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Zanfardino A, Bruzzi P, Trada M, Rapini N, Laudani E, Tornese G, Ortolani F, Piccolo G, Matonti L, Saltarelli MA, Timpanaro T, D'Annunzio G, Predieri B, Rossi F, Mura R, Barat V, Prete A, Schiaffini R, Zucchini S. The real-life management of glucose homeostasis abnormalities in pediatric onco-hematological diseases: data from a national survey. Pediatr Hematol Oncol 2024; 41:198-210. [PMID: 38269620 DOI: 10.1080/08880018.2023.2295454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/09/2023] [Indexed: 01/26/2024]
Abstract
Glycemic abnormalities are a frequent finding in pediatric oncological patients, both during treatment and after its discontinuation. Moreover, impaired glucose tolerance (IGT), impaired fasting glycemia (IFG) and diabetes mellitus (DM) are not rarely diagnosed in non-oncological hematological diseases. To explore the current pediatric Italian approach to the diagnosis and the management of the glycemic alterations in this clinical setting and, thus, to identify and enforce current clinical needs, we submitted an online 23-items survey to all the Italian Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers, and surveys were descriptively analyzed. Thirty-nine AIEOP centers were involved in the study. In 2021, among 75278 children and adolescents affected by an oncological or a hematological disease, 1.2 and 0.65% developed DM, while IGT or IFG were widespread in 2.3 and 2.8%, respectively. The main causes of DM were the use of corticosteroids in patients with cancer and the iron overload in patients with thalassemia. Venous fasting plasma glycemia was the most used tool to detect glycemic abnormalities. The performance of oral glucose tolerance test (OGTT) was extremely limited, except when IFG occurred. Despite the diagnosis of DM, ∼45% of patients with cancer and 30% of patients with one hematological disease did not receive an appropriate treatment. In the other cases, insulin was the drug of first choice. Emerging technologies for diabetes care (glucose sensors and insulin pumps) are not largely used yet. The results of our study support the standardization of the care of the glycemic abnormalities during or after onco-hematologic diseases in the pediatric age. Despite the scarce data in pediatric literature, proper guidelines are needed.
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Affiliation(s)
| | - Patrizia Bruzzi
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena & Reggio Emilia, Modena, Italy
| | - Michela Trada
- Center of Pediatric Diabetology-A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Novella Rapini
- Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Laudani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica Ortolani
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Gianluca Piccolo
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lorena Matonti
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | | | - Giuseppe D'Annunzio
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Barbara Predieri
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Rossella Mura
- Department of Paediatric Haematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Veronica Barat
- SC Onco-Ematologia Pediatrica, AOU Città della Salute e della Scienza, Turin, Italy
| | - Arcangelo Prete
- Pediatric Oncohematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiaffini
- Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Zucchini
- Coordinator of the Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED), Bologna, Italy
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2
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Cherubini V, Fargalli A, Arnaldi C, Bassi M, Bonfanti R, Patrizia Bracciolini G, Cardella F, Dal Bo S, Delvecchio M, Di Candia F, Franceschi R, Maria Galassi S, Gallo F, Graziani V, Iannilli A, Mameli C, Marigliano M, Minuto N, Monti S, Mozzillo E, Pascarella F, Predieri B, Rabbone I, Roppolo R, Schiaffini R, Tiberi V, Tinti D, Toni S, Scaramuzza A, Vestrucci B, Gesuita R. Glucometrics and device satisfaction in children and adolescents with type 1 diabetes using different treatment modalities: A multicenter real-world observational study. Diabetes Res Clin Pract 2024; 210:111621. [PMID: 38499182 DOI: 10.1016/j.diabres.2024.111621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024]
Abstract
AIMS To analyze metabolic outcomes, diabetes impact and device satisfaction in children and adolescents with type 1 diabetes in Italy who used different treatment modalities for diabetes care in a real-life context. METHODS In this multicenter, nationwide, cross-sectional study, 1464 participants were enrolled at a routine visit. The following treatment modalities were considered MDI + SMBG; MDI + CGM; Sensor Augmented Pump Therapy; predictive management of low glucose; Hybrid Closed Loop (HCL); Advanced Hybrid Closed Loop (AHCL). Health related quality of life was evaluated by the Italian version of the Diabetes Impact and Device Satisfaction Scale (DIDS) questionnaire. RESULTS Patients treated with AID systems were more likely to have HbA1c ≤ 6.5 %, higher percentage of time with glucose levels between 70 and 180 mg/dL, lower percentage of time with glucose levels above 180 mg/dL, higher device satisfaction, and reduced impact of diabetes. All the therapeutic modalities with respect to MDI + CGM, except for MDI + SMBG, contributed to increase the device satisfaction. HCL and AHCL respect to MDI + CGM were associated with lower diabetes impact. CONCLUSION Real-life use of automated insulin delivery systems is associated with reduced type 1 diabetes impact, increased device satisfaction, and achievement of glycemic goals.
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Affiliation(s)
- Valentino Cherubini
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Andrea Fargalli
- Center of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, 60020 Ancona, Italy.
| | - Claudia Arnaldi
- UOS Diabetologia Pediatrica ASL Viterbo, 01100 Viterbo, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, 20132 Milan, Italy
| | | | | | - Sara Dal Bo
- Department of Pediatrics, Santa Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, L'Aquila, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | | | | | | | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, 48121 Ravenna, Italy
| | - Antonio Iannilli
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Chiara Mameli
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Azienda Ospedaliera Universitaria Integrata Ospedale della Donna e del Bambino, 37126 Verona, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Sara Monti
- Department of Pediatrics, Bufalini Hospital, 47521 Cesena, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant'Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Ivana Rabbone
- Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Rosalia Roppolo
- Department of Pediatrics, University of Palermo, 90133 Palermo, Italy
| | - Riccardo Schiaffini
- Diabetology and Growth Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Valentina Tiberi
- Department of Women's and Children's Health, Salesi Hospital, 60123 Ancona, Italy
| | - Davide Tinti
- Pediatric Diabetology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Sonia Toni
- Diabetology Unit, AOU Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Andrea Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, 26100 Cremona, Italy
| | | | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, 60020 Ancona, Italy
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Rapini N, Delvecchio M, Mucciolo M, Ruta R, Rabbone I, Cherubini V, Zucchini S, Cianfarani S, Prandi E, Schiaffini R, Bizzarri C, Piccini B, Maltoni G, Predieri B, Minuto N, Di Paola R, Giordano M, Tinto N, Grasso V, Russo L, Tiberi V, Scaramuzza A, Frontino G, Maggio MC, Musolino G, Piccinno E, Tinti D, Carrera P, Mozzillo E, Cappa M, Iafusco D, Bonfanti R, Novelli A, Barbetti F. The changing landscape of neonatal diabetes mellitus in Italy between 2003-2022. J Clin Endocrinol Metab 2024:dgae095. [PMID: 38408297 DOI: 10.1210/clinem/dgae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
CONTEXT In the last decade Sanger method of DNA sequencing has been replaced by next generation sequencing (NGS). NGS is valuable in conditions characterized by high genetic heterogeneity such as neonatal diabetes mellitus (NDM). OBJECTIVE To compare results of genetic analysis of patients with NDM and congenital severe insulin resistance (c.SIR) identified in Italy in 2003-2012 (Sanger) versus 2013-2022 (NGS). METHODS We reviewed clinical and genetic records of 104 cases with diabetes onset before 6 months of age (NDM+c.SIR) of the Italian dataset. RESULTS Fiftyfive patients (50 NDM + 5 c.SIR) were identified during 2003-2012 and 49 (46 NDM + 3 c.SIR) in 2013-2022. Twenty-year incidence was 1:103,340 (NDM) and 1:1,240,082 (c.SIR) live births. Frequent NDM/c.SIR genetic defects (KCNJ11, INS, ABCC8, 6q24, INSR) were detected in 41 and 34 probands during 2003-2012 and 2013-2022, respectively. We identified a pathogenic variant in rare genes in a single proband (GATA4) (1/42 or 2.4%) during 2003-2012 and in 8 infants (RFX6, PDX1, GATA6, HNF1B, FOXP3, IL2RA, LRBA, BSCL2) during 2013-2022 (8/42 or 19%, p= 0.034 vs 2003-2012). Notably, five among rare genes were recessive. Swift and accurate genetic diagnosis led to appropriate treatment: patients with autoimmune NDM (FOXP3, IL2RA, LRBA), were subjected to bone marrow transplant; patients with pancreas agenesis/hypoplasia (RFX6, PDX1) were supplemented with pancreatic enzymes and the individual with lipodystrophy caused by BSCL2 was started on metreleptin. CONCLUSIONS NGS substantially improved diagnosis and precision therapy of monogenic forms of neonatal diabetes and congenital SIR in Italy.
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Affiliation(s)
- Novella Rapini
- Monogenic Diabetes Clinic, Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maurizio Delvecchio
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
- Unit of Pediatrics, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mafalda Mucciolo
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosario Ruta
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ivana Rabbone
- Department of Health Sciences, Division of Pediatrics, University of Eastern Piedmont, Novara, Italy
| | - Valentino Cherubini
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health Azienda Ospedaliero Universitaria delle Marche, G. Salesi Hospital, Ancona, Italy
| | - Stefano Zucchini
- Pediatric Endocrine Unit, University Hospital of Bologna Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Cianfarani
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Elena Prandi
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carla Bizzarri
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara Piccini
- Endocrinology and Diabetology Unit, Meyer University children's hospital IRCCS, Florence, Italy
| | - Giulio Maltoni
- Pediatric Endocrine Unit, University Hospital of Bologna Sant'Orsola-Malpighi, Bologna, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Minuto
- Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Rossella Di Paola
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mara Giordano
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Laboratory of Genetics, "Maggiore della Carità" Hospital, Novara, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II/CEINGE Advanced Biotechnologies Franco Salvatore, Naples, Italy
| | - Valeria Grasso
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Russo
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Tiberi
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health Azienda Ospedaliero Universitaria delle Marche, G. Salesi Hospital, Ancona, Italy
| | - Andrea Scaramuzza
- Diabetes and Endocrine Service, Pediatric Unit, ASST Cremona, Maggiore Hospital, Cremona, Italy
| | - Giulio Frontino
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele
| | | | - Gianluca Musolino
- Growth disorders, Endocrinology and Diabetology Clinic, Filippo del Ponte Pediatric Hospital, ASST Sette Laghi, Varese, Italy
| | - Elvira Piccinno
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Paola Carrera
- San Raffaele Scientific Institute, Center for Omics sciences @OSR, Genomics for the Diagnosis of Human Pathologies, Milan, Italy
- San Raffaele Scientific Institute, Laboratory of Molecular Genetics and Cytogenetics, Milan, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Marco Cappa
- Research Area for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS
| | - Dario Iafusco
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele and Vita Salute San Raffaele University, Milan, Italy
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio Barbetti
- Monogenic Diabetes Clinic, Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Zucchini S, Ripoli C, Cherubini V, Coccioli MS, Delvecchio M, De Marco R, Franceschi R, Gallo F, Graziani V, Iafusco D, Innaurato S, Lasagni A, Lombardo F, Marigliano M, Monti S, Pascarella F, Pezzino G, Predieri B, Rabbone I, Schiaffini R, Trada M, Tumini S, Scaramuzza A. Nasal glucagon is safe and effective in children and adolescents with type 1 diabetes: A real-world prospective cohort study. Diabetes Obes Metab 2024; 26:754-757. [PMID: 37867226 DOI: 10.1111/dom.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Stefano Zucchini
- IRCCS Endocrinologia Pediatrica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Ripoli
- Pediatric Diabetology Unit, Department of Pediatrics, ASL 8 Cagliari, Cagliari, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, 'Salesi Hospital', Ancona, Italy
| | | | - Maurizio Delvecchio
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | | | - Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento, Italy
| | | | - Vanna Graziani
- Department of Woman's, Child, and Adolescent Health, AUSL Romagna, Pediatrics Unit, Bufalini Hospital, Cesena, and Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Stefania Innaurato
- Maternal and Child Health Department, Pediatric Unit, San Bortolo Hospital, Vicenza, Italy
| | - Anna Lasagni
- Pediatric Unit, Department of Obstetrics, Gynaecology and Paediatrics, Azienda AUSL-IRCCS, Reggio Emilia, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Sara Monti
- Department of Woman's, Child, and Adolescent Health, AUSL Romagna, Pediatrics Unit, Bufalini Hospital, Cesena, and Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Giulia Pezzino
- Endocrinology, Azienda Ospedaliera di Rilievo Nazionale ad Alta Specializzazione Garibaldi, Catania, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Michela Trada
- Department of Public Health and Pediatric Sciences, University of Turin-Regina Margherita Children Hospital-A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Tumini
- Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, Annunziata Hospital, Chieti, Italy
| | - Andrea Scaramuzza
- Unit of Pediatrics, Endocrinology and Diabetes Service, ASST Cremona, Maggiore Hospital, Cremona, Italy
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Trevisani V, Iughetti L, Lucaccioni L, Predieri B. Endocrine immune-related adverse effects of immune-checkpoint inhibitors. Expert Rev Endocrinol Metab 2023; 18:441-451. [PMID: 37682107 DOI: 10.1080/17446651.2023.2256841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Immune-checkpoint inhibitor therapy modulates the response of the immune system acting against cancer. Two pathways impacted by this kind of treatment are the CTLA4 and the PD-1/PD-L1 pathways. ICI therapy can trigger autoimmune adverse effects, known as immune-related Adverse Events (irAEs). AREAS COVERED This review focuses on irAEs which affect the endocrine system. This review elucidates the pathways used by these drugs with a focus on the hypothetical pathogenesis at their basis. In fact, the pathophysiology of irAEs concerns the possibility of an interaction between cellular autoimmunity, humoral immunity, cytokines, chemokines, and genetics. The endocrine irAEs examined are thyroid dysfunctions, immune related-hypophysitis, diabetes, peripheral adrenal insufficiency, and hypoparathyroidism. EXPERT OPINION There is still much to investigate in endocrine irAES of checkpoint inhibitors. In the future, checkpoint inhibitors will be increasingly utilized therapies, and therefore it is crucial to find the proper diagnostic-therapeutic program for irAEs, especially as endocrine irAEs are nonreversible and require lifelong replacement therapies.
