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By Dr. Alessio Maiorino, Endocrinologist at Aventino Medical Group, Rome The thyroid is a small gland located in the front of the neck, yet it plays a fundamental role in the balance of the entire body. Through the production of thyroid hormones, it helps regulate metabolism, energy consumption, body temperature, heart rate, and numerous other functions. When the thyroid is overactive, underactive, or presents structural alterations, symptoms can vary widely and—especially in the early stages—be non-specific: fatigue, weight fluctuations, palpitations, nervousness, heat or cold intolerance, mood changes, or sleep disturbances can all have multiple causes. For this reason, when there is a clinical suspicion or risk factors are present, a thyroid check allows for the evaluation of both its function and, when indicated, its structure. What does checking the thyroid mean?  Thyroid evaluation is not based on a single test. It generally comprises three complementary levels: It is important to understand the difference: blood tests primarily tell us how the thyroid functions, while ultrasound mainly shows us what it looks like.  A thyroid can therefore have normal hormone values yet present a nodule on ultrasound; similarly, it may be structurally little altered while functioning too much or too little. 1. The endocrinological consultation  The first step is gathering the clinical history.  The endocrinologist evaluates the potential presence of symptoms compatible with thyroid dysfunction and takes into consideration certain factors that may increase the likelihood of developing a thyroid condition.  These may include: During the consultation, the doctor may also observe and palpate the neck region to assess the size, consistency, and regularity of the thyroid and check for any nodules or enlargements.  However, the presence of a single symptom is not sufficient to diagnose a thyroid disease: many disorders commonly attributed to the thyroid can have other causes. 2. Blood tests: what do they measure? TSH: the main indicator of thyroid function  TSH (Thyroid Stimulating Hormone) is produced by the pituitary gland and has the task of stimulating the thyroid to produce its own hormones. It is generally the first test used to evaluate thyroid function. In simplified terms: This data must nevertheless be interpreted together with the clinical picture and, when necessary, other thyroid hormones. FT4: Free Thyroxine  FT4, or free thyroxine, represents one of the main forms of thyroid hormone present in the blood.  The combined interpretation of TSH and FT4 makes it possible to distinguish different conditions: In the presence of a TSH below the reference range, in fact, measuring FT3 as well may be indicated. 3. Thyroid antibodies: anti-TPO and anti-Tg  Some of the most common thyroid diseases are of autoimmune origin: the immune system produces antibodies directed against components of the gland itself. Anti-Thyroperoxidase Antibodies – Anti-TPO  Anti-TPO antibodies are particularly useful when an autoimmune thyroid pathology is suspected.  Their positivity is frequently associated with Hashimoto’s autoimmune thyroiditis, one of the main causes of hypothyroidism.  However, they may also be present in other autoimmune thyroid conditions and, in some subjects, may test positive without a clinically manifest thyroid dysfunction being present. Anti-Thyroglobulin Antibodies – Anti-Tg  Anti-thyroglobulin antibodies (Anti-Tg) represent a further indicator of thyroid autoimmunity and can be present especially in autoimmune thyroiditis.  In this case as well, the result must not be interpreted in isolation but alongside TSH, FT4, ultrasound, and the clinical picture.  Thyroid antibodies, therefore, are not used to diagnose thyroid cancer: their main task is to contribute to the evaluation of autoimmune pathologies. 4. Thyroid ultrasound: what does it allow us to see? Thyroid ultrasound is a non-invasive, painless examination free of ionizing radiation.  The patient is made to lie down with the neck slightly extended. The doctor applies a small amount of gel to the skin and uses an ultrasound probe to observe the gland.  The examination makes it possible to evaluate: What happens if a nodule is found? Thyroid nodules are very common, and the majority are benign.  The discovery of a nodule therefore does not mean having cancer.  However, ultrasound makes it possible to study certain characteristics, including composition, echogenicity, margins, shape, and the potential presence of calcifications or suspicious lymph nodes.  Based on ultrasound characteristics and size, the doctor can determine whether monitoring is sufficient or whether it is advisable to proceed with further checks, such as ultrasound-guided thyroid fine-needle aspiration. What diseases can a thyroid check help detect?  The check-up can lead to the identification of very diverse conditions: Hypothyroidism In hypothyroidism, the thyroid produces an insufficient quantity of thyroid hormones.  It can manifest with:  Diagnosis stems primarily from the evaluation of TSH and FT4.  There are also subclinical forms, in which TSH is altered while FT4 still remains within reference values. Hashimoto’s Thyroiditis Chronic autoimmune thyroiditis of Hashimoto is a disease in which the immune system reacts against the thyroid.  Over time, it can cause a progressive reduction in gland function and thus hypothyroidism.  Evaluation may include: Having positive antibodies does not necessarily mean already having hypothyroidism: function and autoimmunity are two linked yet distinct aspects. Hyperthyroidism In hyperthyroidism, the thyroid produces an excessive quantity of thyroid hormones.  Among possible symptoms:  Tests may highlight reduced TSH, associated in overt forms with an increase in FT4 and/or FT3. Graves-Basedow Disease Graves-Basedow disease is one of the main causes of autoimmune hyperthyroidism.  When the clinical and hormonal picture suggests this possibility, specific antibodies directed against the TSH receptor, called TRAb, may be requested.  These antibodies are not necessarily part of an initial routine check-up, but are used when it is necessary to investigate the cause of hyperthyroidism. Thyroiditis The thyroid can also be affected by inflammatory processes of varying origins.  Some types of thyroiditis may initially provoke the release into the blood of hormones already stored in the gland, resulting in a temporary phase of thyrotoxicosis; subsequently, a phase of reduced thyroid function may appear.  The necessary investigations depend on the type of suspected thyroiditis and the clinical history. Goiter Goiter refers to an increase in thyroid dimensions.  It can be: The combination of consultation, hormone

