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Vyzhga Y, Wittkowski H, Hentgen V, Georgin-Lavialle S, Theodoropoulou A, Fuehner S, Jesenak M, Frenkel J, Papadopoulou-Alataki E, Anton J, Olivieri AN, Brunner J, Sanchez J, Koné-Paut I, Fingerhutova S, Pillet P, Meinzer U, Khubchandani R, Jansson A, Haas JP, Berendes R, Kallinich T, Horneff G, Lilienthal E, Papa R, Foell D, Lainka E, Caorsi R, Gattorno M, Hofer M. Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation. Pediatr Rheumatol Online J 2024; 22:55. [PMID: 38760816 PMCID: PMC11100049 DOI: 10.1186/s12969-024-00987-z] [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: 01/14/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.
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Affiliation(s)
- Y Vyzhga
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
| | - H Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - V Hentgen
- Department for Pediatrics, National Referral Centre of Auto-Inflammatory Diseases and Inflammatory Amyloidosis, - CEREMAIA, Versailles Hospital, Le Chesnay (Paris), France
| | - S Georgin-Lavialle
- CEREMAIA (French Reference Center for Auto-Inflammatory Diseases and Inflammatory Amyloidosis), Kremlin-Bicêtre, France
- Department of Internal Medicine, Sorbonne University, Tenon Hospital (APHP), Paris, France
| | - A Theodoropoulou
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - S Fuehner
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - M Jesenak
- Department of Peadiatrics and Adolescent Medicine, Jesenius Faculty of Medicine in Martin, Comenius University, University Hospital Martin, Martin, Slovakia
| | - J Frenkel
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, Netherlands
| | - E Papadopoulou-Alataki
- Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Papageorgiou General Hospital, Fourth, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona. Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - A Nunzia Olivieri
- Dipartimento Della Donna del Bambino E Di Chirurgia Generale E Specialistica, Università Degli Studi Della Campania L.Vanvitelli, Naples, Italy
| | - J Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck and Danube Private University Krems, Innsbruck, Austria
| | - J Sanchez
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - I Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Sud, Le Kremlin Biĉetre, France
| | - S Fingerhutova
- Department of Paediatrics and Inherited Metabolic Disorders, Centre for Paediatric Rheumatology and Autoinflammatory Diseases 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - P Pillet
- Pediatrics and Immunology, CHU Pellegrin, Bordeaux, France
| | - U Meinzer
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Université de Paris, Paris, France
| | - R Khubchandani
- Department of Pediatrics, Jaslok Hospital, Mumbai, India
| | - A Jansson
- Division of Pediatric Rheumatology and Immunology, Dr. Von Hauner Children's Hospital, University Hospital Munich, Munich, Germany
| | - J-P Haas
- German Center for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - R Berendes
- Marien Children's Hospital, Landshut, Germany
| | - T Kallinich
- German Rheumatism Research Center, Leibniz Institute Berlin Charité Universitätsmedizin Berlin, Paediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Berlin, Germany
| | - G Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
| | - E Lilienthal
- Department of Pediatrics, Ruhr University of Bochum, Bochum, Germany
| | - R Papa
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - E Lainka
- Department of Pediatric Rheumatology, University Children's Hospital Essen, Essen, Germany
| | - R Caorsi
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Gattorno
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Hofer
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Lampidi S, Maritsi D, Charakida M, Eleftheriou I, Farmaki E, Spyridis N, Charisi K, Vantsi P, Filippatos F, Skourti K, Papadopoulou-Alataki E, Papadopoulou-Legbelou K, Kampouridou P, Grivea IN, Vergadi E, Gkentzi D, Dimou D, Koletsi P, Fotis L, Liakopoulou T, Agrafiotou A, Kourtesi K, Tsolas G, Kafetzis D, Papaevangelou V, Dimitriou G, Galanakis E, Syrogiannopoulos GA, Spoulou V, Michos A, Roilides E, Tsolia MN. Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population. Eur J Pediatr 2024; 183:1693-1702. [PMID: 38214810 PMCID: PMC11001744 DOI: 10.1007/s00431-023-05383-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 109/mm3. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (p < 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock. CONCLUSION MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity. WHAT IS KNOWN • MIS-C is an infrequent but serious disease entity. • Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems. WHAT IS NEW • NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. • Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.
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Affiliation(s)
- Stavroula Lampidi
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Despoina Maritsi
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Marietta Charakida
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Evangelia Farmaki
- First Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Nikos Spyridis
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Konstantina Charisi
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Petrina Vantsi
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Filippos Filippatos
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kleopatra Skourti
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429, Thessaloniki, Greece
| | - Kyriaki Papadopoulou-Legbelou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429, Thessaloniki, Greece
| | | | - Ioanna N Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Greece
| | - Eleni Vergadi
- Department of Paediatrics, Medical School, University of Crete, 71003, Heraklion, Greece
| | - Despoina Gkentzi
- Department of Paediatrics, University of Patras, University General Hospital of Patras, 26504, Patra, Greece
| | - Despina Dimou
- Paediatric Department, Penteli Children's Hospital, 15236, Athens, Greece
| | - Patra Koletsi
- Paediatric Department, Penteli Children's Hospital, 15236, Athens, Greece
| | - Lampros Fotis
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
- Department of Paediatrics, Metropolitan Hospital, 18547, Athens, Greece
- IASO Children's Hospital, 15123, Athens, Greece
| | | | | | - Katerina Kourtesi
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
| | - Georgios Tsolas
- Department of Paediatrics, Metropolitan Hospital, 18547, Athens, Greece
| | | | - Vassiliki Papaevangelou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, University of Patras, University General Hospital of Patras, 26504, Patra, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, Medical School, University of Crete, 71003, Heraklion, Greece
| | - George A Syrogiannopoulos
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Greece
| | - Vassiliki Spoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Athanasios Michos
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Emmanuel Roilides
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Maria N Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece.
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Bustaffa M, Koné-Paut I, Ozen S, Amaryan G, Papadopoulou-Alataki E, Gallizzi R, Carrabba M, Aviel YB, Cantarini L, Alessio M, Anton J, Obici L, Gok F, Batu ED, Moreno E, Brogan P, Trachana M, Simonini G, Rigante D, Uziel Y, Insalaco A, Maggio MC, Ruperto N, Gattorno M, Semerano LR. Corrigendum to The impact of the Eurofever criteria and the new InFevers MEFV classification in real life: Results from a large international FMF cohort. Semin Arthritis Rheum 2023; 58:152123. [PMID: 36404149 DOI: 10.1016/j.semarthrit.2022.152123] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marta Bustaffa
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gayane Amaryan
- National Pediatric Centre for Familial Mediterranean Fever, Arabkir Medical Complex, Institute of Child and Adolescent Health, Yerevan State Medical University, Yerevan, Armenia
| | | | - Romina Gallizzi
- Department of Medical of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Carrabba
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOS Malattie Rare, Milano, Italy
| | | | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Maria Alessio
- Università di Napoli Federico II, Dipartimento di Pediatria, Napoli, Italy
| | - Jordi Anton
- Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Laura Obici
- Fondazione IRCCS Policlinico San Matteo, Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Pavia, Italy
| | - Faysal Gok
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Estefania Moreno
- University Hospital Valle de Hebron, Rheumatology Unit, Barcelona, Spain
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, United Kingdom
| | - Maria Trachana
- First Department of pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki University School of Medicine, Thessaloniki, Greece
| | - Gabriele Simonini
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Donato Rigante
- Department of Life Sciences and Global Health, IRCCS Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Yosef Uziel
- Meir Medical Centre, Pediatric Rheumatology Unit, Department of Pediatrics, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Cristina Maggio
- University Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Printo, Genoa, Italy
| | - Marco Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy; UOSD Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - L Rossi Semerano
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
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Gavriilaki E, Tsiftsoglou SA, Touloumenidou T, Farmaki E, Panagopoulou P, Michailidou E, Koravou EE, Mavrikou I, Iosifidis E, Tsiatsiou O, Papadimitriou E, Papadopoulou-Alataki E, Papayanni PG, Varelas C, Kokkoris S, Papalexandri A, Fotoulaki M, Galli-Tsinopoulou A, Zafeiriou D, Roilides E, Sakellari I, Anagnostopoulos A, Tragiannidis A. Targeted Genotyping of MIS-C Patients Reveals a Potential Alternative Pathway Mediated Complement Dysregulation during COVID-19 Infection. Curr Issues Mol Biol 2022; 44:2811-2824. [PMID: 35877417 PMCID: PMC9325260 DOI: 10.3390/cimb44070193] [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: 05/19/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Complement dysregulation has been documented in adults with COVID-19 and implicated in relevant pediatric inflammatory responses against SARS-CoV-2. We propose that signatures of complement missense coding SNPs associated with dysregulation could also be identified in children with multisystem inflammatory syndrome (MIS-C). We investigated 71 pediatric patients with RT-PCR validated SARS-CoV-2 hospitalized in pediatric COVID-19 care units (November 2020–March 2021) in three major groups. Seven (7) patients suffered from MIS-C (MIS-C group), 32 suffered from COVID-19 and were hospitalized (admitted group), whereas 32 suffered from COVID-19, but were sent home. All patients survived and were genotyped for variations in the C3, C5, CFB, CFD, CFH, CFHR1, CFI, CD46, CD55, MASP1, MASP2, MBL2, COLEC11, FCN1, and FCN3 genes. Upon evaluation of the missense coding SNP distribution patterns along the three study groups, we noticed similarities, but also considerably increased frequencies of the alternative pathway (AP) associated with SNPs rs12614 CFB, rs1061170, and rs1065489 CFH in the MIS-C patients. Our analysis suggests that the corresponding substitutions potentially reduce the C3b-inactivation efficiency and promote slower and weaker AP C3bBb pre-convertase assembly on virions. Under these circumstances, the complement AP opsonization capacity may be impaired, leading to compromised immune clearance and systemic inflammation in the MIS-C syndrome.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
- Correspondence: (E.G.); (S.A.T.); Tel.: +30-697-3841-671 (E.G.); +30-697-9568-269 (S.A.T.)
| | - Stefanos A. Tsiftsoglou
- Laboratory of Pharmacology, Department of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: (E.G.); (S.A.T.); Tel.: +30-697-3841-671 (E.G.); +30-697-9568-269 (S.A.T.)
| | - Tasoula Touloumenidou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Evangelia Farmaki
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Paraskevi Panagopoulou
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Elissavet Michailidou
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Evaggelia-Evdoxia Koravou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Ioulia Mavrikou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Elias Iosifidis
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Olga Tsiatsiou
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Eleni Papadimitriou
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Efimia Papadopoulou-Alataki
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Penelope Georgia Papayanni
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Christos Varelas
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Styliani Kokkoris
- Laboratory of Hematology and Hospital—Blood Transfusion Unit, Medical School, University General Hospital “Attikon”, NKUA, 12462 Athens, Greece;
| | - Apostolia Papalexandri
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Maria Fotoulaki
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Assimina Galli-Tsinopoulou
- 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54621 Thessaloniki, Greece; (A.G.-T.); (A.T.)
| | - Dimitrios Zafeiriou
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Emmanuel Roilides
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Ioanna Sakellari
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Achilles Anagnostopoulos
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Athanasios Tragiannidis
- 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54621 Thessaloniki, Greece; (A.G.-T.); (A.T.)
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Papadopoulou-Legbelou K, Triantafyllou A, Vampertzi O, Koletsos N, Douma S, Papadopoulou-Alataki E. Similar Myocardial Perfusion and Vascular Stiffness in Children and Adolescents with High Lipoprotein (a) Levels, in Comparison with Healthy Controls. Pulse (Basel) 2022; 9:64-71. [PMID: 35083172 DOI: 10.1159/000517871] [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: 03/25/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background and Aims This study investigated the possible correlation between elevated lipoprotein (a) (Lp(a)) levels and early vascular aging biomarkers in healthy children and adolescents. Methods Twenty-seven healthy children/adolescents, mean age 9.9 ± 3.7 years, with high Lp(a) levels without other lipid abnormalities and 27 age- and sex-matched controls with normal Lp(a) levels, were included in the study. The investigation of possible early vascular aging was assessed by measuring vascular function indices: carotid intima-media thickness (c-IMT), pulse wave velocity (PWV), augmentation index (AIx), and subendocardial viability ratio (SEVR). Results Although serum lipid values were within normal levels, mean values of total cholesterol and apolipoprotein B were higher in the group of children with high Lp(a) levels than controls (p = 0.006 and p < 0.001, respectively). Vascular function indices did not show significant differences, neither between the 2 groups nor in the subgroups of children with increased Lp(a) levels. These subgroups were defined by the presence or absence of family history of premature coronary artery disease. Lp(a) levels did not show a significant correlation with the other parameters studied, both regarding the whole sample (patients and controls), as well as in the subgroups of elevated Lp(a) levels. However, in the group of children with high Lp(a) levels, c-IMT and PWV were positively correlated with diastolic blood pressure (r = 0.427, p = 0.026 and r = 0.425, p = 0.030, respectively), while SEVR was negatively correlated with AIx (r = -0.455, p = 0.017). Conclusions Healthy children and adolescents with high Lp(a) levels do not yet have impaired vascular indices, compared to controls. However, in order to prevent early atherosclerosis, it is crucial to early identify and follow up children with high Lp(a) levels and positive family history of premature coronary disease or other cardiovascular risk factors.
