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Soldatou A, Garoufi A. Editorial: Pediatric obesity: how to diverge from developmental pathways? Front Endocrinol (Lausanne) 2024; 15:1363099. [PMID: 38323111 PMCID: PMC10844501 DOI: 10.3389/fendo.2024.1363099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Alexandra Soldatou
- 2 Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anastasia Garoufi
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Rigas N, Kyritsis Z, Dagla M, Soldatou A, Orovou E, Tzitiridou-Chatzopoulou M, Eskitzis P, Antoniou E. Post-Traumatic Stress Disorder Symptoms among Pediatric Healthcare Workers. Nurs Rep 2024; 14:115-127. [PMID: 38251188 PMCID: PMC10801477 DOI: 10.3390/nursrep14010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Post-traumatic stress disorder symptoms related to work in pediatric departments aremajor public health problems, as they directly affect health organizations, healthcare workers, and, due to the poor quality of care, the patients as well. The post-traumatic symptoms that a healthcare worker may experience are related to intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. The aim of the present investigation was to identify risk factors that contribute to the development of PTSD in pediatric healthcare workers, in order to implement necessary workplace measures. A sample of four hundred and forty-five pediatric workers at seven Greek public hospitals consented to participate in the survey. Socio-demographic data and a post-traumatic checklist (5th edition) were used to diagnose post-traumatic stress disorder. According to the results, risk factors for the development of post-traumatic symptoms include medical or nursing errors, threats to a child's life, and incidents of workplace bullying. More specifically, 25.2% of the participants had a provisional PTSD diagnosis, 72.8%of the sample experienced an incident involving a medical or nursing error in their workplace related to the treatment or care of a child, 56% experienced an incident involving a child's death or a threat to a child's life due to a serious illness or injury, and 55.5% experienced an incident of workplace bullying. In addition, it was found that having a university-level education, master's, or PhD, working in a circular shift, being assigned to a department by management rather than the worker, and dissatisfaction with salary were associated with post-traumatic stress disorder. The high rates of PTSD symptoms among participants highlight the need for prevention and management measures to protect and support the mental health of workers in pediatric departments. We propose frequent evaluations of the mental health of employees, more time for rest, incentives for professional development, utilization of their specializations and specialties, support from mental health specialists when symptoms are diagnosed, and the option for employees to change departments if they wish or if they show symptoms of mental trauma.
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Affiliation(s)
- Nikolaos Rigas
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.D.); (E.A.)
| | - Zacharias Kyritsis
- Department of Mathematics, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Maria Dagla
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.D.); (E.A.)
| | - Alexandra Soldatou
- Faculty of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece; (E.O.); (M.T.-C.); (P.E.)
| | | | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece; (E.O.); (M.T.-C.); (P.E.)
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (M.D.); (E.A.)
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Rigas N, Kyritsis Z, Gouroundi K, Soldatou A, Dagla M, Orovou E, Antoniou E. The Mediating Role of Anxiety in the Relationship between Job Satisfaction and Psychosocial Functions of Nurses and Pediatricians in PICUs. Mater Sociomed 2024; 36:26-32. [PMID: 38590601 PMCID: PMC10999150 DOI: 10.5455/msm.2024.36.26-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background Job satisfaction refers to an individual's overall attitude towards their job. It is influenced by various factors such as work environment, job role, work-life balance, compensation, anxiety, opportunities for growth and development. However, low levels of job satisfaction can have a significant impact on an individual's mental health and overall well-being. Objective We contacted this study in order to assess the effect of PICU nurses' and pediatricians' job satisfaction on their psychosocial functioning and to examine the role of anxiety as a mediating factor in this relationship. Methods A sample of 155 nurses and pediatricians at 7 University Hospitals in Greece has consented to participate in the study. Socio-demographic data, Hamilton Rating Scale for Anxiety, Minnesota Satisfaction Questionnaire -short form and a Brief Inventory of Psychosocial Functioning were used to evaluate anxiety, job satisfaction and psychosocial functions. Results According to our results, participants with moderate or severe levels of anxiety showed moderate or low job satisfaction, while moderate or severe anxiety was also associated with low levels of participants' psychosocial functioning. Job satisfaction is a dynamic situation that is affected by the levels of anxiety of each worker in PICU. Conclusion The presence of anxiety may be related to comorbid mental health disorders since it affects the psychosocial functions of the worker. We propose a longer rest period, a change of department in case an employee wishes it or shows symptoms of increased stress or another mental health disorder, regular assessments by mental health experts for all PICU's staff and support after a diagnosis of a mental health problem.
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Affiliation(s)
- Nikolaos Rigas
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Zacharias Kyritsis
- Department of Mathematics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Alexandra Soldatou
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Eirini Orovou
- Department of Midwifery, University of Western Macedonia, Ptolemaida, Greece
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Karavanaki K, Karanasios S, Soldatou A, Tsolia M. SARS-CoV-2 vaccination in children and adolescents with and without type 1 diabetes mellitus. Endocrine 2023; 82:226-236. [PMID: 37587391 PMCID: PMC10543146 DOI: 10.1007/s12020-023-03471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
Adults with Diabetes Mellitus (DM) have increased risk of severe clinical presentation during COVID-19 infection, while children and adolescents with type 1 diabetes (T1D) have the same mild clinical course as their healthy peers, especially those with optimal glycemic control. The present review focuses on the necessity of COVID-19 vaccination among children and adolescents with T1D, and also in their non-diabetic peers. The efficacy and safety of COVID-19 vaccines are also discussed, as well as their various side-effects, ranging from common mild to very rare and serious ones. Furthermore, the results of COVID-19 vaccination of adolescents with and without T1D are reported, as well as the efficacy and concerns about childhood vaccination. It is concluded that patients with DM of all age groups should maintain optimal diabetic control in order to avoid glycemic deterioration during COVID-19 infection. Furthermore, despite the very rare and serious complications of COVID-19 vaccines, vaccination against COVID-19 is recommended for children and adolescents with T1D to prevent glycemic deterioration and rare but serious complications of COVID-19 infection.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
| | - Maria Tsolia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
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Kakleas K, Kandyla B, Tsitsika A, Karanasios S, Tzavara C, Soldatou A, Karavanaki K. The role of various influence sources on sexual behavior in adolescents with type 1 diabetes in comparison to healthy peers: a cross-sectional study from Greece. Hormones (Athens) 2023; 22:395-402. [PMID: 37453987 DOI: 10.1007/s42000-023-00467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Patients with type 1 diabetes mellitus (T1D) are at increased risk of sexually risky behaviors, such as unintended pregnancies. Adolescents with T1D use different sources of information on sexual education such as parents, friends, teachers, and the media. The study aim was to investigate the effect of different sources of information in development of sexual risk behaviors in T1D adolescents in comparison to healthy peers. METHODS The study included 174 adolescents (58 adolescents with T1D and 116 healthy controls). Anonymous questionnaires were used to evaluate sexually risky behaviors. RESULTS T1D adolescents were more frequently asking advice from friends on sexual matters concerning the opposite sex (p = 0.026) and from school teachers (p = 0.059) when compared to controls. The proportion of sexually active T1D adolescents who had ever consumed alcohol before any sexual intercourse was higher when informed by friends of the opposite sex (p = 0.039) and not informed by a physician (p = 0.025) and lower when informed by parents (p = 0.015). When comparing among sexually active adolescents those who felt that they were adequately informed to those not well informed, no significant difference in high risk behaviors was found. CONCLUSIONS The majority of T1D adolescents felt that they were adequately informed on sexual matters compared to healthy peers. They mostly used friends of the opposite sex and teachers as information sources. Nevertheless, T1D adolescents were more likely to adopt a risky sexual behavior if they were not informed by their parents and medical professionals, or preferred friends of the opposite sex.
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Affiliation(s)
- Konstantinos Kakleas
- General Pediatric Clinic, First University Department of Pediatrics, "Agia Sophia" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
- "P. & Α. Kyriakou" Children's Hospital, Thivon Kai Levadeias, 11527, Athens, Greece.
| | - Betina Kandyla
- Diabetes and Metabolism Unit, Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Artemis Tsitsika
- Adolescent Health Unit (Α.H.U.) Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Unit, Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Chara Tzavara
- Adolescent Health Unit (Α.H.U.) Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Unit, Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Unit, Second University Department of Pediatrics, "P. & Α. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Tsimeki M, Tsimpidakis A, Roidi S, Gregoriadis T, Soldatou A, Kitra V, Michala L. Genital GVHD in Female Children and Adolescents: A Systematic Review of Case Reports and Case Series. Children (Basel) 2023; 10:1463. [PMID: 37761424 PMCID: PMC10527655 DOI: 10.3390/children10091463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Genital graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) is an underdiagnosed manifestation of chronic GVHD. Few articles have been published in pediatric populations, and there are no established guidelines for the management of this condition in children. This study aims to provide a systematic literature review of the published studies and cases of genital (vulvovaginal) GVHD in girls and adolescents post HSCT, with a focus on the time of diagnosis and clinical manifestations. The authors searched for English-language articles published after 1990, which included full patient details. Thirty-two cases of female patients under 20 years of age were identified. The median time of diagnosis was 381 days (IQR: 226-730 days), and 83% of patients developed Grade 3 vulvovaginal GVHD. Based on these observations, an early pediatric gynecologic examination of these patients, soon within the first year after HSCT, could be suggested for early diagnosis, treatment initiation and prevention of long-term complications.
