101
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Lucca F, Tenero L, Volpi S, Piazza M, Borruso A, Menin L, Sandri M, Cipolli M, Piacentini G. WS04.2 Electronic nose (E-nose) analysis of systemic volatile organic compounds (VOCs) pattern distinguishes paediatric patients with cystic fibrosis (CF) from healthy controls (HC) and depicts disease status. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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102
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Cavarzere P, Gaudino R, Sandri M, Ramaroli DA, Pietrobelli A, Zaffanello M, Guzzo A, Salvagno GL, Piacentini G, Antoniazzi F. Growth hormone retesting during puberty: a cohort study. Eur J Endocrinol 2020; 182:559-567. [PMID: 32337961 DOI: 10.1530/eje-19-0646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To report the frequency and characteristics of growth hormone (GH) deficiency (GHD) in adolescents who had normalized GH secretion at mid-puberty and to identify possible factors predictive for GH sufficiency at puberty. DESIGN Clinical analysis of children affected by GHD at five time points: diagnosis; first year of therapy; intermediate stage of puberty; retesting and end of growth phase. METHODS The study population was 80 children with idiopathic GHD and treated with GH for at least 2 years. Treatment was discontinued at the intermediate stage of puberty. Retesting with an arginine test was performed 12 weeks later. If GH peak at retesting was ≥8 μg/L, the therapy was definitively discontinued, otherwise it was restarted and continued until achievement of near-final height. RESULTS GH therapy was discontinued in 44 children (55%), and restarted in 36 (45%). No evidence of differences in definitive height and in the delta height between the genetic target and the definitive height was found between the two groups. The only predictive factor for GHD at mid-puberty was the insulin growth factor-1 (IGF-1) level at 1 year of GH treatment. CONCLUSIONS GH secretion should be retested at mid-puberty. Retesting at puberty may reduce potential side effects and minimize costs, without impairing growth potential and final height.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Rossella Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Diego Alberto Ramaroli
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
- Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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103
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Bodini A, Pecoraro L, Catalano F, Aricò MO, Tenero L, Piazza M, Piacentini G. Can inhaled foreign body mimic asthma in an adolescent? Pan Afr Med J 2020; 36:38. [PMID: 32774614 PMCID: PMC7388604 DOI: 10.11604/pamj.2020.36.38.20037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022] Open
Abstract
A 14 year old male was diagnosed with asthma but didn't improve with appropriate inhalation therapy. Rigid bronchoscopy revealed a food fragment, almost completely occluding the lower-left bronchus lumen. Based on the reported history, it had been likely there for several years.
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Affiliation(s)
- Alessandro Bodini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | | | - Melodie Olivia Aricò
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
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104
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Bignamini E, Cazzato S, Cutrera R, Ferrante G, La Grutta S, Licari A, Lombardi E, Midulla F, Piacentini G, Pifferi M, Santamaria F, Tancredi G, Turchetta A. Italian pediatric respiratory society recommendations on pediatric pulmonary function testing during COVID-19 pandemic. Ital J Pediatr 2020; 46:68. [PMID: 32448282 PMCID: PMC7245622 DOI: 10.1186/s13052-020-00829-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background Effective prevention and control strategies are mandatory to prevent SARS-CoV-2 infection. Main text The Italian Pediatric Respiratory Society promotes a series of new recommendations that should be followed in pulmonary function testing laboratories during the COVID-19 pandemic. Conclusion Pulmonary function testing should be performed in children with chronic lung disease only if it is needed to guide management and limited to the necessary tests, namely spirometry. When performed, strict infection control measures should be followed due to the potential risk of transmitting SARS-CoV-2.
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Affiliation(s)
- Elisabetta Bignamini
- Pediatric Pulmonology, Cystic Fibrosis Centre, AOU Città della Salute e della Scienza, Torino, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Renato Cutrera
- Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giuliana Ferrante
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Fabio Midulla
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II, Naples, Italy
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Abstract
INTRODUCTION The availability of high-quality studies on the association between sleep-disordered breathing in children and delayed growth associated with the hormonal profile recorded before surgery and at follow-up is limited. EVIDENCE ACQUISITION Medline PubMed, Scopus and WebOfScience databases were searched for relevant publications published between January 2008 to January 2020 and a total of 261 potentially eligible studies were identified. EVIDENCE SYNTHESIS Following review 19 papers were eligible for inclusion: seven reported a significant postsurgical increase in growth regardless of initial weight status, type of surgery, type of study design, and length of follow-up period. The only high-quality study was a randomized controlled trial that found an increased risk of obstructive sleep apnea syndrome relapse in overweight children. Twelve studies reported the significant increase in growth parameters showing that IGF-1, IGFBP-3, and ghrelin may boost growth after surgery. CONCLUSIONS The current systematic review demonstrates a scarcity of high-quality studies on growth delay in children with sleep-disordered breathing. Significant catch-up growth after surgery in the short term and changes in IGF-1, IGFBP-3, ghrelin, and leptin levels has been reported in most published studies.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute for Research and Biomedical Innovation, Palermo, Italy
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106
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Gaudino R, Pecoraro L, Martini L, Salvottini C, Antoniazzi F, Piacentini G, Cavarzere P. 21-hydroxylase-deficient congenital adrenal hyperplasia classic form therapy knowledge and management: targeted educational intervention for pediatricians. Minerva Pediatr (Torino) 2020; 73:285-287. [PMID: 32241101 DOI: 10.23736/s2724-5276.20.05594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rossella Gaudino
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Luca Pecoraro
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Lucia Martini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Chiara Salvottini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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107
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Gaudino R, Pecoraro L, Martini L, Salvottini C, Antoniazzi F, Piacentini G, Cavarzere P. 21-hydroxylase-deficient congenital adrenal hyperplasia classic form therapy knowledge and management: targeted educational intervention for pediatricians. Minerva Pediatr (Torino) 2020. [PMID: 32241101 DOI: 10.23736/s0026-4946.20.05594-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rossella Gaudino
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Luca Pecoraro
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Lucia Martini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Chiara Salvottini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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108
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Alving K, Diamant Z, Lucas S, Magnussen H, Pavord ID, Piacentini G, Price D, Roche N, Sastre J, Thomas M, Usmani O, Bjermer L. Point-of-care biomarkers in asthma management: Time to move forward. Allergy 2020; 75:995-997. [PMID: 31505025 DOI: 10.1111/all.14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kjell Alving
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology Lund University Lund Sweden
- Department of Respiratory Medicine First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Sarah Lucas
- Respiratory Effectiveness Group Cambridgeshire UK
| | - Helgo Magnussen
- Pulmonary Research Institute at Lung Clinic Grosshansdorf Airway Research Center North German Center for Lung Research Grosshansdorf Germany
| | - Ian D. Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre Nuffield Department of Medicine University of Oxford Oxford UK
| | - Giorgio Piacentini
- Paediatric Section Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona Verona Italy
| | - David Price
- Centre for Academic Primary Care The Institute of Applied Health Sciences University of Aberdeen Aberdeen UK
- Observational and Pragmatic Research Institute Singapore Singapore
| | - Nicolas Roche
- Service de Pneumologie Hôpital Cochin University Paris Descartes Paris France
| | | | - Mike Thomas
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Omar Usmani
- Airway Disease Section National Heart and Lung Institute Imperial College London & Royal Brompton Hospital London UK
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology Lund University Lund Sweden
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109
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Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
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110
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Abstract
Asthmatic children usually reach good control of symptoms with a low-medium dose of inhaled corticosteroids (ICS), but approximately 5% has severe asthma. In this group of patients, when the diagnosis of severe asthma is confirmed, biologic agents have to be considered when there is no control of the symptoms despite conventional treatment with controllers according to guidelines. At present, the only biologic agent available in clinical practice for severe asthma treatment in children (6-18 years) is omalizumab. Mepolizumab has been recently approved by EMA for pediatric use. Reslizumab is a monoclonal antibody anti-IL-5 that has been approved for severe eosinophilic asthma treatment only in patients >12 years. Because of their action on specific molecular targets of the asthma pathophysiology, biologic agents are very promising therapeutic options for severe asthmatic patients based on individual endotypes.
