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Maiandi S, Ghizzardi G, Edefonti V, Giacchero R, Lusignani M, Giannì ML. Is the equimolar mixture of oxygen and nitrous oxide (EMONO) associated with audiovisuals effective in reducing pain and side effects during peripheral venous access placement in children? Protocol for a single-centre randomised controlled trial from Italy. BMJ Open 2023; 13:e067912. [PMID: 37419632 PMCID: PMC10335544 DOI: 10.1136/bmjopen-2022-067912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/31/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Nurses frequently place a peripheral venous catheter during children's hospitalisation. Many studies suggest treatment of venipuncture-related pain. The administration of an equimolar mixture of oxygen and nitrous oxide (EMONO) is employed for pain control; however, no studies have analysed the association between EMONO and audiovisuals.The purpose of the study is to evaluate the effect of EMONO administration when combined with audiovisuals (EMONO+Audiovisual) versus EMONO alone on perceived pain, side effects and level of cooperation during peripheral venous access placement in children aged 2-5 years. METHODS AND ANALYSIS The first 120 eligible children admitted to the paediatric ward of the Lodi Hospital and presenting the indication for peripheral venous access will be enrolled. Sixty children will be randomly assigned to the experimental group (EMONO+Audiovisual) and 60 to the control group (EMONO alone).The Face, Legs, Activity, Cry, Consolability scale will be used to assess pain in the children aged 2-years old; pain in the children aged 3-5 years will be assessed using the Wong-Baker scale. The cooperation throughout the procedure will be measured using the Groningen Distress Rating Scale. ETHICS AND DISSEMINATION The Milan Area 1 Ethics Committee approved the study protocol (Experiment Registry No. 2020/ST/295). The trial results will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05435118.
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Affiliation(s)
- Stefano Maiandi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Greta Ghizzardi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Valeria Edefonti
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology, "G.A. Maccacaro," University of Milan, Milano, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Nazzari S, Grumi S, Biasucci G, Decembrino L, Fazzi E, Giacchero R, Magnani ML, Nacinovich R, Scelsa B, Spinillo A, Capelli E, Roberti E, Provenzi L. Maternal pandemic-related stress during pregnancy associates with infants' socio-cognitive development at 12 months: A longitudinal multi-centric study. PLoS One 2023; 18:e0284578. [PMID: 37068062 PMCID: PMC10109481 DOI: 10.1371/journal.pone.0284578] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Prenatal maternal stress is a key risk factor for infants' development. Previous research has highlighted consequences for infants' socio-emotional and cognitive outcomes, but less is known for what regards socio-cognitive development. In this study, we report on the effects of maternal prenatal stress related to the COVID-19 pandemic on 12-month-old infants' behavioral markers of socio-cognitive development. METHODS Ninety infants and their mothers provided complete longitudinal data from birth to 12 months. At birth, mothers reported on pandemic-related stress during pregnancy. At infants' 12-month-age, a remote mother-infant interaction was videotaped: after an initial 2-min face-to-face episode, the experimenter remotely played a series of four auditory stimuli (2 human and 2 non-human sounds). The auditory stimuli sequence was counterbalanced among participants and each sound was repeated three times every 10 seconds (Exposure, 30 seconds) while mothers were instructed not to interact with their infants and to display a neutral still-face expression. Infants' orienting, communication, and pointing toward the auditory source was coded micro-analytically and a socio-cognitive score (SCS) was obtained by means of a principal component analysis. RESULTS Infants equally oriented to human and non-human auditory stimuli. All infants oriented toward the sound during the Exposure episode, 80% exhibited any communication directed to the auditory source, and 48% showed at least one pointing toward the sound. Mothers who reported greater prenatal pandemic-related stress had infants with higher probability of showing no communication, t = 2.14 (p = .035), or pointing, t = 1.93 (p = .057). A significant and negative linear association was found between maternal prenatal pandemic-related stress and infants' SCS at 12 months, R2 = .07 (p = .010), while adjusting for potential confounders. CONCLUSIONS This study suggests that prenatal maternal stress during the COVID-19 pandemic might have increased the risk of an altered socio-cognitive development in infants as assessed through an observational paradigm at 12 months. Special preventive attention should be devoted to infants born during the pandemic.
