Paediatric activities and adherence to vaccinations during the COVID-19 epidemic period in Tuscany, Italy: a survey of paediatricians.

INTRODUCTION: The global COVID-19 pandemic is placing a heavy burden on health services. One result could be a general reduction in routine vaccination activities. In Tuscany (Central Italy), paediatricians (in agreement with the regional health service) administer and register paediatric vaccinations of their patients. The aim of the present study was to evaluate the impact of the COVID-19 epidemic on paediatric vaccinations administered by Tuscan paediatricians, as a proxy of adherence to vaccinations during this epidemic period. METHODS: Four hundred members of the Tuscany section of the Italian Federation of Paediatricians (FIMP) were invited to participate in a semi-structured online survey. RESULTS: During the COVID-19 pandemic, almost all (98.2%) of the 223 respondents reported a general decline in outpatient paediatric visits; 65.8% reported a more than 60% reduction (144 answers) in comparison with the situation before the COVID-19 pandemic. A total of 208 paediatricians (93.3%) continued to vaccinate in the period considered: 66/208 (31.7%) reported a reduction in parents' compliance with mandatory vaccination (hexavalent and MMRV vaccines), and 88/208 (42.3%) reported a reduction in compliance with non-mandatory vaccinations. Almost all paediatricians declared having taken preventive actions to counter the spread of SARS-CoV-2. DISCUSSION AND CONCLUSIONS: Although the majority of Tuscan paediatricians continued to vaccinate during the lock-down, some parents decided to postpone their children's scheduled vaccinations, mainly owing to fears concerning the safety of access to health services. When Italian immunization coverage data on the first months of 2020 become available, it will be possible to assess the real impact of the COVID-19 pandemic on paediatric vaccinations. It is crucial to continue vaccinating against preventable infectious diseases in order to avoid other possible epidemic outbreaks. The pandemic must not be seen as an obstacle to compliance with the vaccination schedule, but rather as an excellent opportunity to underline the importance of all recommended vaccinations.

Mitochondrial nitric oxide localization in H9c2 cells revealed by confocal microscopy.

This study shows the presence of all three nitric oxide synthases (NOSs) and NOS activity in H9c2 cells cultured under non-stimulated conditions. By using the 4,5 diaminofluoresceindiacetate (DAF-2DA) fluorimetric nitric oxide (NO(*)) detection system we observed NO(*) production in H9c2 cells. As revealed by confocal microscopy, NO(*) fluorescence colocalizes in mitochondria labeled with Mito-Tracker Red CM-H(2)Xros. Upon stimulation with acetylcholine (Ach), which increased NOS activity by 75%, the colocalization coefficient C(green) value, calculated as Pearson's correlation, increased from 0.07 to 0.10, demonstrating an augmented presence of NO(*) in mitochondria. Conversely, the presence of NO(*) in mitochondria decreased following cells pretreatment with l-MonoMethylArginine (L-NMMA), a competitive inhibitor of NOS activity, as indicated by the reduction of the C(green) value to 0.02. This work confirms that the presence of NO(*) in mitochondria can be modulated in response to different fluxes of NO(*).

[Treatment of dysfunctional metrorrhagia with GnRH analogs]. / Trattamento delle metrorragie disfunzionali con GnRH-analoghi.

Thirty patients diagnosed as affected by dysfunctional metrorrhagia were treated with goserelin in a registered formulation of 3.6 mg injected subcutaneously into the anterior abdominal wall. These patients suffered from hypochromic anemia secondary to metrorrhagia with asthenic symptoms. After six months' treatment there was a significant improvement in hemocrasia and symptoms resolved without collateral effects requiring the suspension of treatment. The 10 patients who subsequently underwent surgery were in excellent condition and did not require blood transfusions.

[A case of congenital multiple arthrogryposis. Considerations]. / Un caso di artrogriposi multipla congenita (AMC). Considerazioni.

The paper describes the diagnosis, clinical, anatomopathological and etiopathogenetic aspects of a case of congenital multiple arthrogryposis. The importance of the dialogue between the obstetrician and the parents is underlined in terms of the latters' psychological preparation. The obstetrician must also prepare for an atraumatic delivery, in addition to planning the treatment protocol for the neonate.

[Danazol in the treatment of menometrorrhagia in patients with mitral prosthesis treated with warfarin]. / II danazolo nel trattamento delle menometrorragie di pazienti con protesi mitralica in terapia con warfarin.

The difficulty in the treatment of patients undergoing Warfarin therapy for mitral stenosis, is underlined and cases treated with Danazol in sideropenic anaemia caused by menometrorrhagia are reported.

Conservative management of urinary abnormalities detected in utero.

During a 5-year period, we observed 48 fetuses with urinary malformations diagnosed by antenatal sonography. Postnatal investigations confirmed the presence of a urinary tract anomaly in 44 of the 48 fetuses selected by prenatal ultrasound (91%). Accurate antenatal diagnosis was made in 35 of the 48 cases (73%). In 9 fetuses renal disease was detected, but its specific nature was not in accordance with the prenatal diagnosis. In our series the most common anomaly was hydronephrosis secondary to ureteropelvic junction obstruction. This condition was observed in 31 of the 44 patients (70.4%); 7 of the newborns who showed an obstructive pattern were submitted to early surgical repair, while the remaining 24 cases and 1 renal unit of the group undergoing early surgical repair were relegated to expectant observation, with periodic clinical and laboratory controls. A spontaneous recovery was observed in 12 cases; the dilatation remained unchanged in 10 cases, while 3 patients showed a progressive worsening of the condition which led to a surgical correction. Our findings agree with those in recent reports in providing little support for early, indiscriminate surgical repair. Moreover, our experience confirms the possibility of a spontaneous recovery in newborns with hydronephrosis and draws attention to the benefit of a conservative management in properly selected patients.

[Monitoring of high-risk pregnancies (author's transl)]. / Monitoraggio delle gravidanze a rischio.

The AA. have monitored 202 patients affected by several pathological conditions and at different stages of their pregnancies. Among them, 173 were pregnancies without complications. Monitoring was performed on the basis of the following 3 indices: HCS radioimmunological assay, total plasmatic estriol, and vaginal cytology. Results show, as demonstrated in the graphs and the final discussion, that already within the first weeks of gestation the pathological cases under observation presented marked modifications of the indices studied when compared to controls.

[Rate meaning of estriol-dosage in the pregnant wife pointing out the phoetus development (author's transl)]. / Il valore del dosaggio dell'estriolo nella donna gravida quale indice dello sviluppo del feto

The AA. point out the meaning of the urinary estriol dosage in high risk pregnancy. The screening must be frequent and regular, with constant growing curve all time along. A sudden fall down of the rate shows a severe malaise of the phoetus and proper therapy is badly needed. Extemporary screenings dont supply any sufficient knowledge.