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Milani GP, Ronchi A, Agostoni C, Marchisio P, Chidini G, Pesenti N, Bellotti A, Cugliari M, Crimi R, Fabiano V, Pietrasanta C, Pugni L, Mosca F. Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis. Eur J Pediatr 2024; 183:1751-1758. [PMID: 38236404 PMCID: PMC11001736 DOI: 10.1007/s00431-023-05395-1] [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: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
Bronchiolitis is a common cause of hospitalization in infants. The long-lasting impact of hygiene and social behavior changes during the pandemic on this disease is debated. We investigated the prevalence of hospitalized cases, clinical severity, and underlying risk factors before and during pandemic. The study was conducted in 27 hospitals in Italy and included infants hospitalized for bronchiolitis during the following four periods: July 2018-March 2019, July 2020-March 2021, July 2021-March 2022, and July 2022-March 2023. Data on demographics, neonatal gestational age, breastfeeding history, underlying chronic diseases, presence of older siblings, etiologic agents, clinical course and outcome were collected. A total of 5330 patients were included in the study. Compared to 2018-19 (n = 1618), the number of hospitalizations decreased in 2020-21 (n = 121). A gradual increase was observed in 2021-22 (n = 1577) and 2022-23 (n = 2014). A higher disease severity (need and length of O2-supplementation, need for non-invasive ventilation, hospital stay) occurred in the 2021-22 and, especially, the 2022-23 periods compared to 2018-19. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity. Conclusions: Compared to adults, COVID-19 in infants is often asymptomatic or mildly symptomatic and rarely results in hospitalization. This study indicates that the pandemic has indirectly induced an increased burden of bronchiolitis among hospitalized infants. This shift, which is not explained by the recognized risk factors, suggests the existence of higher infant vulnerability during the last two seasons. What is known: • The pandemic led to a change in epidemiology of respiratory diseases • Large data on severity of bronchiolitis and underlying risk factors before and during COVID-19 pandemic are scarce What is new: • Compared to pre-pandemic period, hospitalizations for bronchiolitis decreased in 2020-21 and gradually increased in 2021-22 and 2022-23 • Compared to pre-pandemic period, higher disease burden occurred in 2021-22 and, especially, in 2022-23. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity • The interplay among viruses, preventive measures, and the infant health deserves to be further investigated.
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Affiliation(s)
- Gregorio Paolo Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
| | - Andrea Ronchi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
| | - Paola Marchisio
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Giovanna Chidini
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anita Bellotti
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
| | - Marco Cugliari
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
| | - Riccardo Crimi
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Carlo Pietrasanta
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Via Della Commenda 9, 20122, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Calcaterra V, Cena H, De Giuseppe R, Biino G, Grazi R, Manuelli M, Zanelli S, Tagi V, Vincenti A, Zuccotti G, Fabiano V. An Adapted Questionnaire Tailored for Assessing the Risk of Vitamin D Deficiency in Children That Is Proving Useful in Guiding Clinical Interventions. Nutrients 2024; 16:971. [PMID: 38613005 PMCID: PMC11013822 DOI: 10.3390/nu16070971] [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: 02/25/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The identification of vitamin D (VitD) deficiency in pediatric populations is essential for preventive healthcare. We refined and tested the Evaluation of Deficiency Questionnaire (EVIDENCe-Q) for its utility in detecting VitD insufficiency among children. PATIENTS AND METHODS We enrolled 201 pediatric patients (aged between 3 and 18 years). Clinical evaluation and serum vitamin D levels were assessed in all subjects. The EVIDENCe-Q was updated to incorporate factors influencing VitD biosynthesis, intake, assimilation, and metabolism, with scores spanning from 0 (optimal) to 36 (poor). RESULTS We established scores for severe deficiency (<10 mg/dL) at 20, deficiency (<20 mg/dL) at 22, and insufficiency (<30 mg/dL) at 28. A score of 20 or greater was determined as the optimal cut-off for distinguishing VitD deficient from sufficient statuses, as evidenced by ROC curve analysis AUC = 0.7066; SE = 0.0841; sensitivity 100%, 95% CI 0.561-1. The most accurate alignment was seen with VitD insufficiency, defined as 25-OH-D3 < 20 ng/mL. CONCLUSIONS This study confirms that the EVIDENCe-Q is a valid instrument for assessing the risk of vitamin D deficiency and insufficiency in children. It offers a practical approach for determining the need for clinical intervention and dietary supplementation of VitD in the pediatric population.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (R.D.G.); (M.M.); (A.V.)
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, Clinical Scientific Institute Maugeri IRCCS, 27100 Pavia, Italy
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (R.D.G.); (M.M.); (A.V.)
| | - Ginevra Biino
- Institute of Molecular Genetics, National Research Council of Italy, 27100 Pavia, Italy;
| | - Roberta Grazi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
| | - Matteo Manuelli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (R.D.G.); (M.M.); (A.V.)
| | - Sara Zanelli
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
| | - Veronica Tagi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
| | - Alessandra Vincenti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (R.D.G.); (M.M.); (A.V.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
| | - Valentina Fabiano
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (R.G.); (S.Z.); (V.T.); (G.Z.); (V.F.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
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Calcaterra V, Magenes VC, Massini G, De Sanctis L, Fabiano V, Zuccotti G. High Fat Diet and Polycystic Ovary Syndrome (PCOS) in Adolescence: An Overview of Nutritional Strategies. Nutrients 2024; 16:938. [PMID: 38612972 PMCID: PMC11013055 DOI: 10.3390/nu16070938] [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: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multifaceted and heterogeneous disorder, linked with notable reproductive, metabolic, and psychological outcomes. During adolescence, key components of PCOS treatment involve weight loss achieved through lifestyle and dietary interventions, subsequently pursued by pharmacological or surgical therapies. Nutritional interventions represent the first-line therapeutic approach in adolescents affected by PCOS, but different kinds of dietary protocols exist, so it is necessary to clarify the effectiveness and benefits of the most well-known nutritional approaches. We provided a comprehensive review of the current literature concerning PCOS definition, pathophysiology, and treatment options, highlighting nutritional strategies, particularly those related to high-fat diets. The high-fat nutritional protocols proposed in the literature, such as the ketogenic diet (KD), appear to provide benefits to patients with PCOS in terms of weight loss and control of metabolic parameters. Among the different types of KD studies, very low-calorie ketogenic diets (VLCKD), can be considered an effective dietary intervention for the short-term treatment of patients with PCOS. It rapidly leads to weight loss alongside improvements in body composition and metabolic profile. Even though extremely advantageous, long-term adherence to the KD is a limiting factor. Indeed, this dietary regimen could become unsustainable due to the important restrictions required for ketosis development. Thus, a combination of high-fat diets with more nutrient-rich nutritional regimens, such as the Mediterranean diet, can amplify positive effects for individuals with PCOS.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.)
| | - Vittoria Carlotta Magenes
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.)
| | - Giulia Massini
- Pediatric Endocrinology, Regina Margherita Children Hospital, 10131 Torino, Italy; (G.M.); (L.D.S.)
- Department of Public Health and Pediatric Sciences, University of Torino, 10131 Torino, Italy
| | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital, 10131 Torino, Italy; (G.M.); (L.D.S.)
- Department of Public Health and Pediatric Sciences, University of Torino, 10131 Torino, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.)
- Department of Biomedical and Clinical Science, Università degli Studi di Milano, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.)
- Department of Biomedical and Clinical Science, Università degli Studi di Milano, 20157 Milan, Italy
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Calcaterra V, Rossi V, Magenes VC, Baldassarre P, Grazi R, Loiodice M, Fabiano V, Zuccotti G. Dietary habits, depression and obesity: an intricate relationship to explore in pediatric preventive strategies. Front Pediatr 2024; 12:1368283. [PMID: 38523835 PMCID: PMC10957686 DOI: 10.3389/fped.2024.1368283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Obesity and depression represent major health problems due to their high prevalence and morbidity rates. Numerous evidences elucidated the connections between dietary habits and the incidence or severity of depression. This overview aims to investigate the intricate relationship between dietary patterns and depression with the objective of elaborating preventive strategies for childhood obesity. Literature data recognized that there is a link between mood and food choices, with certain foods selected for their impact on the brain's reward centers. This behavior parallels the one observed in substance addiction, suggesting a specific neural mechanism for food addiction that contributes to overeating and obesity. It is important to note the significant correlation between obesity and depression, indicating a shared biological pathway influencing these conditions. Stress substantially affects also eating behaviors, often leading to increased consumption of pleasurable and rewarding foods. This can trigger a cycle of overeating, weight gain, and psychological distress, exacerbating mood disorders and obesity. In addition, consumption of certain types of foods, especially "comfort foods" high in fat and calories, may provide temporary relief from symptoms of depression, but can lead to long-term obesity and further mental health problems. Understanding these complex interactions is critical to developing preventive strategies focusing on dietary, emotional, and environmental factors, thereby reducing the risk of obesity and mood disorders.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | | | - Paola Baldassarre
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Roberta Grazi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Martina Loiodice
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, Milan, Italy
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Colombo SFG, Nava C, Castoldi F, Fabiano V, Meneghin F, Lista G, Cavigioli F. Preterm Infants' Airway Microbiome: A Scoping Review of the Current Evidence. Nutrients 2024; 16:465. [PMID: 38398790 PMCID: PMC10891673 DOI: 10.3390/nu16040465] [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: 12/08/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
The aim of this scoping review was to investigate and synthesize existing evidence on the airway microbiome of preterm infants to outline the prognostic and therapeutic significance of these microbiomes within the preterm population and identify gaps in current knowledge, proposing avenues for future research. We performed a scoping review of the literature following the Arskey and O'Malley framework. In accordance with our inclusion criteria and the intended purpose of this scoping review, we identified a total of 21 articles. The investigation of the airway microbiome in preterm infants has revealed new insights into its unique characteristics, highlighting distinct dynamics when compared to term infants. Perinatal factors, such as the mode of delivery, chorioamnionitis, the respiratory support, and antibiotic treatment, could impact the composition of the airway microbiome. The 'gut-lung axis', examining the link between the lung and gut microbiome as well as modifications in respiratory microbiome across different sites and over time, has also been explored. Furthermore, correlations between the airway microbiome and adverse outcomes, such as bronchopulmonary dysplasia (BPD), have been established. Additional research in neonatal care is essential to understand the early colonization of infants' airways and explore methods for its optimization. The critical opportunity to shape long-term health through microbiome-mediated effects likely lies within the neonatal period.
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Affiliation(s)
- Sofia Fatima Giuseppina Colombo
- Department of Pediatrics, Buzzi Children’s Hospital, 20154 Milan, Italy; (S.F.G.C.); (C.N.)
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
| | - Chiara Nava
- Department of Pediatrics, Buzzi Children’s Hospital, 20154 Milan, Italy; (S.F.G.C.); (C.N.)
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
| | - Francesca Castoldi
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
| | - Valentina Fabiano
- Department of Pediatrics, Buzzi Children’s Hospital, 20154 Milan, Italy; (S.F.G.C.); (C.N.)
| | - Fabio Meneghin
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
| | - Gianluca Lista
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
| | - Francesco Cavigioli
- Division of Neonatology, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.C.); (F.M.); (G.L.)
