Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study.

OBJECTIVES: To determine if joint hypermobility is associated with musculoskeletal pain in a population of Italian schoolchildren. DESIGN: Cross-sectional, school-based study, using a pretested questionnaire administered to schoolchildren to enquire about musculoskeletal pain and Beighton criteria, with score of > or =5 as a cut-off, to test for hypermobility. SETTING: Eight primary schools in the town of Cesena, Italy. PARTICIPANTS: 1230 Italian schoolchildren aged 7 to 15 years representing an opportunistic sample of 10% of the schoolchildren in Cesena MAIN OUTCOME MEASURES: (1) The strength of association between hypermobiliy and musculoskeletal pain; (2) the impact of hypermobility on daily activities, using a subjective "disability score" and a "physical activity score." ANALYSIS: Sample size calculation for evaluating if hypermobility was associated with musculoskeletal pain was performed prior starting the study. Children experiencing pain at least once a week were used as cases, children experiencing pain seldom or never served as controls. RESULTS: A total of 1046 consenting Italian schoolchildren (mean age 10.8 years) were included. The prevalence of musculoskeletal pain reported by schoolchildren was 18%. 22% of children with musculoskeletal pain versus 23% of controls had hypermobility (OR 1.057, 95% CI 0.7 to 1.4). Functional limitations measured by a "disability score" correlated in a weak negative way with Beighton score (p = 0.03). The "physical activity score" correlated in a weak positive way with Beighton score (p = 0.012). CONCLUSIONS: No association was found between hypermobility and musculoskeletal pain. Hypermobile children did not experience functional limitations in daily activities, and they were slightly more active than non-hypermobile children.

[Periodic fever, aphthous stomatitis, pharyngitis, and lymphadenopathy: a pediatric caseload]. / Febbre periodica, stomatite aftosa, faringite, linfoadenopatia (PFAPA): una casistica pediatrica.

We report 5 patients (3F; 2M; age 19-60 months) affected by a syndrome characterized by recurrent episodes of abrupt onset of fever, aphtous stomatitis, pharyngitis and cervical adenopathy named by the acronym PFAPA (periodic fever, aphtous stomatitis, pharyngitis and adenopathy). The episodes had clockwork periodicity (3-4 weeks) and the fever was unaccompanied by remarkable respiratory signs or symptoms. All children were doing well between episodes. The inflammatory markers were elevated only during attacks in all children. Steroid therapy was highly effective in controlling symptoms in 5/5 patients and tonsillectomy was associated with remission in two of five patients. In one child the syndrome resolved spontaneously, in two patients resolved after tonsillectomy and in two children persisted. No long-term sequelae were observed.

[Kluver Bucy syndrome and central diabetes insipidus: two uncommon complications of herpes simplex encephalitis]. / Sindrome di Kluver Bucy e diabete insipido centrale: due rare complicanze dell'encefalite erpetica.

Herpes Simplex Encephalitis (HSE) is an uncommon but severe disease with high mortality and morbidity. The major clinical manifestations are deteriorating consciousness with confusion, drowsiness or coma, altered behaviour, convulsions and a variety of neurological signs (hemiplegia, aphasia, ataxia, etc.). An uncommon complication of HSE is Kluver Bucy syndrome (KBS), characterized by hyperorality, bulimia and changes in emotional behaviour. Neuroimaging studies frequently show an involvement of the temporal lobes and limbic areas. Another uncommon complication of HSE is central diabetes insipidus as a result of herpes simplex infection of the hypothalamus. We report two pediatric cases of HSE complicated with Kluver Bucy syndrome and central diabetes insipidus.

[Retrospective analysis of Henoch-Schonlein purpura in children: diagnostic difficulties and renal outcome]. / Analisi di una casistica pediatrica di porpora di Schönlein-Henoch: difficoltà diagnostiche iniziali e follow-up a distanza.

OBJECTIVE: To assess clinical presentation, diagnostic difficulties, natural history and prognostic indicators of renal involvement of Henoch Schönlein Purpura, a ten-years retrospective analysis of all patients case records was performed. METHODS: After a variable interval of 1 to 10 years following the vasculitic episode all the children came to the outpatient clinic for history taking, clinical examination, blood pressure measurements, urine analysis and renal function assessment. RESULTS: 54 children, mean age 5.9 +/- 2.5, were identified. The purpuric rash was associated with arthritis in 46 patients (85%), abdominal pain in 28 (51.8%), temperature > 38 degrees C in 11 (20%). The purpuric rash was present at on presentation in 39 subjects (72%) whereas in 15 children (28%) it followed the subsequent signs or symptoms that were arthritis in 8 (53.3%), joint pain in 2 (13.3%), abdominal pain in 5 (30.3%). Abdominal pain was the only symptom of presentation in 5 patients; two of them underwent surgical laparotomy.