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Ferretti A, Velardi M, Fanfoni C, Di Nardo G, Evangelisti M, Foiadelli T, Orsini A, Del Pozzo M, Terrin G, Raucci U, Striano P, Parisi P. Pediatric hypnic headache: a systematic review. Front Neurol 2023; 14:1254567. [PMID: 37638182 PMCID: PMC10457117 DOI: 10.3389/fneur.2023.1254567] [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: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] [Imported: 09/15/2023] Open
Abstract
Introduction Hypnic headache (HH) is a primary headache, and it is considered a rare condition in children. The underlying mechanisms of HH are not yet fully understood. This systematic review aims to provide a comprehensive description of the clinical features of all published cases of pediatric HH. It will also discuss the differences in headache features between children and adults, the increased diagnostic sensitivity of the new diagnostic criteria (ICHD-3), potential pathophysiological hypotheses explaining the higher incidence in adults, differential diagnoses, and therapeutic options for children. Methods A systematic search was conducted to identify and analyze articles reporting cases of HH in patients under the age of 18. The search was performed in major medical databases including Cochrane Library, EBSCO, Embase, Medline, PubMed, Science Direct, Scopus, and Web of Science. The search covered the period from 1988 to April 2023. Relevant studies were screened for eligibility, and data extraction was performed using a standardized approach. Results Seven children with HH were included in the analysis. The mean age of onset for headache attacks was 10 ± 4.3 years (range 3-15 years). The average time from the start of headaches to diagnosis was 15.8 ± 25.0 months (range 1-60 months). Headache features in children differed from those observed in adult HH patients. Children experienced throbbing/pulsating pain, while adults reported dull/pressure-like pain. Children also had lower frequency and shorter duration of attacks compared to adults. The use of ICHD-3 criteria appeared to be more sensitive and inclusive for diagnosing HH in children compared to the previous ICHD-2 criteria. The association of headache attacks with sleep suggests that HH may be a primary disorder with a chronobiological origin. Hypothalamic dysfunction and melatonin dysregulation, which are more prevalent in older individuals, could potentially explain the higher incidence of HH in adults. Other primary headaches and secondary causes should be ruled out. Melatonin prophylactic therapy may be considered for pediatric patients. Discussion Further evaluation of the clinical features of HH in children is needed. The development of specific diagnostic criteria for pediatric cases could improve diagnostic rates and enhance the management of children with HH.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Claudia Fanfoni
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Melania Evangelisti
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marco Del Pozzo
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, S. Andrea Hospital, Rome, Italy
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Raucci U, Parisi P, Ferro V, Margani E, Vanacore N, Raieli V, Bondone C, Calistri L, Suppiej A, Palmieri A, Cordelli DM, Savasta S, Papa A, Verrotti A, Orsini A, D'Alonzo R, Pavone P, Falsaperla R, Velardita M, Nacca R, Papetti L, Rossi R, Gioè D, Malaventura C, Drago F, Morreale C, Rossi L, Foiadelli T, Monticone S, Mazzocchetti C, Bonuccelli A, Greco F, Marino S, Monte G, Versace A, Masi S, Di Nardo G, Reale A, Villani A, Valeriani M. Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory multicenter Italian study. Cephalalgia 2023; 43:3331024231164361. [PMID: 37345616 DOI: 10.1177/03331024231164361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] [Imported: 09/15/2023]
Abstract
BACKGROUND Preschool age (i.e. children under six years of age) represents a red flag for requiring neuroimaging to exclude secondary potentially urgent intracranial conditions (PUIC) in patients with acute headache. We investigated the clinical characteristics of preschoolers with headache to identify the features associated with a greater risk of secondary "dangerous" headache. METHODS We performed a multicenter exploratory retrospective study in Italy from January 2017 to December 2018. Preschoolers with new-onset non-traumatic headache admitted to emergency department were included and were subsequently divided into two groups: hospitalized and discharged. Among hospitalized patients, we investigated the characteristics linked to potentially urgent intracranial conditions. RESULTS We included 1455 preschoolers with acute headache. Vomiting, ocular motility disorders, ataxia, presence of neurological symptoms and signs, torticollis and nocturnal awakening were significantly associated to hospitalization. Among the 95 hospitalized patients, 34 (2.3%) had potentially urgent intracranial conditions and more frequently they had neurological symptoms and signs, papilledema, ataxia, cranial nerves paralysis, nocturnal awakening and vomiting. Nevertheless, on multivariable logistic regression analysis, we found that only ataxia and vomiting were associated with potentially urgent intracranial conditions. CONCLUSION Our study identified clinical features that should be carefully evaluated in the emergency department in order to obtain a prompt diagnosis and treatment of potentially urgent intracranial conditions. The prevalence of potentially urgent intracranial conditions was low in the emergency department, which may suggest that age under six should not be considered an important risk factor for malignant causes as previously thought.
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Affiliation(s)
- Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Valentina Ferro
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Erika Margani
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit, ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Claudia Bondone
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Italy
| | - Antonella Palmieri
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Salvatore Savasta
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amanda Papa
- S.C.D.O. Neuropsichiatria Infantile AOU Maggiore della Carità, Novara, Italy
| | | | - Alessandro Orsini
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Perugia, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Gravina Hospital, Caltagirone, Catania, Italy
| | - Raffaella Nacca
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Papetti
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Roberta Rossi
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Daniela Gioè
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | | | - Flavia Drago
- Child Neuropsychiatry Unit, Department Pro.Mi.Se, G. D'Alessandro University of Palermo, Italy
| | - Cristina Morreale
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, IRCCS, Genova, Italy
| | - Lucia Rossi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Thomas Foiadelli
- Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Italy
| | - Sonia Monticone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Alice Bonuccelli
- Paediatric Neurology, Paediatric Department, Pisa University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Filippo Greco
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Italy
| | - Gabriele Monte
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Versace
- AOU Città della Salute e della Scienza, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Pediatrics, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Valeriani
- Pediatric Headache Center, Neuroscience Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Passeri L, Andolfi G, Bassi V, Russo F, Giacomini G, Laudisa C, Marrocco I, Cesana L, Di Stefano M, Fanti L, Sgaramella P, Vitale S, Ziparo C, Auricchio R, Barera G, Di Nardo G, Troncone R, Gianfrani C, Annoni A, Passerini L, Gregori S. Tolerogenic IL-10-engineered dendritic cell-based therapy to restore antigen-specific tolerance in T cell mediated diseases. J Autoimmun 2023; 138:103051. [PMID: 37224733 DOI: 10.1016/j.jaut.2023.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/06/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023] [Imported: 09/15/2023]
Abstract
Tolerogenic dendritic cells play a critical role in promoting antigen-specific tolerance via dampening of T cell responses, induction of pathogenic T cell exhaustion and antigen-specific regulatory T cells. Here we efficiently generate tolerogenic dendritic cells by genetic engineering of monocytes with lentiviral vectors co-encoding for immunodominant antigen-derived peptides and IL-10. These transduced dendritic cells (designated DCIL-10/Ag) secrete IL-10 and efficiently downregulate antigen-specific CD4+ and CD8+ T cell responses from healthy subjects and celiac disease patients in vitro. In addition, DCIL-10/Ag induce antigen-specific CD49b+LAG-3+ T cells, which display the T regulatory type 1 (Tr1) cell gene signature. Administration of DCIL-10/Ag resulted in the induction of antigen-specific Tr1 cells in chimeric transplanted mice and the prevention of type 1 diabetes in pre-clinical disease models. Subsequent transfer of these antigen-specific T cells completely prevented type 1 diabetes development. Collectively these data indicate that DCIL-10/Ag represent a platform to induce stable antigen-specific tolerance to control T-cell mediated diseases.
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Affiliation(s)
- Laura Passeri
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Grazia Andolfi
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Virginia Bassi
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; University of Rome Tor Vergata, Via Cracovia 50, 00133, Rome, Italy
| | - Fabio Russo
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Giacomini
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cecilia Laudisa
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Ilaria Marrocco
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Cesana
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marina Di Stefano
- Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Paola Sgaramella
- Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Serena Vitale
- Institute of Biochemistry and Cell Biology, CNR, via P.Castellino 11, 80131, Naples, Italy
| | - Chiara Ziparo
- NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Renata Auricchio
- European Laboratory for the Investigation of Food Induced Diseases (ELFID), Department of Translational Medical Science, Section of Pediatrics, Via Pansini 5, 80131, University Federico II, Naples, Italy
| | - Graziano Barera
- Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Di Nardo
- NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Riccardo Troncone
- European Laboratory for the Investigation of Food Induced Diseases (ELFID), Department of Translational Medical Science, Section of Pediatrics, Via Pansini 5, 80131, University Federico II, Naples, Italy
| | - Carmen Gianfrani
- Institute of Biochemistry and Cell Biology, CNR, via P.Castellino 11, 80131, Naples, Italy
| | - Andrea Annoni
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Laura Passerini
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Silvia Gregori
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Ferretti A, Gatto M, Velardi M, Di Nardo G, Foiadelli T, Terrin G, Cecili M, Raucci U, Valeriani M, Parisi P. Migraine, Allergy, and Histamine: Is There a Link? J Clin Med 2023; 12:jcm12103566. [PMID: 37240671 DOI: 10.3390/jcm12103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] [Imported: 09/15/2023] Open
Abstract
The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Mattia Gatto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuela Cecili
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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Mauro A, Casini F, Talenti A, Di Mari C, Benincaso AR, Di Nardo G, Bernardo L. Celiac crisis as the life-threatening onset of celiac disease in children: a case report. Front Pediatr 2023; 11:1163765. [PMID: 37252043 PMCID: PMC10213434 DOI: 10.3389/fped.2023.1163765] [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: 02/11/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] [Imported: 09/15/2023] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. In rare cases, CD may occur with a severe potential life-threatening manifestation known as a celiac crisis (CC). This may be a consequence of a delayed diagnosis and expose patients to possible fatal complications. We report the case of a 22-month-old child admitted to our hospital for a CC characterized by weight loss, vomiting, and diarrhea associated with a malnutrition state. Early identification of symptoms of CC is essential to provide a prompt diagnosis and management.
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Affiliation(s)
- Angela Mauro
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Francesca Casini
- Department of Biomedical and Clinical Sciences, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Antonella Talenti
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Clelia Di Mari
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Anna Rita Benincaso
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Giovanni Di Nardo
- Faculty of Medicine and Psychology, Sapienza University of Rome-NESMOS Department, Sant’Andrea University Hospital, Rome, Italy
| | - Luca Bernardo
- Department of Childhood and Developmental Medicine, Fatebenefratelli Hospital, Milan, Italy
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FABBRI C, SPADA C, ARAGONA SE, CIPRANDI G. The practical management of chronic constipation as detected by a survey conducted on Italian gastroenterologists. Gazz Med Ital - Arch Sci Med 2023; 182. [DOI: 10.23736/s0393-3660.23.05043-x] [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: 09/15/2023] [Imported: 09/15/2023]
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Blasi E, Stefanelli E, Tambucci R, Salvatore S, Angelis PD, Quitadamo P, Pacchiarotti C, Nardo GD, Crocco F, Felici E, Giorgio V, Staropoli N, Sestito S, Saliakellis E, Borrelli O, Pensabene L. Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study. J Neurogastroenterol Motil 2023; 29:156-165. [PMID: 37019861 PMCID: PMC10083122 DOI: 10.5056/jnm22115] [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: 07/15/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 04/07/2023] [Imported: 09/15/2023] Open
Abstract
Background/Aims Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment.
