Today, as Fifth Avenue turns red, white, and green for the Columbus Day Parade, the Italian American community has one more reason to be proud. Two days ago, on the stage of Carnegie Hall, Concetto “Tino” Ruta received the 2026 Italian Reputation Award, the honor that celebrates those whose work makes Italy respected around the world.

His story speaks to every Italian American family. It is the story of a name that sounds like Italy, and of a career built on the qualities generations of Italians brought to this country: grit, expertise, and a deep sense of responsibility toward others. Ruta has put those qualities to work in one of the most complex and demanding fields in America: healthcare.

As President and CEO of Knights Care Global, Ruta was honored “for building and guiding healthcare platforms across complex regulatory and cross-jurisdictional environments in the United States and Europe.” His platform brings together hospitals, institutions, capital, and technology, with operating bases in New York and Rome. It is an axis that links our city to the Eternal City and brings the best of the Italian culture of care into the American healthcare system.

The medal was presented by Monsignor Dario Edoardo Viganò, Dean of the Faculty of Communication Sciences at UNINETTUNO University and former Prefect of the Holy See’s Secretariat for Communications. It was one of the most moving moments of a ceremony that stirred the audience, especially when the children of La Scuola d’Italia Guglielmo Marconi sang the Italian and American national anthems, one after the other, like two voices of the same family.

What this award means to Americans with Italian roots was best expressed by Davide Ippolito, creator of the Italian Reputation Award and founder of the Italia America Reputation Lab, in his welcome message. “A hundred years ago, for many of our fellow Italians arriving in America, being Italian was something to hide,” he wrote. “People changed their last names, tried to soften their accents, and taught their children to show less of their Italian identity, because looking and sounding more American often meant having a better chance to work, live, and be accepted.” He continued: “This country still carries the mark of those who came before us, of generations of Italians who helped build it, in many cases quite literally with their own hands. There is nothing left to hide. Being Italian is something to be proud of.”

Ruta’s award tells exactly that story. The grandparents who came through Ellis Island built America with their hands. Today their heirs lead it from boardrooms, hospitals, and universities. The circle closed when actress Alice Lussiana Parente read Emma Lazarus’s “The New Colossus,” the poem inscribed at the base of the Statue of Liberty that welcomed millions of Italian immigrants.

Alongside Ruta, the 2026 honorees were:

• Manhattan Borough President Brad Hoylman-Sigal, who this year signed the first cultural cooperation agreement between Manhattan and the historic center of Rome;
• Andrea Mazzucchi, Rector of the University of Naples Federico II;
• Valter Quercioli, National President of Federmanager;
• entrepreneur Nick Eyde, who brought the Italian Bowl to Toledo;
• artist Aldo Gallina.

This year also marked the debut of the Future Leader Under 30 award, dedicated to young Italians making their mark in the United States.

Each honoree received a medal handcrafted by master goldsmith Marco De Luca. Inspired by ancient Roman coins, it depicts Eucleia, the Greek goddess of good repute. The evening closed with Puccini’s “Nessun dorma,” performed on piano by Maestro Francesco Pollon. Few in the hall did not feel a shiver at the final “Vincerò.”

Now in its third edition, the Italian Reputation Award is promoted by Reputation Research, RetImpresa, Campus Salute, Progetto Alfa, and IARL – Italia America Reputation Lab.

Happy Columbus Day to the entire Italian American community.

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Waking up during the night to go to the bathroom is a common experience, but when it happens several times, it’s natural to wonder whether something might be wrong. The bladder isn’t always to blame, and more importantly, there isn’t a single explanation that applies to everyone. The first episode of Urology with Dr. V, a new podcast by urologist Domenico Veneziano, explores the issue. The podcast focuses on urological health and the technologies that are changing the way doctors work.

