L. Da Dalt

Gas exchange during exercise in obese children

Twenty-three obese children, aged 9 to 14 years, ranging in percentage overweight from 26% to 83% (median 51.6%±16.3%), and 37 normal-weight children, matched for sex, age and height, performed a maximal exercise test on a treadmill. Cardiorespiratory performance was assessed by determination of the ventilatory anaerobic threshold (VAT) expressed in ml O2/min per kg and as a percent of maximal oxygen uptake (% VO2max). VAT and VO2max related to body weight were significantly lower (P<0.01) in the obese than in the normal-weight children. VAT % VO2max was similar in the two groups. A significant correlation was found between VAT and VO2max both in the obese (r=0.85) and in the control groups (r=0.79). The habitual level of physical activity was lower in the obese subjects compared to the control subjects (P<0.001). In conclusion our study shows that physical fitness of overweight children is quantitatively lowered and that it can be assessed by VAT. VAT does not require a maximal test and is particularly useful in the ergometric study of subjects with exercise intolerance.

A Case of Infant Botulism due to Neurotoxigenic Clostridium butyricum Type E Associated with Clostridium difficile Colitis

Abstract.Reported here is the sixth case of intestinal toxemia botulism caused by Clostridium butyricum type E in Italy since 1984. In this case, the patient was concomitantly affected with colitis due to Clostridium difficile toxin. A review of previously reported cases revealed that some of these patients may also have had intestinal toxemia botulism associated with Clostridium difficile colitis, based on the reported symptoms. Given that this association has been shown to exist not only in Italy but also in the USA, it is recommended that individuals with intestinal botulism and symptoms of colitis undergo testing for Clostridium difficile and its toxins in fecal samples.

Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux.

One hundred and eleven children admitted with suspected gastro-oesophageal reflux were studied, with 24 hour oesophageal pH monitoring as the first line of investigation. Barium swallow examination, or oesophagoscopy, or both, were carried out only in children with abnormal pH, who subsequently had a trial of 1-12 months medical treatment. All patients were followed up for eight months to two years. A final diagnosis of gastro-oesophageal reflux was made in 41 patients, in all of whom the pH study was abnormal (100% sensitivity). The final diagnosis was different in 70 patients; 66 of these had a normal pH (94% specificity). All children with gastro-oesophageal reflux were treated with drugs. All those with a percentage reflux time of more than 27 and more than 20 episodes of reflux lasting more than 5 minutes failed to improve and needed operation. We conclude that monitoring of the oesophageal pH should be the first line of investigation in patients with gastro-oesophageal reflux and should be used together with clinical data and other investigations, to identify those children who will need operation.

Measuring fecal progestogens as a tool to monitor reproductive activity in captive female bottlenose dolphins (Tursiops truncatus)

The objective was to develop and test radioimmunoassays (RIAs) to measure fecal progestogens (P) and estrogens (E) to monitor ovarian activity in the bottlenose dolphin (Tursiops truncatus). Fecal samples were collected at least once a week for 20 mo from three peripubertal female bottlenose dolphins. Blood samples were collected at least once a month to compare serum and fecal steroid concentrations. Moreover, random fecal samples from three pregnant females, one lactating female, and one sexually mature female receiving oral altrenogest treatment were also collected. Fecal samples were collected behaviorally with a probe to avoid water contamination and extracted with petroleum ether (for P analysis) or diethyl ether (for E analysis). When possible, vaginal cytology and ovarian ultrasonography were used to monitor the estrous cycle. The RIA for fecal P had good reproducibility and negligible matrix effect. In addition, when fecal samples (N=25) were extracted with ethanol, the results with the two methods of extraction were highly correlated (r=0.923). Therefore, extraction of fecal samples with petroleum ether represented a valid alternative to other, more time-consuming methods of determining fecal P concentrations. In the absence of luteal activity, fecal P concentrations were consistently < 10 pmol/g feces, although they never decreased below 10 pmol/g during pregnancy. Thus, the threshold to confirm the presence of an active corpus luteum was provisionally set at 10 pmol/g. Around the onset of puberty, luteal phases appeared shorter and irregular in the bottlenose dolphin, as in other mammalian species. Additional HPLC-MS studies should be performed to identify predominant P metabolites to be used as fecal indicators of luteal activity in this species.

