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Maria Bitsori

Publications and source records attributed to Maria Bitsori.

13 recordsLinked to original sources
PubMed2006

Urine interleukin-8 as a marker of vesicoureteral reflux in infants.

OBJECTIVE: Vesicoureteral reflux (VUR) is a common finding in children presenting with urinary tract infection (UTI) and prenatally diagnosed urinary tract dilatation and in relatives of index patients. Children with VUR are at risk for ongoing renal damage with subsequent infections. Detecting VUR and renal scarring currently depends on imaging modalities with associated problems of radiation, invasiveness, and expense. Noninvasive methods would greatly facilitate diagnosis and would also help in identifying relatives of index cases who should be screened. Interleukin-8 (IL-8) is produced by epithelial cells of the renal tract in response to inflammatory stimuli and has been shown to increase during acute UTI. The objective of this study was to assess the urine levels of IL-8 as a noninvasive marker of VUR in infants in the absence of a recent UTI episode. METHODS: We evaluated urine concentrations of IL-8 in 59 infants aged 1 month to 2 years. All infants were free of UTI for a minimum of 3 weeks before IL-8 evaluation. Infants were divided into 3 groups: group A, subjects with proven VUR (24 infants aged 0.15-1.95 years, median 0.43); group B, subjects with a history of UTI but negative investigation for VUR (14 infants aged 0.32-1.95 years, median 0.57); and group C, subjects without any history of acute or chronic condition that might impair renal function (21 infants aged 0.08-1.92 years, median 0.33). IL-8 concentrations were determined by a commercially available quantitative enzyme-linked immunosorbent assay. To avoid dilution effects, urinary levels of IL-8 were expressed as the ratio of cytokine-to-urinary creatinine. RESULTS: Results were presented as medians and ranges. The Kruskal-Wallis test, the Mann-Whitney rank sum U test, and the Spearman rank order correlation test were performed for the univariate analysis. Two-tailed P values were calculated and the conventional level of significance P < .05 was applied in all cases. Infants in groups A and B had been free of UTI for a period of 3 to 52 weeks (median, 5.0 weeks) and 3 to 78 weeks (median, 4.5 weeks), respectively, before IL-8 determination. No significant difference was noted in the length of the UTI-free period between groups A and B (P = .469). Urine creatinine concentrations did not differ among groups A, B, and C (medians 1.15, 2.25, and 1.15 micromol/mL, respectively; P = .080). The median urine IL-8/creatinine concentrations (pg/micromol) were 40.5 (range, 2.04-3874) in group A, 1.91 (range, 0.001-386) in group B, and 2.47 (range, 0.002-55.6) in group C. Urine IL-8/creatinine concentrations were significantly higher in group A than both in group B (P = .0003) and in group C (P < .0001). No significant difference was observed between groups B and C (P = .749). In group A, no significant correlation was shown between IL-8/creatinine concentrations and the presence of renal parenchymal damage (P = .506), reflux grade (P = .770), or time from UTI (P = .155). A receiver-operator characteristic curve was constructed by plotting the sensitivity versus the specificity for different cutoff concentrations of IL-8/creatinine. With a cutoff concentration of urinary IL-8/creatinine at 5 pg/micromol, the sensitivity of this marker in diagnosing VUR was 88%, the specificity 69%, the positive prognostic value 66%, and the negative prognostic value 89%. In higher cutoff concentrations, specificity of the marker increased but sensitivity rapidly decreased. CONCLUSIONS: We present evidence that urine IL-8 concentrations remain elevated in infants with VUR even in the absence of UTI and that a cutoff of 5 pg/micromol IL-8/creatinine is of high sensitivity and adequate specificity for diagnosing VUR. Elevated urine IL-8 levels in VUR and renal scarring have already been reported; however, the present study is, to our knowledge, the first to confirm significant differences between infants with VUR and infants with a history of UTI alone and healthy controls, and to suggest a reliable cutoff concentration for diagnosing VUR. Our findings additionally suggest that inflammatory process in VUR is ongoing even after UTI has resolved, pointing against the currently held belief that sterile reflux cannot harm kidneys. The chronic inflammatory cell infiltrate associated with reflux nephropathy rather than VUR itself might offer an explanation for the secretion of IL-8, which may well be independent of reflux grade. Using urine IL-8 for diagnosing VUR is not free of limitations, because IL-8 may be elevated as a result of urinary tract manipulation or undetected UTI. In addition, this study focused on infants and not in older children with longstanding VUR. Increased urine IL-8 concentrations after UTI has resolved is a promising noninvasive marker for an initial screening for VUR in infancy with high sensitivity and adequate specificity.

Biomarkers↗
PubMed2006

Invasive non-typhoidal salmonellosis in immunocompetent infants and children.

