[The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. / L'impiego dell'ondansentron nella gastroenterite acuta e la sua efficacia in un pronto soccorso pediatrico.

BACKGROUND: Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE: To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS: A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS: The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.

[The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. / L'impiego dell'ondansentron nella gastroenterite acuta e la sua efficacia in un pronto soccorso pediatrico.

BACKGROUND: Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE: To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS: A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS: The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.

A hybrid achromatic metalens.

Metalenses, ultra-thin optical elements that focus light using subwavelength structures, have been the subject of a number of recent investigations. Compared to their refractive counterparts, metalenses offer reduced size and weight, and new functionality such as polarization control. However, metalenses that correct chromatic aberration also suffer from markedly reduced focusing efficiency. Here we introduce a Hybrid Achromatic Metalens (HAML) that overcomes this trade-off and offers improved focusing efficiency over a broad wavelength range from 1000-1800 nm. HAMLs can be designed by combining recursive ray-tracing and simulated phase libraries rather than computationally intensive global search algorithms. Moreover, HAMLs can be fabricated in low-refractive index materials using multi-photon lithography for customization or using molding for mass production. HAMLs demonstrated diffraction limited performance for numerical apertures of 0.27, 0.11, and 0.06, with average focusing efficiencies greater than 60% and maximum efficiencies up to 80%. A more complex design, the air-spaced HAML, introduces a gap between elements to enable even larger diameters and numerical apertures.

Rational approach to the treatment for heterozygous familial hypercholesterolemia in childhood and adolescence: a review.

Atherosclerosis represents a disease that begins in childhood and in which LDL cholesterol plays a pivotal role for the development of the pathology. Children and adolescents with high cholesterol levels are more likely than their peers to present cholesterol elevation as adults. The identification of genetic dyslipidemias associated with premature cardiovascular disease is crucial during childhood to delay or prevent the atherosclerotic process. Guidelines for the diagnosis and treatment of hypercholesterolemia during pediatric age are available from the National Cholesterol Education Program. A heart-healthy diet should begin at the age of 2 yr and a large number of studies have demonstrated no adverse effects on nutritional status, growth, pubertal development, and psychological aspects in children and adolescents limiting total and saturated fat intake. Pharmacotherapy should be considered in children over 10 yr of age when LDL cholesterol concentrations remain very high despite severe dietary therapy, especially when multiple risk factors are present. The only lipid-lowering drugs recommended up to now for childhood and adolescence are resins reported to be effective and well tolerated, although compliance is very poor because of unpalatability. The use of statins is increasing and seems to be effective and safe in children, even if studies enrolled a small number of patients and evaluated efficacy and safety for short-term periods. Recently, an interesting drug represented by ezetimibe has been found that may provide cholesterol-lowering additive to that reached with statin treatment. This review provides an update on recent advances in the diagnosis, therapy, and follow-up of familial hypercholesterolemia during pediatric age and adolescence.

Clinical effects of erdosteine in the treatment of acute respiratory tract diseases in children.

Erdosteine has positive effects on mucus rheology and transport due to the active metabolite (Metabolite I) which contains a free thiol group. Erdosteine inhibits bacterial adhesiveness and has antioxidant properties. A synergistic effect of erdosteine with various antibiotics has been demonstrated in pharmacological and clinical studies. The present study was multicenter, randomized, double-blind and placebo-controlled. The aims of the study were to compare a combination of erdosteine with amoxicillin against an amoxicillin-placebo combination in pediatric patients with acute lower respiratory tract disease. A total of 158 patients (78 in the erdosteine group and 80 in the placebo group) were treated for 7 +/- 2 days. The efficacy parameters were cough (primary), polypnea, rhonchi, rales and body temperature (all measured at baseline, on Day 3 and at the end of treatment). Safety was assessed by strictly monitoring the occurrence of adverse events and using standard laboratory parameters. The results of the intention-to-treat analysis showed that the severity of cough was decreased by 47% at Day 3 in the erdosteine group with a statistically significant difference compared to placebo, the difference was still significant at the final visit. The decrease in the severity of rales was significantly greater at Day 3 in the erdosteine group than in the placebo group. The incidence of polypnea and rhonchi in the two groups showed similar decreases, an improvement mainly due to the antibiotic. No adverse events occurred and no adverse changes in laboratory parameters were observed. It is concluded that the combination of erdosteine and amoxicillin is a safe medication which is clinically superior to that of the antibiotic combined with placebo, especially in regard to the effects on cough.

