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Noni M, Katelari A, Poulou M, Ioannidis D, Kapasouri EM, Tzetis M, Doudounakis SE, Kanaka-Gantenbein C, Spoulou V. Frequencies of pathogenic CFTR variants in Greek cystic fibrosis patients with allergic bronchopulmonary aspergillosis and Aspergillus fumigatus chronic colonization: A retrospective cohort study. J Mycol Med 2023; 33:101326. [PMID: 36272381 DOI: 10.1016/j.mycmed.2022.101326] [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] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The clinical spectrum of Aspergillus fumigatus diseases in cystic fibrosis (CF) patients, including allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus chronic colonization, has recently gained attention due to its association with the progression of lung disease. Our aim was to examine whether there is a difference on pathogenic variant frequencies of the CFTR gene between CF patients with ABPA and those with A. fumigatus chronic colonization. MATERIAL AND METHODS Greek CF patients diagnosed with ABPA and/or A. fumigatus chronic colonization were grouped according to their CFTR genotype. Patients with "minimal" CFTR function were defined as carrying a combination of class I or II pathogenic variants, while patients with "residual" function as carrying at least one class III, IV, V or VI pathogenic variant. RESULTS Fifty-four CF patients were included and all except one were defined as having "minimal" CFTR function. Among the 108 CFTR alleles, 69 (63.9%) of pathogenic variants belonged to class II, and 32 (29.6%) to class I. Five patients had a history of both ABPA and A. fumigatus chronic colonization. No significant difference was detected among patients diagnosed only with ABPA (n = 29) and those who had only a positive history of A. fumigatus chronic colonization (n = 20). The median age of ABPA diagnosis was significantly lower than the median age of A. fumigatus chronic colonization (P = 0.011), while no significant difference was detected on median FEV1% predicted. DISCUSSION No significant differences were detected in the type of CFTR pathogenic variants among patients with ABPA and those with A. fumigatus colonization. Similar studies should be performed in larger CF populations of different ethnic origin to further confirm our results.
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Affiliation(s)
- Maria Noni
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Anna Katelari
- Institute of Child Health, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Myrto Poulou
- Department of Medical Genetics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Diomidis Ioannidis
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Efthymia-Maria Kapasouri
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Tzetis
- Department of Medical Genetics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vana Spoulou
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Thomson M. Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016-2019. Endosc Int Open 2022; 10:E1371-E1379. [PMID: 36262519 PMCID: PMC9576335 DOI: 10.1055/a-1898-1364] [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: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background and study aims The ability to perform endoscopy procedures safely and effectively is a key aspect of quality clinical care in Pediatric Gastroenterology, Hepatology and Nutrition (PGHN). The aim of this survey, which was part of a global survey on PGHN training in Europe, was to assess endoscopy training opportunities provided across Europe. Methods Responses to standardized questions related to endoscopy training were collected from training centers across Europe through the presidents/representatives of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition National Societies from June 2016 to December 2019. Results A total of 100 training centers from 19 countries participated in the survey. In 57 centers, the endoscopy suit was attached to the PGHN center, while in 23, pediatric endoscopies were performed in adult endoscopy facilities. Ninety percent of centers reported the availability of specialized endoscopy nurses and 96 % of pediatric anesthetists. Pediatric endoscopies were performed by PGHN specialists in 55 centers, while 31 centers reported the involvement of an adult endoscopist and 14 of a pediatric surgeon. Dividing the number of procedures performed at the training center by the number of trainees, ≤ 20 upper, lower, or therapeutic endoscopies per trainee per year were reported by 0 %, 23 %, and 56 % of centers, respectively, whereas ≤ 5 wireless capsule endoscopies per trainee per year by 75 %. Only one country (United Kingdom) required separate certification of competency in endoscopy. Conclusions Differences and deficiencies in infrastructure, staffing, and procedural volume, as well as in endoscopy competency assessment and certification, were identified among European PGHN training centers limiting training opportunities in pediatric endoscopy.
