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Curatola A, Corona F, Squillaci D, Saccari A, Chiaretti A, Barbi E, Maschio M. Lung ultrasound evaluation in people with cystic fibrosis: A new approach in the pulmonology outpatient clinic. Pediatr Pulmonol 2024; 59:592-599. [PMID: 38014586 DOI: 10.1002/ppul.26787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease that causes progressive lung disease with major impact on the quality of life. Lung ultrasound (LUS) allows to assess the lung involvement through the artefacts analysis and is increasingly used in children but is not yet used to monitor people with CF(pwCF). The main aim of this study was to describe the LUS pattern of pwCF during their routinary check-up visit. The secondary objective was to correlate the LUS findings with pulmonary function indices. METHODS We performed a cross-sectional observational study, enrolling adolescents and young adults with CF. Each patient underwent clinical assessment, measurement of SpO2, assessment of lung function by spirometry and LUS. RESULTS Twenty-nine subjects with CF were included. The most frequent alterations were consolidations (72.4%) located in the left apical anterior and right apical posterior regions followed by interstitial syndrome (65.5%). The 41.4% of cases presented the lingula involvement, characterized by a consolidation with static air bronchogram, and 55.2% showed pleural irregularity mainly in the posterior apical regions. A significant correlation was found between the LUS total score and spirometric indices: FEV1 (p = .003), FVC (p = .002), Tiffenau Index <80% (p = .014), and FEF 25-75 (p = .004). CONCLUSIONS Our study describes LUS findings in pwCF. It also showed a correlation between LUS score and the patients' lung function measured by spirometric indices. We conclude that LUS may be useful in routine monitoring of pwCF in combination with clinical and spirometric assessment.
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Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Alessia Saccari
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Massimo Maschio
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Di Sarno L, Curatola A, Pansini V, Caroselli A, Gatto A, Chiaretti A. Antibiotic treatment for streptococcal pharyngitis: time for a new approach? Acta Biomed 2023; 94:e2023219. [PMID: 38054680 PMCID: PMC10734236 DOI: 10.23750/abm.v94i6.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/13/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Lorenzo Di Sarno
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonietta Curatola
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Rome, Italy.
| | - Valeria Pansini
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Rome, Italy.
| | - Anya Caroselli
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gatto
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Rome, Italy.
| | - Antonio Chiaretti
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Capossela L, Ferretti S, D’Alonzo S, Di Sarno L, Pansini V, Curatola A, Chiaretti A, Gatto A. Bone Disorders in Pediatric Chronic Kidney Disease: A Literature Review. Biology (Basel) 2023; 12:1395. [PMID: 37997994 PMCID: PMC10669025 DOI: 10.3390/biology12111395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Intense changes in mineral and bone metabolism are frequent in chronic kidney disease (CKD) and represent an important cause of morbidity and reduced quality of life. These disorders have conventionally been defined as renal osteodystrophy and classified based on bone biopsy, but due to a lack of bone biopsy data and validated radiological methods to evaluate bone morphology in children, it has been challenging to effectively assess renal osteodystrophy in pediatric CKD; the consequence has been the suboptimal management of bone disorders in children. CKD-mineral and bone disorder (CKD-MBD) is a new expression used to describe a systemic disorder of mineral and bone metabolism as a result of CKD. CKD-MBD is a triad of biochemical imbalances in calcium, phosphate, parathyroid hormone, and vitamin D; bone deformities and soft tissue calcification. This literature review aims to explore the pathogenesis, diagnostic approach, and treatment of CKD-MBD in children and the effects of renal osteodystrophy on growing skeleton, with a specific focus on the biological basis of this peculiar condition.
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Affiliation(s)
- Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Silvia D’Alonzo
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy;
| | - Lorenzo Di Sarno
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
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Gatto A, Capossela L, Conti G, Eftimiadi G, Ferretti S, Manni L, Curatola A, Graglia B, Di Sarno L, Calcagni ML, Di Giuda D, Cecere S, Romeo DM, Soligo M, Picconi E, Piastra M, Della Marca G, Staccioli S, Ruggiero A, Cocciolillo F, Pulitanò S, Chiaretti A. Intranasal human-recombinant NGF administration improves outcome in children with post-traumatic unresponsive wakefulness syndrome. Biol Direct 2023; 18:61. [PMID: 37789391 PMCID: PMC10546699 DOI: 10.1186/s13062-023-00418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is one of the most dramatic events in pediatric age and, despite advanced neuro-intensive care, the survival rate of these patients remains low. Children suffering from severe TBI show long-term sequelae, more pronounced in behavioral, neurological and neuropsychological functions leading to, in the most severe cases, an unresponsive wakefulness syndrome (UWS). Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. In experimental animal models, human- recombinant Nerve Growth Factor (hr-NGF) promotes neural recovery supporting neuronal growth, differentiation and survival of brain cells and up-regulating the neurogenesis-associated processes. Only a few studies reported the efficacy of intranasal hr-NGF administration in children with post- traumatic UWS. METHODS Children with the diagnosis of post-traumatic UWS were enrolled. These patients underwent a treatment with intranasal hr-NGF administration, at a total dose of 50 gamma/kg, three times a day for 7 consecutive days. The treatment schedule was performed for 4 cycles, at one month distance each. Neuroradiogical evaluation by Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG), and Power Spectral Density (PSD) was determined before the treatment and one month after the end. Neurological assessment was also deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale. RESULTS Three children with post-traumatic UWS were treated. hr-NGF administration improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary movements, facial mimicry, attention and verbal comprehension, ability to cry, cough reflex, oral motility, and feeding capacity, with a significant improvement of their neurological scores. No side effects were reported. CONCLUSION These promising results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from severe TBI and in patients with better baseline neurological conditions, to explore more thoroughly the benefits of this new approach on neuronal function recovery after traumatic brain damage.
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Affiliation(s)
- Antonio Gatto
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Lavinia Capossela
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Conti
- Terapia Intensiva Pediatrica, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gemma Eftimiadi
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Ferretti
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Manni
- Istituto di Farmacologia Traslazionale, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Benedetta Graglia
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Di Sarno
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Calcagni
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Di Giuda
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cecere
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Marco Romeo
- Unità di Neurologia Pediatrica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marzia Soligo
- Istituto di Farmacologia Traslazionale, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Enzo Picconi
- Terapia Intensiva Pediatrica, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marco Piastra
- Terapia Intensiva Pediatrica, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giacomo Della Marca
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Susanna Staccioli
- Dipartimento di Neuroriabilitazione Intensiva, Ospedale Pediatrico "Bambino Gesù", Rome, Italy
| | - Antonio Ruggiero
- Oncologia Pediatrica, Fondazione Policlinico Universitario A.Gemelli IRCCS - Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Cocciolillo
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Pulitanò
- Terapia Intensiva Pediatrica, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.
- Department of Women's Health Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
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Gatto A, Capossela L, Ferretti S, Di Sarno L, Oliveti A, Talamonti D, Curatola A, Chiaretti A, Fiori B. Single-center, prospective, and observational study on the management and treatment of impetigo in a pediatric population. Eur Rev Med Pharmacol Sci 2023; 27:9273-9278. [PMID: 37843341 DOI: 10.26355/eurrev_202310_33955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Ozenoxacin is a new antibiotic used to treat non-bullous impetigo. The aim of this study is to evaluate the microbiological and clinical efficacy of topical ozenoxacin 1% cream after 5-day twice-daily treatment, in pediatric patients with impetigo. PATIENTS AND METHODS This observational and prospective study included patients aged 6 months to 18 years, with non-bullous impetigo. Efficacy was measured using the Skin Infection Rating Scale (SIRS) and microbiological culture at the first visit (T0), at the second visit after 72 hours (T1) and after 5 days (T2). Safety and tolerability were also evaluated. RESULTS A total of 50 patients was enrolled. A reduction of SIRS score >10% after 72 hours of treatment was noticed in all patients, while a complete reduction was assessed after 5 days in all the population. Microbiologic success rates for ozenoxacin at T1 was 92% (four patients had original pathogens in the specimen culture from the skin area), whereas at T2, it was 100%. CONCLUSIONS Topical ozenoxacin has strong efficacy in treating impetigo in pediatric patients. Ozenoxacin's clinical and microbiological rapid onset of response led to consider this antibiotic a novel efficacy option for the treatment of impetigo.
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Affiliation(s)
- A Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
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Cipolla C, Lazzareschi I, Curatola A, Lasorella C, Pane LC, Sessa L, Rotunno G, Rigante D, Sodero G. Characteristics of Children and Adolescents with Hyperinsulinemia Undergoing Oral Glucose Tolerance Test: A Single-Center Retrospective Observational Study. Diseases 2023; 11:110. [PMID: 37754306 PMCID: PMC10530243 DOI: 10.3390/diseases11030110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
The aim of this study was to evaluate a potential correlation between results of the oral glucose tolerance test (OGTT) and the auxological/metabolic parameters in a cohort of overweight patients assessed for suspicion of hyperinsulinism. We analyzed 206 patients, comparing those with insulin peak below (nonhyperinsulinemic) and over 100 uIU/mL (hyperinsulinemic) at the OGTT. We found a significant difference in weight (p = 0.037), body mass index (BMI, p < 0.001) and BMI standard deviations (SD, p < 0.001), waist circumference (p = 0.001), hip circumference (p = 0.001), and waist-to-height ratio (WHtR, p = 0.016) between the two groups. Analyzing the median insulin value during OGTT in the whole population, a weakly positive correlation emerged with weight SD (p < 0.001; rho = 0.292) and a moderate positive correlation with BMI SD (p < 0.001; rho = 0.323). We also found a weakly positive correlation with waist circumference (p = 0.001; rho = 0.214), hip circumference (p = 0.001; rho = 0.217), and WHTR (p = 0.016; rho = 0.209) and a moderate positive correlation with the HOMA index (p < 0.001; rho = 0.683). The median insulin value correlates with high triglyceride (p < 0.001; rho = 0.266) and triiodothyronine values (p = 0.003; rho = 0.193) and with low HDL values (p < 0.001; rho = -0.272). In clinical practice the interpretation of laboratory and anthropometric parameters could predict the level of insulin, highlighting also a possible underlying diagnosis of insulin resistance and/or hyperinsulinemia without performing an OGTT.
