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Ferrante G, Cogo AL, Sandri M, Piazza M, Costella S, Appodia M, Aralla R, Tenero L, Zaffanello M, Piacentini G. Association between individual sensor behavior of an electronic nose and airways inflammation in children with asthma: a pilot study at alpine altitude climate. Pediatr Pulmonol 2024; 59:1339-1345. [PMID: 38376005 DOI: 10.1002/ppul.26911] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Markers of airway inflammation can be helpful in the management of childhood asthma. Residential activities, such as intensive asthma camps at alpine altitude climate (AAC), can help reduce bronchial inflammation in patients who fail to achieve optimal control of the disease. Analysis of volatile organic compounds (VOCs) can be obtained using electronic devices such as e-Noses. We aimed to identify alterations in urinary e-Nose sensors among children with asthma participating in an intensive camp at AAC and to investigate associations between urinary e-Nose analysis and airway inflammation. METHODS We analyzed data collected in children with asthma recruited between July and September 2020. All children were born and resided at altitudes below 600 m asl. Urinary VOCs (measured using the Cyranose 320® VOC analyzer), Fractional exhaled Nitric Oxide (FeNO) and spirometry were evaluated upon children's arrival at the Istituto Pio XII, Misurina (BL), Italy, at 1756 m asl (T0), and after 7 (T1) and 15 days (T2) of stay. RESULTS Twenty-two patients (68.2% males; median age: 14.5 years) were enrolled. From T0 to T1 and T2, the negative trend for FeNO was significant (p < .001). Significant associations were observed between e-Nose sensors S7 (p = .002), S12 (p = .013), S16 (p = .027), S17 (p = .017), S22 (p = .029), S29 (p = .021), S31 (p = .009) and ΔFeNO at T0-T1. ΔFeNO at T0-T2 was significantly associated with S17 (p = .015), S19 (p = .004), S21 (p = .020), S24 (p = .012), S25 (p = .018), S26 (p = .008), S27 (p = .002), S29 (p = .007), S30 (p = .013). CONCLUSIONS We showed that a decrease in FeNO levels after a short sojourn at AAC is associated with behaviors of individual urinary e-Nose sensors in children with asthma.
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Affiliation(s)
- Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Anna Luisa Cogo
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Marco Sandri
- 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
| | - Silvia Costella
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | | | - Raffaele Aralla
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Laura Tenero
- Department of Women and Children's Health, Pediatric Division C, Azienda Ospedaliera Universitaria Integrata Verona, AOUI Verona, Verona, Italy
| | - Marco Zaffanello
- 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
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Cavarzere P, Pietrobelli A, Gandini A, Munari S, Baffico AM, Maffei M, Gaudino R, Guzzo A, Arrigoni M, Coviello D, Piacentini G, Antoniazzi F. Role of genetic investigation in the diagnosis of short stature in a cohort of Italian children. J Endocrinol Invest 2024; 47:1237-1250. [PMID: 38087044 DOI: 10.1007/s40618-023-02243-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/04/2023] [Indexed: 04/23/2024]
Abstract
BACKGROUND Short stature (SS) is defined as height more than 2 standard deviations below the mean for age and sex. Hypothyroidism, celiac disease, growth hormone deficiency, hormonal abnormalities, and genetic conditions are among its causes. A wide range of conditions often due to largely unknown genetic variants can elude conventional diagnostic workup. AIM We used next-generation sequencing (NGS) to better understand the etiology of SS in a cohort of Italian children. PATIENTS AND METHODS The study sample was 125 children with SS of unknown origin referred to our Institute between 2015 and 2021. All had undergone complete auxological and hormonal investigations to exclude common causes of SS. Genetic analysis was performed using a NGS panel of 104 genes. Clinical data were reviewed to clarify the pathogenicity of the variants detected. RESULTS In this cohort, 43 potentially causing variants were identified in 38 children. A syndromic genetic condition was diagnosed in 7: Noonan syndrome in 3, Leri-Weill syndrome in 3, and hypochondroplasia in 1. Moreover, 8 benign variants and other 37 like benign variants were found. In 88 children, 179 variants of uncertain significance (VUS) were identified. No variant was found in 16 children. CONCLUSION Genetic analysis is a useful tool in the diagnostic workup of patients with SS, in adapting management and treatment, and in identifying syndromes with mild atypical clinical features. The role of VUS should not be underestimated, particularly when multiple VUS with possible mutual worsening effects are present in the same child.
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Affiliation(s)
- P Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy.
- Department of Pediatrics, Child and Mother's Hospital, Piazzale Stefani 1, 37126, Verona, Italy.
| | - A Pietrobelli
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - A Gandini
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - S Munari
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
| | - A M Baffico
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Maffei
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - A Guzzo
- Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M Arrigoni
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
| | - D Coviello
- Laboratory of Human Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Piacentini
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - F Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona (Full Member of European Reference Network Endo-ERN), Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Regional Center for the Diagnosis and Treatment of Children and Adolescents with Rare Skeletal Disorders, Pediatric Clinic, University of Verona, Verona, Italy
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3
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Padoan F, Guarnaroli M, Brugnara M, Piacentini G, Pietrobelli A, Pecoraro L. Role of Nutrients in Pediatric Non-Dialysis Chronic Kidney Disease: From Pathogenesis to Correct Supplementation. Biomedicines 2024; 12:911. [PMID: 38672265 DOI: 10.3390/biomedicines12040911] [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] [Received: 03/16/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Nutrition management is fundamental for children with chronic kidney disease (CKD). Fluid balance and low-protein and low-sodium diets are the more stressed fields from a nutritional point of view. At the same time, the role of micronutrients is often underestimated. Starting from the causes that could lead to potential micronutrient deficiencies in these patients, this review considers all micronutrients that could be administered in CKD to improve the prognosis of this disease.
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Affiliation(s)
- Flavia Padoan
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Matteo Guarnaroli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Milena Brugnara
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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Pecoraro L, Zadra M, Cavallin F, Lauriola S, Piacentini G, Pietrobelli A. Lipid Profile, Eating Habit, and Physical Activity in Children with Down Syndrome: A Prospective Study. Diseases 2024; 12:68. [PMID: 38667526 PMCID: PMC11049486 DOI: 10.3390/diseases12040068] [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] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Children with Down Syndrome (DS) frequently undergo health challenges, including a higher prevalence of overweight and obesity. We aimed to evaluate the impact of dietary and physical advice provided by a specialized pediatrician over two years. In this prospective study, 44 children with DS, aged 2 to 17, underwent outpatient follow-up visits every six months between December 2020 and May 2023. Dietary habits, physical activities, anthropometric data, and laboratory results were recorded at baseline and 2-year follow-up. Adherence to the Mediterranean diet and physical activity were investigated using the 'KIDMED' and 'Godin-Shepard Leisure-Time' questionnaires, respectively, completed by the parents of the children. Venous blood samples were taken to determine the lipid profile. A significant reduction in BMI z-scores (p = 0.006) and an improvement in Godin-Shepard questionnaire scores (p = 0.0004) were observed. On the other hand, the lipid profile worsened, with an increase in LDL-c (p = 0.04) and a decrease in HDL-c (p = 0.03). Children with DS may benefit from an educational program on nutrition and physical activity to optimize weight control. Different interventions should target the lipid profile. Preventive intervention and follow-up by the pediatrician are essential for DS, which should continue into adulthood.
