Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology

This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease

Cardiovascular Pressor Reactivity After Chronic Converting Enzyme Inhibition

In addition to inhibiting the formation of angiotensin II, chronic converting enzyme inhibition may affect other blood pressure modulating factors. The influence of an 8 week treatment phase with Cilazapril on the activity of the renin-angiotensin-aldosterone and sympathetic nervous systems, the pressor reactivity to infused angiotensin II or norepinephrine, the chronotropic response to isoproterenol, and body sodium and plasma atrial natriuretic peptide concentrations was assessed in 11 normal subjects and 12 patients with essential hypertension. As compared to a 4 week placebo phase, Cilazapril decreased arterial pressure in both study groups (from 124/83 ± 9/6 to 114/77 ± 9/5 mm Hg and from 143/102 ± 13/7 to 137/96 ± 10/10 mm Hg; Ρ < .025); exchangeable sodium (−158 mmol and, respectively, −104 mmol) and upright plasma aldosterone (−24% and −15%) also tended to fall. Heart rate, the chronotropic response to posture or isoproterenol, plasma norepinephrine levels, the concentration/pressor response curve to norepinephrine, plasma atrial natriuretic peptide concentration, plasma angiotensin II and the responses of blood pressure or plasma aldosterone to angiotensin II were unchanged after 8 weeks of Cilazapril. Plasma renin activity increased (+175% to + 650%) These findings indicate that the blood pressure lowering effect of Cilazapril in the stable phase of pharmacological intervention is not associated with modifications of sympathetic-dependent pressor reactivity or ^-adrenergic sensitivity. Plasma angiotensin II concentration and angiotensin II-dependent pathways including the pressor and aldosterone responsiveness to angiotensin II are also unchanged. Am J Hypertens 1991;4:348-35

Advances in paediatrics in 2016: Current practices and challenges in allergy, autoimmune diseases, cardiology, endocrinology, gastroenterology, infectious diseases, neonatology, nephrology, neurology, nutrition, pulmonology

Abstract This review reports main progresses in various pediatric issues published in Italian Journal of Pediatrics and in international journals in 2016. New insights in clinical features or complications of several disorders may be useful for our better understanding. They comprise severe asthma, changing features of lupus erythematosus from birth to adolescence, celiac disease, functional gastrointestinal disorders, Moebius syndrome, recurrent pneumonia. Risk factors for congenital heart defects, Kawasaki disease have been widely investigated. New diagnostic tools are available for ascertaining brucellosis, celiac disease and viral infections. The usefulness of aCGH as first-tier test is confirmed in patients with neurodevelopmental disorders. Novel information have been provided on the safety of milk for infants. Recent advances in the treatment of common disorders, including neonatal respiratory distress syndrome, hypo-glycemia in newborns, atopic dermatitis, constipation, cyclic vomiting syndrome, nephrotic syndrome, diabetes mellitus, regurgitation, short stature, secretions in children with cerebral palsy have been reported. Antipyretics treatment has been updated by national guidelines and studies have excluded side effects (e.g. asthma risk during acetaminophen therapy). Vaccinations are a painful event and several options are reported to prevent this pain. Adverse effects due to metabolic abnormalities are reported for second generation antipsychotic drugs

Bioranden richtig lagern und Lagerfäule vermeiden

Randen sind eine interessante Lagerkultur, etwa für die Direktvermarktung oder den Gastrobereich. Als optimale Bedingungen für die Lagerung von Randen wird zu einer Kühlung auf 4 bis 5 Grad mit einer Luftfeuchtigkeit von 95 bis 98 Prozent geraten. Je nach Infrastruktur können diese Bedingungen nicht immer gewährleistet werden, es kann zu grösseren Ausfällen durch Lagerfäule kommen

Lagerfäulen bei Bio-Randen

In den vergangenen Jahren ist es in der Schweizer Bio-Randenproduktion immer wieder zu Problemen mit Lagerfäulen gekommen. Zur Bekämpfung der Lagerfäulen dürfen bei geernteten Produkten keine Pflanzenschutzmittel eingesetzt werden. Deshalb kann auch bei Randen guter Erntequalität eine lange Haltbarkeit nicht garantiert werden. Werden sie bis zum Frühjahr gelagert, kommt es oft zu grossen Verlusten, weshalb dann auf Importware zurückgegriffen werden muss

