Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis

Comparing Approaches to Deal with Non-Gaussianity of Rainfall Data in Kriging-Based Radar-Gauge Rainfall Merging

Merging radar and rain gauge rainfall data is a technique used to improve the quality of spatial rainfall estimates and in particular the use of Kriging with External Drift (KED) is a very effective radar-rain gauge rainfall merging technique. However, kriging interpolations assume Gaussianity of the process. Rainfall has a strongly skewed, positive, probability distribution, characterized by a discontinuity due to intermittency. In KED rainfall residuals are used, implicitly calculated as the difference between rain gauge data and a linear function of the radar estimates. Rainfall residuals are non-Gaussian as well. The aim of this work is to evaluate the impact of applying KED to non-Gaussian rainfall residuals, and to assess the best techniques to improve Gaussianity. We compare Box-Cox transformations with λ parameters equal to 0.5, 0.25, and 0.1, Box-Cox with time-variant optimization of λ, normal score transformation, and a singularity analysis technique. The results suggest that Box-Cox with λ = 0.1 and the singularity analysis is not suitable for KED. Normal score transformation and Box-Cox with optimized λ, or λ = 0.25 produce satisfactory results in terms of Gaussianity of the residuals, probability distribution of the merged rainfall products, and rainfall estimate quality, when validated through cross-validation. However, it is observed that Box-Cox transformations are strongly dependent on the temporal and spatial variability of rainfall and on the units used for the rainfall intensity. Overall, applying transformations results in a quantitative improvement of the rainfall estimates only if the correct transformations for the specific data set are used.ISSN:0043-1397ISSN:1944-797

The sdq in Italian clinical practice: evaluation between three outpatient groups copmpared

Lo scopo del nostro studio è valutare l’efficacia del Strength and Difficulties Questionnarie (SDQ) come strumento di screening per i problemi emotivi e comportamentali in tre diverse popolazioni a rischio. Metodi. L’SDQ è un breve questionario di screening che indaga la presenza di problematiche emotive e comportamentali in bambini e adolescenti. Abbiamo esaminato 497 questionari compilati dai genitori di bambini afferenti alle cliniche di Neuropsichiatria Infantile, Endocrinologia Pediatrica e Oncologia Pediatrica. Risultati. I risultati indicano una maggiore presenza di disturbi psicopatologici nei pazienti della Neuropsichiatria rispetto a quelli dell’Oncologia e dell’Endocrinologia. Inoltre, i pazienti dell’Oncologia hanno più problematiche emotive e comportamentali rispetto a quelli dell’Endocrinologia. Discussione. I risultati supportano l’uso del questionario SDQ per la valutazione di problematiche emotive e comportamentali in queste popolazioni a rischio. Quindi l’SDQ potrebbe essere utilizzato dai clinici per individuare precocemente disturbi psicopatologici in bambini con diversi tipi di patologie organiche croniche

Influenza vaccination in children with cancer receiving chemotherapy

Influenza has a significant clinical impact on pediatric cancer patients because it causes frequent febrile episodes and respiratory tract infections, possibly severe complications, delays in chemotherapy administration and even death, all of which supports the importance of prevention and the widespread use of influenza vaccination. Results from clinical studies show that influenza vaccination can be considered safe in children undergoing chemotherapy and, although weaker than in healthy children, the immune response seems to be sufficient in patients with leukemia or solid tumors even if it is less in children receiving chemotherapy than in those who are not. However, there is an urgent need for universally accepted guidelines concerning the type of vaccine that leads to the best immunological results, the number of administrations, and their timing in relation to the severity of immunosuppression and chemotherapy schedules. Such recommendations, together with a clear demonstration of vaccine efficacy, are also needed to increase influenza vaccination coverage in this high-risk category of patients

The link of pancreatic iron with glucose metabolism and cardiac iron in thalassemia intermedia: A large, multicenter observational study

In thalassemia major, pancreatic iron was demonstrated as a powerful predictor not only for the alterations of glucose metabolism but also for cardiac iron, fibrosis, and complications, supporting a profound link between pancreatic iron and heart disease. We determined for the first time the prevalence of pancreatic iron overload (IO) in thalassemia intermedia (TI) and systematically explored the link between pancreas T2* values and glucose metabolism and cardiac outcomes. We considered 221 beta-TI patients (53.2% females, 42.95 ± 13.74 years) consecutively enrolled in the Extension– Myocardial Iron Overload in Thalassemia project. Magnetic Resonance Imaging was used to quantify IO (T2* technique) and biventricular function and to detect replacement myocardial fibrosis. The glucose metabolism was assessed by the oral glucose tolerance test (OGTT). Pancreatic IO was more frequent in regularly transfused (N = 145) than in nontransfused patients (67.6% vs. 31.6%; p < 0.0001). In the regular transfused group, splenectomy and hepatitis C virus infection were both associated with high pancreatic siderosis. Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with altered OGTT. A pancreas T2* < 17.9 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for cardiac