The Authors describe two cases of theophylline poisoning and discuss advantages of activated char... more The Authors describe two cases of theophylline poisoning and discuss advantages of activated charcoal and magnesium hydroxide therapy. This treatment seems to be better in patients for whom hemoperfusion could be delayed. In fact, activated charcoal can determine a real decrease in serum theophylline as experimental data show. Patients who overdose with slow release theophylline preparation should receive multiple oral doses of activated charcoal; they should also receive multiple oral doses of cathartic, both saline or sorbitol like. There is a lack of references about the activated charcoal plus magnesium hydroxide regimen particularly in childhood. The Authors discuss their own experience.
ABSTRACT To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE... more ABSTRACT To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE (Ap-parent Life Threatening Event) episode may discover cardiovascular disease in the newborn. In-troduction: In the first year of life ALTEs concern 0.8% of access to Pediatric Emergency Depart-ment. The cause of apparent life-threatening events (ALTEs) in infants reflects a differential diag-nosis that includes an array of congenital or acquired disorders. Approximately 10% -25% of ap-parent life-threatening events may remain unexplained following a thorough evaluation. Case re-port: B. E., a 2-month-old child, in wellbeing, shortly before meal, during sleep, was not responsive to repeated stimulations; he was hypotonic and unresponsive. About 15 minutes later, he pre-sented a normal tone and state of consciousness. Evaluating the referred symptoms, diagnostic protocol for ALTE was started; the Angio-MRI brain performed as second line analysis showed a focal gliotic lesion at left striatal area. The cardiological evaluation with echocardiography de-tected a pervium foramen ovale (PFO), with minimum shunt left-right direction. At least, biohu-moral tests revealed protrombin gene heterozygosis mutation. Conclusion: Apparent Life-Threat-ening Events are first manifestation of stroke in infant. Discussion: This report discloses how the multidisciplinary clinical approach is essential in ALTE. The exact management of ALTE patients is very important in situations like this, when the concomitant disease is rare. In fact, arterial stroke incidence in children > 28 days of life is estimated between 1.2 and 7.9 cases/100,000 child-ren/year. However, in the last 20 years, we observed an increased incidence of stroke, probably related to two main causes: a greater attention for this disease and a major survival of children with pathology that arrange for stroke thanks to a better prevention. In conclusion, it's a funda-A. Palmieri 63 mental multidisciplinary approach even in following months after the events.
ABSTRACT Traditional medical records have been oriented toward drug monitoring by adding a sectio... more ABSTRACT Traditional medical records have been oriented toward drug monitoring by adding a section which lists the drugs and adverse events referred to in the progress notes while respecting their temporal sequence. Simple identification and correlation codes allow the indications for the use of drugs and the diagnostic attribution of all of the adverse events experienced by a patient since the beginning of hospital treatment to be deduced. A file created from drug monitoring-oriented medical records can be used to study prescribing habits and for drug safety monitoring. For drug surveillance purposes, it is possible to apply both the adverse drug reaction reporting system based on doctors' suspicions, as well as the event reporting system which records all adverse events regardless of doctors' suspicions as to their cause.
The medical record for hospitalized patients has been modified in order to orient it towards two ... more The medical record for hospitalized patients has been modified in order to orient it towards two types of surveillance: adverse drug reactions (ADRs) and the quality of medical care. The modification consists of an adaptation of the progress notes; the transfer of the information to a special database is facilitated by the use of a simple system of codes that identify and correlate the items necessary for surveillance purposes. During the 6 months of observation of the 1103 pediatric patients included in the study, 35 clinically important suspected ADRs were noted by physicians. For the quality of medical care surveillance, all drug prescriptions were evaluated and areas in which to intervene in order to improve the appropriateness of prescriptions were identified. Quality surveillance was also extended to the monitoring of 'unexplained' adverse events for which no particular cause was attributable. We consider it advantageous to carry out these two types of surveillance simultaneously because they require many common items of information. The use of an oriented medical record as a source of data makes it possible to integrate surveillance with everyday ward activities.
Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 y... more Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 years old and a major cause of access to the emergency department. Even if several drugs may be able to reduce the emesis, the pharmacological treatment of vomiting in children remains a controversial issue, and several drugs are prescribed outside their authorized drug label with respect dosage, age, indication, or route of administration and are named as off-label. The aim of present study was to assess the off-label use of antiemetic drugs in patients less than 18 years with vomiting related to AG. This study was carried out in eight pediatric emergency departments in Italy. The following data were obtained crossing the pharmacy distribution records with emergency departments' patient data: sex and age of the patients and detailed information for each drug used (indication, dose, frequency, and route of administration). We recorded that antiemetic drugs were prescribed in every year, particularly in children up to 2 years old, and compared with both literature data and data sheet; 30 % of the administered antiemetics were used off-label. In particular, domperidone was the only antiemetic used labeled for AG treatment in pediatric patients, while metoclopramide and ondansetron have been off-label for both age and indications (i.e., AG treatment). In conclusion, we documented an off-label use of antiemetics in children, and this could represents a problem of safety for the patient and a legal risk for the prescribing physician if patients have an unwanted or bad outcome from treatment.
Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous s... more Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous system (CNS) infections similar to enterovirus (EVs) meningoencephalitis in the neonatal period, resulting in white matter lesions that can be visualized with cranial ultrasonography and magnetic resonance imaging, and correlated to a large spectrum of neurological outcomes. HPeV should be suspected in neonates with signs and symptoms of sepsis-like illness or CNS disease. We report a case of neonatal HPeV encephalitis, diagnosed on the basis of clinical and radiological findings and HPeV RT-PCR, with a good neurological outcome.
