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Dakar, Senegal

Rossi M.C.,Consorzio Mario Negri Sud | Nicolucci A.,Consorzio Mario Negri Sud | Lucisano G.,Consorzio Mario Negri Sud | Pellegrini F.,Consorzio Mario Negri Sud | And 4 more authors.
Diabetes Technology and Therapeutics | Year: 2013

Background: Telemedicine systems based on mobile phones represent new promising educational tools. The "Diabetes Interactive Diary" (DID) is a carbohydrate/bolus calculator promoting the patient-physician communication via short message service. This study aimed to compare the efficacy of the DID versus usual care on metabolic control, hypoglycemia, and quality of life. Patients and Methods: Patients with type 1 diabetes on a basal:bolus regimen with insulin glargine and insulin glulisine, not previously educated on carbohydrate (CHO) counting, were randomized to DID (Group A; n=63) or traditional education (Group B; n=64). Generalized hierarchical linear regression models for repeated measures were applied to compare changes between groups. Incidence of hypoglycemia was compared using Poisson regression models. Results: Of 127 patients (age, 36.9±10.5 years; diabetes duration, 16.3±9.3 years), 15 (11.8%) dropped out. After 6 months, hemoglobin A1c (HbA1c) levels decreased by -0.49±0.11 in Group A and -0.48±0.11 in Group B (P=0.73). Group A showed a 86% lower risk of grade 2 hypoglycemia than Group B. Compared with usual care, DID improved the "perceived frequency of hyperglycemic episodes" scale of the Diabetes Treatment Satisfaction Questionnaire and the "social relations" and the "fear of hypoglycemia" dimensions of the Diabetes Specific Quality of Life Scale. Results obtained with DID markedly differ among patients and centers. Conclusions: DID is no more effective than traditional CHO counting education in reducing HbA1c levels. DID reduces the risk of moderate/severe hypoglycemia and improves quality of life. A better understanding of patients' and healthcare professionals' attitudes associated with an effective care supported by technology is essential to avoid waste of resources. © Mary Ann Liebert, Inc. Source


Pientong C.,Khon Kaen University | Ekalaksananan T.,Khon Kaen University | Teeratakulpisarn J.,Khon Kaen University | Tanuwattanachai S.,Pediatrics Unit | And 2 more authors.
Journal of Microbiology, Immunology and Infection | Year: 2011

Background: Atypical bacterial pathogens-including Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Chlamydia trachomatis-are important infectious agents of the respiratory system. Most current information pertains to adults and little is known about the role of these organisms in lower respiratory tract infections among young children with acute bronchiolitis. Methods: This study detected these pathogens in the nasopharyngeal secretions of children between 1 month and 2 years of age admitted with acute bronchiolitis to hospitals in Khon Kaen, northeast Thailand. The M pneumoniae and C pneumoniae in the nasopharyngeal secretions were detected using multiplex and nested-polymerase chain reaction (PCR), whereas PCR and restriction fragment length polymorphism were used to investigate C trachomatis. These samples were also tested by multiplex reverse transcriptase PCR for respiratory viruses, including respiratory syncytial virus (RSV), influenza A, influenza B, and human metapneumovirus. Results: Of the 170 samples taken from hospitalized children with acute bronchiolitis, 12.9% were infected with atypical bacteria and 85.3% with respiratory viruses. RSV was the most common causative viral agents found in 64.7% of the samples. M pneumoniae was the most common atypical bacterial pathogen (14/170, 8.2%) and most of the patients infected with it were between 6 and less than 12 months of age (71 cases). Of the infected cases in this age group, 7 of 14 were infected with M pneumoniae and 4 of 4 with C pneumoniae. Both M pneumoniae (13/14) and C pneumoniae (4/4) had etiologies indicating viral coinfections. Four (2.4%) of all of the cases had C trachomatis infections and all of the. se were infected with RSV, including three patients less than 6 months of age. Conclusion: These results suggest that in children with virus-induced acute bronchiolitis coinfection with M pneumoniae, C pneumoniae, or C trachomatis can be expressed differently in each age group. These atypical bacteria may be the important infectious agents that induce severe illness of acute bronchiolitis. © 2011. Source


Basinko A.,University of Western Brittany | Basinko A.,French Institute of Health and Medical Research | Giovannucci Uzielli M.L.,University of Florence | Scarselli G.,University of Florence | And 4 more authors.
European Journal of Medical Genetics | Year: 2012