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Affiliation(s)
- Viola Trevisani
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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De Filippo G, Predieri B, Delvecchio M. Editorial: Debates in clinical management in pediatric endocrinology, volume II. Front Endocrinol (Lausanne) 2023; 14:1270794. [PMID: 37670885 PMCID: PMC10476077 DOI: 10.3389/fendo.2023.1270794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Affiliation(s)
- Gianpaolo De Filippo
- Assistance Publique - Hôpitaux de Paris, Service d’Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, Paris, France
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of The Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Delvecchio
- Metabolic and Genetic Disorders, “Giovanni XXIII” Children’s Hospital, Bari, Italy
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7
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Maffeis C, Olivieri F, Valerio G, Verduci E, Licenziati MR, Calcaterra V, Pelizzo G, Salerno M, Staiano A, Bernasconi S, Buganza R, Crinò A, Corciulo N, Corica D, Destro F, Di Bonito P, Di Pietro M, Di Sessa A, deSanctis L, Faienza MF, Filannino G, Fintini D, Fornari E, Franceschi R, Franco F, Franzese A, Giusti LF, Grugni G, Iafusco D, Iughetti L, Lera R, Limauro R, Maguolo A, Mancioppi V, Manco M, Del Giudice EM, Morandi A, Moro B, Mozzillo E, Rabbone I, Peverelli P, Predieri B, Purromuto S, Stagi S, Street ME, Tanas R, Tornese G, Umano GR, Wasniewska M. The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery. Ital J Pediatr 2023; 49:69. [PMID: 37291604 DOI: 10.1186/s13052-023-01458-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.
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Affiliation(s)
- Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Francesca Olivieri
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy.
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Naples, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, Department of Health Science, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Maria Rosaria Licenziati
- Department of Neurosciences, Neuro-Endocrine Diseases and Obesity Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Mariacarolina Salerno
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Annamaria Staiano
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Raffaele Buganza
- Pediatric Endocrinology Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Francesca Destro
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, S. Maria Delle Grazie Hospital, Naples, Pozzuoli, Italy
| | - Mario Di Pietro
- Pediatric and Neonatal Unit, Hospital of Teramo and Atri, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Luisa deSanctis
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionan Area, University of Bari, Bari, Italy
| | | | - Danilo Fintini
- Refernce Center for Prader Willi Syndrome, Endocrinology and Diabetology Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Elena Fornari
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | | | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, Udine, Italy
| | - Adriana Franzese
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Lia Franca Giusti
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Lucca, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Lera
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Alessandria, Italy
| | | | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Beatrice Moro
- UOSD Diabetology, Complesso Ai Colli, AULSS 6 Euganea, Padua, Italy
| | - Enza Mozzillo
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Paola Peverelli
- Department of Pediatrics and Gynecology, Hospital of Belluno, Belluno, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Stagi
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Maria Elisabeth Street
- Department of Medicine and Surgery, Unit of Paediatrics, University of Parma, University Hospital of Parma, Parma, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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8
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Lucaccioni L, Palandri L, Passini E, Trevisani V, Calandra Buonaura F, Bertoncelli N, Talucci G, Ferrari A, Ferrari E, Predieri B, Facchinetti F, Iughetti L, Righi E. Perinatal and postnatal exposure to phthalates and early neurodevelopment at 6 months in healthy infants born at term. Front Endocrinol (Lausanne) 2023; 14:1172743. [PMID: 37293488 PMCID: PMC10244530 DOI: 10.3389/fendo.2023.1172743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Background Phthalates are non-persistent chemicals largely used as plasticizers and considered ubiquitous pollutants with endocrine disrupting activity. The exposure during sensible temporal windows as pregnancy and early childhood, may influence physiological neurodevelopment. Aims and Scope The aim of this study is to analyze the relationship between the urinary levels of phthalate metabolites in newborn and infants and the global development measured by the Griffiths Scales of Children Development (GSCD) at six months. Methods Longitudinal cohort study in healthy Italian term newborn and their mothers from birth to the first 6 months of life. Urine samples were collected at respectively 0 (T0), 3 (T3), 6 (T6) months, and around the delivery for mothers. Urine samples were analyzed for a total of 7 major phthalate metabolites of 5 of the most commonly used phthalates. At six months of age a global child development assessment using the third edition of the Griffith Scales of Child Development (GSCD III) was performed in 104 participants. Results In a total of 387 urine samples, the seven metabolites analyzed appeared widespread and were detected in most of the urine samples collected at any time of sampling (66-100%). At six months most of the Developmental Quotients (DQs) falls in average range, except for the subscale B, which presents a DQ median score of 87 (85-95). Adjusted linear regressions between DQs and urinary phthalate metabolite concentrations in mothers at T0 and in infants at T0, T3 and T6 identified several negative associations both for infants' and mothers especially for DEHP and MBzP. Moreover, once stratified by children's sex, negative associations were found in boys while positive in girls. Conclusions Phthalates exposure is widespread, especially for not regulated compounds. Urinary phthalate metabolites were found to be associated to GSCD III scores, showing inverse association with higher phthalate levels related to lower development scores. Our data suggested differences related to the child's sex.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Palandri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Passini
- Post graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Viola Trevisani
- Post graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Natascia Bertoncelli
- Neonatology Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanna Talucci
- Neonatology Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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9
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Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, Faienza MF, Improda N, Licenziati MR, Maffeis C, Maguolo A, Patti G, Predieri B, Salerno M, Stagi S, Street ME, Valerio G, Corica D, Calcaterra V. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. Children (Basel) 2023; 10:children10040735. [PMID: 37189984 DOI: 10.3390/children10040735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.
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Affiliation(s)
- Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giorgia Pepe
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Tommaso Aversa
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Turin, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Improda
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Giuseppina Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16128 Genova, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence and Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Elisabeth Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli "Parthenope", 80133 Napoli, Italy
| | - Domenico Corica
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20157 Milano, Italy
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10
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Zucchini S, Iafusco D, Cherubini V, De Sanctis L, Maltoni G, Lenzi L, Mozzillo E, Calcaterra V, Gallo F, Arnaldi C, Delvecchio M, Rabbone I, Minuto N, Predieri B, Zanfardino A, Piscopo A, Tiberi V, Tinti D, Rapini N, Toni S, Schiaffini R. COVID-19 forced restrictions did not affect metabolic control in youth with T2D in Italy. Nutr Metab Cardiovasc Dis 2023; 33:232-233. [PMID: 36404240 PMCID: PMC9585844 DOI: 10.1016/j.numecd.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Stefano Zucchini
- IRCCS AOU di Bologna Policlinico di S.Orsola, Woman and Child, Bologna, Italy
| | - Dario Iafusco
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentino Cherubini
- G. Salesi Children's Hospital, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Luisa De Sanctis
- Centre of Pediatric Diabetology, AOU Città Della Salute e Della Scienza, Department of Pediatrics, University of Turin, Torino, Italy
| | - Giulio Maltoni
- IRCCS AOU di Bologna Policlinico di S.Orsola, Woman and Child, Bologna, Italy
| | | | | | - Valeria Calcaterra
- Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan and University of Pavia, Italy
| | | | | | - Maurizio Delvecchio
- Metabolic Disease and Genetics Unit, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Ivana Rabbone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, Italy
| | | | | | - Valentina Tiberi
- G. Salesi Children's Hospital, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Davide Tinti
- Centre of Pediatric Diabetology, AOU Città Della Salute e Della Scienza, Department of Pediatrics, University of Turin, Torino, Italy
| | - Novella Rapini
- Diabetes Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sonia Toni
- Anna Meyer Children's Hospital, Florence, Italy
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11
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Lucaccioni L, Iughetti L, Berardi A, Predieri B. Challenges in the growth and development of newborns with extra-uterine growth restriction. Expert Rev Endocrinol Metab 2022; 17:415-423. [PMID: 35941822 DOI: 10.1080/17446651.2022.2110468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite enormous improvements in nutritional support and strategies, the growth pattern of preterm infants is still far from the one expected. AREAS COVERED This review focuses on what EUGR is, highlighting controversial aspects of this topic. EUGR is still missing a univocal definition, and the international debate is also open on what is the best growth chart to use. Moreover, professionals in NICU may not be trained on how to perform anthropometric measurements, increasing the risk of over- or underestimation, especially for length assessment. EUGR has recently been described as one of the main comorbidities in NICU, influencing growth, metabolism, and neurodevelopment later in life. EXPERT OPINION There is still much to investigate about what the best growth pattern in the NICU should be. What is known so far is that the majority of preterm neonates develop EUGR, and this leads to several short- and long-term consequences. It is imperative that neonatologists and pediatric endocrinologists work together, to modulate growth in the NICU.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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12
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Rabbone I, Savastio S, Pigniatiello C, Carducci C, Berioli MG, Cherubini V, Lo Presti D, Maltoni G, Mameli C, Marigliano M, Minuto N, Mozzillo E, Piccinno E, Predieri B, Rigamonti A, Ripoli C, Schiaffini R, Lombardo F, Tinti D, Toni S, Zanfardino A, Scaramuzza AE. Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed-loop control system after attending a virtual educational camp. Acta Diabetol 2022; 59:837-842. [PMID: 35312860 PMCID: PMC8935105 DOI: 10.1007/s00592-022-01878-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes. METHODS Children and their parents participated in a three-day vEC. Clinical, glucose, and emotion data were evaluated before, just after, and six months after the vEC. Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels. RESULTS Forty-three children and adolescents (7-16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%, p < 0.05, respectively), while mixed emotions were reduced (32% and 15% vs 61%, p < 0.05 and p < 0.001, respectively). The median percentage TIR increased from 64% (IQR 54-72) to 75% (IQR 70-82) with Control-IQ (p < 0.001) six months after the vEC. CONCLUSIONS Positive emotions (joy, serenity, and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC.
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Affiliation(s)
- Ivana Rabbone
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Silvia Savastio
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Ciro Pigniatiello
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | | | | | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | | | - Giulio Maltoni
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Università Di Milano, Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, Napoli, Italy
| | - Elvira Piccinno
- Metabolic Diseases and Diabetology, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Mdena and Reggio Emilia, Modena, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Carlo Ripoli
- Department of Pediatrics and Microcythemia, ARNAS G. Brotzu, Cagliari, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in adult and developmental age, University of Messina, Messina, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Sonia Toni
- Pediatric Diabetology and Endocrinology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Andrea Enzo Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Division of Pediatrics, ASST Cremona, Cremona, Italy.
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13
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Maltoni G, Zioutas M, Mosticchio M, Iughetti L, Predieri B, Bruzzi P, Iovane B, Lazzeroni P, Graziani V, Suprani T, Monti S, Street ME, Lasagni A, De Luca F, Libertucci F, Mainetti B, Riboni S, Sogno Valin P, Pession A, Zucchini S. A comparative study on the incidence of type 1 diabetes mellitus between children of North African migrants and Italian children in Emilia-Romagna region, Italy. Eur J Pediatr 2022; 181:1523-1529. [PMID: 35028726 DOI: 10.1007/s00431-021-04340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED In the last few decades, many studies have reported an increasing global incidence of type 1 diabetes. Studies on migrant populations have underlined the importance of both environmental and genetic factors. AIMS Evaluate the incidence of type 1 diabetes in North African vs Italian children aged 0-14 years from 1 January 2015, to 31st December 2018, in Emilia-Romagna region, Italy. METHODS Clinical and epidemiological data about childhood onset type 1 diabetes in Emilia Romagna region were retrospectively collected by the regional centers of pediatric diabetology and matched using 3 different data sources. RESULTS 365 new cases were diagnosed. Total cumulative incidence was 15.4/100,000/year. North African cases showed a cumulative incidence of 53.8/100,000/year, statistically significant compared to cumulative incidence of the Italian cases alone 13.1/100,000/year (p value < 0.001). The annual incidence did not differ in the 4 years for both groups. Conclusion: The incidence of type 1 diabetes in the pediatric age (0 14 years) was significantly higher in the North African population than in the Italian one, suggesting that a mix of genetic and environmental factors may have caused the increase in newly diagnosed cases. WHAT IS KNOWN • The incidence of type 1 diabetes largely varies worldwide. • Study on immigrants helped to better understand the interplay role between genetics and environment. WHAT IS NEW • This is the first study focused on the incidence of children and adolescents of North African migrants in Italy. • The incidence of children and adolescents of North African migrants in Emilia Romagna region, Italy, seems to be higher than that reported in the host countries, and, above all, than that reported in highest-incidence countries in Europe and in the world.
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Affiliation(s)
- Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy.
| | - Maximiliano Zioutas
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Marta Mosticchio
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and SurgicalSciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Brunella Iovane
- Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy
| | - Pietro Lazzeroni
- Center for Diabetes in Children and Adolescents, Department of Woman and Child Health, Parma University Hospital, Parma, Italy
| | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Tosca Suprani
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Sara Monti
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Maria E Street
- Division of Pediatric Endocrinology and Diabetology Pediatrics, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Lasagni
- Division of Pediatric Endocrinology and Diabetology Pediatrics, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca De Luca
- Pediatrics Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124, Ferrara, Italy
| | | | | | - Sara Riboni
- Department of Pediatrics and Neonatology, Guglielmo da Saliceto Hospital, Cantone del Cristo 50, Piacenza, Italy
| | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria Della Scaletta Hospital, Imola, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 11, 40138, Bologna, Italy
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14
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Madeo SF, Stanghellini I, Predieri B, Ciancia S, Leo F, Bruzzi P, Calabrese O, Iughetti L. Copy Number Variation Analysis Increases the Number of Candidate Loci Associated with Pediatric Obesity. Horm Res Paediatr 2022; 94:251-262. [PMID: 34482307 DOI: 10.1159/000519299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Obesity is a multifactorial disease caused by the interaction of genetic, environmental, and behavioral factors. Currently, only a small number of obese children undergo genetic analysis, usually when obesity is associated with dysmorphic features. The aim of this study was to identify genomic rearrangement causing obesity. METHODS We analyzed the DNA of children and adolescents by single-nucleotide polymorphism-array (platform CytoScan HD, Affymetrix). Patients included in this study were obese with dysmorphic features and/or intellectual disabilities and/or neuropsychomotor signs. RESULTS Ninety-four children and adolescents with obesity (9.25 ± 4.04 years old, 60 males) were enrolled in the study. Dysmorphic features were found in 64 out of 94 subjects (68.1%), intellectual disability was found in 23 subjects (24.5%), and other neuropsychomotor signs in 31 (32.9%). Copy number variations (CNVs) were identified in 43 out of 94 patients (45.7%): among these 14 subjects showed at least 1 deletion, 22 duplication, whereas 7 patients showed both deletion and duplication. In 20 subjects (13 males), CNVs were linked or possibly related with obesity; in 23 subjects, this correlation cannot be inferred. CONCLUSION A genetic origin of obesity was detected in about half of our obese children and adolescents with associated dysmorphic features and/or intellectual disability and/or neuropsychomotor signs. In these children, array-CGH analysis can be useful to identify causative genetic mutations, with consequent advantage in therapeutic management and follow-up of these patients.
