Metabolic syndrome and diabetes mellitus in childhood cancer survivors.

BACKGROUND: The survival of children with cancer has grown considerably in recent years resulting in a marked increase of endocrine complications. increasingly recognized problems are metabolic syndrome and diabetes mellitus. DATA SOURCES: We critically analysed the most recent literature about the prevalence and molecular mechanisms of metabolic dysregulation and long-term cardio-metabolic risk in this population. RESULTS: Hypothalamic irradiation determines growth hormone deficiency and hypogonadism; moreover it is able to disrupt the appetite regulating centre leading to hyperphagia and progressive obesity. These conditions determine an insulin resistant state, contributing to the development of metabolic syndrome and diabetes mellitus. Irradiation and/or chemotherapy may lead to an insulin secretory defect through a direct damage of pancreatic beta cells. CONCLUSION: Metabolic syndrome and diabetes mellitus represent increasingly recognized long-term complications of childhood cancer treatment. The different impact of insulin resistance and secretory defects on the onset and progression of metabolic syndrome and diabetes mellitus remains unclear.

Humanitarian mission improves health conditions of schoolchildren in Ethiopia. the case of Adwa.

OBJECTIVE: The objective of this study is to compare health conditions of schoolchildren receiving aids from the mission Kidane Mehret Integrated Project (KMIP) in the city of Adwa, Ethiopia, with the ones of the general population. METHODS: From September, 2008, to November, 2008, 400 children were randomly selected in the school inside KMIP and in the one of Adi Abetu. In phase 1, a questionnaire was distributed to children's families. In phase 2, children underwent physical examination. RESULTS: Girls from KMIP started weaning on average at 7.3+/-3.9 vs 8.3+/-4.7 months of the control group (p>0.05); boys from KMIP started weaning on average at 6.7+/-4.1 vs 8.7+/-5.1 months of the control group (p<0.01). Centiles for height for age, weight for age and BMI for age were significantly higher in girls attending KMIP compared to the control group. CONCLUSIONS: Merged data suggests the significant impact of KMIP on the schoolchildren of Adwa. Moreover, women and youngest children, usually the most discriminates, were the band of the society that benefited most from the aids coming from the mission.

The familiarity of idiopathic scoliosis: statistical analysis and clinical considerations.

PURPOSE: The etiology of idiopathic scoliosis (IS) has been the subject of extensive research, and the current opinion is in favor of a multifactorial pathogenesis with an important genetic component. The aim of this study is to investigate the pattern of inheritance over generations of IS and its possible risk factors. METHODS: A total of 70 patients affected by IS was selected and studied up to the third generation for an overall cohort of 2,055 subjects. The genealogy was investigated and correlated for scoliosis. RESULTS: The outcomes showed that 73 % of the patients had an age between 12 and 15 years. The 60 % of the mothers had an age between 20 and 29 years and 57 % of the patients were "first born". The 5.8 % of the brothers and the 12.7 % of the sisters were affected by scoliosis. From the analysis of the total sample, it is clear that in 53 % of the families, there is at least another scoliotic besides the patient. CONCLUSION: The statistical analysis revealed three different types of transmission: autosomic dominant, autosomic recessive and multifactorial. When this last mode of inheritance is involved, female sex and firstborn resulted as risk factors of IS.

Scanning the solutions for the sustainable supply of forest ecosystem services in Europe.

Forests are key components of European multifunctional landscapes and supply numerous forest ecosystem services (FES) fundamental to human well-being. The sustainable provision of FES has the potential to provide responses to major societal challenges, such as climate change, biodiversity loss, or rural development. To identify suitable strategies for the future sustenance of FES, we performed a solution scanning exercise with a group of transdisciplinary forest and FES experts from different European regions. We identified and prioritized fifteen major challenges hindering the balanced provision of multiple FES and identified a series of potential solutions to tackle each of them. The most prominent challenges referred to the increased frequency and impacts of extreme weather events and the normative mindset regarding forest management. The respective solutions pointed to the promotion of forest resilience via climate-smart forestry and mainstreaming FES-oriented management through a threefold strategy focusing on education, awareness raising, and networking. In a subsequent survey, most solutions were assessed as highly effective, transferable, monitorable, and with potential for being economically efficient. The implementation of the solutions could have synergistic effects when applying the notion of leverage points. Seven emerging pathways towards the sustainable supply of FES have been identified. These pathways build on each other and are organized based on their potential for transformation: (1) shifting forest management paradigms towards pluralistic ecosystem valuation; (2) using integrated landscape approaches; (3) increasing forest resilience; (4) coordinating actions between forest-related actors; (5) increasing participation in forest planning and management; (6) continuous, open, and transparent knowledge integration; and (7) using incentive-based instruments to support regulating and cultural FES. These pathways can contribute to the implementation of the new EU Forestry Strategy to support the balanced supply of multiple FES. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01111-4.

