LAT Gel: from the Galenical Laboratory to the Paediatric Emergency Room – A Fondazione Policlinico Gemelli IRCCS Experience Michele Favia, Elena Lupi, Michela Sperandeo, Lidia Di Cerbo, Antonella Sabia, Barbara Ruozi, Ilaria Ottonelli, Antonietta Curatola, Davide Zanon, Rina Campopiano, Marcello Pani, Domenico Tarantino Hospital Pharmacy, 2025 Objectives: Lacerations are one of the most widespread and common emergencies among children, addressed by doctors in emergency room admissions. The aim of this study was to optimize the formulation of a pre-existing anaesthetic gel known as LAT gel (Lidocaine 4%, Adrenaline 0.05%, Tetracaine 0.5% gel), in order to allow the paediatric emergency department of the Policlinico A. Gemelli (Rome) to improve the management of lacerations, while avoiding the mandatory use of infiltrative anaesthesia. The aim of the study was also to assess the stability over time of the active ingredients (lidocaine, adrenaline, tetracaina) in the galenic preparation. Methods: LAT gel is a formulation prepared using: a poloxamer, Lutrol F127 (or Kolliphor P407), two anaesthetics (lidocaine and tetracaine), together with adrenaline. The formulation was prepared in a Grade A laminar flow hood and in a Grade B environment for microbial load. Batches were subjected to microbiological analysis by hospital hygiene as indicated in FU XII (“Official Italian pharmacopoeia XII edition”). The chemical stability of the gel was assessed by high-performance liquid chromatography. Results : Analysis showed that the lidocaine, tetracaine and adrenaline content in the LAT gel remained constant when stored in a refrigerator at 2 to 8°C for up to 120 days. The non-need for additional anaesthetic methods was considered as a parameter of effectiveness. 83 children were evaluated. In the cases recorded, 83.1% (69/83) of patients did not require an additional anaesthesia. Patients who required additional anaesthesia 16.9% (14/83) were those with deep and extensive lacerations. The results show that an effective, sterile, stable preparation with excellent applicability was prepared. Conclusion: This product lends itself to application to the wound surface with a better anaesthetic and haemostatic effect and, unlike injectable lidocaine, is an optimal treatment for increasing compliance in paediatric emergency rooms.
Use of multimedia devices in pediatric age: risks or advantages? a survey in an italian center Ilaria LAZZARESCHI, Antonietta CURATOLA, Sabrina DE PASCALIS, Luca BERNARDO, Antonio GATTO, Serena FERRETTI, Piero VALENTINI, Pietro FERRARA Minerva Pediatrics, 2024 BACKGROUND Nowadays children live in a digital world, exposed to relevant risks for their health and safety. The aim of this study is to investigate the use of multimedia devices in a sample of children and adolescents. METHODS The study was performed between November 2018 and June 2019 in a third-level University Hospital, recruiting children and adolescents during general or specialistic follow-up visits. Anonymous, age-specific, questionnaires were distributed to 500 children and adolescents and 370 parents. RESULTS Among children, 25 (17.1%) had their own mobile device, of which 84% Italian. The 54.1% of them uses multimedia devices half an hour/an hour per day and many of them (37.5% of Italian and 40% of foreign) use it without their parents' control. Most of adolescents had a mobile phone since the age of 10-12 years old. WhatsApp (Meta Inc., Cambridge, MA, USA) is the most used social network, followed by Instagram and Facebook. The use of multimedia devices was widespread between teenagers during classroom hours, meals and before sleeping and they are an important mean for cyberbullying. In addition, in the 29.9% of cases there is no correspondence between information given by parents and respective sons/daughters. CONCLUSIONS This study shows more risks than advantages derived from the use of multimedia devices in children and adolescents. Therefore, it is essential to educate them about their correct and responsible use.
