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INTRODUCTION Following the Sars-Cov2 pandemic of the last 2 years, telemedicine has become fundamental for the territorial assistance of patients and the consultation of professionals among them to carry out assistance services in a very complex territory such as that of the Azienda USL Toscana Sud Est (TSE). Currently, the middleware, on the network, allows for the integration of all data from the physical, chemical and morphological urine examination (ECMU), allowing the transmission of data and images between computer-connected laboratories. This work illustrates the organizational architecture of an analytical integration network managed in telemedicine and teleconsulting applied to the ECMU and consisting of all the laboratories of the Azienda TSE. MATERIALS AND METHODS The integrated network of the ECMU includes the territorial laboratories of the Azienda TSE, such as the hub centers of Arezzo, Grosseto, Nottola and Campostaggia with the spoke centers of Cortona, Bibbiena, Sansepolcro, Valdarno, Massa Marittima, Orbetello, Pitigliano, Abbadia San Salvatore , Castel del Piano. The instrumentation used by the laboratories is Aution Max 4030 (Menarini) and Pochet Chem UA for the chemical-physical examination, Sedimax Contrust (Menarini) and the Director Web (Menarini) management software. RESULTS The integrated network of the ECMU consists of all the Azienda TSE laboratories, which are connected to each other electronically through the middleware Director Web, which allows the sharing of rules, chemical-physical analysis data and images of the urinary sediment. Through the Director Web management software it is possible, in fact, for hub laboratories not only to consult and validate the ECMU carried out by the spoke centers in the area, but to receive and give "second opinion" advice between the network laboratories. CONCLUSIONS The use of the same analytical systems and the middleware system common throughout the Azienda TSE allows to obtain harmonized and standardized results throughout the territory with shared criteria in the integrated network of the ECMU, in fact, the collaboration of specialists is indirectly promoted with time much faster diagnosis and a less rigid and leaner organization of work, uniform throughout the territory.
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PURPOSE: It is well established that thyroiditis and other thyroid disorders can be induced by COVID-19 infection, but there is limited information about the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We report two cases of thyrotoxicosis following SARS-CoV-2 vaccine. METHODS AND RESULTS: Two young health care peoples (wife and husband) received a first dose of SARS-CoV-2 vaccine, and few weeks later developed clinical manifestations of thyroid hyperactivity, with increased thyroid hormone levels on thyroid function tests, suppressed thyroid-stimulating hormone and negative antithyroid antibodies, despite being healthy before vaccination. They were diagnosed at the 4th week after first dose of SARS-Cov-2 vaccine as silent thyroiditis and followed without treatment, since their symptoms were not severe. At the 6th week, the patients became wholly asymptomatic and their thyroid function returned to normal. CONCLUSIONS: Thyrotoxicosis can occur after SARS-CoV-2 vaccination probably related to silent thyroiditis.