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Ceruti D, Colombo C, Loiodice M, DE Leo S, Calcaterra V, Fabiano V. Vitamin D levels and lipid profile in children and adolescents: a tight correlation. Minerva Pediatr (Torino) 2024:S2724-5276.23.07352-4. [PMID: 38224323 DOI: 10.23736/s2724-5276.23.07352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Vitamin D is an essential hormone for humans, playing an important role in musculoskeletal and calcium homeostasis. Its deficiency/insufficiency seems to contribute to the development of cardiometabolic diseases in adults: this correlation appears less clear for children and adolescents. The aim of this paper was to review literature data on the relationship between vitamin D and lipid profile alterations in pediatric population. EVIDENCE ACQUISITION We carried out a comprehensive research in electronic databases, including MEDLINE and PubMed up to December 2022, for cross-sectional or prospective studies that investigated the correlation between serum vitamin D levels and lipid profile in children and adolescents. At the end of the process, 37 articles were included in this review. EVIDENCE SYNTHESIS According to our findings, vitamin D deficiency/insufficiency is strongly associated with lower high-density lipoprotein (HDL) cholesterol levels and higher levels of triglycerides and total cholesterol. Data about low-density lipoproteins (LDL) cholesterol are inconsistent. The potential role of vitamin D supplements for the prevention of cardiometabolic disease currently remains a speculation. CONCLUSIONS An increasing number of studies shows how hypovitaminosis D in the pediatric age may play a role in the pathogenesis of metabolic disorders and lipid profile alterations. Data regarding the potential role of vitamin D supplements for the prevention of cardiometabolic disease are currently controversial. Further studies are needed to evaluate the causality of this association and to assess the underlying pathogenetic mechanisms.
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Affiliation(s)
- Daniele Ceruti
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Carla Colombo
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy -
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico IRCCS, Milan, Italy
| | - Martina Loiodice
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Simone DE Leo
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico IRCCS, Milan, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Lai A, Bergna A, Fabiano V, Ventura CD, Fumagalli G, Mari A, Loiodice M, Zuccotti GV, Zehender G. Epidemiology and molecular analyses of respiratory syncytial virus in the 2021-2022 season in northern Italy. Front Microbiol 2024; 14:1327239. [PMID: 38239726 PMCID: PMC10794773 DOI: 10.3389/fmicb.2023.1327239] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background Human respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infection among infants and young children worldwide, with seasonal peaks in January and February. This study aimed to characterize the RSV samples from a pediatric cohort in the 2021-2022 season in Italy. Methods In total, 104 samples were collected from pediatric patients attending the "Vittore Buzzi" Children's Hospital in Milan, Italy in the 2021-2022 season. RT-PCR and next-generation sequencing were used to discriminate subgroups and obtain whole genomes. Maximum likelihood and Bayesian phylogenetic methods were used to analyze Italian sequences in the European contest and date Italian clusters. Results The median age was 78 days, and 76.9% of subjects required hospitalization, with a higher proportion of patients under 3 months of age. An equal proportion of subgroups A (GA2.3.5) and B (GB5.0.5a) was found, with significant differences in length of hospitalization, days of supplemental oxygen treatment, and intravenous hydration duration. Phylogeny highlighted 26 and 37 clusters containing quite the total of Italian sequences for RSV-A and -B, respectively. Clusters presented a tMRCA between December 2011-February 2017 and May 2014-December 2016 for A and B subgroups, respectively. Compared to European sequences, specific mutations were observed in Italian strains. Conclusion These data confirmed a more severe clinical course of RSV-A, particularly in young children. This study permitted the characterization of recent Italian RSV whole genomes, highlighting the peculiar pattern of mutations that needs to be investigated further and monitored.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valentina Fabiano
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Carla della Ventura
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giulia Fumagalli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Alessandra Mari
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Martina Loiodice
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy
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Casini F, Scaltrito F, Grimaldi MT, Pop TL, Calcaterra V, Zuccotti GV, Pettoello-Mantovani M, Ferrara P, Corsello G, Fabiano V. Use of complementary and alternative medicine in children affected by oncologic, neurologic and liver diseases: a narrative review. Ital J Pediatr 2023; 49:152. [PMID: 37968663 PMCID: PMC10647067 DOI: 10.1186/s13052-023-01554-0] [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: 07/12/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
Complementary and alternative medicine (CAM) consist of a broad group of restorative resources often linked to existing local cultures and established health care systems and are also increasingly used in children with some serious illnesses. In this narrative review, we examine the epidemiology of the use, efficacy, and safety of complementary and alternative medicine in pediatric oncology, neurology, and hepatology. We searched for relevant articles published in Pubmed evaluating CAM use and its efficacy in safety in children affected by oncologic, neurologic and liver diseases. CAM is used to improve the success of conventional therapies, but also to alleviate the pain, discomfort, and suffering resulting from the diseases and their treatment, which are often associated with a significant burden of adverse effects. CAM use must be evaluated in children with neurological, oncological and liver diseases.
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Affiliation(s)
- Francesca Casini
- Pediatric Department, University of Milan, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - Francesca Scaltrito
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Tudor Lucian Pop
- 2Nd Pediatric Discipline, Department of Mother and Child, Center of Expertise in Pediatric Liver Rare Diseases, Iuliu Hatieganu University of Medicine and Pharmacy2Nd Pediatric ClinicEmergency Clinical Hospital for Children Cluj-Napoca, Cluj-Napoca, Romania
- European Pediatric Association-Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Valeria Calcaterra
- Pediatric Department, University of Milan, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Internal Medicine, University of Pavia, 27100, Pavia, Italy
| | - Gian Vincenzo Zuccotti
- Pediatric Department, University of Milan, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Massimo Pettoello-Mantovani
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- European Pediatric Association-Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Pietro Ferrara
- Department of Medicine and Surgery, University Campus Bio-Medico, Rome, Italy
- Operative Research Unit of Pediatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Valentina Fabiano
- Pediatric Department, University of Milan, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy.
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Calcaterra V, Magenes VC, Siccardo F, Hruby C, Basso M, Conte V, Maggioni G, Fabiano V, Russo S, Veggiotti P, Zuccotti G. Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders. Front Nutr 2023; 10:1205331. [PMID: 37841407 PMCID: PMC10576529 DOI: 10.3389/fnut.2023.1205331] [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: 04/13/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Eating disorders (ED) are one of the most prevalent chronic disorders in adolescents and young adults, with a significantly increasing prevalence in younger children, particularly in girls. Even if obesity in essence is not framed as an eating disorder and has always been considered a separate pathology, ED and obesity could be considered part of a continuum. It has become evident that one condition can lead to another, such as binge eating disorder (BED) and bulimia nervosa, and that they share the same repercussions in terms of psychosocial, metabolic, and nutritional health. This narrative review aims to investigate the hypothalamic-pituitary-thyroid axis in undernourished and overnourished patients with ED, including obesity, in order to highlight the relationship between weight control and thyroid function and its effects and to consider therapeutic and preventive strategies in children and adolescents. Literature data report that thyroid alterations occur in patients with ED, both underweight and overweight, and represent a continuum of changes depending on the severity and time course of the disease involving the endocrine system. Considering the relevant role thyroid hormones (TH) play not only in energy expenditure (EE) but also in metabolic control and cardiovascular risks related to dysmetabolism and mood regulation, continuous monitoring of thyroid homeostasis in patients with ED is mandatory to prevent severe complications and to start early treatment when necessary.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
| | | | | | - Chiara Hruby
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
| | - Martina Basso
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Veronica Conte
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Giulia Maggioni
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Valentina Fabiano
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
| | - Susanna Russo
- Child and Adolescent Neuropsychiatry Unit (UONPIA), ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Pierangelo Veggiotti
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatric, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
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Calcaterra V, Magenes VC, Tagi VM, Grazi R, Bianchi A, Cena H, Zuccotti G, Fabiano V. Association between Vitamin D Levels, Puberty Timing, and Age at Menarche. Children (Basel) 2023; 10:1243. [PMID: 37508740 PMCID: PMC10378582 DOI: 10.3390/children10071243] [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: 06/25/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Pubertal development represents the process of physical maturation where an adolescent reaches sexual maturity and attains reproductive function. The effects of vitamin D are mainly mediated by the vitamin D receptor (VDR), which is expressed in almost all body cells, including the ovary and human pituitary gland and animal hypothalamus. Thus, vitamin D has gained great interest as pathogenic factor of pubertal disorders and fertility. This narrative review aimed to provide a broad overview of the available literature regarding the association between vitamin D levels, puberty timing, and age at menarche. A review of the data on the involvement of micronutrient deficiency, as a modifiable cause of pubertal disorders, is important for the prediction and prevention of deficiencies as well as for fertility protection and should be considered a public health priority. Reported data support that vitamin D is a regulator of neuroendocrine and ovarian physiology and, more in detail, a deficiency of vitamin D is involved in altered pubertal timing. Considering the long-term consequences of early pubertal development and early menarche, the detection of modifiable causes is crucial in preventive strategies. Future studies in humans and with an increased scale are needed to elucidate the vitamin D role in sexual maturation and puberty development.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milano, Italy
| | | | | | - Roberta Grazi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milano, Italy
| | - Alice Bianchi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milano, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, Clinical Scientific Institutes Maugeri IRCCS, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milano, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
| | - Valentina Fabiano
- Pediatric Department, Buzzi Children's Hospital, 20154 Milano, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
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Calcaterra V, Rossi V, Massini G, Casini F, Zuccotti G, Fabiano V. Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity. Nutrients 2023; 15:3144. [PMID: 37513562 PMCID: PMC10384396 DOI: 10.3390/nu15143144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) affects a considerable percentage of females of reproductive age. PCOS is an obesity-related condition and its effects are greatly amplified by obesity. Even though the pathogenesis of PCOS remains complex and has not been fully elucidated, a link between obesity, PCOS, and dysbiosis has been described. The potential role of the gut microbiota in the development and progression of PCOS and its associated symptoms has also been reported. The aim of this narrative review is to present a non-systematic analysis of the available literature on the topic of probiotics and PCOS in adolescents with obesity in order to revise the beneficial effects of probiotics/symbiotic supplementation on hormonal and metabolic profiles and inflammatory conditions. The effectiveness of probiotics/synbiotics in PCOS has been supported. The literature suggests that probiotic/symbiotic supplementation may ameliorate hormonal profiles, inflammatory indicators, and lipid metabolism disturbances caused by PCOS. Studies also show improvements in weight, BMI, insulin, and HOMA-IR, including a potential role it plays in protecting fertility. Even though further studies are needed to confirm these findings, particularly in adolescent patients, probiotic supplementation may be considered a solution for managing PCOS in adolescents with obesity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Giulia Massini
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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Di Profio E, Leone A, Vizzuso S, Fiore G, Pascuzzi MC, Agostinelli M, Dilillo D, Mannarino S, Fiori L, D’Auria E, Fabiano V, Carlucci P, Bova SM, Zoia E, Bosetti A, Calcaterra V, Bertoli S, Verduci E, Zuccotti G. Longitudinal Anthropometry and Body Composition in Children With SARS-CoV-2-Associated Multisystem Inflammatory Syndrome. J Pediatr Gastroenterol Nutr 2023; 76:505-511. [PMID: 36689921 PMCID: PMC10012841 DOI: 10.1097/mpg.0000000000003705] [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: 08/04/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Acute coronavirus disease 2019 infection has been shown to negatively affect body composition among adult and malnourished or obesity children. Our aim is to longitudinally evaluate body composition in children affected by the Multisystem Inflammatory Syndrome (MIS-C). METHODS In this cohort study, we recruited 40 patients affected by MIS-C, aged 2-18 years old, who were admitted in our clinic between December 2020 and February 2021. Physical examination for each participant included weight, height, body mass index (BMI) z score, circumferences, and skinfolds assessment. The same measurements were repeated during outpatient follow-up at 10 (T2), 30 (T3), 90 (T4), and 180 (T5) days after hospital discharge. Fat mass and fat free mass were calculated according to skinfolds predictive equations for children and adolescents. A control group was randomly selected among patients attending a pediatric nutritional outpatient clinic. RESULTS BMI z score significantly decrease between preadmission and hospital discharge. Similarly, arm circumference z score, arm muscular area z score, and arm fat area z score significantly decreased, during hospital stay. Fat mass index (FMI) significantly increased over time, peaking at T3. Fat free mass index decreased during hospitalization. CONCLUSIONS To the best of our knowledge, this is the first study to assess body composition in a numerically large pediatric MIS-C population from acute infection to 6 months after triggering event. FMI and anthropometric parameters linked to fat deposits were significantly higher 6 months after acute event. Thus, limiting physical activity and having sedentary lifestyle may lead to an accumulation of adipose tissue even in healthy children who experienced MIS-C and long hospitalization.
