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Paediatriki
Volume 79 | Number 1 | January - February - March - April 2016
Contents Quarterly publication of the Greek Paediatric Society
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PRESIDENT’S LETTER
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EDITORIAL
S. Αntoniadis
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LETTER TO THE EDITOR
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REVIEW ARTICLES
Interpretation of procalcitonin’s serum levels in children
Svirkos Menelaos, Sdouga Maria
022
West Syndrome in Children With Inborn Errors of Metabolism: A Review of the Literature
Anastasia Gkampeta, Evangelos Pavlou
032
Sleep during adolescence-special issues and impact on quality of life
Gogou Maria, Haidopoulou Katerina
042
Early Childhood Caries. A Multi-Factorial Disease
Achtari D. Marina
President
A. Constantopoulos
Editorial board
Director
S. Antoniadis
Members
S. Andronikou
E. Galanakis
A. Evangeliou
L. Thomaidou
M. Kanariou
A. Kapogiannis
S. Kitsiou-Tzeli
E. Mantadakis
P. Panagiotopoulou-Gartagani
A. Papadopoulou
V. Papaevagelou
A. Papathanassiou
A. Siamopoulou-Mavridou
A. Syrigou-Papavasiliou
Manuscript submission
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Annual subscription All foreign countries: US$50
054
CASE REPORTS
Prepubertal breast fibroadenoma: two cases report Adelais K. Tzortzopoulou, Nectarios Ι. Koufopoulos, Ioannis L. Misitzis
060
Iron deficiency anemia and eosinophilia due to extend pediculosis capitis
Stivanaki Chrisoula, Patavoukas Georgios, Tachliampouris Nikitas
064
Intermittent pain in the left upper limb in a 10-year-old girl: an unexpected cause Maria Gogou, Martha Spilioti, Despoina Tramma, Efimia Papadopoulou-Alataki, Athanasios Evangeliou
070
BETWEEN COLLEAGUES
072
BOOK PRESENTATION
“The journey of a pediatrician”
By Dimitris Zoumboulakis
e-mail: svirkos@hol.gr
Correspondence
Svirkos Menelaos
G. Daligary 9, 57300
Halastra Thessaloniki
T. +306974827523
e-mail: svirkos@hol.gr
Interpretation of procalcitonin serum levels in children
Svirkos Menelaos, Sdouga Maria
Abstract
Monitoring of procalcitonin’s (PCT) serum levels contributes to the better treatment and outcome of children hospitalized in P.I.C.U. The early recognition of neonatal infection is possible by repeated measurements of its levels in umbilical blood sample and could be considered as a reliable marker of early neonatal sepsis even during the first hours after birth. Values of PCT over 10ng/ml are almost exclusively due to severe bacterial sepsis or septic shock and advocate a bad prognosis. Monitoring of PCT’s serum levels by repeated measurements provides important information about the effectiveness of the applied antibacterial medication and the need of extension, adjustment or even interruption of the treatment. It also contributes to the diagnostic identification of both early (<72h) and late (>72h) post-operative infection in children undergoing cardiac surgery using extracorporeal circulation. If the increase of PCT is due to non-infectious causes then the normalization of its levels is expected within the next 24-48 hours. Because the increase of PCT`s serum levels depends also on the patients clinical condition, the possible co-morbidity, the immune system state, the preceded medical treatment etc. its interpretation should be related to all of them.
