Child Abuse and Neglect and its Psycho-Physical and Social Consequences: A Review of the Literature.

Child maltreatment is a complex life experience occurs when a parent or caregiver does an intentional or potential damage to a child, including acts of commission and omission. Child abuse is not an uncommon event, but it is not always recognized. Identifying the real number of maltreated children is a challenge because of the large variability in reported prevalence data across studies. Unfortunately, in the United States, it affects 1 in 8 children, by the age of 18 years, annually. Paediatricians may encounter a variety of forms of maltreatment such as neglect, emotional, physical and sexual abuse. These aspects should be recognised, examined and evaluated by employing a systematic approach and focusing on basic needs of children that may not be met. Child maltreatment is a global problem with serious life-long physical and psychological or psychiatric outcomes. It is associated with important economic and social costs (such as physical and mental health, productivity losses, child welfare, criminal justice and special education costs) due to its high prevalence and its long-term and short-term consequences. In the United States, the average cost of nonfatal maltreatment is $210,012 per children and the cost of fatal maltreatment is $1,272,900. General Practitioners are quite prepared to face the problem of child maltreatment: since they have the opportunity to meet several members of the same family, they can detect stressors that put children at risk of maltreatment. All health professionals have the responsibility to protect children from abuse and neglect.

Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going.

BACKGROUND: Nocturnal enuresis (NE) is a very common pediatric disorder. The aim of this study was to evaluate the characteristics of patients with NE or urinary incontinence (UI) during a period of 5 years to increase the knowledge on these conditions and optimize their diagnosis and treatment. METHODS: We enrolled 278 children with NE or UI referred to the pediatric nephrology ambulatory, 'A. Gemelli' University Hospital of Rome, from December 2006 to December 2011. RESULTS: We observed that heredity, parasomnias, left-handedness, polythelia and constipation are correlated to NE and UI. CONCLUSIONS: We wanted to clarify the definition of NE and UI and describe our experience on the main characteristics of these conditions by referring to the latest knowledge reported in the literature.

Low adiponectin in overweight/obese women: association with diabetes during pregnancy.

BACKGROUND: Overweight/obese (OW/OB) women are at high risk to develop gestational diabetes mellitus (GDM) in pregnancy. AIM: To investigate, in pregnant OW/OB women, the longitudinal changes of adiponectin plasma levels, carbohydrate and lipid metabolism, and to identify if there is any association between adipokines and subsequent development of GDM. SUBJECTS AND METHODS: Thirty-two OW/OB normotensive normoglycaemic women at the beginning of pregnancy were studied. Adiponectin, insulin sensitivity (homeostasis model assessment, HOMA) and lipid panel were measured at 1st, 2nd and 3rd trimesters of pregnancy. The bioelectrical impedance to estimate the subject's body composition was also performed. RESULTS: Sixteen OW/OB women developed GDM. There were no significant differences with regard to age, BMI and body composition. Glycaemic and insulinaemic plasma levels, HOMA and lipid panel were comparable in the two groups. Systolic, diastolic and mean blood pressure at the 1st trimester were higher in OW/OB women with GDM (p < 0.05). GDM group showed adiponectin levels significantly lower than control group, at each trimester (p < 0.05). Adiponectin, fat mass, diastolic blood pressure and HOMA are independent predictors of GDM. CONCLUSIONS: OW/OB women who will develop GDM show lower adiponectin than euglycaemic group, across all pregnancy. Furthermore, at first trimester, they showed higher body fat and blood pressure levels than NGT group. Adiponectin, body fat, DBP and HOMA are independent predictors of GDM in OW/OB pregnant women. These results suggest the possibility of using adiponectin as early marker of GDM risk, at least in this cohort of women.

Diet and physical activity "defeated" Tuberil® in treatment of childhood obesity.

AIM: Childhood obesity is remarkably spreading worldwide, involving both industrialized and low-income countries. Its prevalence, outcome and socioeconomic impact call for the attention of medical community. We conducted a monocentric, open, two-arm, parallel-group study to evaluate the efficacy at reducing appetite and increasing dietary compliance of obese children of Tuberil®, a weight-loss supplement derived from potato and devoid of side effects. METHODS: We recruited participants, children with BMI ≥ 85th, through direct referrals in pediatrician's surgeries. Children were randomized to receive Tuberil® (group A) or nothing (group B), following a chronological order (A-B-A-B). Every child received a nutritionally balanced diet and had to record their appetite and to describe their meals in a diary. RESULTS: Even if we found a significant reduction in BMI, weight and waist circumference in both groups, no statistically significant differences between groups were noted. We did not found any significant differences in appetite between group A and B. CONCLUSION: Our data show that Tuberil® has no efficacy neither in reducing appetite in children nor in increasing dietary compliance. We believe that only a nutritionally balanced diet and our attention in verifying their compliance led to the reduction in BMI, weight and waist circumferences noted in our series.

