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Marchili MR, Bozzola E, Guolo S, Marchesani S, Spina G, Mascolo C, Vicari S, De Jacobis IT, Raponi M, Villani A. Pediatric acute hospitalization for anorexia nervosa: an economic evaluation. Ital J Pediatr 2024; 50:33. [PMID: 38413993 PMCID: PMC10900686 DOI: 10.1186/s13052-024-01605-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay. METHODS for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022). RESULTS a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden. CONCLUSIONS the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management. TRIAL REGISTRATION 2526-OPBG-2021.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Child Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvio Marchesani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Mascolo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Bozzola E, Irrera M, Cirillo F, Zanna V, Petrelli I, Diamanti A, Scire Y, Park J, Marchesi A, Marchili MR, Villani A. Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report and a Systematic Revision of the Literature. Nutrients 2024; 16:541. [PMID: 38398865 PMCID: PMC10893019 DOI: 10.3390/nu16040541] [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: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the duodenum, which may occur in the case of fast weight loss. Currently, the relationship between superior mesenteric artery syndrome and anorexia nervosa is still unclear. The aim of this study is to identify the precocious clinical signs and symptoms of SMAS in patients affected by anorexia nervosa so as not to delay the diagnosis. METHODS We present the clinical case of a young female patient with anorexia nervosa complicated by SMAS. We performed a literature review of SMAS in children affected by anorexia nervosa between 1962 and 2023, according to the PRISMA Extension Guide for Scoping Reviews. RESULTS Reviewing the literature, 11 clinical cases were described for the pediatric age. The median age at diagnosis was 17 years (ranging from 13 to 18 years). The diagnosis of SMAS may be challenging as symptoms overlap those of anorexia, but it should be kept in mind mostly in cases of post-prandial abdominal pain, anxiety or depression, nausea, vomiting, and weight loss. CONCLUSION Even specific clinical symptoms may act as flag tags to drive attention to this rare but potentially fatal condition.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Mariangela Irrera
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Flavia Cirillo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Italo Petrelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, 00100 Rome, Italy
| | - Ylenia Scire
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Jibin Park
- Medicine and Surgery School, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
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Aureli A, Recupero R, Mariani M, Manco M, Carlomagno F, Bocchini S, Nicodemo M, Marchili MR, Cianfarani S, Cappa M, Fintini D. Low Levels of Serum Total Vitamin B12 Are Associated with Worse Metabolic Phenotype in a Large Population of Children, Adolescents and Young Adults, from Underweight to Severe Obesity. Int J Mol Sci 2023; 24:16588. [PMID: 38068910 PMCID: PMC10706451 DOI: 10.3390/ijms242316588] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/19/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
Vitamin B12 (or cobalamin) is an essential vitamin for DNA synthesis, fatty acid and protein metabolism as well as other metabolic pathways fundamental to the integrity of cells and tissues in humans. It is derived from the diet and mostly stored in the liver. Its deficiency has been associated with metabolic derangements, i.e., obesity, glucose intolerance, increased lipogenesis and metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). However, data with regard to body weight across the whole spectrum (from underweight to severe obesity) in children and young individuals are scarce. The present study aims to describe the association between serum total vitamin B12 and body mass index (BMI) ranging from underweight to severe obesity in a large population of children, adolescents and young adults. This study also investigates associations with visceral adiposity, glucose and lipid metabolism and liver dysfunction. A cross-sectional, single-centre study was conducted at the Paediatrics and Endocrinology units of the "Bambino Gesù Children Hospital", a tertiary referral institution for eating disorders. Clinical charts were reviewed and 601 patients aged from 5 to 25 years were enrolled in order to analyse anthropometric, auxological, clinical, biochemical and liver ultrasound data using robust statistical approaches. Analyses were adjusted for potential confounders. A reduction in serum total B12 levels was associated with a linear increase in body weight, as expressed by WHO BMI SDS (r = -0.31, p < 0.001, BCa 95% -0.38, -0.24). Lower B12 levels were associated with higher waist circumference but only in pubertal girls (r = -0.33, p = 0.008, BCa 95% -0.53, -0.11). Hepatic insulin resistance was higher in males with lower B12 levels (B = -0.003 (-0.007, -0.0001), p = 0.039), but not in females, whereas whole-body insulin resistance was unaffected. Serum lipid profiles (total, HDL and LDL cholesterol and triglycerides) were not influenced by serum cobalamin levels. However, lower cobalamin levels were associated with higher grading of ultrasound-scored hepatic steatosis (ptrend = 0.035). Lastly, both AST and ALT showed a significant and direct correlation with total B12 levels in underweight (r = 0.22 and 0.24, p = 0.002 and <0.001, respectively) and severely obese subjects (r = 0.24 and 0.32, p = 0.002 and <0.001). In conclusion lower vitamin B12 levels are associated with higher body weight, adiposity and with worse metabolic health in a large population of children, adolescents and young adults.
