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1. Children with covid-19 in pediatric emergency departments in Italy

Author

Parri, N, Lenge, M, Buonsenso, D, Cantoni, B, Arrighini, A, Romanengo, M, Urbino, A, Da Dalt, L, Verdoni, L, Limoli, G, Musolino, A, Pilotto, C, La Fauci, G, Chiossi, M, Agostiniani, R, Plebani, A, Barbieri, M, Lanari, M, Masi, S, Giacalone, M, Leo, M, Falconi, M, Indolfi, G, D'Antiga, L, Mazza, A, De Martiis, D, Bertolozzi, G, Marchisio, P, Chidini, G, Calderini, E, Agostoni, C, Gori, A, Bondone, C, Dona, D, Todeschini, M, Scilipoti, M, Cogo, P, Ginocchio, F, Russotto, V, Biban, P, Stera, G, Margherita, M, Maiandi, S, Tubino, B, Chiaretti, A, Zampogna, S, Mazzuca, A, Parri N., Lenge M., Buonsenso D., Cantoni B., Arrighini A., Romanengo M., Urbino A., Da Dalt L., Verdoni L., Limoli G., Musolino A. M., Pilotto C., La Fauci G., Chiossi M., Agostiniani R., Plebani A., Barbieri M. A., Lanari M., Masi S., Giacalone M., Leo M. C., Falconi M., Indolfi G., D'Antiga L., Mazza A., De Martiis D., Bertolozzi G., Marchisio P., Chidini G., Calderini E., Agostoni C., Gori A., Bondone C., Dona D., Todeschini M., Scilipoti M., Cogo P., Ginocchio F., Russotto V. S., Biban P., Stera G., Margherita M., Maiandi S., Tubino B., Chiaretti A., Zampogna S., Mazzuca A., Parri, N, Lenge, M, Buonsenso, D, Cantoni, B, Arrighini, A, Romanengo, M, Urbino, A, Da Dalt, L, Verdoni, L, Limoli, G, Musolino, A, Pilotto, C, La Fauci, G, Chiossi, M, Agostiniani, R, Plebani, A, Barbieri, M, Lanari, M, Masi, S, Giacalone, M, Leo, M, Falconi, M, Indolfi, G, D'Antiga, L, Mazza, A, De Martiis, D, Bertolozzi, G, Marchisio, P, Chidini, G, Calderini, E, Agostoni, C, Gori, A, Bondone, C, Dona, D, Todeschini, M, Scilipoti, M, Cogo, P, Ginocchio, F, Russotto, V, Biban, P, Stera, G, Margherita, M, Maiandi, S, Tubino, B, Chiaretti, A, Zampogna, S, Mazzuca, A, Parri N., Lenge M., Buonsenso D., Cantoni B., Arrighini A., Romanengo M., Urbino A., Da Dalt L., Verdoni L., Limoli G., Musolino A. M., Pilotto C., La Fauci G., Chiossi M., Agostiniani R., Plebani A., Barbieri M. A., Lanari M., Masi S., Giacalone M., Leo M. C., Falconi M., Indolfi G., D'Antiga L., Mazza A., De Martiis D., Bertolozzi G., Marchisio P., Chidini G., Calderini E., Agostoni C., Gori A., Bondone C., Dona D., Todeschini M., Scilipoti M., Cogo P., Ginocchio F., Russotto V. S., Biban P., Stera G., Margherita M., Maiandi S., Tubino B., Chiaretti A., Zampogna S., and Mazzuca A.

Published
2020

2. Children with Covid-19 in Pediatric Emergency Departments in Italy

Author

Parri, N., Lenge, M., Buonsenso, D., Cantoni, B., Arrighini, A., Romanengo, M., Urbino, A., Da Dalt, L., Verdoni, L., Limoli, G., Musolino, A. M., Pilotto, C., La Fauci, G., Chiossi, M., Agostiniani, R., Plebani, A., Barbieri, M. A., Lanari, M., Masi, S., Giacalone, M., Leo, M. C., Falconi, M., Indolfi, G., D'Antiga, L., Mazza, A., De Martiis, D., Bertolozzi, G., Marchisio, P., Chidini, G., Calderini, E., Agostoni, C., Gori, A., Bondone, C., Dona', D., Todeschini, M., Scilipoti, M., Cogo, P., Ginocchio, F., Russotto, V. S., Biban, P., Stera, G., Margherita, M., Maiandi, S., Tubino, B., Chiaretti, A., Zampogna, S., Mazzuca, A., Parri N., Lenge M., Buonsenso D., Cantoni B., Arrighini A., Romanengo M., Urbino A., Da Dalt L., Verdoni L., Limoli G., Musolino A.M., Pilotto C., La Fauci G., Chiossi M., Agostiniani R., Plebani A., Barbieri M.A., Lanari M., Masi S., Giacalone M., Leo M.C., Falconi M., Indolfi G., D'Antiga L., Mazza A., De Martiis D., Bertolozzi G., Marchisio P., Chidini G., Calderini E., Agostoni C., Gori A., Bondone C., Dona D., Todeschini M., Scilipoti M., Cogo P., Ginocchio F., Russotto V.S., Biban P., Stera G., Margherita M., Maiandi S., Tubino B., Chiaretti A., Zampogna S., and Mazzuca A.

Subjects
Pediatric emergency, 2019-20 coronavirus outbreak, medicine.medical_specialty, China, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, 030204 cardiovascular system & hematology, Betacoronavirus, COVID-19, Child, Humans, Italy, SARS-CoV-2, Coronavirus Infections, Emergency Service, Hospital, Pandemics, Hospital, 03 medical and health sciences, 0302 clinical medicine, Correspondence, Pandemic, medicine, Viral, 030212 general & internal medicine, Emergency Service, Betacoronaviru, business.industry, Coronavirus Infection, Pneumonia, General Medicine, Family medicine, Cohort, business, Human
Abstract

This letter describes a cohort of 100 children younger than 18 years of age with RT-PCR-confirmed Covid-19 who were assessed in 17 pediatric emergency departments in Italy. The descriptive results are compared with previously published results involving children in China and the United States.

