Rivista di formazione e aggiornamento di pediatri e medici operanti sul territorio e in ospedale. Fondata nel 1982, in collaborazione con l'Associazione Culturale Pediatri
Gli articoli più visti nel mese di Settembre 2024
1) Aggiornamento - Settembre 2024
Ematuria e proteinuria
- Scaramuzzino F, Burlo F, Delcaro G, et al.
- Proteinuria and haematuria are common findings in children. However, they are indicative of a renal or urinary condition only in a minority of cases. The probability of an underlying disease causing haematuria and /or proteinuria increases when they are associated and in the presence of symptoms that suggest kidney damage, such as oedema, hypertension, or kidney failure. Transient and orthostatic proteinurias are benign conditions that do not require further investigations. Proteinuria should always be investigated when constant or heavy. If patients present with nephrotic syndrome, oedema and hypoalbuminemia, proteinuria is always pathologic. Tubular proteinuria should always be ruled out, in particular in male subjects with persistent proteinuria. Haematuria can be glomerular or non-glomerular and may present as gross haematuria or can only be detected microscopically. Macroscopic haematuria should always be investigated as it may be associated with benign conditions (fever, exertion, dehydration, nutcracker syndrome), but also with several conditions such as glomerular diseases or urolithiasis. The urine colour, the urinary sediment, the morphology of red blood cells, kidney function, the presence of proteinuria and the medical history help in the differential diagnosis. On the other hand, microscopic haematuria should be investigated only when persistent or if there is a positive family history. This paper presents 5 illustrative cases to highlight the above points.
1246 kB2) Editoriali - Settembre 2024
3) La pagina gialla - Settembre 2024
a cura di Alessandro Ventura4) Problemi speciali - Settembre 2024
Omocisteina alta? Quello che il pediatra deve sapere
- Cantarelli E, Biasucci G, Bortolamedi E, et al.
- Hyperhomocysteinemia may cause concern to the paediatrician due to its correlation with increased cardiovascular risk. In paediatric age, the most common cause is a nutritional vitamin deficiency, particularly vitamin B12 or folate, which can be found in subjects who follow a lacto-ovo-vegetarian diet or one devoid of animal-derived foods for socioeconomic, cultural, or religious reasons. Hyperhomocysteinemia is not uncommon in infants born to mothers with vitamin deficiency and such condition can lead to their neurodevelopmental impairment. Genetic causes are rare. Therefore, a correct diagnostic and therapeutic approach is essential, so that to allow the paediatrician to identify and manage most cases of hyperhomocysteinemia in the outpatient setting, as well as to recognize the red flags for severe disease that require a specialist evaluation.
5) Problemi speciali - Settembre 2024
Parotite ricorrente giovanile: inquadramento clinico e approccio diagnostico-terapeutico
- Giuntoli D.G, Galletti A, Pontrandolfo M, et al.
- Juvenile recurrent parotitis is an uncommon condition characterised by recurrent episodes of parotid swelling that affects school-aged and pre-school children and shows a typical tendency to self-resolution during adolescence. To date, etiopathogenetic hypotheses and treatment options are still debated, as there are no current guidelines for its diagnosis and treatment so far. This article aims to provide valid recommendations for the management of children with recurrent episodes of parotitis and tips to identify cases worthy of further investigation and referral to the specialist.
6) Lettere - Settembre 2024
Routine del sonno: una scelta informata e consapevole nonostante la complessità
- Bontempo F, Malventano M, Corbelli E, et al.
6) Lettere - Settembre 2024
Profitto e diritti sono sempre in contraddizione?
- Neri A, Tamburlini G.
7) Farmacoriflessioni - Settembre 2024
Uso degli antibiotici in età pediatrica: riflessioni e azioni
- Marchetti F.
- The annual report on the national use of antibiotics in Italy for the year 2022 was published by AIFA (Italian Medicines Agency). The report confirms an increase in antibiotic use post-pandemic, particularly in the paediatric population. There is a notable discrepancy in the prescription patterns, with a preference for second-line antibiotics over first-line choices. Regional differences in prescription rates highlight the need for targeted interventions to improve prescribing practices. The WHO AWaRe classification system is used to assess antibiotic use, revealing that a significant portion of antibiotics prescribed belong to the ‘Watch’ category, indicating broad-spectrum antibiotics. This raises concerns about antimicrobial resistance and the need for more judicious prescribing practices. The most commonly prescribed antibiotics include amoxicillin/clavulanic acid and macrolides, despite guidelines recommend first-line agents like amoxicillin. The report emphasises the importance of aligning prescribing practices with evidence-based guidelines to optimise antibiotic use and combat resistance. Strategies such as promoting shared decision-making with parents, implementing local improvement projects and fostering a culture of stewardship among healthcare providers are crucial for driving positive change in antibiotic prescribing practices and mitigating the growing threat of antimicrobial resistance.
8) Domande e risposte - Settembre 2024
a cura di Giorgio Longo
10) Casi indimenticabili - Settembre 2024
La calcolosi renale come causa di dolore addominale
- Burlo F.
- This case shows that kidney stones can cause atypical pain and that large stones require surgical intervention. It has also highlighted how impressions about patients can influence the diagnosis.
10) Casi indimenticabili - Settembre 2024
Calcolosi renale e infezione delle vie urinarie
- Cangemi F, Aloisio A, D’Alessandro MM, Corsello G.
- This case highlights the importance of investigating persistent leukocyturia, as it may indicate nephrolithiasis and require early treatment.