Italian Journal of Pediatrics - Latest Articles

Immunization against A/H1N1 pandemic flu (2009- 2010) in pediatric patients at risk. What might be the most effective strategy? The experience of an health district of Northern Italy

Giuseppe Gregori — 2012-05-17T00:00:00Z

Background: Vaccination coverage rates against pandemic flu were far below those required by ItalianPublic Health Authorities.The aim of this retrospective study was to assess how the management of vaccination againstpandemic flu in the Health District of Piacenza (Northern Italy) had conditioned theadherence of patients at risk to the H1N1flu immunization program. Methods: From a population of 27.018 children aged between 6 months and 16 years, 2361 pediatricpatients considered at risk according to the guidelines of the Ministry of Health were enrolledto receive pandemic flu vaccination.Children enrolled in the immunization program were vaccinated with one of the followingthree options:A) by their pediatrician in his office after contacting him directly or by phoneB) by their pediatrician in his office or in a public Health District office with the assistance ofa nurse after an appointment had been booked by patient's parents using a dedicated free ofcharge phone numberC) by a doctor of the public Health District after an appointment had been booked as foroption B Results: The best outcomes of population vaccination coverage for pandemic flu were achieved whenpatients were vaccinated with option B (44.2%). For options A and C rates coverage resultswere 22.8% (OR 2,69) and 24.9% (OR 2, 39) respectively. Conclusion: The results of this study may be taken into account by the public health Authorities whenplanning the management of future immunization campaigns out of the usual vaccinationschedule or in an emergency event.

An unusual case of foreign body aspiration mimicking cavitary tuberculosis in adolescent patient: Thread aspiration

Erkan Cakir — 2012-05-11T00:00:00Z

Foreign body aspiration continues to be a serious problem in childhood and adolescent period with significant rate of morbidity and rarely mortality. Half of the foreign body aspiration cases have no history of aspiration. The main foreign bodies inhaled are food fragments and different kinds of metallic objects. A 12-year-old girl was referred to the pediatric pulmonology department for chronic cough and hemoptysis. She had persistent infiltration and cavitary lesion mimicking cavitary tuberculosis. There was no contact history with tuberculosis in her family and acid resistant bacillus was not found in the sputum examination. Flexible bronchoscopy was performed for persistent infiltration and hemoptysis and inflamed thread was found in right lower lobe bronchus. This is the first case of thread inhalation mimicking cavitary tuberculosis in an adolescent patient.

Severe reaction in a child with asymptomatic codfish allergy: Food challenge reactivating recurrent pancreatitis

Katia Pellegrino — 2012-05-09T00:00:00Z

An 8-year-old child during the first year of life manifested severe atopic dermatitis and chronicdiarrhea with mucorrhea and rectal bleeding; a fish-free diet was started based on weaklypositive skin-prick tests to codfish extract. At the age of 4 years the child began to suffer ofrecurrent pancreatitis. When he came to our attention for the evaluation of his fish allergy, hewas asymptomatic; a weak reactivity to codfish was observed (SPTs: cod, 4 mm, sIgEImmunoCAP: cod, 1.30kU/l). The food challenge test with cod was negative. When the child atecod again, within 5 minutes, developed anaphylactic reaction and complained of abdominal paincompatible with pancreatitis (enzyme serum levels risen and parenchymal oedema atultrasonography), that resolved within 7 days after specific therapy. This case raises two issues:the elimination diet in asymptomatic food allergy on the basis only of SPT and the ethicality offood challenge in gastrointestinal chronic disease.

