The Kids Are Alright (?). Infants’ Development and COVID-19 Pandemic: A Cross-Sectional Study

Objectives: The study aimed to assess and compare the global development in six-month-old infants before and during the pandemic restrictive social distancing measures. Methods: This cross-sectional nested study involved infants assessed through the Griffiths Scales of Child Development (GSCD) between September 2019 and April 2021. Infants were classified in a pre-COVID or a COVID group, considering the evaluation date and the restrictive measures in place. GSCD subscales and General Development Scores (GDS) were calculated and compared. Results: One hundred and four healthy term-born infants were evaluated. GDS in the COVID group (n:70; median: 94; IQR: 90–100) appeared significantly lower than in the pre-COVID group (n:34; median: 98; IQR: 97–103; p < 0.001). Language and personal-social-emotional subareas scores appeared the most affected. A decreasing trend of GDS along with the severity of restriction was observed. Conclusion: A reduction in infant development scores was observed during pandemic social distancing. Further studies are needed to systematize these findings and to address effective public health policies for infants and families during long-term forced isolation periods

Minipuberty in Male Full-term Neonates Appropriate and Small for Gestational Age and in Preterm Babies: Data from a Single Centre

INTRODUCTION: The postnatal activation of the hypothalamic-pituitary-gonadal (HPG) axis is usually known as 'minipuberty'. There are still open questions about its biological function and significance depending on sex, gestational age (GA) and birth weight (BW) with few available longitudinal data. METHODS: A single-centre, longitudinal study to quantify urinary follicle stimulating hormone (uFSH), luteinizing hormone (uLH) and testosterone (uTs) in male neonates. Neonates were enrolled and stratified into three subgroups: full-term boys appropriate for GA (FT AGA); FT boys with BW ≤3rd centile [FT small for gestational age (SGA)]; and preterm (PT) boys ≤33 weeks of GA. Urinary hormones were correlated to simultaneous auxological parameters, linear growth and external genitalia at scheduled time-points. RESULTS: Forty-six boys were recruited, with subgroup sizes FT AGA n=23, FT SGA n=11 and PT n=12. PT boys display a pulsatile pattern of urinary gonadotropins (uGns) with higher levels of uLH and a gradual increase of uTs. Testicular descent started from 29-32 weeks with the peak of uTs. During the first 12-months post-term age (PTA), FT AGA boys displayed a better linear growth (p<0.05). PT showed higher uGns levels until 3-months PTA. PT babies had higher uLH levels than FT AGA, with a peak at 7 and 30 days, during the first 90 days of life (p<0.001) and higher uTs levels. Correlation analysis between penile growth of all neonates and uTs was significant (p=0.04) but not within subgroups. DISCUSSION AND CONCLUSION: This study investigated postnatal HPG axis activation in term and PT infants. Minipuberty may involve an early window of opportunity to evaluate the functionality of the HPG axis. Further studies with a long-term follow-up are needed with a special focus on possible consequences of GA and BW

Perinatal and postnatal exposure to phthalates and early neurodevelopment at 6 months in healthy infants born at term

BackgroundPhthalates are non-persistent chemicals largely used as plasticizers and considered ubiquitous pollutants with endocrine disrupting activity. The exposure during sensible temporal windows as pregnancy and early childhood, may influence physiological neurodevelopment.Aims and ScopeThe aim of this study is to analyze the relationship between the urinary levels of phthalate metabolites in newborn and infants and the global development measured by the Griffiths Scales of Children Development (GSCD) at six months.MethodsLongitudinal cohort study in healthy Italian term newborn and their mothers from birth to the first 6 months of life. Urine samples were collected at respectively 0 (T0), 3 (T3), 6 (T6) months, and around the delivery for mothers. Urine samples were analyzed for a total of 7 major phthalate metabolites of 5 of the most commonly used phthalates. At six months of age a global child development assessment using the third edition of the Griffith Scales of Child Development (GSCD III) was performed in 104 participants.ResultsIn a total of 387 urine samples, the seven metabolites analyzed appeared widespread and were detected in most of the urine samples collected at any time of sampling (66-100%). At six months most of the Developmental Quotients (DQs) falls in average range, except for the subscale B, which presents a DQ median score of 87 (85-95). Adjusted linear regressions between DQs and urinary phthalate metabolite concentrations in mothers at T0 and in infants at T0, T3 and T6 identified several negative associations both for infants’ and mothers especially for DEHP and MBzP. Moreover, once stratified by children’s sex, negative associations were found in boys while positive in girls.ConclusionsPhthalates exposure is widespread, especially for not regulated compounds. Urinary phthalate metabolites were found to be associated to GSCD III scores, showing inverse association with higher phthalate levels related to lower development scores. Our data suggested differences related to the child’s sex

