Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP)

Background: Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods: Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results: A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion: In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice

Las jornadas de extensión universitaria de la Universidad Nacional de Mar del Plata: Una aproximación bibliométrica

Esta investigación documental, bibliométrica cuali-cuantitativa tuvo como objetivo principal analizar y describir los documentos publicados en las Jornadas de Extensión Universitaria organizadas por la UNMdP. Como objetivos particulares se propuso analizar frecuencia de los documentos según la temática publicada; analizar tipos de publicaciones que se han publicado; identificar autores con mayor cantidad de publicaciones; analizar relaciones de colaboración entre los autores; describir objetivos, metodologías y beneficiarios hallados en la literatura analizada y explorar el contenido temático de los documentos publicados. Consideramos a la extensión universitaria como una de las vías para desarrollar el proceso de comunicación cultural en un sentido amplio ya que la misma facilita el vínculo universidad-sociedad, lo cual concuerda con los resultados del análisis de los campos temáticos realizado en los que se identifica a la capacitación, como la metodología mayormente implementada y como beneficiarios de este aporte, la comunidad en general

Male hypogonadism: an extended classification based on a developmental, endocrine physiology-based approach

Normal testicular physiology results from the integrated function of the tubular and interstitial compartments. Serum markers of interstitial tissue function are testosterone and insulin-like factor 3 (INSL3), whereas tubular function can be assessed by sperm count, morphology and motility, and serum anti-Mu¨llerian hormone (AMH) and inhibin B. The classical definition of male hypogonadism refers to testicular failure associated with androgen deficiency, without considering potential deficiencies in germ and Sertoli cells. Furthermore, the classical definition does not consider the fact that low basal serum testosterone cannot be equated to hypogonadism in childhood, because Leydig cells are normally quiescent. A broader clinical definition of hypogonadism that could be applied to male patients in different periods of life requires a comprehensive consideration of the physiology of the hypothalamic- pituitary-testicular axis and its disturbances along development. Here we propose an extended classification of male hypogonadism based on the pathophysiology of the hypothalamic-pituitary-testicular axis in different periods of life. The clinical and biochemical features of male hypogonadism vary according to the following: (i) the level of the hypothalamic-pituitary-testicular axis primarily affected: central, primary or combined; (ii) the testicular cell population initially impaired: whole testis dysfunction or dissociated testicular dysfunction, and: (iii) the period of life when the gonadal function begins to fail: foetal-onset or postnatal-onset. The evaluation of basal testicular function in infancy and childhood relies mainly on the assessment of Sertoli cell markers (AMH and inhibin B). Hypergonadotropism should not be considered a sine qua non condition for the diagnosis of primary hypogonadism in childhood. Finally, the lack of elevation of gonadotropins in adolescents or adults with primary gonadal failure is indicative of a combined hypogonadism involving the gonads and the hypothalamic-pituitary axis.Fil: Rey, Rodolfo Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Grinspon, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Gottlieb, Silvia Elisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Pascualini, T.. Hospital Italiano de Buenos Aires; ArgentinaFil: Knoblovits, P.. Hospital Italiano de Buenos Aires; ArgentinaFil: Aszpis, S.. Hospital "Carlos G. Durand"; ArgentinaFil: Pacenza, N.. Unidad Asistencial "Dr. César Milstein"; ArgentinaFil: Stewart Usher, J.. Centro Médico Haedo; ArgentinaFil: Bergadá, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Campo, Stella Maris. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; Argentin

Hipogonadismo masculino: una clasificación ampliada basada en la fisiología endocrina del desarrollo

