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Biomedical subjects

F Chiarelli

Publications and source records attributed to F Chiarelli.

At least 181 records · Page 10Linked to original sources
PubMed1995

Necrobiosis lipoidica diabeticorum in children and adolescents: a clue for underlying renal and retinal disease.

The prevalence of persistent microalbuminuria, retinopathy, and peripheral and autonomic neuropathy was assessed in 18 children and adolescents with type 1 (insulin-dependent) diabetes mellitus (IDDM) who suffered from necrobiosis lipoidica diabeticorum (NLD) and in 40 diabetics without NLD, matched for sex, age, duration of disease, and metabolic control. The mean +/- SD age of the patients was 15.1 +/- 8.6 years (range 7.9-23.9 yrs) and their duration of IDDM was 10.9 +/- 8.1 years (range 7.1-21.0 yrs). Their mean glycosylated hemoglobin level was 9.9 +/- 5.0% (7.3-16.6%) and their fructosamine level was 274 +/- 180 mumol/L (199-466 mumol/L). Patients with NLD had a higher frequency of persistent microalbuminuria (p < 0.001) and retinopathy (p < 0.001) than those without NLD. Our study suggests that children as well as adult diabetics with NLD can be at high risk for nephropathy and retinopathy; NLD can be a clue for diabetic nephropathy and retinopathy.

Adolescent↗
PubMed1995

Visual field defects in diabetic children without retinopathy. Relation between visual function and microalbuminuria.

The effects of diabetes on retinal function before the onset of clinically detectable retinopathy have been investigated with several methods. Our aim is to evaluate the usefulness of computerized perimetry in early diagnosis of retinal sensitivity impairment in lack of fluorescein angiographic signs of diabetic retinopathy. Seventy diabetic children and adolescents, 39 normoalbuminuric and 31 microalbuminuric patients, and 70 normal subjects were investigated with static computerized perimetry. Normoalbuminuric patients showed functional parameters similar to those of controls, while microalbuminuric patients had a significant reduction of mid-peripheral light sensitivity in comparison with both normoalbuminuric children and controls. Our data suggest that an impaired light sensitivity, in mid-periphery of the visual field, is present in diabetic patients with persistent microalbuminuria.

Adolescent↗
PubMed1995

Bone mineral content in girls with precocious puberty treated with gonadotropin-releasing hormone analog.

In order to evaluate the effects of gonadotropin-releasing hormone (GnRH) analogs on calcium metabolism, we studied 12 girls with central precocious puberty (CPP) who were treated with the GnRH agonist D-Trp6-GnRH every 28 days. The patients' mean age +/- SD was 5.9 +/- 2.1 years. The patients were studied before commencement and after 6 and 12 months of treatment. We also studied 12 age-matched healthy girls who served as controls. Bone mineral content was measured by dual-photon densitometry with 125I, in the distal third of the left radius. We evaluated the serum levels of calcium, phosphate, magnesium, parathyroid hormone, calcitonin, 25-hydroxy-vitamin D and the 24-h urinary excretion of calcium, phosphate and magnesium. All of these parameters were found to be normal before and during the treatment in both groups. At the beginning of the study, the patients with CPP had significantly higher bone mineral content than controls (0.51 +/- 0.12 g/cm2 vs. 0.39 +/- 0.09, p < 0.001); after 6 months contents were 0.42 +/- 0.11 vs. 0.41 +/- 0.05, p < 0.01; and after 12 months 0.44 +/- 0.11 vs. 0.44 +/- 0.05, NS, for treatment and control groups, respectively. This difference remained after 6 months of treatment, while after 12 months no significant difference between patients and controls was found. Our study shows that girls with CPP have an increased bone mineral content and that GnRH analogs modify bone density with a consequent reduction, it seems, that is not related to any of the calcium parameters studied.

Absorptiometry, Photon↗
PubMed1994

Indications for a more aggressive disease process in newly diagnosed insulin-dependent diabetic children in northern than in southern Europe.

