Ottavio Vitelli

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.

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.

The Thin Line between Munchausen Syndrome and Munchausen Syndrome by Proxy

Factitious disorders are the intentional production of feigning symptoms or disabilities; either physical or psychological. We report the case of a young girl, victim of Munchausen by proxy who became a Munchausen patient.

Cardamom Ingestion as a Possible Cause of Hematuria

Sir,Hematuria in childhood is a common clinical entity whichneeds an extensive evaluation.A 5-year-old girl admitted to our Pediatric Departmentbecause of isolated hematuria without any flank discomfort.The patient denied having fever, infections or any trauma inpreviousmonths.Therewasnofamilyhistoryofurinarystonesor bleeding diathesis. The patient took no medication. Herphysical examination was unremarkable. The child wasafebrile and normotensive. Initial laboratory evaluationrevealed an hemoglobin concentration of 12.5 g/dL, plateletcountof370.000/mm