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Villani A, Vittucci AC, Antilici L, Pisani M, Scutari R, Di Maio VC, Musolino AMC, Cristaldi S, Cutrera R, Perno CF. Prevention of RSV Bronchiolitis: An Ethical Issue. Pediatr Infect Dis J 2024:00006454-990000000-00830. [PMID: 38621157 DOI: 10.1097/inf.0000000000004354] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Alberto Villani
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
- Systems Medicine Departments, Tor Vergata University of Rome, Rome, Italy
| | - Anna Chiara Vittucci
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Livia Antilici
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mara Pisani
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Rossana Scutari
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Velia Chiara Di Maio
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Sebastian Cristaldi
- Hospital University Pediatrics Clinical Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Renato Cutrera
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Garone G, Roversi M, Pisani M, La Penna F, Musolino A, Cristaldi S, Musolino AM, Roberto A, Petrocelli G, Reale A, Midulla F, Villani A, Raucci U. Acute Pupillary Disorders in Children: A 10-Year Retrospective Study of 101 Patients. Children (Basel) 2023; 10:1739. [PMID: 38002830 PMCID: PMC10670392 DOI: 10.3390/children10111739] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. METHODS We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. RESULTS We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. CONCLUSIONS Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.
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Affiliation(s)
- Giacomo Garone
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Marco Roversi
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy (A.M.)
| | - Mara Pisani
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Francesco La Penna
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy (A.M.)
| | - Sebastian Cristaldi
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Anna Maria Musolino
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Amanda Roberto
- School of Pediatrics, Department Mother-Child and Urologic Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Gianni Petrocelli
- Department of Ophthalmology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Antonino Reale
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
| | - Fabio Midulla
- Department Mother-Child and Urologic Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Alberto Villani
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
- Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Umberto Raucci
- General Pediatric and Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.P.); (F.L.P.); (S.C.); (A.M.M.); (A.R.); (A.V.)
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Bottari G, Caruso M, Paionni E, De Luca M, Romani L, Pisani M, Grandin A, Gargiullo L, Zampini G, Gagliardi C, Fegatelli DA, Vestri A, Lancella L, Porzio O, Muda AO, Villani A, Atti MCD, Raponi M, Cecchetti C. Accuracy of Pancreatic Stone Protein for diagnosis of sepsis in children admitted to pediatric intensive care or high-dependency care: a pilot study. Ital J Pediatr 2023; 49:134. [PMID: 37805604 PMCID: PMC10559422 DOI: 10.1186/s13052-023-01540-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Pancreatic Stone Protein (PSP) is one of the most promising diagnostic and prognostic markers. The aim of the study was to assess the accuracy of PSP, compared to C-Reactive Protein (CRP), and Procalcitonin (PCT) for sepsis diagnosis in pediatric patients. Furthermore, we explored the correlation of PSP levels with sepsis severity and organ failure measured with PELOD-2 score. METHODS Forty pediatric patients were enrolled following admission to pediatric intensive care, high dependency care or pediatric ward. PSP blood levels were measured in Emergency Department (nanofluidic point-of-care immunoassay; abioSCOPE, Abionic SA, Switzerland) on day 1, 2, 3, 5 and 7 from the onset of the clinical signs and symptoms of sepsis or SIRS. Inclusion criteria were: 1) patient age (1 month to 18 years old), 2) signs and symptoms of SIRS, irrespective of association with organ dysfunction. Exclusion criteria were: 1) hemato-oncological diseases and/or immunodeficiencies, 2) pancreatic diseases. RESULTS Septic patients showed higher PSP levels than those with non-infectious systemic inflammation. The optimal cut-off in diagnosis of sepsis for PSP at day 1 was 167 ng/ml resulted in a sensitivity of 59% (95% IC 36%-79%) and a specificity of 83% (95% IC 58%-96%) with an AUC of 0.636 for PSP in comparison to AUC of 0.722 for PCT and 0.503 for C-RP. ROC analysis for outcome (survival versus no survival) has showed AUC 0.814 for PSP; AUC 0.814 for PCT; AUC of 0.657 for C-RP. CONCLUSIONS PSP could distinguish sepsis from non-infectious systemic inflammation; however, our results need to be confirmed in larger pediatric population.
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Affiliation(s)
- Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Mariangela Caruso
- Department of Anesthesia and Intensive Care, Catholic University of Rome, Residency School of Anesthesia and Intensive Care, Catholic University, Rome, Italy
| | - Emanuel Paionni
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maia De Luca
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lorenza Romani
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mara Pisani
- Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Grandin
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Livia Gargiullo
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Onetti Muda
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Scientific Direction, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit-Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Di Blasi R, Pisani M, Tedeschi F, Marbiah MM, Polizzi K, Furini S, Siciliano V, Ceroni F. Resource-aware construct design in mammalian cells. Nat Commun 2023; 14:3576. [PMID: 37328476 PMCID: PMC10275982 DOI: 10.1038/s41467-023-39252-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/10/2022] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
Resource competition can be the cause of unintended coupling between co-expressed genetic constructs. Here we report the quantification of the resource load imposed by different mammalian genetic components and identify construct designs with increased performance and reduced resource footprint. We use these to generate improved synthetic circuits and optimise the co-expression of transfected cassettes, shedding light on how this can be useful for bioproduction and biotherapeutic applications. This work provides the scientific community with a framework to consider resource demand when designing mammalian constructs to achieve robust and optimised gene expression.
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Affiliation(s)
- Roberto Di Blasi
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
- Imperial College Centre for Synthetic Biology, South Kensington Campus, London, UK
| | - Mara Pisani
- Synthetic and Systems Biology lab for Biomedicine, Instituto Italiano di Tecnologia-IIT, Largo Barsanti e Matteucci, Naples, Italy
- Open University affiliated centre, Milton Keynes, UK
| | - Fabiana Tedeschi
- Synthetic and Systems Biology lab for Biomedicine, Instituto Italiano di Tecnologia-IIT, Largo Barsanti e Matteucci, Naples, Italy
- University of Naples Federico II, Naples, Italy
| | - Masue M Marbiah
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
- Imperial College Centre for Synthetic Biology, South Kensington Campus, London, UK
| | - Karen Polizzi
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
- Imperial College Centre for Synthetic Biology, South Kensington Campus, London, UK
| | - Simone Furini
- Department of Electrical, Electronic and Information Engineering ″Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Velia Siciliano
- Synthetic and Systems Biology lab for Biomedicine, Instituto Italiano di Tecnologia-IIT, Largo Barsanti e Matteucci, Naples, Italy
| | - Francesca Ceroni
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK.
- Imperial College Centre for Synthetic Biology, South Kensington Campus, London, UK.
