SARS-CoV-2 and Burkholderia cenocepacia infection in a patient with Cystic Fibrosis: An unfavourable conjunction?

The effects of the concomitant infection by COVID-19 and Burkholderia cepacia (Bc) in CF are not known. We describe the case of a 34 years woman with CF, colonized by Bc and found SARS-CoV2 positive. In the first hospital week she suffered acute respiratory failure and chest imaging showed interstitial involvement and multiple thickenings. She was treated with antibiotics, dexamethasone, remdesivir and heparin, with gradual improvement and discharge at day 20th. The reciprocal role of SARS-CoV-2 and Bc, their potential interactions and the contribution of the individual therapies to the favourable outcome are unclear. It is debatable whether it was SARS-CoV2 that triggered a Bc pulmonary exacerbation or if the chronic Bc infection facilitated the development of a COVID-19 more aggressive than usually seen in CF. If the latter hypothesis were confirmed by similar cases, Bc colonization should be regarded as a risk factor for severe COVID-19 expression in CF.

Qualitative analysis of emergency department reports applied to a pilot project for the prevention of pediatric burns.

Accidents and burns are a major problem in Italy and in industrialized countries, due to the consequences they have on health, especially in children aged 0-4 years. In Italy, about 400 people die each year from burns, with over 70% of these occurring in the home. In the European Union, burns are one of the top five causes of death from accidents, accounting for 3% of all deaths from accidents and violence in those age groups. One percent of all deaths in children are due to burns. In this paper, we illustrate the results of qualitative analysis, conducted according to the methodology of content analysis, on narratives included in the anamnesis of clinical papers at the ED in 738 cases of burns in children (0-14 years) observed in a sample of Emergency Departments in the years 2005-2009. The results of content analysis show that the most frequent mechanism that leads to burns is contact with hot liquids and heating surfaces. Much of preventive action should be directed at controlling the child. The accidental event descriptions for the younger age group (0-4 years) reveal an unequivocal responsibility of the parents. The qualitative analysis of narratives was carried out to produce scientific evidence to identify the more frequent and severe burn accidents for specific target/age groups and to establish specific preventive measures. The study of qualitative analysis of burns observed at the ED was introductory to the pilot project PRIUS (Preventing burns among school-aged children). The objective of PRIUS is to increase awareness of the risks of burns in children and adults through a learning path tailored towards their prevention, and the promotion of appropriate standards of personal safe behaviour and first aid actions.

Les accidents et les brûlures représentent en Italie et dans les pays industrialisés, un problème majeur de santé publique, en particulier chez les enfants entre 0 et 4 ans. En Italie, environ 400 personnes meurent chaque année de brûlures, dont 70% sont survenues au domicile. Dans l'Union Européenne, les brûlures (3% des causes de mort violente ou accidentelle), entrent dans le groupe des cinq causes les plus fréquentes de décès dans cette tranche d'âge. Dans cet article, nous présentons les résultats de l'analyse qualitative, réalisée selon la méthodologie de l'analyse de contenu, des dossiers d'entrée aux urgences de 738 cas de brûlures chez les enfants (0-14 ans) survenues entre 2005 et 2009, dans un échantillon représentatif de la population italienne. L'analyse de contenu montre que les causes les plus fréquentes qui conduisent aux brûlures dans les groupes d'âge étudiés sont représentées par le contact avec des liquides chauds et les surfaces de chauffage. Donc, une grande partie des actions préventives doit être élaborée en direction de la surveillance de l'enfant. L'étude de l'événement accidentel, pour ce groupe d'âge (0-4 ans), révèle une responsabilité sans équivoque des parents. L'analyse qualitative des récits a aidé à produire les preuves scientifiques des circonstances de survenue des brûlures graves et étendues chez des enfants petits, afin préconiser des mesures spécifiques de prévention. Notre étude est une étude d'analyse qualitative réalisée avant de proposer le projet pilote Prius (Prévention des accidents et des brûlures chez les enfants d'âge scolaire). L'objectif de Prius est d'accroître la sensibilisation aux risques de brûlures chez les enfants et les adultes à travers un parcours d'apprentissage adapté à leur prévention et la promotion de protocoles appropriés de comportement et de premiers secours.

[The chronically ill patient in the emergency department: management during simultaneous acute diseases]. / Il malato cronico in Pronto Soccorso: gestione in corso di patologia acuta intercorrente.

The chronically ill patient admitted to an Emergency Department or to a Pediatric Emergency Unit for an intercurrent acute episode is rare but requires adequate management. Aim of this study is to evaluate the health care needs of these patients vs patients with exclusively acute disease and to underline the need of identifying criteria for health care taking into account basic clinical conditions. This study can be carried out most suitably at the Gaslini Institute, since it is a children's hospital with a Pediatric Emergency Department admitting children from the Liguria region presenting almost the whole range of chronic pediatric diseases.

[Dichloromethylenbiphosphonic acid in the therapy of myositis ossificans progressive (MOP)]. / L'acido diclorometilenbifosfonico nella terapia della miosite ossificante progressiva.

The authors report 3 cases of myositis ossificans progressiva (MOP) treated with i.v. dichloromethylenbiphosphonic acid. Two of these patients presented a severe development of the disease so that they could not walk anymore. After a few months of treatment with dichloromethylenbiphosphonic acid (300 mg/die for 10 continual days every month) sufficient recovery in motor capacity was achieved that walking was possible again. The favourable effect of therapy has been shown only by clinical features because there is no biological marker to monitor in the follow-up. During the treatment no side effect or modification of the markers of liver and kidney activity was observed.

[Mammary duct ectasia in children]. / Ectasia duttale mammaria infantile.

Authors describe two uncommon cases of infantile mammary duct ectasia (EDM). This disease, first reported in 1983, is characterized by dilatation of the subareolar duct system, and by phlogistic reaction and fibrosis. In the medical literature only 8 cases have been reported, but probably its frequency is undervalued due to the scarce general knowledge of this pathology. The differential diagnosis is reviewed.

[A case of organic psychosis in dermatomyositis. Etiopathogenetic hypothesis]. / Un caso di psicosi organica in corso di dermatomiosite. Ipotesi eziopathogenetiche.

The authors describe a girl affected by dermatomyositis, with a quick and grave evolution, which required urgent tracheostomy to reduce the dysphagic symptoms. During the observation the patient showed psychotic symptoms. After the revision of literature, in which no such complication has ever been described, the authors propose an etiopathogenetic interpretation for a generalized acute psycho-organic syndrome, supposing a cerebral hypoxic damage, as vasculitic manifestation, probably complicated by symptoms of hysterical conversion, due to the isolation of the patient in the Department of Intensive Therapy and to the severe physical conditions.