100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%-100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as "less painful than expected," 25% (30 of 120 women) "just as expected," and only 7% (9 of 120 women) as "more painful than expected." CONCLUSION: VUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.

Microstructural Macular Changes after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment.

PURPOSE: This study aimed to describe foveal microstructural changes after pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD). METHODS: External limiting membrane (ELM) and ellipsoid zone (EZ) integrity, cystoid macular edema (CME), and subretinal fluid bleb (SB) development were analyzed using optical coherence tomography in 59 eyes over a 6-month follow-up period after PPV surgery for RRD. Eyes were grouped as macula-on (n = 30) or macula-off (n = 29), and the association between ELM and EZ recovery and best-corrected visual acuity (BCVA) was investigated. Predictive factors for ELM and EZ recovery were also identified. RESULTS: The interval between symptom onset and surgery did not significantly differ between the macula-on and macula-off groups. Macula-on patients showed ELM and EZ integrity throughout, whereas macula-off patients had ELM and EZ integrity restored in 89.7% and 86.2% cases, respectively, with a resultant increase in final BCVA. Significant associations were found between preoperative macular involvement and ELM/EZ restoration. ELM/EZ recovery was also inversely associated with CME development. Significant associations were also found between final BCVA and preoperative BCVA and EZ recovery. CME and SB development were equally distributed between the 2 groups. CONCLUSION: Prompt surgery for macula-off RRD allows the progressive recovery of outer retinal layers and significant visual gain.

Polyurethane scaffold implants for partial meniscus lesions: delayed intervention leads to an inferior outcome.

PURPOSE: The purpose of this study was to assess the clinical outcomes of the implantation of an aliphatic polyurethane scaffold for the treatment of partial loss of meniscal tissue at a mean follow-up of 36 months. METHODS: A retrospective review on prospectively collected data was performed on patients who underwent implantation of an aliphatic polyurethane-based synthetic meniscal scaffold. Patients were evaluated for demographics data, lesion and implant characteristics (sizing, type and number of meniscal sutures), previous and combined surgeries and complications. Clinical parameters were rated using NRS, IKDC subjective, Lysholm, KOOS, and Tegner activity score, both preoperatively and at final follow-up. RESULTS: Sixty-seven patients were evaluated at a mean follow-up of 36 months (48 M and 19 F; mean age 40.8 ± 10.6 years; mean BMI 25.4 ± 4.3). The scaffold was implanted on the medial side in 54 cases, and on the lateral one in 13. Forty-seven patients had undergone previous surgical treatment at the same knee and 45 required combined surgical procedures. All evaluated scores improved significantly from the baseline. Among possible prognostic factors, a delayed scaffold implantation had lower post-operative clinical scores: IKDC subjective (P = 0.049), KOOS Sport (P = 0.044), KOOS total (p = 0.011), and Tegner (P = 0.03) scores at follow-up. CONCLUSIONS: The polyurethane meniscal scaffold implantation led to a significant clinical benefit in a large number of patients. A delayed intervention correlated with worse results. LEVEL OF EVIDENCE: IV.

Intravitreal Recombinant Tissue Plasminogen Activator and Sulphur Hexafluoride Gas for Submacular Haemorrhage Displacement in Age-Related Macular Degeneration: Looking behind the Blood.

