Prenatal exposure to low-level methylmercury alters the child's fine motor skills at the age of 18 months.

OBJECTIVES: To compare motor, cognitive and language characteristics in children aged 18 months who were prenatally exposed to low-level methyl-mercury (MeHg), and to analyze the eventual differences in these characteristics in relation to cord blood THg concentration. PATIENTS AND METHODS: The total number of 205 child-mother pairs was included in the study, and total cord blood mercury was measured in 198 of them. Out of the 198 already measured samples, 47 of them have also been tested for methyl-mercury in cord blood. Data regarding the 47 samples of MeHg levels has been used for calculating the correlation between cord blood THg and cord blood MeHg. MeHg and THg showed a significant correlation (r=0.95, p<0.05). One month after the delivery, mothers were asked to complete the questionnaire regarding socioeconomic factors, breastfeeding of their infants, and dietary habits during pregnancy. Neurodevelopmental assessment of motor, cognitive and language skills were conducted on 168 children using The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Regarding the cord blood THg concentration, 135 children were divided in 4 quartile groups. Their neurodevelopmental characteristics have been compared. RESULTS: The cord blood THg concentration median and inter-quartile range was 2.98ng/g (1.41-5.61ng/g). There was a negative correlation between cord blood THg concentration and fine motor skills (rho=-0.22, p=0.01). It is evident that children grouped in 2nd ,3rd and 4th quartile had statistically significant lower fine motor skills assessment related to those grouped in 1st quartile (2nd quartile -1.24, p=0.03; 3rd quartile -1.28, p=0.03; 4th quartile -1.45, p=0.01). The differences in fine motor skills assessments between children in 2nd and 3rd and 3rd and 4th quartile were not statistically significant. CONCLUSION: Intrauterine exposure to low-level THg (MeHg) is associated with alterations in fine motor skills at the age of 18 months.

The use of neuroimaging in the management of chronic headache in children in clinical practice versus clinical practice guidelines.

In daily practice, neuroimaging studies are frequently performed for the management of childhood headache. The aim of this study was to determine whether there is significant discrepancy between clinical practice and clinical practice guidelines on the indications for neuroimaging studies. Medical records of children with chronic headache, aged 2 to 18 years and treated at Rijeka University Hospital Center, Kantrida Department of Pediatrics, were retrospectively reviewed. Indications for brain magnetic resonance imaging and computed tomography (MRI/CT) scanning were reviewed and compared with clinical practice guidelines. Brain imaging was performed in 164 (76.3%) of 215 children, MRI in 93 (56.7%) and CT in 71 (43.3%) children. Indications for brain MRI/CT were as follows: anxiety and/or insistence by the child's family (71.3%), presence of associated features suggesting neurologic dysfunction (13.4%), age under 5 years (12.8%) and abnormal neurologic examination (2.4%). The majority of children (71.4%) had normal neuroimaging findings. In the rest of imaging studies (28.1%), MRI/CT revealed different intracerebral/extracerebral findings not influencing changes in headache management. Only one (0.60%) patient required change in headache management after MRI/CT. Study results proved that, despite available evidence-based clinical guidelines, brain imaging in children with chronic headaches is overused, mostly in order to decrease anxiety of the family/patient.

[Psychogenic non-epileptic seizures in children - a case report]. / Psihogeni neepilepticki napadaji u djece - prikaz dviju bolesnica.

Psychogenic non-epileptic seizures (PNES) are paroxysmal attacks that resemble and are often misdiagnosed as epileptic seizures, but are not associated with abnormal cortical electrical discharge. PNES are one of the most important differential diagnosis of epilepsy. However, despite the fact that they are recognized as a specific clinical phenomenon and that the appearance of video-EEG enabled clinicians to set a definitive diagnosis, our understanding of the etiology, present brain processes and resulting classification, nosology and treatment are quite deficient. PNES is a physical manifestation of psychological disorders, and as such belongs to the type of conversion disorders which are not under the influence of voluntary control. Studies in the pediatric population showed a higher incidence of remission than in adults, probably due to the shorter duration of illness and psychopathology, as the causes of stress are different in pediatric patients than in adults. This paper shows two cases in children with PNES, which were treated at the Department of Pediatrics, Clinical Hospital Center Rijeka.

Phenotype of NK cells and cytotoxic/apoptotic mediators expression in ectopic pregnancy.

PROBLEM: The expression of cytotoxic/apoptotic mediators and the phenotype characteristics of uterine NK cells (uNK) in tubal ectopic pregnancy (EP) were investigated. METHOD OF STUDY: Samples of uterine decidua and tubal mucosa as well as peripheral blood (PB) of the same women with EP were used for phenotype characterization of NK cells and detection of cytotoxic/apoptotic mediators and IL-15. RESULTS: In tubal mucosa, perforin, FasL, granulysin and IL-15 were almost completely absent, but they were present in normal and EP uterine deciduas. TRAIL was present on trophoblast and tubal mucosa, contrary to its lack in normal and EP uterine decidua. CD16⁻ CD56(dim) NK cells, mostly CD94⁻ and NKG2A⁻, predominate in tubal mucosa, whereas CD16⁻ CD56(bright) NK cells, predominantly CD94(+) and NKG2A(+) prevail in EP uterine decidua. NK cells at the EP implantation site express lower percentages of perforin and granulysin, but they express a higher percentage of TRAIL than do EP uterine decidual and PB NK cells. Lower percentage of TNF-α-expressing and IL-4-expressing NK cells were found at the implantation site compared to EP uterine decidua. CONCLUSIONS: Authentic uNK cell population seems to be insufficient to restrict trophoblast invasion because of low expression of cytotoxic/apoptotic mediators.

[Regionalization of neonatal intensive care. Results and experience at the Department of Gynecology and Obstetrics of Rijeka University Hospital]. / Regionalizacija neonatalnog intenzivnog lijecenja. Rezultati i iskustva Klinike za ginekologiju i porodni tvo KBC-a Rijeka.

OBJECTIVE: To analyse mortality of extremely low (ELBW) and very low (VLBW) birth weight nawborns at the Department of Gynecology and Obstetrics of Rijeka University Hospital, before, during and after implementing a model of regionalization of perinatal care. In Croatia this model is still not established so the results can help us evaluate whether the suggested model is practicable and whether its appliance decrease newborns' mortality. PATIENTS AND METHODS: We compared early neonatal mortality (RNM), neonatal mortality (NM) and intrahospital mortality (MOB) of ELBW and VLBW newborns at the pediods before (1997-2000), during (2000-2001) and after (2003-2006) the implemented changes. RESULTS: RNM was significantly lowered for both weight groups, but NM and MOB only for VLBW newborns. CONCLUSION: Our results show that appliance of regionalization of perinatal care is possible and unquestionable on local level, so it should be implemented on national level too.