Paediatriki
Contents
REVIEW ARTICLES
159 Natural killer cells and KIRs receptors. Τheir predisposing and prognostic role in haematological malignancies
Z. D. Pana, F. Athanasiadou-Piperopoulou
167 Prenatal hydronephrosis: current views
E. Siomou, C. J. Stefanidis, A. Siamopoulou-Mavridou, S. Andronikou
177 Early growth disturbance and the development of hypertension and renal disease
V. Giapros, S. Andronikou
185 Psychosocial adaptation of immigrant youth
F. Motti-Stefanidi
191 The genetics of epilepsy in childhood
V. Aggelakou, E. Stefanaki, S. Voutoufianakis
200 The role of infectious diseases in the early signs of atherosclerosis
Ε. Efstathiou, V. Papaevangelou
ORIGINAL ARTICLES
206 Sexual behavior and practices of Greek adolescents: a study in Attica
A. Tsitsika, E. Konstantoulaki, V. Boutziouka, I. Deligiannis, V. Dimitrakopoulou, E. Critselis, D. Tounissidou, M. Tsolia, V. Papaevangelou, A. Constantopoulos, D. Kafetzis
213 Violence-related behaviour among students attending senior high school in the prefecture of Thessaloniki: prevalence and differences between native and foreign-born pupils
M. Patseadou, A. Galli-Tsinopoulou, M. Arvanitidou-Vayona, G. Varlamis
CASE REPORTS
221 Idiopathic intracranial pressure and facial nerve palsy: case report and literature review
M. Tzoufi, V. Grammeniatis, A. Makis, G. Eksarhakos, I. Asproudis, A. Zikou, A. Siamopoulou-Mavridou
227 Bacillus pumilus bacteremia in a full term neonate – a case report
M. Papadopoulou, M. Kimouli, N. Rekliti, A. Konstantinidi, S. Tadros, V. Souniadis, O. Dedousi, C. Trompoukis, D. Petropoulou, I. Lambadaridis, A. Gounaris
CURRENT ISSUES OF BIOSTATISTICS
231 The evaluation of screening and diagnostic tests in clinical paediatrics
E. Critselis, C. Ι. Stefanidis, D. Α. Kafetzis
CLINICAL QUIZ
236 Child with black tongue
Ε. Mantadakis, Μ. Sitzimi, S. Thomaidis, A. Chatzimichail
NEWS FROM THE INTERNET
237 Τopics of Paediatric Nephrology in “Paediatriki”
M. Garatzioti
Εμμανουήλ Γαλανάκης, Ηθική και Δεοντολογία,
Μαρία Κανάριου, Ανοσολογία, Αθήνα
Αντώνης Καττάμης, Αιματολογία - Oγκολογία, Αθήνα
Σοφία Κίτσιου-Τζέλη, Γενετική, Αθήνα
Αλεξάνδρα Παπαδοπούλου, Γαστρεντερολογία
Editor-in-Chief
Constantinos Stefanidis, Athens
Section Editors
Stella Andronikou, Neonatology, Ioannina
Michael Anthracopoulos, Pneumonology, Patras
Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki
George Varlamis, Cardiology, Thessaloniki
Emmanouil Galanakis, Ethics and Deontology, Heraklion
Loretta Thomaidou, Developmental Pediatrics, Athens
Maria Kanariou, Immunology, Athens
Antonis Kattamis, Haematology - Oncology, Athens
Sophia Kitsiou-Tzeli, Genetics, Athens
Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens
Vassiliki Papaevagelou, Infectious Diseases, Athens
Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina
Antigone Syrigou-Papavasiliou, Neurology, Athens
Evangelia Charmandari, Endocrinology, Athens
MeMbers of the InternatIonal edItorIal board
Alexis Arzimanoglou, Paris, France
Ellis D. Avner, Milwaukee, USA
Swati Bhave, New Delhi, India
Alberto Bissot, Panama, Panama
David Branski, Jerusalem, Israel
Francesco Chiarelli, Chieti, Italy
Chok-Wan Chan, Hong Kong, China
Denis Daneman, Toronto, Canada
Jochen Ehrich, Hannover, Germany
Demetrius Ellis, Pittsburgh, USA
Yoshikatsu Eto, Tokyo, Japan
Richard N. Fine, Stony Brook, USA
Margaret C. Fisher, Philadelphia, USA
Raif Geha, Boston, USA
Adenike Grange, Lagos, Nigeria
Judith G. Hall, Vancouver, Canada
Patricia Hamilton, London, UK
Enver Hasanoglu, Ankara, Turkey
Christer Holmberg, Helsinki, Finland
Lewis B. Holmes, Boston, USA
Peter Hoyer, Essen, Germany
Jan Janda, Prague, Czech Republic
Jan Kimpen, Ultrecht, Netherlands
Craig B. Langman, Chicago, USA
John Manis, Boston, USA
Manuel Moya, Alicante, Spain
Hugh O'Brodovich, Toronto, Canada
Ross Petty, Vancouver, Canada
Willem Proesmans, Leuven, Belgium
Jose Ramet, Antwerp, Belgium
Nikolai Shabalov, St. Petersburg, Russia
Alan Sinaiko, Minneapolis, USA
Nick J. Spencer, Coventry, UK
Alfred Tenore, Udine, Italy
Alkis Togias, Bethesda, USA
Eva Tsalikian, Iowa City, USA
Catherine Weil-Olivier, Paris, France
Max Zach, Graz, Austria
Zheng-Yan Zhao, Hangzhou, China
Johannes Zschocke, Heidelberg, Germany
Natural killer cells and KIRs receptors. Τheir predisposing and prognostic role in haematological malignancies
Z. D. Pana, F. Athanasiadou-Piperopoulou
Abstract: The phenomenon of cancer escape from immune surveillance is considered to be one of the main mechanisms for the development and progression of cancer. Studies over the past decade have established the concept that the innate immune system can regulate cancer development via multiple mechanisms cumulatively referred to as immune surveillance. Natural killer (NK) cells are a type of cytotoxic lymphocytes (CD56+/CD3-) that play a major role in cancer immune surveillance. The effector function of NK cells is regulated by the dynamic balance between signals transduced from the activating and inhibitory cell surface receptors. NK cell immunoglobulin-like receptors (KIRs) belong to a group of regulatory molecules found on the NK cell membrane. Their main role is based on their ability to regulate (inhibit or activate) NK cytolysis, through binding with HLA I molecules on the surface of target-cells. The NK cell ability to discriminate between normal and transformed cells appears to be influenced by the phenotypic dominance of their KIRs receptors. Recent research in this field supports the hypothesis of a genetic association between KIR isotypes and individual susceptibility to various diseases, including hematological malignancies.
