The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA).

Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/- montelukast, and to compare the impact of standardized approaches for weight loss.

Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age.

INTRODUCTION: In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease. AREAS COVERED: The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management. EXPERT OPINION: Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.

Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for community health officers.

PURPOSE: Point-of-care ultrasound (POCUS) has been shown to have unique potential in low-income countries. Physicians and other healthcare providers can perform effective scans after a short period of training. This study aimed to evaluate indications and utility of ultrasonography as the main imaging service in a poor rural sub-Saharan region of Africa. Second, it evaluated the effect of a short training on POCUS for non-physician health providers and their agreement with a group of Italian physicians. METHODS: This study was undertaken in Lokomasama-a chiefdom of Sierra Leone-between January and February 2019. Based on clinical indications, ultrasound findings were evaluated with respect to the initial diagnostic hypothesis. Volunteer doctors conducted a theoretical-practical training of two community health officers (CHO) on chest and abdominal POCUS and E-FAST protocol. The evaluation of the achieved technical skills was obtained with a numeric score. Inter-observer agreement concerning ultrasound diagnosis based on clinical indications was assessed. RESULTS: A total of 196 consecutive patients underwent ultrasound examination. POCUS findings were in keeping with the clinical diagnosis in the 49.5%. POCUS changed the initial diagnosis in 17% of cases. After training, E-FAST and POCUS knowledge score was 90% and 83%, respectively. An excellent inter-observer agreement (0.88) was found between CHOs and physicians. CONCLUSION: POCUS represents a powerful diagnostic tool in a low-income country that may improve the patient management. Training of non-physician health providers is doable and may improve healthcare management in resource-limited settings.