Glucometrics and device satisfaction in children and adolescents with type 1 diabetes using different treatment modalities: A multicenter real-world observational study.

AIMS: To analyze metabolic outcomes, diabetes impact and device satisfaction in children and adolescents with type 1 diabetes in Italy who used different treatment modalities for diabetes care in a real-life context. METHODS: In this multicenter, nationwide, cross-sectional study, 1464 participants were enrolled at a routine visit. The following treatment modalities were considered MDI + SMBG; MDI + CGM; Sensor Augmented Pump Therapy; predictive management of low glucose; Hybrid Closed Loop (HCL); Advanced Hybrid Closed Loop (AHCL). Health related quality of life was evaluated by the Italian version of the Diabetes Impact and Device Satisfaction Scale (DIDS) questionnaire. RESULTS: Patients treated with AID systems were more likely to have HbA1c ≤ 6.5 %, higher percentage of time with glucose levels between 70 and 180 mg/dL, lower percentage of time with glucose levels above 180 mg/dL, higher device satisfaction, and reduced impact of diabetes. All the therapeutic modalities with respect to MDI + CGM, except for MDI + SMBG, contributed to increase the device satisfaction. HCL and AHCL respect to MDI + CGM were associated with lower diabetes impact. CONCLUSION: Real-life use of automated insulin delivery systems is associated with reduced type 1 diabetes impact, increased device satisfaction, and achievement of glycemic goals.

Clinically Mild Encephalopathy with a Reversible Splenial Lesion Caused by Influenza B Virus in an Unvaccinated Child.

Reversible lesions involved in the splenium of corpus callosum (RESLES) are a rare clinic-radiological condition, whose pathogenesis could be related to infectious events (such as in mild encephalopathy with reversible splenial lesion-MERS), epilepsy or metabolic/electrolyte disorders. MERS is characterized by an acute mild encephalopathy associated with lesions in the splenium of corpus callosum on brain magnetic resonance imaging. Viral infections are commonly associated with this condition and type A influenza is the most common cause. The prognosis is generally favorable with spontaneous resolution of clinical and radiological abnormalities. We report a case report of type B influenza MERS in an 8-year-old unvaccinated girl with complete clinical and radiological recovery.

[The diagnostic framework of optic neuritis: description of a case in adolescence]. / L'inquadramento diagnostico della neurite ottica: descrizione di un caso in età adolescenziale.

The case of a 13-year-old girl who presented a recurrence of left retrobulbar optic neuritis, 3 years after the previous episode, is described. The clinic, the imaging and the laboratory tests carried out allow to classify the pathology as an isolated recurrent optic neuritis. Recurrent optic neuritis cases require careful evaluation to exclude the forms that are part of certain systemic pathologies. These are in addition to multiple sclerosis, also new demyelinating disorders such as NMOSD (NeuroMyelitis Optica Spectrum Disorder), the forms of CRION (Chronic Relapsing Inflamatory Optic Neuritis) as well as the ADEM-ON (Acute Disseminated Encephalomyelitis - Optic Neuritis) that must necessarily enter in differential diagnosis for clinical features, neurological image and possible positivity of specific auto-antibodies. In pediatric-adolescent age some forms of optic neuritis can still be isolated and not necessarily underlie a systemic pathology.

[A sepsis that you don't expect Lemierre's syndrome. Description of a clinical case.] / Una sepsi che non ti aspetti la sindrome di Lemierre. Descrizione di un caso clinico.