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Affiliation(s)
- Elisabetta Di Profio
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandro Leone
- the International Centre for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Sara Vizzuso
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Giulia Fiore
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Martina Chiara Pascuzzi
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Marta Agostinelli
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Dario Dilillo
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Savina Mannarino
- the Pediatric Cardiology Unit, “Vittore Buzzi” Children’s Hospital, Milano, Italy
| | - Laura Fiori
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Enza D’Auria
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Valentina Fabiano
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Patrizia Carlucci
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Stefania Maria Bova
- the Paediatric Neurology Unit, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Elena Zoia
- the Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, Milano, Italy
| | - Alessandra Bosetti
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Valeria Calcaterra
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Simona Bertoli
- Lab of Nutrition and Obesity Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Elvira Verduci
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- From the Pediatric Department, “Vittore Buzzi” Children’s Hospital, University of Milan, Milan, Italy
- the Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
- the Pediatric Clinical Research Centre, Fondazione Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
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Calcaterra V, Magenes VC, Hruby C, Siccardo F, Mari A, Cordaro E, Fabiano V, Zuccotti G. Links between Childhood Obesity, High-Fat Diet, and Central Precocious Puberty. Children (Basel) 2023; 10:children10020241. [PMID: 36832370 PMCID: PMC9954755 DOI: 10.3390/children10020241] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023]
Abstract
In recent years, the existing relationship between excess overweight and central precocious puberty (CPP) has been reported, especially in girls. Different nutritional choices have been associated with different patterns of puberty. In particular, the involvement of altered biochemical and neuroendocrine pathways and a proinflammatory status has been described in connection with a high-fat diet (HFD). In this narrative review, we present an overview on the relationship between obesity and precocious pubertal development, focusing on the role of HFDs as a contributor to activating the hypothalamus-pituitary-gonadal axis. Although evidence is scarce and studies limited, especially in the paediatric field, the harm of HFDs on PP is a relevant problem that cannot be ignored. Increased knowledge about HFD effects will be useful in developing strategies preventing precocious puberty in children with obesity. Promoting HFD-avoiding behavior may be useful in preserving children's physiological development and protecting reproductive health. Controlling HFDs may represent a target for policy action to improve global health.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
- Correspondence:
| | | | - Chiara Hruby
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
| | | | - Alessandra Mari
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
| | - Erika Cordaro
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
| | - Valentina Fabiano
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
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Calcaterra V, Magenes VC, Rossi V, Fabiano V, Mameli C, Zuccotti G. Lipodystrophies in non-insulin-dependent children: Treatment options and results from recombinant human leptin therapy. Pharmacol Res 2023; 187:106629. [PMID: 36566927 DOI: 10.1016/j.phrs.2022.106629] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/10/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Lipodystrophy is a general definition containing different pathologies which, except for those observed in insulin-treated subjects falling outside the scope of this paper, are characterized by total or partial lack of body fat, that, according to the amount of missing adipose tissue, are divided in generalized or partial lipodystrophy. These diseases are characterized by leptin deficiency, which often leads to metabolic derangement, causing insulin resistance, dyslipidemia, and increasing cardiovascular risk. In this narrative review, we presentend the clinical presentation of different types of lipodystrophies and metabolic unbalances related to disease in children and adolescents, focusing on the main treatment options and the novel results from recombinant human leptin (metreleptin) therapy. Milestones in the management of lipodystrophy include lifestyle modification as diet and physical activity, paired with hypoglycemic drugs, insulin, hypolipidemic drugs, and other drugs with the aim of treating lipodystrophy complications. Metreleptin has been recently approved for pediatric patients with general lipodystrophy (GL)> 2 years of age and for children with partial lipodystrophy (PL)> 12 years of age not controlled with conventional therapies. New therapeutic strategies are currently being investigated, especially for patients with PL forms, specifically, liver-targeted therapies. Further studies are needed to achieve the most specific and precise treatment possible.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy.
| | | | - Virginia Rossi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
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Calcaterra V, Marin L, Vandoni M, Rossi V, Pirazzi A, Grazi R, Patané P, Silvestro GS, Carnevale Pellino V, Albanese I, Fabiano V, Febbi M, Silvestri D, Zuccotti G. Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise. Int J Environ Res Public Health 2022; 19:16728. [PMID: 36554608 PMCID: PMC9779104 DOI: 10.3390/ijerph192416728] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Luca Marin
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Agnese Pirazzi
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Roberta Grazi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Pamela Patané
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | | | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Ilaria Albanese
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Massimiliano Febbi
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Dario Silvestri
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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16
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Calcaterra V, Rossi V, Mari A, Casini F, Bergamaschi F, Zuccotti GV, Fabiano V. Medical treatment of weight loss in children and adolescents with obesity. Pharmacol Res 2022; 185:106471. [PMID: 36174963 DOI: 10.1016/j.phrs.2022.106471] [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: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy.
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17
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Casini F, Magenes VC, De Sanctis M, Gattinara M, Pandolfi M, Cambiaghi S, Zuccotti GV, Fabiano V. Henoch-Schönlein purpura following COVID-19 vaccine in a child: a case report. Ital J Pediatr 2022; 48:158. [PMID: 36056360 PMCID: PMC9437414 DOI: 10.1186/s13052-022-01351-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background Henoch-Schönlein purpura (HSP) is an IgA-mediated small vessel vasculitis, typical of childhood. It’s a self-limiting disease and it affects different systems. HSP is characterized by dermatological, abdominal, joint and renal clinical manifestations. This condition usually occurs upon infections, mainly upper respiratory tract ones, medications, vaccinations and malignancies. Case presentation We describe the case of a 11 year-old girl who developed a urticarial rash 12 days after the first dose of Pfizer-BioNTech BNT16B2b2 mRNA vaccine and a clear picture of Henoch Schönlein purpura 5 days after administration of the second dose of the same vaccine. Conclusion To our knowledge, this is the first description of a pediatric patient with Henoch-Schönlein purpura occurring in association with vaccination against COVID-19.
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Affiliation(s)
- Francesca Casini
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.
| | | | - Marina De Sanctis
- Primary Care Pediatrician, ASST Ovest Milan, ATS MILAN, Milan, Italy.
| | | | - Marco Pandolfi
- Pediatric Rheumatology Department, ASST Gaetano Pini-CTO, Milan, Italy
| | - Stefano Cambiaghi
- Unit of Pediatric Dermatology, Department of Pathophysiology and Transplantation, Maggiore Policlinic Hospital, IRCCS Ca' Granda Foundation, Università Di Milano, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Sciences, Università Di Milano, Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Sciences, Università Di Milano, Milan, Italy
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Mari A, Gianolio L, Edefonti V, Khaleghi Hashemian D, Casini F, Bergamaschi F, Sala A, Verduci E, Calcaterra V, Zuccotti GV, Fabiano V. HPV Vaccination in Young Males: A Glimpse of Coverage, Parental Attitude and Need of Additional Information from Lombardy Region, Italy. IJERPH 2022; 19:ijerph19137763. [PMID: 35805445 PMCID: PMC9265455 DOI: 10.3390/ijerph19137763] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022]
Abstract
Background: In the Lombardy Region, Italy, HPV vaccination is recommended and offered free of charge to 12-years-old males since 2017. The expected vaccination thresholds are still far to be reached. Methods: A cross-sectional survey to investigate parents’ attitudes towards the HPV vaccine and knowledge about HPV was administered to parents of boys aged 6 to 18 years attending a large pediatric hospital for outpatient specialistic evaluations. Two parallel multiple logistic regression analyses were conducted to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for attitude towards HPV vaccination and perceived need for more information about HPV vaccination. Results: A positive attitude towards HPV vaccination was found in 74% of interviewed parents. Knowledge of HPV, having a generally positive attitude toward vaccination, and mothers filling in the survey were positively associated with a positive attitude to the HPV vaccine. Parents’ perceived need for more information about HPV vaccination was positively associated with the child’s age, general positive attitude toward vaccination, Christian religion, and positive attitude toward HPV vaccination; knowing that HPV vaccination is free of charge significantly reduced the risk of asking for more information on HPV vaccination. Conclusions: The majority of parents of male children and adolescents in our study have a positive attitude toward HPV vaccination. Attitude toward HPV vaccination and perceived need for more information on HPV vaccination were directly related to a positive attitude toward vaccines in general. In addition, knowledge of HPV and related pathologies favors a positive attitude toward HPV vaccination. Future health programs should target an even wider diffusion of evidence-based information on vaccines in general and on the HPV vaccine in young males, to support a positive attitude toward vaccines in the general population.
