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Tusseau M, Lovšin E, Samaille C, Pescarmona R, Mathieu AL, Maggio MC, Selmanović V, Debeljak M, Dachy A, Novljan G, Janin A, Januel L, Gibier JB, Chopin E, Rouvet I, Goncalves D, Fabien N, Rice GI, Lesca G, Labalme A, Romagnani P, Walzer T, Viel S, Perret M, Crow YJ, Avčin T, Cimaz R, Belot A. DNASE1L3 deficiency, new phenotypes, and evidence for a transient type I IFN signaling. J Clin Immunol 2022; 42:1310-1320. [PMID: 35670985 DOI: 10.1007/s10875-022-01287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deoxyribonuclease 1 like 3 (DNASE1L3) is a secreted enzyme that has been shown to digest the extracellular chromatin derived from apoptotic bodies, and DNASE1L3 pathogenic variants have been associated with a lupus phenotype. It is unclear whether interferon signaling is sustained in DNASE1L3 deficiency in humans. OBJECTIVES To explore interferon signaling in DNASE1L3 deficient patients. To depict the characteristic features of DNASE1L3 deficiencies in human. METHODS We identified, characterized, and analyzed five new patients carrying biallelic DNASE1L3 variations. Whole or targeted exome and/or Sanger sequencing was performed to detect pathogenic variations in five juvenile systemic erythematosus lupus (jSLE) patients. We measured interferon-stimulated gene (ISG) expression in all patients. We performed a systematic review of all published cases available from its first description in 2011 to March 24th 2022. RESULTS We identified five new patients carrying biallelic DNASE1L3 pathogenic variations, including three previously unreported mutations. Contrary to canonical type I interferonopathies, we noticed a transient increase of ISGs in blood, which returned to normal with disease remission. Disease in one patient was characterized by lupus nephritis and skin lesions, while four others exhibited hypocomplementemic urticarial vasculitis syndrome. The fourth patient presented also with early-onset inflammatory bowel disease. Reviewing previous reports, we identified 35 additional patients with DNASE1L3 deficiency which was associated with a significant risk of lupus nephritis and a poor outcome together with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). Lung lesions were reported in 6/35 patients. CONCLUSIONS DNASE1L3 deficiencies are associated with a broad phenotype including frequently lupus nephritis and hypocomplementemic urticarial vasculitis with positive ANCA and rarely, alveolar hemorrhages and inflammatory bowel disease. This report shows that interferon production is transient contrary to anomalies of intracellular DNA sensing and signaling observed in Aicardi-Goutières syndrome or STING-associated vasculitis in infancy (SAVI).
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Affiliation(s)
- Maud Tusseau
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
- Genetics Department, Lyon University Hospital, Lyon, France
| | - Ema Lovšin
- University Children's Hospital University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Charlotte Samaille
- Nephrologie Pediatrique, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Rémi Pescarmona
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
- Immunology Laboratory, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Benite, France
| | - Anne-Laure Mathieu
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
| | - Maria-Cristina Maggio
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Velma Selmanović
- Children's Hospital, University Clinical Center , Sarajevo, Bosnia and Herzegovina
| | - Marusa Debeljak
- University Children's Hospital University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Angelique Dachy
- Nephrologie Pediatrique, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Gregor Novljan
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alexandre Janin
- Cardiogenetics Laboratory, Biochemistry and Molecular Biology Department, Lyon University Hospital, Lyon, France
- NeuroMyoGene Institute, Lyon 1 University, CNRS UMR 5510, INSERM U1217, Lyon, France
| | - Louis Januel
- NeuroMyoGene Institute, Lyon 1 University, CNRS UMR 5510, INSERM U1217, Lyon, France
| | - Jean-Baptiste Gibier
- University Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Emilie Chopin
- Centre de Biotechnologie Cellulaire Et Biothèque, Hospices Civils de Lyon, Bron, France
| | - Isabelle Rouvet
- Centre de Biotechnologie Cellulaire Et Biothèque, Hospices Civils de Lyon, Bron, France
| | - David Goncalves
- Immunology Laboratory, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Benite, France
| | - Nicole Fabien
- Immunology Laboratory, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Benite, France
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gaétan Lesca
- Genetics Department, Lyon University Hospital, Lyon, France
| | - Audrey Labalme
- Genetics Department, Lyon University Hospital, Lyon, France
| | - Paola Romagnani
- Nephrology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Thierry Walzer
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
| | - Sebastien Viel
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
- Immunology Laboratory, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Benite, France
| | - Magali Perret
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
- Immunology Laboratory, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre Benite, France
| | - Yanick J Crow
- Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Université de Paris, Paris, France
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Tadej Avčin
- University Children's Hospital University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rolando Cimaz
- ASST G. Pini, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alexandre Belot
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France.