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Affiliation(s)
- Sarah Nazzari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Grumi
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Elisa Fazzi
- Department of Clinical And Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, Azienda Ospedaliera Spedali Civili of Brescia, Brescia, Italy
| | | | | | - Renata Nacinovich
- Child and Adolescent Neuropsychiatry, Fondazione IRCCS San Gerardo dei Tintori Monza, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), Università Bicocca, Milan, Italy
| | - Barbara Scelsa
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Capelli
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Roberti
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Developmental Psychobiology, IRCCS Mondino Foundation, Pavia, Italy
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Nazzari S, Grumi S, Villa M, Mambretti F, Biasucci G, Decembrino L, Giacchero R, Magnani ML, Nacinovich R, Prefumo F, Spinillo A, Veggiotti P, Fullone E, Giorda R, Provenzi L. Sex-dependent association between variability in infants' OXTR methylation at birth and negative affectivity at 3 months. Psychoneuroendocrinology 2022; 145:105920. [PMID: 36108459 DOI: 10.1016/j.psyneuen.2022.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/24/2022] [Accepted: 09/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sex-specific differences in DNA methylation of the oxytocin receptor gene (OXTR) have been shown in adults and are related to several mental disorders. Negative affectivity early in life is a trans-diagnostic risk marker of later psychopathology and is partly under genetic control. However, sex-specific variations in OXTR methylation (OXTRm) in infants and their associations with negative affectivity are still unknown. AIMS Here, we explored sex differences in the association between infant OXTRm at birth and negative affectivity at 3 months of age. METHODS Infants and their mothers (N = 224) were recruited at delivery. Infants' methylation status was assessed in 13 CpG sites within the OXTR gene intron 1 region (chr3: 8810654-8810919) in buccal cells at birth while 3-month-old infants' negative affectivity was assessed by mothers using a well-validated temperament questionnaire. RESULTS OXTRm at 12 CpG sites was higher in females than in males. Moreover, higher infants' OXTRm at 6 specific CpG sites was associated with greater negative affectivity in males, but not in females. CONCLUSIONS These results provide new insights into the role of sex-dependent epigenetic mechanisms linking OXTRm with early infants' emotional development. Understanding the degree to which epigenetic processes relate to early temperamental variations may help inform the etiology of later childhood psychopathological outcomes.
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Affiliation(s)
- Sarah Nazzari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Grumi
- Developmental Psychobiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Villa
- Molecular Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Fabiana Mambretti
- Molecular Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Giacomo Biasucci
- Department of Pediatrics & Neonatology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Lidia Decembrino
- Unità Operativa di Pediatria e Nido, ASST Pavia, Vigevano, Italy
| | | | | | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery & Milan Center for Neuroscience, Università Bicocca, Milan, Italy
| | - Federico Prefumo
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit, Vittore Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, L. Sacco, University of Milan, Milan, Italy
| | - Eleonora Fullone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Roberto Giorda
- Molecular Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Livio Provenzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Developmental Psychobiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
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Dona’ D, Montagnani C, Di Chiara C, Venturini E, Galli L, Lo Vecchio A, Denina M, Olivini N, Bruzzese E, Campana A, Giacchero R, Salvini F, Meini A, Ponzoni M, Trapani S, Rossi E, Lombardi MH, Badolato R, Pierri L, Pruccoli G, Rossin S, Colomba C, Cazzato S, Pacati I, Nicolini G, Pierantoni L, Bianchini S, Krzysztofiak A, Garazzino S, Giaquinto C, Castelli Gattinara G. COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease? Viruses 2022; 14:v14102256. [PMID: 36298812 PMCID: PMC9612333 DOI: 10.3390/v14102256] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
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Affiliation(s)
- Daniele Dona’
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3388946412
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Nicole Olivini
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Campana
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | | | - Filippo Salvini
- Department of Pediatrics, Niguarda Hospital, 20162 Milan, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
| | - Sandra Trapani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | | | - Mary Haywood Lombardi
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
| | - Ilaria Pacati
- Paediatric Unit, Ospedale Bolognini ASST Bergamo Est, 24068 Seriate, Italy
| | | | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, 40138 Bologna, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
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Grumi S, Capelli E, Giacchero R, Anceresi G, Fullone E, Provenzi L, Bensi G, Biasucci G, Cavallini A, Decembrino L, Falcone R, Fazzi E, Gardella B, Longo R, Magnani ML, Nacinovich R, Pantaleo D, Pietra B, Pisoni C, Prefumo F, Scelsa B, Veggiotti P. Exclusive breastfeeding and maternal postnatal anxiety contributed to infants' temperament issues at 6 months of age. Acta Paediatr 2022; 111:1380-1382. [PMID: 35298077 PMCID: PMC9315020 DOI: 10.1111/apa.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Elena Capelli
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | | | - Giorgia Anceresi
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Eleonora Fullone
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
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Provenzi L, Villa M, Mambretti F, Citterio A, Grumi S, Bertazzoli E, Biasucci G, Decembrino L, Gardella B, Giacchero R, Magnani ML, Nacinovich R, Pisoni C, Prefumo F, Orcesi S, Scelsa B, Giorda R, Borgatti R. Is Brain-Derived Neurotropic Factor Methylation Involved in the Association Between Prenatal Stress and Maternal Postnatal Anxiety During the COVID-19 Pandemic? Front Psychiatry 2022; 13:950455. [PMID: 35911240 PMCID: PMC9329563 DOI: 10.3389/fpsyt.2022.950455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is a collective trauma that may expose susceptible individuals to high levels of stress. Pregnant women represent a high-risk population, considering that pregnancy is a period of heightened neuroplasticity and susceptibility to stress through epigenetic mechanisms. Previous studies showed that the methylation status of the BDNF gene is linked with prenatal stress exposure. The goals of this study were (a) to assess the association between pandemic-related stress and postnatal anxiety and (b) to investigate the potential role of maternal BDNF methylation as a significant mediator of this association. METHODS In the present study, we report data on the association among pandemic-related stress during pregnancy, maternal BDNF methylation, and postnatal anxiety symptoms. Pandemic-related stress and postnatal anxiety were assessed through self-report instruments. BDNF methylation was estimated in 11 CpG sites in DNA from mothers' buccal cells. Complete data were available from 108 mothers. RESULTS Results showed that pandemic-related stress was associated with an increased risk of postnatal anxiety, r = 0.20, p < 0.05. CpG-specific BDNF methylation was significantly associated with both prenatal pandemic-related stress, r = 0.21, p < 0.05, and postnatal maternal anxious symptoms, r = 0.25, p = 0.01. Moreover, a complete mediation by the BDNF CpG6 methylation emerged between pandemic-related stress during pregnancy and postnatal maternal anxiety, ACME = 0.66, p < 0.05. CONCLUSION These findings suggest that BDNF epigenetic regulation by pandemic-related stress might contribute to increase the risk of anxiety in mothers. Policymakers should prioritize the promotion of health and wellbeing in pregnant women and mothers during the present healthcare emergency.
