Managing chronic disease in the COVID-19 pandemic: an e-learning application to promote a healthy lifestyle for persons with multiple sclerosis.

E-health applications can support continuing care for persons with chronic diseases such as multiple sclerosis (MS). We have developed a web-based mobile app called VIOLA to be used at home by persons with MS (pwMS) who previously participated in an innovative multidisciplinary rehab program. The purpose of VIOLA is to reinforce what participants have learned about a healthy lifestyle and to keep them motivated to adhere to rehabilitation programs. As the outbreak of the Covid-19 pandemic has severely curtailed pwMS contact with their usual health providers, we quickly updated VIOLA to grant continuity of care to our home-bound patients.By monitoring pwMS subscriptions to individual modules, we found a definite increase after the national lockdown was declared. Subscribers rated the app very positively.Encouraged by the positive feedbacks, we are planning to extend the access to our app also to pwMS with no prior specific learning experience. This would limit the psychophysical consequences of the lockdown. Furthermore, VIOLA could be effective in maintaining a proper lifestyle, contributing to improve the quality of life of pwMS.VIOLA has the potential of increasing the adherence of pwMS to the rehabilitation confirming that digital communication tools are a valuable solution for those home-bound.].

Influence of ewe feeding systems on fatty acid composition of suckling lambs.

The main objective of this study was to evaluate the effects of ewe dietary treatments on the intramuscular fatty acid composition of suckling lambs. Twenty-four pregnant Italian Merino ewes were divided into two equal groups. One group (pasture-fed group) was allowed to graze a natural pasture and the other group (stall-fed group) was penned indoors and fed with hay and concentrate. After lambing, all ewes stayed with their respective lambs for the whole experimental period. Lambs were slaughtered at 100 days of age with an average live weight of 20kg. Fatty acid profiles of milk and lamb meat (longissimus lumborum muscle) were analysed. Intramuscular fat from pasture-fed lambs showed higher (P<0.001) proportions of polyunsaturated fatty acids. The percentage of lauric (C12:0; P<0.05), palmitic (C16.0; P<0.001) and oleic (C18.1; P<0.001) fatty acids were higher in the intramuscular fat from stall-fed lambs, whereas pasture-fed lambs showed greater proportions of linolenic (C18:3; P<0.001), eicosapentaenoic (C20:5; P<0.001) and docosapentaenoic (C22:5; P<0.05) fatty acids. Moreover, the intramuscular fat from pasture-fed lambs displayed a higher (P<0.001) PUFA/SFA ratio, and a lower (p<0.001) n-6/n-3 ratio. The conjugated linoleic acid (CLA) tended to be higher (P=0.07) in the intramuscular fat from pasture-fed lambs. This study confirmed that pasture enhanced the unsaturated fatty acid profile of intramuscular fat in lambs including n-3 fatty acids.

Prescreening evaluation of a brush-based faecal immunochemical test for haemoglobin.

OBJECTIVES: To undertake a prescreening evaluation of a new brush-based faecal immunochemical test for haemoglobin, relative to a traditional spatula-sampling immunochemical test. SETTING: Patients aged between 24 and 90 years, scheduled to undergo diagnostic colonoscopy in two major urban hospitals, for a range of clinical indications. DESIGN: Patients sampled three stools using a spatula for the reference FlexSure OBT test and two stools using a brush for the InSure test; order of sampling was randomised. Faecal haemoglobin was quantified by a modified InSure in a subset of patients to determine whether brush-sampling allowed discrimination between groups. MAIN OUTCOME MEASURES: Sensitivity for cancer or adenoma; false-positive rate in normals. Faecal haemoglobin levels. Preference for sampling method. RESULTS: InSure and FlexSure OBT did not differ in their sensitivities for cancer (27/36, 75% vs 29/36, 80.5%, respectively), adenomas >or= 10 mm (12/29, 41.4% vs 13/29, 44.8%) or adenomas <10 mm (each 8/56, 14.3%). Likewise, false-positive rates in normals were similar: 4/179 (2.2%) and 5/179 (2.8%) respectively (specificities of 97.8% and 97.2%, respectively). Levels of faecal haemoglobin were highest in those with cancers; those with adenomas had intermediate levels which were also significantly higher than those in normals. The brush sampling method was preferred by 38/46 (82.6%), while 4/46 (8.7%) preferred the spatula (p<0.00001). CONCLUSIONS: InSure is as sensitive and specific as FlexSure OBT for faecal haemoglobin. The novel stool-sampling method of InSure allows discrimination between normals and classes of neoplasia, and is highly preferred. The brush-sampling faecal immunochemical test InSure should now be evaluated in a screening population.