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | | | - Alastair Baker
- Pediatric Liver Center, Kingʼs College Hospital, London, United Kingdom
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Sue Protheroe
- Birmingham Childrenʼs Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Childrenʼs Hospital, Rotterdam, The Netherlands
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Childrenʼs Hospital, Basel, Switzerland
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maria Fotoulaki
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Childrenʼs Hospital, Ljubljana, Slovenia
| | - Vaidotas Urbonas
- Vilnius University Clinic of Childrenʼs Diseases, Vilnius, Lithuania
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Miglena Georgieva
- 2nd Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria
| | - Mike Thomson
- Sheffield Childrenʼs Hospital NHS Foundation Trust, Sheffield, United Kingdom
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Noni M, Koukou DM, Tritzali M, Kanaka-Gantenbein C, Michos A, Spoulou V. Coagulation Abnormalities and Management in Hospitalized Pediatric Patients With COVID-19. Pediatr Infect Dis J 2022; 41:570-574. [PMID: 35389967 PMCID: PMC9177125 DOI: 10.1097/inf.0000000000003545] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence and severity of coagulation abnormalities have not been extensively studied in pediatric populations with coronavirus disease 2019 (COVID-19). Moreover, their association with an increased risk for thromboembolic events remains unclear, and there is a lack of evidence for optimal prophylactic antithrombotic management. The aim of our study was to present our experience in evaluation, management, and long-term outcomes of coagulation abnormalities in pediatric hospitalized patients with COVID-19. METHODS A prospective study was performed in all children hospitalized for COVID-19 during a 6-month period focusing on patients' coagulation abnormalities, the normalization of the coagulation profile with or without anticoagulation prophylaxis and the clinical outcome of the disease. RESULTS Two hundred twenty-three patients (median age: 11.4 months) were enrolled in the study. Coagulation abnormalities were detected in 92.4% of patients with increased D-dimer levels to be the most common abnormality detected in 84.3% of patients. Prophylactic anticoagulation was initiated only in 7 (3.1%) selected patients with severe COVID-19 and at least 2 risk factors for venous thromboembolism (VTE) and in all patients with previous history of VTE. Follow-up coagulation profile in 85 patients showed that changes over time had a tendency towards normalization irrespectively of the initiation of anticoagulant thromboprophylaxis. No thrombotic complications were observed 3 months upon discharge. CONCLUSIONS Although abnormal findings in coagulation profile were very common, they were not associated with risk for VTE even in severe cases. A trend of normalization early in the course of the disease was observed regardless of the use of anticoagulant thromboprophylaxis.
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Affiliation(s)
- Maria Noni
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Dimitra-Maria Koukou
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Maroula Tritzali
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Athanasios Michos
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
| | - Vana Spoulou
- From the First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece
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4
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Ioannidou L, Dettoraki A, Noni M, Koukou DM, Michalopoulou A, Botsa E, Kapsimali Z, Michos A, Spoulou V, Pergantou H, Kanaka-Gantenbein C. Pulmonary embolism in adolescent with COVID-19 during aromatase inhibitor therapy. Pediatr Pulmonol 2022; 57:1789-1791. [PMID: 35475330 PMCID: PMC9111033 DOI: 10.1002/ppul.25944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Loukia Ioannidou
- Hemophilia Center and Hemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Athina Dettoraki
- Hemophilia Center and Hemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Noni
- Division of Infectious Diseases, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra-Maria Koukou
- Division of Infectious Diseases, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Michalopoulou
- Hemophilia Center and Hemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Evanthia Botsa
- First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoey Kapsimali
- Hemophilia Center and Hemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Athanasios Michos
- Division of Infectious Diseases, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Spoulou
- Division of Infectious Diseases, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Pergantou
- Hemophilia Center and Hemostasis and Thrombosis Unit, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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5
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Giacalone R, Ferretti M, Gurgoglione F, Noni M, Pelà G, Vezzani A, Cattabiani M, Benatti G, Tadonio I, Magnani G, Nicolini F, Niccoli G, Ardissino D, Vignali L, Solinas E. P56 SPONTANEOUS CORONARY ARTERY DISSECTIONS: ANALYSIS OF NON TRADITIONAL RISK FACTORS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.054] [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] [Indexed: 11/13/2022]
Abstract
Abstract
The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT–RF) have assumed increasing interest, but few data are available. NT–RF include three categories: Sex–related (SR–NT–FR), Sex–predominant (SP–NT–RF) and Gender–related (GR–NT–RF). (Table 1)
Aim of the Study
The objective of our analysis was to evaluate the incidence of NT–RF in Parma SCAD registry population.
Material and methods
We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021
Results
Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT–RF, 51 patients (82%) had at least one of all, with at least one SR–RF (66%) or GR–RF (64,5%). Patients with NT–RF were younger at time of SCAD (mean age 53 vs 66; p = 0.027) and they were predominantly females (48 vs 7 pts, p = 0.004) (Table 2). No differences were found among NT–RF SCAD and nNT–RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST–segment elevation myocardial infarction (43 pts, 72.6%) vs ST–segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT–RF and nNT–RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow–up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT–RF group without statistical significance (NT–RF SCAD 19.6% – nNT–RF SCAD 9.1%; p = 0.4). (Table 3)
Conclusion
SCAD is an emerging cause of myocardial infarction in young and middle–aged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT–RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.