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Affiliation(s)
- Livio Provenzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marco Villa
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | | | | | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | | | - Barbara Gardella
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Renata Nacinovich
- ASST Monza, Monza, Italy.,Department of Medicine and Surgery, Università Bicocca, Milan, Italy
| | | | - Federico Prefumo
- ASST Spedali Civili, Brescia, Italy.,Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Roberto Giorda
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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7
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Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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8
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Grumi S, Provenzi L, Accorsi P, Biasucci G, Cavallini A, Decembrino L, Falcone R, Fazzi EM, Gardella B, Giacchero R, Guerini P, Grossi E, Magnani ML, Mariani EM, Nacinovich R, Pantaleo D, Pisoni C, Prefumo F, Sabatini C, Scelsa B, Spartà MV, Spinillo A, Giorda R, Orcesi S, Borgatti R. Depression and Anxiety in Mothers Who Were Pregnant During the COVID-19 Outbreak in Northern Italy: The Role of Pandemic-Related Emotional Stress and Perceived Social Support. Front Psychiatry 2021; 12:716488. [PMID: 34539466 PMCID: PMC8446509 DOI: 10.3389/fpsyt.2021.716488] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
The COVID-19 pandemic is a collective trauma that is threatening citizens' mental health resulting in increased emotional stress, reduced social support, and heightened risk for affective symptoms. The present study aimed to investigate the effects of antenatal pandemic-related emotional stress and perceived social support on the symptoms of depression and anxiety of mothers who were pregnant during the initial COVID-19 outbreak in northern Italy. A sample of 281 mothers was enrolled at eight maternity units in the first hotspot region of the COVID-19 outbreak in northern Italy. Participants filled out online questionnaires assessing the direct or indirect exposure to the SARS-CoV-2 virus, pandemic-related stress, perceived social support, as well as symptoms of depression and anxiety. Depressive and anxious symptomatology was above clinical concern, respectively, in 26 and 32% of the respondents. Mothers who reported no exposure to SARS-CoV-2 during pregnancy and those who reported at least one direct or indirect exposure did not differ in terms of affective symptoms. Continuous scores and risk for severe depression and anxiety were positively associated with prenatal pandemic-related emotional stress and negatively linked with perceived social support during pregnancy. Women who become mothers during the COVID-19 emergency may be at high risk for affective problems. Dedicated preventive programs are needed to provide adequate preventive support and care for maternal mental health during and after the COVID-19 pandemic.
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Patrizia Accorsi
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Anna Cavallini
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | | | | | - Elisa Maria Fazzi
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Paola Guerini
- Pediatric Unit and Neonatal Unit, ASST Pavia, Pavia, Italy
| | - Elena Grossi
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | | | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, Università Bicocca, Milan, Italy
| | - Dario Pantaleo
- Pediatric Unit and Neonatal Unit, ASST Pavia, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Prefumo
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Barbara Scelsa
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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9
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D'Andréa G, Giacchero R, Roger C, Vandersteen C, Guevara N. Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:65-71. [PMID: 34229983 DOI: 10.1016/j.anorl.2021.06.002] [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: 11/25/2022]
Abstract
OBJECTIVES Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability.
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Affiliation(s)
- G D'Andréa
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France.
| | - R Giacchero
- Cabinet de psychothérapie et sophrologie, 40 rue Pastorelli, 06000 Nice, France
| | - C Roger
- Département de Statistiques Médicales, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06100 Nice, France
| | - C Vandersteen
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France
| | - N Guevara
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France
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10
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Garazzino S, Lo Vecchio A, Pierantoni L, Calò Carducci FI, Marchetti F, Meini A, Castagnola E, Vergine G, Donà D, Bosis S, Dodi I, Venturini E, Felici E, Giacchero R, Denina M, Pierri L, Nicolini G, Montagnani C, Krzysztofiak A, Bianchini S, Marabotto C, Tovo PA, Pruccoli G, Lanari M, Villani A, Castelli Gattinara G. Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results From an Italian Multicenter Study. Front Pediatr 2021; 9:649358. [PMID: 33796491 PMCID: PMC8007917 DOI: 10.3389/fped.2021.649358] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. Methods: The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020. Results: As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission (p < 0.01) and linearly to length of stay (p = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications (p < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission (p < 0.05). Conclusions: Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.
