Federico Marchetti

1 Frankel S. The origins of waiting lists. In: Frankel S, West R, eds. Rationing and rationality in the National Health Service. London: Macmillan, 1993. 2 Beecham L. BMA chairman criticises erosion of clinical autonomy BMJ 2003;327:8. 3 Gulland A. NHS staff cheat to hit ...

Background Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations. Material and methods A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded. Results ...

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread, becoming the first pandemic of the 21st century by death toll. Children appear to be less affected than adults, with a milder clinical presentation and a significantly lower mortality rate. However, serious complica-tions can occur in childhood, such as COVID-19 temporally related multisystem inflammatory syn-drome (MIS-C). Some aspects of SARS-CoV-2 infection in children and adolescents remain un-clear and the optimal treatment has not been defined. The Working Group on COVID-19 in Paediatrics of the Emilia-Romagna Region (RE-CO-PED) has produced a consensus document with practical recommendations based on a systematic review of the literature and on the clinical experi-ence of the expert group. Evidence is reported regarding prevention measures, diagnostic tools as well as home and hospital therapeutic management of complicated cases (MIS-C). The educational and psychological effects of the pandemic in th...

While continuous antibiotic prophylaxis (CAP) is currently recommended to prevent urinary tract infections (UTIs) in infants with prenatal hydronephrosis (HN), this recommendation is not evidence-based. The objective of this study was to systematically determine whether CAP reduces UTIs in the HN population. Applicable trials were identified through an electronic search of MEDLINE (1946-2015), EMBASE (1980-2016), CINAHL (1982-2016), and CENTRAL (1993-2016) and through a hand search of American Urological Association (AUA) (2012-2015) and European Society for Pediatric Urology (ESPU) (2012-2015) abstracts, as well as reference lists of included trials. The search strategy was not limited by language or year of publication. Eligible studies compared CAP to no CAP in patients with antenatal HN, <2 years of age, and reported development of UTI and HN grades. Two independent reviewers performed title and abstract screening, full-text review, and quality appraisal. Of 1518 citations sc...

Background The spread of knowledge on the important implications of a diagnosis of genetic disease does not correspond to a sharing of the knowledge and equal rights of children. Main body It is estimated that about 5% of newborns may have a rare disease that in some cases, if diagnosed early, could have specific treatments that may be able to modify the natural history of the disease. However, in most countries the diagnosis during the first hours of life is limited to a few diseases, due to the high costs and time required for genetic investigations with classical methods. Recently, experimental projects to subject all newborns to a complete DNA analysis, with Next Generation Sequencing techniques, to detect any genetic pathologies as early as possible, have been reported in some countries. The late diagnosis of some genetic diseases that have treatment plans, such as spinal muscular atrophy, can be a serious damage, for anyone who has seen and accompanied the life of a child with...

In Italy, data concerning the utilization of ceftriaxone in adults and children increased by about 75% from 2001 to 2008. Moreover, a significant variability in its utilization can be observed in the Italian regions, indeed it is more frequently used in the South than in the North of Italy. The data on the overall utilization and the regional variability seem to indicate an inappropriate use of the drug within the territorial medical practice. In particular, ceftriaxone is used in home treatments in 2.4 % of children in paediatric age. Considering that in ambulatory paediatrics just few cases need to be treated with ceftriaxone, this percentage turns out to be very high. Projects aiming at rationalizing the use of drugs that are inappropriately prescribed via parenteral route in the ambulatory setting are urgently needed.

9 off label drugs that are necessary and irreplaceable to treat cardiovascular pathologies in children are legitimized by the paediatric working group of the Italian Medicines Agency (AIFA). Thus, their use is authorized and they can be supplied by the National Health Service. Such drugs belong to the following classes: antiarrthymics, calcium anta- gonists, hypocholesterolemics, hypotensives, peripheral vessel dilators, ACE-inhibitors, beta-blockers, diuretics and sympathicomimetics. RCTs exist for 20 of these drugs; howe- ver, for the remaining 9 consensus articles or guidelines that envisage their utilization for said pathologies in children have been produced.

The European Commission has produced a report on the experience gained in the application of Regulation (EC) No. 1901/2006 concerning medicinal products for paediatric use. Six years after the entry into force of the Regulation, the report describes the stages of its implementation, the results achieved, lessons learned and future prospects, taking into account the fact that, in view of the time required for drug development, not less than ten years will be needed to understand all the repercussions. The paper concludes with a note of optimism showing that: a) the development for paediatric use has become an integral part of the overall process of drug development in the EU; b) new medicines with paediatric indications and dosage forms appropriate to age groups have been approved; c) the large number of approved paediatric investigation plans indicates that other drugs are still being processed.