- National Referee Centre for Rheumatic and Autoimmune Diseases in Children, RAISE, Paris and Lyon, France.
- Pediatric Nephrology, Rheumatology, Dermatology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel, 68677, Bron Cedex, France.
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Affiliation(s)
- M C Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities 'G D'Alessandro' (ProMISE), University of Palermo, Palermo, Italy
| | - R Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M C Failla
- Paediatric Infectious Disease Operative Unit, Children Hospital 'G Di Cristina', ARNAS, Palermo, Italy
| | - P Dones
- Paediatric Infectious Disease Operative Unit, Children Hospital 'G Di Cristina', ARNAS, Palermo, Italy
| | - G Corsello
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities 'G D'Alessandro' (ProMISE), University of Palermo, Palermo, Italy
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Maggio MC, De Pietro A, Porcelli P, Serraino F, Angileri T, Di Peri A, Corsello G. The predictive role of pelvic magnetic resonance in the follow up of spontaneous or induced puberty in turner syndrome. Ital J Pediatr 2018; 44:24. [PMID: 29433553 PMCID: PMC5809937 DOI: 10.1186/s13052-018-0458-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
Puberty is a critical age for patients with Turner syndrome (TS): infertility is reported to be linked to karyotype and spontaneous puberty and menarche occur in approximately 30% of patients, especially in mosaicism. However, it is not always predictable considering hormonal pattern and pelvic transabdominal ultrasound scan (US). The aim of the study is to compare the accuracy of Magnetic Resonance Imaging (MRI) and US to evaluate uterine and gonads volume, to visualize the presence of follicles and to predict spontaneous puberty and menarche in girls with TS. In a retrospective study, we evaluated 19 TS patients (age: 9–16 years), who underwent transabdominal pelvic US and pelvic MRI as required by parents. We correlated pelvic imaging with karyotype, hormonal data and pubertal outcome, and we compared US resolution to MRI. MRI revealed a higher accuracy in the study of uterus and ovaries, and permitted to measure ovaries not visualized by US. Ovarian volume, the presence of follicles and the occurrence of spontaneous puberty were not related to the karyotype; spontaneous puberty started in one patient with a karyotype 45,X and in two patients with mosaicism (45,X/46,XX; 47,XXX/45, X). Ovarian follicles were relieved by MRI in patients with a spontaneous menarche and the persistence of menstrual cycles correlated with an ovarian volume corresponding to Tanner stage 3–4. We stress the role of MRI in the follow-up of TS adolescents, guide in the choice of the timing of treatment.
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Affiliation(s)
- M C Maggio
- Universitary Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, via dei Benedettini n.1, 90134, Palermo, Italy.