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Affiliation(s)
- Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Icilio Dodi
- Emergency and General Pediatric Unit, Pietro Barilla Children's Hospital, Parma, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | | | - Marco Denina
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierri
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | | | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Caterina Marabotto
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | - Pier-Angelo Tovo
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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11
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Provenzi L, Grumi S, Giorda R, Biasucci G, Bonini R, Cavallini A, Decembrino L, Drera B, Falcone R, Fazzi E, Gardella B, Giacchero R, Nacinovich R, Pisoni C, Prefumo F, Scelsa B, Spartà MV, Veggiotti P, Orcesi S, Borgatti R. Measuring the Outcomes of Maternal COVID-19-related Prenatal Exposure (MOM-COPE): study protocol for a multicentric longitudinal project. BMJ Open 2020; 10:e044585. [PMID: 33384402 PMCID: PMC7780424 DOI: 10.1136/bmjopen-2020-044585] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION COVID-19 is a highly infectious respiratory disease that rapidly emerged as an unprecedented epidemic in Europe, with a primary hotspot in Northern Italy during the first months of 2020. Its high infection rate and rapid spread contribute to set the risk for relevant psychological stress in citizens. In this context, mother-infant health is at risk not only because of potential direct exposure to the virus but also due to high levels of stress experienced by mothers from conception to delivery. Prenatal stress exposure associates with less-than-optimal child developmental outcomes, and specific epigenetic mechanisms (eg, DNA methylation) may play a critical role in mediating this programming association. METHODS AND ANALYSIS We present the methodological protocol for a longitudinal, multicentric study on the behavioural and epigenetic effects of COVID-19-related prenatal stress in a cohort of mother-infant dyads in Northern Italy. The dyads will be enrolled at 10 facilities in Northern Italy. Saliva samples will be collected at birth to assess the methylation status of specific genes linked with stress regulation in mothers and newborns. Mothers will provide retrospective data on COVID-19-related stress during pregnancy. At 3, 6 and 12 months, mothers will provide data on child behavioural and socioemotional outcomes, their own psychological status (stress, depressive and anxious symptoms) and coping strategies. At 12 months, infants and mothers will be videotaped during semistructured interaction to assess maternal sensitivity and infant's relational functioning. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER NCT04540029; Pre-results.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute, IRCCS E. Medea, Bosisi Parini, Italy
| | - Giacomo Biasucci
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Renza Bonini
- Pediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Anna Cavallini
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
| | - Lidia Decembrino
- Pediatric Unit and Neonatal Unit, Ospedale Civile di Vigevano, ASST di Pavia, Vigevano, Italy
| | - Bruno Drera
- Neonatal Intensive Care Unit, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Rossana Falcone
- Pediatric Unit and Neonatal Unit, Ospedale Civile di Vigevano, ASST di Pavia, Vigevano, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | | | - Renata Nacinovich
- Child and Adolescent Mental Health, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano Bicocca, Milano, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Scelsa
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milano, Italy
| | | | - Pierangelo Veggiotti
- Unit of Pediatric Neurology, Buzzi Children's Hospital, Milano, Italy
- Biomedical and Clinical Science Department, University of Milano, Milano, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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12
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Parri N, Lenge M, Cantoni B, Arrighini A, Romanengo M, Urbino A, Da Dalt L, Verdoni L, Giacchero R, Lanari M, Musolino AM, Biban P, La Fauci G, Pilotto C, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Zampogna S, Barbieri MA, De Masi S, Agostoni C, Masi S. COVID-19 in 17 Italian Pediatric Emergency Departments. Pediatrics 2020; 146:peds.2020-1235. [PMID: 32968031 DOI: 10.1542/peds.2020-1235] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
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Affiliation(s)
| | - Matteo Lenge
- Clinical Trial Office.,Child Neurology Unit and Laboratories, Neuroscience Department, and.,Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Barbara Cantoni
- Healthcare Professional Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Marta Romanengo
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Gaslini, Genova, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health, Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital and
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Giovanna La Fauci
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Massimo Chiossi
- Department of Pediatrics, Azienda Sanitaria Locale 4 Liguria, Lavagna, Italy
| | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy
| | | | | | | | - Carlo Agostoni
- University of Milan, Milan, Italy; and.,Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center
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13
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Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, Felici E, Urbino A, Da Dalt L, Verdoni L, Armocida B, Covi B, Mariani I, Giacchero R, Musolino AM, Binotti M, Biban P, Fasoli S, Pilotto C, Nicoloso F, Raggi M, Miorin E, Buonsenso D, Chiossi M, Agostiniani R, Plebani A, Barbieri MA, Lanari M, Arrigo S, Zoia E, Lenge M, Masi S, Barbi E, Lazzerini M. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr 2020; 179:1315-1323. [PMID: 32495147 PMCID: PMC7269687 DOI: 10.1007/s00431-020-03683-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known: • There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New: • Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease. • However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | | | | | - Barbara Cantoni
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Arrighini
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Urbino
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Liviana Da Dalt
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
| | - Lucio Verdoni
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Benedetta Armocida
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
| | | | - Chiara Pilotto
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
| | | | | | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Anna Plebani
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
| | | | - Marcello Lanari
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Serena Arrigo
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
| | - Elena Zoia
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
| | - Matteo Lenge
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - on behalf of the CONFIDENCE and COVID-19 Italian Pediatric Study Networks
- Department of Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy
- Department of Pediatrics, Community Pediatrics, Ravenna, Italy
- Department of Pediatrics, Ravenna Hospital, Ravenna, Italy
- Healthcare Professional Department Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
- IRCCS Istituto Gaslini, Genoa, Italy
- Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy
- Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Pediatrics, Lodi Hospital, Lodi, Italy
- Department of Pediatric Emergency Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy
- Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy
- Paediatric Unit, Carlo Poma Hospital, Mantua, Italy
- Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy
- Family Pediatrician, Udine, Italy
- ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy
- Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy
- Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy
- Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy
- Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy
- Department of Pediatrics, Hospital V. Buzzi, Milan, Italy
- Clinical Trial Office, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy
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14
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Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, Bernardi S, Giacchero R, Lo Vecchio A, Marchisio P, Nicolini G, Pierantoni L, Rabbone I, Banderali G, Denina M, Venturini E, Krzysztofiak A, Badolato R, Bianchini S, Galli L, Villani A, Castelli-Gattinara G. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32400362 PMCID: PMC7219028 DOI: 10.2807/1560-7917.es.2020.25.18.2000600] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day–17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.