Key words: Natural immunity, Natural Killer Cells, KIR receptors, haematological malignancy, bone marrow transplantation.
2nd Pediatric Department, AHEPA General University Hospital of Thessaloniki, Greece
Correspondence: Zoe D. Pana panazoi@gmail.com 31, Aristidou St., Kalamaria 55133, Thessaloniki, Greece
(cancer progression) (2).
(Natural Killer cells, NK) (3).
(Natural Killer cells,
KIR
KIR
19p13.3
19p13.2
19p13.13
19p13.12
19p13.11
19p12 19p11 19p11
19q12
19q13.11
19q13.12
19q13.13
19q13.2
19q13.31
19q13.32
19q13.33
19q13.4
19q13.43
KIR2DL3
KIR2DP1
KIR2DL1
KIR3DP1
KIR2DL4
KIR3DL1
KIR2D
KIR2DL KIR2DS
KIR3D KIR3DS KIR3DL
DAP12 (2ITAM)
DAP12 (2ITAM) 2ITIM 2ITIMAΓΝΩΣΤΟΣ
KIR2DS1 KIR2DS2 KIR2DS3 KIR2DS4 KIR2DS5
KIR2DL1 KIR2DL2 KIR2DL3 KIR2DL5A KIR2DL5B KIR3DL1 KIR3DL2 KIR3DS1 KIR3DL3 KIR2DL4
KIR2DS4
150 Kb. Η
επίσης, και γονίδια
DAP
LRC
CD66 αντιγόνα, SIGLEC, FcGRT, LΙLR, LAIR, FcGammaR
και NCR1 υποδοχείς (EBI Database).
κυτταροκινών και χημειοκινών (17). Αντίστοιχα, οι
κυτταροκίνες IL-2, IL-12, IL-15, IL-21, o TNF-a και η IF I ενεργοποιούν τα ΝΚ κύτταρα
υποδοχέων τους (18).
Οι υποδοχείς των ΝΚ κυττάρων
(Ig superfamily),
οικογένεια των υποδοχέων λεκτίνης τύπου C (C-type lectin receptors) (19).
(KIRs), 2) οι LIRLs (Leucocyte Immunoglobin like receptors), 3) οι LAIRs (Leucocyteassociated inhibitory receptors), 4) οι FcαR
τέλος, 5) οι NKp46 υποδοχείς (20).
HLA-G, ενώ οι υποδοχείς NKG2D/CD94 συνδέονται με μόρια HLA-E,
LRC,
(KIR2DS, KIR3DS) (26).
ITIMS (Immunoreceptor tyrosine
(transcriptional start site) (33).
(27).
SSR (sequence specific priming),
(sequence specific
(Mary Carrington et al. The KIR Gene Cluster. Basic Research Program, SAIC, Inc., National Cancer Institute, Frederick, USA).
Βιβλιογραφία
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Prenatal hydronephrosis: current views
E. Siomou1, C. J. Stefanidis2, A. Siamopoulou-Mavridou1, S. Andronikou3
Abstract: The frequency of identification of prenatal hydronephrosis (PH) has increased significantly in recent years as a result of the wide use of prenatal ultrasound (US) in the second trimester of gestation. The lack of consensus regarding the evaluation after birth of the infants with PH confronts the clinician with the dilemma between investigating a large number of infants with PH, or arranging fewer investigations and running the risk of missing some urinary tract malformations. A history of oligohydramnios, persistent severe hydronephrosis in the third trimester of gestation (anterior-posterior renal pelvic diameter >15 mm), bilateral hydronephrosis or hydronephrosis in a solitary kidney, and prenatal US findings compatible with renal hypoplasia/dysplasia are features that are frequently associated with congenital anomalies of urinary tract. Current opinion is that the aim of investigation and follow-up after birth of infants with PH should be selection of those children who comprise a highrisk group and need early diagnosis and intervention, and limitation of radiological investigation of those with low risk for congenital anomalies of the urinary tract.
Key words: Prenatal hydronephrosis, congenital urinary tract anomalies, vesicoureteral reflux, urinary tract obstruction.
