Assessment of respiratory function in infants and young children wearing face masks during the COVID-19 pandemic

Importance: Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older.Objective: To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress.Design, Setting, and Participants: This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020.Interventions: All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes.Main Outcomes and Measures: Changes in respiratory parameters during the use of surgical masks were evaluated.Results: Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis =.59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis =.61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis =.99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis =.69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis =.97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis =.52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test=.48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis =.55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P<.02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P<.05).Conclusions and Relevance: This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger

Research in therapeutic patient education: current challenges

Therapeutic patient education started being recognized in the early 1970s, after the demonstration of the monetary savings associated with the reduction in hospitalizations due to the acute complications of diabetes. Since then it has steadily increased in number, for many chronic diseases, progressively focusing on relevant targets such as quality of life and healthy behaviours. The quality of published papers has progressively improved, with a steady increase of RCTs, but quantitative research has been and still is largely prevalent, with qualitative and mixed-methods research still representing only 3% and 0.8% respectively of total TPE research, despite the recognition that “RCTs in this area of research are not always feasible or even desirable”. Within the framework of narrative medicine, we have integrated the autobiographical approach in our TPE activity and have shown by qualitative methods that it can be appreciated and effective with adolescents with type-1 diabetes, allowing to propose it as a proper way to patient centred care for other chronic diseases

Demonstration of a gastric bioptic specimen mix-up by laser capture microdissection (LCM) and DNA fingerprinting

We demonstrate here the successful use of laser capture microdissection (LCM) and DNA fingerprinting in the identification of a case of gastric bioptic specimen mix-up. A 70-year-old man, suffering from chronic atrophic gastritis, underwent to a gastric biopsy and received a diagnosis of gastric cancer. In the absence of any clinical evidence of gastric cancer, a specimen mix-up was suspected. LCM was used to retrieve gastric cells from the histologic slide, classified as gastric carcinoma, and suspected to be mislabelled. DNA was extracted from microdissected cells, and a total of 16 different genetic loci were analyzed, using an identity test. Comparison of the results with those obtained using DNA extracted from a control slide, and from patient's saliva, demonstrated a distinct DNA fingerprint pattern in all genetic markers examined, clearly indicating the occurrence of a specimen mix-up. The combined use of LCM and DNA fingerprinting represents the most accurate and sophisticated method available for the identification of specimen mix-up, especially when only the tissue on the suspected slide is available

Provenance of White Marbles from the Roman City of Tauriana (Palmi, Reggio Calabria, Italy)

The work shows the results of an archaeometric study performed on fourteen white marble samples from the Roman city of Tauriana (Palmi, Reggio Calabria, Italy), belonging to different architectural elements of the Municipal Museum Complex and artifacts reused in the modern town. Samples were studied by optical microscopy (OM), x-ray powder diffraction (XRPD), and isotope ratio mass spectrometry (IRMS) of 13C and 18O with the aim to identify their provenance. The comparison between the collected data and the historical ones, concerning the ancient quarries of white marble of the Mediterranean area, allowed us to prove that most of the marbles used in the city of Tauriana were from the Apuan Alps Basin (Carrara) and, in few cases, from Minor Asia (Proconnesos, Aphrodisias, Docimium) and Greek (Thasos and Pentelic) quarries

Serum IgG levels in children 6 months after SARS-CoV-2 infection and comparison with adults

Since the outbreak of SARS-CoV-2 among the population has occurred quite recently, there is a lack of evidence on the long-term duration of antibody response, especially in children. It is therefore crucial to clarify this aspect, considering its implications in the development of successful surveillance strategies, therapies, and vaccinations. The aim of this study was to assess the antibody response in a children group after SARS-CoV-2 infection, and to compare it with that of their parents affected by SARS-CoV-2 infection. We enrolled 12 children and their parents, both groups being affected by COVID-19 in April 2020. In the children's group, we collected real-time RT-PCR cycle threshold (Ct) values and gene characterization of first nasal-throat swab at the time of diagnosis (T0); 30 days after the diagnosis (T30), we performed blood tests to detect anti-SARS-CoV-2 IgM and IgG. Finally, 180 days after the diagnosis (T180), we measured anti-SARS-CoV-2 IgG in both children and parents. In children, antibody levels declined significantly at 180 days (T180) after first measurement (T30). There were no significant differences in IgG level related to age, sex, and clinical manifestations. We found a significant correlation between IgG titers at T30 and Ct value of gene N. Children showed a lower level of antibodies against SARS-CoV-2 at T180 compared to their parents.Conclusion: Antibody responses in children waned 180 days after SARS-CoV-2 infection, and at the same time, their parents showed a different antibody response to the virus. These results highlight that serological tests should be used with caution in surveillance strategies among the general population. What is known: • Currently is not known how long antibody response will be maintained or if it protects from reinfection. • Recent reports in adults suggest that antibodies to SARS-CoV-2 declined several months after infection, but data are missing in pediatric age. What is new: • We showed that antibody responses to SARS-CoV-2 wane several months after infection also in children with quantitative differences in antibody levels between children and adults. • In this context, serological tests should be used with caution in surveillance strategie

