Ferrara, Italy


Ferrara, Italy
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Da Costa A.D.P.V.,Federal University of Pernambuco | Da Costa A.D.P.V.,Institute Medicina Integral Professor Fernando Figueira IMIP | Da Silva G.A.P.,Pediatria | Da Silva G.A.P.,Federal University of Pernambuco
Jornal de Pediatria | Year: 2011

Objective: To describe the management of acute diarrhea in emergency departments with emphasis on the type of hydration and exploring factors associated with prescription of oral rehydration therapy vs. intravenous rehydration therapy for children with dehydration that is not severe. Methods: This was a descriptive study conducted from January to May of 2008 observing case management of children with non-severe dehydration due to acute diarrhea at two emergency units (A and B) in Recife, Brazil. Emergency unit B is affiliated to a teaching hospital. The primary variables were: 1) type of hydration prescribed, 2) associations with the characteristics of the children and emergency department (A or B). Results: A total of 166 children took part in the study. The rates of prescription of oral rehydration therapy were similar at both services (32.2 vs. 31.6% for A and B, respectively, p = 0.93) and were lower for cases with moderate dehydration (17.6%) compared with mild dehydration (35.6%) (p = 0.07). Neither service had a dedicated oral rehydration room. Conclusions: Most children were given intravenous rehydration therapy, especially those with moderate dehydration, without differences according type of service: whether a teaching institution or healthcare provider only. Copyright © 2011 by Sociedade Brasileira de Pediatria.

Caffarelli C.,University of Parma | Baldi F.,UO di Pediatria | Marani M.,Pediatria | Pasquinelli P.,UO Pediatria
Italian Journal of Pediatrics | Year: 2010

A joint study group on cow's milk allergy was convened by the Emilia-Romagna Working Group for Paediatric Allergy and by the Emilia-Romagna Working Group for Paediatric Gastroenterology to focus best practice for diagnosis, management and follow-up of cow's milk allergy in children and to offer a common approach for allergologists, gastroenterologists, general paediatricians and primary care physicians. The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas. Cow's milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough, vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis. Late reactions due to cow's milk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy. An overview of acceptable means for diagnosis is included. According to symptoms and infant diet, three different algorithms for diagnosis and follow-up have been suggested. © 2010 Caffarelli et al; licensee BioMed Central Ltd.

Casale M.,Cardarelli Hospital | Casale M.,The Second University of Naples | Meloni A.,CNR Institute of Neuroscience | Filosa A.,Cardarelli Hospital | And 17 more authors.
Circulation: Cardiovascular Imaging | Year: 2015

Background - Cardiovascular magnetic resonance (CMR) plays a key role in the management of thalassemia major patients, but few data are available in pediatric population. This study aims at a retrospective multiparametric CMR assessment of myocardial iron overload, function, and fibrosis in a cohort of pediatric thalassemia major patients. Methods and Results - We studied 107 pediatric thalassemia major patients (61 boys, median age 14.4 years). Myocardial and liver iron overload were measured by T2∗ multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. All scans were performed without sedation. The 21.4% of the patients showed a significant myocardial iron overload correlated with lower compliance to chelation therapy (P<0.013). Serum ferritin ≥2000 ng/mL and liver iron concentration ≥14 mg/g/dw were detected as the best threshold for predicting cardiac iron overload (P=0.001 and P<0.0001, respectively). A homogeneous pattern of myocardial iron overload was associated with a negative cardiac remodeling and significant higher liver iron concentration (P<0.0001). Myocardial fibrosis by late gadolinium enhancement was detected in 15.8% of the patients (youngest children 13 years old). It was correlated with significant lower heart T2∗ values (P=0.022) and negative cardiac remodeling indexes. A pathological magnetic resonance imaging liver iron concentration was found in the 77.6% of the patients. Conclusions - Cardiac damage detectable by a multiparametric CMR approach can occur early in thalassemia major patients. So, the first T2∗ CMR assessment should be performed as early as feasible without sedation to tailor the chelation treatment. Conversely, late gadolinium enhancement CMR should be postponed in the teenager age. © 2015 American Heart Association, Inc.

Martin-Gordo O.,Medicina de Familia y Comunitaria | Aguero-Orgaz D.,Medicina de Familia y Comunitaria | Cubero-Sobrados C.,Pediatria
Semergen | Year: 2010

Localized scleroderma is a benign and chronic disease of the connective tissue characterized by the presence of skin thickening. Its cause is unknown. It has several presentation forms. The lesions may be located on any part of the body, but they are more frequent on the truck.We present the clinical case of a 39-year-old female patient with skin plaques consistent with localized scleroderma. © 2009 Elsevier España, S.L. y SEMERGEN.

