1,721,006 research outputs found
Corticosteroids in pediatric endocrinology
No full textThis comprehensive volume provides current state of the art of the use of corticosteroids in the pediatric patient. It consists of 14 chapters written by leading authors from different countries. The first chapters cover historical notes, general concepts on treatment with corticosteroids with regard to indications and side effects, and basic pharmacologic properties of these compounds. The rest of the book is devoted to the specific use of steroids in the different pediatric subspecialties. Despite advances with newer effective immunosuppressive and anti-inflammatory drugs, corticosteroids still remain the mainstay of therapy for many disorders. Leading authors in their field have summarized these concepts to provide an authoritative, comprehensive guide to help clinicians safely and effectively use corticosteroids in their pediatric patients
Metabolic dysfunction-associated fatty liver disease in obese youth with insulin resistance and type 2 diabetes
No full textPurpose of review: The aim of this review is to present the new definition of the disease, defining the epidemiology, risk factors with a particular attention to the role of insulin resistance (IR) and to define the main treatments explored. Recent findings: Nonalcoholic fatty liver disease (NAFLD) was previously considered a primary liver disease, but it would be more correct to consider it a component of the metabolic syndrome (MetS) in which IR might play a key role. Based on these findings, it has been recently proposed to modify the classic term of NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) that better reflects the pathophysiology of this complex disease. Summary: Currently, no treatments approved in childhood are available, thus the only recommended approach is the prevention and correction of the known risk factors, and particularly of IR. However, further studies are needed to better clarify the pathogenetic mechanisms of NAFLD in order to establish more tailored therapies
Evaluation of Bone Age in Children: A Mini-Review
Full text linkBone age represents a common index utilized in pediatric radiology and endocrinology departments worldwide for the definition of skeletal maturity for medical and non-medical purpose. It is defined by the age expressed in years that corresponds to the level of maturation of bones. Although several bones have been studied to better define bone age, the hand and wrist X-rays are the most used images. In fact, the images obtained by hand and wrist X-ray reflect the maturity of different types of bones of the skeletal segment evaluated. This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute and chronic pathologies especially hormone alteration. As well several differences can be characterized according to the numerous standardized methods developed over the past decades. Therefore, the complete characterization of the main methods and procedure available and particularly of all their advantages and disadvantages need to be known in order to properly utilized this information for all its medical and non-medical main fields of application
Metabolic disorders in young people around the world
Full text linkYouth-onset metabolic diseases, including obesity and type 1 and type 2 diabetes, and their associated cardiometabolic complications represent a major global health challenge. The incidence and prevalence of these conditions vary across regions, with rising trends and a heavier burden observed in middle- and low-income countries. Diet, physical activity and lifestyle choices are key factors in the development and progression of metabolic diseases during childhood and adolescence, along with additional risk factors such as genetic predisposition, ancestry, ethnicity, lifetime events (i.e. puberty) and other environmental factors. Disparities in access to healthcare, diagnostic and management capabilities and treatment options across the world affect outcomes, contributing to high morbidity and mortality rates, particularly in low-resource settings. Compared with onset during adulthood, an early diagnosis of metabolic diseases is associated with a higher risk and severity of complications, including adverse vascular outcomes and premature mortality. Although clinical signs of cardiovascular complications typically appear in adulthood, they are the result of a long, subclinical disease process that can begin in childhood and adolescence. This underscores the need for early prevention strategies and effective treatments to reduce the short- and long-term health impacts of these conditions. Addressing the rising prevalence of metabolic diseases, especially among vulnerable populations, requires comprehensive, culturally tailored actions that consider the available resources in diverse settings
Effects of COVID-19 time on the development of pre-impaired glucose tolerance state in children and adolescents with overweight and obesity
No full textObjectivesWe aimed to characterize the effects of COVID-19 Pandemic on 2 h plasma glucose (2 h PG) values after an OGTT postulating a correlation between 2 h PG spectrum and the decline of & beta;-cell function. Particularly, we tried to evaluate the effects on the risk of showing 2 h plasma glucose values in the highest range of normal values in children and adolescent with obesity during COVID-19 Pandemic compared to those evaluated during the 13 years before.Subjects/MethodsData from 532 children and adolescents with obesity and overweight (before COVID-19 Pandemic, 209M/262F, 2008-2019; during COVID-19 Pandemic, 40M/21F, 2020-2021) who had undergone a complete evaluation and had performed an OGTT were analyzed. The two groups were further divided into three sub-groups based on the 2 h PG, group 1 (2 h PG < 5.55 mmol/L), group 2 (5.56 < 2 h PG < 6.60 mmol/L), group 3 (6.61 < 2h PG < 7.72 mmol/L), respectively. The prevalence