Physical and Neurological Development of a Girl Born to a Mother with Methylmalonic Acidemia and Kidney Transplantation and Review of the Literature

Background: actual literature suggests that children of methylmalonic acidemia patients are mostly healthy, but data are only partial, especially regarding long-term outcome. Therefore, our aim was to evaluate the possible long-term neurological effects of fetal exposure to high levels of methylmalonic acid in a child of a renal transplant recipient. Methods: we retrospectively evaluated the clinical and neurological records of a girl whose mother is a kidney transplant recipient affected by methylmalonic acidemia. Subsequently, we compared our results with the ones already published. Results: the girl’s weight and stature were within the normal range in the first years of life but, starting from 4 years of age, she became progressively overweight. Regarding the neurodevelopment aspects, for the first time we performed a complete and seriated neuropsychological evaluation, highlighting a mild but significant weakness in the verbal domain, with a worsening trend at three-year revaluation. Conclusions: since children of MMA patients are exposed to methylmalonic acid, the efforts of the physicians caring for these children should be directed on careful evaluation of growth, prevention of obesity and regular neurological examination together with structured neuropsychological tests to achieve a better insight in possible complications of pregnancy in patients suffering from this condition

Hydraulicity of lime plasters from Teotihuacan, Mexico: a microchemical and microphysical approach

Hydraulicity is a well-known characteristic of mortars and plasters from the Roman, Late Roman, and Medieval periods, while the use of hydraulic mortars in pre-Columbian Mesoamerica and Central Mexico in particular, has not received equal attention. To address this issue, in this paper, we discuss the problem of hydraulicity and suggest a method to study it in Mesoamerican plasters. To prove the effectiveness of this method, we selected plaster samples from the archaeological site of Teotihuacan (Mexico), the main city of Central Mexico during the Classic period. The characterisation of plaster samples confirmed that, similar to other Teotihuacan plasters, they are made of two layers: the outermost layer (enlucido), composed of a mixture of lime and volcanic glass shards, and the underlying layer locally called firme, consisting of crushed volcanic scoria (tezontle) mixed with a mudbased binder. The compositional characterisation of the plasters confirmed their hydraulicity and the combination of microchemical (energy dispersive spectrometer (EDS) microchemical analysis), microphysical (Vickers microhardness), and petrographic (optical microscopy) measurements demonstrated that it was not the presence of glass shards in the external plaster layer which produced hydraulicity, as we originally thought. Instead, this was due to the reactivity of the tezontle, present in the lower layer. This suggests that the small thickness of the enlucido layer, in addition to save the amount of lime used, increased its performance, promoting chemical reactions with the tezontle in the contact layer and that the glass shards played another role in the mixture, rather than producing hydraulicity

Assessment of Cardio-Respiratory Function in Overweight and Obese Children Wearing Face Masks during the COVID-19 Pandemic

Objective: To evaluate whether the use of a surgical and N95 mask for overweight and obese children was associated with respiratory distress. Methods: We enrolled 15 healthy and 14 overweight or obese children. We performed two sessions: one wearing a surgical, the other an N95 mask. We tracked changes in partial pressure of end-tidal carbon dioxide (PETCO2), oxygen saturation (SaO2), pulse rate (PR), and respiratory rate (RR) during a 72 min test: 30 min without a mask, 30 min wearing a mask, and then during a 12 min walking test. Results: In healthy children, there was no significant change in SaO2 and PETCO2 during the study; there was a significant increase in PR and RR after the walking test with both the masks. In overweight or obese children, there was no significant change in SaO2 during the study period; there was a significant increase in PETCO2 as fast as wearing the mask and an increase in PETCO2, PR, and RR after walking test. After the walking test, we showed a significant correlation between PETCO2 and body mass index. Conclusion: Overweight or Obese children who wear a mask are more prone to developing respiratory distress, which causes them to remove it frequently. In a crowded environment, they are at greater risk of infection. For this reason, it is desirable that they attend environments where everyone uses a mask