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Affiliation(s)
- Maria Tsimeki
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology, School of Medicine, Andreas Syngros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece;
| | - Stella Roidi
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Themos Gregoriadis
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
| | - Alexandra Soldatou
- Second Department of Pediatrics, School of Medicine, Children’s Hospital of Athens “P. & A. Kyriakou”, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Kitra
- Stem Cell Transplant Unit, “Agia Sofia Children’s Hospital” Infectious Diseases Unit, Department of Pathophysiology, School of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Lina Michala
- First Department of Obstetrics and Gynecology, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.T.); (S.R.); (T.G.)
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Herouvi D, Paltoglou G, Soldatou A, Kalpia C, Karanasios S, Karavanaki K. Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents. Children (Basel) 2023; 10:1230. [PMID: 37508727 PMCID: PMC10378563 DOI: 10.3390/children10071230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Obesity is a multifactorial chronic impairment that further decreases quality of life and life expectancy. Worldwide, childhood obesity has become a pandemic health issue causing several comorbidities that frequently present already in childhood, including cardiovascular (hypertension, dyslipidemia), metabolic (Type 2 diabetes mellitus, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal and musculoskeletal disorders. In addition, obese children frequently experience stress and psychosocial symptoms, including mood disorders, anxiety, prejudice and low self-esteem. Given that cardiovascular risk factors and pediatric obesity have the tendency to pertain into adulthood, obesity management, including weight control and physical activity, should start before the late teens and certainly before the first signs of atherosclerosis can be detected. This review aims to concisely present options for childhood obesity management, including lifestyle modification strategies and pharmacological treatment, as well as the respective treatment indications for the general practitioner.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - George Paltoglou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
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Karavanaki K, Rodolaki K, Soldatou A, Karanasios S, Kakleas K. Covid-19 infection in children and adolescents and its association with type 1 diabetes mellitus (T1d) presentation and management. Endocrine 2023; 80:237-252. [PMID: 36462147 PMCID: PMC9734866 DOI: 10.1007/s12020-022-03266-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022]
Abstract
Children seem to be affected by the new SARS-CoV-2 virus less severely than adults, with better prognosis and low mortality. Serious complications of COVID-19 infection in children include multisystem inflammatory response syndrome in COVID-19 infection (MIS-C), myo-or pericarditis and, less frequently, long COVID syndrome. On the other hand, adults with type 1 (T1D) or type 2 diabetes (T2D) are among the most vulnerable groups affected by COVID-19, with increased morbidity and mortality. Moreover, an association of SARS-CoV-2 with diabetes has been observed, possibly affecting the frequency and severity of the first clinical presentation of T1D or T2D, as well as the development of acute diabetes after COVID-19 infection. The present review summarizes the current data on the incidence of T1D among children and adolescents during the COVID-19 pandemic, as well as its severity. Moreover, it reports on the types of newly diagnosed diabetes after COVID infection and the possible pathogenetic mechanisms. Additionally, this study presents current data on the effect of SARS-CoV-2 on diabetes control in patients with known T1D and on the severity of clinical presentation of COVID infection in these patients. Finally, this review discusses the necessity of immunization against COVID 19 in children and adolescents with T1D.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kalliopi Rodolaki
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens,"P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kostas Kakleas
- First Department of Pediatrics, National and Kapodistrian University of Athens,"Aghia Sophia" Children's Hospital, Athens, Greece.
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Herouvi D, Soldatou A, Paschou SA, Kalpia C, Karanasios S, Karavanaki K. Bariatric surgery in the management of childhood and adolescence obesity. Endocrine 2023; 79:411-419. [PMID: 36194346 DOI: 10.1007/s12020-022-03210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nowadays, childhood obesity is literally a global pandemic health problem. According to current data, pediatric obesity is strongly associated with adult excess weight status as well as the development of certain co morbidities, already present in childhood, including cardiovascular disorders (dyslipidemia, hypertension), endocrine/metabolic (Type 2 diabetes, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal, and musculoskeletal problems. Additionally, children with obesity frequently experience psychosocial issues, such as mood disorders, anxiety, prejudice and low self-esteem. METHODS AND RESULTS The aim of this article was to evaluate whether or not bariatric surgery is an effective and safe treatment option for childhood obesity. This paper is based on a literature search in Pub Med for articles referring to the medical co morbidities and the results of different types of bariatric surgery for the treatment of childhood obesity (up to 18 years) until December 2021. The following keywords were used as MESH terms: childhood obesity, adolescence obesity, co morbidities and bariatric surgery. The bibliographic references of the studies found in these databases were also reviewed. CONCLUSION Although some researchers demonstrate that surgical interventions in adolescents might be a reliable intervention to lose weight in a maintainable way and reverse many of the co morbidities associated with severe obesity, their safety and long-term efficacy are still not clarified. Thus, large long-term prospective studies, with detailed recording of complications and co morbidity resolution are obviously needed in order to determine the role of surgical treatment in childhood obesity.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece.
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "P&A Kyriakou" Children's Hospital,, Athens, Greece
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Panagopoulou K, Gkentzi D, Fouzas S, Mentis M, Kostopoulou E, Plotas P, Papaevangelou V, Soldatou A, Karatza A, Bertzouanis A, Spyridakis I, Sfoungaris D, Zavras N, Salakos C, Blevrakis E, Sakellaris G, Kambouri K, Giapros V, Roupakias S, Jelastopulu E, Chantzi Z, Panagiotopoulos V, Varvarigou A, Dimitriou G, Sinopidis X. Child abuse experience, training, knowledge, and attitude of healthcare professionals in sixty hospitals in Greece. Eur Rev Med Pharmacol Sci 2023; 27:659-672. [PMID: 36734738 DOI: 10.26355/eurrev_202301_31068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aims to record the overall perception of healthcare professionals on child abuse and identify potential affecting factors in a nationwide scale in Greece as well as to provide information that might be useful for future educational actions. MATERIALS AND METHODS A total of 1,185 healthcare professionals in 60 hospitals with pediatric departments across Greece participated in this cross-sectional study. Participants included pediatricians, pediatric surgeons, residents, nurses, psychiatrists, psychologists, and social workers. Sections under investigation involved experience and training in child abuse, knowledge of formal and judicial issues, clinical knowledge, and self-assessment. RESULTS Although more than half of the participants had confronted child abuse (n=712, 60.08%), only 273 (38.34% of them) submitted reports. One third of participants reported that they had received some training (n=440, 37.13%), mainly of postgraduate nature and based on personal initiative. Of those who reported child abuse, 175 (64.10%) had been trained. Each professional category was aware of topics regarding its own interest, without adequate knowledge of other disciplines. One third of psychiatrists, psychologists, and social workers felt confident in discussing with children and parents. Relevant scores were lower in the other categories. The lower scores were recorded among nurses and residents. The training deficit and reluctance to engage with judicial issues were the main causes of avoidance to deal with child abuse. CONCLUSIONS Focused and organized training in child abuse is crucial to create reliable professionals in the field. The internet is a considerably helpful tool. Professionalism must characterize knowledge and practice in child abuse at the same level as in other medical topics. Motivation to engage should be early inspired and developed during the graduate years.
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Affiliation(s)
- K Panagopoulou
- Department of Pediatrics, University of Patras School of Medicine, Patras, Greece.
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Giannakas C, Manta A, Livanou ME, Daniil V, Paraskeva A, Georgiadou MK, Griva N, Papaevangelou V, Tsolia M, Leventhal JM, Soldatou A. Creation and evaluation of a participatory child abuse and neglect workshop for medical students. BMC Med Educ 2022; 22:797. [PMID: 36384547 PMCID: PMC9670524 DOI: 10.1186/s12909-022-03837-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Since child abuse and neglect (CAN) is prevalent worldwide, medical students should acquire basic knowledge, skills, and confidence in identifying and addressing CAN. Although significant educational efforts have been previously described, none has focused on using participatory methods to teach medical students CAN. PURPOSE To: 1) develop a participatory educational workshop in CAN for medical students, 2) gather, train, and establish a peer-to-peer teaching group, and 3) assess the effectiveness of the workshop in gain of knowledge and improvement of self-confidence for participants. METHODS A two-hour workshop was created with role-playing, the use of mannikins and peer-to-peer teaching. A 15-item knowledge and a 9-item self-confidence questionnaire were used before, right after, and six months after each workshop. RESULTS Nine workshops in two academic pediatric departments with a total attendance of 300 6th year medical students were conducted. For the 69 students who completed the questionnaires at all three times, there were statistically significant gains in knowledge right after (p < .001) and six months after (p < .0001) the workshops. Similarly, self-confidence increased right after (p < .0001) and six months after (p < .001) the workshops. Self-selection bias testing indicated that these 69 students who completed all three questionnaires were representative of those who completed the pre-testing and the testing right after. CONCLUSIONS We successfully established a peer-to-peer teaching group to conduct nine participatory workshops that improved the participants' knowledge and self-confidence in CAN. This feasible and novel active learning approach may help address inadequacies in medical curricula.