| | - A De Pietro
- Diagnostic Operative Unit, "Villa S. Teresa Diagnostica per Immagini e Radioterapia", Bagheria, Palermo, Italy
| | - P Porcelli
- Operative Unit of Endocrinology "Azienda Ospedali Riuniti Villa Sofia-Cervello", ASP 6, Palermo, Italy
| | - F Serraino
- Universitary Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, via dei Benedettini n.1, 90134, Palermo, Italy
| | - T Angileri
- Diagnostic Operative Unit, "Villa S. Teresa Diagnostica per Immagini e Radioterapia", Bagheria, Palermo, Italy
| | - A Di Peri
- Universitary Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, via dei Benedettini n.1, 90134, Palermo, Italy
| | - G Corsello
- Universitary Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, via dei Benedettini n.1, 90134, Palermo, Italy
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Federici S, Dolezalova P, Cantarini L, Papadopoulou-Alataki E, Alessio M, Herlin T, Gueli I, Modesto C, Fabio G, Maggio MC, Elorduy MJR, Garibotto F, Insalaco A, Kozlova A, Anton J, Brik R, Frenkel J, Hoppenreijs E, Sormani MP, Martini A, Gattorno M. Perspective validation of the eurofever classification criteria for monogenic periodic fevers. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184335 DOI: 10.1186/1546-0096-12-s1-p82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lo Curto M, Maggio MC, Campisi F, Manzo V, Costa A, Montalbano G, Mosa C, Navarra F, Manzoni D, Licastro G, Corsello G. Functional pain in hospitalised and school children. Minerva Pediatr 2012; 64:493-500. [PMID: 22992531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Aim of the study was to recognise the role of psychological disagreement in children and adolescents suffering from functional pain. METHODS Two groups of children, adolescents and their parents were interviewed: group H (hospitalized patients), group S (students, at school). Suitable investigations excluded organic lesions. The following data were analysed: 1) presence of pain in relation with: i) sex and age; ii) relation with parents, brothers, other relatives, schoolfellows; 2) efficacy of possible treatments. RESULTS Group H: 194 patients, median age 10 years; 134 referred pain: 62 out of 92 males and 72 out of 102 females; location of pain: abdomen, limbs, head, back. Family disagreements: 36, functional pain 32; schoolfellows disagreements 114, functional pain 79. Correlations of pain with sex, increasing age, family and schoolfellows disagreements: non statistically significant. Group S: 246 students, median age: 13 years; 188 referred pain: 78 out of 118 males and 110 out of 128 females; pain was statistically more frequent in females, it increased with age. Location of pain: limbs, abdomen, head, back. Family disagreements: 31, functional pain 28, schoolfellows disagreements 140, functional pain 114. Correlations of pain with family and schoolfellows disagreements: non-statistically significant. Several parents gave answers which were different from their children's. Pharmacological and dietary interventions failed to obtain regression of pain. CONCLUSION In both groups, the referred disagreements were not statistically different among children with functional pain and those without pain; such psychological distress was not the only factor causing functional pain. The empiric treatment adopted was inefficacious.
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Affiliation(s)
- M Lo Curto
- Pediatric Department, University of Palermo, Palermo, Italy.
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Bertelloni S, Balsamo A, Giordani L, Fischetto R, Russo G, Delvecchio M, Gennari M, Nicoletti A, Maggio MC, Concolino D, Cavallo L, Cicognani A, Chiumello G, Hiort O, Baroncelli GI, Faienza MF. 17beta-Hydroxysteroid dehydrogenase-3 deficiency: from pregnancy to adolescence. J Endocrinol Invest 2009; 32:666-70. [PMID: 19498320 DOI: 10.1007/bf03345738] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Aim of this study is to report on basal clinical phenotype and follow up after diagnosis, of patients with 17beta-hydroxysteroid-dehydrogenase type 3 (17beta-HSD3) deficiency in Italy. SETTING Pediatric Endocrine Departments, University Hospitals. PATIENTS The cases of 5 Italian subjects affected by 17beta-HSD3 deficiency are presented in this study. INTERVENTIONS Laboratory and genetic assessment. Gonadectomy and female sex assignment (4 patients) or GnRH analog therapy to regress puberty and gender identity disorder (1 patient). RESULTS Presentation lasted from pregnancy (pre-natal diagnosis of a 46,XY fetus with female external genitalia) to infancy (inguinal hernia containing testes/clitoromegaly) and adolescence (virilisation). All subjects but one (subject 1, Central-Northern Italy) were from small areas of Southern Italy. Endocrine data (baseline and/or stimulated testosterone/ Delta4-androstenedione ratio) were informative. Two girls were homozygous for 17beta-HSD3 gene mutations (G289S/G289S; R80W/R80W), while the others were compound heterozygous (IVS325+4 A>T/A203V; L212Q/M235V; R80W/A235E). Four patients were confirmed as females and were well-adjusted with assigned sex; gender identity disorder improved during treatment with GnRH analog in the last subject. CONCLUSIONS 17betaHSD3 deficiency may present from pregnancy to puberty for different clinical issues. Albeit testosterone/Delta4-androstenedione ratio represents the most accurate endocrine marker to diagnose the disorder, hCGstimulation is mandatory in pre-puberty. Molecular analysis of 17beta-HSD3 gene should be performed to confirm the diagnosis. Temporary GnRH analog treatment may regress gender identity disorder and provide time to confirm or change the birth sex assignment. Female individuals seems to be compliant with their sex, providing that virilisation does not occur. In Italy, the disorder seems to be more prevalent in the Southern regions and shows genetic heterogeneity.
