Quantitative ultrasound measurements in children and adolescents with: type 1 diabetes.

The aim of the current study was to evaluate bone status at the radius and phalanx in children and adolescents with type 1 diabetes by using quantitative ultrasound (QUS) measurements. Thirty pediatric patients, 16 male and 14 female, with type 1 diabetes of duration of 5 to 177 months and mean (+/- SD) age 11.3 +/- 4.6 years were studied. QUS measurements were carried out using the Sunlight Omnisense 7000 S device. Speed of sound (SOS) was measured at the radius and tibia. Diabetic control was assessed by glycosylated hemoglobin (HbA(1c)) measurements. Male and female patients with type 1 diabetes did not have significantly different SOS or HbA(1c) values. SOS Z-scores at both the radius and tibia were negatively associated with duration of disease ( r = -0 41 and r = -0.37 for the radius and tibia respectively, P < 0.05 for both correlations). Seven of 15 patients with duration of disease of >6 years had diminished SOS, defined as Z-score of <-1, at either the radius or tibia. SOS measurements at the radius showed moderate correlation with SOS at the tibia ( r = 0.58, P < 0.00 l). There was no correlation between SOS and HbA(1c). In conclusion, SOS Z-scores at both the radius and tibia show a significant negative correlation with duration of insulin-dependent diabetes in children. No relation was found between SOS and metabolic control of young diabetic patients.

Epidemiology of childhood type I diabetes in Crete, 1990-2001.

AIM: To study the epidemiological patterns of childhood-onset type I diabetes in Crete, Greece. METHODS: The incidence (new cases per 100,000 per year) from 1990 to 2001 was determined in the population of Crete < or = 14 y of age. RESULTS: A total of 89 cases was ascertained. The standardized annual incidence rate was 6.1 per 100,000 population [95% confidence interval (95% CI) 4.9-7.5]. Incidence rates were higher in children 10-14 y of age, boys and residents of urban areas (6.8, 6.7 and 6.6 per 100,000, respectively). Incidence rates were higher [relative risk (RR) 1.46, 95% CI 0.956-2.24] during the 6 y period 1996-2001 (7.2, 95% CI 5.4-9.4) than during the 6 y period 1990-1995 (4.9, 95% CI 3.4-6.9). This increase was more prominent in residents of urban areas and 10-14-y-old children. CONCLUSIONS: Although an increase was noted during the period 1990-2001, the childhood type I diabetes incidence rates in Crete remain among the lowest both in Europe and in the Mediterranean islands.

Burden of respiratory syncytial viral infections on paediatric hospitals: a two-year prospective epidemiological study.

This study was designed to prospectively investigate the hospitalisation patterns for respiratory syncytial virus (RSV) disease in children up to 2 years of age, both healthy full-term children and high-risk children. The aim was to evaluate children hospitalised for a respiratory tract infection in four regions and seven paediatric hospital departments or clinics in Greece and to estimate the burden of RSV disease on paediatric hospital beds, as well as to determine the target high-risk age group over two consecutive respiratory infection seasons. Among a total of 1,710 children, the overall prevalence of RSV disease was 33.1%, but prevalence differed between seasons (27% vs. 37.7%, P<0.01). The peak prevalence of RSV disease occurred in February, with the onset in November and the end in May. The monthly distribution was similar in all regions. RSV positivity was strongly associated with young age (4.7 vs. 6.6 months, P<0.001); classification within a high-risk group (43% vs. 32.6%, P=0.04); lower respiratory tract infection (93.8% vs. 86%, P=0.001), particularly bronchiolitis (80.9% vs. 63.9%, P=0.001); more severe disease (P<0.001); longer stay in hospital (P<0.001); and poorer outcome (P<0.001). RSV infections accounted for 38% of the total hospitalisation days for all respiratory infections, and 77% of the hospitalisation days for RSV infection were for infants less than 6 months of age.

Rickettsia typhi infection in childhood.

UNLABELLED: Rickettsia typhi infection (murine typhus) is generally underdiagnosed in childhood, as clinical presentations are often non-specific. We present the manifestations in nine children hospitalized in the Department of Paediatrics of the University Hospital, Heraklion, Crete, over a 3-y period from 1998 to 2000. Titres > 1:400 for IgM and >1:960 for IgG and/or a fourfold increase in a second sample were considered strongly suggestive of acute infection. Children presented with prolonged fever, hepatosplenomegaly and lymphadenopathy. Five children presented with a rash. Unusual manifestations included aseptic meningitis and Kawasaki-like presentation. Laboratory findings included anaemia, leucopenia, and thrombocytopenia. Three children were treated with appropriate antibiotic regimens and all nine had a complete recovery. CONCLUSION: Rickettsia typhi infection should be considered in the differential diagnosis of children residing in or returning from Southern Europe countries who present with prolonged fever, rash and lymphadenopathy.

Transverse myelitis associated with herpes simplex virus infection.

The case of an otherwise healthy 6-year-old boy with symptoms and signs of acute transverse myelitis is presented. The diagnosis was confirmed by magnetic resonance imaging. An episode of gingivostomatitis had preceded, and serology indicated herpes simplex virus type 1 infection. The child recovered gradually, and no relapses were noted during a 30-month follow-up period.

Facial nerve palsy associated with Rickettsia conorii infection.

Facial nerve palsy has been occasionally attributed to infectious agents, but Rickettsiae species have not been documented as causative agents. We report two adolescent girls with facial nerve palsy and serological evidence of R conorii infection. These cases indicate that rickettsioses should be included among the causes of facial nerve palsy, particularly in endemic areas.

