Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

Background: An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition. Methods. The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1-18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score. Results: Of 144 children (75 males, mean age 6.5 \ub1 4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07 \ub1 2.08; p = 0.008) and BMI values (mean SD-values -0.79 \ub1 2.09; p = 0.0021) in comparison to other groups. However, only 29 children were actually malnourished. Conclusions: The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition. \ua9 2013 Spagnuolo et al.; licensee BioMed Central Ltd

Sustained low influenza vaccination in health care workers after H1N1 pandemic: A cross sectional study in an Italian health care setting for at-risk patients

Background: Despite consistent recommendations by all Public Health Authorities in support of annual influenza vaccination for at-risk categories, there is still a low uptake of influenza vaccine in these groups including health care workers (HCWs). Aim of this observational two-phase study was to estimate the immunization rates for influenza in four subsequent seasons and for pandemic H1N1 influenza in HCWs of a University Hospital, and to investigate its distribution pattern and the main determinants of immunization. Phase 1 data collection was performed in 2009-2010, during the peak of H1N1 pandemic. Phase 2 data collection, aimed to investigate seasonal influenza vaccination coverage in the three seasons after pandemic, was performed in 2012-2013. Methods: The overall H1N1 vaccination rate was derived by the Hospital immunization registry. In 2010, the personnel of three Departments (Infectious Diseases, Pediatrics and Gynecology/Obstetrics) completed a survey on influenza. A second-phase analysis was performed in 2012 to investigate influenza vaccination coverage in three consecutive seasons. Results: The first-phase survey showed a low coverage for influenza in all categories (17 %), with the lowest rate in nurses (8.1 %). A total of 37 % of health care workers received H1N1 vaccine, with the highest rate among physicians and the lowest in nurses. H1N1 vaccination was closely related to the Department, being higher in the Department of Infectious Diseases (53.7 %) and Pediatrics (42.4 %) than in Gynecology/Obstetrics (8.3 %). The second-phase survey showed the lowest rate of influenza vaccination in 2012/13 season. The main reasons for not being vaccinated were "Unsure of the efficacy of vaccine" and "Feel not at-risk of getting influenza or its complications". Despite recommendations, influenza vaccine uptake remains poor. Conclusion: Immunization is largely perceived as a personal protection rather than a measure needed to prevent disease spreading to at-risk patients. Compulsory vaccination against influenza should be considered as a possible strategy, at least in health institutions where at-risk patients are admitted

The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era

Background: Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations. Material and methods: A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded. Results: During the study period, a total of 533,318 children were admitted to the pED involved in the study. Despite a 48.2% decline of pED admissions, there was a significant increase (83.1%) in patient admissions for NPD. The most frequent NPD conditions which increased during the COVID-19 pandemic were suicidal ideation (+ 147%), depression (+ 115%), eating disorder (+ 78.4%), and psychosis (+ 17.2%). During the pandemic period, a 39.5% increase in NPD hospitalizations was observed as well. The NPD disorders that mostly required hospitalizations were suicidal ideation (+ 134%), depression (+ 41.4%), eating disorder (+ 31.4%), and drug abuse (+ 26.7%). COVID-19 pandemic had a major impact on children's health, mainly on their NPD development. Neuropsychological assessment should be required at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment and provide an adequate treatment. Conclusion: SIP underlines the psychological consequences of COVID 19 pandemic on the youngest and recommends an early identification of NPD in the pediatric population to avoid other serious consequences for children's physical and mental health

Presence of fluoroquinolones and sulfonamides in urban sewage sludge and their degradation as a result of composting

The concentrations of some widely used pharmaceuticals, namely fluoroquinolones (ciprofloxacin C17H18FN3O3, norfloxacin C16H18FN3O3 and ofloxacin C18H20FN3O4) and sulfonamides (sulfadimethoxine C12H14N4O4S and sulfamethoxazole C10H11N3O3S ) were determined in urban sewage sludge utilized for making compost. The levels of degradation of these pharmaceuticals resulting from sludge treatment were assessed. The concentrations of the studied pharmaceuticals sufficiently varied both in sewage sludge and in compost and due to this phenomenon the possible danger resulting from the presence of pharmaceuticals in sewage sludge, used for composting, can not be ignored. The concentrations of the studied pharmaceuticals were lower in compost, if compared to the relevant concentrations in sewage sludge. The highest pharmaceutical concentration in sewage sludge - 426 μg/kg - was detected in the case of ciprofloxacin. The highest concentrations present in compost were 22 μg/kg of norfloxacin and 20 μg/kg of ciprofloxacin. Results show that before using the sewage sludge for making compost or before using the compost a fertilizer for food plants, they should be carefully tested against the content of commonly used pharmaceuticals