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Affiliation(s)
- Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Melissa Zadra
- Department of Medicine, University of Verona, 37134 Verona, Italy
| | | | - Silvana Lauriola
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Zaffanello M, Pietrobelli A, Zoccante L, Sacchetto L, Nosetti L, Piazza M, Piacentini G. Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up. Children (Basel) 2024; 11:388. [PMID: 38671605 DOI: 10.3390/children11040388] [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] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for pediatric sleep-disordered breathing. This study aims to comprehensively investigate various risk and protective factors in children with sleep-disordered breathing undergoing adenotonsillar or adenoidal surgeries. We also aim to explore the differences in neuropsychological profiles. (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy in children referred to our center. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. The Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) screen sleep-disordered breathing and quality of life, respectively. The data were statistically analyzed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). (3) Results: The study involved 138 patients, but only 100 children participated. A higher percentage of patients with sleep-disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep-disordered breathing habitually used a pacifier. A rise in physical score was associated with a reduced PSQ at follow-up (p = 0.051). An increase in the overall academic score was related to a decrease in the PSQ at follow-up (p < 0.001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth. (4) This comprehensive study delves into the intricate interplay of risk and protective factors impacting children with sleep-disordered breathing undergoing adenotonsillectomy and adenoidectomy.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Luca Sacchetto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
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Panzeri C, Pecoraro L, Dianin A, Sboarina A, Arnone OC, Piacentini G, Pietrobelli A. Potential Micronutrient Deficiencies in the First 1000 Days of Life: The Pediatrician on the Side of the Weakest. Curr Obes Rep 2024:10.1007/s13679-024-00554-3. [PMID: 38512555 DOI: 10.1007/s13679-024-00554-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This study is to examine potential micronutrient deficiencies and any need for supplementation in children following specific diet plans in the first 1000 days of life. RECENT FINDINGS Optimal nutrition in the first 1000 days of life has a lifelong positive impact on child development. Specific intrauterine and perinatal factors, pathological conditions, and dietary restrictions can represent potential risk factors for micronutrient deficiencies in the first 1000 days of life, which can have negative systemic consequences. Preterm and low-birth-weight infants are intrinsically at risk because of immature body systems. Children affected by cystic fibrosis are prone to malnutrition because of intestinal malabsorption. The risk of micronutrient deficiency can increase in various situations, including but not limited to children following selective dietary regimens (vegetarian and vegan diets and children affected by specific neuropsychiatric conditions) or specific dietary therapies (children affected by food allergies or specific metabolic disorders and children following restricted diet as a part of therapeutic approach, i.e., ketogenic diet for epilepsy). In light of this situation, the micronutrient status in these categories of children should be investigated in order to tailor strategies specific to the individual's metabolic needs, with a particular focus on deficiencies which can impair or delay the physical and cognitive development of children, namely, vitamin B12, vitamin D and folic acid, as well as oligo-elements such as iron, zinc, calcium, sodium, magnesium, and phosphorus, and essential fatty acids such as omega-3. Identification of micronutrient deficiency in the first 1000 days of life and timely supplementation proves essential to prevent their long-term consequences.
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Affiliation(s)
- Carolà Panzeri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy
| | - Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy.
| | - Alice Dianin
- Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Sboarina
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy
| | - Olivia C Arnone
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, P.Le Stefani, 1 - 37126, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
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7
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Bush A, Buonsenso D, Peroni D, Piazza M, Piacentini G, Boner AL. Early-life respiratory infection: How do we react to this red flag? Pediatr Pulmonol 2024. [PMID: 38477636 DOI: 10.1002/ppul.26963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, School of Medicine, Imperial College London, London, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS. And Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Piazza
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Attilio L Boner
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Bisoffi L, Sassudelli G, Agostinis F, Cogo A, Cutrera R, Dalpiaz I, Di Cicco ME, Guidi B, Grutta SL, Miceli A, Mori F, Piacentini G, Peroni D, Snjiders D, Giovannini M, Baldo E. Pediatric asthma and altitude: a complex interplay between different environmental factors. Ital J Pediatr 2024; 50:42. [PMID: 38448980 PMCID: PMC10918861 DOI: 10.1186/s13052-023-01492-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/09/2023] [Indexed: 03/08/2024] Open
Abstract
Asthma is one of the most common non-communicable diseases, and its prevalence and morbidity are influenced by a wide array of factors that are only partially understood. In addition to individual predisposition linked to genetic background and early life infections, environmental factors are crucial in determining the impact of asthma both on an individual patient and on a population level.Several studies have examined the role of the environment where asthmatic subjects live in the pathogenesis of asthma. This review aims to investigate the differences in the prevalence and characteristics of asthma between the pediatric population residing at higher altitudes and children living at lower altitudes, trying to define factors that potentially determine such differences. For this purpose, we reviewed articles from the literature concerning observational studies assessing the prevalence of pediatric asthma in these populations and its characteristics, such as spirometric and laboratory parameters and associated sensitization to aeroallergens.Despite the heterogeneity of the environments examined, the hypothesis of a beneficial effect of residing at a higher altitude on the prevalence of pediatric asthma could be confirmed, as well as a good profile on airway inflammation in asthmatic children. However, the possibility of a higher hospitalization risk for asthma in children living at higher altitudes was demonstrated. Moreover, a positive association between residing at a higher altitude and sensitization to pollens and between lower altitude and sensitization to house dust mites could be confirmed in some pediatric patients, even if the results are not homogeneous, probably due to the different geographical and climatic regions considered. Nonetheless, further studies, e.g., extensive and international works, need to be conducted to better understand the complex interplay between different environmental factors, such as altitude, and the pathogenesis of asthma and how its prevalence and characteristics could vary due to climate change.
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Affiliation(s)
- Laura Bisoffi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Annalisa Cogo
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
- Institute Pio XII, Misurina, Italy
| | - Renato Cutrera
- Pediatric Pulmonology Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irene Dalpiaz
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Battista Guidi
- Hospital and Territorial Pediatrics Unit, Pavullo Hospital, Pavullo nel Frignano, Italy
| | - Stefania La Grutta
- National Research Council, Institute of Translational Pharmacology (IFT), Palermo, Italy
| | - Andrea Miceli
- Hospital and Territorial Pediatrics Unit, Pavullo Hospital, Pavullo nel Frignano, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Deborah Snjiders
- Department of Woman and Child Health (SDB), University of Padova, Padua, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy.
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Ermanno Baldo
- "Giovan Battista Mattei" Research Institute, Stenico, Italy
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Pecoraro L, Chiaffoni G, Nisi F, Gamboni C, Chiocca E, Luglio I, Rossi F, Accorsi P, Piacentini G, Pietrobelli A. Weaning, food allergens and potential risk factors for delayed introduction: a cross-sectional study. Int J Food Sci Nutr 2024; 75:221-226. [PMID: 38186341 DOI: 10.1080/09637486.2023.2299773] [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] [Received: 05/30/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Much evidence supports that the early introduction of allergenic foods in weaning is useful to prevent food allergies later in life. Real life is often different, with factors related to mothers and infants. Our study aimed to deepen the timing of introducing the foods responsible for most allergic reactions during the weaning and why parents delay their introduction. 110 mothers participated in the study, compiling a questionnaire. Exclusive breastfeeding was associated with a delayed introduction of allergenic foods at 4 months (r = 0.433, p < 0.01) and 1 year (r = 0.486, p < 0.01). Large-for-gestational age at birth was inversely associated with a delayed introduction of allergenic foods (r=-0.204, p < 0.05). This study demonstrates that introducing many allergens is delayed during the weaning. Parents with infants fed with exclusive breastfeeding could need more information about the correct time of introduction of potential allergens in the weaning.
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Affiliation(s)
- Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giovanni Chiaffoni
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Fulvio Nisi
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | | | | | | | | | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Ferrante G, Piacentini G, Piazza M, Boner AL, Bellanti JA. Addressing global health disparities in the management of RSV infection in infants and children: Strategies for preventing bronchiolitis and post-bronchiolitis recurrent wheezing. Allergy Asthma Proc 2024; 45:84-91. [PMID: 38449013 DOI: 10.2500/aap.2024.45.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/08/2024]
Abstract
Background: The topic of equitable access to health care and its impact on exacerbating worldwide inequities in child health not only strikes at the heart of our health-care delivery systems but also deeply resonates with our collective social consciences. Nowhere is this better seen on a global scale than in the burden of illness caused by respiratory syncytial virus (RSV) infection, which extracts the most severe morbidity and mortality in infants and children in low- and middle-income countries (LMIC). This report addresses global health disparities that exist in the management of RSV infection in infants and children, and offers strategies for preventing bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Methods: A systematic literature review was conducted across the PubMed data bases of RSV infection and the socioeconomic impact of bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Results: The results of the present study address the many issues that deal with the question if prevention of RSV bronchiolitis can mitigate recurrent wheezing episodes and links RSV risks, downstream effects, prevention, malnutrition, and socioeconomic restraints of developing countries with a call for possible global action. Conclusion: The present study stresses the importance of considering the linkage between malnutrition and disease susceptibility because of the known relationships between undernutrition and greater vulnerability to infectious diseases, including RSV infection. These complex interactions between infectious disease and undernutrition also raise issues on the longer-term sequelae of postbronchiolitis recurrent wheezing. This prompts a discussion on whether industrialized countries should prioritize the provision of newly developed monoclonal antibodies and RSV vaccines to LMICs or whether vital nutritional needs should be a first focus. The resolution of these issues will require research and greater international discourse.
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Affiliation(s)
- Giuliana Ferrante
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Michele Piazza
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Attilio L Boner
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
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11
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Venditto L, Morano S, Ferrante G, Piazza M, Tenero L, Piacentini G, Pecoraro L. The Evolution of Scientific Knowledge in Childhood Asthma over Time: A Surprising History. Children (Basel) 2024; 11:262. [PMID: 38397374 PMCID: PMC10887562 DOI: 10.3390/children11020262] [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] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Asthma is a disease that has been described since the times of Hammurabi. However, it is only since the 1960s that effective therapeutic strategies have been available. Pathogenic mechanisms underlying the disease have been deeply studied, contributing to creating a "patient-specific asthma" definition. Biological drugs have been approved over the last twenty years, improving disease management in patients with severe asthma via a "precision medicine-driven approach". This article aims to describe the evolution of scientific knowledge in childhood asthma, focusing on the most recent biological therapies and their indications for patients with severe asthma.
