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Biomedical subjects

F Chiarelli

Publications and source records attributed to F Chiarelli.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Incidence of insulin-dependent diabetes mellitus (0-14 years) in the Abruzzo Region, Italy, 1990-1995: results from a population-based register.

OBJECTIVE: To provide incidence data of insulin dependent diabetes mellitus (IDDM) in the Abruzzo Region, Italy in 0-14 year-old children and contribute to a better understanding of IDDM geographical variability throughout Italy. SUBJECTS AND METHODS: All incident cases younger than 15 years first diagnosed with IDDM according to the WHO criteria between 1 January 1990 and 31 December 1995 and resident in the Abruzzo Region were recorded. The primary sources were divisions of pediatrics, endocrinology or medicine, diabetic centers for adult patients and the Regional Pediatric Diabetology Centre. Secondary independent sources included registered prescriptions for insulin in local district units of the National Health System and the regional IDDM association for children. RESULTS: During the six years, 117 new cases of IDDM in the age-group 0-14 were identified, with an overall standardized incidence rate of 9.34/100,000/year (95% C.I. 7.76-10.95). The crude incidence rate was highest in the 10-14 year age-group (10.64, 95% C.I. 7.66-13.62). Teramo province showed the highest standardized incidence rate, 10.30/100,000/year (95% C.I. 6.58-14.02); it is noteworthy that the IDDM rate in Teramo (15.40/100,000/year) was the highest in peninsular Italy in 1994. Abruzzo Region shows significantly higher rates than other central Italian regions. No significant difference in rates between males and females was observed. Seasonality was not observed from incidence data. CONCLUSIONS: We report the highest incidence rate for IDDM in children in the Italian mainland in the years 1990-95. Our findings confirm the need for epidemiological research to provide more information about the distribution of genetic markers and the etiologic role of environmental factors in Italian regions.

Adolescent↗
PubMedDate not supplied

Bone metabolism in children with congenital hypothyroidism--a longitudinal study.

In order to evaluate the effect of thyroid replacement therapy on bone metabolism in congenital hypothyroid children, we studied 23 (10 girls and 13 boys) consecutive patients. Their age ranged from 3 to 8 weeks. One of these patients had familiar dyshormonogenesis, 21 had ectopic glands and one hemiagenesis. As a control group, we studied 46 sex- and age-matched healthy newborns. Before the beginning of therapy, the hypothyroid patients showed higher values of calcium (2.78 +/- 0.04 vs 2.65 +/- 0.07 mmol/l; p < 0.05) and of 1,25-dihydroxy-vitamin D (159.7 +/- 31.6 vs 90.5 +/- 33.1 ng/l; p < 0.01), while they showed lower values of osteocalcin (1.9 +/- 0.8 vs 2.9 +/- 0.9 ng/ml; p < 0.01) than controls. After 3 months of therapy, we found a complete normalization of all these parameters and a progressive increase of osteocalcin. Our data show that in congenital hypothyroid children there are abnormalities in calcium metabolism which seem to be transient and reversible after L-thyroxine replacement therapy.

Bone and Bones↗
PubMedDate not supplied

Metabolic control in children and adolescents with diabetes: experience of two Italian Regional Centers.

A survey on glycemic control in 201 diabetic children and adolescents, aged 0-18 years, was performed in two Italian Centers for Childhood Diabetes (Chieti and Parma). Mean HbA1c was 7.8+/-1.4 (range 4.8-13.3%; median 7.6%). With progression of diabetes duration, deterioration of glycemic control was observed (r=0.20; p< 0.002), more evident in girls than in boys, with peaks at 14 (8.9+/-2.0 vs 6.9+/-1.7%; p<0.05) and 16 years (9.5+/-1.4% vs 8.1+/-1.1; p<0.02). No differences were found in BMI values in boys or girls, or for insulin doses which were increased significantly in both sexes according to age (r= 0.33, p<0.04). The number of insulin injections did not influence glycemic control. Only one severe hypoglycemic episode was reported during the period of observation. This study demonstrates that modern management, continuous education and patient and family empowerment are effective in attaining excellent glycemic control without increasing the risk of hypoglycemia.

Adolescent↗
PubMedDate not supplied

Maturity-onset diabetes of the young (MODY): a new challenge for pediatric diabetologists.

The differential diagnosis of hyperglycemia in childhood and adolescence has to take into consideration early-onset non-insulin-dependent diabetes, defined as maturity onset diabetes of the young (MODY). To date, mutations in genes of five proteins have been shown to cause MODY: glucokinase (MODY2), hepatic nuclear factor-1 alpha (HNF-1 alpha) (MODY3), hepatic nuclear factor-4 alpha (HNF-4 alpha) (MODY1), insulin promoter factor 1 (IPF-1) (MODY4) and hepatic nuclear factor-1 beta (HNF-1 beta) (MODY5), but other MODY genes still await elucidation. Clinical and metabolic heterogeneity of these subtypes of type 2 diabetes need to be defined, as deficiency of each factor has its own phenotype. Pediatric diabetologists should be aware of the increasing importance of MODY as a possible cause of hyperglycemia in children and adolescents. This will allow for the early diagnosis of these metabolic conditions and for the appropriate follow-up and treatment.

