Francesca Crea

University of Rome Tor Vergata, Roma, Latium, Italy

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Publications (11)19.97 Total impact

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    ABSTRACT: A Real-time polymerase chain reaction (PCR) with melting analysis was devised to target bacterial and fungal genes together with the most prevalent antimicrobial resistance genes in 250 positive blood culture broths. This method allowed the blood culture cultivated pathogens to be classified into clinically relevant groups such as Enterobacteriaceae, oxidase-positive bacilli, oxidase-positive coccobacilli, S. aureus and yeast. Enterococci and streptococci could be distinguished from CoNS only by the Gram stain. Gram-positive bacilli were discriminated from Gram-positive cocci by Gram stain. Furthermore, the most important antimicrobial resistant genes such as mecA, vanA, bla TEM , bla SHV and bla CTX-M could be identified. All results were obtained with a turnaround time of three hours from the moment of blood culture positivity compared to 24-72 hours for phenotypic methods. In conclusion, the proposed approach can allow the clinician to implement proper early management of sepsis patients.
    The New Microbiologica: official journal of the Italian Society for Medical Virology (SIVIM) 01/2013; 36(1):65-74. · 1.67 Impact Factor
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    ABSTRACT: OBJECTIVES: To evaluate the usefulness of continuous glucose monitoring (CGM) to identify nocturnal hypoglycemia in children affected by combined ACTH and GH deficiency and to optimize the hydrocortisone replacement therapy in these patients. STUDY DESIGN: 11 patients with ACTH and GH deficiency (5 boys and 6 girls, age 1.6-16.8 years) underwent CGM for 36 hours, including 2 nights. At least 2 consecutive glucose levels <2.78 mmol/L were considered hypoglycemic episodes. The differences in age and doses of hydrocortisone and recombinant human growth hormone (rhGH) between children with and without hypoglycemia were analyzed. The percentage of the glucose values <3.33 mmol/L and the mean glucose levels were also evaluated. RESULTS: CGM demonstrated nocturnal hypoglycemia lasting from 30 to 155 minutes (1.5% of the total monitoring time) in 3 cases (27%). No statistically significant differences in age and rhGH dose were observed between children with or without hypoglycemia. Conversely, the difference in the hydrocortisone doses between the patients with and without hypoglycemia resulted statistically significant (5.9 vs 8.5 mg/m²/day; p=0.04). Eight patients presented glucose values less than 3.33 mmol/L during 5% of the total monitoring time. Hydrocortisone dose showed significant positive linear relation with mean glucose level (r=0.79, p=0.0035) and inverse relation with time lags of glucose levels under 3.33 mmol/L (r=-0.65, p=0.03). CONCLUSIONS: Our study shows that CGM may represent a valuable tool to detect nocturnal asymptomatic hypoglycemic episodes and optimize the hydrocortisone therapeutic regimen in children with ACTH and GH deficiency. © 2012 Blackwell Publishing Ltd.
    Clinical Endocrinology 12/2012; · 3.40 Impact Factor
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    ABSTRACT: Abstract Precocious pubarche (PP) is defined as the onset of pubic hair at 8 years of age in girls and at 9 years of age in boys. PP is idiopathic (IPP) in most children, but it is the earliest manifestation of non-classical congenital adrenal hyperplasia owing to steroid 21-hydroxylase deficiency (NC21OHD) in 5%-20% of cases. 17-Hydroxyprogesterone (17OHP) levels after ACTH stimulation test are used to distinguish the two forms. We studied clinical indicators of NC21OHD in 289 PP children: 14 (4.8%) showed post-ACTH 17OHP levels >30 nmol/L and NC21OHD due to CYP21A2 gene mutations was confirmed. NC21OHD children were younger (p: 0.006) and thinner (p: 0.003) than IPP children. Height standard deviation score (SDS) was not different (p: 0.97). NC21OHD girls showed more advanced bone age than IPP girls (p<0.001). Earlier PP onset and bone age advance suggest NC21OHD, which requires confirmation by an ACTH stimulation test. Later, PP appearance in overweight children suggests IPP and could merit only clinical monitoring.