Identity, life transitions and reconnecting with your authentic self By Janina Fandel, Psychologist at Aventino Medical Group, Rome. Throughout life, we all play many different roles: student, professional, partner, parent, friend or caregiver. While these roles can provide meaning and direction, they do not fully define who we are. At different stages of life, we may find ourselves asking deeper questions about our identity and the person we are becoming. Identity is constantly evolving One topic that seems more present than ever in today’s society is identity. Who do I identify as? And perhaps just as importantly: who do I want to be seen as by others? Our sense of identity is not fixed. It develops over time and is shaped by our experiences, relationships, values, and the environments we live in. While a stable sense of self can be important, becoming too strongly identified with only one aspect of life can become limiting. If our identity depends mainly on one role, achievement, or characteristic, we may eventually feel stuck or disconnected from who we are beyond that single part. Identity across different stages of life This is especially true during adolescence, a period in which identity formation plays a central role. But identity questions do not end there. They often reappear during major life transitions such as graduating, moving, starting a first job, entering a relationship, becoming a parent, or experiencing loss and change. At these moments, people may begin to question whether the choices they made still fit who they are becoming. The influence of society and social media In today’s world, the pressure to define ourselves can also come from society and social media. We may present carefully selected versions of ourselves online, which can raise questions such as: Is this really me, or just the version I want others to see? Over time, constantly adapting ourselves to the expectations of others can create distance from our own inner experience. We may begin to feel that we are performing an identity rather than truly living it. Exploring identity with flexibility At the same time, identity is not something that should remain rigid. Exploring different interests, values, and ways of being can be an important part of growth. Especially in a world full of options, experimenting with identity can help us discover what truly feels authentic. Yet too many possibilities can also feel overwhelming and sometimes lead to uncertainty, self-doubt, or a weakened sense of belonging. When psychological support may help When these experiences become persistent, or begin to affect everyday life, speaking with a psychologist can be helpful. For example, someone may notice recurring self-doubt, emotional exhaustion from trying to meet other people’s expectations, difficulty making decisions, or a growing sense of disconnection from what feels meaningful. Others may find themselves functioning well on the outside while feeling increasingly unsettled inside. In this sense, psychological support is not about telling someone who they are. It is about offering a reflective space to explore thoughts, emotions, patterns, and boundaries with greater clarity. It can help people reconnect with their values, preferences, and sense of self beneath the many roles they play. A space for reflection If these reflections resonate with you, psychological support can offer a space to explore them with greater clarity. Janina Fandel offers psychological consultations in English and German at Aventino Medical Group. Appointments can be arranged through our reception or booked online via Doctolib.

A practical guide for Italians, expatriates and international families By Dr Armando Calzolari, Cardiologist and Sports Medicine Physician, and Dr Valentina Ambrogio, Medical Doctor, second-year resident in Sports Medicine, Aventino Medical Group, Rome Every year, as the new sports season begins, thousands of people ask the same question: Which medical certificate do I need to practise sport in Italy? For people who have recently moved to Italy, the answer can be surprising. In many countries, a medical certificate is required only in specific circumstances. In Italy, however, medical certification is frequently associated with organised sports activities and represents an important tool for health protection and disease prevention. Italian legislation mainly distinguishes between three types of physical activity: The distinction does not depend solely on the type of exercise performed. More importantly, it depends on the context in which the activity takes place, whether the participant is registered with a sports organisation, and how the activity is organised. This guide explains the main differences and helps you identify which medical certificate, if any, may be required. 1. Recreational physical activity This category includes physical activity undertaken exclusively for personal well-being, without membership of a sports club or a federation recognised by the Italian sports system. Examples include: For this type of activity, Italian national legislation does not require a medical certificate. However, this does not necessarily mean that a certificate will never be requested. A gym, swimming pool or fitness centre may require one as part of its membership conditions or internal regulations, for organisational, insurance or health and safety reasons. Before booking a medical examination, it is therefore advisable to ask the facility: 2. Non-competitive organised sports activity This is the most common situation. Italian legislation requires a medical certificate for certain categories of people participating in organised non-competitive sports activities. According to current regulations, this includes: The medical assessment includes: Preschool children between 0 and 6 years of age are exempt from the requirement for a medical certificate for non-competitive sports activities, unless otherwise recommended by their paediatrician. Unless otherwise specified, the certificate is valid for one year. At Aventino Medical Group, medical examinations for the issuance of a non-competitive sports medical certificate are available for children, adolescents and adults, in full compliance with current Italian legislation. What happens in practice?The legal distinction between recreational physical activity and non-competitive organised sports activity remains valid. In everyday practice, however, the boundary is not always clear, and sports facilities do not always apply these definitions consistently. Many gyms, swimming pools and sports organisations require a medical certificate even when the activity is essentially recreational and would therefore normally fall within the category of recreational physical activity. This may be because: membership includes registration with a sports club or sports organisation;the requirement is established by the affiliated association or governing body; the facility’s insurance policy requires medical certification; the membership contract includes this requirement; the facility wishes to document participants’ health status before they begin the activity.As a result, a gym or swimming pool may simply ask for a non-competitive sports medical certificate, even when the activity itself does not formally fall into the category for which Italian law makes the certificate mandatory. For this reason—especially if you are unfamiliar with the Italian system—the most useful rule is very simple: Before booking your medical examination, ask the gym, swimming pool, school or sports club to specify in writing exactly which type of medical certificate is required. Rather than asking simply whether “a medical certificate” is needed, it is advisable to clarify whether they specifically require: a certificate for recreational physical activity; a certificate for non-competitive organised sports activity; a certificate for competitive sports activity. If you are still unsure, it is also worth asking whether your registration includes membership of a sports club or sports organisation, as this may determine whether a non-competitive sports medical certificate is legally required. 