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Affiliation(s)
- Alessandra Mari
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
| | - Laura Gianolio
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
| | - Valeria Edefonti
- Laboratory of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milano, Italy; (V.E.); (D.K.H.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Dariush Khaleghi Hashemian
- Laboratory of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milano, Italy; (V.E.); (D.K.H.)
| | - Francesca Casini
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
| | - Francesco Bergamaschi
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
| | - Anna Sala
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
| | - Elvira Verduci
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milano, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20147 Milano, Italy
| | - Valentina Fabiano
- Department of Pediatrics, V. Buzzi Children’s Hospital, Università degli Studi di Milano, 20154 Milano, Italy; (A.M.); (L.G.); (F.C.); (F.B.); (A.S.); (E.V.); (V.C.); (G.V.Z.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20147 Milano, Italy
- Correspondence: ; Tel.: +39-026-363-5324
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19
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Battini V, Mari A, Gringeri M, Casini F, Bergamaschi F, Mosini G, Guarnieri G, Pozzi M, Nobile M, Zuccotti G, Clementi E, Radice S, Fabiano V, Carnovale C. Antibiotic-Induced Neutropenia in Pediatric Patients: New Insights From Pharmacoepidemiological Analyses and a Systematic Review. Front Pharmacol 2022; 13:877932. [PMID: 35721197 PMCID: PMC9201445 DOI: 10.3389/fphar.2022.877932] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: to characterize pediatric cases of antibiotic-associated neutropenia through a multidisciplinary approach, focusing on the temporal association between the wide spectrum of treatment options and the occurrence of this relatively uncommon but potentially clinically relevant adverse event. Methods: we carried out a pharmacoepidemiological analysis based on the FDA Adverse Event Reporting System (FAERS) database, a retrospective chart review and a systematic review of the literature, focusing on the time to onset (TTO) of this side effect, in the pediatric clinical setting. Results: A total of 281 antibiotic-related neutropenia events, involving 11 categories of antibiotics, were included in the time to onset analysis. The median TTO ranged from 4 to 60 days after the start of the therapy. A shorter median TTO was found from the retrospective chart review [16 patients: median days (25th-75th percentiles) = 4 (3–5)], compared to 15 (9–18) vs. 10 (6–18) for literature (224 patients) and FAERS (41 cases), respectively. The Anatomical Therapeutic Chemical classes, J01X, J01F, J01E and J04A, and the median TTOs retrieved from more than one source revealed high accordance (p > 0.05), with J01X causing neutropenia in less than a week and J01F/J01E/J04A in more than 10 days. Antibiotics were discontinued in nearly 34% of cases. In FDA Adverse Event Reporting System reports, half of the patients experiencing neutropenia were hospitalized. Conclusion: Whereas antibiotic associated neutropenia is benign in the majority of cases, yet it should not be neglected as, even if rarely, it may put children at higher risk of clinical consequences. Clinicians’ awareness of antibiotic-associated neutropenia and its mode of presentation contributes to the continuous process of monitoring safety of antibiotics.
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Affiliation(s)
- Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Mari
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Casini
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bergamaschi
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Greta Guarnieri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Maria Nobile
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Gianvincenzo Zuccotti
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy.,Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Valentina Fabiano
- Unit of Pediatrics, Department of Biomedical and Clinical Sciences, "Vittore Buzzi" Children's University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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20
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Calcaterra V, Pelizzo G, Pipolo A, Montecamozzo G, Fabiano V, Grazi R, Carlucci P, Zuccotti G. Hypercalcemia and Neurological Symptoms: A Rare Presentation of Hyperfunctioning Parathyroid Adenoma in an Adolescent. Front Surg 2022; 9:885188. [PMID: 36034388 PMCID: PMC9406511 DOI: 10.3389/fsurg.2022.885188] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropsychiatric symptoms are rarely described as a manifestation of hyperparathyroidism, especially in children. We describe the case of an adolescent with hypercalcemia related to and hyperfunctioning parathyroid adenoma presenting with acute neuropsychiatric symptoms. A 14-year-old-girl presented into the Emergency Service Department because of an acute onset of marked asthenia, muscle weakness with difficulty in walking, and altered mental status, which included nonsensical speech. No other neurological signs were present. Abdominal, cardiac, and thoracic examination were unremarkable. There was no recent history of trauma or infection. Family history was negative for neurologic disorders. Her past medical history was unremarkable. A head CT scan showed negative results. The laboratory work-up showed elevated levels of calcium level (14.35 mg/dl; nv 9–11 mg/dl), parathyroid hormone (PTH; 184 pg/ml; nv 3.5–36.8 pg/ml), and creatinine (1.23 mg/dl; nv 0.45–0.75 mg/dl). Sodium, potassium, chloride, thyroid function, glycemia, and insulin values were normal. Neck ultrasonography showed a solid, oval, capsulated, hypoechoic neoformation, with discrete vascularization localized to the inferior pole of the right thyroid lobe, referring to parathyroid tissue. Scintigraphy revealed a hyperfunctioning parathyroid tissue at the inferior pole of the right thyroid lobe. Massive intravenous hydration and diuretic therapy were started. The signs and symptoms of hypercalcemia improved after the initiation of therapy. The patient was submitted to right cervicotomy and muscle sparing for the removal of the adenoma of the right superior parathyroid gland. After surgery, a decrease in PTH levels (<4 pg/ml) and calcium levels (9.1 mg/dl) was recorded. During follow-up, calcium values remained stable; a progressive normalization of PTH was obtained. The oral calcium therapy was suspended after 3 months from surgery. No neuropsychiatric symptoms recurred. An evaluation of the serum calcium level is mandatory in children and adolescents with unexplained neurological signs or symptoms, and a check for hyperparathyroidism should be considered.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Correspondence: Gloria Pelizzo
| | - Andreana Pipolo
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Giulio Montecamozzo
- Department of General Surgery, “Luigi Sacco” University Hospital, Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - Roberta Grazi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Patrizia Carlucci
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
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21
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Sartorio MUA, Munari AM, Carlucci P, Erba P, Calcaterra V, Fabiano V. MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report. Int J Environ Res Public Health 2022; 19:ijerph19021007. [PMID: 35055830 PMCID: PMC8775834 DOI: 10.3390/ijerph19021007] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023]
Abstract
Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is considered a “neglected tropical disease” by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.
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Affiliation(s)
- Marco Ugo Andrea Sartorio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
- Correspondence:
| | - Alice Marianna Munari
- Pediatric Radiology and Neuroradiology, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Patrizia Carlucci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
| | - Paola Erba
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
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22
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Calcaterra V, Biganzoli G, Dilillo D, Mannarino S, Fiori L, Pelizzo G, Zoia E, Fabiano V, Carlucci P, Camporesi A, Corti C, Mercurio G, Izzo F, Biganzoli E, Zuccotti G. Non-thyroidal illness syndrome and SARS-CoV-2-associated multisystem inflammatory syndrome in children. J Endocrinol Invest 2022; 45:199-208. [PMID: 34312809 PMCID: PMC8312710 DOI: 10.1007/s40618-021-01647-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
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Affiliation(s)
- V Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Via Aselli 2, 27100, Pavia, Italy.
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
| | - G Biganzoli
- Pharmacogenomics and Precision Therapeutics Master Degree, University of Milan, 20142, Milan, Italy
| | - D Dilillo
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - S Mannarino
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - L Fiori
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - G Pelizzo
- Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, University of Milan, 20154, Milan, Italy
| | - E Zoia
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - V Fabiano
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
| | - P Carlucci
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - A Camporesi
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - C Corti
- Pediatric Cardiology Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - G Mercurio
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
| | - F Izzo
- Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children's Hospital, 20154, Milano, Italy
| | - E Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, 20122, Milan, Italy
| | - G Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157, Milan, Italy
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23
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Zuccotti G, Calcaterra V, Mannarino S, D'Auria E, Bova SM, Fiori L, Verduci E, Milanese A, Marano G, Garbin M, Zirpoli S, Fabiano V, Carlucci P, Olivotto S, Gianolio L, De Santis R, Pelizzo G, Zoia E, Dilillo D, Biganzoli EM. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience. Front Pediatr 2022; 10:1080654. [PMID: 36776681 PMCID: PMC9909209 DOI: 10.3389/fped.2022.1080654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. METHODS We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. RESULTS Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. CONCLUSIONS The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Enza D'Auria
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Laura Fiori
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy.,Department of Health Sciences, University of Milano, Milano, Italy
| | - Alberto Milanese
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | | | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.,Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Sara Olivotto
- Pediatric Neurology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Laura Gianolio
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children's Hospital, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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24
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Vandoni M, Codella R, Pippi R, Carnevale Pellino V, Lovecchio N, Marin L, Silvestri D, Gatti A, Magenes VC, Regalbuto C, Fabiano V, Zuccotti G, Calcaterra V. Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review. Nutrients 2021; 13:4459. [PMID: 34960011 PMCID: PMC8706684 DOI: 10.3390/nu13124459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023] Open
Abstract
The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks.
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Affiliation(s)
- Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (V.C.P.); (A.G.)
| | - Roberto Codella
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, 20138 Milan, Italy;
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Roberto Pippi
- Healthy Lifestyle Institute, C.U.R.I.A.Mo. (Centro Universitario Ricerca Interdipartimentale Attività Motoria), Department of Medicine and Surgery, University of Perugia, 06126 Perugia, Italy;
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (V.C.P.); (A.G.)
- Department of Industrial Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Nicola Lovecchio
- Department of Human and Social Science, University of Bergamo, 24127 Bergamo, Italy;
| | - Luca Marin
- Laboratory for Rehabilitation Medicine and Sport (LARMS), 00133 Rome, Italy;
- Department of Research, ASOMI College of Sciences, 2080 Marsa, Malta;
| | - Dario Silvestri
- Department of Research, ASOMI College of Sciences, 2080 Marsa, Malta;
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (V.C.P.); (A.G.)
| | - Vittoria Carlotta Magenes
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.); (V.C.)
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.); (V.C.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.); (V.C.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (V.C.M.); (V.F.); (G.Z.); (V.C.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
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Barcellini L, Forlanini F, Sangiorgio A, Gambacorta G, Alberti L, Meta A, Gaia P, Amendola A, Tanzi E, Massa V, Borghi E, Fabiano V, Zuccotti GV. Does school reopening affect SARS-CoV-2 seroprevalence among school-age children in Milan? PLoS One 2021; 16:e0257046. [PMID: 34473776 PMCID: PMC8412254 DOI: 10.1371/journal.pone.0257046] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
The benefits of schools' closure, used as a containment strategy by many European countries, must be carefully considered against the adverse effects of child wellbeing. In this study, we assessed SARS-CoV-2 seroprevalence, which better estimates the real extent of the infection unraveling asymptomatic cases, among schoolchildren aged 3 to 18 in Milan, using dried blood spot, a safe and extremely viable methods for children, and then compared it between September 2020 and January 2021. Secondly, we evaluated the seroconversion rate and compared it between students attending schools in presence and those switched to distance-learning, using a logistic regression model, both as univariate and multivariate, adjusting for age and biological-sex. Among 1109 pupils, we found a seroprevalence of 2.8% in September before school reopening, while in January 2021, the seropositive rate was 12.5%, reflecting the general growth rate of infections during the second pandemic wave. The overall seroconversion rate was 10%, with no differences based on biological-sex and age groups; we observed no seroreversion. When considered age groups, the seroconversion rate was 10.5% (95%Confidence Interval, 2.9-24.8) among children attending preschools, 10.6% (95%Confidence Interval, 8.2-13.4) for primary schools, 9.9% (95%Confidence Interval, 6.8-13.8) for secondary schools, and 7.8% (95%Confidence Interval, 4-13.2) among high-school students. Interestingly, no differences in seroconversion rate were found between students who attended school compared to those who started remote learning in the first days of November. Furthermore, most patients (61%) reported that the contact occurred within the household. We reported a low seroconversion rate among school children in Milan, with no differences between those who attended from September 2020 to January 2021 compared to those who switched to remote learning in the first days of November. Our data suggest that schools do not amplify SARS-CoV-2 transmission, but rather reflect the level of the transmission in the community.