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Affiliation(s)
- Laura Tenero
- Paediatric section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Sara Rossignoli
- Paediatric section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Paediatric section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
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111
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Parissone F, Pucci M, Meneghelli E, Zuffardi O, Di Paola R, Zaffagnini S, Franchi M, Santangelo E, Cantalupo G, Cavarzere P, Antoniazzi F, Piacentini G, Gaudino R. A novel de novo partial xq duplication in a girl with short stature, nonverbal learning disability and diminished ovarian reserve - effect of growth hormone treatment and fertility preservation strategies: a case report and up-to-date review. Int J Pediatr Endocrinol 2020; 2020:1. [PMID: 31938033 PMCID: PMC6953468 DOI: 10.1186/s13633-019-0071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/28/2019] [Indexed: 01/15/2023]
Abstract
Background Xq duplication is a rare condition with a very variable phenotype, which could mimic other genetic syndromes involving the long arm of chromosome X. Sometimes short stature and diminished ovarian reserve (DOR) may be present. Treatments with rGH (Recombinant growth Hormon) or with fertility preservation strategies have not been previously described. Case presentation We present the case of a female with a novel de novo Xq partial duplication (karyotype: 46,Xder(X)(qter→q21.31::pter→qter) confirmed by array-CGH analysis. She presented with short stature, Nonverbal Learning Disability, developmental delay during childhood, severe scoliosis, spontaneous onset of menarche and irregular menstrual cycles. AMH (Anti-Müllerian Hormone) allowed detection of a preserved but severely diminished ovarian reserve with a POI (Premature Ovarian insufficiency) onset risk. She was effectively subjected to fertility preservation strategies and rGH therapy. We also reviewed other published cases with Xq duplication, reporting the main clinics characteristics and any adopted treatment. Conclusions rGH treatment and cryopreservation in a multidisciplinary approach are good therapeutic strategies for Xq duplication syndrome with short stature and premature ovarian failure.
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Affiliation(s)
- Francesca Parissone
- 1Department of Obstetrics and Gynaecology, AOUI Verona, Verona, Italy.,4Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Mairi Pucci
- 2Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry section, University of Verona, P.le L. A Scuro, 10, 37134 Verona, Italy
| | - Emanuela Meneghelli
- 2Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry section, University of Verona, P.le L. A Scuro, 10, 37134 Verona, Italy
| | - Orsetta Zuffardi
- 3Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Rossana Di Paola
- 1Department of Obstetrics and Gynaecology, AOUI Verona, Verona, Italy
| | | | - Massimo Franchi
- 4Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Elisabetta Santangelo
- 5Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- 5Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- 6Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Paediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- 6Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Paediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- 6Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Paediatrics, University of Verona, Verona, Italy
| | - Rossella Gaudino
- 6Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Division of Paediatrics, University of Verona, Verona, Italy
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112
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Zaffanello M, Lippi G, Arman N, Piazza M, Tenero L, Piacentini G. Popularity of sleep disordered breathing in childhood: an analysis of worldwide search using Google Trends. Transl Pediatr 2019; 8:383-390. [PMID: 31993351 PMCID: PMC6970122 DOI: 10.21037/tp.2019.03.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a general term encompassing a variety of breathing problems occurring during the sleep and characterized by frequently reported signs such as sleep apneas and snoring. Published studies on this topic are increasing over time, as demonstrated by the number of papers available on on-line databases. METHODS Google Trends is a freely accessible and reliable online portal, which allows to explore internet search data. Due to the focus on of childhood SDB in published research, and because of its impact on health and wellbeing, this original study aims at investigating the worldwide popularity of most common sleep signs (apnea and snoring) from January 1st, 2004 to present time. RESULTS The trend of interest for 'sleep', 'sleep apneas' and 'snoring' limited to pediatric age was lower than its overall popularity in the general population, thus reflecting a lower interest of these symptoms in children than in adults. Unlike an increasing trend of ongoing research, the popularity of pediatric sleep apnea and snoring was found to be relatively low around the world, and remained fairly stable over time. CONCLUSIONS This is a matter for concern, since the low popularity of SDB in children is counterbalanced by a need for reinforcing educational programs aimed at increasing widespread awareness, diagnosis and management of this condition.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | | | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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113
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Pieropan S, Antoniazzi F, Tadiotto E, Caldonazzi F, Maschio M, Aiello G, Melotti G, Cavarzere P, Piacentini G. Bone Marrow Foot Oedema in Adolescents: The Role of Vitamin D. J Bone Metab 2019; 26:241-246. [PMID: 31832389 PMCID: PMC6901693 DOI: 10.11005/jbm.2019.26.4.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/11/2022] Open
Abstract
Background Bone marrow oedema (BMO) in children/adolescents is a rare clinical condition without an etiologic cause. It is associated with typical increased signal intensity on T2-weighted magnetic resonance images (MRI) and an increase in bone turnover in which vitamin D plays a pivotal role. No treatment guidelines for these young patients are to date available. Methods We performed a retrospective study in a pediatric setting of 13 patients with diagnosis of primary BMO of the foot on the basis of clinical and radiological findings. Data collection included sex, age, patient history, symptoms at presentation, clinical examination, laboratory bone turnover markers, vitamin D levels, MRI, treatment, and outcome. Results Vitamin D deficiency or insufficiency was found in 76.9% of cases. All patients were treated with adequate vitamin D daily intake, a short course of analgesic therapy, physical therapy, avoiding detrimental feet and ankle immobilization. All fully recovered in 3-month lag period. Conclusions Our data highlight that environmental factors, such as underestimated articular or bone microtraumatisms, as well as joint hyper mobility, in a bone turnover milieu of vitamin D deficiency could be the cause of this clinical conditions. Adequate vitamin D supplementation, associated with physical and analgesic therapy, is crucial in the management of BMO.
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Affiliation(s)
- Sara Pieropan
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Franco Antoniazzi
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Elisa Tadiotto
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | | | - Maddalena Maschio
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Giulia Aiello
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Giulia Melotti
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Paolo Cavarzere
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona Italy
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114
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Pecoraro L, Trotolo A, Piacentini G, Pietrobelli A. Sweet at birth, bitter in growth. Int J Food Sci Nutr 2019; 71:133-137. [PMID: 31335227 DOI: 10.1080/09637486.2019.1642859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Complementary feeding plays a primary role in the life of an infant, as long as the correct assumption of nutrients in terms of timing and quality is the key to a healthy growth. Since infants are totally dependent on their parents during complementary feeding, educational programmes and intervention plans are needed to educate parents and caregivers. As to this, children's sugar consumption throughout their life has been specifically investigated and several critical points have been detected, demonstrating how sugar intake should not be higher than necessary in children and should not include sweetened beverages in daily nutrition. The association between children's diet and the subsequent consequences in their later life has been extensively studied, pointing out how countries should invest in policies that aim at decreasing sugar intake and encouraging parents, as well as children, to a healthier behaviour. The aim of this article is to look at the problem from three different perspectives, the parents' one, the scientific one, and the paediatrician one, in order to offer a new insight on the future of complementary feeding.
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Affiliation(s)
- Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Alessandro Trotolo
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy.,Pennington Biomedical Research Center, Baton Rouge, LA, USA
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115
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Gaudino R, Maines E, Guizzardi F, Vezzoli V, Krausz C, Cavarzere P, Piacentini G, Antoniazzi F, Bonomi M. 45,X/46,X,i(Yp): Importance of Assessment and Support during Puberty and Adolescence. Sex Dev 2019; 13:118-124. [PMID: 31266049 DOI: 10.1159/000501377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 01/16/2023] Open
Abstract
The Y-chromosome genes are primarily involved in sex determination, stature control, spermatogenesis, and fertility. Among structural rearrangements of the Y chromosome, the isochromosome of Yp, i(Yp), appears to be the most uncommon. We describe a detailed evolution of puberty in a boy with 45,X/46,X,i(Yp). Array CGH found 2 cell lines, one with i(Yp) and the other with monosomy X. Genetic analysis of currently known genes involved in Kallmann syndrome/normosomic central hypogonadotropic hypogonadism showed no abnormality. The patient presented with a pubertal course suggestive of a delayed puberty with gynecomastia, reduced growth rate, and infertility that need testosterone treatment to induce the appearance of the secondary sex characteristics. This patient shows the potential effects of i(Yp) and emphasizes the importance of appropriate management of puberty in people with 45,X/46,X,i(Yp). Early hormone treatment, concerns regarding fertility, emotional support, and a successful transition to adult care may help improve the physical and psychosocial well-being of affected patients.
