Severe Meningococcal Meningitis Revealing a Novel Form of Properdin Deficiency in a Previously Healthy 13-year-old Child.

A 13-year-old boy was admitted with severe meningococcal meningitis. Immunologic workup revealed a properdin deficiency, and genetic sequencing of CFP identified a novel, private and predicted pathogenic variant in exon 8. The patient received broad immunizations and penicillin prophylaxis. Children with invasive meningococcal disease should be tested for complement deficiency.

In-Vivo Electrical Properties Estimation of Biological Tissues by Means of a Multi-Step Microwave Tomography Approach.

The accurate quantitative estimation of the electromagnetic properties of tissues can serve important diagnostic and therapeutic medical purposes. Quantitative microwave tomography is an imaging modality that can provide maps of the in-vivo electromagnetic properties of the imaged tissues, i.e. both the permittivity and the electric conductivity. A multi-step microwave tomography approach is proposed for the accurate retrieval of such spatial maps of biological tissues. The underlying idea behind the new imaging approach is to progressively add details to the maps in a step-wise fashion starting from single-frequency qualitative reconstructions. Multi-frequency microwave data is utilized strategically in the final stage. The approach results in improved accuracy of the reconstructions compared to inversion of the data in a single step. As a case study, the proposed workflow was tested on an experimental microwave data set collected for the imaging of the human forearm. The human forearm is a good test case as it contains several soft tissues as well as bone, exhibiting a wide range of values for the electrical properties.

Inconsistency Between Pictures on Baby Diaper Packaging in Europe and Safe Infant Sleep Recommendations.

OBJECTIVE: To describe the level of inconsistency between pictures on baby diaper packaging and safe infant sleep recommendations (SISRs) in Europe. STUDY DESIGN: We attempted to identify all packaging of baby diapers sold in 11 European countries for infants weighing less than 5 kg through internet searches from July 2022 through February 2023. For each type of package, we extracted whether there was a picture depicting a baby, whether the baby was sleeping, and whether the picture of the sleeping baby was inconsistent with ≥1 of 3 SISRs: (i) nonsupine sleeping position, (ii) soft objects or loose bedding, or (iii) sharing a sleep surface with another person. Data were aggregated at the country level, and a random-effects meta-analysis of proportions was used to obtain summary estimates. The outcome was the summary estimate of the proportion of pictures that were inconsistent with SISRs. RESULTS: We identified 631 baby diaper packaging types of which 49% (95% CI: 42-57; n = 311) displayed a picture of a sleeping baby. Among those 311 packages, 79% (95% CI 73-84) were inconsistent with ≥1 SISR, including a nonsupine sleeping position, 45% (95% CI 39-51), soft objects or loose bedding such as pillows or blankets, 51% (95% CI 46-57), and sharing a sleep surface with another person, 10% (95% CI 4-18). CONCLUSIONS: Pictures on baby diaper packaging in Europe are often inconsistent with SISRs. The prevention of sudden unexpected death in infancy requires action from manufacturers and legislators to stop parents' exposure to misleading images that may lead to dangerous practices.

Safety and Efficacy Associated With a Family-Centered Procedural Sedation Protocol for Children With Autism Spectrum Disorder or Developmental Delay.

This case series describes a family-centered procedural sedation protocol including home desensitization to intranasal drug delivery, environmental modification, and intranasal dexmedetomidine combined with nitrous oxide for children with autism spectrum disorder or developmental delay.

Field and Temperature Shaping for Microwave Hyperthermia: Recent Treatment Planning Tools to Enhance SAR-Based Procedures.

The aim of the article is to provide a summary of the work carried out in the framework of a research project funded by the Italian Ministry of Research. The main goal of the activity was to introduce multiple tools for reliable, affordable, and high-performance microwave hyperthermia for cancer therapy. The proposed methodologies and approaches target microwave diagnostics, accurate in vivo electromagnetic parameters estimation, and improvement in treatment planning using a single device. This article provides an overview of the proposed and tested techniques and shows their complementarity and interconnection. To highlight the approach, we also present a novel combination of specific absorption rate optimization via convex programming with a temperature-based refinement method implemented to mitigate the effect of thermal boundary conditions on the final temperature map. To this purpose, numerical tests were carried out for both simple and anatomically detailed 3D scenarios for the head and neck region. These preliminary results show the potential of the combined technique and improvements in the temperature coverage of the tumor target with respect to the case wherein no refinement is adopted.

"Procedural sedation and analgesia in Italian pediatric emergency departments: a subgroup analysis in italian hospitals".