Franco A.C.B.F.,Centro Universitario Lusiada | Torrico A.C.,Centro Universitario Lusiada | Moreira F.T.,Centro Universitario Lusiada | Sa F.P.,Pediatria | And 2 more authors.
Jornal de Pediatria | Year: 2012

Objective: To evaluate whether intravenous immunoglobulin reduces mortality and length of hospital stay in the treatment of neonatal sepsis. Sources: The MEDLINE database was searched. The keywords were combined using the following search strategy: [(sepsis OR shock, septic OR infection) AND immunoglobulins, intravenous] AND infant, newborn. Only randomized clinical trials (RCTs) showing good methodological quality and assessing the effect of adjuvant intravenous immunoglobulin in the treatment of neonatal sepsis were selected for inclusion and data analysis. Summary of the findings: Seven RCTs were selected. All of them evaluated the mortality rate, including 3,756 patients. The global effect of this outcome showed no statistically significant difference between the groups. Only five studies evaluated the mean length of hospital stay, including 3,672 patients. Although there is a statistically significant reduction of 1.24 days in the length of hospital stay with the use of intravenous immunoglobulin, such difference is clinically irrelevant and its high cost does not warrant its routine use in medical practice. The data reported in the present review contradict the review by Ohlsson et al., which was updated in 2010 and showed significant benefit with the use of intravenous immunoglobulin on both outcomes. Conclusions: We concluded that the use of adjuvant intravenous immunoglobulin shows no benefit regarding mortality, whereas the reduction in the length of hospital stay is irrelevant. Copyright © by Sociedade Brasileira de Pediatria.

Lopez-Villalobos J.A.,Hospital San Telmo | Serrano-Pintado I.,University of Salamanca | Andres-De Llano J.M.,Servicio de Pediatria | Sanchez-Mateos J.D.,University of Salamanca | And 2 more authors.
Revista de Neurologia | Year: 2010

Aims. The aim of this study is to analyse the differences in the Stroop effect between cases with attention deficit hyperactivity disorder (ADHD) and controls. It also seeks to find the best model based on the third task of the colours and words test (Stroop-CW) for predicting ADHD and to analyse the validity of the Stroop-CW test for diagnosing the disorder. Subjects and methods. The sample studied consisted of 100 cases of ADHD -according to Diagnostic and statistical manual of mental disorders (DSM-IV) criteria- and 100 controls, between 7 and 11 years of age, who were evaluated using the Stroop test. The controls were recruited at random and paired by age, sex and sociodemographic area with the cases. Results. The cases present a mean cognitive style that is significantly less flexible (d = -1.06) and they also display a lower capacity to inhibit or control automatic responses than the controls at all ages (7 years: d = 1.67; 8 years: d = 1.02; 9 years: d = 1.32; 10 years: d = 2.04; 11 years: d = 0.89). The model of logistic regression analysis that best predicts ADHD is made up of age and Stroop-CW. The formulation derived from the model offers a sensitivity of 81% and a specificity of 72%, taking the criteria of the DSM-IV for ADHD as the reference test. Conclusions. The Stroop-CW test presents usefulness and complementary criteria validity for the diagnosis of ADHD. © 2010 Revista de Neurología.

PubMed | Centro Of Salute Globale, University of Florence, Pediatria and University of Barcelona
Type: Journal Article | Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology | Year: 2016

In Europe the management of neurocysticercosis (NCC) is challenging because health care providers are unaware of this condition, thus leading to diagnostic delay and mismanagement. The aim of this study is to retrospectively review the cases of NCC observed in five centers located in Florence, Negrar (Italy) and Barcelona (Spain). A total of 81 subjects with NCC were evaluated in the period 1980-2013. By applying the Del Bruttos criteria 39 cases (48.1%) were classified as definitive cases, 31 (38.8%) as probable cases and 11 (13.6%) did not satisfy the diagnostic criteria. Continent of origin was known for 80 subjects. Latin America and Asia were the most frequent continents of origin (n=37; 46.3% and n=22; 27.5%) followed by Europe (n=14; 17.5%) and Africa (n=7; 8.8%). Compared with adults, paediatric patients were more likely to have eosinophilia, to have other parasitic infections, to be asymptomatic, to not be treated with antiepileptic drugs or analgesic and to heal. The study shows that there are some hurdles in the management of NCC in Europe. A not negligible portion of patients diagnosed at reference centers do not fully satisfy Del Bruttos diagnostic criteria. The higher portion of asymptomatic subjects found among the paediatric group is probably related to an ongoing serological screening among adopted children coming from endemic regions. The value of such a serological screening should be better assessed by a further cost-effective analysis.