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Affiliation(s)
- Kyriaki Papadopoulou-Legbelou
- 4th Department of Pediatrics, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Vampertzi
- 4th Department of Pediatrics, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koletsos
- 3rd Department of Internal Medicine, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- 4th Department of Pediatrics, School of Medicine, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bustaffa M, Koné-Paut I, Ozen S, Amaryan G, Papadopoulou-Alataki E, Gallizzi R, Carrabba M, Aviel YB, Cantarini L, Alessio M, Anton J, Obici L, Gok F, Batu ED, Moreno E, Brogan P, Trachana M, Simonini G, Rigante D, Uziel Y, Insalaco A, Maggio MC, Ruperto N, Gattorno M, Semerano LR. The impact of the Eurofever criteria and the new InFevers MEFV classification in real life: Results from a large international FMF cohort. Semin Arthritis Rheum 2022; 52:151957. [PMID: 35042149 DOI: 10.1016/j.semarthrit.2022.151957] [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: 07/30/2021] [Revised: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION New Eurofever/PRINTO classification criteria (EPCC) for Familial Mediterranean Fever (FMF) and other recurrent fevers have been recently developed, together with the classification of the pathogenicity of MEFV variants. OBJECTIVES To evaluate the impact in real life of both the EPCC and INSAID pathogenicity classification of MEFV variants in the large international Eurofever FMF cohort. METHODS Baseline demographic, genetic and clinical data of FMF patients included in the Eurofever registry were evaluated. The EPCC and the 2018 INSAID classification for MEFV variants were applied in all eligible FMF patients. RESULTS Since November 2009, clinical information was available for 1012 FMF (532 males/480 females, 827 children/185 adults) from 119 centres. Complete data were available for 887 patients in whom 623 (70.2%) satisfied EPCC (EPCC+), while 264 (29.8%) did not (EPCC-). The majority of the EPCC- patients (172, 65.1%) displayed negative or non-informative genetics (monoallelic or biallelic benign variants, monoallelic variant of unknown significance). At baseline, colchicine was used in most of EPCC+ patients (88%) and in a lower percentage of EPCC- patients (69%, p < 0.0001), who were treated in a higher proportion with steroid or NSAID on demand (p = 0.003 and 0.008, respectively). Four percent of patients received Anti-IL-1 treatment. CONCLUSIONS The combination of EPCC and the 2018 INSAID classification of MEFV variants is able to identify two distinct groups of patients, which differ in clinical characteristics, therapeutic approach and response to treatment. EPCC+ patients displayed the typical features of FMF, while EPCC- patients had a more variable phenotype with a lower percentage of response to colchicine.
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Affiliation(s)
- Marta Bustaffa
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gayane Amaryan
- National Pediatric Centre for Familial Mediterranean Fever, Arabkir Medical Complex, Institute of Child and Adolescent Health, Yerevan State Medical University, Yerevan, Armenia
| | | | - Romina Gallizzi
- Department of Medical of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Carrabba
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOS Malattie Rare, Milano, Italy
| | | | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Maria Alessio
- Università di Napoli Federico II, Dipartimento di Pediatria, Napoli, Italy
| | - Jordi Anton
- Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Laura Obici
- Fondazione IRCCS Policlinico San Matteo, Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Pavia, Italy
| | - Faysal Gok
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Estefania Moreno
- University Hospital Valle de Hebron, Rheumatology Unit, Barcelona, Spain
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, United Kingdom
| | - Maria Trachana
- First Department of pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki University School of Medicine, Thessaloniki, Greece
| | - Gabriele Simonini
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Donato Rigante
- Department of Life Sciences and Global Health, IRCCS Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Yosef Uziel
- Meir Medical Centre, Pediatric Rheumatology Unit, Department of Pediatrics, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Cristina Maggio
- University Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Printo, Genoa, Italy
| | - Marco Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy; UOSD Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - L Rossi Semerano
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
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Vampertzi O, Papadopoulou-Legbelou K, Triantafyllou A, Douma S, Papadopoulou-Alataki E. Familial Mediterranean fever and atherosclerosis in childhood and adolescence. Rheumatol Int 2019; 40:1-8. [PMID: 31705200 DOI: 10.1007/s00296-019-04457-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/17/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022]
Abstract
Familial Mediterranean fever is a chronic inflammatory disease characterized by periodic and self-limited episodes of fever and aseptic polyserositis. Although colchicine treatment has altered the course of the disease, it is believed that subclinical inflammation is still present, leading to endothelial dysfunction and atherosclerosis in the course of time. In this review, following the published recommendations, we queried online databases such as MEDLINE Pubmed, Scopus, and Web of science for peer-reviewed studies and reviews written in English language, using the following keywords: familial Mediterranean fever, children, endothelial dysfunction, atherosclerosis, cardiovascular disease. The objective of this review is to highlight the correlation between familial Mediterranean fever and atherosclerosis, and moreover to describe new serum inflammatory markers and non-invasive methods of endothelial dysfunction, to detect the atherosclerosis process early starting from childhood.
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Affiliation(s)
- Olga Vampertzi
- 4th Department of Pediatrics, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | - Areti Triantafyllou
- 3rd Department of Internal Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- 4th Department of Pediatrics, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ter Haar NM, Eijkelboom C, Cantarini L, Papa R, Brogan PA, Kone-Paut I, Modesto C, Hofer M, Iagaru N, Fingerhutová S, Insalaco A, Licciardi F, Uziel Y, Jelusic M, Nikishina I, Nielsen S, Papadopoulou-Alataki E, Olivieri AN, Cimaz R, Susic G, Stanevica V, van Gijn M, Vitale A, Ruperto N, Frenkel J, Gattorno M. Clinical characteristics and genetic analyses of 187 patients with undefined autoinflammatory diseases. Ann Rheum Dis 2019; 78:1405-1411. [PMID: 31278138 DOI: 10.1136/annrheumdis-2018-214472] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 09/21/2018] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the clinical characteristics, treatment response and genetic findings in a large cohort of patients with undefined systemic autoinflammatory diseases (SAIDs). METHODS Clinical and genetic data from patients with undefined SAIDs were extracted from the Eurofever registry, an international web-based registry that retrospectively collects clinical information on patients with autoinflammatory diseases. RESULTS This study included 187 patients. Seven patients had a chronic disease course, 180 patients had a recurrent disease course. The median age at disease onset was 4.3 years. Patients had a median of 12 episodes per year, with a median duration of 4 days. Most commonly reported symptoms were arthralgia (n=113), myalgia (n=86), abdominal pain (n=89), fatigue (n=111), malaise (n=104) and mucocutaneous manifestations (n=128). In 24 patients, relatives were affected as well. In 15 patients, genetic variants were found in autoinflammatory genes. Patients with genetic variants more often had affected relatives compared with patients without genetic variants (p=0.005). Most patients responded well to non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine and anakinra. Complete remission was rarely achieved with NSAIDs alone. Notable patterns were found in patients with distinctive symptoms. Patients with pericarditis (n=11) were older at disease onset (33.8 years) and had fewer episodes per year (3.0/year) compared with other patients. Patients with an intellectual impairment (n=8) were younger at disease onset (2.2 years) and often had relatives affected (28.6%). CONCLUSION This study describes the clinical characteristics of a large cohort of patients with undefined SAIDs. Among these, patients with pericarditis and intellectual impairment appear to comprise distinct subsets.
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Affiliation(s)
- Nienke M Ter Haar
- Laboratory of Translational Immunology & Department of Paediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Charlotte Eijkelboom
- Faculty of Medicine, Utrecht University, Utrecht, Netherlands
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Riccardo Papa
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
| | - Paul A Brogan
- Institute of Child Health, University College London, London, UK
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology and CEREMAI, Hôpital de Bicêtre, National Reference Centre for Auto-Inflammatory Diseases, le Kremlin-Bicêtre, Paris, France
| | - Consuelo Modesto
- Pediatric Rheumatology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Michael Hofer
- Unité Centre Multisite Romande d'Immuno-e Rhumatologie Pediatrique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nicolae Iagaru
- Pediatrie, Institutul pentru Ocrotirea Mamei și Copilului, București, Romania
| | - Sárka Fingerhutová
- Department of Pediatrics and Adolescent Medicine, Charles University in Prague and General University Hospital, Praha, Czech Republic
| | | | - Francesco Licciardi
- Dipartimento di Scienze della Sanità Pubblica e Pediatrica, Università degli Studi di Torino, Torino, Italy
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Centre, Kfar Saba and Sackler School of Medicine, Kfar Saba, Israel
| | - Marija Jelusic
- Department of Paediatric Rheumatology and Immunology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Irina Nikishina
- Pediatric Department, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Susan Nielsen
- Børnereumatologisk, Juliane Marie Centret, Rigshospitalet, København, Denmark
| | - Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece
| | - Alma Nunzia Olivieri
- Department of Woman and Child and General and Specialistic Surgery, University of the Study of Campania Luigi Vanvitelli, Napoli, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gordana Susic
- Department of Pediatric Rheumatology, Institute of Rheumatology, BelgradeInstitute of Rheumatology, Belgrade, Serbia
| | - Valda Stanevica
- Paediatric Department, Riga Stradins University, Children University Hospital, Rīga, Latvia
| | - Marielle van Gijn
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Nicolino Ruperto
- Center for Autoinflammatory Diseases and Immunodeficiency, IRCCS Instituto Giannina Gaslini, Genoa, Italy
| | - Joost Frenkel
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiency, IRCCS Instituto Giannina Gaslini, Genoa, Italy
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Pepin S, Dupuy M, Borja-Tabora CFC, Montellano M, Bravo L, Santos J, de Castro JA, Rivera-Medina DM, Cutland C, Ariza M, Diez-Domingo J, Gonzalez CD, Martinón-Torres F, Papadopoulou-Alataki E, Theodoriadou M, Kazek-Duret MP, Gurunathan S, De Bruijn I. Efficacy, immunogenicity, and safety of a quadrivalent inactivated influenza vaccine in children aged 6–35 months: A multi-season randomised placebo-controlled trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1876-1884. [DOI: 10.1016/j.vaccine.2018.11.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
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ter Haar NM, van Delft ALJ, Annink KV, van Stel H, Al-Mayouf SM, Amaryan G, Anton J, Barron KS, Benseler S, Brogan PA, Cantarini L, Cattalini M, Cochino AV, de Benedetti F, Dedeoglu F, de Jesus AA, Demirkaya E, Dolezalova P, Durrant KL, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman HM, Insalaco A, Jansson AF, Kallinich T, Kone-Paut I, Kozlova A, Kuemmerle-Deschner JB, Lachmann HJ, Laxer RM, Martini A, Nielsen S, Nikishina I, Ombrello AK, Özen S, Papadopoulou-Alataki E, Quartier P, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Ravelli A, Schulert G, Gattorno M, Frenkel J. In silico validation of the Autoinflammatory Disease Damage Index. Ann Rheum Dis 2018; 77:1599-1605. [PMID: 30077992 PMCID: PMC8411437 DOI: 10.1136/annrheumdis-2018-213725] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/22/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
Introduction Autoinflammatory diseases can cause irreversible tissue damage due to systemic inflammation. Recently, the Autoinflammatory Disease Damage Index (ADDI) was developed. The ADDI is the first instrument to quantify damage in familial Mediterranean fever, cryopyrin-associated periodic syndromes, mevalonate kinase deficiency and tumour necrosis factor receptor-associated periodic syndrome. The aim of this study was to validate this tool for its intended use in a clinical/research setting. Methods The ADDI was scored on paper clinical cases by at least three physicians per case, independently of each other. Face and content validity were assessed by requesting comments on the ADDI. Reliability was tested by calculating the intraclass correlation coefficient (ICC) using an ‘observer-nested-within-subject’ design. Construct validity was determined by correlating the ADDI score to the Physician Global Assessment (PGA) of damage and disease activity. Redundancy of individual items was determined with Cronbach’s alpha. Results The ADDI was validated on a total of 110 paper clinical cases by 37 experts in autoinflammatory diseases. This yielded an ICC of 0.84 (95% CI 0.78 to 0.89). The ADDI score correlated strongly with PGA-damage (r=0.92, 95% CI 0.88 to 0.95) and was not strongly influenced by disease activity (r=0.395, 95% CI 0.21 to 0.55). After comments from disease experts, some item definitions were refined. The interitem correlation in all different categories was lower than 0.7, indicating that there was no redundancy between individual damage items. Conclusion The ADDI is a reliable and valid instrument to quantify damage in individual patients and can be used to compare disease outcomes in clinical studies.
