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5. “Block-and-replace” treatment in Graves’ disease: experience in a cohort of pediatric patients

Author

Vigone, M. C., Peroni, E., Di Frenna, M., Mora, S., Barera, G., and Weber, G.

Abstract

Purpose: The “block-and-replace” (BR) method involves the use of a high dose of antithyroid drugs (ATD) with levothyroxine (L-T4). Its use in the management of Graves’ disease (GD) is still debated mainly because the frequency of side effects of ATD is dose dependent. We retrospectively studied the effect of medium dose of ATD with L-T4 versus monotherapy with ATD in pediatric patients with unstable GD. Methods: 28 pediatric patients with GD with unstable response to ATD were treated with L-T4 and medium dose of ATD. We compared the rate of euthyroidism, hypothyroidism and hyperthyroidism episodes observed during treatment with methimazole alone with those observed during the BR approach. We evaluated the occurrence of side effects and the rate of remission in patients treated with ATD + L-T4 therapy and the efficacy of combination therapy to postpone a definitive treatment (radioiodine and thyroidectomy). Results: Patients showed a better control of thyroid function during the BR therapy, presenting fewer episodes of hyperthyroidism and hypothyroidism. No serious side effects during the BR approach were observed. Only one patient went into remission with the ATD + L-T4 therapy. Fifteen patients required a definitive therapy (4 radioiodine, 11 thyroidectomy). The use of BR method has delayed radioiodine treatment for 4.9 years and surgery for 2.9 years. Conclusions: The BR method does not increase the remission rates. It may be useful to combine L-T4 with a medium dose of methimazole when GD is difficult to manage with methimazole alone. It may represent a therapeutic option to postpone definitive treatments to a suitable age.

Published
2024
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13. Changes in ventilator strategies and outcomes in preterm infants

Author

Vendettuoli, Valentina, Bellù, Roberto, Zanini, Rinaldo, Mosca, Fabio, Gagliardi, Luigi, Turoli, D, Weissmann, G, De Nisi, G, Barbarini, M, Villa, E, Franco, C, Fasolato, V, Contiero, MR, Cattarossi, L, Ellero, S, Tagliabue, P, Abbiati, L, Fabris, C, Prandi, G, Vielmi, F, Agosti, M, Tandoi, F, De Curtis, M, Lucchini, R, Ferrari, F, Gallo, C, Bellante, E, Boccacci, S, Latini, G, Giannuzzi, R, Martinelli, S, Brunelli, A, Di Nunzio, ML, Filippone, M, Carli, G, Ancora, G, Mammoliti, P, Gancia, GP, Dalmazzo, C, Messina, F, Magaldi, R, Rinaldi, M, Lago, P, Saia, OS, Visentin, S, Presta, G, Cella, D, Poggiani, C, Ferrari, D, Barera, G, Bove, M, Burgio, G, Sala, E, Barberi, I, Tiralongo, V, Faldella, G, Grandi, S, and Cimatti, AG

Published
2014
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14. Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study

Author

Aloi, M., Bramuzzo, M., Norsa, L., Arrigo, S., Distante, M., Miele, E., Romano, C., Giobbi, C., Panceri, R., Cucchiara, S., Alvisi, P., Lombardi, G., Salvatore, S., Gatti, S., De Giacomo, C., Knafelz, D., Barera, G., Provera, S., Pastore, M., Aloi, M, Bramuzzo, M, Norsa, L, Arrigo, S, Distante, M, Miele, E, Romano, C, Giobbi, C, Panceri, R, Cucchiara, S, and Alvisi, P

Subjects
Male, medicine.medical_specialty, Adolescent, Population, Disease, Logistic regression, Severity of Illness Index, Clusters, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, clusters, natural history, ulcerative colitis, Medicine, Humans, Registries, cluster, education, Child, Glucocorticoids, Colectomy, natural history, ulcerative colitis, education.field_of_study, business.industry, Remission Induction, Gastroenterology, Area under the curve, General Medicine, medicine.disease, Ulcerative colitis, Confidence interval, Drug Utilization, Natural history, Italy, 030220 oncology & carcinogenesis, Cohort, Disease Progression, 030211 gastroenterology & hepatology, Colitis, Ulcerative, Female, business, Follow-Up Studies
Abstract