[Clinical pattern of pediatric acute gastroenteritis in the community]. / Aspetti clinici della gastroenterite acuta del bambino nel territorio.

Acute gastroenteritis (AGE) is a typical illness seen in outpatient children, usually treated by Family Pediatricians (FP). To analyze the characteristics of community AGE, we have collected all the case histories of children observed in a FP office, analyzing computerized clinical file (FIMED Infantia), taken from the period 2003-2007. We enrolled 1140 children with AGE were gathered, for an average of 228 cases/year; 578 (51%) males and 562 (49%) females; the month with highest number of cases is October (120 cases, 10.5%), followed by September and April (105 cases in both, 9.2%). The month with the lowest incidence is February (75 cases, 6.6%) followed by August (81 cases, 7.1%); children's mean age is 4.6 +/- 3.4 years with a wide range (10 days divided by 16 years). As regards the clinical pattern, 314 children (27.5%) presented high fever, 395 (34.6%) vomiting and 24 cases (2.1%) bloody diarrhea; mean daily stools is 3.9 +/- 1.1; only 4 children suffered from severe dehydration. 255 children (22.4%) received antibiotic prescription, mainly cotrimoxazole (51%), followed by cephalosporins (39%) and macrolides (10%); 893 children (78.3%) were prescribed probiotics. Oral rehydrating solution was always offered to all children, followed by normal diet and only 4 children (0.4%) need the administration of a lactose free formula. Mean duration of diarrhea was 3.4 +/- 1.7 days, only 10 children (0.9%) suffered from chronic diarrhea and only 2 children (0.2%) were hospitalized due to severe dehydration. In conclusion, the child that refers to the FP office, is often a child with minor symptoms, for whom admission is not required; he/she presents a regular course and slight complications.

[Epidemiology and clinical pictures of pharyngitis: report on the activity of a family paediatrician]. / Epidemiologia e clinica della faringotonsillite: report dell'attività ambulatoriale di un pediatra di famiglia.

OBJECTIVES: Pharyngitis (PM) is the most common child disease, that Family Paediatricians (FP) have to deal with. The aim of this study is to analyze epidemiology of PM comparing the validity of clinical scores and Rapid Antigen Detection Test (RADT) to diagnose Group A Streptococci PM. An evaluation of antibiotic prescription was performed too on the basis of the two groups. METHODS: A three-years epidemiological investigation was performed on a group of children observed in a FP office. Children was divided into two groups on the basis of the RADT (RADT+ and RADT-) and for each group statistical and epidemiological analysis was performed. RESULTS: A total of 1.445 children was gathered, 1.128 of them (78%) had RADT- and 317 (22%) RADT+. Data analysis shows significant statistical differences between data of children with RADT+, comparing to those of RADT-, regarding Milano Score and other clinical criteria, with the only exception of McIsaac Score. CONCLUSIONS: PM remains the most important children disease in an FP office. The use of RADT allows a rapids and correct etiological diagnosis and to contain to less than 50% antibiotic prescription. RADT is the diagnostic test to use in the PM practice, being easy and quick to perform, compared with clinical criteria and scores.

Autism and celiac disease: failure to validate the hypothesis that a link might exist.

Autism is a heterogeneous condition and the possible pathogenic role of several different factors has been postulated. Association between celiac disease and neurological manifestations such as drug resistant epilepsy and cerebral calcifications is well known. Some authors in the past also reported the existence of a linkage with autism. On the basis of these observations, we have evaluated 120 patients with celiac disease diagnosed at the Pediatric Clinic of the University of Catania, Italy, in order to identify behavioral problems and autistic features: there were 20 controls for this part of the study. At the same time, AGA and AEMAb were assayed in 11 patients with infantile autism and 11 age- and sex-matched controls. No celiac case was detected among the group of autistic patients and, although two of them had slightly increased levels of AGA IgG and AEMAb, subsequent antibodies determinations and jejunal biopsies gave normal results. Moreover none of the celiac patients had a positive DSM-III-R test for infantile autism.

Mutation of Lys-120 and Lys-134 drastically reduces the catalytic rate of Cu,Zn superoxide dismutase.

Lys-120 and Lys-134, located at the edge of the active site channel in most Cu,Zn superoxide dismutases, have been suggested to play a major role in steering the anionic substrate towards the catalytic copper ion. In this study, mutants of Xenopus laevis Cu,Zn superoxide dismutase have been engineered, with Lys-120 and Lys-134 changed into leucine and threonine, respectively, and their catalytic properties have been investigated by pulse radiolysis. Results obtained demonstrate that both residues decrease the catalytic rate by about 40%, in partial disagreement with previous brownian dynamics calculations, carried out on bovine Cu,Zn superoxide dismutase.