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Affiliation(s)
- S Bertelloni
- Adolescent Medicine, Department of Reproductive Medicine and Paediatrics, Santa Chiara University Hospital, 56126 - Pisa, Italy.
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Maggio MC, Corsello M, Piccione M, Piro E, Giuffrè M, Liotta A. Neonatal presentation of Prader Willi sindrome. Personal records. Minerva Pediatr 2007; 59:817-823. [PMID: 17978792] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Prader Willi Syndrome (PWS) is characterized by typical appearance, obesity, short stature, hypothalamic hypogonadism, cryptorchidism, hypotonia, behavioural abnormalities and mental retardation. It is considered as a continuous genes syndrome with different genotypes: microdeletion of the region 15q11-q13 with paternal imprinting; maternal uniparental disomy (UPD) of chromosome 15; chromosomal rearrangement. Clinical manifestations evolve with age from newborn (hypotonia, poor sucking, hypoplastic external genitalia) to childhood (delay in psychomotor development, hyperphagia, obesity, acromicria and craniofacial dysmorphisms). We present five newborns who received an early diagnosis, based on clinical presentation. The early treatment and follow-up can in fact improve the natural evolution of the syndrome in order to prevent respiratory tract diseases and obesity, and to improve growth.
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Affiliation(s)
- M C Maggio
- Maternal and Child Health Department, University of Palermo, Palermo, Italy.
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Maggio MC, Liotta A, De Grazia E, Cimador M, Di Pace R, Corsello G. Polycystic ovary and gonadoblastoma in Turner's syndrome. Minerva Pediatr 2007; 59:397-401. [PMID: 17947845] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Turner's syndrome (TS) is characterized by typical facial features, short stature, hypergonadotropic hypogonadism, streak gonads, infertility, hearth and kidney malformations. Typical karyotype is 45,X0; however, 6% of TS have mosaic patterns including Y chromosome or fragments of Y. This karyotype is a risk factor of developing a dysgerminoma in dysgenic gonads. Furthermore, rare cases of polycystic ovary are described in young-adult patients with TS. We describe the clinical case of a 12-year-old girl with TS treated with GH who showed a good response to treatment. She developed an ovary with histological polycystic pattern and a contralateral gonadoblastoma in the streak gonad. Laparoscopic gonadectomy was performed, with a good prognosis. Of remark is the opportunity to carry out gonadectomy in prepubertal age in girls with TS and Y chromosome material. This is a rare precocious case of polycystic ovary in TS, with different evolution in the two gonads with different histological differentiation.
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Affiliation(s)
- M C Maggio
- Maternal Infantile Department, University of Palermo, Palermo, Italy.
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Maggio MC, Corsello G, Iacono G, Teresi S, Guicciardino E, Terrana S, Liotta A. Gluten-free diet impact on leptin levels in asymptomatic coeliac adolescents: one year of follow-up. Horm Res 2006; 67:100-4. [PMID: 17057405 DOI: 10.1159/000096422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 08/08/2006] [Indexed: 12/19/2022]
Abstract
Coeliac disease, daily more frequently diagnosed in our population, involves many organs also in oligosymptomatic patients and with an adequate nutritional regime. Possible endocrine implications include failure to thrive, pubertal delay and reproduction diseases due to deregulation of GH, FSH and LH secretion. Leptin, an adipose tissue hormone, can be decreased as well and its deficiency could be related to growth and puberty anomalies. We studied 14 asymptomatic coeliac patients in peripubertal age (7.5-13.8 years) and tested their leptin levels in order to correlate them with endocrine and anthropometric data. Before the diet was started leptinaemia (M+/-DS) was: 4.94+/-5.53 ng/ml. In 10/14 patients (71%) leptinaemia was<or=2 DS for gender and age. In all the patients, after a period of 6-12 months of gluten-free diet, Leptin levels appreciably raised to 10.8+/-7.9 ng/ml, with a significant correlation to the time of the diet. Leptinaemia was actually lower in patients with a severe mucosal atrophy, and in these patients it increased more significantly after the diet was started. The removal of gluten itself may reduce immunological hit to adipose tissue and the 'malnutrition' of adipocytes: leptin can hence increase despite no significant increase of body mass index occurs. This study could partially explain the correlation between body mass index, Coeliac disease and the deregulation of puberty and fertility, mainly in patients who started the diet late. It could also explain the reversibility of this alteration if the cause is removed.