Background The aim of this study was to define clusters of activity in a population-based cohort during the first 5 years after diagnosis in children with ulcerative colitis [UC] and to identify early prognostic risk factors. Methods All UC patients from the SIGENP IBD registry with a complete follow-up of at least 5 years were included. Active disease was defined every 6 months in the presence of at least one of the following: clinical activity [Paediatric Ulcerative Colitis Activity Index ≥ 35]; endoscopic activity [Mayo score ≥ 1]; faecal calprotectin > 250 µg/g; hospitalization; surgery; or treatment escalation. Formula-based clusters were generated based on four published questionnaire-based activity patterns in adults, plus one additional cluster. Results In total, 226 patients were identified. Forty-two [19%] had moderate–severe chronically active disease, 31 [14%] chronic–intermittent, 75 [33%] quiescent, 54 [24%] active disease in the first 2 years after the diagnosis, then sustained remission, and 24 [11%] a remission in the first 2 years then an active disease. Mild disease onset along with a lower clinical severity not requiring the use of corticosteroids at 6 months were related to a quiescent disease course at the next follow-up (logistic model area under the curve 0.86 [95% confidence interval 0.78–0.94]; positive predictive value 67%; negative predictive value 70%). Eight per cent of patients needed surgery, none in the quiescent group [p = 0.04]. Conclusions More than one-third of children with UC present with a chronically active or intermittent course during the first 5 years of follow-up. A significant group of patients has active disease in the first 2 years and then sustained remission. Interestingly, after initial treatment, one-third of patients have well-controlled disease throughout.

Published
2020

17. CO08 POTENTIAL CELIAC DISEASE IN A LARGE COHORT OF AT-RISK INFANTS: “THE ITALIAN BABY-STUDY ON WEANING AND CD RISK”

Author

Lionetti, E., primary, Francavilla, R., additional, Castellaneta, S., additional, Pulvirenti, A., additional, Drago, S., additional, Tonutti, E., additional, Castellano, E., additional, Barbato, M., additional, Barbera, C., additional, Amarri, S., additional, Barera, G., additional, Zuin, G., additional, Polloni, C., additional, Bellantoni, A., additional, Ughi, C., additional, Guariso, G., additional, Magazzù, G., additional, Iacono, G., additional, Troncone, R., additional, Corvo, M., additional, Scotta, M., additional, Lombardi, G., additional, Castellucci, G., additional, and Catassi, C., additional

Published
2011
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21. Gastrointestinal symptoms in severe COVID-19 children

Author

Vania, Giacomet, Lucia, Barcellini, Marta, Stracuzzi, Emma, Longoni, Laura, Folgori, Alessandro, Leone, and Gian Vincenzo Zuccotti, Dilillo, on behalf of COVID-19 Pediatric network § § D., Meini, A., Plebani, A., Marseglia, Gl, Giacchero, R., Rossi, P., Palma, P., Monticone, S., De Giacomo, C., Pogliani, L., Ilaria, Brambilla, Barera, G., Banderali, G., Biondi, A., Rossi, L., Traina, G., Barberi, S., Bruni, P., Bellù, R., Martelli, A., Decembrino, L., Bernardo, L., Agosti, M., Abbagnato, L., Morandi, F., Varisco, T., Nebdal, M., Mirri, G., Giaquinto, C., Da Dalt, L., Donà, D., and Costenaro, P.

