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Barbara Maria BERGAMINI

Ricercatore Universitario
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - COVID-19 restrictions and hygiene measures reduce the rates of respiratory infections and wheezing among preterm infants [Articolo su rivista]
Scarponi, D.; Bedetti, L.; Zini, T.; Di Martino, M.; Cingolani, G. M.; Spaggiari, E.; Rossi, K.; Miselli, F.; Lugli, L.; Bergamini, B. M.; Iughetti, L.; Berardi, A.
abstract

Background and aim: During the 2020 and 2021 Italian COVID-19 pandemic social restrictions and strict hygiene measures were recommended to limit the spread of SARS-CoV-2. We aimed to assess whether rates of respiratory infections and wheezing in preterm infants have changed during the pandemic. Methods: Single center, retrospective study. Preterm infants in the first 6 months of life discharged home prior to (Period 1, January 2017 - December 2019) or during the pandemic (Period 2, January 2020 - March 2021) were compared. Rates of respiratory infection and wheezing in preterm infants with or without bronchopulmonary dysplasia (BDP) were assessed. Results: During period 2 premature infants had lower rates of respiratory infections (36 out of 55 in Period 1 vs 11 out of 28 in Period 2, P=0.023) and wheezing (20 out of 55 in Period 1 vs 1 out of 28 in Period 2, P=0.001). This difference remained significant when infants with BPD (all grades) were analyzed separately (respiratory infections 26 out of 40 in Period 1 vs 7 out of 24 in Period 2, P=0.005; wheezing 16 out of 40 in Period 1 vs 1 out of 24 in Period 2, P=0.001). In contrast, respiratory infections and wheezing in preterm infants without BPD did not change after pandemic. Conclusions: Episodes of respiratory infections and wheezing among preterm infants were reduced during pandemic. We highlight the importance of proper family education for preventing respiratory tract infections in preterm infants with BPD, beyond the extraordinary conditions of the COVID-19 pandemic.

2022 - Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group [Articolo su rivista]
Fainardi, V.; Caffarelli, C.; Deolmi, M.; Skenderaj, K.; Meoli, A.; Morini, R.; Bergamini, B. M.; Bertelli, L.; Biserna, L.; Bottau, P.; Corinaldesi, E.; De Paulis, N.; Dondi, A.; Guidi, B.; Lombardi, F.; Magistrali, M. S.; Marastoni, E.; Pastorelli, S.; Piccorossi, A.; Poloni, M.; Tagliati, S.; Vaienti, F.; Gregori, G.; Sacchetti, R.; Mari, S.; Musetti, M.; Antodaro, F.; Bergomi, A.; Reggiani, L.; Caramelli, F.; De Fanti, A.; Marchetti, F.; Ricci, G.; Esposito, S.
abstract

Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

2021 - Management of children with acute asthma attack: A rand/ucla appropriateness approach [Articolo su rivista]
Fainardi, V.; Caffarelli, C.; Bergamini, B. M.; Biserna, L.; Bottau, P.; Corinaldesi, E.; Dondi, A.; Fornaro, M.; Guidi, B.; Lombardi, F.; Magistrali, M. S.; Marastoni, E.; Piccorossi, A.; Poloni, M.; Tagliati, S.; Vaienti, F.; Venturelli, C.; Ricci, G.; Esposito, S.
abstract

Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease.

2020 - Lo stridore vien leggendo [Articolo su rivista]
Leo, Francesco; Fontijn, Simone; Bergamini, Barbara Maria; Iughetti, Lorenzo
abstract

2020 - Psychosocial assessment of families caring for a child with acute lymphoblastic leukemia, epilepsy or asthma: Psychosocial risk as network of interacting symptoms [Articolo su rivista]
Colliva, C.; Cellini, M.; Porta, F. D.; Ferrari, M.; Bergamini, B. M.; Guerra, A.; Di Giuseppe, S.; Pinto, A.; Capasso, R.; Caprino, D.; Ferrari, M.; Benatti, C.; Tascedda, F.; Blom, J. M. C.
abstract

The purpose of this study is to assess psychosocial risk across several pediatric medical conditions and test the hypothesis that different severe or chronic pediatric illnesses are characterized by disease specific enhanced psychosocial risk and that risk is driven by disease specific connectivity and interdependencies among various domains of psychosocial function using the Psychosocial Assessment Tool (PAT). In a multicenter prospective cohort study of 195 patients, aged 5-12, 90 diagnosed with acute lymphoblastic leukemia (ALL), 42 with epilepsy and 63 with asthma, parents completed the PAT2.0 or the PAT2.0 generic version. Multivariate analysis was performed with disease as factor and age as covariate. Graph theory and network analysis was employed to study the connectivity and interdependencies among subscales of the PAT while data-driven cluster analysis was used to test whether common patterns of risk exist among the various diseases. Using a network modelling approach analysis, we observed unique patterns of interconnected domains of psychosocial factors. Each pathology was characterized by different interdependencies among the most central and most connected domains. Furthermore, data-driven cluster analysis resulted in two clusters: patients with ALL (89%) mostly belonged to cluster 1, while patients with epilepsy and asthma belonged primarily to cluster 2 (83% and 82% respectively). In sum, implementing a network approach improves our comprehension concerning the character of the problems central to the development of psychosocial difficulties. Therapy directed at problems related to the most central domain(s) constitutes the more rational one because such an approach will inevitably carry over to other domains that depend on the more central function.