Published
2020
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4. Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

Author

Lazzerini, M., Sforzi, I., Trapani, S., Biban, P., Silvagni, D., Villa, G., Tibaldi, J., Bertacca, L., Felici, E., Perricone, G., Parrino, R., Gioe, C., Lega, S., Conte, Fabrizio Paolo Massimo, Marchetti, Fabio, Magista, A., Berlese, P., Martelossi, S., Vaienti, F., Valletta, E., Mauro, Michele, Dall'Amico, R., Fasoli, S., Gatto, Antonio, Chiaretti, Antonio, Dragovic, D., Pascolo, P., Pilotto, C., Liguoro, I., Miorin, E., Saretta, F., Trobia, G. L., Di Stefano, A., Orlandi, Armando, Cardinale, F., Lubrano, R., Testa, A., Binotti, M., Moressa, V., Barbi, E., Armocida, B., Mariani, I., Conte M., Marchetti F., Mauro M., Gatto A., Chiaretti A. (ORCID:0000-0002-9971-1640), Orlandi A. (ORCID:0000-0001-5253-4678), Lazzerini, M., Sforzi, I., Trapani, S., Biban, P., Silvagni, D., Villa, G., Tibaldi, J., Bertacca, L., Felici, E., Perricone, G., Parrino, R., Gioe, C., Lega, S., Conte, Fabrizio Paolo Massimo, Marchetti, Fabio, Magista, A., Berlese, P., Martelossi, S., Vaienti, F., Valletta, E., Mauro, Michele, Dall'Amico, R., Fasoli, S., Gatto, Antonio, Chiaretti, Antonio, Dragovic, D., Pascolo, P., Pilotto, C., Liguoro, I., Miorin, E., Saretta, F., Trobia, G. L., Di Stefano, A., Orlandi, Armando, Cardinale, F., Lubrano, R., Testa, A., Binotti, M., Moressa, V., Barbi, E., Armocida, B., Mariani, I., Conte M., Marchetti F., Mauro M., Gatto A., Chiaretti A. (ORCID:0000-0002-9971-1640), and Orlandi A. (ORCID:0000-0001-5253-4678)

Abstract

BackgroundVery few studies describe factors associated with COVID-19 diagnosis in children.AimWe here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.MethodsWe included cases aged 0-18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.ResultsAmong 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52-90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19-5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67-5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69-9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.ConclusionRecommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.

Published
2021

14. At the borders of friendship: work, morality and survival in a colonial Israeli-Palestinian space

Author

Pilotto, C, VAN AKEN, MAURO IVO, PILOTTO, CHIARA, Pilotto, C, VAN AKEN, MAURO IVO, and PILOTTO, CHIARA

Abstract

My dissertation explores the relationship between personal ties and the political in the context of the Israeli military occupation and settler colonization of the West Bank. Based on a fieldwork conducted from 2011 to 2014 in a Palestinian village under complete Israeli control, my methodological choice focused on an ethnography of Palestinians’ everyday life in order to grasp the moral and affective dimensions in which social relationships are embedded. The research questions how a moral economy of friendship, regulating personal relationships between distinguished populations, emerged from the Palestinians’ work experience in a colonial context. In the first chapter I introduce the context of my fieldwork focusing on the social identity of fellāḥīn (peasants) through which Palestinians in the village represent themselves. Peasants’ narratives and memories are linked to Palestinians’ violent dispossession due to the creation of the Israeli State, but also reveal present fractures in the Palestinian society. In the context of the progressive expansion of the Israeli sovereignty in the West Bank, agriculture has become a political practice claiming the Palestinian ownership over the land. I analyze such a politization through the different ways Palestinian agriculture has been appropriated by both Palestinian and Israeli activists in the public arena, showing the conjuncture and disjuncture of emerging political subjectivities. Given the structural dismantlement of Palestinian peasants’ life, the second chapter focuses on Palestinian labor in Israel as an apparatus of the Israeli colonial governamentality. In the context of the Palestinians’ growing economical dependence on Israel since the 1967 Israeli occupation of the West Bank and Gaza, a special attention is dedicated to Palestinian laborers’ experience. I examine labor through three dimensions: work values in the Palestinian domestic economy, where norms regulating masculinity are explored in details; labor

Published
2016

16. Algorithms for the Selection of the Active Sensors in Distributed Tracking: Comparison Between Frisbee and GNS Methods

Author

ARMY RESEARCH LAB ADELPHI MD, Capponi, A., Pilotto, C., Golino, G., Farina, A., Kaplan, L., ARMY RESEARCH LAB ADELPHI MD, Capponi, A., Pilotto, C., Golino, G., Farina, A., and Kaplan, L.

Abstract

This paper compares two different approaches for sensor selection for distributed tracking: 1) The Frisbee method, and 2) Global Node Selection (GNS). The Frisbee method is based on the proximity of the nodes to the predicted location of the target; GNS is based on minimizing the unbiased Cramer Rao lower bound (CRLB). Both theoretical and experimental results indicate that the Frisbee method is as effective as GNS. Furthermore, the Frisbee method is attractive due to its very light computational load., Presented at the International Conference on Information Fusion (9th), FUSION 2006, Florence, Italy, 10-13 Jul 2006. Prepared in collaboration with Department of Computer Science, California Institute of Technology, Pasadena, CA and Selex SI, Rome, Italy. Sponsored by the International Society of Information Fusion (ISIF), Aerospace & Electronic Systems Society (AES), IEEE, ONR, ONR Global, Selex - Sistemi Integrati, Finmeccanica, BAE Systems, TNO, AFOSR's European Office of Aerospace Research and Development, and the NATO Undersea Research Centre. The original document contains color images.

Published
2006

17. Connectivity for the Frisbee Architecture

Author

ARMY RESEARCH LAB ADELPHI MD, Capponi, A., Pilotto, C., Farina, A., Golino, G., Kaplan, L., ARMY RESEARCH LAB ADELPHI MD, Capponi, A., Pilotto, C., Farina, A., Golino, G., and Kaplan, L.

