Need for resuming sports and physical activity for children and adolescents following COVID-19 infection.

Introduction: A decline in sports activities among children and adolescents was noted during the stay-at-home restrictions imposed by COVID-19. With the easing of restrictions, physical activities are being resumed. Evidence acquisition: A data search was conducted to identify the role of parents in resuming sporting activities, the risks and benefits of doing so, the physical examination to be conducted prior to physical activity, the existence of guidelines/protocols for return to sports and physical activity, the role of comorbidities in influencing the restart of the same. Evidence synthesis: Parents should consult the child's physician prior to allowing he/she to resume physical exercise. In preparation for this, a careful physical examination should be performed. Children with COVID-19, even if asymptomatic, should not resume any physical activity until at least 10 days after testing positive. Those with moderate or severe COVID-19 should be referred for cardiological evaluation. The level of activity should be resumed gradually, as per the GRTP protocol. Athletes with a positive COVID-19 test in the presence of concomitant medical conditions (diabetes, cardiovascular or respiratory or renal disease) should undergo medical evaluation prior to adhering to a GRTP. Those with complicated COVID19 infection or long Covid may need additional investigations. Conclusions: While there is no doubt that it will bring multiple benefits in terms of general health, returning to play sport should be gradual and preceded by an accurate physical examination in those young subjects previously affected by the coronavirus disease, especially when their heart and/or lungs and/or kidneys were affected.

Italian contributions to Turkish paediatrics during the Ottoman Empire.

The Ottoman Empire maintained close relations with the neighbouring Italian city states in the 16th and 17th century. Yacub Pasha (1425-1481), personal physician of Mehmed II the Conqueror, was an Italian Jew who advanced to the title of pasha and vizier. Domenico Hierosolimitano (ca. 1552-1622), the third physician to Sultan Murad III, was a Jerusalemite rabbi. His book is an important source about everyday life and medical practice in Istanbul at the time. Nuh bin Abd al-Mennab (1627-1707), also of Italian stock, was the Chief Physician of the Ottoman Empire, who translated a pharmacopoeia into Turkish. In the same century, two Italians, Israel Conegliano (Conian) and Tobia Cohen became private physicians to leading Ottoman pashas and the Grand Vizier. A. Vuccino (1829-1893) and Antoine Calleja Pasha (1806-1893) taught at the Istanbul Medical School. Italy was a favoured country for medical education during the early period of Ottoman westernisation. Sanizade Mehmet Ataullah Efendi (1771-1826) translated the first medical book printed in the Ottoman Empire from Italian into Turkish. Mustafa Behcet Efendi (1774-1833), chief physician to the Sultan and the founder of the first western medical school in Turkey, translated several medical books from Italian into Turkish. The first printed pharmacopeia in the Ottoman Empire was also originally Italian In the 19th century, Edouard Ottoni and his son Giuseppe Ottoni were well-known military pharmacists, both under the name of Faik Pasha. Probably the most influential physician of Italian origin was Giovanni Battista Violi (1849-1928), who had practiced paediatrics in Turkey for more than fifty years. Violi was the founder of the first children's hospital, the first vaccine institute, and the first paediatric journal in the Ottoman Empire.

Prenatal and perinatal risk factors of schizophrenia.

Schizophrenia could be considered the most severe of all psychiatric disorders. It shows a heterogeneous clinical picture and presents an etiopathogenesis that is not cleared sufficiently. Even if the etiopathogenesis remains a puzzle, there is a scientific consensus that it is an expression of interaction between genotype and environmental factors. In the present article, following a study of literature and the accumulated evidence, the role of prenatal and perinatal factors in the development of schizophrenia will be revised and synthesized. We think that better knowledge of the risk factors could be helpful not only for better comprehension of the pathogenesis but especially to optimize interventions for prevention of the disorder.

Ultrasound mass screening for congenital anomalies of the kidney and urinary tract.

