[Show abstract][Hide abstract] ABSTRACT: Medical nutritional therapy (MNT) is a key component of diabetes management. The carbohydrate content in a healthy diet is a major determinant of the insulin doses required at meals. In diabetic adolescents carbohydrate counting allows them the same range of food choices as non-diabetic people. To assess the benefits on glycemia of using an automatic bolus calculator in a group of adolescents with type 1 diabetes, trained for carbohydrate counting, we organized a one-week summer camp in cooperation with four diabetes centers in the Vasta Romagna area. We analyzed 52 adolescents (age 9-18 years) who had already been taught to estimate the carbohydrate content of their food. They all took part in the same activities during the week and used an automatic bolus calculator (Accu-Chek® Aviva Expert) pre-set with individual insulin sensitivity factors (ISF), insulin:carbohydrate ratio (ICR) and glycemic targets. Postprandial glycemia was significantly lowered, reaching the target range in 87% of the youngsters, with an average drop of 14.9 ± 3.75 mg/dl from preprandial levels; hyperglycemic events (> 180 mg/dl) occurred in 14% and hypoglycemia (< 60 mg/dl) in 7%. After using the bolus calculator, those with preprandial hyperglycemia (35/52; 88.6%; mean bG 160.9 ± 22.6 mg/dl) reached normal blood glucose 2 h after the meal (128.7 ± 27.5 mg/dl). Conclusion. This short educational trial suggests that an automatic bolus calculator is helpful for insulin management in adolescents who have been trained how to count their carbohydrates.
No preview · Article · Sep 2013 · Giornale Italiano di Diabetologia e Metabolismo
[Show abstract][Hide abstract] ABSTRACT: Childhood infectious mononucleosis is a benign and self-limited disease. Complications are rare but not unremarkable: 3 out of 107 patients experienced haematological complications (1 autoimmune haemolytic anaemia and 2 autoimmune thrombocytopenia), 2 of which required specific treatment (blood transfusion and IvIg respectively). Steroid treatment was reserved to patients with respiratory obstruction or prolonged fever with poor general condition and symptomatic effect was observed in all of the treated cases within 24 hours. The risk/benefit ratio of steroid treatment was justified by the brief period of therapy (4 days) and the dose (1 mg/kg of prednisone or 0.1 mg/kg of betamethasone).
No preview · Article · Oct 2012 · Medico e Bambino
[Show abstract][Hide abstract] ABSTRACT: To determine if joint hypermobility is associated with musculoskeletal pain in a population of Italian schoolchildren.
Cross-sectional, school-based study, using a pretested questionnaire administered to schoolchildren to enquire about musculoskeletal pain and Beighton criteria, with score of > or =5 as a cut-off, to test for hypermobility.
Eight primary schools in the town of Cesena, Italy.
1230 Italian schoolchildren aged 7 to 15 years representing an opportunistic sample of 10% of the schoolchildren in Cesena
(1) The strength of association between hypermobiliy and musculoskeletal pain; (2) the impact of hypermobility on daily activities, using a subjective "disability score" and a "physical activity score."
Sample size calculation for evaluating if hypermobility was associated with musculoskeletal pain was performed prior starting the study. Children experiencing pain at least once a week were used as cases, children experiencing pain seldom or never served as controls.
A total of 1046 consenting Italian schoolchildren (mean age 10.8 years) were included. The prevalence of musculoskeletal pain reported by schoolchildren was 18%. 22% of children with musculoskeletal pain versus 23% of controls had hypermobility (OR 1.057, 95% CI 0.7 to 1.4). Functional limitations measured by a "disability score" correlated in a weak negative way with Beighton score (p = 0.03). The "physical activity score" correlated in a weak positive way with Beighton score (p = 0.012).
No association was found between hypermobility and musculoskeletal pain. Hypermobile children did not experience functional limitations in daily activities, and they were slightly more active than non-hypermobile children.
