Linking the Psychosocial Impact of Assistive Devices Scale (PIADS) to the International Classification of Functioning, Disability, and Health.

PURPOSE: Assistive technologies are widely implemented in clinical and research settings. Despite their dissemination, the psychosocial impact of their adoption still deserves further consideration. The aim of the present study is to determine the degree of compatibility between the Psychosocial Impact of Assistive Devices Scale (PIADS) and the International Classification of Functioning, Disability, and Health (ICF). METHODS: Six health professionals (two neurologists, one neuro-rehabilitation technician, two psychologists, one university professor of rehabilitation) created a technical board to discuss upon the PIADS-ICF linking. The standardized linking methodology was applied, and a Delphi technique was used to examine consensus. RESULTS: Five Delphi sessions were required to reach 100% of consensus and to finalize the procedure. Of the 26 PIADS' items, 23 were linked to an ICF category: 9 items were endorsed at the 3rd ICF level, and 14 items at the 2nd ICF level. Two items were classified as "not defined" and 1 item as "not covered". CONCLUSION: The study highlighted the conceptual connection between the PIADS and the ICF framework and set a bio-psychosocial standpoint by which accounting the role of assistive devices in rehabilitation settings.

Rifaximin treatment for small intestinal bacterial overgrowth in children with irritable bowel syndrome.

OBJECTIVES: Aims of the study were to assess the effects of rifaximin treatment on small intestinal bacterial overgrowth (SIBO) prevalence and gastrointestinal symptoms. STUDY DESIGN: Fifty (50) irritable bowel syndrome (IBS) children were consecutively enrolled. All subjects underwent lactulose hydrogen/methane breath test (LBT) to assess SIBO before and one month after the treatment with rifaximin 600 mg daily for one week. All IBS patients filled out a Visual Analogic Scale (VAS) to assess and score gastrointestinal symptoms (abdominal pain, constipation, diarrhoea, bloating, flatulence) at baseline and one month after treatment. RESULTS: The prevalence of abnormal LBT in patients with IBS was 66% (33/50). LBT normalization rate was 64% (21/33). Compliance was excellent, and no relevant side-effects were observed during treatment. VAS score was significantly higher in IBS patients with abnormal LBT than SIBO negatives, and strongly improved after successful treatment. CONCLUSIONS: Rifaximin was effective and safe in SIBO treatment and IBS symptoms improvement in childhood. Double blind placebo-controlled interventional studies are warranted to verify the real impact of SIBO on gastrointestinal symptoms in children with IBS.

Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature.

PURPOSE: Every year 300,000 children with accidental head trauma are admitted to Italian emergency departments. Our aims were: (1) to describe patients with minor traumatic brain injury who were admitted to pediatric departments and underwent CT, and (2) to analyze the appropriateness of management according to current guidelines. METHODS: We retrospectively analyzed patients with minor head injury (median age 4.5 years, range 1 month to 16 years) who were admitted to the pediatric department of the Catholic Medical School of Rome, from January 2005 to September 2010, who performed head CT. Univariate analysis was performed using the Fisher's exact test. Multivariate analysis was performed by logistic regression. RESULTS: One hundred and seventy-four patients were enrolled in the study. Fifty-four patients (31%) had pathological CT findings. Eight patients underwent neurosurgical treatments. Vomiting was the only symptom significantly prevalent in the infant group, compared to the children group (10.7% vs. 38.9%, p = 0.007), while loss of consciousness in the children group (50.0% vs. 25.0%, p = 0.040). The relationship between scalp swelling and CT abnormalities was statistically significant in the entire population. The incidence of head abnormalities was significantly higher in children with abnormal CT (92.6% vs. 72.5%). CONCLUSIONS: The best way to manage children with minor head trauma is still matter of debate. Loss of consciousness and scalp swelling are risk factors predicting brain injury that deserve CT control. The radiation risks posed by CT scanning in children must be balanced by the benefits. We believe that even though CT scans may be clinically unnecessary in many cases, the rate of scanning is justified by the even limited number of abnormalities which require neurosurgical treatment.

How parkinsonism influences life: the patients' point of view.

