Use of herbal medicines in children following EBM criteria. Effectiveness and tolerability of echinacea, cranberry, and chamomile

The recent appreciation of phytotherapy is related to the evidence of efficacy of herbal medicines, as well as to the continuous improvement of scientific and clinical knowledge of their effects. Unfortunately among herbal medicine it is frequent to find products that are neither registered nor controlled by regulatory bodies, with a lack of proofs regarding their constituents and quality.Phytotherapy can find its role among medical therapies only if each medication is standardised and controlled according to the requirements of an official Pharmacopoeia, and produced on the basis of Good Manufacturing Practices similar to those used in pharmaceutical companies. This is even more important in paediatric age, also because often parents administer herbal medications to their children, without asking the physician or the pharmacist for advice, being convinced that “natural products” are always safe and do not have adverse events or interactions. The evaluation of these products, ensuring their safety and efficacy through registration and regulation,is an important challenge. To improve an evidence-based and safe use, herbal medicines should be titrated, standardised and labelled. Clinical applications, pharmacology, dosage, possible contraindications and precautions (i.e. during pregnancy, breastfeeding and paediatric age), and potential adverse reactions should be clearly described and codified, for example in the officialPharmacopeia and in the various Monographs (ESCOP, The European Scientific Cooperative On Phytotherapy, and WHO, World Health Organization).The purpose of this article is to provide a review on the safety and efficacy of some medicinal plants widely used in the paediatric age: echinacea, cranberry, and chamomile. The final aim is to help to use herbal medicine on the basis of the criteria of the Evidence Based Medicine

488 Candidacy for heart transplantation in adult congenital heart disease patients: a single-centre, retrospective, cohort study

Abstract Aims End-stage heart failure (HF) is the leading cause of death in adult congenital heart disease (ACHD) population. Heart transplantation (HTx) improves prognosis in ACHD end-stage HF but candidacy evaluation, referral pattern, and correct listing timing are not fully elucidated in this population. To evaluate factors associated to refusal from Htx in ACHD patients with end-stage HF referred for HTx evaluation. Methods and results This retrospective cohort study enrolled consecutive ACHD patients considered for HTx in our institution between 2014 and 2020 and patients undergone HTx between 2000 and 2013. Refusal from HTx served as primary study endpoint. Between 2014 and 2020, 46 ACHD patients were evaluated for HTx, 14 ACHD patients underwent HTx between 2001 and 2013. The main indication to HTx in patients with single ventricle physiology was Fontan failure, while in patients with systemic left ventricle and systemic right ventricle physiology, it was systemic ventricular dysfunction. We compared clinical, anatomical and demographic data of 41 patients accepted for transplantation with 15 patients refused after screening. Risk factors for refusal were: coexistence of multiple high risk features [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.1–12.9; P 0.048]; anatomical factors (OR: 14.5; 95% CI: 3.1–68.4; P 0.001), out-of-centre ACHD/HTx program referral (OR: 5.3; 95% CI: 1.5 to 19.0; p 0.01). Survival in patients accepted for HTx was significantly higher than survival in patients declined from HTx with landmark comparison at 20, 40 and 60 months of 87%, 78%, and 72% vs. 70%, 59%, and 20%, respectively. HTx refusal identifies a high risk ACHD patient subgroup (hazard ratio for overall mortality: 3.1; 95% CI: 1.1–8.3; P 0.02). Conclusions In our study risk factors for refusal from HTx are adverse anatomical features, coexistence of multiple conventional HTx high risk factors and out-of-centre referral. ACHD patients refused from HTx present shorter time to death. Efforts to increase HTx candidacy and to reduce referral delay in tertiary centre are strongly necessary for this growing population

Angiographic aspect of longstanding Starr-Edwards valve for type C Ebstein anomaly

This is a rare report of a longstanding well-functioning Starr-Edwards valve in the tricuspid position

Survey on the use of Homeopathy among Pediatricians of the Italian Federation of Pediatric Physicians (FIMP) [Article in English and Italian] • [Indagine sull’utilizzo dell’Omeopatia tra i Pediatri della Federazione Italiana Medici Pediatri (FIMP)]

