A 16-year-old boy was admitted to our emergency department, in Lombardy, complaining of intense pain in his chest-radiating to his left arm-which had started 1 h earlier. The day before he had a fever of 38•3°C that decreased after 100 mg of nimesulide. He reported no other symptoms, no medical history, and no contact with anyone with confirmed COVID-19.We found his vital signs to be normal apart from his temperature which was raised at 38•5°C. On auscultation of the patient's chest, we heard normal heart sounds, no pericardial rub, and no abnormal respiratory signs. We found no lymphadenopathy, no rash, and no areas of localised tenderness on the chest wall. An electrocardiogram (ECG) showed inferolateral ST-segment elevation (figure) and a transthoracic echocardiography showed hypokinesia of the inferior and inferolateral segments of the left ventricle, with a preserved ejection fraction of 52%; no pericardial effusion was seen. Investigations showed raised high-sensitivity cardiac troponin I (9449 ng/L), creatine phosphokinase (671•0 U/L), C-reactive protein (32•5 mg/L), and lactate dehydrogenase (276•0 U/L) concentrations (appendix). The leucocyte count was 12•75 × 10⁹ per L, the neutrophil count was 10•04 × 10⁹ per L, and the lymphocyte count was 0•78 × 10⁹ per L.We gave the boy aspirin to relieve his pain and transferred him to the coronary care unit with a working diagnosis of acute myocarditis. The patient's pain gradually improved and after 2 h had completely resolved.However, during the first night, he reported further chest pain; the ECG was repeated but no significant changes were seen (appendix). We started him on intravenous ibuprofen 600 mg three times a day and both his symptoms and raised temperature resolved. Tests for autoantibodies and cardiotropic viruses were negative (appendix). On day 3, a nasopharyngeal swab test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive, so we started hydroxychloroquine and antiviral therapy. Serial measurements of the patient's troponin concentration showed a gradual reduction from a peak of 16 862 ng/L on day 1, to 39 ng/L on day 8. The inflammatory markers also returned to normal and the ST-segment elevation on ECG resolved (appendix).On day 11-after nasopharyngeal swabs taken on 2 consecutive days were negative-MRI T2-weighted short-tau inversion recovery sequences showed changes supporting the diagnosis of acute myocarditis (figure; appendix). On day 12, he was well, asymptomatic, and allowed home.Notably, throughout the entire time he was in hospital, our patient did not have any of the signs or symptomsapart from a fever-typically reported in COVID-19; his peripheral oxygen saturation levels remained within normal limits and two chest x-rays, on days 3 and 6, were clear (appendix). Paediatric patients reporting chest pain and other features suggestive of acute myocarditis-with or without respiratory symptoms-should, we believe, also be tested for SARS-CoV-2 (video). ContributorsWe were all involved in the care and management of ...

Aim: Human-induced climate change requires conservation strategies incorporating its potential effects on species and communities. Key components of population persistence can be attributed to resistance (the capacity to remain unaffected) or resilience (capacity to absorb and recover) to climate change. In situ climatic refugia can act as resistant distribution units, and ex situ climatic refugia and the corridors to reach them may enhance resilience. We develop a novel approach selecting conservation priorities, resistant units and resilient areas according to structural connectivity and future distribution, to identify strategies that maximize the chances of species persistence in a changing climate. Location: Italian Alps.Methods: Conservation priorities were defined across species according to the regional conservation status and the level of threat from climate change, and across sites according to their suitability for target species and their related potential for population persistence (in situ climatic refugia, i.e., resistant units) or redistribution (ex situ climatic refugia and main corridors according to current and future connectivity, i.e., resilient units).Results: Models suggested a marked loss of suitable area for all species by 2050 (ranging from ~50% for pygmy owl and water pipit, to 84% for snowfinch in the worst scenario), and a general loss of connectivity, which was particularly marked for pygmy owl and snowfinch. The approach applied to Alpine birds of different habitats led to a spatially explicit definition of conservation priorities. Main conclusions:The spatial definition of conservation priorities according to species (regional importance and level of threat), resistance and resilience refines the definition of management/conservation priorities (including protected area definition), complementing the existing approaches to address climate change-induced threats in planning conservation and ecological networks. K E Y W O R D SAlps, birds, distribution, ecological connectivity, global warming, spatial planning

