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Fantacci C, Fabrizio GC, Ferrara P, Franceschi F, Chiaretti A. Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room. Eur Rev Med Pharmacol Sci 2019; 22:217-222. [PMID: 29364490 DOI: 10.26355/eurrev_201801_14120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain relief is a very important aspect in Pediatrician's clinical practice. It is often thought that young children, particularly infants, do not perceive as much pain as adults because of their immature nervous system and that untreated pain would not have adverse long-term consequences. Instead, it has been demonstrated that infants and children experience pain in a similar manner to adults. Many factors, particularly emotional factors, can increase the child's pain perception. Children live with anxiety even minor procedures. This suggests the need for an adequate sedation and the way of sedation should be free of pain itself. We believe the route to be followed may be the intranasal (IN) administration of sedative drugs. MATERIALS AND METHODS We have conducted a brief review of the literature by Pubmed about the most commonly used sedative drugs: sufentanyl, fentanyl, midazolam, ketamine, nitrous oxide and dexmedetomidine. We have investigated in the literature the type of administration of IN drugs: drop instillation or by a mucosal atomizer device (MAD). RESULTS In our study, it was noted that IN drugs administration is an effective and safe method to reduce anxiety and to deliver analgesia because it is practical and non-invasive. Moreover, therapeutic levels of sedatives are low due to the presence of a rich vascular plexus in the nasal cavity, which communicates with the subarachnoid space via the olfactory nerve and reduce the time of medication delivery, that is, the onset of action. The use of MAD even gives as better bioavailability of drugs. CONCLUSIONS IN sedation via MAD is effective and safe and should be one of the first choices for procedural sedation in children.
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Affiliation(s)
- C Fantacci
- Department of Pediatrics, Catholic University of The Sacred Heart, School of Medicine Gemelli Hospital Foundation, Rome, Italy.
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Miceli Sopo S, Bersani G, Fantacci C, Romano A, Monaco S. Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress? Allergol Immunopathol (Madr) 2018; 46:607-611. [PMID: 29456036 DOI: 10.1016/j.aller.2017.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 11/15/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.
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Affiliation(s)
- S Miceli Sopo
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy.
| | - G Bersani
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - C Fantacci
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - A Romano
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - S Monaco
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
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Miceli Sopo S, Fantacci C, Bersani G, Romano A, Liotti L, Monaco S. Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy? Allergol Immunopathol (Madr) 2018; 46:499-502. [PMID: 29472022 DOI: 10.1016/j.aller.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view.
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Miceli Sopo S, Fantacci C, Bersani G, Romano A, Monaco S. Loss of tolerance for fishes previously tolerated in children with fish food protein induced enterocolitis syndrome. Allergol Immunopathol (Madr) 2018; 46:394-396. [PMID: 29338963 DOI: 10.1016/j.aller.2017.09.029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Abstract
We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish.
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Affiliation(s)
- S Miceli Sopo
- Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy.
| | - C Fantacci
- Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - G Bersani
- Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - A Romano
- Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - S Monaco
- Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
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Fantacci C, Ferrara P, Franceschi F, Chiaretti A. Pneumopericardium, pneumomediastinum, and pneumorrachis complicating acute respiratory syncytial virus bronchiolitis in children. Eur Rev Med Pharmacol Sci 2017; 21:3465-3468. [PMID: 28829494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We report 2 children with Respiratory Syncytial Virus (RSV) infection complicated with spontaneous pneumopericardium (PP) and pneumomediastinum (PM), one also associated with pneumorrhachis (PR). PATIENTS AND METHODS Two previously healthy children presented with fever, violent dry cough, dyspnea, and tachypnea. Chest X-ray and CT scans showed sizeable PP and PM in both patients. One of them also presented PR. Children were initially treated with intravenous antibiotics, antipyretics, and a cough sedative. Because of worsening of respiratory distress syndrome, children underwent helmet-delivered CPAP with oxygen supplementation. The patients' clinical conditions quickly improved and they were discharged in good conditions. RESULTS Pathogenetic mechanism of spontaneous PP and PM complicating RSV infection could be related to the cough, causing intrathoracic pressure increase and rupture of alveoli near the mediastinal pleura. Nevertheless, RSV seems to play a role in facilitating such complications, attenuating the cough threshold in infected children. CONCLUSIONS RSV bronchiolitis can lead respiratory and systemic consequences, so their prompt recognition is essential to establish a fast and adequate therapy, especially control of cough and respiratory distress syndrome treatment.
