Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases

The Physics of the B Factories

This work is on the Physics of the B Factories. Part A of this book contains a brief description of the SLAC and KEK B Factories as well as their detectors, BaBar and Belle, and data taking related issues. Part B discusses tools and methods used by the experiments in order to obtain results. The results themselves can be found in Part C

Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

Correction to: BMC Health Serv Res 22, 41 (2022) [Published: 17 January 2022] https://doi.org/10.1186/s12913-021-07432-x Following publication of this article [1], the corresponding author should be changed from José Antonio Orellana Turri to Nana Kwame Anokye due to a typesetting error. The original article [1] has been corrected.Copyright © 2022 The Author(s). Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) - Finance Code 001 - 88887.368403/2019-00; Conselho Nacional de Desenvolvimento Cientifco e Tecnologico (CNPq, National Council for Scientifc and Technologic Development, Ministry of Science and Technology) - Grants 307175/2016-2 and 301109/2019-2

Il latte d’asina di razza Amiatina nella gestione del bambino con allergia alle proteine del latte vaccino

Background. Il latte di asina (LA) ha buone caratteristiche nutrizionali ed è tollerato nel 90-95% dei soggetti con allergia alle proteine del latte vaccino (APLV). L’asino Amiatino è una razza autoctona originaria del Monte Amiata allevata principalmente tra le province di Siena e Grosseto dove è stata creata una filiera del latte di asina Amiatina che rappresenta un punto di forza per la salvaguardia della specie. Obiettivi Il presente studio ha valutato le caratteristiche nutrizionali, igienico-sanitarie e allergeniche del latte di asina Amiatina in un gruppo di bambini affetti da APLV. Materiali e metodi Per la valutazione dei componenti nutrizionali e nutraceutici del latte di asina Amiatina sono state effettuate sui campioni di latte le seguenti determinazioni: proteine, sostanza secca, ceneri, Ca, P, Mg, Na, K. (AOAC, 1990); grasso e profilo acidico (Rose-Gottlieb, seguito da metilazione in accordo con Christie,1982). La valutazione del rischio igienico-sanitario del LA è stata effettuata con le analisi di laboratorio previste dalla normativa comunitaria e nazionale in materia di sicurezza alimentare, igiene di processo e verifica del trattamento termico effettuato su 3 lotti di campioni di latte crudo e pastorizzato prelevati con cadenza settimanale. I soggetti con APLV sono stati individuati attraverso l’esecuzione di test cutanei ed in vitro per latte vaccino e LA e successiva valutazione della tolleranza e palatabilità del LA con test di tolleranza. Risultati In Tabella1 sono riportati i risultati delle analisi effettuate per pH, Carica batterica totale, Cellule somatiche, Staphylococchi coagulasi positivi, Carica mesofila a 30°C ed Enterobacteriaceae. Salmonella spp, Campylobacter spp. e Listeria monocytogenes sono sempre risultati assenti. La qualità igienico-sanitaria del latte è risultata sempre conforme ai criteri di sicurezza alimentare. In tabella2 sono riportati i valori nutrizionali. Il LA, è risultato ricco di lattosio ma povero in grassi, limite facilmente superabile attraverso la supplementazione di olio di oliva (in quantità pari al 2% della dose di LA), va tuttavia sottolineato il buon rapporto tra acidi grassi insaturi e saturi e gli elevati contenuti di acidi grassi della serie n3 ed n6 che lo rendono idoneo all’utilizzo anche in pazienti affetti da dislipidemie. I sintomi dei bambini al momento della prima reazione al latte vaccino sono riportati in tabella 3. Ventisei su 33 (78,8%) hanno presentato TC per LA negativi, solo in 7 pazienti (21,2%) sono risultati positivi. Trentadue pazienti hanno eseguito test di tolleranza con LA e di questi solo 1 è risultato intollerante (3%). In questi pazienti è stata inoltre fatta una valutazione del gusto utilizzando come scala di riferimento quella del dolore di Wong-Baker modificata: 5 pazienti lo hanno considerato molto buono (15,6%), 10 pazienti buono (31,3%), 4 pazienti normale (12,5%), 2 pazienti non buono (6,2%), 5 pazienti cattivo (15,6%) e 6 bambini (età < 2 aa) hanno, a giudizio del medico e del genitore, gradito il latte (18,8%). Conclusioni Il LA è risultato sicuro dal punto di vista igienico-sanitario e nutrizionalmente simile a quello di donna ad eccezione del contenuto lipidico che si mostra più basso e che rende necessaria una supplementazione di olio d’oliva nella dieta dei lattanti. Nel bambino con APLV il latte di asina è stato ottimamente tollerato e l’alto contenuto di lattosio lo ha reso di gusto gradevole per la maggior parte dei pazienti

Donkey's Milk in the Management of Children with Cow's Milk protein allergy: Nutritional and hygienic aspects

Background: The therapeutic strategy for children with cow's milk allergy (CMA) consists in the elimination of cow's milk (CM) from their diet. Donkey's milk (DM) has been reported to be an adequate alternative, mainly to his nutritional similarities with human milk (HM) and excellent palatability. The aim of present prospective study was to evaluate the nutritional impact of DM on the diet of children with CMA in term of children growth. Methods: Before the nutritional trial on children and during the study the health and hygiene risks and nutritional and nutraceuticals parameters of DM were monitored. Children with CMA were identified by the execution of in vivo and in vitro tests for CM and subsequent assessment of tolerability of DM with oral food challenge (OFC). Finally, we prescribed DM to a selected group of patients for a period of 6 months during which we monitored the growth of children. A total of 81 children, 70 with IgE mediated cow's milk protein allergy (IgE-CMPA) and 11 with Food Protein Induced Enterocolitis Syndrome to CM (CM-FPIES), were enrolled. Results: Seventy-eight out of 81 patients underwent the OFC with DM and only one patient with IgE-CMPA (1.5 %) reacted. Twenty-two out of 81 patients took part of the nutritional trial. All the 22 patients took and tolerated the DM, moreover DM did not change the normal growth rate of infants. Conclusions: In conclusion, DM resulted safe in term of health and hygiene risks and nutritionally adequate: no negative impact on the normal growth rate of children was assessed. Therefore, it may be a suitable alternative for the management of IgE mediated CMA and FPIES, also in the first 6 months of life, if adequately supplemented