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Affiliation(s)
- Alessia Aureli
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Rosanna Recupero
- Pediatric Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy;
- Pediatrics Department, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michela Mariani
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Melania Manco
- Research Area for Foetal Neonatal and Cardiological Sciences, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Francesco Carlomagno
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Sarah Bocchini
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Mirella Nicodemo
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Maria Rosaria Marchili
- Department of Emergency Admission and General Pediatrics, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Stefano Cianfarani
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Marco Cappa
- Research Area of Innovative Therapies in Endocrinopathies, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Danilo Fintini
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
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Straface E, Jacobis ITD, Capriati T, Pretelli I, Grandin A, Mascolo C, Vona R, Gambardella L, Cittadini C, Villani A, Marchili MR. The impact of the COVID-19 pandemic on eating disorders risk and symptoms: a retrospective study. Ital J Pediatr 2023; 49:50. [PMID: 37101237 PMCID: PMC10132438 DOI: 10.1186/s13052-023-01443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Social distancing and quarantine imposed by the authority during the COVID-19 pandemic caused restrictions, which had a negative impact on eating behavior, especially among adolescents. We proposed a retrospective study aimed to evaluate the effect of the COVID-19 pandemic on eating disorders risk and symptoms. METHODS In this study, a group of 127 pediatric patients (117 females and 10 males) with eating disorders admitted to the Bambino Gesù Children's Hospital of Rome (Italy), in the period between August 2019 and April 2021, was analyzed. All patient data were collected from patients' electronic medical records. RESULTS We found that 80.3% of patients were at the onset of eating disorders and that 26% of patients had familiarity for psychotic disorders. Often these patients had comorbidities and alterations in blood parameters such as leukocytopenia, neutropenia, hypovitaminosis and hormonal problems that could affect their future. CONCLUSIONS Our findings could provide a framework for developing clinical and educational interventions to mitigate the short- and long-term negative impact of the pandemic on adolescent future health.
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Affiliation(s)
- Elisabetta Straface
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy.
- Biomarkers Unit, Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena, Rome, 299 - 00161, Italy.
| | - Isabella Tarissi De Jacobis
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy.
| | - Teresa Capriati
- Gastroenterology and Nutritional Rehabilitation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Italo Pretelli
- Anorexia and Eating Disorder Unit, Child and Adolescent Psichiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Annalisa Grandin
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Cristina Mascolo
- Pediatric Academic Department, University of Rome Tor Vergata, Via Cracovia 50, Rome, 00133, Italy
| | - Rosa Vona
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Lucrezia Gambardella
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Camilla Cittadini
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Alberto Villani
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Maria Rosaria Marchili
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
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Marchili MR, Diamanti A, Zanna V, Spina G, Mascolo C, Roversi M, Guarnieri B, Mirra G, Testa G, Raucci U, Reale A, Villani A. Early Naso-Gastric Feeding and Outcomes of Anorexia Nervosa Patients. Nutrients 2023; 15:nu15030490. [PMID: 36771197 PMCID: PMC9919815 DOI: 10.3390/nu15030490] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Nutritional rehabilitation with weight restoration is an important step in patients hospitalised for anorexia nervosa (AN). Naso-gastric feeding (NGF) should be considered when oral nutrition (OF) and oral nutritional supplementation (ONS) are insufficient. We evaluated the role of NGF on short- and long-term outcomes, considering weight gain, the length of hospitalisation (LOS) and the time to relapse. We report on the characteristics of patients under 18 years of age with AN admitted to the Department of Emergency and Acceptance of the Bambino Gesù Children's Hospital, IRCCS, Rome, between March 2019 and August 2022. Three hundred and fifteen patients were enrolled. We compared patients treated with NGF (group A) and patients without NGF (group B). Group A was characterised by a significantly lower BMI on admission and discharge, more frequent use of inpatient psychotropic therapy (IPDT) and longer hospital stay. The time to relapse was significantly longer in group A compared to group B. An early NGF setting correlates with a longer time to relapse and may be associated with a shorter LOS. A high caloric intake with a balanced nutritional formula provided by NGF allows an earlier recovery. The main advantages of this approach could be the rapid discharge of patients and a more effective psychological and social recovery.