Originally from Reggio Calabria, Italy, Domenico Veneziano is a surgeon specializing in urology who currently works at BronxCare Health System in New York. His clinical work focuses primarily on robotic and minimally invasive surgery, particularly in the treatment of urinary tract cancers. Alongside his clinical practice, he is involved in surgical education and the development of new technologies for surgical training. He oversees the development of educational programs at the European School of Urology and is the founder of INTECH, a company specializing in medical education technologies.

The first episode addresses nocturia, the medical term for waking up during sleep to urinate. Veneziano begins with one of the questions he says patients ask him most frequently: «Doctor, I wake up several times at night to pee. Should I worry?»

To answer that question, he explains, the first step is understanding why it happens. Throughout the episode, Veneziano distinguishes between situations considered normal and those that may require medical evaluation, examining the different factors that can contribute to nighttime awakenings. These include kidney function, sleep quality and, in men, possible prostate-related problems.

One of the episode’s main points is that nighttime urination should not automatically be attributed to the bladder. Urine production during the night, sleep patterns and the functioning of the urinary system can all contribute to the problem in different ways. This is why understanding the underlying causes is essential before considering possible treatments.

The episode also discusses when it may be appropriate to consult a doctor. Among the resources available to listeners is a bladder diary template, which allows people to track their urination habits and collect information that may be useful during a specialist evaluation. The template can be downloaded for free online.

In preparing the episode, Veneziano referred to the European Association of Urology’s 2026 guidelines and several scientific studies on nocturia, nighttime urine production and the relationship between sleep disorders and the need to urinate.

Urology with Dr. V was created to make aspects of urological medicine easier to understand, addressing patients as well as students and healthcare professionals. The podcast will cover everyday health concerns alongside topics related to surgery and the technological tools used in medical practice. Each episode will draw on scientific literature, offering explanations designed for audiences without specialized medical knowledge.

The first episode, titled Waking Up at Night to Pee? Here’s What It Really Means, is available in audio format on Spotify, Apple Podcasts, Amazon Music and Spreaker, as well as in video format on YouTube.

To follow upcoming episodes and updates about the project, listeners can visit Domenico Veneziano’s official website and his Instagram profile.

Questa conversazione ti è stata utile finora?

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MILAN (ITALPRESS) – October is the month dedicated to raising awareness about the prevention of female tumors and especially breast cancer. Lombardy Region raises the importance of early screening and diagnosis, with the aim of making it increasingly accessible and close to citizens. In the two-year period 2024-2025, in the age group 50-69, 759.088 women joined the regional program of mammographic screening, while 53.092 were excluded by pathology and 218.268 performed a diagnostic test outside the screening program. Accession to the programme thus stood at 60.5%, exceeding the ministerial standard of 60% provided by the New Guarantee System (NSG).

“Prevention – he stressed the regional Councillor at Welfare, Guido Bertolaso – is our first tool to protect women’s health. The 60.5% admission to mammographic screening is an important result, but we are not satisfied. Our goal is also to reach those who today adhere less, eliminating barriers and bringing prevention increasingly close to people.” “For this reason – Bertolaso added – we prepared October Rosa with a coordination work involving the whole Regional Health Service, with initiatives, Open Day and awareness-raising activities on the territory. Community homes, territorial services and mobile units are key tools to make access to prevention easier.”.

“The message of October Rosa is very concrete – the Councillor concluded – as to better inform, facilitate access and reach people who still do not participate in screening. I invite all women to seize this opportunity. Adhering to screening means taking care of your health.”.

“Today’s information in the Regional Council – reiterated Councillor Elena Lucchini – was an important occasion to reaffirm that prevention is a culture of health. October Rosa reminds us that we must not wait: early diagnosis can change the path of care and life of people. We must continue working to reach all women, especially those who encounter greater difficulties in accessing services. In this path I want to thank the associations and the many volunteers who are at the side of women every day: with their work they build trust, inform, listen and accompany, representing a fundamental part of our territorial welfare network”.

“As a Family Councillor – Lucchini concluded – we want to take care of the woman in her entirety, because an oncological diagnosis involves the person, the family and her everyday life. This is why the measure for wigs and tricological prostheses, which has proven to be effective and highly appreciated, and the introduction of the contribution to oncological aesthetics represent important tools: psychophysical well-being is an integral part of the treatment path”.