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Affiliation(s)
- Nienke M ter Haar
- Laboratory for Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Paediatric Immunology and Rheumatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Kim Valerie Annink
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Henk van Stel
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Sulaiman M Al-Mayouf
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gayane Amaryan
- National Paediatric Centre for Familial Mediterranean Fever and Gastroenterology Service, Arabkir Medical Centre–Institute of Child and Adolescent Health, Yerevan, Armenia
| | - Jordi Anton
- Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Karyl S Barron
- Division of Intramural Research and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Susanne Benseler
- Departments of Paediatrics and Rheumatology, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Paul A Brogan
- Department of Infection, Inflammation and Rheumatology, University College London Institute of Child Health, London, UK
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marco Cattalini
- Paediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Alexis-Virgil Cochino
- Department of Paediatrics, National Institute for Mother and Child Health Alessandrescu-Rusescu, Bucharest, Romania
| | | | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erkan Demirkaya
- Western University Children’s Hospital, London Health Sciences Centre, London, UK
| | - Pavla Dolezalova
- Department of Paediatrics and Adolescent Medicine, Charles University, General University Hospital, Praha, Czech Republic
| | | | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Romina Gallizzi
- Department of Paediatric Rheumatology, AOUG Martino, Messina, Italy
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | - Veronique Hentgen
- Reference Centre for Autoinflammatory Diseases (CEREMAI), Versailles Hospital, Le Chesnay, France
| | - Troels Herlin
- Departmentof Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Michaël Hofer
- Department of Paediatric Rheumatology, University of Lausanne, Lausanne, Switzerland
- Departmentof Paediatric Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Hal M Hoffman
- Department of Paediatrics, University of California, San Diego, California, USA
| | - Antonella Insalaco
- Dipartimento di Medicina Pediatrica, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Annette F Jansson
- Paediatric Pneumology and Immunology and Interdisciplinary Centre for Social Paediatrics, Charite University Medicine Berlin, Berlin, Germany
- Department of Rheumatology and Immunology, Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Tilmann Kallinich
- Paediatric Pneumology and Immunology and Interdisciplinary Centre for Social Paediatrics, Charite University Medicine Berlin, Berlin, Germany
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology and CEREMAI, Bicêtre Hospital, APHP, University of Paris Sud, Paris, France
| | - Anna Kozlova
- Department of Immunology, Federal Research and Clinical Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | | | | | - Ronald M Laxer
- Department of Paediatrics and Medicine, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Susan Nielsen
- Paediatric Rheumatology Unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Irina Nikishina
- Department of Paediatric Rheumatic Diseases, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Amanda K Ombrello
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Seza Özen
- Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Pierre Quartier
- Department of Paediatric Immunology–Hematology and Rheumatology Unit and IMAGINE Institute, Institution Necker-Enfants Malades Hospital and Paris Descartes University, Paris, Île-de-France, France
| | - Donato Rigante
- Institute of Paediatrics, Fondazione Policlinico Universitario A Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Ricardo Russo
- Servicio de Inmunología/Reumatología, Hospital de Pediatria Juan P Garrahan, Buenos Aires, Argentina
| | - Anna Simon
- Department of General Internal Medicine, Radboud Expertise Centre for Immunodeficiency and Autoinflammation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maria Trachana
- Paediatric Immunology and Rheumatology Referral Centre, First Paediatric Clinic, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Yosef Uziel
- Department of Paediatrics, Meir Medical Centre, Kfar Saba, Israel
| | - Angelo Ravelli
- Institution Università degli Studi di Genova and G Gaslini Institute, Genova, Italy
| | - Grant Schulert
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Marco Gattorno
- Institution Università degli Studi di Genova and G Gaslini Institute, Genova, Italy
| | - Joost Frenkel
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
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Gogou M, Papadopoulou-Alataki E, Spilioti M, Alataki S, Evangeliou A. Clinical Applications of Intravenous Immunoglobulins in Child Neurology. Curr Pharm Biotechnol 2018; 18:628-637. [PMID: 28914199 DOI: 10.2174/1389201018666170915123700] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 08/28/2017] [Accepted: 09/10/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND While there are guidelines for the use of intravenous immunoglobulins in children with Guillain-Barre syndrome and myasthenia gravis based on high-level evidence studies, data are scarce for the majority of neurologic disorders in this age group. Neuronal antibodies are detected in children with seizures of autoimmune etiology. Intravenous immunoglobulins with their broad immunomodulatory mechanism of action could be ideally effective in different forms of immunedysregulated intractable epilepsies such as autoimmune epilepsy and autoimmune Rasmussen encephalitis. We conducted a systematic review of the literature for evidence of the use of intravenous immunoglobulins in a variety of neurologic diseases in childhood. METHOD A comprehensive literature search was conducted using Pubmed as the medical database source without date range. Prospective studies in pediatric groups including objective measures of clinical outcomes were systematically selected. RESULTS A total of 11 prospective studies were identified in the literature demonstrating a favorable effect of this therapeutic option in children with drug-resistant epilepsy and in cases of encephalitis. No serious adverse effects were reported. No prospective studies about the use of intravenous immunoglobulins in children with demyelinating disorders or neurologic paraneoplasmatic syndromes were found. CONCLUSION In this review, we summarize the recent advances in the field of intravenous immunoglobulins used in pediatric neurological diseases. Literature data supports a beneficial effect in this age group. Whilst awaiting the results of large scale studies, administration of intravenous immunoglobulins could be justified in refractory child epilepsy. Otherwise, its use should be guided by the individual needs of each child, depending on the underlying neurological disease.
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Affiliation(s)
- Maria Gogou
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Martha Spilioti
- 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Sofia Alataki
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Athanasios Evangeliou
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
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Papadopoulou M, Panagopoulou P, Papadopoulou A, Hatzipantelis E, Efstratiou I, Galli-Tsinopoulou A, Papadopoulou-Alataki E. The multiple faces of Langerhans cell histiocytosis in childhood: A gentle reminder. Mol Clin Oncol 2018; 8:489-492. [PMID: 29468064 DOI: 10.3892/mco.2017.1539] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematologic disorder that results from the clonal multiplication and accumulation of immature dendritic Langerhans cells. Its reported incidence rate varies, but is considered to be 2.6-8.9 per million children who are <15 years of age each year. It may affect any system or organ. The present study reported 4 pediatric LCH cases in order to highlight the heterogeneity of the initial presentation, and the pitfalls that may mislead clinicians and delay diagnosis. The clinical features, as well as the pathognomonic imaging, pathology findings and treatment options were presented. LCH may be rare, but it should always be included in the differential diagnosis of persistent eczema, unexplained skin lesions, diabetes insipidus and persistent bone pain, among others. While the debate on pathogenesis and treatment is ongoing, high index of suspicion among pediatricians, pediatric oncologists and other specialists (pathologists, dermatologists, orthopaedic surgeons, general practitioners or family physicians) is essential for early diagnosis, and optimal outcome.
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Affiliation(s)
- Maria Papadopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Paraskevi Panagopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Anastasia Papadopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, 56403 Thessaloniki, Greece
| | - Ioannis Efstratiou
- Pathology Department, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
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Zanichelli A, Longhurst HJ, Maurer M, Bouillet L, Aberer W, Fabien V, Andresen I, Caballero T, Grumach A, Bygum A, Blanchard Delaunay C, Bouillet L, Coppere B, Fain O, Goichot B, Gompel A, Guez S, Jeandel P, Kanny G, Launay D, Maillard H, Martin L, Masseau A, Ollivier Y, Sobel A, Arnolds J, Aygören-Pürsün E, Baş M, Bauer A, Bork K, Martinez I, Maurer M, Papadopoulou-Alataki E, Psarros F, Graif Y, Kivity S, Reshef A, Toubi E, Arcoleo F, Cicardi M, Manconi P, Marone G, Montinaro V, Baeza M, Caballero T, Cabañas R, Guilarte M, Hernandez de Rojas D, Hernando de Larramendi C, Lleonart R, Lobera T, Sáenz de San Pedro B, Bjorkander J, Helbert M, Longhurst H. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting. Ann Allergy Asthma Immunol 2017; 117:394-398. [PMID: 27742086 DOI: 10.1016/j.anai.2016.08.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) causes swelling in the skin and upper airways and pain in the abdomen because of mucosal swelling. C1-INH-HAE is frequently misdiagnosed, leading to delays in diagnosis, inadequate treatment, and unnecessary procedures. OBJECTIVE To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS). METHODS The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before being diagnosed as having C1-INH-HAE. RESULTS In January 2016, a total of 418 of 633 IOS patients with C1-INH-HAE type I or II had provided misdiagnosis data. Of these, 185 of 418 (44.3%) received 1 or more prior misdiagnoses. The most common misdiagnoses were allergic angioedema (103 of 185) and appendicitis (50 of 185). A variety of other misdiagnoses were reported, including a substantial number of gastrointestinal disorders (excluding appendicitis). Misdiagnosis rates were similar between males (41.1%) and females (46.5%) and between C1-INH-HAE type I (43.7%) and type II (51.6%). Patients with family members diagnosed as having C1-INH-HAE were significantly less likely to be misdiagnosed than patients without a family history (140 of 366 [41.7%] vs 38 of 58 [65.5%], respectively; P = .001). Patients with a prior misdiagnosis had longer median delay to C1-INH-HAE diagnosis (13.3 years) than patients without (1.7 years; P < .001). CONCLUSION From this large database, approximately 50% of patients with C1-INH-HAE type I or II have previously had their conditions misdiagnosed, most commonly as allergic angioedema or appendicitis. Misdiagnosis results in marked delays in receiving the correct diagnosis, during which time patients cannot access effective, lifesaving treatment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01034969.
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Affiliation(s)
