28 research outputs found
Delayed puberty versus hypogonadism: a challenge for the pediatrician
No full textConstitutional delay of growth and puberty (CDGP) is the most common cause of delayed puberty (DP), is mainly found in males, and is characterized by short stature and delayed skeletal maturation. A family history of the subject comprising the timing of puberty in the parents and physical examination may provide clues regarding the cause of DP. Delayed onset of puberty is rarely considered a disease in either sex. In fact, DP usually represents a common normal variant in pubertal timing, with favorable outcomes for final height and future reproductive capacity. In adolescents with CDGP, a linear growth delay occurs until immediately before the start of puberty, then the growth rate rapidly increases. Bone age is often delayed. CDGP is a diagnosis of exclusion; therefore, alternative causes of DP should be considered. Functional hypogonadotropic hypogonadism may be observed in patients with transient delay in hypothalamic-pituitary-gonadal axis maturation due to associated conditions including celiac disease, inflammatory bowel diseases, kidney insufficiency, and anorexia nervosa. Permanent hypogonadotropic hypogonadism (pHH) showing low serum value of testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Therefore, magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Moreover, pHH may be isolated, as observed in Kallmann syndrome, or associated with other hormone deficiencies, as found in panhypopituitarism. Baseline or gonadotropin-releasing hormone pituitary stimulated gonadotropin level is not sufficient to easily differentiate CDGP from pHH. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism. A genetic analysis can reveal a chromosomal abnormality (e.g., Turner syndrome or Klinefelter syndrome). In cases where the adolescent with CDGP is experiencing psychological difficulties, treatment should be recommended
Delayed puberty versus hypogonadism: A challenge for the pediatrician
No full textConstitutional delay of growth and puberty (CDGP) is the most common cause of delayed puberty (DP), is mainly found in males, and is characterized by short stature and delayed skeletal maturation. A family history of the subject comprising the timing of puberty in the parents and physical examination may provide clues regarding the cause of DP. Delayed onset of puberty is rarely considered a disease in either sex. In fact, DP usually represents a common normal variant in pubertal timing, with favorable outcomes for final height and future reproductive capacity. In adolescents with CDGP, a linear growth delay occurs until immediately before the start of puberty, then the growth rate rapidly increases. Bone age is often delayed. CDGP is a diagnosis of exclusion; therefore, alternative causes of DP should be considered. Functional hypogonadotropic hypogonadism may be observed in patients with transient delay in hypothalamic-pituitary-gonadal axis maturation due to associated conditions including celiac disease, inflammatory bowel diseases, kidney insufficiency, and anorexia nervosa. Permanent hypogonadotropic hypogonadism (pHH) showing low serum value of testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Therefore, magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Moreover, pHH may be isolated, as observed in Kallmann syndrome, or associated with other hormone deficiencies, as found in panhypopituitarism. Baseline or gonadotropin-releasing hormone pituitary stimulated gonadotropin level is not sufficient to easily differentiate CDGP from pHH. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism. A genetic analysis can reveal a chromosomal abnormality (e.g., Turner syndrome or Klinefelter syndrome). In cases where the adolescent with CDGP is experiencing psychological difficulties, treatment should be recommended