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Affiliation(s)
| | | | - Giuliana Ferrante
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy; (L.V.); (S.M.); (M.P.)
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12
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Zaffanello M, Ersu RH, Nosetti L, Beretta G, Agosti M, Piacentini G. Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review. Children (Basel) 2024; 11:208. [PMID: 38397319 PMCID: PMC10887195 DOI: 10.3390/children11020208] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
| | - Refika Hamutcu Ersu
- Division of Pediatric Respirology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (G.B.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics, and Gynecology University of Verona, 37134 Verona, Italy;
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13
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Zaffagnini A, Rigotti E, Opri F, Opri R, Simiele G, Tebon M, Sibani M, Piacentini G, Tacconelli E, Carrara E. Enforcing surveillance of antimicrobial resistance and antibiotic use to drive stewardship: experience in a paediatric setting. J Hosp Infect 2024; 144:14-19. [PMID: 38092304 DOI: 10.1016/j.jhin.2023.12.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Antibiotic stewardship (AS) interventions in paediatrics are still not standardized regarding methodology, metrics, and outcomes. We report the results of an AS intervention in the paediatric area based on education and guideline provision via an electronic App. MATERIALS AND METHODS The AS intervention was conducted in 2021 through observation, education, audit and feedback and provision of an electronic App (Firstline.org) to support antibiotic prescription based on local susceptibility data. The primary outcome was the antibiotic consumption in the 12 months following the intervention (year 2022) compared with a historical 12-month control (year 2019) via an interrupted time series analysis. Secondary outcomes were appropriateness of therapy, length of stay, 30-day readmission, transfers to the paediatric intensive care unit, in-hospital mortality, and prevalence of antimicrobial resistance (AMR). RESULTS During the post-intervention phase, 29 cross-sectional audits and feedback were conducted including 467 patients. Prescriptions were appropriate according to the guidelines in 85.7% of cases, with a stable trend over time. A significant decrease in antibiotic consumption was measured in terms of defined daily doses per 1000 patient days (-222.13; P<0.001) and days of therapy per 1000 patient days (-452.49; P<0.001) in the post-intervention period with a clear inversion of the Access to Watch ratio (from 0.7 to 1.7). Length of stay, in-hospital mortality, intensive care unit transfers, and incidence of AMR infections remained stable, while 30-day readmission decreased from 4.9 per 100 admissions to 2.8 per 100 admissions (P<0.001). CONCLUSIONS The intervention was associated with a significant reduction in antimicrobial consumption and an increase in the appropriateness of prescriptions. Electronic tools can be of value in promoting adherence to guidelines and ensuring the sustainability of results.
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Affiliation(s)
- A Zaffagnini
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - E Rigotti
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - F Opri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - R Opri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - G Simiele
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - M Tebon
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - M Sibani
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - G Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - E Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - E Carrara
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
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14
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Mazzuca G, Artusa S, Pietrobelli A, Di Cara G, Piacentini G, Pecoraro L. The Future for the Children of Tomorrow: Avoiding Salt in the First 1000 Days. Children (Basel) 2024; 11:98. [PMID: 38255411 PMCID: PMC10814202 DOI: 10.3390/children11010098] [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] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
It is widely known that optimal nutrition in the first 1000 days of life positively impacts the child's development throughout adulthood. In this setting, salt should not be added to complementary feeding. In developed countries, salt intake is generally higher than recommended for children. Excessive salt intake is the major determinant of hypertension and is associated with several cardiovascular outcomes. Therefore, pediatricians have a key role in raising awareness among parents to avoid salt consumption in the first 1000 days of life to ensure better health for their children. Starting from a review of the literature published in PubMed/MedLine regarding the short- and long-term consequences of salt consumption during the first 1000 days of life, our comprehensive review aims to analyze the beneficial effects of avoiding salt at such a vulnerable stage of life as the first 1000 days. Obesity, hypertension, increased salt sensitivity, high sweet drink consumption, increased mortality, and morbidity persisting in adult age represent the principal consequences of a higher salt intake during the first 1000 days of life.
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Affiliation(s)
- Giorgia Mazzuca
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Silvia Artusa
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Giuseppe Di Cara
- Department of Pediatrics, University of Perugia, 06129 Perugia, Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
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15
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Pagliaro M, Pecoraro L, Stefani C, Pieropan S, Piacentini G, Pietrobelli A. Bathing in Atopic Dermatitis in Pediatric Age: Why, How and When. Pediatr Rep 2024; 16:57-68. [PMID: 38251315 PMCID: PMC10801494 DOI: 10.3390/pediatric16010006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease. The treatment plays an important role in influencing the patients' quality of life. The basic management consists of appropriate skin cleansing, including bathing and eventually using bathing additives. Recommendations regarding frequency and duration of bathing, water temperature and usefulness of bathing additives are widely different, often leading to confusion among patients. This review aims to give insights into the best bathing practices and the use of bathing additives in atopic dermatitis in children. Several bathing additives, including bleach baths, commercial baby cleansers, bath baby oils and bath salt, appear to be promising adjunctive therapies for atopic dermatitis due to their anti-inflammatory, anti-bacterial, anti-pruritus and skin barrier repair properties through different mechanisms of action. However, their efficacy and safety are not fully understood in some cases. The usefulness of other bath additives, such as acidic and more natural substances (green tea extracts, pine tar, sodium bicarbonate), is still under investigation. Further studies are needed to determine their optimal use to achieve clinical benefit safely.
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Affiliation(s)
- Margherita Pagliaro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Camilla Stefani
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Sara Pieropan
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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16
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Caminati M, Micheletto C, Norelli F, Olivieri B, Ottaviano G, Padoan R, Piacentini G, Schiappoli M, Senna G, Menzella F. Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence. Expert Opin Biol Ther 2024; 24:15-23. [PMID: 38197326 DOI: 10.1080/14712598.2024.2304556] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, effectively blocks both IL-4 and IL-13 mediated pathways. Its introduction has represented a significant advancement in the treatment of severe asthma and other Type 2 (T2) conditions, including nasal polyps, atopic dermatitis, and eosinophilic esophagitis. To date, Dupilumab has demonstrated optimal efficacy and safety profile. AREAS COVERED The safety profile of dupilumab has been extensively studied, especially for its effects on blood eosinophil count. Transient eosinophil increase during treatment is typically insignificant from a clinical point of view and related to its mechanism of action. Rare cases of hyper-eosinophilia associated with clinical conditions like eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) have been reported. Those cases are often related to the drug's steroid-sparing effect or the natural trajectory of the underlying disease rather than a direct cause-effect relationship with dupilumab. EXPERT OPINION The management of hyper-eosinophilia during dupilumab treatment requires comprehensive diagnostic work-up and strict follow-up monitoring for early detection of systemic disease progression in order to avoid unnecessary discontinuation of an effective treatment. This approach highlights the importance of a personalized treatment.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | | | | | - Bianca Olivieri
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
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Zaffanello M, Bonacci E, Piacentini G, Nosetti L, Pedrotti E. Pediatric Ocular Health and Obstructive Sleep Apnea Syndrome: A Review. Pediatr Rep 2023; 15:741-749. [PMID: 38133434 PMCID: PMC10747302 DOI: 10.3390/pediatric15040066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Obstructive sleep apnea (OSA) affects neurobehavioral, cognitive, and cardiovascular aspects, particularly in children, by obstructing the upper airways during sleep. While its impact in adult ocular health is recognized, there is ongoing debate about OSA's relevance in pediatrics. This review explores the relationship between OSA and ocular health in children, focusing on the effects and potential improvements through treatment. A systematic search found 287 articles through PubMeD/MEDLINE, Scopus, Web of Science, and ScienceDirect; 94.4% were excluded. After careful selection, six English articles were included, addressing the effects of OSA on children's eyes. Three studies examined choroidal alterations, three explored retinal and optic nerve changes, and two analyzed ocular changes following otorhinolaryngological intervention. The immediate correlation in children is inconclusive, but age may be a contributing factor. Pediatric OSA patients exhibit corneal anomalies and increased optic nerve thickness, possibly due to intermittent hypoxia. OSA influences retinal vascular density in children, with increased density after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. This review emphasized OSA's significant impact on children's ocular health, revealing alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve is not always evident, OSA raises intraocular pressure and induces structural changes. Treatment holds promise, highlighting the need for regular monitoring to promptly address childhood OSA.