In the course of the month initiatives have been promoted throughout the Lombardy territory, with the involvement of the authorities of the Regional Health Service. Here are the screenings available in Lombardy: breast cancer: by invitation for women between 45 and 74 years; cervical cancer: by invitation for women between 25 and 64 years; colorectal cancer: by invitation for people between 50 and 74 years; lung cancer: for people between 55 and 74 years strong smokers.

Lombardy also participates in the EUCanScreen European project, an important opportunity to compare with other EU countries to improve screening programmes in terms of accessibility, quality, innovation and equity. October will also be a moment of comparison among professionals. Among the appointments scheduled, on October 10 in Milan there will be a conference dedicated to the Network Region Lombardy TSRM (Sanitary Technicians of Medical Radiology) in Senologia, with the aim of enhancing the network work between professionals, health structures and associations and deepening themes such as the quality of the paths, innovation and opportunities offered by artificial intelligence.

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ROMA (ITALPRESS) – A shirt, a scarf, a tie, a scarf. A green leader is enough to participate in “All the voices of the green”, the national initiative that from 5 to 10 October involves professionals and citizens of all Italy. To promote it is the National Commission of Psychiatric Rehabilitation Technicians, along with the Territorial Albo Commissions of the Tsrm and Pstrp Orders and the Italian Technical Association of Psychiatric Rehabilitation (Aiterp). This year the World Health Organization has chosen, in order to raise awareness on the subject, the phrase “Lived experiences heard: real voices, real change”, to which the Technicians of psychiatric rehabilitation were inspired. Whoever lives in the first person the mental discomfort knows better than anyone else what helps and what not. This is why the real change goes from putting these people to the centre, deciding with them and not for them: in the care paths, services and in the fight against the stigma. The theme involves many people. According to the report of the Ministry of Health, in 2024 mental health services assisted 845.516 people, and 272.497 had a first contact with the Departments: in 95% of cases it was the first time in life.

From light green to dark green, from pastel to brilliant, shades represent the plurality of people, professions and territories that make up the world of mental health. From 5 to 10 October, these professionals will go to work with something green, in the shade they prefer. “The psychologists of psychiatric rehabilitation work in the network of services alongside people and families, in therapeutic-rehabilitative paths, to build autonomy, support social inclusion and improvement of the quality of life,” says Roberta Famulari, president of the National Commission of Psychiatric Rehabilitation Technicians. Famulari also reports the data of the Censis survey presented in January 2026, from which it emerges that 90.3% of Italians consider it possible and necessary to intervene early in order to avoid the aggravation of disorders. “This means that the importance of acting soon and well is recognized. With our initiative we want to make this commitment visible, helping to reduce stigma and prejudices”. Le fa eco Luca Rossi, of the Italian Association Tecnici of Psychiatric Rehabilitation: “The invitation to participate in the ‘All the voices of green’ initiative is addressed to all. Just wear something green, share the message and talk about it in the family, at school, at work: it’s the first step. Listening to the experiences of those who live psychic discomfort means breaking silence and building together a more welcoming and conscious community.”.

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STOCCOLMA (SVEZIA) (ITALPRESS) – The Nobel Prize for Medicine 2026 was awarded to Karl Deisseroth, Peter Hegemann and Georg Nagel “for their discoveries related to ionic channels activated by light and hopogenetic.”.

“ Understanding how the brain pierces memories, emotions and behaviors has long been a dream for researchers. Karl Deisseroth, Peter Hegemann and Georg Nagel were awarded the Nobel Prize for Physiology or Medicine 2026 for the discoveries that led to the hopogenetics, a technique that allows to activate or deactivate the activity of individual nerve cells in a living brain. This method is now used in laboratories around the world to reveal the mysteries of the brain,” explains the Nobel Foundation in a note.