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Marano M, Roversi M, Severini F, Memoli C, Musolino A, Pisani M, Cecchetti C, Villani A. Adverse drugs reactions to paracetamol and ibuprofen in children: a 5-year report from a pediatric poison control center in Italy. Ital J Pediatr 2023; 49:20. [PMID: 36788576 PMCID: PMC9925930 DOI: 10.1186/s13052-023-01427-6] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This study aimed to analyze all the patients who contacted the hospital's pediatric poison control center (PPCC) for exposure to ibuprofen and acetaminophen, in order to assess the incidence of any adverse reactions. METHODS We retrospectively reported the clinical data of children who accessed the PPCC of the Bambino Gesù Children's Hospital, IRCCS, Rome, from January 1, 2018 to September 30, 2022 due to wrong, accidental or intentional intake of inappropriate doses of acetaminophen and/or ibuprofen. In addition, we compared patients according to the intake of one of the two drugs and reported the trimestral distribution of cases during the study period. RESULTS A total of 351 patients accessed the PPCC during the study period. The median age was 3.0 years. Most patients were females (57.8%). The most common reason for inappropriate oral intake of paracetamol or ibuprofen was a wrong use or an accidental intake (78.6%), with a fifth of patients taking the drug with suicidal intent (21.1%). According to the PPCC evaluation, most patients were not intoxicated (70.4%). Hospitalization was required for 30.5% of patients. Adverse reactions were reported in 10.5% of cases, with a similar incidence in patients who took paracetamol or ibuprofen. Nausea and vomiting were the most commonly reported adverse reactions. A higher frequency of moderate intoxication was found in patients who took paracetamol compared to ibuprofen (p = 0.001). The likelihood of intoxication was also higher in the paracetamol cohort. A spike of cases was registered at the end of 2021. CONCLUSIONS We analyze exposures to the two most commonly used pediatric molecules, paracetamol and ibuprofen, to assess the frequency of adverse reactions. We demonstrated that these relatively "safe" drugs may be associated with intoxications and adverse reactions when inappropriately administered.
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Affiliation(s)
- Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. .,Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Severini
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Memoli
- grid.414125.70000 0001 0727 6809Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- grid.6530.00000 0001 2300 0941Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Corrado Cecchetti
- grid.414125.70000 0001 0727 6809Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
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Mascolo C, Pisani M, Marano M, Bertucci P, Bellelli E, Severini F, Reale A, Villani A, Raucci U. Unintentional cannabis intoxication in infants and toddlers presenting with neurological impairment in a Pediatric Emergency Department. Minerva Pediatr (Torino) 2022:S2724-5276.22.06991-9. [PMID: 36322018 DOI: 10.23736/s2724-5276.22.06991-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Recent data show that the rising consumption of cannabis has increased the rate of acute intoxication in pediatric age. Common patterns of pediatric poisoning consist of exploratory ingestions in younger children. A history of poisoning is often not provided; therefore, it could be advisable to use an objective biological marker. The clinical presentation of occult ingestion can range from asymptomatic to critically ill. Neurological involvement is one of the most described presentations. The goal of our study was to examine the presentation of acute cannabis intoxication in a sample of 13 pediatric patients under 3 years. METHODS A retrospective epidemiological investigation on acute cannabinoid intoxication was conducted on children under 3 years, recruited between 2016 and 2020. All patients were tested for urine drug screening suspecting poisoning as reason for Emergency Department (ED) admission. RESULTS Thirteen of forty-eight patients tested (27%) were positive for Tetrahydrocannabinol (THC). Ingestion was the route of intoxication in all of them. Only in five cases the possible accidental intake of cannabinoids was promptly declared. Twelve children accessed on ED due to a neurological symptomatology not attributable to known causes in the medical history. CONCLUSIONS Differential diagnosis for abuse drugs exposure in young children is broad: the urine drug screening plays a central role for confirmation of the diagnostic suspicion and identification of the specific substance. A positive result combined with a history of potential access to cannabis could prevent unnecessary, invasive, expensive procedures. When identified, the management is predominantly supportive. In this article, we want to emphasize the importance of always considering drug intoxication in children with acute neurological symptoms especially in cases of ambiguous familiar or social context. Further studies will be needed to better characterize the alarm bells for intoxication and to identify a strategy for the prevention of unintentional cannabinoid intoxication.
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Affiliation(s)
- Cristina Mascolo
- Department of Pediatrics, Bambino Gesù Children's Hospital, Tor Vergata University, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Marano
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
- Paediatric Clinical Toxicology Center, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Elena Bellelli
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Flavia Severini
- Department of Pediatrics, Bambino Gesù Children's Hospital, Tor Vergata University, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy -
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Ferro V, Nacca R, Pisani M, Cristaldi S, Faa MF, Supino MC, Raucci U, Reale A, Atti MCD, Raponi M, Villani A, Musolino AM. Children at risk of domestic accidents when are locked up at home: the other side of COVID-19 outbreak lockdown. Ital J Pediatr 2022; 48:129. [PMID: 35897106 PMCID: PMC9326437 DOI: 10.1186/s13052-022-01318-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background We proposed to analyze thoroughly the impact of the COVID-19 lockdown (CL) in changes of profiles and in trend of the domestic accidents (DAs) in children. Methods This was a single experience, cross-sectional study conducted at the emergency department (ED) of III trauma center. We enrolled children under 18 years admitted to ED with a diagnosis of DAs comparing the CL period from 10th March 2020 to 4th May 2020 with the same period of the previous year,10th March 2019 to 4th May 2019. Results In CL period, the cumulative incidence of ED visits for DAs increased from 86.88 to 272.13 per 1,000 children and the cumulative incidence of hospitalizations for DAs increased from 409.72 to 534.48 per 1,000 children. We reported in CL a decrease in the severity of ED presentation assessed by proxy measures: the level of priority ED visits reduced by 67% in CL period (OR: 0.33; 95%CI 0.22–0.48; p < 0.001); the likelihood of delayed time of presentation to ED increased by 65% in case of domestic injuries occurring in CL period (OR: 1.65; 95% CI: 1.17–2.34; p = 0.004); the odds of transfer from other hospital decreased by 78% in CL (OR: 0.15–0.33; p < 0.001). Children were more at risk of poisoning (OR:3.35–106.11; p = 0.001), of body foreign ingestion (OR: 1.83–14.39; p = 0.002) and less at risk of animal bite trauma (OR:0.05–0.35; p < 0.001). Conclusion Although the need to stay home has made a decisive breakthrough on the spread of COVID-19, the experience from this study underlines how this preventive measure has also had a downside in term of increased cumulative incidence of ED visits and of hospitalizations for DA.
