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Background Lynch syndrome (LS) is an autosomal dominant condition due to the germline mutation in the mismatch repair (MMR) genes including MLH1, MSH2, MSH6, and PMS2 (post-meiotic segregation increased 2). The MMR mutation carriers have high risk for cancers. Pathogenic PMS2 variants are rarely reported in LS-associated colorectal cancer (CRC) with colorectal polyps. The aim of the study was to investigate the genetic etiology of CRC in an individual with CRC with multiple colorectal polyps and a family history of cancers. Patients and Methods The index patient was an African male affected by CRC with multiple colorectal polyps. The clinical diagnostic for LS was based on the Amsterdam II criteria and pedigree. Next-generation sequencing with inherited cancer genes panel was used to detect the pathogenic variant. Results The patient fulfilled the Amsterdam II criteria and the pedigree revealed a family history of recurrent CRC. A deleterious PMS2 germline heterozygous mutation c.2192_2196delTAACT was detected. Conclusion Our study supports the notion that LS may be associated with polyps and shows the predisposition of PMS2 heterozygous mutation in LS-associated CRC at young age.

Violence against children (VAC) is a global issue due to its biological, psychological, and social effects. Research in this field is valuable for understanding unknown aspects of VAC and for defining updated intervention strategies. Until now, there have been no clear indications about the possible effects of the SARS-CoV-2 pandemic on VAC. In this study, the authors compared quantitative and qualitative variables of pre-pandemic and pandemic cases evaluated at an Italian center specialized in VAC. The aims were to determine if the cases referred for VAC changed during the pandemic and if there were statistically significant differences in variables' distributions between pre-pandemic and pandemic periods. The referrals during the first 13 months of the 2020 SARS-CoV-2 pandemic were compared to cases referred over 13 months (2018-2019) to the same center. The analysis showed no statistical differences between age distributions and most qualitative variables. A decrease in the number of cases was observed. The comparison of frequency distributions of most variables between pre and post-pandemic samples did not differ. The most important result of the analysis is that the volume of observed VAC cases decreased during the pandemic period, confirming the indications of the scientific literature. It could not be excluded that the decrease was due to the negative impact of the pandemic on the child protection system. The above data could help develop innovative prevention tools and corrective intervention programs for future emergencies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA., Competing Interests: Conflict of interest statement: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Migraine is one of the most frequent primary headaches in childhood. The role of thrombotic predisposition in its pathogenesis is debated. Our aim was to analyse the cardiovascular risk factors and family history of major thrombotic events in children with migraine., Methods: A retrospective, single-centre study was performed over 12 years. Our headache centre record database was screened for migraine with aura (MA) and migraine without aura (MO) on the basis of the ICHD-II (until 2013) and III criteria. A control group of otherwise healthy children was recruited. Descriptive and multivariate analyses are provided; significance was set at p < 0.05., Results: Migraine was diagnosed in 930 children (24.7% MA); 73.3% were 9-14 years old. Children with MA were older ( p < 0.001). A family history of cerebral ischemic events at ≤50 years old was more commonly reported by children with MA than those with MO ( p < 0.001) and those in the control group ( p = 0.001). Children with MA showed a higher risk of a family history of cerebral ischemic events at ≤50 years old than children with MO (OR: 2.6) and those in the control group (OR: 3.1). When comparing the family history of DVT, we observed a significantly increased risk for MA vs. MO (OR: 2.9)., Conclusion: A family history of cerebral ischemic events at ≤50 years old leads to an increased risk of MA. Further studies are needed to explore such an association.

Background: The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.

Since the early stage of the current pandemic, digital contact tracing (DCT) through mobile phone apps, called "Immuni", has been introduced to complement manual contact tracing in Italy. Until 31 December 2021, Immuni identified 44,880 COVID-19 cases, which corresponds to less than 1% of total COVID-19 cases reported in Italy in the same period (5,886,411). Overall, Immuni generated 143,956 notifications. Although the initial download of the Immuni app represented an early interest in the new tool, Immuni has had little adoption across the Italian population, and the recent increase in its download is likely to be related to the mandatory Green Pass certification for conducting most daily activities that can be obtained via the application. Therefore, Immuni failed as a support tool for the contact tracing system. Other European experiences seem to show similar limitations in the use of DTC, leaving open questions about its effectiveness, although in theory, contact tracing could allow useful means of "proximity tracking".

Competing Interests: We declare no competing interests. BA and SU are joint first authors.

