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Roversi M, Musolino A, Di Giuseppe M, Tripiciano C, Cursi L, Lancella L, Krzysztofiak A. Back to the Future: Intravenous Fosfomycin is Safe and Effective for the Treatment of Complicated Infections in Children. Pediatr Infect Dis J 2024; 43:426-429. [PMID: 38295231 DOI: 10.1097/inf.0000000000004263] [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: 02/02/2024]
Abstract
BACKGROUND Despite its broad spectrum and excellent safety profile, fosfomycin is still rarely used in pediatrics, with very limited experience from clinicians. METHODS We retrospectively reviewed the medical records of all children admitted to Bambino Gesù Children's Hospital, IRCCS, Rome, Italy, and treated with fosfomycin for any serious infection. Children with immunodeficiency and oncologic diseases were excluded. Of each, we reported and analyzed demographic and clinical data. RESULTS The clinical charts of 20 patients were reviewed and analyzed. The mean age was 10.2 years. Most children were males (85%). Most patients treated had an osteo-articular infection (65%). In our sample, 7 patients (35%) had an underlying comorbidity. The causative agent was isolated in 14 cases (70%). All patients were treated with a combination of 2-3 antibiotics, including fosfomycin. The average duration of antibiotic treatment was 18 days. After treatment, 8 patients (40%) experienced a mild adverse reaction, possibly correlated with the administration of fosfomycin. All patients were discharged in good clinical condition. CONCLUSIONS The present study reports on a sample of pediatric patients with complicated infections where administration of fosfomycin led to eradication of the disease with little or no side effects. Role of the underlying condition and concomitant medication in causing the reaction could not be ruled out. These data suggest that fosfomycin is an effective and safe antibiotic in the pediatric population, particularly for deep-seated infections sustained by multi-drug resistant pathogens.
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Affiliation(s)
- Marco Roversi
- From the PhD program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Martina Di Giuseppe
- Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Costanza Tripiciano
- Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Cursi
- Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Raucci U, Roversi M, Ferretti A, Faccia V, Garone G, Panetta F, Mariani C, Rizzotto E, Torelli A, Colafati GS, Aulisa AG, Parisi P, Villani A. Pediatric torticollis: clinical report and predictors of urgency of 1409 cases. Ital J Pediatr 2024; 50:86. [PMID: 38659045 PMCID: PMC11044417 DOI: 10.1186/s13052-024-01653-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND To date, the etiology and risk factors of torticollis are still poorly defined in the pediatric literature. Especially in the Emergency Department (ED) scenario, it is critical to reliably distinguish benign and transient conditions from (potentially) life-threatening disorders. This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and predictive variables associated with a higher risk of life-threatening conditions in acute torticollis. METHODS We conducted a pediatric retrospective study of acute torticollis over a 13-year period referred to the ED of a tertiary pediatric Hospital. We reported the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we developed a multivariate model aimed at identifying the main clinical predictors of the need for urgent care. RESULTS 1409 patients were analyzed (median age 5.7 years, IQR 5.8). A history of trauma was present in 393 patients (27.9%). The symptom most frequently associated with torticollis were pain (83.5%). At least one pathological finding was found in 5.4 to 7.9% of patients undergoing further imaging. Hospitalization was required in 11.1% of cases (median duration 4 days). The most frequent etiologies of torticollis were postural cause (43.1%), traumatic (29.5%), and infective/inflammatory (19.1%). A longer time from onset of torticollis and the presence of headache or vomiting were strongly correlated with an underlying urgent condition, after adjusting for the other clinically and statistically significant variables in the bivariate analysis. CONCLUSION Our study shows that an urgent condition most commonly occur in patients presenting with history of trauma or headache, vomiting and torticollis for more than 24 h should undergo further diagnostic evaluation and short-term follow-up, restricting invasive or expensive investigations to patients with clinical suspicion of an underlying harmful condition.
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Affiliation(s)
- Umberto Raucci
- Institute of Child and Adolescent Health, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- General Pediatrics and ED 2nd Level, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- PhD Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Ferretti
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valerio Faccia
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giacomo Garone
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Neurology, Epilepsy and Movement Disorders Unit, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Panetta
- General Pediatrics and Emergency Department 2nd Level, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Mariani
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Eloisa Rizzotto
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Torelli
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | | | - Angelo Gabriele Aulisa
- Orthopaedics and Traumatology Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043, Cassino, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alberto Villani
- General Pediatrics and Emergency Department 2nd Level, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
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Romani L, Roversi M, Bernardi S, Venturini E, Garazzino S, Donà D, Krzysztofiak A, Montagnani C, Funiciello E, Calò Carducci FI, Marabotto C, Castagnola E, Salvini F, Lancella L, Lo Vecchio A, Galli L, Castelli Gattinara G. Use of Remdesivir in children with COVID-19: report of an Italian multicenter study. Ital J Pediatr 2024; 50:32. [PMID: 38413992 PMCID: PMC10900665 DOI: 10.1186/s13052-024-01606-z] [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: 09/28/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study conducted in 10 Italian Hospitals to investigate the safety of RDV in children affected by COVID-19. METHODS We collected the clinical data of children with COVID-19 treated with RDV between March 2020 and February 2022 in 10 Italian hospitals. Clinical data were compared according to a duration of RDV therapy more or less than 5 days. Linear regression model was used to determine the association of significant variables from the bivariate analysis to the duration of RDV therapy. RESULTS A total of 50 patients were included, with a median age of 12.8 years. Many patients had at least one comorbidity (78%), mostly obesity. Symptoms were fever (88%), cough (74%) and dyspnea (68%). Most patients were diagnosed with pneumonia of either viral and/or bacterial etiology. Blood test showed leukopenia in 66% and increased C-reactive protein (CRP) levels in 63% of cases. Thirty-six patients received RDV for 5 days, nine patients up to 10 days. Most children who received RDV longer were admitted to the PICU (67%). Treatment with RDV was well tolerated with rare side effects: bradycardia was recorded in 6% of cases, solved in less than 24 h after discontinuation. A mild elevation of transaminases was observed in 26% of cases, however for the 8%, it was still detected before the RDV administration. Therefore, in these cases, we could not establish if it was caused by COVID-19, RDV o both. Patients who received RDV for more than 5 days waited longer for its administration after pneumonia diagnosis. The presence of comorbidities and the duration of O2 administration significantly correlated with the duration of RDV therapy at the linear regression analysis. CONCLUSION Our experience indicates that RDV against SARS-CoV-2 is safe and well-tolerated in pediatric populations at high risk of developing severe COVID-19. Our data suggest that delaying RDV therapy after diagnosis of pneumonia may be associated with a longer duration of antiviral therapy, especially in patients with comorbidities.
