Where have the children with epilepsy gone? An observational study of seizure-related accesses to emergency department at the time of COVID-19

Purpose: The COVID-19 pandemic and related lockdown measures drastically changed health care and emergency services utilization. This study evaluated trends in emergency department (ED) access for seizure-related reasons in the first 8 weeks of lockdown in Italy. Methods: All ED accesses of children (<14 years of age) at two university hospitals, in Turin and Rome, Italy, between January 6, 2020 and April 21, 2020, were examined and compared with the corresponding periods of 2019. Results: During the COVID-19 lockdown period (February 23-April 21, 2020), there was a 72 % decrease in all pediatric ED accesses over the corresponding 2019 period (n = 3,395 vs n = 12,128), with a 38 % decrease in seizure-related accesses (n = 41 vs n = 66). The observed decrease of seizure-related ED accesses was not accompanied by significant changes in age, sex, type of seizure, or hospitalization rate after the ED visit. Conclusion: The COVID-19 lockdown was accompanied by a sudden decrease in seizure-related hospital emergency visits. School closure, social distancing, reduced risk of infection, and increased parental supervision are some of the factors that might have contributed to the findin

Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents’ life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale “Negative Meta Worrying” of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales “Difficulty Identifying Feelings” and “Difficulty Describing Feelings” than controls. Moreover, children between 8 and 10 years statistically differed from older children in “Difficulty Identifying Feelings” and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA

Drugs used in the treatment of multiple sclerosis during COVID-19 pandemic: a critical viewpoint

: Since COVID-19 has emerged as a word public health problem, attention has been focused on how immune suppressive drugs used for the treatment of autoimmune disorders influence the risk for SARS-CoV-2 infection and the development of the acute respiratory distress syndrome (ARDS). Here we discuss the disease-modifying agents approved for the treatment of multiple sclerosis (MS) within this context. Interferon (IFN)-1a and -1b, which display antiviral activity, could be protective in the early stage of COVID-19 infection, although SARS-CoV-2 may have developed resistance to IFNs. However, in the hyper inflammation stage, IFNs may become detrimental by facilitating macrophage invasion in the lung and other organs. Glatiramer acetate and its analogues should not interfere with the development of COVID-19 and may be considered safe. Teriflunomide, a first-line oral drug used in the treatment of relapsing-remitting MS (RRMS) may display antiviral activity by depleting cellular nucleotides necessary for viral replication. The other first-line drug, dimethyl fumarate, may afford protection against SARS-CoV-2 by activating the Nrf-2 pathway and reinforcing the cellular defences against oxidative stress. Concern has been raised on the use of second-line treatments for MS during COVID-19 pandemic. However, this concern is not always justified. For example, fingolimod, might be highly beneficial during the hyperinflammatory stage of COVID-19 for a number of mechanisms including the reinforcement of the endothelial barrier. Caution is suggested for the use of natalizumab, cladribine, alemtuzumab, and ocrelizumab, although MS disease recurrence after discontinuation of these drugs may overcome a potential risk for COVID-19 infection

Vocal and motor behaviors as a possible expression of gastrointestinal problems in preschoolers with Autism Spectrum Disorder

Gastrointestinal (GI) problems are one of the most frequent comorbidities in Autism Spectrum Disorder (ASD) but can be under-recognized due to the concomitant communication difficulties of this population. Accordingly, some associated behaviors (AB) such as verbal and motor behaviors (VB and MB, respectively) have been identified as a possible expression of an underlying GI problem and evaluated through an ad hoc questionnaire (the Associated Behaviors Questionnaire -ABQ-). The aims of this study were to investigate the presence and the type of AB in an Italian sample of ASD preschoolers, and to determine their correlations with GI problems

Emergency and urgency in pediatric subjects with neuropsychiatric disorders: a pilot study in a tertiary center