Effect of pravastatin on endothelial function and endothelial progenitor cells in healthy postmenopausal women.

PURPOSE: Coronary heart disease is the leading cause of morbidity and mortality in postmenopausal women. Among statins, pravastatin has been shown to significantly reduce fatal and non-fatal cardiovascular events in primary and secondary prevention trials. The aim of the present research was to investigate whether treatment with pravastatin can modify some indices of cardiovascular risk in healthy postmenopausal women such as significant reductions in total and LDL cholesterol and triglyceride levels. METHODS: 20 patients were randomized in double-blind fashion to treatment for eight weeks with either pravastatin 40 mg/day or placebo, and subsequently, after one-week wash-out, crossed-over to the alternative treatment (placebo or pravastatin) for the following eight weeks. We performed clinical and laboratory investigations, before and at the end of each treatment period, to evaluate patient response to the treatment with pravastatin. RESULTS: After eight weeks pravastatin therapy reduced the median low density lipoprotein (LDL) and total cholesterol (p < 0.01 in both cases). In contrast, insulin level and insulin sensitivity did not show any difference with regard to values observed after placebo treatment. The absolute number of endothelial progenitor cells-colony forming unit (EPC-CFU) was significantly increased by pravastatin treatment (30.6% increase, p < 0.05) and the number of senescent cells was significantly decreased. However pravastatin did not increase tube-like formation by EPC and did not improve endothelial function. CONCLUSIONS: Despite beneficial effect on lipids and EPC, short term pravastatin does not seem to improve other cardiovascular risk factors, at least in healthy postmenopausal women.

Outpatient parenteral antibiotic therapy in the elderly: an Italian observational multicenter study.

Bacterial infections are the most frequent cause of hospitalization in elderly patients. In the early eighties, the advantages of Outpatient parenteral Antibiotic therapy (OPAT) were identified in the United States, and suitable therapeutic programs were established. In order to understand the different ways of managing OPAT, a National OPAT Registry was set up in 2003 in Italy. This study analyzes data concerning bacterial infections in 176 elderly patients including demographics, therapeutic management, clinical response, and side-effects. Bone and joint infections (48.9%) and skin and soft tissue infections (27.8%) were the most common infections treated with OPAT. Teicoplanin (28.9%) and ceftriaxone (22.1%) were the top two antibiotics chosen. OPAT was mainly performed at a hospital infusion center (52.8%). The clinical success rate was high and side-effects were low (12.6% of cases). Management of bacterial infections in the elderly with an outpatient program is effective and safe.

Coronary artery disease: a study on the joint role of birth weight, adenosine deaminase, and gender.

An inverse relationship between birth weight and coronary artery diseases is well documented but it remains unclear which exposure in early life might underlie such association. Recently it has been reported an association between adenosine deaminase genetic polymorphism and coronary artery diseases. Gender differences in the degree of this association have been also observed. These observations prompted us to study the possible joint effects of BW, ADA, and gender on the susceptibility to coronary artery diseases. 222 subjects admitted to hospital for nonfatal coronary artery diseases, and 762 healthy consecutive newborns were studied. ADA genotypes were determined by DNA analysis. A highly significant complex relationship has emerged among ADA, birth weight, and gender concerning their role on susceptibility to coronary artery diseases in adult life. Odds ratio analysis suggests that low birth weight is more important in females than in males. ADA( *)2 allele appears protective in males, while in females such effect is obscured by birth weight.

Primary paraganglioma of thyroid gland: a clinicopathologic and immunohistochemical study with review of the literature.

Primary paraganglioma of the thyroid is a very rare neuroendocrine tumour. Only 24 cases have been reported in the Literature. A case of a primary paraganglioma of the thyroid is presented in order to provide a review of the Literature, an update on current knowledge and to emphasize the key diagnostic role of immunohistochemistry. A 63-year-old female presented with a 6-month history of right-sided solitary thyroid nodule. Ultrasonography and fine needle aspiration biopsy were not diagnostic. The patient underwent right hemithyroidectomy. The tumour cells showed a strongly positive staining for chromogranin A, synaptophysin and neuron specific enolase, whereas S-100 protein was positive in sustentacular cells. A diagnosis of primary paraganglioma of the thyroid was made. Radiotherapy for suspected local tumour persistence was planned. At 18-months follow-up, the patient is alive without evidence of recurrence. This case highlights the need to include primary paraganglioma of the thyroid in the differential diagnosis of neuroendocrine intra-thyroidal tumours. Immunohistochemistry is essential for diagnosis. Surgery is the treatment of choice.

