Family Pediatrician and Public Health collaboration, an alliance to increase vaccination coverage: an experience with MenB vaccination in Italy

BACKGROUND

Invasive Meningococcal Disease is a severe disease mainly affecting infants and young children. Most infections are caused by serogroups A, B, C, W, X, and Y. In the last 10 years, serogroup B has been the main cause of Invasive Meningococcal Disease in Europe. Recent data resulting from an observational study conducted in Italy show a significant reduction in the number of Invasive Meningococcal Disease cases due to Neisseria meningitidis B after the introduction of vaccine 4CMenB. Thus, the Naples Team of Federation of Italian Primary Care Pediatricians and the Public Health Department started an active collaboration focused on vaccination process management (named "Progetto Via") with the aim of increasing Meningococcal B vaccination coverage.

STUDY DESIGN

Source of data is the regional platform "GE.VA.". Every Primary care Pediatrician uses daily to record vaccination activity. This platform is integrated with data entered by operators of the District/Vaccination Center.

METHODS

Time: January 2019 - December 2019. The Federation of Italian Primary Care Pediatricians/Naples organized a meeting to identify six coordinators. The pediatricians could choose to counsel in their own offices and send children to the vaccination center or to counsel and vaccinate directly in their own clinics.

RESULTS

A total of 78 pediatricians took part in the project: 46 did only counseling and 32 did both counseling and vaccination in their medical clinic. Data obtained show an overall average vaccination coverage growth of about 13% in the first 4 months of the survey, and a further growth of about 11% in the following seven months, with a total growth in the entire period of 24%. The pediatricians' counseling is essential to recover non-compliant subjects, considering both the relationship of trust with the families and the visits already scheduled as an ideal moment for vaccinations' status check.

CONCLUSIONS

The project highlights how an effective collaboration between family pediatricians and the Local Health Authority becomes valuable in getting closer to reach the Ministerial goal of 95%. Vaccination coverage increased significantly when family pediatricians supported the activity of vaccine centers in distress in many regional situations. The trust relationship, the hourly availability and the capillary network of family pediatricians' clinics were key elements for the success of this project and were also recognized by parents.

Benchmarking between two different hospitals on health risk management in the covid-19 emergency

Iusse

The strategies adopted during COVID19 emergencies by two different hospitals in the Lazio Region are presented: S. Maria Goretti Hospital (SMGH) directly managed by the ASL Latina, hub and centre of the Emergency Department, and Cristo Re Classified Hospital (CRH), accredited in the territory of the ASL Roma1.

Description of the problem

SMGH has been identified as COVID19 Intervention Hospital. CRH initially was a No-COVID support structure, then included in the COVID19 network. During the COVID19 emergency, the directors of both hospitals had to simultaneously ensure activity as usual, COVID19 recovery and risk management.

Results

SMGH, while continuing the emergency, oncological, pregnancy, paediatrics and outpatient activities, COVID19 patients was isolated on 7 different floors/areas. Moreover was defined: chain of command; clinical admission criteria; COVID19 multi-professional and support teams, roles, skills and specific training; health surveillance; environmental hygiene, safety paths/procedures, vaccinal center and much more. CRH, while continuing minimum programmed activities to reduce waiting lists, in the first epidemic phase was created 4 tensile structures for Pre-triage and COVID pathways, respiratory isolation area for supsected patient; transfer admission for emergency networks, clean-dirty pathway. Moreover in the second phase, was activated beds of COVID19 network and 4 technical beds OBI; the ‘Walk-in' for antigenic testing, with molecular confirmation <24h and infectious counselling; multi-disciplinary and specialist support teams, training courses, health surveillance, vaccinal center and much more.

Lessons

During COVID19 pandemic, risk management skills linked to the technical-organisational strategy of hospital directors, making it possible to reprogramme their structure in a short period of time with flexibility and resilience of the whole organization.

Key messages

Specific skills and roles, both hygienic and organizational, are essential to risk management in hospitals during epidemic emergencies.

