Archivio istituzionale della ricerca - Università dell'Insubria
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Neonatal Food Protein-Induced Enterocolitis: Current Insights and Knowledge Gaps
No full textAcute and chronic Food Protein-Induced Enterocolitis Syndrome (FPIES) has been well characterized in children; otherwise, neonatal FPIES (N-FPIES) remains poorly understood. In terms of pathophysiology, neonatal FPIES appears to have a more prevalent TH2 response and is characterized by specific clinical features that make the diagnosis challenging. Genetic and environmental risk factors may predispose to the development of FPIES. Recent evidence indicates that a characteristic microbiota signature may lead to barrier dysfunction, reduced regulatory T cells, and abnormal intestinal production of serotonin, responsible for the symptoms of FPIES. Regarding clinical presentation, newborns with FPIES may not fully meet the current guideline’s diagnostic criteria at disease onset, being more similar to clinical entity specific of neonatal age than to acute FPIES in infants and children. Hence, differentiation from other neonatal medical and surgical conditions—particularly necrotizing enterocolitis (NEC)—remains a critical challenge for clinicians. This present review highlights our current understanding of N-FPIES, in term of pathophysiology, clinical presentation diagnosis, and treatment strategies. Refining diagnostic criteria for N-FPIES represents a clinical priority to help physicians in diagnosing and managing this challenging condition. Last, but not least, larger clinical trials are needed to optimize treatment practices in term and preterm newborns with FPIES
Piccolo viaggio nel mondo del libro insubre: la libreria antiquaria Spalavera tra città, laghi e montagne.
No full textAssessing the Reliability of 12- vs 24-Hour Esophageal pH-Impedance Monitoring for Gastroesophageal Reflux in Infants
No full textINTRODUCTION: – The recommended duration of esophageal multichannel intraluminal impedance pH (MII-pH) monitoring to detect gastroesophageal reflux (GER) is currently 24 hours. This prolonged recording can be challenging in certain circumstances. We aimed to assess the diagnostic reliability of 12- vs 24-hour MII-pH in infants.METHODS: – Retrospective multicenter study assessing MII-pH tracings from infants referred for suspect gastroesophageal reflux disease (GERD). Each MII-pH was analyzed twice as full-time recording and in the first 12 hours, and data were compared. GERD was diagnosed if one of the following occurred: number of GER episodes ≥100 in 24 hours, proximal GER episodes >44 (acid) or 57 (nonacid), reflux index (percent time with pH < 4) >7%, Bolus Exposure Index >2.4%, Bolus Clearance Time >18 seconds, Symptom index ≥50%, and Symptom Association Probability ≥95%. Univariate analysis was performed to compare MII-pH data.RESULTS: – One hundred twenty-seven infants were studied. The median age at MII-pH was 61 days (interquartile range-IQR 27–116), and 49 were born preterm. There were no significant differences between the 12- and the 24-hour analysis regarding the number of total GER and proximal GER events/hr, reflux index, Bolus Exposure Index, Bolus Clearance Time, positive Symptom index/Symptom Association Probability. GER events lasting >5 min/hr were 1.97 ± 0.27 and 1.83 ± 0.44, respectively (P < 0.001). The 12-hour MII-pH recording showed 87.7% sensitivity, 75.6% specificity, 89.7% positive predictive value, and 71.7% negative predictive value for GERD compared with 24-hour MII-pH.DISCUSSION: – Twelve-hour MII-pH had a good diagnostic performance compared with 24-hour recording. Only GER events lasting >5 minutes were significantly different between the 2, but the clinical significance of this observation is unclear
Il cinema e la televisione possono cambiare la perceazione della società nei confronti della disabilità?
No full textWhen the medical history does not help... keep an eye on the clinical signs (and the spleen)
No full textThe case of a 15-year-old girl with Epstein-Barr virus infectious mononucleosis complicated by splenomegaly and traumatic splenic rupture with haemoperitoneum is described. She was treated with splenic embolization, blood transfusion, antibiotic therapy and vaccination/antibiotic prophylaxis for hyposplenism
Therapy-Induced Metastatic Melanoma During Treatment With Encorafenib and Cetuximab for BRAF-Mutated Colorectal Cancer: A Case Report and Short Literature Review
No full text• BRAF inhibitor therapy, due to paradoxical activation of the MAPK pathway (RAS-RAF-MEK-ERK), can lead to the development of melanomas and new nevi. • Patients with BRAF-mutated metastatic colorectal cancer may benefit from combined BRAF and MEK inhibitor therapy. • A pretreatment dermatologic evaluation is recommended for all patients. • Patients at high risk for melanoma (eg, positive family history, Fitzpatrick skin phototype I-II, or presence of atypical nevi) may benefit from a preventive surgical approach
Intra-patient comparison of trapeziectomy with LRTI and dual mobility prosthesis for trapeziometacarpal osteoarthritis: a multicenter observational study
No full textPurpose: Thumb osteoarthritis is a debilitating condition that affects a large portion of the elderly population. Conservative treatments for this condition often fail, and a surgical solution is required. Many different surgical techniques have been described, but the current literature has not yet demonstrated the superiority of one over the others. In this study, we analyzed the clinical and radiological findings of a population of 26 patients who were operated on both hands but with different techniques. Methods: One hand underwent trapeziectomy with suspension arthroplasty, while the other hand was operated on with a double mobility trapeziometacarpal prosthesis. Results: Our findings show that, while on the long-term follow-up the two techniques are equally valid, in the short term, the hands that were operated on with the prosthesis had a faster recovery of strength and pain. Conclusion: Therefore, we reckon that double mobility trapeziometacarpal prostheses are a better choice of treatment, especially for patients who require a faster recovery for work or leisure activities