- Andrea Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Hilary J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, United Kingdom
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Laurence Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Werner Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | | | - Teresa Caballero
- Allergy Department, Hospital La Paz Institute for Health Research, Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
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De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Caorsi R, Penco F, Grossi A, Insalaco A, Alessio M, Conti G, Marchetti F, Tommasini A, Martino S, Gallizzi R, Salis A, Schena F, Caroli F, Martini A, Damonte G, Ceccherini I, Gattorno M, Frémond ML, Uggenti C, Van Eyck L, Melki I, Duffy D, Bondet V, Rose Y, Neven B, Crow Y, Rodero MP, Kusche Y, Roth J, Barczyk-Kahlert K, Ferrara G, Chiocchetti A, Polizzi S, Vuch J, Vozzi D, Mondino A, Valencic E, Pastore S, Taddio A, Faletra F, Dianzani U, Ramenghi U, Tommasini A, Zhou Q, Yu X, Demirkaya E, Deuitch N, Stone D, Tsai W, Ombrello A, Romeo T, Remmers EF, Chae J, Gadina M, Welch S, Ozen S, Topaloglu R, Abinun M, Kastner DL, Aksentijevich I, Vairo D, Ferraro RM, Zani G, Galli J, De Simone M, Cattalini M, Fazzi E, Giliani S, Omoyinmi E, Standing A, Rowczenio D, Keylock A, Gomes SM, Price-Kuehne F, Nanthapisal S, Murphy C, Cullup T, Jenkins L, Gilmour K, Eleftheriou D, Lachmann H, Hawkins P, Klein N, Brogan P, Nikolayenko VB, Şahin K, Karaaslan Y, Civino A, Alighieri G, Davì S, Rondelli R, Martino S, Filocamo G, Magnolato A, Dhanrajani A, Ricci F, Gallizzi R, Olivieri A, Gerloni V, Lattanzi B, Soscia F, De Fanti A, Manzoni SM, Citiso S, Quartulli L, Chan M, La Torre F, Rigante D, Maggio MC, Marsili M, Pelagatti MA, Conter V, Fagioli F, Lepore L, Pession A, Ravelli A, Pau S, Consolaro A, Ruperto N, Garrone M, Rinaldi M, De Inocencio J, Demirkaya E, Garay S, Foell D, Lovell DJ, Lazar C, Ellsworth J, Nielsen S, Flato B, Martini A, Ravelli A, Marasco E, Aquilani A, Cascioli S, Caiello I, Moneta GM, Pires-Marafón D, Guzman J, Magni-Manzoni S, Carsetti R, De Benedetti F, Robinson E, Albani S, Beresford MW, de Jager W, de Roock S, Duong T, Ellis J, Aeschlimann FA, Hyrich K, Jervis L, Lovell D, Marshall L, Mellins ED, Minden K, Munro J, Nigrovic PA, Palman J, Roth J, Twilt M, Ruperto N, Sampath S, Schanberg LE, Thompson SD, Thomson W, Vesely R, Wallace C, Williams C, Wu Q, Wulffraat N, Eng SW, Yeung RSM, Prakken B, Wedderburn LR, Horneff G, Seyger MB, Arikan D, Kalabic J, Anderson JK, Lazar A, Williams DA, Sheikh S, Wang C, Tarzynski-Potempa R, Hymans JS, Simonini G, Scoccimarro E, Pontikaki I, Ferrara G, Giani T, Ventura A, Meroni PL, Laxer RM, Cimaz R, Minnone G, Soligo M, Caiello I, Prencipe G, Marafon DP, Magni-Manzoni S, Manni L, De Benedetti F, Laudiero LB, Hebert D, Groot N, Grein I, Wulffraat NM, Schepp R, Berbers G, de Souza CCBS, Ferriani VPL, Pileggi G, de Roock S, Grein IHR, Noone D, Scala S, Patrone E, Schoemaker C, Costello W, Wulffraat N, Parsons S, McDonagh J, Thomson W, Cohen JD, Bentayou D, Pagnoux C, Brunel MAB, Trope S, Klotsche J, Listing M, Niewerth M, Horneff G, Thon A, Huppertz HI, Mönkemöller K, Foeldvari I, Benseler SM, Föll D, Minden K, Marino A, Stagi S, Carli N, Bertini F, Giani T, Simonini G, Cimaz R, Díaz-Maldonado AS, Yeung RS, Pino S, Guarnizo P, Torres-Jimenez AR, Sanchez-Jara B, Solis-Vallejo E, Cespedes-Cruz AI, Zeferino-Cruz M, Ramirez-Miramontes JV, Kumar A, Gupta A, Kessel C, Suri D, Rawat A, Kakkar N, Singh S, Makay B, Gücenmez ÖA, Ünsal E, Magnusson B, Mördrup K, Vermé A, Lippitz K, Peterson C, Freychet C, Stephan JL, Hofer M, Belot A, Harkness CE, Rooney M, Foster L, Henry E, Taggart P, Weinhage T, Simsek D, Ozkececi CF, Kurt E, Basbozkurt G, Gok F, Demirkaya E, Gorczyca D, Postępski J, Czajkowska A, Szponar B, Hinze C, Paściak M, Gruenpeter A, Lachór-Motyka I, Augustyniak D, Olesińska E, Asuka ES, Golovko T, Aliejim SU, Clemente EI, Jimenez EI, Wittkowski H, Hernandez JC, Fernandez SB, Roca CG, Romo DM, Nieva NR, Angarita JMM, Lopez JA, Nuñez-Cuadros E, Diaz-Cordovés G, Galindo-Zavala R, Holzinger D, Urda-Cardona A, Fernández-Nebro A, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Gallo MM, Borrell RP, Barril SM, Sánchez AMM, Caballero CM, Grün N, Merlin E, Breton S, Fraitag S, Stephan JL, Wouters C, Bodemer C, Bader-Meunier B, Baldo F, Annoni F, Di Landro G, Föll D, Torreggiani S, Torcoletti M, Petaccia A, Corona F, Filocamo G, Tiller G, Buckle J, Munro J, Cox A, Gowdie P, Van Dijkhuizen P, Allen RC, Akikusa JD, Hernández-Huirache HG, Rodea-Montero ER, Cohen JD, Belot A, Fahy W, Quartier P, Sordet C, Trope S, Del Chierico F, Berggren KB, Kembe JT, Bos J, Armbrust W, Wulffraat N, van Brussel M, Cappon J, Dijkstra P, Geertzen J, Legger E, Malattia C, van Rossum M, Sauer P, Lelieveld O, Ozturk K, Buluc L, Akansel G, Muezzinoglu B, Ekinci Z, Rychkova L, Knyazeva T, Russo A, Pogodina A, Belova T, Mandzyak T, Kulesh E, Cafarotti A, Marsili M, Giannini C, Salvatore R, Lapergola G, Di Battista C, Marafon DP, Marcovecchio ML, Basilico R, Pelliccia P, Chiarelli F, Breda L, Almeida B, Tansley S, Simou S, Gunawardena H, McHugh N, ter Haar NM, Wedderburn L, Aouizerate J, Bader-Meunier B, De Antonio M, Bodemer C, Barnerias C, Bassez G, Desguerre I, Quartier P, Gherardi R, Magni-Manzoni S, Charuel JL, Authier FJ, Gitiaux C, Spencer CH, Aziz RA, Yu CY, Adler B, Bout-Tabaku S, Lintner K, Moore-Clingenpeel M, Vastert SJ, Boros C, McCann L, Ambrose N, Cortina-Borja M, Simou S, Pilkington C, Wedderburn L, Hinze C, Oommen PT, Speth F, Dallapiccola B, Haas JP, Hinze C, Oommen PT, Speth F, Haas JP, Speth F, Haas JP, Hinze C, Lavarello C, Giancane G, Prakken B, Pistorio A, Rider L, Aggarwal R, Oliveira SK, Cuttica R, Fischbach M, Sterba G, Brochard K, Dressler F, Barone P, Martini A, Burgos-Vargas R, Chalom EC, Desjonqueres M, Espada G, Fasth A, Garay SM, Herbigneaux RM, Hoyoux C, Deslandre CJ, Miller FW, De Benedetti F, Vencovsky J, Ravelli A, Martini A, Ruperto N, Sag E, Ozen S, Kale G, Topaloglu H, Talim B, Giancane G, Putignani L, Lavarello C, Pistorio A, Zulian F, Magnusson B, Avcin T, Corona F, Gerloni V, Pastore S, Marini R, Martino S, Fidanci BE, Pagnier A, Rodiere M, Soler C, Stanevicha V, Ten Cate R, Uziel Y, Vojinovic J, Ravelli A, Martini A, Ruperto N, Barut K, Villarreal AV, Acevedo N, Diaz T, Ramirez Y, Faugier E, Maldonado R, Arabshahi B, Lee JH, Leibowitz I, Okong’o LO, Arıcı S, Wilmshurst J, Esser M, Scott C, Batu ED, Emiroglu N, Sonmez HE, Tugcu GD, Arici ZS, Yalcin E, Dogru D, Simsek D, Ozcelik U, Bilginer Y, Haliloglu M, Kiper N, Ozen S, Yashiro M, Yamada M, Yabuuchi T, Kikkawa T, Nosaka N, Cakan M, Fujii Y, Saito Y, Tsukahara H, Al-Mayouf SM, AlMutiari N, Muzaffer M, shehata R, Al-Wahadneh A, Abdwani R, Al-Abrawi S, Batu ED, Abu-shukair M, El-Habahbeh Z, Alsonbul A, Szabat A, Chęć M, Opoka-Winiarska V, Kumar A, Gupta A, Rawat A, Saikia B, Şahin S, Minz RW, Suri D, Singh S, Arango C, Malagon C, Gomez MDP, Mosquera AC, Yepez R, Gonzalez T, Vargas C, Kısaarslan A, Zulian F, Balzarin M, Castaldi B, Reffo E, Sperotto F, Martini G, Meneghel A, Milanesi O, Foeldvari I, Klotsche J, Yilmaz E, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Sifuentes-Giraldo WA, Basaran Ö, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Kallinich T, Demir F, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Foeldvari I, Baildem E, Blakley M, Boros C, Ozturk K, Fligelstone K, Kienast A, Nemcova D, Pain C, Saracino A, Simoni G, Torok K, Weibel L, Helmus N, Foeldvari I, Gunduz Z, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Sozeri B, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Makay B, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Osminina MK, Geppe NA, Niconorova OV, Ayaz N, Karashtina OV, Abbyasova OV, Shpitonkova OV, Adrovic A, Sahin S, Barut K, Durmus S, Uzun H, Kasapcopur O, Foeldvari I, Yavascan O, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Aydog O, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Bilginer Y, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Mauro A, Fanti E, Voller F, Ekinci Z, Rusconi F, Cimaz R, Garcia-Rodriguez F, Villarreal-Treviño AV, Flores-Pineda AJ, Lara-Herrea PB, Salinas-Encinas DR, Diaz-Prieto T, Maldonado-Velazquez MR, Moreno-Espinosa S, Yıldız D, Faugier-Fuentes E, Gallizzi R, Finetti M, Crapanzano M, Cantarini L, Cattalini M, Filocamo G, Insalaco A, Mauro A, Rigante D, Gök F, Zulian F, Alessio M, Parissenti I, Ruperto N, Gattorno M, Cimaz R, Parihar MS, Singh S, Vignesh P, Gupta A, Erguven M, Rohit M, Gopalan K, Singh S, Vignesh P, Gupta A, Rohit M, Attri SV, Hong Y, Eleftheriou D, Nanthapisal S, Unsal E, Salama A, Jayne D, Little M, Brogan P, Kostina Y, Lyskina G, Shpitonkova O, Torbyak A, Lyskina G, Shirinsky O, Kasapcopur O, Mauro A, Gicchino MF, Smaldone MC, Diplomatico M, Olivieri AN, Spencer CH, Aziz RA, McClead R, Bout-Tabaku S, Patel H, Ozen S, Yu CY, Ozkececi CF, Basbozkurt G, Simsek D, Kurt E, Gok F, Demirkaya E, Cebecauerová D, Dallos T, Kabíčková E, Demirkaya E, Kynčl M, Chroustová D, Hoza J, Němcová D, Tesař V, Doležalová P, Batu ED, Sonmez HE, Hazirolan T, Ozaltin F, Sönmez HE, Bilginer Y, Ozen S, Almeida F, de Paula IHF, Sampaio MM, Arita FN, Alves AG, Santos MC, Okuda EM, Sacchetti SB, Batu ED, Falcini F, Francesca M, Stagi S, Rigante D, Lepri G, Matucci-Cerinic M, Brandi ML, Di Landro G, Torreggiani S, Petaccia A, Sözeri B, Torcoletti M, Corona F, Filocamo G, Kisaoglu H, Misir S, Demir S, Aliyazicioglu Y, Kalyoncu M, de Paula IHF, Ramalho CE, Butbul Y, Almeida FD, Alves AG, Santos MC, Sacchetti SB, Okuda EM, Calzada-Hernández J, Bou R, Iglesias E, Sánchez-Manubens J, Martínez FHP, Bilginer Y, Roca CG, Fernández SB, Angarita JMM, Anton J, Bohm M, Mahmood K, Leone V, Wood M, Yamaguchi KI, Fujikawa S, Özen S, Kim KY, Kim DY, Kim DS, Ioseliani M, Chkhaidze I, Lekishvili M, Tskhakaia N, Tvalabeishvili S, Kajrishvili A, Takakura M, Bracaglia C, Shimizu M, Inoue N, Mizuta M, Yachie A, Alizzi C, Corsello G, Maggio MC, Piram M, Maldini C, Biscardi S, Prencipe G, Desuremain N, Orzechowski C, Georget E, Regnard D, Kone-Paut I, Mahr A, Sparchez M, Damian L, Sparchez Z, Silva NA, Pardeo M, Treviño AVV, Loyola YR, Prieto TD, Fuentes EF, Velazquez MDRM, Perez P, Mosquera AC, Malagon C, Bhattad S, Rawat A, Lapeyre G, Saikia B, Minz R, Shandilya J, Singh S, Parihar MS, Singh S, Vignesh P, Gupta A, Rohit M, Maldonado R, Marasco E, Faugier E, Villarreal A, Acevedo N, Ramírez Y, Diaz T, Kostina Y, Lyskina G, Shpitonkova O, Ozturk K, Ekinci Z, Insalaco A, Özçakar ZB, Fitoz S, Yalcinkaya F, Horne A, Minoia F, Bovis F, Davi S, Pal P, Anton J, Stein K, Ferlin W, Enciso S, Kasapcopur O, Jeng M, Maritsi D, Cron RC, Ravelli A, Thorwarth A, von Stuckrad SL, Rösen-Wolff A, Luksch H, Nelson R, Hundsdoerfer P, Minden K, Krawitz P, Kallinich T, Sozeri B, Ayaz NA, Batu ED, Makay B, Şahin S, Simsek D, de Min C, Kılıc ŞS, Ozturk K, Sonmez E, Kisaarslan AP, Gucenmez OA, Cakan M, Arıcı ZS, Adrovic A, Kelesoglu F, Bilginer Y, De Benedetti F, Demirkaya E, Ekinci ZE, Dusunsel R, Unsal E, Kasapcopur O, Ozen S, Lerkvaleekul B, Vilaiyuk S, Miranda-Garcia M, Pretzer C, Ruperto N, Huppertz HI, Horneff G, Haas JP, Ganser G, Kuemmerle-Deschner J, Wittkowski H, Frosch M, Roth J, Foell D, Holzinger D, Brunner HI, Gohar F, McArdle A, Callan N, Hernandez B, Lavric M, Kessel C, Holzinger D, FitzGerald O, Pennington SR, Foell D, Quartier P, Horneff G, Peitz J, Kekow J, Klein A, Horneff G, Schulz AC, Minden K, Weller-Heinemann F, Hospach A, Haas JP, Constantin T, Put K, Vandenhaute J, Avau A, van Nieuwenhuijze A, Brisse E, Dierckx T, Rutgeerts O, Garcia-Perez JE, Toelen J, Waer M, Alexeeva E, Leclercq G, Goris A, Van Weyenbergh J, Liston A, De Somer L, Matthys P, Wouters CH, Mizuta M, Shimizu M, Inoue N, Kone-Paut I, Nakagishi Y, Yachie A, Shimizu M, Inoue N, Mizuta M, Yachie A, Ombrello MJ, Arthur V, Remmers EF, Hinks A, Marzan K, Kastner DL, Woo P, Thomson