This review focuses on the current knowledge of the effects of thyroid hormones on central nervous system differentiation and development in animals and the human fetal brain. The outcomes of children with congenital hypothyroidism and of newborns with hypothyroid pregnant mothers are emphasized, focusing on how therapies could affect and especially improve the outcomes.

Pyomyositis is an acute bacterial infection of skeletal muscle that results in localized abscess formation. This infection was thought to be endemic to tropical countries, and is also known as “tropical pyomyositis”. However, pyomyositis is increasingly recognized in temperate climates and is frequently associated with an immunosuppressive condition, such as human immunodeficiency virus, malignancy, and diabetes mellitus. It is also found in healthy and athletic people after strenuous or vigorous exercise or following localized and possibly unnoticed trauma. It can be primary or secondary to neighboring or remote infection. Primary pyomyositis is a rare condition that can affect children and adolescents. Diagnosis can be delayed because the affected muscle is deeply situated and local signs are not apparent. This delay in diagnosis can result in increased morbidity and a significant mortality rate. The pediatric population, which comprises 35% of the reported pyomyositis cases, is an especially difficult subset of patients to diagnose. In our series, we describe the cases of four previously healthy Caucasian children who were admitted to our Pediatric Department with different clinical presentations. Pyomyositis in our patients was related to factors affecting the muscle itself, including strenuous exercise and direct muscle trauma. Therapy was started with a cephalosporin antibiotic and teicoplanin was subsequently added. The minimum length of therapy was 3 weeks. The diagnosis of pyomyositis in our patients, none of whom were immune-compromised, is confirmation that this disease is not an exclusive pathology of tropical countries and demonstrates that there is an increasing prevalence of pyomyositis in temperate climates.

Headache is the most frequent neurological symptom in childhood and the main reason for admission to pediatric emergency departments. The aim of this consensus document is to define a shared clinical pathway between primary care pediatricians (PCP) and hospitals for the management of children presenting with headache. For the purposes of the study, a group of hospital pediatricians and a group of PCP from the Emilia Romagna’s health districts were selected to achieve consensus using the RAND/UCLA appropriateness method. Thirty-nine clinical scenarios were developed: for each scenario, participants were asked to rank the appropriateness of each option from 1 to 9. Agreement was reached if ≥75% of participants ranked within the same range of appropriateness. The answers, results, and discussion helped to define the appropriateness of procedures with a low level of evidence regarding different steps of the diagnostic-therapeutic process: primary care evaluation, emergency department evaluation, hospital admission, acute therapy, prophylaxis, and follow-up. The RAND proved to be a valid method to value appropriateness of procedures and define a diagnostic-therapeutic pathway suitable to the local reality in the management of pediatric headache. From our results, some useful recommendations were developed for optimizing the healthcare professionals’ network among primary care services and hospitals.

Introduction: In type 1 diabetes (T1D), several genetic factors are associated to β-cell autoimmunity onset and clinical progression. HLA-genes play a major role in susceptibility and initiation of β-cell autoimmunity, whereas non-HLA genes may influence the destruction rate. Areas covered: Our review focuses on the possible role of the PTPN22 C1858 T variant as a prognostic factor, given its influence on disease variability. Moreover, we present the potential role of C1858 T as a target for tertiary prevention trials and new therapeutic strategies, such as the LYP inhibitors. We used PubMed for literature research; key words were ‘PTPN22’, ‘C1858 T polymorphism’, ‘lymphoid-specific tyrosine phosphatase’ and ‘type 1 diabetes’. We selected publications between 2000 and 2016. Expert commentary: Current data suggest that PTPN22 can be a promising target for therapeutic interventions and identification of at-risk subjects in autoimmune diseases such as T1D.

A 13-year-old girl was admitted to the pediatric ward for acute onset of mouth deviation to the left, drooping of the right corner of the mouth, poor right eyelid closure, right hypoacusis, and reduced taste perception. She also complained of right ear pain a week ago, and she had low-grade fever 2 weeks ago. Her history showed only respiratory allergy. At first evaluation she was afebrile and she also showed inability to wrinkle the right side of the forehead, right lagophthalmos, loss of the right nasolabial fold and inability to puff her right cheek and to lift the ipsilateral mouth corner. Otoscopy revealed hyperemic tympanic membranes bilaterally, more evident to the right. Enlarged lateral cervical lymph nodes, painless and tender to palpation were found bilaterally. The remaining physical findings and neurologic examination were normal. Hence peripheral facial paralysis was diagnosed. Laboratory examinations revealed a mild increase in white blood cell count with neutrophilia (leukocytes: 17.03 × 10 9 /µl; neutrophils: 82.7%). C-reactive protein was negative. Serologic tests for Varicella Zoster virus, Epstein-Barr virus (EBV), Paramyxovirus and ToRCH (Toxoplasma gondii, Rubella, Cytomegalovirus and Herpes Simplex virus) were performed. The EBV IgM titer was found positive (49.9 U/ml, reference range: 0-20 U/ ml), with positive IgG (139 U/ml, reference range: 0-20 U/ml). The polymerase chain reaction (PCR) result for EBV DNA was positive, so facial paralysis associated with EBV infection was diagnosed. Magnetic resonance of the brain was normal and no abnormalities of the infratemporal tract of the facial nerve were detected. Thus, oral acyclovir (800 mg 5 times a day) plus oral steroid therapy with prednisone (2 mg/kg/day) were administered for 10 days with slow and gradual improvement of symptoms and subsequent prednisone tapering. After discharge, the girl underwent a weekly follow-up until nearly complete remission of right facial muscle weakness, after less than 2 months. Acute peripheral facial paralysis is the most common acute mono-neuropathy [1], and it is often a challenge for clinicians. Its incidence has been reported as 21.1 per 100,000 per year for children < 15 years old [2]. The causes of pediatric facial nerve paralysis (Table I) can be congenital or acquired, but the idiopathic form or Bell's palsy is the most frequent (40-75% of cases) [3]. Acquired facial paralysis can often be caused by viral infections. In the present case, although the clinical and laboratory findings did not show a typical EBV infection pattern (neutrophilia with no symptoms or signs