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Affiliation(s)
- Simona Filomena Madeo
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria Stanghellini
- Medical Genetics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ciancia
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Leo
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Olga Calabrese
- Medical Genetics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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15
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Trevisani V, Predieri B, Madeo SF, Fusco C, Garavelli L, Caraffi S, Iughetti L. Growth hormone deficiency in a child with benign hereditary chorea caused by a de novo mutation of the TITF1/NKX2-1 gene. J Pediatr Endocrinol Metab 2022; 35:411-415. [PMID: 34710315 DOI: 10.1515/jpem-2021-0402] [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: 06/14/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Benign Hereditary Chorea (BHC) (MIM 118700) is a rare childhood-onset movements disorder characterized by non-progressive chorea. It is usually caused by variants in the thyroid transcription factor 1 (TITF-1/NKX2-1) gene and it is associated with thyroid dysfunction and pulmonary symptoms in the brain-lung-thyroid syndrome. CASE PRESENTATION We reported the clinical case of a toddler presenting with neurological symptoms (hypotonia, delayed motor milestones, and axial dystonia) and subclinical hypothyroidism in which we found a 'de novo' variant in the NKX2-1 gene. CONCLUSIONS The peculiarity of our case is that the mild alteration of thyroid-stimulating hormone (TSH) levels, hypotonia, and delayed motor milestones were associated with growth hormone deficiency.
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Affiliation(s)
- Viola Trevisani
- Department of Medical and Surgical Sciences of the Mothers, Post Graduate School of Pediatrics, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mothers, Post Graduate School of Pediatrics, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences of the Mothers, Pediatric Unit, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Filomena Madeo
- Department of Medical and Surgical Sciences of the Mothers, Pediatric Unit, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Fusco
- Department of Pediatrics, Child Neurology Unit and Pediatric Neurophysiology Laboratory, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Livia Garavelli
- Mother and Child Health Department, Medical Genetics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Stefano Caraffi
- Mother and Child Health Department, Medical Genetics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mothers, Post Graduate School of Pediatrics, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences of the Mothers, Pediatric Unit, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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16
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Predieri B, Alves CAD, Iughetti L. New insights on the effects of endocrine-disrupting chemicals on children. J Pediatr (Rio J) 2022; 98 Suppl 1:S73-S85. [PMID: 34921754 PMCID: PMC9510934 DOI: 10.1016/j.jped.2021.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Endocrine disrupting chemicals (EDCs) are present in many areas and materials of the common life, and exposure to these chemicals can occur from products to personal care, from air and food. This review aims to summarize the more recent epidemiological findings for the impact of EDCs on endocrine system health in children, including effects in growth, metabolism, sexual development, and reproduction. SOURCES The MEDLINE database (PubMed) was searched on August 24th, 2021, filtering for EDCs, endocrine disruptors, children, and humans. SUMMARY OF THE FINDINGS Intrauterine exposure of EDCs can have transgenerational effects, thus laying the foundation for disease in later life. The dose-response relationship may not always be predictable as even low-level exposures that may occur in everyday life can have significant effects on a susceptible individual. Although individual compounds have been studied in detail, the effects of a combination of these chemicals are yet to be studied to understand the real-life situation where human beings are exposed to a "cocktail effect" of these EDCs. Epidemiological studies in humans suggest EDCs' effects on prenatal growth, thyroid function, glucose metabolism, obesity, puberty, and fertility mainly through epigenetic mechanisms. CONCLUSIONS EDCs cause adverse effects in animals, and their effects on human health are now known and irrefutable. Because people are typically exposed to multiple endocrine disruptors, assessing public health effects is difficult. Legislation to ban EDCs and protect especially pregnant women and young children is required and needs to be revised and adjusted to new developments on a regular basis.
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Affiliation(s)
- Barbara Predieri
- University of Modena and Reggio Emilia, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Pediatric Unit, Modena, Italy
| | - Crésio A D Alves
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Unidade de Endocrinologia Pediátrica, Salvador, BA, Brazil
| | - Lorenzo Iughetti
- University of Modena and Reggio Emilia, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Pediatric Unit, Modena, Italy.
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17
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Cherubini V, Marino M, Scaramuzza AE, Tiberi V, Bobbio A, Delvecchio M, Piccinno E, Ortolani F, Innaurato S, Felappi B, Gallo F, Ripoli C, Ricciardi MR, Pascarella F, Stamati FA, Citriniti F, Arnaldi C, Monti S, Graziani V, De Berardinis F, Giannini C, Chiarelli F, Zampolli M, De Marco R, Bracciolini GP, Grosso C, De Donno V, Piccini B, Toni S, Coccioli S, Cardinale G, Bassi M, Minuto N, D’Annunzio G, Maffeis C, Marigliano M, Zanfardino A, Iafusco D, Rollato AS, Piscopo A, Curto S, Lombardo F, Bombaci B, Sordelli S, Mameli C, Macedoni M, Rigamonti A, Bonfanti R, Frontino G, Predieri B, Bruzzi P, Mozzillo E, Rosanio F, Franzese A, Piredda G, Cardella F, Iovane B, Calcaterra V, Berioli MG, Lasagni A, Pampanini V, Patera PI, Schiaffini R, Rutigliano I, Meloni G, De Sanctis L, Tinti D, Trada M, Guerraggio LP, Franceschi R, Cauvin V, Tornese G, Franco F, Musolino G, Maltoni G, Talarico V, Iannilli A, Lenzi L, Matteoli MC, Pozzi E, Moretti C, Zucchini S, Rabbone I, Gesuita R. Corrigendum: The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the covid-19 pandemic in 2020. Front Endocrinol (Lausanne) 2022; 13:977211. [PMID: 35992112 PMCID: PMC9387139 DOI: 10.3389/fendo.2022.977211] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article .].
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Affiliation(s)
- Valentino Cherubini
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital”, Ancona, Italy
| | - Monica Marino
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital”, Ancona, Italy
- *Correspondence: Monica Marino,
| | - Andrea E. Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, Cremona, Italy
| | - Valentina Tiberi
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital”, Ancona, Italy
| | | | - Maurizio Delvecchio
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Elvira Piccinno
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Federica Ortolani
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Stefania Innaurato
- Maternal and Child Health Department, Pediatric Unit - San Bortolo Hospital, Vicenza, Italy
| | - Barbara Felappi
- Pediatric Clinic, Children’s Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Carlo Ripoli
- Pediatric Diabetology Unit, Pediatric and Microcytemia Department, AO Brotzu, Cagliari, Italy
| | | | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant”Anna e San Sebastiano Hospital, Caserta, Italy
| | | | - Felice Citriniti
- Department of Pediatrics “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
| | | | - Sara Monti
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | - Vanna Graziani
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | | | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Maria Zampolli
- Department of Pediatrics, ASST Lariana, Sant’Anna Hospital, Como, Italy
| | | | - Giulia Patrizia Bracciolini
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | - Caterina Grosso
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Barbara Piccini
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Sonia Toni
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Susanna Coccioli
- Unit of Pediatrics, “D. Camberlingo” Hospital, Francavilla Fontana, Brindisi, Italy
| | - Giuliana Cardinale
- Unit of Pediatrics, “Sacro Cuore di Gesu” Hospital Gallipoli (LE), Gallipoli, Italy
| | - Marta Bassi
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Nicola Minuto
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Giuseppe D’Annunzio
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Assunta S. Rollato
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Alessia Piscopo
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Stefano Curto
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | | | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children’s Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children’s Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Andrea Rigamonti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulio Frontino
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Universita degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Universita degli Studi di Napoli Federico II, Naples, Italy
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Universita degli Studi di Napoli Federico II, Naples, Italy
| | - Gavina Piredda
- Unit of Paediatrics, “Giovanni Paolo II” Hospital, ASSL Olbia, Olbia, Italy
| | - Francesca Cardella
- Department of Pediatrics, Regional Center of Pediatric Diabetes, Children Hospital G. Di Cristina, Palermo, Italy
| | - Brunella Iovane
- Parma University Hospital Department of Mother and Child Pediatric, Parma, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia and “Vittore Buzzi” Chidren’s Hospital, Milano, Italy
| | - Maria Giulia Berioli
- Pediatric Diabetology Department, Azienda Ospedaliera di Perugia, Perugia, Umbria, Italy
| | - Anna Lasagni
- Pediatric Unit, Department of Obstetrics, Gynaecology and Paediatrics, Azienda AUSL-IRCCS Reggio Emilia, Italy
| | - Valentina Pampanini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | | | - Riccardo Schiaffini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | - Irene Rutigliano
- Casa Sollievo della Sofferenza” Research Institut, San Giovanni Rotondo, Puglia, Italy
| | - Gianfranco Meloni
- Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luisa De Sanctis
- Center of Pediatric Diabetology - A.O.U. Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Davide Tinti
- Center of Pediatric Diabetology - A.O.U. Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Michela Trada
- Center of Pediatric Diabetology - A.O.U. Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Paola Guerraggio
- Centre of Paediatric Diabetology, Paediatric Unit, “Filippo Del Ponte” Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Francesca Franco
- Pediatric Department, ASUFC Hospital of Udine, Friuli-Venezia Giulia, Italy
| | - Gianluca Musolino
- Centre of Paediatric Diabetology, Paediatric Unit, “Filippo Del Ponte” Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Giulio Maltoni
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Iannilli
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital”, Ancona, Italy
| | - Lorenzo Lenzi
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | | | - Erica Pozzi
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Carlo Moretti
- UOSD Pediatric Diabetology and Metabolism Unit, Children and Women Health Department, AOU Padova, Padova, Italy
| | - Stefano Zucchini
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
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Bruzzi P, Valeri L, Sandoni M, Madeo SF, Predieri B, Lucaccioni L, Iughetti L. The impact of BMI on long-term anthropometric and metabolic outcomes in girls with idiopathic central precocious puberty treated with GnRHas. Front Endocrinol (Lausanne) 2022; 13:1006680. [PMID: 36263328 PMCID: PMC9574359 DOI: 10.3389/fendo.2022.1006680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone analogs (GnRHas) are effective in increasing the final height of children with idiopathic central precocious puberty (ICPP). However, in previous years, some transient metabolic complications have been described during this treatment, for which there are no long-term outcome data. Our study aimed to evaluate the efficacy of GnRHas and clarify if body mass index (BMI) at diagnosis of ICPP could influence long-term outcomes. METHODS This was an observational, retrospective study that recruited a cohort of girls with ICPP. Data for anthropometric measures, fasting lipid profile, and glucose metabolism were collected at baseline [when GnRHas treatment started (T1)], at the end of the treatment (T2), and near-final height (nFH) or final height (FH) (T3). Predicted adult height (PAH) was calculated at T1 following Bayley and Pinneau's method. Analysis was carried out using BMI standard deviation score (SDS) categories at T1 (group A, normal weight, vs. group B, overweight/obese). RESULTS Fifty-seven girls with ICPP who were treated with GnRHas were enrolled in the study (group A vs. group B: 33 vs. 24 patients, aged 7.86 ± 0.81 vs. 7.06 ± 1.61 years, respectively; p < 0.05). In the study population, nFH/FH was in line with the target height (TH) (p = 0.54), with a mean absolute height gain of 11.82 ± 5.35 cm compared with PAH. Even if the length of therapy was shorter (group A vs. group B: 1.84 ± 2.15 vs. 2.10 ± 0.81 years, respectively; p < 0.05) and the age at menarche was younger (group A vs. group B: 10.56 ± 1.01 vs. 11.44 ± 0.85 years, respectively; p < 0.05) in group B than in group A, the nFH/FH gain was still comparable between the two groups (p = 0.95). At nFH/FH, BMI SDS was still greater in group B than in group A (p = 0.012), despite the fact that BMI SDS significantly increased in group A only (p < 0.05). Glucose metabolism got worst during GnRHa with a complete restoring after it, independently from pre-treatment BMI. The ratio of low-density to high-density lipoprotein cholesterol transiently deteriorated during treatment with GnRHas in group A only (p = 0.030). CONCLUSIONS Our results confirm the effectiveness of treatment with GnRHas on growth and do not support the concern that being overweight and obese can impair the long-term outcomes of GnRHas therapy. However, the observed transient impairment of metabolic parameters during treatment suggests that clinicians should encourage ICPP girls treated with GnRHas to have a healthy lifestyle, regardless of their pretreatment BMI.
