Lo studio FAST: FAringotonsillite STreptococcica in età pediatrica Impatto farmacoeconomico delle Linee Guida dell'American Academy of Pediatrics sulla pratica clinica di 600 pediatri italiani

The American Academy of Pediatrics (AAP) has recently published its new guidelines for the treatment of pediatric tonsillopharyngitis; a diagnostic test for the detection of streptococci is recommended, followed by a treatment with penicillins (10 days) or cephalosporins (5 days) in case of positivity, and by no treatment otherwise. The success of a guideline, in general, depends on its diffusion in practice and on its adaptability to different local settings. The aim of the present study (FAST) was the evaluation of the clinical and economical impact of the application of the AAP guidelines in the Italian reality. The study was conducted with the cooperation of 600 pediatricians, uniformly distributed on the Italian territory, and involved 3072 patients. The pediatricians were left free to decide whether to follow the guidelines or not. The results of the analysis indicate that only some 20% of the pediatricians adhered to the suggested protocol; the total cost (calculated in the perspective of the National Health System, with a time horizon of about 3 months) per patient, nonetheless, resulted inferior in the group treated according to the proposed protocol (50,45 • vs. 53,30 •). Furthermore, a lower incidence of complications occurred in these patients. Among the "off-protocol" behaviors, two showed particularly evident misuse of health resources: inappropriate treatment after test positivity (59,15 •/patient), and treatment after test negativity (14% of the total population). Another interesting, although not surprising, result of this study was the evidence that penicillins are as effective as cephalosporins in the short-term, but significantly inferior in terms of complications, positivity for streptococci at the control test, and complications detected at follow-up

Immunomodulation in pediatric asthma

Childhood asthma is actually defined as a heterogeneous disease, including different clinical variants and partially sharing similar immune mechanisms. Asthma management is mainly focused on maintaining the control of the disease and reducing the risk of adverse outcomes. Most children achieve good control with standard therapies, such as low doses of inhaled corticosteroids (ICS) and/or one or more controller. These medications are targeted to suppress bronchial inflammation and to restore airway responsiveness. However, they are not disease-modifying and do not specifically target inflammatory pathways of asthma; in addition, they are not significantly effective in patients with severe uncontrolled asthma. The aim of this review is to update knowledge on current and novel therapeutic options targeted to immunomodulate inflammatory pathways underlying pediatric asthma, with particular reference on biologic therapies

Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis

Necrotizing enterocolitis continues to be a devastating disease process for very low birth weight infants in Neonatal Intensive Care Units. The aetiology and pathogenesis of necrotizing enterocolitis are not definitively understood. It is known that necrotizing enterocolitis is secondary to a complex interaction of multiple factors that results in mucosal damage, which leads to intestinal ischemia and necrosis. Advances in neonatal care, including resuscitation and ventilation support technology, have seen increased survival rates among premature neonates and a concomitant detection in the incidence of this intestinal disease.Diagnosis can be difficult, and identifying infants at the onset of disease remains a challenge. Early diagnosis, which relies on imaging findings, and initiation of prompt therapy are essential to limit morbidity and mortality. Moreover, early management is critical and life-saving.This review summarizes what is known on the laboratory and instrumental diagnostic strategies needed to improve neonatal outcomes and, possibily, to prevent the onset of an overt necrotizing enterocolitis

Food allergies: Current and future treatments

Food allergies are an increasingly public health problem, affecting up to 10% of children and causing a significant burden on affected patients, resulting in dietary restrictions, fear of accidental ingestion and related risk of severe reactions, as well as a reduced quality of life. Currently, there is no specific cure for a food allergy, so the only available management is limited to strict dietary avoidance, education on prompt recognition of symptoms, and emergency treatment of adverse reactions. Several allergen specific-and nonspecific-therapies, aiming to acquire a persistent food tolerance, are under investigation as potential treatments; however, to date, only immunotherapy has been identified as the most promising therapeutic approach for food allergy treatment. The aim of this review is to provide an updated overview on changes in the treatment landscape for food allergies

Acute pain management in children: A survey of Italian pediatricians

Background: Current guidelines recommend assessing and relieving pain in all children and in all instances; yet, in clinical practice, management is frequently suboptimal. We investigated the attitude of Italian family pediatricians towards the evaluation and treatment of different types of acute pain in children aged 7-12 years. Methods: This is a cross-sectional study based on a 17-question survey accessible online from October 2017 to October 2018. Responders had to describe cases of children suffering from any type of acute pain among headache, sore throat, musculoskeletal/post-traumatic pain, and earache. Children's characteristics, pain assessment modalities and therapeutic approaches were queried. The following tests were used: Z-proportion to evaluate the distribution of categorical data; chi-squared and Kruskall-Wallis to explore data heterogeneity across groups; Mann-Whitney for head-to-head comparisons. Results: Overall, 929 pediatricians presented 6335 cases uniformly distributed across the types examined. Pain was more frequently of moderate intensity (42.2%, P < 0.001) and short duration (within some days: 98.4%, P < 0.001). Only 50.1% of responders used an algometric scale to measure pain and 60.5% always prescribed a treatment. In children with mild-moderate pain (N = 4438), the most commonly used first-line non-opioids were ibuprofen (53.3%) and acetaminophen (44.4%). Importantly, a non-recommended dosage was prescribed in only 5.3% of acetaminophen-treated cases (overdosing). Among the misconceptions emerged, there were the following: I) ibuprofen and acetaminophen have different efficacy and safety profiles (when choosing the non-opioid, effectiveness weighted more for ibuprofen [79.7% vs 74.3%, P < 0.001] and tolerability for acetaminophen [74.0% vs 55.4%, P < 0.001]); ii) ibuprofen must be taken after meals to prevent gastric toxicities (52.5%); ibuprofen and acetaminophen can be used combined/alternated for persisting mild-moderate pain (16.1%). In case of moderate-severe pain not completely controlled by opioids, ibuprofen and acetaminophen were the most used add-on medications, with ibuprofen being much more prescribed than acetaminophen (65.2% vs 23.7%, respectively) overall and in all pain types. Conclusions: Several gaps exist between the current practice of pain assessment and treatment and recommendations. Further efforts are needed to raise awareness and improve education on the possible exposure of the child to short- A nd long-term consequences in case of suboptimal pain management