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ROMA (ITALPRESS) – The three main European scientific societies in the cardiometabolic field – the European Society of Cardiology (ESC), the European Association for the Study of Diabetes (EASD) and the European Association for the Study of Obesity (EASO) – joined the European Commissioner for Health and Animal Wellness Olivér Varhelyi to promote the launch of the first European screening week, never. The initiative stems from the observation that cardiovascular diseases, diabetes and obesity are among the most urgent health challenges in Europe. Often coexist, they are deeply interconnected and represent an increasing burden for people, families, operators and health systems. The scale of the challenge is evident: cardiovascular diseases remain the main cause of mortality and morbidity in the EU, representing a death on three – 1.7 million deaths in 2022 – and hitting about 62 million people. Diabetes affects 35.3 million people in the EU, while about one adult on six suffers from obesity. Diabetes and obesity are serious diseases of themselves and, in addition to this, they represent important risk factors for cardiovascular morbidity and mortality, along with hypertension and high cholesterol.

Too often these diseases are detected only when symptoms appear or when complications have already developed. The first EU screening Week is an opportunity to move from a reactive approach to disease to early and timely intervention. Under the slogan “Know your numbers – Know your values”, the campaign encourages people to control key health indicators – including blood pressure, blood sugar and cholesterol – and take preventive measures faster. European Commissioner for Animal Health and Wellness, Olivér Varhelyi, commented: “Prevention cannot wait. This is why we are launching the first European Week of Screening: to encourage people across Europe to know their values and to act for their health. By sensing public opinion and making screening more visible and accessible, we can help identify risks in advance and prevent serious cardiometabolic diseases before complications arise. Prevention begins with awareness: you know your blood pressure, cholesterol and blood sugar. I invite all citizens to undergo control, turn to a health care worker and take their health in hand. The EU Council Recommendation on health controls, recently published, strengthens this message and encourages Member States to introduce comprehensive health controls to support early prevention and diagnosis across Europe.”.

Professor Cecilia Linde, president of the European Society of Cardiology (ESC), underlined: “For too long, the possibilities of a person to prevent cardiovascular diseases have been influenced by factors outside their control, including the place of residence, gender or socio-economic conditions. Screening is our chance to change this situation. By identifying risks early and providing people with timely assistance, we can help ensure that everyone has equal opportunities to live a longer and healthier life. This is not only an investment in the health of today’s population; it is an investment in our children, in our communities and in the future of Europe.” Professor Francesco Giorgino, President of the European Association for the Study of Diabetes (EASD), added: “ Too many people still live with type 2 diabetes without knowing it, sometimes until complications have already been developed. Screening can help us identify the risk in advance and act first. Unfortunately, type 2 diabetes greatly increases the risk of cardiovascular disease and therefore requires an accurate prevention strategy. Prevention must also include people with type 1, diabetes who in turn face a growing cardiovascular risk over time. Early intervention and better prevention can reduce complications and improve the quality of life.”.

Professor Volkan Yumuk, President of the European Association for Obesity Study (EASO), said: “Obesity is at the heart of cardiometabolic health. It is a chronic disease in itself and one of the main factors determining type 2 diabetes, cardiovascular diseases and other serious complications. If Europe really wants to engage in prevention, we must identify and address obesity at a more early stage. This means going beyond the only body mass index (BMI) and ensuring that screening, diagnosis and management of obesity, based on scientific evidence, are integrated into health systems. The European Week of Screening is an important opportunity to put into practice an early, integrated and person-centered action.” Professor Chantal Mathieu, President of the European Diabetes Forum (EUDF), concluded: “This is a historical moment in which cardiovascular diseases, with the two most serious diseases associated with them, diabetes and obesity, take a central role. The European Commission has clearly taken the necessary momentum to present Europe a plan to prevent, identify and better manage all forms of diabetes, obesity and cardiovascular disease. With the support of the EU Commission and under the guidance of these three solid scientific organizations, our Member States must now do one thing: translating the plan into action. And start with screening during this European Week of Screening.”.

