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Paediatriki
Volume 82 | Number 2 | May - June - July - August 2019
Four monthly publication of the Greek Paediatric Society
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Stelios Antoniadis
126
AWARDED ARTICLE
Study of risk factors for dyslipidemia in childhood and young adulthood
Kyriaki Papadopoulou-Legbelou, Ioannis Doundoulakis, Anastasia Papadopoulou, Ioannis Barbalias, Maria Emporiadou-Petikopoulou
136
RESEARCH STUDIES
Evaluation of Töllner test and other biomedical markers in early detection of neonatal sepsis
Chatziioannidis I., Lithoxopoulou M., Papacharalambous E., Babatseva E., Kokoviadou K., Kontou A., Tsakalidis C., Karagianni P., Mitsiakos G.
148
Positive-expiratory pressure (PEP) device compared with Flutter device in children with cystic fibrosis
Ntinou Stefania-Rafailia, Hristara-Papadopoulou Alexandra, Hatziagorou Elpida, Tsanakas Ioannis, Fitili Dimitra
158
CASE REPORTS
Pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia (Rendu- Osler- Weber syndrome)
Gketsi Vasiliki, Kyrochristou Electra, Vlachou Georgia, Tsoutsinos Alexandros, Apostolopoulou Soteria
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Transient neonatal myasthenia Gravis due to a mother with asymptomatic myasthenia gravis: a case study A. Drougia, F.Balomenou, M. Katsalouli, E. Domouzoglou, V. Giapros
178
Glomerulonephritis as a complication of H1N1 influenza virus infection
Garyfallia Syridou, Ioannis Drikos, Eleni Papa, Rougas Panagiotis, Dimitrios Kyriazopoulos, Antigoni Pegkou, Artemis Vintila, Eleni Antonopoulou
184 BETWEEN COLLEAGUES
Stelios Antoniadis
186 NEW PUBLICATIONS
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188 BOOK PRESENTATION
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190
INSTRUCTIONS TO AUTHORS
(21/35<250mg/dl, 14/35>250mg/dl), ενώ 33/35 (94,3%)
20/35 (57,1%)
6/35 (17,1%)
e-mail: kelipap@gmail.com, kpapadopoulou@auth.gr
Correspondence
Kyriaki PapadopoulouLegbelou
Τ. +30 2310991463, +30 6944421060
e-mail: kelipap@gmail.com, kpapadopoulou@auth.gr
Study of risk factors for dyslipidemia in childhood and young adulthood
Kyriaki Papadopoulou-Legbelou, Ioannis Doundoulakis, Anastasia Papadopoulou, Ioannis Barbalias, Maria Emporiadou-Petikopoulou
Abstract
Backround: Prompt diagnosis and management of dyslipidemia in childhood is imperative, as it is one of the main risk factors for premature atherosclerosis. Our aim was to record the risk factors (hereditary and acquired) responsible for dyslipidemia in childhood. Methods: Thirty-five children/adolescents (17 boys) aged 6-22years (mean age 12.43±3.9years) were studied, being followed-up in the outpatient clinic of dyslipidemia. A detailed medical history was given by all patients/parents with their consent. Results: All participants had increased levels of total cholesterol (21/35<250mg/dl, 14/35>250mg/dl), while 33/35 (94.3%) also had increased non-HDLcholesterol levels. Furthermore, high levels of lipoprotein (a) and triglycerides were observed in 20/35 (57.1%) and 8/35 (22.8%) respectively, as well as low levels of HDL-Cholesterol in 6/35 (17.1%). Most children (32/35) had normal body weight (BMI<85th percentile), one of the remaining was overweight and two were obese. As for food habits, 20/35 children followed a Mediterranean diet, 10/35 overconsumed red meat and 5/35 consumed fast food frequently. The majority of children (21/35) had low-intensity exercise (<5hours/week), while the remaining 40% had medium/high-intensity exercise (>5hours/week). Family history revealed that at least one parent was obese (45% of participants), or had hypercholesterolemia (88.8%), hypertension (17.1%), coronary artery disease (28.6%), or was a smoker (68.6%). Conclusions: Non-HDL-cholesterol is a highly-sensitive marker for diagnosing hypercholesterolemia in childhood. Dyslipidemia cannot be excluded even in the absence of obesity, unhealthy diet or limited exercise-especially if there is family history of dyslipidemia, premature coronary artery disease, smoking, or obesity in at least one parent.