Abstract

In this paper we investigate the kappa-connectivity threshold of distributed dense ad hoc heterogeneous wireless sensor network architecture. We consider the situation when sensors are deployed in the surveillance area according to a uniform distribution perturbed by a Gaussian noise. We derive analytically the minimum detection range which guarantees an emerging structure in the network, namely the connectivity, which becomes larger and larger as the number of sensors in the network increase. This allows the target track to be propagated almost surely throughout the network using the minimum possible amount of prime energy. We report the results of some simulation experiments which further support the theoretical results., Presented at the International Conference on Information Fusion (9th) held in Florence, Italy on 10-13 July 2006. Published in the Proceedings of the International Conference on Information Fusion (9th), 2006. Sponsored by the International Society of Information Fusion (ISIF), Aerospace & Electronic Systems Society (AES), IEEE, ONR, ONR Global, Selex - Sistemi Integrati, Finmeccanica, BAE Systems, TNO, AFOSR's European Office of Aerospace Research and Development, and the NATO Undersea Research Centre.. The original document contains color images.

Published
2006

18. Algorithms for the selection of the active sensors in distributed tracking: Comparison between Frisbee and GNS methods

Author

Capponi, A., Pilotto, C., Golino, G., Farina, A., Kaplan, L., Capponi, A., Pilotto, C., Golino, G., Farina, A., and Kaplan, L.

Abstract

This paper compares two different approaches for sensor selection for distributed tracking: 1) The Frisbee method, and 2) Global Node Selection (GNS). The Frisbee method is based on the proximity of the nodes to the predicted location of the target; GNS is based on minimizing the unbiased Cramer Rao lower bound (CRLB). Both theoretical and experimental results indicate that the Frisbee method is as effective as GNS. Furthermore, the Frisbee method is attractive due to its very light computational load.

Published
2006

19. Connectivity for the frisbee architecture

Author

Capponi, A., Pilotto, C., Farina, A., Golino, G., Kaplan, L., Capponi, A., Pilotto, C., Farina, A., Golino, G., and Kaplan, L.

Abstract

In this paper we investigate the kconnectivity threshold of distributed dense ad hoc heterogeneous wireless sensor network architecture. We consider the situation when sensors are deployed in the surveillance area according to a uniform distribution perturbed by a Gaussian noise. We derive analytically the minimum detection range which guarantees an emerging structure in the network, namely the connectivity, which becomes larger and larger as the number of sensors in the network increase. This allows the target track to be propagated almost surely throughout the network using the minimum possible amount ofprime energy. We report the results of some simulation experiments which further support the theoretical results.

Published
2006

30. Seizure characteristics and the use of anti-epileptic drugs in children and young people with brain tumours and epileptic seizures: analysis of regional paediatric cancer service population

Author

Pilotto, C, Liu, Jo-Fen, Walker, David A., Whitehouse, William P., Pilotto, C, Liu, Jo-Fen, Walker, David A., and Whitehouse, William P.

Abstract

PURPOSE: Epileptic seizures complicate the management of childhood brain tumours. There are no published standards for clinical practice concerning risk factors, treatment selection or strategies to withdraw treatment with antiepileptic drugs (AED). METHOD: We undertook a case note review of 120 patients with newly diagnosed brain tumours, referred to a regional paediatric cancer service. RESULTS: Data was available on 117/120 (98%) children <18 years: median age at tumour presentation was 8.1 years (IQR 25°-75°: 3.6-12.7), median follow up was 33 months (IQR 25°-75°: 24-56), and 35/117 (29%) experienced seizures. A cortical tumour location was associated with the highest risk of seizures (OR: 7.1; CI 95% 2.9-17.3). At a median follow up of 24 months (IQR25°-75°: 15-48), 22/35 (63%) with seizures, had a single seizure episode, 15/35 (43%) were seizure free (SF) on AEDs, 13/35 (37%) were SF off AEDs, and 7/35 (20%) experienced continuing epileptic seizures. Overall 34/35 (97%) were treated with AEDs after a seizure, of whom 12/35 (35%) withdrew from AED medication, and although 4/35 (12%) had seizure relapse, all were after further acute events. The median duration of AED before withdrawal was 11 months (IQR25°-75° 5-14 months), and the median follow up after withdrawal was 15 months (IQR25°-75° 5-34 months). CONCLUSIONS: Seizures affect about 1/3rd of children and young people presenting with and being treated for brain tumours particularly when the tumour is in the cerebral cortex. The low risk of recurrent seizures after AED treatment justifies consideration of early withdrawal of AED after seizure control.

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31. G392(P) A Regional paediatric neuro-oncology cohort study of seizure characteristics and their management: a proposal for service evaluation criteria

Author

Pilotto, C, Whitehouse, WP, Liu, JF, Grundy, R, Wilne, S, and Walker, D

Abstract

AimsTo describe the presentation of epileptic seizures, the tumour-related risk factors, seizure treatments used and the timing of withdrawal of anti-epileptic drugs (AEDs).MethodsRetrospective case note review of 120 newly diagnosed brain tumour patients referred between 01/2010 and 12/2014 to the regional paediatric cancer service was carried out to determine patient, tumour, seizure characteristics and their treatment and outcomes. Statistical analyses using Fischer Test, Mann-Whitney U test and logistic regression test of association between variables were performed.ResultsTwo patients with tuberous sclerosis and associated seizures and 1 patient lost to follow up, were excluded. 67/117 (57.3%) were male, median age at tumour presentation was 8.1 years (IQR 25°–75°: 3.6–12.7). Anatomical distribution was posterior fossa 36%, cerebral hemisphere 28%, supratentorial midline 24%, spinal cord 5%, metastatic 7%. Most common histological types include pilocytic astrocytoma 15%, visual pathway glioma 8%, other low grade astrocytoma 11%; high grade glioma 10%, medulloblastoma 11%.With a median follow up of 33 months (IQR 25°–75°:24–56), there were 35 patients (29%) with seizures. Logistic regression analysis identified cerebral hemisphere localization as risk factor for seizures (OR: 7.07 IC 95% 2.89–17.3). In particular, neither age at diagnosis nor tumour type were associated with seizure risk, although 6/8 patients with glioneuronal tumours developed seizures.With a median follow up of 24 months (IQR25°-75°: 15–48) 37% were seizure free (SF) off AEDs, 43% were SF on AEDs and 20% experienced continuing seizures. One patient was untreated, seizures resolved.12 patients withdrew AEDs, median duration of AED therapy before withdrawal was 11 months (IQR25°–75°5–14 months), and the median follow up after withdrawal was 15 months (IQR25°–75° 5–34 months). 4 children had seizure relapse after further acute events (2 had acute hydrocephalus, 1 had sepsis, 1 had ventriculitis after shunt revision).ConclusionsEpileptic seizures affect about 1/3rdof children presenting with brain tumours, most commonly in cortically-located tumours. The low risk of recurrent seizures after treatment justifies early withdrawal of AED after stabilisation of seizures. A 3 month seizure free interval prior to AED withdrawal is proposed as a service evaluation target for future studies.Acknowledgement: on behalf of the East Midlands Children and Young People’s Integrated Cancer Service (EMCYPICS) and University of Nottingham Children’s Brain Tumour Research Centre (www.cbtrc.org)

