Viral pneumoniae in children: incidence and aetiology.

Community-acquired pneumonia remains a common and serious illness, which affects children of all age groups. The spectrum of causative organisms is wide and it differs according to the age of the patients. With the advent of new and improved diagnostic techniques our understanding of the aetiology of the disease has been improved considerably. Viruses have been shown to cause up to 90% of pneumonias, especially in the first year of life, with the respiratory syncytial virus to be the most important pathogen and this percentage decreases to approximately 50% by school age. Viral pneumonias frequently are complicated by bacterial infections and mixed infections are identified in 30% of the cases. The precise role of viruses and bacteria in these cases, remains to be clarified.

The impact of Greece's childhood tuberculosis screening programme on the epidemiological indexes in the greater Athens area.

SETTING: A hospital referral centre for childhood tuberculosis in Athens. OBJECTIVE: To evaluate the effectiveness of the screening programme implemented for childhood tuberculosis, through its impact on the epidemiological index. DESIGN: In Greece, tuberculosis has been systematically screened for in children since 1991 using the tuberculin skin test. The epidemiological and clinical profiles of all tuberculous children who attended the TB clinic were compared. The children were divided into those who attended in 1982-1990 and those who did so in 1991-1999. RESULTS: A total of 1122 TB patients were screened. In the second period there was an increase in numbers of immigrant children (3% vs. 28%, P = 0.0001), the rate of extra-pulmonary TB decreased (16% vs. 7.6%, P = 0.0001), patients identified by the screening programme increased (19% vs. 57%, P = 0.0001) and the number of symptomatic children fell (51% vs. 16%, P = 0.0001). The proportion of children who failed to attend for regular follow-up was lower during the second period (20% vs. 7%, P = 0.0001). CONCLUSIONS: Our study suggests that the screening programme applied in Greece during the last decade has contributed to the early identification of tuberculosis, and the limitation of symptomatic patients and extrapulmonary TB cases.

Community-acquired pneumonia: diagnosis and treatment.

Community-acquired pneumonia remains a common and serious illness, which affects children of all age groups. The spectrum of causative organisms is wide and it differs according to the age of patients. Therefore, age is a good predictor of the cause of pneumonia. Because of the nonspecificity, of clinical and radiological findings and the limitations of diagnostic tests for identifying the etiologic pathogen, initial therapy is inevitably empiric.

Epidemiology of invasive Haemophilus influenzae type b infections among children in Greece before the introduction of immunization.

We prospectively examined the epidemiology of invasive Haemophilus influenzae type b (Hib) infections among children under 5 y of age in the Greater Athens area before the introduction of immunization. The annual incidence of systemic Hib infections was 12/100000. Meningitis was the most common clinical entity and accounted for 69% of the cases. In the prevaccine era, the incidence of systemic Hib disease, particularly that of meningitis, was much lower in Greece compared to rates reported from Northern and Central Europe.

Congenital nephrotic syndrome, diffuse mesangial sclerosis, and bilateral cataract.

A case of congenital nephrotic syndrome with diffuse mesangial sclerosis and bilateral cataract without other ocular anomalies is presented. This association, to our knowledge, has not been reported before.

High nitrate content in drinking water: cytogenetic effects in exposed children.

The potential genotoxicity of nitrates and nitrites-contaminants of drinking water that have been implicated in carcinogenesis-was investigated in this study. Sister chromatid exchanges and frequency of chromatid/chromosome aberrations were studied in peripheral blood lymphocytes of 70 children who were 12-15 y of age. These children were permanent residents in geographical areas of Greece, where elevated concentrations of nitrates (i.e., 55.70-87.98 mg/l) existed in drinking water. The control group comprised 20 healthy children who resided in areas with very low nitrate concentrations (i.e., 0.7 mg/l). A significant increase in the mean number of chromatid/chromosome breaks was observed in children exposed to nitrate concentrations that exceeded 70.5 mg/l (p < .01), but there was no significant increase in the mean number of sister chromatid exchanges per cell. The results indicate that chronic administration of elevated concentrations of nitrate in drinking water has the capability of inducing cytogenetic effects.

Partial disomy of Xp and the presence of SRY in a phenotypic female.

We present a study of a mentally retarded and mildly dysmorphic female in whom initial cytogenetic studies identified the karyotype 46,X, + mar. Further characterisation of the structurally abnormal chromosome by fluorescence in situ hybridisation (FISH) showed that it is composed of both X and Y chromosome material with a centromere originating from the Y chromosome. The presence of the DMD gene and the absence of the XIST gene was shown by FISH using locus specific probes. The Y segment included the SRY and ZFY genes. Based on these findings, the karyotype was defined as 46, X,der(Y)t(X;Y) (p21.1;q11). This case illustrates male to female sex reversal owing to a partial duplication of the short arm of the X chromosome in the presence of SRY.

