Due polsi scomparsi in un soffio

Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. Clinical presentation varies from heart failure in neonatal period to asymptomatic cases diagnosed later in life. CoA was suspected in a 12-month-old child who showed moderate precordial murmur accompanied by hypertension exclusively present at the upper limbs with absence of the femoral pulses. The evaluation of femoral pulses should be repeated during the child growth because CoA may not be completely developed in the neonatal period

The Risks of Phosphate Enemas in Toddlers: A Life-Threatening Unawareness

Background: While oral laxatives represent the first-line treatment of fecal impaction, enemas are frequently used in clinical practice in pediatric emergency departments (PEDs) and by family pediatricians (FPs). Objectives: Phosphate-containing enemas (PcEs) are commonly employed, even causing the risk of rare but lethal toxicity. We investigated pediatricians' awareness of PcE risks. Methods: We conducted an online survey by sending a multiple-choice questionnaire to the referents of 51 PEDs and 101 FPs. We collected and compared the answers with recommendations reported by the Italian Drug Agency (AIFA) and the available literature about PcE administration. Results: Of the institutions and pediatricians receiving the questionnaire, 23 PEDs (45%) and 63 FP (62.3%) participated in the survey. Of PEDs, 95% and 33.0% of FPs treated fecal impaction with PcE. Moreover, 54% of PEDs and 86.0% of FPs did not provide treatment according to the AIFA recommendations for the daily dose. Conclusions: This study shows limited pediatricians' awareness of the potential risks related to PcE

Definition and prevalence of familial short stature

Objective: To verify the prevalence of novel definitions of familial short stature on a cross-sectional cohort of children referred for short stature when their height and that of both parents were measured. Methods: We consecutively enrolled 65 individuals referred for short stature when both parents were present. We defined \u201ctarget height-related short stature\u201d (TH-SS) when child\u2019s height is 64 12 2 SDS and included in the range of target height; suspected \u201cautosomal dominant short stature\u201d (AD-SS) when child height and at least one parent height are 64 12 2 SDS; \u201cconstitutional familial short stature\u201d (C-FSS) when a child with TH-SS does not have any parents with height 64 12 2 SDS. Results: Of 65 children referred for SS, 48 individuals had a height 64 12 2 SDS. Based on the parents\u2019 measured heights, 24 children had TH-SS, 16 subjects AD-SS, and 12 individuals C-FSS. If we had considered only the parents\u2019 reported height, 3 of 24 children with TH-SS, 9 of 16 with AD-SS, and 10 of 12 with C-FSS would have been lost. Conclusion: We suggest novel definitions to adequately detect and approach the cases of FSS since C-FSS (25%) might not need any specific investigation, while on the contrary, AD-SS (33%) should undergo genetic evaluation. Moreover, this study underlines that adequate measurement and consideration of children\u2019s and parents\u2019 heights (individually and together) are crucial in the clinical evaluation of every child with short stature

Ulnar Pseudarthrosis in a Child with Type 1 Neurofibromatosis

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Painful thoracic swelling in a refugee teenager

CaseA 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sternal region. The lesion was reddish, warm, tender and painful (figure 1). Digital clubbing was also noticed. The remaining examination was normal. White blood cell count was 9000 cells per mm3, haemoglobin 145 g/L, erythrocyte sedimentation rate and C reactive protein were normal as well as renal and liver function tests. ECG was regular.edpract;archdischild-2020-319658v1/F1F1F1Figure 1Swelling in the sternal region. QUESTION 1: Based on the clinical picture, laboratory tests and history, what is the most likely diagnosis?Chest wall tuberculosisLymphomaThoracic actinomycosisInfected haematoma QUESTION 2: Which is the best diagnostic test to confirm this diagnosis?Ultrasound scanMRICTChest radiograph QUESTION 3: What is the mainstay of the management of this condition?Drainage of the abscessAntitubercular chemotherapyAspiration of the abscess and antitubercular chemotherapyHyperbaric oxygen therapyAnswers can be found on page 02

Rebound of Severe Alcoholic Intoxications in Adolescents and Young Adults After COVID-19 Lockdown

The coronavirus lockdown in Italy ended, but the postlockdown phase may be even more challenging than the outbreak itself if the impact on mental health is considered. To date, little evidence is available about the effect of lockdown release in terms of adolescent health from the perspective of an emergency department (ED)

COVID-19-Induced Thrombosis in Patients without Gastrointestinal Symptoms and Elevated Fecal Calprotectin: Hypothesis Regarding Mechanism of Intestinal Damage Associated with COVID-19

Background: Patients with coronavirus infectious disease 2019 (COVID-19) and gastrointestinal symptoms showed increased values of fecal calprotectin (FC). Additionally, bowel abnormalities were a common finding during abdominal imaging of individuals with COVID-19 despite being asymptomatic. The current pilot study aims at evaluating FC concentrations in patients without gastrointestinal symptoms. Methods: we enrolled 25 consecutive inpatients with COVID-19 pneumonia, who were admitted without gastrointestinal symptoms and a previous history of inflammatory bowel disease. Results: At admission, 21 patients showed increased FC with median values of 116 (87.5; 243.5) mg/kg despite absent gastrointestinal symptoms. We found a strong positive correlation between FC and D-Dimer (r = 0.745, p < 0.0001). Two patients developed bowel perforation. Conclusion: our findings may change the current understanding of COVID-19 intestinal-related disease pathogenesis, shedding new light on the potential role of thrombosis and the consequent hypoxic intestinal damag

Spontaneous Rectal Perforation in a Patient with SARS–CoV-2 Infection

Coronavirus disease 2019 (COVID-19) is mostly perceived as a respiratory disease. However, there is increasing evidence of patients showing gastrointestinal symptoms, with increasing rates of presentation according to the severity of the disease. In a few cases, the abdominal involvement of COVID-19 resulted in spontaneous bowel perforation. Here, we present in detail the first case of rectal perforation in a patient with COVID-19