OBJECTIVE: To investigate the extraintestinal manifestations of non-typhoidal Salmonellae (NTS) infection in immunocompetent infants and children. METHOD: The study took place at the University General Hospital at Heraklion, Crete. Over a 10-year period from 1993-2002 we studied 1087 patients, of whom 443 were children less than 14 years old, with a culture-proven diagnosis of NTS infection. Stool and blood cultures were routinely obtained in patients presenting with fever and diarrhea. The cases of invasive infection in otherwise well children, including bacteremia and/or extraintestinal focal infections were further analyzed. RESULTS: Invasive cases were less common in children than adults (4.06% vs. 8.7%; relative risk 0.467; 95% confidence intervals (CI) 0.279-0.784; p=0.0033). Furthermore, invasive cases were much less common in the otherwise well than in immunocompromised children (3.5% vs. 21.4%; relative risk 0.163; 95% CI 0.053-0.500; p=0.0008). The 15 otherwise well children with invasive NTS infection were aged from 3 weeks to 7.5 years, and nine were aged less than 12 months. Among them, 11 presented with bacteremia, and four with focal extraintestinal infections (rectal abscess, deep neck abscess, urinary tract infection, elbow arthritis). Salmonella enterica subsp. enterica serovars Enteritidis and Virchow were the most common invasive serotypes. All invasive strains were susceptible to beta-lactams including ampicillin, and to cotrimoxazole. All patients made a complete recovery with intravenous antibiotics and did not present with relapses or major infections during long-term follow-up. CONCLUSION: Invasive non-typhoidal salmonellosis in immunocompetent children is less frequent than in both immunocompromised children and in adulthood. However, invasive cases may well occur in otherwise healthy children, especially during infancy. In these patients, prompt appropriate treatment leads to favorable outcomes.

Adolescent↗
PubMed2006

Insulin-induced oedema in children and adolescents.

Oedema is an uncommon complication of insulin therapy, which has only rarely been reported in childhood. We describe a case of a 12-year-old girl with newly diagnosed type 1 diabetes, who presented with oedema of the lower extremities and periorbitally, one day after the initiation of insulin treatment. Other causes of oedema were excluded. Following administration of frusemide, oedema resolved within ten days. An extended review of the literature revealed only nine cases of insulin-induced oedema in children and adolescents aged </=16 years. In conclusion, insulin-induced oedema should be considered during the introduction of insulin therapy in children and adolescents with newly diagnosed type 1 diabetes. Loop diuretics and ephedrine may be beneficial when spontaneous resolution does not occur.

Adolescent↗
PubMed2005

Breastfeeding and vitamin D status in Greece during the first 6 months of life.

UNLABELLED: Since no foods are vitamin D supplemented in Greece, vitamin D status was assessed in mothers at birth and their infants up to the first 6 months of life, while they were exclusively breast-fed. This was a prospective study. Full-terms (n =35) born during the summer-autumn months and their mothers were assigned to the summer group and the remainder (n =31) to the winter group. One week after birth, serum 25-hydroxyvitamin D (25OHD) was significantly lower in the winter-born than in the summer-born neonates (6.7+/-0.7 vs. 10.1+/-0.9 ng/ml, P <0.01). The respective levels of parathyroid hormone (iPTH) were 64.9+/-13.4 and 33.9+/-4.4 pg/ml (P <0.01). The mothers had serum 25OHD levels of 10.8+/-1.0 ng/ml and iPTH levels of 15.2+/-3.5 pg/ml in the winter and 12.9+/-1.3 ng/ml and 24.8+/-4.8 pg/ml in the summer. During the 6-month follow-up, a steady increase in circulating 25OHD (up to 19.4+/-2.8 ng/ml, P <0.0001) and a decrease in iPTH (to 26.8+/-3.5 pg/ml, P =0.10) were observed in the infants born in the winter. In the summer-born infants, serum 25OHD did not change but iPTH had increased significantly by the 3rd month (59.4+/-21.8, P <0.05). Serum calcium (Ca) increased within normal limits during the study period in both groups. Serum phosphorus (Pi) started higher in the winter group (7.43+/-0.38 vs. 6.27+/-0.23 mg/dl, P <0.01) but thereafter, it was similar in both groups. Total alkaline phosphatase (ALP) increased in both groups during the study (164+/-15 vs. 219+/-17 IU/l, P <0.05 and 189+/-14 vs. 288+/-35 IU/l, P <0.001, respectively). Serum osteocalcin (OC) decreased in the winter-born neonates (32.0+/-3.4 vs. 21.5+/-3.4 ng/ml, P <0.05) and did not change in the summer group (28.9+/-3.5 vs. 26.5+/-2.8 ng/ml). CONCLUSION: Neonates who are breast-fed exclusively during the first 6 months of life are in need of vitamin D supplementation irrespective of the season even in a sunny country like Greece where foods are not supplemented.

Adult↗
PubMed2005

Community-acquired enterococcal urinary tract infections.

Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gram-negative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.