1 Department of Paediatrics, University Hospital of Ioannina
2 Department of Nephrology, “P. & A. Kyriakou” Children’s Hospital, Athens
3 Neonates Intensive Care Unit, University Hospital of Ioannina
Correspondence: Ekaterini Siomou eksiomou@cc.uoi.gr Department of Child Health, Medical School, University of Ioannina Po. Box 1186, 451 10, Ioannina, Greece
for Fetal Urology:
(Society for Fetal Urology:
(hydronephrosis index),
3.
4.
5.
6.
2.
3.
4.
5. Ανωμαλιών
(σύν-
technetium99m-diethylenetriamine pentaacetic acid ( 99m Tc-
Ήπια: 6-9 mm**
6-9 mm
>15 mm Μέτρια: 9-15 mm
9-15 mm
>15 mm
9-15 mm
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51. Wollenberg A, Neuhaus TJ, Willi WV, Wisser J. Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol 2005;25:483-488.
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Quiz
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4.
Early growth disturbance and the development of hypertension and renal disease
V. Giapros, S. Andronikou
Abstract: A growing body of evidence links adverse events during early life and a variety of adult onset diseases, such as type 2 diabetes mellitus, ischaemic heart disease and hypertension. Hypertension is a strong risk factor for early morbidity and mortality. Epidemiological studies from many parts of the world have shown correlation between low birth weight (LBW) and high blood pressure (BP) in later life. Nephron loss that occurs in response to intrauterine growth restriction may be the main causal factor for elevated BP in these individuals. It is hypothesized that a reduced number of nephrons would be associated with greater glomerular size and volume, and that such enlarged glomeruli would be hyperfiltering. Glomerular hyperfiltration is associated with reduced renal reserve and elevated BP. Recent studies have documented the mechanisms of oligonephronia and impaired renal function in LBW individuals. The relationship between prenatal insults and postnatal pathological conditions is currently the subject of intensive research. Postnatal growth retardation, which is common in preterm infants, and catch-up growth, are postnatal conditions which have been shown to be related to impaired renal function and hypertension. Evidence for the origins of adult hypertension and renal deterioration may be found early in childhood. Renal function may be affected early after birth in individuals who are born small for gestational age (SGA), and their BP may be elevated at school age. Subtle changes in their renal function may provide important clues indicating reduced nephron numbers and increased risk of renal disease. Early detection of these derangements provides the opportunity for close surveillance and possible application of preventive measures during childhood in order to prevent or ameliorate hypertension and renal disease.
Key words: Low birth weight, hypertension, renal function, intrauterine growth retardation, catch-up growth.
Neonatal Intensive Care Unit, University Hospital of Ioannina
Correspondence: Vasilios Giapros vgiapros@cc.uoi.gr
Neonatal Intensive Care Unit, University Hospital of Ioannina, Stavros Niarchou Av., Ioannina, Greece
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Psychosocial adaptation of immigrant youth
F. Motti-Stefanidi
Abstract: Most of the economically developed countries have, during recent decades, become the recipients of large numbers of immigrants. In some places, especially in metropolitan areas, immigrant children comprise 50% of the pupils in the schools. International experience shows that significant numbers of immigrant children will stay on in their host countries. Their positive adaptation is in their own interests as well as those of the recipient country. This paper presents findings from studies on the adaptation of immigrant youth conducted by the Department of Psychology of the University of Athens. It is argued that in order for immigrant children to be considered well adapted they need to be shown, firstly, to be dealing effectively with the developmental demands of their age and times, and secondly, to have learned how to navigate between two cultures, that of their country of origin and that of the host country. The comparison of the school adjustment and the psychological well-being of immigrant youth with that of their native classmates revealed that the former are less well adjusted in the school setting than the latter, but that they do not appear to differ in terms of their psychological well-being.
Key words: Immigration, adolescence, adaptation.
Department of Psychology, Faculty of Philosophy, Paedagogy and Psychology, University of Athens
Correspondence: Frosso Motti-Stefanidi frmotti@psych.uoa.gr
Department of Psychology, Faculty of Philosophy, Paedagogy and Psychology, University of Athens
15784 Athens, Greece
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The genetics of epilepsy in childhood
V. Aggelakou, E. Stefanaki, S. Voutoufianakis
Abstract: The majority of epilepsies in childhood are characterized as “idiopathic” because despite detailed investigation no obvious underlying causes can be found. Over the past decade, major progress in the field of molecular genetics has contributed to the recognition, in many types of “idiopathic” epilepsy in childhood, of various different mutations in genes that control the excitability of neurons. Most of the mutations that have been identified involve genes that encode ion channels, mainly sodium, potassium, chloride and calcium channels, but also γ-aminobutyric acid (GABA) and nicotinic acetylcholine receptors. These mutations have been found in not only familial, but also sporadic cases. Based on these data, many of the “idiopathic” epilepsies with a documented genetic basis are now classified as “channelopathies”. In addition, the identification of genes that contribute to individual genetic vulnerability to epilepsy (epilepsy susceptibility genes) furthers understanding in the field of the genetics of epilepsy. At present, the contribution of genetic testing in everyday clinical practice is limited to a small subgroup of patients. The differential diagnosis between mild and severe types of epilepsy is difficult and an extended observation time is needed before a final diagnosis can be reached. The identification of the underlying causes, including by genetic testing, sometimes helps in explaining the prognosis and in the avoidance of unnecessary investigations. The finding of a mutation will guide the therapeutic approach and influence the genetic counselling of the family.
Key words: Childhood epilepsy, genetics, channelopathies, idiopathic epilepsy, severe myoclonic epilepsy of infancy, GEFS+.
