Pediatric tuberculosis in Italian children: Epidemiological and clinical data from the Italian register of pediatric tuberculosis

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

Cannabis ed epilessia in Pediatria: mito o realtà? [Cannabis and epilepsy: Myth or reality?]

In recent years, there has been an increasing interest for the use of medical Cannabis in Paediatrics. Several pharmacological properties are attributed to Cannabis by preclinical studies, but the most important application is related to the treatment of drug-resistant epilepsy. The aim of this paper is to review the preclinical data on cannabidiol, one of the most popular cannabinoids, and to discuss the recent clinical trial published in the New England Journal of Medicine that led the US Food and Drug Administration to approve a drug derived from marijuana for treating two rare and severe forms of epilepsy: the Dravet syndrome and the Lennox-Gastaut syndrome

Prognostic factors in epileptic encephalopathies at onset in the first 2 years of life: the experience of a tertiary healthcare center in Italy

The aim of this retrospective cohort study was to identify some prognostic factors in anamnestic/clinical/instrumental data at the onset of epileptic encephalopathy (EE), for multiple outcome measures. We recruited patients diagnosed as affected by EE at Sant'Anna University Hospital, with onset in the first 24 months of life, with follow-up lasting longer than 3 years. This study was conducted to recognize possible prognostic factors among onset data of patients with EE, considering multiple outcome measures. This study design represents an innovative element compared to available papers, which were centered on isolated endpoints of prognosis, such as the prediction of neurocognitive development impairment or drug resistance. The data obtained from the study confirm that EEs prognosis is generally, but not universally, poor. Structural etiology and/or lack of response to antiepileptic drug (AED) within three months are main risk factors for DRE. Normal development at the onset of EEs and early response to treatment are the main positive prognostic factors

Acute mastoiditis in children. An increasing entity?

Recent papers suggest [1,2] a renewed increase in the incidence of acute mastoiditis in children over the last few years. A retrospective study was carried out with the aim to investigate the incidence in our country: all the case sheets of the children admitted to Paediatrics, at the University Hospital of Ferrara from January 1994 to December 2008 (Fig. 1) were examined

Multifocal Skin Tuberculosis. Report of a case.

A rare case of multifocal Skin Tuberculosis is describe

Pediatric Headache in Primary Care and Emergency Departments: Consensus with RAND/UCLA Method

Headache is the most frequent neurological symptom in childhood and the main reason for admission to pediatric emergency departments. The aim of this consensus document is to define a shared clinical pathway between primary care pediatricians (PCP) and hospitals for the management of children presenting with headache. For the purposes of the study, a group of hospital pediatricians and a group of PCP from the Emilia Romagna's health districts were selected to achieve consensus using the RAND/UCLA appropriateness method. Thirty-nine clinical scenarios were developed: for each scenario, participants were asked to rank the appropriateness of each option from 1 to 9. Agreement was reached if >= 75% of participants ranked within the same range of appropriateness. The answers, results, and discussion helped to define the appropriateness of procedures with a low level of evidence regarding different steps of the diagnostic-therapeutic process: primary care evaluation, emergency department evaluation, hospital admission, acute therapy, prophylaxis, and follow-up. The RAND proved to be a valid method to value appropriateness of procedures and define a diagnostic-therapeutic pathway suitable to the local reality in the management of pediatric headache. From our results, some useful recommendations were developed for optimizing the healthcare professionals' network among primary care services and hospitals

Early triple therapy vs mono or dual therapy for children with perinatal HIV infection.

