Themistoklis Karpathios

The role of dairy products and non alcoholic beverages in bone fractures among schoolage children

In order to assess consumption of the calcium rich dairy products, intake of non alcoholic beverages and physical activity as risk factors for bone fractures among schoolage children, a case control study was undertaken in Athens, Greece. During 1995 one hundred children 7 to 14 years old (74 boys and 26 girls) with single uncomplicated fractures of the upper and lower extremities and no evidence of coexisting metabolic condition affecting bone fragility were compared with 100 age-and gender-matched controls. The analysis was undertaken by modeling the data through conditional logistic regression. Several indicators point to an increased risk of fractures among physically active children, although none of the individual variables was statistically significant. Somatometrc factors were not related to fractures, although children with more advanced stage of development at Tanners scale were apparently at increased risk. Intake of dairy products and of carbonated non cola beverages was not related to the occurrence of fractures. By contrast, intake of non carbonated beverages, mainly fruit juices, and of cola beverages were significantly associated with elevated risks of fractures [for an increase of one-half can per day, the odds ratios and associated 95% confidence intervals were 1.6 (1.2 to 2.3) and 1.7 (1.2 to 2.6) respectively]. In the absence of other common elements between cola and non carbonated beverages the positive associations of these beverages, with bone fractures probably reflect the increased rehydration needs of active children who are also at high risk for injuries.

Transient exposures and the risk of childhood injury : A case-crossover study in Greece

We used a case-crossover design to evaluate short-term effects of several exposures on the risk of childhood accident. One hundred fifty-six hospitalized children with injuries responded to an interviewer-administered questionnaire that included, among other variables, information concerning transient exposures that had terminated within 26 hours before the occurrence of the accident. We considered the 2-hour interval preceding the accident as the likely effect period and made within-individual comparisons between this period and the remaining 2-hour intervals during which the child was awake. We used conditional logistic regression analyses to evaluate the effect of the transient exposures on the occurrence of childhood accidents. We present univariate and multivariate analyses adjusting for possible within-person confounding by exposure to more than one exposure simultaneously and for clock time. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were as follows: for strenuous physical activity, OR = 24.2, 95% CI = 10.8–54.4; for intellectual exertion, OR = 9.0, 95% CI = 1.9–25.8; for involvement in family quarrels, OR = 2.6, 95% CI = 0.4–16.9; for school examination, OR = 3.8, 95% CI = 1.5–9.4; and for a pleasing event, OR = 3.4, 95% CI = 1.5–8.2. Other transient exposures were not associated with increased accident risk. Comparison of the overall frequency of reported transient events between the first of the control intervals (3rd and th hours before the accident) and the 2-hour interval covering the th and th hours before the accident suggested that information bias may have led to slight overreporting of transient exposures during the period most proximal to the accident; this bias, however, was too small to explain the marked risk elevations associated with the indicated transient exposures. We conclude that several transient exposures are important component causes in the occurrence of childhood accidents. (Epidemiology 1998; 9:622–625)

Evidence on the infectious etiology of childhood leukemia: the role of low herd immunity (Greece)

AbstractObjective: Acute lymphoblastic leukemia (ALL) among children may be a rare outcome of a delayed non-specific infection in situations of overall low herd immunity. We evaluated the hypothesis as to whether newly diagnosed ALL cases, compared to their controls, are characterized by lower herd immunity, as reflected in a more seronegative spectrum to several agents, with the exception of a strongly positive response to a single infectious agent, assumed to trigger ALL. Methods: The study included 94 incident cases of ALL, from all pediatric hematology–oncology units of Greece, and 94, matched for age and gender, controls hospitalized with minor non-infectious conditions. The past exposure to common infections was assessed using 10 serological markers. Results: There was little evidence for an association of ALL with the serology of any of the studied infectious agents among the very young children. In contrast, among children aged 5 years or older, leukemia was inversely associated with seropositivity to Epstein–Barr virus, human herpes virus-6, Mycoplasma pneumoniae and parvovirus B19. Conclusions: Among children aged 5 years or older the risk of leukemia may be higher when the low herd immunity for several agents is challenged by late infection from an agent that, as a rule, would attack children at a younger age.

Family Pattern of Idiopathic Hypercalciuria and its Subtypes

PURPOSE We determined the mode of inheritance of idiopathic hypercalciuria and its subtypes. MATERIALS AND METHODS We evaluated 40 children with symptomatic idiopathic hypercalciuria and 129 of their first-degree relatives (80 parents and 49 siblings). In hypercalciuric individuals in families with at least 2 affected members the type of idiopathic hypercalciuria was determined by the calcium loading test. RESULTS Of the 40 affected children 19 (47.5%) had 1 or more affected first-degree relatives (23 of 80 parents and 2 of 49 siblings). In all 44 affected members of the 19 hypercalciuric families (19 index cases, 23 parents and 2 siblings) the type of idiopathic hypercalciuria was determined (absorptive in 38 and renal in 6). Study of the pedigree of the 19 families showed that idiopathic hypercalciuria appears to be transmitted as an autosomal dominant trait. With only 1 exception the subtype of disease was specific for members of the same family. CONCLUSIONS Idiopathic hypercalciuria has a familial or sporadic pattern. In the familial pattern an autosomal dominant inheritance is present. The type of the disease is identical in affected members of the same family. The absorptive subtype is more frequent.

Cat scratch disease in 2 siblings presenting as acute gastroenteritis.

The cases of 2 siblings with cat scratch disease are described who presented with symptoms suggestive of acute febrile gastroenteritis. The first patient, a 7.5-y-old girl, developed mesenteric lymphadenitis, hepatosplenic granulomas and osteolytic bone lesions only late in the course of her protracted illness. Her 3-y-old brother had a shorter, self-limited illness without complications. Cat scratch disease is often unrecognized and the full spectrum of its clinical manifestations remains to be investigated.The cases of 2 siblings with cat scratch disease are described who presented with symptoms suggestive of acute febrile gastroenteritis. The first patient, a 7.5-y-old girl, developed mesenteric lymphadenitis, hepatosplenic granulomas and osteolytic bone lesions only late in the course of her protracted illness. Her 3-y-old brother had a shorter, self-limited illness without complications. Cat scratch disease is often unrecognized and the full spectrum of its clinical manifestations remains to be investigated.

Transient psychosomatic exposures and childhood injuries: a case-crossover study from Athens

Transient psychosomatic exposures and childhood injuries: a case-crossover study from Athens