In vitro activity of tigecycline: MICs, MBCs, time-kill curves and post-antibiotic effect.

The minimum inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs), time-kill curves, and postantibiotic effect (PAE) of tigecycline, the first in the glycylcycline class of antibiotics, were evaluated. MICs were determined against 749 clinical isolates. Time-kill curves were performed against two isolates each of Enterococcus faecalis, MSSA, and MRSA. The presence of PAE, against the same isolates, was investigated. MIC(90)s (microg/mL) were the following: Escherichia coli 0.25; Klebsiella spp 0.5; Enterobacter spp 1; Acinetobacter spp. 2; Staphylococcus aureus (MSSA+MRSA) 0.25; CNS (MS+MR) 0.25; vancomycin-susceptible Enterococcus faecalis 0.12. Tigecycline exerted bacteriostatic activity against all the tested isolates, MBC(90)values being 32xMIC. Time-kill experiments showed a marked reduction in bacterial growth. A PAE at 1- to 20-fold the MIC was observed against the two enterococcal isolates (1.5-3.2h, range) and the four staphylococci (1.6-3h, range). Our findings confirm the excellent antimicrobial activity of tigecycline, adding informations on its bacteriostatic activity vs enterococci and staphylococci, whether methicillin-resistant or -susceptible, and its PAE.

Foot infections in diabetes (DFIs) in the out-patient setting: an Italian multicentre observational survey.

AIMS: To conduct a multicentre observational study to describe management of foot infections in diabetes in the out-patient setting in Italy. PATIENTS AND METHODS: Ten centres equally distributed nationwide were asked to collect, by means of a spreadsheet (Access/Excel Microsoft program), data concerning 30 consecutive diabetic patients with foot infections deemed suitable for antibiotic treatment in the out-patient setting. Centres with > or = 5 years' experience of out-patient management were selected. Data from 271 consecutive patients treated as out-patients were collected and analysed by the central coordinator. Statistical analysis was performed using the SPSS statistical software package. RESULTS: Lesions were mainly located at the toes and midfoot (33.6 and 30.2%, respectively); 63 (23.2%) patients had multiple ulcers. Seventy (25.8%) patients also had concomitant osteomyelitis. Three hundred and four pathogens, including Gram-positive and Gram-negative aerobes and anaerobes, were isolated in 219/271 patients (80.8%) by culturing debrided tissue (71.2%) or purulent material (28.8%). Infections were polymicrobial in 33.8% of patients. The most common pathogens were Staphylococcus aureus (27.3%) and Pseudomonas spp. (20.4%); enterobacteriaceae, enterococci, streptococci and anaerobes accounted for 11.5, 7.6, 6.9 and 1.9%, respectively. Antibiotics were frequently administered by parenteral route and frequently in combination. Piperacillin/tazobactam was the parenteral antibiotic most frequently utilized (21.1%). Cure/improvement was observed in 93.4% of patients. CONCLUSIONS: Foot ulcers in diabetes are common and serious; the aetiology is often polymicrobial, often including S. aureus and Pseudomonas spp. Treatment in the out-patient setting is safe and effective, and penicillins together with beta-lactamase inhibitors and fluoroquinolones are the most frequent choice.

Outpatient parenteral antibiotic therapy for bone and joint infections: an italian multicenter study.

In the early eighties, the advantages of outpatient parenteral antibiotic therapy (OPAT) (reduced costs, no hospitalization trauma in children, no immobilization syndrome in elderly, reduction in nosocomial infections by multiresistant organisms) were identified in the United States, and suitable therapeutic programs were established. Currently, more than 250,000 patients per year are treated according to an OPAT program. In order to understand the different ways of managing OPAT and its results, a National OPAT Registry was set up in 2003 in Italy. Analysis of data concerning osteomyelitis, septic arthritis, prosthetic joint infection and spondylodiskitis, allowed information to be acquired about 239 cases of bone and joint infections, with particular concern to demographics, therapeutic management, clinical response, and possible side effects. Combination therapy was the first-line choice in 66.9% of cases and frequently intravenous antibiotics were combined with oral ones. Teicoplanin (38%) and ceftriaxone (14.7%), whose pharmacokinetic/pharmacodynamic properties permit once-a-day administration, were the two top antibiotics chosen; fluoroquinolones (ciprofloxacin and levofloxacin) were the most frequently utilized oral drugs. Clinical success, as well as patients' and doctors' satisfaction with the OPAT regimen was high. Side-effects were mild and occurred in 11% of cases. These data confirm that the management of bone and joint infections in an outpatient setting is suitable, effective and safe.

