Castell'Umberto, Italy
Castell'Umberto, Italy

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Battelino T.,University of Ljubljana | Conget I.,Hospital Clinici Universitari | Olsen B.,Glostrup Hospital | Schutz-Fuhrmann I.,Hospital Hietzing | And 5 more authors.
Diabetologia | Year: 2012

Aims/hypothesis The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitorin (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Methods Children and adults (n=153) on CSII with HbA1c 7.5-9.5% (58.5-80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months' washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA1c levels between arms after 6 months. Results Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA1c was -0.43% (-4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI -0.32%, -0.55% [-3.50, -6.01 mmol/mol]; p<0.001). Following cessation of glucose sensing, HbA 1c reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p=0.009). The mean number of daily boluses increased in the Sensor On arm (6.8±2.5 vs 5.8±1.9, p<0.0001), together with the frequency of use of the temporary basal rate (0.75± 1.11 vs 0.26±0.47, p<0.0001) and manual insulin suspend (0.91±1.25 vs 0.70±0.75, p<0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p=0.40). Conclusions/interpretation Continuous glucose monitoring was associated with decreased HbA1c levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects.Trial registration registration no. NCT00598663. Funding The study was funded by Medtronic International Trading Sarl Switzerland. © Springer-Verlag 2012.

Pession A.,University of Bologna | Masetti R.,University of Bologna | Rizzari C.,University of Milan Bicocca | Putti M.C.,University of Padua | And 16 more authors.
Blood | Year: 2013

We evaluated the outcome of 482 children with acute myeloid leukemia (AML) enrolled in the Associazione Italiana di Ematologia e Oncologia Pediatrica AML 2002/01 trial. Treatment was stratified according to risk group; hematopoietic stem cell transplantation (HSCT) was used in high-risk (HR) children. Patients with core binding factor leukemia achieving complete remission (CR) after the first induction course were considered standard risk (SR; 99 patients), whereas the others (n 5 383) were assigned to the HR group. Allogeneic (ALLO) or autologous (AUTO) HSCT was employed, respectively, in 141 and 102 HR patients after consolidation therapy. CR, early death, and induction failure rates were 87%, 3%, and 10%, respectively. Relapse occurred in 24%of patients achieving CR. The 8-year overall survival (OS), event-free survival (EFS), and disease-free survival (DFS) were 68%, 55%, and 63%, respectively. OS, EFS, and DFS for SR and HR patients were 83%, 63%, and 66% and 64%, 53%, and 62%. DFS was 63% and 73% for HR patients given AUTO-HSCT and ALLO-HSCT, respectively. In multivariate analysis, risk group, white blood cell >100 × 109/L at diagnosis, and monosomal karyotype predicted poorer EFS. Risk-oriented treatment and broad use of HSCT result in a long-term EFS comparing favorably with previously published studies on childhood AML. (Blood. 2013; 122(2):170-178) © 2013 by The American Society of Hematology.

Marchetti F.,Clinica Pediatrica | Panizon F.,University of Trieste
Medico e Bambino | Year: 2010

It is reasonable to delay the antibiotic treatment of a few days in all the apparently not serious cases of upper respiratory infection. "Risk" groups, in which antibiotics should be used to treat each fever, are: chronic pulmonary, kidney and heart diseases, immunodeficiency, cystic fibrosis, muscular diseases and prematurity. In case of a child with sore throat, if there are other concomitant signs of respiratory infection (nasal secretion, cough) it is certainly a viral disease. If pharyngitis is not accompanied by signs of infection to the upper respiratory tract, perform rapid strep test, it should come out positive in half of cases. Antibiotics are of little help in sinusitis. If the cough that accompanies fever is very severe and the outcome of auscultation is not significant, respiratory rate must be counted. If it is not higher than 45/m (under 2 years) it is not bronchopneumonitis, or at least, the latter is neither significant nor worrying. Waiting is still reasonable. The problem of antibiotic resistance for excessive use is real; it certainly concerns more macrolides than amoxicillin and it is proportional to the antibiotic pressure (which is very high in Italy). The problem of methicillin-resistant Staphylococcus pathology, though quantitatively limited, is growing and may have tragic outcomes. The "complete" resistance of Pneumococcus to amoxicillin is assessed at about 2-3%. An intermediate resistance (between 10% and 15%) can be easily overcome by using, when needed, higher doses of amoxicillin.

Stilli S.,Instituto Ortopedico Rizzoli | Reggiani L.M.,Instituto Ortopedico Rizzoli | Muccioli G.M.M.,Instituto Ortopedico Rizzoli | Cappella M.,Clinica Pediatrica | Donzelli O.,Instituto Ortopedico Rizzoli
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Purpose: The purpose of this study was to review the operative long-term results of a large cohort of children treated arthroscopically for a symptomatic discoid lateral meniscus. Methods: We retrospectively reviewed the arthroscopic procedures performed on 104 knees (97 patients) between 1990 and 2006 to treat symptomatic discoid lateral meniscus in children. The median age at the time of surgery was 8 years (range 2.5-13.9 years). Results: The follow-up was 8.5 ± 2.5 (mean ± SD) years (median 9, range 2-18.5 years). In this series, young children (2-7 years) usually presented complete discoid menisci with deficit in extension and little pain. The meniscal tissue was almost degenerated, and subtotal meniscectomy was performed. Children aged from 8 to 14 years referred to our institute typically presented a symptomatic tear (pain and swelling joint with snap) of a complete or incomplete discoid lateral meniscus, usually pursuant to a trauma. The treatment performed in this group was a partial meniscectomy. Clinical results at long-term follow-up show better results for subtotal meniscectomies than for partial ones. Conclusion: The results showed the long-term efficacy of arthroscopic treatment of a symptomatic discoid lateral meniscus. On the basis of this study, subtotal meniscectomies in younger patients are preferable when meniscal tissue is degenerated. In older children, we recommend to preserve meniscal tissue as much as possible. In younger patients submitted to subtotal meniscectomies, some adaptation of the knee to stress activity may occur. Level of evidence: Therapeutic case series, Level IV. © 2011 Springer-Verlag.