3. Attività sportiva agonistica Competitive sports activity Athletes participating in competitive sports must undergo a specific medical certification process. Whether an athlete is considered competitive does not simply depend on the intensity of training. Instead, it is determined by the rules of the relevant Sports Federation, which defines, for each discipline, the age groups and competition categories classified as competitive. Depending on the sport, the medical examination may include: A competitive sports medical certificate may only be issued by authorised Sports Medicine physicians working in accredited facilities, in accordance with current Italian legislation. Aventino Medical Group does not issue medical certificates for competitive sports activities. Who decides which certificate is required? The type of medical certificate required depends on the context in which the activity takes place, whether the participant is registered with a sports club or organisation, and the rules applied by the sports facility or club. Before booking your medical examination, it is therefore advisable to ask the gym, swimming pool, school or sports club to specify: Doing so helps avoid misunderstandings and ensures that you book the appropriate medical examination from the outset. Why is a medical certificate required in Italy? The purpose of medical certification is not to create unnecessary barriers to participation in sport, but to help ensure that physical activity is practised safely. Even a routine medical examination may identify cardiovascular conditions or other health issues that warrant further investigation before a person begins regular or intensive physical activity. Italy is internationally recognised for its longstanding experience in cardiovascular screening for athletes, and the current certification system was developed primarily to reduce the health risks associated with sports participation. The legal framework The main regulations governing medical certification for sports activities in Italy are: How we can help At Aventino Medical Group, we provide medical examinations for the issuance of non-competitive sports medical certificates for children, adolescents and adults. Each examination includes a thorough clinical assessment together with all investigations required under current Italian legislation, with the aim of ensuring that every patient can participate in sports safely and with confidence. If you need a non-competitive

Following the full-scale Russian invasion of Ukraine, psychoanalysts across Europe organized volunteer initiatives to support colleagues, patients, and families affected by the war. One such initiative was an online mothers’ group facilitated by the author. This article brings together excerpts from the testimonies of two Ukrainian psychoanalytic psychotherapists and mothers who participated in the group. The excerpts have been edited and rearranged while preserving the authors’ original words. The full version of this article is published in ‘Child and Adolescent Psychoanalysis in Times of Crisis War, Pandemic and Climate Change’, edited by Kristin. Fiorella and published by Routledge in 2025. Mary Cassatt (1844–1926), The Child’s Bath, 1893. Olio su tela. The Beginning KATERYNA Before the war started, I lived comfortably in my country and had a private psychotherapy practice. Together with my beloved husband, we were raising our son, had bought a house and were planning to renovate it in preparation for the arrival of our daughter. I never planned to emigrate when I was eight months pregnant. I could not even imagine in my worst nightmares that I would give birth under the explosions of enemy rockets and that our first days with our daughter would take place in a bomb shelter. I could not imagine that my fear of death would become so real that it would manifest itself in a desire to hold my daughter constantly, even when there was no need or threat. TETIANA The war took us by surprise. But I was already familiar with the first powerful explosions I heard at five in the morning on 24 February. My heart was pounding, and tears were streaming down my face. I felt a sticky, hot déjà vu from the summer of 2014 in Donetsk. For a moment I was immersed in memories of a wonderful family and peaceful life. Then, with the Russian invasion, I lost everything at once. I could not believe that the situation was repeating itself. My heart cried out in denial, but reality broke into my consciousness with terrible explosions from all sides. In the first days of the war, when I was full of despair and fear, my six-month-old son did not seem to react at all to the events around him. He remained as cheerful and lively as ever. One moment stands out in my memory. Almost at midnight, a powerful bombardment began and everything around us exploded loudly. We took the children to the stairwell next to the lift and just stood there, trembling from the sound of the deadly shells. I held the baby in my arms and tried to talk to him, and he babbled back, looked into my eyes and smiled. At that moment, a wild fear for my children’s lives overwhelmed me. At the same time, I was relieved that my baby was fine and did not seem frightened at all. Birth KATERYNA The war caught me at the beginning of my eighth month of pregnancy. I refused to even think about giving birth in a cellar or a bomb shelter. Photographs of the first women giving birth in underground and metro shelters horrified me. I could not believe in this reality or that I would have to face it directly. I dreamed that my child would be born in my hometown, accompanied by a doctor I trusted and in partnership with my husband. I imagined that we would return home with our daughter to our son and gradually get used to our new family member. I felt that all the conditions were in place to give this child a basic sense of security and safety in the world I would be bringing her into. A woman enters the maternity ward with one identity and leaves with another. But in the harsh reality of war, with constant sirens and being in a bomb shelter with a newborn in my arms, this space was transformed into something damaged, further increasing my regression and fears. I was lucky. Our first meeting with my daughter was in the delivery room, not the bomb shelter, and we managed