BACKGROUND: There is a high incidence of congenital anomalies of the kidneys and urinary tract (CAKUT). Early diagnosis of these defects may allow the best medical and/or surgical treatment to be implemented as rapidly as possible, preventing or at least slowing down an evolution toward chronic kidney disease. METHODS: Ultrasound mass screening for kidney and urinary tract abnormalities in infants at 2 months of age was carried out in Salento, Italy. The centers involved in the study examined a total of 17,783 infants between January 1992 and December 2010. RESULTS: A total of 171 CAKUT were identified in the course of the mass screening. The frequency of CAKUT was 0.96%. Vesicoureteral reflux (n = 39) was the most frequent renal abnormality found, followed by ureteropelvic junction obstruction (n = 33), ectopic kidney (n = 26), and renal dysplasia (n = 19). In addition, nephrogenic rests (n = 2), as well as several extra-renal pathologies, including abdominal neuroblastoma (n = 3), were diagnosed incidentally. CONCLUSION: Ultrasound has been effective for early detection of renal and urinary tract anomalies. In addition, this screening has proved to be very useful for the early identification and management of both renal and extra-renal precancerous as well as cancerous lesions. However, most patients requiring surgery in this study (0.24%) would probably have been symptomatic and come to medical attention without routine screening. On the basis of our results screening is not justified.

Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up.

UNLABELLED: We report the recommendations for the diagnosis, treatment, imaging evaluation and use of antibiotic prophylaxis in children with the first febrile urinary tract infection, aged 2 months to 3 years. They were prepared by a working group of the Italian Society of Pediatric Nephrology after careful review of the available literature and a consensus decision, when clear evidence was not available. CONCLUSION: These recommendations are endorsed by the Italian Society of Pediatric Nephrology. They can also be a tool of comparison with other existing guidelines in issues in which much controversy still exists.

Genetic susceptibility to renal scar formation after urinary tract infection: a systematic review and meta-analysis of candidate gene polymorphisms.

Identifying patients who may develop renal scarring after urinary tract infections (UTI) remains challenging, as clinical determinants explain only a portion of individual risk. An additional factor that likely affects risk is individual genetic variability. We searched for peer-reviewed articles from 1980 to December 2009 in electronic databases that reported results showing an association between gene polymorphims and renal scaring after UTI. Two independent researchers screened articles using predetermined criteria. Studies were assessed for methodological quality using an aggregate scoring system. The 18 studies ultimately included in the review had investigated 16 polymorphisms in nine genes in association with renal scarring formation after UTI. Based on the predetermined criteria for assessing the quality of the studies, 12 studies (67%) were identified as being of poor quality design. A meta-analysis of cumulative studies showed on association between renal scarring formation after UTI and the angiotensin converting enzyme insertion/deletion polymorphism [ACE I/D; recessive model for D allele; odds ratio (OR) 1.73, 95% confidence interval (CI) 1.09-2.74, P = 0.02] or transforming growth factor (TGF)-ß1 c.-509 T > C polymorphism (dominant model for T allele; OR 2.24, 95% CI 1.34-3.76, P = 0.002). However, heterogeneity among studies was large, indicating a strong difference that cannot only be explained by differences in study design. The studies reviewed in this article support a modest involvement of the vasomotor and inflammatory genes in the development of renal scarring after UTIs. This review also shows that only few possible candidate genes have been investigated for an association with renal scarring, raising the hypothesis that some gene polymorphisms may exert their effects through an interaction with as yet uninvestigated factors that may be related to geographic and/or socio-economic differences.

Urinary tract infection in the newborn and the infant: state of the art.

Urinary tract infection is one of the most common causes of infection in newborns. Obtaining a urinary tract infections (UTIs) diagnosis just on the basis of the clinical findings is frequently difficult, however, being the pediatrician's goal to reduce the risk of renal scarring, a prompt diagnosis and treatment is of extreme importance. The key instrument for the diagnosis of UTIs is represented today by urine culture. However, in reality, the caregivers and investigators are increasingly demanding fast and cheap methods for a rapid and effective diagnosis.