The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects.

BACKGROUND: Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy. PATIENTS AND METHODS: Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency. RESULTS: Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7. CONCLUSIONS: These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.

[Evaluation of the clinical efficacy of azithromycin in acute respiratory infections in children]. / Valutazione dell'efficacia clinica dell'azitromicina nelle infezioni acute delle vie respiratorie del bambino.

Azithromycin activity in vivo has been studied in a group of children with acute respiratory tract infections in order to test the efficacy and tolerability of this antibiotic. The study involved 135 children treated with a single daily 10 mg/kg dose of azithromycin for three consecutive days. Ten days after this treatment 100% of children with otitis media, tracheobronchitis, or rhinosinusitis and 95.9% of children with pharyngo-tonsillitis were cured. Recurrences were never observed. Azithromycin proved remarkably effective for treatment of acute respiratory infections and otitis media in children. Tolerability and therapeutic compliance were excellent.

[Scanning electron microscopy (S.E.M.) aspects of intestinal mucosal surface in childhood coeliac disease]. / Aspetto della mucosa intestinale al microscopio a scansione elettronica (S.E.M.) nella malattia celiaca del bambino.

Intestinal mucosal surface in 5 children suffered with Coeliac Disease was observed at Scanning Electron Microscopy. The comparison between two techniques of dehydration demonstrated that the Alcool-Amile Acetate dehydration reduces the technical errors to the minimum. Therefore, a better visualization allows us to recognize the surface coat, the microvillous and some mucosal functional aspects (scale off), which were previously undistinguished. There are no differences between the mucosal aspects in adult coeliac disease and childhood coelia disease.

[Kaposi's varicelliform eruption. Presentation of 3 cases]. / Eruzione varicelliforme di Kaposi. Presentazione di 3 casi.

Three cases of Kaposi's Varicelliform Eruption are reported. In all cases the herpes virus simplex etiology was demonstrated. Every patients had in the anamnesis clinical signs of atopy. The findings in all patients of depressed cell-mediated immunity confirmed a minimal immunodeficiency as cause of atopy. The course of K.V.E. was normal, but the patients presented constant cherato-conjunctival and palpebral alterations.

[Cushing's ulcer in childhood. Description of a case]. / L'ulcera di Cushing in età pediatrica. Descrizione di un caso.

The authors describe a case of Cushing's duodenal ulcer associated with Encephalitis. Diagnosis was made as the following criteria: neurological manifestations (fever, seizures, coma) and clinical manifestations of ulcer (hematemesis and melena); endoscopic evidence of ulcer and demonstration of increased gastric acid secretion; direct correlation between neurological lesion and duodenal ulcer. The good therapeutic result obtained with Ranitidine was noteworthy. The high dosage (20 mg/kg/die) allowed the control of the bleeding and the ulcer cicatrization.

[Acute ulcer of the stomach caused by the concurrent administration of the antipyretic-intended betamethasone and a non-steroid anti-inflammatory drug]. / Ulcera acuta dello stomaco da somministrazione contemporanea a scopo antipiretico di betametasone e di un farmaco antiinfiammatorio non steroideo (fans).

The authors report a case of acute gastric ulceration in a 4 year-old-child after contemporary administration of Betametason and Dypiron as antipyretic. A pathogenetic interpretation of the rapid formation of gastric ulceration it is briefly noticed. The Authors concluded with some considerations on the side effects of Betametason and Anti inflammatory Non-Steroidal Drugs.

[The diagnostic approach to and clinical study of 23 children with an obstructive sleep apnea syndrome]. / Approccio diagnostico e studio clinico di 23 bambini affetti da "sindrome di apnea ostruttiva nel sonno".

23 children, aging from 3 to 13 years, affected by chronic upper airway obstruction, were studied. The clinical suspicion was "obstructive sleep apnea" (O.S.A.). In this study was found a significantly different frequency, in O.S.A. group, if compared with controls, of the following symptoms: nocturnal snoring (100%), mouth breathing when awake (69%), and during sleep (91%), abnormal restless movements (69%), behavioral disturbances (60%). Clinical evaluation revealed: pectus excavatum (82%), enlarged tonsils and adenoids (82%), failure to thrive (39%). Chest index was 0.72 +/- 0.07 significantly higher (p < 0.001) than controls. The authors also carried out in all patients and controls pCO2 venous blood determination during sleep, to screen subjects with high risk of cardiopulmonary dysfunction. Data obtained showed that threshold value of pCO2 was 45.6 mmHg.