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Affiliation(s)
- Clelia Cipolla
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Ilaria Lazzareschi
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Antonietta Curatola
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Claudia Lasorella
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Lucia Celeste Pane
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Linda Sessa
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Giulia Rotunno
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Giorgio Sodero
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito n. 1, 00168 Rome, Italy; (C.C.); (I.L.); (A.C.); (C.L.); (L.C.P.); (L.S.); (G.R.); (D.R.)
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Di Sarno L, Gatto A, Korn D, Pansini V, Curatola A, Ferretti S, Capossela L, Graglia B, Chiaretti A. Pain management in pediatric age. An update. Acta Biomed 2023; 94:e2023174. [PMID: 37539605 PMCID: PMC10440769 DOI: 10.23750/abm.v94i4.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/16/2023] [Indexed: 08/05/2023]
Abstract
Differently from the adult patients, in paediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, a selection of appropriate pain assessment tools should consider the age, the cognitive level, the presence of eventual disability, the type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drug pharmacokinetics should facilitate a better management of childhood pain. The objective of this update is to discuss the current practice and the recent advances in pediatric pain management. Using PubMed and the Cochrane Library we conducted an extensive literature analysis on pediatric pain assessment and commonly used analgesic agents in this kind of patients. According to our results, a multimodal analgesic regimen provides a better pain control and a functional outcome in children. Cooperation and communication among the anaesthesiologist, the surgeon and the paediatrician remains essential for successful anaesthesia and pain management in childhood.
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Affiliation(s)
- Lorenzo Di Sarno
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - Antonio Gatto
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - David Korn
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - Valeria Pansini
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - Antonietta Curatola
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - Serena Ferretti
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | - Lavinia Capossela
- Department of Pediatrics. Fondazione Policlinico "A. Gemelli", IRCCS. Largo Gemelli, 1 - 00168 Roma, Italia..
| | | | - Antonio Chiaretti
- a:1:{s:5:"en_US";s:81:"Fondazione Policlinico Gemelli IRCCS - Università Cattolica del Sacro Cuore ROMA";}.
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Capossela L, Margiotta G, Ferretti S, Curatola A, Bertolaso C, Pansini V, Di Sarno L, Gatto A. Presepsin as a diagnostic marker of sepsis in children and adolescents: a short critical update. Acta Biomed 2023; 94:e2023062. [PMID: 37326282 PMCID: PMC10308464 DOI: 10.23750/abm.v94i3.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Sepsis is a potentially fatal condition which strikes 1.2 million children worldwide per year. New biomarkers have been proposed in the assessment of the risk of sepsis progression and in the identification of patients with the worst outcome. This review aims to assess the diagnostic value of presepsin, a promising new biomarker, in pediatric sepsis, with particular attention to its usefulness in emergency department. METHODS We performed a literature search of the last 10 years to find presepsin related studies and reports concerning pediatric population aged from 0 months to 18 years. We mainly focused on randomized placebo-control studies, followed by case-control studies, observational (both retrospective or prospective), and finally systematic reviews and meta-analysis. The article selection process was carried out independently by three reviewers. Results: A total of 60 records were identified in literature, 49 were excluded according to the exclusion criteria. The highest presepsin sensitivity value was 100%, with a high cut-off (800.5 pg/mL). The highest sensitivity-specificity ratio was 94% vs 100%, with a similar considered presepsin cut-off (855 ng/L). As regards the presepsin cut-offs reported in the various studies, several authors agree on a critical threshold of about 650 ng/L to guarantee a sensitivity> 90%. The analyzed studies show a wide variability for patients' age and presepsin risk cut-offs. Conclusions: Presepsin seems to be a new useful marker for early diagnosis of sepsis, even in a pediatric emergency setting. Being a new marker of sepsis, more studies are required to better understand its potential.
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Affiliation(s)
- Lavinia Capossela
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gaia Margiotta
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Serena Ferretti
- a:1:{s:5:"en_US";s:114:"Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy ";}.
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
| | - Chiara Bertolaso
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy.
| | | | - Lorenzo Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
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Ferretti S, Curatola A, Chiaretti A, Graglia B, Gatto A, Capossela L, Pansini V. Early treatment with N-acetylcysteine reduces hepatotoxicity in acute acetaminophen poisoning. Acta Biomed 2023; 94:e2023033. [PMID: 37247196 DOI: 10.23750/abm.v94is1.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/14/2022] [Indexed: 05/30/2023]
Abstract
During the outbreak of COVID19 measures taken to contain the spread of the virus have influenced the mental well-being of adults and adolescents. Acetaminophen overdose is the major cause of drug intoxication among children and adolescents. We reported a case of a 15-year- old girl referred to our Emergency Department 3 hours after ingestion of 10 g of paracetamol for suicidal purposes. She promptly started the administration of intravenous N-acetylcysteine (NAC) and the patient was discharged after 5 days of hospitalization in good clinical condition and with neuropsychiatric follow-up. Our case shows that the timing of the intravenous NAC administration is considered the most important factor in the prevention of acetaminophen-induced hepatic failure, despite high serum levels after acetaminophen ingestion.
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Affiliation(s)
- Serena Ferretti
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Benedetta Graglia
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
| | - Lavinia Capossela
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Valeria Pansini
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
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10
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Curatola A, Graglia B, Granata G, Conti G, Capossela L, Manni L, Ferretti S, Di Giuda D, Romeo DM, Calcagni ML, Soligo M, Castelli E, Piastra M, Mantelli F, Marca GD, Staccioli S, Romeo T, Pani M, Cocciolillo F, Mancino A, Gatto A, Chiaretti A. Combined treatment of nerve growth factor and transcranical direct current stimulations to improve outcome in children with vegetative state after out-of-hospital cardiac arrest. Biol Direct 2023; 18:24. [PMID: 37165387 PMCID: PMC10170696 DOI: 10.1186/s13062-023-00379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is one of the most dramatic events in pediatric age and, despite advanced neurointensive care, the survival rate remains low. Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. Nerve Growth Factor (NGF) is a neurotrophin potentially able to counteract many of the deleterious effects triggered by OHCA. Transcranial Direct Current Stimulation (tDCS) has been reported to be neuroprotective in many neurological diseases, such as motor deficit and cognitive impairment. Children with the diagnosis of chronic vegetative state after OHCA were enrolled. These patients underwent a combined treatment of intranasal administration of human recombinant NGF (hr-NGF), at a total dose of 50 gamma/kg, and tDCS, in which current intensity was increased from zero to 2 mA from the first 5 s of stimulation and maintained constant for 20 min. The treatment schedule was performed twice, at one month distance each. Neuroradiogical evaluation with Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG) and Power Spectral Density of the brain (PSD) was determined before the treatment and one month after the end. Neurological assessment was deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale. RESULTS Three children with a chronic vegetative state secondary to OHCA were treated. The combined treatment with hr-NGF and tDCS improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary finger movements, improved facial mimicry and reaction to painful stimuli. No side effects were reported. CONCLUSIONS These promising preliminary results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from OHCA and in patients with better baseline neurological conditions, in order to explore more thoroughly the benefits of this new approach on neuronal function recovery after OHCA.
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Affiliation(s)
- Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Benedetta Graglia
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Granata
- Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giorgio Conti
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Terapia Intensiva Pediatrica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Lavinia Capossela
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Manni
- Istituto di Farmacologia Traslazionale, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Serena Ferretti
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Di Giuda
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Marco Romeo
- Unità di Neurologia Pediatrica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Lucia Calcagni
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marzia Soligo
- Istituto di Farmacologia Traslazionale, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Enrico Castelli
- Dipartimento di Neuroriabilitazione Intensiva, Ospedale Pediatrico "Bambino Gesù", Rome, Italy
| | - Marco Piastra
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Terapia Intensiva Pediatrica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Flavio Mantelli
- Dompé Farmaceutici Spa, Via Campo di Pile, snc, L'Aquila, 67100, Italy
| | - Giacomo Della Marca
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Susanna Staccioli
- Dipartimento di Neuroriabilitazione Intensiva, Ospedale Pediatrico "Bambino Gesù", Rome, Italy
| | - Tiziana Romeo
- Dompé Farmaceutici Spa, Via Campo di Pile, snc, L'Aquila, 67100, Italy
| | - Marcello Pani
- Direttore Farmacia Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Fabrizio Cocciolillo
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aldo Mancino
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e Rianimazione, Terapia Intensiva Pediatrica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Gatto
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
- Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.
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11
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Curatola A, Graglia B, Ferretti S, Covino M, Pansini V, Eftimiadi G, Chiaretti A, Gatto A. The acute bronchiolitis rebound in children after COVID-19 restrictions: a retrospective, observational analysis. Acta Biomed 2023; 94:e2023031. [PMID: 36786263 PMCID: PMC9987502 DOI: 10.23750/abm.v94i1.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Bronchiolitis represents the main cause of illness and hospitalization in infants and young children. The aim of this study was to compare the Pediatric Emergency Department (PED) admissions for bronchiolitis during the post-COVID (Coronavirus disease) period to those of previous seasons and to analyze their etiology during COVID and post-COVID period. METHODS We compared demographics, clinical and microbiological data of children admitted to PED with bronchiolitis between September 2021 and March 2022 (post-COVID period) to the previous seasons (COVID and pre-COVID period). RESULTS During the post-COVID period the bronchiolitis season started earlier than usual, with a peak reached in November 2021; a gradual reduction was subsequently observed between December 2021 and January 2022. Our data showed a prevalence of High Priority code in children admitted to the PED with bronchiolitis during the post-COVID period (61.4%) compared the pre-COVID period (34.8%) (p=0.00). Also regarding the hospitalization of these patients, we found a major rate of hospitalization during this epidemic season (p=0.035). In addition, only 4 (1.5%) of the tested children resulted positive for SARS-CoV-2 and all of them were admitted to PED during the post-COVID period. The search for the other respiratory viruses showed during the current season a prevalence of respiratory syncytial virus (RSV) (60.2%), followed by Human Rhinovirus (30.1%). CONCLUSIONS The post-COVID period was characterized by an early and short-term peak in acute bronchiolitis, with an increased rate of hospitalization. In addition, SARS-CoV-2 infection was rarely cause of bronchiolitis in children under 2 years old.
