Celiac disease in type 1 diabetes mellitus

Celiac Disease (CD) occurs in patients with Type 1 Diabetes (T1D) ranging the prevalence of 4.4-11.1% versus 0.5% of the general population. The mechanism of association of these two diseases involves a shared genetic background: HLA genotype DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, DR3-DQ2 with CD. The classical severe presentation of CD rarely occurs in T1D patients, but more often patients have few/mild symptoms of CD or are completely asymptomatic (silent CD). In fact diagnosis of CD is regularly performed by means of the screening in T1D patients. The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in CD/T1D patient are controversial. Regarding of the GFD composition, there is a debate on the higher glycaemic index of gluten-free foods respect to gluten-containing foods; furthermore GFD could be poorer of fibers and richer of fat. The adherence to GFD by children with CD-T1D has been reported generally below 50%, lower respect to the 73% of CD patients, a lower compliance being more frequent among asymptomatic patients. The more severe problems of GFD adherence usually occur during adolescence when in GFD non compliant subjects the lowest quality of life is reported. A psychological and educational support should be provided for these patients

Changing Parental Style for the Management of Childhood Obesity: A Multi-Component Group Experience

Obesity is a complex public health issue with increasing prevalence in childhood and with a large burden on physical and mental health. Recent data suggest the effectiveness of multi-component approach, of interventions aimed at changing parenting style, and of group educational sessions. In particular, interventions containing a family-behavioral component produce larger effect sizes than alternative treatment groups. Many models have been developed for the multi-component and multi-stakeholder treatment of childhood obesity, with a frequent discrepancy in the intensity of the treatment programme and in the resources available within clinics. Looking for effective strategies for the treatment of childhood obesity we built a Multi-component Obesity Group Experience (MOGE) model, analysing BMI and fat mass reduction as primary outcomes and qualitative improvements in the behavior towards nutrition and lifestyle as secondary one. Thirty-five consecutive obese children (20 girls, BMI z-score 2.1+0.2), were treated by MOGE model and the results were compared with 35 matched obese subjects of the same age (control group followed with a traditional treatment). After 3, 6 and 12 months of treatment it has been observed a significant reduction of BMI z-score and body fat mass. Moreover, a clinically significant psychological wellness was observed in children of MOGE group

Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review

Achilles tendinopathy is a common musculoskeletal disorder. Athletes, runners and jumpers, and the sedentary are frequently affected. Numerous are the therapeutic choices to manage these kinds of disorders. The aim of this review is to analyze the available literature to document the up-to-date evidence on conservative management of Achilles tendinopathy. A systematic review of two medical electronic databases was performed by three independent authors, using the following inclusion criteria: conservative treatment consisted of pharmacologic, physical therapy without operative treatment, with more of 6 months symptoms and a minimum average of 6-months follow-up. Studies of any level of evidence, reporting clinical results, and dealing with Achilles tendinopathy and conservative treatment were searched for. A total of n = 1228 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 94 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 29 articles. Achilles tendinopathy is a frequent musculoskeletal disorder and several conservative treatments have been proposed, but no therapy is universally accepted, except for eccentric exercise training, which is the gold standard and a commonly used protocol