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Affiliation(s)
- Christos Giannakas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Manta
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vasiliki Daniil
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Paraskeva
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nefeli Griva
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Rimini 1, 124 62 Chaidari, Greece
| | - Maria Tsolia
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon and Levadeias, Goudi 11527, Athens, Greece
| | - John M. Leventhal
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, CT 06510 New Haven, USA
| | - Alexandra Soldatou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon and Levadeias, Goudi 11527, Athens, Greece
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12
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Karavanaki K, Paschou SA, Tentolouris N, Karachaliou F, Soldatou A. Type 2 diabetes in children and adolescents: distinct characteristics and evidence-based management. Endocrine 2022; 78:280-295. [PMID: 36029440 DOI: 10.1007/s12020-022-03172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Since the dramatic rise of obesity prevalence in childhood and adolescence has contributed to increased rates of type 2 diabetes (T2D) in youth, we sought to explore current evidence-based management options for pediatric T2D patients. METHODS A comprehensive literature search was performed for studies of T2D in childhood and adolescence until September 2021. RESULTS Special pathophysiological and diagnostic characteristics of T2D in this age are presented, while the main focus of the article is on management. Lifestyle interventions with healthy diet and exercise are of great importance for the treatment of T2D in children and adolescents. Metformin and insulin remain the traditional therapeutical means, while liraglutide recently gained indication for children older than 10 years both in USA and Europe. Data on the use, efficacy, safety and therapeutic considerations of other pharmacological treatments in children and adolescents with T2D are critically discussed. CONCLUSION Although many new and promising therapeutic strategies have been introduced during recent years for the management of T2D in adults, available therapeutic options for the management of pediatric T2D remain limited.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Tentolouris
- Diabetes Centre, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens, Greece
| | - Foteini Karachaliou
- Diabetes and Endocrine Clinic, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
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Papailiou S, Soldatou A, Marmarinos A, Avgeris M, Papathoma E, Sindos M, Georgantzi S, Rodolakis Α, Iacovidou N, Gourgiotis D, Tsolia M. Inadequate protection against measles and rubella among pregnant women in Greece during the last measles outbreak. J Infect 2022; 84:e95-e97. [DOI: 10.1016/j.jinf.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Sakou II, Soldatou A, Seretis A, Karanasios E, Paltoglou G, Karavanaki K. Markedly elevated troponin and NT-proBNP and myocardial dysfunction in an adolescent with severe diabetic ketoacidosis: a case report. Clin Pediatr Endocrinol 2022; 31:192-198. [PMID: 35928382 PMCID: PMC9297169 DOI: 10.1297/cpe.2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/16/2022] [Indexed: 12/04/2022] Open
Abstract
Severe diabetic ketoacidosis (DKA), rarely, may be associated with elevated troponin and
proBNP levels in adults with a history of diabetes. However, few cases have reported this
association in children with severe and complicated DKA. We describe a case of severe DKA
(pH: 6.89, HCO3: 6.5) in a 14-yr-old female adolescent in which the symptoms of DKA were
presented days before the diagnosis. The patient was under the effect of acidosis
(Kussmaul respiration) for 12 h before admission to our hospital, where she was admitted
in a critical clinical condition. After successful treatment with DKA with intensive
intravenous fluid and regular insulin, the patient presented with abnormal cardiac rhythm,
disturbance of interventricular septum motility, a mild decrease in left ventricular
systolic function, negative T waves in leads III and aVF, and a marked increase in
troponin and brain natriuretic peptide (NT-proBNP) levels. All abnormal findings
completely resolved within 8 days after the initiation of DKA treatment. The phenomenon in
our case was transient, and the patient had a good long-term outcome. However, it
represents a challenge for clinicians; therefore, emphasis should be given to cardiac
monitoring during the course of severe and prolonged DKA in children and adolescents.
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Affiliation(s)
- Irine-Ikbale Sakou
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | - Aristeidis Seretis
- Cardiology Deparment, “P&A Kyriakou” Children’s Hospital, Athens, Greece
| | | | - George Paltoglou
- University Research Institute of Maternal and Child Health and Precision Medicine, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P&A Kyriakou” Children’s Hospital, Athens, Greece
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Kandyla B, Tsitsika A, Soldatou A, Tzavara C, Karanasios S, Karavanaki K. Sexual Risk Behaviors of Adolescents with Type 1 Diabetes in Comparison with Their Peers. Children (Basel) 2021; 9:20. [PMID: 35053645 PMCID: PMC8774407 DOI: 10.3390/children9010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents with type 1 diabetes mellitus (T1D) may differ from peers regarding sexual risk behaviors. OBJECTIVES To explore sexual risk behaviors of adolescents with T1D in comparison with peers. MATERIALS AND METHODS The subjects were 174 adolescents, 58 adolescents with T1D (mean ± SD age 16.3 ± 2.0 yrs, disease duration 6.7 ± 3.5 yrs and HbA1c:8.0 ± 1.3%) and 116 without (matched 1:2). Anonymous, self-reported questionnaires were used to evaluate sexual education and behaviors. RESULTS Fewer adolescents with T1D than those without had a sexual experience (74.1% vs. 87.4%, p = 0.033), with similar age of sexual debut. Among adolescents with T1D, ≥2 risky behaviors were observed less frequently than adolescents without T1D (8.62% vs. 23.27%, p = NS respectively) and in fewer girls than boys in both adolescents with T1D (0% vs. 18.5%, p = NS) and adolescents without T1D (11% vs. 44%, p = 0.022). Adolescents with T1D with ≥2 risky behaviors were older (p = 0.031), younger at first sexual intercourse (p = 0.031), with higher maternal education (p = 0.039). Early sexual debut was associated with higher maternal education (p = 0.014) and HbA1c (p = 0.049). Most adolescents without T1D with ≥2 risky behaviors were boys and older than peers. CONCLUSIONS Adolescents with T1D and females were more cautious than adolescents without T1D regarding sex. The associations of increased risky behaviors with male gender, older age, younger age at sexual debut and higher maternal education in adolescents with T1D merit further investigation.
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Affiliation(s)
- Betina Kandyla
- Diabetes and Metabolism Clinic, Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.S.); (S.K.); (K.K.)
| | - Artemis Tsitsika
- Adolescent Health Unit (A.H.U.), Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.T.); (C.T.)
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.S.); (S.K.); (K.K.)
| | - Chara Tzavara
- Adolescent Health Unit (A.H.U.), Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.T.); (C.T.)
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.S.); (S.K.); (K.K.)
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, Second University Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, 115 27 Athens, Greece; (A.S.); (S.K.); (K.K.)
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16
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Garoufi A, Pagoni A, Papadaki M, Marmarinos A, Karapostolakis G, Michala L, Soldatou A. Cardiovascular Risk Factors and Subclinical Atherosclerosis in Greek Adolescents with Polycystic Ovary Syndrome: Its Relationship with Body Mass Index. Children 2021; 9:children9010004. [PMID: 35053629 PMCID: PMC8773958 DOI: 10.3390/children9010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition affecting 6–18% of adolescents and is strongly associated with obesity and cardiovascular risk factors, enhancing the risk of atherosclerosis. Thirty-two adolescents with newly diagnosed PCOS were evaluated for lipid profile disorders, insulin resistance, inflammation, non-alcoholic fatty liver disease (NAFLD), and subclinical atherosclerosis through measurements of carotid intima–media thickness (cIMT). The relationships of the above markers with increased body mass index and abdominal obesity were investigated. Twenty-three adolescents (72%) were overweight (OW) or obese (OB). The OW/OB group had significantly higher insulin, HOMA-IR, high-sensitive C-reactive protein (hsCRP), visceral adiposity index (VAI), and lipid accumulation product (LAP) levels; and lower glucose-per-insulin ratios and HDL-C levels compared to the healthy weight group. The cIMT and small dense low-density lipoprotein cholesterol (sdLDL-C) levels did not differ between the two groups. Similarly, cIMT and sdLDL-C levels did not differ between PCOS-adolescents and healthy controls. CIMT was positively correlated with systolic blood pressure and waist circumference per height ratio. In conclusion, OW/OB PCOS-adolescents have a cluster of adverse factors predisposing them to atherosclerotic cardiovascular disease. Therefore, early cardiovascular risk assessment, as well as timely and targeted interventions, are necessary for prevention.
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Affiliation(s)
- Anastasia Garoufi
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Athanasia Pagoni
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Maria Papadaki
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry—Molecular Diagnostic, 2nd Department of Pediatrics, Medical School, NKUA, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, Greece;
| | - Georgios Karapostolakis
- Radiology Department, 401 Military General Hospital of Athens (MGHA), 138 Mesogeion Av., 11525 Athens, Greece;
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, Medical School, Alexandra General Hospital, National and Kapodistrian University of Athens (NKUA), 80 Vassilissis Sofias Av., 11528 Athens, Greece;
| | - Alexandra Soldatou
- Lipid Outpatient Unit, 2nd Department of Pediatrics, Medical School, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens (NKUA), Thivon & Levadias Str., Goudi, 11527 Athens, Greece; (A.G.); (A.P.); (M.P.)
- Correspondence:
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Papadaki M, Marmarinos A, Tsolia M, Gourgiotis D, Soldatou A. Cathelicidin levels in nasal secretions are associated with the severity of acute bronchiolitis. Pediatr Pulmonol 2021; 56:1673-1680. [PMID: 33656266 DOI: 10.1002/ppul.25349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/29/2021] [Accepted: 02/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the association of serum vitamin D and nasal secretion antimicrobial peptides (AMPs) levels with the severity of acute bronchiolitis. STUDY DESIGN We conducted a prospective single pediatric tertiary care center cohort study of inpatients aged 0-18 months with a first episode of acute bronchiolitis from November 1st 2014 to April 30th 2017. Disease severity was determined by the length of hospitalization and supplemental hospital data. Qualitative measurements included serum 25(OH)D and nasal secretion LL-37 and β-defensin-2 levels. Correlations were examined with the Mann-Whitney and Kruskal-Wallis criteria for qualitative and the correlation coefficient Spearman's rho for quantitative factors. Multiple linear and logarithmic regression were performed to adjust for confounding factors. RESULTS The study population consisted of 153 infants and toddlers with median age 3.1 months (interquartile range:1.6-4.9). No association was found between serum 25(OH)D and AMPs nasal secretions levels. Serum 25(OH)D and nasal secretion β-defensin-2 levels were not associated with the severity of bronchiolitis. In contrast, LL-37 levels were inversely associated with the length of hospitalization (rho = -0.340, p = .001), the need for medication use (p = .001), as well as the duration of oxygen supplementation (rho = -0.339, p = .001), and intravenous fluid administration (rho = -0.323, p = .001). This association remained significant after adjustment for potential confounders. CONCLUSION A significant association between LL-37 nasal secretions levels with the severity of acute bronchiolitis was found in hospitalized infants and toddlers. The role of LL-37 in the pathogenesis of bronchiolitis merits further investigation.