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Affiliation(s)
- R Giacalone
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - M Ferretti
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - F Gurgoglione
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - M Noni
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - G Pelà
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - A Vezzani
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - M Cattabiani
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - G Benatti
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - I Tadonio
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - G Magnani
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - F Nicolini
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - G Niccoli
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - D Ardissino
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - L Vignali
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
| | - E Solinas
- DIVISIONE DI CARDIOLOGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; DIPARTIMENTO DI MEDICINA E CHIRURGIA, UNIVERSITÀ DI PARMA, PARMA; UNITA‘ DI TERAPIA INTENSIVA CARDIOCHIRURGICA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA; UNIVERSITA‘ DI PARMA, DIVISIONE DI CARDIOCHIRURGIA, AZIENDA OSPEDALIERO–UNIVERSITARIA DI PARMA, PARMA
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6
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Koletzko B. Training in Paediatric Clinical Nutrition Across Europe: A Survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2022; 74:662-667. [PMID: 35135959 DOI: 10.1097/mpg.0000000000003376] [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: 12/10/2022]
Abstract
OBJECTIVES/BACKGROUND Disease-related malnutrition is common in patients with chronic diseases and has detrimental effects, therefore, skills in nutrition care are essential core competencies for paediatric digestive medicine. The aim of this survey, conducted as part of a global survey of paediatric gastroenterology, hepatology and nutrition (PGHN) training in Europe, was to assess nutrition care-related infrastructure, staff, and patient volumes in European PGHN training centres. METHODS Standardized questionnaires related to clinical nutrition (CN) care were completed by representatives of European PGHN training centres between June 2016 and December 2019. RESULTS One hundred training centres from 17 European countries, Turkey, and Israel participated in the survey. Dedicated CN clinics exist in 66% of the centres, with fulltime and part-time CN specialists in 66% and 42%, respectively. Home tube feeding (HTF) andhome parenteral nutrition (HPN) programmes are in place in 95% and 77% of centres, respectively. Twenty-four percent of centres do not have a dedicated dietitian and 55% do not have a dedicated pharmacist attached to the training centre. Even the largest centres with >5000 outpatients reported that 25% and 50%, respectively do not have a dedicated dietitian or pharmacist. Low patient numbers on HTF and HPN of <5 annually are reported by 13% and 43% of centres, respectively. CONCLUSIONS The survey shows clear differences and deficits in Clinical Nutrition training infrastructure, including staff and patient volumes, in European PGHN training centres, leading to large differences and limitations in training opportunities in Clinical Nutrition.
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Affiliation(s)
- Alexandra Papadopoulou
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | | | - Alastair Baker
- The Paediatric Liver Centre, King's College Hospital, London
| | - Maria Noni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Eleni Koutri
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Maria-Vasiliki Karagianni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Sue Protheroe
- The Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Alfredo Guarino
- The Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Emmanuel Mas
- The Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Michael Wilschanski
- The Paediatric Gastroenterology Unit, Department of Paediatrics, Hadassah University Hospitals, Jerusalem, Israel
| | - Enriqueta Roman
- The Paediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Johanna Escher
- The Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Raoul I Furlano
- The Division of Paediatric Gastroenterology and Nutrition, University Children's Hospital, Basel, Switzerland
| | - Carsten Posovszky
- The Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Ilse Hoffman
- The Department of Paediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium
| | - Gabor Veres
- The Paediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary
| | - Jiri Bronsky
- The Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Duska Tjesic-Drinkovic
- The University Hospital Center Zagreb - Division for Paediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maria Fotoulaki
- The 4th Department of Paediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rok Orel
- The Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children's Hospital, Ljubljana, Slovenia
| | - Vaidotas Urbonas
- The Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - Aydan Kansu
- The Division of Paediatric Gastroenterology, Department of Paediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Miglena Georgieva
- The 2nd Department of Paediatrics, Saint Marina University hospital, Varna, Bulgaria
| | - Berthold Koletzko
- The LMU - Ludwig Maximilians Universität Munich, Department of Paediatrics, Dr. von Hauner Children's Hospital, LUM University Hospitals, Munich, Germany
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7
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Papadopoulou A, Ribes-Koninckx C, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Baker A, Kelly D. Training in pediatric hepatology across Europe: a survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Ann Gastroenterol 2022; 35:187-193. [PMID: 35479583 PMCID: PMC8922256 DOI: 10.20524/aog.2022.0698] [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: 11/11/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background The widely recognized burden of liver diseases makes training in pediatric hepatology (PH) imperative. The aim of this survey, which was part of a global survey on training in pediatric gastroenterology, hepatology and nutrition (PGHN) across Europe, was to assess the PH and liver transplantation (LT) infrastructure, staff and training programs in PGHN training centers. Method Standardized questionnaires were collected from training centers via the presidents/representatives of the National Societies Network of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) from June 2016 to December 2019. Results A total of 100 PGHN training centers participated in the survey (14/100 were national referral centers in PH and/or LT). Dedicated PH clinics were available in 75%, but LT clinics in only 11%. Dedicated beds for PGHN inpatients were available in 47/95 (49%) centers. Full-time or part-time specialists for PH care were available in 31/45 (69%) and 11/36 (31%) centers, respectively. Liver biopsies (LB) were performed in 93% of centers by: a PGHN specialist (35%); an interventional radiologist (26%); a pediatric surgeon (4%); or a combination of them (35%). Dividing the annual number of LBs in the centers performing LBs by the number of trainees gave a median (range) of 10 (1-125) per trainee. Transient elastography was available in 60/92 (65%) of centers. Conclusions The survey highlighted the differences and shortcomings in PH training across Europe. ESPGHAN should take initiatives together with National Societies to ensure the acquisition of PH knowledge and skills according to the ESPGHAN curriculum. An infographic is available for this article at: http://www.annalsgastro.gr/files/journals/1/earlyview/2022/Infographic-Hepatology-training-paper.pdf