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Affiliation(s)
- Lorenza Romani
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- PhD Course "Immunology, Molecular Medicine and Applied Biotechnology", University of Rome Tor Vergata, Rome, Italy
| | - Stefania Bernardi
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisa Funiciello
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Caterina Marabotto
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elio Castagnola
- Hematology and Oncology, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filippo Salvini
- Pediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Lancella
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
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Garone G, Roversi M, Pisani M, La Penna F, Musolino A, Cristaldi S, Musolino AM, Roberto A, Petrocelli G, Reale A, Midulla F, Villani A, Raucci U. Acute Pupillary Disorders in Children: A 10-Year Retrospective Study of 101 Patients. Children (Basel) 2023; 10:1739. [PMID: 38002830 PMCID: PMC10670392 DOI: 10.3390/children10111739] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. METHODS We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. RESULTS We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. CONCLUSIONS Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.
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Affiliation(s)
- Giacomo Garone
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Marco Roversi
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy (A.M.)
| | - Mara Pisani
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Francesco La Penna
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy (A.M.)
| | - Sebastian Cristaldi
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Anna Maria Musolino
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Amanda Roberto
- School of Pediatrics, Department Mother-Child and Urologic Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Gianni Petrocelli
- Department of Ophthalmology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Antonino Reale
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Fabio Midulla
- Department Mother-Child and Urologic Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Alberto Villani
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
- Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Umberto Raucci
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
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Tambucci R, Roversi M, Rea F, Malamisura M, Angelino G, Biondi I, Simeoli R, Goffredo BM, Francalanci P, Simonetti A, Livadiotti S, Corsetti T, Dall'Oglio L, Rossi P, Pontrelli G, De Angelis P. Oral Viscous Budesonide in Children With Eosinophilic Esophagitis After Repaired Esophageal Atresia: A Clinical Trial. J Pediatr Gastroenterol Nutr 2023; 77:249-255. [PMID: 37195886 DOI: 10.1097/mpg.0000000000003830] [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: 05/19/2023]
Abstract
OBJECTIVES A high prevalence of eosinophilic esophagitis (EoE) has been reported in children with repaired esophageal atresia (EA). Topical steroids proved to be an effective and safe therapy in EoE, although not approved in pediatrics. We report the results of the first clinical trial of oral viscous budesonide (OVB) performed in children with EoE after repaired esophageal atresia (EoE-EA). METHODS This open-label, single-arm, phase 2 clinical trial with randomized pharmacokinetic sampling, was conducted at the Bambino Gesù Children's Hospital between September 2019 and June 2021. EoE-EA patients received an age-banded dose of OVB twice daily for 12 weeks and were endoscopically evaluated. The primary endpoint was the rate of patients achieving histological remission. Secondary endpoints included clinical and endoscopic benefit after treatment, and safety assessments. RESULTS Eight consecutive EA-EoE patients were enrolled (median age 9.1 years, interquartile range 5.5). Of these, 5 received 0.8 mg and 3 received 1.0 mg twice daily of OVB. Histological remission was obtained in all but 1 patient (87.5%). The clinical score showed significant improvement at the end of treatment in all patients. No endoscopic features of EoE were found after treatment. No treatment-emergent adverse event occurred. CONCLUSION OVB is an effective, safe, and well-tolerated formulation of budesonide for use in pediatric patients with EoE-EA.
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Affiliation(s)
- Renato Tambucci
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Roversi
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Rea
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Monica Malamisura
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giulia Angelino
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Isabella Biondi
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Raffaele Simeoli
- the Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Bianca Maria Goffredo
- the Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paola Francalanci
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Simonetti
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Susanna Livadiotti
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Tiziana Corsetti
- the Unit of Clinical Pharmacy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luigi Dall'Oglio
- the Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Pontrelli
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paola De Angelis
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Roversi M, Coltella L, Piccioni L, Raucci U, Torelli A, Papini L, Olita C, Reale A, Perno CF, Villani A, Russo C. Relationship between viral load and symptoms in children infected with SARS-CoV-2. Pediatr Res 2023; 93:897-904. [PMID: 36071238 PMCID: PMC9451120 DOI: 10.1038/s41390-022-02293-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the association between SARS-CoV-2 viral load in respiratory secretions of infected children and signs/symptoms of COVID-19. METHODS We reported the clinical characteristics of SARS-CoV-2-infected children during the study period. We compared viral load for several clinical variables, performed a predictive linear regression analysis to identify signs and symptoms significantly associated with viral load, and searched for discriminant viral load thresholds for symptomatic versus asymptomatic infections based on receiver-operating characteristics. RESULTS A total of 570 patients were included. The median age was 4.75 years. Comparison of CT values by dichotomous variable showed higher viral loads in children with fever, respiratory symptoms, and previous exposure to SARS-CoV-2. The linear regression analysis confirmed a significant relationship between the CT value with these variables and with age, other symptoms, and asymptomaticity. In particular, infants with fever and SARS-CoV-2 exposure had higher viral loads. No viral load cut-offs were found to distinguish symptomatic from asymptomatic patients. CONCLUSION Our study shows that fever, SARS-CoV-2 exposure, and respiratory symptoms are associated with higher viral load in children, especially infants, while age, presence of nonrespiratory symptoms, or absence of any symptoms are associated with lower viral load. IMPACT Key message: the clinical variables that best predict viral load in infected children are history of previous exposure to a SARS-CoV-2-infected person and presence of fever and respiratory symptoms (higher viral load). Added value to the current literature: this is the first article to prove this point. IMPACT SARS-CoV-2 viral load should not be used as a measure of clinical severity of COVID-19 in the pediatric population; however, lower viral load appears to be associated with asymptomatic COVID-19 in older children.