No preview · Article · May 2009 · Archives of Disease in Childhood
[Show abstract][Hide abstract] ABSTRACT: We describe 54 transient focal neurologic deficits (TFND) episodes in 44 children under 18 y observed retrospectively during a 5-y period (1991–96). Mean age and duration of insulin-dependent diabetes mellitus (IDDM) were 8.4 and 3.4 y, respectively. None of the children had a history of seizure disorder and only one had a personal history of migraine. Twenty-nine episodes were characterized by right- and 25 by left-sided hemiparesis. Three of six patients who presented more than one event had alternate episodes of right- and left-sided hemiparesis. On 8 occasions the episode was preceded by a brief convulsion, in 39 it was not witnessed, and in 7 it was certainly absent. Hypoglycaemia (<2.77 mmol/l) was documented on 26 occasions. On 18 of these 26 occasions, the episodes did not resolve promptly after sugar administration. The clinical course was benign, all patients remained neurologically normal and none developed migraine at follow up. Episodes of TFND were associated with hypoglycaemia in the majority of our cases and we do not consider invasive investigations to be mandatory, since the long-term prognosis was invariably good.
No preview · Article · May 2007 · Acta Paediatrica
[Show abstract][Hide abstract] ABSTRACT: Subclinical hypothyroidism is a biochemical state characterized by an elevated serum TSH level with concomitant normal FT4 value. While in adults it frequently progresses to clinically evident hypothyroidism, in children it may be a benign and remitting process. L-thyroxine therapy should therefore be recommended only in selected conditions, considering the potential risks of treatment.
No preview · Article · Mar 2005 · Medico e Bambino
[Show abstract][Hide abstract] ABSTRACT: We report our experience in the organization of diabetic children summer-camps since 1973. Guidelines for organization have been recently reported by the SIEDP (Società Italiana di Endocrinologia e Diabetologia Pediatrica). Our attention is focused on diabetes management at camp, organization and planning, medical staff composition and staff training, treatment of diabetes-related emergencies, written camp management plan, diabetes education and psychological issues at camp, prevention of possible risks, assessment of effectiveness of education in summer camps and research at camp.
[Show abstract][Hide abstract] ABSTRACT: Acute disseminated encephalomyelitis (ADEM) is a rare acute inflammatory demyelinating disorder of central nervous system characterized by multifocal white matter involvement. Children and young adults are more commonly affected. The onset of ADEM usually follows a viral infection or immunization after a mean period of 7-14 days. The pathogenesis is not clear but several evidences support the autommune aetiology. ADEM is characterized by multifocal neurological signs and occasionally it rapidly progresses to coma. Magnetic resonance imaging (MRI) is useful to confirm the diagnosis. Treatment is based on intravenous high dose methylprednisolone, which usually leads a rapid improvement. Recently the use of i.v. immunoglobulins has also been suggested. We report a case of a 2-year-old girl with sudden onset of neurological symptoms (irritability, drowsiness, hemiparesis, ataxia, strabismus) after an upper respiratory tract infection. MRI showed the presence of multiple high signal areas in the brain and in the spinal cord. High doses of methylprednisolone (10 mg/Kg) i.v. determined a rapid and persistent improvement of neurological signs and symptoms.
No preview · Article · Jan 2005 · La Pediatria medica e chirurgica: Medical and surgical pediatrics
[Show abstract][Hide abstract] ABSTRACT: We report 5 patients (3F; 2M; age 19-60 months) affected by a syndrome characterized by recurrent episodes of abrupt onset of fever, aphtous stomatitis, pharyngitis and cervical adenopathy named by the acronym PFAPA (periodic fever, aphtous stomatitis, pharyngitis and adenopathy). The episodes had clockwork periodicity (3-4 weeks) and the fever was unaccompanied by remarkable respiratory signs or symptoms. All children were doing well between episodes. The inflammatory markers were elevated only during attacks in all children. Steroid therapy was highly effective in controlling symptoms in 5/5 patients and tonsillectomy was associated with remission in two of five patients. In one child the syndrome resolved spontaneously, in two patients resolved after tonsillectomy and in two children persisted. No long-term sequelae were observed.
