Showing papers by "Luca Ronfani published in 2012"

Burden of disease caused by otitis media: systematic review and global estimates.

Abstract: Background Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas.

Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.

Abstract: Objective The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard. Patients and methods We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90% sensitivity or specificity were reported. Results A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was ≥90% in 7/11 studies and pooled specificity 98.2%. For IgA-anti-TG2, 11/15 studies yielded sensitivities ≥90% and 13/15 specificities ≥90%. For IgA-DGP, sensitivity ranged between 80.7% and 95.1% (specificity 86.3%-93.1%); for IgG-DGP between 80.1% and 98.6% (specificity 86.0-96.9%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4% for IgA-TG2 (specificity 97.7%). Conclusions IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

The submerged dyslexia iceberg: how many school children are not diagnosed? Results from an Italian study.

Abstract: Background Although dyslexia is one of the most common neurobehavioral disorders affecting children, prevalence is uncertain and available data are scanty and dated. The objective of this study is to evaluate the prevalence of dyslexia in an unselected school population using clearly defined and rigorous diagnostic criteria and methods. Methods Cross sectional study. We selected a random cluster sample of 94 fourth grade elementary school classes of Friuli Venezia Giulia, a Region of North Eastern Italy. We carried out three consecutive levels of screening: the first two at school and the last at the Neuropsychiatry Unit of a third level Mother and Child Hospital. The main outcome measure was the prevalence of dyslexia, defined as the number of children positive to the third level of screening divided by the total number of children enrolled. Results We recruited 1774 children aged 8–10 years, of which 1528 received parents’ consent to participate. After applying exclusion criteria, 1357 pupils constituted the final working sample. The prevalence of dyslexia in the enrolled population ranged from 3.1% (95% CI 2.2–4.1%) to 3.2% (95% CI 2.4–4.3%) depending on different criteria adopted. In two out of three children with dyslexia the disorder had not been previously diagnosed. Conclusions This study shows that dyslexia is largely underestimated in Italy and underlines the need for reliable information on prevalence, in order to better allocate resources both to Health Services and Schools.

Does the LATCH score assessed in the first 24 hours after delivery predict non-exclusive breastfeeding at hospital discharge?

Abstract: Aim: The aims of this study were to analyze the relationship between the LATCH score assessed in the first 24 hours after delivery and non-exclusive breastfeeding at discharge and to identify a cutoff for the LATCH score in order to identify women with higher risk of non-exclusive breastfeeding who may need additional breastfeeding support. Subjects and Methods: We conducted a prospective observational study in the Maternity Ward of the Institute for Maternal and Child Health “Burlo Garofolo” (Trieste, Italy) and collected data from 299 mother–infant dyads. Results: The rate of nonexclusive breastfeeding was inversely related to the LATCH score (p<0.001) with non-exclusive breastfeeding infants scoring less (6.9) than infants exclusively breastfed at discharge (7.6) (p=0.001). In multivariate analysis, non-exclusive breastfeeding was also associated with cesarean section, primiparity, and infant phototherapy. In order to support maternity staff in providing targeted interventions, we identified f...

Adverse effects during specific oral tolerance induction: in home phase

Abstract: Summary Background Specific oral tolerance induction (SOTI) is a promising approach for severe food allergies. There are little data in the literature regarding the home-phase of SOTI, not only with regard to type and frequency of adverse reactions but also regarding the most suitable treatment and protocol. Aims To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of the home-phase of an original SOTI protocol in a large group of children with severe cow's milk (CM) allergy, after the hospital “rush” phase. Methods The study was conducted by recording in-home phase adverse events, success and failure as reported by parents, and calling families. Adverse reactions were treated following the International Guidelines, arbitrarily modified by introducing nebulised epinephrine for respiratory reactions, oral beclomethasone for acute gastric pain and oral cromolyn for recurrent gastric pain. Results Out of 140 patients, 132 were contacted; eight were inaccessible (follow-up 2–84 months). The number of adverse reactions was 1 in every 100 doses. The reactions were treated with nebulised epinephrine (221 reactions), IM epinephrine (6 reactions), and other drugs. Patients with high specific IgE levels (greater than 100 kU A /L) and lower CM dose (less than 5 ml) at the end of in-hospital phase showed a higher risk both for number of reactions and use of nebulised epinephrine. Conclusions The home phase of SOTI was characterised by a significant number of adverse reactions, mostly managed with an acceptable rate of side effects. Nebulised epinephrine played a pivotal role in respiratory reactions.