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Affiliation(s)
- Lucia Barcellini
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Federica Forlanini
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Arianna Sangiorgio
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Greta Gambacorta
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Luisella Alberti
- Newborn Screening Laboratory, Regional Reference Center for Metabolic Screening, Buzzi Children Hospital, Milan, Italy
| | - Andrea Meta
- Newborn Screening Laboratory, Regional Reference Center for Metabolic Screening, Buzzi Children Hospital, Milan, Italy
| | - Paola Gaia
- Newborn Screening Laboratory, Regional Reference Center for Metabolic Screening, Buzzi Children Hospital, Milan, Italy
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valentina Massa
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Elisa Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Valentina Fabiano
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
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Bresesti I, Vanzù G, Redaelli F, Daniele I, Zuccotti GV, Cerritelli F, Lista G, Fabiano V. New perspective for pain control in neonates: a comparative effectiveness research. J Perinatol 2021; 41:2298-2303. [PMID: 33664472 DOI: 10.1038/s41372-021-01025-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare sucrose 24% oral gel formulation to liquid formula and breastfeeding during a heel prick in neonates. STUDY DESIGN In this comparative effectiveness research 195 neonates >36 weeks' gestation were randomised to three groups, receiving during heel stick: (i) breastfeeding, (ii) sucrose 24% liquid with non-nutritive sucking and (iii) sucrose 24% gel with non-nutritive sucking. The pain was assessed through the Neonatal Infant Pain Scale. RESULTS All the methods analysed has shown to be effective in reducing pain. There was an increase in odds of pain following liquid sucrose compared to breastfeeding (OR = 1.60; 95% CI: 0.82-3.3; p = 0.17). A reduction of odds of pain was showed comparing sucrose to breastfeeding (OR = 0.78; 0.38-1.6; 0.48), and comparing sucrose gel to liquid formula (OR = 0.48; 0.23-0.96; p = 0.04). CONCLUSION Sucrose 24% gel with non-nutritive sucking seems to be a valid alternative when breastfeeding is not possible. Further research is needed.
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Affiliation(s)
- I Bresesti
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - G Vanzù
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - F Redaelli
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - I Daniele
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - G V Zuccotti
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - F Cerritelli
- Clinical human-based research Department, Foundation COME collaboration, Pescara, Italy
| | - G Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.
| | - V Fabiano
- Department of Pediatrics, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
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Vandoni M, Lovecchio N, Carnevale Pellino V, Codella R, Fabiano V, Rossi V, Zuccotti GV, Calcaterra V. Self-Reported Physical Fitness in Children and Adolescents with Obesity: A Cross-Sectional Analysis on the Level of Alignment with Multiple Adiposity Indexes. Children (Basel) 2021; 8:children8060476. [PMID: 34200029 PMCID: PMC8230218 DOI: 10.3390/children8060476] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
Obesity has been associated with several alterations that could limit physical activity (PA) practice. In pediatrics, some studies have highlighted the importance of enjoyment as a motivation to begin and maintain adherence in PA. Since self-reported physical (SRPF) fitness was related to motivation, the aim of this study was to investigate the existence of differences between SRPF in children with obesity (OB) compared to normal weight (NW). The International Fitness Enjoyment Scale (IFIS) questionnaire was administered to 200 OB and 200 NW children. In all the subjects, height, weight, and BMI and in OB children adiposity indexes including waist circumference (WC), body shape index (ABSI), triponderal mass index (TMI), and fat mass were measured. NW group showed higher IFIS item scores than the OB group (p < 0.01), except in muscular strength. In OB, the anthropometric outcomes were inversely correlated to SRPF outcome except for muscular strength. OB children reported a lower perception of fitness that could limit participation in PA/exercise programs. The evaluation of anthropometric patterns may be useful to prescribe a tailored exercise program considering individual better self-perception outcomes to obtain an optimal PA adherence.
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Affiliation(s)
- Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy;
- Correspondence:
| | - Nicola Lovecchio
- Department of Human and Social Science, University of Bergamo, 24127 Bergamo, Italy;
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy;
- Department of Industrial Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Roberto Codella
- Department of Biomedical Science for Health, University of Milan, 20133 Milan, Italy;
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, 20122 Milan, Italy
| | - Valentina Fabiano
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy; (V.F.); (V.R.); (G.V.Z.)
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Virginia Rossi
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy; (V.F.); (V.R.); (G.V.Z.)
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milan, 20157 Milan, Italy; (V.F.); (V.R.); (G.V.Z.)
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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Fabiano V, Barcellini L, Sartorio MUA, Pendezza E, Leone A, Meneghin F, Dilillo D, Zuccotti GV. Nutritional status of children and adolescents in three Serbian enclaves in Kosovo and Metohija. BMC Public Health 2021; 21:794. [PMID: 33894743 PMCID: PMC8070319 DOI: 10.1186/s12889-021-10848-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate nutritional status of children and adolescents living in three Serbian enclaves in Kosovo and Metohija. Methods We conducted an observational cross-sectional, population-based study, enrolling children and adolescents who underwent a pediatric screening performed in the three Serbian enclaves of Gračanica, Gornje Kusce and Velika Hoča in Kosovo and Metohija. Children and adolescents (5–19 years) of all ethnic groups were evaluated in one of the three free outpatient medical facilities in rural villages in Kosovo. Body weight and height were measured, height-for-age z- scores (HAZ) and BMI-for-age z-scores (BAZ) indicators were analyzed. The anthropometric indicators HAZ and BAZ distributions were compared between sex and ages using Fisher’s exact test. A two-sample Z-test for proportions was used to detect differences in individual categories of height- and BMI-for-age categories across sexes and age classes. Results Three hundred twenty-eight children and adolescents (184 females, 56.1% and 144 males, 43.9%) aged between 5 and 19 years were enrolled in the study. 241/328 participants showed a normal linear growth; with significantly more girls (78.3%) than boys (67.4%) being in the normal category. Similarly, a significant difference in BAZ distribution between sexes was noted, with more females being in the normal BMI category compared to males (63.0% vs 50.0%, respectively). Underweight and severe underweight subjects showed a prevalence of 1.5 and 0.6%, respectively. Overweight and obesity prevalence was 19.5 and 9.1%, respectively, which was comparable to World Health Organization overweight and obesity prevalence data for Serbia. Conclusions Prevalence of undernutrition and severe undernutrition in children and adolescents living in three Serbian enclaves in Kosovo and Metohija is small. By contrast, a tendency to an increase in overweight and obesity, especially in the male population, was noted.
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Affiliation(s)
- Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Lucia Barcellini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy.
| | - Marco Ugo Andrea Sartorio
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
| | - Fabio Meneghin
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Università di Milano, Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
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Carnovale C, Gringeri M, Battini V, Mosini G, Invernizzi E, Mazhar F, Bergamaschi F, Fumagalli M, Zuccotti G, Clementi E, Radice S, Fabiano V. Beta-blocker-associated hypoglycaemia: New insights from a real-world pharmacovigilance study. Br J Clin Pharmacol 2021; 87:3320-3331. [PMID: 33506522 DOI: 10.1111/bcp.14754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/05/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS To investigate the statistical association between hypoglycaemia and β-blocker use and to define what patient and drug characteristics could potentially increase the risk for its occurrence. METHODS We investigated the relationship between pharmacological parameters of β-blockers and the occurrence of hypoglycaemia by conducting a case/non case analysis using the Food and Drug Administration Adverse Event Reporting System database. Pharmacological properties that could represent a predictive factor for hypoglycaemia were analysed through a multilinear binary logistic regression (null hypothesis rejected for values of P < .05). We also performed a systematic review of clinical studies on this association. RESULTS Of 83 954 selected reports, 1465 cases (1.75%) of hypoglycaemia were identified. The association was found statistically significant for nadolol (reporting odds ratio [95% confidence interval]: 6.98 [5.40-9.03]), celiprolol (2.35 [1.35-4.10]), propranolol (2.14 [1.87-2.46]) and bisoprolol (1.42 [1.25-1.61]). Paediatric cases (n = 310) showed a positive association with hypoglycaemia for long half-life drugs (odds ratio [95% confidence interval]: 2.232 [1.398-3.563]) and a negative association for β1-selectivity (0.644 [0.414-0.999]). Seven papers were included in the systematic review. Because of great heterogeneity in study design and demographics, hypoglycaemia incidence rates varied greatly among studies, occurring in 1.73% of the cases for propranolol treatment (n total participants = 575), 6.6% for atenolol (n = 30) and 10% for carvedilol (n = 20). CONCLUSION Nadolol appears to be the β-blocker significantly most associated with hypoglycaemia and children represent the most susceptible sample. Furthermore, long half-life and nonselective β-blockers seem to increase the risk for its occurrence.
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Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Elena Invernizzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Francesco Bergamaschi
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Università di Milano, via Castelvetro, 32, Milan, 20154, Italy
| | - Mara Fumagalli
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Università di Milano, via Castelvetro, 32, Milan, 20154, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Università di Milano, via Castelvetro, 32, Milan, 20154, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy.,Scientific institute IRCCS E. Medea, Bosisio Parini, LC, 23892, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Valentina Fabiano
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Università di Milano, via Castelvetro, 32, Milan, 20154, Italy
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30
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Amendola A, Bianchi S, Gori M, Barcellini L, Colzani D, Canuti M, Giacomet V, Fabiano V, Folgori L, Zuccotti GV, Tanzi E. Dried Blood Spot as an Alternative to Plasma/Serum for SARS-CoV-2 IgG Detection, an Opportunity to Be Sized to Facilitate COVID-19 Surveillance Among Schoolchildren. Pediatr Infect Dis J 2021; 40:e46-e47. [PMID: 33181785 DOI: 10.1097/inf.0000000000002955] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Antonella Amendola
- Department of Biomedical Sciences for Health, Coordinated Research Center "EpiSoMI", University of Milan, Milan, Italy
| | - Silvia Bianchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Gori
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Lucia Barcellini
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Daniela Colzani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marta Canuti
- Department of Biology, Memorial University of Newfoundland, NL, Canada
| | - Vania Giacomet
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Valentina Fabiano
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Laura Folgori
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, Milan, Italy
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health, Coordinated Research Center "EpiSoMI", University of Milan, Milan, Italy
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31
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Calcaterra V, Regalbuto C, Porri D, Pelizzo G, Mazzon E, Vinci F, Zuccotti G, Fabiano V, Cena H. Inflammation in Obesity-Related Complications in Children: The Protective Effect of Diet and Its Potential Role as a Therapeutic Agent. Biomolecules 2020; 10:E1324. [PMID: 32947869 PMCID: PMC7564478 DOI: 10.3390/biom10091324] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 07/26/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Obesity is a growing health problem in both children and adults, impairing physical and mental state and impacting health care system costs in both developed and developing countries. It is well-known that individuals with excessive weight gain frequently develop obesity-related complications, which are mainly known as Non-Communicable Diseases (NCDs), including cardiovascular disease, type 2 diabetes mellitus, metabolic syndrome, non-alcoholic fatty liver disease, hypertension, hyperlipidemia and many other risk factors proven to be associated with chronic inflammation, causing disability and reduced life expectancy. This review aims to present and discuss complications related to inflammation in pediatric obesity, the critical role of nutrition and diet in obesity-comorbidity prevention and treatment, and the impact of lifestyle. Appropriate early dietary intervention for the management of pediatric overweight and obesity is recommended for overall healthy growth and prevention of comorbidities in adulthood.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
| | - Corrado Regalbuto
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (D.P.); (H.C.)
| | - Gloria Pelizzo
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
- Pediatric Surgery Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi “Bonino-Pulejo”, 98124 Messina, Italy;
| | - Federica Vinci
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Gianvincenzo Zuccotti
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
| | - Valentina Fabiano
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (D.P.); (H.C.)
