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Romani L, Del Chierico F, Pane S, Ristori MV, Pirona I, Guarrasi V, Cotugno N, Bernardi S, Lancella L, Perno CF, Rossi P, Villani A, Campana A, Palma P, Putignani L. Exploring nasopharyngeal microbiota profile in children affected by SARS-CoV-2 infection. Microbiol Spectr 2024; 12:e0300923. [PMID: 38289047 PMCID: PMC10913489 DOI: 10.1128/spectrum.03009-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/12/2023] [Indexed: 03/06/2024] Open
Abstract
The relationship between COVID-19 and nasopharyngeal (NP) microbiota has been investigated mainly in the adult population. We explored the NP profile of children affected by COVID-19, compared to healthy controls (CTRLs). NP swabs of children with COVID-19, collected between March and September 2020, were investigated at the admission (T0), 72 h to 7 days (T1), and at the discharge (T2) of the patients. NP microbiota was analyzed by 16S rRNA targeted-metagenomics. Data from sequencing were investigated by QIIME 2.0 and PICRUSt 2. Multiple machine learning (ML) models were exploited to classify patients compared to CTRLs. The NP microbiota of COVID-19 patients (N = 71) was characterized by reduction of α-diversity compared to CTRLs (N = 59). The NP microbiota of COVID-19 cohort appeared significantly enriched in Streptococcus, Haemophilus, Staphylococcus, Veillonella, Enterococcus, Neisseria, Moraxella, Enterobacteriaceae, Gemella, Bacillus, and reduced in Faecalibacterium, Akkermansia, Blautia, Bifidobacterium, Ruminococcus, and Bacteroides, compared to CTRLs (FDR < 0.001). Exploiting ML models, Enterococcus, Pseudomonas, Streptococcus, Capnocytopagha, Tepidiphilus, Porphyromonas, Staphylococcus, and Veillonella resulted as NP microbiota biomarkers, in COVID-19 patients. No statistically significant differences were found comparing the NP microbiota profile of COVID-19 patients during the time-points or grouping patients on the basis of high, medium, and low viral load (VL). This evidence provides specific pathobiont signatures of the NP microbiota in pediatric COVID-19 patients, and the reduction of anaerobic protective commensals. Our data suggest that the NP microbiota may have a specific disease-related signature since infection onset without changes during disease progression, regardless of the SARS-CoV-2 VL. IMPORTANCE Since the beginning of pandemic, we know that children are less susceptible to severe COVID-19 disease. A potential role of the nasopharyngeal (NP) microbiota has been hypothesized but to date, most of the studies have been focused on adults. We studied the NP microbiota modifications in children affected by SARS-CoV-2 infection showing a specific NP microbiome profile, mainly composed by pathobionts and almost missing protective anaerobic commensals. Moreover, in our study, specific microbial signatures appear since the first days of infection independently from SARS-CoV-2 viral load.
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Affiliation(s)
- L. Romani
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - F. Del Chierico
- Research Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S. Pane
- Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - M. V. Ristori
- Research Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - I. Pirona
- GenomeUp SRL, Viale Pasteur, Rome, Italy
| | | | - N. Cotugno
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
| | - S. Bernardi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - L. Lancella
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - C. F. Perno
- Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P. Rossi
- Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - A. Villani
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - A. Campana
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P. Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
| | - L. Putignani
- Unit of Microbiomics and Research Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - the CACTUS Study TeamCarducciFrancesca CalòCancriniCaterinaChiurchiùSaradegli AttiMarta CiofiCursiLauraCutreraRenatoD’AmoreCarmenD’ArgenioPatriziaDe IorisMaria A.De LucaMaiaFinocchiAndreaMannoEmma ConcettaMorrocchiElenaPansaPaolaSessaLiberaZangariPaola
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Research Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- GenomeUp SRL, Viale Pasteur, Rome, Italy
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
- Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Unit of Microbiomics and Research Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Scutari R, Fox V, Fini V, Granaglia A, Vittucci AC, Smarrazzo A, Lancella L, Calo' Carducci F, Romani L, Cursi L, Bernaschi P, Russo C, Campana A, Bernardi S, Villani A, Perno CF, Alteri C. Molecular characterization of SARS-CoV-2 Omicron clade and clinical presentation in children. Sci Rep 2024; 14:5325. [PMID: 38438451 PMCID: PMC10912656 DOI: 10.1038/s41598-024-55599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
Since its emergence, SARS-CoV-2 Omicron clade has shown a marked degree of variability and different clinical presentation compared with previous clades. Here we demonstrate that at least four Omicron lineages circulated in children since December 2021, and studied until November 2022: BA.1 (33.6%), BA.2 (40.6%), BA.5 (23.7%) and BQ.1 (2.1%). At least 70% of infections concerned children under 1 year, most of them being infected with BA.2 lineages (n = 201, 75.6%). Looking at SARS-CoV-2 genetic variability, 69 SNPs were found to be significantly associated in pairs, (phi < - 0.3 or > 0.3 and p-value < 0.001). 16 SNPs were involved in 4 distinct clusters (bootstrap > 0.75). One of these clusters (A23040G, A27259C, T23617G, T23620G) was also positively associated with moderate/severe COVID-19 presentation (AOR [95% CI] 2.49 [1.26-4.89] p-value: 0.008) together with comorbidities (AOR [95% CI] 2.67 [1.36-5.24] p-value: 0.004). Overall, these results highlight the extensive SARS-CoV-2 Omicron circulation in children, mostly aged < 1 year, and provide insights on viral diversification even considering low-abundant SNPs, finally suggesting the potential contribution of viral diversification in affecting disease severity.
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Affiliation(s)
- Rossana Scutari
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Major School in Microbiology and Virology, Campus Bio-Medico University, Rome, Italy
| | - Valeria Fox
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Vanessa Fini
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annarita Granaglia
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Chiara Vittucci
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Smarrazzo
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Lorenza Romani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Cursi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Bernaschi
- Microbiology and Diagnostics in Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Russo
- Microbiology and Diagnostics in Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- Microbiology and Diagnostics in Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Claudia Alteri
- Multimodal Laboratory Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Piazzesi A, Pane S, Del Chierico F, Romani L, Campana A, Palma P, Putignani L. The pediatric gut bacteriome and virome in response to SARS-CoV-2 infection. Front Cell Infect Microbiol 2024; 14:1335450. [PMID: 38318164 PMCID: PMC10839054 DOI: 10.3389/fcimb.2024.1335450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Since the beginning of the SARS-CoV-2 pandemic in early 2020, it has been apparent that children were partially protected from both infection and the more severe forms of the disease. Many different mechanisms have been proposed to explain this phenomenon, including children's frequent exposure to other upper respiratory infections and vaccines, and which inflammatory cytokines they are more likely to produce in response to infection. Furthermore, given the presence of SARS-CoV-2 in the intestine and its ability to infect enterocytes, combined with the well described immunomodulatory capabilities of the microbiome, another potential contributing factor may be the presence of certain protective microbial members of the gut microbiota (GM). Methods We performed shotgun metagenomic sequencing and profiled both the bacteriome and virome of the GM of pediatric SARS-CoV-2 patients compared to healthy, age-matched subjects. Results We found that, while pediatric patients do share some pro-inflammatory microbial signatures with adult patients, they also possess a distinct microbial signature of protective bacteria previously found to be negatively correlated with SARS-CoV-2 infectivity and COVID-19 severity. COVID-19 was also associated with higher fecal Cytomegalovirus load, and with shifts in the relative abundances of bacteriophages in the GM. Furthermore, we address how the preventative treatment of COVID-19 patients with antibiotics, a common practice especially in the early days of the pandemic, affected the bacteriome and virome, as well as the abundances of antimicrobial resistance and virulence genes in these patients. Discussion To our knowledge, this is the first study to address the bacteriome, virome, and resistome of pediatric patients in response to COVID-19 and to preventative antibiotics use.
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Affiliation(s)
- Antonia Piazzesi
- Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefania Pane
- Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Lorenza Romani
- Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Palma
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Lorenza Putignani
- Unit of Microbiomics and Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Marzano V, Mortera SL, Marangelo C, Piazzesi A, Rapisarda F, Pane S, Del Chierico F, Vernocchi P, Romani L, Campana A, Palma P, Putignani L. The metaproteome of the gut microbiota in pediatric patients affected by COVID-19. Front Cell Infect Microbiol 2023; 13:1327889. [PMID: 38188629 PMCID: PMC10766818 DOI: 10.3389/fcimb.2023.1327889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction The gut microbiota (GM) play a significant role in the infectivity and severity of COVID-19 infection. However, the available literature primarily focuses on adult patients and it is known that the microbiota undergoes changes throughout the lifespan, with significant alterations occurring during infancy and subsequently stabilizing during adulthood. Moreover, children have exhibited milder symptoms of COVID-19 disease, which has been associated with the abundance of certain protective bacteria. Here, we examine the metaproteome of pediatric patients to uncover the biological mechanisms that underlie this protective effect of the GM. Methods We performed nanoliquid chromatography coupled with tandem mass spectrometry on a high resolution analytical platform, resulting in label free quantification of bacterial protein groups (PGs), along with functional annotations via COG and KEGG databases by MetaLab-MAG. Additionally, taxonomic assignment was possible through the use of the lowest common ancestor algorithm provided by Unipept software. Results A COVID-19 GM functional dissimilarity respect to healthy subjects was identified by univariate analysis. The alteration in COVID-19 GM function is primarily based on bacterial pathways that predominantly involve metabolic processes, such as those related to tryptophan, butanoate, fatty acid, and bile acid biosynthesis, as well as antibiotic resistance and virulence. Discussion These findings highlight the mechanisms by which the pediatric GM could contribute to protection against the more severe manifestations of the disease in children. Uncovering these mechanisms can, therefore, have important implications in the discovery of novel adjuvant therapies for severe COVID-19.
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Affiliation(s)
- Valeria Marzano
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Levi Mortera
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Marangelo
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonia Piazzesi
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Rapisarda
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefania Pane
- Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Del Chierico
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Pamela Vernocchi
- Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Lorenza Romani
- Unit of Infectious Disease, Bambino Gesu’ Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Palma
- Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Lorenza Putignani
- Unit of Microbiomics and Research Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Licciardi F, Covizzi C, Dellepiane M, Olivini N, Mastrolia MV, Lo Vecchio A, Monno V, Tardi M, Mauro A, Alessio M, Filocamo G, Cattalini M, Taddio A, Caorsi R, Marseglia GL, La Torre F, Campana A, Simonini G, Ravelli A, Montin D. Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study. Front Pediatr 2023; 11:1137051. [PMID: 37675397 PMCID: PMC10478576 DOI: 10.3389/fped.2023.1137051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Background The treatment of multisystem inflammatory syndrome in children unresponsive to first-line therapies (IVIG and/or steroids) is challenging. The effectiveness of IL-1 receptor antagonist, anakinra, is debated. Patients and methods We conducted an anonymous retrospective multicenter study on MIS-C patients treated with anakinra in Italy from January 2020 to February 2021. Our study outcomes included the percentage of patients who required further therapeutic step-up, the percentage of patients who experienced fever resolution within 24 h and a reduction of CRP by half within 48 h, and the percentage of patients who developed Coronary Artery Anomalies (CAA) during follow-up. Results 35 cases of MIS-C were treated in 10 hospitals. Of these, 13 patients started anakinra while in the ICU, and 22 patients started anakinra in other wards. 25 patients (71.4%) were treated with corticosteroids at a starting dose 2-30 mg/Kg/day plus IVIG (2 g/Kg), 10 patients (28.6%) received only corticosteroids without IVIG. Anakinra was administered intravenously to all patients in Group A (mean dose 8 mg/Kg/day), and subcutaneously in Group B (mean dose 4 mg/Kg/day). Only two patients required further treatment step-up and no patients developed CAA after receiving anakinra. The most commonly observed side effect was an increase in ALT, occurring in 17.1% of patients. Conclusions In this retrospective cohort of severe MIS-C patients treated with anakinra we report favorable clinical outcomes with a low incidence of side effects. The simultaneous use of steroids ± IVIG in these patients hinders definitive conclusions regarding the need of IL-1 inhibition in MIS-C treatment.
