AbstractsResults Of the 1123 infants (Invasive Bacterial Infection -IBI-, 48; 4.2%), 488 (43.4%) were classified as low risk criteria for IBI according to the "step by step" approach (vs 693-61.7%-with the Labscore and 458-40.7%-with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0-0.6%) using the "step by step" approach (vs 0.7%-95% CI 0.1-1.3% with the Labscore and 1.1%-95% CI 0.1-2%-with Rochester). Using the "step by step" approach, 1 patient with IBI was not correctly classified (2.0%, CI95% 0-6.12) vs 5 using the Labscore or Rochester (10.4%, CI95% 1.76-19.04%). Conclusions A sequential approach to young febrile infants including procalcitonin identifies better patients more suitable for outpatient management. Inhaled foreign bodies are very serious problem in the pediatric pulmonology since they increase the rate of morbidity and mortality. Aim of this study was analysis of endoscopic changes caused by vegetable foreign bodies (VFB) in correlation with their long -standing in the bronchial tree. ENDOSCOPIC ASPECTS OF INHALED VEGETABLE FOREIGN BODIES IN CHILDREN Material and MethodsIn ten years period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) inhaled foreign bodies were removed in 219 children (age 6 mths-14 yrs), 60.27%-male and 39.73%-female. Most of the children (57.50%) belong to the youngest group of age (1-2 yrs). The inhaled foreign bodies were from organic origin in 208 (94.97%). Of these, 203 (92.69%) were with vegetable origin. The most commonly found grains were peanuts (57.14%). Inhaled foreign bodies were single object in 123 (56.16%) while in 96 (43.80%) they were multiple. Results Endoscopically we found:Insignificant inflammation (some hours presence of VFB) in 48 (23.64%)Significant inflammation -vulnerable mucous membrane (VFB with presence more than 3 days) in 78 (38.42%) Severe inflammation -manifest inflammation (VFB more than 7 days presence) in 77 (37.93%). In this group of children we detected:-granulomatous formations 57 (82.60%)-decubital changes 28 (40.57%)-mucopurulent secretion 41 (59.42%). Conclusion Severity of the endoscopic changes was closely correlated with the quality of the foreign body (vegetable ones), the period of lodgement and the age of the patients. Timely broncoscopic extirpation of VFB decreases the percentage of complications and represents the most successful and only logically carried out therapeutically procedure.

In fission yeast, the cyclin-dependent kinase (CDK) inhibitor p25(rum1) is a key regulator of progression through the G1 phase of the cell cycle. We show here that p25(rum1) protein levels are sharply periodic. p25(rum1) begins to accumulate at anaphase, persists in G1 and is destroyed during S phase. p25(rum1 )is stabilized and polyubiquitinated in a mutant defective in the 26S proteasome, suggesting that its degradation normally occurs through the ubiquitin-dependent 26S proteasome pathway. Phosphorylation of p25(rum1 )by cdc2-cyclin complexes at residues T58 and T62 is important to target the protein for degradation. Mutation of one or both of these residues to alanine causes stabilization of p25(rum1) and induces a cell cycle delay in G1 and polyploidization due to occasional re-initiation of DNA replication before mitosis. The CDK-cyclin complex cdc2-cig1, which is insensitive to p25(rum1 )inhibition, seems to be the main kinase that phosphorylates p25(rum1). Phosphorylation of p25(rum1) in S phase and G2 serves as the trigger for p25(rum1) proteolysis. Thus, periodic accumulation and degradation of the CDK inhibitor p25(rum1 )in G1 plays a role in setting a threshold of cyclin levels important in determining the length of the pre-Start G1 phase and in ensuring the correct order of cell cycle events.

A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered "not well-appearing" and those with leukocyturia and/or nitrituria.

More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.

ABSTRACT. Objective. To assess clinical and epidemiologic data of 7 infants diagnosed with acquired methemoglobinemia at the pediatric emergency department between 1993 and 1998. All cases were attributed to the consumption of mixed vegetables.Methods. Medical records were reviewed to collect anamnestic data; history of food ingestion; and results of physical examination, pulse oximetry, gasometry, cooximetry, urinalysis, and outcome. Local health authorities provided information on nitrate concentration in running water and in vegetables of common consumption in the area.Results. The mean age of the patients was 8.14 months (range: 7-13). None of the infants was undernourished, had diarrhea, or was given any drug. Drinking water showed a nitrate concentration of 3 to 6 ppm. All were fed homemade purée of mixed vegetables, prepared in advance and kept in the refrigerator for 12 to 27 hours. Silver beets were a common ingredient. No case showed metabolic acidosis. Methemoglobin level ranged between 10% and 58%. Three cases had nitrituria. Silver beets in our area were the vegetables with the highest nitrate concentration (mean: 3200 mg/kg).Conclusions. Consumption of silver beets and incorrect storage of homemade purées of mixed vegetables were potential causes of methemoglobinemia in this series. The disease may occur in children older than 6 months of age. Nitrituria in a cyanotic infant may suggest the diagnosis of methemoglobinemia. Pediatrics 2001; 107:1024 -1028; methemoglobinemia, nitrates, nitrites, food analysis, infant food, food preservation.ABBREVIATIONS. Sao 2 , oxygen saturation; Hb, hemoglobin. M ethemoglobinemia is a rare cause of cyanosis in pediatric patients. Methemoglobin, a derivative of hemoglobin in which the iron component has been oxidized from the Fe 2ϩ to the Fe 3ϩ state, imparts a characteristic brownish color to blood and is unable to transport oxygen. 1,2 Under physiologic conditions, methemoglobin reduction is accomplished primarily by red cell reduced nicotinamide adenine dinucleotide reductase so efficiently that there is Ͻ1% of methemoglobin in the circulating blood. Hereditary methemoglobinemia is attributable either to deficiency of erythrocyte methemoglobin reductase or to the presence of one of the M hemoglobins. Acquired methemoglobinemia is induced by oxidizing agents, particularly chlorates and inorganic and organic nitrites, or by exposure to certain drugs or their metabolites.The most common sources of nitrate exposure are well water, which is mixed with infant formula, consumption of some vegetables with high nitrate concentration, administration of oxidant drugs, and the presence of diarrheal episodes. After ingestion, nitrates are converted to nitrites by fecal organisms, rapidly absorbed from the intestine by passive diffusion reaching the systemic circulation without undergoing first-pass metabolism in the liver (extrahepatic metabolism). Nitrites are potent oxidant agents of ferrohemoglobin. Infants younger than 6 months old are particularly susceptible to nitrate-...

There are substantial epidemiological differences in acute poisonings among children in different countries and regions of the globe. International best practices need to be identified for prevention of acute poisonings in childhood.

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