Lung ultrasound evaluation in people with cystic fibrosis: A new approach in the pulmonology outpatient clinic Antonietta Curatola, Federica Corona, Domenica Squillaci, Alessia Saccari, Antonio Chiaretti, Egidio Barbi, Massimo Maschio Pediatric Pulmonology, 2024 BackgroundCystic fibrosis (CF) is a genetic disease that causes progressive lung disease with major impact on the quality of life. Lung ultrasound (LUS) allows to assess the lung involvement through the artefacts analysis and is increasingly used in children but is not yet used to monitor people with CF(pwCF). The main aim of this study was to describe the LUS pattern of pwCF during their routinary check‐up visit. The secondary objective was to correlate the LUS findings with pulmonary function indices.MethodsWe performed a cross‐sectional observational study, enrolling adolescents and young adults with CF. Each patient underwent clinical assessment, measurement of SpO2, assessment of lung function by spirometry and LUS.ResultsTwenty‐nine subjects with CF were included. The most frequent alterations were consolidations (72.4%) located in the left apical anterior and right apical posterior regions followed by interstitial syndrome (65.5%). The 41.4% of cases presented the lingula involvement, characterized by a consolidation with static air bronchogram, and 55.2% showed pleural irregularity mainly in the posterior apical regions. A significant correlation was found between the LUS total score and spirometric indices: FEV1 (p = .003), FVC (p = .002), Tiffenau Index <80% (p = .014), and FEF 25–75 (p = .004).ConclusionsOur study describes LUS findings in pwCF. It also showed a correlation between LUS score and the patients' lung function measured by spirometric indices. We conclude that LUS may be useful in routine monitoring of pwCF in combination with clinical and spirometric assessment.
Diagnosis and Treatment of Group A Streptococcal Pharyngitis in Children Antonietta Curatola, Lorenzo Di Sarno, Miriam Massese, Anya Caroselli, Antonio Gatto, Antonio Chiaretti Pediatric Annals, 2024 The purpose of this review is to summarize the current evidence regarding the management of streptococcal pharyngitis in children. This article aims to provide a valid support to discriminate streptococcal pharyngitis from viral cases and treat it appropriately to avoid the development of complications. Differential diagnosis based only on clinical features is not always easy. For this reason, different clinical scores were created to provide an accurate diagnosis. Microbiological tests are valuable tools as well, but their use is not recommended unanimously. Concerning treatment, all guidelines agree on the drug to be used. However, doubts remain about the optimal duration of antibiotic therapy, especially in this specific historical moment as we are experiencing a peak in streptococcal infections. [ Pediatr Ann . 2024;53(6):e234–e238.]
Increased serum levels of proNGF, mature NGF and interleukins in burn-injured children L. Di Sarno, G. Eftimiadi, A. Chiaretti, L. Manni, O. Genovese, M. Soligo, A. Curatola, T. C. Morena, A. Gatto, M. Piastra, G. Sferrazza, V. Pansini, G. Conti European Review for Medical and Pharmacological Sciences, 2024 OBJECTIVE Burns are among the most common injuries in children. In burns of more than 20% of the total body surface area, a systemic inflammatory response involving several chemical mediators occurs. Among them, nerve growth factor (NGF) regulates the inflammatory response related to wound healing and promotes keratinocyte proliferation and angiogenesis. The aim of our study was to investigate the physiological response to injury in children with moderate-severe burns, assaying proNGF, mature NGF (mNGF), interleukins (IL)-1β, and Il-10 serum levels. PATIENTS AND METHODS This is a prospective observational study, including twelve children hospitalized for moderate-severe burns at the Gemelli Hospital (Rome). Their laboratory features were compared to those of patients with obstructive hydrocephalus who underwent surgery. RESULTS Our results showed an increase in proNGF and mNGF serum levels. In burn patients, proNGF levels increased before mNGF, and serum concentrations of both were not correlated with burn extension and depth. The most significant levels of mNGF and proNGF were reported in scalds involving the face. Serum IL-1β and IL-10 peak levels were reached with a time-course pattern similar to proNGF. CONCLUSIONS Our preliminary results validate the hypothesis that serum levels of proNGF and mNGF may represent inflammatory biomarkers useful for monitoring burn patients and defining new strategies for their treatment.