Subjects
Male, Microbiology (medical), medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Gastrointestinal Diseases, Pneumonia, Viral, macromolecular substances, medicine.disease_cause, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, 030225 pediatrics, Internal medicine, medicine, Retrospective analysis, Humans, In patient, 030212 general & internal medicine, Pediatrics, Perinatology, and Child Health, Respiratory system, Pandemics, Coronavirus, Retrospective Studies, child, business.industry, child, COVID-19, SARS-CoV-2, gastrointestinal symptoms, SARS-CoV-2, Infant, COVID-19, Retrospective cohort study, medicine.disease, Pneumonia, Infectious Diseases, Italy, Cardiovascular Diseases, gastrointestinal symptoms, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, business, Coronavirus Infections
Abstract

There are growing evidence of clinical manifestations other than acute respiratory syndrome in severe acute respiratory syndrome associated with coronavirus 2-infected children. In our multicenter retrospective analysis, we observed among 127 severe acute respiratory syndrome associated with coronavirus 2 positive children that the presence of gastrointestinal symptoms was more frequently associated with severe and critical phenotype (P = 0.029). Moreover, having gastrointestinal symptoms was more frequently reported in patients who developed cardiac impairment.

Published
2020

24. Respiratory Disorders and Hospitalization Rates During the Second RSV Season in Preterm Infants Who Received Palivizumab Prophylaxis During Their First RSV Season

Author

Fanos, V., primary, Scarcella, A., additional, Puddu, M., additional, Gallini, F., additional, Tuminelli, F., additional, Bragetti, P., additional, Gallina, M.R., additional, Quartulli, L., additional, Benincori, N., additional, Citro, G., additional, Dalla Via, L., additional, Barera, G., additional, Paparatti, U. Di Luzio, additional, Merolla, R., additional, Romano, G.V., additional, Guida, G., additional, Silvestri, M., additional, and Rossi, G.A., additional

Published
2009
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27. Inflammatory bowel disease in children and adolescents in Italy: Data from the pediatric national IBD register (1996–2003)

Author

Castro, M., primary, Papadatou, B., additional, Baldassare, M., additional, Balli, F., additional, Barabino, A., additional, Barbera, C., additional, Barca, S., additional, Barera, G., additional, Bascietto, F., additional, Canani, Berni R., additional, Calacoci, M., additional, Campanozzi, A., additional, Castellucci, G., additional, Catassi, C., additional, Colombo, M., additional, Covoni, M. R., additional, Cucchiara, S., additional, DʼAltilia, M. R., additional, De Angelis, G. L., additional, De Virgilis, S., additional, Di Ciommo, V., additional, Fontana, M., additional, Guariso, G., additional, Knafelz, D., additional, Lambertini, A., additional, Licciardi, S., additional, Lionetti, P., additional, Liotta, L., additional, Lombardi, G., additional, Maestri, L., additional, Martelossi, S., additional, Mastella, G., additional, Oderda, G., additional, Perini, R., additional, Pesce, F., additional, Ravelli, A., additional, Roggero, P., additional, Romano, C., additional, Rotolo, N., additional, Rutigliano, V., additional, Scotta, S., additional, Sferlazzas, C., additional, Staiano, A., additional, Ventura, A., additional, and Zaniboni, M. G., additional

Published
2008
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35. COELIAC DISEASE IN TURNER SYNDROME

Author

Bonamico, M, primary, Pasquino, A M, additional, Bianchi, C, additional, Barera, G, additional, Barbera, C, additional, Rea, V, additional, Rotolo, M, additional, Caruso-Nicoletti, M, additional, D'Altilia, M, additional, Baldassarre, M, additional, Boscherini, B, additional, Scirè, G, additional, and Businco, M L, additional

Published
1999
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36. IBD IN PEDIATRIC PATIENTS: DATA FROM THE ITALIAN REGISTER

Author

Castro, M., primary, Baldassare, M., additional, Barabino, A., additional, Barca, S., additional, Barera, G., additional, Bascietto, F., additional, Calacoci, M., additional, Cardi, E., additional, Castellucci, G., additional, Catassi, C., additional, Colombo, M., additional, Cucchiara, S., additional, D' Altilia, M. R., additional, De Angelis, G. L., additional, Fontana, M., additional, Govoni, M. R., additional, Lazzari, R., additional, Lionetti, P., additional, Licciardi, S., additional, Liotta, L., additional, Maestri, L., additional, Mastella, G., additional, Mastrangelo, C., additional, Oderda, G., additional, Papadatou, B., additional, Perini, R., additional, Roggero, P., additional, Rotolo, M., additional, Rutigliano, V., additional, Santini, B., additional, Scotta, M. S., additional, Sferlazzas, C., additional, Ventura, A., additional, Zancan, L., additional, and Zaniboni, M. G., additional