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Affiliation(s)
- Elisa Blasi
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London, UK
- Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ettore Stefanelli
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital - Research Institute IRCCS, Rome, Italy
| | - Silvia Salvatore
- Pediatric Department, University of Insubria, Hospital "F. Del Ponte", Varese, Italy
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital - Research Institute IRCCS, Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Napoli, Italy
| | - Claudia Pacchiarotti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Fanj Crocco
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Staropoli
- A.O.U. Mater Domini, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Efstratios Saliakellis
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Osvaldo Borrelli
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London, UK
| | - Licia Pensabene
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London, UK
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy
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8
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Di Nardo G, Zenzeri L, Guarino M, Molfino A, Parisi P, Barbara G, Stanghellini V, De Giorgio R. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17:325-341. [PMID: 36939480 DOI: 10.1080/17474124.2023.2193887] [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] [Indexed: 03/21/2023] [Imported: 09/15/2023]
Abstract
INTRODUCTION Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous and severe form of gastrointestinal dysmotility. AREAS COVERED Pertinent literature on pediatric and adult CIPO management has been assessed via PubMed, Scopus, and EMBASE from inception to June 2022. Prokinetics, aimed at restoring intestinal propulsion (e.g. orthopramides and substituted benzamides, acetyl cholinesterase inhibitors, serotonergic agents and others), have been poorly tested and the available data showed only partial efficacy. Moreover, some prokinetic agents (e.g. orthopramides and substituted benzamides) can cause major side effects. The CIPO-related small intestinal bacterial overgrowth requires treatment preferably via poorly absorbable antibiotics to avoid bacterial resistance. Apart from opioids, which worsen gut motility, analgesics should be considered to manage visceral pain, which might dominate the clinical manifestations. Nutritional support, via modified oral feeding, enteral or parenteral nutrition, is key to halt CIPO-related malnutrition. EXPERT OPINION There have been significant roadblocks preventing the development of CIPO treatment. Nonetheless, the considerable advancement in neurogastroenterology and pharmacological agents cast hopes to test the actual efficacy of new prokinetics via well-designed clinical trials. Adequate dietary strategies and supplementation remain of crucial importance. Taken together, novel pharmacological and nutritional options are expected to provide adequate treatments for these patients.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.,Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Alessio Molfino
- Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Barbara
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Vincenzo Stanghellini
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Di Nardo G, Cremon C, Staiano A, Stanghellini V, Borrelli O, Strisciuglio C, Romano C, Mallardo S, Scarpato E, Marasco G, Salvatore S, Zenzeri L, Felici E, Pensabene L, Sestito S, Francavilla R, Quitadamo P, Baldassarre M, Giorgio V, Tambucci R, Ziparo C, Parisi P, Barbaro MR, Barbara G. Role of inflammation in pediatric irritable bowel syndrome. Neurogastroenterol Motil 2023; 35:e14365. [PMID: 35340083 DOI: 10.1111/nmo.14365] [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: 08/16/2021] [Revised: 02/09/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] [Imported: 09/15/2023]
Abstract
BACKGROUND IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain-gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low-grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory-motor function. Likewise, the development of long-standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory-motor function, and potential implications for symptom generation emerged in both children and adults with IBS. PURPOSE The aim of this review is to summarize the main evidence on the presence of low-grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | | | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Elena Scarpato
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.,Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ruggiero Francavilla
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Mariella Baldassarre
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Ziparo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Di Nardo G, Micheli F, Cozzi DA, Mercantini P, Parisi P, Baccini F, Mennini M, Raucci U, Marasco G. Magnetic-assisted capsule endoscopy in children with Crohn's Disease: feasibility and impact on gastric transit time. J Pediatr Gastroenterol Nutr 2023. [PMID: 36763990 DOI: 10.1097/MPG.0000000000003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] [Imported: 09/15/2023]
Abstract
OBJECTIVES standard capsule endoscopy (CE) is ineffective for upper gastrointestinal (GI) tract examination because it does not allow operator-controlled navigation of the capsule. Magnetically assisted capsule endoscopy (MACE) may offer a solution to these problems. This pilot study is aimed to evaluate the feasibility of MACE system in pediatric Crohn's disease (CD) and if magnetic steering could enhance capsule gastric emptying when compared with standard CE. METHODS pediatric CD patients already studied by standard small bowel CE were enrolled. All participants swallowed a magnetically assisted CE and an external magnetic field navigator was used to guide the capsule through the upper GI tract. Maneuverability, completeness of the MACE examination and differences in the esophageal transit time (ETT), gastric transit time (GTT) and pyloric transit time (PTT) between standard CE and MACE were assessed. RESULTS ten patients [mean age 11,4 years (range 6-15); 60% male] were enrolled. Maneuverability was defined as good and fair in 60% and 40% of participants, respectively. Completeness of MACE examination was 95%, 65% and 92,5% in the esophagus, proximal and distal stomach, respectively. Transpyloric passage of the capsule under magnetic control was successfully performed in 80% of patients.Magnetic intervention significantly increased ETT (P < 0.001) and reduced GTT and PTT (P = 0.002). No significant adverse events occurred. CONCLUSIONS MACE is a safe and feasible technique in children. Magnetic steering enhances capsule gastric emptying and facilitates capsule transpyloric passage when compared with standard CE.
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Martelli E, Zamboni M, Sotgiu G, Saderi L, Federici M, Sangiorgi GM, Puci MV, Martelli AR, Messina T, Frigatti P, Borrelli MP, Ruotolo C, Ficarelli I, Rubino P, Pezzo F, Carbonari L, Angelini A, Galeazzi E, Di Pinto LC, Fiore FM, Palmieri A, Ventoruzzo G, Mazzitelli G, Ragni F, Bozzani A, Forliti E, Castagno C, Volpe P, Massara M, Moniaci D, Pagliasso E, Peretti T, Ferrari M, Troisi N, Modugno P, Maiorano M, Bracale UM, Panagrosso M, Monaco M, Giordano G, Natalicchio G, Biello A, Celoria GM, Amico A, Di Bartolo M, Martelli M, Munaó R, Razzano D, Colacchio G, Bussetti F, Lanza G, Cardini A, Di Benedetto B, De Laurentis M, Taurino M, Sirignano P, Cappiello P, Esposito A, Trimarchi S, Romagnoli S, Padricelli A, Giudice G, Crinisio A, Di Nardo G, Battaglia G, Tringale R, De Vivo S, Compagna R, Tolva VS, D’Alessio I, Curci R, Giovannetti S, D’Arrigo G, Basile G, Frigerio D, Veraldi GF, Mezzetto L, Ippoliti A, Oddi FM, Settembrini AM. Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry. J Pers Med 2023; 13:jpm13020316. [PMID: 36836550 PMCID: PMC9959358 DOI: 10.3390/jpm13020316] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/08/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] [Imported: 09/15/2023] Open
Abstract
BACKGROUND Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). METHODS Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. FOLLOW-UP One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. RESULTS Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. CONCLUSION Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.
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Affiliation(s)
- Eugenio Martelli
- Department of General and Specialist Surgery Paride Stefanini, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 viale del Policlinico, 00161 Rome, Italy
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Sciences, 8 via di Sant’Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
- Correspondence: ; Tel.: +39-3294003220
| | - Matilde Zamboni
- Division of Vascular Surgery, Saint Martin Hospital, 22 viale Europa, 32100 Belluno, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Giuseppe M. Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, viale San Pietro, 07100 Sassari, Italy
| | - Allegra R. Martelli
- Medicine and Surgery School of Medicine, Campus Bio-Medico University of Rome, 21 via À. del Portillo, 00128 Rome, Italy
| | - Teresa Messina
- Division of Anesthesia and Intensive Care of Organ Transplants, Umberto I Polyclinic University Hospital, 155 viale del Policlinico, 00161 Rome, Italy
| | - Paolo Frigatti
- Divisions of Vascular Surgery, S. Maria Misericordia University Hospital, 15 Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Maria Pia Borrelli
- Divisions of Vascular Surgery, S. Maria Misericordia University Hospital, 15 Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Carlo Ruotolo
- Divisions of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy
| | - Ilaria Ficarelli
- Divisions of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy
| | - Paolo Rubino
- Divisions of Vascular Surgery, Pugliese Ciaccio Hospital, 83 viale Pio X, 88100 Catanzaro, Italy
| | - Francesco Pezzo
- Divisions of Vascular Surgery, Pugliese Ciaccio Hospital, 83 viale Pio X, 88100 Catanzaro, Italy
| | - Luciano Carbonari
- Divisions of Vascular Surgery, Riuniti University Hospitals, 71 via Conca, Torrette (AN), 60126 Ancona, Italy
| | - Andrea Angelini
- Divisions of Vascular Surgery, Riuniti University Hospitals, 71 via Conca, Torrette (AN), 60126 Ancona, Italy
| | - Edoardo Galeazzi
- Divisions of Vascular Surgery, Treviso Hospital, 1 piazzale del’Ospedale, 31100 Treviso, Italy
| | - Luca Calia Di Pinto
- Divisions of Vascular Surgery, Treviso Hospital, 1 piazzale del’Ospedale, 31100 Treviso, Italy
| | - Franco M. Fiore
- Divisions of Vascular Surgery, SS. Annunziata Hospital, 31 via dei Vestini, 66100 Chieti, Italy
| | - Armando Palmieri
- Divisions of Vascular Surgery, SS. Annunziata Hospital, 31 via dei Vestini, 66100 Chieti, Italy
| | - Giorgio Ventoruzzo
- Divisions of Vascular Surgery, San Donato Hospital, 20 via Pietro Nenni, 52100 Arezzo, Italy
| | - Giulia Mazzitelli
- Divisions of Vascular Surgery, San Donato Hospital, 20 via Pietro Nenni, 52100 Arezzo, Italy
| | - Franco Ragni
- Divisions of Vascular Surgery, San Matteo Polyclinic, 19 viale Camillo Golgi, 27100 Pavia, Italy
| | - Antonio Bozzani
- Divisions of Vascular Surgery, San Matteo Polyclinic, 19 viale Camillo Golgi, 27100 Pavia, Italy
| | - Enzo Forliti
- Divisions of Vascular Surgery, Infermi Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Italy
| | - Claudio Castagno
- Divisions of Vascular Surgery, Infermi Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Italy
| | - Pietro Volpe
- Divisions of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, 21 via G. Melacrino, 89124 Reggio di Calabria, Italy
| | - Mafalda Massara
- Divisions of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, 21 via G. Melacrino, 89124 Reggio di Calabria, Italy
| | - Diego Moniaci
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Elisa Pagliasso
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Tania Peretti
- Divisions of Vascular Surgery, San Giovanni Bosco Hospital, 3 piazza del Donatore di Sangue, 10154 Turin, Italy
| | - Mauro Ferrari
- Divisions of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 2 via Paradisa, 56124 Pisa, Italy
| | - Nicola Troisi
- Divisions of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 2 via Paradisa, 56124 Pisa, Italy
| | - Piero Modugno
- Divisions of Vascular Surgery, Gemelli Molise Hospital, 1 largo A. Gemelli, 86100 Campobasso, Italy
| | - Maurizio Maiorano
- Divisions of Vascular Surgery, Gemelli Molise Hospital, 1 largo A. Gemelli, 86100 Campobasso, Italy
| | - Umberto M. Bracale
- Divisions of Vascular Surgery, Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 via S. Pansini, 80131 Naples, Italy
| | - Marco Panagrosso
- Divisions of Vascular Surgery, Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 via S. Pansini, 80131 Naples, Italy
| | - Mario Monaco
- Divisions of Vascular Surgery, Pineta Grande Hospital, Km. 30 via Domitiana, 81030 Castelvolturno, Italy
- Divisions of Vascular Surgery, Sanatrix Clinic, 31 via S. Domenico, 80127 Naples, Italy
| | - Giovanni Giordano
- Divisions of Vascular Surgery, Sanatrix Clinic, 31 via S. Domenico, 80127 Naples, Italy
| | - Giuseppe Natalicchio
- Divisions of Vascular Surgery, Venere Hospital, 1 via Ospedale di Venere, 70131 Bari, Italy
| | - Antonella Biello
- Divisions of Vascular Surgery, Venere Hospital, 1 via Ospedale di Venere, 70131 Bari, Italy
| | - Giovanni M. Celoria
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Alessio Amico
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Mauro Di Bartolo
- Divisions of Vascular Surgery, Sant’Andrea Hospital, 197 via Vittorio Veneto, 19121 La Spezia, Italy
| | - Massimiliano Martelli
- Divisions of Vascular Surgery, MultiMedica Hospital, 300 via Milenese, 20099 Sesto San Giovanni, Italy
| | - Roberta Munaó
- Divisions of Vascular Surgery, MultiMedica Hospital, 300 via Milenese, 20099 Sesto San Giovanni, Italy
| | - Davide Razzano
- Divisions of Vascular Surgery, San Pio Hospital, 1 via dell’angelo, 82100 Benevento, Italy
| | - Giovanni Colacchio
- Divisions of Vascular Surgery, F.Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km. 4, 70021 Acquaviva delle Fonti, Italy
| | - Francesco Bussetti
- Divisions of Vascular Surgery, F.Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km. 4, 70021 Acquaviva delle Fonti, Italy
| | - Gaetano Lanza
- Divisions of Vascular Surgery, Multimedica Hospital, 70 viale Piemonte, 21053 Castellanza, Italy
| | - Antonio Cardini
- Divisions of Vascular Surgery, Multimedica Hospital, 70 viale Piemonte, 21053 Castellanza, Italy
| | | | - Mario De Laurentis
- Divisions of Vascular Surgery, Monaldi Hospital, via L. Bianchi, 84100 Naples, Italy
| | - Maurizio Taurino
- Divisions of Vascular Surgery, Department of Molecular and Clinical Medicine, Sapienza University of Rome, Giorgio Nicola Papanicolau, 00189 Rome, Italy
- Divisions of Vascular Surgery, Sant’Andrea University Hospital, 1035/1039 via di Grottarossa, 00189 Rome, Italy
| | - Pasqualino Sirignano
- Department of General and Specialist Surgery Paride Stefanini, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 viale del Policlinico, 00161 Rome, Italy