The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature by hand and computer searches. The resulting profile, from 13 identified studies, was that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids. However, important variables (such as date of surveillance; country; size of involved population; habits; physiopathological and demographic characteristics), differently taken into account in each selected study, made it impossible to construct a comprehensive, detailed, up-to-date picture about drug utilization during pregnancy. The evaluation confirmed the need for and value of systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data obtained in widely differing contexts, times, and methods, in a field where knowledge is often based on sc...

The 4q deletion syndrome shows varying phenotype, ranging from severe and complex malformations, unconformable with life, to more specific findings, as genitourinary, gastrointestinal and cardiac malformations, cleft palate,microcephaly, hypertelorism and abnormal ears and limbs. Strabismus, nystagmus, ophthalmoplegia, and optic nerve anomalies have been rarely described in literature. We report an original case of simultaneous deletion and duplication of chromosome 4q, confirmed by SNPs-array analysis of DNA, and characterized by a previously unreported association between optic nerve hypoplasia and progressive external ophthalmoplegia.

The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960-1988. The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids. However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy. The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.

La riproduzione senza autorizzazione è vietata. Le informazioni di tipo sanitario contenute in questo sito Web sono rivolte a personale medico specializzato e non possono in alcun modo intendersi come riferite al singolo e sostitutive dell'atto medico. Per i casi personali si ...

Summary Fever in young children usually indicates an underlying infection, but identifying the cause can pose a diagnostic challenge. In the absence of guidance, feverish illness is variably assessed and managed by paediatricians. In May 2007, the National Institute for ...

Editor—Changes to the UK General Medi-cal Services (GMS) quality and outcomes framework review include several new therapeutic areas.1 However, although the GMS contract continues to emphasise risk factor management in patients with coro-nary heart disease, stroke, or ...

... Noi italiani poi non ab-biamo neanche idea delle arachidi e noccioline in un bambi-no prima dei 2-3 anni, figuriamoci entro il primo anno di ... I tagli si capiscono; ma sarà forse dura, poi, sopportarli, se è vero come è vero che il SSN è un potente am-mortizzatore sociale, per gli ...

ABSTRACT Background Many drugs currently on the market have no specific authorisation for use in children and are used outside the licensed indications (off-label use). Off-label use might be associated with an increased risk of adverse drug reactions (ADRs), therefore it is important to implement monitor it in order to provide more careful clinical surveillance of prescriptions. An online database could offer an active network of off-label drugs pharmacovigilance, helping paediatricians and hospital pharmacists in prescribing, assessment of efficacy, follow-up and collection of ADRs. Purpose To create an Italian online network and offer it to hospital pharmacists collaborating with paediatricians, so that they may share optimal off-label prescription practice and monitor possible adverse drug reactions. Materials and methods The project examined all off-label prescriptions and follow-ups of children aged 0–18 years in regional paediatric departments participating in a web-based Friuli-Venezia Giulia Italian region network developed in Hypertext Preprocessor (PHP), based on open-source tools. Physicians create an online prescription for each new patient, referencing the literature that supports the off-label use, recording the follow-up, and reporting any adverse reactions. The hospital pharmacist examines each off-label prescription in detail, and updates the relative off-label archive, integrating and reviewing literature references, and recording dispensing data of prescribed medications (date, amount and costs). Results We started to set up the Regional Pharmacovigilance Network in March 2013 and it is now almost ready to be used. Conclusions: If pharmacists and paediatricians cooperate successfully in this project, it will allow more complete and thorough monitoring of off-label treatment, to better protect paediatric patients’ health.

Objective - To review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children. Methods - A literature search using “appendicitis” and “antibiotics” as key words and restricting target population to children (0-18) was carried out. Selected studies were analyzed to find answers to the following questions: 1) Should perioperative antibiotics be used for paediatric patients with nonperforated appendicitis? 2) Which perioperative antibiotic should be chosen? 3) Is it possible to treat children with nonperforated appendicitis with antibiotics solely? 4) For patients with perforated appendicitis treated with appendicectomy: a) Which intravenous antibiotics should be used? b) How long should intravenous antibiotics be used? c) Is it possible to shift to oral drugs? Results - Children with nonperforated appendicitis must receive preoperative, broad-spectrum antibiotics, even if there is no univocal evidence about which regimen is the best. The sole...