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Affiliation(s)
- Francesco Licciardi
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Carlotta Covizzi
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Marta Dellepiane
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Nicole Olivini
- Pediatrics Unit, University Department of Pediatrics (DEAPG), Bambino Gesù Children’s Hospital—IRCCS, Rome, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Viviana Monno
- Pediatric Rheumatology Section, Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Bari, Italy
| | - Maria Tardi
- Rheumatology Unit, Department of Pediatrics, Santobono Pausilipon Children Hospital, Naples, Italy
| | - Angela Mauro
- COVID Unit, Emergency Department, Santobono-Pausilipon Children Hospital, Naples, Italy
| | - Maria Alessio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Marco Cattalini
- Spedali Civili, Unità di Immunologia e Reumatologia Pediatrica, Clinica Pediatrica dell’Università di Brescia, Brescia, Italy
| | - Andrea Taddio
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, Trieste and University of Trieste, Trieste, Italy
| | - Roberta Caorsi
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic Foundation IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Francesco La Torre
- Pediatric Rheumatology Section, Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Bari, Italy
| | - Andrea Campana
- Pediatrics Unit, University Department of Pediatrics (DEAPG), Bambino Gesù Children’s Hospital—IRCCS, Rome, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Davide Montin
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
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Scarselli V, Calderoni D, Terrinoni A, Davico C, Pruccoli G, Denina M, Carducci C, Smarrazzo A, Martucci M, Presicce M, Marcotulli D, Arletti L, Ferrara M, Garazzino S, Mariani R, Campana A, Vitiello B. A Neuropsychiatric Assessment of Children with Previous SARS-CoV-2 Infection. J Clin Med 2023; 12:3917. [PMID: 37373611 DOI: 10.3390/jcm12123917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
AIM Concerns have been raised about possible neuropsychiatric sequelae of COVID-19. The objective of this study was to examine the plausibility of long-term mental health consequences of COVID-19 by assessing a sample of children after the resolution of the acute SARS-CoV-2 infection. METHOD As part of a systematic follow-up assessment of pediatric patients with COVID-19 conducted at two university children's hospitals, 50 children (56% males) aged 8 to 17 years (median 11.5), 26% with previous multisystem inflammatory syndrome in children (MIS-C), without a prior history of neuropsychiatric disorders, received a battery of clinical neuropsychiatric and neuropsychological rating scales that included the Pediatric Migraine Disability Assessment (PedMIDAS), Sleep Disturbance Scale for Children (SDSC), Multidimensional Anxiety Scale for Children (MASC-2), Child Depression Inventory (CDI-2), Child Behavior Checklist (CBCL), and the NEPSY II (Neuropsychological Assessment, Second Edition). The assessments were conducted between 1 and 18 months (median 8 months) after the acute infection. RESULTS The CBCL internalizing symptoms score was in the clinical range for 40% of the participants (vs. a population expected rate of about 10%, p < 0.001). A sleep disturbance was detected in 28%, clinically significant anxiety in 48%, and depressive symptoms in 16%. The NEPSY II scores showed impairment in attention and other executive functions in 52%, and memory deficits in 40% of the children. CONCLUSIONS These data from direct assessment of a sample of children who had SARS-CoV-2 infection show higher than expected rates of neuropsychiatric symptoms, thus supporting the possibility that COVID-19 may have mental health sequelae long after the resolution of the acute infection.
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Affiliation(s)
- Veronica Scarselli
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Dario Calderoni
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Arianna Terrinoni
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Giulia Pruccoli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Marco Denina
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Chiara Carducci
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Andrea Smarrazzo
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Melania Martucci
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Mariaelena Presicce
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Luca Arletti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Mauro Ferrara
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Silvia Garazzino
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Rosanna Mariani
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Andrea Campana
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
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7
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Scarselli A, Smarrazzo A, De Sanctis F, Ravà L, Carletti M, Ciofi Degli Atti M, Aversa M, Drago R, Crocoli A, Geremia C, Guerricchio A, Lucignano B, Campana A, De Ioris MA, Perrotta D. The burden of central line-associated bloodstream infections in children with medical complexity. J Vasc Access 2023; 24:198-204. [PMID: 34148383 DOI: 10.1177/11297298211027468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC. METHODS This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) surveillance. RESULTS A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC (p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered. CONCLUSIONS A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.
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8
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Giuliano M, Tiple D, Agostoni P, Armocida B, Biardi L, Bonfigli AR, Campana A, Ciardi M, Di Marco F, Floridia M, Gnerre P, Grassi T, Grattagliano I, Kruger P, Leonardi M, Liguori R, Pagani E, Perger E, Pricci F, Ruggeri M, Silenzi A, Spannella F, Tascini C, Teté G, Tosato M, Vecchi S, Villa M, Onder G. Italian good practice recommendations on management of persons with Long-COVID. Front Public Health 2023; 11:1122141. [PMID: 37151592 PMCID: PMC10157646 DOI: 10.3389/fpubh.2023.1122141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient's needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- *Correspondence: Marina Giuliano,
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Piergiuseppe Agostoni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | - Maria Ciardi
- Department of Public Health and Infectious Diseases, University “La Sapienza”, Rome, Italy
| | - Fabiano Di Marco
- Department of Health Sciences and Pneumology, University of Milan, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Gnerre
- Department of Internal Medicine, ASL AL, Acqui Terme, Italy
| | - Tiziana Grassi
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Ignazio Grattagliano
- SIMG, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Paola Kruger
- European Patients Academy for Therapeutic Innovation (EUPATI), Rome, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rocco Liguori
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Pagani
- Department of Internal Medicine, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Flavia Pricci
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Andrea Silenzi
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Teté
- Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Matteo Tosato
- Department of Geriatrics and Othopedic Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marika Villa
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics and Othopedic Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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Dona’ D, Montagnani C, Di Chiara C, Venturini E, Galli L, Lo Vecchio A, Denina M, Olivini N, Bruzzese E, Campana A, Giacchero R, Salvini F, Meini A, Ponzoni M, Trapani S, Rossi E, Lombardi MH, Badolato R, Pierri L, Pruccoli G, Rossin S, Colomba C, Cazzato S, Pacati I, Nicolini G, Pierantoni L, Bianchini S, Krzysztofiak A, Garazzino S, Giaquinto C, Castelli Gattinara G. COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease? Viruses 2022; 14:v14102256. [PMID: 36298812 PMCID: PMC9612333 DOI: 10.3390/v14102256] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
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Affiliation(s)
- Daniele Dona’
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3388946412
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Nicole Olivini
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Campana
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | | | - Filippo Salvini
- Department of Pediatrics, Niguarda Hospital, 20162 Milan, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
| | - Sandra Trapani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | | | - Mary Haywood Lombardi
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
| | - Ilaria Pacati
- Paediatric Unit, Ospedale Bolognini ASST Bergamo Est, 24068 Seriate, Italy
| | | | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, 40138 Bologna, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
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Cantarutti N, Battista V, Stagnaro N, Labate ME, Cicenia M, Campisi M, Vitali V, Secinaro A, Campana A, Trocchio G, Drago F. Long-Term Cardiovascular Outcome in Children with MIS-C Linked to SARS-CoV-2 Infection-An Italian Multicenter Experience. Biology (Basel) 2022; 11:biology11101474. [PMID: 36290378 PMCID: PMC9598394 DOI: 10.3390/biology11101474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
Simple Summary MIS-C is a multisystem inflammatory syndrome that is characterized by severe systemic signs of inflammation and multi-organ failure, including the involvement of the heart. Our study described the long-term cardiovascular outcome in a cohort of pediatric patients with MIS-C, who were admitted to two Italian Pediatric Referral Centers. The number of pediatric patients with an MIS-C diagnosis was 67. Among them, 65% of them had ventricular dysfunction, 66% of them had pericarditis, 35% of them had coronary involvement, and 9% of them showed arrhythmias. Our data described many cases of myocarditis and pericarditis, with mild coronary involvement and a few cases of arrhythmias. This experience showed that cardiac involvement in MIS-C patients is almost the rule, and that LV dysfunction and pericarditis are the most frequent manifestations of it. However, the patients’ clinical course was satisfactory, and during the controls, no additional events or sequelae were observed apart from long-term myocardial scars in 50% of the patients that underwent CMR. Early treatment not only provides a prompt full recovery, but it also has a probably “protective” effect towards late adverse events and long-term complications. Abstract MIS-C is a multisystem inflammatory syndrome that is characterized by multi-organ failure and cardiac involvement. The aim of this study was to describe the long-term cardiovascular outcome in a cohort of MIS-C pediatric patients, who were admitted to two Italian Pediatric Referral Centers. Sixty-seven patients (mean age 8.7 ± 4.7 years, male 60%) were included; 65 (97%) of them showed cardiac involvement. All of the patients completed one month of the follow-up, and 47% completed 1 year of it. ECG abnormalities were present in 65% of them, arrhythmias were present in 9% of them during an acute phase and it disappeared at the point of discharge or later. Pericarditis were detected in 66% of them and disappeared after 6 months. Coronaritis was observed in 35% of the children during an acute phase, and there were no more instances at the 1-year point. An LV dysfunction was present in 65% of the patients at the beginning of the study, with them having a full recovery at the point of discharge and thereafter. Elevated values of the NTproBNP and hsTp were initially detected, which progressively decreased and normalized at the points of discharge and FU. The CMR at the point of FU, there was a presence of long-term myocardial scars in 50% of the patients that were tested. No deaths that were caused by MIS-C during the FU were recorded. Cardiac involvement in MIS-C patients is almost the rule, but the patients’ clinical course was satisfactory, and no additional events or sequelae were observed apart from there being long-term myocardial scars in 50% of the patients that underwent CMR.
