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Biomedical subjects

G Morgese

Publications and source records attributed to G Morgese.

At least 19 recordsLinked to original sources
PubMed1999

Serum leptin changes in epileptic patients who gain weight after therapy with valproic acid.

Weight gain has been recognized as an adverse effect of valproic acid therapy, but there are are no data about serum leptin levels in patients receiving this drug. To evaluate if valproic acid treatment in epileptic patients in whom obesity develops modifies serum levels of insulin and leptin, 40 female patients with epilepsy were evaluated before therapy and after 1 year of therapy. At the end of follow-up, 15 patients were obese and showed higher serum leptin and insulin levels than patients who did not gain weight. As in other types of obesity, elevation of serum leptin concentrations is related to the increase in body mass index.

Adolescent↗
PubMed1999

Calcium metabolism in adolescents and young adults with type 1 diabetes mellitus without and with persistent microalbuminuria.

Alterations in calcium metabolism can be demonstrated in the course of insulin-dependent diabetes mellitus. In order to clarify if the presence of persistent microalbuminuria (MA) can affect the main parameters of calcium metabolism, we studied 22 diabetic adolescents and young adults with persistent MA and compared them with 24 patients without MA and 24 healthy controls. Mean values of serum calcium, phosphorus and magnesium were similar in diabetic children and young adults without persistent MA and in controls. In addition, the mean values of PTH and 25-OHD, 1,25 (OH)2D3 and OC did not differ between these diabetics and controls. Diabetics with persistent MA showed no significant difference from the values of either controls or the group of diabetics without persistent MA for the mean values of serum calcium, phosphorus and magnesium and PTH. In contrast, diabetics with persistent MA had significantly (p<0.01) lower 25-OHD (26.5+/-5.2 ng/ml) and 1,25 (OH)2D3 (24.7+/-5.6 pg/ml) as well as OC levels (9.8+/-2.5 ng/ml; p<0.001) than controls (38.1+/-4.9 ng/ml, 40.7+/-6.4 pg/ml and 16.5+/-5.8 ng/ml, respectively) and subjects with normoalbuminuria (36.0+/-4.5 ng/ml, 38.8+/-8.9 pg/ml and 14.5+/-3.2 ng/ml). In conclusion, our study suggests that abnormalities in 25-OHD, 1,25(OH)2D3 and OC can be present in diabetic adolescents and young adults with incipient nephropathy.

Adolescent↗
PubMed1999

Carnitine deficiency and hyperammonemia in children receiving valproic acid with and without other anticonvulsant drugs.

Plasma ammonia and total and free carnitine were measured in 84 children requiring anticonvulsant drugs: 32 patients (group A) on valproic acid alone, 28 children (group B) on polytherapy including valproic acid, and 24 patients (group C) on polytherapy without valproic acid. The other anticonvulsant drugs used in groups B and C were carbamazepine and phenobarbital. Plasma ammonia concentrations were elevated in both group A and B compared with controls. Group B patients showed significantly higher hyperammonemia than group A (59.9 +/- 16.3 micrograms/dl vs. 36.7 +/- 12.4 micrograms/dl; P < 0.05). Group C patients had plasma ammonia levels similar to those of controls (31.1 +/- 14.7 micrograms/dl vs. 29.7 +/- 12.1 micrograms/dl; NS). In both group A and group B patients, plasma ammonia levels were correlated with the valproic acid dosage (r = 0.32, P < 0.01) and with serum concentrations of valproic acid (r = 0.41, P < 0.001). Moreover, a significant correlation between plasma ammonia and duration of valproic acid therapy was found in the patients as a whole (r = 0.31, P < 0.01). Plasma total and free carnitine concentrations were significantly reduced in groups A and B (total carnitine 36.9 +/- 6.9 mumol/l vs. 32.9 +/- 9.7 mumol/l; free carnitine 28.9 +/- 5.1 mumol/l vs. 25.7 +/- 4.3 mumol/l, respectively) compared with group C patients who did not receive valproic acid and in whom values were similar to controls (total carnitine 46.1 +/- 9.0 mumol/l vs. 47.7 +/- 10.1 mumol/l; free carnitine 40.1 +/- 7.1 mumol/l vs. 42.9 +/- 8.0 mumol/l, respectively). Twenty-eight patients (18 of group A and 10 of group B) were re-evaluated and showed a complete normalization of plasma ammonia, and total and free carnitine levels which were similar to controls. Our data suggest that hyperammonemia is an important problem in patients receiving valproic acid, particularly in association with other anticonvulsant drugs. This increase of plasma ammonia and the concomitant reduction of carnitine seem to be transient and completely reversible.

