Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study

Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated.Background Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated. Methods We retrospectively investigated EV infections occurring at an Italian tertiary care center during 2006-2017. Cases were confirmed with a positive polymerase chain reaction on blood or cerebrospinal fluid. Clinical and laboratory findings according to age at presentation were analyzed. Results Among 61 cases of EV infection, 56 had meningitis, 4 had encephalitis, and 1 had unspecific febrile illness. Forty-seven cases (77.0%) presented at less than 1 year of age, and most were less than 90 days of age (n = 44). Presentation with fever (p < 0.01), higher median temperature (p < 0.01), and irritability (p < 0.01) were significantly more common among infants aged less than 90 days, who also had significantly higher peak temperatures during the course of the disease (p < 0.01). In contrast, gastrointestinal symptoms were more common in infants and children aged over 90 days (p = 0.02). Only 4 of 61 infections (6.5%) were severe and all affected younger infants (p < 0.01). Conclusions We detail epidemiological, clinical, and laboratory findings in a cohort of 61 children. Infants aged less than 90 days have more severe disease; they are more likely to present with fever, higher median temperature, and irritability and less likely to develop gastrointestinal symptoms

THE IMPACT OF SENSOR-AUGMENTED INSULIN PUMP (SAP) THERAPY ON QUALITY OF LIFE (QOL) IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES (T1D) AND THEIR PARENTS

Background and Aims: Ensuring QoL while maintaining a good glycemic control is an important challenge in T1D treatment. Aim of this study was to evaluate the impact of SAP therapy on QoL in children and adolescents with T1D and their parents. Method: 125 patients (T1D duration \u20211 year;) were recruited in the study. Twenty-one out of 125 (16.8%) were on SAP by at least 1 year (11.7 \u2013 3.5 yrs old; T1D duration = 6.6 \u2013 3.5 yrs) while others were on MDI by T1D onset (12.5 \u2013 3.5 yrs old; T1D duration = 5.4 \u2013 3.5 yrs). Patients and parents filled in the PedsQLTM 3.0 Diabetes Module including diabetes symptoms, treatment barriers, treatment adherence, worry, and communication scales. Results: Patients in the SAP group reported a higher score in the \u2018\u2018hypoglycemic\u2019\u2019 item of worry scale (p = 0.035) than the MDI group. Mothers in the SAP group, respect to MDI group ones, reported a lower score in both the \u2018\u2018injection pain\u2019\u2019 item of treatment barriers scale (p = 0.023) and the \u2018\u2018difficulty to control glycemia\u2019\u2019 item in treatment adherence scale (p = 0.009). HbA1c (p = 0.001) and fasting plasma glucose (p = 0.044) values were significantly lower in SAP group than in MDI. Conclusion: SAP seems to reduce the fear of hypoglycemia in children and adolescents with T1D and this could be important to improve glycemic control. In mothers SAP seems to increase both barriers and adherence to treatment. The impact of new technologies on QoL should be regularly evaluated because it is critical to better understand both the medical and psychological care of T1D

L’infiltrato speciale

In letteratura, esistono pochi casi di mastocitosi cutanea a esordio neonatale, da considerare nella diagnosi differenziale delle lesioni bollose congenite. Descriviamo un caso di mastocitosi cutanea a esordio neonatale, diagnosticato clinicamente

Identification and characterization of a new reversible MAGL inhibitor

Monoacylglycerol lipase is a serine hydrolase that play a major role in the degradation of 2-arachidonoylglycerol, an endocannabinoid neurotransmitter implicated in several physiological processes. Recent studies have shown the possible role of MAGL inhibitors as antiinflammatory, anti-nociceptive and anti-cancer agents. The use of irreversible MAGL inhibitors determined an unwanted chronic MAGL inactivation, which acquires a functional antagonism function of the endocannabinoid system. However, the application of reversible MAGL inhibitors has not yet been explored, mainly due to the scarcity of known compounds possessing efficient reversible inhibitory activities. In this study we reported the first virtual screening analysis for the identification of reversible MAGL inhibitors. Among the screened compounds, the (4-(4-chlorobenzoyl)piperidin-1-yl)(4-methoxyphenyl)methanone (CL6a) is a promising reversible MAGL inhibitor lead (Ki = 8.6 μM), which may be used for the future development of a new class of MAGL inhibitors. Furthermore, the results demonstrate the validity of the methodologies that we followed, encouraging additional screenings of other commercial databases