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Affiliation(s)
| | | | - Serena Ferretti
- a:1:{s:5:"en_US";s:114:"Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy ";}.
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12
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Curatola A, Ferretti S, Graglia B, Capossela L, Menchinelli G, Fiori B, Chiaretti A, Sanguinetti M, Gatto A. COVID-19 increased in Italian children in the autumn and winter 2021-2022 period when Omicron was the dominant variant. Acta Paediatr 2023; 112:290-295. [PMID: 36259786 PMCID: PMC9874380 DOI: 10.1111/apa.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
AIM We examined the prevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children during the autumn and winter season from 1 September 2021 to 30 January 2022 and compared it with the same period in 2020-2021. METHODS This study was carried out int the paediatric emergency department (PED) of a tertiary Italian hospital. We compared the clinical and demographical features of all children who presented during the two study periods and tested positive for SARS-CoV-2. RESULTS During the 2021-2022 autumn and winter season 5813 children presented to the PED, 19.0% were tested for SARS-CoV-2 and 133 (12.0%) of those tested positive. In 2020-2021, 2914 presented to the PED, 12.3% were tested, and 30 (8.3%) of those tested positive. There were no statistically significant differences in clinical severity during the two study periods, despite a higher percentage of neurological symptoms in 2020-2021. Of the SARS-CoV-2-positive cases, 29/133 (21.8%) were hospitalised during the 2021-2022 season and 10/30 (33.3%) during the previous one. Only 3/163 children required intensive care. CONCLUSION The greater spread of SARS-CoV-2 was probably due to the greater transmissibility of the Omicron variant, but the symptoms were mild and only 3 children required intensive care.
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Affiliation(s)
- Antonietta Curatola
- Department of PediatricsFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Serena Ferretti
- Department of PediatricsCatholic University of the Sacred HeartRomeItaly
| | - Benedetta Graglia
- Department of PediatricsCatholic University of the Sacred HeartRomeItaly
| | - Lavinia Capossela
- Department of PediatricsCatholic University of the Sacred HeartRomeItaly
| | - Giulia Menchinelli
- Department of Basic Biotechnological SciencesIntensivology and Perioperative ClinicsCatholic University of the Sacred HeartRomeItaly,Department of Laboratory and Infectious SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Barbara Fiori
- Department of Laboratory and Infectious SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Antonio Chiaretti
- Department of PediatricsFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly,Department of PediatricsCatholic University of the Sacred HeartRomeItaly
| | - Maurizio Sanguinetti
- Department of Basic Biotechnological SciencesIntensivology and Perioperative ClinicsCatholic University of the Sacred HeartRomeItaly,Department of Laboratory and Infectious SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Antonio Gatto
- Department of PediatricsFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
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Curatola A, Ferretti S, Gatto A, Chiaretti A. COVID-19 vaccine for young children: Will parents accept it? Acta Paediatr 2023; 112:301-302. [PMID: 36415084 DOI: 10.1111/apa.16601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/10/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Serena Ferretti
- Dipartimento di Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Dipartimento di Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Dipartimento di Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Sarno LD, Cammisa I, Curatola A, Pansini V, Eftimiadi G, Gatto A, Chiaretti A. A scoping review of the management of acute mastoiditis in children: What is the best approach? Turk J Pediatr 2023; 65:906-918. [PMID: 38204305 DOI: 10.24953/turkjped.2023.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature. METHODS We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`. RESULTS We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%. CONCLUSIONS Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community.
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Affiliation(s)
- Lorenzo Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignazio Cammisa
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Pansini
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gemma Eftimiadi
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Ferretti S, Lazzareschi I, Curatola A. Assessment of the COVID-19 Pandemic Associated Sleep Abnormalities in Children: Authors' Reply. J Child Neurol 2022; 37:1012-1013. [PMID: 36128791 PMCID: PMC9490385 DOI: 10.1177/08830738221123173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Serena Ferretti
- Department of Pediatrics, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Pediatrics, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Rome, Italy
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16
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Di Sarno L, Curatola A, Cammisa I, Capossela L, Eftimiadi G, Gatto A, Chiaretti A. Non-pharmacologic approaches to neurological stimulation in patients with severe brain injuries: a systematic review. Eur Rev Med Pharmacol Sci 2022; 26:6856-6870. [PMID: 36196734 DOI: 10.26355/eurrev_202209_29789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This review aimed to evaluate and summarize the current knowledge about the non-pharmacological neurological stimulation (NPNS) in patients with severe brain injuries (SBI). The approaches we analyzed included sensory stimulation, music therapy, virtual reality, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). MATERIALS AND METHODS We performed a review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards. The key words used for the search across electronic databases such as PubMed and the Cochrane Library were "brain injury" or "coma" or "vegetative state" and "neurological stimulation" or "sensory stimulation" or "music therapy" or "virtual reality" or "transcranial direct current stimulation" or "transcranial magnetic stimulation". RESULTS 38 studies matched the inclusion criteria. These articles were categorized into five clusters: sensory stimulation, music therapy, virtual reality, transcranial direct current stimulation and transcranial magnetic stimulation. Hence, a concise summary of each study was made up, including study population characteristics, type of non-pharmacological neurological stimulation, neurological clinical outcomes or neuroimaging outcomes. CONCLUSIONS Overall, all the non-pharmacological approaches to neurological stimulation in patients with SBI seem to be innovative and promising. Further randomized clinical trials, including a wide range of patients, will be necessary to definitely validate these methods and develop standardized protocols shared in the scientific community.
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Affiliation(s)
- L Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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17
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Lazzareschi I, Curatola A, Massimi L, Rendeli C, Rollo E, Scala I, Della Marca G, Brunetti V. Sleep-disordered breathing in patients with Chiari malformation type II: a case-control study and review of the literature. J Clin Sleep Med 2022; 18:2143-2154. [PMID: 35645039 PMCID: PMC9435333 DOI: 10.5664/jcsm.10062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The main aim was to evaluate the prevalence of sleep-disordered breathing (SDB) in patients with Chiari II malformation (CM-II). The secondary objectives were to evaluate the association between SDB, morphological abnormalities, and neurological symptoms and to review the literature on patients with SDB and CM-II. METHODS The study has a cross-sectional, case-control design. Patients with CM-II (patients) were compared to control patients referred for clinical polysomnography in the Sleep Medicine Unit, matched for age and sex. All patients underwent brain and spinal cord magnetic resonance imaging, and polysomnography was conducted for all participants. A review of the literature about SDB in patients with CM-II was performed. RESULTS Forty patients were included (20 patients vs 20 control patients). SDB was identified in 45% of patients, a significantly higher prevalence compared to control patients. Three patients presented with purely obstructive SDB, 3 patients with purely central SDB, and 3 patients with both obstructive and central SDB. Compared with control patients, patients with CM-II showed a higher oxygen desaturation index (median: CM-II, 3.7; interquartile range, 1.6-19.5; control patients: 1.1; interquartile range, 0.3-3.2) and obstructive apnea-hypopnea index (median: CM-II, 1.5; interquartile range, 0.5-5.1; control patients, 0.1; interquartile range, 0.0-0.7). A logistic regression showed that the risk of developing SDB in patients affected by CM-II was 14.7 times higher than in the control population. CONCLUSIONS Our study and literature review showed a high prevalence of SDB in patients with CM-II. These patients are often asymptomatic at diagnosis, suggesting that PSG should be routinely provided in this population. CITATION Lazzareschi I, Curatola A, Massimi L, et al. Sleep-disordered breathing in patients with Chiari malformation type II: a case-control study and review of the literature. J Clin Sleep Med. 2022;18(9):2143-2154.
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Affiliation(s)
- Ilaria Lazzareschi
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Massimi
- Department of Pediatric Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Rendeli
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Rollo
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Irene Scala
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Della Marca
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Valerio Brunetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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18
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Ferretti S, Chiaretti A, Gatto A, Curatola A. Incidence of MIS-C during the Omicron wave: authors' replay. Acta Paediatr 2022; 111:1821-1822. [PMID: 35778906 PMCID: PMC9349942 DOI: 10.1111/apa.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Serena Ferretti
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Morello R, Pepe M, Martino L, Lazzareschi I, Chiaretti A, Gatto A, Curatola A. COVID-19 review shows that benefits of vaccinating children and adolescents appear to outweigh risks of post-vaccination myopericarditis. Acta Paediatr 2022; 111:1846-1852. [PMID: 35735066 PMCID: PMC9350405 DOI: 10.1111/apa.16462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
AIM Myopericarditis after COVID-19 vaccination were the most serious adverse events reported in children over 5 years of age. We want summarize these cases, describing their incidence, clinical features, diagnostic pathways, therapeutic strategies and outcome. METHODS A systematic review of the literature was conducted until 20 March 2022 by bibliographic electronic databases. We included all reports of post-vaccination myopericarditis in children aged between 5 and 18 years. RESULTS All reported cases had elevated serum Troponin levels, associated with electrocardiogram changes, but often with normal echocardiogram. Cardiac magnetic resonance images always showed typical alterations. The pathogenetic mechanism is still unknown. Myocarditis following post-COVID vaccination is more frequent in males with an average age of about 15 years. Treatment involves the usage of non-steroidal anti-inflammatory drugs, and the average hospitalization is about 3 days. The long-term consequences are not yet known, so these patients should be studied in a cardiological follow up and abstention from physical activity should be recommended. CONCLUSION The benefits of COVID-19 vaccination in children and adolescents appear to outweigh the risk of developing post-vaccination myopericarditis. We can also speculate a possible approval of vaccination in children under 5 years for the coming winter.
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Affiliation(s)
- Rosa Morello
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Università Cattolica Sacro Cuore, Rome, Italy
| | - Mara Pepe
- Department of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy
| | - Laura Martino
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Università Cattolica Sacro Cuore, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli", I.R.C.C.S., Rome, Italy
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20
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Cozzi G, Cortellazzo Wiel L, Amaddeo A, Gatto A, Giangreco M, Klein-Kremer A, Bosis S, Silvagni D, Debbia C, Nanni L, Chiappa S, Minute M, Corsini I, Morabito G, Gortan AJ, Colombo M, Marchetti F, Garelli D, Piffer A, Cardinale F, Levy N, Curatola A, Gojsina B, Basu S, Barbi E, Sovtic A. Prevalence of SARS-CoV-2 positivity in infants with bronchiolitis: a multicentre international study. Arch Dis Child 2022; 107:archdischild-2021-323559. [PMID: 35705371 PMCID: PMC9240451 DOI: 10.1136/archdischild-2021-323559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bronchiolitis is the leading acute respiratory tract infection in infants during the winter season. Since the beginning of the SARS-CoV-2 pandemic, a reduction in the number of bronchiolitis diagnoses has been registered. OBJECTIVE The present study aimed to describe the incidence and clinical features of bronchiolitis during the 2020-2021 winter season in a large cohort of children in Europe and Israel, and to clarify the role of SARS-CoV-2. SETTING, PATIENTS, INTERVENTIONS We conducted a multicentre observational cross-sectional study in 23 paediatric emergency departments in Europe and Israel. Clinical and demographic data about all the cases of infants diagnosed with bronchiolitis from 1 October 2020 to 30 April 2021 were collected. For each enrolled patient, diagnostic tests, treatments and outcomes were reported. MAIN OUTCOME MEASURES The main outcome was the prevalence of SARS-CoV-2-positive bronchiolitis. RESULTS Three hundred and fourteen infants received a diagnosis of bronchiolitis during the study period. Among 535 infants who tested positive for SARS-CoV-2, 16 (3%) had bronchiolitis. Median age, male sex predominance, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. Rhinovirus was the most common involved pathogen, while respiratory syncytial virus (RSV) was detected in one case. SARS-CoV-2 bronchiolitis had a mild clinical course, with one patient receiving oxygen supplementation and none requiring paediatric or neonatal intensive care unit admission. CONCLUSIONS During the SARS-CoV-2 pandemic, a marked decrease in the number of bronchiolitis diagnoses and the disappearance of the RSV winter epidemic were observed. SARS-CoV-2-related bronchiolitis was rare and mostly displayed a mild clinical course.
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Affiliation(s)
- Giorgio Cozzi
- IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | | | | | - Antonio Gatto
- Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | | | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Silvagni
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carla Debbia
- Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Laura Nanni
- Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | | | - Marta Minute
- Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
| | - Ilaria Corsini
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | | | | | | | | | - Arianna Piffer
- Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland
| | | | - Nitai Levy
- Ruth Rappaport Children's Hospital, Haifa, Israel
| | | | - Bojana Gojsina
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
- University of Belgrade Faculty of Medicine, Beograd, Serbia
| | | | - Egidio Barbi
- IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Aleksandar Sovtic
- Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
- University of Belgrade Faculty of Medicine, Beograd, Serbia
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21
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Curatola A, Ferretti S, Gatto A, Chiaretti A. Will cases of multisystem inflammatory syndrome rise with the greater spread of the Omicron variant amongst children? Acta Paediatr 2022; 111:1207-1208. [PMID: 35181917 PMCID: PMC9304197 DOI: 10.1111/apa.16304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS Rome Italy
| | - Serena Ferretti
- Department of Pediatrics Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Antonio Gatto
- Department of Pediatrics Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS Rome Italy
| | - Antonio Chiaretti
- Department of Pediatrics Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS Università Cattolica del Sacro Cuore Rome Italy
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22
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Turriziani Colonna A, Curatola A, Sodero G, Lazzareschi I, Cammisa I, Cipolla C. Central precocious puberty in children after COVID-19 outbreak: a single-center retrospective study. Minerva Pediatr (Torino) 2022:S2724-5276.22.06827-6. [PMID: 35586885 DOI: 10.23736/s2724-5276.22.06827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Central precocious puberty (CPP) was an unexplored issue during COVID-19 pandemic and an important disease in the adolescence life. Our aim was to evaluate the incidence of the new cases of central precocious puberty (CPP) during COVID-19 pandemic, comparing these results with the data for the same period over the previous three years. The secondary objective was to analyze the rate of pubertal progression in children during COVID-19 outbreak. METHODS We performed a retrospective study of all children presented at our hospital for suspected CPP during COVID-19 outbreak, comparing their clinical and endocrinological data to the same over the previous three years. Secondary, endocrinological data of some patients in follow-up, with at least two visits 6 months apart during the COVID-19 period, are compared to evaluate the rate of pubertal progression. RESULTS We enrolled 90 suspected enrolled CPP cases, 26 (28.9%) referred to our hospital during the COVID-19 outbreak and 64 (71.1%) in the previous 3 years. During COVID-19 outbreak 12 girls (42.9%) were at stage T3 compared to 14 (23%) of the 3 previous years (p=0.01). New CPP diagnosis were found in 11 (39.3%) children during pandemic, while 15 (24.2%) in the previous 3 years. A accelerated pubertal progression rate was observed in 22/45 (48.9%) patients, with a greater number of children at stages T3 and T4-5. CONCLUSIONS Our data showed a progressive increase of newly diagnosed CPP and a significantly accelerated rate of pubertal progression in children during COVID-19 outbreak. We hypothesize that the increase in the weight and BMI during the lockdown and the psychological effects of the COVID-19 outbreak were involved in triggering and progression of puberty.
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Affiliation(s)
- Arianna Turriziani Colonna
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Giorgio Sodero
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignazio Cammisa
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clelia Cipolla
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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23
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Curatola A, Ferretti S, Gatto A, Valentini P, Giugno G, Della Marca G, Brunetti V, Lazzareschi I. The Effects of COVID-19 Pandemic on Italian School-Aged Children: Sleep-Related Difficulties and Trauma Reactions. J Child Neurol 2022; 37:8830738221096194. [PMID: 35535411 PMCID: PMC9096002 DOI: 10.1177/08830738221096194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The COVID-19 pandemic has affected the mental and physical health of the world population. This study aims to investigate incidence of sleep-related difficulties and post-traumatic stress disorder in the school-aged children after 1 year of the pandemic. METHODS A sample of Italian children (6-12 years) was queried about their sleep behaviors after 1 year of the pandemic, answering the Children's Sleep Habits Questionnaire (CSHQ). We also evaluated trauma symptoms with the Children's Impact of Event Scale (CRIES-8). RESULTS Among 205 participants, 184 (89.8%) presented sleep-related difficulties. Out of all, 99 (48.3%) had a high risk to develop post-traumatic stress disorder. Ninety-five (51.6%) children with sleep-related difficulties also presented an abnormal CRIES-8 total score. A correlation was found between the CSHQ total score and the CRIES-8 total score (r = 0.354, P < .01). CONCLUSIONS The sleep-related difficulties occurring during COVID-19 outbreak may compound to increase the risk to develop post-traumatic stress disorder among Italian children.
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Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Serena Ferretti
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Piero Valentini
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Giulia Giugno
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Giacomo Della Marca
- Institute of Neurology, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Valerio Brunetti
- Institute of Neurology, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
| | - Ilaria Lazzareschi
- Department of Pediatrics, Fondazione
Policlinico Universitario “Agostino Gemelli,” IRCCS,
Università
Cattolica del Sacro Cuore, Rome,
Italy
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24
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Di Sarno L, Curatola A, Conti G, Covino M, Bertolaso C, Chiaretti A, Gatto A. The effects of COVID-19 outbreak on pediatric emergency department admissions for acute wheezing. Pediatr Pulmonol 2022; 57:1167-1172. [PMID: 35170263 PMCID: PMC9088495 DOI: 10.1002/ppul.25858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/05/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute wheezing is a common clinical presentation of viral respiratory infections in children, which can also be caused by exposure to allergens and, rarely, by foreign body inhalation. Since the beginning of the COVID-19 (coronavirus disease 2019) outbreak, several public health interventions have been adopted to reduce viral spread. The aim of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on Pediatric Emergency Department (ED) admission for acute wheezing. MATERIALS AND METHODS We compared demographics and clinical data of patients admitted to the ED for acute wheezing during the COVID-19 outbreak and in the 5 previous years through a retrospective cross-sectional study. RESULTS During the COVID-19 outbreak we observed an average drop of 83% in pediatric ED admission for acute wheezing, compared to the 5 previous years. In this period, 121 (80.7%) children presented with wheezing and 29 (19.3%) with bronchiolitis. The mean age of the sample was higher compared to the 5 previous years. We also noted an increased number of children presenting with higher acuity color codes during the COVID-19 period, while no differences emerged as for the hospitalizations. During the pandemic we recorded a decrease in the number of viral infections detected. Only two cases of wheezing associated with SARS-CoV-2 were identified. CONCLUSION The COVID-19 outbreak and the national lockdown led to a drop of the number of admission to the ED for wheezing in children. This could be due to a reduction in the circulation of common respiratory viruses and partially to a reduced exposure to aeroallergens during the COVID-19 period. Future epidemiological surveillance studies will be needed to support these prelimianry findings.