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Affiliation(s)
- Marco Roversi
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Luana Coltella
- Microbiology and Immunology Diagnostics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Livia Piccioni
- Microbiology and Immunology Diagnostics, 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.
| | - Antonio Torelli
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Laura Papini
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carla Olita
- 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
| | - Carlo Federico Perno
- Microbiology and Immunology Diagnostics, 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
| | - Cristina Russo
- Microbiology and Immunology Diagnostics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Marano M, Roversi M, Severini F, Memoli C, Musolino A, Pisani M, Cecchetti C, Villani A. Adverse drugs reactions to paracetamol and ibuprofen in children: a 5-year report from a pediatric poison control center in Italy. Ital J Pediatr 2023; 49:20. [PMID: 36788576 PMCID: PMC9925930 DOI: 10.1186/s13052-023-01427-6] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This study aimed to analyze all the patients who contacted the hospital's pediatric poison control center (PPCC) for exposure to ibuprofen and acetaminophen, in order to assess the incidence of any adverse reactions. METHODS We retrospectively reported the clinical data of children who accessed the PPCC of the Bambino Gesù Children's Hospital, IRCCS, Rome, from January 1, 2018 to September 30, 2022 due to wrong, accidental or intentional intake of inappropriate doses of acetaminophen and/or ibuprofen. In addition, we compared patients according to the intake of one of the two drugs and reported the trimestral distribution of cases during the study period. RESULTS A total of 351 patients accessed the PPCC during the study period. The median age was 3.0 years. Most patients were females (57.8%). The most common reason for inappropriate oral intake of paracetamol or ibuprofen was a wrong use or an accidental intake (78.6%), with a fifth of patients taking the drug with suicidal intent (21.1%). According to the PPCC evaluation, most patients were not intoxicated (70.4%). Hospitalization was required for 30.5% of patients. Adverse reactions were reported in 10.5% of cases, with a similar incidence in patients who took paracetamol or ibuprofen. Nausea and vomiting were the most commonly reported adverse reactions. A higher frequency of moderate intoxication was found in patients who took paracetamol compared to ibuprofen (p = 0.001). The likelihood of intoxication was also higher in the paracetamol cohort. A spike of cases was registered at the end of 2021. CONCLUSIONS We analyze exposures to the two most commonly used pediatric molecules, paracetamol and ibuprofen, to assess the frequency of adverse reactions. We demonstrated that these relatively "safe" drugs may be associated with intoxications and adverse reactions when inappropriately administered.
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Affiliation(s)
- Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. .,Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Severini
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Memoli
- grid.414125.70000 0001 0727 6809Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Corrado Cecchetti
- grid.414125.70000 0001 0727 6809Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
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9
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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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10
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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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11
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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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12
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Krzysztofiak A, Roversi M, Musolino A, Cirillo M, Toniolo RM, Mazza O, Gargiullo L, Lancella L, Rossi P, Villani A. Clinical report and predictors of sequelae of 319 cases of pediatric bacterial osteomyelitis. Sci Rep 2022; 12:14846. [PMID: 36050441 PMCID: PMC9437046 DOI: 10.1038/s41598-022-19208-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric osteomyelitis is an insidious disease that can lead to permanent sequelae, the management of which still relies on lengthy intravenous antibiotic therapy. The purpose of this study is to report and describe the clinical course and outcome of pediatric bacterial osteomyelitis in our experience. We reported the clinical, diagnostic, and treatment characteristics of all cases of osteomyelitis in children younger than 18 years of age who were hospitalized between January 2010 and December 2021 at the Bambino Gesù Children’s Hospital in Rome, Italy, we compared patients with and without complications at follow-up, to identify any predictive factor for sequelae. The study sample included 319 cases of pediatric bacterial osteomyelitis. The median age was 7.77 years. Males (60.8%) were more affected than females. The most affected bones were the femur, tibia, and spine. Etiology was identified in 40.1% of cases, with S.aureus as the most common causative agent. Sequelae were reported in 43 cases (13.5%). The main predictors of sequelae were sepsis on admission and hypergammaglobulinemia. Our results show that a severe presentation with sepsis and hypergammaglobulinemia on admission may be associated with a higher frequency of late sequelae. Early recognition and aggressive treatment of this subgroup of patients may lead to a reduction in complications.
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Affiliation(s)
- Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Antonio Musolino
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Maria Toniolo
- Traumatology Unit, Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Livia Gargiullo
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Alberto Villani
- 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, Ferrara P, Spina G, Villani A, Roversi M, Raponi M, Corsello G, Staiano A. The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era. Ital J Pediatr 2022; 48:126. [PMID: 35897109 PMCID: PMC9326438 DOI: 10.1186/s13052-022-01324-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023] Open
Abstract
Background Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations. Material and methods A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded. Results During the study period, a total of 533,318 children were admitted to the pED involved in the study. Despite a 48.2% decline of pED admissions, there was a significant increase (83.1%) in patient admissions for NPD. The most frequent NPD conditions which increased during the COVID-19 pandemic were suicidal ideation (+ 147%), depression (+ 115%), eating disorder (+ 78.4%), and psychosis (+ 17.2%). During the pandemic period, a 39.5% increase in NPD hospitalizations was observed as well. The NPD disorders that mostly required hospitalizations were suicidal ideation (+ 134%), depression (+ 41.4%), eating disorder (+ 31.4%), and drug abuse (+ 26.7%). COVID-19 pandemic had a major impact on children's health, mainly on their NPD development. Neuropsychological assessment should be required at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment and provide an adequate treatment. Conclusion SIP underlines the psychological consequences of COVID 19 pandemic on the youngest and recommends an early identification of NPD in the pediatric population to avoid other serious consequences for children's physical and mental health. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01324-4.
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Affiliation(s)
| | | | - Giulia Spina
- The Italian Pediatric Society, 00100, Rome, Italy.