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ROMA (ITALPRESS) – There will be 12.1 million people with type 1 diabetes globally by 2049, 29 percent more than 9.4 million in 2025. The estimate comes from the DIAMOND-T1D model which outlined a real health emergency, even more paediatric and teenage: in 2025 the 0-19-year-olds represented 42 percent of new type 1 diabetes cases (37 percent in high income countries and 49 percent in low income). Young people under 20 years are particularly at risk for type 2: diabetes according to an American study of the Colorado School of Public Health the rate of new cases has seen an increase of almost ten times since the beginning of the century: a fact that certifies how type 2 diabetes is no longer a pathology that affects only middle-aged people and the elderly.

These are some of the most alarming data presented during the 22nd Congress of the European Association for the Study of Diabetes (EASD), which ended in Milan on 2 October. In Italy today there are almost 4 million people living with diabetes, to which approximately 1.5 million people who do not know they have it. The cases of type 1 diabetes, as a percentage less than type 2, will increase by 16 percent by 2049, reaching a total of more than 239,000 people.

Among the main themes of Congress the disease-modifying therapies in type 1. diabetes While not replacing insulin, these treatments are an innovative therapeutic approach aimed at modulating the autoimmune response and preserving the function of beta cells. Although a single approved drug is available today to slow the progression of the disease and change its course, other immunomodulators and antigen-specific and cell strategies are currently being tested, prospecting an extension of therapeutic options for the future.

“The increase in type 1 diabetes and type 2 debut anticipation outlines the need for increasingly timely interventions to protect the quality of life of patients. In this direction, the documents and activities presented during the conference are also moving,” comments Francesco Giorgino, President European Association for the Study of Diabetes (EASD). “From the new EASD guideline on continuous blood glucose monitoring, which assesses the extent of CGM to all adults with type 2 diabetes, regardless of insulin treatment. Until the new Consensus Report ADA/EASD 2026, which is oriented towards an early and intensive treatment of the disease, able to support glycemic control cardiovascular, kidney and hepatic protection and weight management”.

Obesity emerges as a key component of the cardiometabolic spectrum, a link evidenced by the parallel growth of type 2 diabetes cases in pediatric age and weight excess, especially in industrialized countries. Particular attention will be paid to new scientific evidence and their integration in clinical practice: from data on incretines and multi-agonists, the role of starch and the latest therapeutic novelties for obesity, with insights into action mechanisms, safety profile, side effects management and clinical application in specific patient subgroups. In this global health context, Italy is confirmed as a reference point in the care and assistance of metabolic diseases with a historically advanced legislative framework. From the framework law on diabetes in 1987, to the Mulè law — which introduced the first screening program in pediatric age for the early diagnosis of type 1 diabetes and celiac disease — and to the recent law Pella, which recognized obesity as chronic, progressive and relapsed disease, is accompanied by the bill 287 signed by Senator Daniela Sbrollini, currently in the examination phase, which aims to recognize the physical activity.

“The Italian experience shows how the alliance between scientific research and pioneering legislative choices can transform clinical evidence into a concrete and effective organizational model. The goal is to intercept the disease at an early stage to minimize risks, support families and ensure our children a better quality of life. Italy has outlined an avant-garde road that I hope will soon become a point of reference for health policies across Europe,” says Giorgio Mulè, Vice President of the Chamber of Deputies.

“The growing spread of diabetes and obesity among young people places us in the face of the urgency of continuing to innovate deeply our health and social system, to go more and more towards a holistic approach oriented to prevention, which puts the person at the centre. In this vision is inserted the bill that I presented to allow the prescription of sport as a real “farm” without contraindications, which is good for all ages. Investing today in prevention and correct lifestyles means protecting our children and ensuring the sustainability of the healthcare system. In this legislation the Intergroup’s commitment has been constant and recently the DM on Diabetes registers shows an institutional synergy with Minister Schillaci and its offices”, continues Daniela Sbrollini, co-president Intergroup parliamentary obesity, diabetes and chronic non-transmissible diseases.