2019 - Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study [Articolo su rivista]
Berardi, Alberto; Sandoni, Marcello; Toffoli, Carlotta; Boncompagni, Alessandra; Gennari, William; Bergamini, Maria Barbara; Lucaccioni, Laura; Iughetti, Lorenzo
abstract

Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated.

2019 - QuantiFERON-TB performs better in children, including infants, than in adults with active tuberculosis: A multicenter study [Articolo su rivista]
Lombardi, G.; Pellegrino, M. T.; Denicolo, A.; Corsini, I.; Tadolini, M.; Bergamini, B. M.; Meacci, M.; Garazzino, S.; Peracchi, M.; Lanari, M.; Re, M. C.; Monte, P. D.
abstract

Immunological tests, including the QuantiFERON-TB Gold In-Tube (QFT-IT) assay, represent an important aid for diagnosing active tuberculosis (TB) and latent TB infections in children, but concerns about their use in children <5 years of age persist. This is a multicenter retrospective study comparing a population of 226 children to 521 adults with pulmonary or extrapulmonary TB. The aim was to evaluate the QFT-IT performance, analyzing both qualitative and quantitative results, according to age, birthplace, and disease localization. Compared to culture, QFT-IT sensitivity was 93.9%, 100%, and 94.4% in children <= 2, 2 to 5, and 5 to 16 years of age, respectively, and was significantly higher than that in adults (81.0%) (P < 0.0001). The rate of indeterminate test results for children (2.2%) was significantly lower than that for adults (5.2%) (P < 0.0001). In children, QFT-IT sensitivity was not affected by disease localization or birthplace (Italy born versus foreign born). Interferon gamma (IFN-gamma) values in response to TB antigen and mitogen were significantly higher in children than in adults (TB antigen, median of 10 versus 1.66 IU IFN-gamma/ml; mitogen, median of 10 versus 6.70 IU IFN-gamma/ml; P < 0.0001). In summary, this study supports the use of QFT-IT as a complementary test for the diagnosis of pediatric TB even under 2 years of age. Our observations could be applicable to the new version of the test, QuantiFERON-TB Gold Plus, which has recently been shown to have similar sensitivity in active TB, although data in children are still lacking.

2017 - Un bambino con tachipnea - A child with tachypnea [Abstract in Rivista]
Del Greco, Paolo; Calogero, Claudia; Fenu, Grazia; Beltrami, Cristina; Caparrelli, Chiara; Alice Donati, Maria; Avenali, Stefano; Maria Buccoliero, Anna; Della Monica, Matteo; Bergamini, Barbara Maria; Lombardi, Enrico
abstract

Il surfactante polmonare, un complesso di proteine proteiche, è sintetizzato, aggregato e secreto dalle cellule alveolari di tipo II ed ha la funzione di ridurre la tensione superficiale, ponendosi all’interfaccia aria-acqua a livello alveolare. La porzione lipidica rappresenta la quasi totalità del complesso, mentre la porzione proteica è associata alle proteine tipo A, B, C e D. Un importante componente del metabolismo del surfactante è il trasportatore proteico (ABCA3) dei fosfolipidi all’interno dei corpi lamellari (1). Mutazioni dei geni delle proteine del surfactante sono state associate allo sviluppo di pneumopatie interstiziali. La malattia polmonare causata da mutazioni del gene ABCA3 è un disturbo ereditario autosomico recessivo. Una percentuale significativa di casi segnalati è rappresentata da eterozigoti composti con espressione variabile della malattia nel periodo neonatale o nell’infanzia . Lo spettro clinico e la gravità della malattia polmonare causata dalla carenza di ABCA3 è infatti estremamente variabile e fortemente dipendente dalle mutazioni causanti e dal modello morfologico-patologico indotto . Uno studio di coorte del 2017 ha mostrato come la presentazione più frequente delle mutazioni del gene ABCA3 sia un quadro di RDS neonatale severo, clinicamente non distinguibile dalla PAP e con rischio di esito infausto elevato entro il primo anno di età (5). Sebbene una piccola parte dei disordini del surfattante sia dovuta a mutazioni causanti una sua alterata o mancata produzione, la gran parte delle patologie del surfattante che esitano in un quadro di PAP sono causate dalla distruzione del GM-CSF da parte di autoanticorpi, determinando così la perdita della cruciale funzione di clearence alveolareed un conseguente accumulo di residui cellulari depositati in tale sede. Attualmente la PAP può essere classificata come primaria, a sua volta suddivisa in autoimmune quando è causata da autoanticorpi anti-GM-CSF (questa forma rappresenta circa il 90% dei casi) ed in ereditaria quando dovuta a mutazioni del gene per il recettore del GM-CSF (6), o secondaria. Quest’ultima forma, più frequentemente riscontrabile in età adulta, è associata principalmente a patologie sottostanti, quali malattie ematologiche (sindromi mielodisplastiche, leucemia mieloide acuta, leucemia linfoblastica acuta, leucemia cronica mielocitica, leucemia linfatica cronica, anemia aplastica, mieloma multiplo, linfoma e macroglobulinemia di Waldenstrom), neoplasie non ematologiche (adenocarcinoma polmonare, glioblastoma e melanoma), malattie infettive (citomegalovirus, Mycobacterium tuberculosis, Nocardia, Pneumocystis jirovecii), sindromi da immunodeficienza/disgregazione (AIDS, amiloidosi, sindrome di Fanconi, agammaglobulinemia, malattia di Bechet, dermatomiosite giovanile, acidosi tubulare renale e SCID) ed infine esposizioni tossiche per inalazione di polveri inorganiche (alluminio, cemento, silice, titanio ed indio), di polveri organiche (sostanze agricole, farina da forno, fertilizzanti e segatura) o di fumi (cloro, prodotti per la pulizia, benzina, petrolio, biossido di azoto, vernice e fumi di plastica sintetica). Infine, esiste una forma di PAP (in letteratura anche definita come PAP-Like) causata da mutazioni dei geni del surfattante (SFTPB, SFTPC, ABCA3 e TTF1 (NKX2.1)). La forma associata a mutazioni del surfattante (come nel nostro caso) può esordire con un quadro di insufficienza respiratoria grave sin dalla nascita, mentre la presentazione clinica delle altre forme include dispnea ingravescente, tachipnea, tosse e perdita di peso in un quadro di pneumopatia interstiziale ad esordio adolescenziale o in età adulta. La diagnosi può essere sospettata sulla base della storia clinica, di reperti radiologici tipici, della citologia al BAL, dei risultati della biopsia polmonare e/o di biomarker compatibili. Indubbiamente, nel sospetto clinico di PAP, deve essere effettuata la ricerca degli