Key words: Dyslipidemia, hypercholesterolemia, risk factors, children and adolescents
Kyriaki PapadopoulouLegbelou
Ioannis Doundoulakis
Anastasia Papadopoulou
Ioannis Barbalias
Maria Emporiadou-Petikopoulou
4th Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, "Papageorgiou"
General Hospital, Thessaloniki, Greece
(m) και ο
δείκτης μάζας σώματος (ΒΜΙ) (kg/m2). Παιδιά
(TC), τριγλυκερίδια (TG), HDL-χοληστερόλη (HDL-C), LDL- χοληστερόλη ( LDL-C), απολιποπρωτεϊνη Α-I (ApoA-I), απολιποπρωτεϊνη
Juonala et al,
Bogalusa Heart Study, Muscatine Study, Childhood Determinants of Adult Health study
Cardiovascular Risk in Young Finns Study) (17, 32-34),
(38).
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Paediatr 2008;97:1165–1172.
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Correspondence
Ι. Chatziioannidis
3B Ag. Triados Str., 57010 Pefka, Thessaloniki, Greece.
Τ. +30 2310 910401, +306977244542
e-mail: drilias@windowslive. com
Evaluation of Töllner test and other biomedical markers in early detection of neonatal sepsis
Chatziioannidis I., Lithoxopoulou M., Papacharalambous E., Babatseva E., Kokoviadou K., Kontou A., Tsakalidis C., Karagianni P., Mitsiakos G.
Abstract
Backround: Early diagnosis of sepsis is an important step to early initiation of therapy.
Aim: Assessment of clinical-laboratory indicators from Töllner test by adding additional indicators in neonates suspected of sepsis in order to develop a predictive risk model.
Materials and Methods: This study prospectively examined the clinical-laboratory findings from 55 newborn infants with 74 possible sepsis episodes in the “early stage” of the disease hospitalized in the NICU. The newborns were divided in group A with positive blood culture (n=22) and group B with negative blood culture (n=52). The presence of positive blood culture was considered as sepsis. Statistical analysis was performed using the SPSS v.17.
Results: From the Töllner score clinical and hematological symptoms, skin coloration, microcirculation, muscular hypotonia, bradycardia, leucocytosis/leukocytopenia, thrombocytopenia and additional markers as temperature increase, hyperglycemia hypotension and CRP were found statistically significant (p<0,05) for group A. Pathological Töllner test and CRP were associated with increased risk for sepsis.
Conclusions: Skin coloration, microcirculation, hypotonia, bradycardia, presence of leucocytosis/leukocytopenia, thrombocytopenia, temperature increase, hyperglycemia hypotension and increased CRP are important clinical-laboratory indicators for early diagnosis of sepsis. Major prognostic indicators for early diagnosis of sepsis were found to be pathological Töllner test and CRP.
Key words: Töllner test, sepsis, neonates, biomedical markers, indicators
Chatziioannidis I.
Lithoxopoulou M.
Papacharalambous E.
Babatseva E.
Tsakalidis C.
Karagianni P.
Mitsiakos G.
B΄ Neonatal Intensive Care
Unit A.U.T., General Hospital Papageorgiou, Thessaloniki, Greece
Kokoviadou K.
Hematology Department,
G.P.N. Papageorgiou, Thessaloniki
Kontou A.
Α' Neonatal Intensive Care
Unit A.U.T., General Hospital Hippokration, Thessaloniki
κυάνωση ή
πτώσης κορεσμού οξυγόνου ≤85%], (γ) το καρδιαγγειακό σύστημα (βραδυκαρδία (σφύξεις <100 παλμοί/λεπτό), ταχυκαρδία, υπόταση) (δ) το πεπτικό σύστημα (δυσανεξία
σίτιση, γαστρικά υπόλοιπα > 30%, μετεωρισμός)
dows (SPSS Inc., Chicago,
λοίμωξης (χοριοαμνιονίτιδα
group B streptococcus (GBS)),
(Candida parapsilosis).
exact t-test
(10/22 έναντι 7/52),
(5/22
3/52),
(24,29).