    Journal of pediatric endocrinology & metabolism: JPEM 12/2012; 25(11-12):1059-1064. · 0.75 Impact Factor
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    ABSTRACT: Several studies have demonstrated that Helicobacter pylori (H. pylori) eradication does not affect metabolic control in diabetic patients. The prevalence of H. pylori infection and reinfection rate in adult diabetic patients seems to be higher than in controls. To evaluate the reinfection rate of H. pylori three years after a standard eradicating treatment and the late effect of eradication upon metabolic control in young diabetic patients. We enrolled 75 diabetic patients and 99 controls, from previous our studies in which we had evaluated H. pylori infection. In all subjects we re-evaluated the presence of H. pylori by means of 13C-Urea Breath Test, metabolic control and the prevalence of gastrointestinal symptoms. The effect of age, sex and socio-economic factors on H. pylori reinfection were also evaluated. The prevalence of H. pylori infection was higher in diabetic patients (17/69, 24%) than in dyspeptic controls of similar age, gender and socio-economical status after three years of follow-up. The reinfection rate was higher in diabetic patients than in controls. Multivariate analysis confirmed that age and socio-economical status were independently associated with H. pylori reinfection. Young patients with diabetes present a higher risk of H. pylori gastric reinfection than controls. In addition, age and mean annual income are associated with reinfection.
    European review for medical and pharmacological sciences 11/2012; 16(11):1468-72. · 1.09 Impact Factor
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    ABSTRACT: We performed a comparative evaluation of the Vitek-2 Compact and Phoenix systems for direct identification and antimicrobial susceptibility testing (AST) from positive blood culture bottles in comparison to the standard methods. Overall, 139 monomicrobial blood cultures, comprising 91 Gram-negative and 48 Gram-positive isolates, were studied. Altogether, 100% and 92.3% of the Gram-negative isolates and 75% and 43.75% of the Gram-positive isolates showed concordant identification between the direct and the standard methods with Vitek and Phoenix, respectively. AST categorical agreements of 98.7% and 99% in Gram-negative and of 96.2% and 99.5% in Gram-positive isolates with Vitek and Phoenix, respectively, were observed. In conclusion, direct inoculation procedures for Gram-negative isolates showed an excellent performance with both automated systems, while for identification of Gram-positive isolates they proved to be less reliable, although Vitek provided acceptable results. This approach contributes to reducing the turnaround time to result of blood cultures, with a positive impact on patient care.
    Diagnostic microbiology and infectious disease 01/2012; 72(1):20-31. · 2.45 Impact Factor
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    ABSTRACT: Metabolic characteristics and rate of progression to overt Type 2 diabetes (T2D) in low-risk European obese children are not well documented. Aim of the study was to investigate differences in insulin sensitivity and secretion in Italian obese children and youngsters with pre-diabetes. Ninety-six obese children and youngsters with pre-diabetes, pair-matched with individuals with normal glucose tolerance (NGT) were included in the present study. Participants were screened by oral glucose tolerance. Pre-diabetes was classified as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and combined IFG-IGT. Homeostasis model assessment of insulin resistance (HOMA-IR), 2-h insulin, insulin sensitivity index (ISI) and disposition index (DI) were calculated to estimate fasting, peripheral and whole body insulin sensitivity and capacity of pancreatic islets to compensate for lower insulin sensitivity, respectively. One-way analysis of variance was used to compare groups. Eleven subjects had IFG (11.5%), 79 IGT (82.3%), 6 combined IFG-IGT (6.3%). Individuals with IFG showed the highest HOMA-IR (p=0.0007), those with IGT the highest 2-h insulin (p<0.0001), those with IFG-IGT the lowest ISI (p<0.0001), with severely reduced DI (p=0.0003). Compared with NGT, DI was 60% lower in those with IFG-IGT. IFG is linked primarily to fasting insulin resistance, IGT to peripheral insulin resistance. IFG-IGT is hallmarked by reduced whole body insulin sensitivity and an additional severe defect in DI. Further longitudinal studies are needed to understand whether the different categories of pre-diabetes in European obese adolescents represent real pre-diabetic alterations.