First Department of Paediatrics, Venizeleio General Hospital, Heraklion Crete
Correspondence: Vasiliki Aggelakou vasiliki.aggelakou@gmail.com
Gournes Temenous, 71500, Heraklion, Greece
MASS1 (Monogenic Audiogenic Seizure Susceptibility 1) στο FEB4 και το IMPA2 (myo-inositol monophosphatase 2)
FEB6 (16-18).
SEZ6 (Seizures related gene 6)
(19).
+ (generalized epilepsy with febrile seizures plus, GEFS+) Το
GEFS+ από τους Wallace και συν (22). To γονίδιο
SCN1A,
GEFS+ (23).
myoclonic
Dravet syndrome)
- GEFS+
-
Dravet
KCNQ2
KCNQ3
SCN2A
SCN1B
SCN1A
GABRG2 GABRD
SCN1A
(IMPA2) (MASS1)
(SEZ6)
GABRA1 CACNA1H
GABRA1 EFHC1
- Σ. Panayiotopoulos (SCN1A)
CHRNA4 CHRNB2 CHRNA2
κληρονομικότητας (33). Εκτός των μεταλλάξεων στους GABA υποδοχείς,
(41,42).
(40).
NEDD4-2 (neuronally expressed developmentally downregulated 4 gene) (44).
κτηριστικά, καθώς και η αυτοσωματική επικρατητική νυχτερινή επιληψία του μετωπιαίου λοβού. Η
ταυτοποίηση μεταλλάξεων στα γονίδια KCNQ2, KCNQ3 και SCN2A, στο γονίδιο LGI1, και στα γονίδια CHRNA4, CHRNB2 και CHRNA2 αντίστοιχα, θα
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Nakahara S, et al. Linkage and association of febrile seizures to the IMPA2 gene on human chromosome 18. Neurology 2004;63:1770-1771.
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27. Claes L, Del-Favero J, Ceulemans B, Lagae L, Van Broeckhoven C, De Jonghe P. De novo mutations in the sodium-channel gene SCN1A cause severe myoclonic epilepsy of infancy. Am J Hum Genet 2001;68:1327-1332.
28. Lossin C. A catalog of SCN1A variants. Brain Dev 2009;31: 114-130.
29. Hattori J, Ouchida M, Ono J, Miyake S, Maniwa S, Mimaki N, et al. A screening test for the prediction of Dravet syndrome before one year of age. Epilepsia 2008;49:626-633.
30. Berkovic SF, Harkin L, McMahon JM, Pelekanos JT, Zuberi SM, Wirrell EC, et al. De-novo mutations of the sodium channel gene SCN1A in alleged vaccine encephalopathy: a retrospective study. Lancet Neurol 2006;5:488-492.
31. Kahane P, Arzimanoglou A. Vaccine encephalopathy: a myth collapses? Presse Med 2007;36:1339-1340.
32. Maljevic S, Krampfl K, Cobilanschi J, Tilgen N, Beyer S, Weber YG, et al. A mutation in the GABA(A) receptor alpha(1)-subunit is associated with absence epilepsy. Ann Neurol 2006;59:983-987.
33. Cossette P, Liu L, Brisebois K, Dong H, Lortie A, Vanasse M, et al. Mutation of GABRA1 in an autosomal dominant form of juvenile myoclonic epilepsy. Nat Genet 2002;31:184-189.
34. Haug K, Warnstedt M, Alekov AK, Sander T, Ramírez A, Poser B, et al. Mutations in CLCN2 encoding a voltagegated chloride channel are associated with idiopathic generalized epilepsies. Nat Genet 2003;33:527-532.
35. D'Agostino D, Bertelli M, Gallo S, Cecchin S, Albiero E, Garofalo PG, et al. Mutations and polymorphisms of the CLCN2 gene in idiopathic epilepsy. Neurology 2004;63: 1500-1502.
36. Mulley JC, Scheffer IE, Harkin LA, Berkovic SF, Dibbens LM. Susceptibility genes for complex epilepsy. Hum Mol Genet 2005;14:243-249.
37. Lucarini N, Verrotti A, Napolioni V, Bosco G, Curatolo P. Genetic polymorphisms and idiopathic generalized epilepsies. Pediatr Neurol 2007;37:157-164.
38. Chen Y, Lu J, Pan H, Zhang Y, Wu H, Xu K, et al. Association between genetic variation of CACNA1H and childhood absence epilepsy. Ann Neurol 2003;54:239-243.
39. Heron SE, Phillips HA, Mulley JC, Mazarib A, Neufeld MY, Berkovic SF, et al. Genetic variation of CACNA1H in idiopathic generalized epilepsy. Ann Neurol 2004;55:595596.
40. Dibbens LM, Feng HJ, Richards MC, Harkin LA, Hodgson BL, Scott D, et al. GABRD encoding a protein for extra- or peri-synaptic GABAA receptors is a susceptibility locus for generalized epilepsies. Hum Mol Genet 2004;13:13151319.
41. Pinto D, Louwaars S, Westland B, Volkers L, de Haan GJ, Trenité DG, et al. Heterogeneity at the JME 6p11-12 locus: absence of mutations in the EFHC1 gene in linked Dutch families. Epilepsia 2006;47:1743-1746.
42. Suzuki T, Delgado-Escueta AV, Aguan K, Alonso ME, Shi J, Hara Y, et al. Mutations in EFHC1 cause juvenile myoclonic epilepsy. Nat Genet 2004;36:842-849.
43. Pal DK, Evgrafov OV, Tabares P, Zhang F, Durner M, Greenberg DA. BRD2 (RING3) is a probable major susceptibility gene for common juvenile myoclonic epilepsy. Am J Hum Genet 2003;73:261-270.