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Affiliation(s)
- Patrizia Bruzzi
- Pediatric Unit, Department of Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
- *Correspondence: Patrizia Bruzzi,
| | - Lara Valeri
- Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Post Graduate School of Paediatrics, University of Modena & Reggio Emilia, Modena, Italy
| | - Marcello Sandoni
- Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Post Graduate School of Paediatrics, University of Modena & Reggio Emilia, Modena, Italy
| | - Simona Filomena Madeo
- Pediatric Unit, Department of Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Post Graduate School of Paediatrics, University of Modena & Reggio Emilia, Modena, Italy
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena & Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Post Graduate School of Paediatrics, University of Modena & Reggio Emilia, Modena, Italy
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena & Reggio Emilia, Modena, Italy
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19
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Cherubini V, Marino M, Scaramuzza AE, Tiberi V, Bobbio A, Delvecchio M, Piccinno E, Ortolani F, Innaurato S, Felappi B, Gallo F, Ripoli C, Ricciardi MR, Pascarella F, Stamati FA, Citriniti F, Arnaldi C, Monti S, Graziani V, De Berardinis F, Giannini C, Chiarelli F, Zampolli M, De Marco R, Bracciolini GP, Grosso C, De Donno V, Piccini B, Toni S, Coccioli S, Cardinale G, Bassi M, Minuto N, D’Annunzio G, Maffeis C, Marigliano M, Zanfardino A, Iafusco D, Rollato AS, Piscopo A, Curto S, Lombardo F, Bombaci B, Sordelli S, Mameli C, Macedoni M, Rigamonti A, Bonfanti R, Frontino G, Predieri B, Bruzzi P, Mozzillo E, Rosanio F, Franzese A, Piredda G, Cardella F, Iovane B, Calcaterra V, Berioli MG, Lasagni A, Pampanini V, Patera PI, Schiaffini R, Rutigliano I, Meloni G, De Sanctis L, Tinti D, Trada M, Guerraggio LP, Franceschi R, Cauvin V, Tornese G, Franco F, Musolino G, Maltoni G, Talarico V, Iannilli A, Lenzi L, Matteoli MC, Pozzi E, Moretti C, Zucchini S, Rabbone I, Gesuita R. The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020. Front Endocrinol (Lausanne) 2022; 13:878634. [PMID: 35784550 PMCID: PMC9247264 DOI: 10.3389/fendo.2022.878634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/04/2022] [Indexed: 01/19/2023] Open
Abstract
AIM/HYPOTHESIS To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. METHODS Forty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. RESULTS Overall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p<0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p<0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). CONCLUSIONS/INTERPRETATION There was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.
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Affiliation(s)
- Valentino Cherubini
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | - Monica Marino
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
- *Correspondence: Monica Marino,
| | - Andrea E. Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Pediatric Unit, ASST Cremona, Ospedale Maggiore, Cremona, Italy
| | - Valentina Tiberi
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | | | - Maurizio Delvecchio
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Elvira Piccinno
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Federica Ortolani
- Metabolic Disease and Genetics Disorders Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Stefania Innaurato
- Maternal and Child Health Department, Pediatric Unit - San Bortolo Hospital, Vicenza, Italy
| | - Barbara Felappi
- Pediatric Clinic, Children’s Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Carlo Ripoli
- Pediatric Diabetology Unit, Pediatric and Microcytemia Department, AO Brotzu, Cagliari, Italy
| | | | - Filomena Pascarella
- Pediatric Endocrinology Unit, Sant”Anna e San Sebastiano Hospital, Caserta, Italy
| | | | - Felice Citriniti
- Department of Pediatrics “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
| | | | - Sara Monti
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | - Vanna Graziani
- Unit of Paediatrics, “ M.Bufalini” Hospital Cesena (FC), Unit of Paediatrics, “ S.M. Croci” Hospital Ravenna (RA), AUSL della Romagna Ravenna, Emilia-Romagna, Italy
| | | | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Maria Zampolli
- Department of Pediatrics, ASST Lariana, Sant’Anna Hospital, Como, Italy
| | | | - Giulia Patrizia Bracciolini
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | - Caterina Grosso
- Pediatric and Pediatric Emergency unit, Children Hospital, ASO SS Antonio Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Barbara Piccini
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Sonia Toni
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | - Susanna Coccioli
- Unit of Pediatrics, “D. Camberlingo” Hospital, Francavilla Fontana, Brindisi, Italy
| | - Giuliana Cardinale
- Unit of Pediatrics, “Sacro Cuore di Gesù” Hospital Gallipoli (LE), Gallipoli, Italy
| | - Marta Bassi
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Nicola Minuto
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Giuseppe D’Annunzio
- Pediatric Clinic, IRCCS Giannina Gaslini; Department of Neuroscience Rehabilitation Ophtalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Assunta S. Rollato
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Alessia Piscopo
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Stefano Curto
- Department of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | | | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children's Hospital. Univerisity of Milan, Milano, Lombardia, Italy
| | - Andrea Rigamonti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulio Frontino
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Gavina Piredda
- Unit of Paediatrics, “Giovanni Paolo II“ Hospital, ASSL Olbia, Olbia, Italy
| | - Francesca Cardella
- Department of Pediatrics, Regional Center of Pediatric Diabetes, Children Hospital G. Di Cristina, Palermo, Italy
| | - Brunella Iovane
- Parma University Hospital Department of Mother and Child Pediatric, Parma, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia and “Vittore Buzzi” Chidren’s Hospital, Milano, Italy
| | - Maria Giulia Berioli
- Pediatric Diabetology Department, Azienda Ospedaliera di Perugia, Perugia, Umbria, Italy
| | - Anna Lasagni
- Pediatric Unit, Department of Obstetrics, Gynaecology and Paediatrics, Azienda AUSL-IRCCS Reggio Emilia, Italy
| | - Valentina Pampanini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | | | - Riccardo Schiaffini
- Pediatric Diabetology Department, Bambino Gesu Pediatric Hospital Roma, Lazio, Italy
| | - Irene Rutigliano
- Casa Sollievo della Sofferenza” Research Institut, San Giovanni Rotondo, Puglia, Italy
| | - Gianfranco Meloni
- Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luisa De Sanctis
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Davide Tinti
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michela Trada
- Center of Pediatric Diabetology - A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Paola Guerraggio
- Centre of Paediatric Diabetology, Paediatric Unit, "Filippo Del Ponte" Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, S.Chiara Hospital of Trento, Trento, Trentino-Alto Adige, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Francesca Franco
- Pediatric Department, ASUFC Hospital of Udine, Friuli-Venezia Giulia, Italy
| | - Gianluca Musolino
- Centre of Paediatric Diabetology, Paediatric Unit, “Filippo Del Ponte” Children Hospital, ASST Sette Laghi, Varese, Italy
| | - Giulio Maltoni
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Iannilli
- Department of Women’s and Children’s Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, “G. Salesi Hospital” , Ancona, Italy
| | - Lorenzo Lenzi
- Diabetology and Endocrinology Unit, Meyer University Children’s Hospital, Florence, Italy
| | | | - Erica Pozzi
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Carlo Moretti
- UOSD Pediatric Diabetology and Metabolism Unit, Children and Women Health Department, AOU Padova, Padova, Italy
| | - Stefano Zucchini
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy
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Catellani C, Ravegnini G, Sartori C, Righi B, Lazzeroni P, Bonvicini L, Poluzzi S, Cirillo F, Predieri B, Iughetti L, Giorgi Rossi P, Angelini S, Street ME. Specific miRNAs Change After 3 Months of GH treatment and Contribute to Explain the Growth Response After 12 Months. Front Endocrinol (Lausanne) 2022; 13:896640. [PMID: 35813630 PMCID: PMC9256936 DOI: 10.3389/fendo.2022.896640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
CONTEXT There is growing evidence of the role of epigenetic regulation of growth, and miRNAs potentially play a role. OBJECTIVE The aim of this study is to identify changes in circulating miRNAs following GH treatment in subjects with isolated idiopathic GH deficiency (IIGHD) after the first 3 months of treatment, and verify whether these early changes can predict growth response. DESIGN AND METHODS The expression profiles of 384 miRNAs were analyzed in serum in 10 prepubertal patients with IIGHD (5 M, 5 F) at two time points before starting GH treatment (t-3, t0), and at 3 months on treatment (t+3). MiRNAs with a fold change (FC) >+1.5 or <-1.5 at t+3 were considered as differentially expressed. In silico analysis of target genes and pathways led to a validation step on 8 miRNAs in 25 patients. Clinical and biochemical parameters were collected at baseline, and at 6 and 12 months. Simple linear regression analysis and multiple stepwise linear regression models were used to explain the growth response. RESULTS Sixteen miRNAs were upregulated and 2 were downregulated at t+3 months. MiR-199a-5p (p = 0.020), miR-335-5p (p = 0.001), and miR-494-3p (p = 0.026) were confirmed to be upregulated at t+3. Changes were independent of GH peak values at testing, and levels stabilized after 12 months. The predicted growth response at 12 months was considerably improved compared with models using the common clinical and biochemical parameters. CONCLUSIONS MiR-199a-5p, miR-335-5p, and miR-494-3p changed after 3 months of GH treatment and likely reflected both the degree of GH deficiency and the sensitivity to treatment. Furthermore, they were of considerable importance to predict growth response.
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Affiliation(s)
- Cecilia Catellani
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Chiara Sartori
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Beatrice Righi
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Lazzeroni
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Poluzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Cirillo
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Maria Elisabeth Street
- Department of Mother and Child, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Maria Elisabeth Street,
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21
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Ceccarelli PL, Lucaccioni L, Poluzzi F, Bianchini A, Biondini D, Iughetti L, Predieri B. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr 2021; 21:523. [PMID: 34836527 PMCID: PMC8620229 DOI: 10.1186/s12887-021-02941-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6–12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes. Methods Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon). Results 187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5–22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child’s age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child’s HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents. Conclusion Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.
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Affiliation(s)
- Pier Luca Ceccarelli
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Francesca Poluzzi
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Anastasia Bianchini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Diego Biondini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
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22
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Esposito S, Biasucci G, Pasini A, Predieri B, Vergine G, Crisafi A, Malaventura C, Casadio L, Sella M, Pierantoni L, Gatti C, Paglialonga L, Sodini C, La Scola C, Bernardi L, Autore G, Canto GD, Argentiero A, Cantatore S, Ceccoli M, De Fanti A, Suppiej A, Lanari M, Principi N, Pession A, Iughetti L. Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections. J Glob Antimicrob Resist 2021; 29:499-506. [PMID: 34801739 DOI: 10.1016/j.jgar.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giacomo Biasucci
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Pasini
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Barbara Predieri
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonella Crisafi
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Luca Casadio
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Marcello Sella
- Pediatric Clinic, Azienda Sanitaria Locale Romagna, Cesena, Italy
| | - Luca Pierantoni
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Claudia Gatti
- Paediatric Surgery, University of Parma, Parma, Italy
| | - Letizia Paglialonga
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Chiara Sodini
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudio La Scola
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Luca Bernardi
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Autore
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sante Cantatore
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Ceccoli
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Agnese Suppiej
- Paediatric Clinic, University of Ferrara, Ferrara, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | | | - Andrea Pession
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Lorenzo Iughetti
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
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Bruzzi P, Predieri B, Madeo S, Lami F, Iughetti L. Longitudinal evaluation of endothelial markers in children and adolescents with familial hypercholesterolemia. Acta Biomed 2021; 92:e2021343. [PMID: 34738580 PMCID: PMC8689302 DOI: 10.23750/abm.v92i5.11074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
Background and aim: Children with heterozygous familial hypercholesterolemia (heFH) are at risk of premature atherosclerosis. Aims of this study were: (a) to longitudinally evaluate the endothelial dysfunction, estimated through brachial flow mediated dilation (FMD), as first sign of subclinical atherogenesis in a group of children and adolescents affected by heFH in comparison to normo-lipidemic controls, and (b) to identify predictive factors influencing the endothelial function and its development in the same cohort of patients. Methods: This is a prospective, longitudinal and cross-sectional study. Physical examination, plasma lipid profile and brachial artery FMD were measured at baseline and after follow-up. Results: At baseline, FMD did not differ between heFH children (n.24, median age 9.71) and controls (n. 24, median age 10.29) (7.67 ± 9.26 vs. 11.18 ± 7.28 %, p 0.09). Nevertheless, during follow-up (median length of lipid-lowering diet 4.52 years), FMD got worse in 54% of heFH subjects and its worsening correlated to the increasing of low-density lipoprotein cholesterol (r -0.21, p < 0.05). Moreover, being male (β -0.46, p 0.03), undergoing puberty (β -0.61, p 0.03) and increasing of body mass index standard deviation score (β -0.39, p 0.03) were identified as main independent predictor factors of FMD drop. Conclusions: During the first decades of life, not only hypercholesterolemia, but also clusters of pro-atherogenic conditions and their persistence, could affect the endothelial function and its trend. (www.actabiomedica.it)
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Affiliation(s)
- Patrizia Bruzzi
- 1Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Barbara Predieri
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Simona Madeo
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Francesca Lami
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
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24
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Cherubini V, Rabbone I, Berioli MG, Giorda S, Lo Presti D, Maltoni G, Mameli C, Marigliano M, Marino M, Minuto N, Mozzillo E, Piccinno E, Predieri B, Ripoli C, Schiaffini R, Rigamonti A, Salzano G, Tinti D, Toni S, Zanfardino A, Scaramuzza AE, Gesuita R, Tiberi V, Savastio S, Pigniatiello C, Trada M, Zucchini S, Redaelli FC, Maffeis C, Bassi M, Rosanio FM, Delvecchio M, Buzzi P, Ricciardi MR, Carducci C, Bonfanti R, Lombardo F, Piccini B, Iafusco D, Calandretti M, Daga FA. Effectiveness of a closed-loop control system and a virtual educational camp for children and adolescents with type 1 diabetes: A prospective, multicentre, real-life study. Diabetes Obes Metab 2021; 23:2484-2491. [PMID: 34227214 DOI: 10.1111/dom.14491] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the impact of a virtual educational camp (vEC) on glucose control in children and adolescents with type 1 diabetes using a closed-loop control (CLC) system. MATERIALS AND METHODS This was a prospective multicentre study of children and adolescents with type 1 diabetes using the Tandem Basal-IQ system. Insulin pumps were upgraded to Control-IQ, and children and their parents participated in a 3-day multidisciplinary vEC. Clinical data, glucose metrics and HbA1c were evaluated over the 12 weeks prior to the Control-IQ update and over the 12 weeks after the vEC. RESULTS Forty-three children and adolescents (aged 7-16 years) with type 1 diabetes and their families participated in the vEC. The median percentage of time in target range (70-180 mg/dL; TIR) increased from 64% (interquartile range [IQR] 56%-73%) with Basal-IQ to 76% (IQR 71%-81%) with Control-IQ (P < .001). After the vEC, more than 75% of participants achieved a TIR of more than 70%. The percentage of time between 180 and 250 mg/dL and above 250 mg/dL decreased by 5% (P < .01) and 6% (P < .01), respectively, while the time between 70 and 54 mg/dL and below 54 mg/dL remained low and unaltered. HbA1c decreased by 0.5% (P < .01). There were no episodes of diabetic ketoacidosis or severe hypoglycaemia. CONCLUSIONS In this study of children managing their diabetes in a real-world setting, more than 75% of children who participated in a vEC after starting a CLC system could obtain and maintain a TIR of more than 70%. The vEC was feasible and resulted in a significant and persistent improvement in TIR in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Ivana Rabbone
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | | | - Sara Giorda
- Department of Pediatrics, University of Torino, Torino, Italy
| | | | - Giulio Maltoni
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Chiara Mameli
- Department of Pediatrics, Università di Milano, Buzzi Children's Hospital, Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Monica Marino
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, Napoli, Italy
| | - Elvira Piccinno
- Metabolic Diseases and Diabetology, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Ripoli
- Department of Pediatrics and Microcythemia, ARNAS G. Brotzu, Cagliari, Italy
| | | | - Andrea Rigamonti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Sonia Toni
- Pediatric Endocrinology and Diabetology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology, University of Campania "L. Vanvitelli", Napoli, Italy
| | | | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Valentina Tiberi
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Silvia Savastio
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Ciro Pigniatiello
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Michela Trada
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | | | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Marta Bassi
- Pediatric Clinic, IRCCS G. Gaslini, Genova, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, Napoli, Italy
| | - Maurizio Delvecchio
- Metabolic Diseases and Diabetology, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Patrizia Buzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Riccardo Bonfanti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Barbara Piccini
- Pediatric Endocrinology and Diabetology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Michela Calandretti
- Adapted Training and Performance Research Group, School of Exercise and Sport Sciences, University of Turin, Turin, Italy
| | - Federico Abate Daga
- Adapted Training and Performance Research Group, School of Exercise and Sport Sciences, University of Turin, Turin, Italy
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25
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Mozzillo E, Zito E, Calcaterra V, Corciulo N, Di Pietro M, Di Sessa A, Franceschi R, Licenziati MR, Maltoni G, Morino G, Predieri B, Street ME, Trifirò G, Gallè F, Franzese A, Valerio G. Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth. Int J Environ Res Public Health 2021; 18:ijerph18179355. [PMID: 34501945 PMCID: PMC8431705 DOI: 10.3390/ijerph18179355] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022]
Abstract
Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, 80131 Naples, Italy; (E.M.); (A.F.)