Watch out for malaria: still a leading cause of child death worldwide.

BACKGROUND: Due to the efforts in malaria control promoted by the World Health Organization (WHO), the reported malaria burden is being reduced throughout the world. Nevertheless, malaria remains a leading cause of child death worldwide. AIMS: Purpose of the paper is to summarize the main historical steps in fighting malaria, from the first descriptions to the last ones. RESULTS: A case of probable autochthonous malaria has been recently described in Italy, raising concern over the possibility of resurgence of malaria in countries previously interested by this disease. Moreover, both the constant threat of the parasite and vector mosquito developing resistance to medicines and insecticides, and the on-going climate change make the challenge of eradicating malaria really difficult. Therefore, malaria is still an actual disease, requiring adequate programs of surveillance, stronger health systems in poor countries, and efforts in order to develop new and effective tools in malaria control. WHO has definitely demonstrated the effects of "social determinants" on health. So, eradication strategies cannot be based only on a scientific background, because culture, politics, power, resources and wars have a profound impact on health and disease. These elements should be introduced in all the programs of malaria control. CONCLUSIONS: Malaria is still an actual disease with great public health implications, and the approaches for control and prevention should have the appropriate social and political context in addition to the science involved in order to save lives of children at risk.

Long-term effects of neonatal drugs on the kidney.

Several drugs have been shown to produce an adverse affect on kidneys, mainly when exposure occurred during active nephrogenesis (pregnancy or prematurity). Several experimental studies on drug-related renal injury have been done on animal models. Observational reports on early drug-related nephrotoxicity in humans are increasing. The investigations regard nephrotoxicity from antibiotics (particularly aminoglycosides), angiotensin-converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs and antifungins. Few reports have been specifically on the long-term effects on kidneys of drugs given to newborns during active nephrogenesis. Most observations were targeted to investigate long-term renal effects of prematurity and intrauterine growth retardation (IUGR). Nephrotoxic medication taken during fetal life and during postnatal nephrogenesis could interfere with nephron generation contributing to a particular magnitude of damage. Such adjunctive damage could further increase the risk of renal failure in the adulthood of children born prematurely.

ABO hemolytic disease of the fetus and newborn: an iatrogenic complication of heterologous assisted reproductive technology-induced pregnancy.

BACKGROUND: ABO hemolytic disease of the fetus and newborn (ABO HDFN) may manifest itself in cases of mothers belonging to blood group O and newborns of groups A or B and more frequently in group A and less so in group B. CASE STUDY: The case subjects are twin-birth newborns with ABO HDFN, of group AB born to a mother of group O. These cases of ABO HDFN prove inconsistent with Mendel's law of segregation. RESULTS AND CONCLUSION: This case study finds its explanation in new methods of assisted reproduction, particularly heterologous in vitro fertilization with ovodonation.

Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children.

The majority of children with the epidemic form of acute post-streptococcal glomerulonephritis (APSGN) have an excellent prognosis, which contrasts with the poor long-term outcome of sporadic cases. Therapy is largely supportive. Rarely, the disease shows long-term complications, worsening to chronic kidney disease requiring long-term interventional measures. To compare the effectiveness of different therapeutic strategies for the prevention and treatment of APSGN in childhood, the authors reviewed randomized controlled trials on the prevention and treatment of APSGN in children. Nine studies fit the inclusion criteria. Primary outcomes were the development of APSGN, the effectiveness of medication for controlling hypertension, and the development of chronic renal failure in patients with crescentic glomerulonephritis. No advantages of antimicrobials (cefuroxim, ceftibuten, and others) given for 5 days were found over penicillin V given for 10 days (4 trials). Nifedipine showed advantages in controlled acute hypertension (1 trial). ACE inhibitors (captopril and enalapril) had better control of blood pressure and echocardiographic changes than other antihypertensive drugs/diuretics (2 trials). The use of combined immunosuppressants for crescentic poststreptococcal glomerulonephritis showed no advantages over supportive therapy alone (1 study). The studies were of small number and with limitations that seriously weaken the results.