to enjoy the silence in each other’s strong embrace for the first hour and a half. But soon the chaos began and the siren went off. Shortly afterwards we heard that two cruise missiles had fallen near the maternity hospital. That day, my daughter and I spent time in the corridor and in the bomb shelter. Tears streamed uncontrollably down my face. Inside me and around me echoed the question: “When will this nightmare end?” TETIANA Almost a year later, after we had reached safety, the neighbors started setting off fireworks. Suddenly my son started screaming, grabbed his clothes and pulled me down the stairs. It struck me that he seemed to be experiencing the same thing I had experienced when I held him to my heart to the sound of cannon fire. When he slept, he would cling to my neck as if to prevent me from falling if I suddenly had to run somewhere. I also felt much calmer having him close. In this way I felt I could protect him better, shielding him with my body in case of danger. Käthe Kollwitz (1867–1945), Die Mütter (Le Madri), 1921–1922. Xilografia. Leaving TETIANA I had fled Donetsk under fire with two children, and now I had a newborn with winter outside. For the first few days I was in a state of utter shock and helplessness, with an almost animal fear for my children’s lives. Somewhere around the fifth day, after another terrifying night in a cold basement with a screaming baby, I realized that I had to secure a safe place for all of us. If something happened to me, who would look after them? My emotions ranged from helplessness to inner strength and determination. The fear of danger on the road for my baby was extremely heavy for me, but staying was much more dangerous. We were very lucky to reach the station, board a train

Small bites, major discomfort Article prepared by the specialists of Aventino Medical Group.Scientific review: Dr Megon Bresciani, Specialist in Allergology; Dr Paola Groff, Specialist in Paediatrics. Mosquito bites For many people, mosquitoes are simply a summer nuisance. In fact, they are the insects that most frequently come into contact with humans during the warmer months, causing millions of bites every year. In recent decades, the Asian tiger mosquito (Aedes albopictus) has spread throughout much of Italy alongside the common mosquito. It is easily recognisable by the distinctive black-and-white stripes on its legs and body. Where are they found? Mosquitoes need water to reproduce and can breed in even very small amounts of it. They are frequently found: The common mosquito is particularly active from dusk until dawn, whereas the Asian tiger mosquito mainly bites during the daytime, with peaks in activity during the early morning and late afternoon. How does a mosquito bite? Only female mosquitoes bite, as they use blood as a source of nutrients for the development of their eggs. When biting, the mosquito injects a small amount of saliva containing anticoagulant substances into the skin. It is this saliva that triggers the inflammatory reaction responsible for the itching. What symptoms do mosquito bites cause? In most cases, the following symptoms appear: Children and people who are allergic or particularly sensitive may experience more pronounced reactions, with extensive and persistent swelling. Children with atopic conditions, for example, may develop particularly noticeable local reactions, with red and swollen areas that can reach several centimetres in diameter and persist for a few days. What about horseflies? A horsefly does not sting: it bites, superficially tearing the skin in order to feed on blood. This is why a horsefly bite is often more painful than a mosquito bite. It may cause immediate pain, redness, swelling, itching, and sometimes a small superficial wound. In most cases, it causes an unpleasant but harmless local reaction. More rarely, extensive swelling or allergic reactions may occur and require medical assessment. Why are some people bitten more than others? Many people feel that they are mosquitoes’ “favourite victims”, and this is partly true. Mosquitoes are attracted by: For this reason, some people are bitten much more frequently than others, even when they are in the same environment. When should you be concerned? In most cases, mosquito bites are harmless. It is advisable to consult a doctor if: 🦟 Can mosquitoes in Italy transmit diseases? For most people in Italy, mosquito bites remain nothing more than a minor local nuisance. However, the Asian tiger mosquito is closely monitored by public health authorities because it can transmit certain viruses, including chikungunya, dengue, and Zika, after biting an infected person and subsequently biting other people. The disease most frequently associated with the Asian tiger mosquito in Italy is chikungunya. The name of this viral disease literally means “that which bends”, referring to the severe joint pain that can characterise it. Its main symptoms include: In most cases, people recover spontaneously, although joint pain may persist for several weeks or, more rarely, for several months. Fortunately, the risk for people living or spending a holiday in Italy remains low and should not cause alarm. However, it is advisable to consult a doctor if high fever, severe joint pain, or unusual symptoms develop after numerous mosquito bites or following a trip to a tropical or subtropical country. 💡 Good to know: the presence of the Asian tiger mosquito is one of the reasons why mosquito-control programmes and the elimination of stagnant water are considered important public health measures. What should you do after a mosquito bite? ✅ Applying a cold compress can quickly reduce itching and swelling. The following may be helpful: The most important rule, however, is to avoid scratching, as scratching encourages inflammation and secondary infections. How can mosquito bites be prevented? Prevention is the most effective strategy. 🧴 Use suitable insect repellents on the skin. 👕 Wear lightweight clothing that covers the skin during the times of day when mosquitoes are most active. 🪟 Install mosquito screens in the home. 💧 Remove stagnant water from plant saucers, watering cans, and outdoor containers. 👶 For young children, it is preferable to use mosquito netting over pushchairs and cots rather than relying exclusively on insect repellents. Did you know…? Only female mosquitoes bite. They need the proteins found in blood to support the maturation of their eggs. A mosquito can detect a person from dozens of metres away. Carbon dioxide, body heat, and skin odours help it locate its target. In summary 📍 Where? Gardens, parks, terraces, balconies, and areas with stagnant water. 📍 When? From spring to autumn. 📍 Main symptom? Itching and localised swelling. 📍 Main risk? Inflammatory reactions and, rarely, the transmission of viruses such as chikungunya. 📍 First aid? Cold compresses and soothing creams. 📍 Prevention? Insect repellents, mosquito screens, and the elimination of stagnant water. Concerns after an insect bite? Book an appointment with one of the Aventino Medical Group specialists directly online.