2016 - Pediatric tuberculosis in Italian children: Epidemiological and clinical data from the Italian register of pediatric tuberculosis [Articolo su rivista]
Galli, Luisa; Lancella, Laura; Tersigni, Chiara; Venturini, Elisabetta; Chiappini, Elena; Bergamini, Barbara Maria; Codifava, Margherita; Venturelli, Cristina; Tosetti, Giulia; Marabotto, Caterina; Cursi, Laura; Boccuzzi, Elena; Garazzino, Silvia; Tovo, Pierangelo; Pinon, Michele; Serre, Danielele; Castiglioni, Laura; Vecchio, Andrealo; Guarino, Alfredo; Bruzzese, Eugenia; Losurdo, Giuseppe; Castagnola, Elio; Bossi, Grazia; Marseglia, Gianluigi; Esposito, Susanna; Bosis, Samantha; Grandolfo, Rita; Fiorito, Valentina; Valentini, Piero; Buonsenso, Danilo; Domenici, Raffaele; Montesanti, Marco; Salvini, Filippomaria; Riva, Enrica; Dodi, Icilio; Maschio, Francesca; Abbagnato, Luisa; Fiumana, Elisa; Fornabaio, Chiara; Ballista, Patrizia; Portelli, Vincenzo; Bottone, Gabriella; Palladino, Nicola; Valenzise, Mariella; Vecchi, Barbara; Gangi, Mariadi; Lupi, Carla; Villani, Alberto; De Martino, Maurizio
abstract

Tuberculosis (TB) is one of the leading causes of death worldwide. Over the last decades, TB has also emerged in the pediatric population. Epidemiologic data of childhood TB are still limited and there is an urgent need of more data on very large cohorts. A multicenter study was conducted in 27 pediatric hospitals, pediatric wards, and public health centers in Italy using a standardized form, covering the period of time between 1 January 2010 and 31 December 2012. Children with active TB, latent TB, and those recently exposed to TB or recently adopted/immigrated from a high TB incidence country were enrolled. Overall, 4234 children were included; 554 (13.1%) children had active TB, 594 (14.0%) latent TB and 3086 (72.9%) were uninfected. Among children with active TB, 481 (86.8%) patients had pulmonary TB. The treatment of active TB cases was known for 96.4% (n = 534) of the cases. Overall, 210 (39.3%) out of these 534 children were treated with three and 216 (40.4%) with four first-line drugs. Second-line drugs where used in 87 (16.3%) children with active TB. Drug-resistant strains of Mycobacterium tuberculosis were reported in 39 (7%) children. Improving the surveillance of childhood TB is important for public health care workers and pediatricians. A non-negligible proportion of children had drug-resistant TB and was treated with second-line drugs, most of which are off-label in the pediatric age. Future efforts should concentrate on improving active surveillance, diagnostic tools, and the availability of antitubercular pediatric formulations, also in low-endemic countries.

2014 - Performance of interferon-γ Release Assay for the Diagnosis of Active or Latent Tuberculosis in Children in the First 2 Years of Age [Articolo su rivista]
Silvia, Garazzino; Luisa, Galli; Elena, Chiappini; Michele, Pinon; Bergamini, Barbara Maria; Salvatore, Cazzato; Paola Dal, Monte; Icilio, Dodi; Laura, Lancella; Susanna, Esposito; Iughetti, Lorenzo; Carlotta, Montagnani; Maurizio De, Martino; Pier Angelo, Tovo
abstract

Background: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. Methods: We performed a multicenter, retrospective study in children aged 0–24 months who were tested at least once with QuantiFERON-TB Goldin-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. Results: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. Conclusions: QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTFIT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.

2011 - Tuberculosis infection in foreign-born children: a screening survey based on skin and blood testing. [Articolo su rivista]
Losi, M.; Bergamini, Barbara Maria; Venturelli, C.; DEL GIOVANE, Cinzia; Sighinolfi, G.; Rumpianesi, F.; Richeldi, Luca
abstract

This study, carried out in a low tuberculosis (TB) prevalence country with high immigration rates from high TB prevalence countries, deals with the interferon-gamma release assay, QuantiFERON®-TB Gold In-Tube, for the diagnosis of latent TB infection (LTBI) in foreign-born children. The results of our study highlight the potential advantages and concerns of using a blood test for diagnosing LTBI in a 'two-step' strategy in foreign-born children.

