Orticaria emorragica: Eppur si muove

Acute urticaria is a frequent benign disease in children and is often secondary to infections. Usually it is a self-limited histamine-dependent cutaneous condition marked by transient, erythematous, and pruritic wheals and frequently by acral angioedema. A haemorrhagic pattern characterised by annular and polycyclic lesions with central ecchymosis is a possible presentation especially in young children and it can be so alarming as to cause hospital admission. Establishing the correct diagnosis of acute annular urticaria (a morphologic subtype of simple infectious urticaria recently referred as urticaria multiforme) is important to prevent an unnecessary diagnostic work up. In an otherwise well-appearing child erythema multiforme, serum sickness-like reaction and acute haemorrhagic oedema of infancy are the principal differential diagnoses. A direct history and physical examination can reliably distinguish all these conditions, avoiding laboratory investigations and allowing appropriate treatment. Reassurance and oral non-sedating antihistamine therapy are sufficient

Candidate Biomarkers for the Detection of Serious Infections in Children: A Prospective Clinical Study

Serious bacterial infections (SBI) in children are associated with considerable morbidity and mortality, and their early identification remains challenging. The role of laboratory tests in this setting is still debated, and new biomarkers are needed. This prospective, observational, single-center study aims to evaluate the diagnostic role of blood biomarkers in detecting SBI in children presenting with signs of systemic inflammatory response syndrome (SIRS). A panel of biomarkers was performed, including C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), absolute neutrophil count (ANC), interleukin (IL)-6, IL-8, IL-10, human terminal complement complex (C5b-9), Plasmalemma-Vesicle-associated protein 1 (PV-1), Intercellular Adhesion Molecule-1 (ICAM-1), and Phospholipase A2 (PLA2). Among 103 patients (median age 2.9 years, 60% males), 39 had a diagnosis of SBI (38%). Significant predictors of SBI were CRP (p = 0.001) and ICAM-1 (p = 0.043). WBC (p = 0.035), ANC (p = 0.012) and ANC/WBC ratio (p = 0.015) were also significantly associated with SBI in children without pre-existing neutropenia. ROC curves, however, revealed suboptimal performance for all variables. Nevertheless, a model that combined CRP and ANC/WBC ratio had more in-depth diagnostic accuracy than either of the two variables. Overall, this study confirms the limited usefulness of blood biomarkers for the early diagnosis of SBI. WBC, ANC, ANC/WBC ratio, CRP, and ICAM-1 showed the best, albeit moderate, diagnostic accuracy

Italian standardization of the Apples Cancellation Test

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect)

Noduli tiroidei, quando preoccuparsi?

Una formazione nodulare nel contesto del parenchima tiroideo; pu\uf2 essere rilevata sia clinicamente (ispezione e palpazione) che ecograficamente. Fino al 40% dei noduli tiroidei vengono riscontrati accidentalmente all\u2019ecografia (\u201cincidentalomi\u201d). I noduli possono essere singoli o multipli. Il nodulo solitario risulta il pi\uf9 frequente in et\ue0 pediatrica e va sempre indagato, in quanto espressione non specifica di una variet\ue0 di possibili malattie, che impongono la diagnosi differenziale con il carcinoma tiroideo. Il gozzo multinodulare risulta infrequente e tipico dell\u2019et\ue0 adolescenziale-adulta; nel suo contesto va indagato un eventuale nodulo dominante, che si caratterizza per il maggior volume e per il rapido accrescimento

Pediatric endocrinology through syndromes

In everyday practice, a pediatric endocrinologist will face a variety of different endocrine issues (such as short or tall stature, dysthyroidism, abnormal pubertal timing or impaired glucose metabolism), which relevantly contribute to the global care of a number of syndromic conditions. On the other hand, the presence of endocrine features may assist in the diagnostic process, leading to final diagnosis of a syndromic disorder. The intention of this review is to provide a referenced overview of different genetic syndromes characterized by endocrine features, and to present a possible classification, based on whether the endocrinopathy or the syndrome is typically recognized first. Thus, the first part of the manuscript deals with the most common syndromes associated with endocrine dysfunctions, while the second part describes the conditions by which a syndrome is most frequently diagnosed after an endocrine finding. The aim is to provide a practical overview of the assessment of syndromic patients, so that they can be recognized and managed in an integrated, multidisciplinary fashion

Pediatric Adrenal Insufficiency: Challenges and Solutions

5noAdrenal insufficiency is an insidious diagnosis that can be initially misdiagnosed as other life-threatening endocrine conditions, as well as sepsis, metabolic disorders, or cardiovascular disease. In newborns, cortisol deficiency causes delayed bile acid synthesis and transport maturation, determining prolonged cholestatic jaundice. Subclinical adrenal insufficiency is a particular challenge for a pediatric endocrinologist, representing the preclinical stage of acute adrenal insufficiency. Although often included in the extensive workup of an unwell child, a single cortisol value is usually difficult to interpret; therefore, in most cases, a dynamic test is required for diagnosis to assess the hypothalamic-pituitary-adrenal axis. Stimulation tests using corticotropin analogs are recommended as first-line for diagnosis. All patients with adrenal insufficiency need long-term glucocorticoid replacement therapy, and oral hydrocortisone is the first-choice replacement treatment in pediatric. However, children that experience low cortisol concentrations and symptoms of cortisol insufficiency can take advantage using a modified release hydrocortisone formulation. The acute adrenal crisis is a life-threatening condition in all ages, treatment is effective if administered promptly, and it must not be delayed for any reason.openopenNisticò, Daniela; Bossini, Benedetta; Benvenuto, Simone; Pellegrin, Maria Chiara; Tornese, GianlucaNisticò, Daniela; Bossini, Benedetta; Benvenuto, Simone; Pellegrin, Maria Chiara; Tornese, Gianluc

Twenty-four hour ambulatory central blood pressure in adolescents and young adults: methodological issues

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Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis.

To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).Systematic review and meta-analysis.Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI

Reumatologia per il pediatra

"This book is a real Treaty of paediatric Rheumatology. (Perhaps the only treaty that's out there. Certainly the more usable than a pediatrician could find: complete and easy to read at the same time. This book is more than just a Treaty of Rheumatology. And in fact a living tool that, through the interpretation of Rheumatology, lets go over a large part of Pediatrics which is useful to the present day: easy or difficult. It is a work in which the experience of the older authors and prestigious joins, and it was revived, the enthusiasm and desire to do well (and teach) of younger authors. A miracle only possible thanks to the dedication and passion of Loredana Lepore, to its ability to act concretely with joy and never stop learning and teaching "

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