Prospective Study of the Burden of Acute Gastroenteritis and Rotavirus Gastroenteritis in Children Less Than 5 Years of Age, in Padova, Italy

Background:Data on the burden of rotavirus gastroenteritis in Europe are needed to help understand the potential impact of introducing new rotavirus vaccines.Materials and Methods:As part of prospective observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in Public Health and Society Study, REVEAL) conducted in 2004–2005 in seven European countries, we studied, the characteristics of acute gastroenteritis and rotavirus gastroenteritis in children less than 5 years in primary care, emergency room and hospital settings (Padova, Italy).Results:A total of 757 children with acute gastroenteritis were included and enzyme-linked immunoabsorbent assay (ELISA) results were available for 725 cases. The overall estimated annual incidence for rotavirus gastroenteritis was 4.7%. Overall, rotavirus gastroenteritis was estimated to account for 43.6% of acute gastroenteritis cases. Among children with acute gastroenteritis (AGE) aged 6–23 months, 61.2% were rotavirus positive. Rotavirus gastroenteritis (RVGE) was responsible for 68.8% of hospitalizations, 61% of emergency consultations, and 33% of primary care consultations. The most prevalent serotype was G9 (84.4%) followed by G1 (11.8%). The relative risk for rotavirus gastroenteritis of being referred to hospital after an initial consultation in primary care was 3.37 (95% CI: 1.77–6.43) and 3.38 (95% CI: 2.28–5.01) for emergency room referral. Children with rotavirus gastroenteritis generally had more severe disease than children with rotavirus-negative gastroenteritis.Conclusion:Rotavirus accounts for a significant proportion of acute gastroenteritis cases in children less than 5 years in Italy, many of whom require frequent primary care consultations, or care in emergency room or hospital settings.

Severe clinical course of systemic lupus erythematosus in the first year of life

Systemic lupus erythematosus (SLE) very rarely occurs before the age of 5. Herein we describe the clinical features of infantile SLE (iSLE) with onset during the first year of life. The clinical and laboratory characteristics of iSLE patients followed at the Department of Pediatrics of Padua were analyzed. They were combined with those collected from the literature by performing a systematic literature search on PubMed using the following keywords: SLE, infant, laboratory, therapy, and outcome. A total of 13 patients with iSLE, 2 from our Institution and 11 from the literature, are included in this review. Seven (53.8%) were females and 6 were males (46.2%). The age at disease onset ranged from 6 weeks to 11 months. In comparison with juvenile systemic lupus erythematosus (jSLE), iSLE showed a higher prevalence of positive family history for autoimmune diseases, systemic symptoms at presentation, internal organs involvement, and shorter time between symptoms onset and diagnosis. Anemia and thrombocytopenia were present in the majority of the patients at diagnosis, whereas leukopenia was rarely observed. The overall prognosis in iSLE was very poor: 5/13 infants died between 2 and 31 months after the onset, and 5/13 had severe disease course with residual organ damage. SLE can start as early as during the first year of life and is more severe than in the later age groups.