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain (Carmen Ribes-Koninckx)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Women’s & Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children’s Hospital, Toulouse University Hospital, Toulouse, France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz, Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Alastair Baker
- Pediatric Liver Center, King’s College Hospital, London, United Kingdom (Alastair Baker)
| | - Deirdre Kelly
- Birmingham Women’s & Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
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8
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Thomson M, Benninga M, Thapar N, Kelly D, Koletzko B. Association of training standards in pediatric gastroenterology, hepatology and nutrition in European training centers with formal national recognition of the subspecialty: a survey of the ESPGHAN National Societies Network 2016-2019. Ann Gastroenterol 2022; 35:317-324. [PMID: 35599923 PMCID: PMC9062838 DOI: 10.20524/aog.2022.0711] [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: 11/16/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background This survey evaluated the effects of the recognition of pediatric gastroenterology, hepatology and nutrition (PGHN) on European PGHN training centers. Method Standardized questionnaires were collected from training centers via the presidents/representatives of the National Societies Network of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, from June 2016 to December 2019. Results A total of 100 training centers from 19 countries participated in the survey: 55 from 12 countries where PGHN is formally recognized (Group 1) and 45 from 7 countries where it is not (Group 2). Training centers in Group 2 were less likely to have an integrated endoscopy suite, a written training curriculum and a training lead (P=0.059, P<0.001 and P=0.012, respectively). Trainees in Group 2 were less likely to be exposed to an adequate number of diagnostic endoscopies, while no differences were found in relation to liver biopsies. Half of the training centers in both Groups do not have dedicated beds for PGHN patients, while in 64% and 58%, respectively, trainees do not participate in on-call programs for PGHN emergencies. Research training is mandatory in 26% of the centers. The duration of training, as well as the assessment and accreditation policies, vary between countries. Conclusions This study has revealed significant discrepancies and gaps in infrastructure and training programs, training leadership, and assessment of training and certification across European training centers in PGHN. Strategies to support the recognition of PGHN and to standardize and improve training conditions should be developed and implemented. An infographic is available for this article at: http://www.annalsgastro.gr/files/journals/1/earlyview/2022/Infographic_AG-6496.pdf
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain (Carmen Ribes-Koninckx)
| | - Alastair Baker
- Pediatric Liver Center, King’s College Hospital, London, United Kingdom (Alastair Baker)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz, Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Mike Thomson
- Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, United Kingdom (Mike Thomson)
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (Marc Benninga)
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane, Australia (Nikhil Thapar)
| | - Deirdre Kelly
- Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Berthold Koletzko
- LMU – Ludwig Maximilians Universität Munich, Dept. Pediatrics, Dr. von Hauner Children’s Hospital, LUM University Hospitals, Munich, Germany (Berthold Koletzko)
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Benninga M, Thapar N. Training in pediatric neurogastroenterology and motility across Europe: a survey of the ESPGHAN National Societies Network 2016-2019. Ann Gastroenterol 2022; 35:325-332. [PMID: 35599925 PMCID: PMC9062837 DOI: 10.20524/aog.2022.0710] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/09/2022] [Indexed: 11/11/2022] Open
Abstract
Background Method Results Conclusions
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology
and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia
Children’s Hospital, Thivon and Papadiamantopoulou, 11527 Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital,
Valencia, Spain (Carmen Ribes-Koninckx)
| | - Alastair Baker
- Pediatric Liver Centre, King’s College Hospital, London,
United Kingdom (Alastair Baker)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Children’s Hospital, NHS Foundation Trust,
Birmingham, United Kingdom (Sue Protheroe)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of
Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and
Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse,
France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics,
Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de
Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition,
University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University
Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University
Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen,
Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague,
Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz,
Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for
Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of
Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University
of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition,
Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases,
Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of
Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina
University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma
Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands (Marc Benninga)
| | - Nikhil Thapar
- Gastroenterology Department, UCL Great Ormond Street Institute
of Child Health, London, United Kingdom (Nikhil Thapar)
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Spoulou V, Noni M, Koukou D, Kossyvakis A, Michos A. Clinical characteristics of COVID-19 in neonates and young infants. Eur J Pediatr 2021; 180:3041-3045. [PMID: 33786658 DOI: 10.1007/s00431-021-04042-x/tables/2] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 05/25/2023]
Abstract
We report the clinical characteristics and management of fourteen neonates and very young infants with COVID-19. Although all presented with mild symptoms and did not require specific treatment, most of them had abnormal laboratory and radiological findings. Ten infants presented with neutropenia and/or monocytosis but none with lymphopenia. Transient hypertriglyceridemia and/or prolonged viral shedding were detected in 9 patients.Conclusion: Based to our experience, COVID-19 is mild in very young infants and might have distinct laboratory findings. What is Known: • SARS-CoV-2 in infants is a mild disease. • The period of transmission is approximately 2 weeks. What is New: • Very young age is not a risk factor for severe COVID-19 but could be associated with prolonged viral shedding. • Neutropenia and monocytosis are distinct characteristics of COVID-19 in very young infants.