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Abstract
The first 1000 days of life represent a critical window for infants' and children's development. Overweight and insulin resistance, at the basis of non-communicable diseases (NCDs), are linked to various risk factors that begin in childhood, including children's diet. Italian data on infants' and children's dietary habits show higher intake of proteins, simple sugars, unhealthy fats and salt than recommended, while the iron intake is below requirement. We reviewed current literature analyzing observational studies, meta-analysis, systematic review and randomized clinical trials of the last 10 years (from 2009) on nutrition in developmental age, providing some few rules to abide by. Exclusive breastfeeding is recommended by World Health Organization for the first 6 months of life and it should be continued alongside the complementary feeding period until 12 months, or even afterward. Complementary feeding should not be started before the 17th week of age with energetically adequate foods, paying attention to limit protein intake and favoring iron-rich foods. Intake of simple sugars should be limited or avoided at all; it has been demonstrated that substituting sugar-sweetened beverages with water decreases body fatness development in adolescence. Quality of the ingested fats is more important than their quantity: polyunsaturated fatty acids should be preferred. Sodium intake should be limited in the first 24 months of life, as first prevention measure of arterial hypertension later in adulthood. Healthy eating habits are the first important step toward the prevention of NCDs.
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Affiliation(s)
- Valentina Fabiano
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy -
| | - Elena Albani
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giulia M Cammi
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Gian V Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
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Goulet O, Hojsak I, Kolacek S, Pop TL, Cokugras FC, Zuccotti G, Pettoello‐Mantovani M, Fabiano V. Paediatricians play a key role in preventing early harmful events that could permanently influence the development of the gut microbiota in childhood. Acta Paediatr 2019; 108:1942-1954. [PMID: 31197890 PMCID: PMC6852013 DOI: 10.1111/apa.14900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 02/05/2023]
Abstract
Aim The development of the gut microbiota occurs primarily during infancy, and growing evidence has emphasised its positive role and implications for human health. The aim of this review was to provide essential knowledge about the gut microbiota and to describe and highlight the importance of the factors that influence the gut microbiota in early life and their potential harmful effects later in life. Methods The European Paediatric Association, the Union of the National European Paediatric Societies and Associations, convened a panel of independent European experts to summarise the research on microbiota for general paediatricians. They used PubMed and the Cochrane Library to identify studies published in English up to June 2018. Results A number of clinical conditions can disrupt the development of a stable gut microbiota. Changes in the microbiome have been documented in many chronic diseases, mainly immune‐mediated gastrointestinal and liver diseases, and distinct patterns have been associated with each specific disease. The gut microbiota can be positively modulated with probiotics, prebiotics, synbiotics, paraprobiotics and postbiotics. Conclusion Paediatricians can play a key role in preventing harmful events that could permanently influence the composition and/or function of the gut microbiota. Various treatment strategies can be used.
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Affiliation(s)
- Olivier Goulet
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Centre, National Reference Centre for Rare Digestive Diseases, APHP Necker‐Enfants Malades Hospital Paris‐Descartes University Paris France
| | - Iva Hojsak
- Children’s Hospital Zagreb University of Zagreb School of Medicine Zagreb Croatia
- School of Medicine University J.J. Strossmayer Osijek Croatia
| | - Sanja Kolacek
- Children’s Hospital Zagreb University of Zagreb School of Medicine Zagreb Croatia
| | - Tudor Lucian Pop
- Second Paediatric Clinic University of Medicine and Pharmacy Iuliu Hatieganu Cluj‐Napoca Romania
| | - Fugen Cullu Cokugras
- Paediatric Gastroenterology, Hepatology and Nutrition, Cerrahpas_a Medical Faculty Istanbul University Istanbul Turkey
| | - Gianvincenzo Zuccotti
- Pediatric Department, Vittore Buzzi Children’s Hospital Università degli Studi di Milano Milan Italy
| | - Massimo Pettoello‐Mantovani
- Department of Pediatrics, Scientific Institute ‘Casa Sollievo della Sofferenza’ University of Foggia Foggia Italy
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA) Berlin Germany
| | - Valentina Fabiano
- Pediatric Department, Vittore Buzzi Children’s Hospital Università degli Studi di Milano Milan Italy
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Hojsak I, Fabiano V, Pop TL, Goulet O, Zuccotti GV, Çokuğraş FC, Pettoello‐Mantovani M, Kolaček S. More research is needed on the use of probiotics for critically ill patients. Acta Paediatr 2019; 108:181. [PMID: 30129274 DOI: 10.1111/apa.14547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Affiliation(s)
- Iva Hojsak
- Children's Hospital Zagreb University of Zagreb School of Medicine Zagreb Croatia
- School of Medicine University J.J Strossmayer Osijek Croatia
| | - Valentina Fabiano
- Paediatric Department Vittore Buzzi Children's Hospital Università degli Studi di Milano Milan Italy
| | - Tudor Lucian Pop
- 2nd Paediatric Clinic University of Medicine and Pharmacy Iuliu Hatieganu Cluj‐Napoca Romania
| | - Olivier Goulet
- Department of Paediatric Gastroenterology, Hepatology and Nutrition Intestinal Failure Rehabilitation Centre National Reference Centre for Rare Digestive Diseases APHP Necker‐Enfants Malades Hospital Paris‐Descartes University Paris France
| | - Gian Vincenzo Zuccotti
- Paediatric Department Vittore Buzzi Children's Hospital Università degli Studi di Milano Milan Italy
| | - Fugen Cullu Çokuğraş
- Paediatric Gastroenterology, Hepatology and Nutrition Cerrahpaşa Medical Faculty Turkey
| | - Massimo Pettoello‐Mantovani
- Department of Paediatrics Scientific Institute “Casa Sollievo della Sofferenza” University of Foggia Foggia Italy
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA) Berlin Germany
| | - Sanja Kolaček
- Children's Hospital Zagreb University of Zagreb School of Medicine Zagreb Croatia
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Bruno L, Costanzo M, Ostinelli C, Nervo A, Nadal J, Colo F, Loza J, Loza C, Ponce C, Fabiano V, Blanco A, Perez de la Puente C, Chacon R. Efficacy and toxicity of endocrine therapy + cyclin-dependent kinases 4/6 inhibitors (iCDK4/6) in metastatic breast cancer patients according to gBRCA status. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hojsak I, Fabiano V, Pop TL, Goulet O, Zuccotti GV, Çokuğraş FC, Pettoello-Mantovani M, Kolaček S. Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups. Acta Paediatr 2018; 107:927-937. [PMID: 29446865 PMCID: PMC5969308 DOI: 10.1111/apa.14270] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 11/21/2017] [Revised: 01/07/2018] [Accepted: 02/05/2018] [Indexed: 02/05/2023]
Abstract
AIM The use of probiotics has been covered by many guidelines, position papers and evidence-based recommendations, but few have referred to specific patient groups or clinical indications. This review summarises recommendations and scientifically credited guidelines on the use of probiotics for children with selected clinical conditions and provides practice points. METHODS An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric health care and review and summarise the guidelines, recommendations, position papers and high-quality evidence. RESULTS The panel found that specific probiotic strains were effective in preventing antibiotic-associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breastfed infants. However, special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short-gut syndrome. This review discusses the safety of using probiotics in selected groups of paediatric patients and the quality of the available products providing practice points based on proved findings. CONCLUSION Efficacy of probiotics is strain specific. Their benefits are currently scientifically proven for their use in selected clinical conditions in children and not recommended for certain patient groups.
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Affiliation(s)
- Iva Hojsak
- Children's Hospital Zagreb; University of Zagreb School of Medicine; Zagreb Croatia
- School of Medicine; University J.J Strossmayer; Osijek Croatia
| | - Valentina Fabiano
- Paediatric Department; Vittore Buzzi Children's Hospital; Università degli Studi di Milano; Milan Italy
| | - Tudor Lucian Pop
- 2nd Paediatric Clinic; University of Medicine and Pharmacy Iuliu Hatieganu; Cluj-Napoca Romania
| | - Olivier Goulet
- Department of Paediatric Gastroenterology, Hepatology and Nutrition; Intestinal Failure Rehabilitation Centre; National Reference Centre for Rare Digestive Diseases; APHP Necker-Enfants Malades Hospital; Paris-Descartes University; Paris France
| | - Gian Vincenzo Zuccotti
- Paediatric Department; Vittore Buzzi Children's Hospital; Università degli Studi di Milano; Milan Italy
| | - Fugen Cullu Çokuğraş
- Paediatric Gastroenterology, Hepatology and Nutrition; Cerrahpaşa Medical Faculty; Istanbul University; Istanbul Turkey
| | - Massimo Pettoello-Mantovani
- Department of Paediatrics; Scientific Institute ‘Casa Sollievo della Sofferenza’; University of Foggia; Foggia Italy
- European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA); Berlin Germany
| | - Sanja Kolaček
- Children's Hospital Zagreb; University of Zagreb School of Medicine; Zagreb Croatia
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Mandó P, Rizzo MM, Perez de la Puente C, Costanzo MV, Nervo A, Nadal J, Colo F, Loza CM, Loza J, Fabiano V, Ponce C, Chacon R. Abstract P6-09-09: Meta-analysis of ESR1 mutation prevalence in metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: ESR1 mutations were described for the first time in 1996 when different tyrosine 537 mutations were found to confer constitutive activation of the receptor, describing this region as a key factor in the ligand regulation of ER transcriptional activity. However, due to the low prevalence of this mutation in primary breast tumors its clinical significance maintained unknown. With the advent of large scale genomic analysis, a new understanding of breast cancer molecular characteristics has gained relevance. The low prevalence of ESR1 mutations in primary breast cancer has been confirmed but mutations in metastatic ER-positive breast cancers has been proved to be a completely different scenario. Nevertheless, information regarding real prevalence of ESR1 mutation in metastatic breast cancer is not known as selection of patients and molecular technique used are heterogeneous.
Sources: Search was carried by corresponding clinical oncologists of the Breast Cancer Unit of Alexander Fleming Institute. In March 2017, key words “ESR1 mutations”, “Estrogen receptor mutations” and “Breast cancer” were used as search strategy for the present meta-analysis in PubMed. Furthermore, abstracts from congress presentations were analyzed and hand searching from reference list of obtained articles was executed. Online search retrieved 60 articles published, 3 abstracts related were found and 3 further studies were detected by hand search. Articles were excluded if they only included primary tumors and not metastatic cases and if they were undertaken before 2000 due to important technical differences of mutation detection, including finally 23 cohorts.
Study Selection: Studies considered were prospective or retrospective cohorts of metastatic breast cancer patients with mutation analysis of tissue or circulating DNA. A data form was used by the primary reviewer to extract equivalent information from each article. Information extracted included population sampled, prevalence estimates, clinical characteristics of cohort, sample analyzed and technical procedure for mutation detection. A second reviewer blinded to the primary reviewer's decisions checked the article selection and data extraction. Any differences of opinion were discussed, and a third reviewer was available to arbitrate any issues.