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Affiliation(s)
- Marco Zaffanello
- Pediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy;
| | - Erika Bonacci
- Ophthalmology Clinic, Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy;
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Department of Pediatrics, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy;
| | - Emilio Pedrotti
- Ophthalmology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37134 Verona, Italy;
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18
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Gritti MM, Pecoraro L, Ceol M, Pietrobelli A, Piacentini G, Anglani F, Brugnara M. From pollakiuria to Donnai-Barrow syndrome diagnosis in pediatric age. Clin Genet 2023; 104:711-712. [PMID: 37592754 DOI: 10.1111/cge.14417] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
We report the case of two siblings with incomplete Donnai-Barrow syndrome (DBS) phenotype carrying three LRP2 variants never associated before with DBS phenotype.
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Affiliation(s)
- Michela M Gritti
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Monica Ceol
- Kidney Histomorphology and Molecular Biology Laboratory, Nephrology, Dialysis and Transplantation Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Angelo Pietrobelli
- 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
| | - Franca Anglani
- Kidney Histomorphology and Molecular Biology Laboratory, Nephrology, Dialysis and Transplantation Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Milena Brugnara
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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19
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Padoan F, Colombrino C, Sciorio F, Piacentini G, Gaudino R, Pietrobelli A, Pecoraro L. Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View. Children (Basel) 2023; 10:1721. [PMID: 38002812 PMCID: PMC10670833 DOI: 10.3390/children10111721] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.
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Affiliation(s)
| | | | | | | | | | | | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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20
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Pecoraro L, Ferron E, Solfa M, Mirandola M, Lauriola S, Piacentini G, Pietrobelli A. Body composition and laboratory parameters in children with down syndrome: The DONUT study. Clin Nutr ESPEN 2023; 57:253-257. [PMID: 37739665 DOI: 10.1016/j.clnesp.2023.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Children affected by Down syndrome (DS) have a higher prevalence of obesity, dyslipidemia, and altered liver enzymes. This study investigates a small sample of pediatric patients with DS and possible associations among their anthropometric and laboratory data. METHODS Cross-sectional study involving 33 children (5-17 years old) affected by DS. Children underwent the measurement of anthropometric parameters through bioelectrical impedance analysis and a venous sampling to check their hepatic and lipid profiles. RESULTS 54.6% of subjects were overweight or obese according to WHO (BMI z-score ≥1) and 42% of subjects were overweight or obese according to McCarthy et al. with a percentage of body fat (PBF) ≥ 85° centiles. 28% of subjects were dyslipidemic, showing an alteration of total, LDL, HDL cholesterol or triglycerides according to our laboratory reference values, and a low HDL value (under the normal range for gender and age) was the most frequent lipidic alteration (12.5%). An association was found between some values: lower HDL value was associated with higher PBF (p = 0.025); higher ALT value was associated with higher BMI z-score (p = 0.01) and higher PBF (p = 0.01); higher GGT value was associated with higher BMI z-score (p = 0.002) and higher PBF (p = 0.002). CONCLUSIONS Children with DS are at high risk for obesity and its complications. Our results show dyslipidemia and altered liver enzymes in obese subjects. Pediatricians should monitor children with DS for obesity and consider liver function testing and lipid profiles on children with DS and obesity.
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Affiliation(s)
- Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Department of Medicine, University of Verona, Verona, Italy
| | - Elena Ferron
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Pediatric and Neonatology Unit, "Magalini" Hospital, AULSS9, Verona, Italy
| | - Martina Solfa
- Department of Medicine, University of Verona, Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Italy
| | - Silvana Lauriola
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; Pennington Biomedical Research Centre, Baton Rouge, 70808, LA, USA.
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Zaffanello M, Piacentini G, Nosetti L, Zoccante L. Sleep Disordered Breathing in Children with Autism Spectrum Disorder: An In-Depth Review of Correlations and Complexities. Children (Basel) 2023; 10:1609. [PMID: 37892271 PMCID: PMC10605434 DOI: 10.3390/children10101609] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Sleep-disordered breathing is a significant problem affecting the pediatric population. These conditions can affect sleep quality and children's overall health and well-being. Difficulties in social interaction, communication, and repetitive behavioral patterns characterize autism spectrum disorder. Sleep disturbances are common in children with ASD. This literature review aims to gather and analyze available studies on the relationship between SDB and children with autism spectrum disorder. We comprehensively searched the literature using major search engines (PubMed, Scopus, and Web of Science). After removing duplicates, we extracted a total of 96 records. We selected 19 studies for inclusion after a thorough title and abstract screening process. Seven articles were ultimately incorporated into this analysis. The research findings presented herein emphasize the substantial influence of sleep-disordered breathing on pediatric individuals diagnosed with autism spectrum disorder (ASD). These findings reveal a high incidence of SDB in children with ASD, emphasizing the importance of early diagnosis and specialized treatment. Obesity in this population further complicates matters, requiring focused weight management strategies. Surgical interventions, such as adenotonsillectomy, have shown promise in improving behavioral issues in children with ASD affected by OSA, regardless of their obesity status. However, more comprehensive studies are necessary to investigate the benefits of A&T treatment, specifically in children with ASD and OSA. The complex relationship between ASD, SDB, and other factors, such as joint hypermobility and muscle hypotonia, suggests a need for multidisciplinary treatment approaches. Physiotherapy can play a critical role in addressing these intricate health issues. Early sleep assessments and tailored weight management strategies are essential for timely diagnosis and intervention in children with ASD. Policy initiatives should support these efforts to enhance the overall well-being of this population. Further research is crucial to understand the complex causes of sleep disturbances in children with ASD and to develop effective interventions considering the multifaceted nature of these conditions.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy;
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, “F. Del Ponte” Hospital, Insubria University, 21100 Varese, Italy;
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy;
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Zaffanello M, Pietrobelli A, Piacentini G, Guzzo A, Antoniazzi F. The Impact of Growth Hormone Therapy on Sleep-Related Health Outcomes in Children with Prader-Willi Syndrome: A Review and Clinical Analysis. J Clin Med 2023; 12:5504. [PMID: 37685570 PMCID: PMC10488332 DOI: 10.3390/jcm12175504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/10/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
This literature review of growth hormone (GH) therapy and sleep-related health outcomes in children diagnosed with Prader-Willi syndrome (PWS) assembles evidence for the consequences of sleep deprivation and poor sleep quality: difficulty concentrating and learning at school, behavioral problems, diminished quality of life, and growth impairment. Sleep-disordered breathing (SDB) is another factor that impacts a child's well-being. We searched the electronic databases Medline PubMed Advanced Search Builder, Scopus, and Web of Science using MeSH terms and text words to retrieve articles on GH deficiency, recombinant human growth hormone (rhGH) therapy, sleep quality, SDB, and PWS in children. The censor date was April 2023. The initial search yielded 351 articles, 23 of which were analyzed for this review. The study findings suggest that while GH may have a role in regulating sleep, the relationship between GH treatment and sleep in patients with PWS is complex and influenced by GH dosage, patient age, and type and severity of respiratory disorders, among other factors. GH therapy can improve lung function, linear growth, and body composition in children with PWS; however, it can also trigger or worsen obstructive sleep apnea or hypoventilation in some. Long-term GH therapy may contribute to adenotonsillar hypertrophy and exacerbate sleep apnea in children with PWS. Finally, GH therapy can improve sleep quality in some patients but it can also cause or worsen SDB in others, leading to diminished sleep quality and overall quality of life. The current evidence suggests that the initial risk of worsening SDB may improve with long-term therapy. In conclusion, rhGH is the standard for managing patients with PWS. Nonetheless, its impact on respiratory function during sleep needs to be thoroughly evaluated. Polysomnography is advisable to assess the need for adenotonsillectomy before initiating rhGH therapy. Close monitoring of sleep disorders in patients with PWS receiving GH therapy is essential to ensure effective and safe treatment.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, 37129 Verona, Italy;
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
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Nosetti L, Zaffanello M, De Bernardi di Valserra F, Simoncini D, Beretta G, Guacci P, Piacentini G, Agosti M. Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. Children (Basel) 2023; 10:1426. [PMID: 37628425 PMCID: PMC10453215 DOI: 10.3390/children10081426] [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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and chronic inflammation characterizes the latter form. As the go-to treatment, adenotonsillectomy has proven effective. However, it is not a guarantee for all patients, leaving us without reliable predictors of treatment success. Evidence suggests a connection between adenotonsillar hypertrophy and specific oral breathing patterns resulting from craniofacial development. This finding implies an intricate interdependence between the two, hinting at a self-sustaining vicious cycle that persists without proper intervention. The theories regarding the relationship between craniofacial conformation and sleep-disordered breathing have given rise to intriguing perspectives. In particular, the "gracilization theory" and the "gravitational hypothesis" have provided fascinating insights into the complex interaction between craniofacial conformation and SDB. Further investigation is crucial to unraveling the underlying pathophysiological mechanisms behind this relationship. It is also vital to explore the risk factors linked to adenotonsillectomy failure, study the long-term effects of adenotonsillar hypertrophy on craniofacial growth, and devise innovative diagnostic techniques to detect upper airway compromise early. Moreover, to assess their efficacy, we must delve into novel therapeutic approaches for cases that do not respond to traditional treatment, including positional therapy and orofacial myofunctional therapy. Though complex and unpredictable, these challenges promise to enhance our understanding and treatment of adenotonsillar hypertrophy and its related complications in children. By taking on this task, we can pave the way for more effective and targeted interventions, ultimately improving affected individuals' well-being and quality of life.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Francesca De Bernardi di Valserra
- Division of Otorhinolaryngology, Department of Biotechnologies and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Daniela Simoncini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giulio Beretta
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Pietro Guacci
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Giorgio Piacentini
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.); (D.S.); (G.B.); (P.G.); (G.P.)
