Creation of a specific and separated pediatric intra-hospital pathway in primary level hospitals during the era of COVID-19

Every new pandemic forces us to start new specific behaviors both in the civil life and within the hospitals trying to contain the spreading of the infection and preserve the more fragile people. In this regard, at the debut of Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2) pandemic, our Local Health Agency had drastically modified every clinical and organizational pathways in order to limit the diffusion of the infection as well as to maintain a good quality of care and preserve healthcare workers. We report how we have modified the usual pediatric intra-hospital pathways in our primary level hospital to avoid mixing children with suspected and non-suspected symptoms of SARS-CoV-2 infection. Before every hospitalization, regardless of symptoms, each child and him/her parent/caregiver are undergone to rapid antigenic and molecular swab to rule out a SARS-CoV-2 infection; hence, positive patients are transferred to Pediatric Unit of third level hospital equipped by a Pediatric COVID Intensive Unit. We think the healthcare behaviors described in this manuscript can help to reduce the intra-hospital spreading of SARS-CoV-2, although children seem to have a minimal role in the dissemination, but we cannot let down your guard. Simultaneously we observed that the overall children requiring inpatient pediatric evaluation and hospitalization have dramatically decreased from the beginning of pandemic

Evolution of fermenting microbiota in tarhana produced under controlled technological conditions

The purpose of this study was to evaluate the evolution of lactic acid bacteria (LAB) and yeasts during the fermentation of tarhana produced with some pasteurised ingredients and carried out at 30 and 40 C. The chemical parameters were those typical for tarhana production. Coliform bacteria were not detected during fermentation, while LAB and yeasts were in the range 107e108 colony forming units (CFU) g 1. Plate counts showed an optimal development of both fermenting microbial groups and the differences in cell concentrations were not significant (P > 0.05). LAB were isolated during fermentation and grouped on the basis of phenotypic and polymorphic characteristics. LAB isolates were identified by a combined genetic approach consisting of 16S/23S rRNA intergenic spacer region (ITS) and partial 16S rRNA gene sequencing as Pediococcus acidilactici, Lactobacillus plantarum and Lactobacillus brevis. Hence, the pas- teurisation of the vegetable ingredients, excluded wheat flour, enhanced the hygienic conditions of tarhana without influencing the normal evolution of LAB. However, the fermentation at 40 C favoured pediococci, while the production at 30 C was mainly characterised by lactobacilli. Yeasts, identified by the restriction fragment length polymorphism (RFLP) of the 5.8S ITS rRNA gene, were mainly represented by the species Saccharomyces cerevisiae in both productions

Second Trimester Amniocentesis Is Not a Risk Factor for Very Low Birth Weight and Extremely Low Birth Weight

Objectives. To assess the risk of very low birth weight (VLBW) and extremely low birth weight (ELBW) attributable to second trimester amniocentesis. Methods. Records of 4,877 consecutive amniocentesis, performed between 1997 and 2003, were analyzed. Only VLBW and ELBW in the study population (exposed) and in the control group (unexposed) were evaluated. Comparisons were made between the amniocentesis group versus nonexposed. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for VLBW and ELBW classes. Results. In the study population, the VLBW were 35 (0.71%) and the ELBW were 20 (0.41%). In the control group, the VLBW were 220 (0.67%) and the ELBW were 112 (0.34%). The Odds ratios of the VLBW between the study and the control group did not show any statistical significant risk (OR = 1.07, 95% CI = 0.72–1.54). Also in ELBW odds ratios between study and control group were not statistically significant (OR = 1.20, 95% CI = 0.7–1.95). Conclusions. No effect of the second trimester amniocentesis was noted on VLBW and ELBW

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01). Conclusion Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications

Group B Streptococcus early-onset disease and observation of well-appearing newborns

Background International guidelines lack a substantial consensus regarding management of asymptomatic full-term and late preterm neonates at risk for early-onset disease (EOS). Large cohorts of newborns are suitable to increase the understanding of the safety and efficacy of a given strategy. Methods This is a prospective, area-based, cohort study involving regional birth facilities of Emilia-Romagna (Italy). We compared cases of EOS (at or above 35 weeks\u2019 gestation) registered in 2003\u20132009 (baseline period: 266,646 LBs) and in 2010\u20132016, after introduction of a new strategy (serial physical examinations, SPEs) for managing asymptomatic neonates at risk for EOS (intervention period: 265,508 LBs). Results There were 108 cases of EOS (baseline period, n = 60; intervention period, n = 48). Twenty-two (20.4%) remained asymptomatic through the first 72 hours of life, whereas 86 (79.6%) developed symptoms, in most cases (52/86, 60.5%) at birth or within 6 hours. The median age at presentation was significantly earlier in the intrapartum antibiotic prophylaxis (IAP)exposed than in the IAP-unexposed neonates (0 hours, IQR 0.0000\u20130.0000 vs 6 hours, IQR 0.0000\u201315.0000, p<0.001). High number of neonates (n = 531) asymptomatic at birth, exposed to intrapartum fever, should be treated empirically for each newborn who subsequently develops sepsis. IAP exposed neonates increased (12% vs 33%, p = 0.01), age at presentation decreased (median 6 vs 1 hours, p = 0.01), whereas meningitis, mechanical ventilation and mortality did not change in baseline vs intervention period. After implementing the SPEs, no cases had adverse outcomes due to the strategy, and no cases developed severe disease after 6 hours of life. Conclusions Infants with EOS exposed to IAP developed symptoms at birth in almost all cases, and those who appeared well at birth had a very low chance of having EOS. The risk of EOS in neonates (asymptomatic at birth) exposed to intrapartum fever was low. Although definite conclusions on causation are lacking, our data support SPEs of asymptomatic newborns at risk for EOS. SPEs seems a safe and effective alternative to laboratory screening and empirical antibiotic therapy