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, 80138 Naples, Italy;
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Nicola Corciulo
- Unit of Auxology and Pediatric Endocrinology, Sacred Heart of Jesus Hospital, Gallipoli, 73014 Lecce, Italy;
| | | | - Anna Di Sessa
- Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | | | - Maria Rosaria Licenziati
- Obesity and Endocrine Disease Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy;
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Giuseppe Morino
- Research Unit for Multifactorial Diseases, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults—Pediatric Unit University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Maria Elisabeth Street
- Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giuliana Trifirò
- Endocrinology and Metabolism Division, IRCCS Policlinico San Donato, 20097 Milan, Italy;
| | - Francesca Gallè
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, 80133 Naples, Italy;
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, 80131 Naples, Italy; (E.M.); (A.F.)
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, 80133 Naples, Italy;
- Correspondence:
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26
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Esposito S, Mariotti Zani E, Torelli L, Scavone S, Petraroli M, Patianna V, Predieri B, Iughetti L, Principi N. Childhood Vaccinations and Type 1 Diabetes. Front Immunol 2021; 12:667889. [PMID: 34512622 PMCID: PMC8427438 DOI: 10.3389/fimmu.2021.667889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Type 1 diabetes (T1D) is the most common paediatric endocrine disease, and its frequency has been found to increase worldwide. Similar to all conditions associated with poorly regulated glucose metabolism, T1D carries an increased risk of infection. Consequently, careful compliance by T1D children with schedules officially approved for child immunization is strongly recommended. However, because patients with T1D show persistent and profound limitations in immune function, vaccines may evoke a less efficient immune response, with corresponding lower protection. Moreover, T1D is an autoimmune condition that develops in genetically susceptible individuals and some data regarding T1D triggering factors appear to indicate that infections, mainly those due to viruses, play a major role. Accordingly, the use of viral live attenuated vaccines is being debated. In this narrative review, we discussed the most effective and safe use of vaccines in patients at risk of or with overt T1D. Literature analysis showed that several problems related to the use of vaccines in children with T1D have not been completely resolved. There are few studies regarding the immunogenicity and efficacy of vaccines in T1D children, and the need for different immunization schedules has not been precisely established. Fortunately, the previous presumed relationship between vaccine administration and T1D appears to have been debunked, though some doubts regarding rotavirus vaccines remain. Further studies are needed to completely resolve the problems related to vaccine administration in T1D patients. In the meantime, the use of vaccines remains extensively recommended in children with this disease.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Elena Mariotti Zani
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Lisa Torelli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Sara Scavone
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Viviana Patianna
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Principi
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
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Marcovecchio ML, Predieri B, De Filippo G, Delvecchio M. Editorial: Debates in Clinical Management in Pediatric Endocrinology. Front Endocrinol (Lausanne) 2021; 12:663860. [PMID: 33776945 PMCID: PMC7988199 DOI: 10.3389/fendo.2021.663860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianpaolo De Filippo
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert Debré, Paris, France
| | - Maurizio Delvecchio
- Metabolic and Genetic Disorders, “Giovanni XXIII” Children’s Hospital, Bari, Italy
- *Correspondence: Maurizio Delvecchio,
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28
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Mozzillo E, Franceschi R, Piona C, Passanisi S, Casertano A, Pjetraj D, Maltoni G, Calcaterra V, Cauvin V, Cherubini V, D’Annunzio G, Franzese A, Frongia AP, Lombardo F, Lo Presti D, Matteoli MC, Piccinno E, Predieri B, Rabbone I, Scaramuzza AE, Toni S, Zucchini S, Maffeis C, Schiaffini R. Diabetes and Prediabetes in Children With Cystic Fibrosis: A Systematic Review of the Literature and Recommendations of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED). Front Endocrinol (Lausanne) 2021; 12:673539. [PMID: 34017312 PMCID: PMC8130616 DOI: 10.3389/fendo.2021.673539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were reported in tables sorted by outcomes, including comprehensive evidence grading according to the GRADE approach. Following the grading of the quality of the evidence, the entire ISPED diabetes study group achieved consensus for the Italian recommendations based on both evidence and clinical experience. We concluded that in patients with CF, prediabetes should be carefully considered as it can evolve into CFRD. In patients with CF and prediabetic conditions, after complete evaluation of the OGTT trend, glucometrics, glycemic values measured during pulmonary exacerbations and/or steroid therapy, early initiation of insulin therapy could have beneficial effects on clinical outcomes of patients with CF and prediabetes.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Roberto Franceschi
- Pediatric Unit, S. Chiara Hospital, Trento, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Claudia Piona
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Alberto Casertano
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulio Maltoni
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Calcaterra
- University of Pavia, Pavia and Department of Pediatrics, "Vittore Buzzi" Children’s Hospital, Milano, Italy
| | | | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Donatella Lo Presti
- Centro di Riferimento Regionale di Diabetologia Pediatrica A.O.U. Policlinico G. Rodolico, Catania, Italy
| | | | - Elvira Piccinno
- D.A.I. Pediatria, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | | | - Sonia Toni
- Pediatric Diabetology Unit, Meyer Children Hospital, Florence, Italy
| | - Stefano Zucchini
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Riccardo Schiaffini
- Diabetes Unit, Bambino Gesù Children’s Hospital, Rome, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
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29
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Fornari E, Piona C, Rabbone I, Cardella F, Mozzillo E, Predieri B, Lo Presti D, Cherubini V, Patera IP, Suprani T, Bonfanti R, Cauvin V, Lombardo F, Zucchini S, Zanfardino A, Giani E, Reinstadler P, Minuto N, Buganza R, Roppolo R, Marigliano M, Maffeis C. Cardiovascular risk factors in children and adolescents with type 1 diabetes in Italy: a multicentric observational study. Pediatr Diabetes 2020; 21:1546-1555. [PMID: 32939906 DOI: 10.1111/pedi.13123] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/27/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS To assess the prevalence of cardiovascular risk factors (CVRFs) and to identify the variables associated with CVRFs in a cohort of children and adolescents with Type 1 Diabetes. METHODS 2021 subjects, 2-18 year-old, were recruited in 17 Italian Pediatric Diabetes Centers. Anthropometric, blood pressure, biochemical (HbA1c, lipid profile, ACR), insulin therapy, physical activity level, smoking and family socio-economic status data were collected. CVRFs prevalence and their distribution were analyzed according to age and binary logistic regression was performed with positivity for at least one major CVRF (BMI-SDS > +2SD, blood pressure > 90th percentile, LDL cholesterol>100 mg/dL) as dependent variable and age, duration of illness, gender, HbA1c and physical activity, as independent variables. RESULTS The prevalence of CVFRs not at the recommended target was respectively: 32.5% one CVRF, 6.7% two CVRFs and 0.6% three CVRFs, with no significant differences across the 3 age groups (2-10, 10-15, 15-18 years). In the total sample, HbA1c and inadequate physical activity were associated with a higher probability of having at least one major CVRF. This probability was associated with physical activity in the 2-10-year-old group, with physical activity and HbA1c in the 10-15-year-old group and with HbA1c only in subjects older than 15 years. CONCLUSIONS More than 30% of subjects had at least a major CVRF. Early detection of CVRFs may be useful to enforce the therapeutic intervention in this subgroup, in order to reduce the risk to develop cardiovascular complications.
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Affiliation(s)
- Elena Fornari
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Cardella
- Department of Pediatrics, Regional Center for Pediatric Diabetology, Children Hospital ARNAS Civico Di Cristina, Palermo, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Campania, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Donatella Lo Presti
- Regional Center for Pediatric Diabetology A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, "G. Salesi Hospital", Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Italy
| | | | - Tosca Suprani
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Riccardo Bonfanti
- Pediatric Diabetology Unit, Pediatric Department, Diabetes Research Institute, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, S. Chiara Hospital, Trento, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult an Developmental Age "Gaetano Barrresi", University of Messina, Italy
| | - Stefano Zucchini
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Department of Woman Child Health and Urologic Diseases, Bologna, Emilia-Romagna, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Regional Center for Pediatric Diabetology "G.Stoppoloni", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elisa Giani
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy - Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy - Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | | | - Nicola Minuto
- IRCCS Giannina Gaslini, Department of Pediatrics, Genoa, Liguria, Italy
| | - Raffaele Buganza
- Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, University of Turin, Italy
| | - Rosalia Roppolo
- Regional Center for Pediatric Diabetology, Children Hospital, Palermo, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
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Bruzzi P, Bigi E, Felici F, Lami F, Cano Garcinuno MDC, Giovanni P, Cellini M, Predieri B, Iughetti L. Markers of Inflammation and Endothelial Dysfunction in Young Survivors from Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2020; 10:599-605. [PMID: 33237835 DOI: 10.1089/jayao.2020.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To assess subclinical markers of endothelial inflammation in young survivors from acute lymphoblastic leukemia (ALL) treated with chemotherapy without cranial irradiation. Methods: Anthropometric parameters [height (H), body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/H, and WC/HC ratio], blood pressure, lipid profile, serum markers of inflammation and endothelial dysfunction [Interleukin 6 (IL-6), vascular cell adhesion molecule, intercellular adhesion molecule, tumor necrosis factor-alfa (TNF-α), Endogenous secretory Receptor for Advanced Glycation Endproducts (Es-RAGE)], and carotid intima-media thickness (c-IMT) were assessed in a group of young ALL survivors and in matched controls. Local Ethics Committee approved the study (code 56/13) on June 24, 2013. Results: 28 ALL survivors (71% male, 18% prepubertal, aged 15.98 ± 4.41 years, mean follow-up 8.57 ± 3.14 years) exhibited lower levels of Es-RAGE than controls (0.18 ± 0.07 vs. 0.27 ± 0.08 ng/mL, p < 0.001). Among survivors, Es-RAGE values significantly correlated with BMI-SD off-therapy (R2 -0.42), WC/H ratio (R2 -0.41), WC/HC ratio (R2 -0.38), and low-density-lipoprotein cholesterol (LDL-C; R2 -0.43). Most of the ALL survivors (78%) presented c-IMT above the 95th centile if compared with gender and age standard. Mean c-IMT value correlated with blood pressure (R2 0.56) and with LDL-C levels (R2 0.56). Metabolic syndrome (MetS) was fully detected only in one ALL survivor. Nevertheless, 18% ALL survivors presented more than one MetS diagnostic criteria: 14% insulin resistance, 25% dyslipidemia, and 17.8% hypertension. Conclusion: We demonstrated an initial functional vascular alteration in young ALL survivors even when treated with standard risk protocols. Our data already support the activation at endothelial level of glycosylation and oxidation processes that are persistent long after the end of the treatment.