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
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Venditto L, Ferrante G, Caccin A, Franchini G, Zaffanello M, Tenero L, Piazza M, Di Gioia S, Piacentini G, Pietrobelli A. Lung abscess as a complication of Lemierre Syndrome in adolescents: a single center case reports and review of the literature. Ital J Pediatr 2023; 49:96. [PMID: 37563612 PMCID: PMC10413500 DOI: 10.1186/s13052-023-01499-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fusobacterium necrophorum is an anaerobic, gram-negative, non-motile, filamentous, non-spore forming bacillus found in the oral cavity, gastrointestinal tract, and female genital tract, responsible of a rare disease named Lemierre Syndrome, characterized by septic thrombophlebitis of the internal jugular vein, which mainly affects previously healthy adolescents and young adults; some risk factors are reported, as smoking or primary viral or bacterial infection leading to the disruption of mucosa. The syndrome originates commonly from an upper respiratory infection such as pharyngotonsillitis, acute otitis media, cervical lymphadenitis, sinusitis, or odontogenic abscess, and may result in multiorgan metastasis, more frequently leading to pulmonary complications, especially lung abscesses. CASE PRESENTATION We describe two cases of adolescents with atypical Lemierre Syndrome evaluated in a tertiary care center, one with a confirmed infection by Fusobacterium necrophorum and one with a presumptive diagnosis based on clinical features, who developed lung abscesses needing a prolonged antibiotic course and hospitalization. Of interest, both were user of electronic cigarette, configuring a possible new risk factor. The proper diagnosis of Lemierre Syndrome is often difficult to establish, so a high degree of suspicion is needed, especially in the case of lung abscesses in otherwise healthy adolescents. CONCLUSION The current study will contribute to providing insight into Lemierre Syndrome clinical presentation and management in adolescents, promoting awareness for a rare but potentially fatal disease. Moreover, it suggests a possible relationship between Lemierre syndrome and the use of electronic cigarette, that should be investigated by future studies.
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Affiliation(s)
- Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Anna Caccin
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giulia Franchini
- 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
| | - Laura Tenero
- Pediatric Division, University Hospital of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Stefano Di Gioia
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Giorgio Piacentini
- 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
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Lella G, Pecoraro L, Benetti E, Arnone OC, Piacentini G, Brugnara M, Pietrobelli A. Nutritional Management of Idiopathic Nephrotic Syndrome in Pediatric Age. Med Sci (Basel) 2023; 11:47. [PMID: 37606426 PMCID: PMC10443265 DOI: 10.3390/medsci11030047] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
Nephrotic syndrome (NS) is a common pediatric disease characterized by a dysfunction in the glomerular filtration barrier that leads to protein, fluid, and nutrient loss in urine. Corticosteroid therapy is the conventional treatment in children. Long-term complications of NS and prolonged exposure to steroids affect bones, growth, and the cardiovascular system. Diet can play an important role in preventing these complications, but there is a scarcity of scientific literature about nutritional recommendations for children with NS. They need individualized nutrition choices not only during the acute phase of the disease but also during remission to prevent the progression of kidney damage. The correct management of diet in these children requires a multidisciplinary approach that involves family pediatricians, pediatric nephrologists, dietitians, and parents.
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Affiliation(s)
- Graziana Lella
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy
| | - Olivia Chapin Arnone
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Milena Brugnara
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Stefani C, Pecoraro L, Flodmark CE, Zaffanello M, Piacentini G, Pietrobelli A. Allergic Diseases and Childhood Obesity: A Detrimental Link? Biomedicines 2023; 11:2061. [PMID: 37509700 PMCID: PMC10377533 DOI: 10.3390/biomedicines11072061] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Several epidemiological studies have described childhood obesity as a risk factor for atopic disease, particularly asthma. At the same time, this association seems to be more conflicting for allergic rhinitis, atopic dermatitis, and chronic urticaria. This article aims to deepen the possibility of a relationship between childhood obesity and allergic diseases. As regards asthma, the mechanical and inflammatory effects of obesity can lead to its development. In addition, excess adiposity is associated with increased production of inflammatory cytokines and adipokines, leading to low-grade systemic inflammation and an increased risk of asthma exacerbations. Allergic rhinitis, atopic dermatitis, food allergies, and chronic urticaria also seem to be related to this state of chronic low-grade systemic inflammation typical of obese children. Vitamin D deficiency appears to play a role in allergic rhinitis, while dyslipidemia and skin barrier defects could explain the link between obesity and atopic dermatitis. Starting from this evidence, it becomes of fundamental importance to act on body weight control to achieve general and allergic health, disentangling the detrimental link between obesity allergic diseases and childhood obesity. Further studies on the association between adiposity and atopy are needed, confirming the biologically active role of fat tissue in the development of allergic diseases and exploring the possibility of new therapeutic strategies.
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Affiliation(s)
- Camilla Stefani
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | | | - Marco Zaffanello
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Zaffanello M, Pietrobelli A, Zoccante L, Ferrante G, Tenero L, Piazza M, Ciceri ML, Nosetti L, Piacentini G. Mental Health and Cognitive Development in Symptomatic Children and Adolescents Scoring High on Habitual Snoring: Role of Obesity and Allergy. Children (Basel) 2023; 10:1183. [PMID: 37508681 PMCID: PMC10377772 DOI: 10.3390/children10071183] [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] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Obstructive sleep apnea can have a negative impact on children's and adolescents' neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored. METHODS The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject's parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings. RESULTS We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up. CONCLUSIONS Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Laura Tenero
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, Filippo Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
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Zaffanello M, Piacentini G. Unveiling the Hidden Connection between Allergies and Sleep-Disordered Breathing in Children and Its Impact on Health. Children (Basel) 2023; 10:1143. [PMID: 37508641 PMCID: PMC10378427 DOI: 10.3390/children10071143] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Sleep-disordered breathing (SDB) and allergies in children are increasingly relevant health issues that require attention [...].
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy
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29
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Zaffanello M, Ferrante G, Zoccante L, Ciceri ML, Nosetti L, Tenero L, Piazza M, Piacentini G. Predictive Power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in Detecting Long-Term Neurocognitive and Psychosocial Outcomes of Sleep-Disordered Breathing in Children: A Questionnaire-Based Study. J Clin Med 2023; 12:jcm12093060. [PMID: 37176501 PMCID: PMC10179379 DOI: 10.3390/jcm12093060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/27/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Pediatric obstructive sleep apnea can negatively affect children's neurocognitive function and development, hindering academic and adaptive goals. Questionnaires are suitable for assessing neuropsychological symptoms in children with sleep-disordered breathing. The study aimed to evaluate the effectiveness of using the Oxygen Desaturation Index compared to the Obstructive Apnea-Hypopnea Index in predicting long-term consequences of sleep-disordered breathing in children. We conducted a retrospective analysis of respiratory polysomnography recordings from preschool and school-age children (mean age: 5.8 ± 2.8 years) and followed them up after an average of 3.1 ± 0.8 years from the home-based polysomnography. We administered three validated questionnaires to the parents/caregivers of the children by phone. Our results showed that children with an Oxygen Desaturation Index (ODI) greater than one event per hour exhibited symptoms in four domains (physical, school-related, Quality of Life [QoL], and attention deficit hyperactivity disorder [ADHD]) at follow-up, compared to only two symptoms (physical and school-related) found in children with an Obstructive Apnea-Hypopnea Index greater than one event per hour at the time of diagnosis. Our study also found a significant correlation between the minimum SpO2 (%) recorded at diagnosis and several outcomes, including Pediatric Sleep Questionnaire (PSQ) scores, physical, social, and school-related outcomes, and ADHD index at follow-up. These results suggest that the Oxygen Desaturation Index could serve as a valuable predictor of long-term symptoms in children with sleep-disordered breathing, which could inform treatment decisions. Additionally, measuring minimum SpO2 levels may help assess the risk of developing long-term symptoms and monitor treatment outcomes.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital Verona, 37126 Verona, Italy
| | - Luana Nosetti
- Department of Pediatrics, Pediatric Sleep Disorders Center, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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30
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Cinquetti M, Marchiotto C, Fingerle M, Salani M, Adami A, Dainese D, Magaraggia S, Rigotti E, Piacentini G. Breastfeeding rates fell in an Italian baby friendly hospital during the 2020 COVID-19 pandemic year and difficulties increased. Acta Paediatr 2023; 112:770-775. [PMID: 36644949 DOI: 10.1111/apa.16674] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/29/2022] [Revised: 12/22/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023]
Abstract
AIM Our aim was to evaluate the impact of the COVID-19 pandemic on breastfeeding at discharge in a Baby Friendly hospital in 2020. METHODS This study retrospectively compared healthy neonates born in 2019 with those born in 2020 at the Baby Friendly San Bonifacio Hospital in Verona, Italy. We also compared those born to mothers who tested negative and positive for the virus that causes COVID-19. Breastfeeding support practices, nationality and type of birth were evaluated. The outcomes were type of breastfeeding at discharge and the presence of breastfeeding difficulties. RESULTS We analysed 2171 healthy neonates, which was 83.5% of those born in the hospital in 2019 and 2020, and 20 were born to mothers with the virus. Exclusive breastfeeding rates were 4.6% lower in 2020 than 2019 and breastfeeding difficulties rose by 10.1%. Mixed feeding, at the mother's request, and formula feeding due to medical indications, increased by 5.9% and 18.1% respectively. Most of the Baby Friendly hospital practices were implemented, but prenatal and intrapartum support decreased. CONCLUSION Exclusive breastfeeding fell during the COVID-19 pandemic in 2020 and breastfeeding difficulties rose. These may have been due to the effect of maternal and healthcare factors during the pandemic.
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Affiliation(s)
- Mauro Cinquetti
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Carolina Marchiotto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Michele Fingerle
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Salani
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Anna Adami
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Daniela Dainese
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Silvia Magaraggia
- Maternal and Child Department, Azienda ULSS 9 Scaligera, Verona, Italy
| | - Erika Rigotti
- 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, Panzeri C, Nisi F, Lauriola S, Piacentini G, Pietrobelli A. Parental perception of SIDS prevention measures: where are we at? Minerva Pediatr (Torino) 2023; 75:433-435. [PMID: 36757017 DOI: 10.23736/s2724-5276.23.07182-3] [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: 02/10/2023]
Affiliation(s)
- Luca Pecoraro
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy -
| | - Carolà Panzeri
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Fulvio Nisi
- IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Silvana Lauriola
- 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
| | - Angelo Pietrobelli
- Unit of Pediatrics, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy.,Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Bodini A, Pecoraro L, Piazza M, Piacentini G. Symptomatic vascular rings: a case misdiagnosed as difficult asthma in a school-age girl. Minerva Pediatr (Torino) 2023; 75:139-141. [PMID: 33845564 DOI: 10.23736/s2724-5276.21.06139-9] [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)
- Alessandro Bodini
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Clinic of Pediatrics, ASST Mantova, Mantova, Italy - .,Department of Medicine, University of Verona, Verona, Italy
| | - Michele Piazza
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Unit of Pediatric, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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33
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Tenero L, Vaia R, Ferrante G, Maule M, Venditto L, Piacentini G, Senna G, Caminati M. Diagnosis and Management of Allergic Rhinitis in Asthmatic Children. J Asthma Allergy 2023; 16:45-57. [PMID: 36636703 PMCID: PMC9829985 DOI: 10.2147/jaa.s281439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Allergic rhinitis (AR) is a common upper airways inflammatory condition especially in paediatric population; its burden potentially impacts on quality of life, quality of sleep and daily performance, which can be difficult to perceive but not less relevant in the middle-long term. The present review aims to provide an updated overview on AR epidemiology, diagnosis and with a special focus on its connections with bronchial asthma. In fact, when considering asthmatic pediatric population, AR is probably the most important risk factor for asthma onset and the most impactful extra-bronchial determinant of asthma control. Under this perspective, allergen immunotherapy (AIT) should always be considered in the light of a precision medicine approach. In fact, AIT does represent a unique opportunity to specifically interfere with AR immunological background, improve both AR and bronchial asthma control and prevent allergic disease evolution. Verifying the patient's eligibility to that option should be considered as a priority for every physician managing children suffering from AR, especially when associated with bronchial asthma.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Rachele Vaia
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Matteo Maule
- Department of Medicine, University of Verona, Verona, Italy
| | - Laura Venditto
- 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
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy,Department of Medicine, University of Verona, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy,Correspondence: Marco Caminati, Department of Medicine, University of Verona, Piazzala L.A. Scuro, 10, Verona, 37134, Italy, Email
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Puma A, Pecoraro L, Salvottini C, Carbonare LD, Piacentini G, Pietrobelli A. Parental Perceptions and Concerns Related to the Consequences of Pediatric Obesity: Feeling or Real Problem? Endocr Metab Immune Disord Drug Targets 2023; 23:1380-1391. [PMID: 35638538 DOI: 10.2174/1871530322666220530121012] [Citation(s) in RCA: 1] [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: 02/03/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Lifestyle modifications (i.e., nutrition and physical activity) remain the main tools in the context of childhood obesity's treatment and prevention of short and long-term consequences. At the same time, parental perception of child weight represents an even more important tool. It is known that more than half of parents of overweight/obese children underestimate their child's weight status or are not worried about the risks associated with childhood overweight/obesity. Consequently, parental perception of childhood obesity can often be erroneous, and, even when accurate, subsequent parental behaviors can inadvertently contribute to the onset or persistence of childhood and adult obesity. Starting from the evidence that targeting a parent to induce a behavioral change is more effective than targeting the child only without parental participation, parental perceptions of childhood obesity can therefore represent a very important tool to take into consideration to achieve improvements in the context of childhood obesity. Therefore, knowledge of parental perception of children's weight status is needed to help pediatricians to organize and adapt activities and programs that promote healthy weight management among children. Specifically, early assessments of parents' perceptions of a child's weight, followed by regular follow-up visits, appropriate feedback, continuing education efforts, and efforts to follow the child's weight status over time, can be potentially very helpful.
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Affiliation(s)
- Andrea Puma
- Department of Surgical Sciences, Pediatric Unit, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Department of Surgical Sciences, Pediatric Unit, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Salvottini
- Department of Surgical Sciences, Pediatric Unit, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | | | - Giorgio Piacentini
- Department of Surgical Sciences, Pediatric Unit, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Pediatric Unit, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Ferruzzi A, Vrech M, Pietrobelli A, Cavarzere P, Zerman N, Guzzo A, Flodmark CE, Piacentini G, Antoniazzi F. The influence of growth hormone on pediatric body composition: A systematic review. Front Endocrinol (Lausanne) 2023; 14:1093691. [PMID: 36843617 PMCID: PMC9947344 DOI: 10.3389/fendo.2023.1093691] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Growth hormone (GH) affects metabolism and regulates growth in childhood. The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature. In adult-onset GHD, lean body mass (LBM) is reduced, and visceral fat mass (FM) increased. Beneficial effects of GH treatment on body composition in adults with GHD, including an increase in muscle mass and a decrease in FM, are well established. Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency. This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD. METHODS The PubMed, Science Direct, Cochrane Trials, and Embase databases, were searched with keywords including "GH", "body composition", "children", and "growth hormone" for English-language articles, published between January 1999 and March 2021. Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment, regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy. Data extracted from each study included study quality, study sample characteristics, study interventions, and body composition. Data on fat-free mass and LBM were combined into a single category of LBM. RESULTS Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy. CONCLUSION Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD.
