Oral ondansetron versus domperidone for symptomatic treatment of vomiting during acute gastroenteritis in children: multicentre randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking.</p> <p>Objectives</p> <p>To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed ORT.</p> <p>Methods/Design</p> <p>Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children aged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration will be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to receive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight); 3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic oral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study outcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made 48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled.</p> <p>Discussion</p> <p>The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01257672">NCT01257672</a></p

Structure and diversity trends at Fagus timberline in central Italy

Structure and diversity trends (β-diversity and species richness) across the Fagus sylvatica timberline in the central Apennines were investigated. Twenty-three belt transects were laid out across the upper forest line in the Simbruini Mountains. Number of species, plant cover, and height of different layers were recorded in each quadrat. The moving split-window method was used to detect ecological discontinuities across beech timberlines. We show how β-diversity changes along timberlines and we put forward some hypotheses about the possible dynamics of these transitions. Fourmodels resulted from the analysis of β-diversity trends: two β-diversity peaks indicated a transition where shrubs, mainly Juniperus communis ssp. alpina, (two high peaks) or beech scrub (two small peaks) formed a mantle that could allow forest expansion. One high β-diversity peak referred to an anthropo-zoogenic boundary maintained by disturbance, without the presence of a mantle. A little peak indicated a gradual transition at the upper potential timberline limit where beech forest had lost its typical floristical composition and structural characteristics

Ricerche archeometriche sulle fornaci romane di S.Antonio di Formigine (Modena).

analisi palinologiche delle fornaci di Formigin

Ricerche archeometriche sulle fornaci romane di S.Antonio di Formigine (Modena).

Uno dei primi esempi di lavoro archeobotanico multidisciplinare, con analisi polliniche per ricostruzioni archeoambientali

Pollini e tecniche investigative - Studio palinologico e ambientazione dei reperti criminologici.

SOno riportate tecniche di repertamento e interpretazione utili allo studio di palinologia forense. Sono illustrati i primi casi studio noti in Italia

Contributi alla palinologia del fondovalle padano. Analisi polliniche nella sequenza della Torre Ghirlandina di Modena.

analisi pollinica dei depositi sotto la Torre Ghirlandin