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Affiliation(s)
- Patrizia Bruzzi
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bigi
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Felici
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Lami
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Del Carmen Cano Garcinuno
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Palazzi Giovanni
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Cellini
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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Lucaccioni L, Ficara M, Cenciarelli V, Berardi A, Predieri B, Iughetti L. Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy. Acta Biomed 2020; 92:e2021010. [PMID: 33682817 PMCID: PMC7975942 DOI: 10.23750/abm.v92i1.9696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 01/07/2023]
Abstract
According to Barker’s hypothesis, sub-optimal conditions during gestation might affect the predisposition for diseases in adulthood. Alteration in endocrine functions during pregnancy, such us thyroid function or glucose metabolism, are not exempt. It is well known that subclinical hypothyroidism and thyroperoxidase antibodies-positive euthyroidism during early pregnancy are associated with increased risk of gestational diabetes mellitus and both conditions influence pregnancy outcome and newborn development and metabolism at short and long terms. Fetal production of thyroid hormones starts from the 12th week of gestational age. The transplacental passage of maternal thyroxine (T4) is therefore essential for the fetal neurological development, especially during the first half of pregnancy. If this passage is interrupted, such as in premature birth, neonates are more susceptible to develop impaired thyroid function, because of physiological immaturity of their hypothalamic-pituitary-thyroid axis, acute illnesses and stressful events (sepsis, invasive procedures, drugs). The aim of this review is to investigate the short and long term effects of maternal dysthyroidisms on term and preterm newborns, with particular attention to the metabolic and thyroid consequences. Metabolic syndrome, higher body mass index and greater waist circumference, seem to be more prevalent in children of TPO-Ab-positive mothers. Maternal hypothyroidism may be associated with higher risk of gestational diabetes and adverse birth outcomes, such as preeclampsia, preterm delivery, fetal death and low birth weight offspring. In adulthood, preterm (< 37 weeks of gestational age) or low birth weight (<2.500 g) newborns seem to be more susceptible to develop gestational diabetes, preeclampsia, type 2 diabetes mellitus and behavioral alterations. (www.actabiomedica.it)
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Iughetti L, Trevisani V, Cattini U, Bruzzi P, Lucaccioni L, Madeo S, Predieri B. COVID-19 and Type 1 Diabetes: Concerns and Challenges. Acta Biomed 2020; 91:e2020033. [PMID: 32921727 PMCID: PMC7716973 DOI: 10.23750/abm.v91i3.10366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 02/08/2023]
Abstract
Due to the current COVID-19 pandemic, worldwide population's lifestyle has changed dramatically, causing psychosocial consequences. Patients presenting a preexisting chronic condition, as Type 1 Diabetes (T1D), are the ones suffering the most from this situation. Moreover, people affected by diabetes are the ones with the worst prognosis, if infected by SARS-CoV-2. We analyzed why patients with T1D were poorly represented between the subjects hospitalized for COVID-19 and why the cases of diabetic ketoacidosis (DKA) were fewer and more severe compared with the past years. Furthermore, literature has showed how patients of all ages with T1D did not experience a deterioration in their glucose control throughout the lockdown. Among other causes, this is also due to the surging use of telemedicine. Finally, we tried to understand how the coronavirus tropism for endocrine tissues could influence the future epidemiology of T1D, focusing on the effects they have on pancreatic β-cells.
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Affiliation(s)
- Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Modena, Italy.
| | - Viola Trevisani
- Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
| | - Umberto Cattini
- Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
| | - Simona Madeo
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia.
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Predieri B, Bruzzi P, Bigi E, Boncompagni A, Bocchi F, Cenciarelli V, Madeo SF, Poluzzi S, Pugliese M, Toffoli C, Lucaccioni L, Iughetti L. Health-related quality of life and metabolic control in immigrant and Italian children and adolescents with type 1 diabetes and in their parents. Pediatr Diabetes 2020; 21:1031-1042. [PMID: 32418308 DOI: 10.1111/pedi.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine if the diabetes-specific health-related quality of life (D-HRQOL) of young people with type 1 diabetes (T1D) and their parents is influenced by migrant status. SUBJECTS AND METHODS One hundred and twenty-five patients (12.4 ± 3.55 years, males 53.6%) with T1D and their parents (102 mothers, 37 fathers) were enrolled and categorized into: group A (both foreign parents) and group B (both native Italian parents). The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Data on diabetic ketoacidosis (DKA) at T1D onset, insulin therapy, and glycosylate hemoglobin (HbA1c) were also collected. RESULTS Group A (n = 40), compared to group B (n = 85), had higher frequency of DKA at T1D onset (P < .001) and a lower use of sensor augmented insulin pump (P = .015). HbA1c values were higher in group A than in group B (P < .001). Patients' "Diabetes symptoms" (P = .004), "Treatment barriers" (P = .001), and "Worry" (P = .009) scales scores were lower in group A than in group B. Mothers of group A had lower scores in "Diabetes symptoms" (P = .030), "Treatment barriers" (P < .001), "Treatment adherence" (P = .018), "Communication" (P = .009) scales, and total score (P = .011) compared to the group B ones. High PedsQL™ 3.0 DM was significantly associated with being Italian, being prepubertal, and having lower HbA1c mean levels. CONCLUSIONS Being a migrant confers disadvantages in terms of D-HRQOL and metabolic control in children and adolescents with T1D. Specific educational interventions should be considered in the clinical care of patients with migration background, to improve D-HRQOL and health status.
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Affiliation(s)
- Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bigi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Bocchi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Cenciarelli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona F Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Poluzzi
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marisa Pugliese
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Predieri B, Bruzzi P, Bigi E, Ciancia S, Madeo SF, Lucaccioni L, Iughetti L. Endocrine Disrupting Chemicals and Type 1 Diabetes. Int J Mol Sci 2020; 21:ijms21082937. [PMID: 32331412 PMCID: PMC7215452 DOI: 10.3390/ijms21082937] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Type 1 diabetes (T1D) is the most common chronic metabolic disease in children and adolescents. The etiology of T1D is not fully understood but it seems multifactorial. The genetic background determines the predisposition to develop T1D, while the autoimmune process against β-cells seems to be also determined by environmental triggers, such as endocrine disrupting chemicals (EDCs). Environmental EDCs may act throughout different temporal windows as single chemical agent or as chemical mixtures. They could affect the development and the function of the immune system or of the β-cells function, promoting autoimmunity and increasing the susceptibility to autoimmune attack. Human studies evaluating the potential role of exposure to EDCs on the pathogenesis of T1D are few and demonstrated contradictory results. The aim of this narrative review is to summarize experimental and epidemiological studies on the potential role of exposure to EDCs in the development of T1D. We highlight what we know by animals about EDCs’ effects on mechanisms leading to T1D development and progression. Studies evaluating the EDC levels in patients with T1D were also reported. Moreover, we discussed why further studies are needed and how they should be designed to better understand the causal mechanisms and the next prevention interventions.
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Affiliation(s)
- Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
- Correspondence: ; Tel.: +39-059-422-5217
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Pediatrics—AOU Policlinic of Modena, Largo del Pozzo, 71-41124 Modena, Italy; (P.B.); (S.F.M.)
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
| | - Silvia Ciancia
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
| | - Simona F. Madeo
- Pediatric Unit, Department of Pediatrics—AOU Policlinic of Modena, Largo del Pozzo, 71-41124 Modena, Italy; (P.B.); (S.F.M.)
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
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Gesuita R, Maffeis C, Bonfanti R, Cardella F, Citriniti F, D'Annunzio G, Franzese A, Iafusco D, Iannilli A, Lombardo F, Maltoni G, Patera IP, Piccinno E, Predieri B, Rabbone I, Ripoli C, Toni S, Schiaffini R, Bowers R, Cherubini V. Socioeconomic Inequalities Increase the Probability of Ketoacidosis at Diagnosis of Type 1 Diabetes: A 2014-2016 Nationwide Study of 2,679 Italian Children. Front Pediatr 2020; 8:575020. [PMID: 33194905 PMCID: PMC7642455 DOI: 10.3389/fped.2020.575020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/21/2020] [Indexed: 01/05/2023] Open
Abstract
This study aims to compare the frequency of Diabetic Ketoacidosis (DKA) at diagnosis in 2014-2016 with the one previously reported in 2004-2013; and to assess the association between family socioeconomic status and DKA at type 1 diabetes (T1D) diagnosis in children <15 years of age from 2014 to 2016. Methods: This nationwide, population-based, observational study included 2,679 children diagnosed with T1D from 54 Italian centers for pediatric diabetes during 2014-2016. The ISPAD criteria for DKA were used as a standard reference. The overall and by age frequency of DKA between the two time periods were compared. The association between family socioeconomic status and DKA was assessed using multiple logistic regression analysis. Results: Nine hundred and eighty nine children had DKA (36.9, 95% CI: 35.1-38.8). The frequency of DKA was significantly lower in 2014-2016 in comparison to 2004-2013 (40.3, 95% CI: 39.3-41.4, p = 0.002). The probability of having DKA at diagnosis was lower in mothers with a high level of education (OR = 0.69, 95% CI: 0.51-0.93) or a high level of occupation (OR = 0.76, 95% CI: 0.58 0.99), and in fathers with a high level of occupation (OR = 0.72, 95% CI: 0.55-0.94). Children living in Southern Italy had a higher probability of diagnosis with severe DKA than children living in Central Italy. Conclusion: There was a decrease in the frequency of DKA in children diagnosed with T1D under 15 years of age during 2014-2016. However, DKA frequency remains unacceptably high. This study demonstrated that socioeconomic inequalities, measured as low education and occupational levels, were associated with an increased probability of DKA at T1D diagnosis.
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Affiliation(s)
- Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona School of Medicine and Surgery, Verona, Italy
| | | | | | | | - Giuseppe D'Annunzio
- Pediatric Clinic and Endocrinology, Regional Reference Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II School of Medicine and Surgery, Naples, Italy
| | - Dario Iafusco
- Department of Pediatrics, Regional Center of Pediatric Diabetology "G. Stoppoloni", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Iannilli
- Department of Women's and Children's Health, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giulio Maltoni
- Department of Pediatrics, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | - Elvira Piccinno
- Unitá Operativa Complessa (UOC) Malattie Metaboliche e Diabetologia, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Vercelli, Italy
| | - Carlo Ripoli
- Department of Pediatrics, Azienda Ospedaliera G. Brotzu Cagliari, Cagliari, Italy
| | - Sonia Toni
- Meyer Children's Hospital, Pediatric Endocrinology and Diabetology Unit, Firenze, Italy
| | - Riccardo Schiaffini
- Ospedale Pediatrico Bambino Gesù, Endocrinology and Diabetes Unit, Roma, Italy
| | - Renee Bowers
- Population Health, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M, Vivaccia V, Bruzzi P, Iughetti L. Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic. Front Endocrinol (Lausanne) 2020; 11:595735. [PMID: 33424771 PMCID: PMC7793913 DOI: 10.3389/fendo.2020.595735] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVE To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to "stay at home". Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine. SUBJECTS/METHODS This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019-February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24-May 18, 2020; T1) were compared. RESULTS Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001). CONCLUSIONS Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.
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Affiliation(s)
- Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- *Correspondence: Barbara Predieri,
| | - Francesco Leo
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Candia
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Simona F. Madeo
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Marisa Pugliese
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Vivaccia
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Iughetti L, Lucaccioni L, Bruzzi P, Ciancia S, Bigi E, Madeo SF, Predieri B, Roucher-Boulez F. Isolated hypoaldosteronism as first sign of X-linked adrenal hypoplasia congenita caused by a novel mutation in NR0B1/DAX-1 gene: a case report. BMC Med Genet 2019; 20:98. [PMID: 31164167 PMCID: PMC6549270 DOI: 10.1186/s12881-019-0834-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Abstract
Background X-linked Adrenal Hypoplasia Congenita (AHC) is a rare cause of primary adrenal insufficiency due to mutations in the NR0B1 gene, causing a loss of function of the nuclear receptor protein DAX-1. Adrenal insufficiency usually appears in the first 2 months of life, but can sometimes emerge during childhood. Hypogonadotropic Hypogonadism is often associated later in life and patients may develop azoospermia. We describe an unusual onset of AHC started with isolated hypoaldosteronism as first and only sign of the disease. Case presentation A 18-days-old newborn presented with failure to thrive and feeding difficulties. Blood tests showed severe hyponatremia, hyperkalemia and hypochloremia. Renin was found over the measurable range and aldosterone was low whereas cortisol level was normal with a slightly increased ACTH. In the suspicion of Primary Hypoaldosteronism, correction of plasmatic electrolytes and replacement therapy with Fludrocortisone were promptly started. The subsequent evidence of low plasmatic and urinary cortisol and increased ACTH required the start of Hydrocortisone replacement therapy and it defined a clinical picture of adrenal insufficiency. Genetic analysis demonstrated a novel mutation in the DAX-1 gene leading to the diagnosis of AHC. Conclusions AHC onset may involve the aldosterone production itself, miming an isolated defect of aldosterone synthesis. NR0B1/DAX-1 mutations should be considered in male infants presenting with isolated hypoaldosteronism as first sign of adrenal insufficiency.
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Affiliation(s)
- Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy.
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Silvia Ciancia
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Simona Filomena Madeo
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Florence Roucher-Boulez
- Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Groupement Hospitalier Est, Hospices Civils de Lyon, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Iughetti L, Vivi G, Balsamo A, Corrias A, Crinò A, Delvecchio M, Gargantini L, Greggio NA, Grugni G, Hladnik U, Pilotta A, Ragusa L, Salvatoni A, Wasniewska M, Weber G, Predieri B. Thyroid function in patients with Prader-Willi syndrome: an Italian multicenter study of 339 patients. J Pediatr Endocrinol Metab 2019; 32:159-165. [PMID: 30703060 DOI: 10.1515/jpem-2018-0388] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 09/05/2018] [Accepted: 11/25/2018] [Indexed: 11/15/2022]
Abstract
Background Prader-Willi syndrome (PWS) is a genetic disorder due to loss of expression of paternally transcribed genes of the imprinted region of chromosome 15q11-13. PWS is characterized by peculiar signs and symptoms and many endocrine abnormalities have been described (growth hormone deficiency, hypogonadotropic hypogonadism). The abnormalities of thyroid function are discussed in literature and published data are discordant. The aim of our study was to report the thyroid function in patients with PWS to identify the prevalence of thyroid dysfunction. Methods Thyroid function tests were carried out in 339 patients with PWS, aged from 0.2 to 50 years. A database was created to collect personal data, anthropometric data, thyroid function data and possible replacement therapy with L-thyroxine. Subjects were classified according to thyroid function as: euthyroidism (EuT), congenital hypothyroidism (C-HT), hypothyroidism (HT - high thyroid-stimulating hormone [TSH] and low free thyroxine [fT4]), central hypothyroidism (CE-H - low/normal TSH and low fT4), subclinical hypothyroidism (SH - high TSH and normal fT4), and hyperthyroidism (HyperT - low TSH and high fT4). Results Two hundred and forty-three out of 339 PWS patients were younger than 18 years (71.7%). The prevalence of thyroid dysfunction was 13.6%. Specifically, C-HT was found in four children (1.18%), HT in six patients (1.77%), CE-H in 23 patients (6.78%), SH in 13 patients (3.83%), and HyperT in none. All other subjects were in EuT (86.4%). Conclusions Hypothyroidism is a frequent feature in subjects with PWS. Thyroid function should be regularly investigated in all PWS patients both at the diagnosis and annually during follow-up.