“Our commitment as a parliamentary Intergroup is always central to the protection of people’s metabolic well-being within the political and legislative agenda, strengthening the culture and tools of prevention together with territorial institutions. Italy in 2025 made a historical step, becoming the first country in the world to adopt a parliamentary law that recognizes obesity as an illness. I am therefore very happy to host the EEASD European Congress these days, in order to emphasize even more markedly how to invest today in prevention and metabolic health means to protect the health of citizens and, at the same time, contribute to the sustainability of the National Health Service”, adds Roberto Pella, co-president Intergroup parliamentary obesity, diabetes and chronic diseases not transmitted.

“Research is a fundamental lever to strengthen metabolic health and transform scientific knowledge into concrete tools of prevention, diagnosis and care. The EASD Congress represents a precious moment of international confrontation, in which the most recent scientific evidence can be translated into new perspectives for the health of people and health systems”, explains Andrea Lenzi, President of the National Research Council.

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MILAN (ITALPRESS) – Modernizing HIV pathways, from prevention to therapy, to intercept unsatisfied needs and approach international goals at 2030. This is the theme at the center of the second table of HIV-LAB Lombardy, held at Palazzo Pirelli in Milan with the involvement of infectious, pharmacists hospitals, institutions, health professionals, academic world and third sector. “Therapies are increasingly effective, but in order to take a further step forward we must also modernize the paths. Prevention and treatment are two components of the same strategy: it means first reach people at risk, customize available options and build organizational models that support adherence over time. Innovation produces value when it is inserted into the right path for the right person,” said Davide Croce, Director of CREMS – Research Centre in Economics and Management in Health and Social. Despite the increasing effectiveness of therapies, new diagnoses remain substantially stable and persist unconscious people of the infection, patients who do not fully reach the therapeutic goals and populations at risk still difficult to intercept. In Lombardy, in 2024, 449 new HIV diagnoses were recorded, equivalent to approximately 19% of national diagnoses. These data show that the availability of effective pharmacological tools alone is not enough: it is necessary to build paths that can help access, appropriateness and continuity over time. The project HIV-LAB Lombardia, created by CREMS and Summeet as part of the Health Sinergy partnership, with the non-conditional contribution of ViiV Healthcare, continues with a second table that, after the first appointment dedicated to the organization of the network, enters the merit of prevention and internal organization of the centers. The table aims to translate the debate into measurable actions: from updating PrEP programming on the basis of real access to adhesion monitoring, to structured pre-screening of therapies and to the definition of organizational models shared for long-acting paths, both in prevention and treatment. These actions will be the basis of the work of the coming months, which will converge in the course of 2027 in a new moment of comparison dedicated to verify its actual implementation. On the prevention front, the PrEP is now a consolidated reality also in Lombardy, with about 9,000 users from the start of the route, but the offer remains concentrated and some populations are even less reached. The availability of different modes of administration allows today to think of more personalized paths, adapting the preventive strategy to the characteristics and needs of the person. Among the options available, PrEP long-acting can help support the continuity of the preventive path in people for whom oral intake may be a limit. The data recalled during the meeting show significant differences in the continuity of the path in relation to the different modes of administration: evidence presented at the International AIDS Conference 2026 indicate, at one year, a 6.3% interruption with the PrEP injectable long-acting compared to 33.8% with the daily oral one. Suboptimal adhesion is also 9.4% and 54.9% respectively. The availability of innovation must be accompanied by a programming that can evolve together with the accesses and needs observed. In the course of the comparison, the importance of monitoring the use in the different centers has been emphasized, periodically updating the forecasts and sharing operational indications between clinicians, hospital pharmacies and institutions, in order to further improve access and taking charge. More flexible programmingbile and based on data can allow the offer to adapt to the actual trend of access in the different territories.The economic data of recent years strengthen the need to focus attention also on the organization. Between 2018 and 2024, due to an increase of 6.3% of treated patients, average patient spending decreased by 11.1%. A trend that shows how a part of efficiency has already been generated on the pharmaceutical side, while additional margins can be sought in the way in which prevention, treatment and takeover are organised. The programming, therefore, also affects the treatment of people with HIV, where long-acting therapies broaden the possibilities of customizing the grip, but require a dedicated organization. Pre-screening before visiting, identifying eligible patients, programmed agendas, recall systems, role of nursing staff and coordination with hospital pharmacy are some of the elements necessary to integrate these options into clinical practice. With long-acting paths, therapeutic continuity no longer depends solely on the patient’s daily behavior, but it becomes more shared with the health structure.

