Antonio Gatto

Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children.

Objective. This study compares the effects of daily cranberry juice to those of Lactobacillus in children with recurrent urinary tract infections (UTIs). Material and methods. Eighty-four girls aged between 3 and 14 years were randomized to cranberry, Lactobacillus or control in three treatment arms: G1, cranberry juice 50 ml daily (n=28); G2, 100 ml of Lactobacillus GG drink on 5 days a month (n=27); and G3, controls (n=29). The study lasted for 6 months. Results. Only four subjects withdrew: 1/28 (3.5%) from G1, 1/27 (3.7%) from G2 and 2/29 (6.8%) from G3, because of poor compliance to the established protocol. There were 34 episodes of UTIs in this cohort: 5/27 (18.5%) in G1, 11/26 (42.3%) in G2 and 18/27 (48.1%) in the G3, with at least one episode of infection (p<0.05). Conclusion. These data suggest that daily consumption of concentrated cranberry juice can significantly prevent the recurrence of symptomatic UTIs in children.

Polythelia: Still a marker of urinary tract anomalies in children?

Objective. Supernumerary nipples (SNN), or polythelia, are the most common form of the accessory mammary tissue malformation. The frequency of this condition ranges from 0.2% to 5.6% depending on various factors. This condition is associated with several anomalies, although this association is often controversial. The aim of this study was to evaluate the association between SNN and kidney/urinary tract (K/UT) anomalies, where anomalies is taken to mean functional disorders, malformations and diseases. Material and methods. A case–control study was performed. The study evaluated 166 children (case group) referred to the Pediatric Nephrology Unit of the Department of Pediatrics of the Catholic University of Rome and 182 children (control group) admitted to the Department of Pediatrics because of pathologies not involving the urinary tract. Results. There were 11 children with SNN in the case group, and only two patients in the control group (6.62% vs 1.09%, p<0.05). Conclusion. The results show a high incidence of K/UT anomalies in children with SNN, and therefore K/UT should be investigated in this specific population.

Factitious disorders and Munchausen syndrome: The tip of the iceberg

This population-based study evaluates the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy in a clinical setting. All children referred to the Pediatric Unit of the Department of Pediatrics of the Catholic University Medical School (Agostino Gemelli Hospital) in Rome were recruited between November 2007 and March 2010. An experienced interdisciplinary team of medical professionals analyzed all suspected cases. A total of 751 patients were hospitalized. Factitious disorders were diagnosed in 14/751 patients, resulting in a prevalence of 1.8%. Three of 14 (21.4%) patients fulfilled the criteria for Münchausen syndrome. Münchausen syndrome by proxy was identified in four of 751 patients, resulting in a prevalence of 0.53%. The perpetrator was the mother in three of four of these cases. The epidemiological data obtained in this population-based study indicate that the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy is higher than previously observed. Moreover, early detection was possible thanks to the awareness of an expert interdisciplinary team. We suggest that physicians must consider the possibility of these diagnoses whenever there are discrepancies in a child’s illness presentation.

Fetal cholelithiasis: a diagnostic update and a literature review

Fetal gallstones and cholelithiasis, detected by routine third trimester ultrasound, have been described in the literature with controversial clinical significance. We report a case of fetal cholelithiasis detected at 35 weeks gestation during a routine scan. The diagnosis was performed using an integrated 2-dimensional (2-D) and 3-dimensional (3-D) ultrasound approach in order to obtain a better definition of the fetal gallbladder and its content. A neonatal follow-up was achieved. The present study has a twofold purpose: firstly, to update the diagnostic approach using the innovative 3-D modalities and secondly, to review the management of this condition during fetal and postnatal life.

A focus on recent cases of suicides among Italian children and adolescents and a review of literature

Suicidal behaviors are among the leading causes of death worldwide. The large spread of suicide suggests that educational programs and literature to parents or guardians should include information about the potential risks and potential consequences of the onset of the idea of suicide in children. We identified 55 cases of suicide among children and young adults <18-year-old occurring in Italy between 1st January, 2011 and 31st December, 2013. The results point to the need to increase our understanding of the dramatic rise in suicidal behaviors during childhood/adolescence and of the causal pathways linking these behaviors to child-adolescent mental disorders. During routine care visits, pediatricians should be skilled to recognize risk factors for adolescent suicide in order to intervene appropriately.

Massive proteinuria: a possible side effect of pyrantel pamoate?

Abstract Drug-induced renal injury represents a frequent clinical entity. The most common drugs associated with acute tubular necrosis are aminoglycosides, amphotericin B, radiocontrast agents, and cyclosporine, but no data exist about the potential renal toxicity due to anthelmintics administration. Anthelmintics are commonly considered quite safe agents, and side effects such as gastrointestinal, neurologic, hematologic, or hepatic injury have been only rarely described. We report a 4-year-old boy with persistent massive proteinuria without any other symptoms/signs suggesting nephrotic syndrome (NS). The only relevant anamnestic data was the administration of pyrantel pamoate due to oxyuriasis 7 days before the proteinuria development. The patient was affected by NS diagnosed 6 months before and treated with a 12-week course of corticosteroids. During follow-up, carried out at 3 and 6 months after discharge, he did not show further episodes of proteinuria, and no clinical symptoms/signs suggesting a relapse of NS were ever detected. Considering that the proteinuria observed in our patient spontaneously disappeared after 10 days without any treatment, apart from the interruption of the anthelmintic therapy, we would like to alert pediatricians about the possible occurrence of anthelmintics-related renal complications especially among predisposed patients and to perform a watchful waiting not considering the presence of even massive proteinuria as a certain sign of NS relapse.