PURPOSE: To evaluate the effectiveness of recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride gas (SF6) intravitreal injection for the displacement of large submacular haemorrhages (SMH) secondary to neovascular age-related macular degeneration and for guiding the selection of additional treatments or observations for choroidal neovascularization (CNV). METHODS: The medical records of consecutive patients with recent-onset, large SMH, treated at Sacro Cuore Hospital from January 2004 to May 2016, were retrospectively analysed. All eyes underwent a 0.05-mL intravitreal injection of 50 µg rtPA, 0.3 mL of 100% SF6, and then face-down positioning. Afterwards, the eyes received additional treatments for CNV or observation, based on the severity and extent of the underlying pathology. The multimodal imaging features revealed after blood displacement were analysed and then correlated to the treatment selected as a second therapeutic option. RESULTS: A total of 96 eyes met the inclusion criteria and was evaluated in this study. SMH was displaced from the fovea in the majority of the eyes (76%), allowing several diagnostic tools to evaluate the underlying macular features. In 19 cases (19.8%) exhibiting severe macular damage, no additional treatment was applied. In the remaining eyes, subsequent treatments included anti-vascular endothelial growth factor injections (44.8%), photodynamic therapy (n = 2), and submacular surgery (35.4%). Statistically significant correlations were found between the macular findings revealed after blood displacement and the additional treatments or observations selected for the underlying disease. The mean follow-up was 35 months. Improvements in visual acuity were statistically significant up to 3 years. CONCLUSION: Intravitreal rtPA and gas injection was found to be effective for the displacement of large SMH, allowing postoperative diagnostic testing, and thus guiding the opportunity to apply further treatments. The addition of subsequent individualized treatments may allow long-term visual gain in selected cases.

Risk of transfusion-transmitted malaria: evaluation of commercial ELISA kits for the detection of anti-Plasmodium antibodies in candidate blood donors.

BACKGROUND: Transfusion with Plasmodium-infected blood represents a risk for malaria transmission, a rare but severe event. Several non-endemic countries implement a strategy for the screening of candidate blood donors including questionnaire for the identification of at-risk subjects and laboratory testing of blood samples, often serology-based, with temporary deferral from donation for individuals with a positive result. In Italy, the most recent legislation, issued in November 2015, introduced the use of serological tests for the detection of anti-Plasmodium antibodies. METHODS: In the absence of a gold standard for malaria serology, the aim of this work was to evaluate five commercial ELISA kits, and to determine their accuracy (sensitivity and specificity) in comparison to immuno-fluorescence antibody test (IFAT), and their agreement (concordance of results). Serum samples from malaria patients or from subjects with malaria history (N = 64), malaria naïve patients with other parasitic infections (N = 15), malaria naïve blood donors (N = 8) and malaria exposed candidate blood donors (N = 36) were tested. RESULTS: The specificity of all ELISA kits was 100%, while sensitivity ranged between 53 and 64% when compared to IFAT on malaria patients samples. When tested on candidate blood donors' samples, ELISA kits showed highly variable agreement (42-94%) raising the possibility that the same individual could be included or excluded from donation depending on the test in use by the transfusion centre. CONCLUSIONS: These preliminary results indicate how the lack of a gold standard for malaria serology must be taken into account in the application and future revision of current legislation. There is need of developing more sensitive serological assays. Moreover, the adoption of a unique serological test at national level is recommended, as well as the development of screening algorithms based on multiple laboratory tests, including molecular assays.

Prevalence and features of asthma-chronic obstructive pulmonary disease overlap in Northern Italy general population.

OBJECTIVE: There is controversy about the diagnostic criteria, prevalence, symptoms, and spirometry characteristics of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Recent data indicate that the fixed method for diagnosing airway obstruction (AO) may overestimate ACO prevalence in the elderly, and a variable method may be more accurate. We aimed at estimating ACO prevalence in a general population sample and comparing patient and clinical features in subjects with ACO, COPD, and asthma. METHODS: We analyzed data from a cross-sectional study estimating COPD prevalence in randomly selected adults aged 20-79 years in Verona, Italy, and estimated prevalence and analyzed characteristics of asthma, COPD, and ACO. ACO was defined as AO (Forced Expiratory Volume in one second-FEV1/ Forced Vital Capacity-FVC < Lower Limit of Normal-LLN), highly positive bronchodilator test (≥15% increase in FEV1 and FVC ≥400 mL), and personal self-reported history of physician diagnosed asthma and atopy. RESULTS: One thousand two hundred and thirty-six patients were included; 207 (16.7%) had asthma, COPD, or ACO (mean ages: 61.2, 59.7, and 57.2 years, respectively). The 3 groups had similar clinical and demographic variables; however, spirometry revealed differences between ACO and COPD patients, particularly post-bronchodilator FEV1 reversibility, which was detected in ACO and asthma patients but not in those with COPD. CONCLUSION: ACO prevalence in Northern Italy was estimated at 2.1%, in the range of values reported by previous studies. Marked differences between ACO and COPD revealed by spirometry may have important clinical implications in terms of treatment for patients with ACO.