Published
2017
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32. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

Author

M. Romanengo, Annamaria Magista, M. Chiossi, Marco Binotti, Rino Agostiniani, Maria Antonietta Barbieri, Egidio Barbi, Serena Arrigo, L. Verdoni, Marcello Lanari, M. Raggi, Alberto Arrighini, Enrico Felici, Barbara Cantoni, R. Giacchero, Elisabetta Miorin, L. Da Dalt, Matteo Lenge, Anna Maria Musolino, F. Nicoloso, Niccolò Parri, Federico Marchetti, Stefano Masi, B. Covi, Ilaria Mariani, E. Zoia, Antonio Francesco Urbino, Danilo Buonsenso, Chiara Pilotto, Anna Plebani, Benedetta Armocida, Silvia Fasoli, Marzia Lazzerini, Paolo Biban, Parri, N., Magista, A. M., 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, A. M., Binotti, M., Biban, P., Fasoli, S., Pilotto, C., Nicoloso, F., Raggi, M., Miorin, E., Buonsenso, D., Chiossi, M., Agostiniani, R., Plebani, A., Barbieri, M. A., Lanari, M., Arrigo, S., Zoia, E., Lenge, M., Masi, S., Barbi, E., Lazzerini, M., Parri N., Magista A.M., 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 A.M., Binotti M., Biban P., Fasoli S., Pilotto C., Nicoloso F., Raggi M., Miorin E., Buonsenso D., Chiossi M., Agostiniani R., Plebani A., Barbieri M.A., Lanari M., Arrigo S., Zoia E., Lenge M., Masi S., Barbi E., and Lazzerini M.

Subjects
Adolescents, COVID-19, Children, Italy, Male, Pediatrics, Conscious Sedation, Disease, Comorbidity, Clinical Laboratory Technique, 01 natural sciences, law.invention, 0302 clinical medicine, COVID-19 Testing, law, Risk Factors, Retrospective Studie, Hypnotics and Sedatives, 030212 general & internal medicine, Viral, Child, Intensive care unit, Treatment Outcome, Child, Preschool, Female, medicine.symptom, Coronavirus Infections, Cohort study, Human, medicine.medical_specialty, Respiratory Therapy, Neuromuscular disease, Adolescent, Short Communication, Pneumonia, Viral, Asymptomatic, 03 medical and health sciences, Betacoronavirus, Clinical Laboratory Techniques, Humans, Infant, Infant, Newborn, Pandemics, Retrospective Studies, SARS-CoV-2, medicine, Pediatrics, Perinatology, and Child Health, 0101 mathematics, Risk factor, Preschool, Pandemic, business.industry, Coronavirus Infection, Risk Factor, 010102 general mathematics, Retrospective cohort study, Pneumonia, medicine.disease, Newborn, Reading, Pediatrics, Perinatology and Child Health, business
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.

Published
2020
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33. At the borders of friendship: work, morality and survival in a colonial Israeli-Palestinian space

Author

PILOTTO, CHIARA, Pilotto, C, and VAN AKEN, MAURO IVO

Subjects
colonialism, subjectivation, work, friendship, life, M-DEA/01 - DISCIPLINE DEMOETNOANTROPOLOGICHE
Abstract

My dissertation explores the relationship between personal ties and the political in the context of the Israeli military occupation and settler colonization of the West Bank. Based on a fieldwork conducted from 2011 to 2014 in a Palestinian village under complete Israeli control, my methodological choice focused on an ethnography of Palestinians’ everyday life in order to grasp the moral and affective dimensions in which social relationships are embedded. The research questions how a moral economy of friendship, regulating personal relationships between distinguished populations, emerged from the Palestinians’ work experience in a colonial context. In the first chapter I introduce the context of my fieldwork focusing on the social identity of fellāḥīn (peasants) through which Palestinians in the village represent themselves. Peasants’ narratives and memories are linked to Palestinians’ violent dispossession due to the creation of the Israeli State, but also reveal present fractures in the Palestinian society. In the context of the progressive expansion of the Israeli sovereignty in the West Bank, agriculture has become a political practice claiming the Palestinian ownership over the land. I analyze such a politization through the different ways Palestinian agriculture has been appropriated by both Palestinian and Israeli activists in the public arena, showing the conjuncture and disjuncture of emerging political subjectivities. Given the structural dismantlement of Palestinian peasants’ life, the second chapter focuses on Palestinian labor in Israel as an apparatus of the Israeli colonial governamentality. In the context of the Palestinians’ growing economical dependence on Israel since the 1967 Israeli occupation of the West Bank and Gaza, a special attention is dedicated to Palestinian laborers’ experience. I examine labor through three dimensions: work values in the Palestinian domestic economy, where norms regulating masculinity are explored in details; labor as an apparatus through which Israel controls the Palestinian population reproducing relations of personal dependence among Palestinian men and between Palestinians and Israelis, taking into account the institutional context inaugurated by the Oslo Agreements; Palestinians’ moral subjectivation through work, highlighting its contingent character in structurally uncertain political conditions. In the third chapter I go deeper into questioning personal relationships and their relation to the political. The social language of “friendship” is examined through the articulation of language with social practices in everyday life. Different ethnographical cases concerning personal ties between Palestinians and Israelis are presented, showing how “friendship” can be differently thought and mobilized in relation to moral and political values. Ultimately, such personal relations are framed by the perceived fragility of social relationships in the Palestinian society today. On the basis of Palestinians’ moral and political distinctions, in the fourth chapter I question “life” as the core of the political in Palestinian daily experience. In the tension between social death and the quest for a “respectable life”, the normalization of Palestinians’ death produced by the Israeli security regime engenders a “politics of life” which redefines life beyond physical survival.

