Il Forum dei Giovani Ricercatori: edizione 2018 - Giornale SIGENP
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REPORT E CONGRESSI
A CURA DI Mariella Baldassarre, Laura Stronati, Salvatore Cucchiara
Il Forum dei Giovani Ricercatori:
edizione 2018
Ancora una volta ci siamo ritrovati a Roma, nella I lavori a piccoli gruppi, suddivisi per aree tematiche
bellissima cornice della residenza “La Borghesiana” (gastroenterologia, epatologia, gastroenterologia
nei giorni 16-18 marzo, per il “Forum dei Giovani neonatale) sono stati coordinati dai tutors (Mariella
Ricercatori”, insieme a 20 giovani tra specializzandi e Baldassarre, Antonio Di Mauro, Antonella Diamanti,
studenti all’ultimo anno del corso di studi in medicina, Giusi Ranucci, Francesco Cirillo, Salvatore Oliva e
provenienti da tutt’Italia. Il Forum è un’iniziativa unica Marina Aloi), ed hanno rappresentato momenti di
in Italia ed è organizzata dalla Società di esercitazione pratica interattiva, volta alla
Gastroenterologia, Epatologia e Nutrizione Pediatrica simulazione di una ricerca bibliografica, della
(SIGENP), con l’obiettivo formativo di approccio in richiesta di un grant, o della realizzazione di un
modo completo alla metodologia della ricerca, a protocollo di studio. Tutti i giovani hanno presentato
partire dalla capacità di analisi critica della il proprio abstract nell’ambito di ciascun gruppo
letteratura, sino ad arrivare a scrivere un lavoro tematico: è stato poi selezionato in ogni gruppo un
scientifico vero e proprio, passando per la abstract per la sessione plenaria dell’ultimo giorno
conoscenza dei metodi statistici. Il programma è (questi contributi sono pubblicati su questo numero
stato densissimo ed ha offerto quest’anno delle del Giornale). Tra questi il migliore in assoluto è stato
novità importanti, quali il confronto con biologi considerato quello di Danila Volpe (Roma). Tale
molecolari e gastroenterologi dell’adulto. iniziativa da diversi anni è supportata
Le lezioni frontali sono state tenute da Salvatore finanziariamente dalla DICOFARM, azienda da sempre
Cucchiara (Roma, Le qualità di un giovane molto vicina alla SIGENP, che continua ad investire
ricercatore), Domenico Alvaro (Roma, Come nella formazione dei giovani, alla quale va un enorme
impostare un progetto di ricerca), Claudia Carissimi “GRAZIE”. L’atmosfera creatasi nei due giorni vissuti
(Roma, Come integrare le tecniche “omiche” nella insieme ha regalato ad ognuno la sensazione di far
ricerca biomedica), V. Fulci (Roma, Bioinformatica: parte di una “squadra”. Ai momenti di studio ed
applicazioni nella ricerca medica), A. Spagnoli (Roma, ascolto si sono alternati momenti di autentico
Studi osservazionali e studi sperimentali), Cesare divertimento, che hanno contribuito a realizzare un
Hassan (Roma, Effettuare e interpretare una meta- clima di festa.
analisi), Marina Aloi (Roma, Organizzare e pianificare Ulteriore novità di quest’anno è stata la
un trial clinico), Costantino De Giacomo (Milano, videoregistrazione delle lezioni frontali (grazie alla
Scrivere un abstract e presentare una comunicazione collaborazione di Domenico Posa), che saranno a
orale), Salvatore Oliva (Roma, Come scrivere un breve a disposizione sul sito della SIGENP
articolo scientifico), Carlo Agostoni (Milano, Applicare (www.sigenp.org), nell’ottica di condividere la
per un grant), Mariella Baldassarre ed Antonio Di conoscenza e la cultura con tutti coloro che non
Mauro (Bari, Effettuare una ricerca bibliografica sui hanno potuto prendere parte ad una iniziativa così
più comuni motori di ricerca), Laura Stronati (Roma, bella.
Ricerca traslazionale), Giuseppe Maggiore (Pisa,
Mariella Baldassarre, Laura Stronati, Salvatore
Ricerca clinica), Vincenzo Cesi (Roma, Come
Cucchiara
brevettare un’idea).
GIORN GASTR EPATOL NUTR PED 2018;X:2 91BALDASSARRE M., STRONATI L., CUCCHIARA S.