Fecal neutral steroids in normal conditions and in patients with polyps or cancer of the large bowel.

There is evidence suggesting that the excretion and conversion of neutral sterols in the human large bowel might be somewhat related to the development of colorectal cancer. Therefore, our objectives were: to characterize the excretion and the major pattern of sterol degradation in normal conditions, both in children and in adults; and to investigate if abnormalities of these parameters are frequent in patients with colorectal cancer or polyps. The study has been carried out in: 38 adult volunteers; 29 children divided into 4 age groups; 22 patients with colorectal cancer; 16 members of 6 families with adenomatosis coli; 15 members of 2 families with a high prevalence of multiple polyps or cancer of the large bowel; 12 subjects with colorectal polyps without familiality. With the subjects kept under metabolic control, fecal samples were collected for at least 3 days and analyzed by thin layer chromatography and gas-liquid chromatography. Total neutral steroid excretion was lower in children than in adult volunteers; in contrast, there was no significant difference between the latter and the other investigated group of patients with cancer or polyps, with values ranging between 230 and 680 mg/day. All the adult volunteers were "high converters" of cholesterol to its intestinal metabolites coprostanol and coprostanone [89 +/- 10% (SE) of degradation]. Children less than 1 year old degraded little or no cholesterol (10.4 +/- 6% of total neutral sterols), whereas with increasing age the fraction of conversion became more similar to that of adults. In patients with colorectal tumors 2 populations could be defined, one characterized by a large degradation of cholesterol and the other by little or no conversion. Low degradation of cholesterol was found in 3 of 6 families with adenomatosis coli. In conclusion, we did not find any significant difference in total neutral sterol excretion among controls, colorectal cancer patients, or subjects at risk. In adult volunteers the normal pattern of cholesterol degradation is characterized by a large conversion of cholesterol to its intestinal metabolites. In children this process changes with increasing age from an absolute "nonconverter" state (after birth) to the pattern typical of adults. Finally, in a minority of patients with either polyps or cancer of the large bowel and of their first-degree relatives, cholesterol is poorly degraded and represents the most abundant fecal sterol.

[Activity of pediatric acceptance in the Polyclinic of Modena: 1999 to 2003]. / Attività di accettazione pediatrica nel Policlinico di Modena: 1999-2003.

The activity of the pediatric emergency ward in 1999-2003 period is described. An increasing number of contacts was recorded. Most of them should be considered improper. An extra health-care information is required, specially directed to the foreign families, who recently settled in our town. A pediatric outpatient clinic for non-critical patient could cover Sundays and holidays, as in other italian centers.

[The short-stay observation unit: an experience of the Pediatric Department in Modena]. / Osservazione breve intensiva (OBI) in pediatria: l'esperienza del Policlinico di Modena.

The use of a short-stay observation unit (OBI) in a pediatric department has reduced the number of admissions. Significant cost savings and a better care for children and their families have been also achieved. During the year 2003 in our department 1759 children received OBI. 226 (12.8%) were then admitted. 1553 (87.2%) were discharged after a nine-hour mean stay. Descriptive statistics are used to outline the sample of patients and used treatments.

Interferon treatment in children with chronic hepatitis C: long-lasting remission in responders, and risk for disease progression in non-responders.