W, Stanimirovic B, Djurdjevic-Banjac B, Ljuboja O, Hugle B, Speth F, Haas JP, Maritsi D, Wulffraat N, Onoufriou MA, Vougiouka O, Eleftheriou D, Horneff G, Peitz J, Kekow J, Foell D, Bouayed K, El Hani S, Hafid I, Schneider R, Mikou N, Ioseliani M, Lekishvili M, Shelia N, Tvalabeishvili S, Kajrishvili A, Laan M, Ilisson J, Pruunsild C, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Vritzali E, Lheritier K, Martini A, Lovell D, Schena F, Volpi S, Caorsi R, Penco F, Pastorino C, Kalli F, Omenetti A, Chiesa S, Bertoni A, Picco P, Filaci G, Aksentijevich I, Grossi A, Ceccherini I, Martini A, Traggiai E, Gattorno M, Melki I, Rose Y, Uggenti C, Fremond ML, Van Eyck L, Kitabayashi N, Gattorno M, Volpi S, Sacco O, Meyts I, Morren MA, Wouters C, Legius E, Callebaut I, Bodemer C, Rieux-Laucat F, Rodero M, Crow Y, Frémond ML, Rodero MP, Jeremiah N, Belot A, Jeziorski E, Duffy D, Bessis D, Cros G, Rice GI, Charbit B, Hulin A, Khoudour N, Caballero CM, Bodemer C, Fabre M, Berteloot L, Le Bourgeois M, Reix P, Walzer T, Moshous D, Blanche S, Fischer A, Bader-Meunier B, Rieux-Laucat F, Crow Y, Neven B, Annink K, ter Haar N, Al-Mayouf S, Amaryan G, Anton J, Barron K, Benseler S, Brogan P, Cantarini L, Cattalini M, Cochino A, De Benedetti F, Dedeoglu F, De Jesus A, Dellacasa O, Demirkaya E, Dolezalova P, Durrant K, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman H, Insalaco A, Jansson A, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner J, Lachmann H, Laxer R, Martini A, Nielsen S, Nikishina I, Ombrello A, Ozen S, Papadopoulou-Alataki E, Quartier P, Ravelli A, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Gattorno M, Frenkel J, ter Haar N, Jeyaratnam J, Lachmann H, Simon A, Brogan P, Doglio M, Cattalini M, Anton J, Modesto C, Quartier P, Hoppenreijs E, Martino S, Insalaco A, Cantarini L, Lepore L, Alessio M, Penades IC, Boros C, Consolini R, Rigante D, Russo R, Schmid JP, Lane T, Martini A, Ruperto N, Frenkel J, Gattorno M, Passarelli C, Pisaneschi E, Messia V, Pardeo M, Novelli A, Debenedetti F, Insalaco A, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Wei X, Laxer R, Insalaco A, Marafon DP, Finetti M, Pardeo M, Martino S, Cattalini M, Alessio M, Orlando F, Taddio A, Pastore S, Cortis E, Miniaci A, Ruperto N, Martini A, De Benedetti F, Gattorno M, Eijkelboom C, ter Haar N, Cantarini L, Finetti M, Brogan P, Dolezalova P, Koné-Paut I, Insalaco A, Jelusic-Drazic M, Bezrodnik L, Pinedo MC, Stanevicha V, van Gijn M, Federici S, Ruperto N, Frenkel J, Gattorno M, Girschick H, Finetti M, Orlando F, Insalaco A, Ganser G, Nielsen S, Herlin T, Koné-Paut I, Martino S, Cattalini M, Anton J, Al-Mayouf SM, Hofer M, Quartier P, Boros C, Kuemmerle-Deschner J, Schalm S, Alessio M, Ruperto N, Martini A, Jansson A, Gattorno M, Finetti M, Marchi M, Marini C, Doglio M, Malattia C, Ravelli A, Martini A, Garaventa A, Gattorno M, Bertoni A, Carta S, Balza E, Castellani P, Pellecchia C, Penco F, Schena F, Borghini S, Trotta ML, Pastorino C, Ceccherini I, Martini A, Gattorno M, Rubartelli A, Chiesa S, Guzman J, Henrey A, Loughin T, Berard R, Shiff N, Jurencak R, Benseler S, Tucker L, Papadopoulou C, Hong Y, Krol P, Ioannou Y, Pilkington C, Chaplin H, Simou S, Charakida M, Wedderburn L, Brogan P, Eleftheriou D, Spiegel LR, Kohut SA, Stinson J, Forgeron P, Kaufman M, Luca N, Amaria K, Bell M, Swart J, Boris F, Castagnola E, Groll A, Giancane G, Horneff G, Huppertz HI, Lovell D, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, De Benedetti F, Ailioaie LM, Tsitami E, Kamphuis S, Herlin T, Dolezalova P, Susic G, Sztajnbok F, Flato B, Pistorio A, Martini A, Wulffraat N, Ruperto N, Shoop SJW, Verstappen SMM, McDonagh JE, Thomson W, Hyrich KL, Tarkiainen M, Tynjala P, Lahdenne P, Martikainen J, Wilkinson M, Piper C, Otto G, Deakin CT, Dowle S, Simou S, Kelberman D, Ioannou Y, Mauri C, Jury E, Isenberg D, Wedderburn LR, Nistala K, Foeldvari I, Ruperto N, Lovell DJ, Horneff G, Huppertz HI, Quartier P, Simonini G, Bereswill M, Kalabic J, Martini A, Brunner HI, Oen K, Guzman J, Feldman BM, Dufault B, Lee J, Shiff N, Duffy KW, Tucker L, Duffy C, Ruperto N, Lovell DJ, Tzaribachev N, Vega-Cornejo G, Louw I, Berman A, Calvo I, Cuttica R, Horneff G, Avila-Zapata F, Anton J, Cimaz R, Solau-Gervais E, Joos R, Espada G, Li X, Nys M, Wong R, Banerjee S, Martini A, Brunner HI, Nicolai R, Marafon DP, Verardo M, D’Amico A, Bracci-Laudiero L, De Benedetti F, Moneta GM, Belot A, Rice G, Mathieu AL, Omarjee SO, Bader-Meunier B, Walzer T, Briggs TA, O’Sullivan J, Williams S, Cimaz R, Smith E, Beresford MW, Crow YJ, Rooney M, Bishop N, davidson J, pilkington C, Beresford M, Clinch J, Satyapal R, Foster H, Medwin JG, McDonagh J, Wyatt S, Modignani VL, Baldo F, Lanni S, Consolaro A, Ravelli A, Filocamo G, Omenetti A, Frenkel J, Lachmann HJ, Ozen S, Ruperto N, Gattorno M, Insalaco A, Moneta G, Pardeo M, Passarelli C, Celani C, Messia V, De Benedetti F, Cherqaoui B, Rossi-Semerano L, Dusser P, Hentgen V, Koné-Paut I, Grimwood C, Dusser P, Rossi L, Paut IK, Hentgen V, Lasigliè D, Ferrera D, Amico G, Di Duca M, Caorsi R, Lepore L, Insalaco A, Cattalini M, Obici L, Consolini R, Ravazzolo R, Martini A, Ceccherini I, Nishikomori R, Arostegui J, Gattorno M, Borghini S, Penco F, Petretto A, Lavarello C, Inglese E, Omenetti A, Finetti M, Pastorino C, Bertoni A, Gattorno M, Vanoni F, Federici S, Ozen S, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Hofer M, Kuemmerle-Deschner JB, Hoffman HM, Hawkins PN, van der Poll T, Walker UA, Speziale A, Joubert Y, Tilson HH, Kuemmerle-Deschner J, Ozen S, Tyrrell PN, Koné-Paut I, Goldbach-Mansky R, Lachmann H, Blank N, Hoffman HM, Weissbarth-Riedel E, Huegle B, Kallinich T, Gattorno M, Gul A, ter Haar NM, Oswald M, Dedeoglu F, Benseler SM, Hanaya A, Miyamae T, Kawamoto M, Tani Y, Hara T, Kawaguchi Y, Nagata S, Yamanaka H, Ćosićkić A, Skokić F, Čolić B, Suljendić S, Kozlova A, Mersiyanova I, Panina M, Hachtryan L, Burlakov V, Raikina E, Maschan A, Shcherbina A, Acar B, Albayrak M, Sozeri B, Sahin S, Barut K, Adrovic A, Inan N, Sevgi S, Kasapcopur O, Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T, Lazea C, Damian L, Lazar C, Manasia R, Stephenson CM, Prajapati V, Miettunen PM, Yılmaz D, Tokgöz Y, Bulut Y, Çakmak H, Sönmez F, Comak E, Aksoy GK, Koyun M, Akman S, Arıkan Y, Terzioğlu E, Özdeş ON, Keser İ, Koçak H, Bingöl A, Yılmaz A, Artan R, De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Xu X, Mehregan FF, Ziaee V, Moradinejad MH, Ferrara G, Pastore S, Insalaco A, Pardeo M, Tommasini A, La Torre F, Alizzi C, Cimaz R, Finetti M, Gattorno M, D’Adamo P, Taddio A, Lachmann H, Simon A, Anton J, Gattorno M, Kone-Paut I, Ozen S, Frenkel J, Ben-Chetrit E, Hoffman H, Zeft A, Joubert Y, Lheritier K, Speziale A, Junge G, Gregson J, De Benedetti F, Sargsyan H, Sargsyan H, Zengin H, Fidanci BE, Kaymakamgil C, Konukbay D, Simsek D, Batu ED, Yildiz D, Gok F, Ozen S, Demirkaya E, Stoler I, Freytag J, Orak B, Seib C, Esmann L, Seipelt E, Gohar F, Foell D, Wittkowski H, Kallinich T, Dursun I, Tulpar S, Yel S, Kartal D, Borlu M, Bastug F, Poyrazoglu H, Gunduz Z, Kose K, Yuksel ME, Calıskan A, Cekgeloglu AB, Dusunsel R, Bouchalova K, Franova J, Schuller M, Macku M, Theodoropoulou K, Carlomagno R, von Scheven-Gête A, Poloni C, Hofer M, Damian LO, Cosma D, Radulescu A, Vasilescu D, Rogojan L, Lazar C, Rednic S, Lupse M, De Somer L, Moens P, Wouters C, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Forno ID, Pieropan S, Viapiana O, Gatti D, Dallagiacoma G, Caramaschi P, Biasi D, Windschall D, Trauzeddel R, Lehmann H, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Trauzeddel RF, Nirschl C, Quesada-Masachs E, Blancafort CA, Barril SM, Caballero CM, Aguiar F, Fonseca R, Alves D, Vieira A, Vieira A, Dias JA, Brito I, Susic G, Milic V, Radunovic G, Boricic I, Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V, Gran S, Fehler O, Zenker S, Schäfers M, Roth J, Vogl T, Czitrom SG, Foell D, Holzinger D, Lanni S, Van Dijkhuizen EHP, Manzoni SM, Marafon DP, Magnaguagno F, de Horatio LT, Ter Haar NM, Littooij AS, Vastert SJ, De Benedetti F, Ravelli A, Martini A, Malattia C, Teixeira VA, Campanilho-Marques R, Mourão AF, Ramos FO, Costa M, Madan WA, Killeen OG, Vidal AR, Delgado DS, Fernandez MIG, Montesinos BL, Penades IC, Kozhevnikov A, Pozdeeva N, Konev M, Melchenko E, Kenis V, Novik G, Sozeri B, Kısaarslan AP, Gunduz Z, Poyrazoglu H, Dusunsel R, Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S, Pradsgaard DØ, Hørlyck A, Spannow AH, Heuck CW, Herlin T, Diaz T, Garcia F, De La Cruz L, Rubio N, Świdrowska-Jaros J, Smolewska E, Lamot M, Lamot L, Vidovic M, Bosak EP, Rados I, Harjacek M, Tzaribachev N, Louka P, Hagoug R, Trentin C, Kubassova O, Hinton M, Boesen M, Oshlianska OA, Chaikovsky IA, Mjasnikov G, Kazmirchyk A, Garagiola U, Borzani I, Cressoni P, Corona F, Dzsida E, Farronato G, Garagiola U, Cressoni P, Corona F, Petaccia A, Dzsida E, Farronato G, Gagro A, Pasini AM, Roic G, Vrdoljak O, Lujic L, Zutelija-Fattorini M, Esser MM, Abraham DR, Kinnear C, Durrheim G, Urban M, Hoal E, Crow Y, Oshlianska OA. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461530 DOI: 10.1186/s12969-017-0141-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Gogou M, Spilioti M, Tramma D, Papadopoulou-Alataki E, Evangeliou A. Spine pathology in a girl with upper limb pain: A co-incidence or a causal relationship? Sudan J Paediatr 2017; 17:57-60. [PMID: 29213173 PMCID: PMC5621862] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 10-year-old girl was admitted to the Emergency Department due to a history of intermittent pain located in the left radiocarpal joint for a month, as well as in the interphalangeal joints of the left hand without any additional symptoms. Clinical examination revealed mild sensory deficits and diminished muscle strength of the left upper limb without any other pathologic findings. A Magnetic Resonance Imaging scan of the brain and spinal cord was performed, which confirmed a diagnosis of thoracic syringomyelia. We briefly discuss specific traits and diagnostic challenges of this entity in childhood. Our case highlights the difficulty in efficiently correlating a pathologic imaging finding with clinical neurologic symptoms and signs, as well as the value of a thorough clinical neurological evaluation. Furthermore, a clear discrimination of a causal relationship against an incidental co-existence of a radiological finding and a specific symptom is not always possible.
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Affiliation(s)
- Maria Gogou
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
- Corresponding author
| | - Martha Spilioti
- Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Despoina Tramma
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Athanasios Evangeliou
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
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Papadopoulou-Alataki E, Garganis K, Dalpa E, Alataki S, Spilioti M. Intavenous immunoglobulin for the management of intractable epilepsy in a boy. Hippokratia 2017; 21:55-57. [PMID: 29904260 PMCID: PMC5997017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The involvement of the immune system in the pathogenesis of certain types of epilepsy has been supported in the past. The use of intravenous immunoglobulin in the treatment of neurologic diseases has shown a progressive trend over the last years. CASE REPORT We report the case of a 9.5-year-old boy with refractory epilepsy who was admitted for investigation of his persistent seizures and severe psychomotor regression. He experienced persistent tonic-clonic over the preceding six months and long lasting atonic seizures since the age of six and did not respond to multiple anticonvulsant drugs. The administration of intravenous immunoglobulin achieved seizure control and cognitive improvement. CONCLUSION This case underscores the efficacy of intravenous immunoglobulin in the treatment of refractory epilepsy in children. HIPPOKRATIA 2017, 21(1): 55-57.