Rationale: Increasing Emergency department (ED) presentations for neuropsychiatric disorders has been documented in recent years (SINPIA Regional Section Lazio 2014), as a result of both a contraction of mental health resources, especially for children and adolescents, and a lower family and social containment. Factors associated with this phenomeon appear to be multiple, complex and inter-related. Moreover, the interaction among health facilities (community health services [ASL], hospitals, tertiary centers and ED) is not always effective.The goal of this study is to describe the management of neuropsychiatric disorders in ED and to identify the care pathways used in the post acute phase.Methods: We included subjects aged <18 years admitted to general and pediatric ED of Policlinico Umberto I in Rome, from January to December 2013, for whom a neurological or psichiatric consultancy was requested. The project has been divided in three phases: I) Collection of personal information of patients admitted to General or Pediatric ED in 2013 and for whom has been required a neurological or psychiatric consultancy; II) Sending to these patients' parents an introductory letter about the study and a facsimile of a questionnaire, aimed to investigate the evolution of the clinical conditions, the taking charge of the patient and any further access to ED; III) Telephone interview from January 2015 to March 2015, administering the questionnaire previously sent. Results: In 2013, 432 subjects received a neurological or psychiatric consultancy (223 males): 383 (89%) for neurological symptoms and 49 (11%) for psychiatric symptoms. Over the whole sample, 277 patients phone contacts were available, while 255 completed the questionnaire (drop-out 6.5%).99 patients (39%) had paroxysmal events, 39 (15%) headache, 31 (12%) motor and/or sensory disorders, 20 (8%), anxiety disorders, 16 (6%) behavioural disorders, 7 (3%) psychosis, 5 (2%) self harm and 38 (15%) not neurological or psychiatric diagnosis. Patients with psychiatric symptoms were admitted as: • 10 red code; 4 were hospitalized (3 patients in Child Neuropsychiatric [NPI] Service, 1 patients in SPDC service) and 2 were followed in outpatients services in NPI Dpt; • 26 yellow code; 5 were hospitalized in NPI service; • 11 green code. Patients with neurological symptoms were admitted as: • 5 red code; 4 were hospitalized (1 patients in NPI service, 3 patients in Pediatric service); • 108 yellow code; 40 were hospitalized (7 patients in NPI service, 20 patients in Pediatric service and 3 in Neurology service) • 52 green code • 4 white code.63% of psychiatric and 27% of neurological patients had a NPI diagnosis before the admission in ED. After the ED admission and neurological or psychiatric consultancy, the taking charge in tertiary centers increased for psychiatric patients, while the taking charge of neurological patients increased in all facilities (ASL, tertiary centers and private consultants equally). Conclusions: The study identifies the neuropsychiatric disorders that were mostly admitted in a tertiary center ED. Moreover, it shows how the number of NPI patients greatly overcomes the availability of the NPI hospital resources in emergency/urgenc

A Neuropsychiatric Assessment of Children with Previous SARS-CoV-2 Infection

Aim: Concerns have been raised about possible neuropsychiatric sequelae of COVID-19. The objective of this study was to examine the plausibility of long-term mental health consequences of COVID-19 by assessing a sample of children after the resolution of the acute SARS-CoV-2 infection. Method: As part of a systematic follow-up assessment of pediatric patients with COVID-19 conducted at two university children’s hospitals, 50 children (56% males) aged 8 to 17 years (median 11.5), 26% with previous multisystem inflammatory syndrome in children (MIS-C), without a prior history of neuropsychiatric disorders, received a battery of clinical neuropsychiatric and neuropsychological rating scales that included the Pediatric Migraine Disability Assessment (PedMIDAS), Sleep Disturbance Scale for Children (SDSC), Multidimensional Anxiety Scale for Children (MASC-2), Child Depression Inventory (CDI-2), Child Behavior Checklist (CBCL), and the NEPSY II (Neuropsychological Assessment, Second Edition). The assessments were conducted between 1 and 18 months (median 8 months) after the acute infection. Results: The CBCL internalizing symptoms score was in the clinical range for 40% of the participants (vs. a population expected rate of about 10%, p < 0.001). A sleep disturbance was detected in 28%, clinically significant anxiety in 48%, and depressive symptoms in 16%. The NEPSY II scores showed impairment in attention and other executive functions in 52%, and memory deficits in 40% of the children. Conclusions: These data from direct assessment of a sample of children who had SARS-CoV-2 infection show higher than expected rates of neuropsychiatric symptoms, thus supporting the possibility that COVID-19 may have mental health sequelae long after the resolution of the acute infection