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Affiliation(s)
- Lorenzo Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marcello Covino
- Department of Emergency, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Bertolaso
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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25
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Soave PM, Curatola A, Ferretti S, Raitano V, Conti G, Gatto A, Chiaretti A. Acute poisoning in children admitted to pediatric emergency department: a five-years retrospective analysis. Acta Biomed 2022; 93:e2022004. [PMID: 35315415 PMCID: PMC8972869 DOI: 10.23750/abm.v93i1.11602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM to identify most frequent risk factors and to propose prevention strategies for the children admitted to Pediatric Emergency Department (PED) with acute poisoning. METHODS We performed a retrospective study in a tertiary care hospital, describing the frequency and nature of pediatric poisoning, clinical management and outcome. RESULTS We collected data of 436 children admitted for acute poisoning. The mean age was 30 months and 51.1% were male. Most poisoning incidents (90.1%) were unintentional and drug ingestion (39.4%) was the leading cause of poisoning. Acute poisoning happened at home in 83,7% of cases and the mother was the most frequent caregiver during the event in 61.5%. No died were reported. CONCLUSION Our study showed that the two categories of patients at greatest risk for acute poisoning are children under 3 years and adolescents over 12 years. Adequate information campaigns about toxic substances are essential for children, adolescents and their parents.
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Affiliation(s)
- Paolo Maurizio Soave
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Ferretti
- Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Raitano
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Gatto A, Gambacorta A, Ferretti S, Coretti G, Curatola A, Covino M, Chiaretti A. IBI Score to Improve Clinical Practice in Newborns and Infants ≤ 60 Days with Fever in the Emergency Department. Indian J Pediatr 2022; 89:77-79. [PMID: 34609658 DOI: 10.1007/s12098-021-03932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Fever is the most common problem of children admitted to emergency department (ED). The management of febrile patients ≤ 60 d old admitted to the Pediatric Emergency Department in the last 5 y was evaluated, applying the invasive bacterial infection (IBI) score proposed to evaluate the reliability and safety of this score in the authors' setting.Medical records of 280 patients with fever reported and/or detected in ED were retrospectively analyzed. A total of 166 patients were enrolled, whose average IBI score was 2.98 IBI score < 2 showed a sensitivity of 100.00% [95% CI (71.5-100.0)] and a specificity of 28.39% [95% CI (21.4-36.2)] compared to blood culture. IBI score can be a valid support to identify patients with low risk of invasive infection.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy.
| | - Alessandro Gambacorta
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Giulia Coretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
| | - Marcello Covino
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy
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27
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Gambacorta A, Moro M, Curatola A, Brancato F, Covino M, Chiaretti A, Gatto A. PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department. Eur J Pediatr 2022; 181:2147-2154. [PMID: 35194653 PMCID: PMC9056473 DOI: 10.1007/s00431-022-04424-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED This study aims to evaluate the efficacy of the PECARN Rule (PR) in reducing radiological investigations in children with mild traumatic head injury in comparison with current clinical practice. A retrospective study was performed in our hospital between July 2015 and June 2020. Data of all children < 18 years of age admitted to the emergency department (ED), within 24 h after a head trauma with GCS ≥ 14, were analyzed. PECARN Rule was retrospectively applied to all patients. In total, 3832 patients were enrolled, 2613 patients ≥ 2 years and 1219 < 2 years. In the group of children ≥ 2 years, 10 presented clinically important traumatic brain injury (ciTBI) and were hospitalized, 7/10 underwent neurosurgery, and 3/10 clinical observation in the pediatric ward for more than 48 h. In children < 2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without an accurate diagnosis and we would have avoided 139 CT scans in patients ≥ 2 years, and 23 in those < 2 years of age (29% less). CONCLUSION We demonstrated the safety and validity of the PR in our setting with 100% sensitivity in both age groups in identifying patients with ciTBI and theoretically in reducing performed CT scans by 29%. Therefore, in patients classified in the low-risk category, it is a duty not to expose the child to ionizing radiation. WHAT IS KNOWN • CT is the gold standard to identify intracranial pathology in children with head injury but CT imaging of head-injured children expose them to higher carcinogenic risk. • PECARN Rules support doctors in identifying children with ciTBI in order to reduce exposure to ionizing radiation. WHAT IS NEW • We demonstrate the safety and validity of the PR with 100% sensitivity in both age groups in identifying patients with ciTBI. • In our setting, the application of PECARN Rule would theoretically have allowed us to reduce the CT scan by 29%.
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Affiliation(s)
- Alessandro Gambacorta
- Dipartimento Di Pediatria, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Moro
- grid.8142.f0000 0001 0941 3192Dipartimento Di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Dipartimento Di Pediatria, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Brancato
- Dipartimento Di Pediatria, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcello Covino
- grid.8142.f0000 0001 0941 3192Dipartimento Di Medicina d’Emergenza, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Dipartimento Di Pediatria, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Dipartimento Di Pediatria, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy.
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Gatto A, Capossela L, Ferretti S, Orlandi M, Pansini V, Curatola A, Chiaretti A. Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department. Children (Basel) 2021; 8:children8121182. [PMID: 34943378 PMCID: PMC8700598 DOI: 10.3390/children8121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0-17 years) evaluated for foreign body ingestion at the Pediatric ED of "Fondazione Policlinico Universitario A. Gemelli, IRCSS" between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence:
| | - Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Michela Orlandi
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
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Tosi F, Gatto A, Capossela L, Ferretti S, Mancino A, Curatola A, Chiaretti A, Pulitanò S. Role of the pupillometer in the assessment of pain in the sedation of pediatric patients. Eur Rev Med Pharmacol Sci 2021; 25:6349-6355. [PMID: 34730216 DOI: 10.26355/eurrev_202110_27008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pupillometry has been used to assess pain intensity and response to analgesic drugs in adults. The aim of this study was to verify the usefulness and effectiveness of the pupillometer to assess pain and depth of sedation in pediatric patients undergoing painful procedures and to optimize pain management by observing pupillary variations induced by opioids. PATIENTS AND METHODS This is a prospective, monocentric study conducted in the sedation room of the Pediatric Intensive Care Unit of Fondazione Policlinico A. Gemelli in Rome. A population of 22 pediatric patients who underwent painful procedures was enrolled. Eleven children were sedated by opioid drugs. Heart rate, systolic blood pressure, diastolic blood pressure, bispectral index, maximum pupil size (Size), pupil change (CH), Neurological Pupil Index (NPi) were collected over four times: before starting the procedure; before the painful stimulus (when the patient was sedated); when the painful stimulus was applied; at the end of the procedure. A NeurOptics NPi-200 pupillometer was used for the study. RESULTS Statistical significance in the variation of haemodynamic parameters was less significant than the variation obtained by analyzing the pupillary parameters: a significant change in NPi and CH in the transition from wakefulness to sedation and from the application of the painful stimulus to awakening was found in both study populations, patients who have received opioids and patients who have not received opioids. Changes in the mean CH of the pupil diameter correlate with the depth of sedation, and the size values vary in relation to the administration of opioids. CONCLUSIONS Our findings highlight the potential role of pupillometry as a non-invasive method to objectively quantitate pain response in children to reach an efficient analgesic approach.
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Affiliation(s)
- F Tosi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
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Curatola A, Chiaretti A, Ferretti S, Bersani G, Lucchetti D, Capossela L, Sgambato A, Gatto A. Cytokine Response to SARS-CoV-2 Infection in Children. Viruses 2021; 13:v13091868. [PMID: 34578450 PMCID: PMC8473005 DOI: 10.3390/v13091868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
The causal connection between serum biomarkers and COVID-19 severity or pathogenicity in children is unclear. The aim of this study was to describe clinical and immunological features of children affected by COVID-19. The secondary aim was to evaluate whether these cytokines could predict severity of COVID-19. All children (aged 0−18) admitted to the Pediatric Emergency Department and tested with nasopharyngeal swab for SARS-CoV-2 were recruited and assigned to three groups: COVID-19, other infections, control group. Clinical and laboratory data of these patients, including circulating cytokine levels, were analyzed in three groups. Fever was the most frequent symptom in COVID-19 (67.3%). Neutropenia was found in the COVID-19 group (p < 0.05); no difference was observed for lymphocyte counts in the three groups. Higher levels of IL-6 and TNF-alpha were found in the COVID-19 group compared to other infections and control groups (p = 0.014 and p = 0.001, respectively). Whereas, in the COVID-19 group, no difference was observed as for the same cytokines among sub-groups of different disease severity (p = 0.7 and p = 0.8). Serum levels of IL-6 and TNF-alpha were higher in COVID-19 children than in children with other infectious diseases, but those levels did not correlate with disease severity. Clinical studies in a large pediatric population are necessary to better define the role of the immune-mediated response in SARS-CoV-2 infections in children.
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Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
| | - Antonio Chiaretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
| | - Serena Ferretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
- Correspondence: ; Tel.: +39-063-015-4475; Fax: +39-063-383-211
| | - Giulia Bersani
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Lavinia Capossela
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
| | - Alessandro Sgambato
- Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 05028 Rionero in Vulture (PZ), Italy;
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
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Curatola A, Lazzareschi I, Bersani G, Covino M, Gatto A, Chiaretti A. Impact of COVID-19 outbreak in acute bronchiolitis: Lesson from a tertiary Italian Emergency Department. Pediatr Pulmonol 2021; 56:2484-2488. [PMID: 33961732 PMCID: PMC8242382 DOI: 10.1002/ppul.25442] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022]
Abstract
AIM To assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on pediatric emergency department (ED) visits for acute bronchiolitis during the epidemic season. METHODS A retrospective analytical cross-sectional study was performed in our hospital, analyzing medical charts of all children under 2 years of age with a diagnosis of acute bronchiolitis admitted to our ED in the last years. Demographics and clinical data of patients affected with acute bronchiolitis during the 2020-2021 season-COVID-19 outbreak-were compared to those of the 5 previous years. RESULTS We observed an average drop of 84% of the rate of acute bronchiolitis managed by pediatricians in ED in 2020-2021 compared with bronchiolitis seasons of 5 previous years. We also reported, during the COVID-19 outbreak, a higher number of children affected by acute bronchiolitis referred to ED as Emergency Consultations who required hospitalization. Regarding etiological agents, no differences in respiratory virus circulation, especially RSV, were observed in the two groups. The multivariate analysis showed no correlation between the diagnosis of RSV bronchiolitis and COVID-19 period or prematurity; lower age was associated with an increased likelihood of exhibiting RSV bronchiolitis (odds ratio 0.9; 95% confidence interval 0.86-0.95 p < .01). CONCLUSION Our data emphasize the reduction in the rate of admission to pediatric ED for acute bronchiolitis during the COVID-19 outbreak, regardless of changes in circulating respiratory viruses. Therefore we want to highlight the importance of nonpharmacological preventive hygiene measures that should be maintained even at the end of the COVID-19 outbreak.