BACKGROUND AND AIM: Large interferon-based therapeutic trials are still lacking in children with hepatitis C and the long-term safety and efficacy of interferon is unknown. This study describes the outcome of hepatitis C in 43 children enrolled in an open-label interferon trial, and were followed up to 66 months after stopping treatment. PATIENTS AND METHODS: All patients received interferon alfa2a (5MU/m(2)) thrice weekly for 6 months; children with genotype 1b received 3MU/m(2) thrice weekly for 6 additional months. RESULTS: Nine children discontinued interferon for adverse events and three were not compliant to treatment. Eight (19%, intention to treat analysis), including 2/20 (10%) with genotype 1b and 6/12 (50%) with genotypes 2 or 3, were sustained responders 12 months after stopping therapy. During further follow-up (mean+/-S.D.: 44.7+/-14.6 months), response was maintained; two non-responders cleared viremia, while a young boy progressed to cirrhosis. CONCLUSIONS: Small sample size and therapy withdrawal are the major limitations in the interpretation of our results. Nevertheless, our data, suggesting that response to interferon in children with hepatitis C is genotype-related and stable, agree with the results of large studies in adults. The outcome in non-responders was variable, including persistence of viremia and mild-moderate cytolysis (most cases), progression to cirrhosis, or eventual sustained viremia clearance.

Long-term outcome of chronic type B hepatitis in childhood.

The course of hepatitis B was followed in 35 children. Various prognostic factors are evaluated. The long-term outcome of the disease is poor, often progressing to cirrhosis.

Familial clustering of Helicobacter pylori infection: population based study.

OBJECTIVES: To assess the rate of intrafamilial transmission of Helicobacter pylori infection in the general population and the role of a family's social background. DESIGN: Population survey. SETTING: Campogalliano, a town in northern Italy with about 5000 residents. PARTICIPANTS: 3289 residents, accounting for 416 families. MAIN OUTCOME MEASURES: Prevalence of H pylori infection assessed by presence of IgG antibodies to H pylori. RESULTS: The overall prevalence of H pylori infection was 58%. Children belonging to families with both parents infected had a significantly higher prevalence of H pylori infection (44%) than children from families with only one (30%) or no parents (21%) infected (P<0.001). Multivariate analyses confirmed that children with both parents positive had double the risk of being infected by H pylori than those from families in which both parents were negative. Family social status was independently related to infection in children, with those from blue collar or farming families showing an increased risk of infection compared with children of white collars workers (odds ratio 2.02, 95% confidence interval 1.16 to 3.49). CONCLUSIONS: H pylori infection clusters within families belonging to the same population. Social status may also be a risk factor. This suggests either a person to person transmission or a common source of exposure for H pylori infection.

[Experimentation and clinical analysis of the interrelationships between dental damage and celiac disease]. / Sperimentazione ed analisi clinica dei rapporti intercorrenti tra il danno dentale e la malattia celiaca.

Celiac disease is characterized by gluten-dependent atrophy of the intestinal tufts. Aetiologically the genetic "habitus" of the subject has particular importance and, as rear as the pathogenesis is concerned, many theories, among which the most accredited one is "immunopathological", exist. According to what this last one provides, the cell-mediated immunity component is to be considered the true mediator of intestinal injury, whereas the antibody-mediated component and, in particular, anti-gliadin antibodies (AGA) and anti-endomysium antibodies (EMA), has a particular and pre-eminent diagnostic role. Just from this point of view the celiac disease appeared, with the progress of the studies, to be more and more fleeting, because of growing symptomatologic diversification. It is then interesting to take into account that the celiac disease seems to be able to maintain itself asymptomatic for the greatest part of life, perhaps, forever, configuring the appearance of silent celiac disease and contributing to specify the outline of the above-mentioned celiac "habitus". Recently, besides, close associations have been found between many different diseases and celiac disease. Even for such reasons we relied upon the indication of the ESPGAN in order to achieve a sure and standardized diagnosis of celiac disease. Early diagnosis of celiac disease is very important because it allows a normal psychophysical development and it avoids the strong incidence of lymphomas and other neoplasms of the gastrointestinal tractus which can characterize the natural story of celiac patients. From a more specifically odontological point of view, interesting manifestations exist in the ambit of celiac disease. This last may in fact appear associated particular signs, such as recurrent aphthae or plainly autoimmune diseases with even oral verification. There, however, a more frequent association between celiac disease and some lesions of the tooth enamel which occur in the period of the two stages of histodifferentiation and mineralisation, and they are, respectively, hypoplasias and opacities. Alteration of the enamel, in such stages, both in deciduous and in permanent sets of teeth may be caused by different "noxae"; hence it will be necessary to know how to distinguish between the dental lesions typical of celiac disease and the others. It is helpful the fact that the dental lesion, observed in the course of celiac disease, remembers conceptually the Chronologic Hypoplasia of the enamel. This pathologic form damages the enamel which is depositing, and evolving contemporaneously to the local or systemic "noxa" which is its remote cause.(ABSTRACT TRUNCATED AT 400 WORDS)