Published
1999
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38. Targeted NGS Platforms for Genetic Screening and Gene Discovery in Primary Immunodeficiencies. Front Immunol. 2019 Apr 11;10:316. doi: 10.3389/fimmu.2019.00316. eCollection 2019. Erratum in: Front Immunol. 2019 May 31;10:1184

Author

Cifaldi, C, Brigida, I, Barzaghi, F, Zoccolillo, M, Ferradini, V, Petricone, D, Cicalese, Mp, Lazarevic, D, Cittaro, D, Omrani, M, Attardi, E, Conti, F, Scarselli, A, Chiriaco, M, Cesare, Sd, Licciardi, F, Davide, M, Ferrua, F, Canessa, C, Pignata, C, Giliani, S, Ferrari, S, Fousteri, G, Barera, G, Merli, P, Palma, P, Cesaro, S, Gattorno, M, Trizzino, A, Moschese, V, Chini, L, Villa, A, Azzari, C, Finocchi, A, Locatelli, F, Rossi, P, Sangiuolo, F, Aiuti, A, Cancrini, C, and Di Matteo, G

Subjects
Settore MED/38 - Pediatria Generale e Specialistica, gene panels, Next Generation Sequencing, Haloplex, Ion Torrent, primary immunodeficiencies
Published
2019

39. Corrigendum : Targeted NGS platforms for genetic screening and gene discovery in primary immunodeficiencies (Frontiers in Immunology (2019) 10 (316) DOI: 10.3389/fimmu.2019.00316)

Author

Cifaldi, C., Brigida, I., Barzaghi, F., Zoccolillo, M., Ferradini, V., Petricone, D., Cicalese, M. P., Lazarevic, D., Cittaro, D., Omrani, M., Attardi, E., Conti, F., Scarselli, A., Chiriaco, M., Cesare, S. D., Licciardi, F., Davide, M., Ferrua, F., Canessa, C., Pignata, C., Giliani, S., Ferrari, S., Fousteri, G., Barera, G., Merli, P., Palma, P., Cesaro, S., Gattorno, M., Trizzino, A., Moschese, V., Chini, L., Villa, A., Azzari, C., Finocchi, A., Locatelli, Franco, Rossi, P., Sangiuolo, F., Aiuti, A., Cancrini, C., and Di Matteo, G.

Subjects
Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, gene panels, Next Generation Sequencing, Haloplex, Ion Torrent, Settore MED/38, primary immunodeficiencies
Published
2019

46. Analysis of a cohort of pediatric patients treated with continuous subcutaneous insulin infusion

Author

Rubino C., Rigamonti A., Frontino G., Battaglino R., Favalli V., Bonura C., Barera G., Meschi F., Bonfanti R., Rubino, C., Rigamonti, A., Frontino, G., Battaglino, R., Favalli, V., Bonura, C., Barera, G., Meschi, F., and Bonfanti, R.

