1
|
Nicolì S, Benevento M, Ferorelli D, Mandarelli G, Solarino B. Little patients, large risks: An overview on patient safety management in pediatrics settings. Front Pediatr 2022; 10:919710. [PMID: 36186651 PMCID: PMC9523149 DOI: 10.3389/fped.2022.919710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Simona Nicolì
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Marcello Benevento
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Davide Ferorelli
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Gabriele Mandarelli
- Section of Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Biagio Solarino
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| |
Collapse
|
2
|
Schena F, Penco F, Volpi S, Pastorino C, Caorsi R, Kalli F, Fenoglio D, Salis A, Bertoni A, Prigione I, Bocca P, Insalaco A, De Benedetti F, Antonini F, Grossi A, Signa S, Damonte G, Ceccherini I, Filaci G, Traggiai E, Gattorno M. Dysregulation in B-cell responses and T follicular helper cell function in ADA2 deficiency patients. Eur J Immunol 2020; 51:206-219. [PMID: 32707604 DOI: 10.1002/eji.202048549] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/29/2020] [Indexed: 12/21/2022]
Abstract
Adenosine deaminase 2 deficiency (DADA2) is an autoinflammatory disease characterized by inflammatory vasculopathy, early strokes associated often with hypogammaglobulinemia. Pure red cell aplasia, thrombocytopenia, and neutropenia have been reported. The defect is due to biallelic loss of function of ADA2 gene, coding for a protein known to regulate the catabolism of extracellular adenosine. We therefore investigated immune phenotype and B- and T-cell responses in 14 DADA2 patients to address if ADA2 mutation affects B- and T-cell function. Here, we show a significant decrease in memory B cells, in particular class switch memory, and an expansion of CD21low B cells in DADA2 patients. In vitro stimulated B lymphocytes were able to secrete nonfunctional ADA2 protein, suggesting a cell intrinsic defect resulting in an impairment of B-cell proliferation and differentiation. Moreover, CD4+ and CD8+ T cells were diminished; however, the frequency of circulating T follicular helper cells was significantly increased but they had an impairment in IL-21 production possibly contributing to an impaired B cell help. Our findings suggest that ADA2 mutation could lead to a B-cell intrinsic defect but also to a defective Tfh cell function, which could contribute to the immunodeficient phenotype reported in DADA2 patients.
Collapse
Affiliation(s)
- Francesca Schena
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Federica Penco
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Stefano Volpi
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università degli studi di Genova, Genova, Italy
| | - Claudia Pastorino
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Roberta Caorsi
- Unità Operativa Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Francesca Kalli
- Center of Excellence for Biomedical Research/Department of Internal Medicine, Università di Genova, Genova, Italy
| | - Daniela Fenoglio
- Center of Excellence for Biomedical Research/Department of Internal Medicine, Università di Genova, Genova, Italy.,Ospedale Policlinico San Martino, Genova, Italy
| | - Annalisa Salis
- Department of Experimental Medicine and Center of Excellence for Biomedical Research, Università di Genova, Genova, Italy
| | - Arinna Bertoni
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Ignazia Prigione
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paola Bocca
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Antonella Insalaco
- Division of Rheumatology, Department of Pediatric Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Fabrizio De Benedetti
- Division of Rheumatology, Department of Pediatric Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Antonini
- Core Facilities Flow-Cytometry and Cell Imaging Laboratory, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alice Grossi
- UOSD Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Sara Signa
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università degli studi di Genova, Genova, Italy
| | - Gianluca Damonte
- Department of Experimental Medicine and Center of Excellence for Biomedical Research, Università di Genova, Genova, Italy
| | - Isabella Ceccherini
- UOSD Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gilberto Filaci
- Center of Excellence for Biomedical Research/Department of Internal Medicine, Università di Genova, Genova, Italy.,Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Marco Gattorno
- Unità Operativa Semplice Dipartimentale Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Unità Operativa Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| |
Collapse
|
3
|
Solarino B, Aricò M. Covid-19 pandemic and pediatric healthcare policy in Italy: time for a change. Pediatr Rep 2020; 12:8823. [PMID: 32922713 PMCID: PMC7461631 DOI: 10.4081/pr.2020.8823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
The outbreak of coronavirus disease 2019 pandemic forced the Italian Government to act extreme measures that put the entire country under lockdown. The citizens experimented a radical transformation of their lives while the healthcare system started building a novel COVID-system that quickly dissolved the former organization, included pediatric healthcare network. For a number of reasons COVID-19 pandemic is polite with children; however, the fear of this unknown disease drove to develop dedicated pathways in the Pediatric Emergency Departments for the suspected and diagnosed cases of COVID-19, together with their relatives. The combination of conflicting feelings resulted in an unexpected scenario: the number of accesses to the pediatric Hospital or Unit(s) sharply dropped to less than half. How do we explain this phenomenon? The authors believe that our health care system may learn a lesson from the catastrophe of COVID, if we will be able to redesign our way of providing our cares to children. Nothing should be taken for granted, because this might be a real "time for a change".
