Minerva pediatrica最新文献

Background: The molecular interactions between killer-cell immunoglobulin-like receptors (KIRs) and their related HLA class I ligands play a central role in regulating the responses of natural killer (NK) cells. Our study aim was to determine the role played by KIR genes and their HLA ligands in the genetic predisposition for the development of hepatotoxicity in children treated with chemotherapy for an oncological process.

Methods: The study group was composed of 22 children with cancer, being treated with chemotherapy at the Unit of Pediatric Oncology of the Maternity Hospital Virgen de las Nieves (Granada, Spain) and presenting signs of drug-induced liver injury (DILI). Twenty-four children receiving similar treatment but presenting no signs of DILI were selected as a control group.

Results: The children with the KIR K2DS2 were four times more likely to have hepatotoxicity (OR=4.08, P=0.034, 95% CI: 1.1-15). The patients with 2DS2 and the C1 ligand were ten times more likely to undergo an episode of hepatotoxicity (P=0.007).

Conclusions: KIRs may be risk factors for susceptibility to hepatotoxicity following chemotherapy.

Background: Movement and physical activity are the natural needs of a living human. Sedentary lifestyle resulting from the development of car communication, improper nutrition, abuse of drugs and addictive substances, constant rush and stress consequently cause destructive health effects. The aim of the study was to analyze risky behaviors among adolescents in the Silesian voivodeship (Poland), taking into account their resistance to stress and physical activity.

Methods: Two hundred eleven people were examined (100%). Among them there were 122 girls (57.82%) and 89 boys (42.18%) aged 16 to 18 years (x=17.3, SD=0.53). The participants were students from upper secondary schools in the Silesian voivodeship. The research tool was an original questionnaire consisting of a metric part, closed questions related to the examined problem and a standardized questionnaire of physical activity (Subjective Experience of Work Load [SEWL]).

Results: Most of the girls (47, 38.52%) considered themselves to be medically resistant to stress, while boys (30, 33.71%) believed they were rather resistant to stress. On the other hand, there was no correlation between susceptibility to stress of adolescents in relation to age. From the whole group, up to 203 people (96.21%) have already drunk alcohol. Among them there were 117 girls (95.90%) and 86 boys (96.63%). The first cigarette from the studied group of teenagers was ignited by 137 people (64.93%), including 80 girls (65.57%) and 57 boys (64.04%), while psychoactive substances have been already taken by 51 participants (24.17%). Among them there were 23 girls (18.85%) and 28 boys (31.46%). There was no correlation between the self-esteem of susceptibility to stress and the use of stimulants in both boys and girls. The average value of the Sport Index among girls was 2.75, while among boys was 6.37.

Conclusions: Boys in comparison to girls considered themselves more resistant to stress, while the age in both sexes did not affect self-assessment of vulnerability to stress. Gender of the adolescents did not affect the frequency of stimulants use.

Background: The selection of drugs as third-line therapy for patients with Kawasaki disease (KD) who are resistant to second-line therapy remains controversial.

Methods: We reviewed the medical records of 354 patients (216 males/137 females) with KD who were treated in our department from July 2003 to January 2016. The age range was 1 month to 10 years, and the median age was 2 years and 1 month. A combination of 2 g/kg intravenous immunoglobulin (IVIG) plus 30 mg/kg of aspirin was used as first-line therapy. Patients who were refractory to the first-line therapy were administered 2 mg/kg of prednisolone (PSL) in combination with IVIG. Five patients who were refractory to the second-line therapy were treated with cyclosporine A (CsA) combined with PSL as the third-line therapy.

Results: All five patients immediately responded to the third-line therapy. One of the five patients showed a transient dilatation of the coronary artery that regressed to its normal size by the 60^th day of illness.

Conclusions: We suggest that the combination of CsA and steroids might be a promising therapeutic strategy for refractory KD.

