Antiemetics for children with gastroenteritis: off-label but still on in clinical practice

Antiemetics are not included for treatment of vomiting associated with acute gastroenteritis (AGE) in children by standard guidelines. We performed a survey to determine antiemetic prescribing rates by Italian pediatricians. A structured questionnaire was distributed at a pediatric national conference. The majority of responders reported prescribing antiemetics for pediatric gastroenteritis. Although there is insufficient evidence to justify their use, the use of antiemetics is widely present among pediatricians.     

Vaccine Hesitancy and Fear of COVID-19 Among Italian Medical Students: A Cross-Sectional Study

Journal of Community Health - Medical students are in close contact with patients and should adhere to the same recommendations as healthcare workers. The study aimed to explore medical...     

Physical activity and sports participation in children and adolescents with type 1 diabetes mellitus

Background and aimRegular physical activity is of great importance in the management of type 1 diabetes mellitus (T1DM). We investigate here the levels of moderate/vigorous physical activity (MVPA) and participation in sporting activity in a sample of children and adolescents with T1DM and analyse whether they differed from healthy subjects. The family variables associated with MVPA or sports participation and the influence of exercise on metabolic parameters are also explored.Methods and resultsIn this cross-sectional case control study, 138 children and adolescents with T1DM (of which 67 were boys, age 13.6 ± 4.1 years; duration of diabetes 6.1 ± 3.8 years) and 269 (of which 120 were boys) healthy controls were studied. Weekly levels of MVPA and sports participation were investigated using a questionnaire. Body mass index standard deviation score (BMI-SDS) values, plasma total cholesterol, serum triglycerides and the mean glycated haemoglobin (A1c) levels over the past year were assessed in T1DM subjects. MVPA scores in T1DM patients were lower than in controls (p = 0.0004). MVPA was higher in boys than in girls, both in diabetic and control subjects; T1DM girls were less frequently engaged in MVPA than control girls. MVPA scores were significantly and independently correlated with sex, age and diabetic status. Lower triglyceride levels and fewer subjects with poor metabolic control were found more among physically active patients (MVPA > 5 days/week) than in inactive patients (weekly MVPA = 0). Sports participation was lower in T1DM patients than in controls (p = 0.002) and was significantly and independently correlated with sex, father's education level and diabetic status. Triglyceride levels and the percentage of subjects with poor metabolic control were significantly lower in sports participants than in non-participants.ConclusionsChildren and adolescents with T1DM appeared to spend less time in physical activity than their non-diabetic peers. Regular physical activity was associated with better metabolic control and lipid profile. Adolescents, particularly the girls, tended to be less active. Further efforts should be made to motivate patients with type 1 diabetes.     

Trasferrin receptor 2 gene regulation by microRNA 221 in SH-SY5Y cells treated with MPP as Parkinson's disease cellular model

Parkinson's disease (PD) is one of the most frequent human neurodegenerations. The neurodegeneration in PD is related to cellular iron increase but the mechanisms involved in iron accumulation remain unclear. Transferrin receptor type 2 (TFR2) is a protein expressed on cell membrane and involved in the cellular iron uptake. We hypothesized that microRNA 221 could regulate the expression of TfR2 in an in vitro model of Parkinson's disease, SH-SY5Y cells treated with MPP⁺.     

Neuroticism-Anxiety, Impulsive-Sensation Seeking and autonomic responses to somatosensory stimuli.

This study focused on autonomic responding in participants who scored high vs. low on the Neuroticism-Anxiety (N-Anx) and Impulsive-Sensation Seeking (Imp-SS) dimensions of the Zuckerman-Kuhlman Personality Questionnaire--Form III. Participants were presented with series of tones (standards, deviants and novels) and they received a mild electric shock (one, two or three pulses) at each 15th tone. Resting pre-stimulus skin conductance level (SCL) and heart rate (HR) level was recorded, as well as the skin conductance response (SCR) and (anticipatory) HR response to the electric stimuli. The autonomic measures differentiated between high- vs. low Imp-SS participants but failed to discriminate between high- vs. low N-Anx participants, with the exception that high N-Anx participants showed smaller SCRs on some trials compared to the low N-Anx participants. High Imp-SS had a lower pre-stimulus SCL and smaller SCRs to deviant stimuli compared to low Imp-SS participants. Additionally, their HR acceleration was smaller in anticipation of the first and the deviant tones whereas their deceleratory response was larger relative to the HR changes observed for the low Imp-SS participants. This pattern of findings was taken to suggest that high Imp-SS participants are more arousable and less prone to defensive reactions to novel or aversive stimulation.     