Meta-analysis was undertaken using a random-effects model conducted using the metaprop function in Meta package of R studio Version 1.0.136 (© 2009-2016 RStudio, Inc.). PRISMA guidelines were followed in conducting and reporting the results.
Results and Discussion: Results show a prevalence of ESR1 mutation of 24% (CI95% 19-30%) in the 3607 patients included. Nevertheless, important heterogeneity (I2 =90%) is observed due to great differences in the articles published of this topic. This heterogeneity is attributed to the type of cohorts presented, the selection of patients, the technique used and type of sample studied, but another source of heterogeneity must be present as it still persists after grouping studies according to this variables. The importance of this analysis resides in the fact that it is the most complete information of the prevalence of this mutation that may have future importance in therapeutic decisions in metastatic breast cancer.
Citation Format: Mandó P, Rizzo MM, Perez de la Puente C, Costanzo MV, Nervo A, Nadal J, Colo F, Loza CM, Loza J, Fabiano V, Ponce C, Chacon R. Meta-analysis of ESR1 mutation prevalence in metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-09.
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Affiliation(s)
- P Mandó
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - MM Rizzo
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | | | - MV Costanzo
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - A Nervo
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - J Nadal
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - F Colo
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - CM Loza
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - J Loza
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - V Fabiano
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - C Ponce
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
| | - R Chacon
- Instituto Alexander Fleming, Ciudad de Buenos Aires, Argentina
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Rizzo MM, Mando P, Perez de la Puente C, Maino M, Ponce C, Fabiano V, Pombo MT, Loza CM, Costanzo MV, Nervo A, Nadal J, Colo F, Chacon RD. Abstract P6-09-40: Her2 and hormonal receptor analysis in breast cancer synchronic node metastases could add therapeutic information. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Breast cancer is the tumor with highest incidence and mortality in women in Argentina. Hormonal receptors (HR) and HER2 are the most important prognostic and predictive factors. It is suggested that estrogen receptors (ER), progesterone receptors (PR) and HER2 expression can vary during tumor progression and metastases development. Published evidence has reported discordance between primary tumors and its metastases ranging from 15-54% for HR and HER2 overexpression. A similar discordance situation may exist among primary tumor (PT) and its axillary nodal metastases (NM)
Objective: To describe the expression and discordance of ER, PR and HER2 in PT and its synchronic NM
Material and methods: Prospective analysis of surgical breast cancer patients (pts) at Instituto Alexander Fleming (Sept 2013 to Feb 2016). HR were analyzed by immunohistochemistry (IHC) according to CAP protocols; values ≥ 10% were considered positive. HER2 overexpression was defined by 3+ IHC or positive FISH. Paired t test was used to compare mean using Prims 5 software.
Results: In 587 breast cancer surgeries, 190 pts presented NM. HR and HER2 analysis was performed in 101 paired samples. Median age was 51 years (r 25-83). Mean tumor size was 3,3 ± 0,2 cm. 0,99% (1) were stage I, 68,3% (69) stage II and 30,7% (31) stage III. Most frequent histologic subtype was ductal carcinoma (66.3%). 78.2% presented lymphovascular invasion. Median positive nodes were 2 (r 1-21). Paired samples allowed ER analysis in 99 cases, PR in 98 and HER2 in 96; 8 NM were Her2++; FISH analysis was inconclusive in 4 of them due to insufficient tissue. No differences were observed on ER between PT and NM (72% vs 71.1%, OR: 0,91, IC95 -3.2-5.1; p>0,05), nor PR expression (52.1% vs 54,5%, OR: -2.1, IC95 -7.1-3.01; p>0,05). PT were ER+ in 86.1% of the cases; NM were ER+ in 82.2%. Regarding PR, PT were 74.3% PR+ and NM were 76.2% PR+. 28 of the 101 pts (27.7%) were discordant. 5 pts with ER+ PT had ER- NM, and 3 pts had PT ER- but ER+ NM, representing a 7.9% of discordance. 4 of 75 pts with PR+ in PT were PR- in NM, while 8 of 26 pts were PR- in PT but PR+ in NM. Of the 13 HER2+ pts, 2 (15%) did not present overexpression in NM. On the other hand, 6 (7%) of the 83 HER2- PT were HER2+ in NM. 4 of 9 pts had PT RH and Her2- (TN), but NM RH and/or Her2+.
Discussion: Tumor heterogeneity is an important issue that may affect clinical decisions. Axillary nodes are the first metastatic site for breast cancer and different studies have shown discrepancy between PT and NM. We described a discordant expression in ER, PR and HER2 of 8%, 12% and 9% respectively. These differences could be due to technical reasons, intratumor heterogeneity and/or a different cellular phenotype. Although the clinical importance of these changes are not completely understood, NM status could bring important prognostic and therapeutic information defining a particular group of patients in which a specific therapeutic strategy could influence long term results. In fact, in our series 44% of TN tumors presented NM with a therapeutic target, either HR or HER2. We therefore confirm that pathological analysis of NM may bring up additional information that could be useful in a prognostic or therapeutic point of view.
Citation Format: Rizzo MM, Mando P, Perez de la Puente C, Maino M, Ponce C, Fabiano V, Pombo MT, Loza CM, Costanzo MV, Nervo A, Nadal J, Colo F, Chacon RD. Her2 and hormonal receptor analysis in breast cancer synchronic node metastases could add therapeutic information [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-40.
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Affiliation(s)
- MM Rizzo
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - P Mando
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | | | - M Maino
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - C Ponce
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - V Fabiano
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - MT Pombo
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - CM Loza
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - MV Costanzo
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - A Nervo
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - J Nadal
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - F Colo
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
| | - RD Chacon
- Instituto Alexander Fleming, Ciudad Autonoma de Buenos Aires, Argentina
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Zuccotti G, Fabiano V. Indications to respiratory syncytial virus immunoprophylaxis in the 29-32 wGA group: is there still room for debating? Ital J Pediatr 2017; 43:17. [PMID: 28257653 PMCID: PMC5347811 DOI: 10.1186/s13052-017-0341-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/01/2017] [Indexed: 11/30/2022] Open
Abstract
Guidelines on immunoprophylaxis for prevention of RSV infection recommend it in preterm babies born before 29 wGA; in babies affected by bronchopulmonary dysplasia or congenital heart defects; and in post-heart transplantation patients. On the contrary, immunoprophylaxis is not recommended in preterm babies born between 29 and 35 wGA. We evaluated the impact of RSV-related healthcare expenditures in infants in the first 3 years of life in Italy, Lombardy Region. In light of the collected data and considering the cost of a complete palivizumab prophylaxis, extending it to babies 29–32 wGA, aged less than 6 months, appears to be a cost-effective strategy.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, via Castelvetro 32, Milan, 20154, Italy
| | - Valentina Fabiano
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, via Castelvetro 32, Milan, 20154, Italy.
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Maino M, Fabiano V, Ponce C, Loza M, Costanzo V, Nervo A, Nadal J, Mysler D, Amat M, Coló F, Loza J, Chacón R. Abstract P3-01-07: Second axillary sentinel lymph node biopsy for breast tumor recurrence: Instituto Alexander Fleming experience in Buenos Aires, Argentina. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-01-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Sentinel Lymph Node Biopsy (SLNB) is the standard technique for axillary staging of patients with operable breast cancer and a clinically negative axilla because it avoids unwarranted axillary dissection and consequently reduces postoperative morbidity.
Purpose: The aim of this study is to determinate the feasibility and accuracy of the second SLNB for patients with ipsilateral breast cancer recurrences with clinically negative axilla, who were treated previously with breast surgery and study of the axilla.
Methods: Retrospective review of the database of the Instituto Alexander Fleming. Between October 2009 and October 2014, 1029 patients with diagnosis of breast cancer required surgery. The study included 26 patients with the diagnosis of operable local breast cancer recurrence, who had previously undergone axillary surgery either as SLNB, sampling or axillary lymph node dissection (ALND). They subsequently underwent additional breast surgery and a second SLNB.
Results: The mean age of the ipsilateral breast cancer recurrences was 59.23 years (range: 32-87) and the most common histologic subtype was invasive ductal carcinoma in 22 patients (84.6%) and 4 patients (15.4%) with invasive lobular carcinoma. 4 patients (15.4%) had previously ALND or sampling and 22 patients (84.6%) SLNB. The identification rate of the second SLNB was 92.31%. Only 2 patients were not identify, one patient with a previous axillary sampling and another one with previous SLNB. In those patients the ALND was performed and the axilla was negative. Lymphoscintigraphy failed to identify any SLN in 6 patients (23%), 2 patients which were not identify and 4 patients only detected with patent blue. The average number of nodes removed at second SLNB was 1.8 (range: 1-5). Second SLNBs were negative in 21 patients (80.8%), and macrometastasis disease was identified in 2 patients and complete ALND was performed.
In 1 patients additional extra-axillary aberrant drainages was observed in the contralateral axilla and interpectoral, and other 3 patients had aberrant drainage in the contralateral axilla (1 patient), internal mammary regions (1 patient), and interpectoral (1 patient). Aberrant drainage pathways were not routinely dissected. Only those accessible during surgery were removed.
The median time between first surgery and ipsilateral breast tumor recurrence was 7.19 years (range: 1-22). The disease free survival (DFS) was 9.16 years (range: 2.25-24).
Conclusion: In the present serie we show a high identification rate of 92.31% in the second SLNB, comparable with other international series published in the literature (range: 51-97%). A second SLNB should be considered for patients with ipsilateral breast tumor recurrence who underwent conservative surgery and have clinically negative axilla. The procedure is technically feasible and accurate for selected patients, and avoids unnecessary ALND. Extra-axillary sentinel lymph node localization rates are higher than for primary SLNB but the clinical significance and management of extra-axillary nodes needs to be clarified.
Citation Format: Maino M, Fabiano V, Ponce C, Loza M, Costanzo V, Nervo A, Nadal J, Mysler D, Amat M, Coló F, Loza J, Chacón R. Second axillary sentinel lymph node biopsy for breast tumor recurrence: Instituto Alexander Fleming experience in Buenos Aires, Argentina. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-07.