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116
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Nosetti L, Piacentini G, Macchi A, De Bernardi F, Simoncini D, Nicoloso M, Agosti M, Zaffanello M. Nasal cytology in children with primary snoring and obstructive sleep apnoea syndrome. Int J Pediatr Otorhinolaryngol 2019; 122:133-137. [PMID: 31022683 DOI: 10.1016/j.ijporl.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Rhinitis is an acute or chronic inflammatory condition due to several causes (i.e. infections, allergens). There are controversial results that point out the role of nasal inflammation in primary snoring and obstructive sleep apnoea syndrome (OSAS). METHODS The aim of the present investigation is to study the nasal cytology in 58 children aged from 1 to 15 affected by sleep disordered breathing. RESULTS Inflammation of the nasal mucous was found in 88% of children. The most frequent problems were infectious rhinitis (36%), followed by non-allergic rhinitis (28%) and allergic rhinitis (21%). Infectious rhinitis was found in 31% of children with primary snoring and 41% with OSAS. Allergic rhinitis was found in 35% of children with primary snoring, and 6% with OSAS. Non-allergic rhinitis was found in 19% of children with primary snoring, and 34% with OSAS. Bacteria was found in 59% of children with OSAS and 46% in children with primary snoring. CONCLUSION the most prevalent forms of rhinitis in primary snoring were the allergic rhinitis, and in OSAS group were the non-allergic rhinitis. Bacteria were equally distributed in primary snoring and OSAS children. The nasal cytology provided interesting information that can be used to plan possible treatment strategies.
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Affiliation(s)
- Luana Nosetti
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Alberto Macchi
- Department of Otolaryngology, University of Insubria and ASST Laghi, Ospedale di Circolo, Varese, Italy.
| | - Francesca De Bernardi
- Department of Otolaryngology, University of Insubria and ASST Laghi, Ospedale di Circolo, Varese, Italy.
| | - Daniela Simoncini
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Martina Nicoloso
- Division of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | - Massimo Agosti
- Division of Neonatology and Neonatal Intensive Care Unit, "F. Del Ponte" Hospital, Varese, Italy.
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
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117
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Cinquetti M, Colombari AM, Battisti E, Marchetti P, Piacentini G. The influence of type of delivery, skin-to-skin contact and maternal nationality on breastfeeding rates at hospital discharge in a baby-friendly hospital in Italy. Pediatr Med Chir 2019; 41. [PMID: 31114098 DOI: 10.4081/pmc.2019.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
The aim of this epidemiological study is to evaluate how type of delivery, skin-to-skin contact and maternal nationality influence breastfeeding practices of newborns at discharge in a large population of babies born in the Baby-Friendly Hospital of San Bonifacio, Verona, Italy. Data were collected for all healthy newborns consecutively born over a period of three years, regarding type of delivery, feeding at hospital discharge, skin-to-skin procedure, and for a smaller group maternal nationality was recorded as well. The rate of exclusive breastfeeding in a group of 6017 newborns was 82.1%, higher among babies born by vaginal delivery than in those born by cesarean section (84.9% vs 65%; P<0.001). It was higher in those who had skin-to-skin contact than in those who did not, in both vaginal delivery (85.3% vs 69.2%; P<0.001) and cesarean section (67.7% vs 55.1%; P=0.009). Also, it was found to be higher in babies born to immigrant mothers than in those born to Italian mothers (89.9% vs 79.5%). Vaginal delivery, skin-to-skin contact and maternal foreign nationality have a positive association with breastfeeding at hospital discharge.
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Affiliation(s)
- Mauro Cinquetti
- Maternal-Infant Department, Girolamo Fracastoro Baby-Friendly Hospital, San Bonifacio (VR).
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118
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Abstract
The latest guidelines of the American Academy of Dermatology suggest bathing as an advantageous nonpharmacologic intervention for regular skin care of patients with atopic dermatitis. Regular bathing with water can hydrate the skin, remove scale, crust, irritants, and allergens, enhance penetration of topical agents, and potentially reduce bacterial colonization. However, it is still unclear whether the addition of oils, emollients, and other additives to bath water may produce further benefits for the management of atopic dermatitis. This article will review current pearls and pitfalls of adding salts and nonirritating, nonsensitizing substances to water baths for the long-term maintenance treatment of atopic dermatitis in children.
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Affiliation(s)
- Pasquale Comberiati
- From the Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Roberta Pigozzi
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Diego Peroni
- From the Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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119
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Pecoraro L, Comberiati P, Bodini A, Chinello M, Tenero L, Piacentini G. When cough drives you nuts. Minerva Pediatr 2019; 72:137-139. [PMID: 30916517 DOI: 10.23736/s0026-4946.19.05418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Pasquale Comberiati
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Alessandro Bodini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Matteo Chinello
- Unit of Pediatric Hematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Laura Tenero
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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120
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Cappuccio A, Bugliaro F, Caimmi SME, Caldarelli V, Caminiti L, D'Auria E, di Palmo E, Duse M, Fiocchi AG, Gesualdo F, Kantar A, Lombardi E, Lucania A, Marchiani M, Marini MG, Marseglia G, Montera MC, Novembre EM, Pellegrini G, Piacentini G, Policreti A, Santamaria F. Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma. Ital J Pediatr 2019; 45:31. [PMID: 30832703 PMCID: PMC6399976 DOI: 10.1186/s13052-019-0623-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON’ T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma.
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Affiliation(s)
| | | | | | | | - Valeria Caldarelli
- Pediatric Clinic, Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy
| | - Lucia Caminiti
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Emanuela di Palmo
- Pediatric Clinic, Ospedale S. Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Marzia Duse
- Department of Pediatrics and child Neuropsychiatry, University Sapienza, Rome, Italy
| | | | | | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi University and Research Hospitals, Ponte San Pietro-Bergamo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University Hospital, Florence, Italy
| | - Anna Lucania
- Pediatria ospedale dei bambini arnas civico, Palermo, Italy
| | | | - Maria Giulia Marini
- Healthcare Area, ISTUD Foundation, Via Vittor Pisani 28, 20128, Milan, Italy
| | - Gianluigi Marseglia
- Pediatric Clinic of the University of Pavia - IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Carmela Montera
- Department. of Medicine, Unit of Allergology and Clinic Immunology, AOU S.Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Guido Pellegrini
- U.O. of Pediatric and Neonatology, Hospital City of Sesto San Giovanni (MI), ASST Nord Milano, Milan, Italy
| | | | | | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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121
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Tadiotto E, Clemente M, Pecoraro L, Piacentini G, Degani D, Pietrobelli A. Massive thymic hyperplasia in a 15-month-old boy: Case report and literature review. Clin Case Rep 2019; 7:27-31. [PMID: 30656002 PMCID: PMC6333069 DOI: 10.1002/ccr3.1896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
A surgical approach is the choice in young infants with MTH, who are furthest from the time of physiological involution of the thymus, and when the thymus achieves the largest relative size, a surgical approach is the choice. Steroid therapy has been shown to be ineffective (4, 9, 16, 18-20). No surgical complications have been reported, and the outcome is excellent. Recurrence has been seen in only one case.