The multidisciplinarity, flexibility and modularity of the hospital structure are the organizational bases in cases of pandemics.

Assessment of the nutritional status in patients with acute diverticulitis

Background

The study evaluated the implementation of a screening strategy on all hospitalizations for diverticular disease (DD) of the colon with particular reference to acute diverticulitis (AD) regarding nutritional status.

Methods

The Nutritional Risk Security (NRS2002) system, was used, preselecting those with AD by the nurses of the nutrition team on the same day of admission from 1/01 to 31/12/2017 at the S. Eugenio Hospital in Rome. Patients (pts) with positive pre-screening were referred for additional evaluation performed by a dietician.

Results

AD was observed in 133 pts, 58% women, out of a total sample of 4667. The NRS2002 was applied to all, finding a positive screening test in 97 (72.9%) pts of whom a severely compromised nutritional status (NRS2002 score&gt;3) in 61 pts (62.9%). Each patient tested positive was given initial nutritional support: oral supplements (17 pts, 17.52%), enteral nutrition (22 pts 22.68%), total parenteral nutrition (58 pts 59.8%). The mean length of hospital stay was 6.9 days, although was significantly longer for pts with NRS2002 positive (mean of 18 day). NRS2002 score can be a significant predictor of disease severity and outcome, operating independently of BMI, since a total score ≥3 can predict length of hospital stay.

Conclusions

The study confirmed that NRS2002 is a useful screening tool for identifying nutritional risk AD pts in hospital wards and allowed to select pts who needed a more careful monitoring program, diet therapy and possibly nutrition artificial. Furthermore, it showed an increasing and underestimated risk of malnutrition in a large number of pts hospitalized and that NRS2002 screening is a good predictor of some socio-health indicators such as hospital stay.

Key messages

There is an increasing and underestimated risk of malnutrition in a large number of patients hospitalized. NRS2002 is a useful screening tool for identifying nutritional risk and a good predictor of some socio-health indicators such as hospital stay.

Efficacy and safety of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients with virological suppression: 144 week follow-up of the AtLaS pilot study

OBJECTIVES

AtLaS was a single-arm pilot study that demonstrated promising efficacy and safety of treatment simplification to a dual regimen with atazanavir/ritonavir + lamivudine in virologically suppressed HIV-positive patients. Here, we report data from the 144 week follow-up.

METHODS

At baseline, patients treated with a three-drug atazanavir/ritonavir-based regimen were switched to 300/100 mg of atazanavir/ritonavir plus 300 mg of lamivudine once daily. Major clinical events, laboratory parameters, neurocognitive performance, bone composition and body fat distribution were monitored. Treatment failure was defined as a discontinuation/switch of the regimen or virological failure (HIV-RNA >50 copies/mL in two consecutive determinations or a single level above 1000 copies/mL).

RESULTS

After 144 weeks, 9/40 (22.5%) treatment failures occurred, including two virological failures (Weeks 48 and 53, without resistance). A significant increase in the CD4 count was observed at Week 96 (+124 cells/mm(3); P = 0.002) and Week 144 (+94 cells/mm(3); P = 0.008). After 144 weeks, a significant increase in total cholesterol (+25 mg/dL; P = 0.001), HDL cholesterol (+6 mg/dL; P = 0.024) and LDL cholesterol (+12 mg/dL; P = 0.008) was observed, without any change in triglyceride levels, total cholesterol/HDL ratio or LDL/HDL ratio. A significant increase in the estimated glomerular filtration rate (+25 mL/min/1.73 m(2); P < 0.001) and lumbar spine T-score and Z-score (+0.2, P = 0.011; and +0.35, P = 0.001, respectively) and a decrease in trunk fat (-1.898 g; P = 0.005) were also observed. Neurocognitive function did not decline over time. Concerning safety, 10 moderate to severe adverse events were recorded in eight patients; overall seven cases of renal colic (possibly treatment related) were observed, leading to a discontinuation of treatment in two patients.