Published
2016

34. Lesson in understanding parents' perspective: perception of quality of care and COVID-19-related fears among users of paediatric health services over the COVID-19 pandemic in 11 facilities in Italy.

Author

Dalena P, Zago A, Troisi A, Trobia GL, Lucarelli A, Bressan S, Fasoli S, Martelossi S, Lubrano R, Parrino R, Felici E, Pilotto C, Sforzi I, Barbi E, and Lazzerini M

Subjects
Humans, Italy epidemiology, Cross-Sectional Studies, Female, Male, Child, SARS-CoV-2, Child, Preschool, Surveys and Questionnaires, Adolescent, Adult, Pandemics, Child Health Services, Infant, COVID-19 psychology, COVID-19 epidemiology, Fear psychology, Quality of Health Care, Parents psychology
Abstract

Background: The COVID-19 pandemic had an important psychological impact on children and their families. This study aims to explore paediatric health services users' perceptions of quality of care (QOC) and COVID-19-related fears, and their evolution over time in relation to COVID-19 pandemic., Methods: In a multicentre cross-sectional study involving 11 public hospitals providing paediatric care across the Italian territory, we collected data from services users through a validated questionnaire. We analysed four indicators-(1) QOC perceived in relation to COVID-19; (2) overall QOC perceived; (3) fear of accessing health services due to COVID-19; (4) fear of contracting COVID-19 in hospital-and calculated Spearman's correlation indexes (ρ) with the number of COVID-19 new cases over time. Subgroup analyses were conducted by macroregions and single facility., Results: Data from 956 services users were analysed. QOC indicators were stable over time at values close to the maximum (range 77-100 and median 100 for COVID-19 QOC, range 74-98 and median 80 for overall QOC), and no correlations were found with the COVID-19 new cases (ρ=-0.073 and -0.016, respectively). Fear of accessing care and fear of contracting the infection varied over time in between 0%-52% and 0%-53%, respectively, but did not correlate directly with number of COVID-19 new cases (ρ=0.101, 0.107 and 0.233, 0.046, respectively). At subgroup analyses, significantly higher frequencies of fear (p values <0.05) and lower QOC (p values <0.001) were reported in South Italy, and three facilities showed moderate correlation between these indicators., Conclusions: COVID-19-related fears and perceived QOC may be mediated by more complex cultural and facility/regional-level factors, than simply by epidemic peaks. Subgroup analyses can help unpack major differences within the same country., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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35. Analysis of factors conditioning inappropriate visits in a paediatric emergency department.

Author

Liguoro I, Beorchia Y, Castriotta L, Rosso A, Pedduzza A, Pilotto C, and Cogo P

Subjects
Child, Humans, Male, Cross-Sectional Studies, Acute Disease, Parents education, Abdominal Pain, Emergency Service, Hospital, Exanthema
Abstract

Recent studies estimated that about 20-30% of visits in a paediatric emergency department (PED) are inappropriate. Nonurgent visits have been negatively associated with crowding and costs, causing longer waiting and dissatisfaction among both parents and health workers. We aimed to analyze possible factors conditioning inappropriate visits and misuse in a PED. We performed a cross-sectional study enrolling children accessing an Italian PED from June 2022 to September 2022 who received a nonurgent code. The appropriateness of visits, as measured by the "Mattoni SSN" Project, comprises combination of the assigned triage code, the adopted diagnostic resources, and outcomes. A validated questionnaire was also administered to parents/caregivers of included children to correlate their perceptions with the risk of inappropriate visit. Data were analyzed using independent-samples t-tests, Wilcoxon-Mann-Whitney tests, chi-square tests, and Fisher's exact tests. The factors that were found to be associated with inappropriate visits to the PED were further evaluated by univariable and multivariable logistic regression analyses. Almost half (44.8%) of nonurgent visits resulted inappropriate. Main reasons for parents/caregivers to take their children to PED were (1) the perceived need to receive immediate care (31.5%), (2) the chance to immediately perform exams (26.7%), and (3) the reported difficulty in contacting family paediatrician (26.3%). Inappropriateness was directly related to child's age, male gender, acute illness occurred in the previous month, and skin rash or abdominal pain as complaining symptoms.     Conclusion: This study highlights the urgent need to finalize initiatives to reduce misuse in accessing PED. Empowering parents' awareness and education in the management of the most frequent health problems in paediatric age may help to achieve this goal. What is Known: • About 20-30% of pediatric urgent visits are estimated as inappropriate. • Several factors may be associated with this improper use of the emergency department, such as the misperception of parents who tend to overrate their children's health conditions or dissatisfaction with primary care services. What is New: • This study evaluated almost half of pediatric emergency department visits as inappropriate adopting objective criteria. • Inappropriateness was directly related to the child's age, male gender, acute illness that occurred in the previous month, and skin rash or abdominal pain as complaining symptoms. Educational interventions for parents aimed at improving healthcare resource utilization should be prioritized., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2023
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37. A new era for optic pathway glioma: A developmental brain tumor with life-long health consequences.

