Streptococcus pneumoniae colonisation in children and adolescents with asthma: Impact of the heptavalent pneumococcal conjugate vaccine and evaluation of potential effect of thirteen-valent pneumococcal conjugate vaccine

none14noBackground: The main aim of this study was to evaluate Streptococcus pneumoniae carriage in a group of school-aged children and adolescents with asthma because these results might indicate the theoretical risk of invasive pneumococcal disease (IPD) of such patients and the potential protective efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13). Methods: Oropharyngeal samples were obtained from 423 children with documented asthma (300 males, 70.9 %), and tested for the autolysin-A-encoding (lytA) and the wzg (cpsA) gene of S. pneumoniae by means of real-time polymerase chain reaction. Results: S. pneumoniae was identified in the swabs of 192 subjects (45.4 %): 48.4 % of whom were aged = 15 years (p < 0.001). Carriage was significantly less frequent among the children who had received recent antibiotic therapy (odds ratio [OR 0.41]; 95 % confidence interval [95 % CI] 0.22-0.76). Multivariate analyses showed no association between carriage and vaccination status, with ORs of 1.05 (95 % CI 0.70-1.58) for carriers of any pneumococcal serotype, 1.08 (95 % CI 0.72-1.62) for carriers of any of the serotypes included in 7-valent pneumococcal conjugate vaccine (PCV7), and 0.76 (95 % CI 0.45-1.28) for carriers of any of the six additional serotypes of PCV13. Serotypes 19 F, 4 and 9 V were the most frequently identified serotypes in vaccinated subjects. Conclusions: These results showed that carriage of S. pneumoniae is relatively common in all school-aged children and adolescents with asthma, regardless of the severity of disease and the administration of PCV7 in the first years of life. This highlights the problem of the duration of the protection against colonisation provided by pneumococcal conjugate vaccine, and the importance of re-colonization by the same pneumococcal serotypes included in the previously used vaccine.Esposito, Susanna; Terranova, Leonardo; Patria, Maria Francesca; Marseglia, Gian Luigi; Miraglia del Giudice, Michele; Bodini, Alessandro; Martelli, Alberto; Baraldi, Eugenio; Mazzina, Oscar; Tagliabue, Claudia; Licari, Amelia; Ierardi, Valentina; Lelii, Mara; Principi, NicolaEsposito, Susanna; Terranova, Leonardo; Patria, Maria Francesca; Marseglia, GIAN LUIGI; Miraglia del Giudice, Michele; Bodini, Alessandro; Martelli, Alberto; Baraldi, Eugenio; Mazzina, Oscar; Tagliabue, Claudia; Licari, Amelia; Ierardi, Valentina; Lelii, Mara; Principi, Nicol

Severe asthma features in children: A case–control online survey

Background: Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy. Methods: We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6–17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients’ characteristics and severe asthma or non-severe persistent asthma. Results: Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95% Confidence Interval (CI), 1.21–18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95% CI, 1.11–12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95% CI, 2.70–53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95% CI, 2.66–61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40% of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56% of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients’ comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE. Conclusions: As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation

Serie di Puiseux

La tesi è incentrata sullo studio dei punti di singolarità di una curva nel piano proiettivo complesso. Nel caso in cui il punto sia regolare possiamo sfruttare il teorema delle funzioni implicite che ci permette di esplicitare il luogo di zeri di un'equazione implicita rispetto a una variabile. Quando questa ipotesi di regolarità viene meno per avere un risultato analogo diventa necessario utilizzare le serie di Puiseux. L'interpretazione algebrica del teorema di Puiseux risponde alla domanda di trovare un'estensione del campo delle serie di Laurent che sia algebricamente chiuso; prendendo un polinomio di grado positivo in K(x)*[y], mostreremo che esiste sempre una radice del polinomio appartenente a K(x)*. Il legame con l’interpretazione analitica risulta ora evidente: data infatti una curva nel piano complesso la sua equazione può essere vista come un particolare polinomio in K(x)*[y], esplicitare la y in funzione della x equivale appunto a trovare una radice in K(x)*. Nel primo capitolo abbiamo in primo luogo richiamato il risultato di Dini e parlato del luogo singolare di una curva, mostrando che quest'ultimo è un numero finito di punti. In seguito abbiamo introdotto il poligono di Newton, il quale è un insieme convesso del piano associato ad un polinomio in due variabili. Nel secondo capitolo abbiamo visto due formulazioni del teorema di Puiseux, entrambe le dimostrazioni di questo risultato sono costruttive; per renderle più scorrevoli abbiamo ritenuto opportuno costruire degli esempi che evidenziassero i vari passi

