Gli articoli più visti nel mese di Aprile 2017
|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 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.
|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.
|Aggiornamento - Marzo 2017|
|Kawasaki facile e difficile|
Questo contributo degli specializzandi italiani rappresenta una nuova frontiera pratica e di riflessione: vanno riviste alcune delle conoscenze su questa malattia, con risvolti operativi immediati.
Kawasaki disease (KD) is a systemic vasculitis that typically affects children of 2-5 years of age and whose diagnosis and treatment are usually easy, as described in the first case report. Anyway, in spite of adequate therapy, 10-15% of patients develop coronary artery aneurysms. The high-risk patients are those under 1 year of age or with incomplete or atypical presentations. For this reason, to recognize them promptly is fundamental to start adequate therapy. This article describes some cases of the atypical presentation of KD: a retropharyngeal abscess, a febrile cholestatic jaundice and a haemophagocytic syndrome. Moreover, it reports some severe cases of KD such as a severe cardiac shock, the case of a patient that received anti-TNF therapy because of inefficacy of standard therapy and finally the case of an adult that underwent coronary artery bypass surgery because of the consequences of a giant coronary aneurism developed at 2 years of age after a KD. At the end of the article, the messages inferred from the described case reports are summarized in 10 points.
|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.
|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).
|Ricerca - Marzo 2017|
|Il trattamento del dolore nei Pronto Soccorso italiani|
Ci sono ancora delle distanze tra la sensibilità nel rilevare il dolore e il trattamento. Occorre fare un passo più in là.
Background - Pain is a crucial aspect in the emergency-urgent care setting.
Objective - This paper aims to evaluate the satisfaction expressed by accompanying adults and children on pain management in the Italian Emergency Units (EUs) that are members of PIPER Project (Pain In Paediatric Emergency Room).
Materials and Methods - Face-to-face surveys were carried out by training interviewers over a weekend period in 29 Italian EUs. Questionnaires were addressed to accompanying adults and their 3-16 year-old children, who were evaluated for pain in EUs. In the questionnaires the level of satisfaction regarding the management of symptom and quality perceived about interventions were evaluated.
Results - 1,581 questionnaires were administered (923 to parents or caregivers; 658 to children). 95% of adults referred high level of satisfaction. According to accompanying adults, 73.6% of children received questions about pain localization and intensity by health professionals and in 24.7% of cases validated pain scales were administered. In EUs, 47.5% of adults referred the administration of analgesic drugs with waiting times that in 50.5% of cases were lower than 20 minutes. 95.3% of children confirmed that they had received questions regarding site of pain and 46% of cases confirmed the use of validated pain scale. 23% of children referred a reduction of pain after administration of painkillers in EUs.
Conclusions - On the basis of the collected data, a strong dichotomy emerged between users’ satisfaction and level of managing of pain. In one child out of 4, the symptom was measured and in one out of 2 a pharmacological therapy was prescribed. Probably, there are many causes: poor information and education induced users to evaluate positively a poor management path.
|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.
|Il graffio - Febbraio 2017 a cura di Alessandro Ventura|
|La giusta violenza della memoria|
|Schede di neurologia - Febbraio 1997|
|La paralisi di Bell o paralisi idiopatica del nervo faciale|
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