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Affiliation(s)
- Alessandro Ferruzzi
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Massimiliano Vrech
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
- Pennington Biomedical Research Center, Louisiana State University (LSU) System, Baton Rouge, LA, United States
- *Correspondence: Angelo Pietrobelli,
| | - Paolo Cavarzere
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Nicoletta Zerman
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carl-Erik Flodmark
- Department of Clinical Sciences in Malmö, Lunds University, Lund, Sweden
| | - Giorgio Piacentini
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, Verona, Italy
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Ullmann N, Bush A, Piacentini G, Santamaria F, Cutrera R. Editorial: Difficult and severe asthma in children, volume II. Front Pediatr 2023; 11:1158309. [PMID: 37009299 PMCID: PMC10061068 DOI: 10.3389/fped.2023.1158309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- Nicola Ullmann
- Pneumology and Cystic Fibrosis Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
- Correspondence: Nicola Ullmann
| | - Andrew Bush
- Professor of Paediatrics, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Professor of Paediatrics and Paediatric Respirology, National Heart and Lung Institute, London, United Kingdom
- Consultant Paediatric Chest Physician, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - 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
| | - Renato Cutrera
- Pneumology and Cystic Fibrosis Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
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Ferrante G, Fasola S, Piazza M, Tenero L, Zaffanello M, La Grutta S, Piacentini G. Vitamin D and Healthcare Service Utilization in Children: Insights from a Machine Learning Approach. J Clin Med 2022; 11:jcm11237157. [PMID: 36498731 PMCID: PMC9738108 DOI: 10.3390/jcm11237157] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Vitamin D deficiency and insufficiency is a global health issue: an association has been demonstrated between vitamin D deficiency and a myriad of acute and chronic illnesses. Data regarding vitamin D status among children hospitalized with non-critical illnesses are scanty. We aimed to: (1) identify profiles of children hospitalized due to non-critical illnesses, using vitamin D levels as the driving outcome; (2) assess the association between patient profiles and length of stay. The study included 854 patients (1−17 years old) who underwent blood tests for detecting vitamin D levels. A regression tree was used to stratify patients. The relationship between vitamin D levels and length of stay was explored using Poisson regression. The regression tree identified three subgroups. Group A (16%): African, North African, Hispanic, and Indian patients. Group B (62%): Caucasian and Asian patients hospitalized for respiratory, metabolic, ill-defined, infective, and genitourinary diseases. Group C (22%): Caucasian and Asian patients hospitalized for digestive, nervous, and musculoskeletal diseases, blood and skin diseases, and injuries. Mean serum vitamin D level (ng/mL) was 13.7 (SD = 9.4) in Group A, 20.5 (10.0) in Group B, and 26.2 (12.6) in Group C. Group B was associated with the highest BMI z-score (p < 0.001) and the highest frequency of preterm births (p = 0.041). Mean length of stay was longer in Group A than in the other groups (p < 0.001) and decreased significantly by 9.8% (p = 0.024) in Group A and by 5% (p = 0.029) in Group B per 10 ng/mL increase in vitamin D level. We identified three subgroups of hospitalized children, defined according to ethnicity and discharge diagnosis, and characterized by increasing vitamin D levels. Vitamin D levels were associated with length of hospitalization.
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Affiliation(s)
- Giuliana Ferrante
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | - Michele Piazza
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
- Correspondence:
| | - Laura Tenero
- AOUI Verona—Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37126 Verona, Italy
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, 90146 Palermo, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Pediatric Division, University of Verona, 37134 Verona, Italy
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Dal Ben S, Gaudino R, Cavarzere P, Volpi S, Antoniazzi F, Boner A, Piacentini G. Age at menarche in girls with cystic fibrosis and asthma. Minerva Endocrinol (Torino) 2022; 47:479-481. [PMID: 35195379 DOI: 10.23736/s2724-6507.21.03451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah Dal Ben
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy -
| | - Rossella Gaudino
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Sonia Volpi
- Center of Cystic Fibrosis, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Attilio Boner
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
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Zaffanello M, Pietrobelli A, Gozal D, Nosetti L, La Grutta S, Cilluffo G, Ferrante G, Piazza M, Piacentini G. Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective. J Clin Med 2022; 11:jcm11195960. [PMID: 36233827 PMCID: PMC9571925 DOI: 10.3390/jcm11195960] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [-0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
- Correspondence:
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - David Gozal
- Departments of Child Health, and Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology (IFT), National Research Council, 90146 Palermo, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, 90133 Palermo, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
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Zaffanello M, Franchini M, Piacentini G. Pediatric Sleep-Disordered Breathing and Long-Term Complications: Clinical and Health Implications. J Clin Med 2022; 11:jcm11175178. [PMID: 36079107 PMCID: PMC9457297 DOI: 10.3390/jcm11175178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
- Correspondence:
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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Cogo A, Piazza M, Costella S, Appodia M, Aralla R, Zanconato S, Carraro S, Piacentini G. A positive effect of a short period stay in Alpine environment on lung function in asthmatic children. Pediatr Pulmonol 2022; 57:2116-2121. [PMID: 35606932 PMCID: PMC9546332 DOI: 10.1002/ppul.25987] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Lung function is a central issue in diagnosis and determination of asthma severity and asthma control has been previously reported to improve after a stay in mountain environment for at least 2 weeks. No data are available for shorter periods of stay, in particular for small airways during a stay at altitude. The aim of this study is to focus on changes in respiratory function, regarding both the central airways and the peripheral airways in the first 2 weeks of stay in a mountain environment in asthmatic children. In this study, 66 asthmatic children (age: 14 ± 2.8 years) were evaluated through spirometric and oscillometric tests at the time of arrival at the Istituto Pio XII, Misurina (BL), Italy, 1756 m above sea level (T0), after 24 h (T1), and 168 h (T2) of stay. FEV1%, FEF25%-75%, and FEV1/FVC increased significantly from T0 value both at T1 and T2 (respectively, p = 0.0002, p < 0.0001, p = 0.0002). Oscillometry showed a significant improvement in R5, R20, and R5-20 at both T1 and T2 as compared to T0 (respectively, p = 0.0001, p = 0.0002, and p = 0.049). Reactance at 5 Hz (X5) improved significantly at T2 versus T0, p = 0.0022. The area under reactance curve between Fres and 5 Hz (AX) was significantly reduced (p = 0.0001) both at T1 and T2 as compared to T0. This study shows an improvement in respiratory indices as soon as after 24 h of stay at altitude, persisting in the following week.
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Affiliation(s)
- Annalisa Cogo
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Silvia Costella
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | | | - Raffaele Aralla
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Stefania Zanconato
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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Cavarzere P, Camilot M, Palma L, Lauriola S, Gaudino R, Vincenzi M, Antoniazzi F, Teofoli F, Piacentini G. Twenty Years of Neonatal Screening for Congenital Adrenal Hyperplasia in North-Eastern Italy: Role of Liquid Chromatography-Tandem Mass Spectrometry as a Second-Tier Test. Horm Res Paediatr 2022; 95:255-263. [PMID: 35350013 DOI: 10.1159/000524170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Newborn screening for congenital adrenal hyperplasia (CAH) based on 17-hydroxyprogesterone (17-OHP) concentration in dried blood spots has been taking place in North-Eastern Italy since 2001. Since 2017, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been introduced, for the first time in Italy, as a second-tier test. AIMS Our study aims to evaluate, on the one hand, the effectiveness of the newborn screening for CAH after 20 years of testing and, on the other, the impact that the introduction of the second-tier test had on the diagnostic accuracy of the screening program. METHODS Since 2001 dried blood spots taken from newborns have been screened with a time-resolved fluoroimmunoassay for 17-OHP determination. Over the years, the cut-off levels of 17-OHP were adjusted according to gestational age. Since 2017, a second-tier test in LC-MS/MS was introduced for samples displaying fluoroimmunoassay 17-OHP exceeding the cut-off. RESULTS In total, 862,521 newborns have been screened over a period of 20 years. The total incidence of 21-hydroxylase deficiency (21-OHD) was 1:25,368, moreover, a case of 11-β-hydroxylase deficiency was identified. All these diagnoses were genetically confirmed. The sensitivity and specificity of the screening program were 97% and 99.4%, respectively. The use of LC-MS/MS as a second-tier test significantly reduced the recall rate and increased the positive predictive value. CONCLUSIONS Screening for CAH is useful in the neonatal diagnosis of a classic form of 21-OHD, allowing a precocious treatment of affected children. The introduction of an LC-MS/MS second-tier reduced the recall rate, avoiding unnecessary blood withdrawal and medical evaluations and preventing stress to families. Furthermore, it helped identify rarer forms of CAH.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Marta Camilot
- Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy
| | - Laura Palma
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Silvana Lauriola
- Neonatal Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Rossella Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Monica Vincenzi
- Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Section, 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
| | - Francesca Teofoli
- Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy
| | - Giorgio Piacentini
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy.,Pediatric Section, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Regional Center for Newborn Screening, Diagnosis and Treatment of Congenital Metabolic and Endocrinological Diseases, Verona, Italy
