Effect of Lactobacillus reuteri LRE02-Lactobacillus rhamnosus LR04 combination and gastrointestinal functional disorders in an Emergency Department pediatric population.

OBJECTIVE: Probiotics are living microorganisms that, when administered per os in adequate amounts, may confer a health benefit on the host by the regularization of an unbalanced gastroenteric microbiota. The objective of this study was to evaluate treatment effectiveness, safety, and palatability of a probiotic's combination (Lactobacillus reuteri LRE02-DSM 23878 and Lactobacillus rhamnosus LR04-DSM 16605) in a pediatric Emergency Department setting with functional gastrointestinal disorders. PATIENTS AND METHODS: Three groups were enrolled: children with functional abdominal pain; children with gastroenteritis; children with gas colic. Self-reporting sheets were delivered to each patient/parent after probiotics treatment. The primary outcome was to evaluate the evolution of clinical conditions in enrolled children. RESULTS: The outcomes showed a statistical difference among children treated with probiotics and those who did not. In the functional abdominal pain group, 58.2% of patients had a moderate symptoms improvement and 33.5% had a complete disappearance of symptoms, while in the gas colic group, 68.2% of the infants had a moderate improvement and 23.2% had a complete resolution. In the gastroenteritis group, stool consistency and number of evacuations improved in children who took probiotic administration as well. CONCLUSIONS: Probiotics therapy, at the recommended dosage of five drops per day for 15 days, is associated with symptoms improvement. Moreover, the use of probiotics led to a stool consistency's normalization in a shorter time, evaluated with BSS. A randomized trial is needed to confirm these results.

Nerve growth factor serum levels in treatment-resistant schizophrenic patients following electroconvulsive therapy.

BACKGROUND: Electroconvulsive Therapy (ECT) has been widely applied to treat schizophrenia (SCZ) in the presence of resistance to pharmacotherapy. The mechanism of action of ECT in schizophrenia has not been fully clarified, though its intrinsic mechanism presents analogies with some neurobiological processes mediated by nerve growth factor (NGF). OBJECTIVES: The aim of this study was to investigate in patients with treatment-resistant schizophrenia (TRS) the effect of ECT on acute and long-term NGF serum levels and the association with the clinical outcomes. METHODS: Twelve male inpatients with TRS underwent eight sessions of ECT. Blood samples were collected during the first and the eighth ECT at the following time points: 5 minutes before the induction of seizure and then at 0, 5, 15 and 30 minutes after seizure. RESULTS: Following ECT treatment, a substantial clinical improvement in symptom severity was indicated by a significant reduction in the Positive and Negative Syndrome Scale (PANSS) total and subscales scores. Even though the baseline NGF levels showed an increase over time, there were no statistical differences in NGF at time 0 at the first and the eighth ECT session. Furthermore, no correlation was observed between the severity of schizophrenic symptoms and NGF levels. CONCLUSIONS: This is the first study addressing peripheral NGF during ECT treatment in TRS, as well as the first study in which NGF has been evaluated in different ECT sessions at various time points. These findings may potentiate the knowledge about the neurotrophic effects of ECT and the role of NGF in synaptic plasticity related to possible mechanisms of schizophrenia treatment.

Disagreement between guidelines regarding the third step of asthma drug therapy for school-age children

With the help of a routine clinical case, we highlighted the difference between two of the best asthma guidelines available at the time regarding therapeutic suggestions for the so-called "third step" for school-age asthmatic children. We have analyzed the scientific evidence that each of the two guidelines brings to support their position. Finally, we have motivatedly solved the clinical scenario. However, the question of disagreement between two guidelines remains unresolved. This can lead to unjustified differences in the management of schoolchildren with persistent asthma

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Does delayed urticaria induced by drug allergy exist?

With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic. We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria. However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and "official" clearness about this topic because of its important clinical application to our patients

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Does delayed urticaria induced by drug allergy exist?

With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic. We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria. However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and "official" clearness about this topic because of its important clinical application to our patients.

Disagreement between guidelines regarding the third step of asthma drug therapy for school-age children.

With the help of a routine clinical case, we highlighted the difference between two of the best asthma guidelines available at the time regarding therapeutic suggestions for the so-called "third step" for school-age asthmatic children. We have analyzed the scientific evidence that each of the two guidelines brings to support their position. Finally, we have motivatedly solved the clinical scenario. However, the question of disagreement between two guidelines remains unresolved. This can lead to unjustified differences in the management of schoolchildren with persistent asthma.

Nootropics use in the workplace: psychiatric and ethical aftermath towards the new frontier of bioengineering.

OBJECTIVE: The authors have sought to expound upon and shed a light on the rise of nootropics, which have gradually taken on a more and more relevant role in workplaces and academic settings. MATERIALS AND METHODS: Multidisciplinary databases have been delved into by entering the following keys: "nootropics", "cognitive enhancement", "workplace", "productivity", "ethics", "bioengineering". In addition, a broad-ranging search has been undertaken on institutional websites in order to identify relevant analysis and recommendations issued by international institutions and agencies. Papers and reports have been independently pored over by each author. This search strategy has led to the identification of 988 sources but only 64 were considered appropriate for the purposes of the paper after being selected by at least 3 of the authors, independently. RESULTS: The notion of an artificially enhanced work performance - carried out by the 'superworker' - is particularly noteworthy and resonates with the conception of contemporary work on so many different levels: the rising need and demands for higher degrees of flexibility and productivity on the job, the implications of a '24/7' society, where more and more services are available at any time, the ever greater emphasis on entrepreneurial spirit, individual self-reliance and self-improvement, and last but not least, the impact of an ageing society on economic standards and performance. CONCLUSIONS: Moreover, it is worth mentioning that human enhancement technologies will predictably and increasingly go hand in hand with gene editing, bioengineering, cybernetics and nanotechnology. Applications are virtually boundless, and may ultimately affect all human traits (physical strength, endurance, vision, intelligence and even personality and mood).