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Affiliation(s)
- Nicoletta Cantarutti
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
- Correspondence: ; Tel.: +39-06-6859-1
| | - Virginia Battista
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
| | - Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, 16132 Genoa, Italy
| | - Marianna Eleonora Labate
- Department of Internal Medicine and Medical Specialities (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, 16132 Genoa, Italy
| | - Marianna Cicenia
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
| | - Marta Campisi
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
| | - Valerio Vitali
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital IRCSS, 00163 Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
| | - Gianluca Trocchio
- Cardiology Unit, IRCCS Istituto Giannina Gaslini, 16132 Genoa, Italy
| | - Fabrizio Drago
- Cardiology and Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00163 Rome, Italy
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11
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Genna C, Thekkan KR, Geremia C, Di Furia M, Campana A, Dall'Oglio I, Tiozzo E, Gawronski O. Parents' process of recognition and response to clinical deterioration of their children with medical complexity at home: A grounded theory. J Clin Nurs 2022. [PMID: 36101491 DOI: 10.1111/jocn.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To explore the process of recognition and response to clinical deterioration of children with medical complexity at home by their parents. BACKGROUND Children with medical complexity are characterised by known chronic conditions associated with frailty and functional limitations, dependence on healthcare services and high use of technology and resources. Their medical complexity often leads to the onset of complications. Targeted care ensures timely recognition and response to clinical deterioration at home, thus avoiding serious sequelae, inappropriate hospitalisations and improving quality of life. Evidence on parents' process of the recognition and response to clinical deterioration at home is limited. DESIGN Qualitative study using a Grounded Theory methodology. METHOD Seven online focus groups were conducted with parents and healthcare providers experienced in their care. The interviews were transcribed verbatim and analysed through open, axial and selective coding, using a constant comparative iterative method. The COREQ guidelines guided the reporting of this work. RESULTS Four categories and one core category were identified: (1) Awareness of the unique and shared characteristics of children with medical complexity; (2) Parents' care maintenance and management; (3) Parents' care monitoring; (4) Parents' response to clinical deterioration and (5) Seeking the Shift of Agency, the core category as the foundation of the Process of Recognition and rEsponse of PAREnts to Deterioration (PRE-PARE-D) theory. CONCLUSION The role of parents of children with medical complexity is evolving into active care leaders, by developing care management and care monitoring competences and negotiating care with healthcare providers. RELEVANCE TO CLINICAL PRACTICE The shift of agency from healthcare providers to parents requires education and counselling pathways to promote the development of parent's self-efficacy, competencies and empowerment in the care management of their children. Home care delivery for children with medical complexity should aim at sustaining this partnership between healthcare providers and parents.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesiology and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Romani L, Del Chierico F, Macari G, Pane S, Ristori MV, Guarrasi V, Gardini S, Pascucci GR, Cotugno N, Perno CF, Rossi P, Villani A, Bernardi S, Campana A, Palma P, Putignani L. The Relationship Between Pediatric Gut Microbiota and SARS-CoV-2 Infection. Front Cell Infect Microbiol 2022; 12:908492. [PMID: 35873161 PMCID: PMC9304937 DOI: 10.3389/fcimb.2022.908492] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022] Open
Abstract
This is the first study on gut microbiota (GM) in children affected by coronavirus disease 2019 (COVID-19). Stool samples from 88 patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and 95 healthy subjects were collected (admission: 3–7 days, discharge) to study GM profile by 16S rRNA gene sequencing and relationship to disease severity. The study group was divided in COVID-19 (68), Non–COVID-19 (16), and MIS-C (multisystem inflammatory syndrome in children) (4). Correlations among GM ecology, predicted functions, multiple machine learning (ML) models, and inflammatory response were provided for COVID-19 and Non–COVID-19 cohorts. The GM of COVID-19 cohort resulted as dysbiotic, with the lowest α-diversity compared with Non–COVID-19 and CTRLs and by a specific β-diversity. Its profile appeared enriched in Faecalibacterium, Fusobacterium, and Neisseria and reduced in Bifidobacterium, Blautia, Ruminococcus, Collinsella, Coprococcus, Eggerthella, and Akkermansia, compared with CTRLs (p < 0.05). All GM paired-comparisons disclosed comparable results through all time points. The comparison between COVID-19 and Non–COVID-19 cohorts highlighted a reduction of Abiotrophia in the COVID-19 cohort (p < 0.05). The GM of MIS-C cohort was characterized by an increase of Veillonella, Clostridium, Dialister, Ruminococcus, and Streptococcus and a decrease of Bifidobacterium, Blautia, Granulicatella, and Prevotella, compared with CTRLs. Stratifying for disease severity, the GM associated to “moderate” COVID-19 was characterized by lower α-diversity compared with “mild” and “asymptomatic” and by a GM profile deprived in Neisseria, Lachnospira, Streptococcus, and Prevotella and enriched in Dialister, Acidaminococcus, Oscillospora, Ruminococcus, Clostridium, Alistipes, and Bacteroides. The ML models identified Staphylococcus, Anaerostipes, Faecalibacterium, Dorea, Dialister, Streptococcus, Roseburia, Haemophilus, Granulicatella, Gemmiger, Lachnospira, Corynebacterium, Prevotella, Bilophila, Phascolarctobacterium, Oscillospira, and Veillonella as microbial markers of COVID-19. The KEGG ortholog (KO)–based prediction of GM functional profile highlighted 28 and 39 KO-associated pathways to COVID-19 and CTRLs, respectively. Finally, Bacteroides and Sutterella correlated with proinflammatory cytokines regardless disease severity. Unlike adult GM profiles, Faecalibacterium was a specific marker of pediatric COVID-19 GM. The durable modification of patients’ GM profile suggested a prompt GM quenching response to SARS-CoV-2 infection since the first symptoms. Faecalibacterium and reduced fatty acid and amino acid degradation were proposed as specific COVID-19 disease traits, possibly associated to restrained severity of SARS-CoV-2–infected children. Altogether, this evidence provides a characterization of the pediatric COVID-19–related GM.
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Affiliation(s)
- Lorenza Romani
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Del Chierico
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, IRCCS, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Stefania Pane
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Vittoria Ristori
- Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, IRCCS, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | | | - Giuseppe Rubens Pascucci
- Research Unit of Congenital and Perinatal Infections, Bambino Gesu` Children’s Hospital, IRCCS, Rome, Italy
| | - Nicola Cotugno
- Research Unit of Congenital and Perinatal Infections, Bambino Gesu` Children’s Hospital, IRCCS, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
| | - Carlo Federico Perno
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Multimodal Laboratory Medicine Research Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
- Academic Department of Pediatrics, Bambino Gesu` Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Department and General Pediatrics, Children Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Stefania Bernardi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesu` Children’s Hospital, IRCCS, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome ‘‘Tor Vergata’’, Rome, Italy
| | - Lorenza Putignani
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Unit of Microbiomics and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- *Correspondence: Lorenza Putignani,
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Alteri C, Scutari R, Costabile V, Colagrossi L, Yu La Rosa K, Agolini E, Lanari V, Chiurchiù S, Romani L, Markowich AH, Bernaschi P, Russo C, Novelli A, Bernardi S, Campana A, Villani A, Perno CF. Epidemiological characterization of SARS-CoV-2 variants in children over the four COVID-19 waves and correlation with clinical presentation. Sci Rep 2022; 12:10194. [PMID: 35715488 PMCID: PMC9204374 DOI: 10.1038/s41598-022-14426-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
Since the start of SARS-CoV-2 pandemic, children aged ≤ 12 years have always been defined as underrepresented in terms of SARS-CoV-2 infections' frequency and severity. By correlating SARS-CoV-2 transmission dynamics with clinical and virological features in 612 SARS-CoV-2 positive patients aged ≤ 12 years, we demonstrated a sizeable circulation of different SARS-CoV-2 lineages over the four pandemic waves in paediatric population, sustained by local transmission chains. Age < 5 years, highest viral load, gamma and delta clades positively influence this local transmission. No correlations between COVID-19 manifestations and lineages or transmission chains are seen, except for a negative correlation between B.1.1.7 and hospitalization.
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Affiliation(s)
- Claudia Alteri
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Rossana Scutari
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Luna Colagrossi
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Katia Yu La Rosa
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy.,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Valentina Lanari
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Sara Chiurchiù
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenza Romani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paola Bernaschi
- Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Cristina Russo
- Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Multimodal Research Area, Bambino Gesù Children Hospital IRCCS, Rome, Italy. .,Microbiology and Diagnostics of Immunology Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy.
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14
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Musolino AM, Ferro V, Supino MC, Boccuzzi E, Scateni S, Sinibaldi S, Cursi L, Schingo PMS, Reale A, Campana A, Raponi M, Villani A, Tomà P. One Year of Lung Ultrasound in Children with SARS-CoV-2 Admitted to a Tertiary Referral Children's Hospital: A Retrospective Study during 2020-2021. Children (Basel) 2022; 9:761. [PMID: 35626938 PMCID: PMC9139579 DOI: 10.3390/children9050761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
During the COVID-19 pandemic, the lung ultrasound (LU) turned out to be a pivotal tool to study the lung involvement in the adult population, but the same was not well evaluated in children. We detected the LU patterns through an integrated approach with clinical−laboratory features in children hospitalized for COVID-19 in relation to the temporal trend of the Italian epidemic. We conducted a retrospective study which took place at a pediatric tertiary hospital from 15 March 2020 to 15 March 2021. We compared the characteristics of the initial phase of the first COVID-19 year—in the spring and summer (15 March−30 September 2020)—and those of the second phase—in the autumn and winter (1 October 2020−15 March 2021). Twenty-eight patients were studied both in the first and in the second phase of the first COVID-19 year. The disease severity score (DSS) was significantly greater in the second phase (p = 0.015). In the second phase of the first COVID-19 year, we detected a more significant occurrence of the following LU features than in the first phase: the irregular pleural line (85.71% vs. 60.71%; p = 0.035), the B-lines (89.29% vs. 60%; p = 0.003) and the several but non-coalescent B-lines (89.29% vs. 60%; p = 0.003). The LU score correlated significantly with the DSS, with a moderate relationship (r = 0.51, p < 0.001). The combined clinical, laboratory and ultrasound approaches might be essential in the evaluation of pulmonary involvement in children affected by COVID-19 during different periods of the pandemic.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Valentina Ferro
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Maria Chiara Supino
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Elena Boccuzzi
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Simona Scateni
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Serena Sinibaldi
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Antonino Reale
- Pediatric Emergency, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.M.); (M.C.S.); (E.B.); (S.S.); (A.R.)
| | - Andrea Campana
- Pediatric Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00050 Palidoro, Italy; (S.S.); (A.C.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Alberto Villani
- General Pediatrics Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.M.S.S.); (P.T.)
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15
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Romani L, Calò Carducci FI, Chiurchiù S, Cursi L, De Luca M, Di Giuseppe M, Krzysztofiak A, Lancella L, Palma P, Vallesi L, Corsetti T, Campana A, Nicastri E, Rossi P, Bernardi S. Safety of Monoclonal Antibodies in Children Affected by SARS-CoV-2 Infection. Children (Basel) 2022; 9:children9030369. [PMID: 35327741 PMCID: PMC8947030 DOI: 10.3390/children9030369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
Monoclonal antibody therapies for COVID-19 have been frequently used in adults, whereas there are little data regarding the safety or efficacy of monoclonal antibody treatments in pediatric patients affected by COVID-19. We report our experience in the administration of mAb as a treatment for SARS-CoV-2 infection in children aged from 24 days to 18 years old.
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Affiliation(s)
- Lorenza Romani
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
- Correspondence:
| | - Francesca Ippolita Calò Carducci
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Sara Chiurchiù
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Maia De Luca
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Martina Di Giuseppe
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Andrzej Krzysztofiak
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Lancella
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Leonardo Vallesi
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Tiziana Corsetti
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, 00149 Rome, Italy;
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Stefania Bernardi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
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16
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Schiaffini R, Campana A, Deodati A, Peschiaroli E, Lanzillotta MF, Fierabracci A. SARS-CoV-2 infection as possible downstream disease precipitator in autoantibody-positive insulin-dependent diabetes mellitus: a case report. Ital J Pediatr 2022; 48:33. [PMID: 35197086 PMCID: PMC8864604 DOI: 10.1186/s13052-022-01226-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/28/2022] [Indexed: 12/11/2022] Open
Abstract
Background SARS-CoV-2 causes lesions, in addition to lung, in endocrine organs such as the pancreas through ACE2 receptor. Recently the relationship between SARS-CoV-2 exposition and the incidence or evolution of clinical autoimmune diabetes has attracted the attention of diabetologists. Case presentation We report the analysis of the clinical history of a child diagnosed for insulin-dependent diabetes mellitus (Type 1 diabetes) at the time a paucisymptomatic COVID-19 infection occurred, followed by well-controlled metabolic status. As opposite to previous findings SARS-CoV2 did not cause ketosis and ketoacidosis. Polydipsia was reported a few months and weight loss 4 weeks before SARS- CoV-2 infection suggesting that SARS-CoV-2 could not be the trigger of Type 1 diabetes in this patient. Conclusions SARS-CoV-2 in this patient was an unexpected event in the course of disease. We advance the hypothesis that the SARS-CoV-2 infection, even if paucisymptomatic could have acted in the present case report as a hypothetical downstream precipitating factor; whilst the inciting triggering event of the autoimmune disease, as confirmed by the presence of circulating autoantibodies, could have occurred even before, as generally assumed for this category of disorders. The precipitating mechanism could have been the acute interaction between virus and the ACE receptor on the beta cells, at the time that hyperglycemia and glycosuria were ascertained, and HbA1c levels confirmed a metabolic dysregulation over the previous 3 months in absence of ketoacidosis.
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Affiliation(s)
- Riccardo Schiaffini
- Diabetes and Growth Disorders Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Andrea Campana
- Multispecialistic Pediatric Unit, Emergency Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Annalisa Deodati
- Diabetes and Growth Disorders Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Peschiaroli
- Multispecialistic Pediatric Unit, Emergency Acceptance and General Pediatrics Department, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alessandra Fierabracci
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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17
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Lovardi E, De Ioris MA, Lettori D, Geremia C, Staccioli S, Bella GD, Scrocca R, Scarselli A, Aversa M, De Peppo F, Campana A, Castelli E. Glycopyrrolate for drooling in children with medical complexity under three years of age. Ital J Pediatr 2022; 48:2. [PMID: 34998418 PMCID: PMC8742944 DOI: 10.1186/s13052-021-01195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background The aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under 3 years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3–16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review. Methods this is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2–36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1–69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02–0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month. Results Four out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81–100) and after 1 month 61(range 43–78); the difference was statistically significant (P < 0.001). The overall response to treatment was 94%. Conclusions This is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.
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Affiliation(s)
- Eleonora Lovardi
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy. .,Child Neuropsychiatric Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
| | | | - Donatella Lettori
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Susanna Staccioli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gessica Della Bella
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | | | - Marcella Aversa
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery and Transplantation Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Pediatrics, University Department of Pediatrics, Rome, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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18
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Coltella L, Ranno S, Piccioni L, Linardos G, Colagrossi L, Agosta M, Russo C, Concato C, Campana A, Muda AO, Villani A, Perno CF. Quantitative SARS-CoV-2 antigen test as a tool able to predict the stage of the infection. J Infect 2021; 84:418-467. [PMID: 34953907 PMCID: PMC9428766 DOI: 10.1016/j.jinf.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luana Coltella
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Stefania Ranno
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy.
| | - Livia Piccioni
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Giulia Linardos
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Luna Colagrossi
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Marilena Agosta
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Cristina Russo
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Carlo Concato
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Andrea Campana
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Andrea Onetti Muda
- Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
| | - Carlo Federico Perno
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio, 4 00165 Rome, Italy
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19
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Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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20
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Citoni B, Digilio MC, Capolino R, Gagliardi MG, Campana A, Drago F, Calcagni G. SARS-CoV-2 and Pre-Tamponade Pericardial Effusion. Could Sotos Syndrome Be a Major Risk Factor? Genes (Basel) 2021; 12:genes12111782. [PMID: 34828388 PMCID: PMC8622474 DOI: 10.3390/genes12111782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/05/2022] Open
Abstract
Pericarditis with pericardial effusion in SARS CoV-2 infection is a well-known entity in adults. In children and adolescents, only a few cases have been reported. Here, we present here a case of a 15-year-old girl affected by Sotos syndrome with pre-tamponed pericardial effusion occurred during SARS-CoV-2 infection. A possible relation between SARS-CoV-2 pericarditis and genetic syndromes, as a major risk factor for the development of severe inflammation, has been speculated. We emphasize the importance of active surveillance by echocardiograms when SARS-CoV-2 infection occurs in combination with a genetic condition.
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Affiliation(s)
- Barbara Citoni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (R.C.)
| | - Rossella Capolino
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (R.C.)
| | - Maria Giulia Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (B.C.); (M.G.G.); (F.D.)
- Correspondence: ; Tel.: +39-0668594096
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21
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Cotugno N, Ruggiero A, Pascucci GR, Bonfante F, Petrara MR, Pighi C, Cifaldi L, Zangari P, Bernardi S, Cursi L, Santilli V, Manno EC, Amodio D, Linardos G, Piccioni L, Barbieri MA, Perrotta D, Campana A, Donà D, Giaquinto C, Concato C, Brodin P, Rossi P, De Rossi A, Palma P. Virological and immunological features of SARS-COV-2 infected children with distinct symptomatology. Pediatr Allergy Immunol 2021; 32:1833-1842. [PMID: 34174102 PMCID: PMC8420243 DOI: 10.1111/pai.13585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although SARS-CoV-2 immunizations have started in most countries, children are not currently included in the vaccination programs; thus, it remains crucial to define their anti-SARS-CoV-2 immune response in order to minimize the risk for other epidemic waves. This study sought to provide a description of the virology ad anti-SARS-CoV-2 immunity in children with distinct symptomatology. METHODS Between March and July 2020, we recruited 15 SARS-CoV-2 asymptomatic (AS) and 51 symptomatic (SY) children, stratified according to WHO clinical classification. We measured SARS-CoV-2 viral load using ddPCR and qPCR in longitudinally collected nasopharyngeal swab samples. To define anti-SARS-CoV-2 antibodies, we measured neutralization activity and total IgG load (DiaSorin). We also evaluated antigen-specific B and CD8+T cells, using a labeled S1+S2 protein and ICAM expression, respectively. Plasma protein profiling was performed with Olink. RESULTS Virological profiling showed that AS patients had lower viral load at diagnosis (p = .004) and faster virus clearance (p = .0002) compared with SY patients. Anti-SARS-CoV-2 humoral and cellular response did not appear to be associated with the presence of symptoms. AS and SY patients showed similar titers of SARS-CoV-2 IgG, levels of neutralizing activity, and frequency of Ag-specific B and CD8+ T cells, whereas pro-inflammatory plasma protein profile was found to be associated with symptomatology. CONCLUSION We demonstrated the development of anti-SARS-CoV-2 humoral and cellular response with any regard to symptomatology, suggesting the ability of both SY and AS patients to contribute toward herd immunity. The virological profiling of AS patients suggested that they have lower virus load associated with faster virus clearance.
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Affiliation(s)
- Nicola Cotugno
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandra Ruggiero
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Rubens Pascucci
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Maria Raffaella Petrara
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy
| | - Chiara Pighi
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Loredana Cifaldi
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Zangari
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefania Bernardi
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Cursi
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Veronica Santilli
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emma Concetta Manno
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Donato Amodio
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Giulia Linardos
- Division of Virology, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Livia Piccioni
- Division of Virology, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Daniela Perrotta
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniele Donà
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, Padova, Italy
| | | | - Carlo Concato
- Division of Virology, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Petter Brodin
- Department of Woman's and Children Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Rossi
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, Padova, Italy.,Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy
| | - Paolo Palma
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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22
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Cantarutti N, Battista V, Adorisio R, Cicenia M, Campanello C, Listo E, Campana A, Trocchio G, Drago F. Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience. Children (Basel) 2021; 8:children8080717. [PMID: 34438608 PMCID: PMC8392006 DOI: 10.3390/children8080717] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022]
Abstract
Since the spread of COVID-19, pediatric patients were initially considered less affected by SARS-COV-2, but current literature reported subsets of children with multisystem inflammatory syndrome (MIS-C). This study aims to describe the cardiac manifestation of SARS-COV-2 infection in a large cohort of children admitted to two Italian pediatric referral centers. Between March 2020 and March 2021, we performed a cardiac evaluation in 294 children (mean age 9 ± 5.9 years, male 60%) with active or previous SARS-COV-2 infection. Twenty-six showed ECG abnormalities: 63 repolarization anomalies, 13 Long QTc, five premature ventricular beats, two non-sustained ventricular tachycardia, and one atrial fibrillation. In total, 146 patients underwent cardiac biomarkers: NT-proBNP was elevated in 57, troponin in 34. An echocardiogram was performed in 98, showing 54 cardiac anomalies: 27 left-ventricular dysfunction, 42 pericarditis, 16 coronaritis. MIS-C was documented in 46 patients (mean age 9 ± 4.8 years, male 61%) with cardiac manifestations in 97.8%: 27 ventricular dysfunctions, 32 pericarditis, 15 coronaritis, 3 arrhythmias. All patients recovered, and during follow-up, no cardiac anomalies were recorded. Our experience showed that cardiac involvement is not rare in children with SARS-COV-2, and occurred in almost all patients with MIS-C. However, patients' recovery is satisfactory and no additional events were reported during FU.
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Affiliation(s)
- Nicoletta Cantarutti
- Cardiology and Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (R.A.); (M.C.); (F.D.)
- Correspondence: ; Tel.: +39-0668593559
| | - Virginia Battista
- Cardiology and Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (R.A.); (M.C.); (F.D.)
| | - Rachele Adorisio
- Cardiology and Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (R.A.); (M.C.); (F.D.)
| | - Marianna Cicenia
- Cardiology and Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (R.A.); (M.C.); (F.D.)
| | - Claudia Campanello
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), Istituto Giannina Gaslini, University of Genoa, IRCCS, 16100 Genoa, Italy;
| | - Elisa Listo
- Department of Health Sciences DiSSal, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, 16100 Genoa, Italy;
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Fabrizio Drago
- Cardiology and Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (V.B.); (R.A.); (M.C.); (F.D.)
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23
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D'Onofrio A, Solimene F, Calò L, Calvi V, Viscusi M, Melissano D, Russo V, Rapacciuolo A, Campana A, Caravati F, Bonfanti P, Zanotto G, Gronda E, Vado A, Calzolari V, Botto GL, Zecchin M, Bontempi L, Giacopelli D, Gargaro A, Padeletti L. Combining Home Monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF study. Europace 2021; 24:234-244. [PMID: 34392336 PMCID: PMC8824514 DOI: 10.1093/europace/euab170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS We developed and validated an algorithm for prediction of heart failure (HF) hospitalizations using remote monitoring (RM) data transmitted by implanted defibrillators. METHODS AND RESULTS The SELENE HF study enrolled 918 patients (median age 69 years, 81% men, median ejection fraction 30%) with cardiac resynchronization therapy (44%), dual-chamber (38%), or single-chamber defibrillators with atrial diagnostics (18%). To develop a predictive algorithm, temporal trends of diurnal and nocturnal heart rates, ventricular extrasystoles, atrial tachyarrhythmia burden, heart rate variability, physical activity, and thoracic impedance obtained by daily automatic RM were combined with a baseline risk-stratifier (Seattle HF Model) into one index. The primary endpoint was the first post-implant adjudicated HF hospitalization. After a median follow-up of 22.5 months since enrolment, patients were randomly allocated to the algorithm derivation group (n = 457; 31 endpoints) or algorithm validation group (n = 461; 29 endpoints). In the derivation group, the index showed a C-statistics of 0.89 [95% confidence interval (CI): 0.83-0.95] with 2.73 odds ratio (CI 1.98-3.78) for first HF hospitalization per unitary increase of index value (P < 0.001). In the validation group, sensitivity of predicting primary endpoint was 65.5% (CI 45.7-82.1%), median alerting time 42 days (interquartile range 21-89), and false (or unexplained) alert rate 0.69 (CI 0.64-0.74) [or 0.63 (CI 0.58-0.68)] per patient-year. Without the baseline risk-stratifier, the sensitivity remained 65.5% and the false/unexplained alert rates increased by ≈10% to 0.76/0.71 per patient-year. CONCLUSION With the developed algorithm, two-thirds of first post-implant HF hospitalizations could be predicted timely with only 0.7 false alerts per patient-year.
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Affiliation(s)
- Antonio D'Onofrio
- Cardiology Department - Electrophysiology and Cardiac Pacing Unit A.O.R.N. V. Monaldi, Via L. Bianchi, Naples, Italy
| | - Francesco Solimene
- Electrophysiology, Montevergine Clinic, Viale S. Modestino 8, 83013 Mercogliano, Italy
| | - Leonardo Calò
- Cardiology Division, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Valeria Calvi
- Cardiology Department, Policlinico G. Rodolico, AOU Policlinico V. Emanuele, Via S. Sofia 78, 95125 Catania, Italy
| | - Miguel Viscusi
- Cardiology Division, Sant'Anna and San Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Donato Melissano
- Cardiology Division, F. Ferrari Hospital, Viale F. Ferrari 1, 73042 Casarano (LE), Italy
| | - Vitantonio Russo
- Cardiology Division, SS. Annunziata Hospital, Via F. Bruno 1, 74121 Taranto, Italy
| | - Antonio Rapacciuolo
- Cardiology Department of Advanced Biomedical Sciences, Corso Umberto I 40, 80138 Federico II University of Naples, Italy
| | - Andrea Campana
- Cardiology Division, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, 84131 Salerno, Italy
| | - Fabrizio Caravati
- Division of Cardiology, ASST Settelaghi, Di Circolo Hospital, Via L. Borri 57, 21100 Varese, Italy
| | - Paolo Bonfanti
- Cardiology Division, Rho Civil Hospital, Corso Europa 250, 20017 Rho (MI), Italy
| | - Gabriele Zanotto
- Cardiology Division, Mater Salutis Hospital, Via C. Gianella 1, 37045 Legnago, Italy
| | - Edoardo Gronda
- Department of Medicine and Medical Specialties, I.R.C.C.S. Foundation Ca' Granda, Via M. Fanti 6, 20122 Milano, Italy
| | - Antonello Vado
- Cardiology Division, S. Croce e Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy
| | - Vittorio Calzolari
- Cardiology Division, Santa Maria di Ca' Foncello Hospital, Piazzale dell'Ospedale 1, 31100 Treviso, Italy
| | - Giovanni Luca Botto
- Cardiology Division, Rho Civil Hospital, Corso Europa 250, 20017 Rho (MI), Italy
| | - Massimo Zecchin
- Cardiology Department, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Luca Bontempi
- Cardiology Division, Spedali Civili , Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | | | - Alessio Gargaro
- BIOTRONIK Italia, Via delle Industrie 11, 20090 Vimodrone (MI), Italy
| | - Luigi Padeletti
- Cardiology Department, I.R.C.C.S. MultiMedica, Via Milanese 300, 20099 Sesto San Giovanni, Milano, Italy
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24
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Clemente V, Tripiciano C, Moras P, Deriu D, Di Giuseppe M, Piscitelli AL, Cammerata M, De Ioris MA, Calò Carducci FI, Bernardi S, Campana A, D'Argenio P, Rossi P. Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization. Ital J Pediatr 2021; 47:119. [PMID: 34078420 PMCID: PMC8170435 DOI: 10.1186/s13052-021-01065-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. MATERIALS AND METHODS Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. RESULTS During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. CONCLUSION Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.
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Affiliation(s)
- Vitangelo Clemente
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Costanza Tripiciano
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy. .,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy.
| | - Patrizio Moras
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Deriu
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Martina Di Giuseppe
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Anna Lucia Piscitelli
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - Michela Cammerata
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.,Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | | | - Francesca Ippolita Calò Carducci
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Andrea Campana
- Pediatric Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Patrizia D'Argenio
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
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25
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Cotugno N, Ruggiero A, Bonfante F, Petrara MR, Zicari S, Pascucci GR, Zangari P, De Ioris MA, Santilli V, Manno EC, Amodio D, Bortolami A, Pagliari M, Concato C, Linardos G, Campana A, Donà D, Giaquinto C, Brodin P, Rossi P, De Rossi A, Palma P. Virological and immunological features of SARS-CoV-2-infected children who develop neutralizing antibodies. Cell Rep 2021; 34:108852. [PMID: 33730580 PMCID: PMC7962998 DOI: 10.1016/j.celrep.2021.108852] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/28/2020] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
As the global COVID-19 pandemic progresses, it is paramount to gain knowledge on adaptive immunity to SARS-CoV-2 in children to define immune correlates of protection upon immunization or infection. We analyzed anti-SARS-CoV-2 antibodies and their neutralizing activity (PRNT) in 66 COVID-19-infected children at 7 (±2) days after symptom onset. Individuals with specific humoral responses presented faster virus clearance and lower viral load associated with a reduced in vitro infectivity. We demonstrated that the frequencies of SARS-CoV-2-specific CD4+CD40L+ T cells and Spike-specific B cells were associated with the anti-SARS-CoV-2 antibodies and the magnitude of neutralizing activity. The plasma proteome confirmed the association between cellular and humoral SARS-CoV-2 immunity, and PRNT+ patients show higher viral signal transduction molecules (SLAMF1, CD244, CLEC4G). This work sheds lights on cellular and humoral anti-SARS-CoV-2 responses in children, which may drive future vaccination trial endpoints and quarantine measures policies.
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Affiliation(s)
- Nicola Cotugno
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata," 00185 Rome, Italy
| | - Alessandra Ruggiero
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, 35020 Legnaro, Italy
| | - Maria Raffaella Petrara
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, 35128 Padova, Italy
| | - Sonia Zicari
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giuseppe Rubens Pascucci
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Zangari
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | | | - Veronica Santilli
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - E C Manno
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Donato Amodio
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata," 00185 Rome, Italy
| | - Alessio Bortolami
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, 35020 Legnaro, Italy
| | - Matteo Pagliari
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, 35020 Legnaro, Italy
| | - Carlo Concato
- Department of Laboratories, Division of Virology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Linardos
- Department of Laboratories, Division of Virology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Daniele Donà
- Department of Mother and Child Health, University of Padova, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department of Mother and Child Health, University of Padova, 35128 Padova, Italy
| | - Petter Brodin
- Pediatric Rheumatology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Paolo Rossi
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata," 00185 Rome, Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, Unit of Viral Oncology and AIDS Reference Center, University of Padova, 35128 Padova, Italy; Istituto Oncologico Veneto (IOV)-IRCCS, 35128 Padova, Italy
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata," 00185 Rome, Italy.
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Smarrazzo A, Mariani R, Valentini F, Lombardi MH, Sinibaldi S, Peschiaroli E, Papa RE, Campana A. Three-fold increase in admissions for paediatric febrile convulsions during COVID-19 pandemic could indicate alternative virus symptoms. Acta Paediatr 2021; 110:939-940. [PMID: 33145819 DOI: 10.1111/apa.15653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Andrea Smarrazzo
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Rosanna Mariani
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | | | - Mary Haywood Lombardi
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Serena Sinibaldi
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Emanuela Peschiaroli
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Raffaele Edo Papa
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Andrea Campana
- Department of Pediatrics ‐ COVID Center Bambino Gesù Children’s Hospital IRCCS Rome Italy
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Loffredo L, Campana A, Olivini N, Cotugno N, Palma P, Oliva A, Salvatori G, Zicari AM, Violi F. Hypoalbuminemia and clinical adverse events in children with COVID-19. J Med Virol 2021; 93:2611-2613. [PMID: 33554335 PMCID: PMC8013663 DOI: 10.1002/jmv.26856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Lorenzo Loffredo
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Nicole Olivini
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Nicola Cotugno
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Paolo Palma
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guglielmo Salvatori
- Department of Neonatology, Neonatal Intensive Care Unit and Human Milk Bank, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Francesco Violi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Ferro F, Tozzi AE, Erba I, Dall’Oglio I, Campana A, Cecchetti C, Geremia C, Rega ML, Tontini G, Tiozzo E, Gawronski O. Impact of telemedicine on health outcomes in children with medical complexity: an integrative review. Eur J Pediatr 2021; 180:2389-2400. [PMID: 34196791 PMCID: PMC8246433 DOI: 10.1007/s00431-021-04164-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/11/2023]
Abstract
Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families.Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known: • CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions. • There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics. What is New: • There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers' satisfaction with care. • Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC.
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Affiliation(s)
- Federico Ferro
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- grid.414125.70000 0001 0727 6809Scientific Directorate, Multifactorial Diseases and Complex Chronic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Ilaria Erba
- grid.414125.70000 0001 0727 6809Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Immacolata Dall’Oglio
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Campana
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Corrado Cecchetti
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Luisa Rega
- grid.8142.f0000 0001 0941 3192Department of Nursing, Sacred Heart Catholic University, Rome, Italy
| | - Gloria Tontini
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Olivini N, Calò Carducci FI, Santilli V, De Ioris MA, Scarselli A, Alario D, Geremia C, Lombardi MH, Marabotto C, Mariani R, Papa RE, Peschiaroli E, Scrocca R, Sinibaldi S, Smarrazzo A, Stella P, Bernardi S, Chiurchiù S, Pansa P, Romani L, Michaela C, Concato C, De Rose DU, Salvatori G, Rossi P, Villani A, Dotta A, D'Argenio P, Campana A. A neonatal cluster of novel coronavirus disease 2019: clinical management and considerations. Ital J Pediatr 2020; 46:180. [PMID: 33287880 PMCID: PMC7720265 DOI: 10.1186/s13052-020-00947-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lately, one of the major clinical and public health issues has been represented by Coronavirus disease of 2019 (COVID-19) during pregnancy and the risk of transmission of the infection from mother to child. Debate on perinatal management and postnatal care is still ongoing, principally questioning the option of the joint management of mother and child after birth and the safety of breastfeeding. According to the available reports, neonatal COVID-19 appears to have a horizontal transmission and seems to be paucisymptomatic or asymptomatic, compared to older age groups. The aim of this work is to describe a cluster of neonatal COVID-19 and discuss our experience, with reference to current evidence on postnatal care and perinatal management. METHODS This is a retrospective observational case series of five mother-child dyads, who attended the Labor and Delivery Unit of a first-level hospital in Italy, in March 2020. Descriptive statistics for continuous variables consisted of number of observations, mean and the range of the minimum and maximum values. RESULTS Five women and four neonates tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In one case, the mother-child dyad was separated and the neonate remained negative on two consecutive tests. Two positive neonates developed symptoms, with a predominant involvement of the gastrointestinal tract. Blood tests were unremarkable, except for a single patient who developed mild neutropenia. No complications occurred. CONCLUSIONS We agree that the decision on whether or not to separate a positive/suspected mother from her child should be made on an individual basis, taking into account the parent's will, clinical condition, hospital logistics and the local epidemiological situation. In conformity with literature, in our study, affected neonates were asymptomatic or paucisymptomatic. Despite these reassuring findings, a few cases of severe presentation in the neonatal population have been reported. Therefore, we agree on encouraging clinicians to monitor the neonates with a suspected or confirmed infection.