Small, silent, and often underestimated Article prepared by the specialists of Aventino Medical Group.Scientific review: Dr Guido Castelli Gattinara, Specialist in Infectious Diseases; Dr Luigi Cornacchia, Specialist in Dermatology; Dr Paola Groff, Specialist in Paediatrics. Unlike mosquitoes, ticks do not bite in self-defence, but in order to feed. Once attached to the skin, a tick may remain unnoticed for many hours or even several days. The bite is generally painless, which is why many people only notice the tick while showering or changing their clothes after a walk. Where are ticks found? Contrary to popular belief, ticks do not live in trees and do not jump onto people. They are mainly found: They are particularly active from spring to autumn. In Italy, they are most commonly found at altitudes below 1,400 metres, although they may also be present at higher elevations in some mountainous areas. How does a tick bite occur? Ticks position themselves on grass or low-growing shrubs and attach themselves to animals or people as they pass by. Once they reach the skin, they look for a warm, concealed area in which to attach, such as: Because tick saliva contains anaesthetic substances, the bite often goes unnoticed. What should you do if you find a tick? ✅ Early removal is the most important measure. Use fine-tipped tweezers: Whenever possible, note the date of the bite to help with any subsequent medical assessment. What should you not do? ❌ Do not crush the tick with your fingers. ❌ Do not use oil, alcohol, acetone, petroleum jelly, or other substances in an attempt to “suffocate” it. ❌ Do not burn it with a match or cigarette. These methods may increase the risk of transmission of infectious agents. Why do tick bites require attention? The main concern is not the bite itself, but the possibility that some ticks may transmit infections. The best known is Lyme disease, caused by a bacterium transmitted through the bite of certain tick species. In some parts of Europe, ticks may also transmit TBE, or tick-borne encephalitis, a viral infection for which an effective vaccine is available. The risk of transmission increases the longer the tick remains attached to the skin. What symptoms may develop? In most cases, a tick bite causes no consequences. However, after a tick bite, it is advisable to monitor the skin and your general health for approximately one month and watch for the possible appearance of: Erythema migrans is one of the most characteristic signs of Lyme disease. How can tick bites be prevented? Prevention is particularly important during hikes and outdoor activities. 🧴 Apply repellents containing DEET, or diethyltoluamide, to exposed skin. 👖 Treat clothing with permethrin-based products, which are particularly useful during hikes and activities in high-risk areas. 🥾 Wear closed shoes and long trousers. 👖 Tuck the bottoms of your trousers into your socks when hiking in high-risk areas. 🚿 Check your skin carefully when you return and take a shower as soon as possible. 🐕 Check pets as well, as they may carry ticks into the home. When should you consult a doctor? It is advisable to consult a doctor if: Did you know…? The sooner a tick is removed, the lower the risk of transmission of certain infections. This is why it is important to check the skin after hikes and walks in natural areas. A tick can be as small as a sesame seed. During its immature stages, it may be so small that it can easily go unnoticed. In summary 📍 Where? Meadows, woodlands, countryside, and walking trails. 📍 When? From spring to autumn. 📍 Main symptom of the bite? Often none. 📍 Main risk? Transmission of infections such as Lyme disease. 📍 First aid? Correct and prompt removal of the tick. 📍 Prevention? Appropriate clothing, repellents, and checking the skin after outdoor activities. Concerns after a tick bite? In most cases, no specific treatment is required. However, if the tick remained attached for a long time, if unusual symptoms develop, or if you are unsure whether it was removed correctly, a medical assessment may be helpful. The Dermatology, Infectious Diseases, Internal Medicine, and Paediatrics specialists at Aventino Medical Group can assist adults and children with the management and monitoring of tick bites. At Aventino Medical Group, you can also receive advice on the prevention of tick-borne diseases and, when indicated, be vaccinated against TBE, or tick-borne encephalitis.