LONG-TERM MAINTENANCE THERAPY WITH THE the dose every 24 weeks up to a minimum of 0.25
LOWEST EFFECTIVE DOSE OF VISCOUS mg/day and 0.125mg/day (single evening
BUDESONIDE IN PEDIATRIC EOSINOPHILIC administration). Endoscopy was performed at
ESOPHAGITIS 0,12,36,60 and 84 weeks. In case of symptomatic
and/or histological flare-up, patients received a
D. Volpe, S. Oliva, S. Cucchiara
step-up therapy with the previous effective dose.
UOC di gastroenterologia, epatologia e endoscopia Clinical symptom score (CSS) (Gupta SK, Clin
digestiva pediatrica, Azienda Ospedaliero Gastroenterol Hepatol 2015;13:66-76), endoscopy
Universitaria Policlinico Umberto I, Roma (EoE Endoscopic Reference Score, EREFS, modified;
Gut 2013;62:489-95) and histology (count of
Background and aims: Oral viscous budesonide eosinophils/hpf at all esophageal levels) were
(OVB) is efficacious in inducing and maintaining evaluated. Serum cortisol was evaluated at baseline,
clinical/histological remission in pediatric 12,36,60 and 84 weeks.
Eosinophilic Esophagitis (EoE). However, it has not Results: We enrolled 26 children (16 male, 10 female;
been established whether lowest effective dose median age 11 years, range 5-17). After 12 weeks of
might be identified, and whether treatment can be induction therapy with OVB, 23 patients (88%) were
interrupted once patients have achieved remission in clinical, endoscopic and histological remission.
after a history of frequent relapses. This study aims During the progressive halving therapy, remission
to identify the lowest effective dose of OVB by was still observed in 21 (81%), 17 (65%) at 36 and 60
progressive halving dosage and to evaluate its weeks, respectively. At the final 84-week
efficacy on clinical, endoscopic and histological assessment, 14 patients (54%) maintained remission
remission. by the lowest evening dose (0.25 and 0.125 mg/day).
Methods: We prospectively enrolled active pediatric No significant difference in cortisol levels was
EoE patients (diagnosed according to the ESPGHAN observed during the study period. Only one oral
criteria, J Pediatr Gastroenterol Nutr 2014;58:107- candidiasis was recorded.
18) with an history of early relapse following topical Conclusions: This first pediatric study on long-term
steroids withdrawal (REPORT E CONGRESSI
Il Forum dei Giovani Ricercatori: edizione 2018
NUTRITIONAL STATUS IN NEWLY DIAGNOSED circumpherences (63.5 cm vs 67.5 cm, p=0.05) when
INFLAMMATORY BOWEL DISEASE CHILDREN: A compared to healthy patients. The mean daily caloric
PROSPECTIVE, COMPARISON, SINGLE CENTRE intake was not significantly different between IBD
STUDY and healthy patients (1696.7 vs 1692.6 Kcal; p=0.9),
although IBD children showed a significant
M. Martinelli, E. Scarpato, C. Strisciuglio, M.R. Serra,
decreased fibers intake respect to the controls (16.2
E. Miele, A. Staiano
vs 24.3 g, p=0.03). When compared to the controls,
Department of Translational Medical Sciences, IBD children had significantly lower calcium (9.2 vs
Section of Paediatrics, University “Federico II” of 9.6 g/dl, p=0.001), clorum (103 vs 106 ug/dl,
Naples p=0.001) and iron blood levels (34.8 vs 89.9 mg/dl,
p=0.0001). In addition, children with IBD showed a
Objectives and Study: The aims of this study were to higher incidence of vitamin A [20/46 (43.4%) vs 6/43
characterize the incidence of malnutrition and (13.9%), p=0.002] and folate [14/46 (30.4%) vs 4/43
micronutrients´ deficiencies in newly diagnosed IBD (9.3%), p=0.01] deficiencies. Vitamin D mean values
children and to compare with a group of healthy were decreased in both IBD and healthy patients and
controls. were not significantly different (20.2 vs 24.2 ng/ml,
Method: We prospectively enrolled newly diagnosed p=0.1). In details, 7 out of 46 (15.2%) IBD children
IBD children coming to our referral center between showed a vitamin D deficiency (< 10 ng/ml)
September 2015 and October 2017. A group of compared with 4 out of 43 controls (93%) (p=0.5),
healthy children referred to our primary care center while 29/46 (63%) IBD children had vitamin D
for routine well-child visits was also recruited. insufficiency (30 ng/ml) (p=0.8).
