[The management of confirmed cases of Covid-19 infection in schools: the experience of the prevention Department of the Azienda Sanitaria Friuli occidentale in the Pordenone area]. / L'attività del Dipartimento di prevenzione ASFO nella gestione dei casi confermati di Covid-19 nelle scuole del territorio pordenonese.

The SARS-Cov-2 pandemic that exploded in 2020 resulted in an exceptional school closure involving at least 188 countries worldwide, leaving more than 90% of children at home. This event excluded children and teenagers from the opportunity to learn, socialize, experiment and increased early school leaving. In light of these premises, during the summer months of 2020 the Azienda sanitaria Friuli Occidentale (AsFO) decided to set up a working group to accompany schools in the prevention and containment of the spread of the SARS-CoV-2 infection in the course of the school year 2020-21, with the aim of guaranteeing the right to study and favoring teaching activities in presence in the highest conditions of health and safety. The school reality of the Pordenone area is made up of 40 Comprehensive Institutes for a total of about 206 school complexes of all levels (public, equal and private). In total, the local school population is about 33,000 pupils and 4,000 units of school staff (teachers, ATA, etc ...). The activities of the Schools Group were analyzed by monitoring all interventions with carrying out rapid antigen tests at school and by assessing the incidence of infections within schools. From September 2020 to June 2021, the AsFO Schools Group participated in about 35 teaching colleges and more than 10 dedicated meetings with the families of school pupils of all levels. In total, 170 interventions with rapid antigen tests were carried out at school, involving all the schools in the Pordenone area and a total of 206 classes. During the interventions at school, a total of 6,370 rapid antigen tests were carried out, of which 70% concerned pupils (4,458 total tests) and 30% concerned school staff (1,912 total tests). The antigen tests carried out at school found 173 total positivity (equal to 3% of all tests carried out at school). Out of 173 positives found, 121 are students (70% of the total) and 52 are school staff (30% of the total). During the observation period, the results of the interventions with rapid antigen tests carried out at school led to the continuation of the teaching activity in the presence (with respect to the hygiene and behavioral measures defined by the DP) in 69% of cases (118 interventions). In 9% of cases (15 interventions) the "cross" quarantine was carried out, while in 17% of cases (29 interventions) the quarantine was established for the entire class / section. In 7 circumstances, following the intervention at school, quarantine was established for several classes. Only in 4 circumstances was the institution of quarantine for all school staff, a situation that led to the interruption of all educational activities for the quarantine period.

Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects.

BACKGROUND AND STUDY AIMS: The need to administer procedural sedation to children has increased in recent years, as has experience in this field among nonanesthesiologists. Using propofol makes it easier to achieve sufficiently deep sedation. There is a considerable literature on the administration of propofol by nonanesthesiologists for gastroscopy in adults, but very few data are available on this issue in children. The aim of the present study was to assess the safety and efficacy of procedural sedation with propofol for gastroscopy in a pediatric ward with trained personnel and monitoring facilities. PATIENTS AND METHODS: A training protocol was developed to educate nurses and residents. Children requiring gastroscopy were included in the study prospectively and underwent procedural sedation with propofol administered by nonanesthesiologists. RESULTS: A total of 811 upper gastrointestinal endoscopies were carried out with procedural sedation. Sedation was achieved in all procedures, and all but three (0.4%) were conducted successfully. None of the patients required intubation. Stridor with signs of upper airway obstruction occurred in 14 of the 811 procedures (1.7%). Laryngoscopy was required to manage difficulties in introducing the gastroscope in 16 of the 811 procedures (2.0%). Major desaturation requiring a short course of ventilation occurred in six procedures (0.7%), and transient desaturation that resolved spontaneously occurred in 97 of the procedures (12%). CONCLUSIONS: Administration of propofol by nonanesthesiologists for gastroscopy examinations in children was successful in this study, but was associated with a small risk of potentially severe complications. Although the residents were generally able to administer procedural sedation alone, constant and immediate availability of anesthesiological support continues to be mandatory.