The impact of the heptavalent pneumococcal conjugate vaccine on the epidemiology of acute otitis media complicated by otorrhea.

Background: The heptavalent pneumococcal conjugate vaccine (PCV7) has a considerable effect on the epidemiology of pneumococcal disease. The aim of this observational hospital-based study was to examine the effect of the PCV7 (introduced in our settings in 2004) on the epidemiology of spontaneously draining acute otitis media.

Methods: Results of all middle ear fluid cultures (n = 3446) obtained from children with acute otitis media complicated with otorrhea before the introduction of immunization (between 2000 and 2003) were compared with those (n = 2134) obtained during a similar post-PCV7 period (between 2005 and 2008).

Reporting adverse events: Greek doctor and nurse attitudes.

Purpose: The purpose of this paper is to elicit Greek doctors' and nurses' views about adverse event reporting.

Design/methodology/approach: This is an exploratory study using an adverse events questionnaire administered to 209 doctors and 214 nurses in 14 major Athens universities and tertiary hospitals.

Findings: The paper finds that Greek doctors and nurses prefer a strictly confidential or conditionally confidential reporting scheme.

Whole blood interferon-γ release assay is a useful tool for the diagnosis of tuberculosis infection particularly among Bacille Calmette Guèrin-vaccinated children.

The performance of QuantiFERON-tuberculosis (TB) Gold-In-Tube assay was compared with the tuberculin skin test for the diagnosis of TB among children. It was shown that among non-Bacille Calmette Guèrin immunized children, agreement between tests was excellent both in those with TB disease and in TB contacts. Among Bacille Calmette Guèrin-immunized children, agreement was fair in those with active disease and poor among TB contacts.

Primary tooth abscess caused by Mycobacterium bovis in an immunocompetent child.

Bovine tuberculosis is a zoonotic disease, and although its incidence has dramatically decreased in developed countries where effective control measures are applied, it still remains a potential health hazard in the developing world. Tuberculosis of the oral cavity is extremely rare and is usually secondary to pulmonary involvement. We present the unusual case of an immunocompetent 6-year-old child residing in an urban area with primary oral tuberculosis due to Mycobacterium bovis, which was confirmed by the application of a molecular genetic approach.

Factors that prevent physicians reporting adverse events.

Purpose: The purpose of this paper is to explore the reasons why Greek doctors are reluctant to report adverse events.

Design/methodology/approach: The paper is an exploratory study using the adverse events questionnaire, administered to 209 doctors in 14 major Athens hospitals, comprising university as well as tertiary.

Findings: The questionnaire showed a high degree of internal consistency (Cronbach's alpha 0.

Scedosporium apiospermum skeletal infection in an immunocompetent child.

Abstract This is a case of Scedosporium apiospermum skeletal infection in a 10-year-old immunocompetent girl whose chief complaint was left knee swelling and pain. The child had a history of a bicycle accident two months before with a resultant deep penetrating trauma. Systematic administration of broad-spectrum antibiotics for 10 days was used, with no clinical improvement.

Association of mild and severely unstable alpha chain variants: the first observation of a compound heterozygote with Hb Setif [alpha94(G1)Asp-->Tyr (alpha2)] and Hb Agrinio [alpha29(B10)Leu-->Pro (alpha2)] in a Greek family.

Hb Setif is a relatively rare, mildly unstable alpha2-globin hemoglobin (Hb) variant first described in an Algerian family, and subsequently in various populations of the Mediterranean region and the Middle East. Hb Agrinio is a highly unstable variant, classified as a nondeletional alpha-thalassemia (alpha-thal) mutation, which, to date, has only been described in Greece and Cyprus. We report here the clinical and hematological findings in a case of Greek origin, who, following DNA analysis, was characterized with the unusual interaction of the Hb Setif alpha2-globin gene variant at codon 94 variant, in trans to Hb Agrinio, an alpha2-globin gene variant at codon 29.

Timing of voiding cystourethrography in infants with first time urinary infection.