Increasing trend of type 1 diabetes incidence in the pediatric population of the Calabria region in 2019–2021
No full textBACKGROUND: Although type 1 diabetes (T1D) represents one of the most common chronic diseases in pediatric age, few studies on the epidemiology of T1D exist globally and the exact prevalence and incidence rates of the disease are unknown. In many countries, including Italy, national registries are missing. METHODS: This study aims to assess T1D incidence in the pediatric population of the Calabria region (southern Italy) in the period 2019–2021. The secondary objective was to describe the main demographical, clinical and immunological features of incident cases. Case ascertainment and all clinical data were assessed by retrospectively reviewing the electronic medical records of children and adolescents diagnosed with diabetes at any Pediatric Diabetes Center belonging to the Rete Diabetologica Calabrese (Calabria Region Diabetes Network), from January 2019 to December 2021. The incidence of T1D was estimated for the entire region and was stratified according to age group (0–4 years, 5–9 years, and 10–14 years) and gender. Standardized incidence ratios for each province in the region were also calculated. RESULTS: The crude incidence of T1D was 20.6/100,000 person/years. Incidence rates were higher among females and children aged 5–9 years. The crude incidence of T1D was higher in the province of Reggio Calabria (26.5/100,000 person-years). The provinces of Crotone, Catanzaro, and Vibo Valentia showed significantly lower standardized incidence ratios. The annual incidence in the region progressively increased by 43% during the study period. CONCLUSIONS: Our study revealed a relatively high incidence in the Calabria region. The marked increasing incidence trend over the past two years could be related to the global impact of the COVID-19 pandemic, but further long-scale population-based studies are needed to confirm these findings
Sustainable Microgrid for charging electric vehicles from on-road contactless power transfer systems
No full textA sustainable microgrid for supplying power to electric vehicles (EVs) is investigated in this thesis. The energy produced by the microgrid would be directly transferred to the electric vehicles via on-road charging systems. The proposed sustainable microgrid is located on the roadside and consists of wind turbines, solar panels and a stationary storage system. The optimum sizing, the topology and the power management are discussed. Both the grid-connected and the stand-alone options are investigated. The on-road chargers consist of Contactless Power Transfer (CPT) systems for powering electric vehicles without any physical interconnection. The concept of CPT systems is similar to an air-cored transformer, where the primary winding is installed on the road and the secondary winding below the vehicle’s chassis. The implementation of such on-road charging systems for EV driving range extension and EV battery size decrease is also investigated within this thesis.Sustainable Energy TechnologyElectrical Power EngineeringElectrical Engineering, Mathematics and Computer Scienc
Making the invisible visible: A re-activation strategic project starting with the invisible groups and the spatial formation of the area, using a neighborhood as the activator unit
No full textExplore LabUrbanismArchitectur
Comment identifier un autographe : le cas de la Physiologie de Vikentios Damodos
No full textThe topic of the article is the history of a manuscript that provides us with two unedited works of Vikentios Damodos (1700-1754), a philosopher and scholar from Cephalonia, whose life and works have occupied a great part of the research. In this essay the author will attempt to retrace the history of her research and to present the convincing results which led to the only known autograph manuscript to date of the Logic and Physiology of Damodos
Fear and Loaning in Athens: Shifting Perspectives of Space
No full textUrbanismArchitecture and The Built Environmen
Evaluation of an Automated Insulin Delivery System in the Management of Postprandial Glucose Levels During a Pediatric School Camp: The Control-IQ Potato Challenge
No full textBackground: Potatoes are a staple food, especially in pediatric populations, but they pose distinct challenges for individuals with type 1 diabetes (T1D). This study evaluated glycemic responses in youth with T1D using a second-generation automated insulin delivery system after consuming potatoes prepared by two methods: fried and boiled. Methods: The study was conducted during a 5-day school camp for unaccompanied youth with T1D, aged 11-17 years, who had been using the Tandem t:slim X2TM Control-IQ insulin pump for at least 6 months. On two separate days, participants consumed a standardized meal containing 240 g of either fried or boiled potatoes, considered as 38 g of carbohydrates. Continuous glucose monitoring (CGM) data were collected and analyzed for all participants. Results: Our study population consisted of 31 children and adolescents (mean age 14.2 ± 1.7 years). Time in range was slightly higher after consuming boiled potatoes compared with fried potatoes, though the difference was not statistically significant (73.7% vs. 67.8%; P = 0.225). Mean glucose changes from pre-meal to 3-h post-meal were comparable between groups (−34.3 vs. −25.4 mg/dL; P = 0.517). Similarly, no significant differences were observed in the area under the curve of glucose levels. However, the percentage of bolus insulin within the 3-h post-meal period tended to be higher after fried potato consumption (20.7% vs. 11.9%; P = 0.075). Conclusions: Despite differences in glycemic index and fat content, the Tandem t:slim X2 Control-IQ system effectively maintained satisfactory glucose control within the 3-h post-meal period for both fried and boiled potatoes
The archaeology of the clinic: Hippocrates and mania in the books of epidemics I-VII and in the western scientific tradition
No full textThe dissertation examines the role of Hippocrates in the subsequent history of Western Medicine and “Psy” disciplines. Drawing on Foucault’s “toolkit”, it explores the appropriation of Hippocrates by French physicians of the 1790-1815 era. During that time, Hippocrates appears to be (i) the founder of clinical medicine (le fondateur) and a clinical observation genius (au génie observateur), (ii) the author of the exemplary patient reports of Epidemics, (iii) the inventor of a new technical vocabulary and a new language for the description of diseases (qui inventa le langage propre à la méthode descriptive des maladies) and (iv) the model of a new observational method (Hippocrate n'en doit pas moins servir de modèle). Those are all representations brought to life by the pioneers of the ‘Paris School’—a group of clinicians as renowned as Ph. Pinel, M.-Fr.-X. Bichat, P.-J. Desault, J.-L. Alibert, R.-Th.-H. Laennec, P.-J.-G. Cabanis─ in support of their own views. The thesis demonstrates the function of these representations in the pre- and proto- psychological and psychiatric discourse. Sources include Hippocratic treatises (Epidemics I-VII); ancient and modern commentaries; treatises on medical history, meteorology, nosography; neohippocratic writings. The questions asked are: What is the role of Great Authors, like Hippocrates, within a field of knowledge? What could the demand for a "return to Hippocrates” during moments of “complex historical transformation” of a scientific field mean? The first chapter describes the methodological demands of a critical historical analysis, emphasizing (a) the system of concepts, methods, principles whereupon lies the analysis of the function of the "Great Authors" and (b) the elements of the above system used by the study. The second chapter investigates the uses of Hippocrates in the clinical discourse of the pioneers of the Paris School with emphasis on Ph. Pinel, R.