Subjects
Type 1 diabetes, Insulin pump, Children
Abstract

We analyzed a cohort of pediatric patients with type 1 diabetes mellitus treated with continuous insulin infusion (CSII), followed at the San Raffaele Hospital (Milan, Italy) in the period 2007-2014. We collected data from a questionnaire and from outpatient charts for 206 patients, whose average age was 12.93 years; 93.2% followed our protocol for starting CSII. The drop-out rate was 3.4%. Mean HbA1c was comparable to that of patients on multiple daily injections (MDI) and long-term analysis did not show any significant changes before and after CSII. The incidence of acute complications was low: 1.42 episodes/100 patients/year for severe hypoglycemia (about 50% fewer than in those using MDI), 1.11 episodes/100 patients/year for diabetic ketoacidosis. CSII patients did not gain weight and we found a significant relation between follow-up BMI and HbA1c. There was also a correlation between the use of a vertical cannula and HbA1c reduction. Most of these patients used advanced functions (bolus calculator, temporary basal rates), telemedicine and carbohydrate counting, but only carbohydrate counting was related to the improvement in HbA1c: 60.2% used continuous glucose monitoring (CGM) but here too there was no relation with reduced HbA1c; 53.4% replaced the pump at least once and 41.7% reported malfunctions (no adverse events). The distribution of insulin basal rates differed between age groups 0-6, 7-12, and 13-18 years; this confirms other reports and the advantage of CSII over MDI in children under the age of six. The average number of bolus injections was lower than expected and was not significantly related with HbA1c. CSII is safe and effective. Most studies report no significant improvement in HbA1c, but there is a lower incidence of acute complications. CSII therapy is a mandatory step towards the application of new diabetes technology (artificial pancreas) but further studies need to assess long-term cost and benefits.

Published
2015

48. Brain development in preterm and at term newborns: a TBSS DTI comparison study

Author

Scifo, P, Marchetta, E, Della Rosa, P, Pontesilli, S, Poloniato, A, Iadanza, A, Barera, G, Falini, A, Baldoli, C, Scifo, P, Marchetta, E, Della Rosa, P, Pontesilli, S, Poloniato, A, Iadanza, A, Barera, G, Falini, A, and Baldoli, C

Subjects
Pediatric, Development, White Matter Imaging - DTI, MRI
Published
2015

49. Hypoglycemia in insulin-dependent diabetic children

Author

Rigamonti A., Favalli V., Bonura C., Frontino G., Barera G., Meschi F., Bonfanti R., Rigamonti, A., Favalli, V., Bonura, C., Frontino, G., Barera, G., Meschi, F., and Bonfanti, R.

Subjects
Type 1 diabetes mellitus, Children, Hypoglycemia
Abstract

Hypoglycemia is a major obstacle to reaching optimal glucose control in type 1 diabetes patients. Diabetic children present a particular situation, with specific symptoms, consequences and treatment. Epidemiological data regarding the incidence of hypoglycemia indicate that pre-school children and adolescents are at higher-than-normal risk. To reduce the risk of hypoglycemia these patients and their caregivers must all be involved. Advances in technology (telemedicine, insulin pumps, continuous glucose monitors, artificial pancreas, etc.) offer additional tools for preventing hypoglycemia and its consequences in pediatric patients.

Published
2015

50. Work environment, volume of activity and staffing in neonatal intensive care units in Italy: results of the SONAR-nurse study

Author

Corchia, C, Fanelli, S, Gagliardi, L, Bellù, R, Zangrandi, A, Persico, A, Zanini, R, SONAR-Nurse Study Group including Bellù, R, Bertino, E, Casati, M, Cazzaniga, A, Plevani, L, Mosca, F, Baracchetti, R, Villa, E, Tandoi, F, Boccacci, S, Martinelli, S, Coscia, P, Poggiani, C, Ferrari, D, Barera, G, Poloniato, A, Ruggeri, V, Burgio, G, Carrera, G, D'Alterio, R, Merazzi, D, Lomazzi, M, Coscia, A, Borgione, S, Anselmo, C, Galletto, P, Gancia, Gp, Parola, A, Sabatini, M, Gazzolo, D, Carli, G, Filippone, M, Lago, P, Heun, N, Visentin, S, Bertolini, A, Padovani, Em, Bellettato, M, Gasparin, B, Serra, A, Santuz, P, Ellero, S, Fantini, M, Contiero, Rm, Gallo, C, Mammoliti, Pm, Ancora, G, Faldella, G, Sandri, F, Stella, M, Biasini, A, Fioravanti, L, Dessì, S, Sigali, E, Vuerich, M, Cacciavellani, R, Bragetti, P, De Curtis, M, Lucchini, R, Parente, G, Massenzi, L, Calibita, G, Haass, C, Scapillati, E, Pietro, S, Dotta, A, D'Agostino, G, Picone, S, Messina, F, Napolitano, M, Salvia, G, Moschella, S, Orfeo, L, Chello, G, Carpentieri, M, Vacchiano, T, Vetrano, G, Rabuano, R, Simonetti, Dm, Quartulli, L, Rinaldi, M, Magaldi, R, Presta, G, Greco, F, Forziati, V, Acito, A, Gatta, A, Quitadamo, P, Rotondo, S, Laforgia, N, Grassi, A, Del Cuore, F, Lucente, M, Costabile, Cd, Nicolò, A, Arco, A, Marseglia, L, Pinna, G, Rosella, V, Giuffrè, M, Marchesano, G, Inferiore, N, Corso, G, Cannuscio, A, Gargano, G, Pedoni, S, Poloni, G, Di Leo, L, Crescenzi, F, Celi, F, Betta, P, Carlo Corchia, Simone Fanelli, Luigi Gagliardi, Roberto Bellù, Antonello Zangrandi, Anna Persico, Rinaldo Zanini, SONAR-Nurse Study GroupCorchia [.., Giacomo Faldella, ], Corchia, C., Fanelli, S., Gagliardi, L., Bellù, R., Zangrandi, A., Persico, A., Zanini, R., Giuffre, M., and SONAR-Nurse Study Group