The aim of the study was to evaluate whether the timing of performing a voiding cystourethrography (VCUG) following a first urinary tract infection (UTI) in infants is related to the presence or the severity of vesicoureteral reflux (VUR). A total of 411 children (male 230, female 181) with a first-recognised UTI between ages 15 days and 12 months (median 3 months) underwent a VCUG within 4-81 days (median 9 days) following diagnosis. The presence and the grade of the VUR were compared in two groups: an "early" group in which the VCUG was performed during the first week of the start of treatment and a "late" group in which the examination was performed during the second week or thereafter.

Further identification of the hyperunstable alpha-globin chain variant Hb Heraklion [codons 36/37 (-CCC); Pro-->0 (alpha1)] in Greek cases with co-inherited alpha+-thalassemia mutations.

We report four Greek cases (from three unrelated families), who all had a similar atypical thalassemia intermedia phenotype, characterized by chronic moderate anemia, mild hemolysis and splenomegaly in the absence of abnormal hemoglobin (Hb) fractions. In all four cases (two unrelated children and two siblings), DNA analysis identified common alpha(+)-thalassemia (alpha(+)-thal) mutations in trans to the in frame 3 bp deletion (-CCC) on the alpha1-globin gene between codons 36 and 37, which has previously been reported as Hb Heraklion in a single Greek case. Clinical, hematological and biochemical findings in all cases, including a follow-up evaluation of the original case, are described.

First observation of Hb Taybe [Codons 38/39 (-Acc) Thr-->0 (alpha1)] in Greece: clinical and hematological findings in patients with co-inherited alpha+-thalassemia mutations.

This report describes four unrelated Greek patients (one child and three adults) who all had an atypical thalassemia intermedia phenotype, characterized by chronic moderate anemia with mild hemolysis in some cases, and the absence of abnormal hemoglobin (Hb) fractions. DNA analysis identified the inheritance of common alpha(+)-thalassemia (alpha(+)-thal) mutations in trans to an in-frame 3 bp deletion at codons 38/39 (-ACC) on the alpha1-globin gene, previously described as Hb Taybe. Hematological findings in the parents of three of the Hb Taybe carrier cases, together with a fourth unrelated carrier, are also presented.

A rare thalassemic syndrome caused by interaction of Hb Adana [alpha59(E8)Gly-->Asp] with an alpha+-thalassemia deletion: clinical aspects in two cases.

Hb Adana is a highly unstable and rare alpha-globin hemoglobin (Hb) variant, to date described in only three families, in interaction with other alpha-thalassemia (alpha-thal) deletions. We describe the clinical and hematological findings in two cases from independent families of Albanian origin, who have an interaction of the codon 59 (Gly-->Asp) alpha2-globin gene variant in trans to a 3.7 kb alpha(+)-thal deletion (alpha(codon 59)alpha/-alpha).

Evaluating long-term results of modified Heller limited esophagomyotomy in children with esophageal achalasia.

Background/purpose: Modified Heller esophagomyotomy has become the initial treatment of choice for esophageal achalasia in children. However, only limited and not objective data are currently available on the long-term results of modified Heller limited esophagomyotomy (LEM). This retrospective study was undertaken to objectively assess the long-term results of LEM in childhood esophageal achalasia.

Clinical and molecular epidemiology of community-acquired, methicillin-resistant Staphylococcus aureus infections in children in central Greece.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children have increased considerably in our area. In this study, we prospectively examined the epidemiological, clinical and molecular profile of CA-MRSA infections in children in central Greece. A total of 198 staphylococcal strains were isolated from patients with community-acquired infections over a 28-month period and 88 (44%) were found to be methicillin-resistant.

Linezolid in children: recent patents and advances.

Linezolid is the first approved member of a new generation of antibiotics, the synthetic oxazolidinones, to become available, with a broad spectrum of in vitro activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis and vancomycin-resistant Enterococcus faecium. It has an excellent bioavailability both intravenously and orally and a very good safety profile both in adults and in children. With regards to its antimicrobial action, linezolid has a predominantly bacteriostatic action, rather than a bacteriocidal effect and is active against Gram-positive bacteria that are resistant to other antibiotics.

A unique case of reversible myocardial ischemia in a hyperthyroid neonate.

A case of an 8-day-old preterm neonate with heart failure, pulmonary hypertension, and myocardial ischemia due to hyperthyroidism is reported. Treatment of the disease initially with b-blockers and, upon establishment of hyperthyroidism, with propylthiouracil reversed all cardiac abnormalities. Contrary to the rule, diagnosis of hyperthyroidism in the mother was established following the diagnosis of the condition in her baby.