High gamma activity of 60-70 Hz in the area surrounding a cortical tuber in an infant with tuberous sclerosis

Kaori Irahara — 2012-05-03T00:00:00Z

PurposeTo detect the epileptogenic region causing epileptic spasms in an infant with tuberous sclerosis (TS). Methods: We applied a multiple band frequency analysis to video electroencephalographic (EEG) recordings of the infant's scalp. We also performed computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) of the brain in order to ascertain the epileptic focus. Results: During the periodic spasms, we identified fast ictal activity with frequencies of 60-70 Hz in the right centroparietal region. This region was part of the area surrounding the largest cortical tuber that was identified on CT and MRI and was located in the right frontal lobe. An area of increased blood perfusion that was observed with SPECT and dipole sources that were determined with interictal MEG were also located in this area. In addition, ictal frequency oscillations (FOs) with high gamma activity were identified over the cortex surrounding the largest tuber. After a lesionectomy of this tuber, the periodic spasms disappeared, and no FOs were detected over this area. Conclusions: Scalp EEG, which identified the ictal onset zone by detecting fast activity that was suggestive of FOs, was useful for detecting the epileptogenic region in an infant with TS.

Sensory integration and activities of daily living in children with developmental coordination disorder

Bülent Elbasan — 2012-04-30T00:00:00Z

ObjectiveThe aim of our study was to evaluate sensory integration and activities of daily living in children with developmental coordination disorderSubjects and methods37 cases with developmental coordination disorder and 35 healthy age-matched peers were included in this study. Ayres Southern California Sensory Integration Test was used for evaluating the sensory integration and Functional Independence Measure for Children (WeeFIM) was used for evaluating the activities of daily living. Results: Significant differences were found in the visual shape perception, position in space, and design copying (p < 0.05). According to the results of somatosensory perception tests, significant differences were found in kinesthesia, manual form perception, finger identification, figure-ground perception, localization of tactile stimuli, double tactile stimuli perception (p < 0.05). Control group was better in motor planning (p < 0.05). Comprehension, expression, social communication, problem solving, and memory skills were significant in favor of the control group (p < 0.05). Graphestesia and self-care domain was found to be correlated (r = 0,491, p = 0.002) between the groups.DiscussionSpecial education and rehabilitation programs including sensory integration therapy and motor performance will increase independence in the activities of daily living in children with developmental coordination disorder.

Posttraumatic stress symptoms in children diagnosed with type 1 diabetes

Sahika Şişmanlar — 2012-04-26T00:00:00Z

Background: Studies consistently found remarkable rates of posttraumatic stress symptoms (PTSS) inchildren with chronic diseases. But, only one study had searched PTSS in children withdiabetes, until now. So, the present study aimed to examine incidence rate and predictors ofPTSS in children with type 1 diabetes.MethodPTSS were evaluated by Child Posttraumatic Stress Reaction Index in fifty four children withdiabetes (aged between 8-18 years). This assessment was based on hypoglycaemia as thepotential traumatic event. Children were also introduced a brief questionnaire aboutdemographic and disease related information. Some other information was obtained fromfamilies, medical stuff and records. Among 54 children, forty two had complete information.Hence, to evaluate possible predictive factors related with PTSS, multiple regression analysiswas conducted for 42 children. Results: 18.5% of children were reported PTSS at severe or very severe level, and 51.9% werereported PTSS at moderate level or above. Multiple regression analyses were shown thatchild PTSS were not significantly related with possible predictive factors other than numberof hypoglycaemic attacks for the last month. Conclusion: The study results support that posttraumatic stress symptoms are not rarely seen in paediatricpatients with diabetes, and even if not severe, hypoglycaemic attacks may be perceived astraumatic by the children with diabetes. But, because of some limitations, the results shouldbe carefully interpreted.

Chest wall TB and low 25-hidroxy-vitamin D levels in a 15-month-old girl

Danilo Buonsenso — 2012-04-17T00:00:00Z

Parietal chest wall tuberculosis is an extremely rare manifestation of tuberculosis (TB) in children. We present the case of a 15 month-old girl presenting with a chest wall lesion initially thought to be of neoplastic origin and eventually diagnosed as chest wall TB, which was treated with surgical debridement and specific antitubercular therapy. The girl had not-measurable 25-hidroxy-vitamin D levels, an increasingly recognized risk factor for the development of active TB. To our knowledge, in the English literature there are no similar described cases in such young infants. This case highlight the possibility of dealing with TB and its different manifestations also in low TB burden countries, due to continuously increasing migration flows. A detailed history is a key point to reach the diagnosis. Moreover, our case confirm the possible non casual relationship between TB and low 25-hidroxy-vitamin D levels, pointing out the importance of measuring its levels in all TB patients and considering its supplementation in addition to specific antitubercular therapy.