Background: Bronchiolitis is the most frequent lower airway infection leading hospitalization in children younger than 2 years. RSV is the typical common cause, followed by rhinovirus. Criteria for Pediatric Intensive Care Unit (PICU) admission are not defined by guidelines.

Methods: A retrospective analysis of children with severe bronchiolitis admitted from 2013 to 2016 to our PICU was performed to identify the risk factors associated with intubation in this population. Fourteen variables were studied: sex, weight, age, nationality, provenience, duration of symptoms, risk factors for bronchiolitis development, recurrence, apnea, SpO2 in air, Modified Wood's Clinical Asthma score (M-WCAS), microbiological results, medical treatment, CPAP therapy. The relationship between these variables and the need for mechanical ventilation were explored using univariate and multivariate logistic regression analysis. A ROC analysis was used to identify cut-off for the continuous variables identified as risk factors for intubation in multivariate analysis.

Results: We enrolled 93 patients: 19 of them (20.4%) were intubated. Univariate and multivariate analysis demonstrated that a M-WCAS Score ≥7, SpO2 ≤75% and apnea were significantly associated to intubation in children with severe bronchiolitis.

Conclusions: Cut-off values of the variables identified as risk factors for intubation may represent an important tool for pediatricians to decide a prompt and appropriate intensive respiratory support.

Background: In 12.5-56% of extremely low birth weight (ELBW) infants treated in newborn units, acute kidney injury (AKI) develops. Some of these infants may need renal replacement therapy for several reasons including hyperkalemia, hypovolemia and resistant acidosis.

Methods: All ELBW infants who were followed in our hospital between January 2015 and December 2017 and who lived longer than 48 hours were assessed. Patients were followed for AKI and peritoneal dialysis (PD).

Results: AKI developed in 25 of 201 ELBW infants. PD was administered to nine patients. PD was initiated at a median of 11 days (2-22 days) for all patients due to hyperkalemia which did not respond to medical treatment. Three of the nine infants who received PD died while dialysis was ongoing. The remaining six patients completed PD successfully. In these patients, the serum potassium value returned to normal in three days, and dialysis was continued for a median of 93 hours (40-172 hours). Dialysis leakage occurred in two patients, and hyperglycemia developed in two patients. On average, diuresis started at the 25^th hour (8-40^th hour).

Conclusions: In the renal failure treatment of ELBW infants, PD is the only option which can be used for many units. It was found that in ELBW infants, who had wider peritoneal surface when compared to their body weight, biochemical values recovered rapidly with PD, and diuresis started a short while later in most patients.

Background: Literature states that parents of individuals affected by autism spectrum disorder (ASD) can present social and cognitive deficits, restricted behavior patterns and psychiatric difficulties, without meeting standard diagnostic criteria for ASD ("broader autism phenotype"). We explored the relationship between parenting of children affected by ASD and levels of empathy and lack of emotion understanding (alexithymia).

Methods: We enlisted 58 families in which a child was affected by ASD. Parents' empathy and alexithymia were respectively assessed by means of Empathy Quotient (EQ) and Toronto Alexithymia Scale (TAS-20). Additionally, we included the assessment of the perception of children's behavior through the Child Behavior Checklist (CBCL).

Results: Our findings suggest that most parents have normal empathy and do not show significant alexithymia. We found lower EQ and higher TAS-20 scores being more frequent in fathers. Moreover, each parent's empathy degree negatively relates to his/her alexithymia and vice versa, showing that these two features are inversely correlated. Our study unveiled a strong correlation between maternal empathy and alexithymia and child's externalizing problems, as reported by mothers.

Conclusions: Our data reveal differences in mothers and fathers' empathy and alexithymia profiles and confirm the importance of considering both parents' points of view either in the diagnostic and the therapeutic interventions. Parental empathy and alexithymia levels not only play a fundamental role in the evaluation of child's difficulties but can also influence the development of a good relationship with the child for what concerns affective resonance.