Biomarkers Predictive of Metabolic Syndrome and Cardiovascular Disease in Childhood Cancer Survivors.

The improvement in childhood cancer treatments resulted in a marked improvement in the survival of pediatric cancer patients. However, as survival increased, it was also possible to observe the long-term side effects of cancer therapies. Among these, metabolic syndrome is one of the most frequent long-term side effects, and causes high mortality and morbidity. Consequently, it is necessary to identify strategies that allow for early diagnosis. In this review, the pathogenetic mechanisms of metabolic syndrome and the potential new biomarkers that can facilitate its diagnosis in survivors of pediatric tumors are analyzed.

Food Dependent Exercise-Induced Anaphylaxis in pediatric age. Can we trust the oral food challenge with exercise and acetylsalicylic acid?

Food-dependent exercise-induced anaphylaxis (FDEIA) is an IgE-mediated allergy resulting from the combination of the ingestion of an offending food and physical exercise. According literature, oral food challenge (OFC) followed by physical exercise (OFCPE) should be considered the diagnostic gold standard. In the absence of adverse reactions, other cofactors should be added (e.g. acetylsalicylic acid, alcohol in adulthood), one at a time. But many other factors increase patient's reactivity. This could reduce the sensitivity of the OFCPE and, consequently, make instructions for patients less reliable. On the other hand, the addition of cofactors not reported by the patient may reduce test specificity. With the help of two exemplary stories, that present opposite outcomes, diagnostic difficulties of FDEIA are discussed.

Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions.

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1-4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.

Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient.

BACKGROUND: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). OBJECTIVE: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. MATERIALS AND METHODS: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day. RESULTS: We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. CONCLUSIONS: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.

The adverse effects of oral desmopressin lyophilisate (MELT): personal experience on enuretic children.

OBJECTIVE: The aim of this study was to evaluate adverse effects of oral desmopressin lyophilisate (MELT) in enuretic children. MATERIAL AND METHODS: We enrolled 260 children with nocturnal enuresis (NE) referred to the Pediatric Service, 'Campus Bio-Medico' University of Rome, from April 2014 to April 2017 in the study, of these 23 were excluded. The study was characterized by 2 phases. During Phase 1 a careful patient's medical history was obtained and physical examination was performed. After 3 months of treatment with MELT (Minirin/DDAVP®) at the dose of 120 mcg a day, a micturition diary was kept, adherence to therapy and any possible adverse effects were checked during the Phase 2. The study was carried out in compliance with the Helsinki Declaration. RESULTS: Among 237 patients included in the study 11 male and 6 female (n=17; 7.2%) patients with a mean age 10.06±2.49 years, reported 22 adverse effects, with an absolute risk of 7.17%. In particular, 5 neurological symptoms, 3 gastrointestinal effects, 4 sleep disturbances, 8 psycho-behavioral disorders, 2 symptoms of fatigue were reported. CONCLUSION: In our study MELT with its higher bioavailability guaranteed lower frequency of adverse effects which resolved spontaneously and rapidly. The MELT formulation actually represents the first line and safe treatment for the NE.

Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study.

Ferrara P, Cutrona C, Guadagno C, Amodeo ME, Del-Vescovo E, Ianniello F, Petitti T. Changes in trajectories of physical growth in a domestic adoptees sample: A preliminary study. Turk J Pediatr 2018; 60: 464-466. Internationally adopted infants experienced profound institutional deprivation in early infancy. Adoption may have a positive effect on child development, providing a massive catch-up growth in the developmental parameters. In this preliminary study we examined the effect of family deprivation on abandoned children placed in high quality foster care during infancy. We also investigated the presence of a growth delay in Italian domestic adoptees at the time of family placement and the potential physical recovery after adoption. Anthropometric measures (weight, length or height /head circumference) and Body Mass Index (BMI) were measured on arrival (T0) and 6 (T1), 12 (T2) and 24 months (T3) after adoption. The results show moderate delays in physical growth on the children`s arrival into the adoptive family and a significant catch-up growth in all auxological parameters from T < sub > 0 < /sub > to T < sub > 3 < /sub > . This is one of few Italian studies that points out a positive change in trajectories of growth after child adoption.

A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children.

PURPOSE: This study aims to evaluate the prevalence of headaches and migraine in children with nocturnal enuresis (NE) and to improve knowledge on these conditions. In particular, for this purpose, a possible pathogenic relationship linking both conditions and the impact of headaches and migraine on NE persistence was evaluated. METHODS: Researchers enrolled 123 children with NE, aged between 5 and 15 years, referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome between January 2014 and January 2015. Parents of all children enrolled in the study were invited to complete a self-reported questionnaire. The study protocol was approved by the Human Research Ethics Committee of Campus-Bio-Medico University. The NE group data was compared with the data of a control group (107 children). RESULTS: Of the eligible patients, 7.8% suffer from headaches/migraine (mean age, 9.63 years; interquartile range [IQR], 3.5 years) and 47.1% have a family history of headaches (mean age, 8.46 years; IQR, 3.75 years). Of the 8 patients with headaches, all are male, 3 have tension-type headaches (2 of them have maternal family history) and 5 have migraine (3 of them have maternal family history). Of the 35.3% with a migraine family history (mean age, 8.36 years; IQR, 3.5 years), 22 are male, and 14 are female. Three of these patients have migraine. A total of 92.2% suffer from NE but not from headaches (mean age, 8.43 years; IQR, 3 years). Of these patients, 33 are female (35.1%), and 61 are male (64.9%). In the control group, 4.7% (5 out of 107) of the children suffer from headaches, and of these, 4 are affected by nonmigraine headaches and 1 by migraine. CONCLUSIONS: In conclusion, according to the hypothesis, NE and headaches/migraine could be linked by several similarities.