Frequency and type of domestic injuries among children during COVID-19 lockdown: what changes from the past? An Italian multicentre cohort study

: Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3-13 years) receiving a visit in ED during March-June 2019 and March-June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p < 0.001) (IRR: 3.16; p < 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p < 0.001), males (OR: 1.4; p < 0.001), and it increased with age (OR: 1.1; p < 0.001).    Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home. What is Known: • In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer. • During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults. What is New: • During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year. • Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed

Nutrition and Lung Growth

Experimental evidence from animal models and epidemiology studies has demonstrated that nutrition affects lung development and may have a lifelong impact on respiratory health. Chronic restriction of nutrients and/or oxygen during pregnancy causes structural changes in the airways and parenchyma that may result in abnormal lung function, which is tracked throughout life. Inadequate nutritional management in very premature infants hampers lung growth and may be a contributing factor in the pathogenesis of bronchopulmonary dysplasia. Recent evidence seems to indicate that infant and childhood malnutrition does not determine lung function impairment even in the presence of reduced lung size due to delayed body growth. This review will focus on the effects of malnutrition occurring at critical time periods such as pregnancy, early life, and childhood, on lung growth and long-term lung function

Long-term oxygen therapy in children with sickle cell disease and hypoxaemia

Objective: To evaluate the acceptability and safety profile of nocturnal long-term oxygen therapy (LTOT) in children with sickle cell disease (SCD) and chronic hypoxaemia. Design: Retrospective cohort study. Patients, setting and intervention: Children with SCD who started LTOT from 2014 to early 2019 in two tertiary hospitals in London, UK were retrospectively enrolled. Patients who started disease-modifying therapies <12 months before LTOT or while on LTOT were excluded. Main outcome measures: Minor and major adverse events during LTOT were reported. Laboratory and clinical data, transcranial Doppler (TCD) scans and overnight oximetry studies performed at steady state within 12 months before and after starting LTOT were compared. Results: Nineteen children (10 males; median age 12 years, range 6-15) were included. Nearly half of them (9/19; 47%) were on hydroxyurea at baseline. No child discontinued LTOT because of intolerance or poor adherence. No major adverse events were reported. Laboratory data did not show significant changes in haemoglobin and reticulocyte count after 1 year of follow-up. No statistically significant change in the incidence of vaso-occlusive pain events was noted (median annual rate from 0.5 to 0 episode per patient/year; p=0.062). Overnight oximetry tests performed while on LTOT showed improvements in all oxygen saturation parameters (mean overnight and nadir SpO2, % of time spent with SpO2 <90%) compared with the baseline. Conclusion: LTOT is a safe and feasible treatment option for children with SCD and chronic hypoxaemia

Low Dose Bisphenol-A Regulates Inflammatory Cytokines through GPR30 in Mammary Adipose Cells

The dramatic rise in obesity and metabolic syndrome can be related, at least in part, to environmental chemical factors such as Bisphenol-A (BPA). In this study, we aimed to understand the effects of low-dose Bisphenol-A on the human mature adipocytes and stromal vascular fraction (SVF) cells, obtained from subcutaneous mammary adipose tissue of overweight female patients, undergoing surgical mammary reduction. 24 and/or 48 hours exposure to BPA 0.1 nM elicited significant increase of the inflammatory molecules interleukin-6 (IL-6), interleukin-8 (IL-8), Monocyte chemo-attractant protein 1α (MCP1α) and induced G protein-coupled estrogen receptor 30 (GPR30) levels more than 2-fold both in mature adipocytes and SVF cells. These effects were similar to that obtained in presence of GPR30-specific agonist G1 (100 nM) and were reverted by G15 (1 µM), a GPR30-selective antagonist. As a result of BPA-GPR30 signaling activation, Fatty Acid Synthase (FAS) and leptin mRNA levels were significantly higher upon BPA exposure (p<0.05) in mature adipocytes, with an opposite effect on adiponectin (ADIPOQ). In addition, an increase in SVF cell proliferation and ERK1/2 phosphorylation, was observed, compared to untreated cells. G15 reverted all of these effects. Interestingly, the action of BPA on SVF cell growth was mimicked by IL-8 treatment and was reverted by incubation with anti-IL8 antibodies. All these data suggest that BPA at 0.1nM, a 10 times lower concentration than environmental exposure, increases the expression of pro-inflammatory cytokines via GPR30 both in mature mammary adipocytes and in SVF cells with a possible involvement of IL-8

Lung Clearance Index May Detect Early Peripheral Lung Disease in Sickle Cell Anemia