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Affiliation(s)
- Elisa Tadiotto
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Maria Clemente
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Luca Pecoraro
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Giorgio Piacentini
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Daniela Degani
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Angelo Pietrobelli
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
- Pennington Biomedical Research CenterBaton RougeLouisiana
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122
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Affiliation(s)
- Andrew Bush
- Professor of Paediatrics and Head of Section (Paediatrics), Imperial College London, London, United Kingdom.,Professor of Paediatric Respirology, National Heart and Lung Institute, London, United Kingdom.,Consultant Paediatric Chest Physician, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giorgio Piacentini
- Professor of Paediatrics and Head of Paediatric Section AOUI Verona, University of Verona, Verona, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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123
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Abstract
Vitamin C is an organic compound that is almost ubiquitous in the daily diet of individuals. There are clear indications of supplementation when secondary deficiency is detected related with reduced dietary intake or reduced absorption. On the other hand, indications for supplementation concerning an increased need are controversial. Several authors have studied the role of vitamin C as an adjuvant in the treatment of diseases that may affect children and adolescents. These diseases affect all organs and systems: specifically, vitamin C supplementation could play a role in respiratory, neurological, psychiatric, oncohematological, nephrological, ophthalmological and nutritional disorders. In paediatric age, a significant benefit of vitamin C supplementation has been observed in depressive pathology, iron-deficiency anaemia and chronic renal failure related to haemodialysis. No evidence was found with vitamin C supplementation on mortality, cognitive performance, quality of life, eye diseases, infections, cardiovascular diseases and tumours. This evidence may be related to the fact that in developed countries, vitamin C is almost ubiquitous in the daily diet of each individual. In conclusion, studies on non-industrialised populations in which there could be a real benefit from such supplementation, have yet to be conducted.
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Affiliation(s)
- Luca Pecoraro
- a Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics , University of Verona , Verona , Italy
| | - Lucia Martini
- a Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics , University of Verona , Verona , Italy
| | - Franco Antoniazzi
- a Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics , University of Verona , Verona , Italy
| | - Giorgio Piacentini
- a Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics , University of Verona , Verona , Italy
| | - Angelo Pietrobelli
- a Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics , University of Verona , Verona , Italy.,b Pennington Biomedical Research Center , Baton Rouge , LA , USA
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124
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Zaffanello M, Antoniazzi F, Tenero L, Nosetti L, Piazza M, Piacentini G. Sleep-disordered breathing in paediatric setting: existing and upcoming of the genetic disorders. Ann Transl Med 2018; 6:343. [PMID: 30306082 PMCID: PMC6174189 DOI: 10.21037/atm.2018.07.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022]
Abstract
Childhood obstructive sleep apnea syndrome (OSAS) is characterized by anatomical and functional upper airway abnormalities as pathophysiological determinants, and clinical symptoms are frequently clear. OSAS is widely described in rare genetic disorders, such as achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, and mucopolysaccharidosis. Craniofacial and upper airway involvement is frequently morbid conditions. In children with genetic diseases, the clinical symptoms of OSAS are often slight or absent, and related morbidities are usually more severe and can be observed at any age. The present review is aimed to updating the discoveries regarding OSAS on Achondroplasia, Down syndrome, Prader-Willi syndrome, Pierre Robin sequence, Sickle cell disease, or encountered in our clinical practice (Ehlers-Danlos syndrome, Ellis-van Creveld syndrome, Noonan syndrome). Two additional groups of genetic disorders will be focused (mucopolysaccharidoses and osteogenesis imperfecta). The flowing items are covered for each disease: (I) what is the pathophysiology of OSAS? (II) What is the incidence/prevalence of OSAS? (III) What result from the management and prognosis? (IV) What are the recommendations? Considering the worries of OSAS, such as inattention and behavioural problems, daytime sleepiness, failure to thrive, cardiological and metabolic complications, the benefit of a widespread screening and the treatment in children with genetic diseases is undoubtful. The goals of the further efforts can be the inclusion of various genetic diseases into guidelines for the screening of OSAS, updating the shreds of evidence based on the research progression.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Pecoraro L, Clemente M, Tadiotto E, Piacentini G, Pietrobelli A, Degani D. Inflammatory myofibroblastic lung tumor: its birth, its bleeding growth, its difficult diagnosis and its surgical end in a child. Clin Case Rep 2018; 6:1445-1447. [PMID: 30147879 PMCID: PMC6099031 DOI: 10.1002/ccr3.1597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023] Open
Abstract
The diagnosis of inflammatory myofibroblastic tumor is based on radiology and histology. The treatment is surgical, and the prognosis is good. For this reason, although this lung disease is rare, when a child show up at hospital with an unknown hemoptysis, this medical condition should not be underestimated.
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Affiliation(s)
- Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Maria Clemente
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Elisa Tadiotto
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Daniela Degani
- Department of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
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126
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Pecoraro L, Florile M, Piazza M, Comberiati P, Clemente M, Tadiotto E, Pietrobelli A, Piacentini G. Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age. Minerva Pediatr (Torino) 2018. [PMID: 29968448 DOI: 10.23736/s0026-4946.18.05064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.
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Affiliation(s)
- Luca Pecoraro
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Marta Florile
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Michele Piazza
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Pasquale Comberiati
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Maria Clemente
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elisa Tadiotto
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Pecoraro L, Florile M, Piazza M, Comberiati P, Clemente M, Tadiotto E, Pietrobelli A, Piacentini G. Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age. Minerva Pediatr (Torino) 2018; 73:294-300. [PMID: 29968448 DOI: 10.23736/s2724-5276.18.05064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.
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Affiliation(s)
- Luca Pecoraro
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Marta Florile
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Michele Piazza
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Pasquale Comberiati
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Maria Clemente
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elisa Tadiotto
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Zaffanello M, Lippi G, Tenero L, Piazza M, Sacchetto L, Nosetti L, Gasperi E, Piacentini G. Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality? ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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129
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Canestrari F, Dachà U, Giacchi R, Magnani M, Stocchi V, Palma F, Piacentini G, Dachà M. Relationship between Erythrocyte Hexokinase in Cancer Patients and Red Cell Age. Tumori 2018; 69:89-93. [PMID: 6679438 DOI: 10.1177/030089168306900202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A study of hexokinase isozymic pattern and age dependence of the enzyme was carried out on erythrocytes of 4 patients with adenocarcinoma of the gastrointestinal tract. On the basis of our results, we think that the increase in hexokinase activity previously reported and the increase in both subtypes (Ia and Ib) of the enzyme herein described are not due to a mean younger red cell population caused by secondary anemia, which is frequently present in cancer patients.
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130
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Kulkarni N, Kantar A, Costella S, Ragazzo V, Piacentini G, Boner A, O'Callaghan C. Macrophage Phagocytosis and Allergen Avoidance in Children With Asthma. Front Pediatr 2018; 6:206. [PMID: 30116724 PMCID: PMC6082964 DOI: 10.3389/fped.2018.00206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/02/2018] [Indexed: 01/07/2023] Open
Abstract
Background and Objective: Airway macrophages perform the crucial functions of presenting antigens, clearing pathogens, and apoptotic cells. Macrophage phagocytosis is increased in adults with mild asthma and allergen exposure is known to activate macrophages. However, it is not clear whether the mechanism behind this is due to a primary defect or environmental factors such as allergen or lipopolysaccaride (LPS) exposure. Our aim was to assess the phagocytic function of airway macrophages in children with mild to moderate asthma after residence in a low allergen\LPS environment at high altitude. Methods: Sputum induction was performed in children with asthma at baseline and after residence for a 3 weeks' period at a high-altitude asthma center that has very low ambient allergen levels. The markers of eosinophilic inflammation (including percentage of macrophage cytoplasm with red hue) and phagocytosis of fluorescein isothiocyanate-labeled, heat-killed Staphylococcus aureus by airway macrophages was analyzed. Internalized bacteria were quantified using confocal microscopy. Results: The median bacterial count [mean (standard deviation)] per macrophage was significantly lower [39.55 (4.51) vs. 73.26 (39.42) (p = 0.006)] after residence at high altitude. No association was observed between markers of eosinophilic inflammation and bacterial phagocytosis. Conclusions: The results suggest that the mechanism behind the enhanced phagocytosis of bacteria in childhood asthma may be secondary to allergen or possibly LPS exposure.