Hidden high-grade vesicoureteral reflux is the main risk factor for chronic renal damage in children under the age of two years with first urinary tract infection.

OBJECTIVE: The aim of the present prospective trial was to investigate, in a cohort of young children with first urinary tract infection (UTI) and negative prenatal history, the role of imaging in screening babies at risk of renal deterioration. MATERIAL AND METHODS: Children who had experienced the first febrile UTI at or under the age of 2 years were enrolled. They had had normal foetal routine ultrasound. All the children underwent renal ultrasound after admission; those with sonographic signs of obstruction were excluded. Voiding cystoureterogram (VCUG) and (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy were performed approximately 1 month and 6 months after the UTI, respectively. Finally, 65 babies (47.7% males, 38.6 +/- 1.3 weeks of gestational age) were prospectively followed up. RESULTS: In 15.4% and 29.2% of cases, the renal pelvis was < or =7 and >7 mm in diameter, respectively. Vesicoureteral reflux (VUR) was detected in 55.4% of the children and renal scarring in 18.5%. Stepwise binary logistic regression analysis showed that the severity of VUR correlated significantly with renal scarring, excluding all the other variables from the model. In this cohort of babies, the severity of VUR seriously enhanced the risk of renal damage (odds ratio = 6.658, p = 0.004). CONCLUSION: Follow-up renal scintigraphy 6 months after a UTI can predict severe VUR in very young children showing renal scarring, detecting only those who are at risk of loss of kidney function and who would require further assessment. After the first episode of UTI, the practice of performing VCUG in babies with normal DMSA scintigraphy is of doubtful value.

Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children.

OBJECTIVE: This study compares the effects of daily cranberry juice to those of Lactobacillus in children with recurrent urinary tract infections (UTIs). MATERIAL AND METHODS: Eighty-four girls aged between 3 and 14 years were randomized to cranberry, Lactobacillus or control in three treatment arms: G1, cranberry juice 50 ml daily (n=28); G2, 100 ml of Lactobacillus GG drink on 5 days a month (n=27); and G3, controls (n=29). The study lasted for 6 months. RESULTS: Only four subjects withdrew: 1/28 (3.5%) from G1, 1/27 (3.7%) from G2 and 2/29 (6.8%) from G3, because of poor compliance to the established protocol. There were 34 episodes of UTIs in this cohort: 5/27 (18.5%) in G1, 11/26 (42.3%) in G2 and 18/27 (48.1%) in the G3, with at least one episode of infection (p<0.05). CONCLUSION: These data suggest that daily consumption of concentrated cranberry juice can significantly prevent the recurrence of symptomatic UTIs in children.

Early diagnosis of acute kidney injury with urinary biomarkers in the newborn.

Biomarkers are biological parameters that can be objectively measured and evaluated, which act as indicators of normal or pathological processes, or of the response to intervention. Acute Kidney Injury (AKI) biomarkers must be easy to detect and measure, must correlate with severity (offering accurate prognosis), quantitatively describing the level of injury even in the absence of clinical signs. Finally, they must be adequate to indicate treatment initiation. So, the sensitivity (early appearance), specificity (typical of organ injury) and time-course are critical factors in determining the utility of a particular biomarker in the disease process. It is unlikely that a single biomarker will satisfy all of these requirements. As AKI is multifactorial in origin, a panel of biomarkers will be required on one hand to differentiate subtypes of AKI, on the other hand to define the phase and severity of injury. The aim of this review is to present the principal urinary biomarkers used in neonatology.