circumpherences were evaluated at the enrollment. Conclusion: Our results suggest that IBD children at
In addition, a qualitative and quantitative diagnosis are at higher risk of malnutrition and may
assessment of nutritional intake was performed present micronutrients deficiencies. We identified a
through the administration of a validated food high percentage of vitamin D insufficiency and
frequency questionnaire. Finally, the enrolled deficiency in both IBD and healthy controls,
patients underwent the following blood panel: full suggesting that a revision of the current cut-offs
blood count, ferritin, inflammatory indexes [C- should be envisaged.
reactive protein, erythrocyte sedimentation rate],
albumin and other organ function markers, vitamins
(A, B12, D, E and folate) and minerals (calcium,
HEPATITIS E IN ITALY: A SILENT PRESENCE
copper, phosphorus, magnesium, zinc, iron, sodium,
potassium, clorum). For the IBD group data M.G. Clemente1, P. Castiglia2, R. Antonucci1, K.B.
regarding demographic characteristics, disease Schwarz3
localization according to Paris classification, disease 1
Pediatric Clinic, Department of Surgical,
activity indexes and ongoing therapy were also Microsurgical and Medical Sciences, University of
collected. Sassari Medical School, Sassari, Italy
Results: Forty-six children affected by IBD [(CD:24 2
Department of Biomedical Sciences – Hygiene and
(52.1%), UC:22 (47.9%); median age: 12.8 yrs; range Preventive Medicine Unit, University-AOU of Sassari,
2-17.6; M/F: 26/20)] and 43 healthy controls [median Sassari, Italy
age: 11.1 yrs; range 4.7-17; M/F: 21/22)] were 3
Pediatric Liver Center, Johns Hopkins University
consecutively enrolled. IBD children showed School of Medicine, Baltimore, MD, USA
significantly decreased mean values of BMI [17.5
versus (vs) 19.6 kg/m2, p=0.008], biceps (5.9 vs 7.3 Background: Hepatitis E virus (HEV) was discovered
mm, p=0.02), subscapular (8.4 vs 11.5 mm, p=0.001) in the 1980s and has been considered as being
and iliac crest skinfolds (6.6 vs 8.2 mm, p=0.03), confined to developing countries. To date, HEV
wrist (14.8 cm vs 15.7 cm, p=0.01) and waist represents the leading cause of enteric viral hepatitis
GIORN GASTR EPATOL NUTR PED 2018;X:2 93BALDASSARRE M., STRONATI L., CUCCHIARA S. infection worldwide. Previously defined as an Results: 176 publications were initially identified by imported asymptomatic and self-limiting disease in title and abstract and 27 articles were included in the high-income countries, hepatitis E has been final data analysis. A total of 21.882 individuals have associated with a broad spectrum of subclinical and been tested for anti-HEV immunoglobulin (Ig) G clinical manifestations with hepatic and extra- and/or anti-HEV IgM, representing only 0,036% of the hepatic sequelae; ranging from mildly acute liver current Italian population. All sera samples were impairment to chronic liver disease in collected from 1978 to 2015 and provided immunosuppressed individuals. Moreover, HEV information regarding 13 different regional areas: infection has been peculiarly associated with a high Abruzzi, Apulia, Calabria, Latium, Lombard, Marche, mortality and morbidity rate during pregnancy, due Molise, Piedmont, Sardinia, Sicily, Republic of San to acute liver failure and obstetric complications. Marino, Tuscany and Veneto. Food-borne zoonosis Globally, the reported prevalence rate among appears to be the major source of infection and it is developed countries varied from 4% in New Zealand linked to genotype 3. Over three decades, the HEV to 52.5% in the Midi-Pyrenees, southwest France, seroprevalence varied from 0.12% to 49% among with an average of 18,12%. Despite that blood donors, with the highest rates being reported autochthonous infections have been increasingly from the central region of Italy. However, a great reported in industrialized countries (Europe), HEV geographical variability was observed among the remains an underestimated emerging pathogen in Italian regions with an average prevalence of 10,25% Italy. The purpose of this critical review was to in this cohort. The seroprevalence rates found in the collect country specific data on the HEV paediatric and the pregnant women cohort was 0.4% epidemiology in order to: (I) determine the reported and 3.4% respectively. The Bayesian analysis of the HEV seroprevalence rates