Interference of plant peroxidases with guaiac-based fecal occult blood tests is avoidable.

Peroxidase-rich fruits and vegetables are reputed to interfere with guaiac-based fecal occult blood tests. We added horseradish peroxidase to fecal samples and tested them with Hemoccult, Hemoccult SENSA(R), and hydrated Hemoccult. Positivity rates with Hemoccult and Hemoccult SENSA decreased rapidly as the time between smearing (preparation) and development increased, whereas they remained high with hydrated Hemoccult. For samples with added blood, positivity rates did not decrease with time. When 61 volunteers were tested on a standard restriction and on a challenge diet high in plant peroxidase, no positive results occurred during standard restriction. During the challenge diet, one volunteer was positive with Hemoccult and Hemoccult SENSA when development was delayed 24 h, and no volunteers were positive when it was delayed 48 h and 72 h. However, with hydrated Hemoccult, positives occurred in 13 of 61 volunteers at 24 h, 8 of 61 at 48 h, and 5 of 61 at 72 h. Thus, peroxidase-rich plant foods do not need to be excluded from the diet with Hemoccult and Hemoccult SENSA if development is delayed for at least 48 h after smearing. A delay of this duration will not solve the problem of plant peroxidase interference with hydrated Hemoccult.

A study of laboratory based faecal occult blood testing in Melbourne, Australia. The Faecal Occult Blood Testing Study Group.

Faecal occult blood tests (FOBT) are widely used in clinical practice and are under increasing scrutiny as a tool for colorectal cancer screening. However, there is little information regarding the quality of testing performed in pathology laboratories. Therefore, we asked 13 pathology laboratories in Melbourne, Australia, to test coded contrived faecal samples prepared from a composite stool specimen which had been spiked to various concentrations of haemoglobin. The samples were provided to the laboratories in two forms: (i) on/in the sample collection device appropriate for the faecal occult blood test they normally used; and (ii) as a moist faecal sample. Some variation in threshold analytical sensitivity between laboratories for the same FOBT was observed for Hemoccult SENSA, ColoRectal, Hematest, MonoHaem and Hemolex suggesting that, at least for those tests, technician training could be improved. Two tests, Hematest and an in-house FOBT did not perform as well as the other FOBT. When samples were sent in moist form, Hemoccult SENSA (P = 0.0002), ColoRectal (P = 0.02) and MonoHaem (P = 0.04) had significantly lower overall positivity rates; for Hemolex the decrease was not significant (P = 0.3). The lower positivity rate with moist samples is important, given that 11 of the 13 laboratories in the study stated that they receive at least some samples in moist form. Thus, technician training and laboratory procedure need to be reviewed to maximize the benefits of faecal occult blood testing in clinical practice, especially with its expanding role in colorectal cancer screening.

A new approach to fecal occult blood testing based on the detection of haptoglobin.