44. Dibbens LM, Ekberg J, Taylor I, Hodgson BL, Conroy SJ, Lensink IL, et al. NEDD4-2 as a potential candidate susceptibility gene for epileptic photosensitivity. Genes Brain Behav 2007;6:750-755.
45. Taylor I, Berkovic SF, Kivity S, Scheffer IE. Benign occipital epilepsies of childhood: clinical features and genetics. Brain 2008;131:2287-2294.
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47. Grosso S, Orrico A, Galli L, Di Bartolo R, Sorrentino V, Balestri P. SCN1A mutation associated with atypical Panayiotopoulos syndrome. Neurology 2007;69:609-611.
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1
2
elenhef@yahoo.gr
1 2nd Paediatric Department, “P. & A. Kyriakou” Children’s Hospital
2 2nd Paediatric Department, University of Athens, “P. & A. Kyriakou” Children’s Hospital
Correspondence: Εleni Efstathiou elenhef@yahoo.gr 19, Herodou Attikou St., 15124, Maroussi, Greece
The role of infectious diseases in the early signs of atherosclerosis
Ε. Efstathiou1, V. Papaevangelou2
Abstract: Atherosclerosis is responsible for more than half of the annual mortality in the United States. It is a progressive, inflammatory disease which begins early in childhood. The arterial endothelium, which normally has anti-inflammatory and anti-thrombotic properties, plays a crucial role in the pathophysiology of atherosclerosis. Injury of the endothelium provokes an inflammatory response consisting of the accumulation of smooth muscle cells in the area of the lesion, and of macrophages and lymphocytes, which secret cytokines, chemokines and growth factors, which create a vicious circle resulting in thickening of the vessel wall. Apart from the traditional risk factors that contribute to endothelial dysfunction, such as smoking, diabetes mellitus and dyslipidaemia, study has recently been directed towards the possible role of infections. The majority of relevant publications concern Cytomegalovirus and Chlamydia pneumoniae and have been carried out on adults. Taking into consideration the fact that infections occur more frequently during childhood, research is currently being focused on paediatric patients, and the possible role of other pathogens is under study, such as Hepatitis B and C viruses, enteroviruses, Helicobacter pylori, Herpes simplex virus, etc. As the results of the studies are often conflicting, more intensive research is necessary, in order to clarify the effect of infections on the initiation of atherosclerotic disease.
Key words: Atherosclerosis, infections, endothelium.
(endothelium-dependent
DNA
από χλαμύδιο πνευμονίας, μυκόπλασμα πνευμονίας, κυτταρομεγαλοϊό, ιό του απλού έρπητα και ελικοβακτηρίδιο τού πυλωρού σε μακροσκοπικά υγιές τμήμα στεφανιαίας αορτής,
Βιβλιογραφία
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1
1 Adolescent Health Unit, Second University Department of Paediatrics, “P. & A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens, School of Medicine
2 Second University
Department of Paediatrics, “P. & A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens, School of Medicine
Correspondence: Artemis Tsitsika
info@youth-health.gr
Adolescent Health Unit, 2nd Department of Paediatrics, University of Athens, “P. & A. Kyriakou”
Children's Hospital, 24, Mesogeion Av., 11527, Goudi, Greece
Sexual behaviour and practices of Greek adolescents: a study in Attica
A. Tsitsika1, E. Konstantoulaki1, V. Boutziouka1, I. Deligiannis1, V. Dimitrakopoulou1, E. Critselis2, D. Tounissidou1, M. Tsolia2, V. Papaevangelou2, A. Constantopoulos1, D. Kafetzis2
Abstract
Background: Adolescence is a phase of sexual experimentation. Knowledge concerning adolescent sexual behaviour and practices is important for designing and implementing educational or prevention programmes directed at young people in this age group. The objective of this study was to evaluate the prevalence of sexual activity and contraceptive methods used by Greek adolescents and to assess the various factors involved in their decision-making about sexual activity.
Methods: A cross-sectional study design was applied. The population (N=1538) consisted of a random sample, stratified according to locality and population density, of 20 public junior high and high schools located in the urban district of Athens, Greece. Anonymous self-completed questionnaires were used to record sexual practices, contraception methods, and factors affecting sexual activity choices. Statistical analysis was made using Spearman association calculations, χ2 testing and regression analysis models.
Results: Of the study population, 16% reported having had sexual intercourse, with a boy/girl ratio of 3/1 (p<0.05) and a mean age of sexual debut of 14±1.5 years. An additional 20% reported other forms of sexual experience at a mean age 13.5±1.5 years. Although sexually active adolescents generally reported use of condoms (90.6%), only 32% reported correct use (at every, and throughout, sexual contact). About
one third appear to have inadequate protection (use of no method or unreliable methods), and 8.2% of the girls reported use of emergency contraception. Adolescents with an unstable home environment (divorce, recent death, not living with mother), sexually experienced peers, and those that seek sexual education from siblings or friends had a higher likelihood of being sexually active.
Conclusion: Greek adolescents may be sexually active at a young age and they need education on the practice of safe sex.
Key words: Adolescence, sexuality, sexual education, contraception. Συντομογραφίες
Stata/SE 10.0 for Windows (Stata Corporation,
75% (95% CI=1,07-2,84)
46% (95% CI=1,05-2,02)
- 80% (95% CI=1,11-2,93),
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23. Whitaker DJ, Miller KS, May DC, Levin ML. Teenage partners' communication about sexual risk and condom use: the importance of parent-teenager discussions. Fam Plann Perspect 1999;31:117-121.
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26. Eaton DK, Kann L, Kinchen S, Ross J, Hawkins J, Harris WA, et al. Youth Risk Behavior Surveillance -United States, 2005. MMWR Surveill Summ 2006;55:1-108. [Webpage]: http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf
27. Ottensen S, Narring F, Renteria SC, Michaud PA. Emergency contraception among teenagers in Switzerland: a cross-sectional survey on the sexuality of 16 to 20 year olds. J Adol Health 2002;31:101-110.
28. Henderson M, Butcher I, Wight D, Williamson L, Raab G. What explains between-school differences in rates of sexual experience? BMC Public Health 2008;8:53.
29. Valle AK, Torgersen L, Røysamb E, Klepp KI, Thelle DS. Social class, gender and psychosocial predictors for early sexual debut among 16 year olds in Oslo. Eur J Public Health 2005;15:185-194.
30. Lerand SJ, Ireland M, Blum RW. Individual and environmental impacts on sexual health of Caribbean youth. Scientific World Journal 2006;6:707-717.
31. Robles RR, Matos TD, Reyes JC, Colón HM, Negrón J, Calderón J, et al. Correlates of early sexual activity among Hispanic children in middle adolescence. P R Health Sci J 2007;26:119-126.
32. Frappier JY, Kaufman M, Baltzer F. Sex and sexual health: A survey of Canadian youth and mothers. Paediatr Child Health 2008;13:25-30.
33. McLaughlin M, Thompson K, Parahoo K, Armstrong J, Hume A. Inequalities in the provision of sexual health information for young people. J Fam Plann Reprod Health Care 2007;33:99-105.
34. Gray NJ, Klein JD, Noyce PR. Health information seeking behaviour in adolescence: the place of the internet. Soc Sci Med 2005;60:1467-1478.
35. Tsitsika AK, Critselis E, Kormas G, Filippopoulou A, Tounissidou D, Freskou A, et al. Internet use and misuse: a multivariate regression analysis of the predictive factors of internet use among Greek adolescents. Eur J Pediatr 2009;168:655-665.
Violence-related behaviour among students attending senior high school in the prefecture of Thessaloniki: prevalence and differences between native and foreign-born pupils
M. Patseadou1, A. Galli-Tsinopoulou1, M. Arvanitidou-Vayona2, G. Varlamis1
Abstract
Background: Violent and aggressive behaviour in the school setting is a phenomenon observed in contemporary societies. The aim of this study was to register various types of behaviour that are related to violence among pupils in the 15-18 years age-group, and to investigate whether nationality is associated with school bullying or victimization.
Methods: A total of 1,014 pupils attending a representative sample of 20 senior high schools in the prefecture of Thessaloniki (13 public, 3 private and 4 vocational schools) completed a questionnaire, developed by the Centers for Disease Control and Prevention (CDC), USA and adapted to the Greek national priorities and characteristics, which contained a series of questions concerning violence-related behaviour. The frequencies of specific types of aggressive behaviour were estimated and the chi-square test was used to evaluate possible association with the nationality of the pupils.
Results: Of the respondents, 37.5% reported that they had participated in a physical fight at school at least once in the previous 12 months. About 20% of the pupils reported deliberate damage of their property by others, and 10% reported having been threatened or injured in the school environment at least once in the previous 12 months. In addition, 51 pupils (5%) reported avoiding going to school
1 4th Department of Paediatrics, Aristotle University of Thessaloniki
2 Department of Hygiene, Medical School, Aristotle University of Thessaloniki
Correspondence: Magdalini Patseadou mpats82@gmail.com
3, Ypsilantou St., 55337, Thessaloniki, Greece
because they felt unsafe and 130 (12.8%) had experienced date violence. The nationality of the pupils appeared to play a role, and there was a tendency for foreign-born pupils to report a higher probability of victimization and aggressive behaviour in the school setting, but significant association was demonstrated only between foreign nationality and participation in a physical fight, or school absence because of feelings of lack of safety.
Conclusions: Bullying, victimization and violence of various types are common in the Greek senior high school environment. There is a need for prompt implementation of programmes designed for the prevention of violent behaviour among adolescents at school, and for the establishment of an appropriate policy for schools on management of the phenomenon.
Key words: Violence-related behaviour, school bullying, adolescence, high schools, prefecture of Thessaloniki.
νίκης κατανεμήθηκαν
Ανατολική
11 σχολεία διαιρεμένα σε 9 γενικά (2 ιδιωτικά, 7 δημόσια: 1 διαπολιτισμικό, 5 αστικά, 1 προάστιο) και 2 επαγγελματικά (1 αστικό, 1 προάστιο). Β) Δυτική Θεσσαλονίκη: 9 σχολεία διαιρεμένα σε 7 γενικά (1 ιδιωτικό, 6 δημόσια: 1 διαπολιτισμικό, 2 αστικά, 3 προάστια) και 2 επαγγελματικά (1 αστικό, 1 προάστιο). Παράλληλα, για
Επάγγελμα πατέρα (Ν=976) Επιστήμονας-ΔιευθυντήςΕπαγγελματίας
Άλλο (συνταξιούχος, οικιακά,
Επάγγελμα μητέρας (Ν=985) Επιστήμονας-ΔιευθύντριαΕπαγγελματίας
Άλλο (συνταξιούχος, οικιακά, άνεργη κ.λπ.)