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Affiliation(s)
- Vana Spoulou
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maria Noni
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koukou
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Michos
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Koletsi P, Antoniadi M, Mermiri D, Koltsida G, Koukou D, Noni M, Spoulou V, Michos A. A toddler diagnosed with severe postinfectious bronchiolitis obliterans and COVID-19 infection. Pediatr Pulmonol 2021; 56:2381-2384. [PMID: 33945679 PMCID: PMC8242384 DOI: 10.1002/ppul.25436] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
During the COVID-19 pandemic, management of SARS-CoV-2 infection in children with underlying chronic lung disease has been challenging. There are limited studies in children with respiratory comorbidities, apart from asthma, presumably due to low morbidity of SARS-CoV-2 infection in the general pediatric population along with the low incidence of certain pulmonary conditions. Compassionate use of remdesivir has been shown to reduce time to clinical improvement in adults and has been retrospectively studied in small pediatric cohorts with promising results. Whether children with underlying respiratory conditions may benefit from antiviral treatment in the context of different pathophysiologic backgrounds and unknown drug safety and efficacy needs to be further evaluated. We present a case of COVID-19 infection in a 3-year old toddler with severe postinfectious bronchiolitis obliterans, who received compassionate treatment with 5-day-course of remdesivir, and recovered with favourable outcome.
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Affiliation(s)
| | | | | | - Georgia Koltsida
- Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koukou
- Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Noni
- Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Spoulou
- Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Michos
- Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Spoulou V, Noni M, Koukou D, Kossyvakis A, Michos A. Clinical characteristics of COVID-19 in neonates and young infants. Eur J Pediatr 2021; 180:3041-3045. [PMID: 33786658 PMCID: PMC8009690 DOI: 10.1007/s00431-021-04042-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 01/03/2023]
Abstract
We report the clinical characteristics and management of fourteen neonates and very young infants with COVID-19. Although all presented with mild symptoms and did not require specific treatment, most of them had abnormal laboratory and radiological findings. Ten infants presented with neutropenia and/or monocytosis but none with lymphopenia. Transient hypertriglyceridemia and/or prolonged viral shedding were detected in 9 patients.Conclusion: Based to our experience, COVID-19 is mild in very young infants and might have distinct laboratory findings. What is Known: • SARS-CoV-2 in infants is a mild disease. • The period of transmission is approximately 2 weeks. What is New: • Very young age is not a risk factor for severe COVID-19 but could be associated with prolonged viral shedding. • Neutropenia and monocytosis are distinct characteristics of COVID-19 in very young infants.
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Affiliation(s)
- Vana Spoulou
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maria Noni
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koukou
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Michos
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Koutri E, Patereli A, Noni M, Gutiérrez-Junquera C, González-Lois C, Oliva S, Giordano C, Stefanaki K, Papadopoulou A. Distribution of eosinophils in the gastrointestinal tract of children with no organic disease. Ann Gastroenterol 2020; 33:508-515. [PMID: 32879598 PMCID: PMC7406818 DOI: 10.20524/aog.2020.0518] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to assess the eosinophil (eos) density of the mucosa of the gastrointestinal (GI) tract in children undergoing endoscopic procedures following an extensive workup, without diagnosis of an organic disease. Methods Biopsies from GI endoscopies performed at 3 major children’s hospitals (Athens, Madrid and Rome), between January 2012 and June 2018, were evaluated by a single pathologist in each center. Peak eos counts were expressed /high power field and /mm2. Other histological abnormalities were also reported. Results A total of 111 children (median age 11 years; 48 boys) underwent upper endoscopy (333 biopsies), while 44 (median age 12; 25 boys) underwent ileocolonoscopy (262 biopsies). The median (interquartile range) eos/mm2 were as follows: esophagus 0 (0-0); stomach 10.2 (3.3-15.3); duodenum 56.1 (26.1-86.7); ileum 61.2 (49.0-91.8); cecum 76.5 (40.9-99.7); ascending colon 73.9 (49.5-131.4); transverse colon 66.3 (40.8-91.5); descending colon 66.3 (30.6-81.6); sigmoid colon 39.2 (27.8-51.0); and rectum 25.5 (9.8-45.8). Geographical variations in GI tissue eos counts were found amongst the participating centers, but the causative factors need further evaluation. Functional GI disorders according to the Rome IV criteria were diagnosed in 73 children (37 boys, median age 13 years). No differences were found between children with or without functional GI disorder diagnosis, with regard to eos density in the GI tract. Conclusion The reported peak counts of GI tissue eos in children with no organic diseases provide normative values that may be useful in the evaluation of children with GI symptoms suggestive of eosinophilic GI disorders.