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Affiliation(s)
- E Papadopoulou-Alataki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - K Garganis
- Department of Epilepsy, St. Lukes Hospital, Thessaloniki, Greece
| | - E Dalpa
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - S Alataki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - M Spilioti
- 1 Department of Neurology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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ter Haar NM, Annink KV, Al-Mayouf SM, Amaryan G, Anton J, Barron KS, Benseler SM, Brogan PA, Cantarini L, Cattalini M, Cochino AV, De Benedetti F, Dedeoglu F, De Jesus AA, Della Casa Alberighi O, Demirkaya E, Dolezalova P, Durrant KL, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman HM, Insalaco A, Jansson AF, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner JB, Lachmann HJ, Laxer RM, Martini A, Nielsen S, Nikishina I, Ombrello AK, Ozen S, Papadopoulou-Alataki E, Quartier P, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Ravelli A, Gattorno M, Frenkel J. Development of the autoinflammatory disease damage index (ADDI). Ann Rheum Dis 2016; 76:821-830. [PMID: 27811147 DOI: 10.1136/annrheumdis-2016-210092] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/27/2016] [Accepted: 10/08/2016] [Indexed: 11/04/2022]
Abstract
ObjectivesAutoinflammatory diseases cause systemic inflammation that can result in damage to multiple organs. A validated instrument is essential to quantify damage in individual patients and to compare disease outcomes in clinical studies. Currently, there is no such tool. Our objective was to develop a common autoinflammatory disease damage index (ADDI) for familial Mediterranean fever, cryopyrin-associated periodic syndromes, tumour necrosis factor receptor-associated periodic fever syndrome and mevalonate kinase deficiency.MethodsWe developed the ADDI by consensus building. The top 40 enrollers of patients in the Eurofever Registry and 9 experts from the Americas participated in multiple rounds of online surveys to select items and definitions. Further, 22 (parents of) patients rated damage items and suggested new items. A consensus meeting was held to refine the items and definitions, which were then formally weighted in a scoring system derived using decision-making software, known as 1000minds.ResultsMore than 80% of the experts and patients completed the online surveys. The preliminary ADDI contains 18 items, categorised in the following eight organ systems: reproductive, renal/amyloidosis, developmental, serosal, neurological, ears, ocular and musculoskeletal damage. The categories renal/amyloidosis and neurological damage were assigned the highest number of points, serosal damage the lowest number of points. The involvement of (parents of) patients resulted in the inclusion of, for example, chronic musculoskeletal pain.ConclusionsAn instrument to measure damage caused by autoinflammatory diseases is developed based on consensus building. Patients fulfilled a significant role in this process.
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Giza S, Kotanidou E, Papadopoulou-Alataki E, Antoniou MC, Maggana I, Kyrgios I, Galli-Tsinopoulou A. Prevalence of selective immunoglobulin A deficiency in Greek children and adolescents with type 1 diabetes. World J Pediatr 2016; 12:470-476. [PMID: 27286692 DOI: 10.1007/s12519-016-0039-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/05/2014] [Accepted: 02/03/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND The association of selective immunoglobulin A (IgA) deficiency with type 1 diabetes (T1D) remains unclear. This study was to evaluate serum IgA concentrations in Greek children and adolescents with T1D. METHODS In two hundred individuals with T1D, serum IgA concentrations were quantitatively determined using nephelometry. RESULTS Immunoglobulin A deficiency was detected in 6 (3.0%) of 200 patients who were subjected to immunological evaluation. Recurrent infections were not recorded, but human papilloma virus infection was clinically suspected and confirmed by laboratory examination in a 5-year-old girl. In regard to coincidence of selective IgA deficiency with autoimmune diseases, celiac disease was detected in a girl and juvenile idiopathic arthritis in a boy. Serum IgA concentrations differed significantly when patients were grouped according to age at the beginning of the study (P<0.001), age at diagnosis of T1D (P=0.015) and coincidence of celiac disease (CD) (P=0.038). However, when the age of the patients was adjusted, difference in serum IgA concentrations was not statistically significant despite CD was present or not. Moreover, serum IgA concentrations were positively correlated with serum IgG (P<0.001) and IgE (P=0.001) concentrations and negatively correlated with serum antigliadin antibody IgG (P=0.035) concentrations. There was no association or correlation of serum IgA concentrations with glycemic control. CONCLUSION The prevalence of selective IgA deficiency in Greek children and adolescents with T1D is high (3.0%). The correlation of serum IgA concentrations with serum IgG, IgE and anti-gliadin antibody IgG concentrations needs further investigation.
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Affiliation(s)
- Styliani Giza
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleni Kotanidou
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Maria Christina Antoniou
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Ioanna Maggana
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Ioannis Kyrgios
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece.
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Spilioti M, Pavlou E, Gogou M, Katsanika I, Papadopoulou-Alataki E, Grafakou O, Gkampeta A, Dinopoulos A, Evangeliou A. Valproate effect on ketosis in children under ketogenic diet. Eur J Paediatr Neurol 2016; 20:555-9. [PMID: 27117552 DOI: 10.1016/j.ejpn.2016.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 10/13/2015] [Revised: 03/28/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although ketogenic diet has been proven useful in the management of intractable seizures, interactions with other medicines have been reported. This study reports two patients on co-administration with ketogenic diet and valproate appearing undesirable side effects after increase or decrease of valproate pharmaceutical levels. METHODS Totally 75 patients suffering from drug-resistant epilepsy were treated with ketogenic diet in our departments. Their age varied from 6 months to 9 years. All patients were followed for at least 12 months and up to five years. Clinical and laboratory variables have been regularly assessed. RESULTS In 75 patients treated with ketogenic diet and valproate at the same time treatment was well tolerated. Two patients presented mild to moderate undesirable effects. In these patients the removal of valproate treatment resulted in an increase of ketosis with respective clinical signs. The conversion of the diet from 4:1 to 1:1 and 2,5:1 respectively resulted in reduction of ketosis and clinical improvement. CONCLUSION In the majority of cases co-administration of valproate and ketogenic diet seems to be safe. In two cases, valproate appeared to have a negative effect on ketosis (and weaning it led to over-ketosis). This interaction is worthy of future study.
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Affiliation(s)
- Martha Spilioti
- 1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Evangelos Pavlou
- 1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Maria Gogou
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Irene Katsanika
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Efimia Papadopoulou-Alataki
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Olga Grafakou
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Anastasia Gkampeta
- 1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece
| | - Argyrios Dinopoulos
- 3rd Department of Pediatrics, University of Athens, Attikon Hospital, Athens, Greece
| | - Athanasios Evangeliou
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Demirkaya E, Saglam C, Turker T, Koné-Paut I, Woo P, Doglio M, Amaryan G, Frenkel J, Uziel Y, Insalaco A, Cantarini L, Hofer M, Boiu S, Duzova A, Modesto C, Bryant A, Rigante D, Papadopoulou-Alataki E, Guillaume-Czitrom S, Kuemmerle-Deschner J, Neven B, Lachmann H, Martini A, Ruperto N, Gattorno M, Ozen S. Performance of Different Diagnostic Criteria for Familial Mediterranean Fever in Children with Periodic Fevers: Results from a Multicenter International Registry. J Rheumatol 2015; 43:154-60. [PMID: 26568587 DOI: 10.3899/jrheum.141249] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aims were to validate the pediatric diagnostic criteria in a large international registry and to compare them with the performance of previous criteria for the diagnosis of familial Mediterranean fever (FMF). METHODS Pediatric patients with FMF from the Eurofever registry were used for the validation of the existing criteria. The other periodic fevers served as controls: mevalonate kinase deficiency (MKD), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), cryopyrin-associated periodic syndrome (CAPS), aphthous stomatitis, pharyngitis, adenitis syndrome (PFAPA), and undefined periodic fever from the same registry. The performances of Tel Hashomer, Livneh, and the Yalcinkaya-Ozen criteria were assessed. RESULTS The FMF group included 339 patients. The control group consisted of 377 patients (53 TRAPS, 45 MKD, 32 CAPS, 160 PFAPA, 87 undefined periodic fevers). Patients with FMF were correctly diagnosed using the Yalcinkaya-Ozen criteria with a sensitivity rate of 87.4% and a specificity rate of 40.7%. On the other hand, Tel Hashomer and Livneh criteria displayed a sensitivity of 45.0 and 77.3%, respectively. Both of the latter criteria displayed a better specificity than the Yalcinkaya-Ozen criteria: 97.2 and 41.1% for the Tel Hashomer and Livneh criteria, respectively. The overall accuracy for the Yalcinkaya-Ozen criteria was 65 and 69.6% (using 2 and 3 criteria), respectively. Ethnicity and residence had no effect on the performance of the Yalcinkaya-Ozen criteria. CONCLUSION The Yalcinkaya-Ozen criteria yielded a better sensitivity than the other criteria in this international cohort of patients and thus can be used as a tool for FMF diagnosis in pediatric patients from either the European or eastern Mediterranean region. However, the specificity was lower than the previously suggested adult criteria.
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Affiliation(s)
- Erkan Demirkaya
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Celal Saglam
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Turker Turker
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Isabelle Koné-Paut
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Pat Woo
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Matteo Doglio
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Gayane Amaryan
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Joost Frenkel
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Yosef Uziel
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Antonella Insalaco
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Luca Cantarini
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Michael Hofer
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Sorina Boiu
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Ali Duzova
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Consuelo Modesto
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Annette Bryant
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Donato Rigante
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Efimia Papadopoulou-Alataki
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Severine Guillaume-Czitrom
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Jasmine Kuemmerle-Deschner
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Bénédicte Neven
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Helen Lachmann
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Alberto Martini
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Nicolino Ruperto
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Marco Gattorno
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
| | - Seza Ozen
- From the Familial Mediterranean Fever Arthritis Vasculitis and Orphan Disease Research Center (FAVOR), Gulhane Military Medical Faculty; Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey; Centre de référence national des maladies auto-inflammatoires, CEREMAI, Rhumatologie pédiatrique, CHU Le Kremlin Bicêtre (APHP, University of Paris SUD), Paris, France; Center of Paediatric and Adolescent Rheumatology, UCL, London, UK; Istituto Giannina Gaslini, UO Pediatria II, Reumatologia, Genoa, Italy; Arabkir Medical Centre, Institute of Child and Adolescents Health, Yerevan, Armenia; Department of Paediatrics, University Medical Center Utrecht, Utrecht, Netherlands; Pediatrics, Meir Medical Centre, Kfar Saba, Israel; Division of Rheumatology, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome; Rheumatology Unit, Policlinico le Scotte, University of Siena, Siena, Italy; Pediatrie, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier, Universitaire Vaudois (CHUV), Lausanne, Switzerland; Pediatric Rheumatology, Université Paris-Descartes, Paris, France; Pediatric Rheumatology, Hacettepe University, School of Medicine, Ankara, Turkey; Reumatologia, Hospital Valle de Hebron, Barcelona, Spain; Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy; Fourth Department of Pediatrics, Aristotle University of Thessaloniki Papageorgiou Hospital, Thessaloniki, Greece; Universitatsklinik fur Kinderheilkunde und Jugendmedizin, Tübingen, Germany; Université Paris-Descartes, Hôpital Necker-Enfants Malades, Centre de référence national pour les Arthrites Juveniles, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Université Descartes, Sorbonne Paris Cité, Institut IMAGINE, Paris, France; National Amyloidosis Centre, University College London Medical School, Royal Free Campus, London, UK.E. Demirkaya, MD, MSc, FAVOR, Gulhane Military Medical Faculty; C. Saglam, MD, FAVOR, Gulhane Military Medical Facult
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Papadopoulou-Alataki E, Chatziavramidis A, Vampertzi O, Alataki S, Konstantinidis I. Evaluation and management of juvenile recurrent parotitis in children from northern Greece. Hippokratia 2015; 19:356-359. [PMID: 27688702 PMCID: PMC5033148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Juvenile Recurrent Parotitis (JRP) is a recurrent parotid inflammation of childhood. The aim of our study was to investigate the clinical, laboratory and imaging profile of children with JRP as well as to estimate the impact of siadendoscopy as a therapeutic tool in the clinical outcome of JRP. METHODS Twenty-three children with JRP aged 3.5-16 years, were investigated. Twelve of them underwent sialendoscopy: seven aged <8 years under general and five aged >8 years under local anesthesia. RESULTS The age at onset ranged from 2-15 years while the number of episodes from 2-8 per year. The autoantibody profile was negative in all patients, suggesting no evidence for autoimmune diseases. Antibody deficiency was found in two children. The imaging studies reveal an overall parotid swelling and intraparotid lymph nodes while microabscesses were present in 31% of the patients. Twelve patients who underwent sialendoscopy had a significant improvement in their clinical outcome; the mean episodes of JRP before sialendoscopy was 3.9/year and reduced to 0.4 at the post-intervention year. CONCLUSION Sialendoscopy represents an alternative and promising perspective in the management of JRP. Hippokratia 2015; 19 (4): 356-359.
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Affiliation(s)
- E Papadopoulou-Alataki
- 4 Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Chatziavramidis
- Sialendoscopy Section, 2 Department of Otolaryngology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - O Vampertzi
- 4 Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Alataki
- 4 Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Konstantinidis
- Sialendoscopy Section, 2 Department of Otolaryngology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kotanidou EP, Kalinderi K, Kyrgios I, Efraimidou S, Fidani L, Papadopoulou-Alataki E, Eboriadou-Petikopoulou M, Galli-Tsinopoulou A. Apelin and G212A apelin receptor gene polymorphism in obese and diabese youth. Pediatr Obes 2015; 10:213-9. [PMID: 25060841 DOI: 10.1111/ijpo.251] [Citation(s) in RCA: 21] [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] [Received: 01/04/2014] [Accepted: 05/29/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The apelinergic system has been previously described to participate in fluid homeostasis, cardiac contractility, blood pressure and neo-vascularization. The role of apelin in obesity and glucose metabolism has also lately gained interest; however, it still remains obscure. This study aimed to assess serum apelin levels in obese youngsters and to investigate any possible association with the G212A polymorphism of the apelin receptor (APLNR) gene. METHODS Ninety obese individuals and 90 matched for age and gender lean controls were included. Anthropometric measurements, data of glucose metabolism, including an oral glucose tolerance test, and serum apelin levels were obtained. The presence of the G212A polymorphism of the APLNR gene was also analyzed in the obese group. RESULTS Obese participants had significantly lower serum apelin levels as compared with controls (P = 0.011). After being grouped according to their status of glucose metabolism, only obese subjects with impaired glucose metabolism (diabese) exhibited lower apelin levels as compared with controls. The presence of the G212A polymorphism did not differ from the HapMap-reported frequencies in Caucasians (GG = 53.3%/GA = 38.9%/ΑΑ = 7.8% vs. GG = 46.9%/GA = 39.8%/ΑΑ = 13.3%, P = 0.232). The GG and GA obese subgroups had significantly lower apelin levels as compared with the AA group (P = 0.013 and P = 0.016, respectively). CONCLUSION Obese (especially diabese) youngsters demonstrated lower serum apelin levels; the G212A polymorphism of the APLNR gene was found to exert a favourable effect on circulating apelin levels in childhood obesity.
