Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days–18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children

High-fat meal, systemic inflammation and glucose homeostasis in obese children and adolescents

We aimed to assess in obese youths the relationships between interleukin-6 (IL-6), fat meal-induced endotoxemia and glucose homeostasis. Twenty obese children/adolescents (9-17 years old, 11 boys) underwent a standard oral glucose tolerance test and, 7-14 days later, a 5-h fat meal test (fat=69% of energy, saturated/monounsaturated/polyunsaturated fatty acids=31.5%/35%/33.5%), with serial measures of IL-6 and two markers of lipopolysaccharide (LPS) exposure and translocation, LPS-binding protein (LBP) and soluble CD14 (sCD14). IL-6 correlated not only with basal (homeostatic model assessment-insulin resistance) but also with post-prandial (Matsuda index) insulin sensitivity (r=0.61 (0.24-0.82), P=0.005, r=-0.53 (0.12-0.78), P=0.03, respectively). IL-6 did not change after the meal whereas LBP and sCD14 decreased significantly, indicating LPS translocation. Neither basal sCD14 and LBP nor their incremental concentrations correlated with IL-6 or glucose homeostasis. In our sample, IL-6 was associated with insulin sensitivity but not with LPS exposure, suggesting that meals with a balanced content of saturated/monounsaturated/polyunsaturated fatty acids may not be associated with LPS-induced inflammation and metabolic impairment

Adverse drug reaction reporting by nurses: analysis of Italian pharmacovigilance database

Purpose The aim of this study was to describe the pattern of adverse drug reaction (ADR) reports sent by Italian nurses after the enactment of the law involving them in the pharmacovigilance system. We also compared the quantity and quality of reports by nurses with those of reports by hospital physicians sent in the same period. Methods We analysed the reports sent to the Italian pharmacovigilance database by nurses from January 2004 to December 2010. Only reports with ADRs causality assessment defined as definite, probable or possible were included in the analysis. The nurses\u2019 reports were compared with those sent by hospital physicians in the same period. We excluded from this analysis reports associated with vaccines. Results A total number of 1403 reports by nurses have been evaluated. The percentage of nurses\u2019 reports of ADRs, which were serious, were 22.9% lower than the 44.9% of reports by physicians, whereas the proportion of probable ADR reports were higher among nurses than hospital physicians (76% vs 67%). Nurses put more emphasis than physicians on application site disorders (log OR= 0.91, 95%CI = 0.55\u20131.27), skin reactions (log OR= 0.81, 95%CI = 0.70\u20130.92) and nervous system reactions (log OR= 0.28, 95%CI = 0.11\u20130.44), whereas physicians more frequently report blood, platelet and liver disorders. Six drugs are present in both the top 10 drugs reported by nurses and hospital doctors. Conclusion This study gives evidence for the potential capacity of nurses to improve the detection of ADRs

The Role of the Cortex in Absence Epilepsy: Focal or generalized Epilepsy?

Classical theories on absence epilepsy suggest that the bilateral generalized spike-wave discharges (SWDs) characterizing absence epilepsy, are caused by thalamo-cortical oscillations, resulting in a condition in which an abnormally excitable cortex interacts with thalamus and brain stem reticular. Recently, a new theory based on experimental findings in the WAG/Rij rat, a genetic model of absence epilepsy, suggests instead that somatosensory cortex contains a focus that initiates a cascade of events that ultimately leads to the occurrence of the bilateral and generalized SWDs if the state of the thalamo-cortical circuitry is favorable. In this case, the cortical focus could be the dominant factor in initiating paroxysmal oscillations within the corticothalamic loops.In order to confirm these hypothesis, we decided to perform in four different cerebral areas (peri-oral cortex, visual cortex, lateral and ventral thalamus) gene-array analysis for cell signaling pathways involved in spindles generation and propagation, validated subsequently by immunohistochemical procedures. The Oligo GEArray® Rat Signal Transduction Pathway Finder™ Gene-array profiles the expression of 113 genes representative of the 18 signal transduction pathways, such as immediate early genes (egr-1, c-fos, c-jun), genes involved in the cell stress pathway (tcf5, hsp27, hspca, p53) or in NFĸB pathway (icam-1, il1, il2, pecam, vcam1). Although preliminary, these data suggest different genes modulations in the cerebral areas and may provide further evidence of a cortical focus in absence epilepsy