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Affiliation(s)
- Neeta Kulkarni
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - Ahmad Kantar
- Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Silvia Costella
- High Altitude Paediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Vincenzo Ragazzo
- Department of Pediatrics, Versilia Hospital, Lido di Camaiore, Italy
| | - Giorgio Piacentini
- Pediatrics Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Attilio Boner
- Pediatrics Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Christopher O'Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Children's Hospital, London, United Kingdom
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131
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Zaffanello M, Piacentini G, Sacchetto L, Pietrobelli A, Gasperi E, Barillari M, Cardobi N, Nosetti L, Ramaroli D, Antoniazzi F. Sleep-Disordered Breathing in Children with Rare Skeletal Disorders: A Survey of Clinical Records. Med Princ Pract 2018; 27:451-458. [PMID: 29929197 PMCID: PMC6244108 DOI: 10.1159/000491391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Craniofacial disharmony in skeletal diseases is strongly associated with sleep-disordered breathing. This study was aimed at studying the sleep respiratory patterns in young children with rare skeletal disorders. DESIGN This retrospective study included children with achondroplasia (ACH), osteogenesis imperfecta (OI) and Ellis van Creveld Syndrome. Our subjects underwent an in-laboratory overnight respiratory polygraph between January 2012 and April 2016. All medical records were reviewed and brain Magnetic Resonance Imaging was conducted on patients with ACH, nasopharynx, oropharynx and laryngopharynx spaces. PATIENTS Twenty-four children were enrolled, 13 with ACH, 2 with spondyloepiphyseal dysplasia, 1 with odontochondrodysplasia, 6 with OI and 2 with Ellis van Creveld Syndrome. RESULTS Children with ACH, who had adenotonsillectomy, showed fewer sleep respiratory involvement than untreated children. Among 13 patients with ACH, brain magnetic resonance imaging was available in 10 subjects and significant negative correlation was found between sleep respiratory patterns, nasopharynx and oropharynx space (p < 0.05). In 2 patients with spondyloepiphyseal dysplasia, mild-to-moderate sleep respiratory involvement was found. Both subjects had a history of adenotonsillectomy. Mild sleep respiratory involvement was also observed in 4 out of 6 patients with OI. One patient with Ellis van Creveld syndrome had mild sleep respiratory disturbance. CONCLUSIONS Sleep respiratory disturbances were detected in children with ACH, and with less severity also in OI and Ellis van Creveld syndrome. Adenotonsillectomy was successful in ACH in reducing symptoms. In light of our findings, multicenter studies are needed to obtain further information on these rare skeletal diseases.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- *Marco Zaffanello, MD, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division University of Verona, Piazzale Stefani, 1, Woman & Child Hospital, Building 29, IT-37126 Verona (Italy), E-Mail
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Barillari
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Nicolò Cardobi
- Department of Morphological and Biomedical Sciences, Institute of Radiology, University Hospital of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Diego Ramaroli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Abstract
Asthma is the most common chronic respiratory disease in children characterized by airways inflammation, bronchial hyperresponsiveness, recurrent reversible airways obstruction, and respiratory symptoms. The diagnosis of the disease is based on clinical history, airways obstruction at spirometry, and bronchial reversibility. Asthma treatment is aimed to disease control, through the use of controller treatment and monitoring lung function. However, lung function and symptoms not always reflect the underlying airways inflammation and response to the therapy. Objective parameters of asthma inflammation could be important for the clinician in the management of patients with asthma. In the last years, some studies were focused on biomarkers to identify phenotype, inflammation, and pathobiological pathways to help the clinician in the diagnosis and in personalizing the management. Accordingly, clinically feasible tests are represented by the collection of exhaled breath condensate (EBC) and measurement of exhaled nitric oxide (FeNO). Other-methods such as the evaluation of volatile organic compound (VOCs), that reflect airways inflammation and treatment efficacy, are currently used for research purposes For some of these methods, The lack of standardization in pre-collection, collection, post-collection of samples, and interpretation of the results may a problem in clinical practice. Improved these limitations, several biomarkers will be useful to distinguish patients with a different disease condition to personalize the treatment.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Zaffanello M, Piacentini G, Pietrobelli A, Fava C, Lippi G, Maffeis C, Gasperi E, Nosetti L, Bonafini S, Tagetti A, Antoniazzi F. Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems. World J Pediatr 2017; 13:577-583. [PMID: 28702869 DOI: 10.1007/s12519-017-0054-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy. This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children. METHODS We carried out a prospective respiratory sleep study between 2013 and 2015. Nails obstruction, tonsils enlargement and palate position were subjectively measured. Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed. The polygraph study was performed using a portable ambulatory device. RESULTS Forty-four obese children were consecutively recruited into this study. Mild sleep respiratory disturbance was showed in 31.8 % of patients; 18.2% previously had an adeno (tonsillectomy). In 50% of these obese children, both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results. ADHD rating scale for parents scores were positive in 9.1% of patients. CONCLUSIONS We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents. The respiratory disturbance was not totally cured by surgery. Finally, otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Department of Neuroscience, Biomedicine and Movement, Chemistry and Clinical Microscopy Section, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Sara Bonafini
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Angela Tagetti
- Department of Medicine, Section of General Medicine and Hypertension, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Zaffanello M, Gasperi E, Tenero L, Piazza M, Pietrobelli A, Sacchetto L, Antoniazzi F, Piacentini G. Sleep-Disordered Breathing in Children with Recurrent Wheeze/Asthma: A Single Centre Study. Children (Basel) 2017; 4:children4110097. [PMID: 29135910 PMCID: PMC5704131 DOI: 10.3390/children4110097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022]
Abstract
The relationship between asthma and sleep-disordered breathing is bidirectional due to common risk factors that promote airway inflammation. Obstructive sleep-disordered breathing and recurrent wheeze/asthma are conditions that involve the upper and the lower respiratory system, respectively. The aim of the present study was to investigate the sleep disordered breathing in children with recurrent wheeze/asthma. This was a retrospective study concerning children older than 2 years who underwent—between January 2014 and November 2016—an in-laboratory overnight polygraphic study. We match the children between those who do or do not have recurrent wheeze/asthma disease. We examined the clinical records of 137 children. We excluded eight patients because of neurological and genetic conditions. Children with recurrent wheeze/asthma (N = 28) were younger (p = 0.002) and leaner (p = 0.013) compared to non-affected children (N = 98). Children with wheeze/asthma and unaffected ones had a similar obstructive apnea-hypopnea index (p = 0.733) and oxygen desaturation index (p = 0.535). The logistic regression analysis, in which the condition of wheeze/asthma (yes/no) was a dependent variable, while demographic (age, sex, body mass index (BMI) Z-score) and polygraphic results during sleep (obstructive apnea-hypopnea index, central apnea index, peripheral oxygen saturation (SpO2), and snoring) were covariates, showed that children with wheeze/asthma had higher central apnea index (Exp(B) = 2.212; Wald 6.845; p = 0.009). In conclusion, children with recurrent wheeze/asthma showed an increased number of central sleep apneas than unaffected children. This finding may suggest a dysfunction of the breathing control in the central nervous system during sleep. Systemic or central inflammation could be the cause.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Emma Gasperi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Laura Tenero
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Michele Piazza
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Luca Sacchetto
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Otorhinolaryngology Unit, University of Verona, 37134 Verona, Italy.
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Pediatric Division, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
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Bodini A, Tenero L, Sandri M, Maffeis C, Piazza M, Zanoni L, Peroni D, Boner A, Piacentini G. Serum and exhaled breath condensate leptin levels in asthmatic and obesity children: a pilot study. J Breath Res 2017; 11:046005. [PMID: 28952460 DOI: 10.1088/1752-7163/aa61c5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Recent studies have highlighted the possible involvement of leptin in inflammation. The leptin receptor is also expressed by alveolar macrophages, T lymphocytes and bronchial epitelial cells, suggesting a possible role in the cascade of airway inflammation. OBJECTIVES The aim of the study was to evaluate the levels of leptin in exhaled breath condensate (EBC) from asthmatic, normal- and overweight children, in relationship with airway inflammation. METHODS 15 asthmatic non-obese children, 15 healthy non-asthmatic non-obese children, 11 obese children with asthma (OA) and 20 obese children without asthma (ONA) were enrolled. Body impedance of body weight, EBC collection, FeNO, spirometry and a blood sampling for serum leptin were assessed. RESULTS Leptin EBC levels were significantly higher (3.9 ng ml-1 ± 1.3) in overweight children than those obese with asthma (3.6 ng ml-1 ± 1.6; p = 0.97), non-owerweight asthmatics (2.2 ng ml-1 ± 1.2; p < 0.0001) and in healthy children (0.9 ng ml-1 ± 0.6; p < 0.001). Leptin EBC levels in asthmatic children were significantly higher than in healthy children (p = 0.05). Leptin serum levels were significantly higher in the overweight children compared with the asthmatics (12.7 ng ml-1 ± 13.2; p < 0.001) and the healthy group (11.1 ng ml-1 ± 11.2; p < 0.001). We observed a significant correlation between EBC-leptin levels and the serum-leptin levels (p = 0.001). No correlations were found between EBC-leptin levels, FeNO and lung function. CONCLUSIONS This study shows that leptin is measurable in EBC in children and that EBC-leptin levels are significantly higher in the obese subjects and in asthmatic ones compared with healthy subjects. Leptin may therefore represent a non-invasive marker of non-specific airway inflammation in children.
