Risk factors for intussusception in childhood gastroenteritis: a nationwide cross-sectional study in Italy

Background. The aetiology of intussusception is unknown for most of the cases studied, although some associated conditions have been identified. We aimed to clarify the role played by enteric pathogens as potential risk factors for intussusception.   Methods. A retrospective review of the records relating to hospitalizations for gastroenteritis with or without concurrent intussusception in Italian children was conducted among children aged <6 years old during the period 2005-2012. Through a multivariate logistic regression model, the associations, expressed as odds ratios with 95% confidence intervals, were estimated between the presence of gastroenteritis with intussusception and the explanatory variables, such as sex, age, the aetiology of gastroenteritis and whether the subjects lived in the North, South and Islands or Centre Italy. Results. A total of 174 records related to admissions due to the concomitant manifestation of gastroenteritis and intussusception were extracted and analyzed. The estimate of the adjusted odds ratio confirmed the significant contribution that sex and geographical location made to hospitalizations both for gastroenteritis with concurrent intussusception, and in the associated secondary diagnosis of gastroenteritis, with the exception of the rotavirus, where a different seasonality and a bucking trend were observed. The probability of intussusception became statistically significant lower from 12 months of age to ≤23 months and for age 48-59 months, respect to the first year of life. Conclusions. Our observational study highlighted males, affected by enteric infections, other than rotavirus and parasitic, living in North and Centre of Italy have an increased risk of developing intussusceptions. In the second and fifth year of life the probability of intussusceptions becomes lower than in the first year. Additional research is needed to confirm these findings and evaluate the pathogenesis which may link such infections with intussusception.&nbsp

Efficacy and Tolerability of a New Formulation in Rectal Ointment Based on Zn-L-Carnosine (Proctilor®) in the Treatment of Haemorrhoidal Disease

Haemorrhoidal disease (HD) shows high prevalence in western countries, reaching 4.4% per year in the US. Topical preparations are the first-line treatments, which are readily available as "over-the-counter" (OTC) products, often containing a nonstandardised mixture of "natural" remedies, or anaesthetics or cortisol;those latter are not free from undesirable effects. The Zinc-L-Carnosine is a cytoprotective compound, promoting mucosal repair in the gastrointestinal tract and also in mucosal repair, following radiation injuries to the rectum as well as in ulcerative colitis. Our aim was to study the efficacy of Zinc-L-Carnosine in relieving acute symptoms of HD, testing a preparation in the rectal ointment, Proctilor (R), in patients complaining of bleeding or thrombosed piles. In a multicentre open trial, 21 patients older than 18 years of age were enrolled. The symptoms of HD were graded according to the Haemorrhoidal Disease Symptoms Score (HDSS) in association with the Short Health Scale (SHS) to assess the influence of HD on quality of life. The pain was assessed with the VAS score, bowel habit by means of the Bristol scale. The patients were evaluated at enrolment (T0) and 2 (T1) and 4 (T2) weeks of treatment with Proctilor (R) rectal ointment. There were 10 men and 11 women; mean age, 49 years. Pain, bleeding, and thrombosis were all significantly reduced after treatment; the mean VAS score decreased from 4.71 +/- 3.05 at T0 to.52 +/- 0.87 and.05 +/- 0.22 at T1 and T2, respectively; (mean +/- SD; p < 0.001 in both cases). Similarly, the HDSS score showed to be significantly reduced between T0, T1 (8.05 +/- 4.55 vs. 1.14 +/- 1.01), and T2 (8.05 +/- 4.55 vs. 24 +/- 0.44) (mean +/- SD; p < 0.001 in both cases). Quality of life showed to be improved as the SHS score decreased significantly with treatment (7.90 +/- 4.17 at T0 vs. 4.24 +/- 0.44 at T1 vs. 4.05 +/- 0.22 at T2; mean +/- SD; p < 0.001 in both cases). The Bristol score of defecation remained substantially unchanged. No side effects or discontinuation of treatment were reported. Results of our investigation suggest a role of Proctilor (R) rectal ointment in treating symptomatic HD with good results and an excellent safety profile. However, our preliminary results encourage further studies on a larger number of patients to confirm the role of Zinc-L-Carnosine in the rectal ointment for the topical treatment of HD

Bite and Sight: Is There a Correlation? Clinical Association between Dental Malocclusion and Visual Disturbances in Pediatric Patients

Aim: The aim of this study was to evaluate the correlation between malocclusions and visualdefects. Thisisacase-controlstudyevaluatingtheprevalenceofvisualdefectsinpatientswith di\ufb00erent types of malocclusions. Methods: One-hundred and sixty patients aged from 5 to 14 were evaluatedusingtheROMAindextodetectmalocclusion;theoneswiththelowestscoreswereusedas the control group. They were also submitted to visual-capacity inspection for motility and refractive disorders. Results: Our work showed an enhanced prevalence of refractive defects or fusional vergence defects and alteration of eye movements (especially the saccades) in almost all dental malocclusions. Statistics: TheKappatestvaluesforROMAindexwerebetween0.643and1.00forthe intraoperator agreement (0.00 < p < 0.002) and between 0.773 and 1.00 for the agreement between operators (p = 0 < 0.001). The statistically signi\ufb01cance level for the correlation malocclusion/visual defectswassetatp < 0.05. StatisticalanalyseswereperformedwiththeSTATAsoftware(version15.0, Stata Corp LP, College Station, TX, USA). Conclusion: Considering the high level of the statistical analysis and the accuracy of the methodology used, these data allows the establishment of a huge correlation between sagittal, transversal and vertical malocclusions with ocular disorders (myopia, hyperopia, astigmatism and ocular motility defects)

Measles-Related Hospitalizations in Italy, 2004–2016: The Importance of High Vaccination Coverage

Background: Measles is a highly contagious human infectious disease. It can lead to serious complications and often requires hospitalization. In Italy, as in other European countries, the goal of measles elimination in 2015 failed. To reach this target, identifying susceptible individuals, closing any immunity gaps and reaching adequate vaccination coverage is necessary. Objective: To contribute to these purposes, a retrospective observational study on measles-related hospitalization between 2004 and 2016 in Italy was conducted, using the national hospital discharge database as informational flow. Methods: Admission frequencies and hospitalization rates were compared between regions with low (90% led to a halving of measles hospitalizations, but it is insufficient for the elimination: ≥95% coverage continues to be the target to be reached

Active surveillance of adverse events after immunization (AEFI) from the Local Health Unit of Ferrara, Italy

IntroductionVaccine vigilance implies the collection, evaluation, analysis and communication of adverse events following immunization (AEFI) and is a useful tool for vaccine monitoring allowing, even after approval and marketing, to check its safety/tolerability. The multiregional project "Active surveillance of adverse vaccine reactions", joined by the AUSL of Ferrara, is aimed at making parents of children, who have undergone at least one vaccination provided by the regional vaccination calendar in the first 24 months of life, aware of the reporting of any AEFI via mobile phone-SMS.MethodsAn analysis of the project data, collected in the period March 2018 - May 2019, was carried out, to evaluate the effectiveness of the reporting tool and the type and frequency of AEFI. Anonymized data were analyzed by number, gender, distribution by age, type of vaccine, adverse event, severity and outcome.ResultsA total of 1494 consents and 983 SMS messages were obtained from parents.The vaccine doses carried out were 1,984 (28.3% hexavalent, 28% PCV13, 17% anti-rotavirus, 14.3% Men-B). Almost all (99.5%) AEFI were classified as "not serious".Based on the Organ System Class (SOC), most reports are related to "General Disorders and Administration Site Conditions" (52.3%), followed by "Psychiatric Disorders" (26.5%) and "Metabolic and nutrition disorders" (12.5%).ConclusionsThe reported AEFI are in line with the ones reported in the literature.Reporting via SMS is a valid vaccine surveillance tool contributing to the qualitative and quantitative improvement of the information transmitted

Effects of rapid maxillary expander and delaire mask treatment on airway sagittal domention in pediatrc patirnts affected by class III malocclusion and obstructive sleep apnea syndeome

Abstract: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander (RME) in association with the Delaire mask is a common treatment protocol for class III malocclusion. The aim of this work was to evaluate the cephalometric variations of upper airway dimensions and OSArelated clinical conditions after orthodontic treatment with an RME and the Delaire mask, as recorded in pediatric patients with a class III malocclusion who were affected by OSAS. In this preliminary study, 14 pediatric patients with mixed dentition, aged between 6 and 10 years, were selected. All patients were treated with an RME and the Delaire mask. Pre- and post-treatment cephalometric radiographs were traced, analyzed, and compared. The results demonstrated a significant increase in the upper airway linear measurements and the nasopharyngeal and oropharyngeal dimensions (p ≤ 0.05). This increase creates an improvement in airway patency and in OSAS-related clinical conditions. The use of the RME in association with the Delaire mask can be effective in the treatment of pediatric patients with a class III malocclusion who are affected by OSAS

Syndrome or symptoms? Assessing cothymia, neuroticism and lifetime comorbidity in a sample of psychiatric patients