We report here a child with a ring chromosome 5 (r(5)) associated with facial dysmorphology and multiple congenital abnormalities. Fluorescent in situ hybridization (FISH) using bacterial artificial chromosome (BAC) clones was performed to determine the breakpoints involved in the r(5). The 5p deletion extended from 5p13.2-3 to 5pter and measured 34.61 Mb (range: 33.7-35.52 Mb) while the 5q deletion extended from 5q35.3 to 5qter and measured 2.44 Mb (range: 2.31-2.57 Mb). The patient presented signs such as microcephaly, hypertelorism, micrognathia and epicanthal folds, partially recalling those of a deletion of the short arm of chromosome 5 and the "cri-du-chat" syndrome. The most striking phenotypic features were the congenital heart abnormalities which have been frequently reported in deletions of the distal part of the long arm of chromosome 5 and in rings leading to a 5q35-5qter deletion. However, the NKX2-5 gene, which has been related to congenital heart defects, was not deleted in our patient, nor presumably to some other patients with 5q35.3-5qter deletion. We propose that VEGFR3, deleted in our patient, could be a candidate gene for the congenital heart abnormalities observed. © 2011 Elsevier Masson SAS. Source


De Mulder M.,CIBER ISCIII | Yebra G.,CIBER ISCIII | Navas A.,Hospital Universitario Infanta Leonor | Martin L.,CIBER ISCIII | And 7 more authors.
Pediatric Infectious Disease Journal | Year: 2012

BACKGROUND: Drug resistance mutations compromise antiretroviral treatment (ART) effectiveness in HIV-1-infected children. Trends in drug resistance prevalence have not been previously evaluated in HIV-infected children in Spain. METHODS: HIV-1 variants, drug resistance prevalence dynamics and drug susceptibility were analyzed from 1993 to 2010 in HIV-infected children with available pol sequence, sample or drug resistance profile. HIV-1 variants were characterized by phylogenetic analysis. Resistance mutations in pretreated and naive patients were identified according to International AIDS Society-2010 and the World Health Organization list, respectively. RESULTS: In 232 patients, genotypic resistance profiles (n = 11) or pol sequences (n = 128) were recovered or newly generated from infected samples (n = 93). Patients were mainly in care at pediatric units (63%), were mostly Europeans (84%), with moderate AIDS symptoms (65%), on ART (91%) and infected by HIV-1 subtype B (89%). Transmitted major drug resistance mutations were selected in 6 (13.6%) of the 44 ART-naive children: 4.8%, 9.3% and 11.6%, for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Overall resistance prevalence was higher (71.8%) among ART-exposed children: 39.9%, 66.5% and 35.3% for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Resistance prevalence among ART-exposed children was higher in 2009 to 2010 relative to 1993 to1999 for nonnucleoside reverse transcriptase inhibitors (42% versus 6%; P = 0.006), protease inhibitors (39% versus 13%; P = 0.004) and nucleoside reverse transcriptase inhibitors (63% versus 44%; P = NS). Susceptibility to each drug in resistant viruses was predicted. The rate of non-B infections increased in the last years, mainly caused by recombinant viruses. CONCLUSIONS: The increasing resistance prevalence among the HIV-infected pediatric population in Spain highlights the importance of specific drug resistance and drug susceptibility surveillance in long-term pretreated children to optimize treatment regimens. Copyright © 2012 by Lippincott Williams & Wilkins. Source


Sanchez-Solis M.,University of Murcia | Garcia-Marcos L.,University of Murcia | Bosch-Gimenez V.,University of Murcia | Perez-Fernandez V.,Pediatrics Unit | And 2 more authors.
Pediatric Pulmonology | Year: 2012

Objective Both healthy preterm infants and those with bronchopulmonary dysplasia (BPD) have poor lung function during childhood and adolescence, although there is no evidence whether prematurity alone explains the reduction in lung function found in BPD infants. Our study seeks to know if lung function, measured in infancy by means of rapid thoracic compression with raised volume technique, is different between preterm infants with and without BPD. Methods Lung function was measured in 43 preterm infants with BPD and in 32 preterm infants without BPD at a chronological age range of 2-28 months. Forced vital capacity (FVC), forced expiratory volume at 0.5âsec, and forced expiratory flows at 50, 75, 85%, and 25-75% of FVC were obtained from maximal expiratory volume curves by means of rapid thoracic compression with raised volume technique. Maximal flow at functional residual capacity was measured using rapid thoracic compression at tidal volume. Multiple regression analysis and generalized least squares (GLS) random-effects regression model were used to control for variables such as gender, weeks of gestation, age, birth weight, and tobacco smoke exposure. A sub-analysis was performed in infants born at 28+ weeks of gestation. Results BPD was associated to significantly lower flows (regression coefficients: -0.51, -0.54, -57, -0.53, and -0.82, respectively for FEF 50, FEF 75, FEF 85, FEF 25-75). This association was driven by males and maintained in the subgroup of infants born at 28+ weeks of gestation. Conclusion BPD is associated with an additional decrease of lung function during the first 2 years of life in infants born preterm. Pediatr Pulmonol. 2012; 47:674-681. © 2011 Wiley Periodicals, Inc. Source

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