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Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Lazzareschi
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Bersani
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Cipolla C, Curatola A, Ferretti S, Giugno G, Condemi C, Delogu AB, Birritella L, Lazzareschi I. Eating habits and lifestyle in children with obesity during the COVID19 lockdown: a survey in an Italian center. Acta Biomed 2021; 92:e2021196. [PMID: 33988154 PMCID: PMC8182615 DOI: 10.23750/abm.v92i2.10912] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The main aim of this study was to evaluate BMI changes in children and adolescent with obesity or overweight, analyzing the possible risk factors that contributed to weight gain during a pandemic-associated lockdown. MATERIAL AND METHODS The study was conducted at the Pediatric Endocrinology Department of a third-level University Hospital in Rome, including children and adolescents with overweight and obesity. Personal, anthropometrics data and other information about physical activity, eating habits and psychological aspects were collected. RESULTS We included in our study 64 participants, of which 33 (51.6%) were patients with overweight and 31 (48.4%) with obesity. We divided patients in two groups: patients with pre-versus post-lockdown Δ-BMI > 0 (31, 48.4%) and patients with Δ-BMI < 0 (33, 51.6%). Our data showed that patients whose BMI increased were more sedentary (p=0.024 for physical activity and p=0.005 for hours spent with videogames) during the pandemic. As for the eating habits more than half of the subjects (67.2%) had increased the consumption of homemade desserts, bread, pasta and pizza, and a worse diet was found in patients with BMI gain (p=0.000). Regarding the psychic condition the 80% of patients reported psychological discomfort, and patients with an increase in BMI had episodes of emotional feeding more frequently (p=0.016). CONCLUSIONS The COVID19 pandemic has had disastrous effects not only directly, but also indirectly through the lockdown especially on some categories, such as adolescents with overweight and obesity. The results indicate that it also causes significant changes in lifestyle, physical inactivity and psychological problems among children and adolescents with obesity/overweight.
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Affiliation(s)
- Clelia Cipolla
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia.
| | - Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Serena Ferretti
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Giulia Giugno
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Chiara Condemi
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Angelica Bibiana Delogu
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Lisa Birritella
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
| | - Ilaria Lazzareschi
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia- Università Cattolica del Sacro Cuore .
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Gatto A, Angelici S, Soligo M, Di Giuda D, Manni L, Curatola A, Ferretti S, Chiaretti A. Pediatric cerebral stroke induced by Epstein-Barr virus infection: Role of Interelukin overexpression. Acta Biomed 2021; 92:e2021135. [PMID: 33944821 PMCID: PMC8142774 DOI: 10.23750/abm.v92is1.10204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ischemic stroke is an important cause of death and long-term morbidity in children. Viral respiratory infections are emerging as important risk factors for ischemic stroke in this age group of patients. Direct action of virus against cerebral vessels, autoimmune reactivity, and an increased production of cytokines have all been advocated as main factors in determining ischemic stroke. CASE REPORT We report the case of an EBV-induced ischemic stroke in a caucasian 2 year-old female. The cerebrospinal fluid samples showed positivity of polymerase chain reaction for EBV infection, also confirmed by pharyngeal swab culture. Increased levels of interleukin 6 and interleukin 1b were also detected in the cerebrospinal fluid. Discussion: EBV infection has been identified as an important cause of neurological involvement in children. Findings of increased levels of interleukin 6 and interleukin 1b in the cerebrospinal fluid of the child with EBV induced-ischemic stroke seems to validate the role of pro-inflammatory cytokines as crucial mediators of cerebral thrombus formation. Conclusions: We believe that this report can be useful to clarify some pathophysiological mechanisms related to ischemic stroke related to Epstein-Barr Virus (EBV) infection in children.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Serenella Angelici
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
| | - Marzia Soligo
- Institute of Translational Pharmacology CNR, Rome, Italy.
| | - Daniela Di Giuda
- Institute of Nuclear Medicine, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
| | - Luigi Manni
- Institute of Translational Pharmacology CNR, Rome, Italy.
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
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Ferretti S, Gatto A, Curatola A, Pansini V, Graglia B, Chiaretti A. Atypical Reye syndrome: three cases of a problem that pediatricians should consider and remember. Acta Biomed 2021; 92:e2021110. [PMID: 33944820 PMCID: PMC8142747 DOI: 10.23750/abm.v92is1.10205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Reye syndrome is a rare acquired metabolic disorder appearing almost always during childhood. Its aetiopathogenesis, although controversial, is partially understood. The classical disease is typically anticipated by a viral infection with 3-5 days of well-being before the onset of symptoms, while the biochemical explanation of the clinical picture is a mitochondrial metabolism disorder, which leads to a metabolic failure of different tissues, especially the liver. Hypothetically, an atypical response to the preceding viral infection may cause the syndrome and host genetic factors and different exogenous agents, such as toxic substances and drugs, may play a critical role in this process. Reye syndrome occurs with vomiting, liver dysfunction and acute encephalopathy, characterized by lack of inflammatory signs, but associated with increase of intracranial pressure and brain swelling. Moreover, renal and cardiac dysfunction can occur. Metabolic acidosis is always detected, but diagnostic criteria are not specific. Therapeutic strategies are predominantly symptomatic, in order to manage the clinical and metabolic dysfunctions. CASE REPORTS We describe three cases of children affected by Reye syndrome with some atypical features, characterized by no intake of potentially trigger substances, transient hematological changes and dissociation between hepatic metabolic impairment, severe electroencephalographic slowdown and slightly altered neurological examination. CONCLUSIONS The syndrome prognosis is related to the stage of the syndrome and the rapidity and the adequateness of intensive care treatments. The analysis of the patients leads to a greater awareness of the difficult diagnosis of this not well completely known syndrome.
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Affiliation(s)
- Serena Ferretti
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gatto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Valeria Pansini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .
| | - Benedetta Graglia
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy .
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Lazzareschi I, Curatola A, Frassanito P. Reply to letter to the editor regarding "Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis". Childs Nerv Syst 2021; 37:357-358. [PMID: 33404710 DOI: 10.1007/s00381-020-05005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ilaria Lazzareschi
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy. .,Fondazione Policlinico A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Paolo Frassanito
- Dipartimento di Neurochirurgia Infantile, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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De Rose C, Valentini P, Curatola A, Morello R, Musolino AM, Piastra M, Buonsenso D. Lung Ultrasound in Congenital Cardiac Abnormality: ALCAPA. Indian J Pediatr 2021; 88:161-164. [PMID: 32048221 DOI: 10.1007/s12098-020-03208-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a life-threatening ischemic congenital cardiac disease, resulting in myocardial dysfunction and heart failure within the first year of life. The authors report the case of a 1-mo-old infant with a radiological diagnosis of pneumonia handled with point-of-care lung ultrasound (POCUS) due to the persistence of dyspnea, despite a week of antibiotic therapy. Lung ultrasound showed a non-univocal interpretation of the lesion and gave indication to the second level instrumental diagnostics that confirmed the presence of ALCAPA. There is no case of lung ultrasound aiding to the early diagnosis of ALCAPA and no indirect ecographic signs of ALCAPA that have been described in literature yet.
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Affiliation(s)
- Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Piastra
- Pediatric ICU and Trauma Center, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Anesthesiology and Intensive Care, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A. Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review. Ann Transl Med 2021; 9:189. [PMID: 33569491 PMCID: PMC7867955 DOI: 10.21037/atm-20-5177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians. Different painful procedures can be very stressful for young children and their perception of pain can be enhanced by emotional factors, such as anxiety, distress, or anger. Adequate procedural sedation reduces anxiety and emotional trauma for the patient, but it reduces also stress for operators and the time for procedures. We have reviewed the literature on this topic and the drugs covered in these papers were: midazolam, fentanyl, ketamine, and dexmedetomidine. There are several routes of administering for these drugs to provide analgesia and anxiolysis to children: oral, parenteral, or intranasal (IN). Intravenous (IV) sedation, since it involves the use of needles, can be stressful; instead, IN route is a non-invasive procedure and generally well tolerated by children and it has become increasingly widespread. Some medications can be administered by a mucosal atomizer device (MAD) or by drops. The benefits of the atomized release include less drug loss in the oropharynx, higher cerebrospinal fluid levels, better patient acceptability, and better sedative effects. IN midazolam has a sedative, anxiolytic and amnesic effect, but without analgesic properties. Fentanyl and ketamine are mainly used for pain control. Dexmedetomidine has anxiolytic and analgesic properties. In conclusion, IN analgo-sedation is a simple, rapid and painless option to treat pain and anxiety in the PED requiring brief training on the administration process and experience in sedation.