2010 - Efficacy of specific sublingual immunotherapy on quality of life in asthmatic children with house dust mite respiratory allergy: prospective, multicenter case-controls 36-month study [Abstract in Rivista]
Fiocchi, A; Arrigoni, S; Bergamini, Barbara Maria; Bernardo, L; Castella, V; Frediani, T; Strisciuglio, P.
abstract

Rationale: Specific immunotherapy (SIT) is considered as the only causal treatment of respiratory allergies. It is also known that SIT could have a positive impact on Quality of Life (QOL) of the allergic patients. However the are few data evaluating the impact of SIT or symptomatic drug treatment only in children with allergic rhinitis and asthma induced by perennial allergens. Study aim: To investigate the impact of sublingual SIT on Quality of Life and the clinical efficacy in paediatric patients with house dust mite (HDM) respiratory allergy (rhinitis and mild to moderate asthma) in comparison with pharmacological treatment only. Patients and Methods: In a multicentre, prospective 36-month case-control study 76 consecutive paediatric patients with rhinoconjunctivitis and asthma due to HDM (mean [SD] age 11(3); 50 male) were enrolled. A total of 41 patients (cases) started a SIT (SLITone, ALK-Abello’) one vial daily for 12 months as an add-one therapy and 35 matched subjects treated with symptomatic drugs only the controlsgroup. All patients had a confirmed diagnosis of HDM induced respiratory allergy. QOL was evaluated at baseline, after 12, 24 and 36 months by the means of two validated specific questionnaires (EQ-5D, italian version) (PAQLQ(S), italian version) Clinical efficacy was evaluated with symptom and medication score at baseline and after 12 month (intention-to-treat analysis). A Visual Analogic Scale (VAS) was also used to evaluate the subjective health status at the same times. Results: PAQLQ score improved significantly (P = 0.02) after 12 (+14%), 24 (+21%) and 36 (+36%) months of the observation period in case group in comparison with control group. Significant improvement was observed in the symptom and activity domains (10%). PAQLQ score in controls was slight reduced at the end of the observation period in comparison with baseline (P = 0.6). VAS score improves significantly (P = 0.001) in cases but not in the control subjects. Conclusion: Our study confirms that in comparison with symptomatic drug treatment only, SIT improves significantlyQuality of Life and the clinical course of the disease in children with HDM allergic asthma.

2010 - Once-daily intrapleural urokinase treatment of complicated parapneumonic effusion in pediatric patients [Articolo su rivista]
Bianchini, M. A.; Ceccarelli, P. L.; Repetto, P.; Durante, V.; Biondini, D.; Bergamini, Barbara Maria; Cacciari, A.
abstract

In this paper, we describe our experience in the treatment of childhood empyema using urokinase. Patients' ages ranged from 2 to 12 years. Urokinase (dosage: 3,100 IU/kg/day) was diluted in normal saline to produce 1000 IU/ml (maximum dosage 100,000 IU in 100 ml of normal saline). After 2 hours, the clamped catheters were released and connected to water-seal suction at a negative pressure of 10 cm H2O. Pleural irrigations were continued once a day until thoracostomy tube output decreased to less than 10 ml/day (urokinase treatment mean duration: 11.5 days). The complete resolution of the chest effusion was assessed on chest ultrasound scan and radiographs. None of the patients experienced any side effects due to urokinase. It would now seem reasonable to advocate small chest tube thoracostomy and intrapleural urokinase as first-line treatment of pleural empyema in children, with surgery indicated as a secondaryintervention.

2009 - Lipide profile, antioxidant factors and endothelial function in children and adolescent with type 1 diabetes mellitus [Abstract in Rivista]
L., Iughetti; A., Lasagni; Bergamini, Barbara Maria; Rossi, Rosario; P., Appio; A., Nuzzo; Modena, Maria Grazia; Salvini, Annamaria; Lami, Francesca; Bruzzi, Patrizia; Vellani, Giulia; Patianna, VIVIANA DORA; Predieri, Barbara
abstract

Type 1 diabetes mellitus (T1DM) is associated with the development of micro- and macro-vascular complication generally related to the duration of disease and glycemic control. Chronic hyperglycemia increases production of free radical intermediates which in turn augments oxidative stress. The oxidative stress can play a key role in the development of diabetic complications affecting also vascular function.In this study we evaluated the lipid profile, the parameters related to oxidative stress and the endothelial function to assess the relationships between these parameters and metabolic control in children and adolescents with T1DM. A total of 58 T1DM patient (11,5±3,49 yr) and 36 healthy children (9,60±3,21 yr) were studied.In all children serum concentration of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), Lipoprotein(a) (Lp(a)), homocysteine, fibrinogen, MDA, Vitamin E (VitE), beta-carotene, lycopene, retinol, Vitamin C reduced (Vit C-Red) and oxidized (VitC-Oxid) and hemoglobin glycosilated (HbA1c) were measured. Vascular function was assessed by measurement of endothelium-dependent vasodilatation of brachial artery (FMD) using a high-sensibility of ultrasound system. There were no significant difference in the levels of TC, LDL-C and HDL-C between diabetic patients and the controls. Serum concentrations of TG in T1DM subjects were significantly lower than in control ones. Total antioxidant status (VitE, beta-carotene, lycopene, retinol, Vit C-Red) don't showed significant difference between groups. Only levels of VitC-Oxid were significant higher in patiens with T1DM. Moreover, prepuberal T1DM subjects showed higher MDA serum concentration than controls (p<0,01). FMD (7.99±1.06%) was impaired in 46% of T1DM subjects. There was negative correlation between FMD and serum levels of LDL-C. In our T1DM patients the glycemic control (mean value of HbA1c= 8,33%) was associated with normal lipid profile and normal antioxidant levels. Despite of these data diabetic patients show increased oxidative parameters (MDA, VitC-Oxid). Even if FMD was not apparently related to antioxidant status, the relationship with lipid values emphasizes the role of a global metabolic control to optimize the vascular health of these patients.