Finland and Sweden have the highest incidence of insulin-dependent diabetes in children in the world, about 3-4 times that of countries in the Mediterranean area, with the exception of Sardinia. We have collected information from several European clinics and from Pittsburgh, USA, in order to find out whether this difference incidence is associated with corresponding differences of the disease pattern. Patients in Finland or Sweden ('North') and Pittsburgh were younger (< 10 years old) at diagnosis compared with those in the other clinics in Europe (P < 0.05 versus P < 0.02). In the North, boys were in excess (58%) in contrast to France (40%) and Pittsburgh (46%). Patients in the North had a shorter duration of symptoms (< 8 days; P < 0.001) and higher blood glucose (> 20 mmol/l; P < 0.05) than those attending the other European clinics. Irrespective of age, there were more ICA-positive patients in the North (94%) than in Berlin-Vienna (67%; P < 0.01) or in France (70%; P < 0.01). There was a tendency for non-diabetic parents and siblings in the North to have lower C-peptide values (< 0.26 pmol/ml) at the time of diagnosis of the proband and to be ICA-positive more often than relatives in the other European clinics. The seasonal variation of diagnosis showed no obvious geographical differences, with recorded diagnosis always lowest during the summer. We conclude that certain factors seem to cause not only a high incidence of diabetes in children in Finland and Sweden but perhaps also a more aggressive early disease process.

Adolescent↗
PubMed1994

Genetic predisposition to hypertension (as detected by Na+/Li+ countertransport) and risk of diabetic nephropathy in childhood diabetes.

In order to evaluate whether insulin-dependent diabetes mellitus patients with incipient nephropathy have an overactivity of erythrocyte sodium-lithium countertransport (Na+/Li+ CT), 82 diabetic children and 38 healthy age-matched control subjects and their parents and grandparents were studied. The children were divided into two groups according to the presence of persistent microalbuminuria (MA). Diabetic children with MA had Na+/Li+ CT activity higher than normoalbuminuric diabetics and healthy controls. The parents and grandparents of microalbuminuric patients showed higher Na+/Li+ CT than parents and grandparents of normoalbuminuric diabetics and of the controls. This study demonstrates that predisposition to hypertension, as indicated by increased Na+/Li+ CT activity in erythrocytes, is more frequently detectable in patients with persistent microalbuminuria than in diabetics without persistent microalbuminuria or in healthy controls. Overactivity of Na+/Li+ CT is present also in parents and grandparents of diabetic children with MA. This study suggests that genetic predisposition to hypertension is more frequent in patients at risk of developing diabetic nephropathy, as well as in their parents and grandparents.

Adolescent↗
PubMed1994

Diabetic retinopathy. Relationship with nephropathy in pediatric age.

In order to evaluate the relationship between diabetic retinopathy and diabetic nephropathy we studied 55 (25 females, 30 males) retinopathic diabetic children and adolescents: their age ranged from 9.0 to 17.3 (mean +/- SD 13.9 + 3.8) years and the duration of disease from 4.8 to 10.0 (6.9 +/- 3.1) years. The mean glycosilated haemoglobin (HbA1c) was 10.4 + 2.7%. Patient distribution in relation to retinal grading showed that the greatest number of patients (34: 61.82%) were in 14-20 retinopathy level (with minimal signs of retinopathy), 9 patients showed 31 retinopathy level (16.36%) and 12 (21.82%) were in the other classes. Comparison between retinal grading of retinopathy and presence/absence of microalbuminuria showed a significant difference between the evaluated subgroups (p < 0.0001). In fact, only 6 patients out of 34 (17.64%) in class 14-20 retinopathy level, 8 patients out of 16 (50%) in 31-41 retinopathy level and 5 patients out of 5 (100%) in 51 retinopathy level had microalbuminuria. Our study shows that the presence of persistent microalbuminuria is an important risk factor for diabetic retinopathy. In conclusion, we suggest that when diabetic children have persistent microalbuminuria, the eye should be carefully examined, in order to prevent a deterioration of the eye function.

Adolescent↗
PubMed1994

[West syndrome. Clinical, diagnostic and therapeutic aspect].

The authors review the main clinical-electro-encephalographical and therapeutic aspects of the West syndrome (infantile spasms), underlying the problems related to long-term prognosis. The authors describe its clinical variants which, sometimes, can create some difficulties for differential diagnosis. Moreover, the difference between idiopathic and secondary (to pre- and peri-natal) problems syndrome is discussed.

Adrenocorticotropic Hormone↗
PubMed1993

Hyperinsulinism as a marker in obese children.

