ABSTRACT
The antibiotic amoxicillin is usually recommended as a first-line treatment for many common infections affecting children. Repeated lockdowns related to the coronavirus disease 2019 pandemic have contributed to supply difficulties for many drugs, including antibiotics. However, the risks associated with amoxicillin supply shortages appear not to have been sufficiently assessed, and the crisis we are facing today is serious and particularly dangerous for children's health. Without rigorous measures to prevent shortages related to drug production and distribution, populations could face a post-antibiotic era in which common infections and minor injuries can result in serious life-threatening situations. The availability of medicines declared by WHO as essential should be guaranteed not only in production but also in fair distribution. And this principle must be ensured by national and international regulatory agencies.Copyright © 2023 Medico e Bambino. All rights reserved.
ABSTRACT
The antibiotic amoxicillin is usually recommended as a first-line treatment for many common infections affecting children. Repeated lockdowns related to the coronavirus disease 2019 pandemic have contributed to supply difficulties for many drugs, including antibiotics. However, the risks associated with amoxicillin supply shortages appear not to have been sufficiently assessed, and the crisis we are facing today is serious and particularly dangerous for children's health. Without rigorous measures to prevent shortages related to drug production and distribution, populations could face a post-antibiotic era in which common infections and minor injuries can result in serious life-threatening situations. The availability of medicines declared by WHO as essential should be guaranteed not only in production but also in fair distribution. And this principle must be ensured by national and international regulatory agencies. © 2023 Medico e Bambino. All rights reserved.
ABSTRACT
Introduction: Early studies on the short- and medium-term cardiopulmonary sequalae of COVID-19 have shown a certain degree of exercise capacity impairment among survivors (Naeije R, Caravita S. Eur Respir J 2021;58:2101763). Whether such condition is reversible at longer follow-up is unknown. Aim(s): To assess the long-term cardiopulmonary exercise outcomes of COVID-19 in survivors who displayed a reduced exercise capacity shortly after recovery. We tested the hypothesis that physical reconditioning following hospital discharge would improve the aerobic performance and exercise capacity. Method(s): In this observational study 19 COVID-19 survivors who displayed a reduced exercise capacity 6 months after discharge (Rinaldo RF et al. Eur Respir J 2021;58:2100870) underwent reevaluation with CPET between April - May 2022. Lung function and CPET data were recorded. Result(s): At 2 year follow-up, the proportion of patients with a normal exercise capacity (12/19) was statistically significantly different from baseline (0/19), p-value 0.000 (exact McNemar's test). Among the parameters of oxygen delivery/utilization there was an overall statistically significant improvement of the anaerobic threshold (47% vs 54%). Conclusion(s): On a small group of patients, our study supports the hypothesis that exercise capacity impairment after COVID-19 is reversible at longer follow-up, with signs of an improved aerobic performance.
ABSTRACT
We present the case of a 11-years-old girl who came to our attention for a first critical episode lasting a few minutes, with spontaneous resolution, described as a generalized clonic tonic crisis, which occurred in full well-being. An electroencephalogram (EEG) was performed which showed focal epileptiform anomalies in the right temporal center that spread evoked by hyperpnea and eye closure and an EEG after sleep deprivation that showed an accentuation of the anomalies in phase 2-3 of NREM sleep. Brain MRI was normal. An anamnestic analysis revealed that since 1 month she was feeling "strange", as "if she were in a dream". No changes in her mood. Her height and her weight were normal. The clinical examination revealed a palpable thyroid gland. In consideration of the acute neurological symptomatology, in the suspicion of an encephalitis, a rachicentesis was performed which was negative for cellularity with negativity of the panel for autoimmune encephalitis on CSF and serum (NMDAR, anti GAD, LGI1, CASPr2, MOG, aquaporin). At the same time, EBV infection, neurological symptoms post-infection COVID-19, celiac disease, a model of encephalopathy with paraneoplastic aetiology and autoimmune encephalitis were excluded. We found a hyperthyroidism with suppressed TSH (FT4 51.8 ng / L FT3 16.5 ng / L, TSH <0.005 mU/L) and positivity of anti-thyroid peroxidase antibodies (> 600 KU / L), anti-thyroglobulin (261 KU / L) and anti-TSH receptor (13.8 KU / L). The diagnosis was Hashimoto's encephalopathy (HE). A therapy with methimazole at an initial dose of 0,5 mg/kg/day was started. In addition we gave intravenous methylprednisolone bolus therapy for 4 days followed by oral steroid therapy with gradual resolution of the symptoms and complete normalization of the EEG after one month of treatment, next to the normalization of thyroid function after 3 months. Hashimoto's encephalopathy (HE) is a rare condition, especially in children. It can present with neurological symptoms, psychiatric disordes or seizures. It is more frequently associated with hypothyroidism or euthyroidism, but it can occur, more rarely, even in hyperthyroidism. The presence of serum thyroid (thyroid peroxidase, thyroglobulin) antibodies is a criteria for the diagnosis HE. The overall rarity of HE and the lack of knowledge of this condition often represent the main difficulty about diagnosis. We underline that in the clinical suspicion it is a priority to perform the evaluation of thyroid function with autoimmunity to support the diagnosis, as the timely treatment of this condition represents an important prognostic element.