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Affiliation(s)
- A Bodini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
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Tagetti A, Bonafini S, Zaffanello M, Benetti MV, Vedove FD, Gasperi E, Cavarzere P, Gaudino R, Piacentini G, Minuz P, Maffeis C, Antoniazzi F, Fava C. Sleep-disordered breathing is associated with blood pressure and carotid arterial stiffness in obese children. J Hypertens 2017; 35:125-131. [PMID: 27648717 DOI: 10.1097/hjh.0000000000001123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Both sleep-disordered breathing (SDB) and high blood pressure (BP) occur more frequently among obese children than among normal weight children, and this may be due to endothelial dysfunction and worsened arterial stiffness. The aim of this study was to evaluate the possible association between SDB and BP, and the possible role of endothelial function and local and systemic arterial stiffness in a sample of obese children asymptomatic for sleep disturbances. MATERIALS AND METHODS Thirty-nine obese children were included in the study. Children underwent overnight limited channel polysomnography, and the vascular measurements included the following: office and 24-h ambulatory BP; brachial flow-mediated dilatation, carotid intima-media thickness and carotid distensibility measured using ultrasound; and systemic arterial stiffness index measured using digital volume pulse analysis. RESULTS Significant correlations between different BP measurements (both office and ambulatory BP monitoring and estimated by Z score) and SDB were found, including correlations involving the respiratory disturbance index, the apnea-hypopnea index (AHI), the number of desaturations per hour and the mean peripheral saturation (r ranging between 0.330 and 0.474). Carotid distensibility was correlated with the AHI (r = -0.367; P = 0.030) and with the mean oxygen saturation (r = 0.401; P = 0.017). In contrast, there was no relationship among flow-mediated dilatation, stiffness index, carotid intima-media thickness and all the tested respiratory markers. In the multivariate analysis, the supine Z SBP remained independently associated with the number of desaturations per hour and the AHI, even after correction for carotid distensibility and BMI. CONCLUSION Our data suggest that in obese children asymptomatic for sleep respiratory problems, SDB might worsen BP, in part, through an increase in arterial stiffness.
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Affiliation(s)
- Angela Tagetti
- aDepartment of Medicine, Section of General Medicine and Hypertension bDepartment of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division cDepartment of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
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Tenero L, Piacentini G, Nosetti L, Gasperi E, Piazza M, Zaffanello M. Indoor/outdoor not-voluptuary-habit pollution and sleep-disordered breathing in children: a systematic review. Transl Pediatr 2017; 6:104-110. [PMID: 28503417 PMCID: PMC5413472 DOI: 10.21037/tp.2017.03.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Exposure to environmental pollutants is advocated to be a major risk factor, with increased morbidity and mortality in humans due to acute and chronic airway inflammation. The aim of the present review is to show the literature research regarding the link between the sleep-disordered breathing and exposure to indoor/outdoor pollution in children. We hypothesized that environmental air pollution can play a role in childhood sleep-disordered breathing. METHODS We conducted an electronic search in Medline (with PubMed interface), Scopus and the ISI Web of Science using the keywords "sleep" or "sleep apnea" or "sleep disordered breathing" and "pollution" and "children" in "Title/Abstract/Keywords", with language restriction (non-English paper) and no date limitation to present. The tobacco smoke pollution is well established linking and is not considered for the present subject. We examined the strength of the evidence according to the Oxford Centre for Evidence-Based Medicine [2011] and the Centre for Evidence-Based Medicine [2009]. RESULTS A total of 105 articles were identified, but 97 of these had to be excluded after an accurate reading of the title, abstract or full text. In the end, eight studies were selected for our analysis for a total of a total of 5,826 children. The results suggest an involvement (grade C) of environmental (not from voluptuary habits) pollution in the worsening of sleep-disordered breathing in children. CONCLUSIONS To date, some studies reported significant differences between areas with higher and lower pollutants and the interventions on indoor pollution reduced sleep-disordered breathing in children. Therefore, although the relevance of the argument is high, the number of studies and the interest in the subject seems at this time quite limited.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, University of Insubria, Varese, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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Cutrera R, Baraldi E, Indinnimeo L, Miraglia Del Giudice M, Piacentini G, Scaglione F, Ullmann N, Moschino L, Galdo F, Duse M. Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids. Ital J Pediatr 2017; 43:31. [PMID: 28335827 PMCID: PMC5364577 DOI: 10.1186/s13052-017-0348-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/02/2017] [Indexed: 12/27/2022] Open
Abstract
Respiratory diseases account for about 25% of all pediatric consultations, and 10% of these are for asthma. The other main pediatric respiratory diseases, in terms of incidence, are bronchiolitis, acute bronchitis and respiratory infections. Oral corticosteroids, in particular prednisolone, are often used to treat acute respiratory diseases given their anti-inflammatory effects. However, the efficacy of treatment with oral corticosteroids differs among the various types of pediatric respiratory diseases. Notably, also the adverse effects of corticosteroid treatment can differ depending on dosage, duration of treatment and type of corticosteroid administered — a case in point being growth retardation in long-course treatment. A large body of data has accumulated on this topic. In this article, we have reviewed the data and guidelines related to the role of oral corticosteroids in the treatment and management of pediatric bronchiolitis, wheezing, asthma and croup in the attempt to provide guidance for physicians. Also included is a section on the management of acute respiratory failure in children.
