How do Italian pediatric endocrinologists approach gender incongruence?

Background: Gender incongruence (GI) is a term used to describe a marked and persistent incompatibility between the sex assigned at birth (SAAB) and the experienced gender. Some persons presenting with GI experience a severe psychological distress defined as gender dysphoria (GD). Although the prevalence of GI is probably underestimated, recently a great increase in numbers of transgender and gender diverse (TGD) youths presenting at the gender clinics has been registered. After a careful multidisciplinary evaluation and upon acquisition of informed consent from the youth and the legal guardian(s), puberty suppression can be started in TGD youths, followed by the addition of gender affirming hormones (GAH) by the age of 16 years. Although Italian specific guidelines are available, their application is often complex because of (among other reasons) lack of specialized centers and healthcare professional with experience in the field and the regional differences within the Italian healthcare system. Main body: To investigate the care offered to TGD youths across Italy, we proposed a survey of 20 questions to the directors of the 32 Italian Centers of pediatric endocrinology participating to the Study Group on Growth and Puberty of the Italian Society of Pediatric Endocrinology (ISPED). Eighteen pediatric endocrinologists representative of 16 different centers belonging to 11 different regions responded to the survey. In the large majority of centers TGD youths are taken in charge between the age of 12 and 18 years and at least three healthcare professional are involved. Most of Italian pediatric endocrinologists follow only a very limited number of TGD youths and reference centers for TGD youths are lacking. Conclusion: There is an urgent need for gender clinics (homogeneously distributed on the national territory) where TGD youths can access high standard care

Pituitary Macroadenoma and Severe Hypothyroidism: The Link between Brain Imaging and Thyroid Function

In case of primary hypothyroidism, reactive pituitary hyperplasia can manifest as pituitary (pseudo) macroadenoma. We report the case of a 12-year-old boy who was evaluated for impaired growth velocity and increased body weight. Because of low insulin-like growth factor 1 levels and poor response to the growth hormone stimulation test, brain magnetic resonance imaging was performed and a pituitary macroadenoma was found. Treatment with levothyroxine was started, and thyroid function was evaluated approximately every 40 days to titrate the dosage. After few months of therapy, the size of the macroadenoma decreased and growth hormone secretion normalized. The pituitary returned to normal size in approximately 5 years. The boy went through puberty spontaneously and reached a normal adult height. In a patient affected by primary hypothyroidism, reactive pituitary hyperplasia can cause growth hormone deficiency; however, growth hormone secretion usually normalizes after starting levothyroxine treatment. Pituitary macroadenoma can be difficult to distinguish from severe pituitary hyperplasia; however, pituitary macroadenomas are rare in childhood, and our clinical case underlines how the hormonal evaluation is essential to achieve a correct diagnosis and prevent unnecessary surgery in a context of pituitary mass

Long-term change in nutritional status after severe traumatic brain injury

IntroductionIn the acute phase, patients who sustained a severe Traumatic Brain injury (TBI) (Glasgow Coma Scale under 8) frequently present malnutrition during critical care. Long-term nutritional outcome after a severe TBI has been less studied. Cognitive impairments and behavioural disorders together with hormonal disorders can lead to persisting malnutrition or over-eating and obesity. The purpose of this study was to follow the weight, the body mass index (BMI), albuminemia and hormonal dosage after a severe TBI.MethodsThis study relied on a research protocol designed to follow concurrently and prospectively endocrine disorders and cognitive disorders in a cohort of patients with severe TBI (Inspire-TC protocol). In the present work, we focused specifically on the evolution in weight, height, body mass index, albuminemia and endocrine abnormalities. These parameters were collected upon admission to the rehabilitation department, at 4 months, 12 months and 18 months when feasible for the severe TBI patients included in the Inspire-TC protocol. Albuminaemia was measured late after the TBI when patients agreed.Results10 patients were included. Initially 60% of the patients had biological malnutrition, 10% were overweight, 80% presented a normal BMI and 10% had an insufficient BMI. All patients gained weight during the monitoring with an overweight at 18 months for three patients. Along the overall monitoring, 44% of the patients had hormonal disruptions. The 3 patients with long-term overweight had frontal-temporal brain lesions. All three recovered walking. Only one had hormonal disruptions. Albuminaemia was normal for all patients who accepted to make this bioessay control.ConclusionThere is a tendency to gain weight after a severe TBI. Favorable factors include fronto-temporal injuries, and the presence of executive disorders. Endocrine perturbation and immobility can also contribute to overweight but were less frequently observed in this cohort

La disforia di genere in età pediatrica e adolescenziale

While the sex of an individual refers to his/her genetic and anatomical characteristics, gender concerns the perception of oneself, personal and private, as belonging to the male or female gender, to both or neither. Generally gender perception between 3 and 7 years of age. Gender incongruence is defined by the absence of concordance between these two aspects, while gender dysphoria refers to the psychological distress that can follow. The number of children and adolescents showing gender incongruence is increasing and poses problems of diagnosis and treatment. Providing care requires the presence of a multidisciplinary team made up of expert professionals trained in this field, which should include neurospichiatrists, psychologists and pediatric endocrinologists. Pharmacological therapy, that follows a phase of psychotherapy, should be started in puberty and is preliminary to subsequent therapeutic interventions; the latter ones are prerogative of adulthood. A careful multidisciplinary follow-up is needed for these patients until adulthood

