The Global Antibiotic Resistance Partnership (GARP)

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Cardiorespiratory fitness and sports activities in children and adolescents with solitary functioning kidney

Background: An increasing number of children with chronic disease require a complete medical examination to be able to practice physical activity. Particularly children with solitary functioning kidney (SFK) need an accurate functional evaluation to perform sports activities safely. The aim of our study was to evaluate the influence of regular physical activity on the cardiorespiratory function of children with solitary functioning kidney. Method: Twenty-nine patients with congenital SFK, mean age 13.9 ± 5.0 years, and 36 controls (C), mean age 13.8 ± 3.7 years, underwent a cardiorespiratory assessment with spirometry and maximal cardiopulmonary exercise testing. All subjects were divided in two groups: sedentary (S) and trained (T) patients, by means of a standardized questionnaire about their weekly physical activity. Results: We found that mean values of maximal oxygen consumption (VO2max) and exercise time (ET) were higher in T subjects than in S subjects. Particularly SFK-T presented mean values of VO2max similar to C-T and significantly higher than C-S (SFK-T: 44.7 ± 6.3 vs C-S: 37.8 ± 3.7 ml/min/kg; p < 0.0008). We also found significantly higher mean values of ET (minutes) in minutes in SFK-T than C-S subjects (SFK-T: 12.9 ± 1.6 vs C-S: 10.8 ± 2.5 min; p <0.02). Conclusion: Our study showed that regular moderate/high level of physical activity improve aerobic capacity (VO2max) and exercise tolerance in congenital SFK patients without increasing the risks for cardiovascular accidents and accordingly sports activities should be strongly encouraged in SFK patients to maximize health benefit

Measurement of Interrupter Respiratory Resistance and Spirometry in Preschool Children: Influence of Respiratory Symptoms:

Pulmonary function tests play an important role in the diagnosis and management of respiratory diseases in children. The purpose of the study was to evaluate lung function using the interrupter resistance technique (Rint) and spirometry (flow-volume and volume-time) in preschool children and to correlate the findings with respiratory symptoms. We studied 103 children (65 males, 38 females; mean age 5.2±0.7 years; range 3.6–5.8). For each child we collected family history concerning: respiratory diseases, skin prick tests, smoking during maternal pregnancy, history of gestational and neonatal period. All children performed lung function tests (Rint and spirometry) and skin prick test for inhalant and food allergens. Twenty-eight subjects (27.2%) had respiratory symptoms (RS). Expiratory Rint were performed in all subjects and spirometry was carried out on 76 children (73.8%). Spirometric indices were not statistically different between subjects without respiratory symptoms (controls) and RS children except for FEF25–75 expressed as a percentage of the predicted value (RS: 81.5±13.7% vs controls: 94.5±15.8%; p <0.001). Rint mean values were significantly higher in RS children than in controls (RS: 135.6 ±24.8% vs controls: 102.4 ±21.7%; p< 0.0001). We found a statistically negative correlation between Rint and the following Spirometric indices: FEV0.5 (R= −0.696; p < 0.0001), FEV, (R= − 0.728; p < 0.0001) and FEF25–75 (R= −0.681; p < 0.0001). In preschool children with respiratory disease we found significantly higher mean values of Rint and lower FEF25-75 than in the control group and a significant negative relationship between Rint and Spirometric indices

Vernal Keratoconjunctivitis: an update focused on clinical grading system

Vernal keratoconjunctivitis (VKC) is a severe disease with a prevalence of &lt; 1 case out of 10,000 in Europe, which occurs mainly in pediatric age and is characterized by a severe and often bilateral chronic inflammation of the ocular surface. The diagnosis is generally confirmed by the finding at the ocular examination of conjunctival hyperemia, papillary hypertrophy in the tarsal conjunctiva, giant papillae, papillae in the limbus region

Assessing repeatability and reproducibility of Anterior Active Rhinomanometry (AAR) in children