Oligonephronia and Wolf-Hirschhorn syndrome: A further observation

Wolf‐Hirschhorn syndrome (WHS) is a rare chromosomal disorder caused by a partial deletion of chromosome 4 (4p16.3p16.2). We describe a case of a male 9 years old children with WHS proteinuria and hypertension. Laboratory data showed creatinine 1.05 mg/dl, GFR 65.9 ml/min/1.73 m2, cholesterol 280 mg/dl, triglyceride 125 mg/dl with electrolytes in the normal range. Urine collection showed protein 2.72 g/L with a urine protein/creatinine ratio (UP/UCr ratio) of 4.2 and diuresis of 1,100 ml. Renal ultrasound showed reduced kidney dimensions with diffusely hyperechogenic cortex and poorly visualized pyramids. Renal biopsy showed oligonephronia with focal segmental glomerulosclerosis associated with initial tubulointerstitial sclerotic atrophy. The child began therapy with Angiotensin‐converting enzyme inhibitors (ACE‐inhibitors) to reduce proteinuria and progression of chronic kidney disease. In the literature the anomalies of number of glomeruli oligonephronia and oligomeganephronia (OMN) are described in two forms, one without any associated anomalies, sporadic, and solitary and the other with one or more anomalies. Our review of the literature shows that the pathogenesis of this anomaly is unknown but the role of chromosome 4 is very relevant. Many cases of OMN are associated with anomalies on this chromosome, in the literature cases series we observed this association in 14/48 cases (29.2%) and in 7 of these 14 cases with WHS. Our case and the review of literature demonstrate how periodic urinalysis and renal ultrasound monitoring is recommended in patients affected by WHS and the renal biopsy must be performed when there is the onset of proteinuria.

Epstein-Barr virus-related cutaneous necrotizing vasculitis in a girl heterozygous for factor V Leiden

Background Necrotizing vasculitides are basically characterized by vessel wall neutrophil infiltration and necrosis and they can occur as a primary process or secondary to an underlying disease. Although Henoch-Schönlein purpura (HSp) is the more frequent primary vasculitis in childhood, sometimes it has to be distinguished from other secondary vasculitides induced by infections, drugs, vaccines, or immune-mediated disorders. Main observations We report a case of a 14-year-old girl with cutaneous necrotizing vasculitis, appearing in the course of acute Epstein-Barr virus infection. Physical examination revealed highly aching erythematous-purple lesions with reticular edges localized on the back of feet. Pain was non-responsive to ibuprofen and required administration of tapentadol and pregabalin. The patient was also heterozygous for factor V Leiden that might have contributed to the development of cutaneous painful lesions. Conclusions To our knowledge this is the first documented pediatric case of necrotizing vasculitis associated with acute EBV infection in a girl heterozygous for factor V Leiden. In this patient the severity of skin manifestations might have been influenced by the concomitant factor V Leiden, which gave rise to hypercoagulability and occlusive vasculopathy with markedly severe pain, a symptom rather infrequent in other childhood vasculitides.

A 3-Year-Old Child With a History of Persistent Dry Cough and Fever

AFFILIATIONS: From the Department of Pulmonary Medicine (Drs Conte, Gerardi, Smargiassi, and Inchingolo); the Institute of Pediatrics (Drs Gatto and Valentini); and the Institute of Pediatric Surgery (Dr Nanni), Policlinico Universitario Agostino Gemelli, Rome, Italy. E. G. C. and R. E. G. contributed equally to this work. CORRESPONDENCE TO: Rafael Emanuele Gerardi, MD, Department of Pulmonary Medicine, Policlinico Universitario A. Gemelli, Rome 00168, Italy; e-mail: re.gerardi87@gmail.com Copyright 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2016.12.036

Subacute Myopericarditis Without Myocardial Infarction Treated With Intravenous Immunoglobulin in a Child With Marked Elevation of Plasma Cardiac Troponin I.

e report the case of an 11-year-old W boy who came to our emergency room in January 2016 with oppressive retrosternal pain worsened by breathing acts. He never had other similar episodes in the past, although he had experienced asthma and gastroesophageal reflux disease. His family history was negative for any heart disease. On admission, his complete blood count and biochemical analysis were normal, including electrolytes. We noted highly increased myocardial fraction of creatine phosphokinase and cardiac troponin I (cTnI) in the serum, 108.2 ng/mL (normal value < 7.0) and 31.985 ng/mL (normal value < 0.040), respectively. The C-reactive protein level was also raised (133.8 mg/L, normal value < 5). The electrocardiogram findings showed ST segment elevation and globally normal voltage. The serum cTnI level was still raised after 6 hours, requiring the childs admission in the pediatric intensive care unit where his hemodynamics and vital parameters remained stable overall. Heart ultrasound investigation showed a normal function of the left ventricle (LV)with normal ejection fraction (approximately 70%). Amyopericarditiswas suspected, and therapy started with indomethacin, bisoprolol, and enalapril. A serologic test for adenovirus, cytomegalovirus, Epstein-Barr virus, coxsackievirus, echovirus, and Mycoplasma pneumoniae did not reveal any acute infection. A polymerase chain reaction of blood samples for the detection of viral genomeswas negative. However, during the following hours, precordial chest pain seemed to worsen and serum cTnI increased to 34.207 ng/mL, suggesting the start of treatment with 2 cycles of intravenous immunoglobulin (IVIG), each one at a dose of 1 g/kg. These were administered on days 2 and 3 of hospital stay without any adverse effect. Indomethacin, bisoprolol, and enalapril were