CONCLUSIONS

Data from the 144 week follow-up suggested good long-term efficacy of the simplification strategy that was investigated, with rare virological failure and a potential for improvement of the CD4 count, renal function and bone mineral density. This strategy warrants further investigation in a randomized trial.

[Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician's office]

Acute pharyngotonsillitis is one of the most frequent causes of visits in the primary care pediatrician'office. Group A b-hemolytic streptococci (GABHS) or Streptococcus pyogenes causes 15-30% of cases of acute pharyngotonsillitis in pediatric age. Children with pharyngotonsillitis due to GABHS commonly present sore throat, fever more than 38 °C, tonsillar exudate, and tender cervical adenopathy, but the severity of illness ranges from mild throat pain to classic exudative tonsillitis with high fever. The McIsaac criteria is a clinical scoring system to predict the likelihood of streptococcal infection among children. This score is based on 5 clinical criteria: age 3-14 years, fever more than 38°C, tonsillar swelling or exudate, tender and enlarged anterior cervical lymph nodes, and absence of cough, but none of these findings is specific for GABHS pharyngotonsillitis. Culture of a throat swab on a blood agar plate (BAP) remains the gold standard for the diagnosis of acute streptococcal pharyngotonsillitis. Because of the major disadvantage of culturing throat swabs on BAP culture is the delay in obtaining the results (at least 1 day), in the past decades rapid antigen detection test (RAD) were introduced for the rapid identification of GABHS directly from throat swabs. Accurate diagnosis and treatment of GABHS pharyngotonsillitis provides positive benefits, including prevention of complications, such as acute rheumatic fever and peritonsillar abscess and reduce the acute morbidity associated with the illness. Conversely, improper diagnosis may result in negative consequences, including unnecessary antibiotic prescriptions that confer increased health care costs and contibute to the development of bacterial resistance.

Sequence analysis and genetic variability of stearoyl CoA desaturase (SCD) gene in the Italian Mediterranean river buffalo

Stearoyl-CoA desaturase (SCD) plays a key metabolic role by changing the saturated FA content of ruminant milk and meat. In this study we characterized for the first time the stearoyl-CoA desaturase (SCD) gene in river buffalo (Bubalus bubalis) and investigated its genetic variability. On a total of 78 buffaloes, 15 SNPs were detected and 6 of them were preliminarily genotyped. In particular, the g.133A>C SNP was found to create a new consensus site for the SP1 binding site, thus generating a new tandem repeat in the promoter region. A preliminary association study with the milk fatty acid content showed that the C allele significantly affects the total desaturation index (P<0.01). Linkage disequilibrium analysis allowed identification of 7 haplotypes and 4 tag SNPs. Such polymorphisms could represent useful genetic markers for association studies with fatty acid composition, but further studies are needed to evaluate their potential use to improve the nutritional quality of the dairy products.

Biphasic pulses enhance bleomycin efficacy in a spontaneous canine perianal tumors model

Perianal tumors (adenoma and carcinoma of the hepatoid glands) are frequently reported in veterinary literature. They are locally aggressive tumors with a low tendency to metastatic spread. An hormonal ethiology has been identified for the development of perianal adenomas in male dogs, while the carcinomas are free from hormonal influence. Standard treatments include surgery, cryotherapy or, in selected cases, radiation therapy. In this article we describe the outcome of a small cohort of canine patients with perianal tumors treated with bleomycin selectively driven by trains of biphasic pulses (electrochemotherapy). Twelve canine patients, eight with adenoma and four with carcinoma of the perianal glands, entered the study and received two sessions of ECT under sedation. The pets had local injection ofbleomycin at the concentration of 1.5 mg/mg and five minutes after the chemotherapy, trains of 8 biphasic electric pulses lasting 50 + 50 micros each, with 1 ms interpulse intervals, were delivered by means of modified caliper and needle array electrodes or, for difficult districts, through paired needle electrode. The overall response rate was 91% with a 83% of complete response (10/12); one dog had a PR that lasted 12 months and another had progressive disease. Electrochemotherapy appears as a safe and efficacious modality for the treatment of perianal tumors and warrants further investigations.