Subjects
Cross-sectional study, Staffing, Workload, Critical Care Nursing, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Settore MED/38 - Pediatria Generale E Specialistica, Nursing, 030225 pediatrics, Intensive care, Critical care nursing, Surveys and Questionnaires, Neonatal, Intensive Care Units, Neonatal, Medicine, Humans, Surveys and Questionnaire, 030212 general & internal medicine, Location, Workplace, Cross-Sectional Studie, business.industry, Research, Nurse-Patient Relation, Infant, Newborn, Patient Acuity, Infant, Perinatology and Child Health, Newborn, Nurse-Patient Relations, Cross-Sectional Studies, Italy, Pediatric Nursing, Intensive Care Units, Workforce, Intensive care units, Nurse-patient relations, Patient acuity, Pediatrics, Perinatology and Child Health, Pediatric nursing, business, Human
Abstract

Background Neonatal units’ volume of activity, and other quantitative and qualitative variables, such as staffing, workload, work environment, care organization and geographical location, may influence the outcome of high risk newborns. Data about the distribution of these variables and their relationships among Italian neonatal units are lacking. Methods Between March 2010-April 2011, 63 neonatal intensive care units adhering to the Italian Neonatal Network participated in the SONAR Nurse study. Their main features and work environment were investigated by questionnaires compiled by the chief and by physicians and nurses of each unit. Twelve cross-sectional monthly-repeated surveys on different shifts were performed, collecting data on number of nurses on duty and number and acuity of hospitalized infants. Results Six hundred forty five physicians and 1601 nurses compiled the questionnaires. In the cross-sectional surveys 702 reports were collected, with 11082 infant and 3226 nurse data points. A high variability was found for units’ size (4–50 total beds), daily number of patients (median 14.5, range 3.4-48.7), number of nurses per shift (median 4.2, range 0.7-10.8) and number of team meetings per month. Northern regions performed better than Central and Southern regions for frequency of training meetings, qualitative assessment of performance, motivation within the unit and nursing work environment; mean physicians’ and nurses’ age increased moving from North to South. After stratification by terciles of the mean daily number of patients, the median number of nurses per shift increased at increasing volume of activity, while the opposite was found for the nurse-to-patient ratio adjusted by patients’ acuity. On average, in units belonging to the lower tercile there was 1 nurse every 2.5 patients, while in those belonging to the higher tercile the ratio was 1 nurse every 5 patients. Conclusions In Italy, there is a high variability in organizational characteristics and work environment among neonatal units and an uneven distribution of human resources in relation to volume of activity, suggesting that the larger the unit the greater the workload for each nurse. Urgent modifications in planning and organization of services are needed in order to pursue more efficient, homogeneous and integrated regionalized neonatal care systems.

Published
2016

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