    Journal of endocrinological investigation 06/2011; 34(9):e275-80. · 1.65 Impact Factor
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    ABSTRACT: This paper describes severe hyperinsulinemic hypoglycemia during bolus enteral feeding in two neurologically impaired children. Both children were affected by dysphagia with swallowing difficulties; caloric intake was inadequate. For these reasons, percutaneous endoscopic gastrostomy had been positioned during the first months of life. In one patient due to persisting vomiting, after a few months, a gastrojejunal tube (PEG-J) was inserted. Hypoglycemia was revealed by routine blood tests, without evidence of specific symptoms. Continuous subcutaneous glucose monitoring showed wide glucose excursions, ranging from hypoglycemia to hyperglycemia. Extremely high levels of insulin were detected at the time of hypoglycemia. A diagnosis of dumping syndrome (DS) was suspected in both children. In the child with PEG, the tip of the gastrostomy catheter was found to be lying in the bulbus duodeni. Once this had been pulled back, hypoglycemic episodes disappeared. The child with PEG-J needed continuous enteral feeding to reach a normal glucose balance. DS is a relatively common complication in children with gastrostomy, but extremely irregular glucose levels, ranging from hypoglycemia to hyperglycemia, and increased insulin secretion had not been previously demonstrated. The incidence of DS is probably underestimated in children receiving enteral feeding for neurological impairment. In these patients intensive monitoring of blood glucose levels should be performed to calibrate meals. Repeated underestimated hypoglycemic episodes could worsen neurological damage and cause a deterioration in clinical conditions.
    Minerva pediatrica 02/2011; 63(1):67-71. · 0.64 Impact Factor
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    Marco Cappa, Carla Bizzarri, Francesca Crea
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    ABSTRACT: The two major autoimmune thyroid diseases (ATDs) include Graves' disease (GD) and autoimmune thyroiditis (AT); both of which are characterized by infiltration of the thyroid by T and B cells reactive to thyroid antigens, by the production of thyroid autoantibodies and by abnormal thyroid function (hyperthyroidism in GD and hypothyroidism in AT). While the exact etiology of thyroid autoimmunity is not known, it is believed to develop when a combination of genetic susceptibility and environmental encounters leads to breakdown of tolerance. It is important to recognize thyroid dysfunction at an early stage by maintaining an appropriate index of suspicion.
    Journal of thyroid research. 01/2010; 2011:675703.
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    ABSTRACT: Glucocorticoid over-treatment in children with congenital adrenal hyperplasia (CAH) may suppress GH secretion and growth. Aims of our study were: 1) to evaluate post-exercise GH response in patients affected by CAH due to 21-hydroxylase deficiency, in comparison with a group of healthy subjects; 2) to investigate the relationship between the hormonal markers of adequate steroid therapy and GH secretion. We evaluated GH secretion every 6 months in 20 young CAH patients (8 girls, 12 boys). Mean follow-up was 4.6+/-0.9 yr (107 tests performed, 5.35+/-2.05 repeated tests for each patient). Forty-four healthy subjects (25 boys, 19 girls) were selected as a control group. The range of post-exercise GH peak was very wide, but medians were not statistically different in cases and controls (p=0.570). Multivariate analysis showed that post-exercise GH peak was not related to age (p=0.743), gender (p=0.296) or pubertal status (p=0.440) in both groups. GH increase from baseline showed the same behavior (p=0.265, 0.639 and 0.105, respectively). In CAH patients, GH peak and GH increase were both directly related to 17-OH-progesterone levels [GH peak: p=0.032--95% confidence interval (CI): 0.01-0.34--beta=0.18; GH increase: p=0.008--95% CI: 0.06-0.35--beta=0.20]. The negative effect of glucocorticoid therapy on GH secretion seems to be dominant in CAH. The most effective approach to adjust treatment remains monitoring growth. Relying on hormonal markers to adequate steroid therapy may result in over-treatment, GH suppression, and finally poor linear growth.
