@article {10761, title = {Causes of Treatment Failure in Children With Inflammatory Bowel Disease Treated With Infliximab: A Pharmacokinetic Study.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {68}, year = {2019}, month = {2019 Jan}, pages = {37-44}, abstract = {

OBJECTIVES: Anti-tumor necrosis factor antibodies have led to a revolution in the treatment of inflammatory bowel diseases (IBD); however, a sizable proportion of patients does not respond to therapy. There is increasing evidence suggesting that treatment failure may be classified as mechanistic (pharmacodynamic), pharmacokinetic, or immune-mediated. Data regarding the contribution of these factors in children with IBD treated with infliximab (IFX) are still incomplete. The aim was to assess the causes of treatment failure in a prospective cohort of pediatric patients treated with IFX.

METHODS: This observational study considered 49 pediatric (median age 14.4) IBD patients (34 Crohn disease, 15 ulcerative colitis) treated with IFX. Serum samples were collected at 6, 14, 22 and 54 weeks, before IFX infusions. IFX and anti-infliximab antibodies (AIA) were measured using enzyme linked immunosorbent assays. Disease activity was determined by Pediatric Crohn{\textquoteright}s Disease Activity Index or Pediatric Ulcerative Colitis Activity Index.

RESULTS: Clinical remission, defined as a clinical score <10, was obtained by 76.3\% of patients at week 14 and by 73.9\% at week 54. Median trough IFX concentration was higher at all time points in patients achieving sustained clinical remission. IFX levels during maintenance correlated also with C-reactive protein, albumin, and fecal calprotectin. After multivariate analysis, IFX concentration at week 14 >3.11 μg/mL emerged as the strongest predictor of sustained clinical remission. AIA concentrations were correlated inversely with IFX concentrations and directly with adverse reactions.

CONCLUSIONS: Most cases of therapeutic failure were associated with low serum drug levels. IFX trough levels at the end of induction are associated with sustained long-term response.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000002112}, author = {Naviglio, Samuele and Lacorte, Doriana and Lucaf{\`o}, Marianna and Cif{\`u}, Adriana and Favretto, Diego and Cuzzoni, Eva and Silvestri, Tania and Pozzi Mucelli, Martina and Radillo, Oriano and Decorti, Giuliana and Fabris, Martina and Bramuzzo, Matteo and Taddio, Andrea and Stocco, Gabriele and Alvisi, Patrizia and Ventura, Alessandro and Martelossi, Stefano} } @article {10764, title = {Changing Epidemiology of Liver Involvement in Children With Celiac Disease.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {68}, year = {2019}, month = {2019 Apr}, pages = {547-551}, abstract = {

OBJECTIVES: Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15\%-57\%, autoimmune liver disease 1\%-2\%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD.

METHODS: Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet.

RESULTS: CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9\%), and were elevated in 27 (3.9\%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age <=4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95\% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis.

CONCLUSIONS: Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000002209}, author = {Benelli, Elisa and Naviglio, Samuele and De Leo, Luigina and Stera, Giacomo and Giangreco, Manuela and Ronfani, Luca and Villanacci, Vincenzo and Martelossi, Stefano and Ventura, Alessandro and Not, Tarcisio} } @article {10528, title = {Children with cancer: a survey on the experience of Italian primary care pediatricians.}, journal = {Ital J Pediatr}, volume = {43}, year = {2017}, month = {2017 May 25}, pages = {48}, abstract = {

BACKGROUND: Cancer is the second cause of death in children and its diagnosis can be difficult, due to the presence of vague and non-specific symptoms. The primary care pediatrician is often involved in the diagnostic process, but no longer in child care once the treatment started. Care models involving both primary care pediatricians and oncologic referral centre highlighted a higher family satisfaction when they worked together. We conducted a survey on primary care pediatricians involved in childhood cancer in order to describe the actual situation.

METHODS: We conducted a retrospective survey enrolling primary care pediatricians from a north-eastern area of Italy. They received a questionnaire that consisted in two parts: the first one aimed to assess the physician{\textquoteright}s seniority and experience and the second one pertained to each case of cancer and explored the relationship between the pediatrician, the family and the referral centre, and pediatricians degree of satisfaction and emotional impact.

RESULTS: We obtained data from 79 pediatricians who described 150 cancer cases. In 99 cases the primary care pediatrician had visited the child at the onset of symptoms and had referred him to the hospital. In 89 cases, he understood the severity of the disease. In 53.3\% of cases the pediatrician was informed by the referral centre. The relationship between the pediatrician and child{\textquoteright}s family improved in 38\% of cases and this was related with their participation to the multidisciplinary meetings on child health.