[Asymptomatic hypertransaminasemia]. / Ipertransaminasemia asintomatica.

Asymptomatic hypertransaminasemia can be associated with extrahepatic diseases. Viral, bacterial, protozoan infections are the most frequent hepatic causes. Metabolic and autoimmune diseases more rarely cause hepatocitolisis without symptoms. Iatrogenic causes must be also considered in childhood. Obesity, celiac disease, irritable bowel diseases can seldom be associated with hypertransaminasemia. Diagnosis may be difficult and sometimes unsuccessful.

[A new and original therapy for seborrheic dermatitis]. / Una nuova ed originale terapia della dermatite seborroide.

The AA describe the results of an original therapy for seborrhoic dermatitis in both localized and spread forms (Leiner's Disease). Due to similarity of seborrhoic dermatitis in the two forms with acrodermatitis enterophatica and considering that this last disease reacts positively after Zinc administration, the AA stated the validity of such therapy also for seborrhoic dermatitis and discuss its possible mechanism of action.

[High-dose oral bacteria-therapy for chronic non-specific diarrhea of infancy]. / Batterioterapia orale ad alte dosi nella diarrea cronica aspecificia del bambino.

The Authors evaluate the effectiveness of oral bacteriotherapy using a combination of anaerobe fecal Lactobacilli for chronic non specific diarrhea of infancy. A double blind study was carried out in a total of 40 children treated with low and high doses of bacteria. The results confirm the importance of fecal flora in this disease and support the hypothesis that oral bacteriotherapy can improve clinical and laboratory presentation especially when given at high doses.

[Autoimmune hepatitis: pediatric aspects]. / Epatite autoimmune. Aspetti pediatrici.

Autoimmune hepatitis (AIH), a liver inflammatory condition, is characterized by hypergammaglobulinemia, hypertransaminasemia, presence of autoantibody and periportal hepatitis revealed by histology. Usually it comes with acute onset and with bad prognosis. We describe recent updated literature for clinical manifestation and pathogenesis, principally referring to adult disease. We described the data obtained from a multicenter investigation (10 Italian center) included in the Gastroenterology and Hepatology Italian Society. The investigation collected 42 AIH cases in 18 years, this confirms that the disease is rare for pediatric age. There is a prevalence of females on males but not as important as in adults (F/M:3/1). The average age at diagnosis was 7 + 4 years old. The diagnosis was always made based on observed symptoms excluding 2 cases with silent hypertransaminasemia. The most frequently observed autoantibody was SMA. In two cases, diagnosis was done without finding commonly investigated autoantibody. Prognosis is severe, in one case the hepatic transplantation was successful.

[Vaccination against hepatitis A]. / La vaccinazione anti epatite A.