- Divisions of Vascular Surgery, Sant’Andrea University Hospital, 1035/1039 via di Grottarossa, 00189 Rome, Italy
| | - Pierluigi Cappiello
- Divisions of Vascular Surgery, San Carlo Hospital, via Potito Petrone, 85100 Potenza, Italy
| | - Andrea Esposito
- Divisions of Vascular Surgery, San Carlo Hospital, via Potito Petrone, 85100 Potenza, Italy
| | - Santi Trimarchi
- Divisions of Vascular Surgery, Department of Clinical and Community Sciences, University of Milan, 19 via della Commenda, 20122 Milan, Italy
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
| | - Silvia Romagnoli
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
| | - Andrea Padricelli
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
| | - Giorgio Giudice
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, via F. Palasciano, 81100 Caserta, Italy
| | - Adolfo Crinisio
- Divisions of Vascular Surgery, Salus Clinic, 4 via F. Confalonieri, 84091 Battipaglia, Italy
| | - Giovanni Di Nardo
- Divisions of Vascular Surgery, Salus Clinic, 4 via F. Confalonieri, 84091 Battipaglia, Italy
| | - Giuseppe Battaglia
- Divisions of Vascular Surgery, San Marco Hospital, viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Rosario Tringale
- Divisions of Vascular Surgery, San Marco Hospital, viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Salvatore De Vivo
- Divisions of Vascular Surgery, Pellegrini Hospital, 41 via Portamedina alla Pignasecca, 80134 Naples, Italy
| | - Rita Compagna
- Divisions of Vascular Surgery, Pellegrini Hospital, 41 via Portamedina alla Pignasecca, 80134 Naples, Italy
| | - Valerio S. Tolva
- Divisions of Vascular Surgery, Niguarda Hospital, Piazza dell’Ospedale Maggiore 3, 20161 Milan, Italy
| | - Ilenia D’Alessio
- Divisions of Vascular Surgery, Niguarda Hospital, Piazza dell’Ospedale Maggiore 3, 20161 Milan, Italy
| | - Ruggiero Curci
- Divisions of Vascular Surgery, Maggiore Hospital, 10 Piazza Ospitale, 26900 Lodi, Italy
| | - Simona Giovannetti
- Divisions of Vascular Surgery, Maggiore Hospital, 10 Piazza Ospitale, 26900 Lodi, Italy
| | - Giuseppe D’Arrigo
- Divisions of Vascular Surgery, Garibaldi-Nesima Hospital, 636 via Palermo, 95122 Catania, Italy
| | - Giusi Basile
- Divisions of Vascular Surgery, Garibaldi-Nesima Hospital, 636 via Palermo, 95122 Catania, Italy
| | - Dalmazio Frigerio
- Divisions of Vascular Surgery, Vimercate Hospital, 10 via Cosma e Damiano, 20871 Vimercate, Italy
| | - Gian Franco Veraldi
- Divisions of Vascular Surgery, University Hospital Pietro Confortini, 1 Piazzale Aristide Stefani, 37126 Verona, Italy
| | - Luca Mezzetto
- Divisions of Vascular Surgery, University Hospital Pietro Confortini, 1 Piazzale Aristide Stefani, 37126 Verona, Italy
| | - Arnaldo Ippoliti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Fabio M. Oddi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 viale Montpellier, 00133 Rome, Italy
| | - Alberto M. Settembrini
- Divisions of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 35 via Francesco Sforza, 20122 Milan, Italy
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Mauro A, Giani T, Di Mari C, Sandini M, Talenti A, Ansuini V, Biondi L, Di Nardo G, Bernardo L. Gastrointestinal Involvement in Children with Systemic Lupus Erythematosus. Children (Basel) 2023; 10:children10020309. [PMID: 36832440 PMCID: PMC9955206 DOI: 10.3390/children10020309] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] [Imported: 09/15/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. When it presents before the age of 18 years (childhood-onset systemic lupus erythematosus, cSLE), the disease course tends to be more severe with a higher rate of organ involvement and requires an early diagnosis. Gastrointestinal involvement in cSLE is rare and scarcely reported in the literature. Any organ of the gastrointestinal system may be affected, either as a direct consequence of the disease, as a subsequent complication, or as an adverse drug event. Abdominal pain is the most common GI symptom, it can be diffuse or well localized, and can underline different conditions such as hepatitis, pancreatitis, appendicitis, peritonitis, or enteritis. cSLE may have an alteration of the intestinal barrier with features of protein-losing enteropathy or, in genetically predisposed patients, may develop associated autoimmune disorders such as Coeliac Disease or Autoimmune Hepatitis. The aim of this manuscript is to provide a narrative review of gastrointestinal manifestations in cSLE focused on hepatic, pancreatic, and intestinal involvement. A comprehensive literature search based on the PubMed database was performed.
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Affiliation(s)
- Angela Mauro
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Teresa Giani
- Department of Pediatrics, Meyer Children's Hospital, 50139 Firenze, Italy
| | - Clelia Di Mari
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Martina Sandini
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Antonella Talenti
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Valentina Ansuini
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Luigi Biondi
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
| | - Giovanni Di Nardo
- Faculty of Medicine and Psycology, Sapienza University of Rome-NESMOS Department, Sant'Andrea University Hospital, Via Grottarossa 1035-1039, 00189 Roma, Italy
| | - Luca Bernardo
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Piazzale Principessa Clotilde, 20121 Milano, Italy
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Barbara G, Cremon C, Bellini M, Corsetti M, Di Nardo G, Falangone F, Fuccio L, Galeazzi F, Iovino P, Sarnelli G, Savarino EV, Stanghellini V, Staiano A, Stasi C, Tosetti C, Turco R, Ubaldi E, Zagari RM, Zenzeri L, Marasco G. Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Dig Liver Dis 2023; 55:187-207. [PMID: 36517261 DOI: 10.1016/j.dld.2022.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023] [Imported: 09/15/2023]
Abstract
The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements. In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants.
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Affiliation(s)
- Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, United Kingdom
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Falangone
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Sapienza, Rome, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Francesca Galeazzi
- Gastroenterology Unit, Azienda Ospedale Università di Padova, 35128 Padua, Italy
| | - Paola Iovino
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | | | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | | | - Rossella Turco
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Enzo Ubaldi
- Primary Care, Health Care Agency of Ascoli Piceno, Ascoli Piceno, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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Ciacchini B, Di Nardo G, Marin M, Borali E, Caraccia M, Mogni R, Cairello F, Rabbone I, Ferrero GB, Pini Prato A, Felici E. Case report: Gastroenterological management in a case of cardio-facio-cutaneous syndrome. Front Pediatr 2023; 11:1160147. [PMID: 37138575 PMCID: PMC10149741 DOI: 10.3389/fped.2023.1160147] [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: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] [Imported: 09/15/2023] Open
Abstract
Background cardio-facio-cutaneous syndrome is a rare genetic disorder affecting less than 900 people in the world. It is mainly characterized by craniofacial, dermatologic and cardiac defects, but also gastroenterological symptoms may be present, ranging from feeding difficulties to gastroesophageal reflux and constipation.In this report we describe a case of this syndrome characterized by severe feeding and growth difficulties, with a particular focus on the management of gastroenterological complications. Case presentation the patient was a caucasian male affected by Cardio-Facio-Cutaneous syndrome who presented feeding difficulties already a few hours after birth. These symptoms worsened in the following months and lead to a complete growth arrest and malnutrition. He was first treated with a nasogastric tube placement. Subsequently, a laparoscopic Nissen fundoplication and a laparoscopic Stamm gastrostomy were performed. The child was fed with nocturnal enteral nutrition and diurnal oral and enteral nutrition. Eventually the patient resumed feeding validly and regained adequate growth. Conclusion this paper aims to bring to light a complex rare syndrome that infrequently comes to the attention of the pediatricians and whose diagnosis is not always straightforward. We also highlight the possible complications under a gastroenterologic point of view. Our contribution can be helpful to the pediatrician in the first diagnostic suspect of this syndrome. In particular, it is worth highlighting that -in an infant with Noonan-like features- symptoms like suction or swallowing problems, vomiting and feeding difficulties should orient towards the diagnosis of a Cardio-facio-cutaneous syndrome. It is also important to stress that its related gastroenterological issues may lead to severe growth failure and therefore the role of the gastroenterologist is key to manage supplemental feeding and to establish whether a nasogastric or gastrostomic tube placement is necessary.
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Affiliation(s)
- B. Ciacchini
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | - G. Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - M. Marin
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - E. Borali
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - M. Caraccia
- Pediatric Surgery, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - R. Mogni
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - F. Cairello
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - I. Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | - G. B Ferrero
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - A. Pini Prato
- Pediatric Surgery, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - E. Felici
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
- Correspondence: E. Felici
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15
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Cenni S, Sesenna V, Boiardi G, Casertano M, Di Nardo G, Esposito S, Strisciuglio C. The Mediterranean Diet in Paediatric Gastrointestinal Disorders. Nutrients 2022; 15. [PMID: 36615737 DOI: 10.3390/nu15010079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] [Imported: 09/15/2023] Open
Abstract
The Mediterranean diet is considered one of the healthiest dietary patterns worldwide, thanks to a combination of foods rich mainly in antioxidants and anti-inflammatory nutrients. Many studies have demonstrated a strong relationship between the Mediterranean diet and some chronic gastrointestinal diseases. The aim of this narrative review was to analyse the role of the Mediterranean diet in several gastrointestinal diseases, so as to give a useful overview on its effectiveness in the prevention and management of these disorders.
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Di Nardo G, Felici E, Zenzeri L, Mennini M, Evangelisti M, Parisi P, Massolo AC, Hassan C, Piccirillo M, Lucchini L, Furio S, Quatrale G, Strisciuglio C. Split-dose versus day-before regimen of sodium picosulfate plus magnesium citrate for bowel cleansing before colonoscopy in children: Randomized controlled trial. Dig Endosc 2022. [PMID: 36411968 DOI: 10.1111/den.14481] [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: 08/25/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] [Imported: 09/15/2023]
Abstract
OBJECTIVES Polyethylene glycol (PEG) split-dose regimen is recommended as the option of choice for colon preparation before colonoscopy in children and adults. Sodium picosulfate plus magnesium citrate (SPMC) is equally effective but better tolerated than PEG for bowel preparation before colonoscopy in children. The aim of this study was to assess the superiority of SPMC split-dose regimen compared with SPMC day-before regimen for bowel cleansing before colonoscopy in children. METHODS This was a multicenter, randomized, single-blind study. Pediatric inpatients undergoing colonoscopy received SPMC either in the day-before dosing or in split dosing. Overall bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS) and was rated as successful when BBPS was ≥6. Patient tolerability, acceptability, and compliance were recorded. RESULTS The rate of successful cleansing level was significantly higher in the split-dose group than in the day-before group (P < 0.001). The BBPS scores were significantly higher in the split-dose group than in the day-before group for the whole colon (P < 0.001), the right colon (P < 0.001) and transverse colon (P < 0.001). Patient acceptability was better in the split-dose group (P = 0.0003; P = 0.005). The percentage of children needing nasogastric tube placement was better in the split-dose group (P = 0.007). CONCLUSIONS The split-dose regimen of SPMC was superior to the day-before regimen in terms of successful colon cleansing and acceptability.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Enrico Felici
- Pediatric Unit, Children's Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.,Pediatric Unit, Children's Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Mennini
- Translational Research in Pediatric Specialities Area, Allergy Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marisa Piccirillo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Livia Lucchini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Silvia Furio
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanna Quatrale
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Micolonghi C, Piane M, Germani A, Sadeghi S, Libi F, Savio C, Fabiani M, Mancini R, Ranieri D, Pizzuti A, Corleto VD, Parisi P, Visco V, Di Nardo G, Petrucci S. A New SMAD4 Splice Site Variant in a Three-Generation Italian Family with Juvenile Polyposis Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12112684. [PMID: 36359527 PMCID: PMC9689379 DOI: 10.3390/diagnostics12112684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] [Imported: 09/15/2023] Open
Abstract
Juvenile polyposis syndrome (JPS) is an autosomal dominant disorder characterized by hyperplastic polyps in the upper and lower gastrointestinal (GI) tract with a high risk of developing GI cancers. We have described a three-generation Italian family with all the spectrum of SMAD4 phenotype. A multigene panel test was performed on the genomic DNA of the proband by next-generation sequencing, including genes related to hereditary GI tumor syndromes. Molecular analysis revealed the presence of the c.1140-2A>G substitution in the SMAD4 gene, a novel splice variant that has never been described before. Our family is remarkable in that it illustrates the variable expressivity of the SMAD4 phenotype within the same family. The possibility of phenotype variability should also be considered within family members carrying the same mutation. In JPS, a timely genetic diagnosis allows clinicians to better manage patients and to provide early surveillance and intervention for their asymptomatic mutated relatives in the early decades of life.