Massive thymic hemorrhage and hemothorax occurring in utero

Background: Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality. Case Presentation: We report a case of spontaneous massive thymic haemorrhage in a newborn developing at birth acute respiratory distress associated with severe bilateral haemothorax. Thymic enlargement was evident after pleural evacuation and confirmed by radiographic, Computed Tomography (CT) images and Magnetic Resonance Imaging (MRI) sequences. The spontaneous resolution of this enlargement seen with CT scan and MRI sequences suggested a thymic haemorrhage; surgery was not necessary. Conclusion: Thymic haemorrhage should be considered in newborn infants with pleural effusion, mediastinal space enlargement and Respiratory Distress

Current Knowledge on Endocrine Disrupting Chemicals (EDCs) from Animal Biology to Humans, from Pregnancy to Adulthood: Highlights from a National Italian Meeting

Wildlife has often presented and suggested the effects of endocrine disrupting chemicals (EDCs). Animal studies have given us an important opportunity to understand the mechanisms of action of many chemicals on the endocrine system and on neurodevelopment and behaviour, and to evaluate the effects of doses, time and duration of exposure. Although results are sometimes conflicting because of confounding factors, epidemiological studies in humans suggest effects of EDCs on prenatal growth, thyroid function, glucose metabolism and obesity, puberty, fertility, and on carcinogenesis mainly through epigenetic mechanisms. This manuscript reviews the reports of a multidisciplinary national meeting on this topic

Relazione tecnica sulle attività della Campagna oceanografica “Ancheva 2016”

La presente relazione riporta le attività di ricerca della Campagna oceangrafica “Ancheva 2016”, svolte a bordo della N/O “G. Dallaporta” (nel periodo tra il 4 ed il 26 Luglio 2016) nello Stretto di Sicilia e nel mar Ionio occidentale (GSA 16 e 19) e nelle acque maltesi (GSA 15). Nello specifico, le attività svolte vengono sono di seguito descritte sinteticamente: - Rilevazioni acustiche degli stock di piccoli pelagici con echosounder scientifico Simrad EK60, con trasduttori split beam a scafo; - Campionamenti biologici (di piccoli pelagici) con rete pelagica (volante monobarca), dotata di sistema acustico Simrad ITI per il controllo della geometria della rete (apertura e posizione della rete nella colonna d’acqua); - Campionamenti di tessuti di pesci pelagici (gonadi, fegato e sangue); - Campionamento acqua, in specifiche stazioni, con sonda multiparametrica SEABIRD mod. 9/11 plus (per la misurazione dei parametri fisico-chimici della colonna d’acqua) dotata di bottiglie Niskin (per l’analisi di Nutrienti ed Isotopi di azoto e carbonio); - Campionamento ittioplantonico, mediante con “Bongo 40”, in specifiche stazioni, le cui bocche sono state fissate in alcool, per le analisi degli aminoacidi sulle larve di Engraulis encrasicolus

Relazione tecnica sulle attività della campagna oceanografica “Ancheva 2017”

La presente relazione tecnica descrive le attività svolte nella Campagna oceanografica “Ancheva 2017”, tra il 23 luglio ed il 7 agosto 2017, a bordo della N/O “G. Dallaporta”. Gli echosurvey acquisiti hanno permesso di valutare la biomassa e la distribuzione spaziale dei piccoli pelagici nella piattaforma meridionale della Sicilia, da Marsala a oltre Capo Passero, e nella piattaforma Maltese (GSA 16, FAO sub area 37.2.2). Parallelamente alle suddette attività sono state svolti il campionamento biologico (di piccoli pelagici) con rete pelagica (volante monobarca), il campionamento di tessuti di pesci pelagici (gonadi, fegato e sangue), il campionamento di acqua (per la misurazione dei parametri fisico-chimici della colonna d’acqua e per l’analisi di Nutrienti ed Isotopi di azoto e carbonio) ed, infine, il campionamento ittioplantonico (per le analisi degli aminoacidi sulle larve di Engraulis encrasicolus)