Publications by authors named "Chiara Marra"

6 Publications

  • Page 1 of 1

A nationwide study on Sydenham's chorea: Clinical features, treatment and prognostic factors.

Eur J Paediatr Neurol 2021 Nov 6;36:1-6. Epub 2021 Nov 6.

Pediatric Rheumatology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.

Objectives: Sydenham's Chorea (SC) is a neuropsychiatric disorder and a major manifestation of acute rheumatic fever. The erroneous assumption that SC is a benign and self-limiting disease, has led to a lack of high-quality scientific evidence of the therapeutical and prognostic features of SC.

Study Design: We retrospectively analyzed the medical records of patients <18-years old with SC in 17 Italian pediatric centers. Recorded data included clinical, instrumental and laboratory parameters. Prognostic risk factors including treatment regimens were assessed with univariate and multivariate sub-analysis.

Results: We included 171 patients with SC. 66% had generalized chorea, and 34% hemichorea. 81% had carditis (subclinical in 65%). Additional neurological symptoms were reported in 60% of the patients, mainly dysarthria and dysgraphia. 51% had neuropsychiatric symptoms at onset, which persisted after 12 months in 10%. Among psychiatric manifestations, the most common was anxiety disorder/depression (77%). Neurological remission was reached by 93% of the patients at 6 months; 9% relapsed. Patients were treated as follows: 11% penicillin alone, 37% immunomodulatory therapy, 16% symptomatic drugs (i.e. anti-seizure medication, dopamine antagonists) and 37% both symptomatic and immunomodulatory treatment. Neurological outcome did not differ between groups. Patients receiving symptomatic drugs had a higher risk of relapse on multivariate analysis (p = 0.045).

Conclusions: Treatment of SC was largely heterogeneous. Based on our results, immunomodulatory therapy did not show higher efficacy at medium term, although it was associated to a slightly lower risk of relapse compared to symptomatic therapy. Longitudinal studies are needed to assess specific risk factors and best treatment options.
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November 2021

Posterior Reversible Encephalopathy Syndrome in infants and young children.

Eur J Paediatr Neurol 2021 Jan 28;30:128-133. Epub 2020 Oct 28.

Unit of Pediatric Oncology and Haematology "Lalla Seràgnoli", Department of Pediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy. Electronic address:

Aim: The aim of this study was to describe the characteristics of Posterior Reversible Encephalopathy Syndrome (PRES) in infants and young children (<6 years) and to compare them with the older pediatric population affected by PRES.

Methods: we retrospectively reviewed records of 111 children (0-17 years) diagnosed with PRES from 2000 to 2018 in 6 referral pediatric hospitals in Italy. The clinical, radiological and EEG features, as well as intensive care unit (ICU) admission rate and outcome of children aged <6 years were compared to those of older children (6-17 years). Factors associated with ICU admission in the whole pediatric cohort with PRES were also evaluated.

Results: Twenty-nine patients younger than 6 years (26%) were enrolled with a median age at onset of PRES of 4 years (range: 6 months-5 years). Epileptic seizures were the most frequent presentation at the disease onset (27/29 patients). Status epilepticus (SE) was observed in 21/29 patients: in detail, 11 developed convulsive SE and 10 presented nonconvulsive SE (NCSE). SE was more frequent in children <6 years compared with older children (72% vs 45%) as well as NCSE (35% vs 10%). Seventeen children aged <6 years required ICU admission. Prevalence of ICU admissions was higher within younger population compared to older (59% vs 37%). In the whole study population SE was significantly associated with ICU admission (p = 0.001).

Conclusions: PRES in children < 6 years differs from older children in clinical presentation suggesting a more severe presentation at younger age.
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January 2021

Computed Tomography in Acute Severe Central Nervous System Complications in Children Treated for Cancer: Still a Useful Diagnostic Tool in the Emergency Setting.

J Child Neurol 2021 03 19;36(3):169-176. Epub 2020 Oct 19.

Child Neurology and Psychiatry Unit, 18508University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.

We retrospectively checked patients who underwent chemotherapy and/or hematopoietic stem cell transplantation from 2007 to 2016, in order to evaluate whether early computed tomography is useful in children treated for cancer with acute central nervous system complications. Out of a total sample of 443 patients, 52 children (11.7%) presented these complications. In the end, 31 patients were included, with a total of 33 events of central nervous system complications. The computed tomography was abnormal in 22 events (67%) and diagnostic for a specific complication in 20 events (61%), whereas it directly influenced the treatment in 16 events (48%). Computed tomography should be still considered a relevant diagnostic tool in the management of acute central nervous system complications in the emergency setting.
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March 2021

Treatment of simple and complex endometrial non-atypical hyperplasia with natural progesterone: response rate to different doses.

Gynecol Endocrinol 2014 11;30(12):899-901. Epub 2014 Aug 11.

a Division of Obstetrics and Gynecology, San Gerardo Hospital, University of Milan-Bicocca Monza Italy.

The aim of this study is to evaluate the response rate to natural progesterone in non-atypical endometrial hyperplasia and to identify the lowest effective dose. A total of 197 patients of childbearing age with simple or complex hyperplasia were retrospectively identified. The women were treated with a cyclic administration of progesterone at different dosages (100 versus 200 versus 300 mg daily). Endometrial biopsies were performed at 6, 12, 18 months. In comparing progesterone to a regimen of no therapy, a significantly higher remission rate was observed in the progesterone group than in the latter (95 versus 75%, p = 0.05 for simple hyperplasia; 89 versus 35%, p < 0.001 for complex hyperplasia). Out of 60 women with simple hyperplasia, remission was observed in 9/11 (81.8%), 40/41 (97.5%) and 8/8 (100%) patients treated, respectively, with progesterone 100, 200 and 300 mg daily. Out of 72 women with complex hyperplasia, remission was observed in 3/5 (60%), 49/53 (92.4%) and 12/14 (85.7%) patients treated with progesterone 100, 200 and 300 mg daily, respectively. There was no statistically significant difference in the response rate in the two groups, neither with simple nor with complex hyperplasia. In conclusion, progesterone increased the regression rate of both simple and complex hyperplasia.
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October 2016

Wrist-ankle acupuncture as perineal pain relief after mediolateral episiotomy: a pilot study.

J Altern Complement Med 2011 Mar 7;17(3):239-41. Epub 2011 Mar 7.

Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy.

Objectives: The purpose of this pilot study was to evaluate the efficacy of acupuncture in relieving perineal pain after mediolateral episiotomy during childbirth.

Design And Subjects: Women with mediolateral episiotomy during delivery were enrolled in this study and were assigned to be treated or not with acupuncture.

Outcomes Measures: Perineal pain relieving effect of acupuncture was evaluated considering oral analgesics request during post-partum period and was the main outcome of this trial.

Results: A total of 42 women were enrolled in this trial. Twenty-one (21) women were treated with "wrist-ankle" acupuncture, inserting one needle in their right ankle. A second group of 21 women was not treated with acupuncture. Women in the acupuncture group were significantly less likely to experience pain; only 8 of them (38.1%) asked for analgesics. All women in the second group assumed oral analgesics because of perineal pain (p < 0.01).

Conclusions: Wrist-ankle acupuncture during the postpartum period is effective for perineal pain relief after mediolateral episiotomy.
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March 2011

Vulvar endometriosis in surgical scar after excision of the Bartholin gland: report of a case.

Arch Gynecol Obstet 2008 Mar 12;277(3):255-6. Epub 2007 Sep 12.

Department of Obstetrics and Gynecology, University of Milano-Bicocca, Bassini Hospital, Cinisello Balsamo, Milan, Italy.

Endometriosis is a common gynecologic disease characterized by growth of endometrial glands and stroma outside the endometrium. Implants are most commonly found in the pelvis but can occur in many other sites. Vulvar involvement of endometriosis is extremely rare. A case of vulvar endometriosis is presented. Endometriosis was infiltrating the subcutaneous scar tissue of left labia minora after cystectomy of Bartholin gland for abscess that has recurred several times despite office-based treatment.
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March 2008