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Affiliation(s)
- Caterina Micolonghi
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Piane
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
- S. Andrea University Hospital, 00189 Rome, Italy
| | - Aldo Germani
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Soha Sadeghi
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Libi
- S. Andrea University Hospital, 00189 Rome, Italy
| | | | - Marco Fabiani
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00161 Rome, Italy
- ALTAMEDICA, Human Genetics, 00198 Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
- S. Andrea University Hospital, 00189 Rome, Italy
| | - Danilo Ranieri
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00161 Rome, Italy
- Medical Genetics Unit, IRCCS Mendel Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Vito Domenico Corleto
- S. Andrea University Hospital, 00189 Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Pasquale Parisi
- S. Andrea University Hospital, 00189 Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
- S. Andrea University Hospital, 00189 Rome, Italy
| | - Giovanni Di Nardo
- S. Andrea University Hospital, 00189 Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Simona Petrucci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
- S. Andrea University Hospital, 00189 Rome, Italy
- Medical Genetics Unit, IRCCS Mendel Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
- Correspondence: ; Tel.: +39-0633-776-103
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Turco R, Mauro A, Quitadamo P, Gaglione G, Esposito F, Di Nardo G, Tipo V. Acute appendicitis in infants. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102508] [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: 11/09/2022] [Imported: 09/15/2023] Open
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19
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Isoldi S, Di Nardo G, Mallardo S, Parisi P, Raucci U, Tambucci R, Quitadamo P, Salvatore S, Felici E, Cisarò F, Pensabene L, Banzato C, Strisciuglio C, Romano C, Fusco P, Rigotti F, Sansotta N, Caimmi S, Savasta S, Zuin G, Di Stefano M, Provera S, Campanozzi A, Rossi P, Gatti S, Corpino M, Alvisi P, Martelossi S, Suppiej A, Gandullia P, Verrotti A, Terrin G, Pacenza C, Fornaroli F, Comito D, D'Arrigo S, Striano P, Raviglione F, Carotenuto M, Orsini A, Belcastro V, Di Corcia G, Raieli V, Ferilli MAN, Ruscitto C, Spadoni E, Grosso S, D'Alonzo R, Papa A, Pavone P, Meli M, Velardita M, Mainetti M, Vanacore N, Borrelli O. Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Ital J Pediatr 2022; 48:156. [PMID: 36042474 PMCID: PMC9429644 DOI: 10.1186/s13052-022-01346-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] [Imported: 09/15/2023] Open
Abstract
Background Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01346-y.
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Affiliation(s)
- Sara Isoldi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Giovanni Di Nardo
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy.
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Patrizia Fusco
- Pediatric Unit, Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | | | - Naire Sansotta
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Savasta
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Zuin
- Pediatric Department, University of Milano Bicocca, FMBBM, San Gerardo Hospital, Monza, Italy
| | - Marina Di Stefano
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Provera
- Department of Pediatrics, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, Pediatric Unit, University of Foggia, Foggia, Italy
| | - Paolo Rossi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | - Mara Corpino
- Gastroenterologia Pediatrica, Clinica Pediatrica e Malattie Rare, Ospedale Pediatrico Microcitemico A. Cao, ARNAS Brotzu, Cagliari, Italy
| | - Patrizia Alvisi
- Department of Paediatrics, Ospedale Maggiore, Azienda USL, Bologna, Italy
| | | | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Gandullia
- UOC Gastroenterologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Caterina Pacenza
- Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
| | - Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Stefano D'Arrigo
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Pasquale Striano
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health and Physical and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro Orsini
- Paediatric Neurology Section, Paediatric Department, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | | | - Vincenzo Raieli
- Child Neuropsychiatry Unit - ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Elisabetta Spadoni
- Pediatric Department, Azienda Ospedaliera Nord-Ovest of Tuscany, San Luca Hospital of Lucca, Lucca, Italy
| | - Salvatore Grosso
- Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Italy
| | - Amanda Papa
- Infantile Neuropsychiatry Departement Maggiore della Carità University Hospital, Novara, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mariaclaudia Meli
- Azienda Policlinico, "Rodolico-San Marco Hospital", University of Catania, Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Hospital "Salvatore e Saverio Gravina", Caltagirone, Italy
| | - Martina Mainetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, UK
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Polese D, Belli A, Esposito D, Evangelisti M, Luchetti A, Di Nardo G, Parisi P, Bruni O. Psychological Disorders, Adverse Childhood Experiences and Parental Psychiatric Disorders in Children Affected by Headache: A Systematic Review. Neurosci Biobehav Rev 2022; 140:104798. [PMID: 35907492 DOI: 10.1016/j.neubiorev.2022.104798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022] [Imported: 09/15/2023]
Abstract
BACKGROUND Pediatric headaches have been linked to adverse life events or psychological factors in children and their families, with a complex and bidirectional association. Moreover, it is well-known that psychological stress can trigger headaches. METHODS We searched three databases for studies focusing on headaches and adverse events or psychological factors in children up to 12 years old or in their caregivers. RESULTS We included 28 studies. Child psychological factors, including internal and external symptoms, were commonly associated with all types of headaches. Sleep disturbances showed a positive association with headaches in 3 out of 5 studies. Family conflict and unhappiness were frequently found in children suffering with headaches, while single-parent families and divorce were not associated. Stressful environments and adverse life events, particularly bullying, were also found to be linked with headaches. CONCLUSIONS Childhood headaches represent an alarm bell for clinicians to investigate and treat psychological or psychiatric disorders in children and their family. Further studies are needed to elucidate the role of early-life adverse events in children and their families.
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Affiliation(s)
- Daniela Polese
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Arianna Belli
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, Via dei Sabelli 108 - 00185 Rome, Italy
| | - Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, Via dei Sabelli 108 - 00185 Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Anna Luchetti
- "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Oliviero Bruni
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Sant'Andrea Hospital Via di Grottarossa, 1035-1039, 00189, Rome, Italy; Department of Social and Developmental Psychology, Sapienza University, Via dei Marsi 78 - 00185 Rome, Italy.
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21
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Affiliation(s)
- Maurizio Mennini
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome 00100, Italy.
| | - Giovanni Di Nardo
- School of Medicine and Psychology, NESMOS Department, Sapienza University of Rome, Rome, Italy
| | - Alessandro Giovanni Fiocchi
- Translational Research in Paediatric Specialities Area, Allergy Division, Bambino Gesù Children's Hospital IRCCS, Rome 00100, Italy
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22
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Martelli E, Sotgiu G, Saderi L, Federici M, Sangiorgi G, Zamboni M, Martelli AR, Accarino G, Bianco G, Bonanno F, Bracale UM, Cappello E, Cioffi G, Colacchio G, Crinisio A, De Vivo S, Dionisi CP, Flora L, Impedovo G, Intrieri F, Iorio L, Maritati G, Modugno P, Monaco M, Natalicchio G, Palazzo V, Petrosino F, Pompeo F, Pulli R, Razzano D, Ruggieri MR, Ruotolo C, Sangiuolo P, Vigliotti G, Volpe P, Biello A, Boggia P, Boschetti M, Centritto EM, Condò F, Cucciolillo L, D’Amodio AS, De Laurentis M, Desantis C, Di Lella D, Di Nardo G, Disabato A, Ficarelli I, Gasparre A, Giordano AN, Luongo A, Massara M, Molinari V, Padricelli A, Panagrosso M, Petrone A, Pisanello S, Prunella R, Tedesco M, Settembrini AM. How the First Year of the COVID-19 Pandemic Impacted Patients' Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula. J Pers Med 2022; 12:jpm12071170. [PMID: 35887667 PMCID: PMC9316551 DOI: 10.3390/jpm12071170] [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: 06/12/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] [Imported: 09/15/2023] Open
Abstract
Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia.
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Affiliation(s)
- Eugenio Martelli
- Department of General and Specialist Surgery, Sapienza University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy
- Saint Camillus International University of Health Sciences, 8 Via di Sant’Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy;
- Correspondence: (M.Z.); (E.M.); Tel.: +39-3490611365 (M.Z.); +39-3294003220 (E.M.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro, 07100 Sassari, Italy; (G.S.); (L.S.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro, 07100 Sassari, Italy; (G.S.); (L.S.)
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy;
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy;
| | - Matilde Zamboni
- Division of Vascular Surgery, Saint Martin Hospital, 22 Viale Europa, 32100 Belluno, Italy
- Correspondence: (M.Z.); (E.M.); Tel.: +39-3490611365 (M.Z.); +39-3294003220 (E.M.)
| | - Allegra R. Martelli
- Medicine and Surgery School of Medicine, Campus Bio-Medico University of Rome, 21 Via À. del Portillo, 00128 Rome, Italy;
| | - Giancarlo Accarino
- San Giovanni Di Dio e Ruggi d’Aragona Hospital, Via San Leonardo s.n.c., 84125 Salerno, Italy;
| | - Giuseppe Bianco
- San Giovanni Bosco Hospital, 225 Via F. M. Briganti, 80144 Naples, Italy; (G.B.); (M.B.)
| | - Francesco Bonanno
- Madonna delle Grazie Hospital, Via Montescaglioso s.n.c., 75100 Matera, Italy;
| | - Umberto M. Bracale
- Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy; (U.M.B.); (F.C.); (M.P.); (A.P.)
| | - Enrico Cappello
- Mediterranean Neurological Institute NEUROMED, 18 Via Atinense, 80122 Naples, Italy; (E.C.); (F.P.)
| | - Giovanni Cioffi
- Pellegrini Hospital, 41 Via Portamedina alla Pignasecca, 80134 Naples, Italy; (G.C.); (S.D.V.); (A.S.D.)
| | - Giovanni Colacchio
- F. Miulli Hospital, Km. 4100 Strada Provinciale 127 Acquaviva-Santeramo, 70021 Acquaviva delle Fonti, Italy; (G.C.); (A.G.)
| | - Adolfo Crinisio
- Salus Clinic, 4 Via F. Confalonieri, 84091 Battipaglia, Italy; (A.C.); (G.D.N.)
| | - Salvatore De Vivo
- Pellegrini Hospital, 41 Via Portamedina alla Pignasecca, 80134 Naples, Italy; (G.C.); (S.D.V.); (A.S.D.)
| | | | - Loris Flora
- San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy;
| | - Giovanni Impedovo
- SS. Annunziata Hospital, 1 Via F. Bruno, 74121 Taranto, Italy; (G.I.); (S.P.); (R.P.)
| | - Francesco Intrieri
- Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy; (F.I.); (V.M.)
| | - Luca Iorio
- Cardarelli Hospital, 1 Via U. Petrella, 86100 Campobasso, Italy; (L.I.); (L.C.)
| | - Gabriele Maritati
- A. Perrino Hospital, Strada Statale 7 per Mesagne, 72100 Brindisi, Italy; (G.M.); (P.B.)
| | - Piero Modugno
- Gemelli Molise Hospital, Catholic University of the Sacred Heart, 1 Largo A. Gemelli, 86100 Campobasso, Italy; (P.M.); (E.M.C.)