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Affiliation(s)
- Valentina Ferro
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Raffaella Nacca
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mara Pisani
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sebastian Cristaldi
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Francesca Faa
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit-Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alberto Villani
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Maria Musolino
- Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Raucci U, Stanco M, Roversi M, Ponticiello E, Pisani M, Rosa M, Falsaperla R, Pavone P, Bondone C, Raffaldi I, Calistri L, Masi S, Reale A, Villani A, Marano M. Acquired methemoglobinemia in children presenting to Italian pediatric emergency departments: a multicenter report. Clin Toxicol (Phila) 2022; 60:920-925. [PMID: 35416740 DOI: 10.1080/15563650.2022.2061986] [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] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Methemoglobinemia (MetHb) is a rare inherited or acquired cause of cyanosis in children. Owing to its rarity, case reports and case series are mostly available in the current literature. This study reports data on a large sample of children with acquired MetHb. METHODS Data on patients admitted for acquired MetHb between January 2007 to December 2020 was extracted from the databases of five Italian pediatric emergency departments (EDs). Demographical and clinical characteristics was reported and discussed. RESULTS Nineteen cases of acquired MetHb were evaluated. Ten patients (52.6%) were male and 9 (47.4%) were female. The median age was 8.23 months. The median time from trigger to symptom onset was 6 hours. Mostly, the intoxication presumptively occurred by home ingestion of contaminated food, mainly badly preserved vegetable broth. All patients were cyanotic at admission, most patients also presented tachycardia and/or tachypnea, and two patients were comatose. Antidotal therapy with methylene blue was given in 14 patients (73.7%). The median hospital stay was 2 days. All patients survived. DISCUSSION As MetHb leads to the pathognomonic brown blood discoloration, blood gas analysis is mandatory immediately upon hospital arrival of a cyanotic patient. A correct medical history is crucial to identify the trigger and remove it. In our sample, the age onset was much lower than in the previous literature, and MetHb mainly due to ingestion of contaminated vegetable broth. Methylene blue led to a rapid recovery in all patients. Oxygen therapy may well lead to complete recovery when methemoglobin levels do not exceed 30% in asymptomatic and 20% in mildly symptomatic patients. CONCLUSIONS The diagnosis and management of acquired MetHb in the emergency setting requires acknowledgment of this condition as a cause of cyanosis in the weaning child. Indeed, when promptly recognized and treated, this severe condition rapidly resolves with no significant acute sequelae.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Stanco
- Department of Women, Children And General and Specialist Surgery, University of the Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, University of Rome Tor Vergata, Residency School of Pediatrics, Rome, Italy
| | | | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Margherita Rosa
- Dipartimento di Area Critica, AORN Santobono Pausilipon, Naples, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy.,Unit of Pediatrics and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Piero Pavone
- Division of Pediatrics and Pediatric Emergency, University Hospital Policlinico "Rodolico-San Marco," Catania, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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10
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Khalil Ramla M, Goffredo BM, Giustini F, Pisani M, Cairoli S, Simeoli R, Nunziata J, Perdichizzi S, Savarese I, Marano M. The importance of free digoxin serum levels after digoxin poisoning. Clin Toxicol (Phila) 2021; 60:136-137. [PMID: 34080509 DOI: 10.1080/15563650.2021.1928164] [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: 10/21/2022]
Affiliation(s)
- M Khalil Ramla
- Pediatric Poison Control Center, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - B M Goffredo
- Division Of Metabolic Biochemistry, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - F Giustini
- Division of Clinical Laboratory, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Pisani
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - S Cairoli
- Division Of Metabolic Biochemistry, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - R Simeoli
- Division Of Metabolic Biochemistry, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - J Nunziata
- DEA Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - S Perdichizzi
- DEA Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - I Savarese
- Department of Medical and Surgical Neonatology, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Marano
- Pediatric Poison Control Center, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.,DEA Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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11
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Marano M, Rossi F, Ravà L, Khalil Ramla M, Pisani M, Bottari G, Genuini L, Zampini G, Nunziata J, Reale A, Barbieri MA, Celeani F, Di Nardo M, Cecchetti C, Stoppa F, Villani A, Raponi M, Livadiotti S, Pontrelli G. Acute toxic exposures in children: analysis of a three year registry managed by a Pediatric poison control Center in Italy. Ital J Pediatr 2021; 47:125. [PMID: 34078407 PMCID: PMC8170623 DOI: 10.1186/s13052-021-01071-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. Methods This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group “P”), or who presented to the Emergency Department (group “ED”), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for “P”, and hospital admission for “ED”group). Results We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. Conclusions Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.
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Affiliation(s)
- M Marano
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. .,Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
| | - F Rossi
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Italy
| | - L Ravà
- Epidemiology Unit and Biostatistics, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Khalil Ramla
- Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Pisani
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - G Bottari
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - L Genuini
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - G Zampini
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - J Nunziata
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - A Reale
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M A Barbieri
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Italy
| | - F Celeani
- Information Systems Department, General direction Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Di Nardo
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - C Cecchetti
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - F Stoppa
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - A Villani
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Raponi
- Medical Direction, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - S Livadiotti
- Clinical Trials Centre, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Pontrelli
- Clinical Trials Centre, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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12
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Marano M, Pisani M, Zampini G, Pontrelli G, Roversi M. Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach. Toxins (Basel) 2021; 13:toxins13050330. [PMID: 34063282 PMCID: PMC8170888 DOI: 10.3390/toxins13050330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/16/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.