Child, Preschool↗
PubMed2005

Dysmetabolic syndrome in childhood and adolescence.

UNLABELLED: The dysmetabolic syndrome, consisting of dyslipidaemia, hypertension, hyperinsulinaemia and central obesity, has been well recognized as a major risk for cardiovascular disease in adults. Although the clustering of cardiovascular risk factors has also been identified in childhood, the occurrence of full-blown dysmetabolic syndrome at younger ages has only recently been investigated. In this article we attempted an overview of the data for children and adolescents, focused on the mechanisms and natural history of the disease, the prevalence among paediatric populations, the assessment and the treatment approaches. CONCLUSION: There is substantial evidence that the dysmetabolic syndrome has its origins in childhood. In the face of the epidemic increase of obesity in children and adolescents, the development of effective screening and preventive strategies would be a major challenge for paediatricians.

Adolescent↗
PubMed2005

Vaccination coverage among adolescents in certain provinces of Greece.

AIM: To estimate the vaccination coverage in a sample of adolescents in Greece. METHODS: Vaccination status was estimated in 483 adolescents aged 15-19 y in four prefectures. The criteria for full vaccination were based on the recommendations of the Greek National Vaccination Schedule. RESULTS: The participation rate in the study was 78.7% (380/483 adolescents). The rates of full vaccination were 94.2% for poliomyelitis, 78.4% for hepatitis B, 77.4% for BCG, 65.0% for tetanus and 54.4% for diphtheria. The rates of full vaccination for measles, rubella and mumps were 65.0%, 57.6%, and 56.0%, respectively. For pertussis, the full vaccination rate was only 36.0%, and 7.1% of the study population was totally unvaccinated. The most missed dose for all vaccines was the final booster dose, which is usually administered in older children or adolescents. CONCLUSION: Adolescent vaccination coverage was not satisfactory in this study, mainly due to non-compliance to the final booster dose. Completion of missing vaccines at this age represents the last opportunity for massive intervention and would be of essential value for individual and community protection against common preventable diseases.

Adolescent↗
PubMed2004

Epicurus' death.

The aim is to present how an eminent philosopher perceived, reported and faced his progressing and ultimately fatal uropathy, 23 centuries ago. All available ancient Greek sources about Epicurus' life and death were used and urinary tract-related medical knowledge in this era was reviewed. Epicurus died at the age of 71 from urinary calculus after having bravely suffered for a long time. Although he is often cited for his teachings against the fear of pain and death, his own way to death has been overlooked. His exceptional description of his own symptoms provides an unusual insight, given that our knowledge on diseases in older times is mainly based on surviving texts written by the then medical practitioners. Epicurus reported on his terminal symptoms, being entirely aware of the fatal outcome of a disease incurable at that time. Very soon after, Ammonius the Lithotomus in Alexandria was to improve the surgical procedures for urinary calculi. In an era when urinary tract surgery was considered to be an extraordinary means of treatment, Epicurus peacefully passed away, firm to his own teachings about tolerance to disease and pain, and leaving to us both an unusual medical record and a courageous attitude towards suffering and death.

Death↗
PubMed2004

Primary idiopathic segmental infarction of the greater omentum: two cases of acute abdomen in childhood.

Idiopathic segmental infarction of the greater omentum (ISIGO) is a rare cause of acute abdominal pain in childhood. The authors present the case histories of 2 children treated in their department. The children underwent surgery with preoperative diagnosis of acute appendicitis with atypical clinical presentation. The definitive diagnosis of segmental infarction of the great omentum was made intraoperatively and confirmed pathologically. Excision of the infracted omentum was curative.

Abdomen, Acute↗
PubMed2002

Ochrobactrum anthropi bacteraemia in immunocompetent children.

Ochrobactrum anthropi is an emerging pathogen in immunocompromised patients but infections with the bacterium have very rarely been documented in normal hosts. We report the characteristics of O. anthropi bacteraemia in 11 immunocompetent children, aged 2 months to 7 y, hospitalized in a general hospital during a 5-y period. Children commonly presented with fever, non-specific respiratory or gastrointestinal manifestations, leukocytosis and neutrophilia and had a rapid recovery, even when they did not receive a specific treatment. In 10 cases positive blood cultures were obtained on admission and in all cases subsequent cultures were sterile. In conclusion, O. anthropi may cause bacteraemia in immunocompetent hosts, although further studies are required to clarify whether these isolates represent pseudobacteraemia or whether O. anthropi is a potential pathogen of low virulence.

Anti-Bacterial Agents↗
PubMed2002

Rickettsia typhi infection presenting as subacute meningitis.

We report two children with Rickettsia typhi infection presenting with mild central nervous system manifestations and pleocytosis in cerebrospinal fluid. Murine typhus should be included in the differential diagnosis of meningoencephalitis in children who are residents of endemic areas.

Acute Disease↗