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Affiliation(s)
- C Fantacci
- Department of Pediatrics, Institute of Internal Medicine; Gemelli Fundation, Medical School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Paris G, Graziano L, Perelli T, Giacomodonato B, De Marchis M, Fantacci C, Bonci E. 264 Occupational therapy to motivate adherence to nebulized therapy among children with cystic fibrosis: a token economy intervention. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fundarò C, Filoni S, Giorgio V, Calabrese V, Monaco S, Onesimo R, Fantacci C, Molle F, Calandrelli R. An unusual case of neonatal cholestasis. Minerva Pediatr 2013; 65:97-101. [PMID: 23422579] [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: 06/01/2023]
Abstract
Septo-optic dysplasia (SOD), otherwise called De Morsier syndrome, is a developmental anomaly of mid-line brain structures and includes optic nerve hypoplasia, absence of the septum pellucidum and hypothalamo-pituitary abnormalities). In literature an association between optic nerve hypoplasia and neonatal cholestasis is described. We report the case of a female infant with persistent cholestasis, low weight gain and onset of nystagmus that appeared at one month and a half of life. Ophthalmology evaluation showed left optic nerve hypoplasia. MRI scan of the brain demonstrated a thin left optic nerve, an ectoptic posterior pituitary gland, no visible infundibulum and lack of septum pellucidum. Endocrinological investigation showed GH and ACTH deficiency. We discuss about diagnosis and pathogenesis of De Morsier syndrome with a brief review of the literature.
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Affiliation(s)
- C Fundarò
- Pediatric Department, Sacro Cuore Catholic University, Gemelli Hospital, Rome, Italy.
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Fundarò C, Fantacci C, Ansuini V, Giorgio V, Filoni S, Barbaro F, Gasbarrini A, Rossi C. Fecal calprotectin concentration in children affected by SIBO. Eur Rev Med Pharmacol Sci 2011; 15:1328-1335. [PMID: 22195368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Calprotectin is a protein especially expressed in neutrophil cytosol. In the last few years, Fecal calprotectin (FC) turned out to be a direct marker of gastrointestinal inflammation. Because of the simplicity of the method, it has been studied in several gastroenterologic diseases but no data are available about its concentration in children with small intestinal bacterial overgrowth (SIBO), a complex and not well known condition defined by an excessive germs proliferation, especially anaerobic, in the small bowel, and characterized by dyspeptic and malabsorption symptoms. The aim of this study was to evaluate FC values in children with SIBO, comparing to healthy subjects, in order to clarify if an inflammatory process coexists with SIBO. MATERIALS AND METHODS We enrolled fifty-eight children affected by SIBO, as diagnosed by Lactulose Breath Test (LBT). They were assessed for FC values on stool samples. We compared them with a control population of 60 healthy children. RESULTS In SIBO patients, a median value of 36.0 mg/kg and a mean value +/- SD of 43.0 +/- 31.6 mg/kg were calculated, while in healthy controls the median value was 29.5 mg/kg and the mean value +/- SD was 35.7 +/- 20.7 mg/kg, showing no statistically significant differences between the two groups (p = 0.07). CONCLUSIONS FC values are negative in children affected by SIBO, not differing from those obtained in healthy children, suggesting that no subclinical intestinal inflammation involving neutrophils occurs in patients with higher proliferation of bacteria in the small bowel. The presence of high FC levels in children affected by SIBO might not be caused by bacterial overgrowth itself and, in this case, another cause should be investigated.
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Affiliation(s)
- C Fundarò
- Department of Pediatric, School of Medicine, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy
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Adami-Lami Conti C, Corti P, Aulisi A, Nistri R, Fantacci C, Calandi C. [Cleidocranial dysostosis: a clinicoradiologic study of 2 sisters]. Radiol Med 1980; 66:713-5. [PMID: 7221032] [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: 01/24/2023]
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Calandi C, Fantacci C, Adami Lami Conti C, Redi Orienti M, De Martino M, Vierucci A. [Cellular immunity deficiency and chemotaxis deficiency in children with rheumatoid arthritis]. Ann Sclavo 1980; 22:846-56. [PMID: 6973957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Some immunological parameters have been examined in eleven children with juvenile rheumatoid arthritis. A quantitative and functional defect in T lymphocytes has been observed associated with defective chemotaxis of neutrophils. High levels of circulating immune-complexes were detected in sera of 5 out 11 patients. 1 patient showed high levels of antinuclear antibodies and positivity for the rheumatoid factor. Immunological pathogenesis of juvenile rheumatoid arthritis is discussed.
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Calandi C, Fantacci C, Mannori C, Cividalli S, Martinucci EM. [Intrahepatic cholestasis due to ductular hypopolasia. Description of a case associated with multiple malformations]. Minerva Pediatr 1979; 31:1357-62. [PMID: 120933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Calandi C, Adami Lami Conti C, Fantacci C, Guazzelli C, Martinucci EM, Nistri R. [Chronic bronchopneumopathy and idiopathic pulmonary hemosiderosis]. Minerva Pediatr 1979; 31:855-62. [PMID: 470867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Calandi C, Adami Lami Conti C, Emanuele G, Fantacci C, Zammarchi E, Martinucci EM. [Cystinosis. Description of a case with hyperaldosteronism]. Minerva Pediatr 1978; 30:1611-20. [PMID: 360032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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