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 Dicembre 2024
1) Problemi correnti - Novembre 2024
Infezioni delle vie urinarie: dalla diagnosi alla terapia
- De Pra S, Benvenuto S, Pennesi M.
- Urinary tract infections (UTIs) are a common occurrence in the paediatric population and are often paucisymptomatic in children under two years of age. A definitive diagnosis is obtained through urine culture, which should be collected using invasive methods or midstream urine. Intravenous (IV) therapy is indicated for infants under two months of age, in cases of complicated UTIs, or when there is a suspicion of poor therapeutic adherence. The effectiveness of oral antibiotic therapy (OS) has not shown to be inferior to that of IV therapy in other cases. Two large studies have shown that the effectiveness of a 5-day antibiotic therapy is not inferior to a 10-day one. The addition of corticosteroids, although it is safe, does not show solid evidence regarding its benefit and remains at the clinician's discretion. After a first episode of UTI, a renal ultrasound should always be performed to rule out underlying conditions such as vesicoureteral reflux or renal hypodysplasia. Other diagnostic investigations, such as voiding cystourethrography and renal scintigraphy with MAG3 or DMSA, should be performed only as a second step if specific abnormalities are detected on ultrasound or if there are specific clinical findings. UTIs rarely result in renal scarring, which is more often associated with congenital conditions. Moreover, unilateral renal scars are very rarely correlated with a decline in renal function. The usefulness of antibiotic prophylaxis in VUR (vesicoureteral reflux) has been questioned by numerous studies, which have demonstrated its limited effectiveness in reducing the recurrence of UTIs and its ineffectiveness in preventing renal scars, both in children with low-grade and high-grade VUR.
112 kB2) Editoriali - Dicembre 2024
3) Aggiornamento - Dicembre 2024
Orticaria cronica spontanea
- Colussi L, Malni I, Badina L, Berti I.
- Chronic spontaneous urticaria (CSU) is a condition characterized by the daily occurrence of wheals, with or without angioedema. It persists for more than six weeks, without any identifiable triggering factor and is caused by the abnormal activation of mast cells and basophils and by the release of histamine, resulting in itching and skin lesions that can significantly impact patients' quality of life. Diagnosis is primarily based on clinical observation and the exclusion of other conditions, while standard treatment involves the use of second-generation antihistamines, with the addition of omalizumab for more resistant cases.
4) Problemi speciali - Novembre 2024
Sindrome di Brugada: guida pratica per il pediatra di base
- Speranzon A, Chicco D, Bonazza P, et al.
- Brugada syndrome is an autosomal dominant inherited channelopathy affecting the sodium channel and is characterized by predisposition to syncope and sudden death. It typically presents in young adults, but it also presents in the paediatric population, especially during fever, even if the prevalence is low compared with the adult population. The diagnostic ECG pattern is characterized by coved-type ST-segment elevation in the right precordial leads, occurring spontaneously or after provocative drug test with IV administration of Class I antiarrhythmic drug. Nevertheless, the electrocardiographic changes may vary and transient or concealed forms of the syndrome further complicate diagnosis, necessitating thorough evaluation and close follow-up. The clinical presentation of Brugada syndrome may range from asymptomatic individuals to those who have experienced syncope or sudden cardiac arrest. Nonetheless, the syndrome is underdiagnosed because of its elusive symptoms and the absence of abnormal findings between episodes. Additionally, certain triggers such as fever, certain medications and alcohol consumption may unmask the electrocardiographic changes and provoke arrhythmias in susceptible individuals. Given its elusive nature, early diagnosis and risk stratification are crucial in identifying individuals who may benefit from ICD implantation, which is considered the mainstay of treatment for high-risk patients, or pharmacological interventions.
5) Farmacoriflessioni - Dicembre 2024
Un’inconsapevolezza potenzialmente fatale: il dosaggio dei clismi a base di fosfato nella stipsi
- Zampieri A, De Pra S, Zago A, et al.
- While oral laxatives are the first-line treatment for faecal impaction, enemas are frequently used in clinical practice in paediatric emergency departments (PED) and by family paediatricians (FP). Phosphate-containing enemas (PcE) are commonly employed even if at risk of rare but lethal toxicity; recently, a survey has showed limited paediatricians’ awareness of the potential risks related to PcE.
6) Farmacoriflessioni - Novembre 2024
Dexmedetomidina
- Marrazzo M, Galletti A, Solidoro S, Ballaben A, Barbi E.
- Procedural sedation is often required in paediatrics to execute diagnostic procedures. There are many sedative drugs that may be used, but all of them carry not negligible side effect risks and may not be easy to manage. The use of dexmedetomidine has increased in the last few years because of its sedation efficacy in painless procedures. Paediatricians should know the use of dexmedetomidine because of its sensational safety profile even in neonates, its administration route versatility, its neuroprotective properties and its in-home palliative care role in children with otherwise untreatable sleep disorders. This article summarizes the main characteristics of dexmedetomidine, its use, strengths and weaknesses.
7) Aggiornamento monografico - Gennaio 2009
La porpora di Schönlein-Henoch
- L. Calligaris, L. Calligaris, F. Marchetti, E. Barbi, E. da Dalt, E. Panontin, L. Lepore, A. Ventura
- Henoch-Schönlein purpura (HSP) is the most common vasculitic disease of childhood. HSP is a multisystem immunoglobulin A-mediated vasculitis with a self-limited course usually affecting the skin, joints, gastrointestinal tract, and kidneys. HSP occurs most often in children before the age of 10 years, and classically presents with a unique distribution of the rash to the lower extremities and the buttocks. One third of these patients will have one or more recurrences of symptoms, usually within 6 weeks, but they may occur as late as 18 months later. The overall prognosis in HSP is excellent, but the long-term morbidity depends mainly on the renal involvement. In our opinion, actually, there are no data to recommend the routine use of corticosteroids in the management of uncomplicated HSP, in both the acute and chronic settings.
8) Ricerca - Dicembre 2024
Screening per il diabete mellito di tipo 1: la parola ai pediatri di famiglia
- Solidoro S, Tamaro G, Mari J, Braida C, Faleschini E, Tornese G.
- The screening programme for type 1 diabetes mellitus shall be implemented nationwide in Italy in 2025 with the goal of early identification of at-risk individuals through the detection of anti-beta cell autoantibodies. This study explored the knowledge, perceptions and preparedness of the primary care paediatricians in the Friuli Venezia Giulia region and revealed limited awareness of the screening programme among participants and a unanimous request for more information and training. While recognizing the potential benefits of screening, such as reducing the incidence of diabetic ketoacidosis at onset and enabling early interventions, paediatricians expressed concerns about increased anxiety among families, workload management and the need for defined follow-up protocols. The study highlights the importance of providing adequate educational tools, clear guidelines and organizational support to ensure the success of the screening programme. As the programme expands nationwide, further evaluations will be necessary to enhance paediatricians’ preparedness and engagement in this ambitious initiative.