@article {8309, title = {Acute lobar nephritis in children: Not so easy to recognize and manage.}, journal = {World J Clin Pediatr}, volume = {5}, year = {2016}, month = {2016 Feb 8}, pages = {136-42}, abstract = {

Acute lobar nephritis (ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.

}, issn = {2219-2808}, doi = {10.5409/wjcp.v5.i1.136}, author = {Bibalo, Cristina and Apicella, Andrea and Guastalla, Veronica and Marzuillo, Pierluigi and Zennaro, Floriana and Tringali, Carmela and Taddio, Andrea and Germani, Claudio and Barbi, Egidio} } @article {7689, title = {Appendicitis in children less than five years old: A challenge for the general practitioner.}, journal = {World J Clin Pediatr}, volume = {4}, year = {2015}, month = {2015 May 8}, pages = {19-24}, abstract = {

Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33\% to 41\% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61\% of the patients) followed by guarding (55\%), diffuse tenderness (39\%), rebound (32\%), and mass (6\%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70\% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis.

}, issn = {2219-2808}, doi = {10.5409/wjcp.v4.i2.19}, author = {Marzuillo, Pierluigi and Germani, Claudio and Krauss, Baruch S and Barbi, Egidio} } @article {3515, title = {Acquired long QT syndrome: a focus for the general pediatrician.}, journal = {Pediatr Emerg Care}, volume = {30}, year = {2014}, month = {2014 Apr}, pages = {257-61}, abstract = {

Acquired long QT syndrome (LQTS) is a disorder of cardiac repolarization most often due to specific drugs, hypokalemia, or hypomagnesemia that may precipitate torsade de pointes and cause sudden cardiac death. Common presentations of the LQTS are palpitations, presyncope, syncope, cardiac arrest, and seizures. An abnormal 12-lead electrocardiogram obtained while the patient is at rest is the key to diagnosis. The occurrence of drug-induced LQTS is unpredictable in any given individual, but a common observation is that most patients have at least 1 identifiable risk factor in addition to drug exposure. The cornerstone of the management of acquired LQTS includes the identification and discontinuation of any precipitating drug and the correction of metabolic abnormalities, such as hypokalemia or hypomagnesemia. Most of the episodes of torsade de pointes are short-lived and terminate spontaneously. We propose a management protocol that could be useful for the daily practice in the emergency pediatric department to reduce the risk of acquired QT prolongation.

}, keywords = {Adolescent, Death, Sudden, Cardiac, Electrocardiography, Female, General Practitioners, Humans, Long QT Syndrome, Ondansetron, Risk Factors, Serotonin Antagonists}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000000108}, author = {Marzuillo, Pierluigi and Benettoni, Alessandra and Germani, Claudio and Ferrara, Giovanna and D{\textquoteright}Agata, Biancamaria and Barbi, Egidio} }