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Affiliation(s)
- Renato Cutrera
- Pediatric Pulmonology and Sleep & Long Term Ventilation Unit, Academic Department Pediatric Hospital "Bambino Gesù", Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padua, Via Giustiniani 3, 35128, Padova, Italy
| | - Luciana Indinnimeo
- Department of Maternal and Child Care and Urology, Gender Medicine Polyclinic, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Via Luigi De Crecchio 4, 80138, Naples, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Via Vanvitelli 32, 20129, Milan, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Sleep & Long Term Ventilation Unit, Academic Department Pediatric Hospital "Bambino Gesù", Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Laura Moschino
- Women's and Children's Health Department, University of Padua, Via Giustiniani 3, 35128, Padova, Italy
| | - Francesca Galdo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Via Luigi De Crecchio 4, 80138, Naples, Italy
| | - Marzia Duse
- Department of Maternal and Child Care and Urology, Gender Medicine Polyclinic, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
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Zaffanello M, Piacentini G, Lippi G, Fanos V, Gasperi E, Nosetti L. Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association? Swiss Med Wkly 2017; 147:w14400. [PMID: 28165541 DOI: 10.4414/smw.2017.14400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or family practitioner; if there is any doubt, the children may be referred to a paediatric urologist. Obstructive sleep-disordered breathing is a complex, multifactorial disorder. Adenotonsillar hypertrophy is considered an important factor associated with obstructive sleep apnoea syndrome. Enuresis and obstructive sleep-disordered breathing are both frequent problems of sleep in childhood. We conducted an electronic search in Medline, Scopus and the ISI Web of Science to look for published material and identify a putative link between nocturnal enuresis and obstructive sleep-disordered breathing. A total number of 98 documents were found, but 24 of these had to be excluded after an attentive reading of the title, abstract or full text because the information therein was not suitable for the aims of our search. Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both disorders have an underlying sleep disturbance characterised by an altered arousal response and sleep fragmentation. The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. We found 17 studies regarding the urological outcome of treatment for obstructive sleep-disordered breathing in children with enuresis. Although a vast amount of information is now available regarding the relationship between nocturnal enuresis and obstructive sleep-disordered breathing, many of the published studies were uncontrolled, retrospective or prospective cohort studies (grade C recommendation). Resolution of enuresis after medical or surgical treatment for obstructive sleep-disordered breathing has been emphasised. Consequently, symptoms such as snoring, sleep apnoeas and restless sleep should be sought for all children with enuresis. Confirmed obstructive sleep-disordered breathing should be treated promptly; subsequently, the persistence of enuresis requires treatment following the standard protocol.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, Italy
| | - Emma Gasperi
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Paediatric Division, University of Verona, Italy
| | - Luana Nosetti
- Department of Paediatrics, University of Insubria, Varese, Italy
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Cefalì M, Fregoni V, Piacentini G, Sansi C, Gervaso L, Pavesi L, Riccardi A. Is there a role for antithrombotic prophylaxis in oncologic patients who undergo central venous access placement? Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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141
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Tenero L, Piazza M, Sandri M, Azzali A, Chinellato I, Peroni D, Boner A, Piacentini G. Effect of montelukast on markers of airway remodeling in children with asthma. Allergy Asthma Proc 2016; 37:77-83. [PMID: 27657514 DOI: 10.2500/aap.2016.37.3978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Asthma is a pathology characterized by chronic inflammation and remodeling of the airways. OBJECTIVES To evaluate the effect of montelukast treatment on markers of airway inflammation and remodeling in children with mild asthma and to evaluate if the administration of montelukast to children with mild asthma could inhibit the release of matrix metallopeptidase 9, matrix metallopeptidase 12, tissue inhibitor of metalloproteinase 1, transforming growth factor beta 1, C-peptide terminal procollagen type (PICP), and eosinophils count, which are markers of inflammation and remodeling in induced sputum. METHODS Thirty children with mild asthma were recruited. They were randomized into two groups: group A received montelukast and as needed beta-2-agonist for 8 weeks (T0-T1), whereas group B received placebo and as needed beta-2-agonist for 8 weeks. After 2 weeks of washout (T1-T2), they were reallocated for treatment according a crossover design (T2-T3). Tests for lung function, oral exhaled nitric oxide, and hypertonic saline solution-induced sputum level were performed at T0-T1-T2-T3. RESULTS In the placebo group, the PICP mean (standard deviation [SD]) value at baseline was 2279.42 ± 2530.77 pg/mL and 1916.00 ± 2178.75 pg/mL after treatment. Patients treated with montelukast, in contrast, showed a baseline mean (SD) value of 2439.29 ± 2834.51 pg/mL and 1406.72 ± 1508.65 pg/mL after treatment. The difference between the mean pre- and posttreatment decrease of PICP in the two groups was statistically significant (delta -690.21 pg/mL [95% confidence interval, -1220.83 to -159.5844 pg/mL]; p = 0.011). The mean (SD) percentage of the eosinophil count in the placebo group was 3.11 ± 4.03% at baseline and 4.86 ± 5.83% after treatment. Patients treated with montelukast, in contrast, showed a percentage mean (SD) value at baseline of 4.51 ± 5.48% and, after treatment, of 3.06 ± 3.29%. The difference between the mean pre- and posttreatment decrease of the percentage eosinophil count in the two groups was statistically significant (delta -2.76% [95% confidence interval, -4.65 to -0.87%]; p = 0.004). CONCLUSION This study investigated in vivo effects of montelukast on remodeling markers. The reduction of PICP levels and eosinophil count supported the hypothesis that montelukast can modulate collagen deposition in airways and reduce eosinophilic airway inflammation. Clinical Trials database clinicaltrials.gov (NCT00875082).
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Pieropan S, Degani D, Picassi S, Dal Forno I, Caldonazzi F, Piacentini G, Boner A, Biasi D, Adami S, Prioli M. AB0882 Acute Rheumatic Fever: A Ever Present Disease in The Western World with Possible Insidious Invalidating Heart Involvement. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moeller A, Carlsen KH, Sly PD, Baraldi E, Piacentini G, Pavord I, Lex C, Saglani S. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation. Eur Respir Rev 2016; 24:204-15. [PMID: 26028633 DOI: 10.1183/16000617.00003914] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
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Affiliation(s)
- Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kai-Hakon Carlsen
- Dept of Paediatrics, Women and Children's Division, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Eugenio Baraldi
- Women's and Children's Health Department, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, NDM Research Building, Oxford, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Paediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
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Montella S, Baraldi E, Cazzato S, Aralla R, Berardi M, Brunetti LM, Cardinale F, Cutrera R, de Benedictis FM, di Palmo E, Di Pillo S, Fenu G, La Grutta S, Lombardi E, Piacentini G, Santamaria F, Ullmann N, Rusconi F. Severe asthma features in children: a case-control online survey. Ital J Pediatr 2016; 42:9. [PMID: 26796331 PMCID: PMC4722711 DOI: 10.1186/s13052-016-0217-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022] Open
Abstract
Background Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy. Methods We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6–17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients’ characteristics and severe asthma or non-severe persistent asthma. Results Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95 % Confidence Interval (CI), 1.21–18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95 % CI, 1.11–12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95 % CI, 2.70–53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95 % CI, 2.66–61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients’ comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE . Conclusions As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation. Electronic supplementary material The online version of this article (doi:10.1186/s13052-016-0217-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padua, Padua, Italy.
| | - Salvatore Cazzato
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Raffaele Aralla
- High Altitude Pediatric Asthma Center-Pio XII Institute, Misurina, Italy.
| | - Mariangela Berardi
- Women's and Children's Health Department, University of Padua, Padua, Italy.
| | | | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital "Giovanni XXIII", University of Bari, Bari, Italy.
| | - Renato Cutrera
- Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy.
| | | | - Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | | | - Grazia Fenu
- Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy.
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology of National Research Council, University of Palermo, Palermo, Italy. .,Department of Science for Health Promotion and Mother and Child, University of Palermo, Palermo, Italy.
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy.
| | - Giorgio Piacentini
- Pediatric Section, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Nicola Ullmann
- Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy.
| | - Franca Rusconi
- Epidemiology Unit, A. Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
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Abstract
Recurrent wheezing have a significant morbidity and it's estimated that about one third of school-age children manifest the symptom during the first 5 years of life. Proper identification of children at risk of developing asthma at school age may predict long-term outcomes and improve treatment and preventive approach, but the possibility to identify these children at preschool age remains limited. For many years authors focused their studies to identify early children with recurrent wheezing at risk to develop asthma at school age. Different phenotypes have been proposed for a more precise characterization and a personalized plan of treatment. The main criticism concerns the inability to define stable phenotypes with the risk of overestimating or underestimating the characteristics of symptoms in these children. The aim of this review is to report the recent developments on the diagnosis and treatment of recurrent paediatric wheezing.
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Affiliation(s)
- Laura Tenero
- Department of Life and Reproduction Sciences, Pediatrics Section, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Life and Reproduction Sciences, Pediatrics Section, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Life and Reproduction Sciences, Pediatrics Section, University of Verona, Verona, Italy
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146
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Zaffanello M, Lo Tartaro P, Piacentini G, Cantalupo G, Gasperi E, Antoniazzi F. Sleep disordered breathing in a cohort of children with achondroplasia: correlation between clinical and instrumental findings. Minerva Pediatr 2015; 69:481-488. [PMID: 26041006 DOI: 10.23736/s0026-4946.16.04282-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the present study was to show the results of an overnight polysomnography in a cohort of 9 children (7 females and 2 males) with achondroplasia, aged between 1 and 12 years (5.56±4.7 years). All of the children carried the Gly380Arg (G380R) mutation on the FGFR3 gene. METHODS All the young patients underwent nocturnal polysomnography without sleep deprivation. Sleep staging was noted according to the guidelines of the American Academy of Sleep Medicine. At the time of registration, the parents answered to a Sleep Control Test questionnaire regarding medical history and diurnal and nocturnal symptoms of their children. RESULTS Respiratory sleep disorder was present in 78% of cases, and was generally mild. In 67% of the children there was respiratory effort for more than 30% of the total sleep time. The sample was divided into two age categories: 5 children under the age of 3 years and 4 children over 10 years old. A higher incidence of sleep disorder was found in the first few years of life, where the obstructive pattern predominates. Regarding sleep architecture, we did not find macroscopic alterations of sleep architecture and its phasic manifestations in our paediatric group. However, parents have not been referred daytime sleepiness, attention deficiency, hyperactivity and nocturnal enuresis. Only one had referred recurrent respiratory infections. CONCLUSIONS Polysomnography is a very useful tool in the evaluation of sleep-disordered breathing in children with achondroplasia.