RETINAL PIGMENT EPITHELIUM-CHOROID GRAFT WITH A PERIPHERAL RETINOTOMY FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION: Long-Term Outcome.

PURPOSE: To investigate the long-term outcome of autologous retinal pigment epithelium -choroid transplantation with a peripheral retinotomy for exudative age-related macular degeneration. METHODS: In a retrospective study, we selected all patients who underwent a retinal pigment epithelium-choroid transplantation from 2007 through 2013. Exclusion criteria were age <60 years, <12 months of follow-up, and retinal pigment epithelium-choroid graft for other diseases than age-related macular degeneration. The main outcome measure was best-corrected visual acuity converted into logarithm of the minimum angle of resolution. RESULTS: In this study, 81 patients were included with a mean follow-up of 38 months (SD = 19). Median best-corrected visual acuity improved from 1.30 logarithm of the minimum angle of resolution (20/400 Snellen) to 0.90 logarithm of the minimum angle of resolution (20/160 Snellen) 1 year after surgery (P < 0.001). A ≥3-line gain was achieved in 43 patients (53%) 1 year postoperatively and 37 patients (46%) preserved their visual gain until last visit. Of 4 patients with an 8-year follow-up, 3 patients had a ≥6-line gain at last visit. Severe complications were submacular hemorrhage (n = 8, 10%), macular hole (n = 6, 7%), and proliferative vitreoretinopathy (n = 3, 4%). CONCLUSION: Best-corrected visual acuity improved significantly after retinal pigment epithelium-choroid transplantation in patients with age-related macular degeneration and preservation of visual gain was possible in the long term.

Identification of residual-recurrent cholesteatoma in operated ears: diagnostic accuracy of dual-energy CT and MRI.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and dual-energy computed tomography (DECT) to identify residual-recurrent cholesteatoma using the second-look surgery as the reference standard. METHODS: This prospective, institutional review board-approved study included 19 consecutive patients (11 males and 8 females; mean age of 62.2, range 34-80 years). Since five patients were studied bilaterally, a total of 24 ears were evaluated with DECT and MRI between February 2017 and June 2018. Any abnormal middle ear attenuation on high-resolution CT images (HRCT) or DECT color-coded maps, and any abnormal signal on MRI images was evaluated by four experienced radiologists. Diagnostic accuracy values of HRCT, DECT maps and CT numbers (by using receiver operator curves) and MRI were compared. Interobserver and intraobserver agreement were calculated. RESULTS: Residual-recurrent cholesteatoma was diagnosed at surgery in 16/24 ears (66.6%). MRI and DECT revealed a total of 15/16 and 14/16 cholesteatomas, respectively. The sensitivity, specificity, PPV and NPV and accuracy of MRI and DECT were 93.7, 87.5, 93.7, 87.5, and 91.6% and 87.5, 87.5, 93.3, 87.5 and 87.5%, respectively. CT numbers were significantly different between positive (mean 57.6 HU, range - 65, 112 HU) and negative cases (mean 5.4 HU, range - 100, 66 HU) with p < 0.001. The interobserver and intraobserver agreement were k = 0.87 and k = 0.83, respectively. CONCLUSION: DECT may provide an accurate demonstration of residual-recurrent middle ear cholesteatoma.

Acute histoplasmosis in immunocompetent travelers: a systematic review of literature.