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Affiliation(s)
- Maria Papadaki
- 2nd Department of Pediatrics, Children's Hospital of Athens "P. & A. Kyriakou", National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Marmarinos
- 2nd Department of Pediatrics, Laboratory of Clinical Biochemistry - Molecular Diagnostics, Children's Hospital of Athens "P. & A. Kyriakou", National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Pediatrics, Children's Hospital of Athens "P. & A. Kyriakou", National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Gourgiotis
- 2nd Department of Pediatrics, Laboratory of Clinical Biochemistry - Molecular Diagnostics, Children's Hospital of Athens "P. & A. Kyriakou", National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Soldatou
- 2nd Department of Pediatrics, Children's Hospital of Athens "P. & A. Kyriakou", National and Kapodistrian University of Athens, Athens, Greece
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Abstract
OBJECTIVE We aimed to describe our experience in diagnosing and managing Lipschutz ulcers in children. METHODS This was a retrospective data review in a tertiary referral clinic for pediatric and adolescent gynecology. We identified patients referred with a vulval ulcer and recorded relating symptoms, presentation, and resolution. RESULTS We identified 7 nonsexually active girls with vulvar ulcers presenting within the course of an upper respiratory infection, including fever and cough. Average age was 12.25 years (range, 11-14.5 years). All patients presented with at least one large painful ulcer within the inner surface of the labium minor, of up to 2 cm in diameter.Initial presentation was of a bullous lesion that was then ulcerated, covered by a black gangrenous scab. Over the course of the week, the scab fell leaving a white-based ulcer that gradually healed. All children complained of dysuria stemming from contact irritation with urine. The ulcer gradually disappeared, leaving no mark within 10 days of initial presentation.Two of 7 patients presented with 3 similar recurrences after flu-like symptoms.None of the patients qualified for diagnosis of Behcet disease. CONCLUSIONS Lipschutz ulcers are painful genital lesions causing anxiety to the girl and her family. Pediatricians and gynecologists should be aware of the condition, diagnose it where appropriate, avoid unnecessary medication, and reassure the patient that it is self-limited.
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Affiliation(s)
- Maria Charamanta
- From the 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra Hospital
| | - Alexandra Soldatou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens, Aglaia and Panagiotis Kyriakou Hospital, Athens, Greece
| | - Lina Michala
- From the 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra Hospital
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Krepis P, Papasotiriou M, Tsolia MN, Soldatou A. Child Car Safety: A Parental Survey at a Tertiary Care Emergency Treatment Center in Greece. Pediatr Emerg Care 2021; 37:29-33. [PMID: 29489606 DOI: 10.1097/pec.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to assess parental behavior in terms of child restraint systems (CRS) use under emergency conditions while driving to the hospital's outpatient settings as well as their routine child car safety (CCS) practices. METHODS A cross-sectional survey of parents/caregivers transporting children 13 years or younger was conducted at the Emergency Treatment Center of a pediatric tertiary care center in Athens, Greece. Participants completed a questionnaire inquiring about the possession of CRS, and type and use of appropriate CRS while driving to the Emergency Treatment Center and under routine conditions. In addition, presence and type of parental education with regard to CCS and the use of seat belts among drivers were assessed. RESULTS Of 444 participants, 51.4% children were carried restrained, although 48.6% were fastened in an improper seat for their age, in contrast with 23.7% who travel unrestrained on a daily basis. Forward-facing restraint seats were most popular, with 53.9% total use even in children younger than 2 years or older than 4 years, whereas booster seats (9.4%) and rear-facing restraint seats (18.2%) were inappropriately disfavored. Children younger than 4 years, male drivers, and drivers who had received information on CCS had higher odds of using CRS. The proportion of those had never been provided any CCS education was 38.5%. CONCLUSIONS Child restraint systems use was inappropriately low under routine conditions and declined even further under emergency circumstances. Most children younger than 2 years and older than 4 years traveled inappropriately restrained in a forward-facing restraint seat. Parents should be more intensively educated on child car safety seat and the proper CRS use.
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Affiliation(s)
- Panagiotis Krepis
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Maria N Tsolia
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandra Soldatou
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Ntineri A, Kollias A, Bountzona I, Servos G, Moyssakis I, Destounis A, Vazeou A, Soldatou A, Stergiou GS. Twenty-four-hour ambulatory central blood pressure in adolescents and young adults: association with peripheral blood pressure and preclinical organ damage. J Hypertens 2020; 38:1980-1988. [PMID: 32890274 DOI: 10.1097/hjh.0000000000002518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the relationship of 24-h ambulatory central blood pressure (ABP) with preclinical organ damage in youth. METHODS Individuals aged 10-25 years referred for suspected hypertension and healthy volunteers had simultaneous 24-h peripheral and central ABP monitoring (Mobil-O-Graph 24 h PWA). Central BP was calculated using two different calibration methods (c1 using oscillometric systolic/diastolic ABP; c2 using mean arterial/diastolic ABP). Their association with preclinical organ damage [left ventricular mass index (LVMI), carotid intima-media thickness (IMT), 24-h pulse wave velocity (PWV)] was investigated. RESULTS A total of 136 participants were analyzed (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 34% with elevated ABP). Twenty-four-hour peripheral systolic ABP (pSBP) was higher than c1 systolic ABP (c1SBP) by 14.1 ± 3.7 mmHg, but lower than c2SBP by 6.5 ± 7.6 mmHg (all P < 0.01). c2SBP quartiles provided better stratification of preclinical organ damage than pSBP. Both c1SBP/c2SBP were significantly associated with LVMI (r = 0.35/0.33) and IMT (r = 0.23/0.42; all P < 0.01; primary endpoint). These associations were stronger for c2SBP compared with those of pSBP in adolescents but not in adults. PWV was more closely associated with pSBP than c2SBP (r = 0.94/0.83, P < 0.01). LVMI variation was best determined by c2SBP in adolescents and pSBP in adults; IMT by c2SBP and PWV by pSBP in both subgroups. CONCLUSION These findings suggest that in young individuals, the calibration method for 24-h central ABP plays a major role in determining its association with preclinical organ damage. In adolescents, 24-h central ABP appears to be more strongly associated with early cardiac and carotid damage than peripheral BP.
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Affiliation(s)
- Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - George Servos
- Department of Cardiology, P. & A. Kyriakou Children's Hospital
| | | | - Antonios Destounis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Andriani Vazeou
- First Department of Pediatrics, P. & A. Kyriakou Children's Hospital
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
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Soldatou A, Stathi A, Panos A, Paouri B, Koutsoukou E, Krepis P, Tsolia M, Oral R, Leventhal JM. A national educational campaign to raise awareness of child physical abuse among health care professionals. Eur J Pediatr 2020; 179:1395-1402. [PMID: 32152700 DOI: 10.1007/s00431-020-03625-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmental organization in child protection aimed at (a) training hospital physicians in a train-the-trainer course for the detection and management of child physical abuse and (b) conducting workshops and measuring attendance and gain of knowledge of participants. A train-the-trainer and a national curriculum were created. A 78-item and a 20-item knowledge questionnaire were used pre and post the train-the-trainer course and all workshops, respectively. Nineteen physicians from all pediatric departments of the seven medical schools in Greece attended the course. Eight workshops in seven cities took place with a total attendance of 1220 health care professionals. Gain of knowledge was demonstrated for participants in the train-the-trainer course (p = 0.0015) and local workshops (p < 0.001).Conclusion: We successfully engaged physicians from all medical schools in Greece and conducted a train-the-trainer module and eight workshops in major cities that improved the participants' knowledge in child physical abuse. This approach may help address physician deficiencies in emerging areas of child abuse clinical practice. What is Known: • Education is necessary to improve child physical abuse detection and management. • Although national training programs have been described, none has measured participants' changes in knowledge. What is New: • A collaboration of child abuse experts, all medical schools in Greece, and a non-governmental organization resulted in a national educational campaign in child physical abuse and gains in knowledge for participants. • This approach may help address deficiencies in emerging areas of clinical practice.