Antibiotic prophylaxis in hernia repair and breast surgery: a prospective randomized study comparing piperacillin/tazobactam versus placebo.

Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery, its use for these clean procedures is widely adopted, albeit to a different extent in different countries, often on the personal decision of the individual surgeon. The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery.A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospective randomized clinical study. Patients were randomly assigned to receive preoperative antibiotic prophylaxis or placebo. One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v. 30 minutes prior to the surgical procedure. Using statistical univariate analysis, the following variables were correlated with a higher infection risk: age >40 years, concomitant disease, WBC <3500, surgical wound size >9cm, use of drainages, non-prophylaxis. Using multivariate analysis, no antibiotic pre-operative prophylaxis, concurrent chronic diseases, especially diabetes (risk 15 times higher), and length of intervention >45 min (risk 6 times higher) were independent predictors of infection. Finally, patients with postoperative infections had a significantly longer hospitalisation. One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair.

Antibiotic prophylaxis in surgery: an observational prospective study conducted in a large teaching hospital in Naples.

This was a 9-month observational prospective study conducted in two steps to evaluate surgical prophylaxis procedures used by surgeons in several departments of the Second University of Naples (SUN). In step 1 (4 months), we collected and analyzed data on surgical interventions and antibiotic prophylaxis. Surgeons were informed of the analysis outcome and were given an antibiotic prophylaxis protocol based on international guidelines. In step 2 (5 months), we collected data on surgical interventions and antibiotic prophylaxis, and compared them with step 1 data. The analysis of 354 forms (step 1) showed that third-generation cephalosporins were the preferred prophylactic antibiotics. The analysis of 369 forms (step 2) showed that ceftriaxone and ampicillin were the most frequently used antibiotics. Surgeons did not comply with guidelines for antibiotic prophylaxis as regards type of antibiotic and treatment duration but implementation of antibiotic prophylaxis protocols resulted in more appropriate and better timing of antibiotic prophylaxis.

Clinical efficacy and tolerability of levofloxacin in patients with liver disease: a prospective, non comparative, observational study.

The aim of this open, non comparative, observational study was to assess the clinical and bacteriological efficacy, the tolerability and safety of levofloxacin for treatment of concurrent bacterial infections in patients with chronic liver disease. Overall, 40 patients (inpatients or outpatients) were recruited to the study (28 with UTI, 6 with pneumonia, and 6 with spontaneous bacterial peritonitis (SBP)). Patients affected by UTI received 250 mg oral levofloxacin once daily for five days; patients with pneumonia or SBP underwent a 10/14-day therapeutic oral regimen with 500 mg b.i.d. Clinical evaluation and possible side effects were monitored daily both in out- and in-patients. For all patients, laboratory tests were performed at baseline and 3-4 days after the end of therapy in order to evaluate levofloxacin tolerability. Statistical analysis was performed by means of Student's t test to show differences between cases; all values are reported as means and standard deviations and p values were considered as significant when p<0.05. After treatment, clinical cure and bacteriological eradication were achieved in all patients (40/40; 100%). Adverse events, mainly gastrointestinal disturbances (e.g. nausea), were observed in 5 out of 40 patients (12.5%) and no neurotoxic effects were registered (e.g. anxiety, hallucinations, convulsions, mental confusion). No significant variation in laboratory tests due to hematic crasis and/or hepatic and renal disorders was observed. Levofloxacin proved to be highly efficacious and safe in the treatment of bacterial infections in patients affected by liver disease.

Myoepithelioma of a minor salivary gland of the cheek: case report.

Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid gland and less often in the minor accessory salivary gland of the oral cavity. The histological appearance includes solid, myxoid and reticular growth patterns. Vimentin and S-100 protein are very sensitive but non-specific immunohistochemical markers of neoplastic myoepithelium. Conservative surgery is the treatment of choice. A case of myoepithelioma of the minor salivary gland of the cheek with low grade malignancy is described, focusing on clinical behaviour, histopathological and immunohistochemical features and differential diagnosis.

Maxillo-ethmoidal chloroma in acute myeloid leukaemia: case report.