Identification and characterization of a new reversible MAGL inhibitor

Monoacylglycerol lipase is a serine hydrolase that play a major role in the degradation of 2-arachidonoylglycerol, an endocannabinoid neurotransmitter implicated in several physiological processes. Recent studies have shown the possible role of MAGL inhibitors as anti-inflammatory, anti-nociceptive and anti-cancer agents. The use of irreversible MAGL inhibitors determined an unwanted chronic MAGL inactivation, which acquires a functional antagonism function of the endocannabinoid system. However, the application of reversible MAGL inhibitors has not yet been explored, mainly due to the scarcity of known compounds possessing efficient reversible inhibitory activities. In this study we reported the first virtual screening analysis for the identification of reversible MAGL inhibitors. Among the screened compounds, the (4-(4-chlorobenzoyl)piperidin-1-yl)(4-methoxyphenyl)methanone (CL6a) is a promising reversible MAGL inhibitor lead (Ki = 8.6 μM), which may be used for the future development of a new class of MAGL inhibitors. Furthermore, the results demonstrate the validity of the methodologies that we followed, encouraging additional screenings of other commercial databases. © 2014 Elsevier Ltd. All rights reserved

Health-Related Quality of Life and Diabetes Control in Immigrant and Italian Children and Adolescents with Type 1 Diabetes and in their Parents

Background/Objectives: Type 1 diabetes (T1D) is a chronic metabolic disease that requires daily and complex management for both patients and their caregivers, impairing the quality of life. Aim of this cross-sectional observational study was to determine whether metabolic control and health-related quality of life (HRQOL) of T1D subjects and their parents could be influenced by immigration status. Methods: We enrolled 125 children and adolescents with T1D (12.4\ub13.55 years; males 53.6%; T1D duration 5.61\ub13.50 years) and their parents (102 mothers and 37 fathers). According to patients\u2019 maternal origin, the study population was categorized into Group A (immigrant) and Group B (Italian). The Italian translation of the PedsQL\u2122 3.0 Diabetes Module was used to evaluate the HRQOL. Information on presence of diabetic ketoacidosis (DKA) at T1D onset, insulin therapy (MDI/SAP), and glycosylate hemoglobin (HbA1c), were collected at the same time of the questionnaire. Results: Group A, respect to Group B, had significantly higher frequency of DKA at T1D onset (55.0 vs. 22.3%; Chi-square=13.1; p<0.001) and a significant lower use of SAP (5.0 vs. 22.3%; Chi-Square=5.86; p=0.015). HbA1c values were significantly higher in Group A respect to Group B (72.7\ub117.6 vs. 62.6\ub112.9 mmol/mol; p<0.001). Patients\u2019 HRQOL scores were significantly lower in Group A than in Group B in the following scales: \u201cDiabetes selfsymptoms\u201d (57.9\ub114.6 vs. 66.9\ub112.8; p=0.004), \u201cTreatment barriers\u201d (68.1\ub123.6 vs. 82.9\ub113.0; p=0.001), and \u201cWorry\u201d (52.9\ub126.9 vs. 66.9\ub123.7; p=0.009). Mothers\u2019 HRQOL scores were significantly lower in Group A than in Group B in the following scales: \u201cDiabetes self-symptoms\u201d (56.7\ub118.1 vs. 65.8\ub115.7; p=0.030), \u201cTreatment barriers\u201d (55.9\ub119.8 vs. 71.3\ub119.7; p<0.001), \u201cTreatment adherence\u201d (71.2\ub118.1 vs. 80.6\ub111.2; p=0.018), \u201cCommunication\u201d (58.9\ub131.4 vs. 75.9\ub123.3; p=0.009) scales, and total score (57.2\ub117.1 vs. 68.8\ub112.6; p=0.011). No differences were found in fathers\u2019 data. The multivariate regression model for child HRQOL scales identified the following significant predictive factors: MDI insulin therapy ('=0.438; p=0.008), Italian ethnicity ('=0.018; p=0.004), HbA1c ('=-0.228; p=0.029) for \u201cTreatment barriers\u201d scale; Italian ethnicity ('=0.584; p=0.046) for \u201cWorry\u201d scale. Conclusions: Our results strongly suggest that immigrant status confers significant disadvantages in terms of T1D treatment, glycemic control, and HRQOL in children and adolescents with T1D. Moreover, parents\u2019 HRQOL data suggest that daily T1D management is usually supervised by mothers rather than fathers. Specific challenges and educational interventions should be considered in clinical care of T1D patients with distinct migration background