Treatment of chronic infected post-oncological wounds with a dermal matrix: two case studies

The reconstruction of complex wounds in patients with comorbidities in the lower extremities is a challenging problem for surgeons. Skin grafting is frequently used to cover large skin defects, but it has several limits, including unwanted outcomes resulting from scars, poor elasticity and limitations in joint movement due to contractures. Locoregional flaps, particularly in the lower limbs, have limited application due to the size of the defect. Tissue engineering of the skin has offered major improvements in the coverage of large defects. Dermal matrix can be applied in order to generate a new dermis that allows good re-epithelialisation or skin grafting at a later stage. The reconstruction of large lower limb defects is more complicated in the case of chronic wounds showing no tendency to heal due to chronic infection. For all surgeons, it is very important to prevent the formation of a biofilm or manage it when it is already established before undertaking surgical procedures that involve a dermal matrix. We report our reconstruction strategy of chronic infected neoplastic ulcers of the lower extremities with a dermal matrix and our postoperative dressing protocol

Parenting stress: socio-economic determinants before and during the covid-19 pandemic. results of an italian cross-sectional study

Background and objective: Parenting can be a stressful experience and in the context of a pandemic it can represent a challenge for many families. The aim of this study was to investigate socio-demographic factors related to parenting stress before and after the SARS-CoV-2 outbreak in Italian parents living in Modena (Italy). Methods: From September 2019 to May 2021, 80 parents of 6 months healthy children were enrolled in a prospective cohort study at the local University Hospital and filled in the Parenting Stress Index Short Form (PSI-SF), a validated questionnaire measuring parenting stress, well-known in clinical practice for its reliability and simplicity of use. PSI scores over the 90th percentile of the Italian population distribution were considered indicative of a highly stressful condition. The role played by different socio-demographic factors in increasing PSI score was tested by chi-square test in the whole sample and by stratifying parents according to the evaluation time (PRE-COVID and COVID period). Results: Overall, 11% of parents reported high stress scores and prevalence was higher during lockdown (15% vs 6%). In the COVID group, higher scores were observed in younger mothers (17%), higher educated parents (16% and 23% of mothers and fathers respectively), having only one child (18%) and living in the urban environment (23%), regardless of infant’s gender. In the PRE-COVID group higher stress scores were reported mainly by parents with more than one child (10%), with male children (9%), and by mothers with lower education (8%). Nevertheless, differences were often not statistically significant. Conclusion: Different socio-demographic factors appear to be related to higher parenting stress and our results suggest that they could show inverse trends in different conditions. Parenting stress in difficult circumstances must be addressed carefully and promptly and specific public health interventions for families with special needs must be planned and implemented

Early life exposure to phthalates and risk assessment: are we doing enough?