BACKGROUND: Repeatability and reproducibility are essential for clinicians for several purposes. Although discouraged, use of the Coefficient of Variation (CV) for assessing repeatability and reproducibility, rather than the Intraclass Correlation Coefficient (ICC), is still widespread. The aim of the present study was to highlight how using inappropriate indices may lead to misleading results, and this is done by simulation study and using real data on Anterior Active Rhinomanometry (AAR) in both healthy children and ones with rhinitis. METHODS: A simulation study was carried out to highlight how using inappropriate indices could be misleading. Then a comparison was made between CV and ICC to assess repeatability and reproducibility of AAR, for which previous studies have given underestimated results. AAR is recommended as the gold standard tool for measuring nasal resistance in clinical practice. RESULTS: A simulation study showed that the ICCs estimated from data generated assuming a true CV yielded results in agreement with estimated CVs; by contrast, if data were generated assuming a true ICC, CVs yielded conflicting results. For AAR, ICCs showed good repeatability, whereas CVs showed unacceptable repeatability. AUC and 95% CI for AAR showed good performance in predicting current symptoms of rhinitis in the overall study population. CONCLUSIONS: The present study focused on the importance of the choice of appropriate indices of repeatability and reproducibility, demonstrating the repeatability of AAR in both healthy children and ones with rhinitis

Digital health in the management of allergic diseases

In recent years there has been an important implementation in the medical field of both Mobile Health, such as the use of mobile communication devices, and of other telemedicine tools in general, with the aim of supporting the supervision of diseases from the moment of the first diagnosis to the therapeutic follow-up. In fact, Digital Health can also have a very positive impact on the management of allergic patients, who are known to have the greatest need for regular monitoring, simplifying contact between doctor and patient, but there is still a need to improve implementation regulations, define certification programs and adequate reimbursement systems, as well as to guarantee a high level of attention to the protection of sensitive data. The hope is that one positive outcome of the Covid-19 pandemic will be an acceleration, by all stake-holders involved, of the process of the modernization of health care. (www.actabiomedica.it)

Le immunoglobuline per via endovenosa nel trattamento delle neuropatie infantili

Agli inizi degli anni ’80, l’avvento dei preparati di immunoglobuline per via endovenosa (IVIG) nella la terapia sostitutiva delle ipo-agammaglobulinemie, ha radicalmente cambiato la prognosi dei pazienti con immunodeficienze umorali 1. Fino ad allora infatti erano utilizzabili solo preparati per via intramuscolare, con importanti limitazioni legate ai volumi di liquido iniettabili per questa via e la sostituzione degli anticorpi carenti era perciò poco soddisfacente. La disponibilità delle IVIG (quindi la possibilità di somministrare grandi volumi = quantità di IgG) non solo ha consentito la completa sostituzione dei difetti anticorpali, ma ha anche aperto la strada ad altri impieghi sfruttandone le attività immunomodulanti e antinfiammatorie prima sconosciute e rivelatesi in modo del tutto occasionale. Fu Imbach che casualmente osservò in un paziente con difetto anticorpale e piastrinopenia non solo la normalizzazione delle IgG, ma anche del numero di piastrine, in corso di terapia con IVIG e intraprese il primo studio con IVIG in pazienti con porpora trombocitopenia idiopatica, dimostrandone una eccellente efficacia 2. Da allora i campi applicativi si sono estesi a tutte quelle malattie autoimmuni e infiammatorie per le quali i risultati della terapia classica erano insoddisfacenti e si è focalizzata l’attenzione sui meccanismi attraverso cui le IVIG esercitano la loro azione antinfiammatoria e immunomodulante. Si può dire che ad oggi pressoché tutte le malattie autoimmuni – e le malattie neuromuscolari in particolare per le loro caratteristiche invalidanti ed evolutive – sono state oggetto di tentativi terapeutici con IVIG. I risultati non sono stati sempre incoraggianti e, in considerazione dell’alto costo dei preparati, si è sentita e si sente l’esigenza di porre ordine e di rivedere criticamente tutta la letteratura sull’argomento per dare indicazioni più precise, in accordo ai criteri EBM, sull’impiego di tali preparati. Ormai sono numerose le indicazioni e le consensus redatte sia da Neurologi che da Immunologi; a queste si aggiungono le direttive ufficiali, emanate dagli organi di controllo statali (FDA, WHO, AIFA) che ne approvano le indicazioni per alcune malattie e ne coprono il costo a carico dei sistemi sanitari nazionali. Tuttavia la approvazione riguarda un numero estremamente esiguo di patologie e tuttora le IVIG vengono spesso utilizzate off label