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Child malnutrition in developed countries is mainly due to secondary chronic diseases and it can be aggravated by prolonged hospitalization. Child malnutrition has severe consequences for growth, development and health. Objectives and Aim: Are to assess the nutritional status of children with cancer compared with children with other causes of malnutrition and with control group. Material and method: A prospective study was performed on 106 children hospitalized in the Pediatric Clinic I Tg.-Mures, Romania, between November 1, 2010- february 2011, children who were divided into three groups: group 1, children with malnutrition of different causes: 25 cases (23.58%), group 2, children with neoplastic diseases 33 cases (31.13 %) and control group 3, consisting of 48 children (45.28%) with normal nutritional status. Results and discussions: In study group 1 we observed a low weight -3, 22 SD, comparative with control group, {p=0.001}. We got statistically significant differences in terms of height (p=0.0022), BMI (p=0.0001) and MUAC (p=0.0001); all parameters beeing much lower in the group with malnutrition, less decreased in the group with oncological diseases compared with controls. In addition, it was observed a good correlation, statistically significant between BMI and total serum proteins in children in group 1, (p=0.05) and significant correlation to both as group 1 and group 2 between the MUAC and serum albumin (p=0,05). In conclusion we found to be most affected nutrional status in children with malnutrition secondary to other causes than the cancer, BMI, MUAC and serum protein, respectively albumin characterize better nutritional status.

Background: Vitamin D deficiency is an unrecognized epidemic and a common health problem worldwide. Methods: This study was conducted in the pediatric clinic in Jeddah Clinic Hospital-Kandarah from April through December 2010 . 510 healthy children aged 4 to15 years old were enrolled. Serum 25-hydroxyvitamin D (25-OHD) wasmeasured. Dietary vitamin D intake, duration of daily sunlight exposure were determined. 25-OHD levels < 20 ng/mL and < 7 ng/mL were defined as relative and severe vitamin D deficiency, respectively. Results: The mean concentration of 25(OH)D was 13.07±7.81 ng/mL 70 subjects (13.72%) had normal 25(OH)D level . 300 (58.82%) had relative 25(OH)D deficiency and 140 (27.45%) had severe deficiency (P=0.000). 220 (43.14%) were males and 290(56.86%) were females having a statistical significant difference in the incidence of 25(OH)D deficiency (P=0.019). Saudis and Yemenis were more subjected to 25(OH)D deficiency in comparison to Egyptians and other nationalities (P=0.01). there were significant inverse correlations between 25-hydroxyvitamin D levels and both body weight and height (P=0.000). There was a significant correlation between bony aches and 25(OH)D deficiency (P=0.000). Duration of sunlight exposure and daily intake of vitamin D had significant effects on serum level of vitamin D. Conclusions: A high prevalence of vitamin D deficiency in children living in Jeddah was observed in this study. Routine screening for vitamin D status should be done for all children. Further studies including larger number of subjects are recommended for proper evaluation and management of this problem.

Overall prevalence of obesity in children has increased over the world. Leptin plays an important role in the pathogenesis of obesity. In obese persons leptin levels are higher than physiological concentration. The objective of this study was to evaluate the relationship between leptin and gender in obese children. Matherial and Method: A prospective study was carried out in the Ist Pediatric Clinic from Targu- Mures between September and 2005 December 2008; a lot of 86 children divided into two lots with similar age and sex structure: lot I with high BMI (17 girls, 24 boys) and lot II with low BMI (18 boys, 27 girls). Leptin serum conentrations were measured and correlations between serum leptin and gender were examined by linear regression and Pearson product-moment correlation analyses. Results: Comparing the values of serum leptin in girls with high BMI and low BMI, we observed that leptin is much higher in group with high BMI than in the group with low BMI, with a significant difference between the two groups (p < 0.01); significant differences exist between leptin in girls with high BMI compared to leptin in boys with high BMI (p < 0,01). In boys, with aging, leptin values approaching to those of adults, with a negative linear correlation between age and leptin regardless of BMI. Conclusion: In guys, whether with high or low BMI, leptin values are similar and much lower compared to lots of girls. High leptin levels appear in all obese children with high BMI.