OBJECTIVE: To determine the relationship between insulin and the metabolic profile and eventual weight loss in obese children. DESIGN: We first attempted to define the metabolic profile for 18 obese children; we then studied weight loss in this group longitudinally. SETTING: Department of Pediatrics in a university hospital. PARTICIPANTS: Eighteen randomly selected, young, obese male subjects from 5 to 16 years of age. INTERVENTIONS: (1) Metabolic screening at the outset, including insulinemia and glycemia after the oral glucose tolerance test and plasma levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides, and (2) weight loss treatment. RESULTS: We divided the sample into "normoinsulinemic" and "hyperinsulinemic" groups, similar for all the variables tested except for weight loss and plasma triglyceride levels. A direct relationship between weight loss results and duration of treatment was found for the entire group. The "hyperinsulinemic" group had a lower percentage reduction in excess weight, and the results in this group were not dependent on the duration of treatment. CONCLUSIONS: The effort to keep "normoinsulinemic" obese children in treatment may be useful; it is advisable to study "hyperinsulinemic" children more in depth.

Adolescent↗
PubMed1993

Prediabetes: genetic, immunological and metabolical aspects.

There is mounting evidence from experimental animal diabetes and from human epidemiological studies that a long period of "prediabetes" precedes the clinical onset of type 1 (Insulin Dependent) Diabetes Mellitus. In this review, the authors evaluate the main informations concerning the genetic, immunological and metabolic aspects of this phase of prediabetes and the relationship of prediabetes with the onset of the disease. Prediabetes is a long period; in this period the destruction of beta cells can be caused by many factors and by many pathogenetic mechanisms. Nowadays, we begin to understand some of these mechanisms and the central role of the activation of the immune system; this activation results in various humoral and cellular abnormalities detectable in the prediabetic phase. These abnormalities, together with metabolic ones, have been reported in many studies. Consequently, we have at our disposal some genetic, immunological and metabolical markers which can be useful in the detection of the person at risk of developing diabetes mellitus.

Animals↗
PubMed1992

[Immunologic changes in diabetic ketoacidosis].

We studied 13 children and adolescents during diabetic ketoacidosis; the duration of diabetes ranged from 1.4 to 6.0 years. A group of 13 diabetic sex, age and duration of disease-matched children served as control. Patients in ketoacidosis showed important abnormalities of T subset percentages (OKT3: 63.4 +/- 1.87% vs 72.1 +/- 3.4; p less than 0.001. OKT4: 37.18 +/- 1.85% vs 44.6 +/- 3.9; p less than 0.01. OKT8: 28.5 +/- 6.51% vs 28.1 +/- 1.9; p less than 0.04) and impaired neutrophil chemotaxis (53.10 +/- 3.3 vs 88.1 +/- 7.2; p less than 0.001). The patients showed normal levels of all classes of immunoglobulins. No correlation was observed between these abnormalities and the degree of ketoacidosis or glycaemia. When the patients were re-evaluated out of ketoacidosis, the values of the immunological parameters were normal and similar to those of the control group.

Chemotaxis, Leukocyte↗
PubMed1990

Controlled study in diabetic children comparing insulin-dosage adjustment by manual and computer algorithms.

A controlled trial of a new microprocessor device for insulin-dosage adjustment was undertaken in two matched groups of a priori well-controlled diabetic children. A prospective study design with three equal 8-wk periods was used. In the first period, both groups used manual methods for insulin-dosage adjustment after manual criteria. In the second period, one group of children adjusted insulin dosage by computer algorithms, whereas the other continued to use manual methods. In the third period, both groups again adjusted insulin by traditional methods. Mean premeal glycemia and glycosylated hemoglobin levels did not change in either group throughout the study. During the second period, episodes of hypoglycemia were more frequent in children without the computer than in those who used the device. In keeping with the latter outcome, the group that used the microprocessor device was given less insulin in the second period than the first (0.88 +/- 0.02 vs. 0.94 +/- 0.02 U.kg-1.day-1, P less than 0.0001) and in comparison to the control group of patients who concurrently were given an increased insulin dose in the second period compared with the first. This study showed that insulin treatment through specific computer-mediated dosage-adjusting algorithms was safe and minimized hypoglycemia by effectively accommodating seasonally changing insulin requirements. We recommend the device to help diabetic children and their families in the care of insulin-dependent diabetes.

Algorithms↗
PubMed1990

Long-term therapy in childhood asthma: clinical and auxological effects.

The authors studied the effect of different therapeutical regimens on the growth of children suffering from asthma. These patients were subdivided into four groups of ten patients according to their therapeutic regimens: Group A = ketotifene (1 mg, two times/day), Group B = diproprionate beclomethasone + salbuthamol (100 + 200 mcg, 3 times/day), Group C = ketotifene + diproprionate beclomethasone, Group D = disodiumcromoglycate (20 mg, 3 times/day). The patients were followed for at least 1 year. Our study has shown that all the children treated with the four different regimens had a normal growth and growth velocity.

Adolescent↗