ABSTRACT
Background. At the beginning of the COVID-19 pandemic, healthcare workers were faced with difficult decisions about maternity care practices. The evidence-based practices recommended by the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) were confirmed by Italian national guidance. Aim. To describe, in a number of facilities that are part of a national Baby-Friendly network, the adherence to some steps of BFHI standards during the COVID-19 emergency. Methods. We conducted a cross-sectional online survey, inviting all hospitals interested in the Initiative, to fill out a semi-structured questionnaire. Results. Out of the 68 participating hospitals, 30.9% were hubs and 69.1% spokes. During May 2020, 61.8% of hospitals had COVID-19 and non-COVID-19 clinical pathways, while 38.8% were only non-COVID-19. None was dedicated exclusively to COVID-19 pathways. The BFHI was effective in guaranteeing 80% exclusive breastfeeding, the presence of companion of mother's choice, skin-to-skin and rooming-in. The type of accreditation was associated with the presence of a companion of the mother's choice during labour (p=0.022) and with skin-to-skin (p < 0.001). According to the narratives. increased interpersonal distance made interactions with mothers difficult and the absence of a birth companion was reported as a major issue. Discussion and conclusions. The BFHI is a highly-structured, evidence-based care model. Investing in strong collaborative care approaches contributes to hospitals' preparedness.
ABSTRACT
The pandemic has accelerated a series of processes taking place within our cities, forcing people to live, work and socialize exclusively in their own home for several months and, even today, for large portions of time. On the one hand, the use of digital devices and web space for work, study and leisure has allowed to carry out most of the daily functions and work activities, on the other hand many others have had to open to new uses producing unprecedented spatial possibilities. All these processes are interesting because they define more hybrid, flexible, lean and phygital characteristics of the space. The aim of this research is to demonstrate how the proximity and sharing spaces of the city can be characterized by these new aspects. The methodology that was used is the selection of contemporary examples thanks to literature and web sources. In the end, the case studies outline possible scenarios describing opportunities for the post-covid age in the near future. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Introduction - MIS-C is the most relevant complication of SARS-CoV-2 infection and has an incidence of 1 case / 2,200 children and adolescents with previous infection. The clinical picture is characterized by a multiorgan involvement and an insufficiently known response to therapy. Objectives - Retrospective analysis carried out in the Paediatric Department of the Ravenna Hospital from April 2020 to March 2022 of the cases admitted with MIS-C, with description of the presentation characteristics, the differences with respect to Kawasaki disease and the therapeutic strategies adopted also with regard to the clinical response. Results - Thirteen cases diagnosed with MIS-C with an average age of 6 years and four months were hospitalized, 4 cases were of Italian origin, 6 of Balkan and 3 of African. All the cases presented with fever> 39 ° C with severe malaise / irritability, associated with skin rash in 9 cases, conjunctivitis in 7 and cheilitis in 5. The most prominent manifestations of organ involvement were abdominal pain / diarrhoea (N = 9), myocardial dysfunction in the absence of coronary involvement (N = 5), presence of pulmonary thickening (N = 5), painful laterocervical lymphadenitis with reduced neck motility (N = 5), subnephrotic proteinuria (N = 7) and hypertransaminasaemia (N = 8). Two cases with “encephalitic-like” psychomotor slowing, one with important ascites and one with oedema of the para/retropharyngeal tissues were clinically relevant for the severity of the onset. Twelve cases were treated with IVIG and methylprednisolone (2 mg /kg), 4 of them were found to be non-responders and required the use of steroid boluses (4 cases) and anakinra (4 cases), in three of the latter in association with steroid boluses, with rapid and decisive clinical response. Conclusions - The serious clinical manifestations that characterize MIS-C do not concern only cardiac involvement. Therapy with an IL-1 inhibitor, anakinra, must also be envisaged as a possible first-line treatment in case of a particularly severe clinical picture at the onset.
