12 research outputs found

    Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

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    <p>Abstract</p> <p>Background</p> <p>Bronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.</p> <p>Aim of the study</p> <p>To unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.</p> <p>Methods</p> <p>Patients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1<sup>st </sup>lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.</p> <p>Results</p> <p>Eighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.</p> <p>Conclusions</p> <p>We strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach to bronchiolitis therapy, by adopting specific and shared resident guidelines.</p

    Il progetto Lab2Go per la diffusione della pratica laboratoriale nelle Scuole Secondarie di II grado

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    Even if laboratory practice is essential for all scientific branches of knowledge, it is often neglected at High School, due to lack of time and/or resources. To establish a closer contact between school and experimental sciences, Sapienza Università di Roma and the Istituto Nazionale di Fisica Nucleare (INFN) launched the Lab2Go project, with the goal of spreading laboratory practice among students and teachers in high schools

    Cyclo-oxygenase enzyme in the perilymph of human inner ear.

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    Conclusions: Cyclo-oxygenase-2 (COX-2) enzyme would not appear to be constitutively expressed in human perilymph while it is always induced in the perilymph of patients affected by sensorineural hearing loss (SNHL). The COX-2 isoform may be involved in hearing loss and, therefore, pathological states of the inner ear should possibly be further analyzed to clarify the clinical relevance of prostaglandin and selective COX-2 antagonist therapy. Objectives: Perilymph samples from a group of patients with bilateral SNHL and another with conductive hearing loss were collected to evaluate the presence of the COX-2 enzyme. The possible correlation between different causes of deafness and the expression of COX-2 in the human ear was studied. Methods: A prospective clinical study of 14 patients with severe or profound hearing loss who underwent cochlear implant surgery and 4 patients with conductive hearing loss who underwent stapes surgery was carried out. Western blot analysis of perilymph samples was performed with monoclonal anti-human COX-2 antibody. Results: COX-2 enzyme was detected in all patients affected by SNHL and was absent in all those with conductive hearing loss due to otosclerosis

    Exploring high-density corticomuscular networks after stroke to enable a hybrid Brain-Computer Interface for hand motor rehabilitation

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    Abstract Background Brain-Computer Interfaces (BCI) promote upper limb recovery in stroke patients reinforcing motor related brain activity (from electroencephalogaphy, EEG). Hybrid BCIs which include peripheral signals (electromyography, EMG) as control features could be employed to monitor post-stroke motor abnormalities. To ground the use of corticomuscular coherence (CMC) as a hybrid feature for a rehabilitative BCI, we analyzed high-density CMC networks (derived from multiple EEG and EMG channels) and their relation with upper limb motor deficit by comparing data from stroke patients with healthy participants during simple hand tasks. Methods EEG (61 sensors) and EMG (8 muscles per arm) were simultaneously recorded from 12 stroke (EXP) and 12 healthy participants (CTRL) during simple hand movements performed with right/left (CTRL) and unaffected/affected hand (EXP, UH/AH). CMC networks were estimated for each movement and their properties were analyzed by means of indices derived ad-hoc from graph theory and compared among groups. Results Between-group analysis showed that CMC weight of the whole brain network was significantly reduced in patients during AH movements. The network density was increased especially for those connections entailing bilateral non-target muscles. Such reduced muscle-specificity observed in patients was confirmed by muscle degree index (connections per muscle) which indicated a connections’ distribution among non-target and contralateral muscles and revealed a higher involvement of proximal muscles in patients. CMC network properties correlated with upper-limb motor impairment as assessed by Fugl-Meyer Assessment and Manual Muscle Test in patients. Conclusions High-density CMC networks can capture motor abnormalities in stroke patients during simple hand movements. Correlations with upper limb motor impairment support their use in a BCI-based rehabilitative approach

    Lab2Go: a project for supporting laboratory practice in teaching STEM disciplines in high school

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    The laboratory practice is essential for learning physics and scientific subjects; unfortunately it is often overlooked in teaching. In order to establish a contact between schools and experimental science, Sapienza Università di Roma and INFN launched Lab2Go, an initiative in the framework of Percorsi per le Competenze Trasversali e per l’Orientamento (PCTO) and supported by Piano Lauree Scientifiche (PLS), with the goal of spreading laboratory practice among students and teachers in high schools. Lab2Go was born in Rome and focused on physics, however in just few years it expanded across Italy thanks to an increasing involvement of INFN and university departments and enlarged its scope to other disciplines (animal biology, botany, chemistry, geology, robotics, scientific museology). Moreover, for preserving the mission of promoting hands-on learning despite the restrictions introduced by COVID-19 pandemic, Lab2Go@Home has been introduced: on-line seminars aimed at showing experiments that can be reproduced at home using easily accessible materials, using resources such as smartphones apps, web tools and devices as the Arduino board

    Il progetto Lab2Go per la diffusione della pratica laboratoriale nelle Scuole Secondarie di II grado

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    Even if laboratory practice is essential for all scientific branches of knowledge, it is often neglected at High School, due to lack of time and/or resources. To establish a closer contact between school and experimental sciences, the University Sapienza of Roma and the Istituto Nazionale di Fisica Nucleare (INFN) launched the Lab2Go project, with the goal of spreading laboratory practice among students and teachers in high schools.Comment: in Italia
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