Chloroma, also called Granulocytic Sarcoma or Myeloid Sarcoma, is a rare malignant extra-medullary neoplasm of myeloid precursor cells. It is usually associated with myelo-proliferative disorders but its appearance may precede the onset of leukaemia. Chloroma may be found in several extracranial sites. Involvement of the head and neck region is uncommon. Differential diagnosis is often difficult and includes acute lymphoblastic leukaemia, large cell NHL, lymphoblastic lymphoma and Ewing's sarcoma. The case is presented of a maxillo-ethmoidal chloroma occurring in a case of poor prognosis acute myeloid leukaemia, emphasizing the clinical and cyto-histological features and problems concerning differential diagnosis.

[Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients]. / Tratamiento quirúrgico de la hipertrofia de cornetes inferiores con plasma de argón: estudio a largo plazo con 157 pacientes.

Surgical treatment of the inferior turbinate in patients with chronic hypertrophic rhinitis that does not respond to medical treatment is a well established procedure. CO2 laser, YAG laser, KTP laser, conventional electrocautery, cryotherapy, chemosurgery and turbinectomy or submucosal turbinectomy have been performed for the removal of nasal obstruction. Argon Plasma Coagulation (APC) is a new, innovative technique in Otorhinolaryngology which is based on high-frequency electrocoagulation with an argon-gas source. The shorter surgical times, the absence of hemorrhagic complications and, in rhinosurgery, not requiring any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgical Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t-test was used for statistical data. After 24 months, 87% (p < 0.001) of patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. We review and discus the indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery.

Surveillance of post-operative infections and management of antibiotic surgical prophylaxis in an Italian region.

The aim of the study was to evaluate the incidence of post-surgical infections and to assess management of antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynecology Departments in Campania (southern Italy) participated in the study, which was carried out from December 2001-January 2002. Overall, 410 questionnaires were collected, referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing, for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.9% of patients undergoing clean surgery and in 3.6% of patients undergoing clean-contaminated surgery. Distant infections occurred in 1.5% in clean-contaminated surgery. The results of the present study suggest the need for continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis.

Tratamiento quirúrgico de la hipertrofia de cornetes inferiores con plasma de argón: estudio a largo plazo con 157 pacientes / Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients

La obstrucción nasal crónica es una alteración que se observa con frecuencia y que en muchos casos está causada por una hipertrofia de cornetes inferiores. Si hay una respuesta inadecuada al tratamiento médico conservador, debemos realizar una reducción en el tamaño de los cornetes. Existen varias técnicas: coagulación mono o bipolar, reducción parcial del cornete mediante el conchotomo o las tijeras, cirugía láser mediante Nd: YAG, CO 2 o KTP. La coagulación mediante plasma de argón (APC) es una técnica nueva basada en una corriente eléctrica de alta frecuencia y una fuente de gas argón. La rapidez en la realización de la técnica, la ausencia de complicaciones hemorrágicas, así como la no necesidad de ningún tipo de taponamiento la hacen muy interesante para cirugía nasal. Entre marzo y noviembre de 2000, un grupo de 157 pacientes con síntomas de obstrucción nasal debida a hipertrofia de cornetes inferiores fueron tratados mediante APC. Se realizaron revisiones a la semana y al 1, 3, 6, 12 y 24 mes. Se practicó una rinomanometría para verificar objetivamente si la hipertrofia de cornetes era debida a una hipertrofia mucosa. Después de 24 meses, el 87 por ciento (p menor 0,01) de los pacientes refirieron tener mejor flujo nasal que antes de la operación. Ningún paciente precisó taponamiento después de la cirugía. Se revisan y discuten las indicaciones, ventajas, complicaciones, controversias y resultados a largo plazo en el tratamiento con APC en rinocirugía (AU)

Surgical treatment of the inferior turbinate in patients with chronic hypertrophic rhinitis that does not respond to medical treatment is a well established procedure. CO2 laser, YAG laser, KTP laser, conventional electrocautery, cryotherapy, chemosurgery and turbinectomy or submucosal turbinectomy have been performed for the removal of nasal obstruction. Argon Plasma Coagulation (APC) is a new, innovative technique in Otorhinolaryngology which is based on high-frequency electrocoagulation with an argon-gas source. The shorter surgical times, the absence of hemorrhagic complications and, in rhinosurgery, not requiring any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgical Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t-test was used for statistical data. After 24 months, 87% (p < 0.001) of patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. We review and discus the indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery (AU)