ENGLISH TEXT: The use of Complementary Alternative Medicine (CAM), and more specifically of Homeopathy, is common among the pediatric population in Italy. In order to verify the attitude of family pediatricians (pediatri di famiglia) towards the use of Homeopathy, a survey has been carried out among 5,399 (number of doctors who received the questionnaire) family pediatricians enrolled in the Italian Federation of Pediatric Physicians (Federazione Italiana Medici Pediatri, FIMP) by means of an online questionnaire. The response has been significant (1,252 questionnaires have been filled in, corresponding to 23.19% of the total submitted) and has highlighted that 29.4% of the pediatricians who took part in the survey use homeopathic medicine to cure their patients. The study has also analyzed several other parameters related to the use of Homeopathy, including age and pediatric education, most commonly treated diseases, pharmaceutical forms and possible adverse effects. ITALIAN TEXT: L’impiego delle Medicine Complementari e Al­ter­native (Complementary Alternative Medicine, CAM), e più spe­cifica­men­te dell’Omeopatia, è comune tra la popolazione pediatrica in Italia. Allo scopo di verificare l’attitudine dei pediatri di famiglia nei confronti dell’utilizzo dell’Omeopatia, è stata condotta un’indagine, tramite un questionario online, tra i 5.399 (numero di medici che ha ricevuto il questionario) pediatri di famiglia appartenenti alla Federazione Italiana Medici Pediatri (FIMP). Il riscontro è stato significativo (1.252 questionari, corrispondenti al 23,19% di quelli inviati, sono stati compilati ) ed ha evidenziato che il 29,4% dei pediatri che hanno risposto all’indagine utilizza la medicina omeopatica per curare i propri pazienti. Lo studio ha anche analizzato alcuni altri para­metri correlati all’impiego dell’Omeopatia, inclusi l’età e la formazione dei pediatri, le patologie più frequentemente trattate, le forme farmaceutiche utilizzate e i possibili effetti avversi

Bentall Endocarditis by C. Lusitaniae After COVID-19: The Finger Covers The Moon

We report a case of endocarditis months after a Bentall procedure. This was caused by Candida Lusitaniae, in an immunocompetent patient with a recent SARS-CoV-2 infection. The patient underwent a new Bentall procedure. SARS-CoV-2 has been associated with co-infection by Candida species since the beginning of the pandemic, nevertheless, Candida Lusitaniae remains a very uncommon causative agent of prosthetic endocarditis. We suggest a possible role of the SARS-CoV-2, which may have delayed the diagnosis of endocarditis and the appropriate therapy

Endovascular repair in extra-anatomic bypass after hypoplastic aortic arch repair

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The Effective Management of Fever in Pediatrics and Insights on Remote Management: Experts' Consensus Using a Delphi Approach

Background: Even after the publication of the 2017 update of Italian guidelines on treatment of fever in pediatrics, some fundamental questions are still open and new ones emerged during the COVID-19 pandemic. Objective: To assess the level of consensus among Italian pediatricians on different topics related to treatment of fever in children by using the Delphi technique. Methods: A Delphi study was undertaken between June and September 2021, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. An invitation to participate was sent to 500 pediatricians distributed over the whole national territory and 80 (16%) of them accepted to participate on a voluntary basis. The questionnaires were structured into three specific topics: "therapeutic appropriateness and management of the febrile child," "management of the febrile child in the presence of other diseases," and "future perspectives in remote management." Each topic had six statements. Results: A first-round questionnaire was sent to 80 accepting pediatricians from different Italian regions. Of the 72 respondents (23% working in hospitals and 72% outside), 33% were from northern, 12% central, and 55% southern Italy or islands. A second-round questionnaire was sent to the same 80 pediatricians and 69 of them responded, without significant differences for workplaces or geographical distribution as compared with the first questionnaire. Overall, 75 participants answered at least one of the two questionnaires. All the statements on the topics of "therapeutic appropriateness and management of the febrile child" and "future perspectives in remote management" reached the predefined cut off for consensus (75% or more). Only one statement on "management of the febrile child in the presence of other diseases" did not achieve the consensus even after the second round. Conclusions: Italian pediatricians agree on several aspects of treatment of febrile children and their expert opinions could support everyday decision process complementary to recommendations by regulatory agencies and guidelines

Primary Cardiac Leiomyoma Causing Right Ventricular Obstruction and Tricuspid Regurgitation

We report the unique case of a primary cardiac leiomyoma originating from the right ventricle and involving the tricuspid valve in a 43-year-old woman. Echocardiography showed a giant mass causing severe pulmonary stenosis and tricuspid valve regurgitation. The patient underwent surgical excision and histologic examination revealed a primary cardiac leiomyoma. To the best of our knowledge only three cases of primary cardiac leiomyoma have so far been reported, and this is the first case of primary cardiac leiomyoma involving the tricuspid valve apparatus

Aortopulmonary Collateral Artery from the Proximal Ascending Aorta: A Rare Anatomical Finding

Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries is a rare congenital heart lesion in which pulmonary blood supply may arise from different segments of the aorta. We report an unusual case of a newborn with a major collateral artery originating from the proximal ascending aorta. Successful reparative surgery was undertaken