Collapse
Affiliation(s)
- Biagio Solarino
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari
| | - Maurizio Aricò
- Azienda Ospedaliero Universitaria Consorziale Policlinico, Giovanni XXIII Children Hospital, Bari, Italy
| |
Collapse
|
4
|
Valitutti F, Zenzeri L, Mauro A, Pacifico R, Borrelli M, Muzzica S, Boccia G, Tipo V, Vajro P. Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19. Front Pediatr 2020; 8:521. [PMID: 33072657 PMCID: PMC7530634 DOI: 10.3389/fped.2020.00521] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: The aim of this study was to assess the impact of the COVID-19 pandemic and population lockdown on pediatric ED consultations. Methods: A cross-sectional study on pediatric emergency department consultations before and during the current COVID-19 pandemic (March-May 2019 vs. March-May 2020) was performed in two hospitals in the Campania region (Southern Italy) [i.e., Salerno University Hospital (Salerno) and Pediatric Regional Referral Emergency Hub "AORN Santobono-Pausillipon" (Naples)]. Results: 29,368 consecutive ED pediatric patients (13,430 females; mean age ± SD = 5.4 ± 4.7 years) were seen in March-May 2019 and 9,133 (4,494 females; mean age ± SD = 5.9 ± 4.2 years) in March-May 2020. Resuscitation/emergency and urgent care pediatric ED consultations were 1,388 (4.7%, 95% CI 4.5-4.9) in the 2019 trimester, while they were 648 (7.1%, 95% CI 6.6-7.6) in the 2020 trimester (p < 0.01). Mean pediatric ED daily consultations were 326.3 (95% CI 299.9-352.7) in the considered period of 2019 and 101.4 (95%CI 77.9-124.9) in the same period of 2020 (p < 0.001). COVID-19 nasal swabs were performed for 385 children; of those, six resulted positive and four of them were hospitalized. Conclusions: This work provides a unique snapshot of the pediatric EDs demands in the era of COVID-19. We witnessed a significant reduction of non-urgent health care demands during the pandemic but an increase of more severe urgent cases. The COVID-19 pandemic and the following lockdown unveiled the inappropriateness of the majority of pediatric ED consultations. Nevertheless, the current scenario highlighted the need for appropriate and timely clinical evaluations in the pediatric primary care to tackle late and more severe diagnoses in EDs.
Collapse
Affiliation(s)
- Francesco Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, AORN Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Angela Mauro
- Emergency Pediatric Department, AORN Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rosario Pacifico
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Micaela Borrelli
- Pediatric Surgery Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Stefania Muzzica
- Emergency Pediatric Department, AORN Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Boccia
- Hospital Hygiene and Epidemiology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Vincenzo Tipo
- Emergency Pediatric Department, AORN Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Vajro
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Clinical Pediatrics Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| |
Collapse
|
5
|
Enyuma COA, Anah MU, Pousson A, Olorunfemi G, Ibisomi L, Abang BE, Imoke EJ. Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria. Afr Health Sci 2019; 19:1910-1923. [PMID: 31656474 PMCID: PMC6794543 DOI: 10.4314/ahs.v19i2.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. OBJECTIVE To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. METHODS This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). RESULT The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). CONCLUSION Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.
Collapse
Affiliation(s)
- Callistus OA Enyuma
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - Maxwell U Anah
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - Amelia Pousson
- John Hopkins school of Medicine, Baltimore, Maryland, USA
| | - G Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public health, University of the Witwatersrand, Johannesburg, South Africa
| | - L Ibisomi
- Division of Epidemiology and Biostatistics, School of Public health, University of the Witwatersrand, Johannesburg, South Africa
| | - B E Abang
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - EJ Imoke
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| |
Collapse
|
6
|
Riva B, Clavenna A, Cartabia M, Bortolotti A, Fortino I, Merlino L, Biondi A, Bonati M. Emergency department use by paediatric patients in Lombardy Region, Italy: a population study. BMJ Paediatr Open 2018; 2:e000247. [PMID: 29942865 PMCID: PMC6014225 DOI: 10.1136/bmjpo-2017-000247] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/02/2018] [Accepted: 04/29/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To estimate the rate of paediatric attendance at emergency departments (EDs) in the Lombardy Region, Italy, and to determine the factors contributing to different patterns of use. METHODS By analysing healthcare administrative databases, ED attendance by 1.6 million youths <18 years old during 2012 in the Lombardy Region was assessed. The pattern of use was categorised based on the number of ED visits and level of emergency, defined by triage code and outcome of the visit. Logistic regression analyses were performed to identify the characteristics of access for non-urgent reasons and those of patients with frequent non-urgent access (≥4 accesses for non-urgent reasons only). A case-control study was carried out to compare healthcare resource use by children 1-5 years old who were 'frequent non-urgent users' with that of randomly selected controls, matched by age, gender, nationality and primary care physician. RESULTS During 2012, 440 284 (27%) of children and adolescents had at least one ED attendance, with trauma (26%) and respiratory tract infections (22%) as the most frequent diagnoses. In all, 533 037 (79%) accesses were for non-urgent reasons, and 12 533 (3% of the ED users) were frequent non-urgent users. Male gender (OR 1.12; 95% CI 1.08 to 1.17), preschool age (OR 3.14; 95% CI 2.98 to 3.31) and place of residence (OR 1.74; 95% CI 1.70 to 1.99) were associated with a higher risk of being a frequent non-urgent user. Moreover, a greater healthcare consumption was observed in this group. CONCLUSIONS One out of four children and adolescents attended the ED at least once per year, 3% of whom were frequent non-urgent users, with a high overall healthcare resource consumption.
Collapse
Affiliation(s)
- Benedetta Riva
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.,Department of Pediatrics, Hospital S. Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Antonio Clavenna
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Massimo Cartabia
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | | | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Andrea Biondi
- Department of Pediatrics, Hospital S. Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
| | - Maurizio Bonati
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| |
Collapse
|