| | - Mario Monaco
- Pineta Grande Hospital, Km. 30 Via Domitiana, 81030 Castelvolturno, Italy;
| | | | - Vincenzo Palazzo
- Casa Sollievo della Sofferenza Hospital, Viale Cappuccini s.n.c., 71013 San Giovanni Rotondo, Italy; (V.P.); (A.N.G.)
| | - Fernando Petrosino
- San Luca Hospital, 1 Via F. Cammarota, 84078 Vallo della Lucania, Italy; (F.P.); (A.L.)
| | - Francesco Pompeo
- Mediterranean Neurological Institute NEUROMED, 18 Via Atinense, 80122 Naples, Italy; (E.C.); (F.P.)
| | - Raffaele Pulli
- Polyclinic of Bari, Department of Emergency and Organs Transplantation, Aldo Moro University of Bari, 11 Piazza Giulio Cesare, 70124 Bari, Italy; (R.P.); (C.D.)
| | - Davide Razzano
- San Pio Hospital, 1 Via dell’angelo, 82100 Benevento, Italy;
| | | | - Carlo Ruotolo
- Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy; (C.R.); (I.F.)
| | - Paolo Sangiuolo
- Monaldi Hospital, Via L. Bianchi s.n.c., 84100 Naples, Italy; (P.S.); (M.D.L.)
| | - Gennaro Vigliotti
- Del Mare Hospital, 11 Via E. Russo, 80147 Naples, Italy; (G.V.); (D.D.L.)
| | - Pietro Volpe
- Bianchi-Melacrino-Morelli Hospital, 21 Via G. Melacrino, 89124 Reggio di Calabria, Italy; (P.V.); (M.M.)
| | - Antonella Biello
- Venere Hospital, 1 Via Ospedale di Venere, 70131 Bari, Italy; (G.N.); (A.B.)
| | - Pietro Boggia
- A. Perrino Hospital, Strada Statale 7 per Mesagne, 72100 Brindisi, Italy; (G.M.); (P.B.)
| | - Michelangelo Boschetti
- San Giovanni Bosco Hospital, 225 Via F. M. Briganti, 80144 Naples, Italy; (G.B.); (M.B.)
| | - Enrico M. Centritto
- Gemelli Molise Hospital, Catholic University of the Sacred Heart, 1 Largo A. Gemelli, 86100 Campobasso, Italy; (P.M.); (E.M.C.)
| | - Flavia Condò
- Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy; (U.M.B.); (F.C.); (M.P.); (A.P.)
- San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy;
| | - Lucia Cucciolillo
- Cardarelli Hospital, 1 Via U. Petrella, 86100 Campobasso, Italy; (L.I.); (L.C.)
| | - Amodio S. D’Amodio
- Pellegrini Hospital, 41 Via Portamedina alla Pignasecca, 80134 Naples, Italy; (G.C.); (S.D.V.); (A.S.D.)
| | - Mario De Laurentis
- Monaldi Hospital, Via L. Bianchi s.n.c., 84100 Naples, Italy; (P.S.); (M.D.L.)
| | - Claudio Desantis
- Polyclinic of Bari, Department of Emergency and Organs Transplantation, Aldo Moro University of Bari, 11 Piazza Giulio Cesare, 70124 Bari, Italy; (R.P.); (C.D.)
| | - Daniela Di Lella
- Del Mare Hospital, 11 Via E. Russo, 80147 Naples, Italy; (G.V.); (D.D.L.)
| | - Giovanni Di Nardo
- Salus Clinic, 4 Via F. Confalonieri, 84091 Battipaglia, Italy; (A.C.); (G.D.N.)
| | - Angelo Disabato
- Cardinal Panico Hospital, 4 Via San Pio X, 73039 Tricase, Italy; (C.P.D.); (A.D.)
| | - Ilaria Ficarelli
- Cardarelli Hospital, 9 Via A. Cardarelli, 80131 Naples, Italy; (C.R.); (I.F.)
| | - Angelo Gasparre
- F. Miulli Hospital, Km. 4100 Strada Provinciale 127 Acquaviva-Santeramo, 70021 Acquaviva delle Fonti, Italy; (G.C.); (A.G.)
| | - Antonio N. Giordano
- Casa Sollievo della Sofferenza Hospital, Viale Cappuccini s.n.c., 71013 San Giovanni Rotondo, Italy; (V.P.); (A.N.G.)
| | - Alessandro Luongo
- San Luca Hospital, 1 Via F. Cammarota, 84078 Vallo della Lucania, Italy; (F.P.); (A.L.)
| | - Mafalda Massara
- Bianchi-Melacrino-Morelli Hospital, 21 Via G. Melacrino, 89124 Reggio di Calabria, Italy; (P.V.); (M.M.)
| | - Vincenzo Molinari
- Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy; (F.I.); (V.M.)
| | - Andrea Padricelli
- Division of Vascular Surgery, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy;
| | - Marco Panagrosso
- Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy; (U.M.B.); (F.C.); (M.P.); (A.P.)
| | - Anna Petrone
- Federico II Polyclinic, Department of Public Health and Residency Program in Vascular Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy; (U.M.B.); (F.C.); (M.P.); (A.P.)
- Del Mare Hospital, 11 Via E. Russo, 80147 Naples, Italy; (G.V.); (D.D.L.)
| | - Serena Pisanello
- SS. Annunziata Hospital, 1 Via F. Bruno, 74121 Taranto, Italy; (G.I.); (S.P.); (R.P.)
| | - Roberto Prunella
- SS. Annunziata Hospital, 1 Via F. Bruno, 74121 Taranto, Italy; (G.I.); (S.P.); (R.P.)
| | - Michele Tedesco
- Riuniti Polyclinic, 1 Viale L. Pinto, 71122 Foggia, Italy; (M.R.R.); (M.T.)
| | - Alberto M. Settembrini
- Division of Vascular Surgery, Maggiore Polyclinic Hospital Ca’ Granda IRCCS and Foundation, 28 Via F. Sforza, 20122 Milan, Italy;
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Colucci MC, Triolo MF, Petrucci S, Pugnaloni F, Corsino M, Evangelisti M, D'Asdia MC, Di Nardo G, Garibaldi M, Terrin G, Parisi P. A dangerous food binge: a case report of hypokalemic periodic paralysis and review of current literature. Ital J Pediatr 2022; 48:116. [PMID: 35841048 PMCID: PMC9287989 DOI: 10.1186/s13052-022-01315-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] [Imported: 09/15/2023] Open
Abstract
BACKGROUND Hypokalemic periodic paralysis is a rare neuromuscular genetic disorder due to defect of ion channels and subsequent function impairment. It belongs to a periodic paralyses group including hyperkalemic periodic paralysis (HEKPP), hypokalemic periodic paralysis (HOKPP) and Andersen-Tawil syndrome (ATS). Clinical presentations are mostly characterized by episodes of flaccid generalized weakness with transient hypo- or hyperkalemia. CASE PRESENTATION A teenage boy presented to Emergency Department (ED) for acute weakness and no story of neurological disease, during the anamnestic interview he revealed that he had a carbohydrates-rich meal the previous evening. Through a focused diagnostic work-up the most frequent and dangerous causes of paralysis were excluded, but low serum potassium concentration and positive family history for periodic paralyses raised the diagnostic suspicion of HOKPP. After the acute management in ED, he was admitted to Pediatric Department where a potassium integration was started and the patient was counselled about avoiding daily life triggers. He was discharged in few days. Unfortunately, he presented again because of a new paralytic attack due to a sugar-rich food binge the previous evening. Again, he was admitted and treated by potassium integration. This time he was strongly made aware of the risks he may face in case of poor adherence to therapy or behavioral rules. Currently, after 15 months, the boy is fine and no new flare-ups are reported. CONCLUSION HOKPP is a rare disease but symptoms can have a remarkable impact on patients' quality of life and can interfere with employment and educational opportunities. The treatment aims to minimize the paralysis attacks by restoring normal potassium level in order to reduce muscle excitability but it seems clear that a strong education of the patient about identification and avoidance triggering factors is essential to guarantee a benign clinical course. In our work we discuss the typical clinical presentation of these patients focusing on the key points of the diagnosis and on the challenges of therapeutic management especially in adolescence. A brief discussion of the most recent knowledge regarding this clinical condition follows.
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Affiliation(s)
- Maria Carolina Colucci
- NESMOS department, Unit of Pediatrics, Sapienza University, c/o Sant Andrea University Hospital, Rome, Italy.
| | - Marica Fabiana Triolo
- NESMOS department, Unit of Pediatrics, Sapienza University, c/o Sant Andrea University Hospital, Rome, Italy
| | - Simona Petrucci
- UOC Medical Genetics and Advanced Cell Diagnostics, Sant Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Division of Medical Genetics, IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Flaminia Pugnaloni
- NESMOS department, Unit of Pediatrics, Sapienza University, c/o Sant Andrea University Hospital, Rome, Italy
| | | | - Melania Evangelisti
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant Andrea Hospital University, Sapienza University, Rome, Italy
| | - Maria Cecilia D'Asdia
- Division of Medical Genetics, IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giovanni Di Nardo
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant Andrea Hospital University, Sapienza University, Rome, Italy
| | - Matteo Garibaldi
- Department of Neurology Mental Health and Sensory Organs (NESMOS), Unit of Neuromuscular Diseases, Neuromuscular Disease Centre, Faculty of Medicine and Psychology, Sant Andrea Hospital University, Sapienza University, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant Andrea Hospital University, Sapienza University, Rome, Italy
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24
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Renzo S, Scarallo L, Antoniello LM, Bramuzzo M, Chiaro A, Cisarò F, Contini ACI, De Angelis GL, De Angelis P, Di Nardo G, Felici E, Iuliano S, Macchini F, Mantegazza C, Martelossi S, Oliva S, Parrinello F, Rea F, Pizzol A, Romano C, Russo G, Sansotta N, Lionetti P; SIGENP Endoscopy Working Group. Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group. Dig Liver Dis 2022; 54:572-9. [PMID: 35361566 DOI: 10.1016/j.dld.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022] [Imported: 09/15/2023]
Abstract
BACKGROUND Aim of the present report was to investigate the repercussions of COVID-19 pandemic on the procedural volumes and on the main indications of pediatric digestive endoscopy in Italy. METHODS An online survey was distributed at the beginning of December 2020 to Italian digestive endoscopy centers. Data were collected comparing two selected time intervals: the first from 1st of February 2019 to 30th June 2019 and the second from 1st February 2020 to 30th June 2020. RESULTS Responses to the survey came from 24 pediatric endoscopy Units. Globally, a reduction of 37.2% was observed between 2019 and 2020 periods with a significant decrease in median number of procedures (111 vs 57, p < 0.001). Both the median number of procedures performed for new diagnoses and those for follow-up purposes significantly decreased in 2020 (63 vs 36, p < 0.001 and 42 vs 21, p< 0.001, respectively). We reported a drastic reduction of procedures performed for suspected Celiac Disease and Functional Gastrointestinal Disorders (55.1% and 58.0%, respectively). Diagnostic endoscopies for suspected IBD decreased of 15.5%, whereas procedures for Mucosal Healing (MH) assessment reduced of 48.3%. CONCLUSIONS Our study provides real-world data outlining the meaningful impact of COVID-19 on pediatric endoscopy practice in Italy.
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Quitadamo P, Ranucci G, Ragozzino S, Tamasi S, Giugliano M, Gaglione G, De Brasi D, Mastrominico A, Di Nardo G. Giant bezoar causing recurrent abdominal pain in a young girl with autism spectrum disorder. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102241] [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: 11/17/2022] [Imported: 09/15/2023] Open
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Salvatori G, De Rose DU, Massolo AC, Patel N, Capolupo I, Giliberti P, Evangelisti M, Parisi P, Toscano A, Dotta A, Di Nardo G. Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review. J Clin Med 2022; 11:jcm11071841. [PMID: 35407451 PMCID: PMC8999967 DOI: 10.3390/jcm11071841] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] [Imported: 08/29/2023] Open
Abstract
(1) Objective: This review aims to identify the clinical and practical barriers to optimizing nutrition in newborn infants with congenital heart disease (CHD) and to describe updated evidence-based recommendations for clinical and nutritional management of these patients in a narrative review. (2) Research Methods and Procedures: We conducted a search of the relevant literature published from 2000 to December 2021. (3) Results: CHD patients undergo several nutritional challenges related to the underlying cardiac disease anomaly, the potential increased risk of NEC, and delayed enteral feeding, resulting in inadequate energy intake and sub-optimal growth, increased morbidity and mortality. (4) Conclusions: To optimize nutrition and growth in newborn infants with CHD, standardized protocols should be implemented. Regular nutritional and growth assessment with a multi-disciplinary team is essential. We propose a decisional algorithm that may represent a potentially useful tool to guide clinicians to optimize growth and nutrition.