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Affiliation(s)
- Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Spina
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence:
| | - Cristina Mascolo
- University Hospital Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Benedetta Guarnieri
- University Hospital Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gianluca Mirra
- University Hospital Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giulia Testa
- University Hospital Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy
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Bozzola E, Marchesani S, Ficari A, Brusco C, Spina G, Marchili MR, Guolo S. Assessing the use of antibiotics in pediatric patients hospitalized for varicella. Ital J Pediatr 2022; 48:196. [PMID: 36503563 PMCID: PMC9743721 DOI: 10.1186/s13052-022-01393-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella. METHODS Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered. RESULTS According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures. CONCLUSION Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
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Affiliation(s)
- Elena Bozzola
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Silvio Marchesani
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Ficari
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Brusco
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Spina
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Guolo
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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Spina G, Clemente A, Roversi M, Marchili MR, Silvestri P, Mascolo C, Zanna V, Diamanti A, Reale A, Villani A, Raucci U, Ammirati A. Early echocardiographic evaluation of children admitted to the emergency department for anorexia nervosa during the COVID-19 pandemic. Eat Weight Disord 2022; 27:3409-3417. [PMID: 36053460 PMCID: PMC9438386 DOI: 10.1007/s40519-022-01474-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is the most frequent eating disorder (ED), whose cardiac complications may have life-threatening consequences for both the physical and psychological health of affected children. In this study, we reported and analysed the echocardiographic anomalies found in pediatric patients diagnosed with AN. METHODS We reported the demographic and clinical characteristics of children aged 8 to 18 years, who were diagnosed with AN and underwent a complete cardiological evaluation at the Emergency Department of the Bambino Gesù Children's Hospital, IRCCS, Rome between the 1st January 2021 and the 30th June 2021. Furthermore, we compared the patients according to the presence of pericardial effusion and a BMI (body mass index) cut-off 14.5 kg/m2. RESULTS Forty-nine patients were included in the study. The mean age was 15.1 years. Most patients were female (89.8%). The mean length of hospitalization was 18 days. The mean BMI at admission was 14.8 kg/m2, with a median weight loss of 9 kg in the last year. Eleven patients (22.4%) presented with cardiovascular signs or symptoms at admission. Most patients had pericardial effusion on heart ultrasound, with a mean thickness of 6 mm (SD ± 4). The LV (left ventricle) thickness over age was significantly higher in patients with pericardial effusion, with a Z score of -2.0 vs -1.4 (p = 0.014). The administration of psychiatric drugs was significantly more frequent in patients with a lower BMI (37.5% vs 12%, p = 0.038). CONCLUSION Our study suggests that a non-urgent baseline echocardiographic evaluation with focus on left-ventricular wall thickness and mass in children with anorexia nervosa is advisable. LEVEL III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Giulia Spina
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Clemente
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Silvestri
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Mascolo
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Antonio Ammirati
- Consultant Cardiologist at Pediatric Emergency Unit, Department of Emergency, Acceptance and General Pediatrics, Pediatric Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
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8
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Spina G, Roversi M, Marchili MR, Raucci U, Fini F, Mirra G, Testa G, Guarnieri B, Clemente A, Diamanti A, Zanna V, Castiglioni MC, Vicari S, Reale A, Villani A. Psychiatric comorbidities and dehydration are more common in children admitted to the emergency department for eating disorders in the COVID-19 era. Eat Weight Disord 2022; 27:2473-2480. [PMID: 35294772 PMCID: PMC8925290 DOI: 10.1007/s40519-022-01386-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/10/2021] [Accepted: 02/26/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Since the beginning of COVID-19 pandemic, social distancing and home confinement had a significant impact on children, especially on those with eating disorders (ED). The primary objective of this retrospective study was to describe and analyze the demographic and clinical profiles of children presenting with ED during the COVID-19 pandemic. METHODS We conducted a retrospective review of clinical charts of patients with ED younger than 18 years who accessed the emergency department of the Bambino Gesù Children's Hospital, Rome, between March 2019 and March 2021. Of these, we reported and compared the demographic, clinical and laboratory data before and after the COVID-19 pandemic and looked for predictors of ED severity. RESULTS A total of 211 admissions for ED were recorded. The patients, mostly females (86.3%) were on average 14.1 years old. The mean weight loss on admission was 11 kg. Bradycardia was observed in 31.3% of the study sample. 16.6% of patients had an associated psychiatric disorder and 60.2% required psychotropic drugs. 68.7% of the patients required hospitalization. Respectively, 96 and 115 patients were admitted before and during the COVID-19 pandemic. The latter were hospitalized more (78.3 vs 57.3%; p = 0.001), yet for less time (19 vs 26 days; p = 0.004), had a higher mean serum creatinine (0.68 vs 0.47; p < 0.001) and were more frequently diagnosed with an associated psychiatric disorder (23.5 vs 8.3%; p = 0.003). CONCLUSION Our study shows a significant increase of hospitalizations of children with ED during the COVID-19 pandemic, along with a shorter length of stay, more psychiatric comorbidities, and some distinctive features at the laboratory work-up, such as an increase of serum creatinine and/or a reduction of serum albumin. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Giulia Spina