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Affiliation(s)
- Alexandra Soldatou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece.
| | - Aphrodite Stathi
- ELIZA, Society for the Prevention of Cruelty to Children, Ermou & Christopoulou 2, 10563, Athens, Greece
| | - Alexander Panos
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Bilio Paouri
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Electra Koutsoukou
- ELIZA, Society for the Prevention of Cruelty to Children, Ermou & Christopoulou 2, 10563, Athens, Greece
| | - Panagiotis Krepis
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, Goudi, 11527, Athens, Greece
| | - Resmiye Oral
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Ntineri A, Kollias A, Zeniodi ME, Vazeou A, Soldatou A, Stergiou GS. Insight into the 24-hour ambulatory central blood pressure in adolescents and young adults. J Clin Hypertens (Greenwich) 2020; 22:1789-1796. [PMID: 32812687 DOI: 10.1111/jch.13999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
This study attempted to investigate the behavior of 24-hour central ambulatory blood pressure (ABP) in adolescents and young adults. Adolescents and young adults (age 10-25 years) referred for elevated blood pressure (BP) and healthy volunteers had simultaneous 24-hour peripheral (brachial) and central (aortic) ABP monitoring using the same automated upper-arm cuff device (Mobil-O-Graph 24h PWA). Central BP was calculated by the device using two different calibration methods (C1SBP using peripheral systolic (pSBP)/diastolic BP and C2SBP using mean arterial/diastolic BP). A total of 136 participants (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 25% volunteers, 34% with elevated peripheral ABP) were analyzed. Twenty-four-hour pSBP was higher than C1SBP, with this difference being more pronounced during daytime than nighttime (16.3 ± 4.5 and 10.5 ± 3.2 mm Hg, respectively, P < .001). Younger age, higher body height, and male gender were associated with greater systolic ABP amplification (pSBP-C1SBP difference). C1SBP followed the variation pattern of pSBP, yet with smaller nighttime dip (8.4 ± 6.0% vs 11.9 ± 4.6%, P < .001), whereas C2SBP increased (2.4 ± 7.2%) during nighttime sleep (P < .001 for comparison with pSBP change). Older age remained independent determinant of larger nighttime BP fall for pSBP and C1SBP, whereas male gender predicted a larger nighttime C2SBP rise. These data suggest that the calibration method of the BP monitor considerably influences the diurnal variation in central BP, showing a lesser nocturnal dip than pSBP or even nocturnal BP rise, which are determined by the individual's age and gender.
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Affiliation(s)
- Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Maria Elena Zeniodi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Papapanagiotou IK, Charamanta M, Roidi S, Al-Achmar NS, Soldatou A, Michala L. Letter to the Editor and Response. J Pediatr Adolesc Gynecol 2020; 33:316-317. [PMID: 32169401 DOI: 10.1016/j.jpag.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ioannis K Papapanagiotou
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Maria Charamanta
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Stella Roidi
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Nikolaos Samer Al-Achmar
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Hospital, Athens, Greece
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece.
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Soldatou A, Pantzios SI, Panagiotou MR, Panagiotopoulos T, Nicoletos T, Michala L. Correction: Child sexual abuse among medical school students: experiences and perceptions. Int J Impot Res 2020; 33:386. [PMID: 32265526 DOI: 10.1038/s41443-020-0267-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alexandra Soldatou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, Children's Hospital of Athens "P. & A. Kyriakou", Athens, Greece
| | - Spiridon I Pantzios
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | - Theodoros Nicoletos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas Sofias Avenue, Athens, Greece.
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Soldatou A, Pantzios SI, Panagiotou MR, Panagiotopoulos T, Nicoletos T, Michala L. Child sexual abuse among medical school students: experiences and perceptions. Int J Impot Res 2020; 33:364-368. [PMID: 32203425 DOI: 10.1038/s41443-020-0254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 11/09/2022]
Abstract
Given that 5-25% of the adult population report child sexual abuse (CSA), most clinicians will care for victims. Data regarding CSA experiences among medical students are limited and the association of medical students' own history of CSA with relevant perceptions has not been previously examined. The aim of this study was to assess CSA perceptions and exposure of medical students, while exploring their associations. For this purpose, a link was created and made available on a site accessed solely by the Athens medical school undergraduates from February 20 to March 20 2019, comprising a 12-item questionnaire to assess the knowledge and past experience of CSA. This was based on a larger published questionnaire, which was translated and adapted. The questionnaire was then transcripted online, and after pilot testing, was disseminated using the Google documents® platform. Out of 261 responses, CSA was reported by 48 participants (18%), of which 39 were women. Thirty five reported contact CSA. Thirty seven victims (77%) reported previous disclosure of the event, but 18 of them were not protected post disclosure. CSA victims were less likely to agree with the perception that most perpetrators are mentally ill or disabled (p = 0.043), and more likely to strongly disagree with the statement that reputable families are protected from sexual abuse (p = 0.019). In agreement with existing data in general populations globally, about one in five medical students had exposure to CSA. In addition, a potential association of their own experiences with shaping perceptions regarding the identity of CSA perpetrators and affected families for medical students is highlighted.
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Affiliation(s)
- Alexandra Soldatou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, Children's Hospital of Athens "P. & A. Kyriakou", Athens, Greece
| | - Spiridon I Pantzios
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | - Theodoros Nicoletos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas Sofias Avenue, Athens, Greece.
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Papapanagiotou IK, Charamanta M, Roidi S, Al-Achmar NS, Soldatou A, Michala L. The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience. J Pediatr Adolesc Gynecol 2019; 32:596-599. [PMID: 31520717 DOI: 10.1016/j.jpag.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. DESIGN This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. SETTING We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January 2019. PARTICIPANTS The study included 29 female adolescents aged 11-17 (mean, 13.14) years. INTERVENTIONS Patients were administered a daily dose of 10-30 mg, depending on the severity of the condition, bleeding duration, and patient weight. MAIN OUTCOME MEASURES Cessation of vaginal bleeding. RESULTS Mean age at menarche of our patient sample was 11.4 years (range, 10.7-14 years). AUB presented at a mean time of 24.6 months after menarche (range, 0-79 months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. CONCLUSION The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.
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Affiliation(s)
- Ioannis K Papapanagiotou
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Maria Charamanta
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Stella Roidi
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Nikolaos Samer Al-Achmar
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Hospital, Athens, Greece
| | - Lina Michala
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Athens, Greece.
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Kallinikou D, Soldatou A, Tsentidis C, Louraki M, Kanaka-Gantenbein C, Kanavakis E, Karavanaki K. Diabetic neuropathy in children and adolescents with type 1 diabetes mellitus: Diagnosis, pathogenesis, and associated genetic markers. Diabetes Metab Res Rev 2019; 35:e3178. [PMID: 31083769 DOI: 10.1002/dmrr.3178] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 01/09/2023]
Abstract
Diabetic neuropathy (DN) is a common long-term complication of type 1 (T1D) and type 2 (T2D) diabetes mellitus, with significant morbidity and mortality. DN is defined as impaired function of the autonomic and/or peripheral nervous system, often subclinical, particularly in children and adolescents with T1D. Nerve conduction studies (NCS) and skin biopsies are considered gold-standard methods in the assessment of DN. Multiple environmental and genetic factors are involved in the pathogenesis of DN. Specifically, the role of metabolic control and glycemic variability is of paramount importance. A number of recently identified genes, including the AKR1B1, VEGF, MTHFR, APOE, and ACE genes, contribute significantly in the pathogenesis of DN. These genes may serve as biomarkers to predict future DN development or treatment response. In addition, they may serve as the basis for the development of new medications or gene therapy. In this review, the diagnostic evaluation, pathogenesis, and associated genetic markers of DN in children and adolescents with T1D are presented and discussed.
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Affiliation(s)
- Dimitra Kallinikou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Charalambos Tsentidis
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Louraki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Emmanouil Kanavakis
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
- Department of Medical Genetics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
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Tranoulis A, Georgiou D, Soldatou A, Triantafyllidi V, Loutradis D, Michala L. Poor sleep and high anxiety levels in women with functional hypothalamic amenorrhoea: A wake-up call for physicians? Eur J Obstet Gynecol Reprod Biol X 2019; 3:100035. [PMID: 31403123 PMCID: PMC6687383 DOI: 10.1016/j.eurox.2019.100035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/20/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To assess sleep disorders (SleD) in women with functional hypothalamic amenorrhoea (FHA) and to identify possible associations with known FHA predisposing factors. Study design We conducted a prospective case-control study spanning the period January 2016 to April 2018. We recruited forty-one FHA women and 86 healthy controls. We assessed SleD and other FHA predisposing factors via self-reported questionnaires. The Spearman's correlation coefficient (rho) was used to examine possible correlations among the different variables. Multivariate logistic regression analysis was conducted to identify independent factors associated with SleD. Results Women with FHA reported having higher SleD (p = 0.004), abnormal eating attitudes (p < 0.0001), higher anxiety levels (AL) (p < 0.0001), overweight preoccupation (P < 0.0001) and increased weekly physical activity (p = 0.004). There was a significant positive correlation between SleD and AL (rho = 0.88, p < 0.0001). Significant correlation was also found between AL and several Athens insomnia scale constituents, including sleep induction (rho = 0.53, p = 0.0004), awakenings during the night (rho = 0.6, p < 0.0001), final awakening (rho = 0.42, p = 0.006), total sleep duration (rho = 0.64, p < 0.0001), quality of sleep (rho = 0.63, p < 0.0001), well-being during the day (rho = 0.34, p = 0.03) and sleepiness during the day (rho = 0.51, p = 0.007). High AL were correlated with 2.83-fold increased SleD risk (p = 0.04). Conclusion FHA women are seemingly more prone to SleD and those with SleD suffer from higher AL. In view of this evidence, the potential rationale of adding psychological and SleD evaluation to their clinical care is highlighted.