    Journal of endocrinological investigation 07/2009; 32(11):903-7. · 1.65 Impact Factor
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    ABSTRACT: Eradication of Helicobacter pylori is more difficult in adult patients with diabetes than in patients with dyspepsia. It has also been suggested that eradication of H. pylori in children with type 1 diabetes mellitus improves their metabolic control. The aim of the current study was to assess the eradication rate of a standard triple therapy and its effects on glycemic control in young patients with type 1 diabetes. The authors enrolled 29 type 1 diabetic patients with H. pylori, 29 type 1 diabetic patients without H. pylori, and 29 dyspeptic children with H. pylori. Groups were matched for gender and age and had similar geographical origin and socioeconomic status. H.pylori status was investigated before and 6 weeks after therapy by C-urea breath test. All enrolled patients with H. pylori were prescribed a standard triple therapy for eradicating H. pylori. Glycosylated hemoglobin A and daily insulin requirement were evaluated at enrollment and 6 months later in all patients with diabetes. The prevalence of the most common gastrointestinal symptoms also was investigated by means of a questionnaire in all subjects at enrollment and 6 months later. Eradication of H. pylori was similar in patients with diabetes (24/29) and those with dyspepsia (23/29) (83%v 79%; P = NS). No difference in metabolic control was observed before or after antibiotic treatment in the patients who experienced H. pylori eradication. No difference in glycemic control was observed after 6 months of follow-up. The eradication rate of H. pylori infection was similar for young patients with type 1 diabetes and those with dyspepsia and did not improve metabolic control in a short-term follow-up.
    Journal of Pediatric Gastroenterology and Nutrition 05/2004; 38(4):422-5. · 2.20 Impact Factor
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    ABSTRACT: The role of Helicobacter pylori infection in metabolic control and gastrointestinal symptoms in type 1 diabetes mellitus (DM1) patients has been debated. The aim of this study was to investigate the prevalence of H pylori, of the more cytotoxic Cag-A-positive strains, and the effects of infection on gastrointestinal symptoms and metabolic control in young DM1 patients. Research Design and Methods. H pylori infection was investigated by using the 13C-urea breath test in 121 DM1 patients (65 males, 56 females; mean age: 15 +/- 6 years) and 147 matched controls. In positive patients, an assay for specific immunoglobulin G against Cag-A was performed. Glycosylated hemoglobin A, daily insulin requirement, and duration of illness were established; a questionnaire concerning the presence of dyspeptic symptoms was administered. No difference in H pylori infection rate between patients and controls was observed. Thirty-four (28.1%) of 121 patients and 43 (29.25%) of 147 controls were infected. Twenty-one patients and 24 controls were positive for Cag-A. Glycosylated hemoglobin A, daily insulin requirement, and duration of illness were not affected by infection nor by Cag-A status. Among gastrointestinal symptoms, only halitosis was related to H pylori infection, but this association disappeared after correction for age. Positive patients with halitosis showed a worse glycemic control than uninfected patients with halitosis. H pylori infection and Cag-A-positive strains do not affect metabolic control in DM1 patients. With regard to gastrointestinal symptoms studied, H pylori infection, when present in participants with halitosis, seems to predict a worse metabolic control than in H pylori-negative patients with halitosis.
    PEDIATRICS 05/2003; 111(4 Pt 1):800-3. · 4.47 Impact Factor