A prompt diagnosis of late-onset congenital diaphragmatic hernia with Point of Care Ultrasound (POCUS) in a Pediatric Emergency Department.

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Esophageal Duplication Cyst in Newborn

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Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Vitamin D and its metabolites in the pathogenesis and treatment of osteoporosis

Vitamin D and calcium are essential for normal skeletal growth and for maintaining the mechanical and structural integrity of the skeleton. Reduced intake of calcium and vitamin D may be associated with reduced bone mass and osteoporosis while a chronic and severe vitamin D deficiency may lead to osteomalacia. 1,25(OH)2D (calcitriol) is the major active metabolite of vitamin D and promotes intestinal calcium absorption and the mineralization of bone matrix and reduces PTH secretion. Despite vitamin D and calcium are considered essential components of management strategies for the prevention and treatment of osteoporosis, many people do not have adequate vitamin D levels. Vitamin D insufficiency is particularly common in the elderly due to reduced exposition to sunlight, declined synthesis of vitamin D in the skin and impaired renal hydroxylation. Even though secure inferences from randomized controlled trials on the prevention of osteoporotic fracture with vitamin D or its metabolites are limited, these compounds have been demonstrated to be pharmacologically active, safe and cost-effective for the prevention of age-related bone loss. Their use should be encouraged expecially in elderly subjects or in condition of dietary deficiencies. Interestingly, health benefits of vitamin D and its analogues may go beyond osteoporosis, including prevention of cancer and autoimmune diseases and improvement of neuromuscular function

Oncogenic osteomalacia

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized biochemically by hypophosphatemia, excessive urinary phosphate excretion, low 1,25-dihydroxyvitamin D levels, and clinically by osteomalacia, pseudofractures, bone pain, fatigue, and muscle weakness. TIO can occur in patients with a variety of benign mesenchimal tumors (hemangiopericitomas, fibromas, angiosarcomas, etc.) and the disease is invariably curable with the removal of the tumor, indicating that it has humoral basis. Phosphate wasting and the defect in vitamin D synthesis are caused by a humoral factor produced by tumors, initially termed phosphatonin, and recently identified as fibroblast growth factor-23 (FGF-23) although other substances as secreted frizzled-related protein 4 (SFRP4) and matrix extracellular phospho-glycoprotein (MEPE) can be involved in pathophysiology of osteomalacia. In contrast with more common forms of osteomalacia, patients with TIO have normal serum calcium, normal serum 25- hydroxy-vitamin D and normal intact serum parathyroid hormone. On the other hand TIO is biochemically indistinguishable from several inherited forms of hypophosphatemic rickets as X-linked hypophosphatemia (XLH) and autosomical dominant hypophosphatemic rickets (ADHR). The definitive diagnosis of TIO is established by identification of the causative tumor and remission of the syndrome after complete tumor resection. Recently a few cases in which 111In-pentetreotide scintigraphy visualized the tumor have been reported and also positron emission tomography using F-18-fluorodeoxyglucose showed encouraging results. When the suspected tumour cannot be located, periodical follow-up with conventional imaging is indicated with special attention directed to craniofacial locations and extremities because they are the more common localization for tumour. In conclusion in patients with TIO resection of a tumour is the treatment of choice; if the tumour cannot be found or if the tumour is unresectable for its location, chronic administration of phosphate and calcitriol is indicated

Comparison of outcomes following radiological reduction of intussusception with or without sedation

Background: Non-operative radiological reduction (NORR) is usually the first line treatment in pediatric ileo-colic intussusception. The aim of our study was to compare outcomes of NORR with or without sedation. Methods: All patients undergoing to contrast enema NORR for intussusception between 01.01.2015 to 31.12.2020 in two hospitals were included: in one centre patients were sedated (A) while in the other patients were awake (B). Primary outcome was the rate of radiological reduction. Secondary outcomes were length-of-stay, complications and recurrence rate. Results: Seventy-seven and 49 patients were included in group A and B respectively. Successful reduction rate was 72.7% in group A and 61.2% in group B (P>0.05). There were no complications related to the procedure among the 2 groups. Adverse events to sedation were observed in 3 patients. Conclusions: NORR has similar success rate when performed under sedation or awake, despite the former being graved by additional anesthesiologic risks and thus warrant careful indications

Comparison of different intravenous bisphosphonate regimens for Paget's disease of bone.

This randomized study compared different intravenous bisphosphonates in PDB. Zoledronate was superior with respect to pamidronate in achieving biochemical remission, with therapeutic response maintained in most patients at 15 mo. Single neridronate and zoledronate infusion showed a similar efficacy in up to 90% of patients nonresponders to pamidronate. INTRODUCTION: Intravenous bisphosphonates represent a common therapy for Paget's disease of bone (PDB). However, there have been few head to head randomized trials comparing intravenous bisphosphonates. MATERIALS AND METHODS: We performed a 15-mo, randomized study comparing different intravenous bisphosphonates in 90 subjects with active PDB. At baseline, patients were randomly assigned to receive pamidronate (30 mg, i.v., for 2 consecutive days every 3 mo; n = 60) or zoledronate (4 mg, i.v.; n = 30). After 6 mo, nonresponders to pamidronate were crossed over to zoledronate or neridronate (100 mg, i.v., for 2 consecutive days). The primary efficacy endpoint was therapeutic response at 6 mo, defined as normalization of alkaline phosphatase (ALP) or a reduction of at least 75% in total ALP excess. RESULTS: At 6 mo, 97% of patients receiving zoledronate had a therapeutic response compared with 45% of patients receiving pamidronate. Normalization of ALP was achieved in 93% of patients in the zoledronate group and in 35% of patients in the pamidronate group. ALP normalization was maintained in 79% and 65% of zoledronate-treated patients after 12 and 15 mo, respectively; loss of therapeutic response was observed in 2 of 30 (6%) at 12 and 15 mo. At 6 mo, 27 patients showing therapeutic response to pamidronate continued the treatment, whereas nonresponders were crossed-over to neridronate (n = 15) or zoledronate (n = 18). Among these subjects, 14 of 15 (93%) in the neridronate group and 17 of 18 (94%) in the zoledronate group achieved a therapeutic response. Similar normalization rates were observed between neridronate- (80%) and zoledronate- (83%) treated subjects. Normalization and therapeutic response were maintained at 9 mo from treatment (corresponding to 15 mo from the baseline visit) in either neridronate or zoledronate groups. CONCLUSIONS: Single neridronate and zoledronate infusion showed a similar efficacy in achieving biochemical remission in up to 90% of patients nonresponders to pamidronate. Therapeutic response to zoledronate seems to be maintained in most patients at 15 mo