BACKGROUND: Colorectal carcinoma is a common disease, occurring in 1 in 20 adults in Western society, and there is a compelling need for an effective early diagnostic test. Several serum tests, including carcinoembryonic antigen have been used, but none are sufficiently sensitive for the early diagnosis of the disease. METHODS: In a novel approach using fecal extracts from patients with colorectal cancer as the antigen for immunization, several MoAbs were produced. One (FE14.1) was found to react with the feces from patients with colon cancer, but not with those from normal subjects. A sandwich enzyme-linked immunoadsorbent assay was developed, and its ability to diagnose colorectal carcinoma evaluated. RESULTS: Of the patients with colorectal carcinoma, 91.5% (43/46) were positive compared with 1.9% of normal individuals (4/211). Analysis of the N-terminal amino acid sequence of a subunit of the molecule detected by FE14.1 shows it to be the beta chain of haptoglobin. CONCLUSIONS: The assay developed in this study has several advantages compared with current fecal occult blood tests, including no requirement for dietary restriction and the ability to distinguish between upper and lower gastrointestinal bleeding, while retaining the sensitivity and specificity of the current tests. Furthermore, the sensitivity of the tests increases to 100% if the FE14.1 and HemeSelect are combined. In addition, the study shows the potential to produce anticancer agents by immunizing with fecal material.

Auditory brainstem response patterns in familial and sporadic olivopontocerebellar atrophy.

Auditory brainstem responses (ABR) have been obtained in 22 patients, 15 with familial and 7 with sporadic olivopontocerebellar atrophy; 8 of them were pairs of siblings. ABR abnormalities have been found in 72.7%, with a significant higher percentage in familial versus sporadic patients. Similar ABR patterns have been obtained in affected members of the same family. No correlations have been found between ABR results and the following parameters: age, gender, disease duration, degree of clinical involvement and fashion of inheritance. ABR pattern did not show any modification over a follow-up period of 15-24 months. Our findings suggest that the involvement of the auditory pathways may be under genetic control.

Neurocysticercosis: clinical and therapeutic considerations. Review of Italian literature.

We describe two cases of neurocysticercosis, the first with a spinal extramedullary form, the second with hydrocephalus secondary to basal cistern and convexity arachnoiditis. Praziquantel was given without evident benefit; this therapeutic response is discussed in relation to the clinical and radiological findings. The Italian literature is reviewed.

Brainstem auditory evoked potentials in migraine patients in basal conditions and after chronic flunarizine treatment.

BAEPs have been studied in a group of 20 migraine subjects before and after chronic flunarizine treatment. No statistically significant modifications of neurophysiological parameters have been observed. We confirm flunarizine effectiveness in migraine treatment.

Neuropsychological evaluation in transient ischaemic attack and minor stroke.

Two groups of patients with transient ischaemic attack and minor stroke without detectable haemodynamic stenotic lesions were evaluated by neuropsychological tests and compared with a control group. The mean values of the scores adjusted for age and educational background demonstrated that the patients with transient ischaemic attack did not have a worse performance than normal subjects in any of the tests, the patients with minor stroke had a worse performance than normals, particularly in Rey's figure-copying test (P less than 0.025), and the latter test was not affected by educational background or age of the subjects. The results are discussed with reference to other case series, and the importance of age and cerebral damage in causing intellectual impairment evaluated by neurophysiological tests is stressed.

Chronic subdural hematoma: reliability of radioisotope imaging versus computed tomography.

25 surgically verified cases of chronic subdural hematoma (CSH) were examined retrospectively. All the patients had been investigated both with computed tomography (CT) and with radioisotope imaging (RI). RI supplied a correct diagnosis in all cases whilst CT yielded a doubtful diagnosis (generic signs of space-occupying lesion) in 5 cases and normal findings (false negative) in one. The clinical use of the two investigations is discussed. The study shows the reliability of RI in the diagnosis of CSH especially when CT determines the site but not the nature of the lesion (hematoma in the isodense phase).

A case of glioblastoma with multiple centers above and below the tentorium.

A case of multicentric glioblastoma with the clinical and histopathological findings is presented in which three lesions are located above and below the tnetorium. Multicentric glioblastomas are those which have no macroscopic or microscopic connection.

[Clonazepam in painful syndromes of the head]. / Il clonazepam nelle sindromi dolorose del distretto cefalico.

A study of 46 patients has shown that Clonazepam is an effective drug in preventing attacks of pain in essential trigeminal and glossopharyngeal neuralgia and in Sluder's syndrome. The therapeutic action of the drug is less evident in different types of migraine, among which only the combined headache presents good results to the treatment. The effective dose of this drug is generally not greater than 3 mg/die and does not give rise to side effects in long-term prescription.