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Affiliation(s)
- Marco Zaffanello
- Pediatric Section, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy -
| | - Patrizia Lo Tartaro
- Pediatric Section, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Section, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Unit of Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Emma Gasperi
- Pediatric Section, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Section, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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147
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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Barreto M, Piacentini G, Chiossi L, Ruggeri F, Caiazzo I, Campisano M, Martella S, Villa MP. Tidal-breathing measurement of exhaled breath temperature (EBT) in schoolchildren. Pediatr Pulmonol 2014; 49:1196-204. [PMID: 24604829 DOI: 10.1002/ppul.22994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/05/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Non-invasive assessment of airway inflammation is particularly useful in children. The exhaled breath temperature (EBT) may reflect inflammatory vasodilation and serve to assess respiratory symptoms and therapy with inhaled corticosteroids (ICs). AIMS To compare EBT with other non-invasive measurements in unselected schoolchildren in relation to respiratory symptoms and IC-therapy, as well as to assess reproducibility, and potentially influencing factors. METHODS In 298 Italian schoolchildren, we assessed tidal-EBT, FE(NO), spirometry, skin-prick tests, questionnaires on chronic respiratory symptoms, and medication. Subjects were divided as follows: reported wheeze, respiratory symptoms other than wheeze, and without symptoms. RESULTS Subjects with reported wheeze (n = 30) more frequently presented atopy, respiratory symptoms, higher FE(NO), lower lung function than subjects with symptoms other than wheeze (n = 141) and those without symptoms (n = 127), but had a similar EBT. IC-treated children (5 wheeze, 9 respiratory symptoms other than wheeze, 4 without chronic symptoms) had lower median (interquartile range) EBT levels than IC-untreated children (n = 280) [EBT: 31.7 (30.1-32.5) vs. 32.6 (31.4-33.4), P = 0.027]. Duplicate EBT measurements were highly reproducible (ICC = 0.94). In a multiple linear-regression model, EBT was explained by age, weight, duration of EBT measurement, FE(NO), and ambient temperature (r = 0.63, P < 0.001). CONCLUSION Tidal-EBT measurements are easy to perform, reproducible, though symptom misclassification may affect the results obtained regarding the effect of IC therapy. Factors influencing EBT should be addressed in further epidemiological studies.
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Affiliation(s)
- M Barreto
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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De Sanctis V, Soliman AT, Fiscina B, Elsedfy H, Elalaily R, Yassin M, Skordis N, Di Maio S, Piacentini G, Kholy ME. Endocrine check-up in adolescents and indications for referral: A guide for health care providers. Indian J Endocrinol Metab 2014; 18:S26-38. [PMID: 25538875 PMCID: PMC4266866 DOI: 10.4103/2230-8210.145055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The American Academy of Pediatrics recommends that young people between the ages of 11 and 21 years should be seen annually by their pediatricians, since annual checkups can be an important opportunity for health evaluation and anticipatory guidance. Parents of infants and young children are accustomed to regularly visiting a pediatrician for their child's checkups. Unfortunately, when children reach the teen years, these annual checkups may decrease in frequency. In routine check-ups and medical office visits, particular attention should be paid to the possibility of a developmental or endocrine disorder. Early diagnosis and treatment may prevent medical complications in adulthood and foster age-appropriate development. Our purpose is to acquaint readers with the concept, based on current scientific understanding, that some endocrine disorders may be associated with a wide range of deleterious health consequences including an increased risk of hypertension and hyperlipidemia, increased risk of coronary artery disease, type 2 diabetes, significant anxiety and lack of self-esteem. Understanding the milestones and developmental stages of adolescence is essential for pediatricians and all other health providers who care for adolescents. Treating adolescents involves knowledge of a variety of medical, social and legal information; in addition, close working relationships must be established within the adolescent's network to create an effective care system. In summary, we underline the importance of a periodic endocrine checkup in adolescents in order to identify endocrine problems early and develop an approach to treatment for those patients who need help during this time. Indications for endocrine referral for professional and other healthcare providers are also included. These lists are clearly not intended to be comprehensive, but will hopefully serve as a guide for specific clinical circumstances.
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Affiliation(s)
- Vincenzo De Sanctis
- Quisisana Hospital, Pediatric and Adolescent Outpatient Clinic, Ferrara, Italy
| | - Ashraf T Soliman
- Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, USA
| | | | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Rania Elalaily
- Department of Primary Health Care, AbuNakhla Hospital, Doha, Qatar
| | - Mohamed Yassin
- Department of Hematology, Alamal Hospital, Hamad Medical Center, Doha, Qatar
| | - Nicos Skordis
- Division of Pediatric and Adolescent Endocrinology, Paedi Center for Specialized Pediatrics, St George's University Medical School at the University of Nicosia, Cyprus, Italy
| | - Salvatore Di Maio
- Emeritus Consultant in Pediatrics, Santobono-Pausilipon Hospital, Naples, Italy
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Schmidt A, Belaaouaj A, Bissinger R, Koller G, Malleret L, D'Orazio C, Facchinelli M, Schulte-Hubbert B, Molinaro A, Holst O, Hammermann J, Schniederjans M, Meyer KC, Damkiaer S, Piacentini G, Assael B, Bruce K, Häußler S, LiPuma JJ, Seelig J, Worlitzsch D, Döring G. Neutrophil elastase-mediated increase in airway temperature during inflammation. J Cyst Fibros 2014; 13:623-31. [PMID: 24713593 DOI: 10.1016/j.jcf.2014.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND How elevated temperature is generated during airway infections represents a hitherto unresolved physiological question. We hypothesized that innate immune defence mechanisms would increase luminal airway temperature during pulmonary infection. METHODS We determined the temperature in the exhaled air of cystic fibrosis (CF) patients. To further test our hypothesis, a pouch inflammatory model using neutrophil elastase-deficient mice was employed. Next, the impact of temperature changes on the dominant CF pathogen Pseudomonas aeruginosa growth was tested by plating method and RNAseq. RESULTS Here we show a temperature of ~38°C in neutrophil-dominated mucus plugs of chronically infected CF patients and implicate neutrophil elastase:α1-proteinase inhibitor complex formation as a relevant mechanism for the local temperature rise. Gene expression of the main pathogen in CF, P. aeruginosa, under anaerobic conditions at 38°C vs 30°C revealed increased virulence traits and characteristic cell wall changes. CONCLUSION Neutrophil elastase mediates increase in airway temperature, which may contribute to P. aeruginosa selection during the course of chronic infection in CF.
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Affiliation(s)
- Annika Schmidt
- Institute of Medical Microbiology and Hygiene, German Center for Infection Research, University Clinic Tübingen, Germany
| | - Azzaq Belaaouaj
- INSERM U-1111, Centre International de Recherche en Infectiologie (CIRI), Lyon, France
| | - Rosi Bissinger
- Institute of Medical Microbiology and Hygiene, German Center for Infection Research, University Clinic Tübingen, Germany
| | | | - Laurette Malleret
- INSERM U-1111, Centre International de Recherche en Infectiologie (CIRI), Lyon, France
| | | | | | | | - Antonio Molinaro
- Department of Chemical Sciences, Università di Napoli Federico II, Italy
| | - Otto Holst
- Research Center Borstel, Center for Medicine and Biosciences, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Jutta Hammermann
- Department of Pediatrics, Technical University Dresden, Dresden, Germany
| | | | - Keith C Meyer
- University of Wisconsin School of Medicine, Madison, USA
| | - Soeren Damkiaer
- Department of Systems Biology and Center for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | | | | | | | - Susanne Häußler
- Research Center Borstel, Center for Medicine and Biosciences, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - John J LiPuma
- Department of Paediatrics, University of Michigan, Ann Arbor, USA
| | - Joachim Seelig
- Biophysical Chemistry, University of Basel, Basel Switzerland
| | | | - Gerd Döring
- Institute of Medical Microbiology and Hygiene, German Center for Infection Research, University Clinic Tübingen, Germany
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