Key words: procalcitonin, infection, sepsis, children, cardiac surgery
Svirkos Menelaos
Sdouga Maria
P.I.C.U. “Ippokrateio” General Hospital of Thessaloniki
1)
2)
3)
4)
5)
6)
7)
9)
Βιβλιογραφία
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2. Watson RS1, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003 Mar 1;167(5):695-701. Epub 2002 Nov 14
3. Joram N1, Muller JB, Denizot S, Orsonneau JL, Caillon J, Rozé JC et al. Umbilical cord blood procalcitonin level in early neonatal infections: a 4-year university hospital cohort study. Eur J Clin Microbiol Infect Dis. 2011 Aug;30(8):1005-13. doi: 10.1007/s10096-011-1187-0. Epub 2011 Feb 12
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5. Altunhan H, Annagür A, Örs R, Mehmetoğlu I. Procalcitonin measurement at 24 hours of age may be helpful in the prompt diagnosis of early-onset neonatal sepsis. Int J Infect Dis. 2011 Dec;15(12):e854-8. doi: 10.1016/j.ijid.2011.09.007. Epub 2011 Oct 22
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8. Maniaci V, Dauber A, Weiss S, Nylen E, Becker KL, Bachur R. Procalcitonin in young febrile infants for the detection of serious bacterial infections. Pediatrics 2008;122;701-710 doi:10.1542/ peds.2007-3503
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11. Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402
12. Müller F1, Christ-Crain M, Bregenzer T, Krause M, Zimmerli W, Mueller B et al. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest. 2010 Jul;138(1):121-9. doi: 10.1378/chest.09-2920. Epub 2010 Mar 18
13. Beat Müller, Kenneth L. Becker. Procalcitonin: How a hormone became a marker and mediator of sepsis. SWISS MED WKLY 2 0 0 1 ; 1 3 1 : 5 9 5 – 6 0 2
14. Ming Jin, Adil I. Khan. Procalcitonin: Uses in the Clinical Laboratory for the Diagnosis of Sepsis. LabMedicine 2010;41(3): 173-177. doi: 10.1309/LMQ2GRR4QLFKHCH9
15. Hans Jürgen Dornbusch, Volker Strenger,Petra Sovinz,Herwig Lackner, Wolfgang Schwinger, Reinhold Kerbl et al. Non-infectious causes of elevated procalcitonin and C-reactive protein serum levels in pediatric patients with hematologic and oncologic disorders. Support Care Cancer 2008 Sep 15;16(9):1035-40. Epub 2008 Jan 15
16. Séguéla PE, Joram N, Romefort B, Manteau C, Orsonneau JL, Branger B et al. Procalcitonin
as a marker of bacterial infection in children undergoing cardiac surgery with cardiopulmonary bypass. Cardiol Young 2011;21(4):392-9. doi: 10.1017/S104795111100014X. Epub 2011 Mar 9.
Correspondence
Gkampeta Anastasia
St. Kiriakidi 1, 54636 Thessaloniki e-mail: anastagab@yahoo. gr
West Syndrome in Children With Inborn Errors of Metabolism: A Review of the Literature
Anastasia Gkampeta, Evangelos Pavlou
Abstract
West syndrome is an epileptic encephalopathy which in rare cases is due to an inherited metabolic disease. This is a review of the literature on reported cases of children diagnosed with a metabolic disease who developed West syndrome. This article briefly presents the most frequent inborn errors of metabolism that have been associated with West syndrome. Although it has been underestimated, West syndrome may be caused or predisposed by an underlying inborn error of metabolism. The present review illustrates the importance of the early diagnosis and consequently the initiation of the proper treatment, which are important for a favorable prognosis.
Key words: West syndrome, metabolic disorders
Anastasia Gkampeta Evangelos Pavlou
2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital
(ε)
Βιβλιογραφία
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Correspondence
Maria Gogou
Dimitriou Nika 44, 60100, Katerini, Greece e-mail: mariaangogou@ gmail.com
Sleep during adolescence-special issues and impact on quality of life
Gogou Maria, Haidopoulou Katerina
Abstract
A series of changes in circadian clock and brain function take place during adolescence and modify sleep. At the same time multiple environmental factors act synergistically having as a result the reduction of total sleep time, as well as in increasingly later bedtimes, without any reduction in sleep needs. Besides, patterns of sleep disorders in this age change as a result of maturation and secondary gender traits development. On the other hand, it has been found that early-starting high schools have a negative impact on sleep quality and on daily functioning of adolescents. For all these reasons sleep hygiene promotion during adolescence is essential.
Key words: sleep, adolescence, sleep disorders, circadian system, school programs
Gogou Maria Haidopoulou Katerina 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital Papageorgiou
time of the day in hours
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e-mail:
Correspondence
Achtari Marina
Ipokratous 8, 15236
Penteli Τ. +306972158412
e-mail: dshmarina@gmail. com
Early Childhood Caries. A Multi-Factorial Disease
Achtari D. Marina
Abstract
Early childhood caries (ECC) is globally considered as the most common disease in children. The most important risk factors are the frequent consumption of sugar and other fermentable carbohydrates together with the presence of dental plaque.
ECC is an aggressive form of dental caries resulting in functional, esthetic and psychological disturbances in children and great concern to the parents.
The paper reviews the literature to determine the aetiology, the clinical considerations, the consequences of ECC, assess the prevention strategies and apply that information to enhance dental practice.
Methods: Articles were identified by electronic searching from PubMed as well as other scientific resources like documents of the American Academy of Paediatric Dentistry and the World Health Organization. They were reviewed on the basis of key words, title, abstract, time of publication, by the reviewer to assess whether inclusion criteria were met.