2009 - Performance of commerical blood tests for the diagnosis of latent tuberculosis infection in children and adolescents [Articolo su rivista]
Bergamini, Barbara Maria; M., Losi; F., Vaienti; D'Amico, Roberto; B., Meccugni; M., Meacci; D., De Giovanni; F., Rumpianesi; Fabbri, Leonardo; F., Balli; Richeldi, Luca
abstract

BACKGROUND: The accurate diagnosis of latent tuberculosis infection reduces the risk of progression to severe disseminated disease. However, in young children, a major limitation of the standard tuberculin skin test is that false-negative results cannot be detected. The new interferon-gamma release assays QuantiFERON-TB Gold (Cellestis Carnegie Victoria, Australia), QuantiFERON-TB In-Tube (Cellestis), and T-SPOT.TB (Oxford Immunotec, Abingdon, United Kingdom) show promise of greater accuracy, but they may also be affected by impaired cellular immunity, resulting in indeterminate results (ie, insufficient response in positive-control wells).OBJECTIVE:To evaluate the impact of age on the performance of interferon-gamma release assays when used in a routine hospital setting among children tested for suspected active or latent TB infection.METHODS:We retrospectively studied 496 children 0 to 19 years of age who had been tested with the tuberculin skin test and at least 1 interferon-gamma release assay: 181 with QuantiFERON-TB Gold and 315 with QuantiFERON-TB In-Tube. In 154 of the children, paired interferon-gamma release assay testing was available: 87 with QuantiFERON-TB Gold/T-SPOT.TB and 67 with QuantiFERON-TB In-Tube/T-SPOT.TB.RESULTS:Compared with T-SPOT.TB, the rates of indeterminate results were significantly higher for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube. QuantiFERON-TB Gold and QuantiFERON-TB In-Tube also gave indeterminate results more frequently in children <4 years of age than in those >/=4 years of age. Indeterminate results were associated with younger age for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube but not for T-SPOT.TB. Considering age as a binary variable (<4 and >/=4 years of age), a significantly higher concentration of phytohaemagglutinin-produced interferon-gamma was observed in older children with both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube.CONCLUSIONS:Different blood tests for the diagnosis of latent tuberculosis infection in children seem to perform differently, because both QuantiFERON-TB tests were more likely than T-SPOT.TB to give indeterminate results in children <4 years of age.

2009 - rates of latent tuberculosis infection using different diagnostica test [Abstract in Rivista]
Losi, M; Piro, Roberto; D'Amico, Roberto; Luppi, Francesco; Bergamini, Barbara Maria; Ferrari, D; Miglietta, Roberta; Codeluppi, M; Luppi, M; Fantini, R.
abstract

Background.The interferon−g−release assays (IGRA) are emerging as an attractive alternative to the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI).The absence of a gold standard for LTBI hampers the assessment of any diagnostic test. Methods.In a prospective study,229 patients (mean age 35.5±24.6 y) from different ward of the Hospital (Respiratory Diseases,Dermatology, Rheumatology, Pediatrics, Infectious Diseases, Hematology and Transplant Unit) were simultaneously tested for a suspect of either LTBI or active tuberculosis using all commercially available diagnostics: TST,QuantiFERON−TB Gold (QFT−2G), QuantiFERON−TB Gold In−Tube(QFT−3G) and T−SPOT.TB(TS.TB). Results. 42(18.3%),37(16.2%),59(25.8%) and 79(34.5%) patients were positive with TST,QFT−2G,QFT−3G and TS.TB, respectively.TS.TB(p&lt;0.001) and QFT−3G(p=0.016) provided more positive results than TST, while no difference was found for TST and QFT−2G(p=0.53).All IGRA showed a good overall agreement (TS.TB vs QFT−2G,k=0.55; TS.TB vs QFT−3G,k=0.72;QFT−2G vs QFT−3G, k=0.62). In 22 subjects (9.6%) QFT−3G was positive and QFT−2G negative. Indeterminate results were more frequent with QFT−2G(18.3%) and QFT−3G (12.7%) than with TS.TB(1.3%,p&lt;0.0001). Conclusion. Rates of LTBI as detected by different diagnostic tests may have significant variations. Performances of various IGRA formats were variable in this population.