Encephalitis due to herpes zoster without rash in an immunocompetent 12-year-old girl: Case report and review of the literature

Background: Neurological complications due to reactivation of varicella-zoster virus (VZV) are very uncommon in immunocompetent patients. Generally a vesicular rash is present on one or more dermatomes, preceding or following the main manifestation. Few cases are reported in the international literature, but they concern mainly adult or elderly patients. Case presentation: A 12-year-old girl was referred to our hospital for persisting headache, cough and rhinitis for six days. After first examination, diagnosis of anterior sinusitis was made by nasal endoscopy. The day after, the girl developed psychotic symptoms and altered mental status. Computed tomography (CT) scan was immediately performed but was unremarkable; lumbar puncture revealed leukocytosis with lymphocytic predominance and cerebrospinal fluid polymerase chain reaction (PCR) detected varicella-zoster virus DNA. The diagnosis of acute VZV encephalitis was made. The patient was promptly treated with acyclovir infused intravenously and her clinical conditions rapidly improved. Tests made did not show any condition of immunosuppression. Conclusions: Although if rare, reactivation of VZV can occur in immunocompetent children and its complications can involve central nervous system. Among these complications, meningitis is more common, but cerebral parenchyma can also be involved leading to a severe medical condition that is defined meningoencephalitis. In rare cases vesicular rash may be absent; therefore high level of suspicion is required even in those patients in which suggestive clinical features are not present to guide the diagnosis. Intravenous acyclovir represents the treatment of choice to obtain a fast clinical response and to prevent the onset of late-term complications

Deep belief network based audio classification for construction sites monitoring

In this paper, we propose a Deep Belief Network (DBN) based approach for the classification of audio signals to improve work activity identification and remote surveillance of construction projects. The aim of the work is to obtain an accurate and flexible tool for consistently executing and managing the unmanned monitoring of construction sites by using distributed acoustic sensors. In this paper, ten classes of multiple construction equipment and tools, frequently and broadly used in construction sites, have been collected and examined to conduct and validate the proposed approach. The input provided to the DBN consists in the concatenation of several statistics evaluated by a set of spectral features, like MFCCs and mel-scaled spectrogram. The proposed architecture, along with the preprocessing and the feature extraction steps, has been described in details while the effectiveness of the proposed idea has been demonstrated by some numerical results, evaluated by using real-world recordings. The final overall accuracy on the test set is up to 98% and is a significantly improved performance compared to other state-of-the-are approaches. A practical and real-time application of the presented method has been also proposed in order to apply the classification scheme to sound data recorded in different environmental scenarios

Modeling and multi-temporal characterization of total suspended matter by the combined use of sentinel 2-MSI and landsat 8-OLI Data: The Pertusillo lake case study (Italy)

The total suspended matter (TSM) variability plays a crucial role in a lake's ecological functioning and its biogeochemical cycle. Sentinel-2A MultiSpectral Instrument (MSI) and Landsat 8 Operational Land Instrument (OLI) data offer unique opportunities for investigating certain in-water constituents (e.g., TSM and chlorophyll-a) owing to their spatial resolution (10-60 m). In this framework, we assessed the potential of MSI-OLI combined data in characterizing the multi-temporal (2014-2018) TSM variability in Pertusillo Lake (Basilicata region, Southern Italy). We developed and validated a customized MSI-based TSM model (R2 = 0.81) by exploiting ground measurements acquired during specific measurement campaigns. The model was then exported as OLI data through an intercalibration procedure (R2 = 0.87), allowing for the generation of a TSM multi-temporal MSI-OLI merged dataset. The analysis of the derived multi-year TSM monthly maps showed the influence of hydrological factors on the TSM seasonal dynamics over two sub-regions of the lake, the west and east areas. The western side is more influenced by inflowing rivers and water level fluctuations, the effects of which tend to longitudinally decrease, leading to less sediment within the eastern sub-area. The achieved results can be exploited by regional authorities for better management of inland water quality and monitoring systems

Unusual onset of a case of chronic recurrent multifocal osteomyelitis

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition that commonly affects the clavicle and pelvis. Case presentation: We report here a case a 12 years old girl with CRMO arising with recurrent episodes of left supraorbital headache, followed by the appearance of a periorbital dyschromia. Magnetic resonance imaging (MRI) of the skull and orbits revealed an important subacute inflammatory process. Few months after, the child presented a painful swelling of the left clavicle; the histological examination of the related biopsy allowed to establish the diagnosis of CRMO. Conclusion: CRMO presenting as acute headache involving neurocranium is rare; to our knowledge this is the first recognized case in the world literature. This pathological condition is frequently misdiagnosed as infection or neoplasm and needs a deep investigation for the differential diagnosis. The physical, laboratoristic and instrumental diagnostic investigations of the patient and the treatment employed are described in detail