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Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Giuseppe Pontrelli
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Roversi
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Correspondence:
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13
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Raucci U, Musolino AM, Di Lallo D, Piga S, Barbieri MA, Pisani M, Rossi FP, Reale A, Ciofi Degli Atti ML, Villani A, Raponi M. Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children's hospital. Ital J Pediatr 2021; 47:21. [PMID: 33514391 PMCID: PMC7844808 DOI: 10.1186/s13052-021-00976-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children's hospital, composed by two different pediatric centers, one located in Rome's city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED's) and urgent hospitalizations compared to prepandemic period. METHODS The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. RESULTS The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. CONCLUSIONS In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn't demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Anna Maria Musolino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Domenico Di Lallo
- Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Piga
- Clinical Pathways and Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Mara Pisani
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Paolo Rossi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Palidoro, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Luisa Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Palidoro, Rome, Italy
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14
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Affiliation(s)
| | - Mara Pisani
- DEA, IRCCS Bambino Gesu Children's Hospital, Rome, Italy
| | | | - Marta Crevani
- Pavia Poison Control Centre -National Toxicology Information Centre, Maugeri Clinical and Scientific Institutes IRCCS and University, Pavia, Italy
| | - Roberto Pantaleoni
- Department of Agriculture, Section of Entomology, University of Sassari, Sassari, Italy
| | - Marco Marano
- Regional Paediatric Poison Center, IRCCS Bambino Gesu Children's Hospital, Rome, Italy.,DEA Paediatric Intensive Care Unit, IRCCS Bambino Gesu Children's Hospital, Rome, Italy
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15
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Marano M, Di Giuseppe M, Pro S, Pisani M, Montibeller M, Bottari G, Nunziata J, Cecchetti C. Vipera aspis bite neurotoxicity: two pediatric cases in Central Italy. Clin Toxicol (Phila) 2019; 58:849-850. [PMID: 31724448 DOI: 10.1080/15563650.2019.1687906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Marano
- DEA Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Regional Paediatric Poison Control Center, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - M Di Giuseppe
- University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital IRCSS, "Tor Vergata University", Rome, Italy
| | - S Pro
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - M Pisani
- Emergency Department, Bambino Gesù Children's Hospital, Irccs, Rome, Italy
| | - M Montibeller
- DEA Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - G Bottari
- DEA Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - J Nunziata
- DEA Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - C Cecchetti
- DEA Paediatric Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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16
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Marano M, Goffredo BM, Pisani M, Filippelli S, Cecchetti C, Drago F, Barbieri MA, Nunziata J, Genuini L, Di Nardo M. Pediatric extracorporeal cardiopulmonary resuscitation settled in an emergency department for a propafenone intentional intoxication. Am J Emerg Med 2018; 36:2132.e1-2132.e3. [PMID: 30082186 DOI: 10.1016/j.ajem.2018.08.001] [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: 07/19/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
The use of drugs in suicide attempts is becoming more and more frequent among adolescents. Intentional intoxication with propafenone is very rare and mainly reported in adults associated with other drugs. The therapeutic approach is symptomatic, since there is no specific antidote for propafenone. We present a pediatric case of intentional ingestion of 1.8 g of propafenone that caused refractory cardiogenic shock. The patient was successfully rescued with extracorporeal cardiopulmonary resuscitation in the emergency department of a secondary level peripheral hospital.
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Affiliation(s)
- Marco Marano
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Bianca M Goffredo
- Laboratory of Analytical Biochemistry, IRCCS, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Mara Pisani
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Corrado Cecchetti
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Maria A Barbieri
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Joseph Nunziata
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
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17
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Murphy T, Pisani M, Ferrante L, Gill T. ASSOCIATIONS WITH POST-DISCHARGE FUNCTION OF OLDER ICU SURVIVORS: SENSITIVITY TO DEATH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.070] [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)
- T.E. Murphy
- Yale School of Medicine, New Haven, Connecticut,
- Yale Program on Aging, New Haven, Connecticut
| | - M. Pisani
- Yale School of Medicine, New Haven, Connecticut,
- Yale Program on Aging, New Haven, Connecticut
| | - L. Ferrante
- Yale School of Medicine, New Haven, Connecticut,
- Yale Program on Aging, New Haven, Connecticut
| | - T.M. Gill
- Yale School of Medicine, New Haven, Connecticut,
- Yale Program on Aging, New Haven, Connecticut
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18
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Han L, Pisani M, Araujo K, Allore H. ESTIMATING TREATMENT EFFECT OF HALOPERIDOL ON DELIRIUM SYMPTOMS USING OBSERVATIONAL DATA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3482] [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)
- L. Han
- Yale School of Medicine, New Haven, Connecticut
| | - M. Pisani
- Yale School of Medicine, New Haven, Connecticut
| | - K.L. Araujo
- Yale School of Medicine, New Haven, Connecticut
| | - H. Allore
- Yale School of Medicine, New Haven, Connecticut
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19
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Itoh A, Pisani M, Baltalzar M, Balsara K, Masood M, Tepper S, Han J, Ranney D, Daneshmand M, Sun B, Kai M, Camacho M, Takayama H. Clinical Benefits and Complications in Patients with Percutaneous VAD versus Surgical LV Vent with ECLS: Multicenter REgiStry for Cardiogenic Shock - Utilization and Efficacy of Device Therapy (RESCUE). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1258] [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: 11/28/2022] Open
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20
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Massoud M, Del Bufalo F, Caterina Musolino AM, Schingo PM, Gaspari S, Pisani M, Orazi C, Reale A, Raucci U. Myeloid Sarcoma Presenting as Low Back Pain in the Pediatric Emergency Department. J Emerg Med 2016; 51:308-14. [DOI: 10.1016/j.jemermed.2016.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
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21
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Marano M, Lonati D, Locatelli CA, Pisani M. Letter in response to: “Hyperglycemia is a risk factor for high-grade envenomations after European viper bites ( Vipera spp.) in children”. Clin Toxicol (Phila) 2016; 54:539. [DOI: 10.3109/15563650.2016.1166374] [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: 11/13/2022]
Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, IRCCS “Bambino Gesù” Children Hospital, Piazza Sant'Onofrio, 4, Rome, Italy
| | - Davide Lonati
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, via Maugeri, 10, Pavia, 27100, Italy
| | - Carlo Alessandro Locatelli
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, via Maugeri, 10, Pavia, 27100, Italy
| | - Mara Pisani
- Emergency Department, IRCCS “Bambino Gesù” Children Hospital, Piazza Sant'Onofrio, 4, Rome, Italy
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Haland T, Neglia L, Mas-Stachurska A, Malanin D, Baruteau AE, Pontnau F, Capotosto L, Hristova K, Sevilla T, Wojtkowska A, Almaas VM, Hasselberg NE, Saberniak J, Leren IS, Hopp E, Edvardsen T, Haugaa KH, Piazza R, Doronzo A, Leonelli V, Morosin M, Leiballi E, Pecoraro R, Lutman C, Dragos A, Cassin M, Sitges M, Meirelles T, Hernandez V, Egea G, Bijnens B, Poggio D, Ferrazzi P, Spirito P, Specchia G, Grillo M, Amigoni P, Bersano C, Pisani M, Chioffi M, Hascoet S, Piot D, Lambert V, Petit J, Ladouceur M, Ferreira A, Iserin L, Mousseaux E, D'angeli I, Conde Y, Ashurov R, Miraldi F, Vitarelli A, Dasheva A, Marinov R, Lasarov S, Mitev I, Mitev P, Konstantinov G, Kaneva A, Katova TZ, Revilla-Orodea A, Uruena-Martinez N, Fuertes-Alija JJ, Rodriguez-Velasco M, Gomez-Salvador I, San Roman-Calvar JA, Tomaszewski A, Czekajska-Chehab E, Wysokinski A, Adamczyk P, Siek E, Zakoscielna M. Moderated Posters session: advanced echo techniques in congenital heart diseaseP526Systolic function by strain echocardiography is related to cardiac fibrosis and arrhythmias in hypertrophic cardiomyopathyP527Natural history of bicuspid aortic valve valvulo-aortopathy in affected patients followed in a single centerP528Postsystolic thickening as a likely sign of altered deformation due to pressure overload in a Marfan murine model.P529Strain rate echocardiography in patients with hypertrophic cardiomyopathy undergoing surgical myectomy.P530Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in childrenP531Aortic root dilatation and stiffness assessed by magnetic resonance imaging in adults with repaired tetralogy of FallotP532Assessment of biventricular and vascular function using three-dimensional speckle tracking echocardiography in adult patients with surgical repair of tetralogy of FallotP533A study of functional anatomy of aortic-mitral valve coupling using 3D echocardiography in patients with double orifice mitral valveP534Evaluation of bicuspid aortic valve and its repercussion in the left ventricle with cardiovascular magnetic resonanceP535Echocardiographic assessment of anomalous pulmonary venous connection. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev252] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marano M, Bottaro G, Goffredo B, Stoppa F, Pisani M, Marinaro AM, Deodato F, Dionisi-Vici C, Clementi E, Falvella FS. Deferasirox-induced serious adverse reaction in a pediatric patient: pharmacokinetic and pharmacogenetic analysis. Eur J Clin Pharmacol 2015; 72:247-8. [PMID: 26403473 DOI: 10.1007/s00228-015-1956-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- M Marano
- DEA Intensive Care Unit, IRCCS "Bambino Gesù" Children Hospital, Piazza S. Onofrio 4, Rome, 00165, Italy.