Author

Walker DA, Aquilina K, Spoudeas H, Pilotto C, Gan HW, and Meijer L

Abstract

Optic pathway and hypothalamic glioma (OPHG) are low-grade brain tumors that arise from any part of the visual pathways frequently involving the hypothalamus. The tumors grow slowly and present with features driven by their precise anatomical site, their age at presentation and the stage of growth and development of the host neural and orbital bony tissues. Up to 50% of optic pathway glioma arise in association with Neurofibromatosis type 1 (NF1), which affects 1 in 3,000 births and is a cancer predisposition syndrome. As low-grade tumors, they almost never transform to malignant glioma yet they can threaten life when they present under two years of age. The main risks are to threaten vision loss by progressive tumor damage to optic pathways; furthermore, invasion of the hypothalamus can lead to diencephalic syndrome in infancy and hypopituitarism later in life. Progressive cognitive and behavioural dysfunction can occur, as part of NF1 syndromic features and in sporadic cases where large bulky tumors compress adjacent structures and disrupt neuro-hypothalamic pathways. Persistently progressive tumors require repeated treatments to attempt to control vision loss, other focal brain injury or endocrine dysfunction. In contrast tumors presenting later in childhood can be seen to spontaneously arrest in growth and subsequently progress after periods of stability. These patterns are influenced by NF status as well as stages of growth and development of host tissues. The past two decades has seen an expansion in our understanding and knowledge of the clinical and scientific features of these tumors, their modes of presentation, the need for careful visual and endocrine assessment. This influences the decision-making surrounding clinical management with surgery, radiotherapy, chemotherapy and most recently, the potential benefit of molecularly targeted drug therapy. This article, based upon the authors' clinical and research experience and the published literature will highlight advances in approach to diagnosis, the established role of vision loss as justification of treatments and the emerging evidence of endocrine and neurological consequences that need to be incorporated into judgements for case selection for therapy or observation. Consideration is given to the current state of biological evidence justifying current trials of new therapies, the genetic studies of the NF1 gene and the potential for new approaches to OPHG detection and treatment. The outstanding health system priorities from the perspective of children, their parents and health system commissioners or insurers are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Walker, Aquilina, Spoudeas, Pilotto, Gan and Meijer.)

Published
2023
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39. The impact of COVID-19 on a tertiary care pediatric emergency department.

Author

Liguoro I, Pilotto C, Vergine M, Pusiol A, Vidal E, and Cogo P

Subjects
Child, Child, Preschool, Female, Humans, Infant, Male, Retrospective Studies, COVID-19, Emergency Service, Hospital statistics & numerical data, Pandemics, Pediatrics statistics & numerical data, Tertiary Healthcare statistics & numerical data
Abstract

The restrictive measures required to face the recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impact patterns of healthcare utilization. Our aim was to provide an insight into the change in the use of a pediatric emergency department (ED) during the SARS-CoV-2 pandemic. The medical records of the children seen in our pediatric ED during March and April 2020 were retrospectively reviewed. Consequently, these were compared to the medical records of 2018 and 2019 from the same time period and from other control periods (January-February 2019 and 2020, and July-August 2018 and 2019). The total number of ED visits declined by 73% from 2019 to 2020 (3051 vs 818). Significant variations were observed in the distribution of children between triage categories: the proportion of patients who was given a green-code showed a 0.59-fold decrease in comparison to 2019 (95% CI 0.5-0.69), while a relative increase in the proportion of yellow codes was observed (OR 1.46, 95% CI 1.2-1.78).Conclusion: Quarantine measures significantly impacted on the total number of patients and on the reasons for visiting them in our pediatric ED. This substantial decrease in pediatric care may either be due to lower rates of acute infections because of social distancing, or to parents' or caregivers' reticence to risk exposure to SARS-CoV-2 in a health-care setting. What is known: • A recent outbreak of a novel coronavirus responsible for a severe acute respiratory syndrome is spreading globally. • Restrictive measures may impact patterns of healthcare utilization, as observed in other previous outbreaks. What is new: • This study shows significant variations in the distribution of children among triage categories during the COVID-19 pandemic. • Discharge diagnosis was significantly different as well, in particular a relative increase in the proportion of children presenting with traumatic injuries and a decrease of viral infections were observed.

Published
2021
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40. Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020.

Author

Lazzerini M, Sforzi I, Trapani S, Biban P, Silvagni D, Villa G, Tibaldi J, Bertacca L, Felici E, Perricone G, Parrino R, Gioè C, Lega S, Conte M, Marchetti F, Magista A, Berlese P, Martelossi S, Vaienti F, Valletta E, Mauro M, Dall'Amico R, Fasoli S, Gatto A, Chiaretti A, Dragovic D, Pascolo P, Pilotto C, Liguoro I, Miorin E, Saretta F, Trobia GL, Di Stefano A, Orlandi A, Cardinale F, Lubrano R, Testa A, Binotti M, Moressa V, Barbi E, Armocida B, and Mariani I

Subjects
Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Italy epidemiology, Male, Risk Factors, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 Testing, Pandemics
Abstract

BackgroundVery few studies describe factors associated with COVID-19 diagnosis in children.AimWe here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.MethodsWe included cases aged 0-18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.ResultsAmong 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52-90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19-5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67-5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69-9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.ConclusionRecommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.

Published
2021
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41. Risk Factors of Persistent Hydrocephalus in Children with Brain Tumor: A Retrospective Analysis.

Author

Pilotto C, Liguoro I, Scaravetti S, Passone E, D'Agostini S, Tuniz F, Skrap M, and Cogo P

Subjects
Child, Female, Humans, Infant, Male, Prospective Studies, Retrospective Studies, Risk Factors, Brain Neoplasms complications, Brain Neoplasms epidemiology, Brain Neoplasms surgery, Hydrocephalus diagnostic imaging, Hydrocephalus epidemiology, Hydrocephalus etiology
Abstract

Object: Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10-40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor., Methods: Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans' index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A p value <0.05 was considered significant., Results: Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2-13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI >0.34 (p = 0.028) and an FOHR >0.46 (p = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase., Conclusion: Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI >0.34 and an FOHR >0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach., (© 2021 S. Karger AG, Basel.)

Published
2021
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42. COVID-19 in 17 Italian Pediatric Emergency Departments.

Author

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, and Masi S

Subjects
Asymptomatic Infections epidemiology, COVID-19 diagnosis, COVID-19 diagnostic imaging, COVID-19 Testing statistics & numerical data, Child, Child, Preschool, Female, Humans, Infant, Italy epidemiology, Male, Point-of-Care Testing statistics & numerical data, Radiography, Thoracic statistics & numerical data, Retrospective Studies, Symptom Assessment, Systemic Inflammatory Response Syndrome diagnosis, Systemic Inflammatory Response Syndrome epidemiology, Tomography, X-Ray Computed statistics & numerical data, Ultrasonography statistics & numerical data, COVID-19 epidemiology, Emergency Service, Hospital statistics & numerical data, SARS-CoV-2
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., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Published
2020
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43. SARS-COV-2 infection in children and newborns: a systematic review.

