Prevalence and risk factors for microalbuminuria in children and adolescents with type 1 diabetes: long-term experience of a single centre

Objectives: Diabetic nephropathy is a late complication of type 1 diabetes mellitus (T1DM) and microalbuminuria (MA) is an early and reversible sign of diabetic renal disease. Aims of this longitudinal study were: to define the prevalence of MA in children and adolescents with T1DM; to identify which risk factors are predictive for the development of MA. Methods: Seventy children and adolescents with T1DM [57% male; age at T1DM onset (T0) 5.95 3.16 yrs] were enrolled. The mean follow-up (FU) period was 7.18 1.89 yrs. Blood and urinary tests were performed once a year from the T0. MA screening was evaluated by urinary albumin concentration (UAC) or by timed urine collections for urinary albumin/creatinine ratio (ACR). MA was considered persistent (PMA) when at least 2 out of 3 consecutive evaluation of UAC and/or ACR were found positive. Results: PMA was found in 13% of patients. Subjects with PMA compared to normoalbuminuric ones had both significantly higher GFR at T0 (p = 0.025) and UAC at 1-year FU (T1) (p = 0.045). Predictive cut-off values for PMA development were 160 ml/min/1.73 m2 for GFR at T0 (sensitivity: 57%, specificity: 75%) and 8.5 mg/L for UAC at T1 (sensitivity:75%, specificity:80%). Relative risk for PMA was 23-times higher when UAC was >8.5 mg/L (p = 0.004). Kaplan- Meier survival curves as a function of age at T0 showed an increased probability of developing PMA among children in which T1DM onset occured between 5 and 11 years of age compared to those with younger onset (p = 0.014) and a pubertal diabetes duration >5 years was also a significant risk factor for PMA (p < 0.0005). Conclusions: Age at T1DM onset, pubertal timing, high UAC, and hyperfiltration predispose to PMA development and increase the risk for diabetic nephropathy. Specific cut-off values at T1DM onset and during first years of FU could provide indications to avoid disease progression

Severe metabolic alkalosis due to diuretic treatment in a patient with distal renal tubular acidosis: a rare association.

Introduction: Distal renal tubular acidosis is a rare genetic disease, characterised by deficit in renal tubular transport. Clinical features are metabolic acidosis with hypercloraemia and hypokalemia, and inability in urine acidification. Hypercalciuria may also be present, often treated with the use of a diuretic therapy with thiazides. Case Presentation: We present a severe disease onset in a neonate with consanguineous parents, both autosomal-recessive for an ATP6VOA4 gene mutation, and a nevertheless severe episode of metabolic alkalosis, occurred in the same patient after few months, during the diuretic therapy. Conclusion: Biochemical results lead us to hypothesize a susceptibility to the treatment that need further investigations

Data analysis and modelling

This deliverable on data analysis provides guidance and general principles for: - pre-testing to check the usability of the system and the feasibility of the evaluation process, - controlling the consistency of the chain and the precision with different sampling schemes, - modelling the impact for each indicators and for an integrated evaluation including a systemic and multidisciplinary interpretation of the effects, - integrating and controlling the quality of space-time data from various sources (numerical, video, questionnaires), - selecting the appropriate statistical techniques for data processing, PI estimation and hypothesis testing in accordance to the list of indicators and experimental design, - scaling up from experimental data and identified models to population and network level. Experimentalists stress the role and importance of a preliminary field test in FOT. Three main objectives have been defined to make a preliminary diagnosis of usability of the systems and to check the relevance and feasibility of the evaluation process. These preliminary tests are very important for the practical deployment of the FOT as well as for the overall scientific evaluation process

Principio di responsabilità e ricerca pedagogica

Il volume raccoglie gli scritti di molti studiosi, italiani e stranieri, in onore di Umberto Margiotta: testimone attivo e protagonista dell'innovazione scientifica pedagogica nell'ultimo mezzo secolo. Come curatori, abbiamo operato per trovare, nella complessità del suo percorso, alcune direttrici che più di altre hanno contrassegnato l'evoluzione delle sue indagini scientifiche. La prima parte si concentra sull'approccio fenomenologico-critico della pedagogia, approccio incardinato nelle scienze umane e nelle scienze sociali, approdato in Margiotta all'analisi delle ontologie pedagogiche e alla formazione capacitante dei talenti, concepite in termini di razionalità incrementale. La seconda parte si occupa di quei dispositivi che hanno reso esplicita l’agentività di Margiotta, che non può fermarsi alla dimensione speculativa, deve originare percorsi di ricerca caratterizzati da evidenze, percorsi dove prevale la visione pragmatica del mondo

Landascape education as italian contribution to the implementation of the Agenda 2030

Perhaps it could be suggested to the Commission of Sages who are elaborating the Plan for the National Strategy for Sustainable Development in implementation of the global commitments established by the Agenda 2030, to deepen the theme of landscape education: it could thus make a real original contribution and specifically national protection, of the destinies of the world. In fact, in the Italian landscape, many of those 17 “goals” are embodied which constitute the objectives of the Agenda. But above all in the Italian landscape, as it has been configured in secular history, it is outlined - this is the meaning of this article - a real alternative ecological paradigm, a model of balance between humanity and nature full of future and able to overcome , in friendship, beauty, harmony, conviviality, the often violent and contrasting hybris that yesterday in the West and today also in the East has marked modernity

Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk