BACKGROUND: To compare data obtained through actigraphy with data from parental diaries to evaluate their concordance.METHODS: We enrolled 55 hospitalized infants aged 1-12 months with a gestational age higher than 35 weeks and without sleep disorders, complications due to perinatal events or movement deficits. They were monitored using both methods for 24 hours. Total diurnal and nocturnal sleep times and the numbers of awakenings were evaluated. Actigraph data were analyzed with Sadeh’s algorithm.RESULTS: Sleep time was analyzed in 51 infants. The average sleep time was 724.33 (±104.69) minutes according to the diaries and 625.18 (±109.14) minutes according to the actigraphy data, yielding a difference of 99.16 (±97.53) minutes (p<0.0001). The average number of awakenings was 8.65 (±3.78) according to the diaries and 13.43 (±5.09) according to the actigraphy data, with a difference of -4.78 (±4.50) (p<0.0001). A low concordance (≤0.66) was found between the two methods. The two methods provided different results (p<0.05) regarding nocturnal and diurnal sleep. After accounting for differences in disease and feeding types, the actigraphy and diary data were significantly different except for the number of daily awakenings. Concordances were higher in infants with respiratory diseases and those who were breastfed, except for the evaluation of nocturnal sleep.CONCLUSIONS: Concordance between actigraphy and parental reporting is low. Actigraphy may be a useful and easy to use method for collecting data on infants’ sleep than a parental diary, but actigraphy data should be analyzed in conjunction with infants’ passive movement records.
The use of complementary and alternative medicine (CAM) has not been widely studied among children in Italy. ISTAT-2005 survey showed a prevalence of 10% of children treated with CAM. Most of other contributes were related to Northern populations. The aim of our study was to analyse the rate of CAM use in the children living in Piemonte compared to the children living in Calabria.Data were collected through a structural questionnaire administered to the parents of the children admitted to the pediatric department of the Regional Hospital in Torino, Catanzaro and Cosenza. The questionnaire included questions about the use of CAM and the demographic characteristics of the parents and the child responding.For the study 1156 questionnaires were distributed in total and 1,136 were analyzed. Overall the response rate was more than 98%. In Turin 43% of the children were treated also with CAM, in Cosenza and in Catanzaro 38% and 21%, respectively. The parents who used CAM for their children were more aged and with a higher education. In Turin homeopathy was used more, in the south of Italy phytotherapy was preferred. More acute respiratory diseases were the most frequent diseases treated with CAM. In the majority of cases CAM were prescribed by pediatricians. Most of the people preferred CAM for less side effects and the majority of them declared to be satisfied. Furthermore, this survey shows that parents use CAM as complementary rather than alternative to medicine.Our study remarks as the use of CAM is dramatically increased among the Italian children in the last years as well as in other countries. Pediatricians need to improve their knowledge about CAM in order to better manage parental attitude.
The iron absorption process developsmainly in the proximal duodenum. This portion of the intestine is typically destroyed in celiac disease (CD), resulting in a reduction in absorption of iron and subsequent iron deficiency anemia (IDA). In fact, the most frequent extra-intestinal manifestation (EIM) of CD is IDA, with a prevalence between 12 and 82% (in relation with the various reports) in patients with new CD diagnosis. The primary treatment of CD is the gluten-free diet (GFD), which is associated with adequate management of IDA, if present. Iron replacement treatment historically has been based on oral products containing ferrous sulphate (FS). However, the absorption of FS is limited in patients with active CD and unpredictable in patients on a GFD. Furthermore, a poor tolerability of this kind of ferrous is particularly frequent in patients with CD or with other inflammatory bowel diseases. Normalization from anemic state typically occurs after at least 6 months of GFD, but the process can take up to 2 years for iron stores to replenish.
Studies on the use of revertants to overcome MDR have aroused a great interest even if they failed to prove their actual usefulness. A case of 10 years and 6 months old boy is described. He suffered from osteoblastic osteosarcoma and underwent chemotherapy following CNR-NEO3 protocol, wide surgical resection and postoperative chemotherapy. Nineteen months after diagnosis he underwent the removal of a little subpleural nodule in the right lung. Forty-five days later, in the same site, a large local metastasis was observed together with many others secondaries localizations spred in both lungs. Because of the rapid evolution they were considered not suitable for surgical treatment. A cyclosporine and verapamil treatment in association with adryamicin and etoposide was begun with the aim overcoming multidrug resistance. Five treatments were provided. ECG monitoring during verapamil infusion did not show any trouble; mielotoxicity was mild, with no need of transfusions. A lung CT scan at the end of the therapy demonstrated an important decrease of the subpleural metastasis and the vanishing of lung nodules. Another surgical intervention was provided together with 2 postoperative chemotherapy treatments. Twenty-six months later no sign of the disease was observed. Association of verapamil and cyclosporine with chemotherapy allowed to get a good clinical response with a very low toxicity, in a critical situation in which chemotherapy alone did not seem to offer any real possibility.
Pulmonary toxicity occurs in approximately 10 to 50% of patients undergoing bone marrow transplantation (BMT). Bacterial pneumonia very commonly affects patients within the first 6 months post-BMT. Etiologic factors include neutropenia and the presence of graft-versus-host disease (GVHD). Pulmonary fungal infections, due to candida and aspergillus, may develop in 16% of patients receiving BMT, with a high mortality rate, being about 80%. A prolonged neutropenia as well as GVHD and associated immunosuppressive treatments are important factors in predisposing a patient to develop fungal pneumonitis. Interstitial pneumonitis occurs in 10-40% of patients; herpes viruses are the most commonly documented cause, with cytomegalovirus (CMV) being the most common pathogen. No causative organism is identified in up to 60% of the cases. It is likely that some of these cases may result from drug or radiation toxicity. Lung shielding and fractionation of the dose have decreased the incidence of interstitial pneumonitis to less than 5%. Patients with GVHD are predisposed to lung infections because of the immunosuppression that accompanies GVHD and its treatment. In addition, GVHD itself appears to have a direct effect on pulmonary epithelium. Cultural and serologic studies as well as radiographic investigations and other diagnostic procedures (ie bronchoalveolar lavage) are needed for appropriate management of pulmonary complications.
Retinal vein occlusions (RVOs) are rare in the younger population. Hematological pro-thrombotic factors are thought to be important in a minority, amplifying an atherosclerotic anatomical predisposition.Anotherwise healthy 13-year-old girl presented two episodes of sudden decreased vision in few months.Ophthalmological exams pointed out post-thrombotic intra-retinal hemorrhage. All investigations were normal, thrombophilia screen showed factor XII deficiency and genetic mutations of methylenetetrahydrofolate reductase (MTHFR), angiotesin convertin enzyme (ACE) and angiotensinogen (AGT). Two intravitreal injection of bevacizumab was administered with improving visual acuity; subsequently the patient did not report further episodes.In addition to traditional factors with procoagulant activity, factor XII deficiency plays an important role in thrombosis's mechanism. Its deficiency causes a marked prolongation of the activated partial thromboplastin time in the laboratory examination. Moreover also MTHFR, ACE and AGT could have been involved in this case, so it is important to evaluate these parameters in the differential diagnosis of RVOs.