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Affiliation(s)
- Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Vivi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Balsamo
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - Andrea Corrias
- Department of Pediatrics, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Maurizio Delvecchio
- Pediatric Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - Luigi Gargantini
- Department of Pediatrics, Civic Hospital, Treviglio (Bergamo), Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano - IRCCS, Piancavallo (Verbania), Italy
| | - Uros Hladnik
- Genetics Unit, Mauro Baschirotto Institute for Rare Diseases-B.I.R.D. Foundation, Costozza di Longare (Vicenza), Italy
| | - Alba Pilotta
- Department of Pediatrics, University of Brescia, Brescia, Italy
| | - Letizia Ragusa
- Department of Pediatric Endocrinology, Oasi Maria SS, Research Institute, Troina (Enna), Italy
| | | | | | - Giovanna Weber
- Department of Pediatrics, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Mandese V, Bigi E, Bruzzi P, Palazzi G, Predieri B, Lucaccioni L, Cellini M, Iughetti L. Endocrine and metabolic complications in children and adolescents with Sickle Cell Disease: an Italian cohort study. BMC Pediatr 2019; 19:56. [PMID: 30744584 PMCID: PMC6371531 DOI: 10.1186/s12887-019-1423-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Sickle Cell Disease (SCD) show endocrine complications and metabolic alterations. The physiopathology of these conditions is not completely understood: iron overload due to chronic transfusions, ischemic damage, and inflammatory state related to vaso-occlusive crises may be involved. Aims of this study were to evaluate the growth pattern, endocrine complications, and metabolic alterations and to detect the relationship between these conditions and the SCD severity in affected children and adolescents. METHODS Fifty-two children and adolescents with SCD [38 homozygous sickle hemoglobin (HbSS) and 14 heterozygous sickle hemoglobin (HbSC); age range 3-18 years] were recruited. Anthropometric [height, body mass index (BMI), arm span, sitting height, target height (TH), and pubertal status] and laboratory [blood cell counts, hemolysis indices, metabolic and nutritional status indices and hormonal blood levels] data were evaluated. The SCD severity was defined according to hematological and clinical parameters. RESULTS Height-SDS adjusted for TH and BMI-SDS were significantly higher in HbSC children than in HbSS ones. Forty-eight out of 52 patients (92%) had at least one metabolic and/or endocrine alteration: insufficiency/deficiency of vitamin D (84.7%), insulin resistance (11.5%), growth hormone deficiency (3.8%), subclinical hypothyroidism (3.8%), and hypogonadism (1.9%). Levels of vitamin D were significantly and negatively correlated with clinical indicators of the SCD severity. Subjects with HbSS genotype show significant lower levels of both insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein 3 than children with HbSC. In the study population IGF-1 values were significantly and positively correlated with Hb and negatively with lactate dehydrogenase. CONCLUSIONS Metabolic alterations and endocrine complications are very common in children and adolescents with SCD. A regular follow-up is necessary to identify subjects at risk for complications to precociously start an appropriate treatment and to improve the quality of life of SCD patients.
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Affiliation(s)
- V Mandese
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - E Bigi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - P Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Palazzi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - B Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Lucaccioni
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - M Cellini
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Iughetti
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy. .,Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy. .,Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy.
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Child CJ, Zimmermann AG, Chrousos GP, Cummings E, Deal CL, Hasegawa T, Jia N, Lawrence S, Linglart A, Loche S, Maghnie M, Pérez Sánchez J, Polak M, Predieri B, Richter-Unruh A, Rosenfeld RG, Yeste D, Yorifuji T, Blum WF. Safety Outcomes During Pediatric GH Therapy: Final Results From the Prospective GeNeSIS Observational Program. J Clin Endocrinol Metab 2019; 104:379-389. [PMID: 30219920 PMCID: PMC6300411 DOI: 10.1210/jc.2018-01189] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/10/2018] [Indexed: 02/06/2023]
Abstract
Context Safety concerns have been raised regarding premature mortality, diabetes, neoplasia, and cerebrovascular disease in association with GH therapy. Objective To assess incidence of key safety outcomes. Design Prospective, multinational, observational study (1999 to 2015). Setting A total of 22,311 GH-treated children from 827 investigative sites in 30 countries. Patients Children with growth disorders. Interventions GH treatment. Main outcome measures Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% CIs for mortality, diabetes, and primary cancer using general population registries. Results Predominant short stature diagnoses were GH deficiency (63%), idiopathic short stature (13%), and Turner syndrome (8%), with mean ± SD follow-up of 4.2 ± 3.2 years (∼92,000 person-years [PY]). Forty-two deaths occurred in patients with follow-up, with an SMR (95% CI) of 0.61 (0.44, 0.82); the SMR was elevated for patients with cancer-related organic GH deficiency [5.87 (3.21, 9.85)]. Based on 18 cases, type 2 diabetes mellitus (T2DM) risk was elevated [SIR: 3.77 (2.24, 5.96)], but 72% had risk factors. In patients without cancer history, 14 primary cancers were observed [SIR: 0.71 (0.39, 1.20)]. Second neoplasms occurred in 31 of 622 cancer survivors [5.0%; 10.7 (7.5, 15.2) cases/1000 PY] and intracranial tumor recurrences in 67 of 823 tumor survivors [8.1%; 16.9 (13.3, 21.5) cases/1000 PY]. All three hemorrhagic stroke cases had risk factors. Conclusions GeNeSIS (Genetics and Neuroendocrinology of Short Stature International Study) data support the favorable safety profile of pediatric GH treatment. Overall risk of death or primary cancer was not elevated in GH-treated children, and no hemorrhagic strokes occurred in patients without risk factors. T2DM incidence was elevated compared with the general population, but most cases had diabetes risk factors.
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Affiliation(s)
| | | | - George P Chrousos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Cheri L Deal
- University of Montreal and CHU Ste-Justine, Montreal, Quebec, Canada
| | | | - Nan Jia
- Eli Lilly and Company, Indianapolis, Indiana
| | - Sarah Lawrence
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Sandro Loche
- Ospedale Pediatrico Microcitemico “A. Cao,” AO Brotzu, Cagliari, Italy
| | - Mohamad Maghnie
- Istituto Giannina Gaslini, University of Genova, Genoa, Italy
| | | | - Michel Polak
- Hôpital Universitaire Necker Enfants Malades and Université Paris Descartes, Centre des Maladies Endocrines Rares de la Croissance, Paris, France
| | | | | | | | - Diego Yeste
- Hospital Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Tohru Yorifuji
- Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
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Bruzzi P, Bigi E, Predieri B, Bonvicini F, Cenciarelli V, Felici F, Iughetti L. Long-term effects on growth, development, and metabolism of ALL treatment in childhood. Expert Rev Endocrinol Metab 2019; 14:49-61. [PMID: 30596296 DOI: 10.1080/17446651.2019.1561271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/30/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION One aim of the long-term care in survivors from acute lymphoblastic leukemia (ALL) during childhood is to avoid or limit complications caused by aggressive therapeutic strategies. AREAS COVERED ALL survivors are a heterogeneous group according to therapeutic protocols. In the last decades, cranial radiotherapy (cRT) has been largely replaced by intrathecal chemotherapy (CT) with a reduction of endocrine sequelae. Published studies are generally difficult to be interpreted because patients were treated according to different risk-adapted protocols and results are conflicting. We perform this review on endocrine long-term effects in childhood ALL survivors focusing on studies published in the last decades. Articles were selected using the following terms (Mesh terms): 'acute lymphoblastic leukemia' AND 'survivors' AND 'childhood' AND 'growth/puberty/fertility/obesity/metabolic syndrome/bone'. EXPERT COMMENTARY Most childhood ALL survivors treated with CT alone attain normal height and have adequate pubertal development. Despite recent protocols improvements, ALL survivors still develop long-term metabolic complications (overweight, obesity, and cardiovascular disease) especially the female gender and patients with an increased body mass index (BMI) at diagnosis. The aim of this review is to describe the state of the art on these topics. We should be able to anticipate, prevent, and treat endocrine long-term morbidities through a well-established follow-up strategy.
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Affiliation(s)
- Patrizia Bruzzi
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Elena Bigi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Barbara Predieri
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Federico Bonvicini
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Valentina Cenciarelli
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Francesca Felici
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Lorenzo Iughetti
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
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Ferrito L, Predieri B, Pjetraj D, Alessandrelli MC, Pagnini M, Iannilli A, Marino M, Tombolini S, Pintaudi B, Lucisano G, Zani F, Iughetti L, Nicolucci A, Cherubini V. Weekend-Based Parent-Group Intervention to Reduce Stress in Parents of Children and Adolescents with Type 1 Diabetes: A Pilot Study. J Diabetes Res 2019; 2019:7935945. [PMID: 31871949 PMCID: PMC6906866 DOI: 10.1155/2019/7935945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of type 1 diabetes (T1D) in a child is often associated with anger, denial, fear, and depression from the parents. The aim of the study was to improve parents' adaptation to the diagnosis of diabetes of their child. Sixty-two parents (29 mothers, 33 fathers) of 36 children with type 1 diabetes (mean age = 11.3-3.3 years; diabetes duration > 1 year; HbA1c = 57 ± 11 mmol/mol) participated in a three-day educational working group pilot intervention study. Intervention was based on the reexamination of the traumatic event of diagnosis of T1D through spatial and time-line anchorage, retracing of the future, emotional awareness, and interactive discussion. Relaxing technique, diaphragmatic breathing, and guided visualization were used by 2 psychologists and 1 pediatric endocrinologist. The study was approved by EC and participants filled a consent form. At baseline and after intervention, parents filled in a questionnaire including Diabetes-Related Distress (DRD), Parent Health Locus of Control Scale (PHLOC), Parent Stress Index Short Form (PSI-SF), Hypoglycemia Fear Survey-Parents (HFS-P) and Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC), and Health Survey Short Form-36 (SF-36). Three months after the intervention, both parents reported a reduction in the "difficult child" subscale of the PSI-SF (p < 0.05) and increased scores of social functioning of the SF-36 (p < 0.05). DRD score was significantly reduced in mothers (p = 0.03), while the "parental distress" subscale of the PSI-SF was significantly improved in fathers (p = 0.03). This weekend-based parent group intervention seems to reduce stress and improve social functioning of parents of children and adolescents with type 1 diabetes.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adolescent Behavior
- Adult
- Age Factors
- Breathing Exercises
- Child
- Child Behavior
- Child, Preschool
- Cost of Illness
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Emotions
- Feasibility Studies
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Imagery, Psychotherapy
- Male
- Middle Aged
- Parents/education
- Parents/psychology
- Pilot Projects
- Psychotherapy, Group
- Relaxation Therapy
- Social Behavior
- Stress, Psychological/diagnosis
- Stress, Psychological/prevention & control
- Stress, Psychological/psychology
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Lucia Ferrito
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Manuela Pagnini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Antonio Iannilli
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Monica Marino
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Stefano Tombolini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Giuseppe Lucisano
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Fabiana Zani
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Nicolucci
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
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Iughetti L, Lucaccioni L, Fugetto F, Predieri B, Berardi A, Ferrari F. Brain-derived neurotrophic factor and epilepsy: a systematic review. Neuropeptides 2018; 72:23-29. [PMID: 30262417 DOI: 10.1016/j.npep.2018.09.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 04/17/2018] [Revised: 08/13/2018] [Accepted: 09/19/2018] [Indexed: 12/09/2022]
Abstract
Several in vitro, ex vivo and in vivo studies imply brain-derived neurotrophic factor (BDNF) in the pathophysiology of epilepsy. Aim of our work is to report the most important findings regarding BDNF and its potential role in epilepsy. We targeted those publications addressing both in vitro and in vivo evidences of relationship between BDNF and epilepsy. Basic researches, randomized trials, cohort studies, and reviews were contemplated to give a breadth of clinical data. Medline, CENTRAL, and Science Direct were searched till August 2017 using keywords agreed by the authors. Together with a defined role in developmental and mature brain, BDNF has excitatory effects in neuronal cultures and animal brain slices. Furthermore, both BDNF and its conjugated receptor (i.e. Tropomyosin receptor kinase B or TrkB) are increased in animal models and humans with epilepsy, particularly in the temporal and hippocampal areas. Acute injection of BDNF in brain of mice induces seizures, which are almost or totally abolished blocking its transcription and pathway. Chronic infusion of BDNF is conversely associated with a decreased neuronal excitability, probably via several mechanism including an increase in central levels of neuropeptide Y (NPY), altered conductance of chloride, and downregulation of TrkB. While genetic studies are inconclusive, serum BDNF is more frequently higher in patients with epilepsy and appears to be correlated to severity of disease. Current evidences suggest that inhibiting BDNF-TrkB signaling and reinforcing the NPY system could represent a potential therapeutic strategy for epilepsy, especially for temporal lobe epilepsy.
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Affiliation(s)
- Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy.