Author

Liguoro I, Pilotto C, Bonanni M, Ferrari ME, Pusiol A, Nocerino A, Vidal E, and Cogo P

Subjects
Adolescent, COVID-19, COVID-19 Testing, Child, Child, Preschool, Clinical Laboratory Techniques methods, Coronavirus Infections mortality, Coronavirus Infections therapy, Global Health, Humans, Infant, Infant, Newborn, Pandemics, Pneumonia, Viral mortality, Pneumonia, Viral therapy, Prognosis, SARS-CoV-2, Severity of Illness Index, Tomography, X-Ray Computed, Betacoronavirus isolation & purification, Coronavirus Infections diagnosis, Pneumonia, Viral diagnosis
Abstract

A recent outbreak of a novel Coronavirus responsible for a Severe Acute Respiratory Syndrome (SARS-CoV-2) is spreading globally. The aim of this study was to systematically review main clinical characteristics and outcomes of SARS-CoV-2 infections in pediatric age. An electronic search was conducted in PubMed database. Papers published between 1 January and 1 May 2020 including children aged 0-18 years were selected. Sixty-two studies and three reviews were included, with a total sample size of 7480 children (2428/4660 males, 52.1%; weighted mean age 7.6 years). Patients showed mainly mild (608/1432, 42.5%) and moderate (567/1432, 39.6%) signs of the infection. About 2% of children were admitted to the pediatric intensive care unit. The most commonly described symptoms were fever (51.6%) and cough (47.3%). Laboratory findings were often unremarkable. Children underwent a chest CT scan in 73.9% of all cases, and 32.7% resulted normal. Overall, the estimated mortality was 0.08%. A higher proportion of newborns was severely ill (12%) and dyspnea was the most common reported sign (40%).Conclusion: SARS-CoV-2 affects children less severely than adults. Laboratory and radiology findings are mainly nonspecific. Larger epidemiological and clinical cohort studies are needed to better understand possible implications of COVID-19 infection in children.What is Known:• A novel Coronavirus has been recently identified as responsible for a new Severe Acute Respiratory Syndrome (SARS-CoV-2) spreading globally.• There is limited evidence on SARS-CoV2 infection in children.What is New:• Systematically reviewed available evidence showed that children with SARS-CoV-2 infection may have a less severe pattern of disease in comparison to adults.• Blood tests and radiology findings are mainly nonspecific in children but may help to identify those who are severely ill.

Published
2020
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44. Toward a characterization of language development in children with congenital heart disease: A pilot study.

Author

Sommariva G, Zilli T, Crescentini C, Marini A, Pilotto C, Venchiarutti M, Gortan AJ, Fabbro F, and Cogo P

Subjects
Child, Female, Humans, Male, Pilot Projects, Heart Defects, Congenital psychology, Language Development
Abstract

Congenital heart diseases (CHDs) represent one of the most common types of congenital abnormalities. More than 90% of children with critical heart defects achieve adulthood due to improvements in medical and surgical treatments. Nonetheless, survivors are at risk for neurodevelopmental disorders that may lead also to language impairments. The current study analyzed the linguistic profiles of a group of school-aged children treated surgically for CHD.Fifteen Children with CHDs (7 girls and 8 boys; mean age = 9.31 with SD = 2.10), without intellectual disability (i.e., IQ>70), who underwent cardiac surgery on cardiopulmonary bypass (CPB), were administered a selection of tests from the language assessment tool BVL 4-12. Their performance was compared with that of 15 healthy children matched for age and gender. As a result, children with CHDs scored significantly lower than healthy peers on tasks tapping lexical and grammatical processing as well as the episodic buffer component of working memory. Interestingly, the two groups did not differ on tasks assessing their lexical repertoire and phonological discrimination abilities. These findings are discussed in light of current theories of cognitive development and functioning.

Published
2020
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45. Sleep disorders in children with brain tumors: a pilot study based on a sleep disorder questionnaire.

Author

Pilotto C, Passone E, Coassin E, Birri S, Bidoli E, Crichiutti G, Cogo P, and Mascarin M

Subjects
Adolescent, Case-Control Studies, Child, Child, Preschool, Female, Humans, Male, Pilot Projects, Retrospective Studies, Brain Neoplasms diagnosis, Brain Neoplasms epidemiology, Sleep Wake Disorders diagnosis, Sleep Wake Disorders epidemiology, Surveys and Questionnaires
Abstract

Purpose: The aim of this study is to compare the prevalence of sleep disorders (SD) between children treated for brain tumors and healthy children, and to define the type of SD., Methods: A case-control study was performed from October 2014 to April 2015. Inclusion criteria were patients between 2 and 16 years with "cases" defined as children affected by central nervous system tumors at least 3 months after the end of treatment (surgery and/or radiotherapy and/or chemotherapy) at the time of evaluation and "controls" as healthy children. Children's sleep quality was assessed with a questionnaire administered to parents (Child's Sleep Habits Questionnaire, CSHQ). A total score greater than 41 is suggestive for the presence of disturbed sleep. The risk of SD was estimated by the odds ratio (OR) and their 95% confidence intervals (95% CI) through logistic regression models., Results: Twenty-nine cases and 87 controls (in a 1:3 model) were enrolled, for a total of 116 subjects. The prevalence of SD resulted of 82.8% among cases and 64.4% in controls. A statistically significant difference between the two groups (OR 2.65; 95% CI 0.92-7.65) was not reached. Analyzing singular disturbances, parasomnias and night awakenings showed a statistically significant difference between the two groups (OR 4.32; 95% CI 1.08-17.34)., Conclusions: Our study revealed a trend toward SD in children with brain tumor when compared to healthy population. Hovewer, analyzing specific subtypes of SD some significant differences were obtained. A significant difference was obtained only for specific subtypes of SD. Further investigations could better define the real burden of SD.

