Minerva Pediatrics最新文献

Introduction: The aim of this study was to evaluate the difference between symptomatic discoid lateral meniscus (DLM) and healthy knees in terms of gait analysis.

Evidence acquisition: A systematic review was conducted from the electronic databases PubMed/MEDLINE, EMBASE and Scopus. The review was performed on studies that reported data on kinematics, gait analysis, biomechanics in discoid lateral meniscus, before and after surgery.

Evidence synthesis: Out of 127 identified items, six full-text articles were assessed for eligibility. Three of these studies were included in the quantitative synthesis. Those studies reported a significantly slower gait speed and shorter stride length, smaller excursion during weight acceptance and mid-stance phases and during the whole gait cycle, smaller maximum flexion angle in swing phase, lower frontal excursion, smaller axial excursion in the DLM groups compared to the control groups. One study reported a significative increase in the walking speed and in the stride length, increase both in the maximum knee flexion angle during stance phase and swing phase, and in the range of flexion-extension after arthroscopic surgical treatment for symptomatic DLM.

Conclusions: Literature about gait analysis on DLM patients is still very scarce and heterogeneous. The few studies on this topic show a different gait pattern between DLM knees and healthy knees and are encouraging about the surgical outcomes of DLM in terms of gait. Larger and standardized studies should be designed to assess a more suitable number of subjects with DLM.

Background: Neuroinflammation seems to be involved in ADHD pathogenesis. Recently, in this regard, some evidence suggests the possibility of an autoimmune mechanism related to anti-Purkinje cell antibodies. The aim of this paper is to confirm this evidence searching for a possible specificity for some subtype of ADHD.

Methods: We studied 112 consecutive drug-naïve Caucasian ADHD outpatients, who were attending their first psychiatric examination (91 males and 21 females; median age =108.14 months; sd=34.58 months). K-SADS interview and ADHD rating scale were used for a DSM 5 diagnosis of ADHD and subtype. WISCIII and a validated list of words were used to assess a possible dyslexia. Antibodies to Yo (Purkinje cell cytoplasmic antibody type 1 [PCA-1]) were detected by indirect immunofluorescence assay.

Results: Forty-nine point one percent (55) of ADHD children were positive to Anti-Yo antibodies. A lower percentage than in previous studies. We found that in the Anti-Yo positive children, the subtype most represented was significantly the combined subtype. No significant relation was found with ADHD plus Dyslexia children.

Conclusions: The number of ADHD subjects positive to Anti-Yo antibodies is less than in previous studies, but it remains interesting and it is more likely to find a positive child in the combined ADHD than in the other subtypes.

Background: Lung auscultation using a smartphone built-in microphone is promising for home monitoring of pediatric respiratory diseases. Our aim was to compare respiratory sounds recorded by a smartphone and a digital stethoscope by assessing the proportion of quality recordings and adventitious sounds detected by each device.

Methods: A comparative early feasibility study with children from a public school in Northern Portugal was conducted. Lung auscultation was performed at 7 locations (trachea, anterior superior, posterior superior, and posterior inferior regions of both hemithoraces). Two researchers recorded lung auscultation simultaneously with a smartphone and a digital stethoscope, and independently classified recordings regarding their quality (at least one respiratory cycle audible with minimal artefacts) and presence of adventitious sounds. A third researcher resolved the disagreements. Proportions of sounds with quality and with adventitious sounds were compared between devices using chi-square tests. Inter-device agreement was also assessed with proportion of agreement and Cohen kappa.

Results: Twenty-seven children (20 male, 10.2±0.6 years) were enrolled, 8 had self-reported asthma. A total of 378 respiratory sounds (smartphone N.=190, digital stethoscope N.=188 [2 missing]) were recorded. The percentage of recordings with quality was high in both devices (93% smartphone vs. 97% digital stethoscope, P=0.065). Adventitious sounds were identified in 11% and 19% of the recordings acquired with smartphone and digital stethoscope, respectively (P=0.021). The overall inter-device proportion of agreement for the presence of adventitious sounds was 90% (kappa 0.60, 95%CI 0.42, 0.77).