| | - G Bottaro
- Department of Pediatrics "Tor Vergata University", Rome, Italy
| | - B Goffredo
- Laboratory of Analytical Biochemistry, IRCCS "Bambino Gesù" Children Hospital, Rome, Italy
| | - F Stoppa
- DEA Intensive Care Unit, IRCCS "Bambino Gesù" Children Hospital, Piazza S. Onofrio 4, Rome, 00165, Italy
| | - M Pisani
- DEA, IRCCS "Bambino Gesù" Children Hospital, Rome, Italy
| | - A M Marinaro
- Department of Pediatrics, Section of Pediatrics Haematology and Oncology, University of Sassari, Sassari, Italy
| | - F Deodato
- Department of Pediatric Medicine, Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Dionisi-Vici
- Department of Pediatric Medicine, Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - E Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.,Department of Biomedical and Clinical Sciences L. Sacco, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, "Luigi Sacco" University Hospital, University of Milano, Milan, Italy
| | - F S Falvella
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, "Luigi Sacco" University Hospital, University of Milano, Milan, Italy
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Barakat LA, Juthani-Mehta M, Allore H, Trentalange M, Tate J, Rimland D, Pisani M, Akgün KM, Goetz MB, Butt AA, Rodriguez-Barradas M, Duggal M, Crothers K, Justice AC, Quagliarello VJ. Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia. HIV Med 2015; 16:421-30. [PMID: 25959543 DOI: 10.1111/hiv.12244] [Citation(s) in RCA: 9] [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] [Accepted: 11/26/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear. METHODS Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models. RESULTS Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714). CONCLUSION Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
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Affiliation(s)
- L A Barakat
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Juthani-Mehta
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - H Allore
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Trentalange
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Tate
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - D Rimland
- Infectious Disease, VA Medical Center, Decatur, GA, USA
| | - M Pisani
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - K M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - M B Goetz
- Infectious Disease, VA Greater Los Angles Healthcare System, Los Angelos, CA, USA
| | - A A Butt
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Rodriguez-Barradas
- Infectious Diseases (MS 111G), Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - M Duggal
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - K Crothers
- Pulmonary Disease and Critical Care, University of Washington, Seattle, WA, USA
| | - A C Justice
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - V J Quagliarello
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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25
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Galeazzi R, Bruni P, Crucianelli E, Laudadio E, Marini M, Massaccesi L, Mobbili G, Pisani M. Liposome-based gene delivery systems containing a steroid derivative: computational and small angle X-ray diffraction study. RSC Adv 2015. [DOI: 10.1039/c5ra08439c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The structural properties and the phase behaviour of mixed composition liposomes containing a functionalized lipid are investigated with the aim to design neutral liposomes able to coordinate metals and to complex DNA.
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Affiliation(s)
- R. Galeazzi
- Di.S.V.A. Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - P. Bruni
- SIMAU Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - E. Crucianelli
- Di.S.V.A. Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - E. Laudadio
- Di.S.V.A. Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - M. Marini
- SIMAU Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - L. Massaccesi
- Di.S.V.A. Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - G. Mobbili
- Di.S.V.A. Department
- Polytechnic University of Marche
- Ancona
- Italy
| | - M. Pisani
- SIMAU Department
- Polytechnic University of Marche
- Ancona
- Italy
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26
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Marano M, Pisani M, Stoppa F, Di Nardo M, Pirozzi N, Luca E, Pulitanò S, Conti G, Marzano L, De Luca D, Valentini P, Pietrini D, Piastra M. Antitoxin use and pediatric intensive care for viper bites in Rome, Italy. Eur Rev Med Pharmacol Sci 2014; 18:485-492. [PMID: 24610614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Italy viper bites represent an uncommon event, though envenomation can cause severe complications, more in children than adults, because of dose/body size ratio. We present a case series within a selected population: 10 Italian cases (from Rome surroundings) of viperbites requiring PICU admission, over a 5-year interval. Five children showed a systemic involvement, whereas the remaining patients showed a damage. All were managed and closely monitored in an ICU setting. Relevant clinical findings and therapeutic approach, ICU course and complications have been recorded. Age range was 3-15 years with mean age of 6,9 (SD±4,58) years; 2 patients needed respiratory support beyond oxygen supplementation. Most patients underwent fluid loading, while hemodynamic support was given to4/10. Median PICU stay was 60 hours (IQR=24.0-75.5). No mortality was reported. Indications and precautions for administration of antivenom in the last years have been reviewed: early treatment seems to reduce mortality/morbidity, though representing a threat for children. Current recommendations for the treatment of viper envenomation have been described, based on a literature's review and the application of these knowledges to clinical reality of our PICUs. Therefore, paediatric patients with systemic or rapidly evolving symptoms should be monitored carefully for the development of bite-related complications in an ICU setting mostly in younger children.
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Affiliation(s)
- M Marano
- Antitoxin use and pediatric intensive care for viper bites in Rome, Italy.
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Crucianelli E, Bruni P, Frontini A, Massaccesi L, Pisani M, Smorlesi A, Mobbili G. Liposomes containing mannose-6-phosphate-cholesteryl conjugates for lysosome-specific delivery. RSC Adv 2014. [DOI: 10.1039/c4ra08681c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We present a novel liposomal nanocarrier containing mannose 6-phosphate-cholesteryl conjugates and show its ability to reach the lysosomes by means of confocal and fluorescence microscopy measurements.
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Affiliation(s)
- E. Crucianelli
- Di.S.V.A. Department
- Università Politecnica delle Marche
- 60131 Ancona, Italy
| | - P. Bruni
- SIMAU Department
- Università Politecnica delle Marche
- 60131 Ancona, Italy
| | - A. Frontini
- Department of Experimental and Clinical Medicine
- Università Politecnica delle Marche
- 60126 Ancona, Italy
| | - L. Massaccesi
- Di.S.V.A. Department
- Università Politecnica delle Marche
- 60131 Ancona, Italy
| | - M. Pisani
- SIMAU Department
- Università Politecnica delle Marche
- 60131 Ancona, Italy
| | - A. Smorlesi
- Department of Experimental and Clinical Medicine
- Università Politecnica delle Marche
- 60126 Ancona, Italy
| | - G. Mobbili
- Di.S.V.A. Department
- Università Politecnica delle Marche
- 60131 Ancona, Italy
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Allan TD, Dehlinger P, Gantar C, Morelli C, Pisani M, Harrison JC. Comparison of Graf-Askania and LaCoste-Romberg surface-ship gravity meters. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/jz067i013p05157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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29
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Signorini ML, Gaggiotti M, Molineri A, Chiericatti CA, Zapata de Basílico ML, Basílico JC, Pisani M. Exposure assessment of mycotoxins in cow's milk in Argentina. Food Chem Toxicol 2011; 50:250-7. [PMID: 22015550 DOI: 10.1016/j.fct.2011.09.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 09/26/2011] [Accepted: 09/28/2011] [Indexed: 11/28/2022]
Abstract
A stochastic simulation model was developed to carry out the first quantitative risk exposure assessment of the mycotoxin level in cow's milk produced in Argentina. The prevalence and concentration of aflatoxin M1 (AFM1), deoxynivalenol (DON) and zearalenone (ZEA) were modeled at various stages through milk processes complying with Argentinean practices. Concentration of AFM1 (0.059ppb), DON (0.338ppb) and ZEA (0.125ppb) in dairy milk were estimated. The proportion of feed samples that exceeded the maximum level accepted by European regulations for AFB1, DON and ZEA were estimated at 25.07%, 0.0% and 8.9%, respectively. The percentage of milk samples that exceeded the maximum level accepted for AFB1 by the MERCOSUR (0.5ppb) and the European Union regulations (0.05ppb) were 0.81 and 32.65, respectively. The probability distribution of AFM1 concentration in milk was affected by the carry-over rate equations applied in the model. Mycotoxin levels in corn silage and concentrated feeds were the factors most correlated with mycotoxin concentrations in milk. Therefore, agricultural practices, crop management and feed production require prompt attention regarding mycotoxin issues.
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Affiliation(s)
- M L Signorini
- Instituto Nacional de Tecnología Agropecuaria EEA Rafaela, Ruta 34 Km 227, Rafaela, C.P. 2300, Provincia de Santa Fe, Argentina.
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Tognoni P, Simonato A, Robutti N, Pisani M, Cataldi A, Monacelli F, Carmignani G, Odetti P. Preoperative risk factors for postoperative delirium (POD) after urological surgery in the elderly. Arch Gerontol Geriatr 2011; 52:e166-9. [DOI: 10.1016/j.archger.2010.10.021] [Citation(s) in RCA: 45] [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] [Received: 07/10/2010] [Revised: 10/19/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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31
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Bruni P, Francescangeli O, Marini M, Mobbili G, Pisani M, Smorlesi A. Can Neutral Liposomes be Considered as Genetic Material Carriers for Human Gene Therapy? MINI-REV ORG CHEM 2011. [DOI: 10.2174/157019311793979891] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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32
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Diamanti A, Bracci F, Reale A, Crisogianni M, Pisani M, Castro M. Incidence, clinical presentation, and management of constipation in a pediatric ED. Am J Emerg Med 2010; 28:189-94. [DOI: 10.1016/j.ajem.2008.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 11/07/2008] [Accepted: 11/08/2008] [Indexed: 12/27/2022] Open
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33
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Nobili V, Reale A, Alisi A, Morino G, Trenta I, Pisani M, Marcellini M, Raucci U. Elevated serum ALT in children presenting to the emergency unit: Relationship with NAFLD. Dig Liver Dis 2009; 41:749-52. [PMID: 19362523 DOI: 10.1016/j.dld.2009.02.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [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] [Received: 10/06/2008] [Revised: 02/20/2009] [Accepted: 02/25/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease, ranging from hepatic steatosis to necro-inflammation with or without fibrosis (non-alcoholic steatohepatitis), is a growing clinical liver disorder in children. AIM The goals of this study were to characterize liver disorders associated with elevated aminotransferases and establish the non-alcoholic fatty liver disease/non-alcoholic steatohepatitis prevalence in hypertransaminasemic children admitted to the emergency room. METHODS The medical records of 3280 children (2-17 years of age) admitted to the emergency room of Bambino Gesù Children's Hospital of Rome, and presenting with hypertransaminasemia were analysed retrospectively. RESULTS Elevation of serum alanine aminotransferases was present in 897 patients. Of these, 520 (58%) spontaneously normalized alanine aminotransferases, and 179/897 (20%) maintained persistently elevated alanine aminotransferases levels. Twenty-one patients were excluded because of medication or alcohol use. In the remaining 157 patients with elevated alanine aminotransferases, obesity was found in 87 (55%), viral infections in 52 (33%) and genetic diseases in 14 (9%). Obesity-related alanine aminotransferases elevation was associated with a histological diagnosis of non-alcoholic fatty liver disease in 85% of patients. In particular, steatosis was histologically confirmed in 74 patients; 43/74 (58%) had steatohepatitis, and 12/74 (16%) had fibrosis. CONCLUSIONS Twenty percent of children with elevated aminotransferases on routine testing may hide non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. A careful diagnostic workup of persistent hypertransaminasemia in all obese subjects is warranted in the paediatric setting.
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Affiliation(s)
- V Nobili
- Liver Unit, Bambino Gesù Children's Hospital, Rome, Italy.