none91The time at which antiretroviral therapy (ART) should be initiated in children with perinatal human immunodeficiency virus (HIV) infection remains controversial. In a cohort study, Berk et al1 reported clinical benefit from mono/dual ART started before 60 days of life in 10 children compared with treatment administered at 61 to 120 days of life in 16 children. The 23 children who received early triple ART were not investigated because none of them progressed to category C diagnosis by 3 years of age. We performed a similar analysis in a cohort study of a larger data set of children with a longer follow-up to evaluate the outcomes of early and very early triple ART.noneChiappini E; Galli L; Gabiano C; Tovo PA; de Martino M; P.Osimani; R. Cordiali; D. De Mattia; M. Manzionna; C. Di Bari; M. Ruggeri; M.Masi; A. Miniaci; F. Specchia; M. Ciccia; M. Lanari; F. Baldi; L. Battisti; C. Fiorino; C.Dessı`; C. Pintor; M. Dedoni; M.L. Fenu; R. Cavallini; E. Anastasio; F. Merolla; M. Sticca; G. Pomero; T. Bezzi; E. Fiumana; F. Bonsignori; P. Gervaso; E. Seini; M.T. Cecchi; D. Cosso; A. Timitilli; M.Stronati; A. Plebani; R. Pinzani; I. Bongianin; A.Vigano`; V. Giacomet; P. Erba; F. Salvini; G.V. Zuccotti; M. Giovannini; G. Ferraris; R. Lipreri; C. Moretti; M. Cellini; M.C. Cano; P. Paolucci; E. Bruzzese; G. De Marco; L. Tarallo; F. Tancredi; M. Pennazzato;O. Rampon; E.R. Dalle Nogare; A. Sanfilippo; A.Romano; M. Saitta; I. Dodi; A. Barone; A. Maccabruni; R. Consolini; A. Legitimo; C. Magnani; P. Falconieri; C. Fundaro`; O.Genovese; A. Panzanella; A.M. Casadei; A. Martino;C. Concato; G. Anzidei; G. Bove; S. Cerilli; S. Catania;C. Ajassa; A. Ganau; L. Cristiano; A. Mazza; A. Di Palma; F. Mignone; C. Riva; C. Scorfaro; V. Portelli; M. Rabusin; A. Pellegatta; M. MolesiniChiappini, E; Galli, L; Gabiano, C; Tovo, Pa; de Martino, M; P., Osimani; R., Cordiali; D., De Mattia; M., Manzionna; C., Di Bari; M., Ruggeri; M., Masi; A., Miniaci; F., Specchia; M., Ciccia; M., Lanari; F., Baldi; L., Battisti; C., Fiorino; C., Dessı`; C., Pintor; M., Dedoni; M. L., Fenu; R., Cavallini; E., Anastasio; F., Merolla; M., Sticca; G., Pomero; Bezzi, Teresa Maria; Fiumana, Elisa; F., Bonsignori; P., Gervaso; E., Seini; M. T., Cecchi; D., Cosso; A., Timitilli; M., Stronati; A., Plebani; R., Pinzani; I., Bongianin; A., Vigano`; V., Giacomet; P., Erba; F., Salvini; G. V., Zuccotti; M., Giovannini; G., Ferraris; R., Lipreri; C., Moretti; M., Cellini; M. C., Cano; P., Paolucci; E., Bruzzese; G., De Marco; L., Tarallo; F., Tancredi; M., Pennazzato; O., Rampon; E. R., Dalle Nogare; A., Sanfilippo; A., Romano; M., Saitta; I., Dodi; A., Barone; A., Maccabruni; R., Consolini; A., Legitimo; C., Magnani; P., Falconieri; C., Fundaro`; O., Genovese; A., Panzanella; A. M., Casadei; A., Martino; C., Concato; G., Anzidei; G., Bove; S., Cerilli; S., Catania; C., Ajassa; A., Ganau; L., Cristiano; A., Mazza; A., Di Palma; F., Mignone; C., Riva; C., Scorfaro; V., Portelli; M., Rabusin; A., Pellegatta; M., Molesin

Persistently high IgA serum levels are a marker of immunological or virological failure of combined antiretroviral therapy in children with perinatal HIV-1 infection

Non-expensive and low-complexity surrogate markers for monitoring the response to combined antiretroviral therapy (combined-ART) are needed in poor-resource settings where routine assessment of CD4+ T-lymphocyte count and viral load can not be afforded. We longitudinally evaluated Ig serum levels in 234 HIV-1 infected children receiving combined-ART with ≥ 3 drugs. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using the mean and standard deviation of the normal population for each age period. Data from 17 (7·3%) children with immunological failure and from 54 (23·1%) children with virological failure of combined-ART were compared with data from not-failed children. At baseline children with immunological failure showed higher IgM z-scores (P = 0·042) than children without. After 3–12 months of therapy immunologically failed children displayed higher viral loads (P < 0·0001) and IgA (P = 0·043) z-scores than not-failed children. Similarly, at the same follow-up time, children with virological failure showed lower CD4+ T-lymphocyte percentages (P = 0·005) and higher IgA z-scores (P < 0·0001) than not-failed children. No difference in IgG or IgM z-scores was evidenced between failed and not-failed children after 3–12 months of therapy. In conclusion, IgA serum level is a cheap and low-complexity marker of immunological or virological failure of combined-ART which might be adopted in poor-resource settings