Adolescent↗
PubMed1999

Advanced glycation end products in children and adolescents with diabetes: relation to glycemic control and early microvascular complications.

OBJECTIVE: The measurement of serum advanced glycation end products (S-AGEs) in children, adolescents, and young adults with diabetes to determine whether increased S-AGE levels may be associated with long-term glycemic control and early microvascular complications. STUDY DESIGN: The study was performed in (1) 178 children and adolescents with type 1 diabetes mellitus (age range, 2 to 21 years, onset before the age of 12 years; duration longer than 2 years) without clinical and laboratory signs of microvascular complications, (2) 39 adolescents and young adults (age range, 16.1 to 28.8 years) with background or preproliferative retinopathy or persistent microalbuminuria, and (3) 98 healthy age- and sex-matched control subjects. RESULTS: S-AGEs were significantly increased in preschool and prepubertal children with diabetes and were particularly elevated in pubertal subjects with diabetes compared with control subjects. S-AGEs were markedly increased in adolescents with early microvascular complications compared with both control subjects and diabetic patients without retinopathy or nephropathy. No correlation was found between S-AGEs and albumin excretion rate or blood pressure values. Glycated hemoglobulin values and S-AGEs were significantly correlated (r = 0.32; P <.01). In children with poorly controlled diabetes (HbA1 c >10%), long-term (2 years) improvement of glycemic control resulted in a significant reduction of S-AGE levels in preschool and prepubertal children, as well as in pubertal individuals. CONCLUSIONS: S-AGE concentrations may be elevated even in preschool and prepubertal children with diabetes; this means that the risk of microvascular complications may be present at an early age. Improvement in glycemic control may be associated with a significant decrease in S-AGEs.

Adolescent↗
PubMed1999

Centro-temporal spikes in non-epileptic children: a long-term follow up.

OBJECTIVE: This study was undertaken in order to determine the natural evolution of centro-temporal spikes (CTS) in a healthy paediatric population. METHODOLOGY: Forty children and adolescents (mean age +/- SD: 9.9 +/- 4.1 years) with non-epileptic disturbances (tics, headache, pavor nocturnus, vertigo, etc), who showed CTS during routine EEG recordings were studied. No patient suffered from seizures. A clinical and electroencephalographic follow-up of at least 5.5 years was carried out in all subjects. RESULTS: At the follow-up examination, 33 of the 40 cases (82.5%) had no CTS or other epileptic discharges in awake and sleep EEGs, while six subjects continued to show CTS discharges in sleep EEG. Among those subjects who showed persistence of CTS in sleep EEG, rolandic epilepsy developed in two cases, while all other subjects continued to be seizure free. CONCLUSIONS: This study demonstrates that CTS can be present in non-epileptic children and adolescents; in the majority of subjects this EEG abnormality disappears spontaneously and only a small percentage of subjects who have persistence of this pattern develops rolandic epilepsy.

Action Potentials↗
PubMed1998

Transient neonatal hypothyroidism after gestational exposure to amiodarone: a follow-up of two cases.

Amiodarone (AMD) is an antiarrhythmic drug which contains 37% of iodine. It can reach the fetus by transplacental passage and induce fetal hypothyroidism. Since in some pregnant women AMD represents a cardinal therapeutic opportunity, it is necessary to establish not only the risk of teratogenicity linked to fetal AMD exposure but also to evaluate the psychomotor development of children with neonatal thyroid dysfunction related to fetal AMD exposure. We report on two cases involving children with an AMD gestational exposure and transient neonatal hypothyroidism, who were followed-up until the age of 4 years 8 months and 5 years 6 months, respectively. Denver's developmental milestone test and Whechsler Preschool and Primary Scale of Intelligence (WPPSI) were administered to the patients in accordance to their age. A normal psychomotor development was observed in both patients with full scale IQ score, verbal and performance IQ scores within normal range. In conclusion, if these data were validated by larger studies, it might not be obligatory to discontinue AMD administration in cardiopathic pregnant women, since mental impairment may not necessarily occur in children with transient neonatal hypothyroidism caused by fetal AMD exposure. However, the evaluation of the thyroid function of these children is imperative.