Introduction: Poisonings in childhood are a usual cause of children's admission to a pediatric ward. The most usual toxic exposures and ingestions occur at home and involve drugs, cigarettes and nondrug products such as chemical substances, plants and hydrocarbons. Aim: of the study is to make an epidemiological recording of the poisoning incidents in a distict hospital's pediatric clinic during the period 2008- 2009. Material-Methids: 96 children were admitted in a two years' period and were studied according to age, sex, nationality and the ingested substance. Results: 96/1228 (7,8%) children with a mean age 3,3y admitted because of a drug-substance poisoning. 80/96(83,3%) were greek, 13/96(13,5%) were roma and only 3/96(3,2%) were foreigners. The male children were significantly more (58/96(60,4%)) than the females (38/96(39,6%)). The majority of the incidents happened during fall (37/96(38,5%)) and spring (34/96(35,4%)). Fewer happened during summer (14,6%) and winter (11,4%). 67/96 (69,8%) were infants (1,0-3,0) y, 22/96(22,9%) were 3,1-6,0 y and 7(7,3%)were > 6 y. 19/96(19,8%) with a mean age 1,5 years old, ingested cigarettes and 48/96(50%) ingested drugs (3 of them attempted to suicide). The rest 29 cases involved non drug products (alcohol:5, hydrocarbons:8, cleaning substances: 9, plants:4, cosmetics:3) None of these cases had adverse reactions. Conclusion: Unintetional poisonings are common in children younger than 6 years of age, happen mostly at home and involve mostly cigarette and drug ingestion. Pediatricians must be aware and have to educate the parents in order the chidren to live in a safer environment.

1196 Epidemiological Aspects of Salmonella and Shigella Infections in Children. Statistics of Pediatric Clinic

123 children (median age 4.5 years) were referred from a well-baby clinic to a behavior clinic established to evaluate the suitability and efficacy of behavioral techniques as applied in a medical setting by pediatricians. The clinic's permanent staff are a behavioral psychologist and an attending pediatrician. Rotating students, house staff and fellows are taught a standard approach to history-taking and treatment in a one-hour lecture and appropriate readings. Proficiency is generally acquired in two or three supervised sessions. Thirty different individual behavior problems were treated: Trouble sleeping (N=33) and eating (25), bedwetting (19) toileting problems (11) temper tantrums and other minor disobedience (20) and others (dawdling, phobias, hairpulling, medicine refusal, functional pain, etc (36). Also referred were children (46) with multiple behavior problems, i.e. "hyperactivity" and general home and school disobedience. Parents and children were seen together in 1 to 3, 30-minute sessions. Using a parent rated behavior check list and standardized interviews, follow-ups were conducted at 2 weeks and 6 months. 75.3% of parents with single complaints reported resolution. Only 21% of those with multiple problems benefited from the contact. 90% of those parents with single problems who could give a good description of the pediatrician's advice reported resolution; only 7% of those with poor recall were successful. However, of those parents with hyperactive children, parental recall of advice made no apparent difference in success rate.

Numerous studies have documented the deleterious effects of prolonged bottle feeding in children. Little information exists regarding the optimal age for terminating bottle feedings, what advice pediatricians provide to parents, and what methods parents employ for bottle weaning. Information about bottle weaning practices was gathered from 172 mothers with bottle-fed children between the ages of 2 and 5 years (x = 42 mos.) scheduled for pediatric clinic visits. SES ranged from lower to upper middle, with 75% falling in the lower middle and lower categories. Forty percent of mothers reported pediatricians as the primary care provider. Although the mean recommended age for weaning was 7 months, the average age for attainment of daytime bottle weaning was 14 months. Seventy-one percent of mothers reported that bedtime bottle feeding practices were not discussed by their physicians. Forty-five percent of children were allowed to sleep with the bottle, which contained milk in 27% of the cases. Two weaning methods were commonly reported: (1) gradual reduction of the number of bottles (42%) and (2) abrupt termination (38%). Only 11% of mothers cited physicians as the primary source of information on nursing bottle weaning, with 36% relying on instinctual judgement. Data suggest pediatricians need to include explicit information on the timing of and methods for cessation of bottle feeding as part of anticipatory guidance interventions.