Management of cryptorchidism: a survey of clinical practice in Italy

Abstract: An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately. Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive. Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy. Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

Videogame playing as distraction technique in course of venipuncture.

Abstract: Background: needle-related procedures (venipuncture, intravenous cannulation) are the most common source of pain and distress for children. reducing needle related pain and anxiety could be important in order to prevent further distress, especially for children needing multiple hospital admissions. the aim of the present open randomized controlled trial was to investigate the efficacy of adding an active distraction strategy (videogame) to eMlA premedication in needle-related pain in children. Methods: one-hundred and nine children (4 -10 years of age) were prospectively recruited to enter in the study. ninety-seven were randomized in two groups: CC group (conventional care: eMlA only) as control group and Ad group (active distraction: eMlA plus videogame) as intervention group. outcome measures were: selfreported pain by mean of FPS-r scale (main study outcome), observer-reported pain by FlACC scale, number of attempts for successful procedure. Results: in both groups FPS-r median rate was 0 (interquartile range: 0-2), with significant pain (FPS-r>4) reported by 9% of subjects. FlACC median rate was 1 in both groups (interquartile range 0-3 in CC group; 0-2 in Ad group). the percentage of children with major pain (FlACC>4) was 18% in CC group and 9% in Ad group (p=0.2). the median of necessary attempts to succeed in the procedures was 1 (interquartile range 1-2) in both groups.. Conclusion: Active distraction doesn’t improve eMlA analgesia for iv cannulation and venipuncture. even though, it resulted in an easily applicable strategy appreciated by children. this technique could be usefully investigated in other painful procedures.

Diagnosed child, treated child: Food challenge as the first step toward tolerance induction in cow's milk protein allergy

Abstract: Summary Background:food challenge is required to assess tolerance in cow milk (CM) allergy. A positive challenge contraindicates the reintroduction of CM. Specific oral tolerance induction (SOTI) is a promising treatment. Methods: all children admitted for a challenge were prospectively enrolled. To those tolerating between 2 and 150 ml a SOTI protocol was offered. Outcome, adverse reactions, parents’ satisfaction were recorded. Results: out of 245 challenged patients, 175 reacted. 122 out of 125, able to tolerate a minimum dose of 2 ml, underwent SOTI. After one year 75.4% were in an unrestricted diet, 16.1% tolerated between 5 and 150 ml, 8.5% stopped SOTI. Side effects were mild, parents’ satisfaction was very high. Conclusions: the majority of c hildren tolerating limited amounts of CM at the challenge acquires tolerance with SOTI without relevant side effects. Maintaining on an exclusion diet partially tolerant children should be considered debatable.

First Trimester Maternal Serum PlGF, Free β-hCG, PAPP-A, PP-13, Uterine Artery Doppler and Maternal History for the Prediction of Preeclampsia