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Fini
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Gianluca Mirra
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Giulia Testa
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Benedetta Guarnieri
- University Hospital Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Anna Clemente
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù" Children Hospital, IRCCS, Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù" Children Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù" Children Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Head Child and Adolescent Psychiatry, Bambino Gesù" Children Hospital, IRCCS, Rome, Italy.,Child Neuropsychiatry Department of Life Sciences and Public Health, Catholic University, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
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9
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Trovato CM, Capriati T, Bolasco G, Campana C, Papa V, Mazzoli B, Zanna V, Marchili MR, Basso MS, Maggiore G, Diamanti A. Five-Year Inpatient Management of Teenagers With Anorexia Nervosa: Focus on Nutritional Issues. J Pediatr Gastroenterol Nutr 2022; 74:674-680. [PMID: 35149647 DOI: 10.1097/mpg.0000000000003410] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES In patients with Anorexia Nervosa (AN) malnutrition can lead to life-long nutritional treatments. The refeeding process can combine natural feeding (NF) with specific nutritional strategies, including oral nutritional supplements (ONS) and nasogastric feeding (NGF). Aims of the present study were to assess the efficacy of hospital protocol and identify the most effective inpatient nutritional strategies for weight restoration. METHODS All patients hospitalized from April 2015 to April 2020 were enrolled. According to hospital protocol, NF was proposed to all patients; ONS were combined with NF if caloric intake was <70% of the requirements and NGF was added if caloric intake did not reach 30% in the first week from admission. RESULTS Overall, 186 patients [M = 20; median age 14 (interquartile range 1316)] were included. Nutritional issues were the main indication to admission (56.6%). A significant effect of combination treatment, with a shorter duration of hospitalization when using ONS with NGF in addition to NF was found (ß: -20.28 [95% confidence interval -34.92:-5.65], P < 0.001). Only one patient showed a significant but limited increase of liver enzymes. CONCLUSIONS We provide a safe and effective standardized protocol to treat the malnutrition of teenagers with AN in an inpatient setting. Malnutrition was the most important cause of admission, and more than half of the patients admitted were severely malnourished. The combination of NF, ONS, and NGF was the most effective strategy to achieve the weight restoration; however, this result should be validated on larger series of patients treated with NGF and NF.
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Affiliation(s)
| | | | | | | | | | | | - Valeria Zanna
- the Department of Neuroscience, Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry
| | | | - Maria Sole Basso
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
| | - Giuseppe Maggiore
- Gastroenterology and Nutritional Rehabilitation Unit
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
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10
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Retrosi C, Diociaiuti A, De Ranieri C, Corbeddu M, Carnevale C, Giancristoforo S, Marchili MR, Salvatori G, Atti MLCD, Hachem ME, Raponi M. Multidisciplinary care for patients with epidermolysis bullosa from birth to adolescence: experience of one Italian reference center. Ital J Pediatr 2022; 48:58. [PMID: 35414096 PMCID: PMC9006505 DOI: 10.1186/s13052-022-01252-3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a disabling and chronic genodermatosis characterized by mucocutaneous fragility with blister formation after minimal trauma. Severity ranges between very mild forms to extremely severe or lethal subtypes. Depending on disease subtypes, blisters may be localized also in larynx, bladder, esophagus, and most frequent disease complications are malnutrition, chronic anemia, osteoporosis, limb contracture and early development of squamous cell carcinomas. EB is classified into four major groups: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and Kindler EB (KEB). No specific treatment is available; however, a multidisciplinary management is mandatory in order to treat the lesions, to prevent complication, and to give a psychological support to the patient and family members. OBJECTIVE To report the experience on a therapeutic education plan of an Italian reference center for epidermolysis bullosa in the last 30 years. METHODS In our study we included all patients with EB from 1990 to the present, dividing them into three age groups (< 5 years, > 5-12 years and > 12-18 years). The therapeutic plan involved all multidisciplinary team members, since born until adolescence. The multidisciplinary team has been progressively established; the dermatologists act as patient case manager, in collaboration with the pediatrician, endocrinologist, dietician, dentist, plastic surgeon, digestive surgeon, geneticist, psychologist and a dedicated nurse. Other dedicated specialists are involved upon patient needs. RESULTS Two hundred fifteen patients have been recruited and followed in our hospital since 1990. One hundred forty patients (65%) are on follow-up, 27 patients (13%) died and only 11 (5%) were lost to follow-up. Our patients manifested the specific complications related to their EB subtype in keeping with the data reported in the literature. Eighteen (8%) patients affected with JEB severe died within the first year of life, 9 patients (5%) died for squamous cell carcinoma in adulthood and were affected with recessive DEB; only 1 patient died for squamous cell carcinoma at the age of 16. CONCLUSIONS An adequate management of EB patients require a multidisciplinary approach with an educational plan to guarantee an appropriate treatment and to support and accompany patients and their families since birth along life. The dynamic educational plan adopted in our hospital showed good clinical and psychological outcome in our population, allowing adherence to treatment, reducing the frequency of complications and improving life expectancy and quality of life.