To explore the experience of living with parkinsonism, a survey form was sent to the members of a patients' association; 1,256 forms were analysed. The mean age was 65.75 ± 9.29 years; 64.4% males. A family history was reported by 19.2%. Basic abilities were preserved in 75% of the responders; the ability to do indoor and outdoor activities was preserved in 42 and 28%, respectively. 70% of the responders liked to meet other people and about 50% liked discussing their condition. 80.3% of the responders lived with partner, while 7.8% did not live with family. Of the patients' partners, 38.9% took drugs, and 9.4% themselves needed assistance. Care programmes for parkinsonians should take into account the disease duration, the degree of disability, the presence of caregiver/s, and the level of caregiver burden; but it should also be appreciated that social habits, need of help, and severity of symptoms influence disability.

Fecal calprotectin concentration in children affected by SIBO.

BACKGROUND AND OBJECTIVES: Calprotectin is a protein especially expressed in neutrophil cytosol. In the last few years, Fecal calprotectin (FC) turned out to be a direct marker of gastrointestinal inflammation. Because of the simplicity of the method, it has been studied in several gastroenterologic diseases but no data are available about its concentration in children with small intestinal bacterial overgrowth (SIBO), a complex and not well known condition defined by an excessive germs proliferation, especially anaerobic, in the small bowel, and characterized by dyspeptic and malabsorption symptoms. The aim of this study was to evaluate FC values in children with SIBO, comparing to healthy subjects, in order to clarify if an inflammatory process coexists with SIBO. MATERIALS AND METHODS: We enrolled fifty-eight children affected by SIBO, as diagnosed by Lactulose Breath Test (LBT). They were assessed for FC values on stool samples. We compared them with a control population of 60 healthy children. RESULTS: In SIBO patients, a median value of 36.0 mg/kg and a mean value +/- SD of 43.0 +/- 31.6 mg/kg were calculated, while in healthy controls the median value was 29.5 mg/kg and the mean value +/- SD was 35.7 +/- 20.7 mg/kg, showing no statistically significant differences between the two groups (p = 0.07). CONCLUSIONS: FC values are negative in children affected by SIBO, not differing from those obtained in healthy children, suggesting that no subclinical intestinal inflammation involving neutrophils occurs in patients with higher proliferation of bacteria in the small bowel. The presence of high FC levels in children affected by SIBO might not be caused by bacterial overgrowth itself and, in this case, another cause should be investigated.

Efficacy of over-the-counter immunostimulants in the prevention of paediatric recurrent acute respiratory tract infections. Criticisms and pitfalls of available metanalyses.

UNLABELLED: Preschool children frequently suffer from acute respiratory tract infections (ARTI). Immunostimulants (ISs) are often administered to reduce their impact. This study aimed to establish the efficacy of ISs in the prevention of pediatric ARTI through the analysis of systematic reviews (SRs). We explored Medline database in October 2010 limiting our search to SRs, that included studies on the effectiveness of ISs in the prevention of pediatric ARTI. Six SRs with meta analysis (MA) were found. The studies included showed a low methodological quality and a high statistical heterogeneity. All papers published on journals with impact factor > 1 and a Jadad score > 3 reviewed the efficacy of OM-85. The number needed to treat (NNT) was between 2 and 11, depending on the setting. CONCLUSIONS: Pediatric ARTI are a social and health care problem. When they impair the quality of life of the family a course of OM-85 might be warranted. Although scientific knowledge of clinicians may be improved by SRs, MA and aggregation of results may not always be the best way to accomplish this.

Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case-control study.

OBJECTIVE: To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in children affected by irritable bowel syndrome (IBS). STUDY DESIGN: Consecutive children affected by IBS according to Rome II criteria (n = 43) were enrolled at the Gemelli Hospital, Catholic University of Rome. The control population (n = 56) consisted of healthy subjects without IBS symptoms, similar to patients for age, sex, and social background. All subjects underwent lactulose/methane breath test (LBT) to assess small intestinal bacterial overgrowth. RESULTS: The prevalence of abnormal LBT result was significantly higher in patients with IBS (65%, 28/43) with respect to control subjects (7%, 4/56; OR 3.9, 95% CI 7.3-80.1, P < .00001). Patients with abnormal LBT showed a trend toward a worse visual analog scale score with respect to children with IBS without SIBO, but a significant statistical difference was observed only for bloating. CONCLUSIONS: Results from this study suggest a significant epidemiologic association between SIBO and IBS in childhood. Placebo-controlled interventional studies with antibiotics used to treat bacterial overgrowth are warranted to clarify the real impact of the disease on IBS symptoms.

Polyethylene glycol 4000 vs. lactulose for the treatment of neurogenic constipation in myelomeningocele children: a randomized-controlled clinical trial.