Ναι 90 (11%) 29 (16,8%) 119 (12%)
Όχι 729 (89%) 144 (83,2%) 873 (88%)
Σύνολο 819 173 992
Chi-square value=4,511, df=1, p=0,034
Ναι 294 (36%) 75 (43,4%) 369 (37,5%)
523 (64%) 98 (56,6%) 621 (62,5%)
Σύνολο 817 173 990
Chi-square value=3,314, df=1, p=0,069
Ναι 85 (10,4%) 33 (19,1%) 138 (11,9%)
Όχι 732 (89,6%) 140 (80,9%) 872 (88,1%)
Σύνολο 817 173 990
Chi-square value=10,225, df=1, p=0,001
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14. Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D et al (eds). Inequalities in young people’s health. Health behaviour in school-aged children (HBSC) study: International report from the HBSC 2005/06 survey. WHO Policy Series: Health policy for children and adolescents. Issue 5, WHO Regional Office for Europe, Copenhagen, 2008:1–206.
15.
16. Grunbaum JA, Kann L, Kinchen S, Ross J, Hawkins J, Lowry R, et al. Youth Risk Behavior Surveillance-United States, 2003. MMWR Surveill Summ 2004;53:1-96.
17. Brener ND, Kann L, Kinchen SA, Grunbaum JA, Whalen L, Eaton D et al. Methodology of the Youth Risk Behavior Surveillance System. MMWR Recomm Rep 2004;53(RR-12):1-13.
18. Γεννηματά
2007,24:270-90.
19. SPSS 16.0, SPSS Inc., Chicago, IL, USA.
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21. Fekkes M, Pijpers FI, Verloove-Vanhorick SP. Bullying behaviour and associations with psychosomatic complaints and depression in victims. J Pediatr 2004;144:17-22.
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24. Rose E, Diclemente RJ, Wingood GM, Sales JM, Latham TP, Crosby RA et al. The Validity of Teens' and Young Adults' Self-reported Condom Use. Arch Pediatr Adolesc Med 2009;163:61-4.
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Idiopathic intracranial pressure and facial nerve palsy: case report and literature review
M. Tzoufi1, V. Grammeniatis1, A. Makis1, G. Eksarhakos2, I. Asproudis3, A. Zikou4, A. Siamopoulou-Mavridou1
Abstract: The case is reported of an 11 year-old obese girl, who presented with headache, vomiting and diplopia. Ophthalmological examination revealed bilateral papilloedema, and left-sided lateral abducens nerve palsy was detected. Brain imaging with magnetic tomography was normal. Lumbar puncture revealed elevated intracranial pressure with cerebrospinal fluid (CSF) pressure >260 mmH2Ο, and idiopathic intracranial hypertension was diagnosed. The girl was immediately started on acetazolamide, but on the 5th day of treatment she presented unilateral, severe, peripheral facial palsy, on the left side. Physical examination, laboratory tests and imaging, including brain magnetic tomography, magnetic resonance imaging (MRI) venography and computed tomography (CT) along the route of facial nerve, were consistently normal, which excluded cerebral venous thrombosis and sustained the initial diagnosis. Despite possible contraindications (i.e., obesity, elevated intracranial pressure), steroids were administered for 2 weeks, with gradual reduction of the dose over one month, for treatment of the facial palsy and to help in the remission of the already elevated intracranial pressure, according to the ophthalmological findings. The residual ophthalmological signs resolved within 1.5 months, while the facial palsy receded after 4 months. Peripheral facial palsy is an extremely rare complication of idiopathic intracranial hypertension. As a presenting sign it should be investigated thoroughly, including by MRI venography, in order to exclude cerebral venous sinus thrombosis, before the diagnosis of idiopathic intracranial hypertension can be made. Regarding treatment, in addition to the initial treatment with acetazolamide, corticosteroids can be
1 University Paediatrics Clinic, Regional General Hospital of Ioannina
2 University ENT Clinic, Regional General Hospital of Ioannina
3 University Ophthalmology Clinic, Regional General Hospital of Ioannina
4 University Radiology Clinic, Regional General Hospital of Ioannina
Correspondence: Meropi Tzoufi mtzoufi@uoi.gr Department of Children’s Health, Medical School, University of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
used, as this combination is relatively safe for a short period of time and contributes to the remission of the idiopathic intracranial hypertension.
Key words: Idiopathic intracranial hypertension, facial nerve palsy, childhood.
C/S, LA, V Leiden, t-MTHFR, G20210A),
Borellia
(ακεταζολαμίδη και κορτιζόνη) (Εικόνα 2) με πλήρη ύφεση
Bacillus pumilus bacteremia in a full term neonate – a case report
M. Papadopoulou1, M. Kimouli2, N. Rekliti2, A. Konstantinidi1, S. Tadros1, V. Souniadis2, O. Dedousi1, C. Trompoukis2, D. Petropoulou1, I. Lambadaridis2, A. Gounaris2
Abstract: Despite the widespread distribution of Bacillus spp (aerobic spore-forming rods) in nature, they rarely cause infection, although they can be pathogenic in immunocompromised hosts. The case is reported for the first time of Bacillus pumilus bacteraemia in a full term neonate in Greece. A female neonate, weighing 3,390 g was born at 38 wks of gestation by caesarean section with Apgar Score of 7 at 1 min and 9 at 5 min. She was admitted to the neonates intensive care unit (NICU) with abdominal distension and gastric residue. At day 2, milk was commenced, which she tolerated well. On the 8th day, she looked unwell and became lethargic, and hypotonic. Her condition deteriorated and she was administered Dopamine and FFP transfusion. A full investigation for sepsis was carried out: WBC 20,180/mm3 (neutrophils 89%, lymphocytes 6%, monocytes 5%), Hb 12 g/dl, Hct 36%, PLT 28,000/mm3, C reactive protein (CRP) 120 mg/L. The chest X-ray was normal. Blood culture grew a motile Gram positive rod and identification with API 50 CHB (Biomerieux, France) showed Bacillus pumilus which was reported as a contaminate. Urine culture was negative. Cerebrospinal fluid (CSF) study was negative. Blood culture repeated two days later continued to grow the same organism, at which time it was apparent that the isolate could not be considered a contaminant. Vancomycin and cefotaxime were administered, based on susceptibility pattern. There was clinical and laboratory response to the antibiotics, which she received for a total of 10 days.