To Töllner
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6979335279
e-mail: stefi_ntinou@hotmail.com
Correspondence
Ntinou Stefania-Rafailia
Koritsas 23, 5133
Kalamaria-Thessaloniki Τ. +302310446478, +306979335279
e-mail: stefi_ntinou@hotmail.com
Positive-expiratory pressure (PEP) device compared with Flutter device in children with cystic fibrosis
Ntinou Stefania-Rafailia, Hristara-Papadopoulou Alexandra, Hatziagorou Elpida, Tsanakas Ioannis, Fitili Dimitra
Background: Respiratory physiotherapy should be a daily activity in the life of Cystic Fibrosis patients. However, the patients usually tend to neglect the importance of respiratory physiotherapy, due to its time-consuming techniques. Through researches, easy to use, time saving, economical and effective devices have been developed to support those techniques. The purpose of this study is to compare the effects of two respiratory devices, PEP and Flutter, on patients with cystic fibrosis who have been admitted to the hospital for intravenous administration. Material and methods: Seventeen (17) Cystic Fibrosis patients took part in the study. The maximum exhaled air volume of first second (FEV1), LCI (Lung Clearance Index) and their weight were measured. The study population was divided into 2 groups: Group A: Physiotherapy session with PEP and active cycle of breathing technique (6 individuals) and Group B: Physiotherapy session with Flutter and active cycle of breathing technique (11 individuals).
Results: The mean value of the variable FEV1 with the Flutter device increased from 59.72 to 73.54 units. Differences with PEP do not show marked changes in FEV1 from 82.13 to 87.08. The mean value of the variable LCI with the Flutter device dropped from 15.80 to 13.82 units. Moreover, the PEP device showed a corresponding decrease in the mean value of the variable LCI by 2.35 units (from 14.07 to 11.72). Finally, the average weight value increased from 47.83 to 48.31 when using the Flutter device, while with the PEP device there was a decrease from 50.03 to 49.80.
Conclusions: There was a statistically significant difference in FEV1 and the weight of the individuals using the Flutter device, while there was no statistically significant difference in the LCI. In PEP group, there was a statistically significant difference in the FEV1 and in the LCI, but there was no difference observed in the weight. Based on our results, we could not conclude that one device is superior to another.
Key words: Cystic Fibrosis, Respiratory Physiotherapy, PEP Device, Flutter Device, Active Cycle of Breathing Technique
Ntinou Stefania-Rafailia
Hristara-Papadopoulou
Alexandra
Fitili Dimitra
Department of physiotherapy, Alexander Technological Educational Institute of Thessaloniki, Greece
Hatziagorou Elpida
Tsanakas Ioannis
Pediatric Clinic, Pediatric Pulmonary Unit, Aristotle University of Thessaloniki, Gen. Hospital Ippokrateio, Thessaloniki, Greece
ATS/ERS (Beydon N, Davis SD, Lombardi E, Allen JL et al.
(Vitalograph 2120, VitalographLtdEnnis, Ireland).
(Exhalyzer D, Ecomedics,
(Fuchs
Gappa M.,
Winden, A. Visser, et
Magdalen Gondor, Patricia A.
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(Peak Expiratory Flow,
AVP= Amplatzer vascular plugs
Rendu-Osler-Weber.
Willebrand. Ωστόσο,
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e-mail: vgiapros@uoi.gr
Correspondence
Vasileios Giapros
T. +302651099326
M.+30 6974754893
e-mail: vgiapros@uoi.gr
Transient neonatal myasthenia Gravis due to a mother with asymptomatic myasthenia gravis: a case study
A. Drougia, F. Balomenou, M. Katsalouli, E. Domouzoglou, V. Giapros
Abstract
Introduction: Transient neonatal myasthenia Gravis is a rare disorder that affects 10-20% of neonates of mothers with myasthenia gravis (MG). In most cases it is caused by transplacental transfer of maternal antibodies against the acetylcholine receptor at the neuromuscular junction. Myasthenic symptoms are manifested during the first 24-72 hours of life with variable severity. The risk for the neonate to develop symptoms is not linked to the maternal state of MG nor to the antibody title. It is a transient disorder, and if not treated promptly it could be life threatening.
Case presentation: A neonate of a mother with generalized MG in full clinical remission during the pregnancy is presented. The older sibling was born after a pregnancy with exacerbation of myasthenia, and he remained asymptomatic. The neonatein our case, developed gradually after birth poor sucking, weak cry and hypotonia-muscle weakness, clinical signs that led to the diagnosis of transient neonatal MG. The neonate was tube fed and treatment with pyridostigmine was initiated with good response and total recovery. This case is reported due to the rarity of the disorder and the different impacts of MG in neonates born to the same mother.