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Affiliation(s)
- E P Kotanidou
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Federici S, Dolezalova P, Cantarini L, Papadopoulou-Alataki E, Alessio M, Herlin T, Gueli I, Modesto C, Fabio G, Maggio MC, Elorduy MJR, Garibotto F, Insalaco A, Kozlova A, Anton J, Brik R, Frenkel J, Hoppenreijs E, Sormani MP, Martini A, Gattorno M. Perspective validation of the eurofever classification criteria for monogenic periodic fevers. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184335 DOI: 10.1186/1546-0096-12-s1-p82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gathmann B, Mahlaoui N, Gérard L, Oksenhendler E, Warnatz K, Schulze I, Kindle G, Kuijpers TW, van Beem RT, Guzman D, Workman S, Soler-Palacín P, De Gracia J, Witte T, Schmidt RE, Litzman J, Hlavackova E, Thon V, Borte M, Borte S, Kumararatne D, Feighery C, Longhurst H, Helbert M, Szaflarska A, Sediva A, Belohradsky BH, Jones A, Baumann U, Meyts I, Kutukculer N, Wågström P, Galal NM, Roesler J, Farmaki E, Zinovieva N, Ciznar P, Papadopoulou-Alataki E, Bienemann K, Velbri S, Panahloo Z, Grimbacher B. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. J Allergy Clin Immunol 2014; 134:116-26. [PMID: 24582312 DOI: 10.1016/j.jaci.2013.12.1077] [Citation(s) in RCA: 381] [Impact Index Per Article: 38.1] [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: 05/06/2013] [Revised: 12/03/2013] [Accepted: 12/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative disorders. OBJECTIVE This study analyzes the clinical presentation, association between clinical features, and differences and effects of immunoglobulin treatment in Europe. METHODS Data on 2212 patients with CVID from 28 medical centers contributing to the European Society for Immunodeficiencies Database were analyzed retrospectively. RESULTS Early disease onset (<10 years) was very frequent in our cohort (33.7%), especially in male subjects (39.8%). Male subjects with early-onset CVID were more prone to pneumonia and less prone to other complications suggesting a distinct disease entity. The diagnostic delay of CVID ranges between 4 and 5 years in many countries and is particularly high in subjects with early-onset CVID. Enteropathy, autoimmunity, granulomas, and splenomegaly formed a set of interrelated features, whereas bronchiectasis was not associated with any other clinical feature. Patient survival in this cohort was associated with age at onset and age at diagnosis only. There were different treatment strategies in Europe, with considerable differences in immunoglobulin dosing, ranging from 130 up to 750 mg/kg/mo. Patients with very low trough levels of less than 4 g/L had poor clinical outcomes, whereas higher trough levels were associated with a reduced frequency of serious bacterial infections. CONCLUSION Patients with CVID are being managed differently throughout Europe, affecting various outcome measures. Clinically, CVID is a truly variable antibody deficiency syndrome.
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Affiliation(s)
- Benjamin Gathmann
- Center for Chronic Immunodeficiency (CCI), University Medical Centre Freiburg and University of Freiburg, Freiburg, Germany
| | - Nizar Mahlaoui
- Assistance Publique-Hôpitaux de Paris, Service d'Immuno-Hématologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France, Assistance Publique-Hôpitaux de Paris, CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, Paris, France, and Université Paris Descartes - Sorbonne Paris Cité, Institut Imagine, Paris, France
| | | | - Laurence Gérard
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP and Univ Paris Diderot, Sorbonne Paris Cité, EA3963, Paris, France, Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Paris, France, and the DEFI study group
| | - Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP and Univ Paris Diderot, Sorbonne Paris Cité, EA3963, Paris, France, Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Paris, France, and the DEFI study group
| | - Klaus Warnatz
- Center for Chronic Immunodeficiency (CCI), University Medical Centre Freiburg and University of Freiburg, Freiburg, Germany
| | - Ilka Schulze
- Center for Chronic Immunodeficiency (CCI), University Medical Centre Freiburg and University of Freiburg, Freiburg, Germany
| | - Gerhard Kindle
- Center for Chronic Immunodeficiency (CCI), University Medical Centre Freiburg and University of Freiburg, Freiburg, Germany
| | - Taco W Kuijpers
- Dutch Working Party for Immunodeficiencies (WID), Amsterdam, The Netherlands
| | | | - Rachel T van Beem
- Medical Department Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - David Guzman
- UCL Medical School Royal Free Campus and Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarita Workman
- UCL Medical School Royal Free Campus and Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Javier De Gracia
- Department of Pneumology, Hospital Universitari Vall d'Hebron, UAB, CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Torsten Witte
- Clinic for Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - Reinhold E Schmidt
- Clinic for Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - Jiri Litzman
- Department of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University and St Anne's University Hospital, Brno, Czech Republic
| | | | - Vojtech Thon
- Department of Clinical Immunology and Allergy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michael Borte
- Children's Hospital, Municipal Hospital "St Georg," Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Stephan Borte
- Children's Hospital, Municipal Hospital "St Georg," Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany; Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Dinakantha Kumararatne
- Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Conleth Feighery
- Department of Immunology, St James's Hospital Dublin and Trinity College Dublin, Dublin, Ireland
| | - Hilary Longhurst
- Department of Immunology, Barts Health NHS Trust, London, United Kingdom
| | - Matthew Helbert
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | | | - Anna Sediva
- Department of Immunology, 2nd School of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Bernd H Belohradsky
- Dr v. Haunersches Kinderspital, Ludwig Maximilians University, Munich, Germany
| | - Alison Jones
- Institute of Child Health/Great Ormond Street Hospital, London, United Kingdom
| | - Ulrich Baumann
- Immunology Unit, Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Isabelle Meyts
- Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Necil Kutukculer
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Per Wågström
- Department of Infectious Diseases, County Hospital Ryhov Jönköping, Jönköping, Sweden
| | - Nermeen Mouftah Galal
- Primary Immunodeficiency Clinic, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Joachim Roesler
- Department of Pediatrics, University Hospital Dresden, Dresden, Germany
| | - Evangelia Farmaki
- Pediatric Immunology and Rheumatology Referral Centre, First Department of Pediatrics, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Natalia Zinovieva
- Research and Clinical Centre for Pediatric Hematology, Oncology, Immunology, Moscow, Russia
| | - Peter Ciznar
- 1st Pediatric Department, Faculty of Medicine, Comenius University and Children University Hospital, Bratislava, Slovakia
| | - Efimia Papadopoulou-Alataki
- Aristotle University of Thessaloniki, Fourth Department of Pediatrics, Papageorgiou Hospital, Thessaloniki, Greece
| | - Kirsten Bienemann
- Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | - Zoya Panahloo
- Medical Science Department, CSL Behring, West Sussex, United Kingdom
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency (CCI), University Medical Centre Freiburg and University of Freiburg, Freiburg, Germany; UCL Medical School Royal Free Campus and Royal Free Hospital NHS Foundation Trust, London, United Kingdom.
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Demirkaya E, Ozen S, Saglam C, Turker T, Duzova A, Woo P, Konè-Paut I, Doglio M, Amarian G, Frenkel J, Uziel Y, Insalaco A, Cantarini L, Hofer M, Boiu S, Modesto C, Bryant A, Rigante D, Papadopoulou-Alataki E, Guillaume-Czitrom S, Ruperto N, Gattorno M. PReS-FINAL-2207: Results from a multicenter international registry of Familial Mediterranean Fever: validation of the new set of pediatric diagnostic criteria. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043250 DOI: 10.1186/1546-0096-11-s2-p197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Demirkaya E, Ozen S, Saglam C, Turker T, Duzova A, Woo P, Konè-Paut I, Doglio M, Amaryan G, Frenkel J, Uziel Y, Insalaco A, Cantarini L, Hofer M, Boiu S, Modesto C, Bryant A, Rigante D, Papadopoulou-Alataki E, Guillaume-Czitrom S, Ruperto N, Gattorno M. PW01-026 – Validation of pediatric diagnostic criteria in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952088 DOI: 10.1186/1546-0096-11-s1-a79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ozen S, Demirkaya E, Amaryan G, Koné-Paut I, Woo P, Uziel Y, Finetti M, Quartier P, Modesto C, Papadopoulou-Alataki E, Nielsen S, Hofer M, Polat A, Turker T, Insalaco A, Cantarini L, Al-Mayouf S, Frenkel J, Ozdogan H, Ruperto N, Gattorno M. THU0334 Differences in the features of familial mediterranean fever among patients from europe as compared to those from the eastern mediterranean countries. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2299] [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: 11/04/2022]
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Ozen S, Demirkaya E, Amaryan G, Koné-Paut I, Polat A, Woo P, Uziel Y, Modesto C, Finetti M, Quartier P, Papadopoulou-Alataki E, Al-Mayouf SM, Fabio G, Gallizzi R, Cantarini L, Frenkel J, Nielsen S, Hofer M, Insalaco A, Acikel C, Ozdogan H, Martini A, Ruperto N, Gattorno M. Results from a multicentre international registry of familial Mediterranean fever: impact of environment on the expression of a monogenic disease in children. Ann Rheum Dis 2013; 73:662-7. [PMID: 23463692 DOI: 10.1136/annrheumdis-2012-202708] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. We analyse the impact of ethnic, environmental and genetic factors on the severity of disease presentation in a large international registry. METHODS Demographic, genetic and clinical data from validated paediatric FMF patients enrolled in the Eurofever registry were analysed. Three subgroups were considered: (i) patients living in the eastern Mediterranean countries; (ii) patients with an eastern Mediterranean ancestry living in western Europe; (iii) Caucasian patients living in western European countries. A score for disease severity at presentation was elaborated. RESULTS Since November 2009, 346 FMF paediatric patients were enrolled in the Eurofever registry. The genetic and demographic features (ethnicity, age of onset, age at diagnosis) were similar among eastern Mediterranean patients whether they lived in their countries or western European countries. European patients had a lower frequency of the high penetrance M694V mutation and a significant delay of diagnosis (p<0.002). Patients living in eastern Mediterranean countries had a higher frequency of fever episodes/year and more frequent arthritis, pericarditis, chest pain, abdominal pain and vomiting compared to the other two groups. Multivariate analysis showed that the variables independently associated with severity of disease presentation were country of residence, presence of M694V mutation and positive family history. CONCLUSIONS Eastern Mediterranean FMF patients have a milder disease phenotype once they migrate to Europe, reflecting the effect of environment on the expression of a monogenic disease.
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Affiliation(s)
- Seza Ozen
- Department of Pediatrics, Hacettepe University, , Ankara, Turkey
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Papadopoulou-Alataki E, Hassan A, Davies EG. Prevention of infection in children and adolescents with primary immunodeficiency disorders. Asian Pac J Allergy Immunol 2012; 30:249-258. [PMID: 23393904] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Primary Immunodeficiency diseases (PIDs) are a heterogenous group of inherited disorders that may involve one or multiple components of the immune system. PIDs are uncommon, chronic and severe disorders, in which patients cannot mount a sufficiently protective immune response, leading to an increased susceptibility to infections. This review addresses the current practices for the prevention of infection in children and adolescents with PIDs, particular covering immunisations and antimicrobial prophylaxis. RESULTS Over recent years, there have been major advances in molecular and cellular understanding in the field of PIDs. Many different disorders are recognised with variable spectra of infection susceptibility depending on the particular aspects of the immune response that are affected. Immunoglobulin prophylaxis is the mainstay of treatment for PIDs and provides passive protection. Prophylactic antimicrobials are efficacious in children and adolescents with predominant defects in primary T cell immunodeficiency diseases and phagocytic disorders, and also with predominant defects in antibody production. Prophylactic antibiotics are suggested for patients with antibody deficiency diseases if recurrent infections exceed three per year, if severe infections occur despite adequate immunoglobulin replacement and in hypogammaglobulinaemic patients who have bronchiectasis. Certain immunisations are effective in antibody deficiencies, T cell deficiencies, complement deficiencies and phagocytic disorders. CONCLUSION There are remarkably few published data relating to clinical management aimed at preventing infectious complications in children and adolescents with PIDs. The cornerstones of the prevention of infection in most PID patients are: antimicrobial prophylaxis, appropriate vaccination, immunoglobulin replacement, for the more severe cases, and regular ongoing follow-up.
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Affiliation(s)
- Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics Aristotle University of Thessaloniki, General Regional Hospital Papageorgiou, Ring Road 56403 Thessaloniki, Greece.