One of the most feared animals, yet rarely aggressive Article prepared by the specialists at Aventino Medical Group.Scientific review: Dr Alessandro Cristaudo, Specialist in Internal Medicine; Dr Paola Groff, Specialist in Paediatrics. Few creatures cause as much concern as the viper. Yet despite its bad reputation, this snake generally tries to avoid contact with humans and bites almost exclusively when it feels threatened or is accidentally stepped on. In Italy, vipers are found in many regions, particularly in hilly and mountainous areas. Encounters may occur during hikes, but bites remain relatively rare events. Where are vipers found? Vipers prefer quiet, sunny environments with plenty of hiding places. They are more commonly encountered: They are particularly active from spring through autumn. During the hottest hours of the day, they may be seen basking in the sun on rocks, trails or stone walls. How can you recognise a viper? Some features are fairly typical: However, confidently distinguishing a viper from other harmless snakes can be difficult, even for experienced people. For this reason, it is always best to keep your distance and avoid trying to identify it at close range, capture it or kill it. How does the bite occur? A viper does not attack humans in order to hunt them. Bites generally occur when: Many hikers do not see the animal until the moment of contact. What symptoms can it cause? The bite is generally painful from the outset. The most common symptoms are: Two small, closely spaced puncture marks left by the venomous fangs are often visible, although their absence does not completely rule out a bite. In more significant cases, the following may occur: Severity depends on several factors: Viper bite: what happens over the following hours? A viper bite is not always equally severe. In some cases, it may be a “dry bite”, meaning that no significant amount of venom has been injected. In other cases, however, the venom causes local and systemic symptoms that may develop over the following hours. During the first few minutes, the following usually appear: Over the following hours, the swelling may increase and spread upwards along the limb. The following may occur: Significant symptoms often appear within the first few hours, but medical observation is necessary because the condition may worsen progressively. Are children at greater risk? Yes. For the same amount of venom, a child receives a proportionally larger dose than an adult. For this reason, every suspected viper bite in a child requires urgent medical assessment. Particular caution is also required in older people, pregnant women and people with chronic medical conditions. 🐍 Do vipers really chase people? No. This is one of the most widespread and least substantiated beliefs. A viper tends to move away when it detects vibrations or noise and prefers to avoid contact with humans. Most bites occur because the animal is accidentally stepped on or because someone tries to approach it too closely. 💡 Good to know: many people who have been bitten report that they did not see the viper before the incident. What should you do after a bite? ✅ Stay calm.✅ Move away from the animal.✅ Keep the person still, preferably lying down.✅ Immobilise the affected limb as much as possible.✅ Remove rings, bracelets, tight shoes or restrictive clothing, as swelling may increase rapidly.✅ Call 112 or reach an Emergency Department as quickly as possible.✅ If possible, use a pen to mark the edge of the swelling and write down the time, to help doctors assess its progression. If the snake is still visible, it may be useful to remember what it looked like or photograph it from a distance, without exposing yourself to further risk. What should you do if you are far from a medical facility? The most important thing is to minimise movement. Walking, running or becoming agitated may promote the spread of the venom. If you are on a trail, in the mountains or in an isolated area, it is better to stop and arrange for emergency assistance. If possible: ✅ call 112 immediately;✅ keep the person calm and lying down;✅ immobilise the affected limb with an improvised splint or simply keep it still;✅ prevent the person from walking;✅ protect the person from heat or cold while waiting for help;✅ monitor their general condition, breathing and level of consciousness. If transport is unavoidable, the person who has been bitten should exert as little effort as possible. What should you NOT do? ❌ Do not cut the wound.❌ Do not suck out the venom.❌ Do not apply a tourniquet.❌ Do not tighten the limb with improvised compression bandages.❌ Do not apply ice directly to the wound.❌ Do not give alcohol.❌ Do not run to seek help.❌ Do not attempt to capture or kill the snake. These practices, although once widespread, are ineffective and may worsen the situation. Is there any medication you should carry with you? No. Carrying viper antivenom is neither useful nor recommended. Antivenom must only be administered in hospital, following medical assessment and under monitoring, because it can cause serious reactions and is not indicated in every case. What does make sense to carry during a hike is a small, practical kit containing: After a suspected viper bite, it is prudent to avoid aspirin and anti-inflammatory medicines such as ibuprofen or ketoprofen, unless otherwise advised by a doctor, because they may interfere with bleeding or blood clotting. Treatment in hospital In the Emergency Department, the patient is monitored through: Antivenom is not always administered. It is reserved for cases involving signs of significant envenomation, systemic symptoms or marked worsening of the local condition. The decision is made by the doctor, often in consultation with a Poison Control Centre. How can bites be prevented? Prevention is simple and highly effective. 🥾 Wear hiking boots or closed shoes during walks and hikes.👖 Choose long trousers on trails with tall vegetation.👀 Watch where you place your hands and feet.🪵 Take care when moving stones or piles of firewood.🚶

The danger hidden beneath the sand Article prepared by the specialists at Aventino Medical Group.Scientific review: Dr Alessandro Cristaudo, Specialist in Internal Medicine; Dr Luigi Cornacchia, Specialist in Dermatology. Many tourists have never heard of it, yet the weever fish, also known as the greater weever or spider fish, is probably responsible for some of the most painful stings occurring on Italian beaches every summer. Where does it hide? This small fish lives on sandy seabeds and spends much of the day partially buried in the sand, with only its eyes and venomous dorsal spines protruding. It is most commonly found: How does the sting occur? The sting is almost always accidental. While walking through shallow water, a person may step on the fish hidden beneath the sand. To defend itself, the weever fish raises its dorsal spines, which penetrate the skin and inject venom. What symptoms can it cause? ⚠️ Pain begins immediately and is often extremely intense, sometimes described as a burning sensation or an electric shock. Within a few minutes, the following may develop: More sensitive individuals may also experience: What should you do? ✅ Weever fish venom is heat-sensitive, meaning that it is inactivated by heat. For this reason, the most effective treatment is to immerse the affected area in very warm water at a temperature of approximately 40–45°C for at least 30 minutes, taking care not to cause burns. How can stings be prevented? Prevention is simple: 👟 Wear water shoes or protective beach footwear when walking through shallow water. Another useful precaution is to shuffle the feet gently along the sandy seabed. The vibrations tend to make the fish move away before contact occurs. Did you know? The weever fish spends much of the day hidden beneath the sand. Although it is often only 10–30 centimetres long, it can be almost invisible to beachgoers walking through shallow water. Even a dead weever fish can still sting Its venomous spines remain dangerous and the fish should always be handled with care. In summary 📍 Where? Sandy seabeds and shallow water.📍 When? Mainly during the summer and when the sea is calm.📍 Main symptom? Immediate and extremely intense pain.📍 First aid? Warm water for at least 30 minutes.📍 Prevention? Water shoes and caution when walking over sandy seabeds. Concerns after a sting or bite? If the pain is severe, your symptoms worsen, or you develop difficulty breathing, feel generally unwell, or experience other significant symptoms, go to the nearest Emergency Department. For non-urgent concerns, you can book an appointment at Aventino Medical Group.

