We present a case report on an older woman with unspecific symptoms and predominant long-term gastrointestinal disturbances, acute overall health deterioration with loss of autonomy for daily activities, and cognitive impairment. Autopsy revealed the presence of alpha-synuclein deposits spread into intestinal mucosa lesions, enteric plexuses, pelvic and retroperitoneal nerves and ganglia, and other organs as well as Lewy pathology in the central nervous system (CNS). Moreover, we isolated norovirus from the patient, indicating active infection in the colon and detected colocalization of norovirus and alpha-synuclein in different regions of the patient’s brain. In view of this, we report a concomitant norovirus infection with synthesis of alpha-synuclein in the gastrointestinal mucosa and Lewy pathology in the CNS, which might support Braak’s hypothesis about the pathogenic mechanisms underlying synucleinopathies.

Rationale: The Personalised Multidisciplinary Care Programme (PMCC) in operation at Donostia University Hospital since 2009 for patients suffering from Heart Failure (HF) and/or Chronic Obstructive Pulmonary Disease (COPD) has helped to cut down the number of re-admissions and visits to the emergency department (ED), at the expense of increasing the number of consultations and telephone calls.Objectives: To compare whether a web-based self-care programme (WSC group) can maintain the same standard as that found in the PMCC programme, while reducing the number of times patients needed to contact professionals (consultations and calls). Methods: Randomised clinical trials with concealment of the randomised sequence, not blind, involving 100 patients recruited from a historical cohort study (PMCC study participants) and monitored for one year (from May 2014 to May 2015). Mortality rates, the number of visits to the ED and hospital admissions in relation to the process, the number of telephone calls and consultations and quality of life (QoL) were measured using EuroQol while patients were a part of the study.Results: No significant statistical differences were observed in terms of mortality, visits to the ED and hospital admissions between the comparison groups. More in-person consultations and calls from nurses to patients were registered with the PMCC group, as expected as this was part of the procedure.Conclusion: A self-care web can be an effective and useful tool when managing chronic diseases in re-admitted patients, the effectiveness of which greatly depends on the patients’ preparedness and on their access to multimedia format.