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Affiliation(s)
- Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children's Hospital, Athens, Greece (Eleni Koutri, Maria Noni, Alexandra Papadopoulou)
| | - Amalia Patereli
- Department of Pathology, Agia Sofia Children's Hospital, Athens, Greece (Amalia Patereli, Kaliopi Stefanaki)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children's Hospital, Athens, Greece (Eleni Koutri, Maria Noni, Alexandra Papadopoulou)
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Autonomous University of Madrid, Spain (Carolina Gutiérrez-Junquera)
| | - Carmen González-Lois
- Pathology Department, University Hospital Puerta de Hierro Majadahonda, Autonomous University of Madrid, Spain (Carmen González-Lois)
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy (Salvatore Oliva)
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy (Carla Giordano)
| | - Kaliopi Stefanaki
- Department of Pathology, Agia Sofia Children's Hospital, Athens, Greece (Amalia Patereli, Kaliopi Stefanaki)
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children's Hospital, Athens, Greece (Eleni Koutri, Maria Noni, Alexandra Papadopoulou)
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Benfari G, Noni M, Onorati F, Cerrito L, Pernigo M, Vinco G, Cameli M, Mandoli G, Borio G, Geremia G, Zivelonghi C, Abbasciano R, Mazzali G, Zamboni M, Faggian G, Rossi A, Ribichini F. Effects of Aortic Valve Replacement on Left Ventricular Diastolic Function in Patients With Aortic Valve Stenosis. Am J Cardiol 2019; 124:409-415. [PMID: 31186115 DOI: 10.1016/j.amjcard.2019.04.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
The afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e' 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p <0.0001). In the 37 patients with biopsy available, fibrosis was 24 ± 12%. PALS and AS severity were correlated with LV fibrosis (R2 = 0.19; p = 0.006, and R2 = 0.15; p = 0.02, respectively). PALS (odds ratio: 1.19 [1.05 to 1.41], p = 0.02) and PACS (odds ratio: 1.24 [1.06 to 1.50], p = 0.006) were the only baseline noninvasive parameters independently associated with normal left atrial pressure at follow-up. Mean follow-up time was 791 ± 245 days, and 8 (12%) patients had cardiovascular events (death, hospital admission due to heart failure or ischemic disease, and onset of atrial fibrillation). Myocardial fibrosis (p = 0.05), baseline PALS (p = 0.004), and PACS (p = 0.03) were associated with cardiovascular events. In conclusion, LV diastolic function generally improves after AVR for severe AS. Baseline PALS, PACS, and LV fibrosis were related to the DD and clinical outcome at follow-up; these parameters might cue a better diastolic response to the afterload correction.
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Noni M, Stathi A, Vaki I, Velegraki A, Zachariadou L, Michos A. Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period. J Fungi (Basel) 2019; 5:jof5010019. [PMID: 30813283 PMCID: PMC6462917 DOI: 10.3390/jof5010019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/29/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008⁻2012 to period 2013⁻2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.
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Affiliation(s)
- Maria Noni
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Angeliki Stathi
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Ilia Vaki
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Aristea Velegraki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Levantia Zachariadou
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Athanasios Michos
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
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Lucarelli C, Biagio LS, Francica A, Benfari G, Noni M, Abbasciano R, Rossi A, Zamboni M, Onorati F, Ribichini F, Faggian G. RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550043.20260.a1] [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: 11/05/2022]
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Lucarelli C, Biagio LS, Francica A, Benfari G, Abbasciano R, Noni M, Rossi A, Zamboni M, Onorati F, Ribichini F, Faggian G. OC04 BASELINE ATRIAL STRAIN RELATES TO POST-SURGICAL FOLLOW UP IN SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549885.49380.9b] [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: 11/05/2022]
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Giannakopoulos A, Katelaris A, Noni M, Karakonstantakis T, Kanaka-Gantenbein C, Doudounakis S. Hyperthyrotropinemia in newly diagnosed cystic fibrosis patients with pancreatic insufficiency reversed by enzyme therapy. Eur J Pediatr 2018; 177:775-779. [PMID: 29487998 DOI: 10.1007/s00431-018-3120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/22/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED Patients with cystic fibrosis (CF) commonly present with an elevated TSH concentration, suggesting subclinical hypothyroidism. Its relation to concomitant pancreatic insufficiency and its natural course upon initiation of enzyme replacement have not been adequately studied. Herein, we investigated the thyroid function in newly diagnosed infants with CF and monitored the course of thyroid function response to pancreatic enzyme substitution treatment. Fourteen, newly diagnosed infants with CF and pancreatic insufficiency, were followed every 6-8 weeks for 6 months ensuing onset of pancreatic enzyme substitution therapy. All infants had normal TSH values on neonatal screening. Ten out of 14 (71%) had hyperthyrotropinemia and normal freeT4 values at presentation. No patient received thyroxine. Upon follow-up, after 6 months, TSH values normalized in 90% of infants with CF and hyperthyrotropinemia. Serum selenium levels were negatively correlated with TSH levels. CONCLUSION Mild TSH elevation is a frequent finding in newly diagnosed cystic fibrosis patients with pancreatic insufficiency during infancy. TSH elevation resolves in most cases after initiation of enzyme substitution and improvement of nutritional status without any substitutive therapy with thyroxine. What is Known: • Newly diagnosed infants with cystic fibrosis often present with a state of hyperthyrotropinemia suggesting subclinical hypothyroidism. What is New: • Pancreatic enzyme substitution and improvement of nutrition restores normal TSH levels without the need of thyroxine therapy.
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Affiliation(s)
- Aris Giannakopoulos
- Department of Pediatrics, University Hospital of Patras, Rio 26500, Patras Medical School, Patras, Greece.
| | - Anni Katelaris
- Cystic Fibrosis Unit, Department of Pediatrics Cystic Fibrosis Unit, Department of Pediatrics, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Noni
- Cystic Fibrosis Unit, Department of Pediatrics Cystic Fibrosis Unit, Department of Pediatrics, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Doudounakis
- Cystic Fibrosis Unit, Department of Pediatrics Cystic Fibrosis Unit, Department of Pediatrics, "Aghia Sophia" Children's Hospital, Athens, Greece
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Noni M, Katelari A, Kapi A, Stathi A, Dimopoulos G, Doudounakis SE. Scedosporium apiospermum complex in cystic fibrosis; should we treat? Mycoses 2017; 60:594-599. [PMID: 28504471 DOI: 10.1111/myc.12634] [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] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/07/2017] [Accepted: 04/16/2017] [Indexed: 11/29/2022]
Abstract
Species of the Scedosporium apiospermum complex are the second most frequent filamentous fungi after Aspergillus fumigatus that can be found in cystic fibrosis (CF). Mixed colonisation by S. apiospermum complex and A. fumigatus is also quite common. In this study we summarise all CF patients who were colonised by S. apiospermum complex during their childhood and we present two CF patients who were treated as fungal bronchitis due to S. apiospermum complex. The medical records of 400 CF patients were reviewed in order to identify those with positive respiratory cultures for S. apiospermum complex. Scedosporium apiospermum complex was isolated in 10 CF patients and six of them had more than two positive sputum cultures during the study period. By the time of first isolation, the median age was 14.5 years, the median BMI was 19.41 kg/m2 , the median predicted FEV1 % was 78.65% and six patients had a history of A. fumigatus isolation. Two patients presented symptoms of infection while they were colonised by S. apiospermum complex. A rapid remission of their symptoms was observed only when antifungal therapy was administered. Antifungal treatment should be considered in CF patients who present symptoms of infection not responding to antibacterial therapy and S. apiospermum complex is persistently growing in sputum cultures.
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Affiliation(s)
- Maria Noni
- Medical School, Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Katelari
- Medical School, Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kapi
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Angeliki Stathi
- Laboratory of Microbiology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George Dimopoulos
- Faculty of Medicine, Department of Critical Care, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
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Noni M, Katelari A, Petrocheilou A, Papakonstantinou E, Loukas I, Doudounakis SE. 13 Cases of false negative cystic fibrosis newborn screening in Greece. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30253-3] [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: 11/29/2022]
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Noni M, Katelari A, Kaditis A, Theochari I, Lympari I, Alexandrou-Athanassoulis H, Doudounakis SE, Dimopoulos G. Candida albicans chronic colonisation in cystic fibrosis may be associated with inhaled antibiotics. Mycoses 2015; 58:416-21. [PMID: 26058475 DOI: 10.1111/myc.12338] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023]
Abstract
Candida albicans is increasingly recognised as a coloniser of the respiratory tract in cystic fibrosis (CF) patients. Yet, the potential role, if any, of the micro-organism in the progress of the disease remains unclear. In this study, we investigated the association between inhaled antibiotics and C. albicans chronic colonisation in patients with CF. A cohort of 121 CF patients born from 1988 to 1996 was, respectively, studied. The medical records of each patient were reviewed from the first time they attended the CF Centre until the occurrence of C. albicans chronic colonisation or their last visit for the year 2010. Chronic colonisation was defined as the presence of C. albicans in more than 50% of cultures in a given year. A number of possible confounders were included in the multivariate logistic regression analysis to identify an independent association between inhaled antibiotics and C. albicans chronic colonisation. Fifty-four (44.6%) of the 121 patients enrolled in the study developed chronic colonisation by the micro-organism. Multivariate logistic regression analysis determined the independent effect of inhaled antibiotic treatment on the odds of chronic colonisation (OR 1.112, 95% CI [1.007-1.229], P = 0.036). Candida albicans chronic colonisation may be associated with the duration of inhaled antibiotic treatment.