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Affiliation(s)
- Nicole Olivini
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
| | - Francesca Ippolita Calò Carducci
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Veronica Santilli
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Maria Antonietta De Ioris
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Alessia Scarselli
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Dario Alario
- Pediatrics and Neonatology Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Caterina Geremia
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Mary Haywood Lombardi
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Caterina Marabotto
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Rosanna Mariani
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Raffaele Edo Papa
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Emanuela Peschiaroli
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Raffaella Scrocca
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Serena Sinibaldi
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Andrea Smarrazzo
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Pietro Stella
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Stefania Bernardi
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Sara Chiurchiù
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Paola Pansa
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Lorenza Romani
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Carletti Michaela
- Laboratory Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Carlo Concato
- Virology Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Gugliemo Salvatori
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Paolo Rossi
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Villani
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Andrea Dotta
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Patrizia D'Argenio
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Andrea Campana
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
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Calò Carducci FI, De Ioris MA, Agrati C, Carsetti R, Perrotta D, D'Argenio P, De Benedetti F, Notari S, Rossi P, Campana A. Hyperinflammation in Two Severe Acute Respiratory Syndrome Coronavirus 2-Infected Adolescents Successfully Treated With the Interleukin-1 Inhibitor Anakinra and Glucocorticoids. Front Pediatr 2020; 8:576912. [PMID: 33330276 PMCID: PMC7734022 DOI: 10.3389/fped.2020.576912] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background: In severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) critically ill adults, hyperinflammation plays a key role in disease progression. The clinical manifestations of SARS-CoV-2 infection among children are much less severe compared with adult patients and usually associated with a good prognosis. However, hyperinflammation in SARS-CoV-2-infected pediatric patients has been described as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or as Kawasaki-like disease but is still little known, and optimal management has to be defined. The World Health Organization (WHO) on the 15th of May 2020 has developed a preliminary case definition for multisystem inflammatory disorder in children and adolescents with coronavirus disease 2019 (COVID-19) and stated for an urgent need to collect data on this condition. Here, we report two adolescent patients affected by COVID-19 presenting with multisystem inflammatory disorder, 3-4 weeks after the first symptoms of SARS-CoV-2 infection, treated with the interleukin-1 receptor antagonist anakinra and glucocorticoids with good clinical response. Cases: We report two patients chronically ill appearing, with high fever, severe gastrointestinal involvement, and increased biomarkers of inflammation onset 3-4 weeks after paucisymptomatic SARS-CoV-2 infection. They had no lung involvement, but abdominal ultrasound and CT scan showed thickening of the bowel wall. SARS-CoV-2 PCR was positive on ileum biopsy in both patients, whereas it was negative on other common sampled sites. They have been admitted to the pediatric intensive care unit and have been treated with a combination of anakinra 6-8 mg/kg/day i.v. and a standard dose of methylprednisolone 2 mg/kg/day in addition to lopinavir/ritonavir 400 mg q12h and low molecular weight heparin 100 UI/kg q12h with good clinical response.
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Affiliation(s)
| | | | - Chiara Agrati
- Cellular Immunology Laboratory, IRCCS National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Rita Carsetti
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Perrotta
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Patrizia D'Argenio
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Stefania Notari
- Cellular Immunology Laboratory, IRCCS National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Romani L, Chiurchiù S, Santilli V, Bernardi S, Haywood Lombardi M, Scarselli A, Villani A, Ciofi Degli Atti ML, Campana A, D'Argenio P. COVID-19 in Italian paediatric patients: The experience of a tertiary children's hospital. Acta Paediatr 2020; 109:2311-2312. [PMID: 32640088 PMCID: PMC7361435 DOI: 10.1111/apa.15465] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lorenza Romani
- Pediatric and Infectious Diseases Unit Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Sara Chiurchiù
- Pediatric and Infectious Diseases Unit Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Veronica Santilli
- Research Unit in Congenital and Perinatal Infections Division of Immunology and Infectious Diseases Academic Department of Pediatrics (DPUO) Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Stefania Bernardi
- Research Unit in Congenital and Perinatal Infections Division of Immunology and Infectious Diseases Academic Department of Pediatrics (DPUO) Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Mary Haywood Lombardi
- Pediatrics University Department of Pediatrics Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Alessia Scarselli
- Pediatrics University Department of Pediatrics Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Alberto Villani
- Pediatric and Infectious Diseases Unit Bambino Gesù Children's Hospital IRCCS Rome Italy
| | | | - Andrea Campana
- Pediatrics University Department of Pediatrics Bambino Gesù Children's Hospital IRCCS Rome Italy
| | - Patrizia D'Argenio
- Research Unit in Congenital and Perinatal Infections Division of Immunology and Infectious Diseases Academic Department of Pediatrics (DPUO) Bambino Gesù Children's Hospital IRCCS Rome Italy
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Novelli A, Biancolella M, Borgiani P, Cocciadiferro D, Colona VL, D'Apice MR, Rogliani P, Zaffina S, Leonardis F, Campana A, Raponi M, Andreoni M, Grelli S, Novelli G. Analysis of ACE2 genetic variants in 131 Italian SARS-CoV-2-positive patients. Hum Genomics 2020; 14:29. [PMID: 32917283 PMCID: PMC7483483 DOI: 10.1186/s40246-020-00279-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronaviruses (CoV) are a large family of viruses that are common in humans and many animal species. Animal coronaviruses rarely infect humans with the exceptions of the Middle East respiratory syndrome ( MERS-CoV ), the severe acute respiratory syndrome corona virus (SARS-CoV), and now SARS-CoV-2, which is the cause of the ongoing pandemic of coronavirus disease 2019 (COVID-19). Several studies suggested that genetic variants in the ACE2 gene may influence the host susceptibility or resistance to SARS-CoV-2 infection according to the functional role of ACE2 in human pathophysiology. However, many of these studies have been conducted in silico based on epidemiological and population data. We therefore investigated the occurrence of ACE2 variants in a cohort of 131 Italian unrelated individuals clinically diagnosed with COVID-19 and in an Italian control population, to evaluate a possible allelic association with COVID-19, by direct DNA analysis. METHODS As a pilot study, we analyzed, by whole-exome sequencing, genetic variants of ACE2 gene in 131 DNA samples of COVID-19 patients hospitalized at Tor Vergata University Hospital and at Bambino Gesù Children's Hospital, Rome. We used a large control group consisting of 1000 individuals (500 males and 500 females). RESULTS We identified three different germline variants: one intronic c.439+4G>A and two missense c.1888G>C p.(Asp630His) and c.2158A>G p.(Asn720Asp) in a total of 131 patients with a similar frequency in male and female. Thus far, only the c.1888G>C p.(Asp630His) variant shows a statistically different frequency compared to the ethnically matched populations. Therefore, further studies are needed in larger cohorts, since it was found only in one heterozygous COVID-19 patient. CONCLUSIONS Our results suggest that there is no strong evidence, in our cohort, of consistent association of ACE2 variants with COVID-19 severity. We might speculate that rare susceptibility/resistant alleles could be located in the non-coding regions of the ACE2 gene, known to play a role in regulation of the gene activity.
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Affiliation(s)
- Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Biancolella
- Department of Biology, Tor Vergata University of Rome, 00133, Rome, Italy.,Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133, Rome, Italy
| | - Dario Cocciadiferro
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Salvatore Zaffina
- Occupational Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Infectious Diseases Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Sandro Grelli
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133, Rome, Italy. .,Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy. .,IRCCS Neuromed, Pozzilli (IS), Italy. .,Department of Pharmacology, School of Medicine, University of Nevada, Reno, NV, 89557, USA.
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Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, Tan Z, Zicari S, Ruggiero A, Pascucci GR, Santilli V, Campbell T, Bryceson Y, Eriksson D, Wang J, Marchesi A, Lakshmikanth T, Campana A, Villani A, Rossi P, Landegren N, Palma P, Brodin P. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell 2020; 183:968-981.e7. [PMID: 32966765 PMCID: PMC7474869 DOI: 10.1016/j.cell.2020.09.016] [Citation(s) in RCA: 585] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/29/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level analyses of blood immune cells, cytokines, and autoantibodies in healthy children, children with Kawasaki disease enrolled prior to COVID-19, children infected with SARS-CoV-2, and children presenting with MIS-C. We find that the inflammatory response in MIS-C differs from the cytokine storm of severe acute COVID-19, shares several features with Kawasaki disease, but also differs from this condition with respect to T cell subsets, interleukin (IL)-17A, and biomarkers associated with arterial damage. Finally, autoantibody profiling suggests multiple autoantibodies that could be involved in the pathogenesis of MIS-C.
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Affiliation(s)
- Camila Rosat Consiglio
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Nicola Cotugno
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy
| | - Fabian Sardh
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
| | - Christian Pou
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Donato Amodio
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy
| | - Lucie Rodriguez
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Ziyang Tan
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Sonia Zicari
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Alessandra Ruggiero
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Giuseppe Rubens Pascucci
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Veronica Santilli
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Tessa Campbell
- Center for Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm 14186, Sweden
| | - Yenan Bryceson
- Center for Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm 14186, Sweden
| | - Daniel Eriksson
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University and Department of Clinical Genetics, Uppsala University Hospital, Uppsala 75185, Sweden
| | - Jun Wang
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Alessandra Marchesi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Tadepally Lakshmikanth
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy; Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | | | - Nils Landegren
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden; Science for life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala 75237, Sweden.
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy.
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden; Pediatric Rheumatology, Karolinska University Hospital, Stockholm 17164, Sweden.
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Novelli A, Andreani M, Biancolella M, Liberatoscioli L, Passarelli C, Colona VL, Rogliani P, Leonardis F, Campana A, Carsetti R, Andreoni M, Bernardini S, Novelli G, Locatelli F. HLA allele frequencies and susceptibility to COVID-19 in a group of 99 Italian patients. HLA 2020; 96:610-614. [PMID: 32827207 PMCID: PMC7461491 DOI: 10.1111/tan.14047] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022]
Abstract
With the aim to individuate alleles that may reflect a higher susceptibility to the disease, in the present study we analyzed the HLA allele frequency distribution in a group of 99 Italian patients affected by a severe or extremely severe form of COVID‐19. After the application of Bonferroni's correction for multiple tests, a significant association was found for HLA‐DRB1*15:01, ‐DQB1*06:02 and ‐B*27:07, after comparing the results to a reference group of 1017 Italian individuals, previously typed in our laboratory. The increased frequencies observed may contribute to identify potential markers of susceptibility to the disease, although controversial results on the role of single HLA alleles in COVID‐19 patients have been recently reported.