Results: 283 papers were identified from the electronic search, 65 met the prima facie inclusion criteria.
Conclusion: ECC is preventable and requires intervention but preventive measures cannot work unless parents and caregivers adhere to the preventive methods being prescribed. It takes a collaborative effort to make the necessary improvements for young children’s oral health.
Key words: Early childhood caries; etiology; risk factors; consequences; Management;
Achtari D. Marina
Paidon Pentelis Childrens Hospital
caries, rampant caries, comforter caries, maxillary anterior caries, early childhood tooth decay, early childhood dental decay, early childhood caries, baby bottle tooth decay κ.α.(2,3).
ECC:Early Chlidhood Caries
Πίνακας
Βιβλιογραφία
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e-mail: imissitzis@gmail.
t.adelais@gmail.com
Correspondence
Ioannis L. Misitzis
Τ. +302106479312
e-mail: imissitzis@gmail. com
t.adelais@gmail.com
Prepubertal breast fibroadenoma: two case reports
Adelais K. Tzortzopoulou, Nectarios Ι. Koufopoulos, Ioannis L. Misitzis
Summary
Introduction: Fibroadenoma is the most common breast mass in pediatric age groups. It is a benign tumor and the gold standard for the diagnosis is the ultrasound. Despite the high diagnostic value of this test, surgical excision and histological study of the tumor are always essential. Macroscopic and microscopic examination of a breast mass by a pathologist is very useful in distinguishing fibroadenomas from carcinomas and phyllodes tumors, although breast malignancy in this age is extremely rare.
Case Report: This article presents two cases of two girls with two different types of fibroadenoma: the first one is a 12 year old girl with a simple fibroadenoma and the second one is a 16 year old girl with a giant (juvenile) fibroadenoma, who had already an operation at the age of 12.
Discussion - Conclusion: The clinical presentation and management of these two patients are discussed in association with a literature review about fibroadenoma in pediatric age groups, in which it seems to be increased.
Key words: Fibroadenoma, breast masses in childhood, prepubertal and pubertal breast masses
Adelais K. Tzortzopoulou
Ioannis L. Misitzis
Surgical Breast Department, Oncologic and Anticancer General Hospital “Agios Savvas”
Nectarios Ι. Koufopoulos
Department of Pathology, Oncologic and Anticancer General Hospital “Agios Savvas”
Βιβλιογραφία
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e-mail: s.chrissa@hotmail. com,
Correspondence
Ioannis L. Misitzis
Τ. +302106479312
e-mail: imissitzis@gmail. com
t.adelais@gmail.com
Iron deficiency anemia and eosinophilia due to extend pediculosis capitis
Stivanaki Chrisoula, Patavoukas Georgios, Tachliampouris Nikitas
Abstract
Backround: Pediculosis is one of the most common parasitoses in children. A limited number of reports of severe iron deficiency anemia have appeared in the veterinary literature but the reports of humans with severe anemia due to lice infection are very rare in the medical literature. Methods - conclusion: We report an 11 years old girl diagnosed with pediculosis whose clinical presentation and laboratory tests revealed severe iron deficiency anemia and eosinophilia. Her symptoms and her laboratory tests were improved after removing the lice from her scalp and providing an oral substance of iron.
Conclusion: The louse (Pediculus humanus capitis) survives from a blood meal from its host so iron deficiency anemia is a possibility.
Κey words: pediculosis, iron deficiency anemia, eosinophilia
Stivanaki Chrisoula
General NHS Hospital of Leros
Patavoukas Georgios
General NHS Hospital of Leros
Tachliampouris Nikitas
General NHS Hospital of Leros
Pediculus humanus corporis
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Correspondence
Maria Gogou
Dimitriou Nika 44, 60100, Katerini, Greece e-mail: mariaangogou@ gmail.com
Intermittent left upper limb pain in a 10-year-old girl: an unexpected cause
Maria Gogou, Martha Spilioti, Despoina Tramma, Efimia Papadopoulou-Alataki, Athanasios Evangeliou
Abstract
A 10-year-old girl was admitted to the Emergency Department due to an 1-month history of intermittent pain located in the left radiocarpal joint, 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. An MRI scan of the brain and spinal cord was performed, which confirmed a diagnosis of thoracic syringomyelia. We briefly discuss specific traits of this disorder in childhood.
Key words: syringomyelia, children, intermittent pain, neurologic examination
Maria Gogou
Despoina Tramma
Efimia PapadopoulouAlataki
Athanasios Evangeliou
4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou
Martha Spilioti
1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA
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The Hospital for Sick Children Great Ormond Street.
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