Abstract: Routine screening of pregnant women for risk factors for preeclampsia (PE) is recommended. However, the detection rate using only maternal history is poor. In a study published in the mid-90’s, use of bilateral uterine artery Doppler (UtA Doppler) velocimetry for screening had high sensitivity, but poor specificity. Data from recent studies suggest that a better approach for PE screening includes integration of UtA Doppler with both maternal history and biochemical serum markers that have been associated with placental and endothelial dysfunction. However, the additive value of placental biomarkers measured during the first trimester to predict which women will subsequently develop PE has not been established. This prospective cohort study was designed to estimate the ability of a model based on integration of maternal history, serum biomarkers, and UtA Doppler in the first trimester to predict hypertensive disorders of pregnancy. Information was obtained on maternal history, UtA Doppler, and for 4 serum biomarkers, PAPP-A, placental growth factor (PlGF), PP-13 and free A human chorionic gonadotropin (A-hCG). Two PE predictive models were developed for outcomes of gestational hypertension, PE, early-onset PE, and late-onset PE. With the first model, multivariate analysis included all maternal variables and markersVthose that were statistically significant as well as those that were not. The second model was performed following a stepwise backward logistic regression and included only statistically significant factors (P G 0.05). For both models, sensitivity was calculated for fixed false-positive rates (FPRs) of 5%, 10%, 15%, and 20% from the receiver operating characteristic curves. Of the 2118 women included in the analysis, 46 (2.2%) developed gestational hypertension, and 25 (1.2%) developed PE, including 12 (0.6%) with early-onset PE and 13 (0.6%) with late-onset PE. The detection rates for early-onset PE using serum PlGF, free A-hCG, and chronic hypertension as predictors of early-onset PE for a fixed FPR of 10% and 5% were 75% and 67%, respectively. Using the same PE predictive model, the combination of UtA pulsatility index (PI) with PlGF and chronic hypertension reached a sensitivity of 60% but with a 20% FPR. These findings suggest that integration of maternal characteristics and first-trimester maternal serum biomarkers (freeA-hCG and PlGF) may provide a useful screening test for early-onset PE. Although UtA PI is statistically significant in the overall PE model, it does not improve the detection rate of early-onset PE. EDITORIAL COMMENTARY (Preeclampsia affects about 2% of pregnant women and is a leading cause of maternal and perinatal morbidity and mortality worldwide. Although the clinical features of PE typically become 623 Obstetrical Complications Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. apparent in the second half of pregnancy, underlying factors such as defective placentation may already be apparent in the first and early second trimester. At present, there is no clinically utilized screening method in the first trimester of pregnancy with sufficient accuracy to identify women at high risk to develop PE. Many firsttrimester biomarkers have been investigated; this approach makes biologic sense, as we know that these biomarkers are typically of placental origin, and therefore levels might be abnormally high or low in patients with defective placentation. Early identification of high-risk pregnancy may facilitate the development of new strategies for antenatal surveillance or prevention and thus improve maternal and perinatal outcome. There are a large number of serum biomarkers that have been used to screen for PE; many of these markers are currently used for aneuploidy screening, whereas others are measured purely on a research basis. With markers such as hCG and PAPP-A, which are used to screen for aneuploidy, the detection of abnormal levels associated with PE is an adverse effect of chromosomal screening, whether welcome or not. With the introduction of cfDNA testing, it is possible that our current serum screening approach will be either abandoned or greatly modified, so gaining a greater understanding of whether these markers are actually helpful in detection of PE is important. In this abstracted article, the authors evaluated the ability to detect PE using a model that includes maternal history, serum biomarkers, and UtA Doppler evaluation in the first trimester. Their results are generally consistent with what has been previously reportedVthe best combination provided a prediction model that was OK, although not great. They found that serum PlGF, free A-hCG, and maternal chronic hypertension could detect 67% and 75% of early-onset PE with an FPR of 5% and 10%, respectively. This compares with a detection rate for Down syndrome of 90% at a 5% FPR for integrated screeningVclearly PE screening is not nearly as good. Even if the screening performance of these serum and clinical markers were better, it was not clear what intervention would be employed. The classic teaching for the requirements of a good screening test is that the disease is important (PE meets this standard, I would say) and common (yes) and that the test is simple (not really for this combination of ultrasound Doppler assessment and multiple serum markers, some of which at present are available only on a research basis) and inexpensive (likely comparable to Down syndrome screening), and that there is an effective intervention (not really). Although there are some studies indicating that low-dose aspirin may be effective in decreasing the risk of early-onset PE in high-risk patients, the data remain inconsistent and limited. The authors of this article state that early identification will benefit by allowing enhanced surveillance (although much of prenatal care is already geared toward identification of PE, and it is not clear that substantially greater surveillance would be helpful) and early and timely prophylaxis. But again, the utility of this is not widely accepted. There have been many studies of various means to prevent or decrease the severity of PE in patients at increased risk, including treatment with low-dose aspirin and other antiplatelet agents; heparin; antioxidants such as vitamins C, E, and D; and omega-3 fatty acids, among others. Although some of these proposed measures have shown some degree of efficacy in small trials, none have been consistently effective in large prospective studies, and therefore widespread promotion of preventive measures has not been adopted. My nay-saying notwithstanding, a search for the optimal screening approach for PE does seem worthwhile, as this disease continues to carry significant maternal and perinatal morbidity and mortality. In addition, continued efforts to identify interventions likely to decrease the severity or incidence of PE and ultimately a screening and intervention trial incorporating these are needed. VMEN) 624 Obstetrical and Gynecological Survey Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Review of the scientific literature on the health of the Roma and Sinti in Italy.