Inflammation and neurological adverse drugs reactions: a case of long lasting impaired consciousness after oxatomide administration in a patient with gastroenteritis.

Stefania Antoniazzi — 2012-03-30T00:00:00Z

Oxatomide at therapeutic doses generates occasionally drowsiness in children. When administered at toxic doses, however oxatomide may induce long lasting impaired consciousness. We now report a case of severe long lasting impaired consciousness induced by therapeutic doses of oxatomide occurring in a child affected by acute gastroenteritis. The clinical symptoms, the pharmacogenetic tests of polymorphisms in cytochrome P450 metabolizing enzymes (CYPs) and the clinical and laboratory analyses indicate that the enhanced drug sedative effect is likely due to an acute, yet mild, inflammatory state of the patient. These findings highlight the importance of assessing common, not serious inflammatory states when oxatomide is prescribed in paediatric patients.

Celiac disease in type 1 diabetes mellitus

Maria Erminia Camarca — 2012-03-26T00:00:00Z

Celiac Disease (CD) occurs in patients with Type 1 Diabetes (T1D) ranging the prevalence of 4.4-11.1% versus 0.5% of the general population. The mechanism of association of these two diseases involves a shared genetic background: HLA genotype DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, DR3-DQ2 with CD. The classical severe presentation of CD rarely occurs in T1D patients, but more often patients have few/mild symptoms of CD or are completely asymptomatic (silent CD). In fact diagnosis of CD is regularly performed by means of the screening in T1D patients. The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in CD/T1D patient are controversial. Regarding of the GFD composition, there is a debate on the higher glycaemic index of gluten-free foods respect to gluten-containing foods; furthermore GFD could be poorer of fibers and richer of fat. The adherence to GFD by children with CD-T1D has been reported generally below 50%, lower respect to the 73% of CD patients, a lower compliance being more frequent among asymptomatic patients. The more severe problems of GFD adherence usually occur during adolescence when in GFD non compliant subjects the lowest quality of life is reported. A psychological and educational support should be provided for these patients.

Multiple Endocrine Neoplasias Type 2B and RET proto-oncogene

Giuseppe Martucciello — 2012-03-19T00:00:00Z

Multiple Endocrine Neoplasia type 2B (MEN 2B) is an autosomal dominant complex oncologic neurocristopathy including medullary thyroid carcinoma, pheochromocytoma, gastrointestinal disorders, marphanoid face, and mucosal multiple ganglioneuromas. Medullary thyroid carcinoma is the major cause of mortality in MEN 2B syndrome, and it often appears during the first years of life. RET proto-oncogene germline activating mutations are causative for MEN 2B. The 95% of MEN 2B patients are associated with a point mutation in exon 16 (M918/T). A second point mutation at codon 883 has been found in 2%-3% of MEN 2B cases. RET proto-oncogene is also involved in different neoplastic and not neoplastic neurocristopathies. Other RET mutations cause MEN 2A syndrome, familial medullary thyroid carcinoma, or Hirschsprung's disease. RET gene expression is also involved in Neuroblastoma . The main diagnosis standards are the acetylcholinesterase study of rectal mucosa and the molecular analysis of RET. In our protocol the rectal biopsy is, therefore, the first approach. RET mutation detection offers the possibility to diagnose MEN 2B predisposition at a pre-clinical stage in familial cases, and to perform an early total prophylactic thyroidectomy. The surgical treatment of MEN 2B is total thyroidectomy with cervical limphadenectomy of the central compartment of the neck. When possible, this intervention should be performed with prophylactic aim before 1 year of age in patients with molecular genetic diagnosis. Recent advances into the mechanisms of RET proto-oncogene signaling and pathways of RET signal transduction in the development of MEN 2 and MTC will allow new treatment possibilities.