Background: To limit the spread of coronavirus disease 2019 , governments have ordered a series of restrictions that may affect glycemic control in individuals with type 1 diabetes mellitus (T1DM), since physical activity (PA) was not allowed outside home. Methods: We retrospectively evaluated glycemic control of individuals with T1DM using hybrid closed loop (HCL) system in the period before the SARS-CoV-2 outbreak in Italy (February 10-23, 2020-Time 1), when movements were only reduced (February 24-March 8, 2020-Time 2) and during complete lockdown (March 9-22, 2020-Time 3). Information about regular PA (at least 3 h per week) prior and during the quarantine was collected. Results: The study included 13 individuals with a median age of 14.2 years and a good glycemic control at baseline (glucose management indicator of 7%, time in range [TIR] of 68%, time below range [TBR] of 2%). All individuals continued to show good glycemic control throughout the study period. There was an increase in TIR during the study period (+3%) and TIR was significantly higher during Time 3 (72%) than during Time 2 (66%). TBR was significantly lower during Time 3 (1%) both compared with Time 1 and Time 2 (2%). A meaningful variance in TIR at Time 3 between individuals who performed or not PA during quarantine and a significant increase in TIR between Time 2 and Time 3 in individuals both doing PA at baseline and during quarantine was found. At logistic regression, only the presence of PA during quarantine significantly predicted a TIR >70%. Conclusions: Glycemic control of T1DM in adolescents using HCL system did not worsen during the restrictions due to COVID-19 pandemics and further improved in those who continued PA during the quarantine. Maintaining regular PA in a safe home environment is an essential strategy for young individuals with T1DM during the COVID-19 crisis.
Highlights A stable or even improved glycemic control was found in adolescents with T1DM using hybrid closed loop system not only during COVID‐19 lockdown but also in the weeks after, when daily activities slowly resumed. Although the slowing down of routine daily activities might still have an influence, we believe that the continuation of the health care professional assistance through telemedicine during lockdown might have led to a “dragging effect” in these patients also after its suspension.
Short stature is a common referral in paediatric endocrinology. The role of the target height (TH) is fundamental in its diagnostic management. In order to investigate for growth hormone deficiency (GHD), one of the clinical criteria in several guidelines is a height <−1.5 standard deviation score (SDS) compared to TH. 1 Despite the importance of reliable measures, the calculation of TH is often entrusted to reported parental heights. Although previous studies showed a substantial error in referred heights, with a trend to overestimate it, 2,3 only two studies assessed the influence of both parents' reported heights on TH 4,5 and none of them, concurrently, considered children's data nor the impact of an inaccurate TH.This observational study aimed to verify whether parents of children referred for short stature tend to overestimate their height more than other parents and to verify how many children could be improperly tested for GHD. 1 | MATERIAL AND ME THODSWe consecutively enrolled 130 individuals referred to the Endocrine Unit of the Institute for Maternal and Child Health 'Burlo Garofolo' when both parents were present, divided into 2 categories (65 trios each) according to the reason for referral (independently from actual height): 'short stature' (SS) and 'no short stature' (noSS). Parents' age, nationality and self-reported height (R-PHt) were recorded after explaining that an accurate estimate of their height was required for their children's medical care. Parents and children were then measured (M-PHt and CHt, respectively) using a Harpenden stadiometer.TH was calculated with the formula: (paternal height + maternal height)/2 −6 for females and +6 for males using Growth Calculator 3 Software, as well as SDS for heights and TH according to Italian reference charts.Due to the nature of the study, we used existing institutional generic ethical approval and informed consent. The study was approved by the Institutional Review Committee (RC33/18).Data were presented as percentages, median and interquartile ranges. Mann-Whitney rank-sum tests and two-tailed Fisher's exact tests were performed to evaluate the relations between variables. Wilcoxon signed-rank test was used to check the differences of paired data. Bivariate and multivariate linear regressions were carried out to study associations between and among independent variables. A P-value < .05 was considered statistically significant.Statistical analysis was conducted using JMP™ software (v.15.1.0). | RE SULTSData on children and parents are reported in Table 1.The overall median discrepancy between R-PHt and M-PHt was 1.2 cm (range −9 ÷ 8.8), 35% of parents having a discrepancy >±2 cm, with no significant differences between mothers and fathers. Parents were concordant in misreporting in 62% of the cases (58% overestimation, 4% underestimation). The median difference between paternal and maternal discrepancy was 0.3 cm (IQR −1 ÷ 1.8) and maternal misreporting prevailed in 54% of the cases.The discrepancy between R-PHt and M-PHt was higher in parents w...