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14
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Raucci U, Stanco M, Roversi M, Ponticiello E, Pisani M, Rosa M, Falsaperla R, Pavone P, Bondone C, Raffaldi I, Calistri L, Masi S, Reale A, Villani A, Marano M. Acquired methemoglobinemia in children presenting to Italian pediatric emergency departments: a multicenter report. Clin Toxicol (Phila) 2022; 60:920-925. [PMID: 35416740 DOI: 10.1080/15563650.2022.2061986] [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] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Methemoglobinemia (MetHb) is a rare inherited or acquired cause of cyanosis in children. Owing to its rarity, case reports and case series are mostly available in the current literature. This study reports data on a large sample of children with acquired MetHb. METHODS Data on patients admitted for acquired MetHb between January 2007 to December 2020 was extracted from the databases of five Italian pediatric emergency departments (EDs). Demographical and clinical characteristics was reported and discussed. RESULTS Nineteen cases of acquired MetHb were evaluated. Ten patients (52.6%) were male and 9 (47.4%) were female. The median age was 8.23 months. The median time from trigger to symptom onset was 6 hours. Mostly, the intoxication presumptively occurred by home ingestion of contaminated food, mainly badly preserved vegetable broth. All patients were cyanotic at admission, most patients also presented tachycardia and/or tachypnea, and two patients were comatose. Antidotal therapy with methylene blue was given in 14 patients (73.7%). The median hospital stay was 2 days. All patients survived. DISCUSSION As MetHb leads to the pathognomonic brown blood discoloration, blood gas analysis is mandatory immediately upon hospital arrival of a cyanotic patient. A correct medical history is crucial to identify the trigger and remove it. In our sample, the age onset was much lower than in the previous literature, and MetHb mainly due to ingestion of contaminated vegetable broth. Methylene blue led to a rapid recovery in all patients. Oxygen therapy may well lead to complete recovery when methemoglobin levels do not exceed 30% in asymptomatic and 20% in mildly symptomatic patients. CONCLUSIONS The diagnosis and management of acquired MetHb in the emergency setting requires acknowledgment of this condition as a cause of cyanosis in the weaning child. Indeed, when promptly recognized and treated, this severe condition rapidly resolves with no significant acute sequelae.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Stanco
- Department of Women, Children And General and Specialist Surgery, University of the Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, University of Rome Tor Vergata, Residency School of Pediatrics, Rome, Italy
| | | | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Margherita Rosa
- Dipartimento di Area Critica, AORN Santobono Pausilipon, Naples, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy.,Unit of Pediatrics and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Piero Pavone
- Division of Pediatrics and Pediatric Emergency, University Hospital Policlinico "Rodolico-San Marco," Catania, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, 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
| | - Marco Marano
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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15
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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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Spina G, Bozzola E, Carsetti R, Mortari EP, Mascolo C, Roversi M, Villani A. Correction to: Follow-up evaluation of the immunological status of children admitted for acute cerebral nervous system infections: a retrospective study. Ital J Pediatr 2021; 47:213. [PMID: 34715896 PMCID: PMC8556912 DOI: 10.1186/s13052-021-01171-9] [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: 11/22/2022] Open
Affiliation(s)
- Giulia Spina
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Bozzola
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Carsetti
- B cell Physiopathology Unit, Immunology Research Area,Bambino Gesù Children Hospital, Rome, Italy
| | - Eva Piano Mortari
- B cell Physiopathology Unit, Immunology Research Area,Bambino Gesù Children Hospital, Rome, Italy
| | - Cristina Mascolo
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Krzysztofiak A, Chiappini E, Venturini E, Gargiullo L, Roversi M, Montagnani C, Bozzola E, Chiurchiu S, Vecchio D, Castagnola E, Tomà P, Rossolini GM, Toniolo RM, Esposito S, Cirillo M, Cardinale F, Novelli A, Beltrami G, Tagliabue C, Boero S, Deriu D, Bianchini S, Grandin A, Bosis S, Ciarcià M, Ciofi D, Tersigni C, Bortone B, Trippella G, Nicolini G, Lo Vecchio A, Giannattasio A, Musso P, Serrano E, Marchisio P, Donà D, Garazzino S, Pierantoni L, Mazzone T, Bernaschi P, Ferrari A, Gattinara GC, Galli L, Villani A. Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children. Ital J Pediatr 2021; 47:179. [PMID: 34454557 PMCID: PMC8403408 DOI: 10.1186/s13052-021-01130-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acute hematogenous osteomyelitis (AHOM) is an insidious infection of the bone that more frequently affects young males. The etiology, mainly bacterial, is often related to the patient's age, but it is frequently missed, owing to the low sensitivity of microbiological cultures. Thus, the evaluation of inflammatory biomarkers and imaging usually guide the diagnosis and follow-up of the infection. The antibiotic treatment of uncomplicated AHOM, on the other hand, heavily relies upon the clinician experience, given the current lack of national guidelines for the management of this infection. METHODS A systematic review of the studies on the empirical treatment of uncomplicated AHOM in children published in English or Italian between January 1, 2009, and March 31, 2020, indexed on Pubmed or Embase search engines, was carried out. All guidelines and studies reporting on non-bacterial or complicated or post-traumatic osteomyelitis affecting newborns or children older than 18 years or with comorbidities were excluded from the review. All other works were included in this study. RESULTS Out of 4576 articles, 53 were included in the study. Data on different topics was gathered and outlined: bone penetration of antibiotics; choice of intravenous antibiotic therapy according to the isolated or suspected pathogen; choice of oral antibiotic therapy; length of treatment and switch to oral therapy; surgical treatment. CONCLUSIONS The therapeutic management of osteomyelitis is still object of controversy. This study reports the first Italian consensus on the management of uncomplicated AHOM in children of pediatric osteomyelitis, based on expert opinions and a vast literature review.