Combined treatment of nerve growth factor and transcranical direct current stimulations to improve outcome in children with vegetative state after out-of-hospital cardiac arrest Antonietta Curatola, Benedetta Graglia, Giuseppe Granata, Giorgio Conti, Lavinia Capossela, Luigi Manni, Serena Ferretti, Daniela Di Giuda, Domenico Marco Romeo, Maria Lucia Calcagni, Marzia Soligo, Enrico Castelli, Marco Piastra, Flavio Mantelli, Giacomo Della Marca, Susanna Staccioli, Tiziana Romeo, Marcello Pani, Fabrizio Cocciolillo, Aldo Mancino, Antonio Gatto, Antonio Chiaretti Biology Direct, 2023 Background Out-of-hospital cardiac arrest (OHCA) is one of the most dramatic events in pediatric age and, despite advanced neurointensive care, the survival rate remains low. Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. Nerve Growth Factor (NGF) is a neurotrophin potentially able to counteract many of the deleterious effects triggered by OHCA. Transcranial Direct Current Stimulation (tDCS) has been reported to be neuroprotective in many neurological diseases, such as motor deficit and cognitive impairment. Children with the diagnosis of chronic vegetative state after OHCA were enrolled. These patients underwent a combined treatment of intranasal administration of human recombinant NGF (hr-NGF), at a total dose of 50 gamma/kg, and tDCS, in which current intensity was increased from zero to 2 mA from the first 5 s of stimulation and maintained constant for 20 min. The treatment schedule was performed twice, at one month distance each. Neuroradiogical evaluation with Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG) and Power Spectral Density of the brain (PSD) was determined before the treatment and one month after the end. Neurological assessment was deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale. Results Three children with a chronic vegetative state secondary to OHCA were treated. The combined treatment with hr-NGF and tDCS improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary finger movements, improved facial mimicry and reaction to painful stimuli. No side effects were reported. Conclusions These promising preliminary results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from OHCA and in patients with better baseline neurological conditions, in order to explore more thoroughly the benefits of this new approach on neuronal function recovery after OHCA.
Intranasal human-recombinant NGF administration improves outcome in children with post-traumatic unresponsive wakefulness syndrome Antonio Gatto, Lavinia Capossela, Giorgio Conti, Gemma Eftimiadi, Serena Ferretti, Luigi Manni, Antonietta Curatola, Benedetta Graglia, Lorenzo Di Sarno, Maria Lucia Calcagni, Daniela Di Giuda, Stefano Cecere, Domenico Marco Romeo, Marzia Soligo, Enzo Picconi, Marco Piastra, Giacomo Della Marca, Susanna Staccioli, Antonio Ruggiero, Fabrizio Cocciolillo, Silvia Pulitanò, Antonio Chiaretti Biology Direct, 2023 Background Severe traumatic brain injury (TBI) is one of the most dramatic events in pediatric age and, despite advanced neuro-intensive care, the survival rate of these patients remains low. Children suffering from severe TBI show long-term sequelae, more pronounced in behavioral, neurological and neuropsychological functions leading to, in the most severe cases, an unresponsive wakefulness syndrome (UWS). Currently, no effective treatments can restore neuronal loss or produce significant improvement in these patients. In experimental animal models, human- recombinant Nerve Growth Factor (hr-NGF) promotes neural recovery supporting neuronal growth, differentiation and survival of brain cells and up-regulating the neurogenesis-associated processes. Only a few studies reported the efficacy of intranasal hr-NGF administration in children with post- traumatic UWS. Methods Children with the diagnosis of post-traumatic UWS were enrolled. These patients underwent a treatment with intranasal hr-NGF administration, at a total dose of 50 gamma/kg, three times a day for 7 consecutive days. The treatment schedule was performed for 4 cycles, at one month distance each. Neuroradiogical evaluation by Positron Emission Tomography scan (PET), Single Photon Emission Computed Tomography (SPECT), Electroencephalography (EEG), and Power Spectral Density (PSD) was determined before the treatment and one month after the end. Neurological assessment was also deepened by using modified Ashworth Scale, Gross Motor Function Measure, and Disability Rating Scale. Results Three children with post-traumatic UWS were treated. hr-NGF administration improved functional (PET and SPECT) and electrophysiological (EEG and PSD) assessment. Also clinical conditions improved, mainly for the reduction of spasticity and with the acquisition of voluntary movements, facial mimicry, attention and verbal comprehension, ability to cry, cough reflex, oral motility, and feeding capacity, with a significant improvement of their neurological scores. No side effects were reported. Conclusion These promising results and the ease of administration of this treatment make it worthwhile to be investigated further, mainly in the early stages from severe TBI and in patients with better baseline neurological conditions, to explore more thoroughly the benefits of this new approach on neuronal function recovery after traumatic brain damage.