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Affiliation(s)
- Maria Noni
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Anna Katelari
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Athanasios Kaditis
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece.,Pulmonology Unit, 1st Department of Pediatrics, Medical School, University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Ioanna Theochari
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Ioulia Lympari
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | | | - George Dimopoulos
- Department of Critical Care, Medical School, University of Athens, University Hospital "Attikon", Athens, Greece
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Katelari A, Tzanoudaki M, Noni M, Kaditis A, Polaki V, Limioti A, Doudounakis SE, Kanariou M. 24 Basophil Activation Test may facilitate ABPA diagnosis in CF patients. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30201-0] [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: 10/23/2022]
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Noni M, Katelari A, Kaditis A, Spoulou V, Dimopoulos G, Bakoula C, Doudounakis SE. ePS04.6 Aspergillus fumigatus chronic colonization and lung function decline in CF may have a two-way relationship. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30157-0] [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: 11/30/2022]
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Kaditis A, Doulgeraki A, Petrocheilou A, Katelari A, Noni M, Doudounakis SE. 230 History of meconium ileus is associated with low fat tissue mass in children and adolescents with cystic fibrosis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30405-7] [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: 11/27/2022]
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Noni M, Katelari A, Dimopoulos G, Kourlaba G, Spoulou V, Alexandrou-Athanassoulis H, Doudounakis SE, Tzoumaka-Bakoula C. Inhaled corticosteroids and Aspergillus fumigatus isolation in cystic fibrosis. Med Mycol 2014; 52:715-22. [PMID: 25056962 DOI: 10.1093/mmy/myu038] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aspergillus fumigatus isolation in cultures from respiratory specimens of patients with cystic fibrosis (CF) is quite common; however, the role of A. fumigatus as a pathogen and whether its presence is associated with progression of pulmonary disease remain unclear. We investigated the association between inhaled corticosteroids and the recovery of A. fumigatus by performing a retrospective cohort study of CF patients born between 1988 and 1996. The patients' medical records from their first visit to the CF Center until December 2010 were reviewed. Outcomes were the occurrence of A. fumigatus first isolation, chronic colonization, or the last visit at the CF Center. A number of possible confounders were included in the multivariate logistic regression analysis in order to identify an independent association between inhaled corticosteroids and colonization status. A total of 121 patients were included in the study. Thirty-nine patients (32.2%) had at least one positive culture and 14 (11.6%) developed chronic colonization. Multivariate logistic regression analysis was used to determine the independent effect of inhaled corticosteroids on the odds of first isolation (odds ratio [OR], 1.165; 95% confidence interval [CI], 1.015-1.337; P = 0.029) and chronic colonization (OR, 1.180; 95% CI, 1.029-1.353; P = 0.018). In conclusion, A. fumigatus first isolation and chronic colonization are associated with the duration of inhaled corticosteroid treatment.
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Affiliation(s)
- Maria Noni
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Medical School, University of Athens, Athens, Greece
| | - Anna Katelari
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Medical School, University of Athens, Athens, Greece
| | - George Dimopoulos
- Department of Critical Care, University Hospital "Attikon," Medical School, University of Athens, Athens, Greece
| | - Georgia Kourlaba
- Department of Cystic Fibrosis, "Aghia Sophia" Children's Hospital, Medical School, University of Athens, Athens, Greece
| | - Vana Spoulou
- Department of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | | | - Chryssa Tzoumaka-Bakoula
- Department of Pediatrics, "P & A Kyriakou" Children's Hospital, Medical School, University of Athens, Athens, Greece
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Noni M, Katelari A, Dimopoulos G, Kaditis A, Theochari I, Lympari I, Alexandrou H, Doudounakis S. 152 Inhaled antibiotics and Candida albicans chronic colonization in cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60288-5] [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: 11/29/2022]
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, 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Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Katelari A, Tzanoudaki M, Noni M, Kanariou M, Doudounakis S. 173 Basophil activation test: A novel approach to the diagnosis of allergic bronchopulmonary aspergillosis in cystic fibrosis patients. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60314-8] [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: 12/01/2022]
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Noni M, Lympari I, Theochari I, Katelari A, Stathi A, Alexandrou E, Doudounakis S. 96 Aspergillus spp. and Candida spp. detection in CF children: implications on lung function and hospitalizations. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60266-5] [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: 11/26/2022]
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