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Affiliation(s)
- Guglielmo Salvatori
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Giliberti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Melania Evangelisti
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
| | - Pasquale Parisi
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
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Raieli V, Capizzi M, Marino A, Di Nardo G, Raucci U, Parisi P. Study on “Atypical” Migraine Auras in the Pediatric Age: The Role of Cortical Spreading Depression and the Physiopathogenetic Hypothesis Arising from Our Clinical Cases. Life (Basel) 2022; 12:450. [PMID: 35330201 PMCID: PMC8954623 DOI: 10.3390/life12030450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/26/2022] [Imported: 09/15/2023] Open
Abstract
Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensory and motor system) may be affected on different levels. About a fourth of migraine patients have migraine auras. The most common aura is the visual aura followed by the sensorial aura but motor deficits, as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence, or concentration), may occur as well. In analogy with a headache diary, an aura diary can deliver important help in the diagnostic process of rare migraine manifestations and prevent the under-diagnosis of unusual migraine manifestations. Complex migraine manifestations are a diagnosis of exclusion, and a broad diagnostic work-up is necessary in order to exclude dangerous neurologic pathologies. In addition, here, we discuss the atypical clinical presentation and possible physio-pathogenetic related aspects of these atypical migraine aura features in the developmental age. In addition, we wanted to stress and analyze the clinical aspects of our children/adolescents with atypical auras, which seem to be more difficult to frame with the mechanisms originally proposed to explain the physio-pathogenetic relationship between CSD and aura. Finally, we discuss in detail the complex aspects of this topic on the basis of available data and propose new terminology: “Multiple, Synchronous and Asynchronous, Cortical and Subcortical Spreading Depression”.
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Dipasquale V, Martinelli M, Aloi M, Accomando S, Alvisi P, Arrigo S, Banzato C, Bramuzzo M, Cananzi M, Corpino M, Di Mari C, Di Nardo G, Dilillo A, Dodaro N, Felici E, Gatti S, Graziano F, Illiceto MT, Norsa L, Opramolla A, Pastore M, Pavanello PM, Romeo E, Scarallo L, Strisciuglio C, Zuin G, Romano C. Real-Life Use of Biosimilars in Pediatric Inflammatory Bowel Disease: A Nation-Wide Web Survey on Behalf of the SIGENP IBD Working Group. Paediatr Drugs 2022; 24:57-62. [PMID: 34914084 DOI: 10.1007/s40272-021-00486-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 10/19/2022] [Imported: 09/15/2023]
Abstract
OBJECTIVE The aim was to assess the awareness and real-life use of biosimilars in inflammatory bowel disease (IBD) among the members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). METHODS An anonymous web survey involving all SIGENP IBD units which can prescribe biosimilars was conducted between July 1st and December 1st, 2020. The questionnaire included 18 questions addressing the most relevant aspects of biosimilars in pediatric IBD, i.e., advantages, disadvantages, costs, traceability, general knowledge, and real-life use. A descriptive analysis of responses was performed. RESULTS Responses came from 26 pediatric IBD units in Italy, with representation of the North, the Center, and the South of Italy. The majority of participants (n = 20) had spent > 10 years caring for pediatric IBD patients, and worked in a center which had between 100 and 500 registered pediatric IBD patients (n = 14). Most participants (n = 18) reported they were aware that biosimilars have similar efficacy and safety to those of the originator, and all regarded cost-sparing as the main advantage of biosimilars. Most respondents (n = 20) reported they switch from originator to biosimilar in their everyday clinical practice, mostly during the maintenance phase. Most respondents (n = 20) registered no acute adverse events. Nearly all participants felt totally or very confident in using biosimilars. CONCLUSIONS A few years after the introduction of the first biosimilar into the market, real-life data coming from the major IBD units in Italy confirm a favorable and confident position on the use of biosimilars in pediatric IBD.
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Radocchia G, Neroni B, Marazzato M, Capuzzo E, Zuccari S, Pantanella F, Zenzeri L, Evangelisti M, Vassallo F, Parisi P, Di Nardo G, Schippa S. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9:2549. [PMID: 34946150 DOI: 10.3390/microorganisms9122549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] [Imported: 09/15/2023] Open
Abstract
Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome characterized by severe impairment of gastrointestinal (GI) motility, and its symptoms are suggestive of partial or complete intestinal obstruction in the absence of any lesion restricting the intestinal lumen. Diagnosis and therapy of CIPO patients still represent a significant challenge for clinicians, despite their efforts to improve diagnostic workup and treatment strategies for this disease. The purpose of this review is to better understand what is currently known about the relationship between CIPO patients and intestinal microbiota, with a focus on the role of the enteric nervous system (ENS) and the intestinal endocrine system (IES) in intestinal motility, underling the importance of further studies to deeply understand the causes of gut motility dysfunction in these patients.
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Di Nardo G, Di Serafino M, Gaglione G, Mercogliano C, Masoni L, Villa MP, Parisi P, Ziparo C, Vassallo F, Evangelisti M, Vallone G, Esposito F. Omental Infarction: An Underrecognized Cause of Right-Sided Acute Abdominal Pain in Children. Pediatr Emerg Care 2021; 37:e1555-e1559. [PMID: 33170567 DOI: 10.1097/pec.0000000000002114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] [Imported: 09/15/2023]
Abstract
OBJECTIVE To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management. METHODS Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively. RESULTS One hundred ninety-nine children (91 male; age range, 3-15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications. CONCLUSIONS Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.
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Affiliation(s)
- Giovanni Di Nardo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | | | | | - Carmela Mercogliano
- Pediatric Gastroenterology Units, Santobono-Pausilipon Children Hospital, Naples
| | - Luigi Masoni
- General Surgery Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Maria Pia Villa
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Pasquale Parisi
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Chiara Ziparo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Francesca Vassallo
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
| | - Melania Evangelisti
- From the NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome
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Bramuzzo M, Lionetti P, Miele E, Romano C, Arrigo S, Cardile S, Di Nardo G, Illiceto MT, Pastore M, Felici E, Fuoti M, Banzato C, Citrano M, Congia M, Norsa L, Pozzi E, Zuin G, Agrusti A, Bianconi M, Grieco C, Giudici F, Aloi M, Alvisi P. Phenotype and Natural History of Children With Coexistent Inflammatory Bowel Disease and Celiac Disease. Inflamm Bowel Dis 2021; 27:1881-1888. [PMID: 33452803 DOI: 10.1093/ibd/izaa360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 12/12/2022] [Imported: 09/15/2023]
Abstract
BACKGROUND Adult patients with both inflammatory bowel disease (IBD) and celiac disease (CeD) have peculiar phenotypic features. This study aimed at describing the characteristics and natural history of children with both IBD and CeD. METHODS This was a case-control study based on a national registry. Cases included children diagnosed with both IBD and CeD. Two matched IBD controls without CeD, and 2 matched CeD controls were selected for each case. Inflammatory bowel disease phenotype and natural history, comprising growth and pubertal development, were compared between groups. RESULTS Forty-nine (1.75%) patients with IBD and CeD were identified out of 2800 patients with IBD. Compared with patients with IBD alone, patients with IBD and CeD presented more frequently with autoimmune diseases (odds ratio, 2.81; 95% CI, 0.97-8.37; P = 0.04). Ileocolonic localization (46.1% vs 73.1%), treatment with azathioprine (46.2% vs 71.2%), and anti-TNF biologics (46.2% vs 69.2%) were less common in patients with Crohn's disease and CeD than in patients with Crohn's disease alone. Patients with ulcerative colitis and CeD had an increased risk of colectomy despite similar medical treatments compared with patients with ulcerative colitis alone (13.0% vs 0%). Pubertal delay was more common in patients with IBD and CeD compared with patients with IBD alone (14.9% vs 3.2%; odds artio, 5.24; 95% CI, 1.13-33.0; P = 0.02) and CeD alone (14.9% vs 1.1%; P = 0.002). CONCLUSIONS Children with IBD and CeD may have peculiar features with a higher risk for autoimmune diseases, colectomy, and pubertal delay compared with IBD alone.
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Affiliation(s)
- Matteo Bramuzzo
- Gastroenterology, Digestive Endoscopy and Nutrition Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Paolo Lionetti
- Department NEUROFARBA, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Erasmo Miele
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II," Naples, Italy
| | - Claudio Romano
- Unit of Pediatric Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute "Giannina Gaslini," Genoa, Italy.,Department of Pediatrics, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Sabrina Cardile
- Department of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital, Pescara, Italy
| | - Maria Pastore
- Pediatric Department, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maurizio Fuoti
- Pediatric Gastroenterology and Endoscopy Unit Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Michele Citrano
- Department of Pediatrics, "Ospedali Riuniti Villa Santa Sofia-Cervello," Palermo, Italy
| | - Mauro Congia
- Pediatric Clinic and Rare Diseases, Microcitemic Pediatric Hospital Antonio Cao, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Elena Pozzi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Giovanna Zuin
- Pediatric Department, University of Milano Bicocca, FMBBM, San Gerardo Hospital, Monza, Italy
| | - Anna Agrusti
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Martina Bianconi
- Department of Health Sciences, University of Florence, Meyer children's Hospital, Florence, Italy
| | - Claudia Grieco
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II," Naples, Italy
| | - Fabiola Giudici
- Biostatistics Unit, Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marina Aloi
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
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Persechino F, Galli G, Persechino S, Valitutti F, Zenzeri L, Mauro A, Corleto VD, Parisi P, Ziparo C, Evangelisti M, Quatrale G, Di Nardo G. Skin Manifestations and Coeliac Disease in Paediatric Population. Nutrients 2021; 13:3611. [PMID: 34684612 PMCID: PMC8537533 DOI: 10.3390/nu13103611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] [Imported: 09/15/2023] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Gloria Galli
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy;
| | - Francesco Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy and EBRIS (European Biomedical Research Institute of Salerno), 84121 Salerno, Italy;
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Angela Mauro
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
| | - Vito Domenico Corleto
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Pasquale Parisi
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Chiara Ziparo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Melania Evangelisti
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanna Quatrale
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanni Di Nardo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
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Quitadamo P, Anselmi F, Caldore M, Caruso F, Bucci C, Monaco C, Tipo E, Gaglione G, Illiceto MT, Esposito F, Dolce P, Ziparo C, Di Nardo G. Foreign body ingestion in children: Beware of disk batteries and multiple magnets. Acta Paediatr 2021; 110:2862-2864. [PMID: 34048089 DOI: 10.1111/apa.15957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 01/16/2023] [Imported: 09/15/2023]
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Federica Anselmi
- Department of Translational Medical Science (Section of Pediatrics) University "Federico II" Naples Italy
| | - Mariano Caldore
- Pediatric Gastroenterology Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Flora Caruso
- Pediatric Gastroenterology Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Cristina Bucci
- Pediatric Gastroenterology Unit Santobono‐Pausilipon Children’s Hospital Naples Italy
| | - Casimiro Monaco
- Pediatric Surgery Unit Santobono‐Pausilipon Children's Hospital Naples Italy
| | - Enzo Tipo
- Emergency Pediatric Department Santobono‐Pausilipon Children's Hospital Naples Italy
| | - Giovanni Gaglione
- Pediatric Surgery Unit Santobono‐Pausilipon Children's Hospital Naples Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Endoscopic Unit "Santo Spirito" Hospital Pescara Italy
| | - Francesco Esposito
- Department of Emergency Radiology Santobono‐Pausilipon Children's Hospital Naples Italy
| | - Pasquale Dolce
- Department of Public Health University of Naples Federico II Naples Italy
| | - Chiara Ziparo
- NESMOS Department Chair of Pediatrics Faculty of Medicine and Psychology Sapienza University of Rome Sant'Andrea University Hospital Rome Italy
| | - Giovanni Di Nardo
- NESMOS Department Chair of Pediatrics Faculty of Medicine and Psychology Sapienza University of Rome Sant'Andrea University Hospital Rome Italy
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Neroni B, Evangelisti M, Radocchia G, Di Nardo G, Pantanella F, Villa MP, Schippa S. Relationship between sleep disorders and gut dysbiosis: what affects what? Sleep Med 2021; 87:1-7. [PMID: 34479058 DOI: 10.1016/j.sleep.2021.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] [Imported: 09/15/2023]
Abstract
Sleep plays a fundamental role in maintaining good psycho-physical health, it can influence hormone levels, mood, and weight. Recent studies, focused on the interconnection between intestinal microbiome and sleep disorders, have shown the growing importance of a healthy and balanced intestinal microbiome for the hosts health. Normally, gut microbiota and his host are linked by mutualistic relationship, that in some conditions, can be compromised by shifts in microbiota's composition, called dysbiosis. Both sleep problems and dysbiosis of the gut microbiome can lead to metabolic disorders and, in this review, we will explore what is present in literature on the link between sleep pathologies and intestinal dysbiosis.