Advances in paediatrics in 2019: current practices and challenges in allergy, endocrinology, gastroenterology, public health, neonatology, nutrition, nephrology, neurology, respiratory diseases and rheumatic diseases

We highlight the main developments that have been published during the first semester of the last year in the Italian Journal of Pediatrics. We have carefully chosen information from numerous exciting progresses issued in the Journal in the field of allergy, endocrinology, gastroenterology, neonatology, nutrition, nephrology, neurology, public health, respiratory diseases and rheumatic diseases. The impact on the care of patients has been placed in the broader context of studies that appeared in other journals. We think that many observations can be used directly to upgrade management of patients

Talking About Uncertainty

In the first article we review existing theories of uncertainty. We devote particular attention to the relation between metacognition, uncertainty and probabilistic expectations. We also analyse the role of natural language and communication for the emergence and resolution of states of uncertainty. We hypothesize that agents feel uncertainty in relation to their levels of expected surprise, which depends on probabilistic expectations-gaps elicited during communication processes. Under this framework above tolerance levels of expected surprise can be considered informative signals. These signals can be used to coordinate, at the group and social level, processes of revision of probabilistic expectations. When above tolerance levels of uncertainty are explicated by agents through natural language, in communication networks and public information arenas, uncertainty acquires a systemic role of coordinating device for the revision of probabilistic expectations. The second article of this research seeks to empirically demonstrate that we can crowd source and aggregate decentralized signals of uncertainty, i.e. expected surprise, coming from market agents and civil society by using the web and more specifically Twitter as an information source that contains the wisdom of the crowds concerning the degree of uncertainty of targeted communities/groups of agents at a given moment in time. We extract and aggregate these signals to construct a set of civil society uncertainty proxies by country. We model the dependence among our civil society uncertainty indexes and existing policy and market uncertainty proxies, highlighting contagion channels and differences in their reactiveness to real-world events that occurred in the year 2016, like the EU-referendum vote and the US presidential elections. In the third article, we propose a new instrument, called Worldwide Uncertainty Network, to analyse the uncertainty contagion dynamics across time and areas of the world. Such an instrument can be used to identify the systemic importance of countries in terms of their civil society uncertainty social percolation role. Our results show that civil society uncertainty signals coming from the web may be fruitfully used to improve our understanding of uncertainty contagion and amplification mechanisms among countries and between markets, civil society and political systems

Sensitivity and specificity of body mass index and skinfold thicknesses in detecting excess adiposity in children aged 8-12 years

Primary objective: The study aimed to evaluate the sensitivity (SN) and specificity (SP) of body mass index (BMI) and skinfold thicknesses in detecting excess adiposity in children. Research design: Cross-sectional. Materials and methods: 986 children (500 females and 486 males) aged 10 +/- 1 years (mean +/- SD; range: 8-12 years) were studied. All underwent anthropometric measurements and bioelectrical impedance analysis (BIA). Dual-energy X-ray absorptiometry (DXA) was performed in 52 children to develop a population-specific algorithm for the assessment of fat-free mass (FFM) from BIA. The algorithm was applied to the remaining 934 children to estimate their FFM. Fat mass (FM) was obtained by subtracting FFM from weight (Wt). Values of FM:Wt were transformed in Z-scores and converted into 19 percentile categories (from 5 to 95 in steps of 5). The same procedure was performed with BMI and the log-transformed sum of four skinfold thicknesses (triceps, biceps, subscapular and suprailiac; lt-4SF). Excess adiposity was defined as a level of FM:Wt greater than the internally derived 85th percentile. SN and SP of each internally derived percentile of BMI and lt-4SF in detecting excess adiposity were calculated. Results: In the pooled sample (n = 934), SN and SP were 0.39 and 0.99 for the 95th percentile of BMI, 0.65 and 0.95 for the 85th percentile of BMI, and 0.75 and 0.94 for the 85th percentile of lt-4SF. Conclusions: BMI percentiles employed in the present study have a high SP but a low SN in detecting excess adiposity in 8-12-year-old children. The use of the sum of four skinfolds has the potential to increase the SN of a screening programme for excess adiposity in children of this age