SIAIP position paper: provocation challenge to antibiotics and non-steroidal anti-inflammatory drugs in children

Drug hypersensitivity reactions (DHRs) in childhood are mainly caused by betalactam or non-betalactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs). Laboratory tests for identifying children who are allergic to drugs have low diagnostic accuracy and predictive value. The gold standard to diagnose DHR is represented by the drug provocation test (DPT), that aims of ascertaining the causative role of an allergen and evaluating the tolerance to the suspected drug. Different protocols through the administration of divided increasing doses have been postulated according to the type of drug and the onset of the reaction (immediate or non immediate reactions). DPT protocols differ in doses and time interval between doses. In this position paper, the Italian Pediatric Society for Allergy and Immunology provides a practical guide for provocation test to antibiotics and NSAIDs in children and adolescents

Indoor free space optics link under the weak turbulence regime: measurements and model validation

This paper is a postprint of a paper submitted to and accepted for publication in [journal] and is subject to Institution of Engineering and Technology Copyright. The copy of record is available at IET Digital LibraryIn this study, the authors present the measurements performed on a free space optics (FSO) communications link using an indoor atmospheric chamber. In particular, the authors have generated several different optical turbulence conditions, demonstrating how even the weak turbulence regime can strongly affect the FSO link performance. The authors have carried out an in-depth analysis of the data collected during the measurements, and calculated the turbulence strength (i.e. scintillation index and Rytov variance) and the important performance metrics (i.e. the Q-factor and bit error rate) to evaluate the FSO link quality. Moreover, the authors have tested, for the first time, an appositely developed temporally-correlated gamma-gamma channel model to generate the temporal irradiance fluctuations observed at the receiver. This has been accomplished by using a complete analysis tool that enables the authors to fully simulate the experimental FSO link. Finally, the authors compare the generated time-series with the collected experimental data, showing a good agreement and thus proving the effectiveness of the model.This work was supported by the European Space Agency under grant no. 5401001020. We are very grateful to Dr. E. Armandillo for enlightening discussions. J. Perez's work was support by Spanish MINECO Juan de la Cierva Fellowship JCI-2012-14805. This research project falls within the frame of COST ICT Action IC1101 - Optical Wireless Communications - An Emerging Technology (OPTICWISE).Pernice, R.; Ando, A.; Cardinale, M.; Curcio, L.; Stivala, S.; Parisi, A.; Busacca, AC.... (2015). Indoor free space optics link under the weak turbulence regime: measurements and model validation. IET Communications. 9(1):62-70. https://doi.org/10.1049/iet-com.2014.0432S627091Tsukamoto, K., Hashimoto, A., Aburakawa, Y., & Matsumoto, M. (2009). The case for free space. IEEE Microwave Magazine, 10(5), 84-92. doi:10.1109/mmm.2009.933086Suriza, A. Z., Md Rafiqul, I., Wajdi, A. K., & Naji, A. W. (2013). Proposed parameters of specific rain attenuation prediction for Free Space Optics link operating in tropical region. Journal of Atmospheric and Solar-Terrestrial Physics, 94, 93-99. doi:10.1016/j.jastp.2012.11.008Nebuloni, R. (2005). Empirical relationships between extinction coefficient and visibility in fog. Applied Optics, 44(18), 3795. doi:10.1364/ao.44.003795García-Zambrana, A., Castillo-Vázquez, C., & Castillo-Vázquez, B. (2011). Outage performance of MIMO FSO links over strong turbulence and misalignment fading channels. Optics Express, 19(14), 13480. doi:10.1364/oe.19.013480Shokrollahi, A. (2006). Raptor codes. IEEE Transactions on Information Theory, 52(6), 2551-2567. doi:10.1109/tit.2006.874390MacKay, D. J. C. (2005). Fountain codes. IEE Proceedings - Communications, 152(6), 1062. doi:10.1049/ip-com:20050237Uysal, M., Jing Li, & Meng Yu. (2006). Error rate performance analysis of coded free-space optical links over gamma-gamma atmospheric turbulence channels. IEEE Transactions on Wireless Communications, 5(6), 1229-1233. doi:10.1109/twc.2006.1638639Tsiftsis, T. A. (2008). Performance of heterodyne wireless optical communication systems over gamma-gamma atmospheric turbulence channels. Electronics Letters, 44(5), 373. doi:10.1049/el:20083028Popoola, W. O., & Ghassemlooy, Z. (2009). BPSK Subcarrier Intensity Modulated Free-Space Optical Communications in Atmospheric Turbulence. Journal of Lightwave Technology, 27(8), 967-973. doi:10.1109/jlt.2008.2004950Nistazakis, H. E., Tsiftsis, T. A., & Tombras, G. S. (2009). Performance analysis of free-space optical communication systems over atmospheric turbulence channels. IET Communications, 3(8), 1402. doi:10.1049/iet-com.2008.0212Bayaki, E., Schober, R., & Mallik, R. (2009). Performance analysis of MIMO free-space optical systems in gamma-gamma fading. IEEE Transactions on Communications, 57(11), 3415-3424. doi:10.1109/tcomm.2009.11.080168Anguita, J. A., Neifeld, M. A., Hildner, B., & Vasic, B. (2010). Rateless Coding on Experimental Temporally Correlated FSO Channels. Journal of Lightwave Technology, 28(7), 990-1002. doi:10.1109/jlt.2010.2040136Andò, A., Mangione, S., Curcio, L., Stivala, S., Garbo, G., Pernice, R., & Busacca, A. C. (2013). Recovery Capabilities of Rateless Codes on Simulated Turbulent Terrestrial Free Space Optics Channel Model. International Journal of Antennas and Propagation, 2013, 1-8. doi:10.1155/2013/692915Ghassemlooy, Z., Le Minh, H., Rajbhandari, S., Perez, J., & Ijaz, M. (2012). Performance Analysis of Ethernet/Fast-Ethernet Free Space Optical Communications in a Controlled Weak Turbulence Condition. Journal of Lightwave Technology, 30(13), 2188-2194. doi:10.1109/jlt.2012.2194271Xiaoming Zhu, & Kahn, J. M. (2002). Free-space optical communication through atmospheric turbulence channels. IEEE Transactions on Communications, 50(8), 1293-1300. doi:10.1109/tcomm.2002.800829Xu, F., Khalighi, A., Caussé, P., & Bourennane, S. (2009). Channel coding and time-diversity for optical wireless links. Optics Express, 17(2), 872. doi:10.1364/oe.17.00087