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34
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Pignatelli P, Properzi E, Pisani M, Clerico A, Schiavetti A, Lenti L, Pulcinelli FM, Ferroni P, Gazzaniga PP. Effects on platelet function of combination etoposide and carboplatin chemotherapy in pediatric oncology patients. Platelets 2009; 9:309-14. [PMID: 16793755 DOI: 10.1080/09537109876555] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The effects of a therapeutic course of the combination of carboplatin and etoposide on platelet function have been evaluated in 10 pediatric patients with brain tumors. Platelet count, in vitro aggregation tests, P-selectin expression and agonist-induced ATP release were evaluated before, and 7 and 15 days after one cycle of chemotherapy. The analysis of the results demonstrated the presence of an in vitro platelet aggregation defect in response to collagen and arachidonic acid in all patients 7 days after therapy. A concomitant decrease of collagen- and arachidonic acid-induced ATP release was also observed. Both platelet aggregation and ATP release returned to baseline values 15 days after chemotherapy administration. Conversely, in vitro platelet aggregation and secretion induced by ADP and epinephrine were unaltered by carboplatin and etoposide administration. Furthermore, P-selectin expression was negative at baseline and did not change after chemotherapy. These results support the hypothesis that combination etoposide and carboplatin chemotherapy in pediatric patients is responsible for possible disturbances in biochemical pathways required for platelet secretion and aggregation.
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Affiliation(s)
- P Pignatelli
- Department of Experimental Medicine and Pathology, University of Rome La Sapienza, Rome, Italy
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35
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Di Crosta I, Inserra A, Gil CP, Pisani M, Ponticelli A. Abdominal pain and wandering spleen in young children: the importance of an early diagnosis. J Pediatr Surg 2009; 44:1446-9. [PMID: 19573677 DOI: 10.1016/j.jpedsurg.2009.02.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/27/2009] [Accepted: 02/28/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study is to increase clinical awareness of torsion of wandering spleen (WS) in childhood and the need of a rapid diagnosis. METHODS Four cases operated for torsion of WS are retrospectively reviewed. Ages at presentation were, respectively, 30 months, 5 years, 4 years, and 3 years, without sex preference. All subjects led a history of abdominal pain and a mass on physical examination. RESULTS Torsion of WS should be suspected in any child presenting with acute abdomen. Moreover, in case of acute abdomen and intermittent abdominal pain, we suggest studying spleen position with ultrasound. CONCLUSIONS Ultrasonography with color Doppler is the best choice for diagnosis of torsion of WS. Computed tomography is a good complementary examination, but it needs to submit young patients to a general anesthesia and delays an emergency situation.
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Affiliation(s)
- Ida Di Crosta
- Department of Pediatric Surgery, University Hospital Joan XXIII, 43007, Tarragona, Spain.
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36
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Bruni P, Fino V, Pisani M, Tosi G, Stipa P, Ferraris P, Francescangeli O. 12-Crown-4-based amphipathic lipid and corresponding metal cation complexes for gene therapy applications: FT-IR characterization and surface charge determination. J Mol Struct 2009. [DOI: 10.1016/j.molstruc.2008.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Marano M, Stoppa F, Tomasello C, Pisani M, Di Nardo M, Pirozzi N. Case 1: Chocolate-coloured blood in infant with shock (case presentation). Diagnosis: Acquired methemoglobinemia. Acta Paediatr 2008; 97:836, 991-2. [PMID: 18532933 DOI: 10.1111/j.1651-2227.2008.00777.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/30/2022]
Affiliation(s)
- M Marano
- Emergency Department (DEA), Area Rossa, Pediatric Hospital Bambino Gesù, Rome, Italy.
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38
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Agricola E, Oppizzi M, Galderisi M, Pisani M, Meris A, Pappone C, Margonato A. Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction. Heart 2006; 92:1390-5. [PMID: 16449509 PMCID: PMC1861021 DOI: 10.1136/hrt.2005.082115] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess regional mechanical dyssynchrony as a determinant of the degree of functional mitral regurgitation (FMR). SETTING Tertiary cardiology clinic. PATIENTS 74 consecutive patients with left ventricular (LV) dysfunction (ejection fraction < 40%, mean 32.2 (SD 7.3)%) were evaluated. METHODS Effective regurgitant orifice (ERO) area, indices of mitral deformation (systolic valvular tenting, mitral annular contraction) and of global LV function and remodelling (ejection fraction, end systolic volume, sphericity index) and local remodelling (papillary-fibrosa distance, regional wall motion score index), and tissue Doppler-derived dyssynchrony index (DI) (regional DI, defined as the standard deviation of time to peak myocardial systolic contraction of eight LV segments supporting the papillary muscles attachment) were measured. RESULTS All the assessed variables correlated significantly with ERO. By multivariate analysis, systolic valvular tenting was the strongest independent predictor of ERO (R(2) = 0.77, p = 0.0001), with a minor influence of papillary-fibrosa distance (R(2) = 0.77, p = 0.01) and regional DI (R(2) = 0.77, p = 0.03). Local LV remodelling (regional wall motion score index: R(2) = 0.58, p = 0.001; papillary-fibrosa distance: R(2) = 0.58, p = 0.002) and global remodelling indices (sphericity index: R(2) = 0.58, p = 0.003) were the main determinants of systolic valvular tenting, whereas regional DI did not enter into the model. Regional DI was an independent predictor of ERO (R(2) = 0.56, p = 0.005) in patients with non-ischaemic LV dysfunction but not in patients with ischaemic LV dysfunction when these groups were analysed separately. CONCLUSIONS The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.
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Affiliation(s)
- E Agricola
- Division of Noninvasive Cardiology, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy.
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39
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Bruni P, Conti C, Giorgini E, Pisani M, Rubini C, Tosi G. Histological and microscopy FT-IR imaging study on the proliferative activity and angiogenesis in head and neck tumours. Faraday Discuss 2004; 126:19-26; discussion 77-92. [PMID: 14992397 DOI: 10.1039/b306787b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Micro Fourier transform infrared spectroscopy enables one to study small samples because of the high quality spectra that can be obtained. Biochemical and morphological changes between control and pathological tissues of head and neck tumours have been monitored drawing three-dimensional chemical maps of the main vibrational modes in the regions of interest. Comparison between spectral and histological data shows a satisfactory degree of accordance. Among all, proliferating and regressive states of the tumours can be identified.