Strongly enhanced photon collection from diamond defect centres under micro-fabricated integrated solid immersion lenses

The efficiency of collecting photons from optically active defect centres in bulk diamond is greatly reduced by refraction and reflection at the diamond-air interface. We report on the fabrication and measurement of a geometrical solution to the problem; integrated solid immersion lenses (SILs) etched directly into the surface of diamond. An increase of a factor of 10 was observed in the saturated count-rate from a single negatively charged nitrogen-vacancy (NV-) within a 5um diameter SIL compared with NV-s under a planar surface in the same crystal. A factor of 3 reduction in background emission was also observed due to the reduced excitation volume with a SIL present. Such a system is potentially scalable and easily adaptable to other defect centres in bulk diamond.Comment: 5 Pages, 5 figures (4 subfigures) - corrected typ

Lo studio FAST: FAringotonsillite STreptococcica in età pediatrica Impatto farmacoeconomico delle Linee Guida dell’American Academy of Pediatrics sulla pratica clinica di 600 pediatri italiani

The American Academy of Pediatrics (AAP) has recently published its new guidelines for the treatment of pediatric tonsillopharyngitis; a diagnostic test for the detection of streptococci is recommended, followed by a treatment with penicillins (10 days) or cephalosporins (5 days) in case of positivity, and by no treatment otherwise. The success of a guideline, in general, depends on its diffusion in practice and on its adaptability to different local settings. The aim of the present study (FAST) was the evaluation of the clinical and economical impact of the application of the AAP guidelines in the Italian reality. The study was conducted with the cooperation of 600 pediatricians, uniformly distributed on the Italian territory, and involved 3072 patients. The pediatricians were left free to decide whether to follow the guidelines or not. The results of the analysis indicate that only some 20% of the pediatricians adhered to the suggested protocol; the total cost (calculated in the perspective of the National Health System, with a time horizon of about 3 months) per patient, nonetheless, resulted inferior in the group treated according to the proposed protocol (50,45 • vs. 53,30 •). Furthermore, a lower incidence of complications occurred in these patients. Among the “off-protocol” behaviors, two showed particularly evident misuse of health resources: inappropriate treatment after test positivity (59,15 •/patient), and treatment after test negativity (14% of the total population). Another interesting, although not surprising, result of this study was the evidence that penicillins are as effective as cephalosporins in the short-term, but significantly inferior in terms of complications, positivity for streptococci at the control test, and complications detected at follow-up

Novel therapeutic targets for allergic airway disease in children

The aim of precision medicine is setting up targeted therapies for selected patients that would ideally have high effectiveness and few side effects. This is made possible by targeted therapy drugs that selectively act on a specific pathway. Precision medicine is spreading to many medical specialties, and there is increasing interest in the context of allergic airway diseases, such as allergic rhinitis, chronic rhinosinusitis, and asthma. This review is an update of new targets in the treatment of childhood allergic upper airway diseases and asthma, including the most recent biologic drugs that have already been licensed or are in the pipeline to be tested with children

Cross-sectional survey on impact of paediatric COVID-19 among Italian paediatricians: Report from the SIAIP rhino-sinusitis and conjunctivitis committee

Background: There is ample evidence that COVID-19 is significantly less severe in children than in adults and asthma and allergy, the most common chronic disorders in children, are not included in the top 10 comorbidities related to COVID-19 fatalities. Nevertheless, concerns about asthma and allergy are still high. In order to evaluate the impact of paediatric COVID-19 among Italian paediatricians, we sent a 20-questions anonymous internet-based survey to 250 Italian paediatricians with particular address to allergic symptoms and those affecting the upper airways. Methods: The questionnaire was conceived and pretested in April 2020, by a working group of experts of the Italian Paediatric Society for Allergy and Immunology (SIAIP), and structured into different sections of 20 categorized and multiple choice questions. The first part included questions about epidemiological data follows by a second part assessing the way to manage a suspected COVID-19 infection and personal experiences about that. The third part concerned questions about patients' clinical characteristics and clinical manifestations. The survey was emailed once between April and mid-May 2020. Results: A total 99 participants had participated in our survey and provided responses to our electronic questionnaire. The distribution of patients reported per month varies significantly according to the geographical area (P = 0.02). Data confirmed that in the North part of Italy the rate of patients referred is higher than in the rest of Italy. Almost all respondents (98%) reported caring for up to a maximum of 10 infected children and the last 2% more than twenty. Among these patients, according to the 75% of responders, a maximum rate of 20% were affected by allergic rhino-conjunctivitis and in particular in the North of Italy while in the Centre and in the South there was a higher incidence (P = 0.09). Almost the same applies for asthma, 83% of responders declared that up to a maximum of 20% of affected children were asthmatic, from 20 to 40% for the 13,5% of responders and from 40 to 60% for the last 3,5%. As for the allergic conjunctivitis also for asthma, we found a higher incidence in the Centre and in South than in the North (P = 0.03). Conclusions: This study is the first to provide a comprehensive review of COVID-19 knowledge and impact among paediatricians in Italy about allergic asthma and upper airway involvement. From our point of view, it provides important information clearly useful for improving a good practice