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Affiliation(s)
- Valeria Pansini
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia
| | - Antonietta Curatola
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gatto
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia
| | - Ilaria Lazzareschi
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Dipartimento di Pediatria, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Gatto A, Curatola A, Ferretti S, Capossela L, Nanni L, Rendeli C, Chiaretti A. The impact of constipation on pediatric emergency department: a retrospective analysis of the diagnosis and management. Acta Biomed 2021; 92:e2021341. [PMID: 35075085 PMCID: PMC8823585 DOI: 10.23750/abm.v92i6.11212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Functional constipation (FC) represents 95% of pediatric constipation cases. The aim of this study was to assess the prevalence of Functional Constipation in children admitted to Pediatric Emergency Department (ED) with acute abdominal pain, the demographic factors associated, the use of imaging exams and laboratory tests. METHODS A retrospective observational study was conducted on 4100 medical records of children aged 0 to 18 years. RESULTS Among children with abdominal pain, 11.3% of them had a discharge diagnosis of constipation and 45.5% underwent imaging exams. Most of children (93.9%) were discharged with home therapy and 6.5% of patients needed of additional visits. In ED 6.7% of patients underwent enema, 45.2% were discharged with indication to perform it at home. CONCLUSIONS FC is a medical condition that could be managed in the outpatient setting, even if we observed a significant percentage of cases in ED. We observed over-utilization of radiologic tests, whereas the diagnosis should be clinical.
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Affiliation(s)
- Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Serena Ferretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lavinia Capossela
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Nanni
- Division of Pediatric Surgery, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Claudia Rendeli
- Spina Bifida Center, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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Buonsenso D, Soldati G, Curatola A, Morello R, De Rose C, Vacca ME, Lazzareschi I, Musolino AM, Valentini P. Lung Ultrasound Pattern in Healthy Infants During the First 6 Months of Life. J Ultrasound Med 2020; 39:2379-2388. [PMID: 32468627 DOI: 10.1002/jum.15347] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) has gained a primary role in the diagnosis and management of pleuropulmonary disorders in pediatric practice. However, normal and pathologic patterns are translated from adult studies and have never been specifically studied in children, particularly in infants. This was a prospective observational pilot study aiming to define the normal LUS pattern in healthy infants during the first 6 months of life. METHODS We recruited healthy neonates at 7 to 10 days of life, and these were followed until the sixth month of life (times: 7-10 days, 1 month, 3 months, and 6 months). We excluded neonates with a gestational age before 33 weeks and neonates with cardiac or lung abnormalities or diseases, immune deficiencies, metabolic or genetic conditions, and acute or chronic respiratory diseases. A LUS evaluation was performed by a single certified pediatrician. The chest wall was examined in 18 areas, addressing A-lines, short and long B-lines, pleural abnormalities, and subpleural consolidations. RESULTS Thirty-seven neonates were enrolled and followed until the sixth month of life, 27 (73%) of whom were born at term (≥37 weeks) and 10 (27%) of whom were born preterm (33-36 weeks). Most of the patients at 7 to 10 days showed multiple B-lines (long and short) with a progressive normalization toward a normal A pattern at 6 months (P < .00001; 95% confidence interval, 13.75-23.24). No infants showed subpleural consolidations or pleural abnormalities. CONCLUSIONS This study has implications for the interpretation of LUS during the first 6 months of life. Most healthy infants show a diffuse pattern of vertical artifacts (B-lines), and the LUS pattern tends to be similar to the physiologic pattern (A-lines) after the sixth month of life. The only pathologic LUS findings were pleural irregularities and effusion and subpleural consolidations, which have never been described in healthy infants.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Lucca, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antonietta Curatola
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Rosa Morello
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Cristina De Rose
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Maria Eugenia Vacca
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna Maria Musolino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Piero Valentini
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia
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Ferretti S, Gatto A, Pansini V, Curatola A, Capossela L, Currò V, Chiaretti A. Telephone consultation during Coronavirus outbreak in a Pediatric Emergency Department: methodological approach of a tertiary care center in a COVID-19 hospital setting. Eur Rev Med Pharmacol Sci 2020; 24:11440-11444. [PMID: 33215467 DOI: 10.26355/eurrev_202011_23638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room. RESULTS The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method. CONCLUSIONS Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.
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Affiliation(s)
- S Ferretti
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
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Buonsenso D, Tomà P, Scateni S, Curatola A, Morello R, Valentini P, Ferro V, D'Andrea ML, Pirozzi N, Musolino AM. Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study. Pediatr Radiol 2020; 50:1560-1569. [PMID: 32821992 DOI: 10.1007/s00247-020-04750-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung ultrasound (US) in the evaluation of suspected pediatric pneumonia is increasingly used and has a recognized role in evaluating pleural effusions, although there are no detailed studies specifically addressing its use in the pediatric population. OBJECTIVES To define lung US findings of severe pediatric community-acquired pneumonia that required surgical procedures during admission. MATERIALS AND METHODS Our prospective case-control study compared lung US findings in patients ages 1 month to 17 years admitted with community-acquired pneumonia that required surgical procedures from findings those who did not. Lung US was performed at admission and always before surgical procedures. Medical treatment, laboratory and microbiological findings, chest X-ray, computed tomography scan and surgical procedures are described. RESULTS One hundred twenty-one children with community-acquired pneumonia were included; of these, 23 underwent surgical intervention. Compared with the control group, children requiring a surgical procedure had a significantly higher rate of large consolidations (52.2%; 95% confidence interval [CI]: 30.6% to 73.2%), larger and complicated pleural effusions (100%; 95% CI: 85.2% to 100%), and both liquid and air bronchograms (73.9%; 95% CI: 51.6% to 89.8%). CONCLUSION Larger consolidations, larger and more complicated pleural effusions, and liquid and air bronchograms were associated with surgical treatment.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paolo Tomà
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Scateni
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Valentina Ferro
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Nicola Pirozzi
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Buonsenso D, Berti B, Palermo C, Leone D, Ferrantini G, De Sanctis R, Onesimo R, Curatola A, Fanelli L, Forcina N, Norcia G, Carnicella S, Lucibello S, Mercuri E, Pane M. Ultrasound assessment of diaphragmatic function in type 1 spinal muscular atrophy. Pediatr Pulmonol 2020; 55:1781-1788. [PMID: 32394611 DOI: 10.1002/ppul.24814] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate ultrasound features of diaphragm motion and function in type 1 spinal muscular atrophy (SMA-1) patients. DESIGN Prospective study. PATIENTS The study cohort included SMA-1 children younger than 18-year-old. Control subjects included type 2 and type 3 SMA and other neuromuscular disorders younger than 18-year-old. METHODOLOGY Diaphragm ultrasound evaluating diaphragmatic excursion, speed of diaphragmatic contraction, duration of the respiratory cycle, inspiratory/expiratory relationship, end-inspiratory and -expiratory thickness, thickening fraction, and pattern of contractility. The interrater reliability for each variable was established by calculation of Cohen's k coefficient. RESULTS Twenty-three SMA-1 patients and 12 controls were evaluated. Diaphragm ultrasound values were within normal ranges in all study cohort patients and no difference was found with controls. There was a gradient of diaphragm function with SMA 1.9 subgroup having the best and SMA 1.1 having the worst parameters, particularly in end-inspiratory thickness and diaphragmatic excursion (P = .031 and P = .041, respectively). Seventy-four percent of SMA-1 patients had a dysmotility pattern of diaphragm contraction, mostly represented in SMA 1.9 subgroup (P = .001). This pattern was observed in 92.8% of children on noninvasive ventilation (NIV) for less than 16 hours/d of and in 20% patients with invasive ventilation or NIV for more than 16 hours/d (P = .027). The dysmotility pattern was never observed in the control group. The levels of interobserver agreement were high for "diaphragm irregularities," "inspiratory/expiratory relationship," and "diaphragm thickness," and good for the other variables. CONCLUSIONS Ultrasound can be used to evaluate diaphragm function and contractility in SMA-1 children, providing additional information to the clinical examination and functional respiratory tests, describing a characteristic contractility pattern in these patients. Longitudinal studies are needed to understand the impact of diaphragm dysmotility and other parameters on long-term outcome in SMA-1 patients.
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Affiliation(s)
- Danilo Buonsenso
- Paediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Beatrice Berti
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Concetta Palermo
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Daniela Leone
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Gloria Ferrantini
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Roberto De Sanctis
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Roberta Onesimo
- Paediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Antonietta Curatola
- Paediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Lavinia Fanelli
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Nicola Forcina
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Giulia Norcia
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Sara Carnicella
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Simona Lucibello
- Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Eugenio Mercuri
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
| | - Marika Pane
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Woman and Child Health and Public Health, Paediatric Neurology and Neuromuscular Omnicentre Clinical Center, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
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Curatola A, Ferretti S, Gatto A, Chiaretti A. Use of Handheld Transceiver for Hospital Healthcare Workers-Caregiver Communication During the Coronavirus disease 2019 (COVID-19) Outbreak in Pediatric Emergency Department. Pediatr Infect Dis J 2020; 39:e80-e81. [PMID: 32287053 PMCID: PMC7363375 DOI: 10.1097/inf.0000000000002689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Antonietta Curatola
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Ferretti
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Woman and Child Health and Public Health, Fondazione Policlinico, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma- Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Buonsenso D, Curatola A, Lazzareschi I, Panza G, Morello R, Marrocco R, Valentini P, Cota F, Rendeli C. Developmental dysplasia of the hip: real world data from a retrospective analysis to evaluate the effectiveness of universal screening. J Ultrasound 2020; 24:403-410. [PMID: 32356221 DOI: 10.1007/s40477-020-00463-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS Developmental dysplasia of the hip is an important cause of disability in children and young adult and it also has a significant socio-economic impact in our society. The main objective of our study is to evaluate, in our hospital, the effectiveness of a universal ultrasound screening protocol and to assess the general knowledge about the theme of pediatricians and neonatologists. METHODS Retrospective study of infants born from January 2016 to April 2019, evaluated with hip ultrasound (Graf method). Risk factors assessed were female gender, breech presentation at birth, positive family history and twin birth. For the secondary objective, an anonymous and validated questionnaire was distributed to all pediatricians and neonatologists. RESULTS Among the 4000 hips analyzed, on ultrasound examination, 98.8% hips resulted mature or immature but appropriate for age, while 1,2% hips were pathological. Analyzing the mature or immature hips, 2,4% were positive on clinical examination and 97,6% were negative. In relation to ultrasound pathological hips, 33,3% have positive clinical examination, while 66,7% negative. From the analysis of risk factors a significant association emerged between female sex, breech presentation and family history with the ultrasound pathological findings. The results of Survey showed that inadequate training about developmental dysplasia of the hip is done during medical school. CONCLUSIONS A universal ultrasound screening allowed us to identify developmental dysplasia of the hip in a number of children with normal clinical examination and no risk factors. Specific training courses should be implemented regarding Developmental Dysplasia of the Hip for neonatologists and pediatricians.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, RM, Italy
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, RM, Italy.