2008 - L'infezione tubercolare nel bambino: il contributo dei nuovi test immunologici [Articolo su rivista]
Bergamini, Barbara Maria; Richeldi, Luca
abstract

Negli ultimi decenni si è verificato un incremento dei casi di tubercolosi anche in aree tradizionalmente ritenute a bassa prevalenza di malattia, in particolare tra i giovani adulti recentemente immigrati. Questo fattore rappresenta un rischio di maggiore diffusione dell’infezione tra i bambini. I soggetti in età pediatrica, in particolare quelli al di sotto dei 5 anni di età, rappresentano un gruppo ad alto rischio di sviluppare malattia se infettati dal M. tuberculosis; peraltro, la diagnosi in questo gruppo di età presenta notevoli difficoltà per l’aspecificità del quadro clinico-radiologico e la bassa resa dei test microbiologici. I bambini ed i ragazzi a rischio di infezione tubercolare latente devono essere pertanto precocemente individuati ed opportunamente trattati.Fino a pochi decenni orsono l’unico test disponibile per individuare i soggetti con infezione tubercolare latente era il test cutaneo tubercolinico (o test di Mantoux), che però presenta notevoli limiti, in particolare mostra scarsa sensibilità (nei pazienti immunodepressi) e scarsa specificità (nei soggetti vaccinati con BCG). Sono stati recentemente sviluppati test basati sul rilascio di interferon-gamma che hanno dimostrato di avere buona sensibilità ed elevata specificità anche nei grupi più a rischio. È prevedibile quindi che l’applicazione di questi nuovi diagnostici in ambito pediatrico possa contribuire ad una più accurata individuazione dei soggetti con infezione tubercolare contribuendo quindi a ridurre la diffusione della malattia nella popolazione generale.

2008 - Prior tuberculin skin testing does not boost QuantiFERON-TB results in paediatric contacts [Articolo su rivista]
Richeldi, Luca; Bergamini, Barbara Maria; Vaienti, Francesca
abstract

Children in a pediatric TB contact case series who performed QuantifFERON after TST did not show boosting effect on QuantiFeron results.

2007 - Clinical effects of erdosteine in the treatment of acute respiratory tract diseases in children [Articolo su rivista]
Balli, F; Bergamini, Barbara Maria; Calistru, P; Ciofu, Ep; Domenici, R; Doros, G; Dragomir, D; Gherghina, I; Iordachescu, F; Murgoci, G; Orasanu, D; Plesca, D; Vaccaro, A; Assereto, R.
abstract

Erdosteine has positive effects on mucus rheology and transport due to the active metabolite (Metabolite 1) which contains a free thiol group. Erdosteine inhibits bacterial adhesiveness and has antioxidant properties. A synergistic effect of erdosteine with various antibiotics has been demonstrated in pharmacological and clinical studies. The present study was multicenter, randomized, double-blind and placebo-controlled. The aims of the study were to compare a combination of erdosteine with amoxicillin against an amoxicillin-placebo combination in pediatric patients with acute lower respiratory tract disease. A total of 158 patients (78 in the erdosteine group and 80 in the placebo group) were treated for 7 2 days. The efficacy parameters were cough (primary), polypnea, rhonchi, rales and body temperature (all measured at baseline, on Day 3 and at the end of treatment). Safety was assessed by strictly monitoring the occurrence of adverse events and using standard laboratory parameters. The results of the intention-to-treat analysis showed that the severity of cough was decreased by 47% at Day 3 in the erdosteine group with a statistically significant difference compared to placebo, the difference was still significant at the final visit. The decrease in the severity of rales was significantly greater at Day 3 in the erdosteine group than in the placebo group. The incidence of polypnea and rhonchi in the two groups showed similar decreases, an improvement mainly due to the antibiotic. No adverse events occurred and no adverse changes in laboratory parameters were observed. It is concluded that the combination of erdosteine and amoxicillin is a safe medication which is clinically superior to that of the antibiotic combined with placebo, especially in regard to the effects on cough.

2007 - T-cell-based diagnosis of neonatal multidrug-resistant latent tuberculosis infection. [Articolo su rivista]
Richeldi, Luca; K., Ewer; M., Losi; Bergamini, Barbara Maria; K., Millington; Fabbri, Leonardo; A., Lalvani
abstract

Non disponibileYoung children exposed to tuberculosis have a high risk of progression to severe tuberculosis disease, but diagnosis of recent infection is hindered by the poor sensitivity of the tuberculin skin test. Whether new blood tests can detect latent infection in this vulnerable group is unknown because there is no gold standard. We monitored a tuberculin skin test-negative infant whose mother had infectious multidrug-resistant tuberculosis with enzyme-linked immunospot, a blood test that enumerates Mycobacterium tuberculosis-specific T cells. The enzyme-linked immunospot test became persistently positive by 6 months, and 18 months later the child developed active tuberculosis despite appropriate chemoprophylaxis. At this point, the magnitude of the enzyme-linked immunospot response increased >10-fold. Our findings demonstrate that this blood test detected latent infection with dormant, yet viable, bacilli and illustrate how enzyme-linked immunospot could improve diagnosis of childhood tuberculosis infection.

2006 - Tracheobronchial anomalies in chromosome 22q11.2 microdeletion [Articolo su rivista]
Bertolani, Mf; Bergamini, Barbara Maria; Predieri, Barbara; Mirmassoumi, S; Bertolani, P; Sacco, O; Ferrari, Paola
abstract

No Abstract

2006 - Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study [Articolo su rivista]
G., Ferrara; Losi, Monica; D'Amico, Roberto; P., Roversi; R., Piro; M., Meacci; B., Meccugni; Im, Dori; A., Andreani; Bergamini, Barbara Maria; Mussini, Cristina; F., Rumpianesi; Fabbri, Leonardo; Richeldi, Luca
abstract