La sfera tra cartografia e geometrie non euclidee

Il teorema Egregium di Gauss afferma che se due superfici hanno diverse curvature gaussiane non possono essere localmente isometriche, per questo motivo non può esistere una mappa tra la sfera e il piano che conservi le distanze. La sfera come approssimazione del nostro pianeta è stata a lungo studiata nell'ambito della cartografia nel tentativo di realizzare planisferi sempre più fedeli alla realtà. La sfera viene poi vista come modello di geometria non euclidea, nel quale non è ammesso il postulato delle parallele, ma viene assunto l'assioma di Riemann

Association between radiological findings and severity of community-acquired pneumonia in children

Background: There are few published data concerning radiological findings and their relationship with community-acquired pneumonia (CAP) severity. The aim if this study was to assess radiographic findings in children with CAP of different severity in order to evaluate whether some parameters are associated with severe CAP. Methods. We analysed the characteristics of parenchymal densities in 335 chest radiographs of otherwise healthy children (173 males; mean age \ub1 standard deviation, 7.5 \ub1 4.5 years) admitted to our Emergency Room for CAP. Upon admission, chest radiographs were obtained in the two standard projections, and the children with severe or mild/moderate CAP were compared in order to identify any correlations between CAP severity and the radiological findings. Results: Seventy-six of the 335 enrolled children (22.7%) fulfilled the criteria for severe CAP. In comparison with the children with mild/moderate CAP, in severe CAP there was a significantly greater frequency of a bilateral multifocal distribution (p = 0.01), the simultaneous involvement of 653 sites (p = 0.007), and the involvement of the right hilum (p = 0.02). The same results were confirmed in the multiple logistic regression model. Conclusions: This study shows that radiological findings such as a multifocal bilateral distribution, the simultaneous involvement of at least three sites, and right hilar consolidation are associated with severe CAP in otherwise healthy children, and could be considered markers of disease severity in children with CAP

Serial high-resolution computed tomography (HRCT) in children with chronic productive cough and bronchiectasis unrelated to cystic fibrosis: correlations with clinical evaluation

Objectives. To follow prospectively for 3 years children with chronic productive cough and non-Cystic Fibrosis bronchiectasis defined by high resolution computed tomographic scanning, in order to determine the evolution of lung damage; to compare their computed tomography scores with the results obtained with a simple clinical parameter (cough index) used to monitor the disease. Methods. We studied 22 children for 3 years, during which they underwent regular physiotherapy and antibiotic therapy for acute lower respiratory tract infections. The number of months/year of productive cough (cough index) was calculated for each patient for the 2 years before study entry and during the study. At the end of follow-up, chest high resolution computed tomographic (HRCT) was repeated. Results. During follow-up the cough index improved or remained stable in 19 children (86%); among these, HRCT scores decreased in 12, remained stable in 6 and worsened in 1. Mild and moderate bronchiectasis remained unchanged in 17 patients (77%) and completely resolved in 4. There was a close correlation between the change in cough index before and during the follow-up, and the change in HRCT scores (r = 0.66; p = 0.0008). Conclusion. The cough index significantly improved and the HRCT score of most patients improved or remained unchanged during the 3 years of systematic treatment; there was a close correlation between the change in the HRCT scores and the change in the cough index used to monitor the evolution of lung damage. Patients with a persistent productive cough do not need to repeat HRCT within a short time if the clinical symptoms improve or remain stable