Background. Cross-sectional and longitudinal psychiatric comorbidity rates could represent a syndromic process rather than the co-occurrence of different disorders. ‘Cothymia’, the concomitant presence of depression and anxiety symptoms, and the ‘neuroticism’ dimension have been proposed as candidate vulnerability factors for psychiatric disorders trajectories. Based on this background, the present research was aimed at assessing the role of cothymia and neuroticism as syndromic processes in lifetime psychiatric disorders, and examining homotypic or heterotypic trends in the diagnostic continuum of comorbid mental disorders. Materials and methods. Data collection was carried out retrospectively through the consultation of medical records at the Psychiatry Unit of the University Hospital of Messina. Cothymia was determined by the lifetime presence of depression and other anxiety disorders, and neuroticism was determined by the presence of borderline personality disorders and other personality disorders. Results. Cothymia and neuroticism were found in 580 patients with higher rates of hospitalization, drug prescription, polypharmacotherapy, and longer duration of illness. Furthermore, diagnostic trajectories in patients with cothymia and neuroticism followed both homotypic and heterotypic progressions. Limitations: This study presented several limitations. The small sample size from a restricted recruitment area, and the retrospective design may have influenced a realistic and accurate estimation of the lifetime prevalence of the disorders. Conclusions. Despite the limitations, the findings of this study confirm the presence of consistent and meaningful homotypic and heterotypic trajectories in psychiatric patients, suggesting that the evolution of lifetime diagnoses should become a focus in theoretical and practical approaches to psychiatric disorders

Trends in Hospital Admissions for Pertussis Infection: A Nationwide Retrospective Observational Study in Italy, 2002–2016

Background: Pertussis is a highly contagious infectious disease which continues to be an important public-health issue despite the high immunization coverage rates achieved. However, evidence of increased circulation of pertussis among adolescents and adults due to waning immunity and atypical clinical manifestations seem to be the main reasons for its resurgence. The aim of this study was the analysis of the epidemiological trend for pertussis-related hospitalizations in Italy, in relation with vaccination coverage and information from laboratory confirmed cases of pertussis. Methods: A retrospective observational study investigating hospitalizations for pertussis from 2002 to 2016 in Italy was conducted. Frequencies and rates of hospitalization were analyzed and hospitalization data were compared with a series of already published laboratory confirmed data. Results: This study highlighted a rising trend for pertussis hospitalizations in Italy since 2008. Infants aged <1 year showed the highest frequencies (63.39%) and average rates (74.60 × 100000 infants) of hospitalization despite an extremely high vaccination coverage (95.89%). An increasing trend of hospitalization frequency emerged for the age group with levels of IgG antibodies to pertussis toxin compatible with pertussis infection within the last year (20–29 years old age group). Conclusions: The rising trend for pertussis hospitalizations and the greater involvement of infants aged <1 year require an integrated approach, including the implementation of booster doses administration in adolescence and adulthood, the vaccination of pregnant women and the cocoon strategy

Pertussis in Italy: how to protect the “unprotectable”?

Whooping cough continues to be an important public health issue despite high levels of vaccination coverage with acellular pertussis vaccine. Young unimmunized infants represent the most vulnerable group with the highest rates of complications and death. As infant-specific pertussis epidemiologic data, especially among neonates, in Italy were limited, a retrospective observational study of hospitalizations for whooping cough in Italian infants aged <12 months between 2007 and 2018 was conducted to address this knowledge gap. The temporal trend of rates, also stratified for age classes according to the expected age for the administration of vaccine doses, were analyzed by the slope of the regression line. The mean age at the time of admission was 92 d (±64). A clear seasonal pattern in the occurrence of pertussis hospitalizations with a summer peak was observed. Infants younger than 3 months old had the highest hospitalization rates (169 x 100000 infants on average), with a significant rising trend of 9 x 100000 infants on average per year. Limiting the analysis to Bordetella pertussis-related hospitalizations such trend was even more evident. In the other age classes, hospitalization rates were considerably lower and gradually decreased with increasing age. This study demonstrated that pediatric populations, too young to be protected by vaccination, had a greater risk of contracting pertussis. Thus, it is necessary to promote additional immunization strategies besides one booster dose in adolescents, including vaccination during pregnancy

Policy of vaccination of “fragile children”: Results of a survey of 14 Italian children’s hospitals

Children with chronic disease are at higher risk of invasive infectious disease, including several vaccine-preventable infections. The Italian Association of Pediatric Hospitals (AOPI) carried out a survey of immunization practices: 14/16 AOPI hospitals completed the survey; 50% of them include 100–199 beds, while 21% have 2,000/year. A COVID-19 vaccination team is in place for any inpatient child older than 12 years in 42% of hospitals, in 42% only for “fragile” children. A centralized in-hospital immunization service is an emerging model that may contribute to increase compliance to vaccination of fragile patients and to fight against vaccination hesitancy