Bone Disorders in Pediatric Chronic Kidney Disease: A Literature Review Lavinia Capossela, Serena Ferretti, Silvia D’Alonzo, Lorenzo Di Sarno, Valeria Pansini, Antonietta Curatola, Antonio Chiaretti, Antonio Gatto Biology, 2023 Intense changes in mineral and bone metabolism are frequent in chronic kidney disease (CKD) and represent an important cause of morbidity and reduced quality of life. These disorders have conventionally been defined as renal osteodystrophy and classified based on bone biopsy, but due to a lack of bone biopsy data and validated radiological methods to evaluate bone morphology in children, it has been challenging to effectively assess renal osteodystrophy in pediatric CKD; the consequence has been the suboptimal management of bone disorders in children. CKD–mineral and bone disorder (CKD-MBD) is a new expression used to describe a systemic disorder of mineral and bone metabolism as a result of CKD. CKD-MBD is a triad of biochemical imbalances in calcium, phosphate, parathyroid hormone, and vitamin D; bone deformities and soft tissue calcification. This literature review aims to explore the pathogenesis, diagnostic approach, and treatment of CKD-MBD in children and the effects of renal osteodystrophy on growing skeleton, with a specific focus on the biological basis of this peculiar condition.
SARS-CoV-2-related bronchiolitis: A multicentre international study Giorgio Cozzi, Aleksandar Sovtic, Davide Garelli, Uros Krivec, Davide Silvagni, Ilaria Corsini, Marco Colombo, Manuela Giangreco, Antonietta Giannattasio, Gregorio Paolo Milani, Marta Minute, Federico Marchetti, Antonio Gatto, Carla Debbia, Anna Jolanda Gortan, Marta Massaro, Elpis Hatziagorou, Domenico Ravidà, Raz Diamand, Elizabeth Jones, Jelena Visekruna, Alessandro Zago, Egidio Barbi, Alessandro Amaddeo, Luisa Cortellazzo Wiel Archives of Disease in Childhood, 2023
Pain management in pediatric age. An update L. Di Sarno, A. Gatto, D. Korn, V. Pansini, A. Curatola, S. Ferretti, L. Capossela, B. Graglia, A. Chiaretti Acta Biomedica, 2023
Prevalence of SARS-CoV-2 positivity in infants with bronchiolitis: A multicentre international study Giorgio Cozzi, Luisa Cortellazzo Wiel, Alessandro Amaddeo, Antonio Gatto, Manuela Giangreco, Adi Klein-Kremer, Samantha Bosis, Davide Silvagni, Carla Debbia, Laura Nanni, Sara Chiappa, Marta Minute, Ilaria Corsini, Giuliana Morabito, Anna Jolanda Gortan, Marco Colombo, Federico Marchetti, Davide Garelli, Arianna Piffer, Fabio Cardinale, Nitai Levy, Antonietta Curatola, Bojana Gojsina, Suvradeep Basu, Egidio Barbi, Aleksandar Sovtic Archives of Disease in Childhood, 2022
Cytokine response to sars-cov-2 infection in children Antonietta Curatola, Antonio Chiaretti, Serena Ferretti, Giulia Bersani, Donatella Lucchetti, Lavinia Capossela, Alessandro Sgambato, Antonio Gatto Viruses, 2021
Lung ultrasound in infants with bronchiolitis Danilo Buonsenso, Anna Maria Musolino, Antonio Gatto, Ilaria Lazzareschi, Antonietta Curatola, Piero Valentini BMC Pulmonary Medicine, 2019