Mucus plugging as a cause of acute lobar overdistension.

Acute lobar overdistension in children is usually indicative of foreign body aspiration, especially when a history of a choking episode is recalled. An unusual presentation of asthma as recurrent overdistension of the left lung in a toddler is described. The child had undergone two consecutive negative bronchoscopies with a presumptive diagnosis of foreign body aspiration; however, it was only the antiasthmatic treatment that resulted in an excellent outcome.

Invasive Salmonella virchow infection in childhood.

Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonellae species; however, several invasive cases have previously been reported. We report 3 cases of otherwise healthy children with S. virchow bacteraemia, monoarthritis and prevertebral abscess, only 1 of whom had previously had gastroenteritis. All 3 children responded to antibiotic regimens consisting of cefotaxime for 10 d, ceftriaxone for 3 weeks and ceftriaxone plus clindamycin for 4 weeks, respectively. In conclusion, S. virchow may be a more invasive serotype in immunocompetent children and present with a wider spectrum of manifestations than considered previously.

A local cluster of achalasia in a province of Crete.

Achalasia has a largely obscure aetiology and is uncommon in childhood. We report three cases of otherwise well children, residents of a small province of Crete, two of them female cousins. This cluster probably indicates an autosomal recessive trait of inheritance. All three children were surgically treated (Heller cardiomyotomy combined with Nissen fundoplication), with excellent results.

An unusual case of lead poisoning in an infant: nursing-associated plumbism.

Lead poisoning remains a common environmental threat for children today. The majority of cases of lead poisoning are caused by oral intake of lead dust or lead-containing paint flakes and thus occur during the second and third years of life. An unusual case of severe lead poisoning in a breast-feeding infant girl is here presented; the source proved to be a nipple shield made of a lead-containing metal. Despite the severity of the intoxication, by the end of treatment and for a year afterwards the infant has been well and her psychokinetic development has been normal.

Effect of hydrochlorothiazide on renal hypercalciuria.

The long-term effect of hydrochlorothiazide (HCT) was studied in 30 children (17 boys and 13 girls), aged 4-13 years (mean 7.6 +/- 3.4), with renal hypercalciuria (HCU) for a period of 2.5 +/- 0.95 years. The purpose of the study was to evaluate the effect of HCT mainly on renal calcium excretion, but also on serum K+, Ca, P, Mg, cPTH, nephrogenic cAMP (ncAMP) and bone mineral content (BMC). In addition to the above-mentioned parameters, oxalate, uric acid, citrate and cystine levels in 24-hour urine collections were also measured, and UCa/UCr, UP/UCr, UMg/UCr in 3-hour urine collections were assayed. The results of the study showed that 1 mg/kg/day of HCT caused a rapid and long-lasting correction of HCU, a decrease in serum cPTH and ncAMP, a significant increase in BMC and prevention of the formation of new urinary stones or of the increase in size of stones already present. No side effects were observed.

The diagnosis of hypercalciuria in children.

Calcium loading tests were performed in 21 children with hypercalciuria, haematuria and/or nephrolithiasis and 10 control subjects. Comparisons of 24-h calcium excretion before and after loading were evaluated rather than fasting urinary calcium to urinary creatinine ratio. The differences in calcium excretion before and after loading clearly distinguished absorptive from renal hypercalciuria. A difference higher than 0.035 mmol/kg indicated absorptive hypercalciuria in 6 of 21 patients, whereas in the remaining 15 much lower differences indicated renal hypercalciuria. Resorptive hypercalciuria caused by low serum values of 25-hydroxyvitamin D was considered in 6 of the 15 patients with renal hypercalciuria. These patients had low values of phosphate reabsorption (TmP/GFR) and could be clearly separated by high values of calcium reabsorption (TmCa/GFR), in contrast to patients with renal hypercalciuria who had normal values of TmP/GFR and low values of TmCa/GFR. The correct treatment and prevention of nephrolithiasis caused by hypercalciuria in children should be based on accurate diagnosis; this can be achieved by using the calcium loading test described in this report.

A simple index for initiating transfusion treatment in thalassaemia intermedia.

In order to develop an objective test for discriminating between patients with thalassaemia intermedia requiring blood transfusion, and those not likely to require transfusion the medullary width (MW) in the midpoint of the second left metacarpal and the bone mass were measured in 34 normal children and in 37 patients. In patients, blood haemoglobin (Hb) and serum ferritin concentration were measured and cephalofacial deformities (CFD) were scored. The mean values of MW were 0.37 +/- 0.06 and 0.44 +/- 0.1 cm (P less than 0.01) and the bone mass 0.091 +/- 0.012 and 0.078 +/- 0.02 (P less than 0.005) in normal children and patients, respectively. In 13 of these patients who had MW more than 2 SD above the mean of the controls, i.e. more than 0.5 cm, regular blood transfusions were instituted. Measurements of MW 12 and 1 month before and 12 months after the initiation of transfusions showed an increase from 0.50 to 0.60 and a decrease to 0.49, respectively. Bone mass measured at the same times decreased from 0.083 to 0.045 and increased to 0.071, respectively. These changes were visible radiologically. It is concluded, therefore, that the measurement of MW seems to be an objective, simple test for discriminating between patients requiring or not blood transfusions, and that bone deformities will be reversible if transfusions are instituted using as criterion the MW (greater than 0.5 cm) regardless of age or haemoglobin concentration. This test may help clinicians to decide about the optimal time for institution of regular transfusions in patients with thalassaemia intermedia.