Despite the presence of Bacillus spp. in air, soil and dust, these organisms have rarely been implicated in human disease. Predisposing risk factors include prematurity and use of mechanical ventilation and indwelling catheters. This was a rare case of Bacillus pumilus bacteraemia in a full term neonate with no predisposing factors.
Key words: Bacillus pumilus, bacteraemia, full term neonate.
1 Neonates Intensive Care Unit, General Hospital of Nikaia, Piraeus “Agios Panteleimon”, Greece
2 Microbiological department, General Hospital of Nikaia, Piraeus “Agios Panteleimon”, Greece
Correspondence: Magdalini Papadopoulou magpapadopoulou@yahoo.gr Neonates Intensive Care Unit General Hospital of Nikaia, Piraeus “Agios Panteleimon”, Nikaia
Εικόνα 2. Gram
Bacillus pumilus
(1,26).
Βιβλιογραφία
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Cases of Bacillus Bacteremia in an Immunosuppressed Patient Population. J Clin Microbiol 1987;25:672-674.
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The evaluation of screening and diagnostic tests in clinical paediatrics
E. Critselis1, C. Ι. Stefanidis2, D. Α. Kafetzis1
Abstract: The timely detection and diagnosis of underlying diseases is of vital importance for the effective and efficacious treatment of children with paediatric diseases. Because of this, the evaluation of the validity of screening and diagnostic tests is of central importance in current clinical paediatrics. As ever-increasing numbers of methods for detecting diseases are being developed, the comparative assessment of screening and diagnostic tests, and evaluation of the efficacy of their subsequent implementation in clinical practice, are of absolute necessity. This review presents methods for evaluating both single and multiple screening and diagnostic tests. In addition, methods for assessing the utilization of such tests in clinical practice are discussed.
Key words: Diagnostic tests, validity, ROC curves, Cohen’s Kappa Coefficient, likelihood ratio
Second Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine 2 Department of Nephrology, “P. & A. Kyriakou” Children’s Hospital, Athens
Correspondence: Elena Critselis ekritseli@med.uoa.gr Second Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
είναι η επιφάνεια
υπό την καμπύλη τόσο μεγαλύτερη είναι
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Ε. Mantadakis, Μ. Sitzimi, S. Thomaidis, A. Chatzimichail Παιδιατρική
Child with black tongue
Paediatrics Clinic, General University Hospital of Alexandroupolis
Correspondence:
Elpidoforos Mantadakis emantada@med.duth.gr
Paediatrics Clinic, General University Hospital of Alexandroupolis, 68 100, Alexandroupolis, Greece
1.
2.
3.
4.
5.
Addison
Peutz-Jegher’s
Τopics of Paediatric Nephrology in “Paediatriki”
M. Garatzioti
1st Paediatric Clinic, Children’s Hospital
“Agia Sofia”
Correspondence: Maria Garatzioti maria.garatzioti@gmail.com
1st Paediatric Clinic, Children’s Hospital
“Agia Sofia” 11527 Athens, Greece
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- Gene therapy for the kidney using viral vectors
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2010
esPGhan Gastroenterology summer school hot topics Αθήνα
“News and Controversies in Paediatric Gastroenterology”
Αίγλη
09:00-15:00
Tηλ.: 210 7726352, 6937 96 24 49
E-mail: labfotis@tellas.gr
17-19
ALDEMAR Olympian village
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22-25 Σεπτεμβρίου 2010 ESPE 2010: 49th Annual Meeting of the European Prague, Society for Pediatric Endocrinology Czech Republic
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22-26
2010 15th Mediterranean Meeting οf Child Neurology Royal Myconian
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24-25
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29 Σεπτεμβρίου - 8th Mediterranean Congress of Physical and limassol, 2
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10-13 Οκτωβρίου 2010 The 33rd World Congress of the International Society Jerusalem, of hematology (Ish 2010) Israel
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23-26
2010 3rd Congress of the European Academy of Copenhagen, Paediatric Societies (EAPS) denmark
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17-21 Ιανουαρίου 2011 Pediatric Emergency Medicine: Sarasota, USA
An Evidence-Based Approach
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17-19 Φεβρουαρίου 2011 the first Global Congress for Consensus in Paris, france
Pediatrics and Child health
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11-14 Μαΐου 2011
12-15 Μαΐου 2011
3rd International Congress on Istanbul, Turkey lymphoma-leukemia-Myeloma
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10th European Symposium on Pediatric Αθήνα, divani Cochlear Implantation Apollon Palace
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3-6 Ιουνίου 2011
2nd Summer School of Pediatric dermatology Aegean Sea
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15-18 Ιουνίου 2011 International Association of Paediatric dentistry Αθήνα
23rd Congress (IAPd 2011)
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