Italy is one of the few countries in the world where pediatric neuropsychiatry is still a united discipline not following the separation that has been underway for several years between adulthood neurology and psychiatry. However, in practice, many pediatric neuropsychiatrists here operate as if this separation was present, dealing with either neurologic or psychiatric pathologies of the developmental age. Indeed, due to the increasing hyperspecialization of skills, there are some pediatric neuropsychiatrists, in the field of neurology, who deal almost only with epilepsy or neuromuscular diseases, while there are others, in the field of psychiatry, who deal almost only with autism spectrum disorder (ASD). At least partially, this trend towards the hyperspecialization of skills is inevitable due to the recent great progress of neurosciences, but at the same time, this situation entails serious risks for adequate patient care. Each individual, particularly during development, should be considered as a single entity both in physiologic and pathologic situations. A clear distinction between normal neurologic and psychic development is very difficult and probably pointless, especially in the earliest stages of life. This distinction becomes almost impossible when, for some reason, the development of the individual shows domain-specific or global deficits. In this regard, there would be innumerable examples of pathologic conditions whose clinical picture at onset may appear misleading and requires a global neuropsychiatric approach; here we will mention only a few. The first example: a child aged around 2 years showing language delay, potentially the prelude to a specific language disorder, who unfortunately in the following months begins to present a series of signs such as epileptic seizures, ataxia, as well as cognitive, motor, and visual deterioration, leading then, based on the results of instrumental tests, to a diagnosis of neuronal ceroid lipofuscinosis type 2 disease. It is known that the first sign of this disease can be language delay (1). The second example: a boy aged 15 months presenting a mild motor developmental delay, but who after a few months starts to show the classic signs of ASD. A consistent series of data shows that, in ASD, motor type signs, including a delay in the gross motor and fine motor acquisitions, may occur even before the impairment of social communication skills (2, 3). The third example: a girl aged 18 months showing an apparently non-specific global developmental delay, whose clinical picture subsequently becomes more complicated following the loss of acquired skills and the appearance of symptoms including handwashing stereotypies, breathing abnormalities during wakefulness (hyperventilation alternating with apnea), and others, leading to a diagnosis of atypical Rett syndrome, whose onset is often difficult to identify (4, 5). These examples highlight that an overall picture of the developing individual, through a global approach combining both the neurologic and psychiatric perspective, facilitates an adequate diagnostic framework and therefore a correct management. The fact that pediatric neuropsychiatry remains a united discipline is not a legacy of the past, but reflects a modern way of dealing with the neuropsychiatric disorders of the developing individual.
Congenital factor VII (FVII) deficiency is a rare bleeding disorder inherited autosomal recessively (1, 2). It is the most common congenital rare factor deficiency in the world. The clinical picture is variable; it may be asymptomatic or may lead to critical bleeding (3). There is a weak correlation between FVII activity and clinical findings (1, 4). Mucocutaneous bleeding is observed predominantly. Bleeding such as hematoma and hemarthrosis occur rarely compared to patients with haemophilia (1, 3, 4). The clinical picture and follow-up of patients who present with hemarthrosis is similiar to patients with haemophilia. Development of a target joint and subsequent chronic synovitis and arthropathy may be observed. Use of radioisotope synovectomy (RS), which is known to have successful outcomes in patients with haemophilia with secondary prophylaxis and surgical interventions, is limited in patients with FVII deficiency. Here, we share our experience of radioisotope synovectomy in the ankle joint in a patient with congenital FVII deficiency who developed a target joint and chronic synovitis.
The child healthcare system in Ukraine is coordinated and managed at a central level by the Ministry of Health and at a local level by the regional health authorities. The Ministry of Health has executive the power for the implementation of state health policies and controls and manages state-owned health facilities. The system of public funding for the pediatric healthcare system is divided into two sources: central and local. Primary healthcare is organized by the National Health Service of Ukraine. Secondary level healthcare is mostly organized by the Ministry of Health, which gives money for hospitals and medical centers. Since 2014, due to reform and decentralization in Ukraine, local, regional, and city administrations received money from the Ukrainian government for the formation of decentralized budgets.
Invasive fungal infections may cause morbidity and mortality in pediatric patients with hematologic and oncologic malignancies treated with intensive protocols. We present a case of mucormycosis in an 8-year-old boy with acute lymphoblastic leukemia. In our patient, the suspicion for an oculoorbital and paranasal infection only due to mild pain in the orbital area without any abnormal pathologic findings in the ophthalmologic and otolaryngologic examination, led us to an early diagnosis. Despite the use of antifungal therapy, the lesion persisted and fever subsided after surgical drainage of the periorbital abscess. Antifungal treatment continued during chemotherapy. He has been in remission for four years. Mucormycosis should be in the differential diagnosis in infections in children with cancer, especially leukemia, according to clinical and radiologic findings. A high degree of suspicion and prompt systemic empirical antifungal therapy, as well as surgical debridement, are crucial for the survival of patients. Beside antifungals, early surgery plays an important role in patients with mucormycosis.
The child healthcare system in Ukraine is coordinated and managed at a central level by the Ministry of Health and at a local level by the regional health authorities. The Ministry of Health has executive the power for the implementation of state health policies and controls and manages state-owned health facilities. The system of public funding for the pediatric healthcare system is divided into two sources: central and local. Primary healthcare is organized by the National Health Service of Ukraine. Secondary level healthcare is mostly organized by the Ministry of Health, which gives money for hospitals and medical centers. Since 2014, due to reform and decentralization in Ukraine, local, regional, and city administrations received money from the Ukrainian government for the formation of decentralized budgets.