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Affiliation(s)
- Bruna Neroni
- Department of Public Health and Infection Disease, Microbiology Section Sapienza University of Rome, Italy
| | | | - Giulia Radocchia
- Department of Public Health and Infection Disease, Microbiology Section Sapienza University of Rome, Italy
| | - Giovanni Di Nardo
- Sant'Andrea Hospital, NESMOS Department, Sapienza University of Rome, Italy
| | - Fabrizio Pantanella
- Department of Public Health and Infection Disease, Microbiology Section Sapienza University of Rome, Italy
| | - Maria Pia Villa
- Sant'Andrea Hospital, NESMOS Department, Sapienza University of Rome, Italy
| | - Serena Schippa
- Department of Public Health and Infection Disease, Microbiology Section Sapienza University of Rome, Italy.
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Quitadamo P, Thapar N, Nardo GD, Pescarin M, Bertelli L, Tortora C, Borrelli O, Giorgio RD, Staiano A. Is there a relationship between joint hypermobility and gastrointestinal disorders in children? Turk J Pediatr 2021; 63:307-313. [PMID: 33929121 DOI: 10.24953/turkjped.2021.02.015] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] [Imported: 09/15/2023]
Abstract
BACKGROUND The main aim of the study was to assess the association between joint hypermobility (JH) and gastrointestinal (GI) disorders in children. METHODS All children aged 4-17 years attending the clinics of the participating Pediatric Gastroenterology Centres for functional GI disorders (FGIDs) and inflammatory bowel disease (IBD) were screened for joint laxity. JH diagnosis was inferred using the Beighton Score. JHS diagnosis was inferred based on the Brighton Criteria. Rome III Diagnostic Criteria were used to diagnose possible FGIDs. Ulcerative colitis and Crohn`s disease diagnoses were made according to the Porto Criteria. Age and sex- matched healthy children were enrolled as controls. RESULTS One-hundred-seventy children with GI disorders (70 with FGIDs, 50 with Crohn`s disease, and 50 with ulcerative colitis) and 100 healthy controls were enrolled in the study. JH was reported in 7/70 (10%) children with FGIDs (p=0.26 compared to controls), 4/50 (8%) children with Crohn`s disease (p=0.21 compared to controls) and 15/50 (30%) children with ulcerative colitis (p=0.09 compared to controls; p=0.01 compared to FGIDs; p=0.01 compared to Crohn`s). CONCLUSIONS JH is more prevalent in patients suffering from ulcerative colitis compared to the healthy general population, yet the difference did not reach statistical significance. Likely, a proportion of children with ulcerative colitis and JH may show connective tissue abnormalities. However, whether JH can be considered a possible feature of pediatric GI disorders deserves further investigation.
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Affiliation(s)
| | - Nikhil Thapar
- Gastroenterology Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, S. Andrea University Hospital, Rome, Italy
| | | | - Luca Bertelli
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Clelia Tortora
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II"
| | - Osvaldo Borrelli
- Gastroenterology Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Roberto De Giorgio
- Internal Medicine Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II"
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Evangelisti M, Barreto M, Di Nardo G, Del Pozzo M, Parisi P, Villa MP. Systemic corticosteroids could be used as bridge treatment in children with obstructive sleep apnea syndrome waiting for surgery. Sleep Breath 2021. [PMID: 34302609 DOI: 10.1007/s11325-021-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022] [Imported: 09/15/2023]
Abstract
PURPOSE Local and systemic inflammatory markers and pro-inflammatory cytokines are increased in children with obstructive sleep apnea syndrome (OSAS). Therefore, systemic or topical anti-inflammatory agents are used to treat this syndrome. We evaluated the treatment with systemic corticosteroids in children with severe OSAS and adenotonsillar hypertrophy before surgery. METHODS This was an unblinded open label study. Children with severe OSAS (diagnosed through polysomnography, obstructive apnea-hypopnea index [AHI] > 10 eV/h) were recruited. Exclusion criteria included age < 3 years, history of acute or chronic cardiorespiratory or neuromuscular or metabolic disease; major craniofacial abnormalities; and chromosomal syndromes and epilepsy. Computer-generated random numbers were used for simple randomization of subjects. All children were treated with intranasal beclomethasone spray, and 15 children additionally received oral betamethasone and 0.1 mg/kg per day for 7 days. Sleep clinical record (SCR) and pulsoximetry were performed before and after 7 days in all children. RESULTS Among 28 children with severe OSAS mean age was 4.5 ± 1.8 years, AHI 20.4 ± 1.8 eV/h). In children treated with intranasal and oral corticosteroids, mean (95.3 ± 1.1 vs 97.0 ± 0.8%, p = 0.0001) and minimum oxygen saturation (78.8 ± 6.3 vs 89.2 ± 4.2, p = 0.001) improved, and the SCR score (12.6 ± 1.2 vs 8.3 ± 1.1, p = 0.0001) was reduced. Children treated only with intranasal beclomethasone spray showed no differences in outcome measures before and after treatments. When we considered the oximetry measures, after corticosteroid treatment, we obtained statistical differences between the 2 groups (p < 0.01). CONCLUSIONS These results seem to suggest that a short course of oral betamethasone could be useful to treat children with severe OSAS and adenotonsillar hypertrophy waiting for surgery.
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Pro S, Vinti L, Boni A, Mastronuzzi A, Scilipoti M, Velardi M, Caroleo AM, Farina E, Badolato F, Alessi I, Di Nardo G, Carai A, Valeriani M, Reale A, Parisi P, Raucci U. Peripheral Nervous System Involvement in Non-Primary Pediatric Cancer: From Neurotoxicity to Possible Etiologies. J Clin Med 2021; 10:3016. [PMID: 34300182 DOI: 10.3390/jcm10143016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023] [Imported: 09/15/2023] Open
Abstract
Peripheral neuropathy is a well described complication in children with cancer. Oncologists are generally well aware of the toxicity of the main agents, but fear the side effects of new drugs. As chemotherapeutic agents have been correlated with the activation of the immune system such as in Chemotherapy Induced Peripheral Neuropathy (CIPN), an abnormal response can lead to Autoimmune Peripheral Neuropathy (APN). Although less frequent but more severe, Radiation Induced Peripheral Neuropathy may be related to irreversible peripheral nervous system (PNS). Pediatric cancer patients also have a higher risk of entering a Pediatric Intensive Care Unit for complications related to therapy and disease. Injury to peripheral nerves is cumulative, and frequently, the additional stress of a malignancy and its therapy can unmask a subclinical neuropathy. Emerging risk factors for CIPN include treatment factors such as dose, duration and concurrent medication along with patient factors, namely age and inherited susceptibilities. The recent identification of individual genetic variations has advanced the understanding of physiopathological mechanisms and may direct future treatment approaches. More research is needed on pharmacological agents for the prevention or treatment of the condition as well as rehabilitation interventions, in order to allow for the simultaneous delivery of optimal cancer therapy and the mitigation of toxicity associated with pain and functional impairment. The aim of this paper is to review literature data regarding PNS complications in non-primary pediatric cancer.
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Norsa L, Ferrari A, Arrigo S, Bramuzzo M, Deganello Saccomani M, Di Nardo G, Illiceto MT, Miele E, Paci M, Romano C, Romeo E, Daperno M, Oliva S; Endoscopy group of the Italian society of pediatric Gastroenterology Hepatology and Nutrition (SIGENP). Scoring Endoscopy in Pediatric Inflammatory Bowel Disease: A Way to Improve Quality. J Pediatr Gastroenterol Nutr 2021; 73:48-53. [PMID: 33720096 DOI: 10.1097/MPG.0000000000003090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 09/15/2023]
Abstract
OBJECTIVES AND STUDY There is a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children. METHODS Fifteen videos of follow-up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or Simple Endoscopic Score for Crohn Disease (SES-CD). Scores from all reviewers were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores' reliability. RESULTS Intraclass correlation was 0.298 (95% confidence interval [CI]: 0.13-0.55) for ulcerative colitis (UC) and 0.266 (0.11-0.52) for Crohn disease (CD). When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss kappa coefficient was 0.408 (0.29-0.53) for UC and 0.552 (0.43-0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321-0.854). In multivariable analysis, none of the reviewer's characteristics affected the readers' errors. CONCLUSIONS This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low-grade concordance with the expert adult gastroenterologist's evaluations. Future-specific training programs should be considered to increase IOA in using IBD endoscopic activity scores.
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Ballesio A, Zagaria A, Baccini F, Micheli F, Di Nardo G, Lombardo C. A meta-analysis on sleep quality in inflammatory bowel disease. Sleep Med Rev 2021; 60:101518. [PMID: 34214847 DOI: 10.1016/j.smrv.2021.101518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] [Imported: 09/15/2023]
Abstract
Evidence of poor sleep quality in inflammatory bowel disease (IBD, i.e., Crohn's disease and ulcerative colitis) has been reported but never systematically reviewed or meta-analysed. We conducted a systematic review and meta-analysis of pairwise comparisons that included 1) IBD patients/controls, 2) Crohn's disease/ulcerative colitis, 3) active/inactive IBD on standardised measures of sleep quality. PubMed, Medline, PsycINFO, Scopus, and CINAHL were searched up to March 2021. Forty-two studies met the inclusion criteria. Results showed poorer subjective sleep quality in IBD patients than in controls, with moderate effect sizes (g = .49, [95% CI = .32 - .66], p < .001). No differences within IBD subtypes were found (g = -.07, [95% CI = -.17-.05], p = .208). Individuals with an active IBD reported poorer sleep quality than those in remission, with a large effect size (g = .66, [95% CI = .35 - .98], p < .001). Results on objectively recorded sleep were mixed, with no clear evidence of objective sleep impairments in individuals with IBD. Results support the view of subjective poor sleep quality as a relevant comorbidity in IBD. As a potential factor affecting immune and inflammatory responses as well as patients' quality of life, sleep quality should be taken into account in the treatment of IBD.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
| | - Andrea Zagaria
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Flavia Baccini
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Federica Micheli
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Italy
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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Garone G, Ferro V, Barbato M, Vanacore N, Papini L, Pro S, Boni A, Scialanga B, Nacca R, Evangelisti M, Di Nardo G, Parisi P, Raucci U. Acute strabismus in neurological emergencies of childhood: A retrospective, single-centre study. Eur J Paediatr Neurol 2021; 32:80-85. [PMID: 33857732 DOI: 10.1016/j.ejpn.2021.03.016] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023] [Imported: 09/15/2023]
Abstract
OBJECTIVES Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs). DESIGN AND SETTING Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs. RESULTS 208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE. CONCLUSIONS Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Barbato
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Laura Papini
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Boni
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Scialanga
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaella Nacca
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Di Nardo G, Quitadamo P, Quatrini M, Malfona F, Moleti ML, La Rocca U, Velardi M, Parisi P, Testi AM. Autoimmune Hemolitic Anemia in a Boy With Inactive Ulcerative Colitis. Inflamm Bowel Dis 2021; 27:e63-e64. [PMID: 33452802 DOI: 10.1093/ibd/izaa363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] [Imported: 09/15/2023]
Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Mara Quatrini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Malfona
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ursula La Rocca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Margherita Velardi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Boscarino G, Conti MG, De Luca F, Di Chiara M, Deli G, Bianchi M, Favata P, Cardilli V, Di Nardo G, Parisi P, Terrin G. Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study. Nutrients 2021; 13:1243. [PMID: 33918860 DOI: 10.3390/nu13041243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] [Imported: 09/15/2023] Open
Abstract
(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case-control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4-10 days vs. 4 days, 95% CI 1-7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome.