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Affiliation(s)
- M Maino
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - V Fabiano
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - C Ponce
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - M Loza
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - V Costanzo
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - A Nervo
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - J Nadal
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - D Mysler
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - M Amat
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - F Coló
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - J Loza
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
| | - R Chacón
- Instituto Alexander Fleming, Capital Federal, Buenos Aires, Argentina
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Mameli C, Fabiano V, Daprai L, Bedogni G, Faccini M, Garlaschi ML, Penagini F, Dilillo D, Torresani E, Gramegna M, Zuccotti GV. A longitudinal study of streptococcus pneumoniae carriage in healthy children in the 13-valent pneumococcal conjugate vaccine era. Hum Vaccin Immunother 2016; 11:811-7. [PMID: 25751237 DOI: 10.1080/21645515.2015.1010945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/27/2023] Open
Abstract
Few epidemiological data are available after the introduction of the 13-valent pneumococcal vaccine (PCV13) in 2010. We performed repeat nasopharyngeal swabs and evaluated the serotype distribution of Streptococcus pneumoniae (SP) and its association with PCV13 vaccine status in healthy Italian children aged 3-59 months. SP serotypes were assessed by the Quellung reaction. 618 children appropriately (28%) or incompletely (72%) vaccinated for age with PCV13 were available at baseline (T0). 515 were re-evaluated at 6 months from baseline (T6) and 436 at 12 months from baseline (T12). The percentage of appropriately vaccinated subjects at T0, T6 and T12 was 28%, 67% and 92%, respectively. Random effects logistic regression models with robust 95% confidence intervals was used to estimate the time-related changes in SP and PCV13 carriage and marginal probabilities were obtained from such models. The age-corrected probability of SP carriage was 0.31 (95% CI 0.22 - 0.41) at T0, 0.32 (0.24 - 0.40) at T6 and 0.28 (0.20 - 0.35) at T12. The probability of PCV13 serotypes carriage was 0.025 (0.001 - 0.050) at T0, 0.018 (0.001 - 0.039) at T6 and 0.010 (0.001 - 0.023) at T12. A decrease in PCV13 serotypes and a shift in non-PCV13 serotypes colonization was observed. In particular, the 15A serotype accounted for 4%, 8% and 23% of SP isolates at T0, T6 and T12, respectively. In conclusion, the benefits of the PCV13 vaccination on SP carriage increase with increasing coverage rates. The shift of SP isolates toward non-PCV13 serotypes needs to be studied further.
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Affiliation(s)
- Chiara Mameli
- a Department of Pediatrics; Children's Hospital "V. Buzzi" ; University of Milan ; Milan , Italy
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Fabiano V, Carnovale C, Gentili M, Radice S, Zuccotti GV, Clementi E, Perrotta C, Mameli C. Enalapril Associated with Furosemide Induced Acute Kidney Injury in an Infant with Heart Failure. A Case Report, a Revision of the Literature and a Pharmacovigilance Database Analysis. Pharmacology 2015; 97:38-42. [DOI: 10.1159/000441950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
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Mameli C, Galli E, Mantegazza C, Fabiano V, Zuccotti GV. The multicomponent meningococcal serogroup B vaccine (4CMenB): origin, composition, health impact and unknown aspects. Future Microbiol 2015; 10:1579-98. [DOI: 10.2217/fmb.15.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Neisseria meningitidis serogroup B is the main cause for meningococcal invasive disease in many parts of the world. Since 2013, a new multicomponent vaccine against meningococcal serogroup B (4CMenB) has been licensed in Europe, Australia, Canada, Chile, Uruguay, USA and Brazil with different immunization schedules. Clinical trials involving adults, adolescents, children and infants showed 4CMenB has a good immunogenicity and safety profile. Strain coverage estimates are similar to or better than other recently approved vaccines, ranging from 66% in Canada to 91% in Unites States. Some points still remain to be clarified such as the best immunization strategy, the effect of 4CMenB on carriage, the long-term persistence of protective bactericidal antibodies titers, long-term safety outcomes, the possible emergence of N. meningitidis escape mutants and the vaccine cost–effectiveness. In this review, we focus on the vaccine composition, clinical trials and suggested schedules, safety data, potential strain coverage and future challenges.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, Children's Hospital V. Buzzi, Via Castelvetro 32, University of Milan, Milan, Italy
| | - Erica Galli
- Department of Pediatrics, Children's Hospital V. Buzzi, Via Castelvetro 32, University of Milan, Milan, Italy
| | - Cecilia Mantegazza
- Department of Pediatrics, Children's Hospital V. Buzzi, Via Castelvetro 32, University of Milan, Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Children's Hospital V. Buzzi, Via Castelvetro 32, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Children's Hospital V. Buzzi, Via Castelvetro 32, University of Milan, Milan, Italy
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Mora S, Puzzovio M, Giacomet V, Fabiano V, Maruca K, Capelli S, Nannini P, Lombardi G, Zuccotti GV. Sclerostin and DKK-1: two important regulators of bone metabolism in HIV-infected youths. Endocrine 2015; 49:783-90. [PMID: 25596857 DOI: 10.1007/s12020-015-0527-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Received: 11/19/2014] [Accepted: 01/08/2015] [Indexed: 12/17/2022]
Abstract
Reduced bone mineral density (BMD) and altered bone metabolism are common findings in HIV-infected patients. Increased bone formation has been described both in HIV-infected adults and children. Wnt ligands promote bone formation by stimulating osteoblast differentiation and their survival. Sclerostin and dickkopf factor 1 (DKK-1), Wnt antagonists, are important negative regulators of bone formation. We studied 86 HIV-infected patients whose ages ranged from 5.7 to 27.9 years. Patients were all on antiretroviral therapy, but seven who were naïve to treatment. Bone alkaline phosphatase (BAP), sclerostin, and DKK-1 were measured in serum by enzyme immunoassay. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine and in the whole skeleton. Biochemical indexes were also measured in 143 healthy controls (age range 4.5-27.4 years). HIV-infected patients had lower than normal BMD (spine P < 0.005, and whole skeleton P < 0.03). BAP measurements were significantly higher in HIV-infected patients than controls (P ≤ 0.05). Sclerostin and DKK-1 concentrations were markedly lower than in controls (P ≤ 0.0006, and P ≤ 0.03, respectively). The serum concentration of both analytes of patients naïve to antiretroviral treatment was not different from that of treated patients. No correlations were found between sclerostin, DKK-1, and bone mineral measurements. Our data confirm the alteration of bone metabolism pathways in HIV-infected individuals. The lower concentration of Wnt antagonists is consistent with the increased bone formation markers.
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Affiliation(s)
- Stefano Mora
- Laboratory of Pediatric Endocrinology, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, MI, Italy,
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Dilillo D, Mauri S, Mantegazza C, Fabiano V, Mameli C, Zuccotti GV. Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them. Ital J Pediatr 2015; 41:49. [PMID: 26149466 PMCID: PMC4494780 DOI: 10.1186/s13052-015-0153-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/16/2015] [Indexed: 01/07/2023] Open
Abstract
Epidemiological data suggests suicide is uncommon in childhood but becomes an extremely serious issue among adolescents. Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, disorders in gender identity or bullying. Pediatricians have a primary role in searching for these risk factors, recognizing them and acting synergistically with other specialists to prevent and treat suicidal behavior. Pediatricians should also be able to identify the “warning signs” for suicide since their presence implies a need for immediate action, as attempted suicide may occur in a few hours or days. The use of antidepressant drugs and its association with suicidal risk in pediatric age is another topic of ongoing debate. Food and Drug Administration has recently introduced the so-called “black box” on antidepressants’ packages with the aim of gaining attention to the possible risk of suicide among adolescents who are treated with antidepressants, with a warning that the risk of suicide is higher when starting a therapy or while adjusting its dosage.
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Affiliation(s)
- Dario Dilillo
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
| | - Silvia Mauri
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Cecilia Mantegazza
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
| | - Valentina Fabiano
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
| | - Chiara Mameli
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Milan, Italy.
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Zuccotti GV, Redaelli F, Gualdi V, Rizzi V, Mameli C, Dilillo D, Fabiano V. Hemolytic crisis in a G6PD-deficient infant after ingestion of pumpkin. Ital J Pediatr 2014; 40:71. [PMID: 25048415 PMCID: PMC4122048 DOI: 10.1186/1824-7288-40-71] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/30/2014] [Indexed: 11/22/2022] Open
Abstract
A 8 month-old infant presented with acute onset of severe jaundice, anemia requiring transfusion and Glucose-6-Phosphate Dehydrogenase deficiency. The infant did not take drugs, he did not consume fava beans, but fava beans DNA was found on pumpkin he consumed the day before jaundice onset. This is the first case of hemolysis triggered by ingestion of food cross-contaminated with fava beans.
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Affiliation(s)
| | | | | | | | | | | | - Valentina Fabiano
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Via G,B, Grassi, 74, 20157 Milan, Italy.
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Beretta S, Fabiano V, Zuccotti GV. Neonatal Lupus or Not? An Intriguing Immunological Dilemma. Pediatr Allergy Immunol Pulmonol 2014; 27:99-102. [PMID: 35923013 DOI: 10.1089/ped.2014.0361] [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] [Indexed: 06/15/2023]
Abstract
Anti-Ro antibodies appear to represent a direct pathogenic factor in neonatal lupus (NL) neutropenia. Resolution of NL neutropenia is expected when anti-Ro antibodies are cleared. In this report, we describe a case of persistent neutropenia in a baby born to an anti-Ro-positive mother. The initial diagnosis of NL neutropenia was later called into question due to the identification of positive anti-neutrophil antibodies and transient hypogammaglobulinemia of infancy. The patient seemed to have had overlapping causes of her hematologic manifestations. To our knowledge, no other similar cases have been previously reported in the literature. Newborns are not routinely tested for white blood cell count, and several neutropenia cases remain undetected.
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Affiliation(s)
- Silvia Beretta
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Itali
| | - Valentina Fabiano
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Itali
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Itali
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Rainone V, Trabattoni D, Penagini F, Fabiano V, Calascibetta F, Giacomet V, Vigano A, Clerici M, Zuccotti GV. HPV vaccination in HIV+ adolescents and young adults induces strong HPV-specific immune responses. BMC Infect Dis 2014. [PMCID: PMC4221045 DOI: 10.1186/1471-2334-14-s2-p93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Mora S, Diceglie C, Viganò A, Giacomet V, Manfredini V, Stucchi S, Fabiano V, Mameli C, Coletto S, Zuccotti GV. Antiretroviral therapy and pregnancy: effect on cortical bone status of human immunodeficiency virus-infected Caucasian women as assessed by quantitative ultrasonography. Calcif Tissue Int 2013; 92:394-8. [PMID: 23307187 DOI: 10.1007/s00223-013-9696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/26/2012] [Indexed: 11/28/2022]
Abstract
Treatment with antiretroviral agents (ARVs) during pregnancy is important to prevent mother-to-child transmission of the human immunodeficiency virus (HIV), but their use has been associated with low bone mineral density in adult patients. Currently, there are no data regarding the bone status of HIV-infected women who received ARV during pregnancy. The aim of this study was to evaluate cortical bone status at delivery in a group of HIV-infected women who received ARV during pregnancy and to monitor the changes occurring during the first year postpartum. We studied 33 HIV-infected and 116 HIV-uninfected healthy Caucasian women within 4 days from delivery. Follow-up measurements were performed at 4 and 12 months postpartum in 17 HIV-infected and 55 healthy women. Cortical bone status was evaluated by quantitative ultrasonography at the mid-tibia, and bone measurements were expressed as the speed of sound (SOS). HIV-infected women after delivery had a median SOS of 3,985 (3,567-4,242) m/s, while the median SOS of healthy women was 4,025 (3,643-4,250) m/s. The difference was not significant (t = 0.39, P = 0.69). No significant differences were observed between ARV-exposed and control subjects at 4 and 12 months. Our data suggest that ARV during pregnancy and the first year after delivery does not affect negatively cortical bone status.
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Affiliation(s)
- Stefano Mora
- Laboratory of Pediatric Endocrinology, BoNetwork, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Barbuscia MA, Cingari EA, Torchia U, Querci A, Lemma G, Ilacqua A, Caizzone A, Sanò A, Fabiano V. Indications for and limits of conservative surgery in breast cancer. G Chir 2013; 34:90-94. [PMID: 23578414] [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: 06/02/2023]
Abstract
Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.
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