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Affiliation(s)
- Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Andreani
- Transplantation Immunogenetics Laboratory, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Michela Biancolella
- Department of Biology, Tor Vergata University of Rome, Rome, Italy.,Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy
| | | | - Chiara Passarelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Rita Carsetti
- Immunology Research Area B-cell development Unit Immunological Diagnosis Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Infectious Diseases Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy.,Department of Pharmacology, School of Medicine, University of Nevada, Reno, Nevada, USA.,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Franco Locatelli
- Department of Haematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome.,Department of Paediatrics, Sapienza University of Rome, Rome, Italy
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Valente P, Iarossi G, Federici M, Petroni S, Palma P, Cotugno N, De Ioris MA, Campana A, Buzzonetti L. Ocular manifestations and viral shedding in tears of pediatric patients with coronavirus disease 2019: a preliminary report. J AAPOS 2020; 24:212-215. [PMID: 32531341 PMCID: PMC7282793 DOI: 10.1016/j.jaapos.2020.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate ocular manifestations and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) prevalence in the tears of children with coronavirus disease 2019 (COVID-19). METHODS A total of 27 pediatric patients with confirmed COVID-19 infection hospitalized from March 16 to April 15, 2020, at the Bambino Gesù Children's Hospital were enrolled in the study. At admission, all patients showed ocular manifestations. Reverse transcriptase-polymerase chain reaction from nasopharyngeal and conjunctival swabs were performed every 2-3 days before discharge. RESULTS Of the 27 patients, 4 (15%) were asymptomatic, 15 (56%) showed respiratory symptoms, and 8 (30%) had gastrointestinal symptoms. At admission, nasopharyngeal swabs were positive for COVID-19 in all patients; on the second swabs, 7 children (26%) tested negative, and 20 remained positive for COVID-19. Ocular manifestations consistent with mild viral conjunctivitis were observed in 4 patients (15%). At first conjunctival swab, 3 patients (11%), 1 symptomatic and 2 asymptomatic for ocular infection, had positive findings for COVID-19; 2 became negative on the second test and 1 on the third. CONCLUSIONS In our study cohort, ocular manifestations of COVID-19 seem to have had a milder clinical course in pediatric patients than in adults. Despite the low prevalence and rapid regression of viral presence in the conjunctiva, SARS-CoV-2 transmission through tears may be possible, even in patients without apparent ocular involvement.
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Affiliation(s)
- Paola Valente
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy.
| | - Giancarlo Iarossi
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Matteo Federici
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Sergio Petroni
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Nicola Cotugno
- Academic Department of Pediatrics (DPUO), Unit of Perinatal Infection and Congenital Infectious Diseases, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Maria A De Ioris
- Pediatric Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Andrea Campana
- Pediatric Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Luca Buzzonetti
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
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36
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Musolino AM, Supino MC, Buonsenso D, Ferro V, Valentini P, Magistrelli A, Lombardi MH, Romani L, D'Argenio P, Campana A. Lung Ultrasound in Children with COVID-19: Preliminary Findings. Ultrasound Med Biol 2020; 46:2094-2098. [PMID: 32409232 PMCID: PMC7196401 DOI: 10.1016/j.ultrasmedbio.2020.04.026] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 05/02/2023]
Abstract
Recent evidence indicates the usefulness of lung ultrasound (LUS) in detecting coronavirus disease 19 (COVID-19) pneumonia. However, no data are available on the use of LUS in children with COVID-19 pneumonia. In this report, we describe LUS features of 10 consecutively admitted children with COVID-19 in two tertiary-level pediatric hospitals in Rome. LUS revealed signs of lung involvement during COVID-19 infection. In particular, vertical artifacts (70%), pleural irregularities (60%), areas of white lung (10%) and subpleural consolidations (10%) were the main findings in patients with COVID-19. No cases of pleural effusions were found. According to our experience, the routine use of LUS in the evaluation of children with suspected or confirmed COVID-19, when performed by clinicians with documented experience in LUS, was useful in diagnosing and monitoring pediatric COVID-19 pneumonia, reducing unnecessary radiation/sedation in children and exposure of health care workers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Anna Maria Musolino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Valentina Ferro
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Magistrelli
- Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mary Haywood Lombardi
- Pediatric Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lorenza Romani
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Patrizia D'Argenio
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Andrea Campana
- Pediatric Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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37
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De Ioris MA, Scarselli A, Ciofi degli Atti ML, Ravà L, Smarrazzo A, Concato C, Romani L, Scrocca R, Geremia C, Carletti M, Calò Carducci FI, Bernardi S, Coltella L, Santilli V, Chiurchiu S, Peschiaroli E, Mariani R, Marabotto C, Perrotta D, Villani A, Rossi P, D’Argenio P, Campana A, Raponi M. Dynamic Viral Severe Acute Respiratory Syndrome Coronavirus 2 RNA Shedding in Children: Preliminary Data and Clinical Consideration from a Italian Regional Center. J Pediatric Infect Dis Soc 2020; 9:366-369. [PMID: 32444874 PMCID: PMC7543227 DOI: 10.1093/jpids/piaa065] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022]
Abstract
We evaluated severe acute respiratory syndrome coronavirus 2 RNA clearance in 22 children. The estimation of positivity at day 14 was 52% for nasopharyngeal swab and 31% for stool samples. These data underline the significance of nasopharyngeal and stoolsample for detecting infected children. Additional studies are needed for transmissibility.
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Affiliation(s)
- Maria A De Ioris
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy,Correspondence: Maria Antonietta De Ioris, Bambino Gesù Pediatric Hospital, University Department of Pediatrics, Passoscuro - via Aurelia km 30200, Rome, Italy ()
| | - Alessia Scarselli
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Lucilla Ravà
- Medical Direction, Bambino Gesù Children Hospital, Rome, Italy
| | - Andrea Smarrazzo
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Carlo Concato
- Laboratory Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Lorenza Romani
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Raffaella Scrocca
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Caterina Geremia
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | - Stefania Bernardi
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Luana Coltella
- Laboratory Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Veronica Santilli
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Sara Chiurchiu
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Rosanna Mariani
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Caterina Marabotto
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Daniela Perrotta
- Anesthesiology and Pediatric Intensive Care, Bambino Gesù Children Hospital, Rome, Italy
| | - Alberto Villani
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Paolo Rossi
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Patrizia D’Argenio
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
| | - Andrea Campana
- Pediatric Academic Department, Bambino Gesù Children Hospital, Rome, Italy
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Salvatori G, De Rose DU, Concato C, Alario D, Olivini N, Dotta A, Campana A. Managing COVID-19-Positive Maternal-Infant Dyads: An Italian Experience. Breastfeed Med 2020; 15:347-348. [PMID: 32311273 DOI: 10.1089/bfm.2020.0095] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Carlo Concato
- Virology Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Dario Alario
- Pediatrics Unit, "San Paolo" Hospital, Civitavecchia (Rome), Italy
| | - Nicole Olivini
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
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39
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Zanotto G, Melissano D, Baccillieri S, Campana A, Caravati F, Maines M, Platania F, Zuccaro L, Landolina M, Berisso MZ, Boriani G, Ricci RP. Intrahospital organizational model of remote monitoring data sharing, for a global management of patients with cardiac implantable electronic devices. J Cardiovasc Med (Hagerstown) 2020; 21:171-181. [DOI: 10.2459/jcm.0000000000000912] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Borro L, Ciliberti P, Santangelo TP, Magistrelli A, Campana A, Carducci FC, Caterina M, Tomà P, Secinaro A. Quantitative Assessment of Parenchymal Involvement Using 3D Lung Model in Adolescent With Covid-19 Interstitial Pneumonia. Front Pediatr 2020; 8:453. [PMID: 32850560 PMCID: PMC7419575 DOI: 10.3389/fped.2020.00453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Amount of parenchymal involvement in patients with interstitial pneumonia Covid-19 related, seems to be associated with a worse prognosis. Nowadays 3D reconstruction imaging is expanding its role in clinical medical practice. We aimed to use 3D lung reconstruction of a young lady affected by Sars-CoV2 infection and interstitial pneumonia, to better visualize, and quantitatively assess the parenchymal involvement. Methods: Volumetric Chest CT scan was performed in a 15 years old girl with interstitial lung pneumonia, Sars-CoV2 infection related. 3D modeling of the lungs, with differentiation of healthy and affected parenchymal area were obtained by using multiple software. Results: 3D reconstruction imaging allowed us to quantify the lung parenchyma involved, Self-explaining 3D images, useful for the understanding, and discussion of the clinical case were also obtained. Conclusions: Quantitative Assessment of Parenchymal Involvement Using 3D Lung Model in Covid-19 Infection is feasible and it provides information which could play a role in the management and risk stratification of these patients.
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Affiliation(s)
- Luca Borro
- Department of Imaging, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | - Paolo Ciliberti
- Pediatric Cardiology and Pediatric Cardiac Surgery Department, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | | | - Andrea Magistrelli
- Department of Imaging, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | - Andrea Campana
- Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Marabotto Caterina
- Unit of General Pediatrics and Pediatric Infectious Diseases, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital IRCSS, Rome, Italy
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41
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D'Onofrio A, Solimene F, Calo' L, Calvi V, Viscusi M, Melissano D, Russo VA, Rapacciuolo A, Campana A, Bonfanti P, Caravati F, Zanotto G, Gronda E, Gargaro A, Padeletti L. P2592Combining home monitoring temporal trends and baseline patient risk profile for predicting impending heart failure hospitalizations. Results from the SELENE HF (BIO.Detect HF IV) study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The lack of a validated method to efficiently combine information provided by Remote Monitoring (RM) of implantable defibrillators (ICD) and patient clinical profile has limited the use of RM in the prevention of worsening heart failure episodes.
Purpose
Our objective was to develop and validate an index combining RM temporal trends and a baseline risk score for predicting the first HF hospitalization after device implantation.
Methods
We prospectively enrolled 918 patients (81% male, median age 69, interquartile interval [QI], 61/76; Seattle Heart Failure Score [SHFS], 0.17, QI, −0.40/0.75) with indication to ICD (56%), or ICD with cardiac resynchronization therapy (44%). The Home Monitoring (HM) system was activated in all patients after implant to collect several technical and HF-related variables daily. Investigators were blinded to HM reports, and only received automatic alerts for critical technical issues. The primary endpoint was the first adjudicated HF hospitalization. The cohort was a posteriori 1:1 randomized in derivation and validation groups stratified by device type and primary endpoint occurrence. The SHFS was used for baseline risk assessment.
Results
During a median follow-up of 23 months (QI, 14/36), 62 first HF hospitalizations were adjudicated. In the derivation group, the index was constructed by combining the SHFS and temporal trends of 24-hour and rest mean heart rates, ventricular ectopic beat frequency, arrhythmic atrial burden, heart rate variability, physical exercise, and thoracic impedance. Variable selection was based on an automatic stepwise procedure, after applying appropriate transformations in variable-specific time frames to maximize the area under the receiver operating characteristics curve (AUC). The resulting index was associated to an AUC of 0.88 and an Odds Ratio of 2.72 (confidence interval [CI] 1.97–3.75, p<0.001) for index unitary increase. In the index validation test, first HF hospitalizations were predicted with a sensitivity of 73.3% (CI, 54.1%-87.7%), a median alerting time of 55 days (QI, 20/68), false alert rate of 0.75 (CI, 0.70–0.81) patient-year, and 95.1% false-alert-free days.