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Affiliation(s)
- Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Antonella Meini
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Enrico Felici
- Paediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Stefania Bernardi
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | | | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Luca Pierantoni
- Paediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Giuseppe Banderali
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | | | - Raffaele Badolato
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Sonia Bianchini
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Luisa Galli
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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- The members of the Italian SITIP-SIP SARS-CoV-2 paediatric infection study group are listed at the end of this article
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15
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Tripodi V, Caruso A, Luraghi M, Armao FT, Bisagni P, Romano S, Scagnelli P, Giacchero R, Gendarini A, Leoni P. Paediatric gastric trichobezoar: the Rapunzel syndrome A report of two cases. Ann Ital Chir 2020; 9:S2239253X20032442. [PMID: 32161183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rapunzel syndrome is a rare case of bowel obstruction resulting from hair ingestion (Trichobezoar). The obstruction can occur in any level of intestinal tract, but usually the stomach is primary involved. This syndrome is usually reported in patients affected by Trichotillomania or Pica syndrome, an obsessive-compulsive disorder that are characterized by an irresistible need to eat body hairs or non-digestible substances 1. When bowel obstruction occurs, it may be treated conservatively, but sometimes surgery is required. We reported two cases of Rapunzel Syndrome in two pediatric patients with different clinical presentation. Both patients were initially treated conservatively but eventually they underwent surgery. KEY WORDS: Bowel obstruction, Rapunzel syndrome, Trichobezoar.
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16
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Morelli F, Ierardi AM, Pompili G, Sacrini A, Biondetti P, Angileri SA, Montesano G, Petrillo M, Giacchero R, Dionigi G, Carrafiello G. Cooled tip radiofrequency ablation of benign thyroid nodules: preliminary experience with two different devices. Gland Surg 2018; 7:67-79. [PMID: 29770303 DOI: 10.21037/gs.2017.11.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Thyroid nodules are very common in general population. Even if benign, they may require a treatment in case of symptoms or cosmetic concerns. In the last years, minimally invasive treatments alternative to surgery have been developed, in particular ultrasound (US) guided radiofrequency ablation (RFA). Methods Twenty-four patients (9 males; 15 females; mean age 57.9 years) were treated and divided in two groups (A and B) according to the RFA needle used (18 gauge needle, AMICA; 17 gauge needle, COVIDIEN). Nodules and patients characteristics, together with procedural data were registered pre-treatment and at 1-month follow-up. US visibility of the needle, volume of the nodules, symptoms and cosmetic concerns, complications were registered. Results Visibility of the needle was not significantly different in the two groups (P=0.0787). At 1 month the mean volume of the nodules dropped from 37.1 to 25 mL in group A and from 23.2 to 15.4 mL in group B; shrinkage rate (36.9% and 39.5%, respectively) was not significantly different (P=0.3137). Symptoms decreased from 3.1 to 1.4 in group A and from 4 to 1.6 in group B: no significant differences in reductions were observed (P=0.3305). Cosmetic score decreased from 3.7 to 3.4 in group A and from 3.9 to 3.6 in group B: no significant differences in reductions were observed (P=0.96). Total complication rate (18.2% in group A vs. 23.1% in group B) did not showed significant differences (P=0.5049). Conclusions The two systems used in our study resulted equivalent in terms of US needle visibility, efficacy, symptom/cosmetic relief, safety. More patients and a longer follow-up are necessary to confirm our results.