ABSTRACT
Long-Covid is a typical condition of adults with a history of probable or confirmed SARS-Cov-2 infection in the previous 3 months with symptoms that last over 2 months and are not explained by an alternative diagnosis. Studies in paediatric age are heterogeneous and show a prevalence of long-Covid from 4% to 66%. The most frequent symptoms in children and adolescents are somatic symptoms and this raises the question whether they are not specific symptoms due to SARS-CoV-2 infection. However, in some cases they are due to the consequences of the pandemic (restrictions, uncertainty and lockdown). The lack of significant differences of the reported symptoms in seropositive and seronegative students suggests that long-Covid-19 might be less common than previously thought and emphasizes the impact of pandemic-associated symptoms as to the well-being and mental health of young adolescents. A targeted approach to functional rehabilitation becomes necessary and should include a psycho-relational evaluation and investigate the presence of a psychiatric comorbidity as well.
ABSTRACT
Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined. Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group. Literature research was carried out using the keywords "COVID-19" or "SARS-CoV-2" and "children" or "pediatrics" and "prevention" or "diagnosis" or "MIS-C" or "treatment" in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature. The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures. The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge. Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19. Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority.
ABSTRACT
Epidemics end. But how we get to the end and how we deal with this ancient threat will define us as people. It is difficult to imagine what our future may be, as people and as paediatricians. The Covid-19 pandemic offers us the opportunity to imagine a better world if we are able to lead the inevitable and necessary change. There are new ways that may be able to govern the inevitable changes better and that concern the social, administrative, scientific and socio-health organization context. After the Covid-19 pandemic we will have to change the focus on the rights of children and adolescents. As paediatricians we must imagine the perspectives of our work aimed at the needs of an entire generation that must be cared for and defended by our continuous sacrifices to ensure the health of parents and grandparents. In our near future we - we first - can give a clear demonstration that we are able to redefine our values.
ABSTRACT
In the context of measures to control the Covid-19 pandemia, risk factors related to reopening of the education system have been overemphasized whereas the risks for health education and social protection of children deriving from persistent closure have been underestimated. A more balanced and comprehensive view is proposed, including the significant risk of spread of infection caused by the uncontrolled socialization of children while parents go back to work. Indications are provided on how to minimize infection risk through accurate screening and monitoring for educators, teachers and caregivers, sanification of the school environment and individual protection measures. © 2020 Medico e Bambino. All rights reserved.
ABSTRACT
Covid-19 is forcing medical doctors to deal with the urgent need to find clinical answers in an area where, unfortunately, there are still therapies with no evidence of efficacy and safety. In any case, they must make decisions and face the dilemma of immediately using any therapeutic options that has some plausibility of treatment or instead making clinical trial. However, the latter require formal steps and procedures. How do medical doctors understand which of these are essential and necessary? Is it really important to register the new clinical trials on the official platforms? Is this an unnecessary bureaucratic passage that can be avoided during the emergency phase? The present article tries to answer these questions by also addressing other critical issues related to clinical trials at a time when the good rules of clinical research must not be an obstacle to accessing the best available treatments.