[Blood beta-carotene after oral administration of carotenoids. A dynamic test of lipid absorption]. / Beta-carotenemia da carico orale di carotinoidi. Prova dinamica di assorbimento dei lipidi.

Authors report a method on the functional investigation of intestinal epithelium, based upon the dosage of serum carotene levels after administration of carotenoids. This test takes advantage of the modality of beta-carotene absorption that it behaves like a lipid. The "beta-carotene test" has demonstrated, as regards to T.A.R.T., great sensibility and specificity over 90%. It doesn't show value overlapping between normal and coeliac children and also it shows good compliance of children and simplicity in laboratory determination. For all these characteristics the Authors suggest the utilization of "beta-carotene test" as screening tool of malabsorption.

[Significance of milk antibodies in cow's milk protein intolerance]. / Significato degli anticorpi antilatte nella intolleranza alle proteine del latte vaccino.

Cow's Milk Protein Intolerance (CMPI) is the most common food intolerance in childhood. The I, III and IV type of the immunological mechanisms are involved in the pathogenesis. Nowadays there are no diagnostic tests with good reliability excluding the IgE-mediated clinical pictures. Recently the evaluation of antibodies (IgA and IgG classes) versus milk proteins has been proposed as reliable test. In order to establish the pattern of antibody response against milk proteins we studied 37 children (17 males and 20 females), aged from 3 months to 6 years, divided as follows: 23 with CMPI of which 16 suffering from gastrointestinal complaints (GI) and 7 from cutaneous ones (CT); 5 children with coeliac disease; 9 normal healthy children without any clinical manifestation. All children at the time of the assessment assuming a diet containing cow's milk proteins. IgA, IgG and IgM antibody classes against cow's milk proteins such as alpha-lactoalbumin (alpha LA), beta-lactoglobulin (beta LG), casein (CAS) and pooled proteins (PPL) were measured using an ELISA method. The results obtained in the various groups were as follows: CMPI-GI group: the percentage of positivity for alpha LA-IgA was 43.8% and alpha LA-IgG 68.7%, for beta LG-IgA was 50% and beta LG-IgG 75%, for CAS-IgA was 43.8% and CAS-IgG 68.7%, for PPL-IgA was 37.5% and PPL-IgG 62.5%. CMPI-CT group: the percentage of positivity for alpha LA-IgA was 42.8% and alpha LA-IgG 57.1%, for beta LG-IgA was 71.4% and beta LG-IgG 42.8%, for CAS-IgA and CAS-IgG was 85.7%, for PPL-IgA was 71.4% and PPL-IgG 57.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Megaloblastic anemia: a unusual complication in an infant with double allergy to both cow's milk protein and soy]. / Anemia megaloblastica: singolare complicanza in lattante con doppia allergia alle proteine del latte vaccino ed alla soja.

The authors reported a case of a child suffering from Cow's milk protein allergy, in which a soybean milk was administered for one month. The incorrect preparation of the formula determined a megaloblastic anaemia due to folate deficiency. The observation of very high levels of seric aminoacids during the acute phase of the disease was noteworthy. The therapy with folic acid and the introduction of protein hydrolysated formula milk determined a rapid normalization of the haematological picture. During the follow-up the administration of soybean protein caused anaphylaxis showing the contemporary presence of soybean allergy. The challenge test with cow's milk performed afterwards showed the restoration of the tolerance towards cow's milk protein.

[Calcium-phosphorus metabolism in celiac disease in children]. / Metabolismo calcio-fosforico nella malattia celiaca del bambino.

The Authors studied the changes of the main parameters of calcium-phosphate metabolism in twenty four untreated celiac children (mean age: 23.7 +/- 14.4 months) and in eleven control subjects (mean age: 28.5 +/- 21.2 months). 16 patients were checked again one and three months after treatment was begun. Compared with controls patients show at diagnosis a significant increase of serum phosphate (P = 0.025) and a decrease of calcitonin levels (P = 0.02), whereas serum calcium is slightly lower and parathyroid hormone higher with serum levels above normal range in 5 of the coeliac patients (20.8%). During the three months of gluten free diet we find a significant increase of calcemia values (ANOVA: P = 0.025) together with a decrease of serum phosphate (ANOVA: P = 0.009) and of parathyroid hormone levels (ANOVA: P = 0.042). No significant change was found in vitamin D metabolites levels. The Authors conclude that coeliac disease affect clearly mineral metabolism. Actually the tendency to hypocalcemia, due to abnormalities of the intestinal mucosa, and the comparative iperphosphatemia, cause in some patients a compensatory increase of PTH levels. This increase seems to be the cause of the osteoporotic lesions described in current literature. Rickets due to the lack of vitamin D does not occur.