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Mauro A, Zenzeri L, Esposito F, Gaglione G, Strisciuglio C, Pilozzi E, Corleto VD, Ziparo C, Di Nardo G. Isolated intestinal Ganglioneuromatosis: case report and literature review. Ital J Pediatr 2021; 47:80. [PMID: 33785023 PMCID: PMC8008650 DOI: 10.1186/s13052-021-01024-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/15/2021] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Intestinal Ganglioneuromatosis (IG) is a rare disorder of the enteric nervous system. In pediatric age it is often associated with genetic syndromes such as Neurofibromatosis 1 (NF1), multiple endocrine neoplasia type 2B (MEN2B) and Cowden syndrome (PTEN mutation), and ganglioneuromas (GNs) may be sometimes the first sign of the disease. Isolated GNs are rare and sporadic. Clinical symptom vary and depend on the size and on the location of the GNs. This disorder affects intestinal motility and it, consequently, causes changes in bowel habits, abdominal pain, occlusive symptoms and rarely lower gastrointestinal bleeding secondary to ulceration of the intestinal mucosa. On the other hand, patients can remain asymptomatic for many years. CASE PRESENTATION We describe a 9-year-old boy referred to our emergency department for right lower quadrant abdominal pain. No familial history for gastrointestinal disorders. No history of fever or weight loss. At physical examination, he had diffused abdominal pain. Abdominal ultrasonography showed a hypoechoic formation measuring 41.8 mm by 35 mm in the right lower quadrant of the abdomen. Routine blood tests were normal, but fecal occult blood test was positive. Abdominal TC confirmed the hypodense formation, of about 5 cm in transverse diameter, in the right hypochondrium that apparently invaginated in the caecum-last ileal loop. Colonoscopy showed in the cecum an invaginated polypoid lesion of the terminal ileal loop. Laparoscopic resection of the polypoid lesion was performed. Histological diagnosis of the large neoplasm observed in the terminal ileum was diffuse ganglioneuromatosis. NF1, RET and PTEN gene tests resulted negative for specific mutations. At the 1 year follow-up, the patient presented good general condition and blood tests, fecal occult blood test, esophagogastroduodenoscopy, colonoscopy and MR-enterography were negative. CONCLUSIONS Only few cases are reported in literature of IG in pediatric age. Although rare, the present case suggests that this disorder must be taken in consideration in every patient with GI symptoms such as abdominal pain, constipation, lower intestinal bleeding, in order to avoid a delayed diagnosis.
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Affiliation(s)
- Angela Mauro
- Pediatric Emergency Unit, AORN Santobono-Pausilipon, Naples, Italy
| | - Letizia Zenzeri
- Pediatric Emergency Unit, AORN Santobono-Pausilipon, Naples, Italy
| | - Francesco Esposito
- Department of Emergency Radiology, AORN Santobono-Pausilipon, Naples, Italy
| | | | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Medicine, UOC Anatomia Patologica, Sant' Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Vito Domenico Corleto
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Chiara Ziparo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
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Alessandri F, Strisciuglio C, Borrazzo C, Cozzi D, Romano C, Betalli P, Villa MP, Parisi P, Ziparo C, Rocco M, Evangelisti M, Pugliese F, Di Nardo G. Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial. J Pediatr Gastroenterol Nutr 2021; 72:366-71. [PMID: 33148981 DOI: 10.1097/MPG.0000000000002981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 09/15/2023]
Abstract
OBJECTIVES Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. METHODS In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. RESULTS Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02-1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%-1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. CONCLUSIONS A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.
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Raucci U, Boni A, Evangelisti M, Della Vecchia N, Velardi M, Ursitti F, Terrin G, Di Nardo G, Reale A, Villani A, Parisi P. Lifestyle Modifications to Help Prevent Headache at a Developmental Age. Front Neurol 2021; 11:618375. [PMID: 33603708 PMCID: PMC7884344 DOI: 10.3389/fneur.2020.618375] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022] [Imported: 09/15/2023] Open
Abstract
Headache is the world's seventh most significant cause of disability-adjusted-life in people aged between 10 and 14 years. Therapeutic management is based on pharmacological approaches and lifestyle recommendations. Many studies show associations between each migraine-promoting lifestyle, behavioral triggers, frequency, and intensity of headaches. Nevertheless, the overall aspects of this topic lack any definitive evidence. Educational programs advise that pediatric patients who suffer from migraines follow a correct lifestyle and that this is of the utmost importance in childhood, as it will improve quality of life and assist adult patients in avoiding headache chronicity, increasing general well-being. These data are important due to the scarcity of scientific evidence on drug therapy for prophylaxis during the developmental age. The "lifestyle recommendations" described in the literature include a perfect balance between regular sleep and meal, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, regular physical activity to avoid being overweight as well as any other elements causing stress. The ketogenic diet is a possible new therapeutic strategy for the control of headache in adults, however, the possible role of dietary factors requires more specific studies among children and adolescents. Educational programs advise that the improvement of lifestyle as a central element in the management of pediatric headache will be of particular importance in the future to improve the quality of life of these patients and reduce the severity of cephalalgic episodes and increase their well-being in adulthood. The present review highlights how changes in different aspects of daily life may determine significant improvements in the management of headaches in people of developmental age.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | | | - Melania Evangelisti
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Nicoletta Della Vecchia
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Margherita Velardi
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabiana Ursitti
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Gianluca Terrin
- Department of Gynecological Obstetric and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Nardo
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Pasquale Parisi
- Department of Pediatrics, Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Di Nardo G, Manca MB, Iannicelli E, D'Ambra G, Laviano A, Guarino M, Parisi P, Pontieri FE, Rosati E, De Giorgio R. Percutaneous endoscopic gastrojejunostomy in pediatric intestinal pseudo-obstruction. Nutrition 2021; 86:111174. [PMID: 33601120 DOI: 10.1016/j.nut.2021.111174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022] [Imported: 08/29/2023]
Abstract
Pediatric intestinal pseudoobstruction (PIPO) is the "tip of the iceberg" of the most severe gut motility disorders. In patients with PIPO, the impairment of gastrointestinal propulsive patterns is such as to result in progressive obstructive symptoms without evidence of mechanical causes. PIPO is an important cause of intestinal failure and affects growth and pubertal development. Bowel loop and abdominal distension represent one of the main features of intestinal pseudo-obstruction syndromes, hence intestinal decompression is a mainstay in the management of PIPO. So far, pharmacologic, endoscopic, and surgical treatments failed to achieve long-term relief of bowel distension and related symptoms, including pain. Recent data, however, indicated that percutaneous endoscopic gastrojejunostomy (PEG-J) might be a minimally invasive approach for intestinal decompression, thereby improving abdominal symptoms and nutritional status in adult patients with chronic intestinal pseudo-obstruction. Based on these promising results, we treated for the first time a 12-y-old patient affected by PIPO refractory to any therapeutic options to obtain intestinal decompression by PEG-J. We showed that PEG-J yielded sustained small bowel decompression in the reported PIPO patient with considerable improvement of both abdominal symptoms and nutritional status. The positive outcome of the present case provides a basis to test the actual efficacy PEG-J versus other therapeutic approaches to intestinal decompression in patients with PIPO.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Pediatric Unit, Faculty of Medicine & Psychology, Sapienza - University of Rome, Sant'Andrea University Hospital, Rome, Italy.
| | - Maria Beatrice Manca
- Department of Medical-Surgical and Translational Medicine, Anesthesia and Intensive Care Unit, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Elsa Iannicelli
- Department of Medical-Surgical and Translational Medicine, Radiology Unit, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giancarlo D'Ambra
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Pasquale Parisi
- NESMOS Department, Pediatric Unit, Faculty of Medicine & Psychology, Sapienza - University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Ernesto Pontieri
- NESMOS Department, Neurology Unit, Faculty of Medicine & Psychology, Sapienza - University of Rome, Sant'Andrea University Hospital, Rome, Italy &Department of Clinical and Behavioral Neurology, IRCCS - Fondazione Santa Lucia, Rome, Italy
| | - Elisa Rosati
- Department of Medical-Surgical and Translational Medicine, Radiology Unit, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Trimarchi R, Visalli C, Quartararo C, Lucanto MC, Nardo GD, Turiaco N, Salamone I. Radiological evaluation of a case of chronic intestinal pseudo-obstruction (CIPO). Radiol Case Rep 2021; 16:651-655. [PMID: 33488892 PMCID: PMC7806544 DOI: 10.1016/j.radcr.2020.12.061] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/21/2020] [Accepted: 12/25/2020] [Indexed: 11/29/2022] [Imported: 09/15/2023] Open
Abstract
Chronic intestinal pseudo-obstruction (CIPO) is a severe form of gastrointestinal dysmotility (often due to derangement of the innervation and/or smooth muscle and/or interstitial cells of Cajal) with recurrent episodes of intestinal sub-occlusion. We describe a clinical setting and radiological features of CIPO in an 11-year-old girl with periodic relapses. Our attention was focused firstly on surgical causes, leading to a delay in the diagnosis; thus, is important detecting equivocal symptoms and considering the possible correlation to the CIPO for an early diagnosis and related prevention of acute episodes improving prognosis and quality of life of pediatric patients.
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Affiliation(s)
- Renato Trimarchi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Radiology, AOU Policlinico Universitario G. Martino, University of Messina, Via consolare Valeria 1, 98125, Messina, Italy,Corresponding author.
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Radiology, AOU Policlinico Universitario G. Martino, University of Messina, Via consolare Valeria 1, 98125, Messina, Italy
| | - Chiara Quartararo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Radiology, AOU Policlinico Universitario G. Martino, University of Messina, Via consolare Valeria 1, 98125, Messina, Italy
| | - Maria Cristina Lucanto
- Pediatric Gastroenterology and Cystic Fibrosis Unit, AOU Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Nunzio Turiaco
- Department of Human Pathology in Adult and Developmental Age Gaetano Barresi, Unit of Paediatric Surgery, University of Messina, Messina, Italy
| | - Ignazio Salamone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Radiology, AOU Policlinico Universitario G. Martino, University of Messina, Via consolare Valeria 1, 98125, Messina, Italy
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Quitadamo P, Isoldi S, Mallardo S, Zenzeri L, Di Nardo G. Scientific Evidence for the Treatment of Children with Irritable Bowel Syndrome. Curr Pediatr Rev 2021; 17:92-102. [PMID: 33504308 DOI: 10.2174/1573396317666210127123330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] [Imported: 09/15/2023]
Abstract
Irritable bowel syndrome (IBS) is one of the most common functional gastro-intestinal disorders which significantly impacts the quality of life of affected children. Abdominal pain improved by defecation, associated with a change in stool form and frequency, represents its specific clinical marker. Even if a number of potential patho-physiological mechanisms have been described, the exact underlying etiology of IBS is so far unclear. Likewise, no optimal treatment has ever been found neither for adult nor for pediatric patients. Current therapeutic options include drugs, dietary interventions and biopsychosocial therapies. The present review aims at evaluating the scientific evidence supporting the efficacy of these treatments for children with IBS.
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Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Pediatric Gastroenterology and Endoscopy Unit, NESMOS Department, Faculty School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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Esposito F, Di Serafino M, Mauro A, Mercogliano C, Cocco C, Zenzeri L, Ferrara D, Iacobellis F, Evangelisti M, Ziparo C, Di Nardo G. Not only fat: omental infarction and its mimics in children. Clinical and ultrasound findings: a pictorial review. J Ultrasound 2020; 23:621-629. [PMID: 32623635 PMCID: PMC7588577 DOI: 10.1007/s40477-020-00492-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] [Imported: 09/15/2023] Open
Abstract
Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.
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Affiliation(s)
- Francesco Esposito
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy.
| | - Angela Mauro
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Carmela Mercogliano
- Department of Pediatric 2nd Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Chiara Cocco
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Letizia Zenzeri
- Department of Pediatric Emergency, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Dolores Ferrara
- Department of Emergency Radiology, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Chiara Ziparo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, "Sant'Andrea" University Hospital, Rome, Italy
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50
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Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol 2020; 11:583425. [PMID: 33224097 PMCID: PMC7667239 DOI: 10.3389/fneur.2020.583425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] [Imported: 09/15/2023] Open
Abstract
Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CVS.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy
| | | | | | - Raffaele Falsaperla
- Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Ada Noris Ferilli
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Diego Martinelli
- Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Institute for Research, Hospitalization and Health Care (IRCCS) “G. Gaslini” Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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