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Affiliation(s)
- Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Chiappini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Livia Gargiullo
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlotta Montagnani
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Bozzola
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Chiurchiu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Vecchio
- Rare Disease and Medical Genetics, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elio Castagnola
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Renato Maria Toniolo
- Surgery Department, Traumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Andrea Novelli
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Silvio Boero
- Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy
| | - Daniele Deriu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Annalisa Grandin
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Martina Ciarcià
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Daniele Ciofi
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Trippella
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | | | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Paola Musso
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Serrano
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Paola Bernaschi
- Microbiology Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | | | | | - Luisa Galli
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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18
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Bozzola E, Staiano AM, Spina G, Zamperini N, Marino F, Roversi M, Corsello G. Social media use to improve communication on children and adolescent's health: the role of the Italian Paediatric Society influencers. Ital J Pediatr 2021; 47:171. [PMID: 34380533 PMCID: PMC8355871 DOI: 10.1186/s13052-021-01111-7] [Citation(s) in RCA: 6] [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: 03/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Fake news on children’s and adolescent health are spreading. Internet availability and decreasing costs of media devices are contributing to an easy access to technology by families. Public health organizations are working to contrast misinformation and promote scientific communication. In this context, a new form of communication is emerging social media influencers. Aim of this study is to evaluate the role of paediatric influencers (PI) in communicating information about children and adolescents’ health. Materials and methods A group of PI was enrolled from December 2019 to January 2020 by a scientific commission nominated by the Italian Paediatric Society (SIP). PI were asked to share Facebook messages from the official page of the SIP to their own network. Social media tools have been evaluated across 12 months, from July 28, 2019, to July 11, 2020. For the purposes of clarity, we schematically divided the study period as follows: the period of PIs activity (January 6, 2020, to July 11, 2020) and the period when PIs were not yet active (July 28, 2019, to January 4, 2020). Information on Facebook page (lifetime total likes, daily new likes, daily page engaged, daily total reach) and on published post (lifetime post total reach, lifetime post organic reach, lifetime engaged users) were evaluated. Results A significant increase in Facebook daily new likes, page engagement and total reach, as well as in lifetime post total and organic reach was evidenced. As for PI, they reported a positive experience in most cases. Discussion In the digital era, communication strategies are becoming more important, so that the scientific community has to be actively involved in social media communication. Our pilot study demonstrated that the recruitment of paediatric influencers has increased communication and interaction of the SIP Facebook page. Conclusion Our study shows the potential role of influencers: spreading health messages via PI seems to be a successful strategy to promote correct communication about children’s and adolescents’ health.
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Affiliation(s)
- Elena Bozzola
- The Italian Paediatric Society, via Gioberti 60, Rome, Italy.
| | | | - Giulia Spina
- The Italian Paediatric Society, via Gioberti 60, Rome, Italy
| | | | | | - Marco Roversi
- The Italian Paediatric Society, via Gioberti 60, Rome, Italy
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Pontrelli G, Cimini G, Roversi M, Gabrielli A, Salina G, Bernardi S, Rocchi F, Simonetti A, Giaquinto C, Rossi P, Sylos Labini F. Prioritizing the First Doses of SARS-CoV-2 Vaccine to Save the Elderly: The Case Study of Italy. Front Public Health 2021; 9:684760. [PMID: 34336771 PMCID: PMC8318130 DOI: 10.3389/fpubh.2021.684760] [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] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
SARS-CoV-2 is currently causing hundreds of deaths every day in European countries, mostly in not yet vaccinated elderly. Vaccine shortage poses relevant challenges to health authorities, called to act promptly with a scarcity of data. We modeled the mortality reduction of the elderly according to a schedule of mRNA SARS-CoV-2 vaccine that prioritized first dose administration. For the case study of Italy, we show an increase in protected individuals up to 53.4% and a decrease in deaths up to 19.8% in the cohort of over 80's compared with the standard vaccine recalls after 3 or 4 weeks. This model supports the adoption of vaccination campaigns that prioritize the administration of the first doses in the elderly.
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Affiliation(s)
- Giuseppe Pontrelli
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
| | - Giulio Cimini
- Physics Department and Istituto Nazionale di Fisica Nucleare, University of Tor Vergata, Rome, Italy.,Enrico Fermi Research Center, Rome, Italy
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
| | - Andrea Gabrielli
- Enrico Fermi Research Center, Rome, Italy.,Engineering Department, Roma Tre University, Rome, Italy
| | - Gaetano Salina
- Physics Department and Istituto Nazionale di Fisica Nucleare, University of Tor Vergata, Rome, Italy.,Enrico Fermi Research Center, Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
| | - Francesca Rocchi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
| | - Alessandra Simonetti
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
| | - Carlo Giaquinto
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy.,Department of Pediatrics, University of Padua, Padua, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,University of Tor Vergata, Rome, Italy
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Bozzola E, Spina G, Marsella P, Scorpecci A, Mascolo C, Salvatori M, Roversi M, Villani A. Predicting Parameters for Audiological Complications in Pediatric Patients Affected by Meningitis. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1731712] [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: 10/20/2022]
Abstract
Abstract
Objective Meningitis is one of the most common causes of acquired sensorineural hearing loss in childhood. The aim of this study was to identify parameters predicting long-term audiological complications in meningitis.
Methods Patients under 18 years admitted to the Bambino Gesù Pediatric Hospital between March 2001 and February 2019 with a diagnosis of meningitis entered the study. Audiological complications had been investigated during hospitalization and at follow-up.
Results During the study period, 425 patients were enrolled. Sensorineural hearing loss was observed in 48 patients (11.3%). Multivariate analysis has shown that female gender predisposes to the development of permanent hearing loss after meningitis. Hearing impairment was associated with pneumococcal etiology (p < 0.001), lethargy (p = 0.027), reduced cerebrospinal fluid glucose level (26.18 mg/dL, p = 0.004), increase in both C-reactive protein (17.77 mg/dL, p = 0.001), and erythrocyte sedimentation rate (106.3 mm/h, p = 0.004). At follow-up, 19 patients had a persisting hearing damage, 7 recovered their hearing capacity and 20 were lost to follow-up. Among patients with permanent hearing damage, treatment was necessary in 16 patients. In details, 6 patients required external hearing aids and 10 patients required a cochlear implant.
Conclusions Female gender, lethargy at onset, reduced cerebrospinal fluid glucose level, increased inflammation index, and pneumococcal etiology are correlated with sensorineural hearing damage in meningitis patients.
