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Benign acute childhood myositis (BACM) is a rare, acute, self-limiting muscle disorder, mainly affecting school-aged boys, with an excellent prognosis, requiring no therapeutic intervention. We report a series of seven previously healthy school-aged children with clinical and laboratory findings suggesting BACM where no specific diagnostic investigations were performed. All of the children were hospitalized without any specific therapeutic intervention and were discharged after two or three days free of symptoms, residual impairment or other complication. This report emphasizes that the correct diagnosis of BACM, by considering the characteristic clinical and laboratory findings of this syndrome and by recognizing more severe pathological conditions, which must be excluded from the diagnosis, can prevent unnecessary diagnostic investigations and reassure both parents and patients of the excellent prognosis.

Foreign body aspiration (FBA) in preschool children is a worldwide challenging clinical problem that can result in life-threatening complications. Three cases of FBA in preschool children are presented. All the children were admitted to the hospital with asthma-like symptoms, without any aspiration history. Although FBA was considered in differential diagnosis, there was no strong evidence to support this diagnosis. The persistence of symptoms despite the appropriate treatment for the asthma symptoms was the main reason for the reconsideration of FBA. All of the children underwent bronchoscopy, with the successful removal of small organic food items from the main bronchi. The main cause of FBA was the parents' lack of awareness concerning the risk of FBA when small organic food items are provided to preschool children. These cases demonstrate that some parents are unfamiliar with the risk of FBA when small organic food items are provided to their children. It is crucial to make it understood that consideration of FBA should be maintained throughout the clinical course of patients with an acute onset of respiratory symptoms, despite the initial lack of evidence to support this diagnosis, and that parental education about the causes and hazards of this condition may be the best preventive measure to decrease its incidence.

Abstract:The accuracy of transcutaneous bilirubin meters has been assessed in newborns from various ethnic backgrounds. However, there are limited data on Greek newborns. Our study examined the accuracy of transcutaneous bilirubin measurements in clinically jaundiced healthy-term Greek newborns, using total serum bilirubin as the reference standard, in order to re-evaluate our local guidelines about neonatal jaundice. Clinically jaundiced newborns requiring total serum bilirubin level estimation were recruited prospectively. 368 pairs of total serum bilirubin/transcutaneous bilirubin measurements were taken in 222 newborns, using a direct spectrophotometric device and the BiliCheck device, respectively. The level of agreement between the obtained transcutaneous bilirubin and total serum bilirubin values was assessed. Our data were analysed using the Stata/SE 12.0 (StataCorp LP, USA) statistical programme. The mean (± SD) TSB was 225.4 ± 25.4 µmol/l and the mean (± SD) TcB was 237.9 ± 21.0 µmol/l. The correlation between the values was poor (Pearson's correlation coefficient 0.439; Lin's concordance coefficient 0.377 [95% CI 0.301 to 0.453]; P<0.001).The Bland-Altman analysis demonstrated that transcutaneous bilirubin measurements tended to overestimate the total serum bilirubin value (mean difference 12.5 ± 24.9 µmol/l), with wide 95% limits of agreement (-36.2 µmol/l to 61.3 μmol/l). Transcutaneous bilirubin values did not correlate well with total serum bilirubin values, being often imprecise in predicting the actual total serum bilirubin levels. This permits us to continue estimating total serum bilirubin in clinically jaundiced newborns according to our local guidelines, in order to safely decide the appropriate care plan.© Charles University in Prague -Karolinum Press, 2014Mailing Address: Charalambos Neocleous, MD., PhD., Department of Medical Pediatrics, General Hospital of Drama, Drama, Greece; e-mail: xneoc@yahoo.gr Neocleous Ch.; Adramerina A.; Limnaios S.; Symeonidis S.; Spanou Ch.; Malakozi M.; Mpampalis E.

IntroductionRalstonia pickettii is an infrequent pathogen of invasive infections in healthy individuals. The microorganism is supposed to be of relatively low virulence, but can cause infections, mainly of the respiratory tract, in immunocompromised and cystic fibrosis patients. Ralstonia pickettii has also been associated with hospital outbreaks related to contamination of products used for medical care and laboratory diagnosis.Case presentationWe report here a case of septic arthritis due to Ralstonia pickettii in a female diabetic patient. The microorganism was identified from the synovial fluid by molecular-based methods, while the conventional synovial and blood cultures proved to be negative. The patient was treated by intravenous ceftazidime with complete remission of her symptoms; she was discharged 3 weeks after admission in a very good health. At follow-up examination 3 weeks later, she was still in good health condition without any sign of arthritis of the right knee and afebrile.ConclusionIn culture negative serious bacterial infections, as septic arthritis, the use of molecular-based techniques might be of outmost importance as additional and rapid diagnostic tools for the identification of the causative agent allowing a prompt and appropriate antimicrobial therapy and a favourable outcome.

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R e c e i ve d M a rc h 2 1 , 2 0 1 3 ; A c c e p t e d A u g u s t 1 4 , 2 0 1 3 . Key words:Acute chest syndrome -Sickle cell anemia -Sickle cell diseaseVaso-occlusive crisis Abstract: The predominant pathophysiological feature of homozygous sickle cell anemia (SCA) is the vaso-occlusion. Vaso-occlusion can be associated with painful crises, which are the primary reason for those patients to seek medical care. Vaso-occlusion is responsible for the acute chest syndrome (ACS) with large morbidity and mortality or more rarely (and especially in adults) for priapism and acute neurological events (strokes). A 10-year-old boy with homozygous SCA was admitted to the Pediatric Emergencies with painful vaso-occlusive crisis and fever. Initially he had normal chest X-ray but, after 24-hour-hospitalization, he developed ACS with new chest X-ray findings. He was treated with broad spectrum antibiotics, blood transfusions and bronchodilators and after a six-day treatment, he was significantly improved. The patient was discharged 13 days later with no other therapy at home. The possibility of ACS development should be still considered, even when a known patient with SCA presents a painful vaso-occlusive crisis with an initial normal chest X-ray. Therefore, repeated clinical examination is required and possible changes in the clinical status could indicate the necessity of a new radiographic examination. In this way, early ACS could be recognized and the catastrophic consequences due to this syndrome could be avoided.

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