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Affiliation(s)
- Anastasios Tranoulis
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, King's College, London, UK.,First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitra Georgiou
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Trust, Imperial College, London, UK
| | - Alexandra Soldatou
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Varvara Triantafyllidi
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitios Loutradis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lina Michala
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Soldatou A. Children older than 12 months and with commercial insurance at risk for delayed treatment of UTI. J Pediatr 2019; 210:239-242. [PMID: 31234984 DOI: 10.1016/j.jpeds.2019.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stergiou G, Stambolliu E, Bountzona I, Ntineri A, Kollias A, Vazeou A, Soldatou A. Home Blood Pressure Monitoring in Children and Adolescents: Systematic Review of Evidence on Clinical Utility. Curr Hypertens Rep 2019; 21:64. [PMID: 31240404 DOI: 10.1007/s11906-019-0967-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW For the accurate diagnosis and management of hypertension, out-of-office blood pressure evaluation using ambulatory (ABPM) or home monitoring (HBPM) is currently recommended. In children, there is considerable evidence on the clinical utility of ABPM, whereas the evidence on HBPM is limited. This systematic review presents (i) the benefits of HBPM in children; (ii) the evidence on normal range, diagnostic accuracy, and relationship with preclinical organ damage; and (iii) guidance for devices, monitoring schedule, and interpretation. RECENT FINDINGS HBPM is a useful adjunct to the conventional office measurements for the evaluation of children with suspected or treated hypertension. HBPM is feasible in children and has good reproducibility, diagnostic accuracy and acceptability by users, and relatively low cost. Thus, it has greater potential for widespread and long-term use than ABPM, which is more expensive and often not available or not tolerated. Automated monitors that have been clinically validated specifically in children should be used with appropriate cuff size. HBPM for 7 days (minimum 3) with duplicate morning and evening measurements (minimum 12 readings) should be performed in children with suspected or treated hypertension before each office visit. Until more data become available, in case of diagnostic disagreement between office blood pressure and HBPM, treatment decisions should be based on ABPM. HBPM is clinically useful in children with hypertension. More research is needed on its clinical application, and more automated devices need to be clinically validated in this population.
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Affiliation(s)
- George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
| | - Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P&A Kyriakou Children's Hospital, Athens, Greece
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Karavanaki K, Koufadaki AM, Soldatou A, Tsentidis C, Sourani M, Gougourelas D, Haliotis FA, Stefanidis CJ. Fever duration during treated urinary tract infections and development of permanent renal lesions. Arch Dis Child 2019; 104:466-470. [PMID: 30389675 DOI: 10.1136/archdischild-2017-314576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effect of the duration of fever after the initiation of treatment (FAT) of febrile urinary tract infections (UTI) on the development of permanent renal lesions based on dimercaptosuccinic acid (DMSA) scintigraphy findings. To evaluate the FAT contribution to permanent renal lesion formation in relation to fever before treatment initiation (FBT), the presence of vesicourinary reflux (VUR), age and severity of infection. METHODS The inpatient records of 148 children (median age: 2.4 months (11 days to 24 months)) with a first episode of UTI during a 3-year period were analysed. DMSA findings, and clinical and laboratory parameters were evaluated. RESULTS Among the study population, 34/148 (22.97%) children had permanent renal lesions on the DMSA scan 6 months after a single episode of UTI. Twenty-three children (15.5%) had mild, 10 (6.7%) had moderate and 1 (0.6%) child had severe lesions on the DMSA. FAT prolongation >/48 hours was associated with older age (p=0.01) and increased absolute neutrophil count (p=0.042). The likelihood of lesions was significantly increased when FAT was ≥48 hours (R2=0.043, p=0.021). On multiple regression analysis, with the addition of FBT>/72 hours (0.022), the presence of VUR (p<0.001), C-reactive protein (p=0.027) and age (p=0.031), the effect of FAT on lesion development disappeared (p=0.15). CONCLUSIONS Prolongation of FAT≥48 hours of febrile UTI in children <2 years significantly contributes to the development of permanent renal lesions. However, delay in treatment initiation >/72 hours, the presence of VUR, older age and infection severity seem to be more significant predictors of the development of renal lesions.
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Affiliation(s)
- Kyriaki Karavanaki
- Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Athina Maria Koufadaki
- Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Charalambos Tsentidis
- Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Sourani
- Second Department of Pediatrics, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Dimitris Gougourelas
- Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Childrens' Hospital, Athens, Greece
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Karavanaki K, Tsouvalas E, Vakaki M, Soldatou A, Tsentidis C, Kaparos G, Augoulea A, Alexandrou A, Lambrinoudaki Ι. Carotid intima media thickness and associations with serum osteoprotegerin and s-RANKL in children and adolescents with type 1 diabetes mellitus with increased risk for endothelial dysfunction. J Pediatr Endocrinol Metab 2018; 31:1169-1177. [PMID: 30352039 DOI: 10.1515/jpem-2018-0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
Abstract
Background Although carotid intima media thickness (CIMT) is an established marker of endothelial dysfunction, limited data exist on relative laboratory biomarkers in youngsters with type 1 diabetes mellitus (T1DM). Our aim was to study CIMT and the biomarkers of the osteoprotegerin (OPG)/RANKL system in young T1DM patients and controls, and also in subgroups of patients with increased risk for endothelial dysfunction, such as those with overweight/obesity, poor metabolic control or the presence of microalbuminuria. Methods CIMT and OPG/RANKL of 56 T1DM children and adolescents were compared to 28 healthy controls. Results Anthropometric, laboratory, CIMT and OPG/RANKL measurements were similar between patients and controls. Overweight/obese patients had greater CIMT than the normal weight ones (0.50 vs. 0.44 mm, p=0.001). Microalbuminuric patients had greater CIMT (0.49 vs. 0.44 mm, p=0.035) than the normoalbuminuric ones, with no difference in terms of OPG/RANKL. In the microalbuminuric group, OPG (r=-0.90, p=0.036) and RANKL (r=-0.92, p=0.024) were significantly negatively associated with CIMT. Following linear regression analysis, in the total patients group, microalbuminuria was the only factor significantly associated with CIMT (beta±SE: 0.050±0.021, p=0.035), body mass index (BMI)-z-scores were negatively associated with OPG (beta±SE: -0.25±0.12, p=0.05), while in the microalbuminuric group, CIMT was negatively associated with OPG (beta±SE: -0.070±0.019, p=0.036). During the forward stepwise procedure, microalbuminuria and age were the only variables negatively associated with RANKL (b=-0.334, p=0.034, b=-35.95, p=0.013, respectively). Conclusions In T1DM pediatric patients, overweight/obesity and microalbuminuria were associated with greater CIMT and with impaired OPG/RANKL levels, as biochemical indices of calcification of the atherosclerotic plaque.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Emmanouil Tsouvalas
- Diabetes and Metabolism Clinic, Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Marina Vakaki
- Radiology Department, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Charalambos Tsentidis
- Diabetes and Metabolism Clinic, Second Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - George Kaparos
- Hormonal Laboratory, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
| | - Ιrene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
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Paouri B, Soldatou A, Petrakou E, Theodosaki M, Tsentidis C, Kaisari K, Oikonomopoulou C, Matsas M, Goussetis E. Quantiferon-Cytomegalovirus assay: A potentially useful tool in the evaluation of CMV-specific CD8+ T-cell reconstitution in pediatric hematopoietic stem cell transplant patients. Pediatr Transplant 2018; 22:e13220. [PMID: 29777573 DOI: 10.1111/petr.13220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/31/2022]
Abstract
Pediatric HSCT recipients are at high risk for CMV reactivation due to their immature immune system and therapy following transplantation. Reconstitution of CMV-specific T-cell immunity is associated with control and protection against CMV. The clinical utility of monitoring CMV-specific CMI to predict CMV viremia in pediatric HSCT patients using the Quantiferon-CMV (QIAGEN® ) test was investigated prospectively. Thirty-seven pediatric allogeneic HSCT recipients were enrolled from 3/2010-6/2012. CMV viremia was detected via weekly real-time PCR. The Quantiferon-CMV test was conducted pretransplant, early after transplantation, 30, 90, 180, 270, and 360 days post-transplantation. The incidence of CMV viremia was 51% (19/37) with half of the episodes within ≤30 days post-transplant. Fifteen patients showed CMV-specific immunity (average of 82 days). The cumulative incidence of CMV reactivation in patients who developed CMV-specific immunity was lower than those who did not (15% vs 53%; P = .023). The ROC statistical analysis showed that the AUC was 0.725 in predicting viremia, for Quantiferon-CMV test. In this cohort, the Quantiferon-CMV assay was a valuable method for identifying pediatric HSCT patients at high risk for CMV viremia, suggesting potential clinical utility to individualize patient's management post-transplant.
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Affiliation(s)
- Bilio Paouri
- Second Department of Pediatrics, National and Kapodistrian University of Athens, P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Eftihia Petrakou
- Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Theodosaki
- Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Charalampos Tsentidis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Katerina Kaisari
- Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Minos Matsas
- Department of Microbiology & Serology, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Eugenios Goussetis
- Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
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Karachaliou F, Athanasakis K, Tsentidis C, Soldatou A, Simatos G, Kyriopoulos J, Michalakos S, Karavanaki K. A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care. Pediatr Diabetes 2017; 18:405-412. [PMID: 27444352 DOI: 10.1111/pedi.12408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/27/2016] [Accepted: 06/03/2016] [Indexed: 11/27/2022] Open
Abstract
AIM To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital-based outpatient clinic in Greece. METHODS The outpatient records of 89 children and adolescents (mean age: 12.05 ± 5.15 y) with T1D followed in the Second Department of Pediatrics, University of Athens Medical School, were analyzed. RESULTS The mean ± SD diabetes duration was 4.9 ± 3.88 y (range: 0.25-17) and glycated hemoglobin (HbA1c) was 8.2 ± 1.09% (66 ± 11.9 mmol/mol). A total of 80% of patients were on multiple daily injections regimen, 10% on pump therapy, and 10% on conventional regimen. Total direct costs per patient-year (ppy) were estimated at €2.712 [95% confidence interval (CI): 2.468-2.956]. Supply costs accounted for 73.7% of total costs and were the highest for pump therapy (P < .001). Multivariate linear regression analysis showed that costs were significantly higher for children (1) on multiple daily injections or pump therapy (r = 0.364, P < .001), (2) of older age (r = 0.25, P < .001) and (3) higher daily insulin dose (r = 0.46, P < .001). Patients on pump therapy had significantly higher costs €5.538 (95%CI 4480-6597) compared with patients on multiple daily injections €2.447 (95% CI 2320-2574) and conventional regimen €1.978.5 (95%CI 1682-2275) (P = .0001). Patients on pump therapy had better glycemic control compared with all other patients [HbA1c (mean ± SD): 7.2% ± 1.0 vs 8.3% ±1.5, P = .039]. CONCLUSION The total T1D cost in this cohort of Greek children was €2712 ppy. The main factor that predicted direct cost was the use of pump. However, pump therapy was associated with better glycaemic control, which may decrease the risk of total long-term diabetes care cost.