Impact of the COVID-19 Pandemic on Child and Adolescent Psychiatric Emergencies

By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020

The Italian instructions for the design, execution and control of timber constructions (CNR-DT 206 R1/2018)

13noIn 2007 the Italian National Research Council published the technical document CNR-DT 206/2007 “Instructions for the design, execution and control of timber structures”, with the purpose to provide a technical support to the operators of the sector, in line with the most advanced knowledge at that time. Since then, the world of timber engineering has largely used such document, even though the instructions are not mandatory standard rules, so that they became the most common tool in Italy for the structural use of timber, opening the markets and favouring competition and new applications. In latest years new studies, researches and innovative proposals have promoted the development and the growth of timber constructions also in the civil residential field. The framework of standard rules for constructions and products, both Europeans and Italians, has evolved too. For these reasons, CNR has considered as opportune to proceed to the editing of a new version, updated and widened, namely with the acronym DT 206-R1. The document comes from the spontaneous cooperation of an open group of specialists and operators of the sector, based on a wide discussion on the common scientific and technical expertise and knowledge. The current version has already taken into account the results of the public inquiry phase (concluded by now). The paper presents the main contents of the document, evidencing the innovations.mixedembargoed_20230111Faggiano, Beatrice; Sandoli, Antonio; Iovane, Giacomo; Fragiacomo, Massimo; Bedon, Chiara; Gubana, Alessandra; Ceraldi, Carla; Follesa, Maurizio; Gattesco, Natalino; Giubileo, Costantino; Lauriola, Marco Pio; Podestà, Stefano; Calderoni, BrunoFaggiano, Beatrice; Sandoli, Antonio; Iovane, Giacomo; Fragiacomo, Massimo; Bedon, Chiara; Gubana, Alessandra; Ceraldi, Carla; Follesa, Maurizio; Gattesco, Natalino; Giubileo, Costantino; Lauriola, Marco Pio; Podestà, Stefano; Calderoni, Brun

The transition from wave-dominated estuary to wave-dominated delta: The Late Quaternary stratigraphic architecture of Tiber River deltaic succession (Italy)

This paper presents a detailed description of the stratigraphic architecture of the Late Pleistocene/Holocene Tiber delta succession in order to document the passage from wave-dominated estuary to wave-dominated delta in the broader context of Late Quaternary sea level fluctuations. This succession constitutes a sequence-stratigraphic unit known as Tiber Depositional Sequence (TDS), which was deposited during the last glacial-interglacial cycle (last 120ka). Our study is based on the examination of an enormous amount of data derived from the stratigraphy of about 300 wells, petrographical and paleontological data (foraminifera, ostracoda, pollen, and plant macrofossils), 14C dating, and from the integration of geomorphological and geoarcheological data. Recently a 100m deep core (Pesce Luna well) was studied through a multidisciplinary approach and a detailed description of sedimentary facies, foraminifer and ostracod assemblages, pollen and 14C dating is presented in this paper. The new data allowed to produce three new correlation panels and to describe in more detail, with respect to previous interpretations, the stratigraphic-depositional architecture of the TDS, which internally shows the preservation of sediment deposited during the early and late lowstand, the transgressive and the highstand systems tracts. Alluvial and coastal depositional systems characterize the early lowstand phase of the TDS, which developed during the eustatic sea-level fall between about 120 and 30-26yrBP. During the late lowstand phase, which is characterized by stillstand and slow eustatic sea-level rise a prograding delta and an aggrading incised-valley fluvial fill developed. The Tiber incised valley was transformed into a wave-dominated estuary during the transgressive phase (TST), whereas a coastal-shelf sedimentation took place during the subsequent highstand phase (HST). This study confirms the lithofacies distribution resulting from transgression and infilling of the wave-dominated estuaries, but also shows how the transition to a wave-dominated delta, prograding at the time of sea-level highstand occurred. Changes in sediment input, climatic variations and, more recently, human activities played a major role in the development of the Tiber delta during the last 20,000yrBP. In the last 3000years a relationship between progradational phases of the delta and flood events of the Tiber river has been highlighted, suggesting also the formation and merging of barrier-spits to the mainland