Pre-eruptive neurologic manifestations associated with multiple cerebral infarcts in varicella.

A boy, 4 years, 9 months of age, presented with acute hemiplegia, lethargy, ataxia, and dysarthria 24 hours prior to the eruption of typical varicella exanthem. Magnetic resonance imaging findings were typical of multiple cerebral ischemic infarcts. It is suggested that during the period of secondary viremia varicella zoster virus invaded the cerebral blood vessels causing vasculopathy and cerebrovascular infarcts.

Multiorgan involvement in systemic cat-scratch disease.

Cat-scratch disease is considered in the differential diagnosis of benign regional lymphadenopathy. We describe a case of cat-scratch disease in a 12-year-old boy with multiple bony, hepatic and splenic lesions which resolved with chemotherapy. The present case with simultaneous multiorgan involvement supports the view of a systemic nature of the disease.

Constitutive heterochromatin polymorphisms in children with acute lymphoblastic leukemia.

The C-band heterochromatin polymorphisms of chromosomes 1, 9, and 16 were studied on peripheral lymphocytes of 67 children with acute lymphoblastic leukemia (ALL) and 50 control individuals. A statistically significant difference between patients and controls was found for large heterochromatin regions (level 3) of chromosomes 1 and 9 (P < 0.001) and for small heterochromatin regions (level 1) of chromosome 16 (P < 0.001). The patients also showed a significant increase in chromosomes 1 and 9 heteromorphism with respect to controls (P < 0.001).

Sister chromatid exchanges in peripheral lymphocytes in newborns treated with phototherapy and vitamin E.

A study was undertaken to determine whether blue fluorescent light might affect the sister chromatid exchange (SCE) frequency of peripheral lymphocytes in icteric newborns undergoing continuous phototherapy treatment (72 h). Also, the potential preventive effect of vitamin E on SCE frequency was studied in a subgroup of 11 preterm and 9 fullterm newborns after daily administration of vitamin E (46.44 mumol/kg/d, im). The results revealed that only the preterm icteric newborns showed an increase in mean SCE frequency of peripheral lymphocytes after phototherapy (9%, p = 0.02), but in no case did the highest SCEs/cell ratio exceed the normal values. No correlation was found between the average SCE rate and birth weight, gestational age or bilirubin levels. Also, no difference in SCEs was observed between newborns treated or untreated with vitamin E.

Effect of ketotifen on childhood asthma: a double-blind study.

Ketotifen was administered orally, for 3 months, to 40 children aged 3-14 years with chronic extrinsic asthma of moderate severity in a double-blind placebo-controlled study. A significant clinical improvement with concomitant reduction of antiasthmatic drugs was found in the group receiving the active drug compared with the placebo group (p less than 0.05). The continued administration of ketotifen in an open study to a group of 21 children comprised of patients belonging to both groups (active-placebo) for a period of 15-18 months resulted in disappearance of symptoms in 10 children (47.6%) and moderate improvement in 7 (33.3%).

Sister chromatid exchanges in peripheral lymphocytes of children vaccinated against rubella and measles-mumps-rubella.

This study was undertaken in order to evaluate the cytogenetic and immunological responses to the effective, harmless and world-wide used vaccines of I. rubella and II. measles-mumps-rubella (M-M-RII). In one group (A) of five girls vaccinated against rubella and in another group (B) of four boys and two girls vaccinated against measles-mumps-rubella, the following parameters were studied before and repeatedly after vaccination: (a) SCE frequency, in peripheral lymphocytes, (b) DNA-synthesis, in peripheral mononuclear cells, and (c) antibody titres. The mononuclear cell proliferation rate was elevated between the 3rd and 7th day, preceeding the humoral immunological reactions, which began after the 25th day (group A) and the 28th day (group B). The latter findings coincided with a significant increase of SCE frequency in group A (one child) and in group B (all six children); in no case did the highest SCE/cell ratio exceed the normal value.

Clinical pharmacology of cefotaxime in pediatric patients.

Cefotaxime is a new cephalosporin with a spectrum of activity which may make it appropriate for use in pediatric patients. In 33 infants and children, administration of cefotaxime resulted in cure or improvement in 97% of patients, with eradication of 94% of isolated pathogens. Toxicity was minimal. The disposition of cefotaxime in this age group was similar to that reported for adults, with an elimination half-life of approximately 1.5 h, a volume of distribution of 1 liter/kg, a total serum clearance of 10 ml/min per kg, and a renal clearance of 6 ml/min per kg.