AIM: To compare the therapeutic effectiveness and tolerability of low daily doses of polyethylene glycol 4000 vs. lactulose in the treatment of neurogenic constipation in children with myelomeningocele. METHODS: Sixty-seven children with chronic neurogenic constipation were randomized allocated to receive either polyethylene glycol 4000 (0.50 g/kg) or lactulose (1.5 g/kg) for 6 months. Patients or their parents reported frequency and modality of evacuation and side effects on a diary card. Primary outcome was bowel frequency > or =3/week, and the second one was side effects at the end of treatment. RESULTS: Complete remission of constipation was reported by a significantly (P < 0.01) higher number of patients treated with polyethylene glycol compared with lactulose. At the end of the study, 46% patients of polyethylene glycol group and 22% of the lactulose group were asymptomatic. Compared with lactulose, patients treated with polyethylene glycol reported higher bowel frequency (5.1 vs. 2.9 bowel movements/week, P < 0.01) and reduction of encopresis. Neither lactulose nor polyethylene glycol caused clinically-significant serious side effects and palatability was similar. CONCLUSIONS: Polyethylene glycol 4000 compared with lactulose provided a higher success rate, without significant side effects, for the treatment of constipation in myelomeningocele children.

[Utility and safety endoscopic digestive procedure in pediatric age]. / Utilità e sicurezza delle procedure endoscopiche digestive in età pediatrica.

The aim of this study is to verify the utility and safety of endoscopic procedures in the evaluation of children with clinically-significant gastrointestinal symptomatology. We report our experience of 87 pediatric endoscopy procedures including esophagogastroduodenoscopy, colonoscopy and tissue biopsies performed in 85 infants, children and adolescent, 3 months-15 years old, over a two-year period, june 2002-november 2004 after complete history, physical examination and basic investigations. General anesthesia was used in all patients after informed consent obtained from parents. Non significant complications were observed in this series of patients. In 81 cases (92.5%) with clinical symptoms and laboratory indications for gastrointestinal disease, the endoscopy and bioptical samples confirmed the utility and safety of procedure. Coeliac disease (39 cases), gastritis (11 cases), esophagitis (6 cases) were the most common organic cause of upper gastrointestinal disease. Allergic and indeterminate colitis (7 cases) were the most common cause of lower gastrointestinal disease. In 4.7% the procedures appear to be particularly helpful in the diagnosis of inflammatory lesions of the esophagus and stomach. In summary, the data demonstrate that endoscopy techniques show low morbidity, provide important diagnostic informations in pediatric gastrointestinal diseases and can be done safely in patients over 3 months of age.

Diagnostic implication of specific immunoglobulin G patterns of children born to HIV-infected mothers.

We analysed HIV-specific immunoglobulin G (IgG) responses to gag and env peptides in infants born to HIV-positive mothers. Questions of interest were whether there are early specific markers for prognosis, and whether any specific IgG is related to the prevention of vertical transmission of infection. Fifty-three children, 0-24 months old and born to HIV-1-infected mothers, were retrospectively divided into two groups based on HIV seroreactivity or non-reactivity at 15 months of age. Their sera were used to find reactivities important in diagnosis and/or prediction of the putative HIV disease. Three important findings emerged. First, a low IgG titer against the very immunodominant penv9 in newborns was found to be associated with rapid progression to AIDS. This difference was clearly reflected in the reactivity to a small peptide representing amino acid (aa) 598-606. The second interesting finding was the putative hypervariable loop on gp120 (especially aa 324-338), reactivity to which was found only in the uninfected group, and was seen in six out of 19 uninfected children under 6 months of age. This specific response was not caused by a generally high total anti-HIV reactivity, and may indicate a role of protective antibodies against vertical transmission. The response to this region in the infected group, on the other hand, was directed to the amino terminal half of the putative loop, in particular peptide 53, aa 304-318. Finally, response to a part of the amino terminal end of P17 was seen in seven out of eight infected children over 6 months of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Sleep in babies born to chronically heroin addicted mothers. A follow up study.

The effects of chronic addiction to, and withdrawal from, opiates on sleep have been described in experimental animals, in human adults and infants born to addicted mothers. These sleep alterations are seen through the first weeks of life. Thirteen maternally addicted babies were studied. Sleep samples were recorded and scored within a few days following birth and repeated 4 or 5 weeks later after recovery from the abstinence syndrome. A significant decrease in quiet sleep and increase of active sleep were found. The same alterations, although less marked, were observed in a follow up recording performed during the second month of life. Sleep alterations in addicted newborns could be related to central nervous system (CNS) distress caused by withdrawal. The authors however propose a perturbation of endogenous opiates subsequent to fetal addiction as a cause of sleep alterations.