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Affiliation(s)
- Chiara Retrosi
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Marialuisa Corbeddu
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia Carnevale
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Giancristoforo
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | | | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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11
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Marchili MR, Spina G, Roversi M, Mascolo C, Pentimalli E, Corbeddu M, Diociaiuti A, El Hachem M, Villani A. Epidermolysis Bullosa in children: the central role of the pediatrician. Orphanet J Rare Dis 2022; 17:147. [PMID: 35379269 PMCID: PMC8978425 DOI: 10.1186/s13023-021-02144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
AbstractEpidermolysis bullosa (EB) is a severe hereditary disease characterized by defective epithelial adhesion causing mucocutaneous fragility. The major types are EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and more than 35 EB subtypes. Another very rare type of EB is Kindler EB (KEB). Clinically, it is a very heterogeneous disease which ranges from localized to extensive skin lesions with frequent multisystem extra cutaneous involvement. The role of a pediatrician-dermatologist cooperation within a multidisciplinary team is fundamental for both the diagnosis and management contributing to these patients’ better life expectancy. Aim of this study is to describe clinical and laboratory characteristics of the main EB subtypes focusing on nutritional and gastrointestinal aspects, providing information to aid the paediatric management of children with EB. This retrospective study reviewed the cases of 160 pediatric EB patients (76 male and 84 female): 31 patients affected by EBS (mean age ± SD: 4.37 ± 7.14), 21 patients affected by JEB (mean age ± SD: 9.26± 17.30) and 108 with DEB (mean age ± SD: 11.61 ± 13.48). All patients were admitted at the Bambino Gesù Children’s Hospital in Rome, between June 2005 to June 2020. The reduced gastrointestinal absorption, chronic losses, esophageal stenosis and chronic inflammatory state, represent the basis of nutritional problems of EB patients. In particular, anemia represents one of the most important complications of DEB patients which could require transfusion-dependent patterns. Malnutrition, vitamin deficiencies and anemia have been related to growth delay in EB patients. A specific diet with a balance of all macronutrients is required and improving caloric intake with sugar limitations is fundamental to prevent dental caries and tooth decay typical of EB patients. While sepsis proved to be the major cause of morbidity and mortality in younger patients, squamous cell carcinoma was mostly observed in older patients, especially those affected by DEB. Patients with EB require regular monitoring for complications and sequelae with a frequency of evaluations which varies based on age and EB subtypes. Cooperation among medical teams involving paediatricians, dermatologists, specialist clinicians including nutritionists such as families and patient’s association is fundamental to approach the disease and improve the quality of life of these patients.
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12
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Offidani C, Villani A, Reale A, Marchili MR, Aufiero LR, Moras P, Lodise M, Raucci U, Barbieri MA, Raponi M. Early recognition of child abuse through screening indicators at the emergency department: experience of a tertiary urban pediatric hospital. Ital J Pediatr 2022; 48:32. [PMID: 35180882 PMCID: PMC8856727 DOI: 10.1186/s13052-022-01214-9] [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: 12/11/2020] [Accepted: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Emergency Departments play a pivotal role in detecting cases of child abuse. Despite the efforts made in the past decades on the need for a screening method for the early detection of abuse victims, a unique instrument shared by the international scientific community has not been made. These instruments should be able to help recognizing whether it is necessary to further investigate the child’s condition. The aim of the study is to illustrate the screening indicators in use since 2010 in the Emergency Department of the Bambino Gesù Children’s Hospital to early recognise the victims of abuse and the modifying process of the screening tool undertaken over the years. Methods We retrospectively analyzed the process that led to the editing of the indicators of child abuse in use nowadays at the Bambino Gesù Children's Hospital. We codified three clinical pathways to apply in case of suspected abuse. Furthermore, we investigated the medical records of screening-positive accesses in the Paediatric Emergency Department of the Bambino Gesù Children's Hospital from January 2008 to October 2020. Results An estimation of positive screening, regarding the type of abuse suspected, and the number of accessed in ED was made, resulting in a cohort of 956 patients. In 2010 we created a list of 14 items grouped in three clusters: anamnestic declarations or incongruences, carelessness/neglect and evident lesions at physical examination. Positivity to one of the items allows the actuation of the investigating protocol named as clinical pathway.In 2013, after three years of experience, the criteria were edited to increase specificity. The application of screening led to a median number of 82 suspected cases/year from 2013 to 2020. Conclusion A screening tool is essential and productive for the early recognition of victims of abuse. An in-deep analysis of suspected cases through a standardized method, such as the clinical pathway, allowed reaching the diagnosis in a more accurate and precise manner.