Background and Objective: Phthalates, potential endocrine disruptors with antiandrogenic effects, are widely used in several everyday products and are ubiquitous pollutants. Since 1999 European Authorities enacted several regulations to limit phthalate use and prevent exposure, mainly for more susceptible populations such as infants. This study aims to evaluate the estimated daily intake (EDI) of phthalates and to perform risk assessment evaluation in an Italian pediatric cohort. Methods: Between 2019 and 2020, 197 mother-child couples were enrolled in a prospective cohort study at the University Hospital of Modena (Italy). Urine samples were collected at birth, 3 and 6-months. 8 phthalates metabolites were analyzed. EDI was estimated and Risk quotients (RQ) were calculated using tolerable daily intake levels, (RQ(TDI)) as determined by the European Food Safety Authority, and the revised reference doses for anti-androgenicity RQ(RfD-AA), recently proposed. Finally, combined Hazard Indexes (HI) were calculated to assess synergic effect of different phthalates. Results: Most EDI and RQ(TDI) were lower than the acceptable values. The highest levels were found for Diethyl-phthalate (DEP), followed by Di-2-ethylhexyl-phthlate (DEHP). Newborns showed the highest values, followed by 6-months infants. Values exceeding the risk levels were observed for DEHP or di-n-butyl-phthalate (DnBP) in 5.5% and 10% of the newborns, respectively for RQ(RfDAA) and HI. Overall, HI higher values than threshold were observed at each follow-up visit. Conclusion: Since the European Union has a strict regulation policy regarding the most critical phthalates, these findings raise concern: exposure affecting children in Modena is still spread and includes phthalates banned in childcare products, such as DEHP and DnBP. Notably, few infants (especially newborns) exceeded the risk threshold for antiandrogenic effects. Further, exposure patterns seem to change over time during their first months of life. More extensive public health measures need to be planned to efficiently protect the most sensitive subgroups, including infants

Interrelationship between the Microbial Communities of the Root Canals and Periodontal Pockets in Combined Endodontic-Periodontal Diseases

Periodontal and Endodontic diseases are biofilm-related diseases. The presence of microorganisms in root canals (RCs) and the complex microbiota of periodontal pockets (PPs) contribute to the development of endodontic-periodontal diseases. This study performed a systemic analysis using state-of-the-art sequence data to assess the microbial composition of infected RCs and PPs to further assess the microbiota and verify the possibility of cross-infection between these sites. The microbiomes of these combined diseases were examined with a focus on the V3-V4 hypervariable region of the 16S rRNA gene. The number of species in PP was higher than in RC, and there was a predominance of obligate anaerobes and gram-negative bacteria. In the RCs, the genera Enterococcus, Parvimonas, Stomatobaculum predominated, in contrast, the PPs revealed a predominance of Enterococcus, Parvimonas, Stomatobaculum, Peptostreptococcus and Mogibacterium. The RC and PP microbiome was not similar with regards to the sharing of OTUs for phyla and genera (8 and 67, respectively). The evaluation of molecular markers revealed a large number of markers for resistance to antibiotics of the carbapenem and beta-lactam type (broad spectrum). Another relevant finding of this study was the markers related to systemic diseases related to cardiac muscle and rheumatology, among others. In conclusion, the RC microbiota was less complex and diverse than PP. Interactions between microbial communities were present. The shared genus can signal communication between the endodontic and periodontal microbiomes

Clinical Presentation of Celiac Disease and Diagnosis Accuracy in a Single-Center European Pediatric Cohort over 10 Years

(1) Background: Changes in the clinical presentation of celiac disease (CD) in children have been reported. The guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) allow esophagogastroduodenoscopy (EGD) with biopsies to be avoided under specific circumstances. We aimed to assess the clinical picture of pediatric CD patients at diagnosis and to validate ESPGHAN non-biopsy criteria. (2) Methods: Patients with suspected CD or undergoing screening from 2004 to 2014 at the University Hospital in Modena, Italy were enrolled. The accuracy of ESPGHAN non-biopsy criteria and modified versions were assessed. (3) Results: In total, 410 patients were enrolled, of whom 403 were considered for analysis. Of the patients considered, 45 were asymptomatic and diagnosed with CD (11.2%) while 358 patients (88.2%) were symptomatic, of whom 295 were diagnosed with CD. Among symptomatic CD patients, 57 (19.3%) had gastrointestinal symptoms, 98 (33%) had atypical symptoms and 140 (47.4%) had both. No difference was found for the presence of gastrointestinal symptoms at different ages. The non-biopsy ESPGHAN criteria yielded an accuracy of 59.4% with a positive predictive value (PPV) of 100%; 173 out of 308 EGD (56.2%) could have been avoided. The modified 7× and 5× upper limit of normal cut-offs for IgA anti tissue-transglutaminase reached 60.7% and 64.3% of EGD avoided, respectively. (4) Conclusions: Over 10 years, late age at diagnosis and increased rates of atypical CD presentation were found. ESPGHAN non-biopsy criteria are accurate for CD diagnosis and allow half of unneeded EGD to be avoided. Modified versions allowed sparing a greater number of EGD