Conclusion
HM temporal trends of selected variables and the SHFS may be combined to timely and efficiently predict the first HF hospitalization after implant, with less than 1 expected per-patient false alert per year.
Acknowledgement/Funding
BIOTRONIK SE & Co. KG, Berlin, Germany
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Affiliation(s)
- A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - L Calo'
- Polyclinic Casilino of Rome, Rome, Italy
| | - V Calvi
- Ferrarotto Hospital, Catania, Italy
| | - M Viscusi
- S. Anna-S. Sebastiano Hospital, Caserta, Italy
| | | | - V A Russo
- OSP. SS. Annunziata ASL Taranto, Taranto, Italy
| | | | - A Campana
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - G Zanotto
- Civil Hospital of Legnano, Legnago, Italy
| | - E Gronda
- IRCCS Multimedica of Milan, Milan, Italy
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42
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Natali M, Campana A, Posati T, Benvenuti E, Prescimone F, Ramirez DOS, Varesano A, Vineis C, Zamboni R, Muccini M, Aluigi A, Toffanin S. Engineering of keratin functionality for the realization of bendable all-biopolymeric micro-electrode array as humidity sensor. Biosens Bioelectron 2019; 141:111480. [PMID: 31272056 DOI: 10.1016/j.bios.2019.111480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 12/22/2022]
Abstract
The technological quest for flexible devices to be interfaced with the biological world has driven the recent reinvention of bioderived polymers as multifunctional active and passive constituent elements for electronic and photonic devices to use in the biomedical field. Keratin is one of the most important structural proteins in nature to be used as biomaterial platform in view of the recently reported advances in the extraction and processing from hair and wool fibers. In this article we report for the first time the simultaneous use of naturally extracted keratin as both active ionic electrolyte for water ions sensing and as bendable and insoluble substrate into the same multielectrode array-based device. We implemented the multifunctional system exclusively made by keratin as a bendable sensor for monitoring the humidity flow. The enhancement of the functional and structural properties of keratin such as bendability and insolubility were obtained by unprecedented selective chemical doping. The mechanisms at the basis of the sensing of humidity in the device were investigated by cyclic voltammetry and rationalized by reversible binding and extraction of water ions from the volume of the keratin active layer, while the figures of merit of the biopolymer such as the ionic conductivity and relaxation time were determined by means of electrical impedance and dielectric relaxation spectroscopy. A reliable linear correlation between the controlled-humidity level and the amperometric output signal together with the assessment on measure variance are demonstrated. Collectively, the fine-tuned ionic-electrical characterization and the validation in controlled conditions of the free-standing insoluble all-keratin made microelectrode array ionic sensor pave the way for the effective use of keratin biopolymer in wearable or edible electronics where conformability, reliability and biocompatibility are key-enabling features.
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Affiliation(s)
- M Natali
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy.
| | - A Campana
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy
| | - T Posati
- Consiglio Nazionale delle Ricerche (CNR), Istituto per la Sintesi Organica e la Fotoreattività (ISOF), Via P. Gobetti 101, 40129, Bologna, Italy
| | - E Benvenuti
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy
| | - F Prescimone
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy
| | - D O Sanchez Ramirez
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Corso Giuseppe Pella 16, 13900, Biella, Italy
| | - A Varesano
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Corso Giuseppe Pella 16, 13900, Biella, Italy
| | - C Vineis
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Corso Giuseppe Pella 16, 13900, Biella, Italy
| | - R Zamboni
- Consiglio Nazionale delle Ricerche (CNR), Istituto per la Sintesi Organica e la Fotoreattività (ISOF), Via P. Gobetti 101, 40129, Bologna, Italy
| | - M Muccini
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy
| | - A Aluigi
- Consiglio Nazionale delle Ricerche (CNR), Istituto per la Sintesi Organica e la Fotoreattività (ISOF), Via P. Gobetti 101, 40129, Bologna, Italy
| | - S Toffanin
- Consiglio Nazionale delle Ricerche (CNR), Istituto per lo Studio dei Materiali Nanostrutturati (ISMN), Via P. Gobetti 101, 40129, Bologna, Italy.
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Tumbarello G, Frisicale EM, Borghini A, La Milia DI, Silenzi A, Miraglia L, Campana A, Parente P. Innovation in healthcare: a key factor to deliver personalized and sustainable care. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Tumbarello
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - EM Frisicale
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Borghini
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - DI La Milia
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Silenzi
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Miraglia
- European Union of Private Hospitals, Rome, Italy
| | - A Campana
- Vihtali - Spin off, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Parente
- Department of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
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Narducci ML, Biffi M, Ammendola E, Vado A, Campana A, Potenza DR, Iori M, Zanon F, Zacà V, Zoni Berisso M, Bertini M, Lissoni F, Bandini A, Malacrida M, Crea F. Appropriate implantable cardioverter-defibrillator interventions in cardiac resynchronization therapy–defibrillator (CRT-D) patients undergoing device replacement: time to downgrade from CRT-D to CRT-pacemaker? Insights from real-world clinical practice in the DECODE CRT-D analysis. Europace 2018; 20:1475-1483. [DOI: 10.1093/europace/eux323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Maria Lucia Narducci
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart Rome, Via Largo Francesco Vito, 1, Rome, Italy
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | | | | | - Andrea Campana
- A.O. Universitaria S. Giovanni Di Dio E Ruggi D’Aragona, Salerno, Italy
| | | | - Matteo Iori
- A.O. IRCCS Arcispedale S. Maria Nuova Di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valerio Zacà
- Azienda Ospedaliero Universitaria Policlinico S. Maria Delle Scotte, Siena, Italy
| | | | - Matteo Bertini
- Azienda Ospedaliero Universitaria Di Ferrara Arcispedale S. Anna, Ferrara, Italy
| | | | | | | | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart Rome, Via Largo Francesco Vito, 1, Rome, Italy
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Abstract
BACKGROUND An individual's chronotype influences his or her physiological rhythms. Some studies have looked at the effect of time of day on the responses to exercise, but studies on the effect of long-term training are lacking. OBJECTIVE To report the effects of an 8-week training period during the polar night in non-athletes of different chronotypes living at 70°N. DESIGN In all, 10 morning (M), 10 neither (N) and 10 evening (E) types were recruited, and their aerobic capacity (VO2max), strength, flexibility and balance before and after the training period were tested. RESULTS 3 E-types, 5 N-types and 6 M-types completed the protocol. An increase in VO2max and strength was observed for the whole group. The best negative correlation (r=-0.5287) was found between the Morningness-Eveningness Questionnaire (MEQ) score and the increase in VO2max, and the best positive correlation (r=0.4395) was found between MEQ and the increase in strength. Changes in balance and flexibility did not show any clear trends. CONCLUSION In an environment with no outdoor daylight, it seems that the response to 8 weeks of aerobic training is larger in the E- than in the M-types, although the M-types showed a larger improvement in strength.
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Affiliation(s)
- Jacopo Antonino Vitale
- a Laboratory of Structures Mechanics , IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
| | - Eva Bjoerkesett
- b School of Sport Sciences , UiT The Arctic University of Norway , Alta , Norway
| | - Andrea Campana
- b School of Sport Sciences , UiT The Arctic University of Norway , Alta , Norway
| | - Giacomo Panizza
- b School of Sport Sciences , UiT The Arctic University of Norway , Alta , Norway
| | - Andi Weydahl
- b School of Sport Sciences , UiT The Arctic University of Norway , Alta , Norway
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Rovaris G, Solimene F, D'Onofrio A, Zanotto G, Ricci RP, Mazzella T, Iacopino S, Della Bella P, Maglia G, Senatore G, Quartieri F, Biffi M, Curnis A, Calvi V, Rapacciuolo A, Santamaria M, Capucci A, Giammaria M, Campana A, Caravati F, Giacopelli D, Gargaro A, Pisanò EC. Does the CHA 2DS 2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices. Heart Rhythm 2018; 15:971-979. [PMID: 29477974 DOI: 10.1016/j.hrthm.2018.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND CHA2DS2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to assess whether the CHA2DS2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring. METHODS Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days. RESULTS During a median duration of 24.1(11.5-42.9) months, the incidence of AHRE increased with increasing CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-VASc increase ranged from 1.09 (confidence interval 1.04-1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11-1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-VASc ≥5 had 77.0% specificity but 34.6% sensitivity. CONCLUSION In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.
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Affiliation(s)
| | | | | | | | | | | | - Saverio Iacopino
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Valeria Calvi
- Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
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Lamarra F, Mennini M, Dahdah L, Giampaolo R, Campana A, Fiocchi A. P429 Aria and gina implementation in a universalistic health system. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bertini M, Vado A, Narducci ML, Rago A, Campana A, Santamaria M, Stabile G, Potenza D, Saporito D, La Rosa C, Baiocchi C, Carinci V, Malagu' M, Malacrida M, Biffi M. P1072Strategies for antimicrobial prophylaxis at ICD/CRT-D Replacement/Upgrade in current italian clinical practice: Insights from the DECODE Registry. Europace 2017. [DOI: 10.1093/ehjci/eux151.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Biffi M, Menardi E, Campana A, Iori M, De Filippo P, Narducci ML, Ferretti C, Saporito D, Zoni Berisso M, Licciardello G, Sabbatani P, Del Rosso A, Bonfantino V, Malacrida M, Parisi Q. 59Manufacturer change and risk of system-related complications after ICD replacement: data from the DECODE registry. Europace 2017. [DOI: 10.1093/ehjci/eux133.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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García MA, Ferrero C, Campana A, Bértola N, Martino M, Zaritzky N. Methylcellulose Coatings Applied to Reduce Oil Uptake in Fried Products. FOOD SCI TECHNOL INT 2016. [DOI: 10.1177/1082013204047564] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing fat content of fried foods by application of coatings is an alternative solution to comply with both health concerns and consumer preferences. The objective of the present work was to analyse the effect of coating formulation on the quantity and composition of oil-uptake by potato strips and dough discs, and the quality of frying oil after several frying batches. The effect of coating composition showed that the most efficient formulations were 1% methylcellulose (MC) and 0.5% sorbitol for fried potatoes and 1% MC and 0.75% sorbitol for dough discs. The most effective coating formulations reduced oil uptake by 35-40%, depending on the product. The increase in water content was 6.3% and 25.7% for potato strips and dough discs, respectively. Although coatings were effective barriers to reduce oil uptake in fried products, they did not modify oil composition as detected by HPLC analysis. Oil stability of frying oils, evaluated by total polar compounds and acidity, was within the allowed limits established by the Argentine Food Code (acidity <0.6mg KOH/g oil).
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Affiliation(s)
- M. A. García
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET and Fac. Ciencias Exactas,
| | - C. Ferrero
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET and Fac. Ciencias Exactas
| | - A. Campana
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET
| | - N. Bértola
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET and Depto. Ingeniería Química, Fac. Ingeniería, Universidad Nacional de La Plata. 47 y 116 La Plata 1900, Argentina
| | - M. Martino
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET and Depto. Ingeniería Química, Fac. Ingeniería, Universidad Nacional de La Plata. 47 y 116 La Plata 1900, Argentina
| | - N. Zaritzky
- Centro de Investigación y Desarrollo en Criotecnología de Alimentos (CIDCA) CONICET and Depto. Ingeniería Química, Fac. Ingeniería, Universidad Nacional de La Plata. 47 y 116 La Plata 1900, Argentina
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