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Affiliation(s)
- M C Maggio
- Department Materno-Infantile, University of Palermo, and Analysis Laboratory, Unit of Paediatric Gastroenterology, Children's Hospital G. Di Cristina, Palermo, Italy.
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Titone L, Maggio MC, Di Carlo P, Romano A, Teresi S, Guicciardino E, Saitta M, Liotta A. Hormonal, auxological and clinical follow-up in children with connatal HIV infection. Personal records. Minerva Pediatr 2006; 58:461-7. [PMID: 17008857] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM HIV infection and antiretroviral drugs have relevant endocrine implications, affecting growth and pubertal development. Moreover stature impairment cannot depend only on decreased hormonal secretion. METHODS We studied for 7 years growth, puberty, bone maturation, hormonal secretion [Growth Hormone (GH) basal and after stimulation with Clonidin and Insulin, Insulin-like Growth Factor 1 (IGF-1), Insulin-like Growth Factor Binding Protein 3 (IGFBP-3), FSH, LH- gonadic hormones axis, ACTH, Cortisol, TSH, fT4, T4, T3, anti-thyroid antibodies, Leptin] of 10 HIV-infected children. RESULTS In 3 patients stature was <-2 SDS in the first 2 years and in prepubertal age, with intervals of improved growth. The weight was >2 SDS in 6 children, <-2 SDS in 1 girl, while the other 3 patients had a weight <-2SDS only in the first 2 years of life. Height growth velocity was >10 degrees Centile all over the years of follow-up in 9 patients, while weight growth velocity was pathological in 5. Leptinemia showed higher levels at the beginning of follow up: 0.82-11.68 ng/L (M+/-DS: 3.29+/-4.15) than at the end of the study: 0.2-3 ng/L (M+/-DS: 1.65+/-1.01). Leptin levels showed a statistically significant correlation with CD4/CD8 count (P: 0.010; r: 0.916) and with the CDC stage (P: 0.006; r: 0.937), meaning a strong link to the severity of the disease. CONCLUSIONS A good clinical control of HIV infection can guarantee growth within physiological centile in most of HIV-infected children. Over all IGFBP-3 and IGF-1 are good markers of growth, more usable than GH.
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Affiliation(s)
- L Titone
- Institute of Infectious Diseases and Virology, University of Palermo, Piazza Edison 2, 90144 Palermo, Italy
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Titone L, Di Carlo P, Romano A, Maggio MC, Salsa L, Abbagnato L, Mazzola A. Tuberculosis of the central nervous system in children: 32 years survey. Minerva Pediatr 2004; 56:611-7. [PMID: 15765023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM In order to study the impact of clinical and diagnostic parameters on the clinical outcome of children with central nervous system tuberculosis (CNS-TB), we retrospectively reviewed all cases of CNS-TB diagnosed over a 32-year period at the Children's Hospital of Palermo, Italy. METHODS Data were collected with regard to the clinical, laboratory and demographic characteristics of patients, as well as the results of radiological investigations and data on clinical outcome. In relation to the date of introduction of new diagnostic methods (indirect as well direct) and to the change of treatment periods, the authors compared the clinical outcome of patients admitted prior and after 1984. They also classified the patients into 3 different stages of illness according to the severity of the disease on admission. RESULTS We identified 80 patients with CNS-TB. The mean age of the children was 3 years with 54% of patients younger than 5 years. The contact source was documented in 40 patients (50%). The mean duration of symptoms prior to admission was 22 days (range 5 days - 3 months). Mantoux skin test was positive on admission in 50 patients (62%). CSF smear microscopy and culture were positive in 29% and 45% of patients respectively. PCR for Mycobacterium tuberculosis introduced in 1994 was positive in 11 out of 13 tested patients. Determination of CSF gdT lymphocytes composition applied in 7 patients shows a predominance of Vg9/Vd2 T lymphocytes. Fifteen subjects (19%) died; 11 (13%) suffered from permanent sequelae. The died children and those with permanent sequelae were younger than the others (p<0.05). Prior to 1984, none of the patients were identified during early stage of illness and 4 out of 37 patients with stage II illness died. After 1985, 44% of children were in stage I and 2 out of 4 patients with stage III died (p<0.05). CONCLUSIONS Stage of disease and young age are still the decisive factors in the clinical outcome of children with CNS-TB. The availability of new advanced methods has improved the identification of patients with CNS-TB in stage I and therefore the possibility of an early treatment of such patients.