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Ter Haar N, Lachmann H, Özen S, Woo P, Uziel Y, Modesto C, Koné-Paut I, Cantarini L, Insalaco A, Neven B, Hofer M, Rigante D, Al-Mayouf S, Touitou I, Gallizzi R, Papadopoulou-Alataki E, Martino S, Kuemmerle-Deschner J, Obici L, Iagaru N, Simon A, Nielsen S, Martini A, Ruperto N, Gattorno M, Frenkel J. Treatment of autoinflammatory diseases: results from the Eurofever Registry and a literature review. Ann Rheum Dis 2012; 72:678-85. [PMID: 22753383 DOI: 10.1136/annrheumdis-2011-201268] [Citation(s) in RCA: 247] [Impact Index Per Article: 20.6] [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: 11/03/2022]
Abstract
OBJECTIVE To evaluate the response to treatment of autoinflammatory diseases from an international registry and an up-to-date literature review. METHODS The response to treatment was studied in a web-based registry in which clinical information on anonymised patients with autoinflammatory diseases was collected retrospectively as part of the Eurofever initiative. Participating hospitals included paediatric rheumatology centres of the Paediatric Rheumatology International Trial Organisation network and adult centres with a specific interest in autoinflammatory diseases. The following diseases were included: familial Mediterranean fever (FMF), cryopyrin-associated periodic syndromes (CAPS), tumour necrosis factor (TNF)-receptor associated periodic syndrome (TRAPS), mevalonate kinase deficiency (MKD), pyogenic arthritis pustulosis acne (PAPA) syndrome, deficiency of interleukin-1 receptor antagonist (DIRA), NLRP12-related periodic fever and periodic fever aphthosis pharyngitis adenitis (PFAPA) syndrome. Cases were independently validated by experts for each disease. A literature search regarding treatment of the abovementioned diseases was also performed using Medline and Embase. RESULTS 22 months from the beginning of the enrolment, complete information on 496 validated patients was available. Data from the registry in combination with evidence from the literature confirmed that colchicine is the treatment of choice for FMF and IL-1 blockade for DIRA and CAPS. Corticosteroids on demand probably represent a valid therapeutic strategy for PFAPA, but also for MKD and TRAPS. Patients with poorly controlled MKD, TRAPS, PAPA or FMF may benefit from IL-1 blockade; anti-TNF treatment may represent a possible valuable alternative. CONCLUSIONS In the absence of high-grade evidence, these results could serve as a basis for therapeutic guidelines and to identify candidate drugs for future therapeutic trials.
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Affiliation(s)
- Nienke Ter Haar
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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ter Haar NM, Frenkel J, Woo P, Cantarini L, Lachmann H, Insalaco A, Hofer M, Uziel Y, Ozen S, Nielsen S, Naselli A, Modesto C, Al-Mayouf SM, Kone-Paut I, Nikishina I, Iagaru N, Obici L, Papadopoulou-Alataki E, Rigante D, Boros C, Martini A, Ruperto N, Gattorno M. Therapy of autoinflammatory diseases: results from an international registry. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194535 DOI: 10.1186/1546-0096-9-s1-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Papadopoulou-Legbelou K, Papadopoulou-Alataki E, Fleva A, Spanou S, Pavlitou A, Varlamis G. Cardiac complications and immunophenotypic profile of infectious mononucleosis syndrome in children. Indian Pediatr 2011; 49:195-8. [PMID: 21992856 DOI: 10.1007/s13312-012-0059-8] [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] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 04/15/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate cardiac complications in infectious mononucleosis patients and to associate them with biochemical and immunological parameters, as well as with spleen ultrasound findings. DESIGN Cross-sectional study with follow-up. SETTING Tertiary care pediatric unit, in the city of Thessaloniki, Greece. PARTICIPANTS AND INTERVENTIONS Twenty-five children (15 boys, aged 1-11.6 years) suffering from infectious mononucleosis were studied during the acute phase and after 3-6 months. Cardiac evaluation comprised of electrocardiogram, echocardiogram, and measurement of creatine phosphokinase, creatine phosphokinase cardiac isoenzyme, and troponin levels. Biochemical and immunological tests included serum transaminases, serum amylase, CD3+/CD8+ T-lymphocytes subpopulation and CD4+/CD8+ T-lymphocytes ratio. RESULTS During acute phase, all children had splenomegaly and normal serum amylase values. 17 patients had elevated serum transaminases. Percentages of CD3+/CD8+ T-lymphocytes subpopulation were elevated and CD4+/CD8+ ratio was decreased in all patients. Echocardiography revealed mild pericardial effusion in 13 patients (10/21 with Epstein-Barr infection, 3/4 with cytomegalovirus infection), but none presented with myocarditis. Four out of these 13 patients also had markedly elevated liver enzymes, 10/13 had significant splenomegaly and 12/13 presented very low CD4+/CD8+ T-lymphocytes ratio. Pericardial effusion demonstrated a statistically significant association solely with very low CD4+/CD8+ T-lymphocytes ratio (<0.5). Repetition of laboratory tests 3-6 months post-discharge detected persistent mild pericardial effusion in five patients, along with decreased CD4+/CD8+ ratio in 1/5. CONCLUSIONS In infectious mononucleosis syndrome, asymptomatic pericardial effusion could be associated with very low CD4+/CD8+ ratio (<0.5). Further studies would extend and confirm such an association.
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Speletas M, Boukas K, Papadopoulou-Alataki E, Tsitsami E, Germenis AE. Hereditary angioedema in Greek families caused by novel and recurrent mutations. Hum Immunol 2009; 70:925-9. [PMID: 19706314 DOI: 10.1016/j.humimm.2009.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/10/2009] [Accepted: 08/18/2009] [Indexed: 11/18/2022]
Abstract
This study constitutes the first molecular analysis of hereditary angioedema (HAE) in Greece, where 11 patients from three unrelated families with recurrent angioedema attacks and decreased C1 inhibitor antigenic levels were analyzed for SERPING1 mutations. Interestingly, one family displayed a novel SERPING1 alteration, characterized by the substitution of two consecutive nucleotides TC to AA, resulting in a termination codon (F225X). To the best of our knowledge, this is the first report of such a mutation in SERPING1, causing HAE. The second family displayed the nonsense mutation W482X, and the third the missense mutation M1V, already described in the literature. The type of mutation did not predict clearly the disease phenotype, since even members of the same family displayed a variety of the frequency and the severity of angioedema attacks. Our study identified a novel mutagenesis mechanism for HAE pathogenesis, providing additional evidence for the genetic heterogeneity of the disease.
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Affiliation(s)
- Matthaios Speletas
- Department of Immunology and Histocompatibility, University of Thessaly Medical School, Larissa, Greece.
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Papadopoulou-Alataki E, Foerster T, Antari V, Pavlitou-Tsiontsi A, Varlamis G. Molecular Diagnosis and Management of Hereditary Angioedema in a Greek Family. Int Arch Allergy Immunol 2008; 147:166-70. [DOI: 10.1159/000137286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 02/19/2008] [Indexed: 11/19/2022] Open
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Papadopoulou-Alataki E, Papadopoulou-Legbelou K, Doukas L, Karatzidou K, Pavlitou-Tsiontsi A, Pagkalos E. Clinical and biochemical manifestations of syndrome X in obese children. Eur J Pediatr 2004; 163:573-9. [PMID: 15241685 DOI: 10.1007/s00431-004-1483-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/26/2022]
Abstract
UNLABELLED The aim of this study was to investigate whether the clinical and metabolic characteristics of syndrome X had their onset in childhood in otherwise healthy but obese children of Greek origin. A group of 25 obese children and 18 age- and sex matched control subjects, aged 6-14 years, underwent an oral glucose tolerance test (OGTT), assessed for determination of plasma glucose and insulin levels. Insulin sensitivity and insulin resistance were estimated by mathematical models using calculations obtained during the OGTT. Body mass index (BMI) and blood pressure were measured, as well as serum lipoprotein and aminotransferase concentrations, after an overnight fast. The obese children had significantly higher blood pressure (systolic and diastolic) (P<0.001), triglycerides, lipoprotein(a) and alanine aminotransferase levels (P<0.05) and significantly lower HDL-cholesterol and apolipoprotein A-1 values (P<0.001). Plasma glucose levels during the OGTT were similar in both obese children and control subjects, while plasma insulin levels were significantly higher in obese children (P<0.01). In mathematical models, mean values of insulin sensitivity predictors: metabolic clearance rate and insulin sensitivity index were significantly lower in obese children (P<0.001). Predictors of beta-cell function: insulin resistance index and insulin release index were significantly higher in obese children (P<0.001). CONCLUSION Childhood adiposity was associated with all traditional components of syndrome X. The early recognition of these factors as predisposing elements of the appearance of metabolic syndrome requires the development of strategies to manage excess weight gain during childhood, with the ultimate goal being the prevention of type 2 diabetes and cardiovascular disease in adulthood.
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Speletas M, Kanariou M, Kanakoudi-Tsakalidou F, Papadopoulou-Alataki E, Arvanitidis K, Pardali E, Constantopoulos A, Kartalis G, Vihinen M, Sideras P, Ritis K. Analysis of Btk mutations in patients with X-linked agammaglobulinaemia (XLA) and determination of carrier status in normal female relatives: a nationwide study of Btk deficiency in Greece. Scand J Immunol 2001; 54:321-7. [PMID: 11555397 DOI: 10.1046/j.1365-3083.2001.00967.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/20/2022]
Abstract
Bruton's tyrosine kinase (Btk) is a nonreceptor tyrosine kinase, critical for B-cell development and function. Mutations that inactivate this kinase were found in families with X-linked agammaglobulinaemia (XLA). In this study the Btk gene was analyzed in 13 registered Greek patients with XLA phenotype originated from 12 unrelated families, in order to provide a definite diagnosis of the XLA. The structure of Btk was analyzed at the cDNA level using the recently developed method, NIRCA (Non-Isotopic-Rnase-Cleavage-Assay). Alterations were detected in all patients and sequencing analysis confirmed the results and defined six novel XLA-associated Btk mutations (three missense mutations: C337G, L346R, L452P; one nonsense mutation: Y392X, and two frameshift alterations: c1211-1212delA, c1306-1307insA). Having defined the genetic alteration in the affected males of these families, the information was used to design polymerase chain reaction (PCR) primers and the Btk segments containing the mutated sequences were amplified from peripheral blood derived genomic DNA of potential female carriers. The PCR products were directly sequenced and carrier status was determined in 12 out of 16 phenotypically normal females analyzed. This protocol can be used once the nature of the Btk mutation has been defined in one of the affected males and provides a convenient, simple and reliable way to determine the carrier status of other female family members. Molecular genetic analysis constitutes a determinative tool for the definitive diagnosis of XLA and may allow accurate carrier and prenatal diagnosis for genetic counselling.
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Affiliation(s)
- M Speletas
- First Division of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Lamari F, Karamanos NK, Papadopoulou-Alataki E, Kanakoudi-Tsakalidou F, Dimitracopoulos G, Anastassiou ED. Monitoring of two intravenous immunoglobulin. Preparations for immunoglobulin G subclasses and specific antibodies to bacterial surface antigens and relation with their levels in treated immunodeficient patients. J Pharm Biomed Anal 2000; 22:1029-36. [PMID: 10857572 DOI: 10.1016/s0731-7085(00)00297-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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
Patients with antibody deficiency disorders are highly susceptible to bacterial infections. Replacement therapy with intravenous immunoglobulin preparations (IVIG) has been established in such patients for two decades. The efficacy of IVIG treatment depends on the amount of functional pathogen-specific antibodies provided. The present study was undertaken to determine the levels of immunoglobulin classes, IgG subclasses, and specific antibodies to bacterial surface antigens in two different IVIG preparations (Sandoglobulin and Gamimmune) and blood sera of IVIG-treated immunodeficient patients. The levels of IgG, IgA, IgM and IgG subclasses were determined in both IVIG preparations and in patients' sera and were compared with those of healthy individuals. Sandoglobulin contained significantly higher concentrations of IgA, IgG, and IgG4 than Gamimmune. The latter contained higher concentrations of IgG1. Patients treated with Gamimmune) had significantly lower concentration of IgG4 as compared with healthy individuals and Sandoglobulin-treated patients. This finding was related to the preparation's composition. Screening of 20 lots from each preparation for antibodies to frequent clinically isolated strains of Escherichia coli, Staphylococcus aureus, S. epidermidis. Klebsiella pneumoniae and Enterococci spp. showed a high lot-to-lot variability. In order to overcome the lot-to-lot variability and correlate the observed effects with each IVIG preparation, the administered IVIG lots were selected so that their titers were in the interval of mean value +/- S.D. for each pathogen. The two tested preparations showed significant differences in their content of specific antibodies that ultimately affected the levels of these antibodies in treated patients. More specifically, Sandoglobulin contained higher levels of antibodies to E. coli and S. epidermidis strains. Infusion of this preparation maintained the respective antibodies in the recipients significantly higher than those of healthy individuals. Gamimmune infusion led to similar and comparable levels. Both IVIG preparations had comparable antibody titers towards K. pneumoniae, provided high amounts of antibodies, and kept recipients' specific IgG at levels significantly higher than those of the healthy individuals. Enterococci spp. specific antibodies were significantly higher in Gamimmune, whereas titers of antibodies towards S. aureus were comparable. Levels of antibodies against both Enterococci spp. and S. epidermidis after administration of both preparations were close to those in healthy individuals. None of the patients developed infection during the time of the study. In conclusion, most of the lots of the two IVIG preparations studied, despite some quantitative differences, provide patients with sufficient amounts of antibodies to bacterial surface antigens that protect them against infections.
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Affiliation(s)
- F Lamari
- Department of Chemistry, University of Patras, Greece
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