Introduction: The measurement of pain is the fundamental prerequisite for its proper management. Since newborns are unable to communicate verbally, neonatal algometric scales have been developed. However, no gold standard has been identified yet., Objective: To identify and classify the most suitable and effective scales for different kinds of pain for term and preterm newborns in different clinical settings., Method: The review was carried out between December 2019 and November 2020 by consulting the PubMed and CINAHL Database, combining Mesh terms and free text with appropriate inclusion and exclusion filters. The references reported in the articles found in the first part of the research were also analyzed, in order to identify further relevant studies., Results: :Out of 2442 papers initially identified, we included 45 articles, describing 50 pain assessment scales (34 for acute pain, 12 for procedural pain, 24 for prolonged/chronic pain and 19 for pain after surgery). Scales with higher evidence are N-PASS, NFCS, BIIP and PIPP for acute and procedural pain, N-PASS, ALPS-Neo, EDIN and EDIN6 for prolonged/chronic pain, and PIPP, CRIES and COMFORT for pain after surgery., Discussion: There is no unanimously accepted gold standard scale for neonatal pain. However, some are more suitable and effective: PIPP, NFCS, N-PASS and BIIP for acute pain; N-PASS, ALPS-Neo and EDIN/EDIN6 for chronic and prolonged pain; PIPP, CRIES and COMFORT for postoperative pain. Among all, N-PASS scale is the most complete and fits to different settings.

Aim To determine the red flags for serious organic causes of headache in children, to analyze if the management of headache in the Pediatric Emergency Department is appropriate, and whether the follow-up may limit repeated visits to the Emergency Department. Methods All the patients ≤ 18 years referred to our pediatric Emergency Department for non-traumatic headache over 5 years were retrospectively reviewed. The patients followed up by the Pediatric Headache Centre were also screened. Statistical analysis was undertaken using the Chi-squared test or Fisher's exact test and multivariate analysis; significance at p < 0.05. Results 1833 patients (54.6% males) accessed our Emergency Department 2086 times; 62.1% had primary headache, 30.0% had secondary headache, 7.8% received inconsistent diagnosis. Among those with secondary headache, 24 (1.1% of total visits) were diagnosed with serious disorders. The clinical red flags for "serious headache" were: Cranial nerves palsy, strabismus, and drowsiness. One hundred and eighty four patients (8.8 %) underwent neuroimaging (rate of pathological findings: 7.1 %); 37.2 % of the patients received analgesic therapy. One hundred and fifteen patients (6.2 %) returned within three months; 24 of these were referred to the Headache Centre, with only one accessing the Emergency Department again. Conclusions The vast majority of headaches referred to the Pediatric Emergency Department are benign, and primary forms prevail. "Serious headache" is rare and shows typical clinical features and abnormal neurologic evaluation; specific clinical red flags, along with suggestive personal history, should lead the pediatrician to prescribe only appropriate neuroimaging. Pain relief is still insufficient in the Pediatric Emergency Department despite appropriate guidelines. Last, the collaboration with the Headache Centre is crucial to limit repeated visits.

The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders. In infants from ''high-risk'' families (i.e. those with one or two parents and/or a sibling with food allergy, eczema, asthma or allergic rhinitis) food allergen avoidance has been advocated as means of preventing the development of atopic disease. The aim of this review was to evaluate the allergy preventive potential of partially or extensively hydrolyzed formulas. When breast-feeding is not possible or supplemental feeding is needed, infants from atopic families should be given a hydrolyzed infant formula for the first 6 month of life. High-risk infants without a history of eczema in a primary relative will receive the protective effect from the less expensive partial hydrolyzed formula (p-HF); whereas those infants who have first-degree relatives with eczema should receive the extensively hydrolyzed formula (e-HF).

Objective: To evaluate the clinical and cost effectiveness of permanent female sterilization using microlaparoscopy and bipolar cauterization. The authors also tested how well the procedure was tolerated when performed under local anesthesia and conscious sedation., Study Design: Patients undergoing microlaparoscopic permanent sterilization were prospectively followed. The rate of procedure completion, patients' pain scores and complication rates were reviewed., Results: The procedure was completed in 93% of patients (28 of 30). The pain scores decreased substantially within one day after the procedure. The total cost savings for the 29 cases were $16,211. Two patients experienced severe intraoperative discomfort and were rescheduled for endoscopic sterilization under general anesthesia. There were no complications., Conclusion: Permanent female sterilization using microlaparoscopy is cost effective and safe in selected patients, patient exclusion criteria need to be instituted to ensure the safety and success of the procedure.

In the present study the efficacy and safety of pefloxacin (400 mg/5 ml vial) intravenously administrated for surgical prophylaxis was assessed. Nine hundred and fifty-two patients were treated (599 M, 343 F), with a mean age of 57.9 years +/- 18.6 SD, and in all cases surgical prophylaxis was carried out according to the following scheme: short-term with 2 vials (800 mg) 1 h before the operation, repeated at 12 and 24 hours after the operation; long-term 2 vials (800 mg) 1 h before the operation repeated at 12 and 24 hours after the operation and followed by 1 vial every 12 h for other 2 days. The choice between the two schemes was conditioned by the type of operation and by the basic conditions of the patient. Pefloxacin was seen to be effective in preventing the onset of post-surgical infections (97%), also maintaining the clinical parameters considered within normal limits. Safety was also highly satisfactory, since only 22 (2.3%) cases of side effects occurred, particularly involving the gastro-intestinal system. Thus, in conclusion, the validity of pefloxacin in surgical prophylaxis, with special emphasis on its efficacy in elderly and compromised patients is asserted.