All girls age 11 and under presenting to the pediatric clinic between 1978-1986 with genital warts were evaluated by the Child Protection Team for coinfetiting STD's and sexual abuse. The 11 children were 1.5-3 yrs (5), 3-6 yrs (1) and 6-11 yrs (5). All had perirectal and/or perivaginal warts, diagnosed by inspection (5) or biopsy (6). Nine had condyloma acuminata and two had crops of verruca volgaris. Nine had findings indicative of sexual abuse including discharge (5), bleeding (5), foul odor (4), hymenal diameter :> 10 mm d), and anal gaping (1). One or more other STD's were diagnosed in 6 children. Cases/number studied were: Tie abuser (s)of 7 were identified. Two girls had multiple abusers and 3 others were highly suspected to have had multiple abusers. These 5 children had other coinfecting STD's. Conclusion: Sexual transmission of genital warts is demonstrated in 9 of the 11 girls by additional indicators including statements from the child, physical evidence, ano coinfecting STD's. Children with genital warts should be evaluated for other STD's and sexual abuse .Coinferting STD's may be an indicator of multiple abusers in children with genital warts.

A cohort of 24 physically and neurologically normal infants followed in a special pediatric clinic designed for care of off-spring of substance abusing mothers† was evaluated at ages 1 and 2 years with the Bayley Scales of Infant Development and with a modification of the Ainsworth-Bell Infant-Mother Attachment Scale. The 11 male and 13 female infants were from a low income Hispanic background. Mean Bayley Mental Scores (MDI) declined from 95.5 at 1 year to 87.3 at 2 years. At 1 year of age 80% of children had normal MDI scores (mean=95.5) and 20% had suspect scores (mean=83.0). When re-tested at age 2, 67% were normal (mean=87.3), 29% were suspect (mean=80.8) and 1 female infant was abnormal (67.0). Of the 7 infants with suspect scores, 5 were male and 2 were female. When infant-mother attachment behavior was evaluated at 1 year, 83% were found to be normal, 17% suspect or abnormal. Normal second year attachment behavior was found in 71% of the sample with 29% suspect or abnormal. All 7 children with suspect/abnormal attachment behavior at 2 years showed a decline in mental score from the first year. Four of these had fallen from normal to suspect category. In summary, infants of substance abuse mothers showed a decline in Bayley mental scores and a decline in appropriate attachment behavior over the first 2 years. Test results suggest that male infants may be more vulnerable to this decline. Health providers must recognize that these families need long term support. †Herion, PCP, polydrugs.

EP is the primary screening test for lead poisoning but also becomes elevated with iron deficiency. The effectiveness and limitations of EP in screening an unselected population for iron deficiency has not been fully evaluated. During a 1 yr period 2150 children under 12 yrs were screened with EP during their routine physical. Ten % of the children had EP ≥ 35 (μg/dl whole blood) and were followed up to determine the cause of EP elevation. Iron deficiency was defined as serum ferritin ≤ 15 ng/ml and/or transferrin saturation < 16%. Elevated blood lead was based on two successive blood lead ≥ 30 μg/dl. Of 191 children found to have EP ≥ 35 and completing study the findings were: Using EP ≥ 35 as the screening level, 87% of the screen positive subjects Fad biochemical evidence of iron deficiency. Approximately half of these subjects also had microcytosis or anemia, more strongly indicative of iron deficiency. An EP ≥ 35 was associated with iron deficiency with sufficient frequency to justify further evaluation or a therapeutic trial with iron.

Clinic staff (CS) working with pediatric patients (pts) benefit from knowing the relationship between pt and parent (par) behaviors in the clinic. Also, CS need to know if they share similar perceptions of family behaviors, and if their perceptions are affected by age of pt. In our study of adolescents with cancer, a pt/par questionnaire was given to CS and research team (RT) to assess patterns of pt/par behaviors seen in clinic. The data were analyzed to assess inter-rater reliability (IRR) and influence of pt's age on IRR. Par and pt anxieties were unrelated, but pt anxieties were related to overprotective and controlling par behavior (factor analysis). Pt maturity was related to perceptions of pars as anxious and overwhelmed by pt's illness. IRR was .78 for CS and .84 for RT (p

Twenty-two of 57 freshmen medical students chose to attend a pediatric clinic once a week in the evening for six months. Responses to a structured questionnaire were scored on a positive-negative attitude continuum (from −7 to +7), a high score indicates a positive attitude. Those students electing to attend an evening pediatric learning experience without credit, scored 4.15 before and 4.30 after exposure. Those who did not attend the presentations scored 2.44 and 2.46 on the two questionnaires. The humanistic student can be identified on admission to medical school and those with this viewpoint may be guided towards appropriate learning experiences. The findings of this study indicate that it is possible to assess differences in expectations of students early in their first year and it is necessary to provide alternative electives to develop differing specialized interest.