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FIRENZE (ITALPRESS) – “Our Ssn is founded on the principles of universality, equality and equity. Principles, however, must be translated into the concrete possibility of receiving the necessary assistance, regardless of the economic conditions and the place where one lives.” Thus the Minister of Health, Orazio Schillaci, in a video message sent to the Festival dell’Economia Civile, in operation in Florence.

“We have progressively increased the resources for health. The national health fund has passed from almost 126 billion to almost 143. We also intervened on waiting lists with new rules, a national system that allows monitoring and today also to know better the times of performance, to identify the most critical situations. With the new National Plan of waiting lists we have also focused on the appropriateness, transparency and protection paths for citizens. Investing in prevention, territorial assistance and appropriateness means better use of available resources, helping to reduce inequalities in access to services,” he added.

“In these 4 years we have made important steps, putting more resources available to health, intervening on some structural aspects of the system,” the minister explained. “From waiting lists to territorial assistance, from personnel to prevention, however, they remain complex challenges, population aging, non-self-sufficiency, the shortage of some professional figures, territorial differences, the need to ensure timely and appropriate access to care. They are challenges that require resources, but also programming skills and increasingly effective use of those available. This is where the reflection on civil economy meets that on health. A universal health system is a social cohesion factor. It protects people in times of greater fragility, reduces inequalities and contributes to the holding of communities,” he concluded.