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy
| | - Francesco Fugetto
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy
| | - Alberto Berardi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy
| | - Fabrizio Ferrari
- Department of Medical and Surgical Sciences of the Mother, Children and Adults. University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124 Modena, Italy
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Predieri B, Suprani T, Maltoni G, Graziani V, Bruzzi P, Zucchini S, Iughetti L. Switching From Glargine to Degludec: The Effect on Metabolic Control and Safety During 1-Year of Real Clinical Practice in Children and Adolescents With Type 1 Diabetes. Front Endocrinol (Lausanne) 2018; 9:462. [PMID: 30190702 PMCID: PMC6115523 DOI: 10.3389/fendo.2018.00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background/Objective: Insulin degludec (IDeg) is an ultra-long-acting analog with less daily variability compared to other basal insulins. In this retrospective study we examined 1-year efficacy and safety of IDeg in youth with type 1 diabetes (T1D). Subjects/Methods: Thirty-seven patients [11.7 ± 4.22 years; T1D duration 4.97 ± 3.63 years; once-daily glargine (IGlar) by at least 1 year] were switched to once-daily IDeg because of glycosylated hemoglobin (HbA1c) >7.5% and/or reported physical pain at IGlar injection. Changes in HbA1c, 30-day mean fasting plasma glucose (mean FPG), daily insulin dose, and severe hypoglycemia rates were collected at basal insulin switch (T0), 3-months (T1), 6-months (T2), and 12-months (T3) after IDeg was started. Results: In patients with HbA1c >7.5% at T0 we found a decrease in HbA1c values (%) from 8.46 ± 0.53 to 7.89 ± 0.72 at T1 (p = 0.008) and 7.97 ± 0.89 at T2 (p = 0.035). At T3, 38.9% of patients had HbA1c ≤ 7.5%. Mean FPG levels significantly decreased at T2 (p = 0.043). In the overall study population, we documented an increase in IDeg dose (+12.5% at T3; p < 0.001) and a decrease in mealtime insulin dose (-11.6% at T3; p = 0.001) after switch. HbA1c levels were unchanged. No episode of severe hypoglycemia was reported. Conclusions: Our data in children and adolescents with T1D suggest that IDeg dose should be increased by 12% and mealtime insulin doses should be lowered by 11% for patients who previously received IGlar. IDeg might be considered useful and well tolerated and it seems to improve the glycemic control compared to IGlar, mainly in patients with poor glycemic control.
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Affiliation(s)
- Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Tosca Suprani
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
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Street ME, Angelini S, Bernasconi S, Burgio E, Cassio A, Catellani C, Cirillo F, Deodati A, Fabbrizi E, Fanos V, Gargano G, Grossi E, Iughetti L, Lazzeroni P, Mantovani A, Migliore L, Palanza P, Panzica G, Papini AM, Parmigiani S, Predieri B, Sartori C, Tridenti G, Amarri S. Current Knowledge on Endocrine Disrupting Chemicals (EDCs) from Animal Biology to Humans, from Pregnancy to Adulthood: Highlights from a National Italian Meeting. Int J Mol Sci 2018; 19:E1647. [PMID: 29865233 PMCID: PMC6032228 DOI: 10.3390/ijms19061647] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [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: 04/16/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 02/07/2023] Open
Abstract
Wildlife has often presented and suggested the effects of endocrine disrupting chemicals (EDCs). Animal studies have given us an important opportunity to understand the mechanisms of action of many chemicals on the endocrine system and on neurodevelopment and behaviour, and to evaluate the effects of doses, time and duration of exposure. Although results are sometimes conflicting because of confounding factors, epidemiological studies in humans suggest effects of EDCs on prenatal growth, thyroid function, glucose metabolism and obesity, puberty, fertility, and on carcinogenesis mainly through epigenetic mechanisms. This manuscript reviews the reports of a multidisciplinary national meeting on this topic.
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Affiliation(s)
- Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy.
| | - Sergio Bernasconi
- Former Department of Medicine, University of Parma, Via A. Catalani 10, 43123 Parma, Italy.
| | - Ernesto Burgio
- ECERI European Cancer and Environment Research Institute, Square de Meeus, 38-40, 1000 Bruxelles, Belgium.
| | - Alessandra Cassio
- Pediatric Endocrinology Programme, Pediatrics Unit, Department of Woman, Child Health and Urologic Diseases, AOU S. Orsola-Malpighi, Via Massarenti, 11, 40138 Bologna, Italy.
| | - Cecilia Catellani
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Francesca Cirillo
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Annalisa Deodati
- Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Tor Vergata University, Piazza S. Onofrio 4, 00165 Rome, Italy.
| | - Enrica Fabbrizi
- Department of Pediatrics and Neonatology, Augusto Murri Hospital, Via Augusto Murri, 17, 63900 Fermo, Itlay.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, via Ospedale, 54, 09124 Cagliari, Italy.
| | - Giancarlo Gargano
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Enzo Grossi
- Villa Santa Maria Institute, Neuropsychiatric Rehabilitation Center, Via IV Novembre 15, 22038 Tavernerio (Como), Italy.
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatrics Unit, University of Modena and Reggio Emilia, via del Pozzo, 71, 41124 Modena, Italy.
| | - Pietro Lazzeroni
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Alberto Mantovani
- Department of Veterinary Public Health and Food Safety, Food and Veterinary Toxicology Unit ISS⁻National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Lucia Migliore
- Department of Traslational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 55, 56123 Pisa, Italy.
| | - Paola Palanza
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Giancarlo Panzica
- Laboratory of Neuroendocrinology, Department of Neuroscience Rita Levi Montalcini, University of Turin, Via Cherasco 15, 10126 Turin, Italy.
- Neuroscience Institute Cavalieri-Ottolenghi (NICO), Regione Gonzole, 10, 10043 Orbassano (Turin), Italy.
| | - Anna Maria Papini
- Department of Chemistry 'Ugo Schiff', University of Florence, Via della Lastruccia, 3-13, 50019 Sesto Fiorentino, Florence, Italy.
| | - Stefano Parmigiani
- Unit of Evolutionary and Functional Biology-Department of Chemistry, Life Sciences and Environmental Sustainability (SCVSA)-University of Parma⁻11/a, 43124 Parma, Italy.
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatrics Unit, University of Modena and Reggio Emilia, via del Pozzo, 71, 41124 Modena, Italy.
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Gabriele Tridenti
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Sergio Amarri
- Department of Obstetrics, Gynaecology and Paediatrics, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
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Salardi S, Maltoni G, Zucchini S, Iafusco D, Zanfardino A, Confetto S, Toni S, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A. Whole lipid profile and not only HDL cholesterol is impaired in children with coexisting type 1 diabetes and untreated celiac disease. Acta Diabetol 2017. [PMID: 28639064 DOI: 10.1007/s00592-017-1019-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Low HDL cholesterol (HDL-C) levels have been described in patients with coexisting type 1 diabetes mellitus (T1DM) and celiac disease (CD). Data on other possible lipid abnormalities that could further increase cardiovascular risk in these patients are scarce and incomplete. Aim of this retrospective multicenter study was to evaluate whole lipid profiles, besides HDL-C, in children with T1DM associated with biopsy-proven CD, and to investigate the influence of age and degree of adherence to gluten-free diet (GFD) on lipid changes. METHODS A total of 261 children with both T1DM and CD were enrolled. Serum lipid profiles at CD diagnosis were compared with those after 1 year of GFD and with those of 224 matched children with T1DM alone. The adherence to GFD was judged by means of CD-related antibodies. RESULTS At CD diagnosis, children with T1DM + CD showed higher LDL cholesterol (LDL-C) compared to children with T1DM alone. Gluten withdrawal failed to normalize LDL-C levels, not even in completely adherent individuals. HbA1c values were not influenced by GFD. The youngest children were characterized at diagnosis by lower levels of total cholesterol and on treatment by a greater decrease in triglycerides levels. CONCLUSIONS An unfavorable lipid profile, characterized not only by low HDL-C levels but also by high LDL-C values, may increase the risk of cardiovascular disease in children with T1DM and untreated CD. Therefore, a strict gluten-free diet is mandatory in these children, especially the youngest.
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Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Santino Confetto
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Sonia Toni
- Meyer Pediatric Institute, University of Firenze, Florence, Italy
| | - Maximiliano Zioutas
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Marco Marigliano
- Department of Life and Reproduction Sciences, Regional Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy
| | | | | | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Averna M, Cefalù AB, Casula M, Noto D, Arca M, Bertolini S, Calandra S, Catapano AL, Tarugi P, Arca M, Averna M, Bertolini S, Calandra S, Catapano AL, Tarugi P, Pellegatta F, Angelico F, Arca M, Averna M, Bartuli A, Biasucci G, Biolo G, Bonanni L, Bonomo K, Borghi C, Bossi AC, Branchi A, Carubbi F, Cipollone F, Citroni N, Federici M, Ferri C, Fiorenza AM, Giaccari A, Giorgino F, Guardamagna O, Iannuzzi A, Iughetti L, Lupattelli G, Mandraffino G, Marcucci R, Mombelli G, Muntoni S, Pecchioli V, Pederiva C, Pipolo A, Pisciotta L, Pujia A, Purrello F, Repetti E, Rubba P, Sabbà C, Sampietro T, Sarzani R, Tagliabue MP, Trenti C, Vigna GB, Werba JP, Zambon S, Zenti MG, Montali A, Noto D, Bertolini S, Calandra S, Fortunato G, Grigore L, Del Ben M, Maranghi M, Cefalù AB, Barbagallo CM, Buonuomo PS, Capra ME, Vinci P, D'Addato S, Galbiati S, Nascimbeni F, Bucci M, Spagnoli W, Cardolini I, Cervelli N, Emanuela C, Vinsin AS, Laviola L, Bello F, Chiariello G, Predieri B, Siepi D, Saitta A, Giusti B, Pavanello C, Lussu M, Prati L, Banderali G, Balleari G, Montalcini T, Scicali R, Gentile L, Gentile M, Suppressa P, Sbrana F, Cocci G, Benso A, Negri EA, Ghirardello O, Lorenzo V, Zambon A, Enzo B, Minicocci I, Spina R, Orlando C, Tarugi P, Di Taranto MD, Catapano AL, Casula M, Chiodo L, Garlaschelli K, Manzato E, Tragni E. Familial hypercholesterolemia: The Italian Atherosclerosis Society Network (LIPIGEN). ATHEROSCLEROSIS SUPP 2017; 29:11-16. [PMID: 28965615 DOI: 10.1016/j.atherosclerosissup.2017.07.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bruzzi P, Messina MF, Bartoli A, Predieri B, Lucaccioni L, Madeo SF, Verrotti A, De Luca F, Iughetti L. Central Precocious Puberty and Response to GnRHa Therapy in Children with Cerebral Palsy and Moderate to Severe Motor Impairment: Data from a Longitudinal, Case-Control, Multicentre, Italian Study. Int J Endocrinol 2017; 2017:4807163. [PMID: 28791047 PMCID: PMC5534302 DOI: 10.1155/2017/4807163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children affected by neurodevelopmental disability could experience early pubertal changes at least 20 times more than the general population. Limited data about central precocious puberty (CPP) among children affected by cerebral palsy (CP) are available. METHODS This is a longitudinal, observational, retrospective, case-control study involving 22 children affected by CPP and CP (group A), 22 paired with CP but without CPP (group B), and 22 children with CPP without CP. Auxological, biochemical, and instrumental data were collected at diagnosis of CPP and at 2 follow-up visits. RESULTS No differences were detected between groups A (at baseline) and B. At diagnosis of CPP, height SDS adjusted for target height (H-TH SDS) was significantly reduced in A than in C (-0.63 ± 1.94 versus 1.56 ± 1.38), while basal LH and oestradiol levels were significantly elevated in A than in C. During follow-up, despite an effective treatment, growth impairment deteriorated in A than in C (Δ H-SDS from diagnosis of CPP to last follow-up: -0.49 ± 0.91 versus 0.21 ± 0.33, p = 0.023). CONCLUSIONS Diagnosis of CPP could be partially mislead in CP due to growth failure that got worse during follow-up despite therapy. CPP in CP seems to progress rapidly along time supporting the hypothesis of a more intense activation of hypothalamic-pituitary-gonadal-axis in these patients.
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Affiliation(s)
- Patrizia Bruzzi
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
- *Patrizia Bruzzi:
| | - Maria Francesca Messina
- Department of Paediatrics, University of Messina, Padiglione NI Policlinico Universitario, Via Consolare Valeria, 98125 Messina, Italy
| | - Alessandra Bartoli
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
| | - Simona Filomena Madeo
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Aquila, Via Vetoio (Coppito 2), 67100 Coppito, Italy
| | - Filippo De Luca
- Department of Paediatrics, University of Messina, Padiglione NI Policlinico Universitario, Via Consolare Valeria, 98125 Messina, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Paediatric Unit, University of Modena & Reggio Emilia, Via del Pozzo, No. 71, 41124 Modena, Italy
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Aversa T, Valenzise M, Corrias A, Salerno M, Iughetti L, Tessaris D, Capalbo D, Predieri B, De Luca F, Wasniewska M. In children with autoimmune thyroid diseases the association with Down syndrome can modify the clustering of extra-thyroidal autoimmune disorders. J Pediatr Endocrinol Metab 2016; 29:1041-6. [PMID: 27442363 DOI: 10.1515/jpem-2016-0073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is known that the association with Down syndrome (DS) can affect the phenotypic expression of autoimmune thyroid diseases (AITDs), whilst is unknown whether the clustering of extra-thyroidal autoimmune diseases (ETADs) may also be atypical in DS children. METHODS The aim of this study was to investigate the clustering of ETADs in 832 children with AITDs divided in two groups with or without DS (A and B, respectively) and in four subgroups of patients aged either <6 or ≥6 years. RESULTS The rate of children with ETADs was significantly higher in Group A; in particular, alopecia areata (p=0.00001) and vitiligo (p=0.00001) were found more often in Group A irrespective of age, whilst the distribution of T1 diabetes mellitus was not different in the two groups. Celiac disease prevalence was significantly higher in DS patients only in the older subgroup. CONCLUSIONS The association with DS may be able to modify the clustering of ETADs in the children with AITDs by favoring the aggregation of some specific diseases such as alopecia areata and vitiligo.
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Salardi S, Maltoni G, Zucchini S, Iafusco D, Confetto S, Zanfardino A, Toni S, Piccini B, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A, Reinstadler P, Berioli G, Cherubini V, d'Annunzio G. Celiac Disease Negatively Influences Lipid Profiles in Young Children With Type 1 Diabetes: Effect of the Gluten-Free Diet. Diabetes Care 2016; 39:e119-20. [PMID: 27271186 DOI: 10.2337/dc16-0717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 04/01/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Santino Confetto
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Sonia Toni
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Barbara Piccini
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Maximiliano Zioutas
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Marigliano
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | | | | | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Giulia Berioli
- Department of Gynaecological, Obstetric and Paediatric Sciences, University of Perugia, Perugia, Italy
| | - Valentino Cherubini
- Division of Paediatric Diabetes in Children and Adolescents, Maternal-Infantile Department, Salesi Hospital, Ancona, Italy
| | - Giuseppe d'Annunzio
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genova, Genova, Italy
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