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Affiliation(s)
- Elena Bozzola
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Giulia Spina
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Pasquale Marsella
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
- Audiological Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Alessandro Scorpecci
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
- Audiological Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Cristina Mascolo
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Martina Salvatori
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Marco Roversi
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Alberto Villani
- Paediatric and Infectious Diseases Unit, Bambino Gesù Children Hospital, Roma, Italy
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21
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Roversi M, Chiappini E, Toniolo RM, Cirillo M, Natale F, Deriu D, Grandin A, Lancella L, Galli L, Villani A, Krzysztofiak A. Neonatal osteomyelitis: an Italian multicentre report of 22 cases and comparison with the inherent literature. J Perinatol 2021; 41:1293-1303. [PMID: 33686117 DOI: 10.1038/s41372-021-00956-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 07/22/2020] [Revised: 11/20/2020] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The primary objective of this study is to report and compare our data with the most relevant literature of the past decade about neonatal osteomyelitis. STUDY DESIGN We retrospectively review the data of 22 subjects aged 35 days or less who were admitted to three different sites in Italy with a radiological diagnosis of osteomyelitis. The inherent literature was searched and reviewed: five studies were considered for comparison with our data. RESULTS All the neonates, except three (two pre-term and one post-term), were born at term. The male to female ratio was 1.75 (14 males and 8 females). The mean age at presentation was 19.5 days. The most common presenting signs of the infection were local swelling and reduced mobility of the affected segment. The most common sites of infection were the femur, humerus, and tibia. The mean duration of intravenous antibiotic therapy was 29.5 days. In most neonates the diagnosis was prompt and the antibiotic treatment immediate. A low rate of sequelae was reported. All infants survived through follow up. The data from the inherent literature showed a wide variability, probably owing to the setting and the historical period of the different studies. CONCLUSION Neonatal osteomyelitis is an alarming yet poorly understood disease. Nonetheless, our report suggests that a quick diagnosis and treatment can be easily achieved, with good outcome on the remarkably plastic structure of neonatal bones.
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Affiliation(s)
- Marco Roversi
- University of Rome Tor Vergata, Residency School of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Chiappini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Renato Maria Toniolo
- Department of Orthopaedics and Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Natale
- Department of Maternal and Child Health and Urologic Science, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Daniele Deriu
- University of Rome Tor Vergata, Residency School of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Grandin
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Galli
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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22
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Marano M, Pisani M, Zampini G, Pontrelli G, Roversi M. Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach. Toxins (Basel) 2021; 13:toxins13050330. [PMID: 34063282 PMCID: PMC8170888 DOI: 10.3390/toxins13050330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.
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Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Giuseppe Pontrelli
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Roversi
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Correspondence:
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23
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Spina G, Elena B, Rita C, Eva PM, Mascolo C, Roversi M, Alberto V. Follow-up evaluation of the immunological status of children admitted for acute cerebral nervous system infections: a retrospective study. Ital J Pediatr 2021; 47:22. [PMID: 33531057 PMCID: PMC7851811 DOI: 10.1186/s13052-021-00973-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Background Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system. Methods Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations. Results Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age. Discussion Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions. Conclusions We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.
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Affiliation(s)
- Giulia Spina
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Bozzola Elena
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carsetti Rita
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Piano Mortari Eva
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Cristina Mascolo
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Villani Alberto
- University/Hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Panfili FM, Roversi M, D'Argenio P, Rossi P, Cappa M, Fintini D. Possible role of vitamin D in Covid-19 infection in pediatric population. J Endocrinol Invest 2021; 44:27-35. [PMID: 32557271 PMCID: PMC7299247 DOI: 10.1007/s40618-020-01327-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [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: 05/07/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Covid-19 is a pandemic of unprecedented proportion, whose understanding and management is still under way. In the emergency setting new or available therapies to contrast the spread of COVID-19 are urgently needed. Elderly males, especially those affected by previous diseases or with comorbidities, are more prone to develop interstitial pneumonia that can deteriorate evolving to ARDS (acute respiratory distress syndrome) that require hospitalization in Intensive Care Units (ICUs). Even children and young patients are not spared by SARS-CoV 2 infection, yet they seem to develop a milder form of disease. In this setting the immunomodulatory role of Vitamin D, should be further investigated. METHODS We reviewed the literature about the immunomodulatory role of Vitamin D collecting data from the databases Medline and Embase. RESULTS Vitamin D proved to interact both with the innate immune system, by activating Toll-like receptors (TLRs) or increasing the levels of cathelicidins and β-defensins, and adaptive immune system, by reducing immunoglobulin secretion by plasma cells and pro-inflammatory cytokines production, thus modulating T cells function. Promising results have been extensively described as regards the supplementation of vitamin D in respiratory tract infections, autoimmune diseases and even pulmonary fibrosis. CONCLUSIONS In this review, we suggest that vitamin D supplementation might play a role in the prevention and/or treatment to SARS-CoV-2 infection disease, by modulating the immune response to the virus both in the adult and pediatric population.
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Affiliation(s)
- F M Panfili
- Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - M Roversi
- Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - P D'Argenio
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - P Rossi
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - M Cappa
- Endocrinology Unit, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - D Fintini
- Endocrinology Unit, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy.
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25
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Roversi M, Mirra G, Musolino A, Barbuti D, Lancella L, Deriu D, Iorio C, Villani A, Crostelli M, Mazza O, Krzysztofiak A. Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis. Front Pediatr 2021; 9:727031. [PMID: 34746055 PMCID: PMC8567140 DOI: 10.3389/fped.2021.727031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: The aim of this study is to provide new data on pediatrics spondylodiscitis for an optimal clinical management of this site-specific osteomyelitis. Methods: We reported 48 cases of pediatric spondylodiscitis and made three comparisons between: (1) tubercular and non-tubercular cases; (2) patients aged more or less than 5 years; (3) children with spondylodiscitis and 62 controls with non-vertebral osteomyelitis. Results: A higher rate of sequelae was reported in patients with tubercular spondylodiscitis, but no significant differences were noted at the cut-off of 5 years of age. Compared to non-vertebral osteomyelitis, pediatric spondylodiscitis affects younger children of both genders, usually presenting with afebrile back pain, and requiring longer time to admission, hospitalization, and antibiotic therapy. Conclusion: Pediatric spondylodiscitis is an insidious disease with a non-specific presentation in childhood and peculiarities of its own. However, when clinical remission is obtained by an early start of broad-spectrum antibiotics, prolonging the therapy does not improve, nor worsens, the outcome. Surgical management is mandatory in case of vertebral instability and neurological signs but can be avoided when the infection is promptly treated with antibiotic therapy.