To date, pain and anxiety are the most common symptoms reported by children who refer to pediatric emergency department. Despite it is well known that the undertreatment of this condition has some negative consequences in a short term and long term of time, gaps in the management of pain in this setting still persist. This subgroup analysis aims to describe the current state of art of pediatric sedation and analgesia in Italian emergency departments and to identify existing gaps to solve. This is a subgroup analysis of a cross-sectional European survey of pediatric emergency departments sedation and analgesia practice undertaken between November 2019 and March 2020. The survey proposed a case vignette and questions addressing several domains, like the management of pain, availability of medications, protocols and safety aspects, staff training and availability of human resources around procedural sedation and analgesia. Italian sites responding to the survey were identified and their data were isolated and checked for completeness. Eighteen Italian sites participated to the study, the 66% of which was represented University Hospitals and/or Tertiary Care Centers. The most concerning results were an inadequate sedation to 27% of patients, lack of availability of certain medications like nitrous oxide, the lack of use of intranasal fentanyl and topical anesthetics at the triage, the rare use of safety protocols and preprocedural checklists, lack of staff training and lack of space. Furthermore, the unavailability of Child Life Specialists and hypnosis emerged. Despite procedural sedation and analgesia in Italian pediatric emergency departments is progressively more used than previously, several aspects still require an implementation. Our subgroup analysis could be a starter point for further studies and to improve and make the current Italian recommendations more homogeneous.

FPIES in exclusively breastfed infants: two case reports and review of the literature.

BACKGROUND: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non IgE-mediated food allergy that generally affects children in the first year of life. Usually symptoms break out when formula milk or solid foods are introduced for the first time but they might also appear in exclusively breastfed infants, since the trigger elements, especially cow's milk proteins, can be conveyed by maternal milk as well. FPIES in exclusively breastfed babies is a very rare clinical condition and only few cases have been reported in the medical literature. CASE PRESENTATION: We describe two cases of FPIES in exclusively breastfed babies. The first one is a two-month-old infant with a brief history of vomit and diarrhea that presented to the Emergency Department in septic-like conditions. The main laboratory finding was a significant increase in methemoglobin (13%). Clinically, we noted that, when breastfeeding was suspended, diarrhea drastically improved, and vice versa when maternal milk was reintroduced. An amino acid-based formula allowed a complete normalization of the symptoms. The second one is a three-month-old infant admitted for a 3 days history of persistent vomit and diarrhea. Blood tests showed a raised level of methemoglobin (7%). An esophagogastroduodenoscopy was performed and biopsies showed an eosinophilic infiltration of the duodenal mucosa. A maternal exclusion diet and an amino acid-based formula allowed a rapid regularization of the bowel function. CONCLUSIONS: We searched all the cases of FPIES in exclusively breastfed babies reported in the medical literature, identifying eight patients, with an average age of 3 months (range 15 days - 6 months). The majority of the cases were initially diagnosed as gastroenteritis or sepsis, five cases were characterized by an acute on chronic scenario and cow's milk was the most frequently involved food. Methemoglobin was never tested. An oral food challenge test was performed in two patients. FPIES in exclusively breastfed infants is a rare condition that, in the presence of compatible history and symptoms, should be considered also in exclusively breastfed babies. The evaluation of methemoglobin can simplify the diagnostic process.

Qualitative Methods for the Inverse Obstacle Problem: A Comparison on Experimental Data.

Qualitative methods are widely used for the solution of inverse obstacle problems. They allow one to retrieve the morphological properties of the unknown targets from the scattered field by avoiding dealing with the problem in its full non-linearity and considering a simplified mathematical model with a lower computational burden. Very many qualitative approaches have been proposed in the literature. In this paper, a comparison is performed in terms of performance amongst three different qualitative methods, i.e., the linear sampling method, the orthogonality sampling method, and a recently introduced method based on joint sparsity and equivalence principles. In particular, the analysis is focused on the inversion of experimental data and considers a wide range of (distinct) working frequencies and different kinds of scattering experiments.

A Compressive Sensing Approach for 3D Breast Cancer Microwave Imaging With Magnetic Nanoparticles as Contrast Agent.

In microwave breast cancer imaging magnetic nanoparticles have been recently proposed as contrast agent. Due to the non-magnetic nature of human tissues, magnetic nanoparticles make possible the overcoming of some limitations of conventional microwave imaging techniques, thus providing reliable and specific diagnosis of breast cancer. In this paper, a Compressive Sensing inspired inversion technique is introduced for the reconstruction of the magnetic contrast induced within the tumor. The applicability of Compressive Sensing theory is guaranteed by the fact that the underlying inverse scattering problem is linear and the searched magnetic perturbation is sparse. From the numerical analysis, performed in realistic conditions in 3D geometry, it has been pointed out that the adoption of this new tool allows improving resolution and accuracy of the reconstructions, as well as reducing the number of required measurements.