Adolescent↗
PubMedDate not supplied

Ketoacidosis and hyperosmolarity as first symptoms of type 1 diabetes mellitus following ingestion of high-carbohydrate-containing fluids.

The concomitant occurrence of diabetic ketoacidosis and hyperosmolarity is reported in two children, as early symptoms of misdiagnosed type 1 diabetes mellitus. The precipitating factor for both severe metabolic abnormalities was the ingestion of a large amount of high-carbohydrate-containing fluids, a few days before admission. A similar situation has never been reported before in the literature. A successful therapeutic scheme is described.

Blood Glucose↗
PubMedDate not supplied

Factors influencing remission phase in children with type 1 diabetes mellitus.

Type 1 diabetes mellitus (DM) is characterized by selective and progressive autoimmune destruction of beta-cells of the pancreas in genetically susceptible individuals. This autoimmune process takes years before the patient eventually develops clinical DM. Over the course of the disease, some patients regain their ability to secrete endogenous insulin to some extent for a period of few months to years. This partial remission phase has drawn a lot of attention since it offers a window of opportunity to intervene in an attempt to restore pancreatic beta-cell function or to prevent development of the disease in the prediabetic population at risk. Several factors, including age, sex, pubertal status, metabolic findings at the time of presentation, HLA types, presence of diabetes-associated autoantibodies, have been recognized to affect the likelihood of partial or complete remission in children with type 1 DM. Several interventions in patients with new-onset type 1 DM have been tried, including oral nicotinamide and immunomodulatory and immunosuppressive treatments, in an attempt to preserve beta-cell function and to promote or prolong the remission phase, but no conclusive data have been obtained so far. This review summarizes current knowledge on the factors that possibly influence the remission phase in children with type 1 DM.

Aging↗
PubMedDate not supplied

Lack of correlation between clinical patterns of asthma and airway obstruction.

To evaluate the relationship between the classification of asthma and obstruction of airways, we have studied 100 children suffering from allergic asthma: 65 males and 35 females, aged 4.2-16.3 years (mean, 7.6 +/- 2.8 years), who were evaluated at least 1 month after the last attack of airway obstruction. We analyzed personal history of all children with special reference to number of attacks of airway obstruction in the last year, severity, and presence of respiratory symptoms in the last month. The children studied have been classified in three groups according to the International Pediatric Respiratory Allergy Forum (IPRAF) '98 method (Third International Pediatric Consensus Statement on the management of childhood asthma). All children underwent the assessment of their respiratory function by means of analysis of the flow/volume loops with measurement of the obstruction indices (forced expiratory volume in 1 second [FEV1], peak expiratory flow [PEF], and maximal midexpiratory flow [MMEF]). The efficacy of the aforementioned method has been evaluated by analyzing the number of the subjects who showed indices of airway obstruction not in agreement with the group assigned. Eighty-five of the children studied were diagnosed with infrequent episodic asthma (IEA), 14 children were diagnosed with frequent episodic asthma (FEA), and 1 child was diagnosed with persistent asthma (PA). Thirty-six of 100 children showed obstruction indices not in agreement with the asthma group: in particular, 24 of 85 children with IEA had FEV1 < 80%, 11 children with FEA had FEV1 > 80%, and 1 child with PA had FEV1 > 80%. The high percentage of discordance between clinical classification and obstruction index in the subjects with IEA can be caused by the persistence of abnormalities of the respiratory function without clinical symptoms. The presence of a normal obstruction index in the subjects with FEA can be explained by the pharmacologic therapies. These data suggest the usefulness of a careful evaluation of the respiratory function associated with a clinical assessment to carry out a more appropriate therapy.

Adolescent↗
PubMedDate not supplied

Leukocyte adhesion deficiency disorder in an infant.

Leukocyte adhesion defect (LAD) is an inherited disorder of phagocytic function. The three different alpha-chains of the leukocyte integrin family (CD 11a, 11b, 11c) are all dependent on the common beta chain (CD18) for proper insertion into the cell membrane. Deficiency of CD 18 thus causes an inability to express any of these proteins and results in the syndrome of LAD type 1. Clinical features include delayed separation of the umbilical cord, persistent leukocytosis and recurrent infection. A case of severe LAD occurred in a 1 month-old infant. The immunological pattern of the baby showed pathological values of CD11b and CD18 (1.3&#x0025; and 0.2&#x0025; respectively) when compared with normal values (50-70&#x0025;) and lack of random (1.0 nm vs normal of 10&#x00B1;5) and casein-induced (22.0 nm vs normal of 60-120nm) chemotaxis. The baby is now waiting for bone marrow transplantation. Although LAD is a rare form of congenital immune deficiency this disease should be considered when delayed wound healing and recurrent bacterial skin infections are present in a newborn.