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Affiliation(s)
- Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Gianluca Mirra
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Antonio Musolino
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Domenico Barbuti
- Department of Imaging, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Daniele Deriu
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Carlo Iorio
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Marco Crostelli
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
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Abstract
Background: About a fifth of all mediastinal masses are primary cysts arising in the absence of other underlying pathology. Bronchogenic cysts, although rare, are the most frequent type responsible for lower airways compression as they often develop in the peripheral branches of the tracheobronchial tree. Case presentation: We report the case of a 6-months-old child admitted for acute respiratory distress and wheezing not responsive to asthma treatment. Digestive and airway endoscopy proved a mild and a marked reduction of the esophageal and tracheal lumen, respectively. The nocturnal polygraphy showed an underlying obstructive disorder and the chest CT scan confirmed the presence of a wide mediastinal cyst compressing the trachea. The mass, later identified as a bronchogenic cyst, was surgically removed with complete resolution of the patient's respiratory symptoms. Discussion: Our case shows that differential diagnosis of wheezing in pre-school aged children should encompass causes others than airway reactivity, thus prompting further evaluation and management.
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Affiliation(s)
- Marco Roversi
- Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Federica Porcaro
- Paediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Paediatrics, Research Institute, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola Francalanci
- Department of Pathology, Research Institute, Bambino Gesù Children's Hospital, Rome, Italy
| | - Adriano Carotti
- Unit of Pediatric Cardiac Surgery, Research Institute, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Paediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Paediatrics, Research Institute, Bambino Gesù Children's Hospital, Rome, Italy
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Roversi R, Rossi G, Ricci S, Roversi M, Pinelli G, Cavallo G. [Intra-arterial antiblastic treatment of breast carcinoma]. Radiol Med 1998; 95:211-6. [PMID: 9638168] [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: 02/07/2023]
Abstract
PURPOSE To report our personal experience with the locoregional treatment of breast cancer. MATERIAL AND METHODS Eighteen patients aged 33-67 years (mean: 54 years) were treated with 31 sessions of intra-arterial antiblastic infusion, 5 of them for neoadjuvant purposes (Group 1), 5 for palliation in unresectable tumors (Group 2) and 8 for cutaneous recurrences after mastectomy (Group 3). RESULTS 2/5 CR and 3/5 PR were obtained in Group 1; 2/5 lesions were made resectable and 3/5 RP obtained in stage III or unresectable lesions (Group 2). Finally, 3/8 CR, 3/8 PR, 1/8 SD and 1/8 PD were observed in Group 3. An objective response according to WHO criteria was demonstrated in 15/18 cases (88%). We had no post-treatment hematologic complications, but one patient presented focal subcutaneous sclerosis and one cutaneous necrosis. CONCLUSIONS The morphological efficacy of intraarterial antiblastic infusion in our series was similar to that of other series. No definitive conclusions can be drawn yet about clinical results and long-term survival. This poorly invasive and low risk procedure, which should be combined with other treatments, permits to reduce the extent of surgery and to treat skin recurrences.
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Affiliation(s)
- R Roversi
- Servizio di Radiologia Diagnostica, Ospedale Bellaria C. A. Pizzardi, Bologna
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Roversi R, Ricci S, Rossi G, Roversi M, Cavallo G. [Locoregional therapy with hypoxic liver perfusion in malignant neoplasms of the gallbladder. Preliminary experience]. Radiol Med 1997; 94:220-5. [PMID: 9446129] [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: 02/05/2023]
Abstract
PURPOSE We report four cases of advanced malignant cancer of the gallbladder treated with hypoxic hepatic perfusion. MATERIAL AND METHODS Hypoxic hepatic perfusion is currently used to treat diffuse hepatic metastases: the common hepatic artery is occluded with a balloon catheter and then a large amount of antiblastic solution is infused into the liver. Hypoxia and slow flow increase the effect of the drug on neoplastic tissue. Two sessions were performed in three patients with an interval ranging 2-4 months, while one patient underwent a single session. The drug was Mitomycin C, whose dose ranged 20-40 mg (mean: 30 mg). Blood filtration was performed after one of the six procedures only and can be considered unnecessary. RESULTS Acute gastric bleeding appeared in a patient after the embolization of the right gastric artery with bucrylate during the first session performed to avoid drug reflux into gastric wall arteries. No other technical or clinical complications occurred. An objective morphological response (tumor necrosis or reduction in size > 50%) was observed in all patients after the first session. CT findings were stable in two of three patients submitted to a second session, while local progression was observed in the other patient. Complete clinical response was achieved in all symptomatic patients. No WHO toxicity was observed. DISCUSSION AND CONCLUSIONS The rate of positive morphological and/or clinical responses after hypoxic perfusion was very high in our experience, even though our series was small. Recurrences were found in two patients some months later, which suggests the need of long-term follow-up. Hypoxic perfusion can be nevertheless considered as a new and interesting therapeutic approach for advanced malignant gallbladder cancer, with a strong short-term effect on the lesion and good results on clinical symptoms.