in Italy, (II) describe the reported seroprevalence rates, among Italian epidemiological trend and regional variability; (III) regions, has shown that the screening methodology identify emerging predisposing factors and potential was adequate in term of sensitivity and specificity sources of infection (IV) determine high-risk groups; only in two studies. Thus, the estimated HEV (V) describe concordance among serological prevalence in Abruzzi, Calabria and Lombardy immunoassay and (VI) outline feasible preventive reflects the real spreading of infection. strategies. Conclusion: To the best of our knowledge, the Methods The critical review was made through a current article represents the first critical review of literature research from PubMed, Scopus, Embase HEV IgG seroprevalence in Italy. Although a and Cochrane database, using the keywords phylogenetic and evolutionary analysis has stated “hepatitis E in Italy” and “hepatitis E seroprevalence that HEV might have been present in the Italian in Italy”. Original studies published from January territory since the early 90s, nowadays it is still a 1994 to date, which included at least 50 samples in silent and understudied entity. At present, HEV is the cohort, have been included. No age restriction undoubtedly endemic in Italy. However, areas of was observed and all studies were written in the uncertainty remain due to the lack of genotype- English or Italian language. Moreover, data were specific immunosorbent assays and their variability stratified by study period, geographical region; in terms of sensibility and specificity. Currently, enzyme immunoassays (EIA) and cohort type major gaps remain both in paediatrics/adolescents (general population, blood donors, pregnant women, and pregnant women cohort. These limitations paediatric/adolescent population, at-risk population empathize the necessity of a comparably standard and immigrants. The statistical analyses of the seroprevalence study at a national level, in order to reported regional seroprevalence have been done. improve estimation of the real prevalence of The screening method was used to adjust the Hepatitis E, to monitor HEV strains circulating in the prevalence value according to the sensitivity and territory and to create an interventional plan directed specificity of the essay. Only estimated at a regional level. seroprevalence rates with a lower positive value for confidence intervals (C.I.) at 95% have been considerate statistically significant. 94 GIORN GASTR EPATOL NUTR PED 2018;X:2
REPORT E CONGRESSI
Il Forum dei Giovani Ricercatori: edizione 2018
STUDY OF INTESTINAL PERMEABILITY IN EX- history of IUGR, persistent height and weight growth
PREMATURE CHILDREN WITH HISTORY OF delay, no history of congenital, metabolic,
INTRAUTERINE GROWTH RESTRICTION AND gastrointestinal, neurologic, cardiac or surgical
PERSISTENT HEIGHT AND WEIGHT GROWTH DELAY diseases. All children performed Lactulose/Mannitol
(L/M) ratio test to assess IP.
G. Margiotta, C. Russo, S. Filoni, S. Persichilli, J.
Results: We enrolled 12 patients (6 males, age range
Gervasoni, F. Scaldaferri, A. Gasbarrini, V. Giorgio
4-8 years), and 10 healthy patients
UOC Pediatria, Fondazione Policlinico Universitario (6 males, age range 8-10 years) for comparison
A. Gemelli, Università Cattolica del Sacro Cuore, purposes. IP was significantly increased in cases
Roma compared to controls (0.0945±0.063 vs
0.0158±0.006, p 0,003) in 100% of patients compared to 5% of
an important marker for intestinal barrier integrity. healthy subjects.
Some recent studies showed that prematurity, even Conclusions: IP is increased in ex-premature
more when associated with inrtrauterine growth children with a history of IUGR, suggesting a role in
restriction (IUGR), can lead to alterations of IP. No the persistent growth delay. Further studies on
study exists in humans. We aimed to perform a pilot larger series are needed to clarify IP role in the
study to assess IP in a pediatric population with pathogenesis of persistent growth restriction.
persistent growth retardation and a history of
preterm birth and IUGR.
Material and methods: We reviewed 1360 clinical
charts of neonates born prematurely between
January 2009 and March 2012. We selected children
small for gestational age (SGA), with a documented
GIORN GASTR EPATOL NUTR PED 2018;X:2 95Puoi anche leggere