PubMed | Anestesia e Rianimazione Pediatrica, Laboratorio Of Microbiologia, Marche Polytechnic University and Pediatria
Type: | Journal: BMC infectious diseases | Year: 2016

Although Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period.A retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patients medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints.Of 270 patients diagnosed with Candida BSIs during the study period, 63 (23%) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30days was 27% (17/63), which was significantly lower than that reported for C. albicans BSIs (42% [61/146], p=0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015-21.080], p=0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102-0.874], p=0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection.Candidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30days. An early CVC removal is associated with a significant reduced mortality.

PubMed | Hospital Universitario La Paz, University of Barcelona, Hospital Infantil Universitario Nino Jesus, Hospital Regional Universitario Carlos Haya and 8 more.
Type: Journal Article | Journal: Anales de pediatria (Barcelona, Spain : 2003) | Year: 2016

Infantile haemangiomas are benign tumours produced by the proliferation of endothelial cells of blood vessels, with a high incidence in children under the age of one year (4-10%). It is estimated that 12% of them require treatment. This treatment must be administered according to clinical practice guidelines, expert experience, patient characteristics and parent preferences.The consensus process was performed by using scientific evidence on the diagnosis and treatment of infantile haemangiomas, culled from a systematic review of the literature, together with specialist expert opinions. The recommendations issued were validated by the specialists, who also provided their level of agreement.This document contains recommendations on the classification, associations, complications, diagnosis, treatment, and follow-up of patients with infantile haemangioma. It also includes action algorithms, and addresses multidisciplinary management and referral criteria between the different specialities involved in the clinical management of this type of patient.The recommendations and the diagnostic and therapeutic algorithms of infantile haemangiomas contained in this document are a useful tool for the proper management of these patients.

PubMed | OXON Epidemiology, Pediatria, University of the Basque Country, Instituto Hispalense Of Pediatria and Sanofi S.A.
Type: Journal Article | Journal: BMC infectious diseases | Year: 2016

Rotavirus is acknowledged as an important cause of paediatric gastroenteritis worldwide. In Spain, comprehensive data on the burden of rotavirus disease was lacking.A prospective, multicenter, observational study was carried out, during the winter season, from October to April 2014 in selected areas of Spain (Catalonia, Basque Country, Andalusia) to estimate the frequency and characteristics of acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) in children 3years of age seeking medical care in primary care and emergency department centres.Of the 1087 episodes of AGE registered, 33.89% were RVGE positive. The estimated incidence of RVGE, was 40.3 (95% CI 36.1-44.8) episodes per 10,000 child-months in children3years of age and the 5-month (December-April) seasonal RVGE incidence rate was 2.01 [1.81-2.24] per 100 children. No vaccination and attending a day care centre were the main risk factors for RV infection. RVGE infected children presented more frequently with fever (63.9% vs. 45.1%, p=0.009), vomiting (61.2% vs. 44.3%, p=0.015), suffered more dehydration, and were hospitalised and went to the emergency room more often (41.7% vs. 15.7%, p <0.001) than non-RVGE infected ones. Children were usually more tired (77.5% vs. 54.2%, p <0.001), tearful, (47.2% vs. 34.8%, p <0.001), and easily irritated (76.5% vs. 59.8%, p <0.001), and parents were more concerned (41.7% vs. 15.7%, p <0.001) and suffered more working rhythm disturbances (39.0% vs. 22.9%, p <0.001). The cost for families of RVGE cases was significantly higher than the cost of non-RVGE infected ones (47.3 vs 36.7 euros, p=0.011). Vaccinated children suffered less clinical symptoms and no hospitalization. Therefore, vaccination decreases the psychosocial stressors caused by the disease in the family.Rotavirus infections are responsible for a substantial proportion of AGE cases in children 3years of age in Spain attended at primary care visits. RVGE episodes are associated with greater clinical severity, greater alterations in the childs behaviour, and higher parental distress. The outcomes of the present study recommend that routine rotavirus vaccination in infants 3years of age could considerably reduce the serious burden of this potentially serious childhood disease.

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