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Affiliation(s)
- Caterina Offidani
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Lelia Rotondi Aufiero
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Patrizio Moras
- University of Rome Tor Vergata, Residency School of Pediatrics, Rome, Italy.,Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Lodise
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Antonietta Barbieri
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Bozzola E, Spina G, Marchili MR, Brusco C, Guolo S, Rossetti C, Logrieco G, Pignatelli F, Raponi M, Villani A. Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost? Int J Environ Res Public Health 2021; 18:ijerph182212053. [PMID: 34831809 PMCID: PMC8617963 DOI: 10.3390/ijerph182212053] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population. METHODS We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020. RESULTS In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively. CONCLUSIONS Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies.
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Affiliation(s)
- Elena Bozzola
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
- Correspondence: ; Tel.: +39-06-6859-2744
| | - Giulia Spina
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Maria Rosaria Marchili
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Carla Brusco
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Chiara Rossetti
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Giuseppe Logrieco
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Francesca Pignatelli
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Massimiliano Raponi
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Alberto Villani
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
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14
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Giangaspero A, Barlaam A, Pane S, Marchili MR, Onetti Muda A, Putignani L, Hall MJR. Accidental Nasal Myiasis Caused by Megaselia rufipes (Diptera: Phoridae) in a Child. J Med Entomol 2021; 58:121-124. [PMID: 32901266 DOI: 10.1093/jme/tjaa184] [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] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 06/11/2023]
Abstract
A case of a nasal myiasis in a 3-yr-old Italian girl who was referred to Bambino Gesù Hospital in Rome, Italy, is reported. Larvae discharged with the nasal mucus were microscopically identified as Megaselia spp.; DNA barcoding analysis showed that they belonged to the 'scuttle fly' species Megaselia rufipes (Meigen). Based on the patient's history, she became infected when she played outside. This is the first report of myiasis in humans due to M. rufipes (Diptera: Phoridae).
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Affiliation(s)
- A Giangaspero
- Department of Science of Agriculture, Food and Environment, University of Foggia, Foggia, Italy
| | - A Barlaam
- Department of Science of Agriculture, Food and Environment, University of Foggia, Foggia, Italy
| | - S Pane
- Department of Laboratories, Unit of Parasitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M R Marchili
- Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome Italy
| | - L Putignani
- Department of Laboratories, Unit of Parasitology and Area of Genetics and Rare Diseases, Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M J R Hall
- Department of Life Sciences, Natural History Museum, London, United Kingdom
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15
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Zanna V, Cinelli G, Criscuolo M, Caramadre AM, Castiglioni MC, Chianello I, Marchili MR, Casamento Tumeo C, Guolo S, Tozzi AE, Vicari S. Corrigendum: Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study. Front Psychiatry 2021; 12:748046. [PMID: 34484012 PMCID: PMC8416163 DOI: 10.3389/fpsyt.2021.748046] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.653482.].
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Affiliation(s)
- Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Chiara Casamento Tumeo
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
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16
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Zanna V, Cinelli G, Criscuolo M, Caramadre AM, Castiglioni MC, Chianello I, Marchili MR, Casamento Tumeo C, Guolo S, Tozzi AE, Vicari S. Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study. Front Psychiatry 2021; 12:653482. [PMID: 34122177 PMCID: PMC8192691 DOI: 10.3389/fpsyt.2021.653482] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP). Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11-18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups. Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs. Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.
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Affiliation(s)
- Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Chiara Casamento Tumeo
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
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Ceglie G, Macchiarulo G, Marchili MR, Marchesi A, Rotondi Aufiero L, Di Camillo C, Villani A. Scurvy: still a threat in the well-fed first world? Arch Dis Child 2019; 104:381-383. [PMID: 30087152 DOI: 10.1136/archdischild-2018-315496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/15/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022]
Abstract
We report three cases of scurvy in previously healthy children referred to us for leg pain and refusal to walk. All children had no significant medical history, symptoms had started months before and subtly advanced. Two of them presented with gingival hyperplasia and petechiae, another one reported night sweats and gingival bleeding in the past few weeks. Two had vitamin D deficiency, and all had microcytic anaemia (in one case requiring transfusional support). A nutritional screening revealed low or undetectable levels of ascorbic acid. This, along with the clinical and radiological findings, led to a diagnosis of scurvy. Vitamin C supplementation was started with rapid improvement of the children's clinical condition. Scurvy is a rare disease in the 'first world', but there are anecdotal reports of scurvy in children without any of the known risk factors for this condition. In our cases, a selective diet was the only risk factor.
