Diarrhea in children: etiology and clinical aspects.

AIM: The aim of this paper was to determine the etiology of diarrhea in children with an age <5 years hospitalised for acute enteritis and to evidence the prevalent clinical aspects in correlation of different etiology agents. METHODS: A total of 402 children with acute diarrhea were examined between February 2003 and December 2006 in the Paediatric Department, Hospital of Sondrio. Fecal samples were collected and was processed by routine microbiological and biochemical tests. For all patients the clinical signs and symptoms at the admission were evidenced. RESULTS: The major part of patients (310/402, 77.1%) resulted infected by rotavirus, while among the remain 82 (22.9%) 40 resulted infected by salmonella species and in 42 any bacterial agent was evidenced by microbiological tests. Clinical signs of mild dehydration were observed in 13 children during the hospital stay (all infected by rotavirus), while any case of metabolic acidosis, hypoglycaemia and hypovolemic shock was documented. Elevated serum levels of uric acid were evidenced in 13/302 (4.3%) of patients with rotavirus infection, while only 1/82 (1.2%) children rotavirus negative presented a minimal increase of serum uric acid level. CONCLUSION: Our retrospective study confirms the major epidemiological and clinical importance of rotavirus, as the principal etiologic agent in hospitalised children affected by acute diarrhea with an age <5 years. Also, we have evidenced a possible correlation between rotavirus infection and hyperuricemia, probably connected with dehydration.

Treatment of juvenile idiopathic arthritis with intra-articular triamcinolone hexacetonide: evaluation of clinical effectiveness correlated with circulating ANA and T gamma/delta + and B CD5+ lymphocyte populations of synovial fluid.

OBJECTIVE: The aims of the study were to assess the effect of intra-articular treatment with triamcinolone hexacetonide (TH) in juvenile idiopathic arthritis (JIA) and to investigate whether treatment response correlates with the presence of antinuclear antibodies (ANA) in the serum and/or B CD5+ and T gamma/delta + lymphocytes in the synovial fluid. METHODS: A total of 37 patients (81% females, 56% ANA+) with oligoarticular JIA involving knees were treated with intra-articular injections of TH after failing to respond to NSAIDs for two months. Eighteen patients were treated within 6 months of onset, 19 were treated more than 6 months after onset. RESULT: Mean duration of remission was 13.9 months. Twelve patients (7 ANA+) had stable remission after a single injection; 13 patients (3 ANA+) experienced more than 6 months' remission but subsequently had a relapse; 12 patients (11 ANA+) had a relapse within six months of injection. Of 20 patients treated within 6 months of onset, 17 had stable remission whereas only 8 out of 17 who were treated during relapse attained stable remission (p = 0.03). The mean percentage of T gamma/delta + and of B CD5+ lymphocytes in synovial fluid was the same as in peripheral blood of normal subjects. CONCLUSION: Our data indicate that local treatment with slow-release steroids is very effective in oligoarticular JIA. Prolonged remission was less likely in the presence of ANA positivity, probably because the disease is immunologically more active. Finally, our data suggest that the earlier the treatment, the easier it is to obtain a protracted, and possibly permanent, response.

Allogeneic bone marrow transplantation in hematologic disorders of childhood: new trends and controversies.

Bone marrow transplantation (BMT) represents an important therapeutic choice for several kinds of disorders: hematologic, metabolic and neoplastic pathologies can be treated with this strategy. The aim of this article is to describe the main indications for allogeneic BMT in haematologic disorders of childhood and possible problems related to this procedure. We consider only hematologic aspects, paying particular attention to unusual disorders of infancy as myelodysplastic syndromes and aplastic anemia. We also consider quality of life after a BMT in patients with sickle cell anemia and thalassemia major and compare this with quality of life of patients receiving chronic periodic blood transfusions.