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The paper describes the case of a 13-year-old boy presenting with fever with chills, abdominal pain and diarrhoea. Further investigation showed an “enteric fever”. Finally, clinical onset, diagnosis and disease management are discussed.

The authors present the case of an 8-year-old boy presenting with a cheek swelling. The fact that he had blown a trumpet all day before led to the diagnosis of pneumoparotitis.

The authors describe the case of a five-day-old newborn affected by atopic dermatitis presenting with hand-foot-and-mouth disease that extended to the face and trunk (eczema coxsackium).

The paper reports the case of a 7-month-old infant who presented with high fever and fussiness. The blood culture reveals a rare form of bloodstream infection sustained by Erysipelothrix rhusiopathiae, a Gram-positive bacillum that may affect a wide range of animals and can also cause zoonotic infections as occupational disease in humans.

The paper describes the case of a 4-year-old boy who presented with sudden head swelling. Clinical findings sustained the diagnosis of “sunburn of the scalp with subsequent oedema of the cutis adjoining the galeal aponeurosis”. Pathogenesis, differential diagnosis and disease management are also discussed.

The paper describes the case of 21-month-old child with prolonged fever, vomiting and diarrhoea. After detecting non-typhoidal Salmonella in his stools, medical history has revealed an unexpected source of the infection.

The paper reports the case of a 3-month girl presenting with “bruising of unknown origin”. Clinical findings sustained the diagnosis of “maltreatment”.

Contains fulltext : 80562.pdf (Publisher’s version ) (Open Access) CONTEXT: Obesity and iron deficiency are two of the most common nutritional disorders worldwide. Several studies found higher rates of iron deficiency in obese than in normal-weight children. Hepcidin represents the main inhibitor of intestinal iron absorption, and its expression is increased in adipose tissue of obese patients. Leptin is able, in vitro, to raise hepcidin expression. OBJECTIVES: Aims of this work were 1) to assess the association between poor iron status and obesity, 2) to investigate whether iron homeostasis of obese children may be modulated by serum hepcidin variations, and 3) to assess the potential correlation between leptin and serum hepcidin variations. METHODS: Iron status and absorption as well as hepcidin, leptin, and IL-6 levels were studied in 60 obese children and in 50 controls. RESULTS: Obese children showed lower iron and transferrin saturation (both P < 0.05) and higher hepcidin levels (P = 0.004) compared with controls. A direct correlation between hepcidin and obesity degree (P = 0.0015), and inverse correlations between hepcidin and iron (P = 0.04), hepcidin and transferrin saturation (P = 0.005), and hepcidin and iron absorption (P = 0.003) were observed. A correlation between leptin and hepcidin (P = 0.006) has been found. The correlation remained significant when adjusted for body mass index, sex, pubertal stage, and IL-6 values. CONCLUSIONS: We propose that in obese patients, increased hepcidin production, at least partly leptin mediated, represents the missing link between obesity and disrupted iron metabolism.

Background: The central melanocortin system is critical for the long-term regulation of energy homeostasis. Melanocortin-3 receptor (MC3R) knock-out mice, despite being hypophagic, have increased fat mass and higher feed efficiency than do their wild-type littermates. Objective: The aim was to evaluate whether, in childhood obesity, MC3Rvariants are associated with changes in fatness reduction as a consequence of a weight-reduction program. Design: Molecular screening of the MC3R coding region in 184 obese children, 77 girls and 107 boys [x (SEM) body mass index (BMI; in kg/m 2 ) z score: 3.3 2.3; age 9.2 2 y], was performed. BMI was evaluated at baseline and after 6 and 12 mo of the weight loss program. Results: No new mutations were found. Two previously described polymorphisms, C17A (Thr6Lys) and G241A (Val81Ile), were observed in 20 patients in almost complete linkage disequilibrium. No significant differences in BMI z scores were observed at baseline of theweight-lossprogrambetweenthegenotypes;however,atfollowup, heterozygotes showed a significantly higher BMI z score (P 0.03). When the patients were divided according to the amount of weight lost, a higher prevalence of heterozygotes was observed among subjects who lowered their BMI z score 1.5 (P 0.03). Conclusion: These results suggest a gene-diet interaction between theMC3RC17A and G241A variants and a weight loss program for the ability to lose weight in childhood obesity. Am J Clin Nutr 2007;85:950–3.

Background and aims Pediatric obesity is an important health problem representing a major public health concern worldwide in the last decades. An isolated elevation of Thyroid Stimulating Hormone (TSH) with normal levels of thyroid hormones is frequently found in obese children. It has been named Isolated Hyperthyreotropinemia or Subclinical Hypothyroidism (SCH) and may be considered a consequence of obesity. Evidence exists that SCH is related to impairment of both systolic and diastolic myocardial function in the adult population. The aim of our study is to establish if obesity-related SCH influences myocardial function in children. Methods and results We examined 34 obese children and adolescents with SCH and 60 obese children with normal TSH levels who underwent Doppler echocardiographic to evaluate myocardial function. Global systolic function as assessed by Ejection Fraction (EF) was comparable between groups, however Right Ventricle pressure global systolic function and pressure were significantly reduced in SCH group. Mitral annulus peak systolic (MAPSE) excursion lateral and MAPSE septum resulted significantly reduced in SCH group. Tissue Doppler imaging peak systolic motion (TDI-S) was reduced in SCH group. Diastolic function also showed significant modifications in SCH group. Conclusion These results suggest possible involvement of cardiac function in obese children with SCH resulting in both abnormal diastolic function and reduced longitudinal systolic function. This new insight into cardiovascular consequences of obesity-related SCH in children could influence clinical approach to such patients by pediatric endocrinologists.

Retinol binding protein 4 (RBP4) is an adipokine involved in the pathogenesis of insulin resistance in obese adults and children. Since insulin resistance occurs during puberty, independently of adiposity, a role for RBP4 in the onset of this phenomenon may be hypothesized. In order to verify our hypothesis, we studied 90 subjects (45 obese and 45 lean controls). A complete physical examination was assessed, the z-score body mass index (BMI) was calculated, fat mass was assessed by bioelectric impedance analysis, and pubertal stage was assessed according to Tanner. Serum insulin and serum RBP4 levels were assayed. Obese and lean children differed for z-score BMI, fat mass, homeostasis model assessment of insulin resistance (HOMA-IR) and RBP4 levels. z-score BMI and HOMA-IR showed a direct correlation with RBP4 in the total population. When the subjects were divided in lean and obese, this correlation was evident only in obese (r2: 0.2; p=0.009 and r2: 0.2; p=0.01), but not in lean subjects (r2: 0.09; p=0.1 and r2: 0.03; p=0.4). Both in obese and lean HOMA-IR values were higher in pubertal subjects than in pre-pubertal (p0.001), while serum RBP4 levels were similar in pubertal and in pre-pubertal subjects (0.1). We conclude that RBP4 is correlated with adiposity and insulin resistance in obese children, but it is not involved in the insulin resistance occurring during puberty.