Published
2018
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46. Seizure characteristics and the use of anti-epileptic drugs in children and young people with brain tumours and epileptic seizures: Analysis of regional paediatric cancer service population.

Author

Pilotto C, Liu JF, Walker DA, and Whitehouse WP

Subjects
Adolescent, Brain Neoplasms physiopathology, Child, Child, Preschool, Epilepsy complications, Epilepsy physiopathology, Female, Follow-Up Studies, Humans, Levetiracetam, Male, Piracetam analogs & derivatives, Piracetam therapeutic use, Recurrence, Retrospective Studies, Risk Factors, Seizures complications, Seizures physiopathology, Time Factors, Anticonvulsants therapeutic use, Brain Neoplasms complications, Brain Neoplasms therapy, Epilepsy drug therapy, Seizures drug therapy
Abstract

Purpose: Epileptic seizures complicate the management of childhood brain tumours. There are no published standards for clinical practice concerning risk factors, treatment selection or strategies to withdraw treatment with antiepileptic drugs (AED)., Method: we undertook a case note review of 120 patients with newly diagnosed brain tumours, referred to a regional paediatric cancer service., Results: data was available on 117/120 (98%) children <18 years: median age at tumour presentation was 8.1 years (IQR 25°-75° : 3.6-12.7), median follow up was 33 months (IQR 25°-75°: 24-56), and 35/117 (29%) experienced seizures. A cortical tumour location was associated with the highest risk of seizures (OR: 7.1; CI 95% 2.9-17.3). At a median follow up of 24 months (IQR 25°-75° : 15-48), 22/35 (63%) with seizures, had a single seizure episode, 15/35 (43%) were seizure free (SF) on AEDs, 13/35 (37%) were SF off AEDs, and 7/35 (20%) experienced continuing epileptic seizures. Overall 34/35 (97%) were treated with AEDs after a seizure, of whom 12/35 (35%) withdrew from AED medication, and although 4/35 (12%) had seizure relapse, all were after further acute events. The median duration of AED before withdrawal was 11 months (IQR 25°-75° 5-14 months), and the median follow up after withdrawal was 15 months (IQR 25°-75° 5-34 months)., Conclusions: Seizures affect about 1/3rd of children and young people presenting with and being treated for brain tumours particularly when the tumour is in the cerebral cortex. The low risk of recurrent seizures after AED treatment justifies consideration of early withdrawal of AED after seizure control., (Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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47. Vascular stenosis in a child with visual pathway glioma treated with bevacizumab: a case report and review of literature.

Author

Pilotto C, Beshlawi I, Thomas A, and Grundy RG

Subjects
Child, Preschool, Constriction, Pathologic diagnostic imaging, Humans, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Male, Optic Nerve Glioma diagnostic imaging, Visual Pathways diagnostic imaging, Visual Pathways pathology, Antineoplastic Agents, Immunological therapeutic use, Bevacizumab therapeutic use, Brain Neoplasms complications, Constriction, Pathologic drug therapy, Constriction, Pathologic etiology, Optic Nerve Glioma complications
Abstract

Background: Bevacizumab (BVZ) is a vascular endothelial growth factor inhibitor that has been widely accepted since its introduction into the cancer pharmacopoeia. Anecdotal reports suggested improvements in vision in children with visual pathway glioma., Case Presentation: We report a boy with visual pathway glioma whose vision had deteriorated significantly on vincristine and carboplatin, to the point that he was registered blind. Following bevacizumab therapy, there was a dramatic improvement in vision with reduction in tumour volume. However, following 20 doses of BVZ given over 19 months, he developed a significant cerebrovascular stenosis., Conclusion: The BVZ-induced cerebrovascular diseases in children are extremely rare but potentially serious. Importantly, stenosis has not been previously described in literature.

Published
2018
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48. Presentation and symptom interval in children with central nervous system tumors. A single-center experience.

Author

Stocco C, Pilotto C, Passone E, Nocerino A, Tosolini R, Pusiol A, and Cogo P

Subjects
Adolescent, Central Nervous System Neoplasms complications, Child, Child, Preschool, Female, Follow-Up Studies, Headache diagnosis, Headache etiology, Headache mortality, Humans, Infant, Male, Retrospective Studies, Survival Rate trends, Vomiting diagnosis, Vomiting etiology, Vomiting mortality, Central Nervous System Neoplasms diagnosis, Central Nervous System Neoplasms mortality, Delayed Diagnosis mortality
Abstract

Purpose: The aim of this study is to describe the symptoms and signs of central nervous system (CNS) tumors in a pediatric population and to assess the time interval between the onset of the disease and the time of the diagnosis., Methods: A retrospective observational study was conducted at our Oncology Pediatric Unit between January 2000 and November 2011. We included 75 children between 5 months and 16 years (mean age of 7.8 ± 4.7 years), with male to female ratio of 3:2. The tumor localization was supratentorial in 51% of cases, and the most frequent histological type was low-grade astrocytoma (48%)., Results: Presenting symptoms were headache (31%), vomiting (31%), seizures (21%), and behavioral change (11%). The most common symptoms at diagnosis were headache (51%), vomiting (51%), visual difficulties (37%), seizures (24%), and behavioral change (21%). By the time of diagnosis, neurologic examination was altered in 68% of our patients. Vomiting (44%) and behavioral change (44%) were the most frequent symptoms in children under 4 years of age, headache (61%) and vomiting (54%) in children older than 4 years. The median interval between symptoms' onset and diagnosis was 4 weeks (range 0 to 314 weeks). A longer symptom interval was associated with younger age, infratentorial localization and low-grade tumors. The differences in symptom intervals between the different age, location, and grade groups were not statistically significant. Survival probability was influenced by tumor grade but not by diagnostic delay or age of the child., Conclusions: Headache and vomiting are the earliest and commonest symptoms in children with brain tumors. Visual symptoms and signs and behavioral change are often present. Abnormalities in neurological examination are reported in most of the children. Intracranial hypertension symptoms suggest the need for a neurological clinical examination and an ophthalmological assessment.

Published
2017
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