Abstract: BACKGROUND: Roma and Sinti in Italy are excluded from the rest of society, often live in precarious housing conditions and have poor access to health services. In Italy, the Roma and Sinti minority (.3% of the overall population) is scarcely represented if compared with other European countries. METHODS: To establish what is known and how Roma and Sinti health is studied in Italy, we conducted a review of the scientific literature, including articles published between 2000 and 2010, found in Medline, Embase and Web of Science. RESULTS: We analyzed 15 relevant articles out of 32 references. Four papers describe rare autosomal recessive disorders. Four illustrate outbreaks of measles. The remaining papers describe health conditions suffered by this minority. All but two, however, are based on data collected at health services. CONCLUSIONS: The lack of prevalence data and analysis of determinants is a detriment to the health of the Roma and Sinti populations in Italy. Participatory research and evidence-based interventions are needed to improve health outcomes and living conditions of the Roma and Sinti people Ethn Dis. 2012;22[3]:367–371

Latent viral infections in young patients with inflammatory diseases treated with biological agents : prevalence of JC virus genotype 2

Abstract: Treatment with biological drugs is associated with increased susceptibility to viral infections. Reactivation of JC virus (JCV) and human cytomegalovirus (HCMV) in adults after therapy has been documented. The long‐term effects of biological and conventional therapy on human herpesviruses and polyomaviruses infections in young patients were assessed. One hundred eighty‐six samples [urine, serum, and blood cells (PBMCs)] from 62 patients (15.8 ± 6.2 years old) with Crohn's disease, ulcerative rectocolitis or juvenile rheumatoid arthritis treated with immunotherapy or conventional therapy for over 12 months were tested by real time PCR. One hundred twenty‐four samples (urine and blood) from 62 matched healthy volunteers (13.8 ± 8.6 years old) were included as controls. Sequencing of the JCV viral protein 1 (VP1) and transcriptional control region (TCR) was performed. Herpes simplex virus 1/2 and varicella zoster virus genomes were not detected in any patients, whereas Epstein–Barr virus, HCMV, and human herpesvirus‐6 genomes were detected in 4.8%, 3.2%, and 1.6% of the patients, respectively. JCV was detected in 22.6% (14/62) of urine samples from patients and in 8% (5/62) from controls, in 50% (7/14) of sera from patients shedding JCV, and in 71.4% (5/7) of matched PBMCs. There was a significant association between infliximab treatment and excretion of JCV genotype 2. Subclinical infection/reactivation of JCV genotype 2 in young patients during infliximab therapy was demonstrated. Conversely, increased susceptibility to herpesviruses infection was not shown. Future studies are warranted to investigate the effects of JCV reactivation on the health of young patients treated with infliximab. J. Med. Virol. 85:716–722, 2013. © 2013 Wiley Periodicals, Inc.

The negative prognostic value of TRAIL overexpression in oral squamous cell carcinomas does not preclude the potential therapeutic use of recombinant TRAIL.

Abstract: Squamous cell carcinoma (SCC) of the head and neck is a common malignancy accounting for over 300,000 cases worldwide every year [1] and occurring at all ages including in children [2]. Of all malignancies locaded in the head and neck region (i.e., oral cavity, pharynx, larynx and paranasal sinuses), the OSCC in its strictest definition (i.e. in front of the tonsils) accounts for the vast majority of cases [1–4]. Surgery remains the first line of treatment for oral cancer, in combination with radiotherapy or chemotherapy [3]. Nevertheless, the poor outcome of many patients affected by OSCC underline the urgent need for innovative therapeutic approaches. In this respect, the development of selective tumor-biology based therapies, that can improve current therapy and allow more tolerable treatment regimens, has become a main field of interest in cancer research. Previous studies have shown that the TNFfamily member TRAIL exhibits selective anti-tumor activity due to its unique ability to induce apoptosis in a variety of continuous cancer cell lines and primary tumor cells, displaying minimal or absent toxicity on most normal cells and tissues [5]. Like other members of the TNF family of proteins, TRAIL can be expressed as type II transmembrane protein or as a soluble protein [6] and, besides inducing apoptosis of cancer cells, it plays a variety of biological functions on immune cells and on other cells of hematopoietic origin [6]. There are several ongoing phase I and phase II clinical trials to evaluate the potential anti-cancer activity of soluble recombinant TRAIL in both solid tumors [7] and hematological malignancies [8]. On these bases, the aim of the present study was to investigate the expression of TRAIL in a large sample (n=134) of paraffin-embedded OSCC specimens and to assess whether this has a prognostic significance for the survival of patients suffering from OSCC. In addition, by using three continuous cell lines (PE15D, PE46 and PE49) of OSCC origin, we analyzed the potential biological significance of the high TRAIL expression in OSCC cells Electronic supplementary material The online version of this article (doi:10.1007/s10637-010-9586-0) contains supplementary material, which is available to authorized users. F. Carinci :A. Palmieri Department of D.M.C.C.C., Section of Maxillo-Facial Surgery, University of Ferrara, Ferrara, Italy