The housemate that prefers not to be seen Article prepared by the specialists at Aventino Medical Group.Scientific review: Dr Guido Castelli Gattinara, Specialist in Infectious Diseases; Dr Alessandro Cristaudo, Specialist in Internal Medicine. Few animals cause as much fear as spiders. Yet the good news is that most spiders found in Italy are completely harmless to humans. Two species, however, regularly attract media attention and raise many questions: the violin spider and the Mediterranean black widow, known in Italian as the malmignatta. The reality is less alarming than it is often portrayed online, but it is still worth learning about these animals, knowing where they are found and recognising the situations that require medical assessment. Violin spider: the housemate that prefers not to be seen The violin spider (Loxosceles rufescens) is found across much of Italy, particularly in the central and southern regions. Its name comes from a distinctive dark marking on the cephalothorax that vaguely resembles the shape of a violin. It is not always easy to see with the naked eye, but this marking is the origin of the common name “violin spider”. Contrary to popular belief, it does not mainly live in forests or gardens. It prefers dry, dark and undisturbed places such as: It is a shy animal and is mainly active at night. How does the bite occur? The violin spider is not aggressive and does not attack humans. Bites almost always occur accidentally: Can it really bite while you are sleeping? Yes, it can happen, but not because the spider actively seeks out humans. The violin spider is not aggressive and generally prefers to hide. Because it is nocturnal, a bite may occur if the spider is accidentally trapped and crushed between the skin and the bed sheets, or between the skin and an item of clothing. Even in these cases, the bite is therefore caused by accidental contact, not by an attack. What symptoms can it cause? This is where many misunderstandings begin. In most cases, the bite causes: Many people do not even realise that they have been bitten. In a minority of cases, a more significant lesion may develop and worsen over the following hours or days, causing: The lesion may become relatively large and may take several weeks to heal. An important clarification 🕷️ Not all skin lesions attributed to the violin spider are actually caused by this spider. Many bacterial infections, bites or stings from other insects, and small infected wounds are mistakenly identified as violin spider bites. For this reason, a definite diagnosis is often difficult. When should you consult a doctor? Medical assessment is advisable if: Mediterranean black widow: the black widow of the Mediterranean The Mediterranean black widow (Latrodectus tredecimguttatus), known in Italian as the malmignatta, belongs to the same family as the black widow spiders found in other parts of the world. It is a shiny black spider, often characterised by red spots on its abdomen. Fortunately, it is much less common than the violin spider. Where is it found? It prefers: It is mainly encountered in the central and southern regions of Italy. How does the bite occur? The Mediterranean black widow is also not particularly aggressive. Bites generally occur: What symptoms can it cause? Unlike the violin spider, the Mediterranean black widow mainly causes systemic symptoms. After a bite, the following may occur: The symptoms can be very alarming but, in most cases, they resolve favourably with appropriate treatment. 🕷️ Spider bites: when should you really be concerned? Most spider bites observed in Italy do not require urgent treatment. Prompt medical attention is recommended if any of the following symptoms occur: Young children, older people and medically vulnerable individuals always require particular attention. What should you do after a suspected spider bite? ✅ Wash the area with soap and water.✅ Apply a cold compress.✅ Monitor the lesion over the following hours.✅ Taking photographs of the lesion may be useful for documenting how it changes over time. If the spider can be observed without taking any risks, a photograph may help the doctor identify it. How can bites be prevented? Prevention is simple and highly effective. 🧤 Wear gloves when handling boxes, firewood or materials that have been left undisturbed for a long time.👟 Check shoes and clothing that have been left outdoors or in a garage.📦 Take care when clearing out cellars, attics or storage areas.🌾 Wear gloves and suitable clothing when carrying out agricultural or gardening work. Did you know? Many spiders are useful in homes and gardens. They help to naturally control mosquitoes, flies and other small insects. The violin spider does not build the classic geometric spider webs. It prefers to hide in quiet, rarely disturbed places, where it produces irregular and barely visible strands of silk. In summary 📍 Where? The violin spider is mainly found in indoor environments; the Mediterranean black widow is found in the countryside and rural areas.📍 When? More frequently during the warmer months.📍 Main symptom of a violin spider bite? A skin lesion that may worsen over time.📍 Main symptom of a Mediterranean black widow bite? Muscle cramps and systemic symptoms.📍 First aid? Washing, cold compresses and observation.📍 Prevention? Gloves and caution around shoes, boxes, firewood and rarely used environments. Concerns after a sting or bite? If you experience severe pain, worsening of the lesion, fever, or feel generally unwell, seek prompt medical attention or go to the nearest Emergency Department. For non-urgent concerns, you can book an appointment at Aventino Medical Group.

