Treatment of GH-deficient children with two different GH doses: effect on final height and cost-benefit implications

OBJECTIVE: Treatment of GH-deficient (GHD) children with higher doses of recombinant human GH (rhGH) than conventional ones has been reported to result in higher growth velocity and increased final height. These findings, however, were observed by comparing large but heterogeneous groups of children. We wanted to verify whether the same results could be obtained in two groups of appropriately well-matched children with isolated GHD treated with high vs conventional doses of rhGH. METHODS: Out of two cohorts of GHD children, cohort A (on a weekly rhGH dose of 0.3 mg/kg body weight) and cohort B (on a weekly rhGH dose of 0.15 mg/kg body weight), we selected two groups, each including 13 patients, who before treatment were matched for age, sex and height standard deviation score (SDS). They were followed up until final height. RESULTS: Final height SDS was significantly higher in group A (-0.45+/-0.36 (s.d.) vs -1.07+/-0.7; P=0.008), as well as height gain SDS (1.81+/-0.58 vs 1.23+/-0.62; P=0.002). The difference between final height SDS and target height SDS was positive only in group A and significantly higher in group A than in group B (0.33+/-0.51 vs -0.46+/-0.7; P=0.01). Glucose tolerance was always normal in the group treated with higher doses. CONCLUSION: The final height of children treated with higher doses of rhGH is increased, also in relation to their genetic target. The economical burden of this choice of treatment, however, has to be taken into account when evaluating the results

Detecting and describing heterogeneity in health care cost trajectories among asylum seekers.

The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim

Corrigendum: The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the covid-19 pandemic in 2020(Front. Endocrinol., (2022), 13, (878634), 10.3389/fendo.2022.878634)

[This corrects the article .]

A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes

We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05-0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

Objective: To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. Research design and methods: This was a cross-sectional, Web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. Results: Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patient who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. Conclusions: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019

Patients issus de l’asile : collaboration infirmiers-étudiants en médecine durant l’épidémie de Covid-19. [Asylum seekers : collaboration between nurses and medical students during the COVID-19 epidemic]

The exceptional health challenges generated by the COVID-19 pandemic have sparked a wave of mobilization among medical students. We were four students to provide support to the Migrant Care Units of the Vulnerability and Social Medicine Department of Unisanté. This two-month experience, very different from the academic framework we were used to during our studies, allowed us to discover a clinic grappling with social and cross-cultural issues, and taught us the mutual benefits of an interprofessional collaboration with experienced nurses. Through a few clinical vignettes, we would like to share the challenges of the care we have seen, as well as the significant lessons we have learned from them