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Affiliation(s)
- L Titone
- Department of Infectious Diseases and Virology, University of Palermo, Palermo, Italy
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Romano A, Di Carlo P, Abbagnato L, Salsa L, Mazzola A, Maggio MC, Titone L. Pulmonary tuberculosis in Italian children by age at presentation. Minerva Pediatr 2004; 56:189-95. [PMID: 15249903] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM To evaluate the clinical characteristics, diagnostic methods and outcome of paediatric pulmonary tuberculosis (PTB) in relation to children's ages when observed. METHODS Children under 15, who had been admitted to the Children's Hospital with PTB were prospectively evaluated. Our sample included patients with a positive tuberculin skin test and signs or symptoms of tuberculosis (TB), including abnormal chest X-rays which suggested PTB. We collected demographic, clinical, radiographic and microbiological data from the patients, in addition to carrying out contact investigations in order to find a source case. All the patients involved in this study were subjected to anti-tuberculosis treatment. RESULTS Sixty-two patients (44% under 5) were eligible for inclusion in our study. Children with presenting symptoms were younger than asymptomatic patients (p<0.05). A source case was found in 38 patients out of 62 children (62%) and children under 5 were more likely to have a source case than that found with older children (p<0.05). Ghon complex (infiltrate + adenopathy) tended to occur in young children (median age of 3.25, p<0.05). Fourteen children (23%) had clinical specimens which tested positive for Mycobacterium tuberculosis (MT), and 20 (32%) for MT DNA according to a polymerase chain reaction (PCR). Resistant strains to 1 or more anti-tuberculosis drugs were found in 5 children and in 4 adult sources. The patients with minimal or no radiographic change during therapy displayed symptoms for a longer period of time and were infected by a resistant strain (p<0.05). CONCLUSION Improvements in case detection, case management and contact investigations are necessary for controlling paediatric TB, especially in young children. Given that any diagnosis of TB in children is supported by epidemiological and clinical evidence rather than isolating MT, detection of the source case is important in selecting appropriate treatment.
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Affiliation(s)
- A Romano
- Civico Hospital, ARNAS, Palermo, Italy
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Liotta A, Maggio MC, Iachininoto R, Bellipanni PF, Calì G, Arena V, Arena F. [Fetal pseudohypoaldosteronism: rare cause of hydramnios]. Pediatr Med Chir 2004; 26:145-7. [PMID: 15700742] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
PHA is a rare cause of hydramnios, characterized by increased amniotic fluid levels of aldosterone and sodium. Two distinct genetic entities (PHA type I and PHA type II) are included. Both are stemmed by a target organ defect with diminished renal tubular responsiveness to aldosterone. The AA present a case in which pregnancy resulted in a preterm infant with severe hydramnios, metabolic acidosis, hyponatriemia, hyperkaliemia. Salt and fluid replacement significantly improved clinical and metabolic condition. However a growth deficiency (-2 SDS) persists at follow-up.
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Affiliation(s)
- A Liotta
- Dipartimento Materno-Infantile, Università di Palermo
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Bertelloni S, Maggio MC, Geraci S, Navari S, Corsello G, Hiort O. [17 beta hydroxysteroid dehydrogenase deficiency. Clinical, endocrinological and molecular features]. Minerva Pediatr 2003; 55:69-71. [PMID: 14992185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- S Bertelloni
- Centro di Riferimento Regionale di Endocrinologia Pediatrica, Dipartimento di Medicina della Procreazione e dell'Età Evolutiva, Università di Pisa, Ospedale Santa Chiara, Pisa.