Health-Related Quality of Life and Metabolic Control in Immigrant and Italian Children and Adolescents with Type 1 Diabetes and in their Parents

Objective: To determine if the diabetes-specific health-related quality of life (D-HRQOL) of young people with type 1 diabetes (T1D) and their parents is influenced by migrant status. Subjects and methods: One hundred and twenty-five patients (12.4±3.55 years, males 53.6%) with T1D and their parents (102 mothers, 37 fathers) were enrolled and categorized into: Group A (both foreign parents) and Group B (both native Italian parents). The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Data on diabetic ketoacidosis (DKA) at T1D onset, insulin therapy, and glycosylate hemoglobin (HbA1c) were also collected. Results: Group A (n=40), compared to Group B (n=85), had higher frequency of DKA at T1D onset (p<0.001) and a lower use of sensor augmented insulin pump (p=0.015). HbA1c values were higher in Group A than in Group B (p<0.001). Patients' "Diabetes symptoms" (p=0.004), "Treatment barriers" (p=0.001), and "Worry" (p=0.009) scales scores were lower in Group A than in Group B. Mothers of Group A had lower scores in "Diabetes symptoms" (p=0.030), "Treatment barriers" (p<0.001), "Treatment adherence" (p=0.018), "Communication" (p=0.009) scales, and total score (p=0.011) compared to the Group B ones. High PedsQL™ 3.0 DM was significantly associated with being Italian, being pre-pubertal, and having lower HbA1c mean levels. Conclusions: Being a migrant confers disadvantages in terms of D-HRQOL and metabolic control in children and adolescents with T1D. Specific educational interventions should be considered in the clinical care of patients with migration background, to improve D-HRQOL and health status

Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit

OBJECTIVES: Current predominant routes of group B Streptococcus (GBS) transmission in preterm neonates admitted to neonatal intensive care unit (NICU) are poorly defined. We report 2 overlapping clusters of GBS late-onset disease (LOD) from June to September 2015 in an Italian NICU.METHODS: During the outbreak, possible sources of transmission (equipment, feeding bottles and breast pumps) were swabbed. Specimens from throat and rectum were collected on a weekly basis from all neonates admitted to NICU. Colonized or infected neonates had cohorting. Bacterial isolates were characterized by serologic and molecular typing methods.RESULTS: GBS was isolated in 2 full-term and 7 preterm neonates. Strains belonged to serotype III, with 3 different sequence types (ST17, ST182 and ST19). Full-term neonates were colonized with GBS strains unrelated to the clusters (ST182 and ST19). Two distinct ST17 strains caused 2 clusters in preterm neonates: a first cluster with 1 case of LOD and a second, larger cluster with 6 LOD in 5 neonates (one of them had recurrence). ST17 strains were isolated from vaginorectal and milk samples of 2 mothers. Two preterm neonates had no evidence of colonization for weeks, until they presented with LOD.CONCLUSIONS: Molecular analyses identified the presence of multiclonal GBS strains and 2 clusters of 7 cases of GBS-LOD. The dynamics of transmission of GBS within the NICU were complex. Breast milk was suspected to be one of the possible sources. In a research setting, the screening of GBS carrier mothers who deliver very preterm could contribute to the tracking of GBS transmission