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Affiliation(s)
- Feneli Karachaliou
- Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Charalabos Tsentidis
- Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - George Simatos
- Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - John Kyriopoulos
- Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Stefanos Michalakos
- Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece
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Garoufi A, Grammatikos EE, Kollias A, Grammatikos E, Stergiou GS, Soldatou A. Associations between obesity, adverse behavioral patterns and cardiovascular risk factors among adolescent inhabitants of a Greek island. J Pediatr Endocrinol Metab 2017; 30:445-454. [PMID: 28315850 DOI: 10.1515/jpem-2016-0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 01/16/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Excess weight, unhealthy lifestyle habits and their sequelae have become a well-recognized public health problem in most countries. The objective of the study was to examine the relationship of adolescent overweight/obesity with behavioral habits and their association with blood pressure (BP) and lipid profile. METHODS Anthropometric parameters, lifestyle, BP and lipid profile of 736 adolescents were evaluated cross-sectionally. The classifications of normal weight, overweight and obese were based on BMI z-scores. RESULTS About 42.1% of adolescents were overweight/obese, 11.3% were smokers, 33.2% consumed alcohol and 34% reported low activity. Males began smoking earlier, consumed alcohol more often, exercised less and spent more screen time than females. Alcohol consumption was more prevalent among smokers and was associated with higher BP and dyslipidemia. Smokers exercised less intensely and had lower high density lipoprotein-cholesterol (HDL-C) than non-smokers. Obesity was a risk factor for higher BP and dyslipidemia. Longer screen time was associated with higher triglycerides, while intense physical activity with lower systolic BP. CONCLUSIONS Obesity is related to an adverse lipid and BP profile during adolescence. Clustering of hazardous habits was observed, which is known to aggravate the cardiovascular risk.
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Affiliation(s)
- Anastasia Garoufi
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens
| | - Evangelos E Grammatikos
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens
| | | | - George S Stergiou
- Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens
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Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ. Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 2017; 106:149-154. [PMID: 27748543 DOI: 10.1111/apa.13636] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/07/2016] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated the controversial relationship between the duration of fever before treatment initiation (FBT) for a febrile urinary tract infection (UTI), with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings. METHODS The inpatient records of 148 children under two years of age with a first episode of febrile UTI were analysed. Acute and repeat DMSA findings, and clinical and laboratory parameters were evaluated. RESULTS Acute DMSA showed that 76 of the 148 children with a febrile UTI had renal lesions: 20 were mild, and 56 were moderate or severe. Repeat DMSA showed renal scarring in 34 patients. The only factors associated with the development of renal scars in the repeat DMSA were FBT of more than 72 hours, the presence and severity of vesicoureteral reflux and increased procalcitonin levels and absolute neutrophil counts. Multiple regression analysis showed that an FBT above 72 hours was the only significant factor that predicted renal scars. CONCLUSION Delay in treatment initiation of 72 hours or more was a risk factor for permanent renal scars after the first episode of febrile UTI. Other associated factors were increased procalcitonin and absolute neutrophil count on admission and the presence and severity of vesicouretal reflux.
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Affiliation(s)
- Kyriaki A. Karavanaki
- Second Department of Pediatrics; National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital; Athens Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics; National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital; Athens Greece
| | - Athina Maria Koufadaki
- Second Department of Pediatrics; National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital; Athens Greece
| | - Charalampos Tsentidis
- Second Department of Pediatrics; National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital; Athens Greece
| | - Fotis A. Haliotis
- Second Department of Pediatrics; “Aghia Sophia” Children's Hospital; Athens Greece
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Garoufi A, Vartzelis G, Tsentidis C, Attilakos A, Koemtzidou E, Kossiva L, Katsarou E, Soldatou A. Weight gain in children on oxcarbazepine monotherapy. Epilepsy Res 2016; 122:110-3. [PMID: 27010568 DOI: 10.1016/j.eplepsyres.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/12/2016] [Accepted: 03/12/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Studies of the effect of oxcarbazepine (OXC) on body growth of children with epilepsy are rare and their results are controversial. To the contrary, many studies have shown significant weight gain following valproate (VPA) treatment. PURPOSE To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy. METHOD Fifty-nine otherwise healthy children, aged 3.7-15.9 years, with primary generalized, partial or partial with secondary generalization seizure disorder, were included in the study. Twenty six children were placed on OXC and thirty three on VPA monotherapy. Body weight (BW), height and body mass index (BMI) as well as their standard deviation scores (SDS), were evaluated prior to as well as 8 months post initiation of OXC or VPA therapy. RESULTS Eight months post OXC-treatment, BW, SDS-BW, BMI and SDS-BMI increased significantly. The increase was similar to that observed in the VPA group. An additional 15.4% of children in the OXC group and 21.2% in the VPA group became overweight or obese. The effect of both OXC and VPA therapy on linear growth did not reach statistical significance. CONCLUSION Similarly to VPA, OXC monotherapy resulted in a significant weight gain in children with epilepsy. Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy.
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Affiliation(s)
- Anastasia Garoufi
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece.
| | - George Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Charalambos Tsentidis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Rimini 1, 12462, Haidari, Athens, Greece
| | - Evangelia Koemtzidou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Lydia Kossiva
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Eustathia Katsarou
- Department of Pediatric Neurology, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
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Amanatidou V, Critselis E, Trochoutsou A, Soldatou A, Benetatou K, Spyridis N, Papadopoulos NG, Tsolia MN. Interferon gamma inducible protein-10 in the diagnosis of paediatric tuberculosis infection in a low TB incidence country. Int J Tuberc Lung Dis 2015; 19:1463-9. [DOI: 10.5588/ijtld.14.0945] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kapitsinou A, Soldatou A, Tsitsika A, Kossiva L, Tsentidis C, Nisianakis P, Theocharis S, Garoufi A. Risk factors for elevated blood lead levels among children aged 6-36 months living in Greece. Child Care Health Dev 2015; 41:1199-206. [PMID: 25968465 DOI: 10.1111/cch.12254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood lead poisoning remains a critical environmental health concern because even low blood lead levels (BLLs) can result in permanent adverse health effects. Social factors and living conditions have been correlated with BLLs. There is no recent survey about the prevalence of elevated BLLs among children in Greece. The purpose of this study was to assess BLLs among children aged 6-36 months born and living in Greece and to evaluate their association with demographic, socio-economic and housing conditions. METHODS In a cross-sectional hospital-based study including 814 randomly selected children aged 6-36 months, BLLs and haematological parameters were evaluated. A questionnaire investigating demographic and socio-economic conditions was completed in all children. Statistical analysis was performed using STATA for Windows v.8.5, and P < 0.05 was considered statistically significant. RESULTS The mean BLLs of the population were 2.78 (SD = 2.34) µg/dl, and the median was 2.02 µg/dl; 11.7% had BLLs above 5 µg/dl, while 15 children (1.8%) exceeded 10 µg/dl. Being a toddler, being Roma or Asian, living in an industrial/low-income neighbourhood or in an old house, using traditional herbs and/or spices and having a mother with a manual occupation were independent risk factors for elevated BLLs. CONCLUSION Lead exposure remains a threat for optimal health especially for toddlers and children of socio-economically disadvantaged families living in Greece. A nationwide survey to assess lead exposure in children is necessary to guide prevention governmental policies.
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Affiliation(s)
- A Kapitsinou
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Soldatou
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Tsitsika
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L Kossiva
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ch Tsentidis
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Nisianakis
- Chemical Laboratory, Center of Biological Research of Armed Forces, Athens, Greece
| | - S Theocharis
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Garoufi
- Second Department of Pediatrics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev 2015; 14:781-97. [DOI: 10.1016/j.autrev.2015.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 12/16/2022]
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Koufadaki AM, Karavanaki KA, Soldatou A, Tsentidis C, Sourani MP, Sdogou T, Haliotis FA, Stefanidis CJ. Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection. Acta Paediatr 2014; 103:e404-9. [PMID: 24862642 DOI: 10.1111/apa.12706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/21/2014] [Accepted: 05/23/2014] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the predictive value of various clinical and laboratory parameters on the identification of acute extensive and/or multifocal renal involvement in children with febrile urinary tract infections (UTI). METHODS The medical records of 148 children (median age: 2.4 months, range: 11 days-24 months), who were admitted during a 3-year period with a first episode of febrile UTI, were analysed. Acute dimercaptosuccinic acid scintigraphy (DMSA), clinical and laboratory parameters were evaluated. RESULTS Seventy six children (51%) had abnormal findings on the acute DMSA. Of them, 20 had DMSA grade 2, while 56 had grade 3 and 4. Patients with a DMSA grade 3 and 4 were more likely to have shivering (OR 3.4), white blood count (WBC) ≥ 18 000/μL (OR 2.4), absolute neutrophil count (ANC) ≥ 9300/μL (OR 4.4), C-reactive protein (CRP) ≥ 50 mg/L (OR 2.7) and procalcitonin (PCT) ≥ 1.64 ng/mL (OR diagnostic). There was a significant difference of WBC (p = 0.004), ANC, CRP and PCT levels (p < 0.001) between children with normal and grade 2 aDMSA versus those with aDMSA grade 3 and 4. CONCLUSIONS Shivering and elevated inflammatory markers increase the risk of acute extensive and/or multifocal kidney involvement in children with febrile UTI. Procalcitonin seems to be an excellent marker of the severity of acute parenchymal involvement.