Pupillary Reactivity in Children With Recurrent Abdominal Pain

SYNOPSIS

Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia

SummaryBackgroundRotavirus gastroenteritis (RVGE) has a major impact in terms of morbidity in Italy. Comprehensive data on the economic impact are needed in order to evaluate the cost-effectiveness of a Rotavirus (RV) vaccination program.MethodsAs part of a prospective observational study (REVEAL) conducted in 2004–2005 in seven European countries, we calculated the average costs per case with confirmed RVGE in primary care (PC), emergency room (ER), and hospital (H) settings, from both the national health care service and societal perspectives.ResultsA total of 336 children <5 years with RVGE were included in the cost analysis. The total societal cost per child was € 292 in PC, € 600 in ER, and € 1,901 in the H setting. Overall total cost of community-acquired RVGE in the Veneto Region was estimated to be around 7 million €. Extrapolating the observed data to the whole Italian country, the total cost was estimated between 67.1–80 million € according to the estimates used. About 61% of the total costs were direct non-medical and indirect costs, mostly related to loss of productivity due to work days lost by parents and other caregivers.ConclusionsRVGE in Italy causes considerable costs in all healthcare settings for the national health care payer and families. An effective childhood vaccination program would have considerable direct and indirect benefits for the Italian society.

368 Markers for Invasive Bacterial Infection in Well-Appearing Young Febrile Infants. The Value of Procalcitonin

Background In the last decade, the procalcitonin (PCT) has been introduced in many protocols for the management of the febrile child. However, its value among young well-appearing infants is not completely defined. Objective To assess the value of PCT in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants under 3 months of age with fever without source (FWS). Design and Methods Retrospective study including well-appearing infants under 3 months of age with FWS attended in seven European Paediatric Emergency Departments. An IBI was defined when a bacterial pathogen was isolated in blood or cerebrospinal fluid culture. Results A total of 1,531 infants under 3 months of age with FWS were attended. There were 1,112 well-appearing infants in whom PCT and a blood culture were performed. Among them, 23 (2.1%) were diagnosed with an IBI. A multivariate analysis showed that, among different epidemicological data and blood tests, PCT was the only independent risk factor for having an IBI (OR 21.69 if PCT 0.5 ng/mL). Comparing with C-Reactive Protein, PCT showed a better performance to rule-in an IBI. Among patients with normal urine dipstick and short-evolution fever (less than 6 hours), areas under the ROC curve were 0.819 and 0.563, respectively for detecting IBIs. Conclusions Among young infants with FWS, PCT showed a better performance than C-Reactive Protein in identifying patients with IBIs and, mainly in those patients with normal urine dipstick and short-evolution fever, PCT seems to be also the best marker to rule out an IBI.

PO-0308 Dural Sinus And Internal Jugular Vein Thrombosis After Blunt Head Injury In A Paediatric Patient: Good Outcome After Prompt Anticoagulation Therapy

Introduction Paediatric cerebral venous sinus thrombosis (CVST) is a rare condition (3 cases/million population), usually idiopathic. Traumatic head injury is a rare cause of this severe disease and no consensus exists regarding diagnosis and management of post-traumatic CVST. We describe the case of a patient with blunt head injury who developed sigmoid sinus and Internal Jugular Vein Thrombosis (IJVT), successfully treated with anticoagulation therapy (ACT). Case-Report A 14 years old boy, previously healthy, was brought to our ED because of an head trauma and transient loss of consciousness after a road traffic accident. On arrival he was conscious and irritated and needed sedation and oro-tracheal intubation. Immediate CT showed right temporo-parietal fracture with left fronto-parietal subarachoid hematoma. A 48 h CT revealed a worsening of right temporal hematoma and an hyperdensity area at the right sigmoid sinus suggestive of CVST, confirmed by CT venography as venous thrombosis of sigmoid sinus and IJV. His coagulation profile was normal. The patient started immediately Low Molecular Weight Heparin therapy, continued for three months. The MRI after two weeks of ACT was normal. He was discharged after 27 days without any neurological deficit. Conclusion Our report demonstrates importance of suspicion for CVST in head trauma, especially in those with high energy trauma or focal lesion, in which the neurological status cannot be monitored. The early diagnosis may permit to start an appropriated ACT, that is probably effective in reducing the risk of death and sequelae, if started early, during the acute phase.