Adult↗
PubMed1998

Hypoglycaemic symptoms described by diabetic children and their parents.

Hypoglycaemic events are frequent complications of insulin-dependent diabetes mellitus in children. The signs and symptoms referred to by young children can be difficult to understand and often seem to be different from those described by their parents. We analysed the hypoglycaemic symptoms described by a group of patients and their parents. We studied 40 pairs consisting of a parent and a diabetic child by using a structured questionnaire with 27 items concerning different symptoms of hypoglycaemia. The mean+/-SD age of the children was 10.4+/-2.4 years, with duration of disease 6.2+/-2.1 years and their HbA1c was 8.2 2.0%. For the statistical analysis we used the principal component analysis. All the children followed a multiple injection regimen. The frequency and intensity of the hypoglycaemic signs described by patients and parents were similar both for neuroglycopenic (uncoordination, confusion, odd behaviour, dizziness) and autonomic symptoms (trembling, sweating, pounding heart, hunger). Moreover, our questionnaire showed a high frequency of behavioural changes. In conclusion, from the analysis of the questionnaires collected, we found that both parents and children gave almost the same score to the symptoms observed. This means that there is a concordance between the symptoms reported by the children and those reported by their parents.

Adolescent↗
PubMed1998

Serum lipids and lipoproteins in patients treated with antiepileptic drugs.

The concentration levels of serum lipids and lipoproteins were measured in three groups of children and adolescents treated with antiepileptic drugs: carbamazepine (14 patients), phenobarbital (20 patients), and valproic acid (20 patients). Patients treated with these drugs revealed significant changes in lipids and lipoproteins, but when the authors reevaluated the three groups of children 1 year after the end of treatment, a complete return to normal of all parameters was observed. These data demonstrate that the changes induced by these drugs are transient and reversible.

Adolescent↗
PubMed1998

Diabetic nephropathy in children and adolescents: a critical review with particular reference to angiotensin-converting enzyme inhibitors.

Clinical diabetic nephropathy is a well-recognized cause of increased morbidity and mortality in patients with type 1 diabetes. The finding that microalbuminuria predicts progression to overt nephropathy has allowed early diagnosis and preventive interventions. Several studies have demonstrated that treatment with angiotensin-converting enzyme (ACE) inhibitors slows down the rate of decline of the glomerular filtration rate in type 1 diabetes patients with established proteinuria. The renoprotective properties of the ACE inhibitor captopril extend beyond its antihypertensive effects. ACE inhibitors represent the most appropriate class of antihypertensive drugs for treating type I diabetes patients because of their efficacy and safety. When microalbuminuria is detected and confirmed in a diabetic child or adolescent, and if it persists despite 6-12 months of improved metabolic control, treatment with ACE inhibitors should be started, even if the child is normotensive. Careful follow-up of renal function is essential.

Adolescent↗
PubMed1998

Approaches to quality of control in diabetes care.

Management methods for quality of diabetes care need new approaches because of the poor metabolic control of most of these patients. Poor quality of care generally results from poor instruction and training rather than from misbehaviour of both patients and their families. Structure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken and what advice for every-day life is given) and outcome quality (which measurements must be done for the evaluation of the progression of the disease and its control) must all be ameliorated and improved. Regional governments and communities should raise funds for the establishment of diabetes centers, giving recognition and economic support to diabetic children and their families and providing for educational programs on diabetic management and care. The educational aspect seems to be crucial for a good metabolic control not only for the practice of treatment (insulin dosage, home blood glucose monitoring, diet, insulin algorithms), but especially for the active involvement of patients and their families in the management of diabetes. It is also important to consider social and cultural differences among patients in order to arrange therapy according to the individual's characteristics and needs. Improvement of quality of care in diabetic children and adolescents must be pursued; better glycemic control is, in fact, one of the major factors which can contribute to possibly reduce the frequency of macro- and microvascular diabetic complications in the coming years.