BACKGROUND: Two commercial blood assays for the diagnosis of latent tuberculosis infection--T-SPOT.TB and QuantiFERON-TB Gold--have been separately compared with the tuberculin skin test. Our aim was to compare the efficacy of all three tests in the same population sample. METHODS: We did a prospective study in 393 consecutively enrolled patients who were tested simultaneously with T-SPOT.TB and QuantiFERON-TB Gold because of suspected latent or active tuberculosis. 318 patients also had results available for a tuberculin skin test. FINDINGS: Overall agreement with the skin test was similar (T-SPOT.TB kappa=0.508, QuantiFERON-TB Gold kappa=0.460), but fewer BCG-vaccinated individuals were identified as positive by the two blood assays than by the tuberculin skin test (p=0.003 for T-SPOT.TB and p&lt;0.0001 for QuantiFERON-TB Gold). Indeterminate results were significantly more frequent with QuantiFERON-TB Gold (11%, 43 of 383) than with T-SPOT.TB (3%, 12 of 383; p&lt;0.0001) and were associated with immunosuppressive treatments for both tests. Age younger than 5 years was significantly associated with indeterminate results with QuantiFERON-TB Gold (p=0.003), but not with T-SPOT.TB. Overall, T-SPOT.TB produced significantly more positive results (38%, n=144, vs 26%, n=100, with QuantiFERON-TB Gold; p&lt;0.0001), and close contacts of patients with active tuberculosis were more likely to be positive with T-SPOT.TB than with QuantiFERON-TB Gold (p=0.0010). INTERPRETATION: T-SPOT.TB and QuantiFERON-TB Gold have higher specificity than the tuberculin skin test. Rates of indeterminate and positive results, however, differ between the blood tests, suggesting that they might provide different results in routine clinical practice.

2005 - Routine hospital use of a new commercial whole blood interferon-gamma assay for the diagnosis of tuberculosis infection [Articolo su rivista]
Ferrara, G; Losi, M; Meacci, M; Meccugni, B; Piro, R; Roversi, P; Bergamini, Barbara Maria; D'Amico, Roberto; Marchegiano, P; Rumpianesi, F; Fabbri, Lm; Richeldi, Luca
abstract

Rationale: Interferon (IFN)-gamma blood tests may improve the current level of diagnostic accuracy for tuberculosis infection. The Quanti-FERON-TB Gold (QFT-Gold) has been used in selected populations and shows higher specificity than the tuberculin skin test (TST). Objective: To evaluate the QFT-Gold test in unselected patients and assess the level of agreement with the TST. Methods: The test has been routinely performed on whole blood samples in our microbiology laboratory for 8 months. Demographic, clinical, and microbiological data have been collected and correlated to the QFT-Gold results. Measurements and Main Results: Of 318 patients tested, 68 (21.4%) gave an indeterminate (low positive mitogen control) QFT-Gold result. Indeterminate results were significantly overrepresented in patients with a negative TST (28.9% vs. 6.6% in TST-positive patients; p &lt; 0.0001, chi(2) test) and were more frequent in patients receiving immunosuppressive therapies than in those who were not receiving such treatments (odds ratio, 3.35; 95% confidence interval, 1.84-6.08; p &lt; 0.0001). After excluding indeterminate results, the concordance between QFT-Gold and TST was significantly lower in Bacille Calmette-Guerin-vaccinated individuals (41.5%) than in nonvaccinated individuals (80.3%) (p &lt; 0.0001). In 11 patients with active tuberculosis (5 culture-confirmed), QFT-Gold provided more positive results than the TST (66.7% vs. 33.3%; p = 0.165). Conclusions: The QFT-Gold test is feasible in routine hospital use for the diagnosis of tuberculosis infection. As with the TST, immunosuppression may negatively affect the test's performance, with a significant rate of indeterminate results in the most vulnerable population.

2004 - Alternaria spores at different heights from the ground [Articolo su rivista]
Bergamini, Barbara Maria; S., Grillenzoni; Ad, Andreoni; P., Natali; A., Ranzi; Mf, Bertolani
abstract

Background: Alternaria tenuis (Alt) is one of the main allergens in pediatric age. In temperate climates, airborne Alt spores are detectable from May to November with peaks in late summer and autumn. Sensitized children display symptoms even in the absence of airborne Alt spores. Alt spore concentration, as well as pollen, is usually detected by fixed devices located on the roof of a building at a height of 10-20 m. The aim of the current study is to find out whether ground-level (50 cm) Alt spore concentrations are different from those at roof-top level, even during low-concentration periods. Methods: Alt samples were taken simultaneously using a Hirst fixed volumetric collector (FVC) placed on a 15 m-high roof and by a portable volumetric collector (PVC). Firstly, the results of FVC and PVC, both placed on the roof-top, were compared to verify the correlation coefficient of the two samplers. Subsequently, the PVC was placed 50 cm above the ground in a courtyard (30 samplings) and in private green areas (50 samplings). The results were compared by statistical analysis (Student's t-test or K-S test). Results: The values of the 20 samples taken jointly in summer time (FVC 195 +/- 134 spores/m(3); PVC = 134 +/- 131 spores/m(3)) showed a good correlation between the two samplers (r = 0.850; P < 0.01), with a correction factor equal to 1.177. 1. Thirty samples obtained in summer and winter when the PVC was positioned in an enclosed courtyard directly below the FVC showed no significant difference (PVC, 181 +/- 194 spores/m(3); FVC, 152 +/- 145 spores/m(3); P = 0.221). 2. Fifty samples taken by PVC placed in private green areas in a low-concentration period, showed significantly higher concentrations than by FVC: PVC, 531 +/- 925 spores/m(3); FVC, 25 +/- 51 spores/m(3) (K-S test: P < 0.0001). In particular, 33 samples taken in winter when Alt counts by FVC were <10 spores/m(3) still demonstrated highly significant differences: PVC, 398 +/- 961 spores/m(3); FVC, 2.0 +/- 2 spores/m(3) (K-S test: P < 0.0001). Conclusion: Our results lead to the conclusion that Alt spore concentration is significantly higher at ground level in the presence of vegetation, even when the spore concentration is very low (<10 spores/m(3)). These results further suggest that the individual's exposure to Alt, especially in the case of children, is underestimated by samples taken at roof-top level by FVC.