Conclusions: Smartphone lung auscultation seems to be a viable technology for recording respiratory sounds and identifying adventitious sounds in children. Further research is needed to validate its potential for effective remote respiratory disease monitoring.

Background: Infection with Adenovirus in children may clinically resemble a bacterial infection in several aspects, including high and prolonged fever, and increased inflammation markers. We aimed to estimate the rate of antibiotics administration among hospitalized infants with Adenovirus infection and to evaluate its justification.

Methods: Included were hospitalized patients aged 2 months - 2 years who found positive for Adenovirus in PCR tests (Ct <36). Basic epidemiological and clinical features were retrieved retrospectively. A panel of three certified pediatricians examined each case to decide whether the antibiotic treatment was justified. Subsequently, the cases were divided into two groups - the group treated with antibiotics and the untreated group. The groups were compared in terms of the various parameters.

Results: Out of 183 children with Adenovirus, 92 (50.3%) were treated with antibiotics. Only 42.4% of the antibiotics prescribed were medically justified. Children treated with antibiotics had a higher level of fever (39.4±0.90 vs. 38.6±0.98 °C; P<0.001), their blood oxygen saturation was higher (96.7±4.4% vs. 92.9±7.7%; P=0.0003), they were less dyspneic, and their inflammatory markers were higher as compared to those who had not been treated with antibiotics.

Conclusions: Approximately half of hospitalized pediatric patients <2 years old who were found positive for Adenovirus infection were treated with antibiotics during hospitalization. Most of these treatments were found retrospectively to be unjustified. Rapid and routine Adenovirus PCR testing can potentially reduce the rate of antibiotic treatment amongst hospitalized children.

Acute post-viral cough is a common symptom, usually mild-moderate and self-resolving. However, acute cough may be particularly annoying, affecting sleep, and quality of life, also of the family. Thus, treatment is deemed necessary. Antitussive remedies may be pharmacological or non-pharmacological. Antitussive drugs are either central or peripheral. Central drugs are burdened with significant side effects and can cause abuse, especially in adolescents. Levodropropyzine, on the other hand, is an effective peripheral drug, as demonstrated by two meta-analyses, and has an optimal safety profile. Non-pharmacological remedies tend to be safe, but few substances have a documented degree of efficacy. Therefore, when managing children and adolescents with a post-viral cough, the practical approach may be based on levodropropizine use, which is preferable when the cough is particularly persistent and disturbs sleep.

Introduction: Vitamin D is an essential hormone for humans, playing an important role in musculoskeletal and calcium homeostasis. Its deficiency/insufficiency seems to contribute to the development of cardiometabolic diseases in adults: this correlation appears less clear for children and adolescents. The aim of this paper was to review literature data on the relationship between vitamin D and lipid profile alterations in pediatric population.

Evidence acquisition: We carried out a comprehensive research in electronic databases, including MEDLINE and PubMed up to December 2022, for cross-sectional or prospective studies that investigated the correlation between serum vitamin D levels and lipid profile in children and adolescents. At the end of the process, 37 articles were included in this review.

Evidence synthesis: According to our findings, vitamin D deficiency/insufficiency is strongly associated with lower high-density lipoprotein (HDL) cholesterol levels and higher levels of triglycerides and total cholesterol. Data about low-density lipoproteins (LDL) cholesterol are inconsistent. The potential role of vitamin D supplements for the prevention of cardiometabolic disease currently remains a speculation.

Conclusions: An increasing number of studies shows how hypovitaminosis D in the pediatric age may play a role in the pathogenesis of metabolic disorders and lipid profile alterations. Data regarding the potential role of vitamin D supplements for the prevention of cardiometabolic disease are currently controversial. Further studies are needed to evaluate the causality of this association and to assess the underlying pathogenetic mechanisms.