Nephrogenic rests: their frequency and their fate.

Nephrogenic rests (NRs) are considered to be precursor lesions of Wilms tumor, the most common malignant neoplasm of the urinary tract in children. We have previously reported on 2 cases of NRs, incidentally diagnosed at 2 to 3 months of age during an ultrasound mass screening for urinary tract malformations between 1992 and 2006. As the screened population consisted of 17,065 infants, the observed prevalence of NRs in our area in the examined time period was of 1.17/10,000. This is the first reliable estimate of the frequency of clinically appreciable NRs in infants. Microscopic NRs have been found at autopsy in about 1% of infants. Our data are, therefore, helpful in the assessment of the proportion of NRs that disappear spontaneously in the childhood age group. To the best of our knowledge, no false-negative cases were found. Our observations indicate that our policy of "wait and see" is appropriate when NRs are identified incidentally during ultrasonographic screening done for whatever purpose.

Oxidative kidney damage in preterm newborns during perinatal period.

BACKGROUND: Oxidative stress has recently been found to play a key role in post-ischemic kidney damage. We tested the hypothesis that oxidative kidney damage due to perinatal hypoxia in preterm newborns is associated with an increased production of oxidative free radicals in plasma. METHODS: Blood and urine samples were obtained at birth and on days 7 and 14, from 55 preterm newborns, without any known congenital abnormalities. Total hydroperoxides (TH) and advanced oxidation protein products (AOPP) as indices of oxidative stress, xanthine (Xa) and hypoxanthine (Hx) as indices of hypoxia, alpha1-microglobulin and N-acetyl-beta-D-glucosaminidase (NAG) as indices of kidney damage were assayed. RESULTS: Statistically significant correlations (p<0.05) were found between biochemical markers of hypoxia, oxidative stress and proximal tubules damage at days 7 and 14. CONCLUSIONS: Perinatal oxidative stress is associated with a variable degree of kidney damage detectable at birth and continuing up to 14 days.

Postnatal renal function in preterm newborns: a role of diseases, drugs and therapeutic interventions.

Since few data are available about factors affecting renal maturation especially in the lower gestational ages (G.A.), the aim of this work was to study postnatal renal function in a representative population sample of preterm newborns (G.A.

Antibiotics or surgery for vesicoureteric reflux in children.

CONTEXT: 1-2% of children have vesicoureteric reflux (VUR). VUR occurs in 25-40% of children with acute pyelonephritis. VUR can lead to renal scarring, hypertension, and end-stage renal disease. The best form of treatment for children with VUR is debated: no treatment, long-term antibiotic prophylaxis, surgery, or a combination of antibiotic prophylaxis and surgery. In children with recurrent urinary tract infections (UTIs) and progressive renal damage, despite antibiotic prophylaxis, surgical correction of VUR, especially high-grade VUR, is generally recommended. STARTING POINT: Danielle Wheeler and colleagues recently did a meta-analysis of ten randomised controlled trials (964 children) to evaluate whether any intervention for VUR is better than no treatment (Cochrane Database Syst Rev 2004; 3: CD001532). The main endpoints were incidence of UTIs, new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. They concluded that it is uncertain whether the identification of children with VUR is associated with clinically important benefit. The additional benefit of surgery over antibiotics is small. WHERE NEXT? New strategies for management will require a tailored diagnostic and therapeutic approach, including non-invasive or less invasive diagnostic procedures, and a less aggressive therapeutic approach. Whether the common practice of cystourethrography as a first-line investigation is warranted needs evaluation. The goal of paediatricians in the future, to prevent kidney damage, will probably be prevention of renal parenchymal injury and not necessarily the correction of ureterovesical junction anomalies. Because two main clinical pictures of VUR (diagnosed prenatally or postnatally with different age and sex distribution) can be identified, boys and girls will probably be managed differently. The factors responsible for congenital and acquired renal injury in children with VUR need to be studied.