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Affiliation(s)
- AM Koufadaki
- Second Department of Pediatrics; University of Athens; “P. & A. Kyriakou” Children's Hospital; Athens Greece
| | - KA Karavanaki
- Second Department of Pediatrics; University of Athens; “P. & A. Kyriakou” Children's Hospital; Athens Greece
| | - A Soldatou
- Second Department of Pediatrics; University of Athens; “P. & A. Kyriakou” Children's Hospital; Athens Greece
| | - Ch Tsentidis
- Second Department of Pediatrics; University of Athens; “P. & A. Kyriakou” Children's Hospital; Athens Greece
| | - MP Sourani
- Second Department of Pediatrics; “Aghia Sophia” Children's Hospital; Athens Greece
| | - T Sdogou
- Second Department of Pediatrics; University of Athens; “P. & A. Kyriakou” Children's Hospital; Athens Greece
| | - FA Haliotis
- Second Department of Pediatrics; “Aghia Sophia” Children's Hospital; Athens Greece
| | - CJ Stefanidis
- Department of Pediatric Nephrology; “P. & A. Kyriakou” Children's Hospital; Athens Greece
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Karavanaki K, Karayianni C, Vassiliou I, Tzanela M, Sdogou T, Kakleas K, Tsentidis C, Vakaki M, Soldatou A, Kallinikou D, Kostaki M, Tsitsopoulos S, Papathanasiou A. Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review. J Pediatr Endocrinol Metab 2014; 27:1011-6. [PMID: 24854531 DOI: 10.1515/jpem-2013-0370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/23/2014] [Indexed: 11/15/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is characterized by selective autoimmune destruction of pancreatic b-cells, resulting in insulin deficiency. Associated autoimmune disorders, such as celiac disease, autoimmune thyroiditis, and gastritis, can coexist in patients with T1DM. These disorders are characterized by the presence of antibodies against tissue transglutaminase (anti-tTG-IgA), thyroglobulin, and thyroid peroxidase (anti-TG, anti-TPO), as well as antibodies against gastric parietal cells. Children with T1DM may also develop organ-specific multiple autoimmunity, with the coexistence of one or more autoimmune disorders. Furthermore, there is a lot of controversy regarding the role of thyroid autoimmunity in the pathogenesis of thyroid cancer. We present a child with T1DM and multiple autoimmunity including autoimmune Hashimoto's thyroiditis (HT), who developed thyroid cancer. The literature on the prevalence of associated autoimmunity in children with T1DM and the prevalence, pathogenesis, and timely diagnosis of thyroid cancer among patients with HT is also reviewed.
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Garoufi A, Vorre S, Soldatou A, Tsentidis C, Kossiva L, Drakatos A, Marmarinos A, Gourgiotis D. Plant sterols-enriched diet decreases small, dense LDL-cholesterol levels in children with hypercholesterolemia: a prospective study. Ital J Pediatr 2014; 40:42. [PMID: 24887013 PMCID: PMC4018958 DOI: 10.1186/1824-7288-40-42] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background Small dense low density lipoprotein-cholesterol (sdLDL-C) molecules are more atherogenic compared with large buoyant ones. Phytosterols-enriched diets are effective in decreasing total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) concentrations in hyperlipidemic children without significant adverse effects. Limited data on the impact of such a diet on sdLDL-C levels is available in adults while there are no reports concerning children. The purpose of this study is to prospectively evaluate the effect of the daily consumption of 2 g of plant sterols on sdLDL-C levels in children with hypercholesterolemia. Methods Fifty-nine children, 25 with LDL-C ≥ 3.4 mmol/l (130 mg/dl) and 34 with LDL-C < 3.4 mmol/l, aged 4.5-15.9 years, were included in the study. A yogurt-drink enriched with 2 g of plant sterols was added to the daily diet of hypercholesterolemic children and 6–12 months later lipid profiles were reassessed. Direct quantitative methods were used to measure LDL-C and sdLDL-C levels. Results The consumption of plant sterols reduced sdLDL-C significantly (p < 0.001), but levels remained higher compared with controls (p < 0.001). TC, LDL-C, non high density lipoprotein-cholesterol (NonHDL-C) and apolipoprotein B (ApoB) levels also decreased significantly (p < 0.05). The median reduction of sdLDL-C and LDL-C was 16.6% and 13%, respectively. These variables decreased >10% in sixteen children (64%), independently from baseline levels, sex, age and body mass index (BMI). High density lipoprotein-cholesterol (HDL-C), lipoprotein a [Lp(a)], and triglycerides (TGs) levels remained unaffected. Conclusions Plant sterols decrease sdLDL-C significantly and may be beneficial for children with hypercholesterolemia.
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Affiliation(s)
- Anastasia Garoufi
- Lipid Outpatient Clinic, Second Department of Pediatrics, Athens University, Athens, Greece.
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Klinaki E, Soldatou A, Marmarinos A, Pagoni A, Tsentidis C, Gourgiotis D, Garoufi A. The Role of Asymmetric Dimethylarginine and Lipoprotein Associated Phospholipase A2 in Children and Adolescents with Dyslipidemia. Health (London) 2014. [DOI: 10.4236/health.2014.612177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Maritsi D, Vartzelis G, Soldatou A, Spyridis N. AB1131 Hepatitis B immunity in children with juvenile idiopathic arthritis at disease onset. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kossiva L, Soldatou A, Gourgiotis DI, Stamati L, Tsentidis C. Serum hepcidin: indication of its role as an "acute phase" marker in febrile children. Ital J Pediatr 2013; 39:25. [PMID: 23618075 PMCID: PMC3660274 DOI: 10.1186/1824-7288-39-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/26/2013] [Indexed: 11/26/2022] Open
Abstract
Background Hepcidin is classified as a type II acute phase protein; its production is a component of the innate immune response to infections. Objective To evaluate the alterations of serum hepcidin in children during and following an acute febrile infection. Materials and methods 22 children with fever of acute onset (< 6 hours) admitted to the 2nd Department of Pediatrics-University of Athens. Based on clinical and laboratory findings our sample formed two groups: the viral infection group (13 children) and the bacterial infection group (9 children). Hepcidin, ferritin and serum iron measurements were performed in all subjects. Results Serum hepcidin values did not differ notably between children with viral and bacterial infection, but a significant reduction of hepcidin was noted in both groups post-infection. Conclusion Our study provides clinical pediatric data on the role of hepcidin in the face of an acute infection. In our sample of children, hepcidin was found to rise during the acute infection and fall post-infection.
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Affiliation(s)
- Lydia Kossiva
- Second Department of Pediatrics P&A Kyriakou Children's Hospital, Medical School, Athens University, Athens, Greece.
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Papandreou O, Soldatou A, Tsitsika A, Kariyannis C, Papandreou T, Zachariadi A, Papassotiriou I, Chrousos GP. Serum S100beta protein in children with acute recurrent headache: a potentially useful marker for migraine. Headache 2006; 45:1313-6. [PMID: 16324163 DOI: 10.1111/j.1526-4610.2005.00263.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the role of glia-derived S100beta protein and to evaluate its use as a biochemical marker in childhood acute recurrent headache. METHODS Twenty-five patients with acute recurrent headache (according to International Headache Society criteria) from our department's Headache Clinic were studied. Blood samples for measurement of serum S100beta were drawn: (1) < or = 3-hour post pain attack from our patients and (2) from 23 healthy controls. RESULTS Of the 25 patients evaluated, 15 suffered from migraine and 10 from tension-type headache (TTH). Statistical analysis of the mean values of S100beta levels demonstrated a significant elevation in children with migraine headache, with values higher than those of both children with TTH and controls (P = .001). CONCLUSIONS Our data suggest a direct relation between childhood migraine attacks and increased production of glial S100beta protein. Serum S100beta determination may be a useful biochemical marker for migraine in acute recurrent headache in childhood.
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Goussetis E, Spiropoulos A, Theodosaki M, Paterakis G, Peristeri I, Kitra V, Petrakou E, Soldatou A, Graphakos S. Culture of bone marrow CD105+ cells allows rapid selection of pure BM-stromal cells for chimerism studies in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant 2005; 36:557-9. [PMID: 16025154 DOI: 10.1038/sj.bmt.1705083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The number of immunocompromised children in the population is increasing for a variety of reasons. Common respiratory viruses acquired in the community or in the hospital setting include the ortho- and paramyxoviruses and may cause severe lower respiratory tract disease in these children. Measles is again becoming a threat. Particularly in transplant patients, Herpes group viruses and adenoviruses, often part of a reactivation illness, can cause potentially life-threatening disease. The use of rapid molecular diagnostic techniques and an increasing array of antiviral therapies can help ensure a good outcome in many cases, although controlled clinical trial data are often lacking. Immunotherapeutic strategies using specific antibodies or cytotoxic T cells are being developed and are likely to have an increasing role in prophylaxis and pre-emptive therapy in the future. The development and introduction of vaccines against common respiratory diseases will help reduce the risks faced by these susceptible children.
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Affiliation(s)
- Alexandra Soldatou
- Department of Immunology, Great Ormond Street Hospital, WC1 N 3JH, London, UK
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