The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study.

Background: A 9-month course of isoniazid monotherapy is currently recommended for the treatment of latent tuberculosis infection (LTBI) and has been shown to be effective in both children and adults. Reduced compliance with this regimen has forced physicians to explore shorter regimens. The aim of this study was to compare 3- and 4-month combination regimens of isoniazid plus rifampin with a 9-month regimen of isoniazid monotherapy for the treatment of LTBI in children.

Use of linezolid in children: an overview of recent advances.

Linezolid is the first member of a new generation of antibiotics, the synthetic oxazolidinones, to become available, with a broad spectrum of in vitro activity against gram-positive organisms, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium. Linezolid is showing great promise currently for the treatment of multiresistant gram-positive bacterial infections, especially complicated skin infections, catheter-induced bacteremia or nosocomial pneumonia both in the community and in a hospital setting, in children and in adults.

The use of fluoroquinolones in children: recent advances.

Fluoroquinolones are an important group of antibiotics that are used widely in the treatment of various infectious diseases in adults as a result of their excellent spectrum of activity, significant tissue penetration and convenient routes of administration. Their use in children, however, has been limited until recently as a result of possible fluoroquinolone-induced joint toxicity. Nevertheless, this group of antibiotics is rapidly gaining consideration for use in children as new agents are emerging with a wide antimicrobial range of action and minimal toxicity, even in young children.

The role of respiratory viruses in the pathogenesis of pediatric asthma.

The role of respiratory viral infection in the development of asthma remains unclear. A number of factors play crucial roles, including the type of virus, the severity of the disease, the time of the infection, and, most important, the host predisposition. On the other hand, there is little doubt that a strong association exists between viral respiratory infections and induction of wheezing illnesses and asthma exacerbations.

Invasive meningococcal disease in children in Greece: comparison of serogroup A disease with disease caused by other serogroups.

Although invasive meningococcal disease caused by serogroup A is not prevalent in developed countries, a considerable number of cases were recently recorded in Greece. In this study, serogroup A meningococcal disease was compared prospectively with meningococcal disease caused by other serogroups, using similar settings of testing and management during a 5-year period between 1999 and 2003. The Neisseria meningitidis serogroup was determined in 262 cases.

Impact of influenza infection in healthy children examined as outpatients and their families.

Decisions regarding the introduction of influenza immunization in healthy children require an accurate evaluation of influenza disease burden not only in the inpatient but also in the outpatient setting. We prospectively examined the impact of virologically confirmed influenza in 1462 outpatient children (> or = 6 months to < 14 years) and their families, during two consecutive influenza seasons. Influenza was documented in 573/1462 (39%) outpatients with febrile respiratory illness and accounted for 13.

Precocious puberty.

The term precocious puberty encompasses a group of heterogeneous conditions that range from variants of normal to slowly progressive and rapidly progressive maturation of both sexes. It is defined as the appearance of secondary sex characteristics before the age of 8 in girls and 9 in boys. The clinician who is evaluating a child with precocious puberty should be aware of the normal events of puberty, the ages at which pubertal milestones are achieved and the tempo of pubertal progression.

Disseminated nontuberculous mycobacterial infection in a child with interferon-gamma receptor 1 deficiency.

We describe the case of a 2-year-old boy with disseminated infection by a rapidly growing, poorly pathogenic mycobacterial species that belonged to the Mycobacterium fortuitum-Mycobacterium peregrinum complex. He had a severe course characterized by a poor response to treatment and recurrent lymph node abscess formation. Sequencing of the interferon-gamma receptor 1 gene (IFNgammaR1) revealed that he was homozygous for a novel null mutation, 453delT.

Colonic necrosis because of strangulated recurrent Morgagni's hernia in a child with Down's syndrome.

Postoperative bowel obstruction complicating a recurrent Morgagni's hernia (MH) is an uncommon condition and hence the presentation. Nonspecific symptoms and misleading radiologic image may result in misdiagnosis and severe complications. We report the case of a child with a transverse colon necrosis because of strangulation in a misdiagnosed recurrent MH.