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Affiliation(s)
- Giulia Ceglie
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Macchiarulo
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatric and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandra Marchesi
- General Pediatric and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lelia Rotondi Aufiero
- General Pediatric and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Di Camillo
- General Pediatric and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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Abstract
Background Vitamin K, a fat soluble vitamin, is a necessary cofactor for the activation of coagulation factors II, VII, IX, X, and protein C and S. In neonatal period, vitamin K deficiency may lead to Vitamin K Deficiency Bleeding (VKDB). Case presentation We present the case of a 2 months and 20 days Caucasian male, presented for bleeding from the injections sites of vaccines. At birth oral vitamin K prophylaxis was administered. Neonatal period was normal. He was exclusively breastfed and received a daily oral supplementation with 25 μg of vitamin K. A late onset vitamin K deficiency bleeding was suspected. Intravenous Vitamin K was administered with complete recovery. Conclusions Nevertheless the oral prophylaxis, our case developed a VKDB: it is necessary to revise the current guidelines in order to standardize timing and dosage in different clinical conditions.
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Affiliation(s)
- Maria Rosaria Marchili
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy.
| | - Elisa Santoro
- Pediatric Department, University of Tor Vergata, Rome, Italy
| | - Alessandra Marchesi
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Simona Bianchi
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Lelia Rotondi Aufiero
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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Marchili MR, Boccuzzi E, Vittucci AC, Aufiero LR, Vicari S, Villani A. Hypertransaminasemia and hypophosphoremia in an adolescent with anorexia nervosa: an event to watch for. Ital J Pediatr 2016; 42:49. [PMID: 27188310 PMCID: PMC4869384 DOI: 10.1186/s13052-016-0258-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Case Presentation Conclusions
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Rosati P, Di Salvo V, Crudo S, D'Amico R, Carlino C, Marchili MR, Gonfiantini M, Di Ciommo V. Are parents of children hospitalized with severe community-acquired pneumonia more satisfied with care when physicians allow them to share decisions on the antibiotic route? Health Expect 2015; 18:2278-87. [PMID: 24766676 PMCID: PMC5810709 DOI: 10.1111/hex.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Accepted: 03/31/2014] [Indexed: 10/25/2022] Open
Abstract
CONTEXT AND OBJECTIVE Despite convincing evidence that oral and injected amoxicillin have equal efficacy in children with severe community-acquired pneumonia (CAP), hospitalized children often receive injected antibiotics. To investigate whether shared decision-making (choosing the antibiotic route) influences parental satisfaction. DESIGN, SETTING AND PARTICIPANTS In a one-year questionnaire-based study, we enrolled consecutive children hospitalized for CAP. At admission, all children's parents received a leaflet on CAP. Parents arriving during the daytime were assigned to a shared group and could choose the antibiotic route, those admitted at other times were assigned to an unshared group for whom physicians chose the antibiotic route. Shared group parents answered anonymous questionnaire investigating why they chose a specific route. Parents in both groups answered another anonymous questionnaire at discharge assessing perceived satisfaction with care. MAIN OUTCOME MEASURE Parents' satisfaction with perceived medical information as assessed by data from a questionnaire. RESULTS Of the 95 children enrolled, more children's parents were assigned to the unshared than the shared group (77 vs. 18). Of the 18 children's parents in the shared group, 14 chose the oral antibiotic route mainly to avoid painful injections. Doctors explanations were considered better in the shared than in the unshared group (P = 0.02). DISCUSSION AND CONCLUSIONS The larger number of children's parents assigned to the unshared group reflects paediatricians' reluctance to offer shared-decision making. Well-informed parents prefer oral antibiotic therapy for children with severe CAP. Allowing parents choose the antibiotic route respects parents' wishes, reduces children's pain and improves satisfaction.
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Affiliation(s)
- Paola Rosati
- Unit of Clinical Epidemiology Bambino Gesù Children's Hospital IRCCSRomeItaly
| | | | | | - Roberto D'Amico
- Italian Cochrane CentreDepartment of DiagnosticClinical and Public Health MedicineUniversity of Modena and Reggio EmiliaModenaItaly
| | - Cecilia Carlino
- Reasearch Training ProgramFacoltà di Medicina e ChirurgiaUniversità La SapienzaRomeItaly
| | | | | | - Vincenzo Di Ciommo
- Unit of Clinical Epidemiology Bambino Gesù Children's Hospital IRCCSRomeItaly
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Salavastru CM, Sprecher E, Panduru M, Bauer J, Solovan CS, Patrascu V, Morariu HS, Tudorache A, Lotti T, Tagliente I, Ciasulli A, Marchili MR, Sabatino G, Burciu E, Cosgarea R, Fritz K, Tiplica GS. Recommended strategies for epidermolysis bullosa management in romania. Maedica (Bucur) 2013; 8:200-205. [PMID: 24371486 PMCID: PMC3865131] [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: 03/15/2013] [Accepted: 05/16/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND There are 72 families with epidermolysis bullosa (EB) in Romania. Since 2012 a National Program for the treatment of these patients is run by the Ministry of Health.The objectives of the strategies for EB patients are to optimize the management (diagnosis, treatment, monitoring) and to provide actual information on classification and patho-physiology which dictate the course of the disease. METHODS An international expert panel of specialists produced by consensus the recommendations for the management of EB cases in Romania taking into account the local possibilities. Patient association proposals were included. A review of the literature was performed to up-date the information. OUTCOMES A strategy for diagnosis, treatment and follow-up of the patients with EB was elaborated in clear steps. Pharmacological treatments and wound care indications are provided together with a useful score for patient evaluation. CONCLUSION These recommended strategies are allowing dermatologists to generate an individualized care plan for patients with EB.
