No abstract

This article describes the child healthcare system in Cyprus up to June 2019. Before that Cyprus used to be the only country in the European Union without a universal National Health System. Up to 2019 child healthcare in Cyprus consisted of two separate sectors: the public and the private system. The public healthcare system is financed by the government, while in the private sector the patients pay themselves or are covered by private insurance. There is easy access to acute medical care in the emergency departments of five public hospitals across the country. However, primary care is not available free-of-charge to all children. Primary healthcare is delivered in the paediatric outpatient departments of various public and private hospitals and clinics, as well as by numerous paediatricians within private practices. Secondary care is provided mainly in the public sector and to a lesser extent in private clinics. Tertiary care is available only centrally in the capital of Cyprus, at a dedicated university-affiliated maternity and children’s public hospital with specialist paediatric services. Current major child health challenges in Cyprus include dealing with obesity, mental health, chronic illnesses, and vulnerable groups. However, the basic available health indicators for children show an improving trend over time. A national healthcare system was introduced at the end of 2017 and is expected to remove the inequalities and discrepancies that currently extend over the area of child health by tackling financial, quality, equity, efficiency, and effectiveness issues.

A 12.6-year-old girl presented with a 2-month history of headache, recurrent vomiting and 5 kg weight loss. She had been receiving recombinant human growth hormone (rhGH) replacement therapy at a dose of 0.035 mg/kg for the past 10 months, due to short stature. Investigations before initiating rhGH, including brain MRI, had been normal. Physical examination revealed a nystagmus and a mildly elevated arterial blood pressure. Brain MRI revealed a lesion in the posterior aspect of the medulla oblongata, adjacent to the foramen of Magendie. rhGH therapy was discontinued, followed by a gradual resolution of the symptoms. At follow-up 3 months later, she was asymptomatic and physical examination was unremarkable. A subsequent repeat brain MRI showed complete resolution of the lesion, supporting the diagnosis of a variant of reversible posterior leucoencephalopathy syndrome. This is the first case report of a reversible brain lesion linked to rhGH replacement therapy.