A healthy 16-year-old boy was hospitalized for fever, septic condition and thrombosis of the left internal jugular vein: The diagnosis of Lemierre syndrome (LS) with positive blood culture for Fusobacterium necrophorum was formalized. He was treated with antibiotics and anticoagulant therapy with enoxaparin with complete recovery. Four weeks after discharge, the jugular vein ecodoppler showed complete resolution of the thrombosis. LS is characterized by thrombosis of the internal jugular vein and anaerobic bacteremia often caused by Fusobacterium necrophorum. It is a rare disease in the post-antibiotic era, but with an increase in cases over the last twenty years. LS should be suspected in young, healthy patients with persistent pharyngitis followed by sepsis, pneumonia or atypical laterocervical pain. The diagnosis is confirmed by the identification of jugular venous thrombosis and is further confirmed by the growth of anaerobic bacteria on blood culture. Prolonged antibiotic and anticoagulant therapies are the essential elements of treatment. However, anticoagulant therapy for internal venous thrombosis associated with LS remains a controversy.

Fecal Calprotectin: Diagnostic Accuracy of the Immunochromatographic CalFast Assay in a Pediatric Population.

BACKGROUND: Fecal calprotectin is a noninvasive marker for bowel diseases and it is high valuable to follow disease activity in Crohn's disease (CD) and ulcerative colitis (UC). In this study, we evaluated the diagnostic performance of the recently introduced immunochromatographic assay CalFast in comparison to the well-known ELISA tests for calprotectin assay to obtain a rapid diagnosis of bowel inflammation in pediatric patients. METHODS: CalFast was tested in parallel to the classic ELISA tests CalPrest and PhiCal (gold standards for the calprotectin determination) on 148 fecal samples from pediatric subjects including 104 healthy subjects, 29 with CD, and 15 with UC. RESULTS: In this study, the sensitivity and specificity of CalFast, CalPrest, and PhiCal were 86.4%, 88.6%, and 93.2% and 86.6%, 74%, and 64.4%, respectively. The area under the curve, obtained from receiver operating characteristic analysis, indicated the lack of significant difference among all the kits used. CONCLUSION: The immunochromatographic assay demonstrated good diagnostic predictive values, comparable to those of the ELISA methods, and may represent a valid alternative in order to save operators' time. The test, in fact, has a short turnaround time and does not need a specific ELISA instrumentation.

Antiepileptic drugs and breastfeeding.

INTRODUCTION: This review provides a synopsis for clinicians on the use of antiepileptic drugs (AEDs) in the breastfeeding mother. METHODS: For each AED, we collected all retrievable data from Hale's "Medications and Mother Milk" (2012), from the LactMed database (2013) of the National Library of Medicine, and from a MedLine Search of relevant studies in the past 10 years. RESULTS: Older AEDs, such as carbamazepine, valproic acid, phenytoin, phenobarbital, primidone are considered to have a good level of safety during lactation, due to the long term clinical experience and the consequent amount of available data from the scientific literature. On the contrary, fewer data are available on the use of new AEDs. Therefore, gabapentin, lamotrigine, oxcarbazepine, vigabatrin, tiagabine, pregabalin, leviracetam and topiramate are compatible with breastfeeding with a less documented safety profile. Ethosuximide, zonisamide and the continue use of clonazepam and diazepam are contraindicated during breastfeeding. CONCLUSIONS: Although the current available advice on the use of AEDs during breastfeeding, given by different accredited sources, present some contradictions, most AEDs can be considered safe according to our review.

Regulatory T-cell function is impaired in celiac disease.

Celiac disease (CD) is characterized by intolerance to gluten and high risk of developing autoimmune phenomena. Possible defects in immune tolerance could have a role in the pathogenesis of the disease. As regulatory T-cells (Tregs) are the main population involved in maintaining peripheral tolerance, we investigated the number of these cells in celiac patients as compared with healthy donors. Moreover, we analyzed the suppressive function of CD4+CD25+ T-cells from celiac disease patients and controls on autologous responder T-cells (CD4+CD25-). The percentage of CD4+CD25+FOXP3+ cells was not different in celiacs and in healthy controls, and among positive cells the level of expression of the two regulatory markers was comparable. However, the suppressor activity of Tregs was significantly impaired in CD patients. These results suggest that a defect in Tregs function could play a role in the pathogenesis of CD and in CD-associated autoimmunity.