BACKGROUND: Histoplasmosis is a fungal infection highly endemic in the American continent. The disease can be severe in immunocompromised subjects. In immunocompetent subjects the clinical manifestations are variable. Aim of this work was to review the cases of acute histoplasmosis in immunocompetent travelers reported in literature. METHODS: A systematic review of literature was conducted. Electronic search was performed in Pubmed and LILACS. Two reviewers independently extracted data on demographic, clinical and radiological features, and treatment. Cases were classified according to Wheat's definitions. RESULTS: Seventy-one studies were included in the analysis, comprising a total of 814 patients. Twenty-one patients diagnosed at the Centre of Tropical Diseases, Negrar (VR), Italy were also included. The most common travel destination was Central America (168 people, 29.8%); the most common way of exposure to histoplasma was the exploration of caves and/or contact with bat guano (349 people, 60.9%). The multivariate logistic regression model showed association between the development of disseminated histoplasmosis (DH) and activities that involved the exploration of caves and/or the contact with bats' guano (adjusted OR: 34.20 95% CI: 5.29 to 220.93) or other outdoor activities (adjusted OR: 4.61 95% CI: 1.09 to 19.56). No significant difference in the attack rate between countries of destination was observed (p-value: 0.8906, Kruskal-Wallis test). CONCLUSIONS: Histoplasmosis often causes no or mild symptoms in immunocompetent individuals, although a severe syndrome may occur. The infection can mimic other diseases, and the epidemiological risk of exposure is an important clue to raise the index of suspicion.

Vitreomacular Adhesion and the Risk of Neovascular Age-Related Macular Degeneration.

PURPOSE: To assess the prevalence of vitreomacular adhesion (VMA) in consecutive naïve eyes diagnosed with exudative age-related macular degeneration (AMD) in comparison with eyes with nonexudative AMD and age-matched controls, and to evaluate prospectively the incidence of vitreomacular interface changes over time and their influence on choroidal neovascularization (CNV) development. DESIGN: Retrospective cross-sectional analysis and longitudinal cohort study conducted at Sacrocuore Hospital, Negrar, Verona, Italy. PARTICIPANTS: A total of 1067 eyes examined at Sacrocuore Hospital between August 2008 and June 2015 met the inclusion criteria and were evaluated in this study. METHODS: Eyes were classified into 3 groups: 403 eyes of 364 patients (mean [standard deviation; SD] age 77.8 [8.0] years) affected by exudative AMD; 350 eyes of 298 subjects (mean [SD] age 78.1 [8.2] years) with nonexudative AMD; and 314 eyes of 214 subjects (mean [SD] age 74.2 [8.2] years) with no signs of AMD enrolled as the control group. The vitreomacular interface status was evaluated by spectral-domain optical coherence tomography (OCT) and was graded according to the OCT-based International Classification System developed by the International Vitreomacular Traction Study Group by 2 independent masked observers. RESULTS: VMA was present in 101 (25.1%) eyes with exudative AMD, 84 (24.0%) eyes with nonexudative AMD, and 84 (26.8%) eyes with no signs of AMD (no statistical difference was found; P = 0.3384). Spontaneous release of VMA (RVMA) was found in 15 (15.3%) eyes with exudative AMD, 21 (28.0%) eyes with nonexudative AMD, and 10 (24.4%) eyes with no signs of AMD over a mean follow-up of 25.5, 25.9, and 24.1 months, respectively. The incidence of RVMA in exudative AMD eyes was significantly lower compared with nonexudative (P = 0.0207) and lower, but not statistically significant, with respect to eyes with no signs of AMD (P = 0.1013). In eyes with nonexudative AMD, de novo development of CNV occurred in 91 eyes (30.6%). There was no significant difference regarding the rate of CNV development in the presence or absence of VMA (P = 0.0966). CONCLUSIONS: The present study found no significant difference in the prevalence of VMA in eyes affected by AMD compared with age-matched controls and no difference in the rate of de novo CNV development in eyes with or without VMA. Conversely, a lower incidence of RVMA over time was found in eyes affected by exudative AMD. The results of this study suggest that VMA might be a consequence rather than a causative factor in the development of CNV.