No preview · Article · May 2003 · La Pediatria medica e chirurgica: Medical and surgical pediatrics
[Show abstract][Hide abstract] ABSTRACT: Herpes Simplex Encephalitis (HSE) is an uncommon but severe disease with high mortality and morbidity. The major clinical manifestations are deteriorating consciousness with confusion, drowsiness or coma, altered behaviour, convulsions and a variety of neurological signs (hemiplegia, aphasia, ataxia, etc.). An uncommon complication of HSE is Kluver Bucy syndrome (KBS), characterized by hyperorality, bulimia and changes in emotional behaviour. Neuroimaging studies frequently show an involvement of the temporal lobes and limbic areas. Another uncommon complication of HSE is central diabetes insipidus as a result of herpes simplex infection of the hypothalamus. We report two pediatric cases of HSE complicated with Kluver Bucy syndrome and central diabetes insipidus.
No preview · Article · Jan 2003 · La Pediatria medica e chirurgica: Medical and surgical pediatrics
[Show abstract][Hide abstract] ABSTRACT: To assess clinical presentation, diagnostic difficulties, natural history and prognostic indicators of renal involvement of Henoch Schönlein Purpura, a ten-years retrospective analysis of all patients case records was performed.
After a variable interval of 1 to 10 years following the vasculitic episode all the children came to the outpatient clinic for history taking, clinical examination, blood pressure measurements, urine analysis and renal function assessment.
54 children, mean age 5.9 +/- 2.5, were identified. The purpuric rash was associated with arthritis in 46 patients (85%), abdominal pain in 28 (51.8%), temperature > 38 degrees C in 11 (20%). The purpuric rash was present at on presentation in 39 subjects (72%) whereas in 15 children (28%) it followed the subsequent signs or symptoms that were arthritis in 8 (53.3%), joint pain in 2 (13.3%), abdominal pain in 5 (30.3%). Abdominal pain was the only symptom of presentation in 5 patients; two of them underwent surgical laparotomy.
No preview · Article · Jul 2002 · La Pediatria medica e chirurgica: Medical and surgical pediatrics
[Show abstract][Hide abstract] ABSTRACT: We tested the hypothesis that silent coeliac disease is more frequent than expected in both patients with Type I (insulin-dependent) diabetes mellitus and their first-degree relatives. We evaluated how the presence of other autoimmune disorders in diabetic patients and their first-degree relatives is related to silent, unrecognized coeliac disease.
Sera from 491 subjects with Type I diabetes, 824 relatives and 4,000 healthy control subjects were screened for anti-endomysial antibodies and all those subjects who tested positive for anti-endomysial antibodies underwent intestinal biopsy.
We found that the prevalence of coeliac disease was 5.7 % among the diabetic patients and 1.9 % among the relatives, values significantly higher than those found among the control subjects (p < 0.0001; p < 0.001). The prevalence of autoimmune disorders in diabetic patients with coeliac disease was significantly higher than in subjects with Type I diabetes alone (p < 0.0001). The prevalence of autoimmune disorders in the relatives with coeliac disease was significantly higher than in those who tested negative for anti-endomysial antibodies (p = 0.01).
This report provides further confirmation of the high prevalence of undiagnosed coeliac disease among diabetic patients and their relatives. This interesting new finding is the increased presence of other autoimmune diseases in these patients, as well as in their relatives with a delayed diagnosis for coeliac disease. Patients newly diagnosed with coeliac disease showed excellent compliance with the gluten-free diet. This should encourage policymakers to consider introducing an easy-to-use screening programme for diabetic patients and their relatives into everyday clinical practice, in order to prevent coeliac-associated symptoms and the onset of additional, more serious auto-immune disorders.