Frequency of genetic diseases and health coverage of children requiring admission in a general pediatric clinic of northern Greece

<p>Abstract</p> <p>Background</p> <p>In order to estimate the causes of pediatric morbidity in our area, with particular emphasis on diseases with a genetic background, we retrospectively categorized the admissions of all children hospitalized in the Department of Pediatrics of the University General Hospital of Alexandroupolis, in the area of Evros, Thrace, Greece over the three year period 2005-2007. Finally, in order to guide health care administrators to improve the delivery of pediatric health care services, we estimated the percentage of hospitalized children who were uninsured and the type of health insurance of those who had medical coverage.</p> <p>Patients and Methods</p> <p>The causes of admission, as recorded in the medical records were categorized in terms of the major organ and/or system involved and/or the underlying pathology, with emphasis on diseases with a genetic background. Duplicate admissions, i.e., admissions of the same child for the same underlying disease were excluded. Additional information recorded was age, sex, and type of health insurance of all admitted children. Distribution of the causes of admission by study year was compared by chi-square. A <it>p </it>value < 0.05 was considered significant.</p> <p>Results</p> <p>Over the study period, there were 4,947 admissions in 2,818 boys and 2,129 girls. Respiratory diseases were the most common accounting for 30%, while infectious diseases followed with 26.4%. The frequency of chromosomal abnormalities among the hospitalized children was only 0.06%. However, if we consider diseases with an underlying genetic background, this percentage rises to 5%. Approximately 10.3% of the admitted children had no health insurance.</p> <p>Conclusions</p> <p>The percentage of children hospitalized in our area due to a disease with an underlying genetic background was 5%. This percentage pertains to a Department of Pediatrics that has no inpatient subspecialty units and which is located within a General hospital, because hospitalizations for genetic diseases are more frequent in specialized pediatric hospitals, with competence in clinical genetics. The double figure of uninsured children is worrisome and dictates the need for governmental efforts for universal pediatric health coverage in our country.</p

Omental infarction in an obese 10-year-old boy

Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intra-operative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction

Ekspresija i obrada somatostatina u gušterači u razvoju i u duktalnom adenokarcinomu gušterače

Somatostatin is a gastrointestinal peptide hormone that inhibits growth of pancreatic cancer as reported by an increasing body of evidence. Yet this is not always the case. To clarify the controversy we aimed to identify the expression of somatostatin in developing human embryonic pancreatic tissue and pancreatic adenocarcinoma given that somatostatin positive cells were shown either into primitive pancreatic ductal epithelium or into pancreatic carcinoma. Tissue sections representing pancreatic fetal specimens (n=15) and ductal pancreatic adenocarcinoma specimens (n=15) were assessed using immunohistochemical methods for somatostatin expression. Normal primitive exocrine ductal epithelium and endocrine epithelium showed a definite, statistically significant, higher expression of somatostatin over neoplastic pancreatic tissue of mixed (ductal-endocrine) and pure ductal type (p1=0.021, p2=0.001, p3<0.0001and p4=0.003 respectively) during the 8th to the 10th week. No statistically significantly different expression of somatostatin in the mantle zone of the islets over neoplastic tissue of mixed (p5=0.16) and pureductal type (p6=0.65), from the 13th to the 24th week was demonstrated. Pancreatic cancer cells can express somatostatin in a model that reproduces the normal expression of the peptide by d-cells during embryonal organogenesis. Therapy aimed at pancreatic cancer must be targeted to somatostatin and analogues as a potential adjuvant novel option.Somatostatin je probavni peptidni hormon koji suzbija rast raka gušterače, za što postoji sve više dokaza. No to se ne događa uvijek. Cilj studije bio je utvrditi ekspresiju somatostatina u ljudskom embrijskom tkivu gušterače u razvoju i u adenokarcinomu gušterače, s tim da su na somatostatin pozitivne stanice dokazane ili u primitivnom duktalnom epitelu gušterače ili u karcinomu gušterače. Tkivni isječci koji su predstavljali uzorke fetalne gušterače (n=15) i uzorke adenokarcinoma gušterače (n=15) ispitani su pomoću imunohistokemijskih metoda za ekspresiju somatostatina. Normalan primitivni egzokrini duktalni epitel i endokrini epitel pokazao je konačnu, statistički značajno višu ekspresiju somatostatina iznad neoplastičnog tkiva gušterače miješanog (duktalno-endokrinog) i čistog duktalnog tipa (p1=0,021, P2=0,001, p3<0,0001 odnosno p4=0,003) tijekom 8. do 10. tjedna. Nije dokazana statistički značajno različita ekspresija somatostatina u ovojnom sloju (mantle zone, mantle layer) otočića iznadneoplastičnog tkiva miješanog (p5=0,16) i čistog duktalnog tipa (p6=0,65) od 13. do 24. tjedna. Dakle, stanice raka gušterače mogu izražavati somatostatin na naein koji ponavlja normalnu d-staničnu ekspresiju peptida za vrijeme embrijske organogeneze. Liječenje zbog raka gušterače usmjereno na somatostatin i njegove analoge moglo bi predstavljati novu mogućnosti adjuvantne terapije

Nuclear Medicine in Pediatric Nephro-Urology: An Overview.

In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments

Predictors of sleep duration and sleep disturbance in children of a culturally diverse region in North-Eastern Greece

Background Aim: The aim of this study was to examine the sleep characteristics of children and explore associations with various socio-demographic factors in an area of Greece characterized by cultural diversity. Methods: A questionnaire about children's sleep habits had been distributed to parents of children who visited the pediatric outpatient clinic of University General Hospital of Alexandroupolis for a medical examination and to get a health certificate for participation in sports activities. Children with chronic health conditions were excluded. Results: In the study, 449 children (27.1% belonging to minorities) were included, aged 7.6 ± 2.9 years. Most of them (81.7%) slept after 10 p.m., with a mean nocturnal sleep duration of 9.4 ± 1.2 h. The most commonly reported disturbance was snoring (26.2%). Age and high educational level of the mother were both important determinants for sleeping late [OR 1.139 (1.033–1.255); p = 0.009 and OR 1.086 (1.004–1.175); p = 0.040, respectively]. The latter was also associated with an absence of any reported sleep disorder in children [OR 0.934 (0.877–0.994); p = 0.031]. A longer sleep duration was reported among Roma children (p = 0.022), which was more overt in girls (mean sleep duration 10.4 ± 1.6 h). In the Roma group also, the prevalence of sleep disorders was higher. Conclusion: Age progression and maternal educational level, along with cultural background, seem to be correlated with variations in the sleep characteristics of children in a culturally diverse population in Greece