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Affiliation(s)
- R Roversi
- Servizio di Radiologia Diagnostica, Ospedale Bellaria C.A. Pizzardi, Bologna
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Roversi R, Ricci S, Rossi G, Cavallo G, Roversi M, Fiorentini G. [Results of flow-controlled antiblastic perfusions (stop-flow technique) carried out with percutaneous technique: 30-month experience]. Radiol Med 1997; 93:732-8. [PMID: 9411522] [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: 02/05/2023]
Abstract
PURPOSE We report the morphological and clinical results in a series of patients with advanced thoracopulmonary, abdominal, pelvic and lower limb tumors treated with stop-flow perfusion (SFP). MATERIAL AND METHODS We performed 77 SFPs with the percutaneous angiographic technique in 55 patients (25 women and 30 men; mean age: 53 years). Eighteen thoracic perfusions with aortocaval block (ASI) were performed in 11 patients, 33 abdominal hypoxic perfusions (HAP) in 26 patients, 17 hypoxic pelvic perfusion (HPP) in 11 patients and 9 hypoxic lower limb perfusions (HILP) in 7 patients. 42/77 procedures were followed by hemofiltration. RESULTS No technical complications were observed. Twenty-eight patients in our series are still alive (mean follow-up: 14 months) and 23 have died (mean survival: 8 months), 20/23 of them (87%) for disease progression. Three of 77 patients (3.8%) died within 7 days of the procedure (2 AS, 1 HAP). At CT or MR follow-up, responses > 50% were observed in 56% of the procedures and clinical CR was achieved in 53/77 patients (69%). In the subgroups classified by procedure, positive responses were observed in 56, 48, 59 and 78%, respectively for ASI, HAP, HPP and HLP. Clinical CR was observed in 67, 67, 71 and 78%, respectively. The death rate for disease progression relative to the overall death rate was 100, 86, 75 and 100%. Hematologic toxicity according to WHO criteria (mean: 2) was observed in 77% of the whole of procedures (59/77). Statistical analysis showed no relationship between morphological responses and type of antiblastic drug or previous antiblastic treatments. CONCLUSIONS SF procedures permit the effective control of many advanced tumors which cannot be treated otherwise, with a high rate of positive morphological and of complete clinical responses. The best results were obtained in hypoxic perfusion of the lower limb. The results were not correlated with previous antiblastic treatments. However, the high rate of sequels and the low hematologic tolerance of those procedures must be emphasized.
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Affiliation(s)
- R Roversi
- Servizio di Radiologia Diagnostica, Ospedale Bellaria-C.A. Pizzardi, Bologna
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Roversi R, Cavallo G, Ricci S, Rossi G, Roversi M, Fiorentini G. [Antiblastic hypoxic stop-flow perfusion in the treatment of liver metastasis: preliminary results]. Radiol Med 1997; 93:410-7. [PMID: 9244920] [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: 02/04/2023]
Abstract
PATIENTS AND METHODS 27 patients (14 men and 13 women aged 35 to 71 years; average: 59 years), with 3-11 months' follow-up (average: 5 months) were treated for hepatic metastases (17/22 from colorectal, 10/22 from other primary tumors) with hypoxic locoregional hepatic perfusion. Sixteen of 22 patients had been pretreated with resection, systemic chemotherapy or freeflow locoregional infusion. Our protocol consists in blocking arterial flow with an occlusion balloon catheter inflated in the hepatic artery; the main catheter channel is connected with a pump system and 250-300 ml saline with 30-40 mg Mitomycin C are perfused in the arterial hepatic system. Embolization with a gelatin sponge is performed after the end of perfusion. RESULTS 19/27 patients are still alive, and 8/27 are dead but death was caused by the progression of intrahepatic disease in only 2/27 (7%). Iatrogenic lesions of the arterial wall were shown at follow-up DSA in 15/22 patients (56%). Thirteen CR (48%) and 9 PR (33%) were demonstrated at CT follow-up, amounting to 81% of objective responses. Follow-up showed a clinical CR in 12/18 symptomatic patients (66%). No case of hematologic toxicity was observed. Mean CEA values changed from 129 to 10.60. Twelve of 27 patients exhibited mild posttreatment sequels, none of them lasting longer than three days; ischemic cholecystitis was seen in 3/15 cases (14%). CONCLUSIONS The occlusion catheters on the market are not optimal for this procedure; the axillary percutaneous approach is advantageous. CR rate was very high in our series but the objective response rate doses do not differ from those in the series with free-flow procedures. The highest CR rate was observed in untreated patients and in hypervascularized lesions; the rate of clinical sequels was low, clinical CR rates were high and there was no hematologic toxicity. This well-tolerated procedure provides good local disease control, but the high rate of deaths from extrahepatic progression suggests that systemic chemotherapy and long-step intraarterial perfusion be combined.
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Affiliation(s)
- R Roversi
- Servizio di Radiologia Diagnostica, Ospedale Bellaria-C.A. Pizzardi, Bologna
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Ricci S, Rossi G, Roversi R, Cavallo G, Romanelli M, Roversi M, Fiorentini G. [Antiblastic locoregional perfusion with control of the aorto-caval flow: technique of percutaneous access]. Radiol Med 1997; 93:246-52. [PMID: 9221418] [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: 02/04/2023]
Abstract
The authors introduce a new technique for performing aortic stop-flow infusion (ASI) or hypoxic abdominal perfusion (HAP) to treat advanced thoracoabdominal tumors, via an angiographic percutaneous approach. To date, the maneuver has always been performed with surgical exposure of vascular sites in the groins. The materials available on the market were initially used and then dedicated materials have been developed, such as 11-F vascular sheaths, 8-F catheters, latex balloons with maximum phi's of 4 cm and maximum capacity of 70 ml. We performed 72 maneuvers in 56 patients during 22 months. No technical or instrumental complications occurred and all treatments were successful. Three patients (6%) died within 12 hours, two because of ARDS following thoracic perfusion and one for acute renal failure and disseminated intravascular coagulation following abdominal perfusion. The percutaneous approach provides the same mechanical-occlusive efficacy for aortocaval occlusion and therefore the same therapeutic results as surgery, but it has fewer risks of technical complications and no technical failures. Moreover, this technique is more repeatable and less expensive than surgery and its hospital stay and recovery time are shorter. To conclude, the ASI/HAP procedure is an interesting therapeutic chance in otherwise untreatable advanced cancer patients offering several prospects of technical and pharmacologic development to further increase its efficacy.
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Affiliation(s)
- S Ricci
- Servizio di Radiologia Diagnostica, Ospedale Bellaria, C.A. Pizzardi, Azienda USL Città di Bologna
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