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Abstract Skin ulcers are a dangerous and uncommon complication of vasculitis. We describe the case of a teenager suffering from Systemic Lupus Erythematosus with digital ulcer resistant to conventional therapy, treated successfully with Hyperbaric Oxygen Therapy. The application of hyperbaric oxygen, which is used for the treatment of ischemic ulcers, is an effective and safe therapeutic option in patients with ischemic vasculitic ulcers in combination with immunosuppressive drugs. Further studies are needed to evaluate its role as primary therapy for this group of patients.

Abstract Ipercaloric diet and reduced physical activity have driven the rise in the prevalence of childhood obesity over a relatively short time interval. Family and twin studies have led to the conclusion that the strong predicitve value of parental body mass index (BMI) mainly stems from genetic rather than environmental factors. Whereas the common polygenic obesity arises when an individual genetic make-up is susceptible to an environment that promotes energy consumption over energy expenditure, monogenic obesity, on the contrary, is the obesity associated with a single gene mutation, which is sufficient by itself to cause weight gain in a food abundant context. Genes involved in the leptin-melanocortin pathway are often mutated in these cases. The cumulative prevalence of monogenic obesity among children with severe obesity is about 5%. Recently, deletions in the region p11.2 of the chromosome 16 encompassing the gene SH2B1, which is involved in the leptin and insulin signaling, have been reported in about 0.5% of children with severe early-onset obesity. These patients show extreme hyperphagia, severe insulin resistance and, in some cases, mild developmental delay.

Abstract Background In recent years, there has been an increasing attention to thyroid function in paediatric obese patients. In the present study we aimed 1) to determine the prevalence of abnormally elevated thyroid-stimulating hormone (TSH) levels in Italian obese children and adolescents 2) to investigate whether hyperthyrotropinemia in obese children cardiovascular and metabolic risk factors 3) to verify if TSH elevation is reversible after weight loss. Methods We examined 938 obese children and adolescents (450 females). Anthropometric, metabolic and hormonal variables were determined at baseline and, in a subgroup of children with hyperthyrotropinemia, after a six month weight loss program. Results Hyperthyrotropinemia (TSH ≥4.2 μUI/ml) was diagnosed in 120 patients (12,8%). Body mass index (BMI) z-score (p = 0.02) and free T3 (fT3) levels (p = 0.03) were higher in patients with elevated TSH compared to the group with normal TSH. There were not significant differences in other metabolic parameters between the two groups. A positive correlation between baseline TSH and BMI z-score (p = 0.0045) and between Ft3 and BMI z-score (p = 0.0034) was observed, while there was no correlation between TSH and lipids. Twenty-three patients among those with hyperthyrotropinemia who participated to weight reduction intervention (64 patients), presented substantial weight loss and concomitantly a significant decrease in TSH and in fT3. Conclusions These results suggest that: (1) a moderate elevation of TSH concentrations, is frequently found in obese children; (2) in obese children increase of TSH is not associated to metabolic risk factors, (3) hyperthyrotropinemia is reversible after weight loss and these data suggest that it should not be treated.

Abstract Background Melanocortin-4-receptor (MC4R) mutations represent the most frequent genetic cause of non-syndromic early onset obesity. Children carrying MC4R mutations seem to show a particular phenotype characterized by early onset, severe obesity and high stature. To verify whether MC4R mutations are associated with this particular phenotype in the Italian pediatric population, we decided to screen the MC4R gene in a group of obese children selected on the basis of their phenotype. Methods To perform this study, a multicentric approach was designed. Particularly, to be enrolled in the study subjects needed to meet the following criteria: Body mass index ≥ 3 deviation scores according to age and sex, familiar history of obesity (at least one parent obese), obesity onset before the 10 years old, height ≥ 2 deviation scores. The coding region of MC4R gene was screened in 240 obese children (mean age 8.3 ± 3.1, mean BMI 30.8 ± 5.4) and in 200 controls (mean age 8.1 ± 2.8; mean BMI 14.2 ± 2.5). Results Three mutations have been found in five obese children. The S127L (C380T), found in three unrelated children, had been described and functionally characterized previously. The Q307X (C919T) and the Y332H (T994C) mutations were found in two patients. Functional studies showed that only Q307X impaired protein function. Conclusion The low prevalence of MC4R mutations (1.6%) in this group of obese children selected according to the obesity degree, the tall stature and the family history of obesity was similar to the prevalence observed in previous screenings performed in obese adults and in not phenotypically selected obese children.