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MILAN (ITALPRESS) – The Columns of San Lorenzo in Milan, among the passers-by, a figure seems to dissolve in the landscape. It is a street artist, painted to merge with the surrounding architecture until it becomes almost indistinguishable. It is not just an exercise of urban camouflage. It is an initiative that tells the deception of the IgG4-related disease: a rare pathology that can involve different organs, present itself with apparently disconnected manifestations and be exchanged for other conditions. For this reason she is nicknamed by the specialists “the great imitator”. From here it takes form “NON M’IngG4nno. IgG4-related disease. Know it to recognize it”, awareness campaign promoted by Amgen, a global leader in pharmaceutical biotechnology, with ANMAR – National Association of Rheumatic Diseases – and APMARR – National Association of People with Reumatological and Rare Diseases, with the patronage of FIR – Italian Foundation of Rene and SIR – Italian Society of Reumatology. Rare and immuno-mediated, IgG4-related disease, or IgG4-RD, has been recognized as a distinct clinical entity only in the last two decades. It is a systemic and chronic pathology that can involve one or more organs at the same time or in different stages. The estimated prevalence is about 5 cases every 100,000 inhabitants. The disease, more common in men, most frequently affects people between 50 and 70 years, while manifesting itself at any age.6 The causes of the disease are not yet fully clarified. Over time, persistent inflammation can promote fibrosis formation and compromise the function of the organs involved. “The most accredited hypothesis is that environmental factors, such as chronic exposure to metal powders or microorganism infections still unknown, lead to persistent inflammation in the affected organs,” explains Emanuel Della Torre, Reumatologist, Allergologue and Immunologist of the San Raffaele Hospital in Milan. “IgG4 antibodies that give the name to the disease would represent, in this context, an attempt of our body, unfortunately not effective, to turn off inflammation rather than the true cause of the disease.” The disease can involve pancreas, liver and gallstones, salivary and tear glands, eye sockets, kidneys, aorta and other body districts. To describe his heterogeneity, specialists distinguish four main clinical phenotypes: pancreato-hepato-biliare, retroperitoneale, head-neck and systemic. Signs and symptoms depend on the organ involved and may be little specific: tiredness, pain, swelling may appear as distinct problems, without immediately showing a single origin. It is precisely from the ability of the IgG4-related disease to be confused with other conditions that the sense of “NON M’IngG4nno” arises: an invitation to increase the knowledge of a rare and unknown pathology and its different manifestations. The campaign continues on www.malattiaigg4correlata.it, information platform created with the contribution of a scientific committee of experts and patient associations partner of the initiative, with content and resources useful on pathology, its manifestations and the diagnostic path. “IgG4-related disease is a rare and complex pathology, which can manifest in very different ways and affect multiple organs. This heterogeneity can make the path to diagnosis complicated,” comments Katia Massaroni, Medical Director of Amgen Italy. “It is therefore important to foster dialogue among the various specialists and also to promote close collaboration between patient associations – continues Massaroni. It is from the desire to relate skills, experiences and different perspectives that the “Non m’IngG4anno” campaign is born: an initiative with which we want to help increase the knowledge of the disease and offer useful information to promote comparison with the specialists of reference”miles with other pathologies, the IgG4-correlata disease can be confused with different conditions. A study reports that 60% of patients had initially received an incorrect diagnosis of malignant tumor, more often than lymphoma (47%) or pancreas tumor (30%). “In the presence of a mass that mainly involves pancreas, but also liver and gallstones, in 90-95% of cases it is a tumor and only in 5-10% of an inflammation,” explains Prof. Luca Frulloni, Gastroenterologist of the Integrated University Hospitaller Company of Verona. “Cylinically, it is not possible to distinguish a tumor from the IgG4-related disease: the diagnosis is based on radiological and biopsy investigations of the lesion.” Diagnosis is not based on a single examination. It requires the integration of the patient’s clinical history, blood tests, image investigations and, when necessary, biopsy.5 The diagnostic and disease classification criteria have only been defined in recent years. For these reasons it is not unusual that the path to diagnosis may take even more than two years. Diagnostic delay can have important consequences: when the disease imitates a neoplasia, it can also lead to unnecessary surgery.6 Just for the variety of its manifestations, the IgG4-related disease requires a multidisciplinary approach. “ The comparison between rheumatologists, pathologists, radiologists and other organ specialists is essential for a correct and timely framement, as it is a rare and systemic condition that can mimic other pathologies often more frequent or affect more body districts”, says Dr. Francesco Ferro, Reumatologist of the University Hospitaller Pisana. For many people, the path to diagnosis is marked by visits and consultations with different specialists, before the connection between apparently independent manifestations emerges. An uncertainty that can affect everyday life, work and family and social relationships. “ When symptoms are different and seemingly disconnected, the path to diagnosis can generate disorientation, fear and a strong sense of loneliness,” says Antonella Celano, President APMARR, National Association of People with Reumatological and Rare Diseases. “It is essential that the person be heard in his entirety and accompanied in a coordinated path. Associations can play an important role in informing, orienting and making people feel less lonely.” “Associations can welcome, listen and guide”, adds Silvia Tonolo, President ANMAR, National Association of Rheumatic Diseases “helping patients and caregiver to identify centers and reference specialists and offer correct information. They can also collect needs and criticality and bring them to the attention of clinicians and institutions. A disease can be rare, but the person who lives it must not become invisible.” IgG4-related disease requires time monitoring, because the inflammatory process can cause permanent damage to the organs involved. “Reaching the diagnosis is essential because organ damage can progress silently,” concludes Gaetano La Manna Nefrologo, IRCCS Policlinico Di Sant’Orsola, Bologna. “If the inflammation persists, it can leave room for fibrosis, i.e. a scarce damage not always reversible. Recognising renal involvement promptly enables the most appropriate therapeutic path. -photo press office campaign “Non M’IngG4nno – (ITALPRESS).

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