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Liotta A, Maggio MC, Iachininoto R, Bellipanni PF, Calì G, Arena V, Arena E. [Fetal pseudohypoaldosteronism: a rare cause of hydramnios]. Pediatr Med Chir 2003; 25:375-7. [PMID: 15058841] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
PHA is a rare cause of hydramnios, characterized by increased amniotic fluid levels of aldosterone and sodium. Two distinct genetic entities (PHA type I and PHA type II) are included. Both are stemmed by a target organ defect with diminished renal tubular responsiveness to aldosterone. The AA present a case in which pregnancy resulted in a preterm infant with severe hydramnios, metabolic acidosis, hyponatriemia, hyperkaliemia. Salt and fluid replacement significantly improved clinical and metabolic condition. However a growth deficiency (-2 SDS) persists at follow-up.
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Affiliation(s)
- A Liotta
- Dipartimento Materno-Infantile, Università di Palermo
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Maggio MC, Iachininoto R, Arena V, Liotta A. Interstitial deletion of the long arm of chromosome 1 (1q 25-32). Clinical and endocrine features with a long term follow-up. Minerva Pediatr 2003; 55:55-9, 59-61. [PMID: 12660627] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Deletion of long arm of chromosome 1 (1q-) is a rare condition with malformations of many organs (central nervous system, heart, kidney, etc.). Authors describe a young girl characterised by 1q 25-32 deletion, with severe intra- and extrauterine growth retardation, facial dismorphisms, multiple organ malformations. The patient is followed for a long-term clinical and endocrine evaluation, with evidence of hypoplastic hypophysis and multiple endocrine deficiency.
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Affiliation(s)
- M C Maggio
- Maternal-Infantile Department, University of Palermo, Palermo, Italy.
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Liotta A, Maggio MC, Di Carlo P, Teresi S, Romano A, Guicciardino E, Miraglia PM, Titone L. Serum leptin and interleukin-6 levels in pediatric patients with HIV. J Pediatr Endocrinol Metab 2003; 16:179-83. [PMID: 12713254 DOI: 10.1515/jpem.2003.16.2.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent therapeutic approaches have improved the prognosis of children with HIV. Many new efforts could be involved in their quality of life and therefore could need additional diagnostic strategies. Leptin regulates pubertal development; furthermore a continuous immune stimulus, as in chronic infectious diseases, can enhance leptin's secretion by the action of cytokines such as interleukin (IL)-6. To clarify this role in patients infected with HIV, we assayed leptin and IL-6 and evaluated the influence of HIV severity on its secretion. IL-6 (380.5 +/- 257.6 pg/ml; range: 22-900 pg/ml) showed a significant correlation with leptinemia, HIV-1 RNA, and viremia related to the stage of HIV disease. The difference in leptinemia from a control group (3 +/- 3.2 ng/ml; range: 1-12 ng/ml in HIV patients; 6.72 +/- 8 ng/ml in the controls) did not reach statistical significance, nor did it correlate with pubertal stage, BMI, viremia, CD4 or anti-retroviral therapy. There was a statistically significant correlation between leptinemia and the stage of the HIV disease, and with IL-6 level. We want to stress the role of immunological factors in enhancing leptin secretion.
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Affiliation(s)
- A Liotta
- Department Materno-Infantile, Children's Hospital G. Di Cristina , Palermo, Italy
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Abstract
A videotape-administered role-play test of children's social skills was developed and its psychometric properties tested. Performance criteria for the test were derived from popular children's ratings of the effectiveness of different role-play responses. The test was administered to 157 fourth- and fifth-grade boys and girls who had been classified as popular, average, neglected, or rejected, on the basis of sociometric testing. The test evidenced good interrater, test-retest, and internal consistency reliabilities. Children's role-play performance correlated significantly with teacher ratings of social competence and with peer-liking ratings. Neglected children performed more poorly on the role-play test than popular children. When differences in intelligence among social status groups were statistically controlled, social status groups did not differ on the role-play test. Results of the discriminant analyses support the conclusion that teacher ratings are better than role-play tests for identifying rejected children, whereas role-play tests and measures of intelligence appear more accurate than teacher ratings for identifying neglected children.
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Affiliation(s)
- J N Hughes
- Department of Educational Psychology, Texas A&M University, College Station 77843-4225
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