Dysregulation of diurnalcortisol rhythms is often seen among children exposed to early adversity and has been associated with a variety of negative physical and mental health outcomes. The present study examined whether two indicators of deprivation, sociodemographic burden and observed parental insensitivity, were associated with child diurnal cortisol rhythms among a diverse community sample of 250 infants ages 5 to 22 months (M = 12.68 months, 47.2% male). The sample was diverse in terms of socioeconomic status as assessed by household income (M = $59,163, SD = $57,775, range = $0-230,000) and infant race/ethnicity (41.6% African American, 19.2% White, 17.2% multiracial, 14.0% Hispanic/Latin, 2.8% Caribbean, 2.8% other, 1.2% American Indian/Alaska Native, and 1.2% Asian). Sociodemographic burden indicators were assessed through questionnaires completed by the parent. Parental sensitivity was assessed through observations of parents' interactions with their infants during a play interaction task. Cortisol was assayed from infant saliva samples collected at waking and bedtime across 3 days. Structural equation modeling revealed that higher sociodemographic burden, but not parental insensitivity, was associated with blunted diurnal cortisol slopes. Neither sociodemographic burden nor parental insensitivity were associated with the cortisol awakening response. These findings suggest that sociodemographic burden may be an important early predictor of diurnal cortisol slope dysregulation, highlighting the importance of interventions providing support to individuals who experience sociodemographic burden and promoting reduction of these early stressors.

Numerous event-related potential (ERP) studies have examined adults' neural responses to child emotional expressions to understand the neurobiological mechanisms contributing to caregiving. It is unclear, however, whether one emotion evokes an enhanced response across components, and whether this pattern differs based on parent status or other sample characteristics. This meta-analysis quantified adult responses to child emotional expressions at the N170 and the late positive potential (LPP) components. Cohen's d reflected the difference between crying and neutral (CN), crying and laughing (CL), and laughing and neutral (LN) N170 and LPP amplitudes. Crying expressions elicited slightly enhanced N170 and LPP amplitudes relative to neutral and laughing expressions (N170 CN: k = 24, d = -0.09, p < 0.001; N170 CL: k = 30, d = -0.07, p = 0.004; LPP CN: k = 20, d = 0.12, p = 0.027; LPP CL: k = 27, d = 0.10, p < 0.001), and laughing expressions elicited slightly enhanced N170 amplitudes relative to neutral expressions (N170 LN: k = 21, d = -0.05, p = 0.02). Parental status, child age, risk factors for insensitive caregiving, and measurement characteristics moderated some effect sizes, with reference electrode emerging as the most consistent moderator. Results shed light on the typical pattern of neural response to child emotions and characteristics that may moderate this response.

Attachment theory suggests that parent responsiveness to infant distress predicts secure parent–child attachment and subsequent healthy child development. While much is known about microsystem factors that interfere with responsive caregiving, there is a paucity of research investigating how exosystem factors, such as neighborhood crime, affect parenting. In a sample of 200 diverse caregivers and their 5- to 21-month-old infants (M = 11.82; 49% male), we leveraged data from a randomized clinical trial of Attachment and Biobehavioral Catch-up (ABC), an attachment-based intervention, to assess whether individual level burden (indicated by single-parent status, low income, residential instability, young parenthood, parental psychopathology, and own history of early adversity) and neighborhood crime density (geocoded within a 500 ft radius of parent's residence) were associated with their beliefs about infant crying, an indicator of responsive parenting. Consistent with Bronfenbrenner's ecological systems' theory of development, both greater exposure to individual burden indicators and greater neighborhood crime density predicted greater maladaptive beliefs about infant crying, suggesting that contextual factors outside the household are associated with parenting cognitions. Further, when accounting for the effect of crime and individual burden on parental beliefs about infant crying, participation in the ABC intervention was effective in reducing maladaptive parenting beliefs. We consider implications for multi-level intervention approaches that target family processes, neighborhood-level factors, and policy initiatives to promote community wellbeing and positive child development. [ABSTRACT FROM AUTHOR]