Gli articoli più visti nel mese di Maggio 2018
|Per una pediatria basata sull'evidenza - Giugno 2000|
|Varicella e aciclovir|
Chicken pox is still a common disease, usually with a favourable course. Complications are rare (2-3/100.000) in immunocompetent patients. The Authors review the published experience regarding treatment with acyclovir and conclude that the advantage is marginall (25% reduction of the duration of symptoms), while there is no reduction in the rate of complications. Acyclovir should be used in immunocompromised patients including primary immune deficiencies, patients treated with steroids or long-term salycilates, patients affected by chronic lung diseases, eczema, diabetes and heart diseases.
|Problemi correnti - Dicembre 2000|
|La tosse (o le tossi)|
Cough is a frequent symptom, ranging from the simple, irritatingly cough associated with the common cold to the catarrhal cough of sinusitis and to the prolonged afebrile non productive cough caused by intracellular pathogens such as Mycoplasma and Chlamydia. Cases of particularly troublesome, recurrent, “untreatable”, nonspecific cough are also commonly seen by paediatricians. Such cases have increasingly been diagnosed as having asthma (cough-variant asthma), but epidemiological and clinical evidence suggests that cough is unlikely to be the only manifestation of asthma. This kind of cough is likely to be related to an increase of cough receptor sensitivity (CRH). The pathways of the reflex for cough and bronchoconstriction are distinctly different. Children with cough receptor hypersensitivity usually start coughing at bedtime and cough is typically unresponsive to treatment, and getting worse with time: in these children an increase of receptor sensitivity is probably due to cough itself. Chronic cough (lasting months and particularly if productive productive) should never be overlooked and requires a thorough diagnostic evaluation including sweat test and high resolution CT scan. Psychogenic cough is typical of school age children, it is stereotyped and stops, as a rule, as the child gets asleep.
|Problemi non correnti - Settembre 1997|
|APEC: esantema periflessurale asimmetrico|
The paper describes a new entity, the Asymmetric Periflexural Exanthem of Childhood (APEC), first described in 1962 and recently recognized as a separate clinical entity by many Authors. It is characterized by scarlatiniform or papular rash which develops usually from a periflexural (axillary or inguinal) area to the thoracic area but with a clear monolateral preference. Respiratory or gastrointestinal symptoms may accompany the eruption. Occasionally moderate pruritus and regional lymphoadenopathy are present. The course is self-limited. This entity is believed to be caused by a virus but no single agent has been identified as a causal agent sofar. The Authors observed 4 cases of APEC over a period of four months in 18 to 24-month old children. It is probable that APEC can be diagnosed more often if increased attention is payed by paediatricians.
|Aggiornamento monografico - Febbraio 2001|
|Le microcitosi nel bambino: classificazione e approccio diagnostico|
The Authors provide an overview of microcytic anemias. Causes of microcytic anemia include a wide variety of diseases, the most common being iron-deficiency, impaired haemoglobin synthesis, sideroblastic anemias and anemias due to chronic disease. Other less common causes are copper deficiency, lead poisoning and haemosiderosis. A classification of the main microcytic anemias is provided and a diagnostic approach to microcytosis, with and without anemia, based on RDW and MCV is suggested.
|Schede di neurologia - Febbraio 1997|
|La paralisi di Bell o paralisi idiopatica del nervo faciale|
|Farmacologia - Gennaio 1997|
|Adrenalina: tante vie per tante indicazioni|
In recent years, new indications for adrenaline have been added to the most timehonored ones, such as anaphylaxis and cardiopulmonary resuscitation: Alternative routes of administration have also been evaluated. For anaphylaxis, nebulised adrenaline is very effective if administrated at an early stage and has the advantage of allowing a quick and easy administration, thus preventing the progress of anaphylactic reactions. Findings from recent studies show that both subcutaneous and nebulized adrenaline are effective in the treatment of acute bronchiolitis in infants and toddlers. Nebulized adrenaline is now an accepted indication in croup. Most of the studies in croup and bronchiolitis were made with racemic adrenaline, but there is evidence that the laevorotatory form is equally effective and does not produce cardiac effects even at relatively high dosages (0.1 mg/kg in croup and 0.25 mg/kg in bronchiolitis).
|Vaccinare - Dicembre 1997|
|Reazioni avverse lievi e gravi (rare) ai vaccini: una revisione|
Adverse reactions to vaccine vary from trivial to severe. Mild reactions include systemic symptoms (fever after DTP vaccine or rash after live measles vaccine) or local flogosis after DTP. Sterile abscesses may occur after immunization with a variety of killed vaccines and may be caused by the inadvertent subcutaneous administration of a vaccine intended for intramuscolar use. Rare, serious consequences of vaccine use that result in severe sequelae or death can also occur impredictably. Examples are paralytic polio after live polio vaccine or hypersensitivity reactions to vaccine components such as bovine or suine collagen, neomycine, mercury. Egg allergy does not represent a contraindication to vaccines containing egg proteins. Health professionals should know the specific reactions that may be associated with the administration of the most commonly used vaccines.
|Specialità - Novembre 1997|
|Il prurito atopico|
Atopic dermatitis is the most frequent skin disease characterized by severe itching. The treatment of atopic itching should start from the evaluation of its severity. An itching score based on the number of crises during daytime, the period of waking up during the night and the extension of scratch marks is suggested. The parents must be trained to prevent the crises of itching and to stop them as soon as possible. Finally, the indications and effectiveness of symptomatic treatments of pruritus such as emollients, corticosteroid creams and oral antihistamines are reviewed.
|Aggiornamento monografico - Novembre 2000|
Enuresis is a very frequent complaint: its prevalence is 10% in 6-year old children. Primary nocturnal enuresis is a multifactorial condition, where an unbalance between urine production and bladder functional capacity is associated with arousal problems. The diagnostic approach is mainly clinical and includes laboratory and instrumental investigations are necessary only when other day symptoms such as incontinence urgency, poliuria or dysuria. Treatment options include behavioural approaches (alarm systems and bladder training) and drugs. Behavioural treatment is usually effective and desmopressin can be associated to it or used to control enuresis in specific situations.
|Problemi correnti - Gennaio 1999|
|La valutazione dello sviluppo psicomotorio nel primo anno di vita|
A neurodevelopmental assessment is proposed, based largely on Milani Comparetti’s concepts, and enriched by certain neonatal neurobehavioral items of Brazelton and Als and the Prechtl’s general movements (GMs) assessment in the first four months of life. It privileges the observation of spontaneous motor and interactive behavioral activity at four different phases during the first year of life, according to the stages of the separation-individuation process. Three main parameters are assessed: a) autonomic stability, focused on the first trimester; b) motor activity, divided into the non-functional spontaneous movement repertoire and adaptive functional motor activity; c) behavioral modulation, interpersonal and with the environment and objects. It is a simple, non intrusive method intended to be included in routine pediatric assessment. The overall main goal is to enable the pediatrician, through the assessment of normality, to reveal any deficit needing referral for specialistic investigation.
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