Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: an ESPNIC survey.

Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non-pharmacologic strategies as early mobilization), and to investigate associations between presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. A multicenter cross-sectional survey-based study collecting data from one experienced physician or nurse per PICU in Europe was conducted from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool-1 (53%). Main first-line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). Main reported first-line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy-one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (Odds Ratio [OR ]1.92, 95% Confidence Interval [CI] 1.01-3.67) and delirium (OR 2.00, 95% CI 1.07-3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20-12.71), and promote mobilization (OR 3.38, 95% CI 1.63-7.03). Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning, and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation-associated adverse outcomes

Relation between EEG source functional connectivity and the negative symptom severity in schizophrenia: a preliminary report from a multicentre study

IntroductionNeural dysconnectivity is hypothesized to be a key element in pathophysiology of schizophrenia. However, the relation of disordered connectivity with the different clinical characteristics of the syndrome is not fully elucidated.ObjectivesThe current research investigated the relations between resting-state EEG Source Functional Connectivity (EEG-SFC) and the two main clusters of negative symptoms derived from the Brief Negative Symptom Scale, the Expressive Deficit (ED) and the Avolition (AV), in subjects with schizophrenia (SCZ) enrolled to the multicentre study of the Italian Network for Research on Psychoses.MethodsOut of 97 chronic, stabilized SCZ included, we selected subjects according the lower and the upper quartile of the ED and AV value distribution: 25 were in upper and 24 in the lower quartile of ED (respectively, HIGH-ED and LOW-ED); 27 were in upper and 24 in the lower quartile of AV (respectively, HIGH-AV and LOW-AV). Fifty-five healthy controls (HC) were included, comparable to SCZ for gender, age and educational level. EEG-SFC analysis was based on the lagged phase synchronization (LPS) computed by eLORETA from 5 minutes resting-state EEG recordings in eyes closed condition. LPS indices were determined for each spectrum band and between all 28 regions of interest (ROI) pairs. Group differences were significant for corrected P-value &lt; 0.05.ResultsSCZ had higher theta band LPS than HC. Respect to LOW-ED, HIGH-ED showed significant increased alpha LPS in fronto-cingulate, para-hippocampal and insular inter-hemispheric ROI pairs. No significant difference emerged between HIGH-AV and LOW-AV.ConclusionsSubgrouping SCZ according to negative symptom severity reveals heterogeneous patterns of resting-state LPS connectivity.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Homeward bound: factors affecting homing ability in a polymorphic lizard

Colour polymorphism is a widespread phenomenon among reptiles and is often associated with alternative physiological and behavioural strategies, including dispersal and movement patterns. To test the homing ability of Podarcis muralis and look for morph-specific responses, we conducted a translocation experiment in two areas of Northern Italy during 2009 and 2010. The first study area is a wall surrounding a city park with a linear and simplified habitat structure; the second one is an archaeological park in a natural area, including stone walls remains, grasses and woods. Lizards of both sexes (203 and 288 for site, respectively) were translocated at 50-200 m distances, using cloth bags to block lizard sight. P. muralis were able to home since 56.7% of translocated individuals in the first site and 35.1% of translocated individuals in the second site successfully returned to their home-range. The homing ability decreased with increasing distances, while body size positively affected homing behaviour, probably depending on the territoriality of adult lizards. More interestingly, homing performance differed among colour morphs, as yellow lizards of both sexes had significantly higher homing skill than other morphs. This result suggests that colour polymorphism could be maintained by different behavioural strategies of colour morphs. Finally, homing success was significantly higher in first than in second site, suggesting that habitat complexity might affect homing with lizards returning more easily when they were able to use visual cues

Detection of QTL affecting fleece traits on CHI 19 in Angora Goats

Some previous studies have indicated the presence of genes or gene families involved in fleece traits in different species. The aim of the present study was to search Quantitative Traits Loci (QTL) associated with fleece qualitative and quantitative traits on goat chromosome (CHI) 19. The population analyzed had a total of 727 kids from 17 Angora bucks. Nine phenotypic fleece traits were recorded. An interval analysis was performed under a half-sib model using the QTL Express program. Our results confirm a QTL for Coefficient of Variation of Average Fiber Diameter (CVAFD) and we found new QTL for Staple Length (SL) and Greasy Fleece Weight (GFW). Further investigations should concern diminishing the confidence interval increasing the number of kids in existing families and making a fine mapping on the candidate region

Due casi studio nell'Hinterland milanese: il Centro civico a Segrate e le Case IACP a Bollate di Guido Canella

Conservare l'oggi. Relatori: Marco Dezzi Bardeschi, Philippe Daverio, Stefano Gizzi, Ugo Carughi, Gentucca Canella, Angelo Torricell

Due casi studio nell'Hinterland milanese: il Centro civico a Segrate e le Case IACP a Bollate di Guido Canella

Conservare l'oggi. Relatori: Marco Dezzi Bardeschi, Philippe Daverio, Stefano Gizzi, Ugo Carughi, Gentucca Canella, Angelo Torricell

Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review

The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants & LE; 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery.Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients