Objective: Growth hormone deficiency (GHD) is the most common pituitary hormone deficiency and is one of the main causes of short stature in children and adolescents. The aim of this study is to evaluate the epidemiology of pediatric GHD worldwide, since no other systematic review has been published so far. Methods: We searched PubMed, Embase, and Web of Science up to July 2023 to find epidemiological studies involving children with GHD. Two review authors independently screened articles, extracted data and performed the quality assessment. Results: We selected 9 epidemiological studies published from 1974 to 2022. The range of prevalence was 1/1107–1/8,646. A study based on a registry of GH users in the Piedmont region (Italy) reported the highest mean prevalence. In the included studies, the mean incidence ranged from 1/28,800 to 1/46,700 cases per year. One study reported a 20-year cumulative incidence of 127/100,000 for boys and 93/100,000 for girls. Studies were heterogeneous in terms of population (age and GHD etiology) and diagnostic criteria. As for the methodological quality of included studies, all but one study satisfied the majority of the checklist items. Conclusions: The included studies are mostly European, so the provided estimates cannot be considered global. International multicentre studies are needed to compare epidemiological estimates of GHD among different ethnical groups. Considering the considerable cost of human recombinant GH, the only available therapy to treat GHD, understanding accurate epidemiological estimates of GHD in each country is fundamental for resource allocation.

Objective: Our study's objective was to assess the incidence trends and healthcare resource utilization of hospitalizations for Tick-Borne Encephalitis (TBE) and associated costs in Italy in order to improve public awareness and preventive measures. Methods: This retrospective observational study was based on the Italian Ministry of Health's Hospital Discharge Record (HDR) database. Data were gathered across Italy from 2015 to 2019, selecting hospitalizations with ICD-9 code 063 related to TBE, both in primary and secondary diagnoses. For each year, we collected the following variables: number of hospitalizations, hospitalization rate, mortality rate, mean length of hospital stay, hospital ward, and cost of hospitalization. Results: There were a total of 237 hospitalizations from 2015 to 2019; 62 % of those were male. The lowest number of TBE hospitalizations was in 2015 (21 cases, corresponding to 0.35 per million inhabitants), the highest in 2019 (64 cases, 1.04 per million inhabitants). The summer months saw a greater than average number of hospitalizations. For the years analyzed, the cumulative number of cases peaked in June (54 cases), July (46 cases), and August (35 cases). There were only two deaths registered in our study sample. TBE cases were mostly localized in the North-Eastern regions of Italy. TBE incidence during the study period in the most affected areas were: Autonomous Province of Trento, ranging from 11.2 to 42.3 per million inhabitants, Autonomous Province of South Tyrol, from 0 to 21.1 per million inhabitants, and Veneto Region, from 2.6 to 4.5 per million inhabitants. In the study period, the average length of hospital stay was largely stable ranging from 10.6 days to 12.8 days, with related costs ranging from 5,813.7 € to 7,352.5 €. Conclusions: According to our data, the majority of TBE hospitalizations occur in North-East Italy with an increasing trend over the analyzed period. Even though Italy has fewer TBE cases than other neighboring European countries, the health and economic impact can be high in the affected areas.

Background and Objective. The significance of microRNAs (miRNAs) in relation to neoplastic diseases; such as renal carcinoma carcinoma (RCC); has been brought to light by recent studies. Analyzing the main urinary miRNAs implicated in RCC and their potential diagnostic use was the goal of this systematic review of the literature. Methods. This systematic review was performed following the PROSPERO protocol CRD42024550716. Our literature search strategies were deciding which database to include (Pubmed; EMBASE and Clinicaltrial.gov) and composing strings with words related to urinary miRNA in patients with RCC. Key findings and limitations. After screening; 10 papers were included from the 593 records that the systematic review found. No miRNA was investigated in more than one paper by different authors. The miR-210 and let-7 family were the most investigated and resulted upregulated in RCC cases compared to controls. Five papers reported different expression of miRNAs in urine samples before and after surgery: miR-15a; miR-34a-5p; miR-200a-3p; miR-205-5p; miR-210; miR-210-3p; miR-365a-3p and let-7d-5p levels decreased after nephrectomy. Meta-analysis was not performed since the included studies were heterogeneous; in terms of studied miRNA; of the normalizer used during stabilization phase; and histologic type of RCC (clear cell RCC; papillary RCC; unspecified RCC). Conclusions. Considering the variability and heterogeneity of the obtained results; as well as the vastness of the topic; expanding research in this field appears highly promising. To support further advancements; it would be useful to establish a database that consolidates international findings.

Background: In recent years, research has highlighted the importance of microRNAs (miRNAs) in the context of oncological diseases, including renal cell carcinoma (RCC). The aim of this systematic review of the literature was to analyze the main serum miRNAs involved in RCC and their potential diagnostic power. Methods: This systematic review was performed following the PROSPERO protocol CRD42024550709. Literature search strategies were developed composing strings with text words related to serum miRNA in RCC for PubMed, EMBASE and Clinicaltrial.gov. The studies enrolling adult populations with RCC and healthy controls measuring circulating miRNAs were included. Results: We found 500 records, and 26 papers were included after screening. Four studies found that miR-210, the most investigated miRNA, was overexpressed in RCC patients compared to controls, while one reported no statistical difference. The expression of some miRNAs was consistently lower in cases compared to healthy controls, such as miR-1-3p and miR-129-5p, while others (miR-221, miR-222, miR-224-5p and miR-1233) were consistently upregulated. Conclusions: Circulating miRNAs represent a promising avenue for the non-invasive diagnosis of RCC. Future research should focus on standardization, validation in larger cohorts and the development of multi-marker diagnostic panels to address these current limitations and pave the way for miRNA-based diagnostics in RCC.

Background: Suspected gastroesophageal reflux disease (GERD) is one of the most common reasons for referral to pediatric and gastroenterology clinics, and proton pump inhibitors (PPIs) are frequently prescribed. Currently, there is still wide heterogeneity in treatment, especially in neonates and extraesophageal presentations. This article aimed to provide guidelines and a consensus of Italian experts on the management of GERD in infants, children, and adolescents, in order to improve the care and treatment of these patients. Methods: A multidisciplinary pediatric panel identified four key clinical questions (PICOs) regarding pharmacological and non-pharmacological treatments, surgical intervention, and prognosis of pediatric GERD. Four databases (PubMed/Medline, Embase, Web of Science, and Google Scholar) were searched from inception to May 2024, using a specific search string for each PICO and limiting the search to children (0–18 years) and to English language. Previous pediatric guidelines, systematic reviews, and clinical trials focused on the treatment of GERD were considered to formulate evidence-based recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and AGREE II systems were used to assess study quality; a 9-point Likert scale was used to rate the recommendations. A two-round Delphi method was conducted to reach consensus, defined as ≥ 80% agreement or disagreement. Results: The systematic review identified three previous pediatric guidelines, eight systematic reviews, 83 RCTs, and three observational studies. The panel provided 26 recommendations regarding the management and treatment of GERD in pediatric patients. All reached consensus, with the majority expressing strong support for the intervention. The panel also provided practice insights for each PICO to improve the clinical application and clarity of these guidelines. Conclusion: Regurgitation is common in infants, but in most cases, no treatment is necessary. When regurgitation causes discomfort, a brief trial of alginate or thickened formulas or a cow’s milk elimination diet may be considered, particularly if other symptoms, including crying and dermatitis, are associated. For children who complain of heartburn or have severe neurologic deficits, a short course of empirical PPIs treatment may be considered, monitoring the clinical response and testing if no improvement is seen. PPIs are recommended in infants and children with reflux esophagitis, or acid reflux detected by esophageal pH monitoring. Children at high- risk for chronic GERD requiring prolonged treatment and multidisciplinary care have been identified. Surgery should be considered for severe or complicated GERD after a comprehensive diagnostic workup and optimal pharmacological management.