-Th.-H. Laennec, P.-J.-G. Cabanis. The third chapter examines the relation of Hippocrates with the famous books of Epidemics which, in the 19th century become a point of reference and a theoretical springboard for clinical research. The fourth chapter examines the relation of Hippocrates with the construction of a new clinical description language and the remoulding of classical nosological categories claiming a «Hippocratic» descent. The fifth chapter examines the relationship of Hippocrates with a complex transformation of medical understanding that brought along «a number of requisites, or references» including «progress in observation», but also new institutions (the clinic) or methods (Analysis) which determined the interaction between the apparatus of Greek medicine and the elements of modern scientific discourse. The dissertation concludes that the European post-medieval “Hippocrates” was less of an actual historical figure and more of an invention of the French clinicians who used the “Father of Medicine” to strengthen their own status quo. The numerous reinventions of the ancient Greek thinker reinforce this hypothesis. One of the most attractive ones, during the 1790-1815 period was the Hippocrates of Francis Bacon’s “De Augmentis Scientiarum” (1623)1: a methodical observer of the natural history of diseases, of data taxonomy, of the deduction of general principles and laws through the study of individual clinical histories. This type became closely related to the appearance of a pivotal idea for the mythology of the modern medical ideal: that of the “médécin observateur”, of an “an empirical vigilance receptive only to the evidence of visible contents” as Foucault will say. As far as its historical documentation is concerned, that was provided by the “Epidemics” books (5th/4th cent. B.C.). The French neo-Hippocratics found in those an “art of observation” (art de bien observer) far from any vain theory (pour toute théorie vaine) and an empirical method of knowledge that could provide a solid scientific foundation to Western medicine. One condition for this method was, as Pétroz admits, the forming of a clinical description language modelled after the ancient Greek one. On this was founded a new knowledge, intended for the protection of “hygiene” and for the medical surveillance of the population —a “medical-administrative” knowledge that will, according to Foucault, form the core of “social economy” or 19th century sociology, and manage to minutely surveil individuals and groups.H Διατριβή εξετάζει τη λειτουργία του «Ιπποκράτη» στην ιστορία των ευρωπαϊκών επιστημών της ιατρικής και των επιστημών του συμπλέγματος «Ψ». Χρησιμοποιώντας ως αφετηρία τις «αρχαιολογικές» έρευνες του Foucault μελετά τις οικειοποιήσεις του Έλληνα Δημιουργού στη μετα-επαναστατική Γαλλία των ετών 1790-1815 (της περιόδου δηλαδή που μεσολαβεί από την έναρξη της Γαλλικής Επανάστασης έως και το τέλος της πρώτης αυτοκρατορίας). Την εποχή αυτή ο Ιπποκράτης εμφανίζεται (i) ως θεμελιωτής (le fondateur) και μεγαλοφυΐα της κλινικής παρατήρησης (au génie observateur), (ii) ως συγγραφέας των υποδειγματικών νοσογραφικών αρχείων των Επιδημιών, (iii) ως ευρετής ενός νέου τεχνικού λεξιλογίου και μιας νέας γλώσσας περιγραφής των ασθενειών (qui inventa le langage propre à la méthode descriptive des maladies) και (iv) ως πρότυπο μιας νέας εμπειρικής μεθόδου (Hippocrate n'en doit pas moins servir de modèle). Πρόκειται για αναπαραστάσεις του Κώου γιατρού που επανενεργοποιούνται από τους εκπροσώπους της Παρισινής Σχολής – μιας πρωτοποριακής ομάδας γιατρών των Ph. Pinel, M.-Fr.-X. Bichat, P.-J. Desault, J.-L. Alibert, R.-Th.-H. Laennec, P.-J.