Complementary Feeding Caregivers’ Practices and Growth,Risk of Overweight/Obesity,and Other Non-Communicable Diseases: A Systematic Review and Meta-Analysis

Several institutions propose responsive feeding (RF) as the caregivers’ relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers’ feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4–24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning’s or Baby-Led Introduction to SolidS’ (BLISS) positive influence on children’s weight–length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child’s meals by an adult represents the most important risk factor; no cause–effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life.     

Dietary ω-3 fatty acids protect against vasculopathy in a transgenic mouse model of sickle cell disease

The anemia of sickle cell disease is associated with a severe inflammatory vasculopathy and endothelial dysfunction, which leads to painful and life-threatening clinical complications. Growing evidence supports the anti-inflammatory properties of ω-3 fatty acids in clinical models of endothelial dysfunction. Promising but limited studies show potential therapeutic effects of ω-3 fatty acid supplementation in sickle cell disease. Here, we treated humanized healthy and sickle cell mice for 6 weeks with ω-3 fatty acid diet (fish-oil diet). We found that a ω-3 fatty acid diet: (i) normalizes red cell membrane ω-6/ω-3 ratio; (ii) reduces neutrophil count; (iii) decreases endothelial activation by targeting endothelin-1 and (iv) improves left ventricular outflow tract dimensions. In a hypoxia-reoxygenation model of acute vaso-occlusive crisis, a ω-3 fatty acid diet reduced systemic and local inflammation and protected against sickle cell-related end-organ injury. Using isolated aortas from sickle cell mice exposed to hypoxia-reoxygenation, we demonstrated a direct impact of a ω-3 fatty acid diet on vascular activation, inflammation, and anti-oxidant systems. Our data provide the rationale for ω-3 dietary supplementation as a therapeutic intervention to reduce vascular dysfunction in sickle cell disease.     

No evidence of circulating autoantibodies against osteoprotegerin in patients with celiac disease

AIM: To investigate risk factors for low bone mineral density (BMD) in celiac disease (CD) patients, focusing on circulating autoantibodies against osteoprotegerin (OPG).METHODS: Seventy asymptomatic CD adult patients on gluten-free diet (GFD) and harbouring persistent negative CD-related serology were recruited. Conventional risk factors for osteoporosis (e.g., age, sex, menopausal status, history of fractures, smoke, and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry. Serum calcium and parathyroid hormone (PTH) levels were evaluated. Thirty-eight patients underwent repeat duodenal biopsy. Serum samples from a selected sub-group of 30 patients, who were also typed for human leukocyte antigen (HLA) DQ2 and DQ8 haplotype, were incubated with homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation.RESULTS: Despite persistent negative CD-related serology and strict adherence to GFD, 49 out of the 70 (74%) patients displayed low BMD. Among these patients, 13 (24%) showed osteoporosis and 36 (76%) osteopenia. With the exception of age, conventional risk factors for osteoporosis did not differ between patients with normal and low BMD. Circulating serum calcium and PTH levels were normal in all patients. Duodenal mucosa healing was found in 31 (82%) out of 38 patients who underwent repeat duodenal biopsy with 20 (64%) still displaying low BMD. The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6 (84%) showing low BMD. No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for, independent of BMD, duodenal histology, and HLA status.CONCLUSION: If any, the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.     

In Vivo and in Vitro Efficacy of Octreotide for Treatment of Enteric Cryptosporidiosis

Previous evidence suggested a role of enterotoxin in the pathophysiology of cryptosporidiosis. If so, antisecretory drugs should be effective in reducing diarrhea. We evaluated the in vivo and in vitro efficacy of octreotide, which possesses antisecretory effects, for cryptosporidial diarrhea. Two children with severe cryptosporidial diarrhea were treated with octreotide. The volume modifications and chemical composition of stools were determined. Fecal supernatant was added to Caco-2 cell monolayers mounted in Ussing chambers with or without serosal octreotide and electrical parameters were monitored. Octreotide was effective in reducing the stool volume and fecal Na concentration. Fecal supernatant induced an enterotoxin-like increase in transepithelial potential difference. Octreotide induced a dosedependent decrease in basal potential difference, consistent with an absorptive effect. In cells pretreated with octreotide, fecal supernatant induced an increase in the potential difference, whose magnitude and duration were significantly reduced compared to untreated cells. These results provide in vivo and in vitro evidence for the secretory nature of cryptosporidial diarrhea and for the efficacy of octreotide through a direct interaction with the enterocyte.