2004 - T cell-based tracking of multidrug resistant tuberculosis infection after brief exposure [Articolo su rivista]
Richeldi, Luca; Ewer, K; Losi, M; Bergamini, Barbara Maria; Roversi, P; Deeks, J; Fabbri, Leonardo; Lalvani, A.
abstract

Molecular epidemiology indicates significant transmission of Mycobacterium tuberculosis after casual contact with infectious tuberculosis cases. We investigated M. tuberculosis transmission after brief exposure using a T cell-based assay, the enzyme-linked-immunospot (ELISPOT) for IFN-gamma. After childbirth, a mother was diagnosed with sputum smear-positive multidrug-resistant tuberculosis. Forty-one neonates and 47 adults were present during her admission on the maternity unit; 11 weeks later, all underwent tuberculin skin testing (TST) and ELISPOT. We correlated test results with markers of exposure to the index case. The participants, who were asymptomatic and predominantly had no prior tuberculosis exposure, had 6.05 hours mean exposure (range: 0-65 hours) to the index case. Seventeen individuals, including two newborns, were ELISPOT-positive, and ELISPOT results correlated significantly with three of four predefined measures of tuberculosis exposure. For each hour sharing room air with the index case, the odds of a positive ELISPOT result increased by 1.05 (95% Cl: 1.02-1.09, p = 0.003). Only four adults were TST-positive and TST results did not correlate with exposure. Thus, ELISPOT, but not TST, suggested quite extensive nosocomial transmission of multidrug-resistant M. tuberculosis after brief exposure. These results help to explain the apparent importance of casual contact for tuberculosis transmission, and may have implications for prevention.

1999 - Extraction of a rubber bullet from a bronchus after 1 year - Complete resolution of chronic pulmonary damage [Articolo su rivista]
Bertolani, Mf; Marotti, Francesca; Bergamini, Barbara Maria; Pellegrino, M; Balli, R; Buonaura, Pc
abstract

Inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose, The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe, Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia, The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchosopy can be avoided.

1997 - Comparison of interrupter resistance with flow/volume method in childREN [Articolo su rivista]
Bertolani, M. F.; Marotti, F.; Bergamini, B. M.; Ferraroni, E.; De Guglielmo, M.; Ganazzi, D.
abstract

Airway resistance measurement with the Interrupter Technique (RINT) has been proposed as a valid method for the evaluation of bronchial obstruction and, being easy to administer, could find its application in the uncooperative child (Ch). In order to evaluate the possible clinical application of RINT (Micro Medical MICROLAB 4000), this technique was compared with the Flow/Volume curve (F/V) (SPIROPRO 2000 Pabysch) in Ch (mean age 109.39±39 months). We studied : A) 54 Ch with normal F/V in baseline conditions; B) 50 asthmatic Ch before and after the exercise test (6' free running); C) 102 asthmatic Ch before and after inhalation of 200 ug salbutamol MDI. RINT was calculated, both with mouthpiece and face mask, as the average of 20 measurements for test A and 10 for tests B and C. Paired t test (significant for p&lt;0.05) and Pearson correlation coefficient (significant for r2 0.50) were calculated. Results : A) RINT vs FEV1, PEF, MEF 25, 50 and 75 were not correlated (r2&lt;0.50) even though r revealed an inverse trend (negative sign). Mean values with mouthpiece were higher than those with face mask (p&lt;0.005). B) The change in mean values of expiratory flows was significant at 6', 12' and 20', while mean RINT change was significant only at 6' whether with mouthpiece or with face mask; r had a negative sign but r2&lt;0.50. C) The bronchodilator test showd significant changes in values (p&lt;0.001) both with RINT and F/V. r had a negative sign but r2 &lt; 0.50. Conclusions : RINT measurements are not generally comparable with F/V curve values. Only the bronchodilator test showed significant changes. The mouthpiece measurements are much lower than those with face mask. The results are extremely non-homogeneous and we conclude that the RINT system used has to be improved before it can be applied in clinical practice. © 1997 Wiley-Liss, Inc.

1997 - Cricoarytenoid arthritis as an early sign of juvenile chronic arthritis [Articolo su rivista]
Bertolani, Mf; Bergamini, Barbara Maria; Marotti, Francesca; Giglioli, P; Venuta, A.
abstract

A 14-month-old girl developed chronic strider and dyspnoea. Four months later she presented arthritis, anterior uveitis and positive ANA. Juvenile chronic arthritis (JCA) was diagnosed. Laryngoscopy demonstrated the presence of cricoarytenoid arthritis (CA). The left vocal cord was adducted and immobile, while the right vocal cord had decreased mobility. Erythema and swelling of the arytenoid cartilage on both sides was seen. Steroid treatment resulted in the resolution of these symptoms and made airway control unnecessary. This case demonstrates that CA may be the first sign of JCA, preceding peripheral arthritis. CA should be considered in, every child with chronic stridor and laryngeal obstruction.

1992 - Dermatophagoides asthma in children. Oral hyposensitization [Articolo su rivista]
Balli, F.; Bergamini, B. M.; Marcolini, C.; De Palma, M.; Marchioni, C. F.; Baldini, E. V.
abstract