Conclusions: The impacts of MG in the pregnant and her offsprings are variable in each case. Τhe close observation of all neonates born to mothers with MG It is of utmost importance for the prompt recognition of the rare cases of TNMG and the initiation of appropriate treatment.
Key words: transient neonatal myasthenia gravis, pregnancy
A. Drougia
F. Balomenou
E. Domouzoglou
V. Giapros
NICU, University Hospital of Ioannina, Ioannina
M. Katsalouli
Neurology Department, Children’s Hospital "Agia Sofia", Athens
Gravis: MG
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ocular onset of anti-muscle specific kinase myasthenia gravis. Neuromascul Dis 2017;27:665657.
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H1N1
K.
e-mail: johndrikos@yahoo. com
Correspondence
Dr. Ioannis Drikos
Gennimata Avenue, Magoula T.+302132028822
M. +306972710576
e-mail: johndrikos@yahoo. com
Glomerulonephritis as a complication of H1N1 influenza virus infection
Garyfallia Syridou, Ioannis Drikos, Eleni Papa, Rougas Panagiotis, Dimitrios Kyriazopoulos, Antigoni Pegkou, Artemis Vintila, Eleni Antonopoulou
Summary
Introduction
Influenza virus primarily affects the respiratory system. It rarely causes extrapulmonary complications, with otitis media and febrile seizures being the most common in children. Acute glomerulonephritis as a complication of H1N1 influenza virus infection has been described only sporadically.
Methods
We present a case of acute glomerulonephritis in a previously healthy adolescent, in the context of infection with influenza A H1N1 virus.
Results
A 15-year old adolescent was admitted to our pediatric department due to fever up to 39.2°C since 36h before admission, along with pharyngalgia, cough, vomit, dizziness and fatigue. Based on his symptoms and the seasonal epidemiology, empiric treatment with oseltamivir was initiated while waiting for RT-PCR for influenza virus in pharyngeal swab, which turned out positive for A H1N1 influenza virus. In the first 24 hours of admission, the patient presented macroscopic haematuria, which completely subsided in the following days, along with fever recession. Urinary phase contrast analysis showed findings compatible with acute glomerulonephritis while the laboratory and imaging testing in the context of AGN were normal. Anti-streptolysin O (ASTO) levels, which were initially above normal (562 IU/ml), did not increase significantly in the following days, and given the fact that C3 levels were constantly within normal limits and pharyngeal culture was negative for pyogenic streptococcus, they were not considered sufficient for poststreptococcal glomerulonephritis diagnosis.
Conclusions
Influenza A virus infection is a rare cause of acute glomerulonephritis in children and should be considered in differential diagnosis in patients with flu-like illness and concomitant haematuria.
Key words: H1N1, acute glomerulonephritis, haematuria, complications of influenza
Garyfallia Syridou
Ioannis Drikos
Eleni Papa
Rougas Panagiotis
Dimitrios Kyriazopoulos
Antigoni Pegkou
Artemis Vintila
Eleni Antonopoulou
Department of Pediatrics, Thriasio General Hospital, Athens, Greece
έλεγχο διαπιστώθηκαν: WBC / 6400 / ml (Ν: 78,1%, L: 9,0%, Μ: 12,7%), Hb 12,4 g / dl, PLT 184000 / ml, CRP 44,6 mg / L. Ο βιοχημικός έλεγχος ήταν φυσιολογικός, ενώ στη γενική ούρων παρουσίασε αιματουρία
(ΕΒ: 1025 pH: 6,0 Αιμοσφαιρίνη (+++), Λέυκωμα: (-) Νιτρώδη: (-), Πυοσφαίρια: 3-5/κοπ Ερυθρά:
ASTO 562 IU / ml, C3 95,3 mg / dl C4 32,4 mg / dl, ΙgG 1050 mg / dl, IgA 173 mg / dl, IgM 108 mg/ dl και ANA (-), antiDNA(-), cANCA(-), pANCA (-), U/S NOK φυσιολογικό.
Κατά τη διάρκεια της νοσηλείας,
(ΕΒ: 1025 pH: 6,0 Αιμοσφαιρίνη (+++), Λέυκωμα: (+) Νιτρώδη: (-) Κετόνες: (-) Πυοσφαίρια: 1-3
Ερυθρά: 15-20/κοπ), με Ca/Cr=0.0076, Cr Ούρων=303mg/dl,
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