Cefalea e dolore cervicale rappresentano un problema estremamente diffuso nella popolazione di tutto il mondo. La cefalea comporta inoltre una forte spesa farmaceutica: è stato calcolato che la spesa annuale italiana in farmaci analgesici ammonta a circa 57 milioni di euro. Infine la cefalea assume spesso caratteristiche di cronicità e/o intermittenza tali da ridurre cospicuamente la qualità della vita dei pazienti e comportare, tra l’altro, una notevole perdita di ore di lavoro.
Questi temi vengono tuttavia generalmente affrontati dalla comunità scientifica e dalla stampa limitatamente al profilo delle terapie di cura e raramente l’approccio è di tipo preventivo.
Specie nei casi di cefalea e dolore cervicale cronici più fattori eziologici (di natura neurologica, psicogena, muscolare, articolare, ecc.) possono sovrapporsi nello stesso paziente. L'articolo illustra i risutati di un programma comportamentale e di esercizi, associato all’opportuna terapia farmacologica e la conseguente programmazione di un intervento a più ampio raggio sulla comunità, in considerazione anche del rapporto costo/beneficio estremamente positivo.

Introduction of Highly Active Antiretroviral Therapy (HAART) and implementation of preventive strategies during pregnancy have resulted in a dramatic reduction of the mortality rate in HIV-1 infected children by over 80-90% and in a decrease in the risk of mother-to-child transmission (MCTC) of HIV-1 to approximately 1-2%. However the MCTC remains the main source of HIV-1 infection within the paediatric population. The risk of disease progression is inversely correlated with the age of the child, with the youngest children at greatest risk of rapid disease progression, but in the first year of life it is not possible to identify infants at greatest risk; therefore, according to all the international guidelines, it is necessary to start antiretroviral therapy in all infants < 12 months of age.
This article provides a summary of the clinical features of the infection and of the methods for diagnosis. Furthermore it offers an overview of antiretroviral therapy in HIV-1 infected children, including a description of the main classes of antiretroviral drugs, the most common side effects and some issues concerning the disclosure of diagnosis. The objectives of this study are to make a set of practical suggestions to paediatricians for the optimum management of the infection and the antiretroviral therapy.

(1) Dipartimento di Scienze per la Salute della Donna e del Bambino, Università di Firenze

We report the case of a 48-year-old female patient with stroke family history that was admitted in our ward with suspected ischemic stroke diagnosis. The diagnostic process is described in detail, paying attention in particular to anamnestic data and to genetic polymorphisms related to higher risk for inherited thrombophilia. At the end, the diagnosis indicates red infarct in a migraine patient with cerebrovascular and cardiovascular risk factors of undetermined aetiology according to TOAST criteria. Some of the known thrombophilic polymorphisms were found in the patient: however not all the mentioned thrombophilic markers are universally recognized as predisposing factors for arterial ischemic stroke.

(1) UOC di Neurologia, Ospedale Sant’Ottone Frangipane, ASL Avellino, Ariano Irpino
(2) Laboratorio di Genetica Medica, Ospedale Moscati, Avellino
(3) Responsabile UOS Diagnostica Cardiologica, Ospedale Sant’Ottone Frangipane, ASL Avellino
(4) Direttore Servizio di Emotrasfusione, Ospedale Sant’Ottone Frangipane, ASL Avellino, Ariano Irpino
(5) Direttore UOC Radiologia, Ospedale Criscuoli, ASL Avellino, Sant’Angelo dei Lombardi
(6) Direttore Distretto Sanitario di Mirabella, ASL Avellino, Mirabella Eclano
(7) Direttore UOC di Neurologia, ASL Avellino, Ariano Irpino

Tourette syndrome is a neurodevelopmental disorder characterised by the chronic presence of multiple motor tics (e.g. eye blinking, shoulder shrugging, etc.) and at least one vocal/phonic tic (e.g. grunting or sniffing). The clinical picture of patients with Tourette syndrome is often complicated by tic-related behavioural problems and associated psychopathology. The pathophysiology of Tourette syndrome is poorly understood, however converging evidence from neuroimaging studies suggests abnormalities within the fronto-striatal pathways. The pharmacological management of the tic symptoms focuses on the dopaminergic and noradrenergic pathways and aims to improve the health-related quality of life of patients.

(1) Michael Trimble Neuropsychiatry Research Group, University of Birmingham and BSMHFT, Birmingham, UK
(2) Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, UK

The case of a 34-year-old patient with uncontrolled hypertension is described in this article, together with the diagnostic path followed in order to make the diagnosis, that finally reveals an arteriovenous fistula due to an old kidney biopsy. Uncontrolled or resistant hypertension may be caused by unrecognized secondary hypertension: we revise the clinical and laboratory criteria for selecting hypertensive patients in whom to look for secondary hypertension through the most appropriate diagnostic work up. A synthesis of the main causes of secondary hypertension is also provided in the discussion.

(1) UOC Medicina Interna 1, Ospedale SS. Giovanni e Paolo, ULSS 12 Veneziana, Venezia, e Dipartimento di Medicina, Università degli Studi di Padova