The unpredictability of seasonal variations in serum vitamin D levels in children with asthma and/or rhinitis

Background: Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status. Objective: We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children. Materials and methods: Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season. Results: We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥ 50 ng/ml in September and showed serum vitD levels ≥ 30ng/ml throughout the year; 16 patients presented vitD value ≥ 40 ng/ml in September and always had ≥ 20 ng/ml in the other months. Conclusions: The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate

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Cooking influence in tolerance acquisition in egg-induced acute food protein enterocolitis syndrome

Background: Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. Objective: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. Methods: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. Results: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. Conclusions: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES

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The unpredictability of seasonal variations in serum vitamin D levels in children with asthma and/or rhinitis.

BACKGROUND: Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status. OBJECTIVE: We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children. MATERIALS AND METHODS: Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season. RESULTS: We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥50ng/ml in September and showed serum vitD levels ≥30ng/ml throughout the year; 16 patients presented vitD value ≥40ng/ml in September and always had ≥20ng/ml in the other months. CONCLUSIONS: The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate.

Paroxysmal non-epileptic events in the pediatric emergency department.

Paroxysmal non-epileptic events (PNEs), or pseudoseizures (PS) resemble epileptic seizures. They are considered part of a personality disorder and have a higher incidence among adolescents. Patients describe episodes (lasting up to 20 minutes) of loss of consciousness, twitching or jerking and unusual emotional states. Unlike epileptic seizures, they are not associated with electroencephalographic abnormalities. Distinguishing epileptic seizures from PNEs is not easy. 20% of patients with seizures have a final PNEs diagnosis but recognizing them on the first examination is difficult. Due to the severe initial clinical presentation, these patients are often admitted in the Pediatric Intensive Care Unit (PICU) and may be over-treated. We report two cases admitted to our PICU for apparent status epilepticus, in which the final diagnosis was PNEs.

Cooking influence in tolerance acquisition in egg-induced acute food protein enterocolitis syndrome.

BACKGROUND: Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. OBJECTIVE: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. METHODS: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. RESULTS: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. CONCLUSIONS: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.

Do carnitine and extra trace elements change stability of paediatric parenteral nutrition admixtures?

INTRODUCTION: High concentrations of trace elements (TE), in particular zinc and selenium, along with carnitine, are often added to parenteral admixtures in paediatric patients on long-term Parenteral Nutrition (PN). We aim to evaluate whether lipid droplet diameters of these admixtures maintain the recommended range of 0.4-1.0 µm. MATERIALS AND METHODS: Stability studies were carried out on six parenteral admixtures with carnitine, trace elements and electrolytes added in different amounts. Each admixture was formulated with five different lipid emulsions with or without fish oil. Analyses were performed at time 0 (t = 0) and 24, 48, 72, 96 (t = 96) hours after compounding. Droplet diameters were determined by Light Scattering-Reverse Fourier Optics Technique. Samples, stored at 4 °C, were triple tested for a total of 450 analyses. Regression analyses were performed using panel-data techniques. RESULTS: During the 4 days, lipid droplet diameters were in the expected range of 0.4-1.0 µm regardless of trace element and carnitine amounts in all admixtures apart from those containing fish-oil based emulsions and calcium concentrations equal to 4.5 mmol/L. In these latter admixtures, 12% of droplet diameters were larger than 1.0 µm and 2% exceeded 5.0 µm immediately after compounding. CONCLUSION: Carnitine and high concentrations of trace elements do not affect PN admixtures stability and can be safely infused in long-term home-PN paediatric patients and prematures. Only high calcium concentrations in compresence with fish oil based lipid emulsions seem to change PN stability.

Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress?

Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES

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Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy?

Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view

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Loss of tolerance for fishes previously tolerated in children with fish food protein induced enterocolitis syndrome

We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish

No disponible

Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress?

Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.

Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy?

Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view.

Loss of tolerance for fishes previously tolerated in children with fish food protein induced enterocolitis syndrome.

We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish.

A very unusual case of food allergy, between FPIES and IgE-mediated food allergy.

Food protein induced enterocolitis syndrome (FPIES) is a food-related gastrointestinal hypersensitivity disorder, probably non-IgE-mediated. Over the years, various diagnostic criteria have been proposed to identify FPIES. In the last few years, there was an increased interest from researchers about FPIES's syndrome, that frequently brought to discover new aspects of this disease. We describe an unusual case of FPIES to egg in a 21-months-old child, because of its clinical characteristics that reflect some aspects of IgE-mediated allergy and other of non IgE-mediated allergy. Although we believe that the most correct diagnosis for our case is FPIES, we think also that this is undoubtedly an atypical form. This is in fact, the first description of a patient who simultaneously has both clinical expressions of IgE-mediated FA that of FPIES. Our case highlights the need to review criteria for FPIES diagnosis.