Ectima gangrenoso in corso di sepsi neonatale da Pseudomonas aeruginosa

La sepsi da Pseudomonas aeruginosa (PA) è un evento raro nel neonato a termine, in assenza di fattori predisponenti quali immunodeficienze congenite o acquisite. In età pediatrica può associarsi a discoagulopatia, neutropenia, manifestazioni cutanee (ectima gangrenoso) e otologiche

Un meconio non fa primavera...

no abstrac

Prevalence and risk factors of chronic Post-Traumatic Stress Disorder in children and adolescents after the 2012 earthquake affecting the Modena province: preliminary results of a cross-sectional study

Background Post-traumatic stress disorder (PTSD) is the most frequent psychological disorder occurring after natural disasters (with a prevalence ranging from 5 to 60% in the first 1-2 years after the event). Many cases remit within 12 months, but nearly one-third have a chronic, unremitting course determining long term negative health impacts and relevant social costs. On May 2012, two earthquakes of high Richter magnitude hit the province of Modena, causing 27 deaths, several hundred of injured citizen and more than 15000 homeless. The aim of this study was to investigate the prevalence of chronic PTSD in children and adolescents, two particularly sensitive subpopulations, and to identify PTSD potentially related individual and social risks and protective factors to be addressed in future effective preventive interventions. Methods A cross-sectional study approved by the local Ethical Committee was conducted between May 2013 and May 2014. Subjects aged 9- 14 were recruited from Primary and Secondary schools of Modena District, which were randomly selected after being assigned to two areas: earthquake area (19 municipalities most affected by the earthquake; EA) and extra-earthquake area (EEA). The two areas had similar demographic and geographic characteristics. Only subjects providing written informed consent from parents were included in the study. The Italian version of the UCLA PTSD Index for DSM-IV (UPID) was used to assess PTSD in students from primary (face to face interviews) and secondary school (self-reported), while risk/protective factors for the development and persistence of PTSD were investigated using the traumatic exposure checklist on objective/subjective experiences during the earthquake and the Strengths and Difficulties Questionnaire (SDQ). This instrument was also administered to subjects’ parents along with the Symptom Checklist-90-R (SCL-90), which aimed to investigate parental psychopathology. Findings We included in our study 682 subjects (male: 349, 51%; mean age: 11,2 ±1,4; 1,8% of the total residents of the same age in the two areas). The prevalence of people hit by the earthquake (damages to properties or people) and forced to leave their homes was significantly higher in the EA than in the EEA (78% vs 14%; 54% vs 2%: p<0.001). Overall, 9 subjects (1,3 %) reported symptoms of chronic PTSD. Most (8) were living in the EA. In this area the prevalence of chronic PTSD was equal to 1,9% and appeared particularly high in girls (2,4%) and in secondary school’s subjects (2,2%). Discussion A higher prevalence of chronic PTSD in children and adolescents living in the most affected area by the earthquake was observed. PTSD prevalence in our study however appeared lower than those observed in similar investigations: specific protective factors related to the social context together with differences in the time elapsed between the traumatic event and PTSD evaluation could partially explain these findings. Further analyses aimed at pointing out potentially protective individual, familiar and social factors will be sooner performed. We believe that any potential significant finding will give an effective contribution in the planning of future preventive and protective interventions in similar distressing situations

Biomonitoring of the population living near the solid waste incinerator plant in Modena, Italy.

Background and aims: As part of the authorization process for the expansion of the municipal solid waste incinerator of Modena, a cross-sectional biomonitoring study on toenail samples was conducted to identify biomarkers of exposure in resident population. Methods: Approximately 500 people were enrolled between October 2013 and May 2014, among residents for at least 3 years within 4 km from the plant. Sampling method implied stratification by exposure, gender and age-group (18-34, 35-49 and 50-69 years). Sampling exposure level was measured through the annual mean PM10 concentration map for 2010. Toenail samples were disintegrated by acid mineralization and tested through inductively coupled plasma mass spectrometry for concentrations of cadmium, chromium, manganese and nickel. Confounders were assessed through a questionnaire covering: personal and biometric data, lifestyle, residential information including traffic exposure, occupational history, health condition and diet. Effective exposure was estimated through fall-out maps from a quasi-gaussian dispersion model. Biannual PM10 concentration prior to the collection date (second semester 2013/first semester 2014) was assigned according to subjects residence and workplace address; exposure values were divided into quartiles. Multivariate regression analyses were performed. Results: Chromium, manganese and nickel were measurable in >95% of samples. Concentrations varied between 0.02-35.11 µg/g for chromium (median 0.52, 5th-95th perc 0.09-4.95), 0.02-7.23 for manganese (median 0.25, 5th-95th perc 0.07-0.97), 0.004-39.28 for nickel (median 0.28, 5th-95th perc 0.03-3.74). Cadmium resulted under the limit of quantification in 74.1% of the samples (range 0.006-0.19 µg/g), and was not included in the analysis. Multivariate regression models showed the following relations: - Chromium: positive relation with incinerator exposure, female gender, education level, hair dye, permanent make-up, woodworking hobby, locally-grown food consumption, orange juice consumption; negative relation with foreign citizenship. - Manganese: positive relation with incinerator exposure, female gender, occupational exposure, sculpture/building hobby, time spent outdoor, presence of prostheses, use of wood as heating system, locally-grown food and red wine consumption; negative relation with age and with all the months of collection except for the last one (May 2014) compared with the first (Oct 2013). - Nickel: positive relation with use of costume jewelry, presence of amalgam fillings, consumption of tomatoes and vegetable pies; negative relation with age. Conclusions: The analysis of heavy metal levels in toenails is a relatively recent technique, therefore reference levels are not available in literature and an analysis on the general distribution of sample levels cannot be performed. However, the presence of some expected associations in multivariate analysis (nickel with use of costume jewelry and tomatoes consumption; manganese with firewood use) suggests that our study method can be appropriate in assessing chronic exposures. Results showed association trends with incinerator exposure for manganese and chromium levels. Findings should be reassessed as soon as more accurate traffic exposure control is available