-G. Cabanis─ για να υπηρετήσουν τις σκοπιμότητες και τα συμφέροντα των νέων επιστημών της Κλινικής. Στόχος της εργασίας ήταν να εξετάσει τις αναπαραστάσεις αυτές και να αναδείξει την ιδεολογική τους λειτουργία στη γαλλική κλινική ιατρική, ψυχολογική και ψυχιατρική ρητορική. Προς αυτή την κατεύθυνση χρησιμοποιήθηκε μια ποικιλία πηγών όπως αρχαίες πραγματείες (Eπιδημίες Ι-VII), αρχαία και νεότερα υπομνήματα, ιατρικά- μετεωρολογικά-νοσογραφικά-νεοϊπποκρατικά συγγράμματα. Με βάση το αρχειακό υλικό η εργασία έθεσε δυο ερωτήματα: Πώς λειτουργεί ο μεγάλος Δημιουργός (Ιπποκράτης) στο εσωτερικό ενός κλάδου γνώσης; Τι σημαίνουν τα αιτήματα «επιστροφής σε έναν μεγάλο Δημιουργό» σε κρίσιμες στιγμές ιστορικών μετασχηματισμών; (Foucault, 1969). Τα ερωτήματα αυτά αναλύθηκαν σε πέντε κεφάλαια. Το πρώτο κεφάλαιο της Διατριβής εξέτασε τις μεθοδολογικές απαιτήσεις της κριτικής ιστορικής ανάλυσης του Foucault με έμφαση (α) στο σύστημα των εννοιών, των μεθόδων, των αρχών πάνω στο οποίο θεμελιώνεται η ανάλυση της λειτουργίας των «Μεγάλων Δημιουργών» και (β) στα στοιχεία του ως άνω συστήματος που αξιοποιεί η εργασία. Το δεύτερο κεφάλαιο διερεύνησε τις μορφές της παρουσίας του Ιπποκράτη στον λόγο των αρχηγετών της Παρισινής Σχολής με έμφαση στους Ph. Pinel, P R.-Th.-H. Laennec, P.-J.-G. Cabanis. Το τρίτο κεφάλαιο εξέτασε τη σχέση του Ιπποκράτη με τα διάσημα βιβλία των Ἐπιδημιῶν. Το τέταρτο κεφάλαιο εξέτασε τη σχέση του Ιπποκράτη με τη δόμηση μιας νέας γλώσσας κλινικής περιγραφής και την επανανοηματοδότηση κλασικών νοσολογικών κατηγοριών που διεκδικούν τον 19ο αιώνα μια «ιπποκρατική» καταγωγή. Το πέμπτο κεφάλαιο εξέτασε τη σχέση του Ιπποκράτη με έναν σύνθετο μετασχηματισμό της ιατρικής κατανόησης που φέρνει «μαζί του έναν αριθμό προαπαιτούμενων ή αναφορών» (όπως η πρόοδος της παρατήρησης), αλλά και νέους θεσμικούς τόπους (Κλινική) ή μεθόδους (Ανάλυση) που καθορίζουν τις αμοιβαίες θέσεις και την αλληλενέργεια ανάμεσα στον εξοπλισμό της ελληνικής ιατρικής και στα στοιχεία της νεότερης Γαλλικής Ιατρικής και πρωτο-Ψυχιατρικής. Η Διατριβή κατέληξε στο συμπέρασμα ότι ο Ιπποκράτης της μετα-μεσαιωνικής Ευρώπης δεν ήταν τόσο το ιστορικό πρόσωπο των ελληνικών κλασικών χρόνων όσο μια επινόηση των Γάλλων Κλινικών που χρησιμοποίησαν τον «Πατέρα της Ιατρικής» προς επίρρωση της δικής τους καταστατικής θέσης και οπτικής. Την υπόθεση αυτή ενισχύουν οι πολυάριθμες μεταμορφώσεις του αρχαίου Έλληνα διανοητή. Από αυτές ιδιαίτερη έλξη άσκησε την περίοδο 1790-1815 ο Ιπποκράτης του «De Augmentis Scientiarum» (1623) του Francis Bacon, ο μεθοδικός παρατηρητής της φυσικής ιστορίας των ασθενειών, της ταξινόμησης των δεδομένων, της συναγωγής γενικών αρχών και νόμων μέσω της μελέτης επιμέρους κλινικών ιστορικών ασθενών. Πρόκειται για έναν τύπο που συνδέθηκε στενά με την εμφάνιση ενός κομβικού για τη μυθολογία του νεότερου ιατρικού βλέμματος ιδεώδους, του «médecin observateur», εκείνης «της εμπειρικής επαγρύπνησης που είναι ανοικτή στην προφάνεια των ορατών περιεχομένων και μόνο» όπως θα πει ο Foucault στο «Naissance de la clinique». Στο βαθμό που όφειλε να τεκμηριωθεί ιστορικά, ο τύπος αυτός βρήκε στήριξη στα βιβλία των «Επιδημιών» (5ος/4ος αι. π.Χ.). Σε αυτά οι Γάλλοι νεοϊπποκρατικοί ανακάλυψαν μια «τέχνη του παρατηρείν» (art de bien observer) μακριά από κάθε μάταιη θεωρία (pour toute théorie vaine) και μια εμπειρική μέθοδο γνώσης ικανή να παρέχει μια στέρεη επιστημονική βάση στη Δυτική ιατρική. Προϋπόθεση της μεθόδου αυτής ήταν, όπως ομολογεί ο Pétroz, η διαμόρφωση μιας γλώσσας κλινικής περιγραφής στα πρότυπα της αρχαίας ελληνικής. Σε αυτή θεμελιώθηκε μια νέα γνώση που αποσκοπούσε στην προστασία της «υγιεινής» και στην ιατρική επιτήρηση του πληθυσμού ─ μια «‘ιατρο-διοικητική’ γνώση (savoir ‘médico-administratif’) που θα σχηματίσει, κατά τον Foucault, τον πυρήνα της ‘κοινωνικής οικονομίας’ ή της κοινωνιολογίας του δέκατου ένατου αιώνα και η οποία θα επιτύχει τη διεξοδική παρακολούθηση ατόμων και ομάδων διαμέσου κανονισμών που δεν αφορούσαν μόνο την υγεία αλλά και γενικούς τύπους ύπαρξης ή συμπεριφορών