Isolated office hypertension: are there any markers of future blood pressure status?

BACKGROUND: The introduction of ambulatory blood pressure monitoring into clinical practice has defined a clinical condition called 'isolated office hypertension'. OBJECTIVE: The aim of this study was to evaluate the long-term systolic and diastolic blood pressure changes in patients with isolated office hypertension and to identify the presence of markers capable of identifying which patients will develop sustained hypertension. METHODS: All the 407 patients enrolled had a random office systolic or/and diastolic blood pressure of over 140/90mmHg and a mean daytime ambulatory blood pressure of 130/84mmHg or less. At enrollment, each patient underwent a 'baseline examination' made up of a physical evaluation, a 24h ambulatory blood pressure monitoring, and a mental arithmetic test performed at the end of the 24h ambulatory monitoring. RESULTS: Of the 173 patients finally studied, 102 (58.9%) developed sustained hypertension with an increase in both ambulatory systolic and diastolic blood pressure. At the time of the baseline examination, the patients were divided into two groups. Group A included patients with mean ambulatory systolic and diastolic blood pressures in the first hour of 130/84mmHg or less; group B included patients with mean ambulatory systolic and diastolic pressures in the first hour of greater than 130/84mmHg. During the mental arithmetic test, the systolic and heart rate values increased significantly only in group B patients. Of the 102 patients who had become hypertensive by the time of the follow-up examination, 84 (82%) belonged to group B. CONCLUSION: These data suggest that isolated office hypertension may indeed be a transitional state towards the development of sustained hypertension. Moreover, the mean ambulatory blood pressure value during the first hour can be considered to be a marker of a higher risk of developing sustained hypertension.

Cognitive impairment in school-age children with asymptomatic HIV infection.

Previous studies have shown that there is a positive correlation between clinical expression of HIV-1 disease and deficits in the cognitive and neuropsychologic abilities in afflicted children. To date there are few studies regarding analysis of the cognitive and neuropsychologic development of HIV-positive, asymptomatic nonprogressor children (6-12 years of age) (long-survivors). The purpose of this study was to explore the differences in neuropsychologic development of asymptomatic HIV-positive school-age children compared with a seroreverted group. Evaluation was conducted in 8 children with asymptomatic or mild clinical signs of HIV infection compared with 8 seroreverted children. All tests were administered in three sessions by a trained specialist in neuropsychologic observation. The results of neuropsychologic testing suggested the presence of some learning disorders, as well as major memory and perception deficit. Most of the children tended to have levels of performance that were below normal values. The impairment could likely be the expression of a greater biologic vulnerability of HIV-positive children. Additional studies are necessary to define the risk factors and, hence, the protective factors that might support normal development of HIV-positive children.

Occurrence of anti-thyroid autoantibodies in children vertically infected with HIV-1.

Autoimmune phenomena, especially occurrence of non organ-specific autoantibodies, are common in congenitally acquired HIV infection, mostly in the symptomatic stages of the disease. Anti-thyroid autoantibodies detected in adult patients represent the only type of organ-specific autoantibodies reported in HIV infection. As far as we know, occurrence of these autoantibodies has not been observed in HIV infected children. In this study thyroid biochemical pattern and possible occurrence of anti-thyroid autoantibodies were investigated in 40 vertically HIV infected, 18 seroreverted and 22 healthy children. 34% of HIV infected symptomatic children showed anti-thyroglobulin antibodies. Asymptomatic patients, seroreverted and healthy controls did not show any anti-thyroid antibodies at the time of the study. High Tg levels were observed in 38% of the 40 HIV infected patients and high TSH concentrations were found in 27.5% of the HIV children. High TSH values were more frequently observed in the infected children with moderate or severe immunocompromised status. Thyroxine binding globulin levels were high in 68% of the HIV children and in 22% of the seroreverted. The finding of anti-thyroid autoantibodies in congenital HIV infected children confirms the thyroid's involvement in HIV infection and provides more information about the wide spectrum of autoimmune phenomena observed in the infection.

Kallikrein and kininase activities excretion in newborns affected by jaundice.

In a homogeneous group of 30 newborns, aging between 10 hours--10 days, and affected by jaundice, urinary kallikrein and kininase activities were determined. The variable considered were: sex, time of life, weight and gestational age. Urinary samples were taken at the beginning and at the end of phototherapy.