La fisiología testicular normal es el resultado de la función integrada de los compartimientos tubular e intersticial. Los marcadores séricos de la función del tejido intersticial son la testosterona y el factor similar a la insulina 3 (INSL3), mientras que la función tubular puede ser evaluada por el recuento, la morfología y la motilidad espermáticos y los niveles circulantes de hormona anti-Mülleriana (AMH) e inhibina B. La definición clásica de hipogonadismo masculino se refiere a la insuficiencia testicular asociada con la deficiencia de andrógenos, sin tener en cuenta las posibles deficiencias en las poblaciones de células germinales y de Sertoli. Tampoco considera el hecho de que la deficiencia de testosterona sérica basal no se puede equiparar a hipogonadismo en la infancia, ya que las células de Leydig son usualmente inactivas en dicha etapa de la vida. Una definición clínica amplia de hipogonadismo masculino en diferentes períodos de la vida requiere de una consideración global de la fisiología del eje hipotálamo-hipófiso-testicular y de sus posibles alteraciones a lo largo del desarrollo. En este trabajo, proponemos una clasificación ampliada de hipogonadismo masculino basada en la fisiopatología del eje hipotálamo-hipófiso-testicular en los diferentes períodos de la vida. Las características clínicas y bioquímicas del hipogonadismo masculino varían en función de: a) el nivel del eje hipotálamo-hipófiso-testicular afectado inicialmente: central, primario o dual; b) la población de células testiculares inicialmente dañada: disfunción testicular generalizada o disfunción testicular disociada; y c) el período de la vida en que la función gonadal se afecta: fetal o postnatal. En el presente trabajo, destacamos que: la evaluación de la función testicular basal en la infancia y la niñez se basa esencialmente en la evaluación de marcadores de células de Sertoli (AMH e inhibina B); el aumento de las gonadotrofinas no debe ser considerado una condición sine qua non para el diagnóstico de hipogonadismo primario en la infancia; y, por último, que la falta de elevación de gonadotrofinas en adolescentes o adultos con insuficiencia gonadal primaria puede ser indicativa de un hipogonadismo dual por afectación concomitante de las gónadas y del eje hipotálamo-hipofisario.Fil: Rey, Rodolfo Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Grinspon, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Gottlieb, S. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Pasqualini, T.. Hospital Italiano de Buenos Aires; ArgentinaFil: Knoblovits, P.. Hospital Italiano de Buenos Aires; ArgentinaFil: Aszpis, S.. Hospital "Carlos G. Durand"; ArgentinaFil: Pacenza, N.. Unidad Asistencial “Dr. César Milstein “; ArgentinaFil: Stewart Usher, J.. Centro Médico Haedo; ArgentinaFil: Bergadá, I.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Campo, Stella Maris. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; Argentin

An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity

Background: Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence. We carried out a prospective survey on NCGS in Italian centers for the diagnosis of gluten-related disorders, with the aim of defining the clinical picture of this new syndrome and to establish roughly its prevalence compared with celiac disease. Methods: From November 2012 to October 2013, 38 Italian centers (27 adult gastroenterology, 5 internal medicine, 4 pediatrics, and 2 allergy) participated in this prospective survey. A questionnaire was used in order to allow uniform and accurate collection of clinical, biochemical, and instrumental data. Results: In total, 486 patients with suspected NCGS were identified in this 1-year period. The female/male ratio was 5.4 to 1, and the mean age was 38 years (range 3-81). The clinical picture was characterized by combined gastrointestinal (abdominal pain, bloating, diarrhea and/or constipation, nausea, epigastric pain, gastroesophageal reflux, aphthous stomatitis) and systemic manifestations (tiredness, headache, fibromyalgia-like joint/muscle pain, leg or arm numbness, 'foggy mind,' dermatitis or skin rash, depression, anxiety, and anemia). In the large majority of patients, the time lapse between gluten ingestion and the appearance of symptoms varied from a few hours to 1 day. The most frequent associated disorders were irritable bowel syndrome (47%), food intolerance (35%) and IgE-mediated allergy (22%). An associated autoimmune disease was detected in 14% of cases. Regarding family history, 18% of our patients had a relative with celiac disease, but no correlation was found between NCGS and positivity for HLA-DQ2/-DQ8. IgG anti-gliadin antibodies were detected in 25% of the patients tested. Only a proportion of patients underwent duodenal biopsy; for those that did, the biopsies showed normal intestinal mucosa (69%) or mild increase in intraepithelial lymphocytes (31%). The ratio between suspected NCGS and new CD diagnoses, assessed in 28 of the participating centers, was 1.15 to 1. Conclusions: This prospective survey shows that NCGS has a strong correlation with female gender and adult age. Based on our results, the prevalence of NCGS seems to be only slightly higher than that of celiac disease. Please see related article http://www.biomedcentral.com/1741-7015/12/86. © 2014 Volta et al.; licensee BioMed Central Ltd

The pediatric endoscopy practice in Italy: A nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP)

Despite digestive endoscopy is a fundamental tool for pediatric gastroenterologists, an official and standardized program does not exist in Europe. Here, we report the results of a nationwide electronic survey realized on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). This study analyzed for the first time the pediatric endoscopy practice in Italy. Global data about the centers performing endoscopy in children have never been reported in our country. However, the number of participants (44 sites), the high response rate, the geographical distribution (16/20 regions) and the overall number of procedures examined suggest that the present data collection might be a reliable picture of the pediatric endoscopy in Ital

The pediatric endoscopy practice in Italy: A nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP)

Despite digestive endoscopy is a fundamental tool for pediatric gastroenterologists, an official and standardized program does not exist in Europe. Here, we report the results of a nationwide electronic survey realized on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). This study analyzed for the first time the pediatric endoscopy practice in Italy. Global data about the centers performing endoscopy in children have never been reported in our country. However, the number of participants (44 sites), the high response rate, the geographical distribution (16/20 regions) and the overall number of procedures examined suggest that the present data collection might be a reliable picture of the pediatric endoscopy in Ital