CONCLUSIONS: Primary pediatricians{\textquoteright} sharing in the management of their patients with cancer was not satisfactory. Development of specific protocols targeted to an integrated care is needed to increase primary pediatricians{\textquoteright} involvement and families{\textquoteright} satisfactions.

}, keywords = {Child, Child, Preschool, Cross-Sectional Studies, Disease-Free Survival, Female, Humans, Italy, Male, Needs Assessment, Neoplasms, Outcome Assessment (Health Care), Pediatricians, Practice Patterns, Physicians{\textquoteright}, Prevalence, Primary Health Care, Retrospective Studies, Risk Assessment, Survival Analysis}, issn = {1824-7288}, doi = {10.1186/s13052-017-0365-9}, author = {Minute, Marta and Cozzi, Giorgio and Plotti, Chiara and Montanari, Giuseppe and Pecile, Paolo and Zanazzo, Giulio Andrea and Ventura, Alessandro and Barbi, Egidio} } @article {8512, title = {Carbamazepine-induced thrombocytopenic purpura in a child: Insights from a genomic analysis.}, journal = {Blood Cells Mol Dis}, volume = {59}, year = {2016}, month = {2016 Jul}, pages = {97-9}, issn = {1096-0961}, doi = {10.1016/j.bcmd.2016.05.001}, author = {Abate, Maria Valentina and Stocco, Gabriele and Devescovi, Raffaella and Carrozzi, Marco and Pierobon, Chiara and Valencic, Erica and Lucaf{\`o}, Marianna and Di Silvestre, Alessia and d{\textquoteright}Adamo, Pio and Tommasini, Alberto and Decorti, Giuliana and Ventura, Alessandro} } @article {8509, title = {A Child with Severe Developmental Delay and Growth Retardation.}, journal = {J Pediatr}, volume = {175}, year = {2016}, month = {2016 Aug}, pages = {241-241.e1}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2016.05.006}, author = {Rossetto, Elena and Matarazzo, Lorenza and Maschio, Massimo and Taddio, Andrea and Costa, Paola and Ventura, Alessandro} } @article {7757, title = {A case of Rubinstein-Taybi syndrome associated with growth hormone deficiency in childhood.}, journal = {Clin Endocrinol (Oxf)}, volume = {83}, year = {2015}, month = {2015 Sep}, pages = {437-9}, issn = {1365-2265}, doi = {10.1111/cen.12748}, author = {Tornese, Gianluca and Marzuillo, Pierluigi and Pellegrin, Maria Chiara and Germani, Claudio and Faleschini, Elena and Zennaro, Floriana and Grandone, Anna and Miraglia Del Giudice, Emanuele and Perrone, Laura and Ventura, Alessandro} } @article {8079, title = {Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study.}, journal = {Arch Dis Child}, year = {2015}, month = {2015 Nov 17}, abstract = {

OBJECTIVE: To evaluate the consequences of the last European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines for the diagnosis of coeliac disease (CD) by means of a prospective study.

DESIGN: Prospective cohort study.

SETTING: Institute for Maternal and Child Health IRCCS Burlo Garofolo (Trieste, Italy).

PATIENTS: Children diagnosed with CD without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2), were prospectively enrolled over a 3-year period. All patients were put on a gluten-free diet (GFD) and were followed up for clinical conditions and laboratory testing at 6 months every year since diagnosis (median follow up: 1.9 years).

OUTCOME MEASURES: Resolution of symptoms, body mass index, laboratory testing (haemoglobin, anti-transglutaminase IgA), adherence to a GFD, quality of life, and supplementary post-diagnosis medical consultations.

RESULTS: 51 out of 468 (11\%) patients were diagnosed without a duodenal biopsy (group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups were statistically comparable in terms of clinical and nutritional status, anti-transglutaminase IgA antibody titres, quality of life, adherence to a GFD, and number of supplementary medical consultations.

CONCLUSIONS: On the basis of this prospective study, diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11\% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with CD.