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Affiliation(s)
- P Bruni
- Dipartimento di Scienze dei Materiali e della Terra, Università Politecnica delle Marche, Ancona, Italy
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40
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Valkova L, Menelle A, Borovkov N, Erokhin V, Pisani M, Ciuchi F, Carsughi F, Spinozzi F, Pergolini M, Padke R, Bernstorff S, Rustichelli F. Small-angle X-ray scattering and neutron reflectivity studies of Langmuir–Blodgett films of copper tetra-tert-butyl-azaporphyrines. J Appl Crystallogr 2003. [DOI: 10.1107/s0021889803004965] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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41
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Valkova L, Borovkov N, Kopranenkov V, Pisani M, Bossi M, Rustichelli F. Some features of the molecular assembly of copper porphyrazines. Materials Science and Engineering: C 2002. [DOI: 10.1016/s0928-4931(02)00166-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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Ferri E, Bonvicini U, Pisani M. [Ultrasonography of normal vermiform appendix]. Chir Ital 2001; 53:231-8. [PMID: 11396073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The aim of this study was the detection and visualisation of the normal vermiform appendix and its characteristics by ultrasonography in adults with no clinical suggestion of acute or chronic abdominal disease. A prospective study was performed in 200 subjects. The graded-compression ultrasonography technique was used to explore the lower right quadrant of the abdomen and the pelvis. The examination was performed using a 4 MHz sector array and 7.5 MHz linear array transducer. In a few cases, a 10 MHz linear array transducer was used. The appendix was visualized in 54% of patients. In all cases where the appendix was visualized it was found to be either on the ileo-psoas muscle or directly beneath the abdominal wall. The ileo-caecal valve was visualized in 78% of cases. The transverse diameter was found to be no greater than 6.5 mm except in three cases that had a diameters ranging from 7 to 9 mm. Diameter variability along the length of the same appendix was demonstrated in 5% of subjects. Wall thickness was no greater than 2.5 mm. Our experience suggests that graded-compression ultrasonography is a valuable procedure for detecting the vermiform appendix more frequently than has been previously reported. The patients physical constitution and the anatomical location of the vermiform appendix were found to be important factors affecting the ability to visualize the vermiform appendix. The ability to visualise the normal vermiform appendix ultrasonographically supports the clinical diagnosis and excludes acute appendicitis.
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Affiliation(s)
- E Ferri
- Unità Operativa Chirurgia II, AUSL 3, Via Taverna, 29100 Piacenza
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43
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Abstract
A sample scanning device operating in a working volume of 30 x 30 x 18 microm with interferometer and capacitance-based controls of displacements, is described. The xy-stage uses plane mirror linear interferometers and fast phase-meters for control of displacements of precise ball-bearing stages driven by piezo flexure actuators. The stage operates with a full range bandwidth of 200 Hz, and an estimated accuracy (k = 2) of 3 nm + 1 x 10(-3) L, where L is the lateral displacement. A novel z-stage based on a kinematic coupling between two plates, the upper one being moved by three bimorph plates and the distance being measured by three capacitive sensor, is described. The tilt of the z-stage is kept within fractions of a microrad, leading to a full range estimated accuracy of 2 nm + 2 x 10(-3) h, where h is the vertical displacement. The control bandwidth is of about 1 kHz, thus allowing fast and accurate step-height measurements. In order to test the device used in a scanning probe microscope, micrometric patterned surfaces made using high resolution e-beam lithography and precise metal deposition on silicon are imaged. Results of pitch measurements are discussed and compared with those obtained using optical diffractometry.
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Affiliation(s)
- G B Picotto
- CNR-Istituto di Metrologia G. Colonnetti (IMGC), Torino, Italy
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44
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Pisani M, Bozzi M. Experimental use of natural interferon alpha by peroral administration in patients affected by recidivant herpes simplex. Clin Ter 2000; 151:19-22. [PMID: 10876962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- M Pisani
- University of Naples, II Faculty of Medicine, Italy
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45
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Mohimen A, Narula M, Ruocco V, Pisani M, Ahmed AR. Presence of the autoantibody in healthy relatives of Italian patients with pemphigus vulgaris. Arch Dermatol Res 1993; 285:176-7. [PMID: 8503701 DOI: 10.1007/bf01112924] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Mohimen
- Department of Oral Pathology, Harvard School of Dental Medicine, Boston, MA 02115
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46
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Marfella A, Satriano RA, Polese C, Perna M, Pisani M. Urinary neopterin and kynurenine in herpes gestationis. Dermatology 1991; 183:56. [PMID: 1769421 DOI: 10.1159/000247636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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47
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Pisani M, Rossi A, Uzzauto MT, Rinaldi E, Savastano S, Napolitano S. [Mottled hyperpigmentation of the fundus oculi associated with angioid streaks in pseudoxanthoma elasticum]. GIORN ITAL DERMAT V 1990; 125:569-74. [PMID: 2091980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Authors report mottled fundus in association with pseudoxanthoma elasticum in 8 of 9 patients. The mottled hyperpigmentation is an early uncommonly described finding, consisting of a speckled, yellowish mottling of the posterior pole temporal to the macula at ophthalmoscopic examination; this appearance, called "peau d'orange", is believed to be caused by changes in the retinal pigmented epithelium overlying a calcified and degenerating Bruch's membrane. This finding is virtually pathognomonic of pseudoxanthoma elasticum and may be present even in the first decade of the disease, prior to the appearance of the angioid streaks. The Authors emphasize the significance of the retinal finding, that may represent an incomplete genetic expression of an autosomal recessive carrier state.
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Affiliation(s)
- M Pisani
- I Facoltà di Medicina e Chirurgia, Clinica Dermosifilopatica, Università degli Studi di Napoli
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48
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Pisani M, Ruocco V, Sacerdoti G. [A case of idiopathic hypereosinophilic syndrome]. GIORN ITAL DERMAT V 1990; 125:409-12. [PMID: 2079352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Idiopathic hypereosinophilic syndrome (IHS) is reported in a 59-year-old farmer. Skin manifestations were represented by pruritic erythemato-squamous and papulonodular lesions, the heart was affected by endomyocardic fibrosis, and periodic intestinal colics denoted a possible gut involvement. A mild and transient beneficial effect was achieved by treatment with antihistamines, sodium-chromoglycate, steroids. Recent studies indicate that IHS hypereosinophilia is caused by interleukins 3 and 5, cytokines able to activate circulating eosinophils and to enhance the survival of these cells.
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Affiliation(s)
- M Pisani
- Clinica Dermosifilopatica, I Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli Federico II
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Ruocco V, Pisani M, de Angelis E, Lombardi ML. Biochemical acantholysis provoked by thiol drugs. Arch Dermatol 1990; 126:965-6. [PMID: 2193630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- P A Villano
- Department of Dermatology, First School of Medicine, University of Naples, Italy
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