Adolescent↗
PubMed1998

Hypoglycemia in childhood: a clinical approach.

A child with hypoglycemia presents very frequently an urgent diagnostic and therapeutic challenge. The main causes of hypoglycemia and the clinical approach and laboratory investigations are reviewed underlining that the relationship between the hypoglycemic event and the last meal can aid in diagnosis, in particular for metabolic diseases. Only a correct and precise diagnosis can allow adequate and appropriate treatment and prevention of future hypoglycemic events.

Child↗
PubMed1998

Leptin levels in non-obese and obese children and young adults with type 1 diabetes mellitus.

OBJECTIVE: To evaluate serum leptin levels in children and young adults with type 1 (insulin-dependent) diabetes mellitus and to investigate whether they are different in prepuberty, puberty and young adulthood. DESIGN: Three groups of diabetics (prepubertal, pubertal and young adults) subdivided into obese and non-obese were studied. Three groups of healthy subjects matched for sex, age and body mass index served as controls. RESULTS: Diabetic patients had serum leptin concentrations similar to those of controls in all three groups. A small non-significant increase in leptin from the prepubertal to the young adult age group for both diabetics and controls was found. A significant association of serum leptin level with body mass index (P < 0.001), female sex (P < 0.001) and age (P < 0.01) in both the diabetic and control group was present. Insulin-dependent diabetes was not associated with higher leptin concentration. CONCLUSIONS: Serum leptin concentrations are similar in diabetic patients and healthy controls. The association between obesity and leptin concentration was similar in the diabetic and non-diabetic subjects. Type 1 diabetes mellitus does not modify serum leptin concentration.

Adolescent↗
PubMed1998

Blue-on-yellow and achromatic perimetry in diabetic children without retinopathy.

OBJECTIVE: We compared blue-on-yellow perimetry with achromatic perimetry to determine whether the first was more sensitive in detecting visual field defects. RESEARCH DESIGN AND METHODS: We studied 50 children and adolescents (22 male, 28 female) with IDDM, ranging in age from 10.1 to 16.3 years (mean 13.3+/-2.1 years), with a disease duration of 5.2-10.0 years (mean 7.1+/-1.9 years). Patients were divided into subgroups according to the presence of persistent microalbuminuria. No one had signs of diabetic retinopathy when studied with fluorescein angiography. RESULTS: By achromatic perimetry, the analysis of subareas of the central 30 degrees of the visual field (0-9 degrees; 10-18 degrees; out of 18 degrees) showed no differences between diabetic subgroups in the central 18 degrees of the visual field, while a significant difference between the same subgroups was found outside the 18 degrees of the 24-2 program of the Humphrey perimeter (P = 0.027). By blue-on-yellow perimetry, in all three of the perimetric subareas evaluated, the sensitivity was lower in microalbuminuric patients than in normoalbuminuric ones. The differential sensitivity between the perimetric tests performed with blue-on-yellow and with achromatic stimuli showed statistically significant data, with a higher level of significance in the central 18 degrees (P < 0.0001) than outside the 18 degrees (P = 0.033). CONCLUSIONS: Our study suggests that blue-on-yellow perimetry is more useful and more sensitive than achromatic perimetry in the detection of preclinical visual field defects in diabetic children with microalbuminuria but without clinically detectable retinopathy.

Adolescent↗
PubMed1998

Relationship between contrast sensitivity and metabolic control in diabetics with and without retinopathy.