The epidemiology of hepatitis A, a disease endemic in various countries, is in a state of continuous change. Adults are more exposed to infection and considering the frequent absence of immunity, in contrast to children in whom the disease is almost always asymptomatic, the disease is often serious and prolonged with a mortality of up to 2.5%. The mode of transmission of HAV is predominantly the fecal-oral route; the virus is isolated during the prodromic period of the disease from the feces, blood, bile and seminal fluid. The virus can also be found in saliva (OMS '95); in addition it may also be transmitted by the maternal-fetal route. The HAV infects cells in vitro but does not cause a direct cytopathic effect. At the beginning of the acute phase of the disease the production of anti-HAV antibodies is of the IgM type followed later by IgG. Some studies have shown a potential role of cellular immunity in clearance of the virus from the hepatocytes and in the pathogenesis of the infection of HAV. The efficacy of immunoglobulin serum in the prevention of hepatitis A has been demonstrated since 1944. As regards active immunity two types of vaccinations have been prepared. One with live attenuated HAV carried by either bacteria or virus. The other, killed inactivated HAV, HAV capsule, antigenic subunit, synthetic peptides, anti-idiotypes or virosomes. The recent literature describe the vaccine produced by Merck Sharp & Dohme and by Smith Kline Beecham (SKB); both vaccines are made from HAV, grown in vitro, inactivated with formalin and adsorbed to aluminum hydroxide. The protection of the vaccine begins 14 days after administration and lasts from one month to one year. Numerous studies have been conducted which have shown that the vaccine is effective when given in 2 doses and confers protection against HAV for at least one year. The results have shown that the vaccination causes seroconversion in approximately 100% of subjects, and does not cause serious side effects and the acceptance of the vaccination worldwide has been good.

[Helicobacter pylori. Part II. Epidemiology, diagnosis, and treatment]. / Helicobacter Pylori. IIa Parte: Epidemiologia, diagnosi e terapia.

In recent years, the diagnosis of Helicobacter Pylori (HP)-mediated infection has become increasingly important not only in adults but also in children. Factors such as residence in a country with low social and economic standards and the presence of HP-positive family members underscore the widely-acknowledged fact that the incidence of HP infection tends to increase with age both in children (where the increase is roughly 1% per year) and in adults, where it reaches values of 50% in the industrialized nations and 80% in developing countries. This has led to research aimed at developing more accurate and less invasive diagnostic techniques that can be used in children as well. Also, the development of simple, cost-effective diagnosis is all the more important given the widespread occurrence of HP infection, particularly in the developing countries. The techniques employed range from the classical histological and culture examination, which involves esophagogastroduodenoscopy (a rather invasive technique), to serology and the Urea Breath Test with 13C. Also, the feasibility of tracing HP antigens in the faeces, a non-invasive and simple technique, is under investigation. As for therapy, there is as yet no unanimous agreement about when to start treatment, about which antibiotics (beta-lactams, macrolides and nitro-imidazoles) to use in association, about their effect on the gastric mucosa, nor, indeed, about the treatment routines to be followed in adults and children.

[Intestinal flora in children with celiac disease]. / La flora intestinale nel bambino celiaco.

The variations of duodeno-jejunal bacterial flora are evaluated. 26 celiac children aged 2 to 7 years were divided in three groups. First group: 8 children in active phase of disease on a free diet; Second group: 10 children kept since one year on a gluten-free diet; Third group: 8 children challenged with gluten for some months. As the same time of the jejunal biopsy, a sample of duodenal juice was obtained for bacteriological examination; for this purpose were used the following culture media: Fluid thioglycollate medium (FTM), Blood-agar, Bile Esculin Azide Agar (BEAA), SF, selective for enterococcus, and MacConkey Agar. The results are: The number of bacterias in the first and third group is significantly higher (p less than 0.001 and p less than 0.05 respectively) than the second group with normal intestinal mucosa. Particular variations in bacteriological species in the three groups are not demonstrated. The excessive growth of bacterias in active phase of celiac disease could worse the absorption of lipids, vitamins, iron, and others substances and it could facilitate the local inflammatory processes in the small intestine.