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Affiliation(s)
| | | | | | - Andrea Sacrini
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | | | | | | | - Mario Petrillo
- Department of Radiology, San Paolo Hospital, Milan, Italy.,Curie Diagnostical Medical Center, Cologno Monzese, Italy
| | | | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
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17
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Fabio R, Martino G, Capri T, Giacchero R, Giannatiem S, Antonietti A, La Briola F, Banderali G, Canevini M, Vignoli A. Long Chain Poly-unsaturated Fatty Acid Supplementation in Rett Syndrome: A Randomized Placebo-controlled Trial. ACTA ACUST UNITED AC 2017. [DOI: 10.3923/ajcn.2018.37.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Referral for an assessment of tall stature is less common than for short stature. Tall stature is defined as a height more than two standard deviations above the mean for age. The majority of subjects with tall stature show a familial tall stature or a constitutional advance of growth (CAG), which is a diagnosis of exclusion. After a careful physical evaluation, tall subjects may be divided into two groups: tall subjects with normal appearance and tall subjects with abnormal appearance. In the case of normal appearance, the paediatric endocrinologist will have to evaluate the growth rate. If it is normal for age and sex, the subject may be classified as having familial tall stature, CAG or obese subject, while if the growth rate is increased it is essential to evaluate pubertal status and thyroid status. Tall subjects with abnormal appearance and dysmorphisms can be classified into those with proportionate and disproportionate syndromes. A careful physical examination and an evaluation of growth pattern are required before starting further investigations. Physicians should always search for a pathological cause of tall stature, although the majority of children are healthy and they generally do not need treatment to cease growth progression. The most accepted and effective treatment for an excessive height prediction is inducing puberty early and leading to a complete fusion of the epiphyses and achievement of final height, using testosterone in males and oestrogens in females. Alternatively, the most common surgical procedure for reducing growth is bilateral percutaneous epiphysiodesis of the distal femur and proximal tibia and fibula. This review aims to provide up-to-date information and suggestions about the diagnosis and management of children with tall stature.
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Affiliation(s)
- Cristina Meazza
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy.
| | - Chiara Gertosio
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Sara Pagani
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy
| | - Mauro Bozzola
- Department of Internal Medicine and Therapeutics, Unit of Pediatrics and Adolescentology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Piazzale C. Golgi 19, 27100, Pavia, Italy
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19
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Morelli F, Sacrini A, Pompili G, Borelli A, Panella S, Masu A, De Pasquale L, Giacchero R, Carrafiello G. Microwave ablation for thyroid nodules: a new string to the bow for percutaneous treatments? Gland Surg 2016; 5:553-558. [PMID: 28149799 DOI: 10.21037/gs.2016.12.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Thyroid nodules are a fairly common finding in general population and, even if most of them are benign, a treatment can be however necessary. In the last years, non surgical minimally invasive techniques have been developed to treat this pathology, starting from percutaneous ethanol injection (PEI), to laser ablation (LA), radiofrequency ablation (RFA) and, most recently, microwave ablation (MWA). METHODS We reviewed all medical literature searching in pubmed.gov the terms "microwave" & "thyroid". We found three original studies concerning MWA treatment, for a total of 263 patients (mean age 51.0 years; range, 15-80 years; male to female ratio 2.55) and 522 nodules. RESULTS A total of 522 nodules (338 solid, 22 cystic, 162 mixed) in 263 patients were treated. Studies have shown a mean reduction in volume of thyroid nodules ranging from 45.9% to 65%. No study reported a significant and definitive change in laboratory parameters, except for one case (Heck et al.). No studies have reported major complications after procedure. CONCLUSIONS MWA is a new, promising technique among the minimally invasive treatments of thyroid nodules. Actually, the larger diameter of MW antenna seems to be the major limiting factor in the use of this technique. More studies are necessary to evaluate feasibility, safety and efficacy of the procedure.
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Affiliation(s)
| | - Andrea Sacrini
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | | | - Anna Borelli
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | - Silvia Panella
- Department of Radiology, San Paolo Hospital, Milan, Italy
| | - Annamaria Masu
- Department of Endocrinology, San Paolo Hospital, Milan, Italy
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20
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Verduci E, Lassandro C, Giacchero R, Miniello VL, Banderali G, Radaelli G. Change in Metabolic Profile after 1-Year Nutritional-Behavioral Intervention in Obese Children. Nutrients 2015; 7:10089-99. [PMID: 26633492 PMCID: PMC4690072 DOI: 10.3390/nu7125520] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Research findings are inconsistent about improvement of specific cardio-metabolic variables after lifestyle intervention in obese children. The aim of this trial was to evaluate the effect of a 1-year intervention, based on normocaloric diet and physical activity, on body mass index (BMI), blood lipid profile, glucose metabolism and metabolic syndrome. Eighty-five obese children aged ≥6 years were analyzed. The BMI z-score was calculated. Fasting blood samples were analyzed for lipids, insulin and glucose. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated and insulin resistance was defined as HOMA-IR >3.16. HOMA-β%, quantitative insulin sensitivity check index and triglyceride glucose index were calculated. The metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. At the end of intervention children showed a reduction (mean (95% CI)) in BMI z-score (-0.58 (-0.66; -0.50)), triglycerides (-0.35 (-0.45; -0.25) mmol/L) and triglyceride glucose index (-0.29 (-0.37; -0.21)), and an increase in HDL cholesterol (0.06 (0.01; 0.11) mmol/L). Prevalence of insulin resistance declined from 51.8% to 36.5% and prevalence of metabolic syndrome from 17.1% to 4.9%. Nutritional-behavioral interventions can improve the blood lipid profile and insulin sensitivity in obese children, and possibly provide benefits in terms of metabolic syndrome.