The Authors describe two cases of theophylline poisoning and discuss advantages of activated char... more The Authors describe two cases of theophylline poisoning and discuss advantages of activated charcoal and magnesium hydroxide therapy. This treatment seems to be better in patients for whom hemoperfusion could be delayed. In fact, activated charcoal can determine a real decrease in serum theophylline as experimental data show. Patients who overdose with slow release theophylline preparation should receive multiple oral doses of activated charcoal; they should also receive multiple oral doses of cathartic, both saline or sorbitol like. There is a lack of references about the activated charcoal plus magnesium hydroxide regimen particularly in childhood. The Authors discuss their own experience.
ABSTRACT To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE... more ABSTRACT To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE (Ap-parent Life Threatening Event) episode may discover cardiovascular disease in the newborn. In-troduction: In the first year of life ALTEs concern 0.8% of access to Pediatric Emergency Depart-ment. The cause of apparent life-threatening events (ALTEs) in infants reflects a differential diag-nosis that includes an array of congenital or acquired disorders. Approximately 10% -25% of ap-parent life-threatening events may remain unexplained following a thorough evaluation. Case re-port: B. E., a 2-month-old child, in wellbeing, shortly before meal, during sleep, was not responsive to repeated stimulations; he was hypotonic and unresponsive. About 15 minutes later, he pre-sented a normal tone and state of consciousness. Evaluating the referred symptoms, diagnostic protocol for ALTE was started; the Angio-MRI brain performed as second line analysis showed a focal gliotic lesion at left striatal area. The cardiological evaluation with echocardiography de-tected a pervium foramen ovale (PFO), with minimum shunt left-right direction. At least, biohu-moral tests revealed protrombin gene heterozygosis mutation. Conclusion: Apparent Life-Threat-ening Events are first manifestation of stroke in infant. Discussion: This report discloses how the multidisciplinary clinical approach is essential in ALTE. The exact management of ALTE patients is very important in situations like this, when the concomitant disease is rare. In fact, arterial stroke incidence in children > 28 days of life is estimated between 1.2 and 7.9 cases/100,000 child-ren/year. However, in the last 20 years, we observed an increased incidence of stroke, probably related to two main causes: a greater attention for this disease and a major survival of children with pathology that arrange for stroke thanks to a better prevention. In conclusion, it's a funda-A. Palmieri 63 mental multidisciplinary approach even in following months after the events.
ABSTRACT Traditional medical records have been oriented toward drug monitoring by adding a sectio... more ABSTRACT Traditional medical records have been oriented toward drug monitoring by adding a section which lists the drugs and adverse events referred to in the progress notes while respecting their temporal sequence. Simple identification and correlation codes allow the indications for the use of drugs and the diagnostic attribution of all of the adverse events experienced by a patient since the beginning of hospital treatment to be deduced. A file created from drug monitoring-oriented medical records can be used to study prescribing habits and for drug safety monitoring. For drug surveillance purposes, it is possible to apply both the adverse drug reaction reporting system based on doctors' suspicions, as well as the event reporting system which records all adverse events regardless of doctors' suspicions as to their cause.
The medical record for hospitalized patients has been modified in order to orient it towards two ... more The medical record for hospitalized patients has been modified in order to orient it towards two types of surveillance: adverse drug reactions (ADRs) and the quality of medical care. The modification consists of an adaptation of the progress notes; the transfer of the information to a special database is facilitated by the use of a simple system of codes that identify and correlate the items necessary for surveillance purposes. During the 6 months of observation of the 1103 pediatric patients included in the study, 35 clinically important suspected ADRs were noted by physicians. For the quality of medical care surveillance, all drug prescriptions were evaluated and areas in which to intervene in order to improve the appropriateness of prescriptions were identified. Quality surveillance was also extended to the monitoring of 'unexplained' adverse events for which no particular cause was attributable. We consider it advantageous to carry out these two types of surveillance simultaneously because they require many common items of information. The use of an oriented medical record as a source of data makes it possible to integrate surveillance with everyday ward activities.
Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 y... more Acute gastroenteritis (AG) represents both the main cause of acute vomiting in children under 3 years old and a major cause of access to the emergency department. Even if several drugs may be able to reduce the emesis, the pharmacological treatment of vomiting in children remains a controversial issue, and several drugs are prescribed outside their authorized drug label with respect dosage, age, indication, or route of administration and are named as off-label. The aim of present study was to assess the off-label use of antiemetic drugs in patients less than 18 years with vomiting related to AG. This study was carried out in eight pediatric emergency departments in Italy. The following data were obtained crossing the pharmacy distribution records with emergency departments' patient data: sex and age of the patients and detailed information for each drug used (indication, dose, frequency, and route of administration). We recorded that antiemetic drugs were prescribed in every year, particularly in children up to 2 years old, and compared with both literature data and data sheet; 30 % of the administered antiemetics were used off-label. In particular, domperidone was the only antiemetic used labeled for AG treatment in pediatric patients, while metoclopramide and ondansetron have been off-label for both age and indications (i.e., AG treatment). In conclusion, we documented an off-label use of antiemetics in children, and this could represents a problem of safety for the patient and a legal risk for the prescribing physician if patients have an unwanted or bad outcome from treatment.
Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous s... more Human parechoviruses (HPeVs) are a new family of neurotropic viruses that cause central nervous system (CNS) infections similar to enterovirus (EVs) meningoencephalitis in the neonatal period, resulting in white matter lesions that can be visualized with cranial ultrasonography and magnetic resonance imaging, and correlated to a large spectrum of neurological outcomes. HPeV should be suspected in neonates with signs and symptoms of sepsis-like illness or CNS disease. We report a case of neonatal HPeV encephalitis, diagnosed on the basis of clinical and radiological findings and HPeV RT-PCR, with a good neurological outcome.
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Papers by Salvatore Renna