RATIONALE: Chronic lung injury is common in sickle cell anemia (SCA) and worsens outcomes. Sensitive lung function tests might predict reversible disease that might benefit from therapeutic interventions. OBJECTIVE: To evaluate whether Lung Clearance Index (LCI), Sacin & Scond, measuring global, intracinar & conductive ventilation inhomogeneity respectively, are more frequently abnormal than lung volumes in young people with SCA. METHODS: Nitrogen multiple breath washout, spirometry and body plethysmography were cross-sectionally evaluated at steady state in subjects with SCA (hemoglobin SS) and healthy controls aged 8-21 years from London, UK. RESULTS: 35 patients (51% boys; mean±SD 16.4±3.5 years) and 31 controls (48% boys; 16.2±3.2 years) were tested. There were significant differences between the study and control group in mean LCI (mean difference 0.42 units, 95%CI 0.22 to 0.63, p = 0.0001), Sacin (mean difference 0.014 units, 95%CI 0.001 to 0.026, p = 0.04), FEV1 (mean difference -0.79 z-scores, 95%CI -1.28 to -0.30, p = 0.002), FVC (mean difference -0.80 z-scores, 95%CI -1.28 to -0.31) and TLC (mean difference -0.79 z-scores, 95%CI -1.25 to -0.29), but not in Scond and FEV1/FVC ratio. While 29% (10/35) of patients had LCI >95th percentile of controls, 23% (8/35) had abnormal FEV1 (<5th of the reference population). CONCLUSION: Lung clearance index detected slightly more abnormalities than lung volumes in young people with SCA. Significant differences with controls in LCI and Sacin but not in Scond and FEV1/FVC ratio suggest that the lung function changes were most likely due to patchy peripheral lung disease

The Effects of Climate Therapy on Cardiorespiratory Fitness and Exercise-Induced Bronchoconstriction in Children with Asthma

We investigated whether a 1-week stay in the mountains may have a positive impact on Exercise-Induced Bronchoconstriction (EIB) and cardiorespiratory endurance in asthmatic children from an urban area. Spirometry was performed before and 10 min after a 20 m shuttle run test (20mSRT) on the first and seventh day of a summer asthma camp in the Italian Alps at 900 m of altitude. Spirometry z-scores were derived from the Global Lung Initiative 2012 prediction equations, and percentiles of the 20mSRT performance were assigned according to De Miguel-Etayo’s and Tomkinson’s predictive equations. A FEV1 decrease ≥10% after the exercise was defined as EIB. Particulate matter pollution was monitored during the camp and in the urban area of provenience. Twenty-four subjects (age range 7–16 years) were included. Frequency of EIB decreased from 58% (14/24) at day-1 to 33% (8/24) at the end of the camp (p = 0.08). Most subjects with a 20mSRT in the lowest quartile at day 1 had EIB (9/11). The proportion of children with a 20mSRT &lt;25° percentile decreased from 45% (11/24) at day-1 to 16% (4/24) at day-7 (p = 0.02). Conclusion: One-week climate therapy in the mountains improved both bronchial hyperreactivity and cardiorespiratory endurance in our cohort of asthmatic children

Low-Dose bisphenol-A impairs adipogenesis and generates dysfunctional 3T3-L1 adipocytes

Environmental endocrine disruptors (EDCs), including bisphenol-A (BPA), have been recently involved in obesity and diabetes by dysregulating adipose tissue function. Our aim was to examine whether prolonged exposure to low doses of BPA could affect adipogenesis and adipocyte metabolic functions. Therefore, 3T3-L1 pre-adipocytes were cultured for three weeks with BPA 1 nM to mimic human environmental exposure. We evaluated BPA effect on cell proliferation, differentiation, gene expression and adipocyte metabolic function. BPA significantly increased pre-adipocyte proliferation (p<0.01). In 3T3-L1 adipocytes differentiated in the presence of BPA, the expression of Peroxisome proliferator-activated receptor gamma (PPARγ), Fatty Acid Binding Protein 4/Adipocyte Protein 2 (FABP4/AP2) and CCAAT/enhancer binding protein (C/EBPα) was increased by 3.5, 1.5 and 3 folds, respectively. Mature adipocytes also showed a significant increase in lipid accumulation (p<0.05) and alterations of insulin action, with significant reduction in insulin-stimulated glucose utilization (p<0.001). Moreover, in mature adipocytes, mRNA levels of Leptin, interleukin-6 (IL6) and interferon-γ (IFNγ) were significantly increased (p<0.05). In conclusion, BPA prolonged exposure at low doses, consistent with those found in the environment, may affect adipocyte differentiation program, enhancing pre-adipocyte proliferation and anticipating the expression of the master genes involved in lipid/glucose metabolism. The resulting adipocytes are hypertrophic, with impaired insulin signaling, reduced glucose utilization and increased pro-inflammatory cytokine expression. Thus, these data supported the hypothesis that BPA exposure, during critical stages of adipose tissue development, may cause adipocyte metabolic dysfunction and inflammation, thereby increasing the risk of developing obesity-related diseases