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, RM, Italy
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppina Panza
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, RM, Italy
| | - Raffaella Marrocco
- Institute of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, RM, Italy
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Claudia Rendeli
- Spina Bifida Center, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Buonsenso D, Brancato F, Valentini P, Curatola A, Supino M, Musolino AM. The Use of Lung Ultrasound to Monitor the Antibiotic Response of Community-Acquired Pneumonia in Children: A Preliminary Hypothesis. J Ultrasound Med 2020; 39:817-826. [PMID: 31633230 DOI: 10.1002/jum.15147] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
Community-acquired pneumonia (CAP) is associated with high morbidity and mortality among children worldwide. Over the last 10 years, lung ultrasound (US) has been widely studied as an alternative diagnostic tool for adult and pediatric CAP with excellent results. In this case series, we describe clinical and laboratory results as well as detailed lung US findings in 6 children with CAP, showing the potential use of lung US in monitoring the response to antibiotic therapy.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Brancato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariachiara Supino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Buonsenso D, Chiaretti A, Curatola A, Morello R, Giacalone M, Parri N. Pediatrician performed point-of-care ultrasound for the detection of ingested foreign bodies: case series and review of the literature. J Ultrasound 2020; 24:107-114. [PMID: 32212088 DOI: 10.1007/s40477-020-00452-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Foreign body (FB) ingestions represent a common problem in children. History and physical examination are commonly not enough to diagnose a foreign body ingestion; therefore, conventional radiography is routinely used to detect them. Point-of-care ultrasound is widely used in the emergency department for several diagnostic applications but there are few articles describing the possibility to use point-of-care ultrasound to detect ingested foreign bodies, and the necessary training to get competent in this application. The main objective of this paper is to illustrate the use of point-of-care ultrasound (POCUS) to detect ingested foreign bodies. The secondary objective is to describe a limited training, necessary for emergency pediatricians, to obtain this skill. METHODS This is a case series of eight pediatric patients who presented to the pediatric Emergency Department (ED), with suspected ingestion of FB, and were assessed with POCUS. Physician sonographers were two pediatricians and three residents in pediatrics working in two Italian Pediatric EDs. All sonographers participated in a 2-day POCUS workshop which included the most common pediatric POCUS applications. RESULTS POCUS, performed by emergency pediatricians who participated to a limited training, allowed to always identify the foreign bodies ingested. CONCLUSIONS We demonstrate that an appropriate and limited training allows pediatric emergency physicians to correctly identify foreign body in the esophagus or stomach. Point-of-care ultrasound in foreign body ingestion in the Emergency Department may allow to prioritize the escalation of care in children and it can contribute to reduce the time to endoscopic management when needed.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Antonietta Curatola
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy.
| | - Rosa Morello
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Martina Giacalone
- Emergency Department and Trauma Center, Meyer University Childrens' Hospital, Florence, Italy
| | - Niccolò Parri
- Emergency Department and Trauma Center, Meyer University Childrens' Hospital, Florence, Italy
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Gary EN, Kathuria N, Makurumidze G, Curatola A, Ramamurthi A, Bernui ME, Myles D, Yan J, Pankhong P, Muthumani K, Haddad E, Humeau L, Weiner DB, Kutzler MA. CCR10 expression is required for the adjuvant activity of the mucosal chemokine CCL28 when delivered in the context of an HIV-1 Env DNA vaccine. Vaccine 2020; 38:2626-2635. [PMID: 32057572 PMCID: PMC10681704 DOI: 10.1016/j.vaccine.2020.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/05/2019] [Accepted: 01/07/2020] [Indexed: 01/07/2023]
Abstract
An effective prophylactic vaccine targeting HIV must induce a robust humoral response and must direct the bulk of this response to the mucosa-the primary site of HIV transmission. The chemokine, CCL28, is secreted by epithelial cells at mucosal surfaces and recruits' cells expressing its receptor CCR10. CCR10 is predominantly expressed by IgA + ASCs. We hypothesized that co-immunization with plasmid DNA encoding consensus envelope antigens with plasmid-encoded CCL28 would enhance anti-HIV IgA responses at mucosal surfaces. Indeed, animals receiving pCCL28 and pEnvA/C had significantly increased HIV-specific IgA in fecal extract. Surprisingly, CCL28 co-immunization induced a significant increase in anti-HIV IgG in the serum in mice compared to those receiving pEnvA/C alone. These robust antibody responses were not associated with changes in the frequency of germinal center B cells but depended upon the expression of CCR10, as these responses we abolished in CCR10-deficient animals. Finally, immunization with CCL28 led to increased frequencies in HIV-specific CCR10 + and CCR10 + IgA + B cells in the small intestine and Peyer's patches of vaccinated animals as compared to those receiving pEnvA/C alone. These data indicate that CCL28 administration can enhance antigen-specific humoral responses systemically and at mucosal surfaces.
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Affiliation(s)
- E N Gary
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - N Kathuria
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - G Makurumidze
- The Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - A Curatola
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - A Ramamurthi
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - M E Bernui
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States; The Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - D Myles
- The Department of Pathology and Laboratory Medicine, The University of Pennsylvania, Philadelphia, PA, United States
| | - J Yan
- Inovio Pharmaceuticals, Blue Bell, PA, United States
| | - P Pankhong
- The Department of Pathology and Laboratory Medicine, The University of Pennsylvania, Philadelphia, PA, United States
| | - K Muthumani
- The Wistar Institute, Philadelphia, PA, United States
| | - E Haddad
- The Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - L Humeau
- Inovio Pharmaceuticals, Blue Bell, PA, United States
| | - D B Weiner
- The Wistar Institute, Philadelphia, PA, United States
| | - M A Kutzler
- The Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States; The Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States.
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Sabatino V, Caramia MR, Curatola A, Vassallo F, Deidda A, Cinicola B, Iodice F, Caffarelli C, Sverzellati N, Buonsenso D. Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for community health officers. J Ultrasound 2020; 23:521-527. [PMID: 31919811 DOI: 10.1007/s40477-019-00426-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) has been shown to have unique potential in low-income countries. Physicians and other healthcare providers can perform effective scans after a short period of training. This study aimed to evaluate indications and utility of ultrasonography as the main imaging service in a poor rural sub-Saharan region of Africa. Second, it evaluated the effect of a short training on POCUS for non-physician health providers and their agreement with a group of Italian physicians. METHODS This study was undertaken in Lokomasama-a chiefdom of Sierra Leone-between January and February 2019. Based on clinical indications, ultrasound findings were evaluated with respect to the initial diagnostic hypothesis. Volunteer doctors conducted a theoretical-practical training of two community health officers (CHO) on chest and abdominal POCUS and E-FAST protocol. The evaluation of the achieved technical skills was obtained with a numeric score. Inter-observer agreement concerning ultrasound diagnosis based on clinical indications was assessed. RESULTS A total of 196 consecutive patients underwent ultrasound examination. POCUS findings were in keeping with the clinical diagnosis in the 49.5%. POCUS changed the initial diagnosis in 17% of cases. After training, E-FAST and POCUS knowledge score was 90% and 83%, respectively. An excellent inter-observer agreement (0.88) was found between CHOs and physicians. CONCLUSION POCUS represents a powerful diagnostic tool in a low-income country that may improve the patient management. Training of non-physician health providers is doable and may improve healthcare management in resource-limited settings.
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Affiliation(s)
- Vittorio Sabatino
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Maria Rosaria Caramia
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, 43100, Parma, Italy
| | | | | | - Andrea Deidda
- Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, 43100, Parma, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Danilo Buonsenso
- Università Cattolica del Sacro Cuore, Rome, Italy. .,Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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49
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Merli L, Nanni L, Curatola A, Pellegrino M, De Santis M, Silvaroli S, Paradiso FV, Buonsenso D. Congenital lung malformations: a novel application for lung ultrasound? J Ultrasound 2019; 24:349-353. [PMID: 31487034 DOI: 10.1007/s40477-019-00406-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023] Open
Abstract
Congenital lung malformations (CLMs) include a group of different disorders. With widespread use of antenatal ultrasonography (aUS) and increased use of pre-natal magnetic resonance imaging (MRI), CLMs are increasingly detected, nevertheless the best postnatal imaging approach is not yet well defined: newborns usually undergo several chest X-rays and eventually computed tomography to confirm the diagnosis. In this case series, we show lung ultrasound features of three different cases of congenital lung malformations, describing prenatal and postnatal images comparing different imaging techniques.
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Affiliation(s)
- L Merli
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Nanni
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Curatola
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Pellegrino
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M De Santis
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro Studi per la Tutela della Salute della Madre e del Concepito, Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Silvaroli
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F V Paradiso
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Università Cattolica del Sacro Cuore, Rome, Italy.
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50
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Buonsenso D, Curatola A, Valentini P, Scialanga B, Toma P, Musolino AM. Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country. Pediatr Pulmonol 2019; 54:1348-1350. [PMID: 31106507 DOI: 10.1002/ppul.24362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/21/2019] [Accepted: 04/26/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Paolo Toma
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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