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Interspecific interactions are crucial in determining species occurrence and community assembly. Understanding these interactions is thus essential for correctly predicting species' responses to climate change. We focussed on an avian forest guild of four hole‐nesting species with differing sensitivities to climate that show a range of well‐understood reciprocal interactions, including facilitation, competition and predation. We modelled the potential distributions of black woodpecker and boreal, tawny and Ural owl, and tested whether the spatial patterns of the more widespread species (excluding Ural owl) were shaped by interspecific interactions. We then modelled the potential future distributions of all four species, evaluating how the predicted changes will alter the overlap between the species' ranges, and hence the spatial outcomes of interactions. Forest cover/type and climate were important determinants of habitat suitability for all species. Field data analysed with N‐mixture models revealed effects of interspecific interactions on current species abundance, especially in boreal owl (positive effects of black woodpecker, negative effects of tawny owl). Climate change will impact the assemblage both at species and guild levels, as the potential area of range overlap, relevant for species interactions, will change in both proportion and extent in the future. Boreal owl, the most climate‐sensitive species in the guild, will retreat, and the range overlap with its main predator, tawny owl, will increase in the remaining suitable area: climate change will thus impact on boreal owl both directly and indirectly. Climate change will cause the geographical alteration or disruption of species interaction networks, with different consequences for the species belonging to the guild and a likely spatial increase of competition and/or intraguild predation. Our work shows significant interactions and important potential changes in the overlap of areas suitable for the interacting species, which reinforce the importance of including relevant biotic interactions in predictive climate change models for increasing forecast accuracy.

We reviewed the importance of power lines as a cause of mortality for Eagle Owl in the Italian Alps. Power lines were the most important cause of unnatural mortality for this species, accounting for over 50% of recorded casualties. The number of reported dead owls tended to be higher in September–October, suggesting an influence on juvenile dispersal. Furthermore, the significance of power lines as a cause of mortality increased over time, being lower in the 1960–1980 period than in 1981–1999. Electrocution, which usually takes place at medium-voltage (15–30 kV) electricity poles, accounted for the vast majority of casualties. We suggest some protective measures that may be put into practice in the proximity of Eagle Owl breeding territories.

Habitat selection is a complex process, that is affected by several factors, including habitat characteristics, environmental conditions, and both intra‐ and interspecific interactions. We analysed habitat preferences of two top avian predators, Peregrine Falcon Falco peregrinus, a medium‐sized diurnal raptor, and Eagle Owl Bubo bubo, a large nocturnal raptor. These two species are known to compete for preferred nest‐sites, and proximity to cliffs with Eagle Owls may reduce Peregrine breeding output through predation of young Falcons. We investigated the environmental factors affecting occurrence and coexistence of the two species and the potential role of habitat suitability in favouring co‐occurrence in 3519 km2 of the central pre‐Alps of Italy, where the two species breed on cliffs and sometimes co‐occur on the same cliff. Peregrines settled on long, steep and favourably orientated cliffs in woodland landscapes close to urban areas. Eagle Owls settled on topographically similar cliffs, but in lower rainfall areas compared with cliffs occupied by Peregrines and cliffs unoccupied by either species. Sites where the two species co‐occurred were characterized by more horizontally extended cliffs compared with sites of exclusive occurrence of each species. An analysis of relative habitat suitability revealed that sites where the two species co‐occurred had the highest predicted probability of occupancy for both species, suggesting that those sites should be regarded as high‐quality sites. Breeding productivity of Eagle Owls was negatively affected by the co‐occurrence of Peregrines, whereas the effect of Eagle Owl proximity on Peregrine productivity varied according to cliff suitability for the Peregrines. Habitat selection had fitness consequences for Eagle Owls because breeding productivity increased with cliff length. Environmental conditions, particularly climatic factors, could allow the widespread coexistence of these competing raptors at the landscape scale, whereas at the local scale co‐occurrence could take place only on larger cliffs. These were preferred sites for both species, presumably because breeding at such sites offsets the costs of settling close to the competitor species.

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A biloma is an encapsulated collection of bile located in the abdomen. It occurs spontaneously or secondary to traumatic or iatrogenic injury to the biliary system. The patient's medical history, symptoms and diagnostic imaging findings suggest the diagnosis, but a definitive diagnosis is provided by drainage and biochemical analysis of the fluid. We report a case of a patient admitted with acute abdominal pain in the right hypochondrium caused by a spontaneous biloma. This is a rare condition, and the reason for the onset was not identified. We discuss the role of the various diagnostic imaging techniques, particularly that of ultrasound.Keywords Spontaneous biloma Á Imaging Á Ultrasound Á Contrast-enhanced CT Riassunto Il biloma è una raccolta circoscritta di bile in addome, spontanea o secondaria ad una lesione traumatica o iatrogena del sistema biliare. L'anamnesi, i sintomi ed i reperti radiologici suggeriscono la diagnosi, anche se spesso la diagnosi finale è legata al drenaggio del liquido. Riportiamo il caso di un paziente ricoverato per dolore addominale acuto in ipocondrio destro determinato da un biloma spontaneo, condizione rara in cui non si identifica la causa del danno al sistema biliare e discutiamo il ruolo delle varie metodiche di diagnostica per immagine, in particolare dell'ecografia.