Cell-cycle molecules in mesothelioma: an overview

Cell cycle progression is mediated by a group of proteins named cyclins that activate a highly conserved family of protein kinases, the cyclin-dependent kinases (CDKs). CDKs are also regulated by related proteins called cdk inhibitors, grouped into two families: the INK4 inhibitors (p16, p15, p19 and p18) and the Cip/Kip inhibitors (p21, p27). Moreover, several tumour suppressor genes (such as Retinoblastoma gene and p53 gene) are implicated in the regulation of the molecular mechanism of cell division. Several studies report the importance of cell cycle regulator proteins in the pathogenesis and the prognosis of mesothelioma. This article will review the most recent data from the literature about the expression and the diagnostic and prognostic significance of cell cycle molecules in mesothelioma.

Hemolytic-uremic syndrome as a presenting form of acute lymphocytic leukemia

We report an 8-year-old girl who presented with hemolytic-uremic syndrome (HUS) as the onset manifestation of acute lymphocytic leukemia (ALL). The patient was admitted to the hospital for renal failure, thrombocytopenia, and anemia during a HUS outbreak. She was discharged 2 weeks later with normal renal function. One month later the girl presented with clinical and laboratory signs consistent with a diagnosis of ALL. The short time interval between HUS and ALL suggests that HUS was probably an early manifestation of acute leukemia.

[Alcohol and work: comments on a clinical case load]

The relationship between alcohol and work was studied in a group of 260 voluntary patients (186 male and 74 female) admitted to the unit of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level.

[Hematologic diagnosis using fluorescence]

The authors have used a fluorescent supravital staining technique that allow the simultaneous study of platelets, the fibrin meshwork, the morphology of white blood cells and its phagocytic activity, the presence of immature cells. The technique is simple and fast and owing to all the information that it furnish, the authors designated it with the initials FED.

[The use of electropherogram in a clinical setting (author's transl)]

The AA. have spent several years working on the correlation between EPG patterns and diagnosis upon discharge. They then attempted to codify those abnormalities which were statistically related to different illnesses. This codification should not be considered definitive; however, it can be suggestive of further studies especially for those hospitals equipped with a computer which can correlate EPG patterns with the initial diagnosis or the diagnosis on discharge.

[A proposed hepatic pie chart]

The AA. have chosen 12 tests to organize an "hepatic flash" after a selection out of 180 cases scheduled as the table no. I through a set of tests showing step by step any modifications in compliance with the sensibility, reliability, statistical clinical and physio-pathological meaning of each test. The 12 tests are set out by circular abscissae of a circus according to the pathogenetic mechanisms leading to their modifications. By the radial ordinates, instead, it is shown the decreasing and increasing values which every test may assume. An hypothetic line (hepatogram) links then the values set out during the process of the disease in such a manner that the particular shapes assumed by the line itself show quickly and visually the spreading rate of the disease process.

[Biology of the "Salmonella wien" (author's transl)]

The Authors after a theoric introduction in regard to the taxonomic position, the history and the epidemiology of the Salmonella wien, explain the biologic characteristic of the bacterium according to results of their experiments.

[Syndrome of the "Lamblia intestinalis" (author's transl)]

The Authors related the physiopathologic remarks executed on subjects that are suffering from Lambia intestinalis. They have been chisen in a group of 226 individuals who had executed the coprologic test because of symptoms of gastroenteric apparatus. With the escort of this observation, the Authors have findings, as constant report, a typical enteritis, that reveals itself in periodical diarrhoea, alternated with constipation and often accompanied, in the children, with gastralgia, in the grown ups with duodenitis. The constancy of these reports and the therapeutical succes, whic the have been achieved in the most of the cases with antilambliasi, induce them to have reasonable motives to attribute to the Lamblia a definite pathogenus entity and to regard it an etiologic element of the above-mentioned unhelty courses.