The caterpillar you should never touch Article prepared by the specialists at Aventino Medical Group.Scientific review: Dr Megon Bresciani, Specialist in Allergology; Dr Paola Groff, Specialist in Paediatrics. The pine processionary is a caterpillar known for its distinctive way of moving: the caterpillars often travel in a line, one behind the other, forming a true “procession”. It is important to recognise this caterpillar because, although it does not sting or bite, it is covered with urticating hairs that can cause severe irritation to the skin, eyes and respiratory tract. Where is it found? The pine processionary caterpillar is mainly found near pine trees, where it builds clearly visible whitish, cotton-like nests among the branches. It may be encountered: The caterpillars descend from the trees and move across the ground, often in a line, especially from late winter through spring. However, the risk of exposure to their urticating hairs may persist during the following months. Why is it dangerous? The problem is not a bite, but contact with the urticating hairs. These hairs are extremely small, invisible to the naked eye and equipped with tiny hooks that allow them to cling easily to the skin and mucous membranes. They can: For this reason, direct contact with the caterpillar is not necessary for a reaction to occur. What symptoms can it cause? Contact with the urticating hairs may cause: Children may be particularly curious about the caterpillars moving in a line and are therefore at greater risk of directly touching them with their hands or coming into contact with them on the face and around the eyes. 🌲 What happens after exposure to pine processionary caterpillars? Once they penetrate the tissues, the urticating hairs release irritating substances that can trigger a sometimes very intense inflammatory reaction. Skin contact The most common reaction is irritant dermatitis characterised by: Symptoms may appear within a few minutes or several hours later. They mainly affect exposed areas such as the arms, legs, neck and face. In children, the itching may be particularly intense and lead to scratching, increasing the risk of a secondary skin infection. Eye contact If the hairs enter the eyes, they may cause: In these cases, it is important not to rub the eyes and to seek medical advice, as the hairs may remain trapped in the conjunctiva. Inhalation of urticating hairs When carried by the wind, the hairs may be inhaled. Symptoms may include: People with asthma or respiratory allergies may develop more pronounced symptoms. Contact with the mouth and mucous membranes More rarely, particularly in young children, the hairs may enter the mouth. In this case, they may cause: Can allergic reactions occur? Yes, although they are uncommon. In predisposed individuals, exposure may cause: If any of these symptoms occur, immediate assessment at an Emergency Department is necessary. 💡 Good to know: many people believe that there is a risk only when the caterpillar is touched. In reality, on windy days symptoms may develop even without direct contact, simply by spending time near infested trees. Be careful with pets Dogs and cats, especially dogs, are particularly at risk because they may sniff or lick the caterpillars. In dogs, exposure may cause: In these cases, a veterinarian should be contacted immediately. What should you do after exposure? ✅ Move away from the affected area.✅ Avoid scratching or rubbing the skin.✅ Remove contaminated clothing and wash it.✅ Rinse the skin thoroughly with plenty of water.✅ If the eyes are affected, rinse them with sterile saline solution.✅ Consult a doctor if the symptoms are severe or if the eyes, mouth or respiratory tract are involved. What should you NOT do? ❌ Do not touch the caterpillars.❌ Do not crush pine processionary caterpillars.❌ Do not handle their nests.❌ Do not scratch irritated skin.❌ Do not allow children or pets to approach them. The nests must be removed by specialised professionals. How can exposure be prevented? Prevention mainly involves recognising the risk. 🌲 Look for white nests in pine trees.🚸 Supervise children in parks and pine forests.🐕 Keep dogs on a lead in areas where there may be a risk.👀 Avoid areas where infestations have been reported.🏡 Report nests found in public spaces or shared residential areas. Did you know? Even when pine processionary caterpillars are no longer visible, their urticating hairs may remain in the environment. During the summer, exposure may occur through residues left on abandoned nests, tree bark, the ground or pine needles. For this reason, nests or suspicious material found beneath pine trees should never be touched. The pine processionary spends almost its entire life as a caterpillar and only a few days as an adult moth. After the eggs hatch, the caterpillar lives on pine trees for approximately seven to nine months. It then burrows into the ground and develops into a pupa, a stage that may last from several weeks to several months. The adult moth emerges during the summer and generally lives for less than a week, just long enough to mate and lay its eggs. In summary 📍 Where? Pine forests, parks, gardens and areas with pine trees.📍 When? Mainly from late winter through spring, although the urticating hairs may persist in the environment.📍 Main symptoms? Itching, dermatitis and irritation of the eyes or respiratory tract.📍 Main risk? Contact with the skin, eyes or mouth, or inhalation of the urticating hairs.📍 First aid? Wash the affected area, do not rub it and remove contaminated clothing.📍 Prevention? Do not touch caterpillars or nests, and supervise children and pets. Concerns after a sting or bite? Book an appointment with one of the specialists at Aventino Medical Group directly online.