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Affiliation(s)
- Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan, Milan 20142, Italy.
| | - Carlotta Lassandro
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan, Milan 20142, Italy.
- Nutritional Sciences, University of Milano, Milan 20157, Italy.
| | - Roberta Giacchero
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan, Milan 20142, Italy.
| | - Vito Leonardo Miniello
- Department of Pediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari 70126, Italy.
| | - Giuseppe Banderali
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan, Milan 20142, Italy.
| | - Giovanni Radaelli
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan, Milan 20142, Italy.
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21
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Duka E, De Marchi G, Giacchero R, Mangano A, Piantanida E, Tanda MLP, Xiaoli L, Hui S, Makay O, Dionigi G, Carrafiello G. Image-guided thyroid nodule ablation: technical notes and critical appraisal. Surg Technol Int 2014; 25:103-109. [PMID: 25398402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Image-guided thyroid nodule ablation is a relatively new technique for the management of thyroid disease. Notably, if there has been the correct patient selection and if they are performed in high volume centers and via a standardized technique, image-guided thyroid nodule ablation seems to be safe and effective and it can be used to treat thyroid goiters. However, there is still paucity of level 1 evidences and recommendation comparing ablation to surgical or to other non-surgical treatment modalities. Herein, some technical notes for the thyroid nodule ablation to achieve the critical view of safety are presented. Moreover, an additional remark and appraisal from a surgical point of view is described.
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Affiliation(s)
- Ejona Duka
- Department of Surgical Sciences and Human Morphology, Radiology Division University of Insubria (Varese-Como), Varese, Italy
| | - Giuseppe De Marchi
- Department of Surgical Sciences and Human Morphology, Radiology Division University of Insubria (Varese-Como), Varese, Italy
| | | | - Alberto Mangano
- 1st Division of General Surgery, Ospedale di Circolo e Fondazione Macchi-Varese, Research Center for Endocrine Surgery Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy
| | - Eliana Piantanida
- Department of Clinical and Experimental Medicine, Endocrine Unit University of Insubria (Varese-Como), Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Maria Laura Piera Tanda
- Department of Clinical and Experimental Medicine, Endocrine Unit University of Insubria (Varese-Como) Ospedale di Circolo e Fondazione Macchi Varese, Italy
| | - Liu Xiaoli
- Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial, Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China
| | - Sun Hui
- Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial, Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China
| | - Ozer Makay
- Department of General Surgery, Division of Endocrine Surgery Ege University Hospital, Izmir, Turkey
| | - Gianlorenzo Dionigi
- Head 1st Division of General Surgery Ospedale di Circolo e Fondazione Macchi, Varese Head Research Center for Endocrine Surgery, University of Insubria (Varese-Como), Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Gianpaolo Carrafiello
- Chief of Interventional Radiology Unit, Director of Research Center in Interventional Radiology, University of Insubria (Varese-Como) Ospedale di Circolo Fondazione Macchi, Varese, Italy
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22
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De Bernardi IC, Floridi C, Muollo A, Giacchero R, Dionigi GL, Reginelli A, Gatta G, Cantisani V, Grassi R, Brunese L, Carrafiello G. Vascular and interventional radiology radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: literature review. Radiol Med 2014; 119:512-20. [PMID: 24927806 DOI: 10.1007/s11547-014-0411-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 04/30/2014] [Indexed: 02/07/2023]
Abstract
Thermal radiofrequency ablation is a relatively new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. Different recommendations are necessary for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.
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Norsa L, Giacchero R, Labriola F, Vignoli A. Chronic hyponatriemia associated with Rett syndrome. Pediatr Neurol 2014; 50:e1-2. [PMID: 23965174 DOI: 10.1016/j.pediatrneurol.2013.05.001] [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] [Received: 04/27/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Lorenzo Norsa
- Department of Pediatrics, Azienda Ospedaliera San Paolo, Milano, Italy; Università degli Studi di Milano, Milano, Italy.
| | - Roberta Giacchero
- Department of Pediatrics, Azienda Ospedaliera San Paolo, Milano, Italy
| | - Francesca Labriola
- Department of Neurology-Epilepsy Centre, Azienda Ospedaliera San Paolo, Milano, Italy
| | - Aglaia Vignoli
- Department of Neurology-Epilepsy Centre, Azienda Ospedaliera San Paolo, Milano, Italy; Università degli Studi di Milano, Milano, Italy
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24
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Bozzola E, Giacchero R, Barberi S, Borroni G. Sutton's nevus and growth hormone therapy. Minerva Pediatr 2004; 56:349-51. [PMID: 15252384] [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: 04/30/2023]
Abstract
Growth hormone (GH) has been suggested to increase the growth of melanocytic nevi and the risk for melanoma in short children treated with substitutive therapy. On the contrary, in GH deficient patients the influence of GH treatment on the appearance and the long-term evolution of Sutton's nevus, a pigmented melanocytic lesion surrounded by a ring (halo) of depigmentation, that usually and progressively involves the nevus, is debated. The aim of this study was to investigate whether GH therapy causes an accelerated growth of Sutton's nevus. In our study, we evaluated 3 children with GH deficiency sharing Sutton's nevus to investigate the relationship between these melanocytic lesions and growth hormone. In case 1 the appearance of the nevus could be induced by hGH therapy. However, the lesion did not change in shape, colour and size even if he entered puberty during substitutive treatment. Moreover, Sutton's nevus is present in case 2, who is prepuberal and not yet treated with hGH. In case 3 Sutton's nevi occurred during GH treatment and after the onset of puberty, but didn't show any long-term change in both the number and size. No clear influence of both GH therapy and sexual steroids on Sutton's nevi was observed.