Monoclonal antibodies against Clostridium difficile infection in the pipeline

The increasing incidence and severity of Clostridium difficile infection (CDI) is becoming a major issue in public health. The identification of new therapeutic options able to control severe cases and reduce the risk of recurrence is a research priority. Toxins A (TcdA) and B (TcdB) and host immune response are the major determinants of CDI pathogenesis and may be a possible target for new therapies. The aim of this review was to critically describe the evidence available on the effect of monoclonal antibodies (MAbs) on CDI, putting them into clinical context and highlighting possible advantages and barriers to their use. Experimental animal studies revealed the potential of MAbs to protect against CDI progression and recurrence, especially when a combination of anti-TcdA and anti-TcdB is used. Only one clinical trial confirmed that this combined approach is well tolerated and effective in controlling CDI recurrences in at-risk subjects with refractory CDI. Other clinical trials are currently ongoing and explore alternative molecules. Toxin-targeted MAbs are one of the most promising approaches and at-risk subjects and those experiencing recurrence are the ideal targets for this second-line treatment. However, CDI epidemiology is rapidly changing and MAbs may also represent a powerful option for other patients

The burden of sleep disordered breathing in children with sickle cell disease

Children with sickle cell disease (SCD) have an increased risk of sleep disordered breathing (SDB) compared with the general pediatric population. There has been a growing research interest on this field in recent years, yet many questions regarding risk factors and clinical implications of SDB remain unclear. The aim of this review is to provide a concise narrative and systematic synthesis of the available evidence on the epidemiology, clinical presentation, complications, and management, of SDB in children with SCD. An electronic search was conducted on studies published from the 1st of January 2000 to the 31st of December 2020 in PubMed/Medline, Scopus, and Cochrane databases. All studies focusing on SDB in children with SCD aged from 0 to 20 years were included. Studies were eligible for inclusion if available in the English language. A quantitative synthesis of the included studies was performed. Only studies focusing on specific treatment outcomes were included in a meta-analytic process. A total of 190 papers were initially identified. After screening the title and abstract, 112 articles were evaluated for eligibility. At the end of the selection process, 62 studies were included in the analysis. Sleep disordered breathing is associated with worse neurological, neurocognitive, and cardiological outcomes, whereas the association with frequency or severity of vaso-occlusive pain events and acute chest syndrome was not clarified. Therapeutic interventions like adenotonsillectomy or oxygen supplementation may result in a significant increase in mean nocturnal oxygen saturation but effective clinical implications remain still unclear

TOSSICITA' DI SULFAGUANIDINA E SULFACHINOSSALINA PER LA MICROALGA VERDE SELENASTRUM CAPRICORNUTUM

The toxicity of sulfaguanidine and sulfaquinoxaline to the freshwater microalga Selenastrum capricornutum was evaluated using the EPA-TSCA 797.1050 growth test method. Sulfaquinoxaline EC50 (0.246mg/L) was about two order of magnitude lower than that of sulfaguanidine. This ratio is reciprocal to the one previously observed for the two drugs on Daphnia magna, underlying the importance of testing drugs on different model organisms for environmental impact assessment. By applying to the algal EC50 of SQO the Assessment Factor of 100, a PNEC of 2.46 \ub5g/L, which is worth of attention, was calculated

Prevalence and significance of BRAF alterations in a pediatric population with low-grade gliomas

Background Low-grade gliomas (LGG) are the most common brain tumours in children, represented by heterogeneous pathological entities. BRAF gene alterations have been recently identified as responsible of constitutive activation of the mitogen-activated protein kinase pathway (MAPK) and hence involved in the development of LGG in children. There is evidence that the BRAF V600E mutation is more common in supratentorial LGG while the KIAA1549:BRAF fusion in posterior fossa pilocytic astrocytoma (PA). Objective This case series describes the prevalence of BRAF alterations in LGG patients, trying to relate them to outcome. Methods Children aged 0\u201314 years, with a diagnosis of LGG, referred to a single neuro-oncologic centre, were retrospectively reviewed to analyze clinical and histopathological features related to BRAF alterations. Results A total of 35 patients were included (16 males, median age 85.5 \ub1 81.3 months). BRAF mutations were searched on 7/35 children (20 %) resulting positive in 5/7 (71 %). Two of them (40 %) showed the KIAA1549:BRAF fusion. They were both pilocytic astrocytomas located in posterior fossa: 1/2 (50 %) was totally resected, showing stable disease (SD) 1 year after surgey; the other was not surgically treatable and showed a progressive disease during chemotherapy. Three out of five (60 %) presented V600E mutation. All of them were supratentorial: 1 pilomyxoid astrocytoma, treated with two partial resections and subse- quent chemotherapy, was in SD 5 years after diagnosis; 1 diffuse pleomorphic xanthoastrocytoma underwent three partial resections and showed SD after 5 years of vemurafenib; 1 glioneuronal tumor was in SD after complete resection and radiotherapy. Conclusion Our data support the evidence that specific mutations of the BRAF pathway are related to site and histological subtype of brain tumors. This sample is too small to help supporting the hypothesis that these alterations have a prognostic impact. Extent of surgery and localization seem to be the most important prognostic factors