Contrast sensitivity was studied in diabetic adolescents and young adults with and without retinopathy in order to evaluate their central vision, to analyze the relationship of metabolic control to the presence and severity of retinopathy, and to re-evaluate the response to this test after a significant improvement in metabolic control. Twenty adolescent and young adult diabetics without retinopathy and 40 diabetics with retinopathy of varying degree were enrolled in the study; 20 healthy age and sex-matched subjects served as controls. Contrast sensitivity was assessed with a CSV-1000 contrast testing instrument, testing for four spatial frequencies, 3, 6, 12 and 18 cycles per degree (cpd). Diabetics with no retinopathy showed a weak but significant difference at 18 cpd compared with controls (P = 0.04), while diabetics with background retinopathy showed a significant reduction of contrast sensitivity at 12 and 18 cpd when compared with controls (P < 0.001). In patients with preproliferative/proliferative retinopathy a highly significant reduction of contrast sensitivity at all frequencies was found compared with controls. Furthermore, these patients had a significantly lower mean contrast sensitivity than patients without retinopathy. The patients were re-evaluated after a significant amelioration of metabolic control. An improvement in contrast sensitivity was found in diabetics without retinopathy and with background retinopathy, while there was no change observed in diabetics with severe retinopathy. These results show that diabetic adolescents and young adults with and without signs of retinopathy observed by fluorescein angiography have a reduced contrast sensitivity, which is more severe in patients with preproliferative/proliferative retinopathy. A significant amelioration of metabolic control is associated with an improvement of contrast sensitivity in all patients with the exception of those patients who had signs of preproliferative/proliferative retinopathy observed by fluorescein angiography. In summary, this longitudinal study provides the first evidence that reduced contrast sensitivity is reversible in diabetics with or without background retinopathy only.

Adolescent↗
PubMed1998

Controversies on the prevention of diabetic nephropathy.

Renal function declines progressively in patients with diabetic nephropathy and the decline may be slowed by some preventive interventions. Optimized and intensive insulin therapy delays the onset and slows the progression of diabetic nephropathy. Moreover, dietary restriction, avoiding a high protein intake, could be effective in reducing glomerular hyperfiltration. Finally, there is evidence that angiotensin-converting enzyme inhibitors reduce renal damage by one or more mechanisms independent of their antihypertensive effects. Some controversial aspects of the prevention of diabetic kidney disease are presented and discussed.

Albuminuria↗
PubMed1998

Familial Mediterranean fever in two Italian brothers.

Familial Mediterranean fever (FMF) is an autosomal recessive disease of unknown etiology, characterized by recurrent self limited episodes of fever and polyserositis. Some patients develop generalized amyloidosis, which can be fatal. Colchicine therapy modifies the natural history of the disease by decreasing the attack frequency and preventing amyloid deposition. The disease is common among Sephardic Jews, Arabs, Armenians and has also been sporadically found in other ethnic groups of Mediterranean origin. We report two cases of FMF in brothers living in Abruzzo, Italy. They were born from consanguineous parents and complained typical symptoms since childhood. The boy suffered from one febrile attack every week; he presented three episodes of acute scrotum at age 8 and 9. The elder sister showed a spontaneous partial relief during adolescence. Juvenile rheumatoid arthritis was suspected and Aspirin was used for many years without any clinical improvement. Treatment with colchicine 1 mg/day was established at age 13 and 17 respectively, and a sudden reduction of frequency of attacks was obtained. A gingival biopsy did not show amyloid. The three elder brothers are, at present, in good health. Our experience point out the diagnostic difficulties of FMF especially in a country where the disease is uncommon.

Adolescent↗
PubMed1997

Does puberty interfere with asthma?

This study reviews whether, to date, scientific evidence exists that puberty interferes with the occurrence of asthma. This question was triggered by three points: (a) clinical experience with asthma as a relatively benign disease that children often 'grow out of'; (b) observations implying that asthma can change during fluctuations of sexual steroid hormones; and (c) knowledge that puberty is an age of deep hormonal changes. No scientific evidence was found that pubertal changes interfere with the occurrence of asthma. Nevertheless, there is a general agreement about the influence of age and sex on its outcome. The overall occurrence of the disease, which is highest in childhood, declines with age. In the wane phenomena, puberty does not seem to be more important than previous ages. Furthermore, the pattern of occurrence is different in the two sexes. Boys have more asthma before 10 years of age or the mid-teens. Girls then overtake boys and have more asthma up to the years of sexual maturity. During the fifth or sixth decade, asthma again seems to become slightly more prevalent in men than women, or at least the difference between the sexes disappears. It is concluded that the risk of asthma is not influenced by puberty. Age and sex seem to be more important factors, although the reason for this is unknown.

Adolescent↗