of 2 h PG values distribution in children was evaluated between before and during COVID-19 Pandemic period and the main differences between the two groups 3 of each period were analyzed.ResultsA significant difference (P = 0.01) in terms of distribution of the prevalence of 2h PG values was documented between the group before COVID-19 (35.6%, 45.9% and 18.5%) and the group during COVID-19 Pandemic (31.1%, 31.1% and 37.8%). A roughly doble higher prevalence of subjects with pre-IGT was documented in the COVID-19 group. In addition, group 3 of COVID-19 time showed significantly higher values for waist circumference (WC), Waist/Height ratio (WtHR), fasting glucose and HOMA-IR compared to the group 3 of the period before COVID-19 Pandemic (all P < 0.05).ConclusionsDuring COVID-19 time a higher percentage of children are in the highest range of normal 2 h PG values which is known to be associated with a significant impairment of & beta;-cell function and insulin sensitivity and have higher risk of developing IGT
Growth Abnormalities in Children with Type 1 Diabetes, Juvenile Chronic Arthritis, and Asthma
Full text linkChildren and adolescents with chronic diseases are commonly affected by a variable degree of growth failure, leading to an impaired final height. Of note, the peculiar onset during childhood and adolescence of some chronic diseases, such as type 1 diabetes, juvenile idiopathic arthritis, and asthma, underlines the relevant role of healthcare planners and providers in detecting and preventing growth abnormalities in these high risk populations. In this review article, the most relevant common and disease-specific mechanisms by which these major chronic diseases affect growth in youth are analyzed. In addition, the available and potential targeting strategies to restore the physiological, hormonal, and inflammatory pattern are described
Weight gain and insulin resistance in children treated with valproate: The influence of time
No full textThis study was undertaken in 2 parts to investigate the relationship between body size and insulin resistance during treatment with valproic acid in children. The cross-sectional part revealed differences in terms of body size and homeostasis model assessment of insulin resistance, which were higher in the group on medication. The longitudinal part showed a major increase in body size and insulin resistance during the first year of therapy. There was a subsequent decrease in insulin resistance in association with the rise of body size, however with a trend to level off. These results might be helpful to enhance the knowledge of valproic acid action on both insulin resistance and weight gain, allowing to plan appropriate approach for the prevention of the consequences of the treatment with valproic acid. © The Author(s) 2010
Cardiovascular Risk in Childhood Cancer Survivors
Full text linkCancer is a prominent cause of death worldwide in the pediatric population. Since childhood cancer is not possible to prevent, it is essential to focus on a prompt and correct diagnosis followed by effective, evidence-based therapy with individualized supportive care. Given the enhancement of childhood cancer management over the past decades, survival rate has significantly improved, thus leading to the progression of several late effects, including metabolic derangements. These metabolic imbalances are associated with the underlying disease and the cancer treatments. As a result, the metabolic state may contribute to a high risk of cardiovascular morbidity and premature mortality among childhood cancer survivors. This review aims to summarize the potential pathophysiological mechanisms linked to the risk of diabetes and metabolic syndrome and screening recommendations. Further investigations are needed to clarify the underlying mechanisms of such metabolic abnormalities and to improve long-term cardiometabolic survival among these patients
MAFLD and Celiac Disease in Children
Full text linkCeliac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten whose clinical presentation ranges from the asymptomatic form to clinical patterns characterized by multiple systemic involvement. Although CD is a disease more frequently diagnosed in patients with symptoms of malabsorption such as diarrhea, steatorrhea, weight loss, or failure to thrive, the raised rate of overweight and obesity among general pediatric and adult populations has increased the possibility to diagnose celiac disease in obese patients as well. Consequently, it is not difficult to also find obesity-related disorders in patients with CD, including “metabolic associated fatty liver disease” (MAFLD). The exact mechanisms linking these two conditions are not yet known. The going assumption is that a gluten-free diet (GFD) plays a pivotal role in determining an altered metabolic profile because of the elevated content of sugars, proteins, saturated fats, and complex carbohydrates, and the higher glycemic index of gluten-free products than gluten-contained foods, predisposing individuals to the development of insulin resistance. However, recent evidence supports the hypothesis that alterations in one of the components of the so-called “gut–liver axis” might contribute to the increased afflux of toxic substances to the liver triggering the liver fat accumulation and to the subsequent hepatocellular damage. The aim of this paper was to describe the actual knowledge about the factors implicated in the pathogenesis of hepatic steatosis in pediatric patients with CD. The presented review allows us to conclude that the serological evaluations for CD with anti-transglutaminase antibodies, should be a part of the general workup in the asymptomatic patients with “non-alcoholic fatty liver disease” (NAFLD) when metabolic risk factors are not evident, and in the patients with steatohepatitis when other causes of liver disease are excluded
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