}, issn = {1468-2044}, doi = {10.1136/archdischild-2015-309259}, author = {Benelli, Elisa and Carrato, Valentina and Martelossi, Stefano and Ronfani, Luca and Not, Tarcisio and Ventura, Alessandro} } @article {3571, title = {Clinical significance of hyper-IgA in a paediatric laboratory series.}, journal = {Arch Dis Child}, volume = {99}, year = {2014}, month = {2014 Dec}, pages = {1114-6}, abstract = {

The causes of extremely elevated IgA, whether isolated or associated with an increase in other classes of immunoglobulin, are poorly defined in paediatrics. We reviewed the diagnostic significance of very high IgA levels (greater than 3 SD above the mean for age) in a cohort of patients referred to a tertiary care children{\textquoteright}s hospital. Hyper-IgA was found in 91 of 6364 subjects (1.4\%) and in 68 cases was not associated with an increased IgG and/or IgM level. Most subjects with hyper-IgA (73.5\%) had a severe immune defect, a chronic rheumatic disease or inflammatory bowel disease, while these conditions were very rare in a control group with normal IgA values (8\%). Although our results may in part reflect the experience of a tertiary care centre, we suggest that hyper-IgA in children should always arouse suspicion of a serious disease.

}, keywords = {Adolescent, Child, Child, Preschool, Female, Hospitals, Pediatric, Humans, Hypergammaglobulinemia, Immunoglobulin A, Infant, Italy, Male, Tertiary Care Centers}, issn = {1468-2044}, doi = {10.1136/archdischild-2014-306607}, author = {Copetti, Valentina and Pastore, Serena and De Pieri, Carlo and Radillo, Oriano and Taddio, Andrea and Ventura, Alessandro and Tommasini, Alberto} } @article {1951, title = {A child with edema, lower limb deformity, and recurrent diarrhea.}, journal = {J Pediatr}, volume = {161}, year = {2012}, month = {2012 Dec}, pages = {1177}, keywords = {Bone Retroversion, Capsule Endoscopy, Child, Preschool, Diarrhea, Edema, Humans, Knee Joint, Lymphangiectasis, Intestinal, Lymphedema, Male, Recurrence}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2012.06.022}, author = {Gortani, Giulia and Maschio, Massimo and Ventura, Alessandro} } @article {1865, title = {A child with severe pneumomediastinum and ABCA3 gene mutation: a puzzling connection.}, journal = {Arch Bronconeumol}, volume = {48}, year = {2012}, month = {2012 Apr}, pages = {139-40}, keywords = {Anemia, ATP-Binding Cassette Transporters, Child, Preschool, Dyspnea, Genetic Predisposition to Disease, Heterozygote, Humans, Intensive Care, Leukocytosis, Male, Mediastinal Emphysema, Mutation, Missense, Point Mutation, Pulmonary Emphysema, Respiratory Tract Infections, Subcutaneous Emphysema, Tomography, X-Ray Computed}, issn = {1579-2129}, doi = {10.1016/j.arbres.2011.11.008}, author = {Copertino, Marco and Barbi, Egidio and Poli, Furio and Zennaro, Floriana and Ferrari, Maurizio and Carrera, Paola and Ventura, Alessandro} } @article {1596, title = {Compliance with the gluten-free diet: the role of locus of control in celiac disease.}, journal = {J Pediatr}, volume = {158}, year = {2011}, month = {2011 Mar}, pages = {463-466.e5}, abstract = {

OBJECTIVES: To verify whether subjects with celiac disease (CD) have a different locus of control (LoC) compared with healthy subjects, and to evaluate the relationship between LoC and compliance with a prescribed gluten-free diet (GFD) and quality of life (QoL).

STUDY DESIGN: We studied 156 subjects on a GFD (mean age, 10 years) and 353 healthy controls (mean age, 12 years). All subjects completed tests on the Nowicki-Strickland Locus of Control Scale; the subjects with CD also completed a questionnaire to measure compliance with dietary treatment and the disease{\textquoteright}s impact on QoL.

RESULTS: There was no difference in LoC values between patients with CD and controls. Subjects with CD with good dietary compliance had a more internal LoC compared with those who were not compliant (P = .01). Patients who reported a satisfactory QoL had a more internal LoC compared with those who reported negative affects on QoL due to CD (P = .01).

CONCLUSIONS: Our study confirms the usefulness of the LoC concept for identifying those patients who might be at risk for dietary transgression. Given the enhanced, psychological, and social well being that can result from adherence to a GFD, educational and psychological support can help internalize the LoC in those patients at risk for dietary transgression.