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Pietrobelli A, Fearnbach N, Ferruzzi A, Vrech M, Heo M, Faith M, Pecoraro L, Zoller T, Antoniazzi F, Piacentini G, Heymsfield SB. Effects of COVID‐19 lockdown on lifestyle behaviors in children with obesity: Longitudinal study update. Obes Sci Pract 2022; 8:525-528. [PMID: 35949277 PMCID: PMC9358732 DOI: 10.1002/osp4.581] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Angelo Pietrobelli
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
- Pennington Biomedical Research Center LSU System Baton Rouge Louisiana USA
| | - Nicole Fearnbach
- Pennington Biomedical Research Center LSU System Baton Rouge Louisiana USA
| | - Alessandro Ferruzzi
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
| | - Massimiliano Vrech
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
| | - Moonseong Heo
- Department of Public Health Sciences Clemson University Clemson South Carolina USA
| | - Myles Faith
- Graduate School of Education Department of Counseling, School and Educational Psychology University at Buffalo‐State University of New York Buffalo New York USA
| | - Luca Pecoraro
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
| | - Thomas Zoller
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
| | - Franco Antoniazzi
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
| | - Giorgio Piacentini
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics Pediatric Unit Verona University Medical School Verona Italy
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Pecoraro L, Solfa M, Ferron E, Mirandola M, Lauriola S, Piacentini G, Pietrobelli A. Mediterranean diet and physical activity in Down syndrome pediatric subjects: the DONUT STUDY. Int J Food Sci Nutr 2022; 73:973-980. [PMID: 35912934 DOI: 10.1080/09637486.2022.2104227] [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: 10/16/2022]
Abstract
INTRODUCTION Children with Down syndrome (DS) are characterised by peculiar dietary choices and approach to physical activity. The aim of this study is to quantify their adherence to the Mediterranean diet, their level of physical activity and lipid profile. METHODS Cross-sectional study, involving 61 children affected by DS. Parents of the patients were requested to complete two questionnaires, Mediterranean Diet Quality Index in children and adolescents (KIDMED) and Godin Leisure-Time Physical Activity Questionnaire (Godin). In addition, children underwent a venous sampling to check their lipid profile. RESULTS High scores on KIDMED and Godin were found and were associated with a reduced likelihood of being overweight or obese (0.001< p < 0.077; 0.001< p < 0.248). The level of physical activity and the probability of finding pathological HDL values in plasma were inversely related (0.001< p < 0.263). CONCLUSIONS The DONUT study proves that KIDMED and Godin questionnaires can identify children affected by DS that can lead to develop inadequate anthropometric variables and low levels of HDL cholesterol. Moreover, the results of this study show that, despite potential difficulties in the pursuit of a correct diet and an adequate approach to physical activity, children with DS could achieve results that are substantially like those of non-DS children.
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Affiliation(s)
- Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Unit, University of Verona, Verona, Italy.,Department of Medicine, University of Verona, Verona, Italy
| | - Martina Solfa
- Department of Medicine, University of Verona, Verona, Italy
| | - Elena Ferron
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Unit, University of Verona, Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Silvana Lauriola
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Unit, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Unit, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Unit, University of Verona, Verona, Italy.,Pennington Biomedical Research Centre, Baton Rouge, LA, USA
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Andrenacci B, Ferrante G, Roberto G, Piacentini G, La Grutta S, Marseglia GL, Licari A. Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician. Expert Rev Clin Immunol 2022; 18:807-821. [PMID: 35730635 DOI: 10.1080/1744666x.2022.2093187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/04/2022]
Abstract
INTRODUCTION Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children's lung function and the whole family's well-being. AREAS COVERED Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma. EXPERT OPINION In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.
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Affiliation(s)
- Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zoller T, Prioli MA, Clemente M, Pilati M, Sandrini C, Luciani GB, Deganello Saccomani M, Ficial B, Gaffuri M, Piacentini G, Calciano L, Pietrobelli A. Congenital Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population. Children 2022; 9:children9060884. [PMID: 35740821 PMCID: PMC9221605 DOI: 10.3390/children9060884] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
(1) Objective: To evaluate: (i) the associations of age and disease severity with anthropometric indices and weight status, (ii) the difference in the frequency of sports activity among different levels of disease severity in paediatric patients with congenital heart disease (CHD). (2) Methods: Clinical data of Caucasian children (aged 2–18 years) diagnosed with CHD (2005–2018) were retrospectively collected from the electronic register of outpatient visits. Of the 475 children with CHD, 368 children and their 1690 complete anthropometric measurements were eligible for inclusion in our analysis. (3) Results: Significant increase with age was observed for weight z-score [beta (95%CI): 0.03 (0.02, 0.05) for one-unit of age] and BMI z-score [0.06 (0.03, 0.08)] but not for height z-score. The probability of being underweight and overweight/obese increased and decreased with disease severity, respectively. The obesity probability of patients with mild CHD (0.06 [95%CI: 0.03, 0.08]) was not statistically distinguishable from that of patients with moderate CHD (0.03 [95%CI: 0.02, 0.05]), whereas it was lower in patients with severe CHD (0.004 [95%CI: 0.0, 0.009]). No obese patients with a univentricular heart defect were observed. Days spent in sport activities were equal to 1.9 [95%CI: 1.6, 2.2] days/week, 1.9 [1.5, 2.2], 1.4 [1.1, 1.7] and 0.7 [0.1, 1.3] in patients with mild, moderate, severe and univentricular CHD, respectively. (4) Conclusions: The risk of being overweight and obese should not be underestimated in paediatric patients diagnosed with CHD, especially in children with mild or moderate heart defects. It could be prevented or reduced by promoting a healthy lifestyle.
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Affiliation(s)
- Thomas Zoller
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Maria Antonia Prioli
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Maria Clemente
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
- Correspondence:
| | - Mara Pilati
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Camilla Sandrini
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Marco Deganello Saccomani
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Benjamim Ficial
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Marcella Gaffuri
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Giorgio Piacentini
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37126 Verona, Italy;
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Ferrante G, Fasola S, Cilluffo G, Piacentini G, Viegi G, La Grutta S. Addressing Exposome: An Innovative Approach to Environmental Determinants in Pediatric Respiratory Health. Front Public Health 2022; 10:871140. [PMID: 35774568 PMCID: PMC9237327 DOI: 10.3389/fpubh.2022.871140] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022] Open
Abstract
Developmental age is particularly vulnerable to impacts of environmental exposures. Until recent years, the field of environment and child health has predominantly relied on the study of single exposure-health effect relationships. The exposome is an emerging concept in epidemiology, encompassing the totality of the exposures experienced by an individual throughout life and their changes over time. This innovative approach provides a risk profile instead of individual predictors. Exposome research may contribute to better understand the complex relationships between environmental exposures and childhood respiratory health, in order to implement prevention strategies and mitigate adverse health outcomes across the life span. Indeed, an accurate assessment of the exposome needs several measurements as well as different technologies. High-throughput "omics" technologies may be promising tools to integrate a wide range of exposures. However, analyzing large and complex datasets requires the development of advanced statistical tools. This narrative review summarizes the current knowledge on exposome-based approaches in pediatric respiratory health. Further, it explores practical implementation, associated evidence gaps, research limitations and future research perspectives.
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Affiliation(s)
- Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Pecoraro L, Chiaffoni G, Dalle Carbonare L, Salvottini C, Piacentini G, Pietrobelli A. Gastroesophageal reflux in the breastfed infant less than 4 months old: is this really an issue? Minerva Pediatr (Torino) 2022; 75:437-439. [PMID: 35620994 DOI: 10.23736/s2724-5276.22.06837-9] [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
- Department of Medicine, University of Verona, Verona, Italy - .,Pediatric Clinic, ASST Mantua, Mantua, Italy -
| | | | | | - Chiara Salvottini
- 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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Baraldi E, Piacentini G. Global Initiative for Asthma 2021: Asthma in Preschool Children and Short-Acting β 2-Agonist-Only Treatment. Am J Respir Crit Care Med 2022; 205:971-972. [PMID: 35202554 PMCID: PMC9838624 DOI: 10.1164/rccm.202111-2465le] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Esposito S, Sgarzani R, Bianchini S, Monaco S, Nicoletti L, Rigotti E, Di Pietro M, Opri R, Caminiti C, Ciccia M, Conti G, Donà D, Giuffré M, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Piacentini G, Pietrasanta C, Puntoni M, Simonini A, Venturini E, Staiano A, Principi N. Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11040506. [PMID: 35453257 PMCID: PMC9029976 DOI: 10.3390/antibiotics11040506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
- Correspondence: ; Tel.: +39-0521-903524
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Marilia Di Pietro
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Carlo Pietrasanta
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Matteo Puntoni
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer’s Children Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
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