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 Agosto 2023
1) Aggiornamento - Ottobre 2007
La splenomegalia
- M. Rabusin, F. Patarino
- The spleen in infants and children is involved in a wide variety of pathological conditions. Splenic disorders may be isolated like splenic cysts or, more frequently, due to multiorgan or systemic disease including hepatic diseases, malignancy, hemoglobinopathy, infectious diseases and storage diseases. The Authors review the role of the laboratory test, the ultrasonography and the peripheral blood smear in orienting the differential diagnosis. Invasive procedure as bone marrow aspiration, lymph node biopsy, hepatic biopsy or fine needle splenic biopsy are often warranted to estabilish the cause of splenomegaly.
1039 kB2) Farmacoriflessioni - Giugno 2023
Farmaci intranasali nel bambino: cosa devono sapere i pediatri
- Nisticò D, Marchetti F, Badina L, Barbi E, Cozzi G.
- The use of the intranasal route of administration to deliver drugs in children has become more and more popular in the last decades. Seizure, severe acute pain and severe hypoglycaemia in diabetic patients may be managed with intranasal drugs. The intranasal administration is minimally invasive, not painful, needleless and easy to learn and use. The evidence shows that it is a safe and effective way to deliver lipophilic drugs that are quickly absorbed. This article is a practical guide that provides indications, dosages and some “tricks” for this way of administration.
3) Problemi correnti - Giugno 2023
Faringotonsillite da streptococco, tempi di risposta all’antibiotico e implicazioni per la pratica corrente
- Iacono A, Mambelli L, De Nardi L, Marchetti F.
- An increase in Group A Streptococcal (GAS) infections higher than seasonally expected levels has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in the disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return to school as early as the day after the beginning of the antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. Furthermore, to avoid mistakes, asymptomatic children should not undergo GAS throat swab so as not to receive further and useless antibiotic therapies.
4) Problemi speciali - Giugno 2023
Ipotiroidismo subclinico: realtà e falsi miti
- Burlo F, Tonetto S, Tamaro G, Faleschini E, Tornese G.
- Subclinical hypothyroidism (SH or hyperthyrotropinemia) is a biochemical condition defined as elevated serum TSH concentrations and normal thyroxine (FT4). Generally, it is asymptomatic and is distinguished in mild (TSH between the upper limit and 9.9 μUI/ml) and severe (TSH equal to or higher than 10 μUI/ml). Replacement L-thyroxine treatment is requested for the severe form, while mild form treatment is still debated. In children, SH is usually a benign and remitting condition and progression to overt hypothyroidism is uncommon. By contrast, the risk of a deterioration of thyroid status is higher in children with SH and Hashimoto’s thyroiditis or chromosomal abnormalities, such as Turner syndrome or trisomy 21. Thyroid function is involved in many aspects of growth and development; therefore, it is important to evaluate whether untreated hyperthyrotropinemia implies long-term consequences. On the contrary, mild thyroid disfunction is improperly considered the cause of some clinical issues, such as obesity, sleep disorders and constipation. Finally, testing only TSH and FT4 in the suspicion of hypothyroidism is highly recommended.
5) La pagina gialla - Giugno 2023
a cura di Alessandro Ventura6) Linee guida - Ottobre 2020
La prima infezione urinaria febbrile in bambini di età compresa tra 2 mesi e 3 anni
- Gruppo di lavoro sulle infezioni delle vie urinarie della Società Italiana di Nefrologia Pediatrica (SINePe)
- The aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were first published in 2012 and endorsed by the Italian Society of Paediatric Nephrology. The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. An ad hoc evaluation of the risk factors, which were published in the previous recommendations, was carried out to identify children with high-grade vesicoureteral reflux or renal scarring. When evidence was not available, the working group held extensive discussions during various meetings and through email exchanges. Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. The algorithm that guides clinical decisions to proceed with voiding cystourethrography has been reformulated. The suggested antibiotics have been revised and further restrictions of the use of antibiotic prophylaxis have been recommended. These updated recommendations have now been endorsed by the Italian Society of Paediatric Nephrology and the Italian Society for Paediatric Infectivology. They can also be used to compare other available recommendations, as a worldwide consensus in this area is still lacking.
7) Lettere - Giugno 2023
8) News box - Settembre 2023
a cura di Giorgio Tamburlini e Federico Marchetti
9) Aggiornamento - Maggio 2023
Vasculiti facili e difficili: cosa deve sapere e saper fare un pediatra
- De Nardi L, Petrone MI, Benvenuto S, et al.
- Vasculitis is defined by a state of inflammation of the blood vessel walls. It can result in formation of either aneurysms or stenosis with ischemia and necrosis. The heterogeneity of clinical presentation depends on the type and size of the vessels involved, which leads to different patterns of organ damage. The skin is usually involved but not necessarily as a first manifestation of disease. Indeed, significant organ damage may occur at any time in the disease course and may precede other symptoms with significant morbidity and mortality, especially in case of diagnostic delay. The most common vasculitides in childhood are IgA-associated vasculitis (Schönlein-Henoch purpura) and Kawasaki disease. Other vasculitides are much rarer, often arising with insidious symp- toms that make them life-threatening. This paper aims to review the literature on paediatric vasculitides providing a practical guide to disentangle between different diagnoses. It also provides an overview that underlines the key differences in vasculitis presentation, management and follow-up.