Reazioni al veleno d'imenotteri nel bambino: Vaccinare o non vaccinare?

Hymenoptera venom allergy is a rare occurrence in children, so paediatricians are frequently unprepared and thus incapable of giving adequate answers. The allergy has usually a benign natural history: systemic reactions characterized only by cutaneous manifestation can either disappear completely, or maintain the same, low severity in case of following punctures. Severe systemic reactions presenting with respiratory and/or cardiocirculatory symptoms and/or laryngeal oedema, exceptionally fatal in paediatric age, are a strong indication for specific immunotherapy (SIT). There are three important reasons for this statement: contrary to common past belief, severe systemic reactions do not disappear rapidly after the paediatric age; SIT for hymenoptera venom is very effective and its effectiveness persists for years after suspension; affected patients' and families' quality of life is frequently lowered by the fear of new punctures and the prescription of adrenaline for auto-injection often worsens the fear instead of helping

Troponin T should not be considered as a screening test for pediatric myocarditis

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Extrauterine growth restriction in very low birth weight infants according to different growth charts: A retrospective 10 years observational study.

BackgroundExtrauterine growth restriction (EUGR) is common among very low birth weight (VLBW) infants and associated with poor neurodevelopmental outcomes. There are two types of EUGR definitions (cross-sectional and longitudinal) and many growth charts for monitoring postnatal growth. Aims of our study were 1) to compare the rate of small for gestational rate (SGA) and EUGR in a population of VLBW infants, both according to different growth charts (Fenton, INeS charts and Intergrowth-21) and different definitions; 2) to identify risk factors for EUGR.MethodsThis is a single centre retrospective observational study, including all VLBW infants born between January 2009 and December 2018. Anthropometric measures were obtained at birth and at discharge and presented as z-scores according to three growth charts (Fenton, INeS charts, Intergrowth-21). Maternal, clinical and nutritional data were retrieved from clinical records.Results228 VLBW were included. Percentage of SGA did not change significantly according to the three different growth charts (Fenton 22.4%, INeS charts 22.8%, Intergrowth 28.2%, p 0.27). Prevalence of EUGR was significantly higher when INeS and Fenton charts were used, compared to Intergrowth charts regardless of EUGR-definition (cross sectional-EUGR: Fenton 33.5%, INeS charts 40.9%, Intergrowth-21 23.8%, p 0.001; longitudinal-EUGR (loss of 1SDS): Fenton 15%, INeS charts 20.4%, Intergrowth 4%, p ConclusionsWe confirmed a wide variability of EUGR rates when using different charts and definitions, highlighting that Intergrowth-21 charts identify less EUGR when compared to INeS and Fenton charts. Standardized criteria for defining EUGR are warranted in order to facilitate comparisons between studies and to improve the nutritional management of VLBW infants

Le molte facce dell'acalasia esofagea: Promemoria per il pediatra

Achalasia is a rare primary esophageal disorder in the paediatric age group and in most cases is idiopathic. Familial achalasia is rarely described and can also be reported in some syndromes. It is predominantly characterized by vomit and regurgitation, dysphagia to solids and liquids, weight loss and chest pain; symptoms are age-specific. Although achalasia is rare in children, with an incidence of approximately 0.1/ 100,000, its symptoms may mimic common childhood diseases and therefore may delay the diagnosis. Moreover, achalasia may be a part of the AAA (achalasia-alacrimiaadrenal insufficiency) syndrome and its identification may help to quickly diagnose the underlying adrenal insufficiency. The management of achalasia in children is still controversial; laparoscopic Heller\u2019s myotomy seems to be the procedure of choice. This report describes the cases of four children affected by achalasia who did not show the symptom dysphagia which, as a result, led to misdiagnosis and diagnostic delay

Miocardite: la grande simulatrice

Myocarditis is a rare, but life threatening disease in childhood. It is most often due to common viral infections; less commonly, it may result from bacterial infections, immune mediated diseases or chemotherapy. Myocarditis may present with unspecific symptoms, ranging from respiratory to gastrointestinal ones; a clear hypomobility is the typical sign of myocarditis (\u201cthe immobile child\u201d). The diagnosis is based on electrocardiogram and echocardiography, which are always pathologic but unspecific; an X-chest is useful to identify cardiomegaly. Among laboratory tests, the most sensitive element is an increased level of aspartate aminotransferase, while troponin dosage has low specificity and not absolute sensitivity. Endomyocardial biopsy is the gold standard diagnostic test, but it should be performed only in patients who do not respond to usual treatment, because of the high risk of side effects. The mainstay of therapy is supportive therapy for left ventricular dysfunction. The fulminant viral forms usually have initial significant cardiovascular impairment, followed by a complete resolution. On the other hand, a subacute disease might have less initial cardiovascular impairment, but more often can evolve to chronic dilated cardiomyopathy. In this case immunosuppressive therapy could be useful

Digital radiology to improve the quality of care in countries with limited resources: a feasibility study from Angola.

OBJECTIVE: Sub-standard quality in X-ray image acquisition and interpretation is common in low-resource countries, and can ultimately result in higher patient morbidity and mortality. This study aimed at evaluating; 1) feasibility of implementing a digital X-ray device in a second level hospital in Angola; 2) quality of digital X-ray images, when digital radiology was in the hands of local technicians; 3) feasibility of digital teleradiology and its potential impact on case management. METHODS: We developed and tested at the Hospital Divina Providencia (HDP) in Luanda, Angola, a digital X-ray device and a telemedicine network to acquire and print digital X-ray images and send them as DICOM files for remote consultation. RESULTS: 20,564 digital X-ray images were made at HDP from November 2010 to December 2012, with no major technical problems and no need for on-site supervision. Digital radiology largely improved the number of X-ray images of good and very good quality (100% of images with digital radiology, compared to 15% of screen-film images, p<0.0001). Teleradiology using digital images was used in 7.6% of paediatric cases, and provided, in these cases, an important contribution to case management. CONCLUSIONS: The implementation of a digital X-ray device is feasible in low resource settings with significant improvement in quality of X-ray images compared to standard screen film radiology

Tutorial for technicians.

<p>Note: This and other similar tutorials were produced to teach technicians how to improve image quality through the functions provided by the digital system.</p