The position of the head in space: a kinematic analysis in patients with cervical dystonia treated with botulinum toxin.

Many instruments have been employed in recent years in order to quantify the posture and motion of the head in normal and pathological subjects. Evaluations of this type present many difficulties related to the influence of individual and external factors and to the accuracy of the system used. In patients with cervical dystonia (CD) the only rating scales currently used are semi-quantitative and subjective. More precise information on disease severity and response to the treatment is needed. Posture and motion of the head were evaluated by means of ELITE motion analyser (BTS, Milan, Italy) in 6 patients with the left laterocollis form of CD undergoing treatment with botulinum toxin (BTX). The method emerged as very useful for the quantification of the therapeutic response (which was more marked in motion than in posture). We found an inverse relationship between the degree of motion improvement and the restriction of motion before treatment.

"Separation" of the mother-child couple: pregnancy and maternity of drug-dependent women.

Children of drug addicts are at risk of neglect and scanty maternal care. The objective of the present study was to identify homogeneous subgroups within a sample of drug addicted women, according to the quality of the outcome of the mother-child relationship. A group of 13 opiate-addicted women, followed from the seventh month of pregnancy up until the child was 2 years of age, underwent psychometric evaluation and was subdivided into two distinct groups based on whether the child remained within the family nucleus or was entrusted to a foster family or institution. The psychometric instrument used, an adaptation of Osgood's semantic differential which investigates maternal representations, allowed us to identify items with a very high predictability for the outcome of the mother-child relationship.

HIV viral sequences in seronegative people at risk detected by in situ hybridisation and polymerase chain reaction.

A study was conducted to assess the occurrence of latent infection with the human immunodeficiency virus (HIV) among seronegative people at high risk of infection. The presence of HIV genomes was analysed by molecular techniques in two seronegative children born to mothers infected with HIV and in three regular sexual partners of seropositive drug addicts. The adults were selected from a seronegative cohort at high risk of infection because of their sexual contacts and the children selected because of impaired growth. HIV retroviral sequences were detected in four of the five subjects directly at the cellular level by in situ hybridisation in peripheral blood mononuclear cells. HIV genomic sequences were confirmed by in vitro amplification of viral DNA with the polymerase chain reaction technique. The existence of a latent viral infection state in these seronegative subjects indicates the unreliability of standard serological analysis in people who have been in regular contact with infected patients.

[Role of depression in the functional recovery and cost of stay in patients with acute cerebrovascular lesions]. / Ruolo della depressione sul recupero funzionale e sui costi di degenza dei pazienti con lesioni cerebrovascolari acute.

BACKGROUND AND PURPOSE: The constant increase in health costs in recent years has led to the introduction of instruments such as DRG--diagnosis-related groups--with the declared aim of best rationalizing in-hospital costs. As part of this rationalisation it has become necessary to identify the causes of prolonged admissions in health-care structures. As far as concerns the rehabilitation of cerebrovascular diseases, attention has been centred on the presence of post-stroke depression. Our study was aimed at analysing the effect of depression on the time spent in hospital and whether the depression also affected on the patient's potential for functional recovery. METHODS: Patients with acute cerebrovascular lesions admitted to our center for rehabilitation were enrolled in this study. Depressive syndromes and functional deficits were evaluated at admission and discharge. RESULTS AND CONCLUSIONS: The most depressed patients were those who spent a longer time in hospital, but they were also those who had a greater functional deficit. The depression did not affect the efficacy and efficiency of the rehabilitation treatment. The time spent in hospital did, however, correlate with the clinical condition of the patient at admission and the age of the lesion.

[Evaluation of renal function in congenital cardiopathies in young children]. / Valutazione della funzionalità renale nelle cardiopatie congenite del piccolo bambino.

The authors evaluated some renal functional parameters of 23 children, the ages ranged 1 to 58 weeks; 8 were affected with cyanotic congenital heart disease and 15 with acyanotic forms. They showed the presence, already in this age, of some affections that are quiet similar to those affecting older children with heart disease. They tried to explain the renal functional deficiency in consideration of the literature data also. The authors formed a functional deficiency greater in the cyanotic forms, proportional to the weight deficiency and the same as that described in dystrophic children. They think that this is due to a first year maturational retardation, because of a low trophism of the body, in particular of the kidney. The authors suggest that these patients have to be fed with appropriate caloric-protein diet.