}, keywords = {Adolescent, Age Factors, Case-Control Studies, Celiac Disease, Child, Diet, Gluten-Free, Female, Humans, Internal-External Control, Italy, Male, Patient Compliance, Quality of Life}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.08.034}, author = {Bellini, Anna and Zanchi, Chiara and Martelossi, Stefano and Di Leo, Grazia and Not, Tarcisio and Ventura, Alessandro} } @article {1741, title = {Cryptic genetic gluten intolerance revealed by intestinal antitransglutaminase antibodies and response to gluten-free diet.}, journal = {Gut}, volume = {60}, year = {2011}, month = {2011 Nov}, pages = {1487-93}, abstract = {

BACKGROUND AND OBJECTIVE: Antitransglutaminase (anti-TG2) antibodies are synthesised in the intestine and their presence seems predictive of future coeliac disease (CD). This study investigates whether mucosal antibodies represent an early stage of gluten intolerance even in the absence of intestinal damage and serum anti-TG2 antibodies.

METHODS: This study investigated 22 relatives of patients with CD genetically predisposed to gluten intolerance but negative for both serum anti-TG2 antibodies and intestinal abnormalities. Fifteen subjects were symptomatic and seven were asymptomatic. The presence of immunoglobulin A anti-TG2 antibodies in the intestine was studied by creating phage-antibody libraries against TG-2. The presence of intestinal anti-TG2 antibodies was compared with the serum concentration of the intestinal fatty acid-binding protein (I-FABP), a marker for early intestinal mucosal damage. The effects of a 12-month gluten-free diet on anti-TG2 antibody production and the subjects{\textquoteright} clinical condition was monitored. Twelve subjects entered the study as controls.

RESULTS: The intestinal mucosa appeared normal in 18/22; 4 had a slight increase in intraepithelial lymphocytes. Mucosal anti-TG2 antibodies were isolated in 15/22 subjects (68\%); in particular symptomatic subjects were positive in 13/15 cases and asymptomatic subjects in 2/7 cases (p=0.01). No mucosal antibodies were selected from the controls{\textquoteright} biopsies. There was significant correlation between the presence of intestinal anti-TG2 antibodies and positive concentrations of I-FABP (p=0.0008). After a gluten-free diet, 19/22 subjects underwent a second intestinal biopsy, which showed that anti-TG2 antibodies had disappeared in 12/15 (p=0.002), while I-FABP decreased significantly (p<0.0001). The diet resolved both extraintestinal and intestinal symptoms.

CONCLUSIONS: A new form of genetic-dependent gluten intolerance has been described in which none of the usual diagnostic markers is present. Symptoms and intestinal anti-TG2 antibodies respond to a gluten free-diet. The detection of intestinal anti-TG2 antibodies by the phage-antibody libraries has an important diagnostic and therapeutic impact for the subjects with gluten-dependent intestinal or extraintestinal symptoms. Clinical trial number NCT00677495.

}, keywords = {Adolescent, Adult, Antibodies, Anti-Idiotypic, Asymptomatic Diseases, Celiac Disease, Child, Child, Preschool, Diet, Gluten-Free, Fatty Acid-Binding Proteins, Female, Genetic Predisposition to Disease, GTP-Binding Proteins, Health Status, Humans, Intestinal Mucosa, Male, Middle Aged, Peptide Library, Transglutaminases, Young Adult}, issn = {1468-3288}, doi = {10.1136/gut.2010.232900}, author = {Not, Tarcisio and Ziberna, Fabiana and Vatta, Serena and Quaglia, Sara and Martelossi, Stefano and Villanacci, Vincenzo and Marzari, Roberto and Florian, Fiorella and Vecchiet, Monica and Sulic, Ana-Marija and Ferrara, Fortunato and Bradbury, Andrew and Sblattero, Daniele and Ventura, Alessandro} } @article {1671, title = {A child with pain after mild trauma.}, journal = {J Pediatr}, volume = {157}, year = {2010}, month = {2010 Oct}, pages = {693}, keywords = {Antigens, CD, Antigens, CD31, Antigens, CD34, Antigens, Differentiation, Myelomonocytic, Biopsy, Child, Factor VIII, Fingers, Hand Injuries, Hemangioendothelioma, Humans, Immunohistochemistry, Injury Severity Score, Male, Osteolysis, Pain, Pain Measurement, S100 Proteins, Vascular Neoplasms}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.04.028}, author = {Londero, Margherita and Pastore, Serena and Zanazzo, Giulio A and Bruno, Irene and Ventura, Alessandro} }