BackgroundEarly onset scoliosis (EOS) can lead to marked spine and chest wall deformity and often to profound cardiopulmonary compromise. Nowadays, treatment benefits from the possibility of a growth-friendly surgical approach to avoid early spinal fusion. Growing rod spinal implants allow maximizing spine and thorax growth during childhood, performing lengthening procedures traditionally approximately every 6 months.MethodsWe retrospectively evaluated 40 patients affected by EOS who underwent growing rod implantations from 2000 to 2020. A 1-year interval between lengthening procedures was adopted. Data about the age at the first and final surgeries, T1-T12 length pre- and post-surgery, T1-S1 pre- and post-surgery, major coronal curve, pre- and post-surgery rate of complications, and unplanned surgeries were collected and compared with those reported in the literature to determinate the effectiveness and safety of this long period between distractions.ResultsThe lengthening procedures were performed, on average, every 12.3 months; children underwent an average of 4.6 lengthening procedures each. Major curve pre-first surgery was 78°, post-first surgery 45°, pre-final surgery 55°, and post-final surgery 43°. The mean absolute difference between pre-initial to post-final major curve was 35°, representing a mean relative difference of 42%. On average, the T1-T12 segment measured 15 cm before the first surgery and 24 cm after the final surgery, while the T1-S1 segment was 25 cm before the growing rods implantation and reached 37 cm after treatment. During treatment, the adverse events affected 27 of the 40 total patients (67%) who experienced at least one complication. No differences were shown concerning both outcomes and complications, comparing these data with the available literature concerning most frequent elongations. This approach avoided four to five surgical procedures in this population.ConclusionOur results related to deformity correction and complication rate are comparable with those found in the literature, where lengthening procedures are performed approximately every 6 months rather than with a 1-year interval between distractions. We also demonstrate a higher risk of complications for patients with implants before the age of 6.
Background C3-glomerulopathy (C3G) is a rare pediatric kidney disease characterised by dysregulation of the alternative complement pathway, with glomerular deposition of C3. C3G may often present as a steroid-resistant nephrotic syndrome (SRNS), and there is no established effective therapy: the usual treatment involves corticosteroids and immunosuppressive drugs. Pioglitazone, a PPAR-γ agonist with a protective action on podocytes, was reported in a few cases as helpful in reducing proteinuria when combined with steroids. Case-Diagnosis/Treatment We report the case of a 13-year-old girl with silent past medical history who presented with SRNS. A kidney biopsy showed findings indicative of C3G. A low sodium diet and angiotensin-converting enzyme inhibitor were started; immunosuppressive treatment with mycophenolate mofetil (MMF) was administered due to the cortico-resistance. Because of poor response to the immunosuppressant, a trial with eculizumab was attempted without significant response and persistence of proteinuria in the nephrotic range. A further therapeutic trial was performed with tacrolimus with no disease remission. Due to a severe deterioration in her condition, the girl was hospitalized and treated with high-dose steroid bolus. A daily dose of oral prednisone and MMF were re-started without benefit with persistent levels of nephrotic range proteinuria. The administration of pioglitazone consistently lowered proteinuria levels for the first time since the onset of the disease, with a maintenance of the effect and normalization (< 0.15 g/24 h) at the 10-month follow-up. Conclusions In this patient affected by C3G, pioglitazone proved effective in reducing proteinuria levels.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.