Journal Article↗
PubMedDate not supplied

[The families of diabetic children: a 2-year follow-up].

A great amount of clinical and experimental evidence has been accumulated on the role of immunological early events in the development of type 1 diabetes mellitus. In order to try to make a precocious diagnosis of type 1 diabetes mellitus, the Authors have studied all the components of the family in a group of diabetic children. This study is a part of a collaborative International Study called IFS (International Family Study). The Authors describe the scheme of this project in detail. During this study the Authors made a very early diagnosis of diabetes in a child, brother of another diabetic boy. The importance of this approach to the diabetic disease is discussed.

Adolescent↗
PubMedDate not supplied

Plasma renin activity (PRA) in type I diabetes mellitus: PRA and metabolic control in diabetes.

Plasma renin activity (PRA) and aldosterone were evaluated in 39 diabetic children and adolescents and in 39 healthy subjects. The mean values of PRA in the diabetics were higher than in controls not only basal (means +/- SD: 2.7 +/- 1.1 vs. 1.3 +/- 0.6 ng/ml/h) but also after physical exercise (5.2 +/- 3.84 vs. 2.8 +/- 0.7 ng/ml/h). Aldosterone was similar in diabetics and controls (basal: 18.1 +/- 6.6 vs. 16.9 +/- 5.1 pmol/l; after physical exercise: 5.3 +/- 14.1 vs. 39.9 +/- 7.1 pmol/l). There was a significant correlation between HbA1c and PRA after exercise (p less than 0.01). The diabetic children were subdivided into 3 groups according to their stable HbA1c values (group A: less than 8.5%; group B: 8.5-10.9%; group C: greater than 11.0%). A group of diabetics (group C) were re-evaluated after a long period of a good metabolic control. The values of PRA were decreased and similar to the controls (PRA basal values: 1.7 +/- 1.9 ng/ml/h; after exercise: 3.2 +/- 2.9 ng/ml/h). Our study suggests that PRA abnormalities present in diabetic patients can be reversible if a good metabolic control is achieved.

Adolescent↗
PubMedDate not supplied

[49 XXXXY syndrome. Description of 2 clinical cases].

Two children with the 49, XXXXY syndrome were described. The main symptoms were the cranio-facial abnormalities (for exp. upward slant to palpebral fissures), hypogonadism with a small penis, skeletal abnormalities (especially radioulnar synostosis) and severe mental deficiency. The diagnosis, suggested by the clinical picture, was confirmed by the karyotypic analysis.

Humans↗
PubMedDate not supplied

[Epidemiology of measles and its complications in Italy. Personal experience with a hospital case load].

The authors relate and comment on the results of admission for measles in the Hospitals of Chieti and Pescara, in the period between 1974 and 1983. The authors have studied the number of admissions and their duration; moreover, they have evaluated the relationship with the pediatric population of the considered area. They point out the importance of the complications of measles to determine the admission's length to Hospital.

Child↗
PubMedDate not supplied

[Clinical and functional sequelae of bronchiolitis].

The authors carried out a follow-up on twenty-five children, affected with bronchiolitis in the early years of life, at seven years of age, in order to evaluate their clinical status and pulmonary function. Their parents were questioned about diseases of the small airways following to acute bronchiolitis. PRIST and RAST were effected in fourteen children; an evaluation of the pulmonary function with spirometry, flow-volume curve and body-plethysmography was done in every child. Then the flow-volume curve was repeated after bronchial provocation test with exercise (free running). Abnormalities of the pulmonary function at resting significant for small airways' obstruction were observed. A great number of children with bronchial hyperreactivity (60%) was observed after bronchial provocation test with exercise, particularly in those with genetic predisposition; 6/14 (43%) showed sensitization to many inhalant allergens, without correlation with genetic predisposition, clinical sequences and bronchial hyperreactivity.

Airway Resistance↗
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[Osteoarticular tuberculosis without pulmonary involvement. Description of 2 pediatric cases].

Tuberculosis of bone and joint is becoming uncommon in childhood, overall in absence of clinical and radiologic pulmonary findings. The Authors describe two cases: the first one had typical radiologic picture of the hand localization; the second one had tibial localization. Both the children had none clinical and radiographic findings of pulmonary tuberculosis. Chemiotherapical treatment and bed rest led to complete recovery, without anatomic and functional sequelae.

Child, Preschool↗
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[Electrolytic changes in febrile convulsions].

The authors valued some metabolic parameters (sodium, potassium, calcium, blood levels of glucose, proteins, nitrogen, creatinine) in 159 children with febrile convulsions and compared the results with those of a group of children with fever (50 subjects) and of a group of health, fever free children (50 subjects). In the patients with febrile convulsions serum levels of sodium, calcium and osmolarity resulted significantly lower than those obtained in both control groups. The electrolytic modification (overall hyponatremia, probably due to a SIADH) may have a role in short-term relapses of febrile convulsions. Hyponatremia is present also in some children with high fever, without seizures; it may be that hyponatremia, in predisposed subjects, lower the threshold of neuromuscular excitability.

Calcium↗