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Affiliation(s)
- Carmen Maria Salavastru
- Colentina Dermatology Clinic 2, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - Eli Sprecher
- Tel Aviv Sourasky Medical Center, Department of Dermatology, Tel Aviv, Israel
| | | | - Johann Bauer
- Universitätsklinik für Dermatologie, Salzburg, Austria
| | - Caius Silviu Solovan
- Dermatology Clinic, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Virgil Patrascu
- Dermatology Clinic, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Anca Tudorache
- Dermatology Clinic 2, "Colentina" Clinical Hospital, Bucharest, Romania
| | | | - Irene Tagliente
- Direzione Scientifica, Area di Ricerca Innovazioni Clinico-Tecnologiche, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Annalisa Ciasulli
- Dipartimento di Medicina Pediatrica UOC di Dermatologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- Dipartimento di Medicina Pediatrica,UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Giuseppe Sabatino
- Direzione Scientifica, Area di Ricerca Malattie Genetiche e Rare, UOC Broncopneumologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Rodica Cosgarea
- Dermatology clinic, "Iuliu Hatieganu" University of medicine and Pharmacy Cluj Napoca, Romania
| | | | - George-Sorin Tiplica
- Colentina Dermatology Clinic 2, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
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Rosati P, Boldrini R, Devito R, Menditto A, Barbuti D, Nibbi F, Mancini S, Reale A, Vignati E, Romanini M, Iannelli M, Marchili MR, Fierimonte V, Castelli M, Vitale L, Villani A. A child with painful legs. Lancet 2005; 365:1438. [PMID: 15836894 DOI: 10.1016/s0140-6736(05)66381-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paola Rosati
- Department of Paediatric Medicine, Bambino Gesù Children's Hospital National Institute of Health, Rome, Italy.
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Currò V, Belli P, Bianchi A, Giovanelli R, Marchili MR, Procaccini M. [The early diagnosis of congenital hip dysplasia: a proposal for a differentiated echographic screening]. Pediatr Med Chir 1994; 16:353-7. [PMID: 7816698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Prevention of congenital hip dislocation is one of the main goals of pediatric activity. 839 newborn outpatients, with six months follow-up at least, were recruited at the Pediatric Clinic of the Catholic University of Rome, from January 1991 to December 1992. Every newborn baby was clinically examined for congenital hip dysplasia (CHD) at nursery and afterwards in the ambulatory. Hip sonography was performed, according to Graf's technique, in 504 babies (60%): 17 resulted pathological (3.3%), 30 borderline (6%) and 457 normal (90.7%). Ultrasonographic and clinical findings were compared. Clinical examinations at nursery and ambulatory have shown low sensitivity (21.3% and 34% respectively) in detecting dysplastic hips. Present experience confirms ultrasonography value in the diagnosis of CHD and the utility of its use in a general screening programme.
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Affiliation(s)
- V Currò
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore di Roma, Italia
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Currò V, Delogu A, La Cava G, Marchili MR, Cascioli E, Procaccini M, Cosentino L, Polidori G, Carboni M. [Otitis media in childhood: a critical review of the literature]. Pediatr Med Chir 1992; 14:167-80. [PMID: 1508754] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Infection of the middle ear is one of the most common childhood illnesses accounting for one-third of the pediatrics practice during the first five years of life. Therefore treatment and prevention of the otitis media are of considerable importance. A review of the literature of the otitis media during the pediatric age is reported. In fact in the last years a large amount of knowledge, sometimes referring discordant opinions, has been acquired. The Authors report epidemiology, anatomy, pathology, physiology, microbiology, classification, clinical data diagnosis and therapy of the otitis media. Common conditions of the middle ear (normal, acute otitis media, chronic otitis media, recurrent otitis media) are described. In particular acute otitis media, otitis media with effusion, perforation of the tympanic membrane, fluid level in the middle ear, severe retraction or bulging of the tympanic membrane are pointed out in color-photographs.
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Affiliation(s)
- V Currò
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Roma, Italia
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