Agreements and controversies of national guidelines for bronchiolitis: Results from an Italian survey

Introduction: Significant variations in the management of bronchiolitis are often recorded, and, in parallel, to recommend a univocal clinical approach is challenging and still questioned. This study is aimed to evaluate the diagnostic and therapeutic management of bronchiolitis in children adopted by Italian pediatricians following the national guidelines. Material and methods: A survey study was designed and carried out by sending an email an open-ended questionnaire developed by an expert panel of the Scientific Board of the Italian Society of Pediatric Allergology and Immunology (SIAIP). Questions were designed according to the national intersociety consensus document on treatment and prevention of bronchiolitis in newborns and infants. Results: Overall, 234 pediatricians were taking part in the study. When diagnosing bronchiolitis, only 44.01% (103/234) of participants correctly followed the national guidelines. All participants (100%) would perform laboratory tests and/or radiological exams. 44.01% administered oxygen (O2 ) when O2 saturation was minor than 92%. About the therapeutic regimen, marked discrepancies between national guidelines and recorded answers were reported. Indications for hospital admission and discharge criteria were in line with the national guidelines. Conclusions: There is a significant practice variation in the management of acute bronchiolitis among Italian physicians. Some wrong attitudes need to be further discouraged, such use of diagnostic procedures and therapeutic approaches. Further research is urgently required to define the best management of patients with bronchiolitis and implement strategies to standardize care and improve the quality of care

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a "wait and see" approach, consisting of parental reassurance and close clinical observation, also due to interprofessional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a "wait and see" approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family. Further high-quality randomized controlled trials are needed to validate this algorithm's performance in real clinical practice

Acute cough in children and adolescents: A systematic review and a practical algorithm by the Italian Society of Pediatric Allergy and Immunology

The current systematic review presented and discussed the most recent studies on acute cough in pediatric age. After that, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to pediatric patients, such as infants, children, and adolescents, with acute cough. An acute cough is usually consequent to upper respiratory tract infections and is self-resolving within a few weeks. However, an acute cough may be bothersome, and therefore remedies are requested, mainly by the parents. An acute cough may significantly affect the quality of life of patients and their family.Several algorithms for the management of acute cough have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, and, also, in accordance to the Italian National Health System, which regularly follows the child from birth to all lifelong. Based on our findings, infants from 6 months, children, and adolescents with acute cough without cough pointers can be safely managed using well-known medications, preferably non-sedative agents, such as levodropropizine and/or natural compounds, including honey, glycerol, and herb-derived components

Atopic dermatitis

Atopic dermatitis (AD) is a common in ammatory skin disease, clinically characterized by recur- rent eczematous lesions and intense itching, leading to excoriations and susceptibility to cutaneous infections. Although it is considered a pediatric disorder, mainly starting in infancy, it is also very common in adults. Etiology of AD is complex and multifactorial: interaction between genetic susceptibility and environment, but also cutaneous barrier impairment, change in microbiome composition and innate and adaptive immune dysregulation are the main factors involved in the pathogenesis of the disease. Originally, the disorder was considered mediated by an imbalance towards a T-helper 2 response and excessive IgE production to aller- gens, but now it is recognized as a lifelong disposition with variable clinical expressivity, where dysfunctions of the epidermal barrier, immune system and microbiome play a central role. AD leads to a substantial psycho- social burden on patients and their relatives and increases the risk of other allergic and non allergic disorders. e real economic impact of AD is di cult to measure due to the broad spectrum of disease severity and the multiple direct and indirect costs, but the overall medical expenses seem to be very high and similar to those of other diseases such as diabetes. Currently, a multiple therapeutic approach is aimed only at improving the skin state, reducing itching and keeping a stable condition. New safety and curative treatments may be devel- oped only after enhancing our understanding on the pathogenesis of AD and the heterogeneity of its clinical manifestations. (www.actabiomedica.it

Severe asthma features in children: A case–control online survey

Background: Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy. Methods: We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6–17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients’ characteristics and severe asthma or non-severe persistent asthma. Results: Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95% Confidence Interval (CI), 1.21–18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95% CI, 1.11–12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95% CI, 2.70–53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95% CI, 2.66–61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40% of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56% of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients’ comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE. Conclusions: As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Background: In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods: Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results: The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions: We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research

Delayed access or provision of care in Italy resulting from fear of COVID-19

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Optimization of photovoltaic energy production through an efficient switching matrix

This work presents a preliminary study on the implementation of a new system for power output maximization of photovoltaic generators under non-homogeneous conditions. The study evaluates the performance of an efficient switching matrix and the relevant automatic reconfiguration control algorithms. The switching matrix is installed between the PV generator and the inverter, allowing a large number of possible module configurations. PV generator, switching matrix and the intelligent controller have been simulated in Simulink. The proposed reconfiguration system improved the energy extracted by the PV generator under non-uniform solar irradiation conditions. Short calculation times of the proposed control algorithms allow its use in real time applications even where a higher number of PV modules is required