Leoni M.C.,Clinica Pediatrica | Pizzo D.,Clinica Pediatrica | Marchi A.,Clinica Pediatrica
Minerva Pediatrica | Year: 2010

Adipose tissue is now considered an important endocrine organ that secretes a large number of physiologically active peptides affecting metabolic homeostasis of human body: they are collectively referred to as adipocytokines. Leptin is a key hormone in the regulation of food intake, energy expenditure, neuroendocrine and immune function. Leptin is related with obesity and its metabolic disorders; starvation-induced depletion of fat stores is accompanied by alterations of circulating adipocytokines that may have potential repercussions in the pathophysiology of anorexia nervosa. Adiponectin enhances insulin sensitivity, controls body weight, prevents atherosclerosis and negatively regulates immune functions. Plasma adiponectin relates inversely to adiposity and reflects the sequelae of accumulation of excess adiposity. Resistin is a protein hormone produced both by adipocytes and immunocompetent cells that affect fuel homeostasis and insulin action. Plasma resistin levels are decreased in anorectic patients, while plasma adiponectin levels are increased. Plasma ghrelin levels present opposite changes in obesity and anorexia nervosa, suggesting that ghrelin is a good marker of nutritional status. Visfatin shows to correlate with visceral fat mass in patients with obesity. Its possible role in patients with anorexia nervosa is unknown. In conclusion, obesity is defined as a state of low-grade inflammation, which is associated with increased leptin, resistin and ghrelin levels and decreased adiponectin levels; anorexia nervosa is characterized by opposite changes. Finally, plasma adipocytokines levels can represent a sensitive parameter of nutritional status that reflects changes in the level of body fat in children and adolescents with obesity and anorexia nervosa.

Since measles and mumps components used in measles-mumps-rubella (MMR) vaccine are grown in cultures of fibroblast from chick embryos, the safety of administering MMR vaccine to patients allergic to eggs has been debated for long time. Finally international recommendations and Italian guide line clearly state that MMR vaccine do not contain significant amounts of egg cross-reacting proteins and so there are no risks for patients allergic to eggs. Furthermore, children with egg allergy are at low risk of allergic reaction to MMR, even if they have a history of severe anaphylaxis to egg ingestion: they can be vaccinated regularly, without previous skin test with the vaccine and the procedure does not need to be done in a hospital.

The debate about acute otitis media (AOM) is endless, like any other subject that greatly affects the daily routine of the family paediatrician. However, much greater rigour is needed in the use of antibiotics (to safeguard a heritage that is certainly not infinite), so our prescription habits must be reassessed. Therefore, the vigilant wait in AOM has become a possible tested and recommended behaviour that today guidelines have opportunely fixed. There are no longer excuses or justifications. However, it is true that otitis with severe otalgia (eversion of the tympanic membrane) must be opportunely and conveniently treated immediately upon the onset at all ages. A few days of therapy with high doses of amoxicillina three times a day is the best treatment. The association with clavulanic acid should mainly be administered to children under 2 years old.

Berti I.,Clinica Pediatrica
Medico e Bambino | Year: 2012

Some degree of acne vulgaris affects almost all the teenagers between 15 and 17 years old and in 20% of them it is remarkable (moderate-severe acne). It is a very frequent problem that paediatricians have often to face and for which they have to prescribe a first treatment.

In Italy, data concerning the utilization of ceftriaxone in adults and children increased by about 75% from 2001 to 2008. Moreover, a significant variability in its utilization can be observed in the Italian regions, indeed it is more frequently used in the South than in the North of Italy. The data on the overall utilization and the regional variability seem to indicate an inappropriate use of the drug within the territorial medical practice. In particular, ceftriaxone is used in home treatments in 2.4 % of children in paediatric age. Considering that in ambulatory paediatrics just few cases need to be treated with ceftriaxone, this percentage turns out to be very high. Projects aiming at rationalizing the use of drugs that are inappropriately prescribed via parenteral route in the ambulatory setting are urgently needed.

Berti I.,Clinica Pediatrica
Medico e Bambino | Year: 2010

Keratosis pilaris is a common cutaneous "abnormality" defined by the presence of rough, follicular papules and erythema. The lesions occur mostly on extensor surfaces of the arms and legs but frequently involve the face. Up to 40% of children presents with mild keratosis pilaris and many times someone in the family shows the same skin appearance. Keratosis pilaris often improves in summer time; facial lesion usually resolves before adulthood while lesions on legs and arms can be more persistent. No treatment is needed because it is not a disease. Mild relief can be achieved using keratolitic agents such as 10% urea.

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