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Affiliation(s)
- E Bozzola
- Departmernt of Pediatrics, University of Pavia, Pavia, Italy.
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25
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Solerte SB, Rondanelli M, Giacchero R, Stabile M, Lovati E, Cravello L, Pontiggia B, Vignati G, Ferrari E, Fioravanti M. Serum glucagon concentration and hyperinsulinaemia influence renal haemodynamics and urinary protein loss in normotensive patients with central obesity. Int J Obes (Lond) 1999; 23:997-1003. [PMID: 10490808 DOI: 10.1038/sj.ijo.0801032] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/08/2022]
Abstract
OBJECTIVES Insulin-resistance syndrome and hyperinsulinaemia are linked with cardiovascular disease (CVD) in the obese population. In particular, cardiovascular risk is more frequent in central obesity and is associated with microalbuminuria (MA). MA and changes of glomerular permeability to proteins in obesity might be related with renal haemodynamic modifications (that is glomerular hyperfiltration). Since glucagon is physiologically involved in renal haemodynamic regulation, the purpose of this study was to examine whether changes of circulating glucagon levels might haemodynamically induce MA and proteinuria in patients with central obesity. SUBJECTS Forty normotensive obese out-patients, 22 with central (CO group) and 18 with peripheral (PO group) body fat distribution and 11 healthy subjects. MEASUREMENTS Serum insulin and glucagon concentrations (fasting and after oral glucose tolerance test (OGTT)) by radio immuno assay (RIA); glomerular filtration rate (GFR, isotopic); total clearances and urinary excretion rates of albumin (AER), IgG (IgGER) and alpha1 microglobulin (computerized immunonephelometry). RESULTS GFR and insulin concentrations (fasting and during OGTT) were higher in the CO than the PO group. Fasting glucagon concentrations were increased, and not physiologically suppressed during OGTT in patients with CO (fasting, P<0.05; OGTT 60 and 120 min, P<0.001 vs PO group). Moreover, glucagon concentrations were significantly correlated with GFR in the CO group (fasting, r=0.49, P<0.05; 60 min after OGTT, r=0.58, P<0.01); whereas no correlations were found in the PO group. Higher AER (P<0.001), IgGER (P<0.001) and alpha1 microglobulin (P<0.05) urinary concentrations were found in patients with CO than in the PO group. CONCLUSIONS The increase of serum glucagon concentrations may be associated with the enhancement of GFR in patients with central obesity. Glomerular hyperfiltration might influence the development of MA and of proteinuria by means of a haemodynamic mechanism so contributing to increase the risk of renal microvascular complications and of CVD in central obesity.
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Affiliation(s)
- S B Solerte
- Department of Internal Medicine, School of Endocrinology and Metabolism and Chair of Geriatrics, University of Pavia, Piazza Borromeo 2, 27100 Pavia, Italy.
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d'Annunzio G, Malvezzi F, Vitali L, Barone C, Giacchero R, Klersy C, Zanette S, Lorini R. A 3-19-year follow-up study on diabetic retinopathy in patients diagnosed in childhood and treated with conventional therapy. Diabet Med 1997; 14:951-8. [PMID: 9400919 DOI: 10.1002/(sici)1096-9136(199711)14:11<951::aid-dia490>3.0.co;2-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
Few data are available from follow-up studies on diabetic retinopathy in patients diagnosed with insulin-dependent (Type 1) diabetes mellitus in childhood and treated with conventional therapy. We report the results of conventional insulin therapy on development of diabetic retinopathy in 100 children and adolescents (47 females and 53 males), aged 8.3 +/- 3.5 (1.2-16.4) years at diagnosis of disease. Oral or intravenous fluorescein angiography was performed during a 3-19 year follow-up in all patients. Retinopathy was staged according to the criteria of the Italian Society of Diabetology (SID). During follow-up, retinopathy was observed in 28 patients (28%). At the end of follow-up, retinopathy was present in 23 patients and had disappeared in 5. Life-table analysis showed a median disease-free interval of 10.8 years. At 10 years from diagnosis the percentage of patients free of retinopathy was 66%. Poor metabolic control, age, and degree of pubertal development at diagnosis were the most important risk factors.
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Affiliation(s)
- G d'Annunzio
- Department of Paediatrics, University of Pavia, Italy
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Giacchero R, Verderio M. [Operability of elderly prostatic patients]. Minerva Urol 1971; 23:157-8. [PMID: 5117336] [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: 01/13/2023]
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