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Paediatriki
Volume 81 | Number 3 | September - October - November - December 2018
Four monthly publication of the Greek Paediatric Society
196
EDITORIAL
Stelios Antoniadis
198
REVIEW ARTICLES
Attention Deficit / Hyperkinetic Disorder at the Paediatrician’ s glance!
Sophie Aronis-Vournas
222
Stress Management among families of children and adolescents with type 1 diabetes mellitus. Review of literature
Pelagia Tsakona, Alexandra Papadopoulou-Xristara, Kiriaki Tsiroukidou, Anastasios Vamvakis, Maria Papagianni
232
Rare neurologic complications of thyroidopathy in children; Hashimoto encephalopathy
Evangelia Blana, Pinelopi Dragoumi, Dimitrios I. Zafeiriou
240
Galactosemia: an inborn error of metabolism of Neonatal Screening
Triantafyllia Sdogou, Evridiki Drogari, Kleopatra Schulpi
246
CASE REPORT
Congenital chylothorax as cause of hydrops fetalis in premature neonate: case report and short literature review
Maria Papadopoulou, Paraskevi Karagianni, Christos Tsakalidis, Maria Lithoxopoulou, Georgios Mitsiakos, Vasiliki Soubasi-Griva
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Convulsion with mild gastroenteritis: a case report of a benign clinical entity Georgia Dimitriou, Alexia-Eleutheria Palioura, Vaios Katsaros, Stavros Antonopoulos
260 RECENT DECLARATION
A brief review of the low fertility rates phenomenon in Greece Panagiota Panagiotou, Theodoros N. Sergentanis, Artemis Tsitsika
266
BETWEEN COLLEAGUES
Stelios Antoniadis
254 BOOK PRESENTATION
Stelios Antoniadis
274
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Correspondence
Sophie Aronis-Vournas
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Attention Deficit / Hyperkinetic Disorder at the Paediatrician’s glance!
Sophie Aronis-Vournas
Summary
Attention Deficit / Hyperkinetic Disorder (ADHD) is a chronic neurobiological defect that affects 5-7% of children and 3-5% of adults. Genetic factors are implicated in the pathogenesis of the disease, whereas environmental factors are considered to exaggerate the symptoms. Many scientists or family members focus on the learning disability, however attention deficit with or without kinetic disorder is much more than of the learning problems. The lack of concentration has a negative impact on every aspect of life of the child, adolescent, adult or elderly, makes his / her life difficult at school or social events, affects the quality of life of the whole family, and increases the social cost, if not diagnosed early in life of the child and it is not managed properly by parents, teachers or friends. ADHD is complicated by one or more comorbids (Depression, Oppositional Defiant Disorder, Conduct Disorder, Bipolar disorder, Learning disability, Sleeping disorders, Alcool / Substances addiction, etc.) that affect the patient’s life and increases enormously the family and social cost. There is no permanent cure of ADHD, however it may be improved by early diagnosis and proper management by a team of specialists (holistic therapy) that educate the patient, the family members and the teachers in how to manage the defect and help the child/adolescent/adult overcome his/her difficulties and improve his quality of life and achievements.
Key words: ADHD, Attention Deficit, Hyperkinetic disorder
Sophie Aronis-Vournas
Associate Professor in Paediatrics, x-Director of Haemophilia-Haemostasis Center, Aghia Sophia Children' s Hospital
Honorary President of "ADHD HELLAS"
electroencephalography)]
δυσκολίες στο συλλαβισμό, στην ανάγνωση (δυσανάγνωση), στο γράψιμο (δυσγραφία) ή
μαθηματικά (δυσαριθμησία). Πιο συγκεκριμένα, 8-39% έχουν δυσλεξία, 12-26%
http://www.chadd. org/Understanding-ADHD/For-Adults/Living-with-ADHD-A-LifespanDi sorder/Womenand-Girls.aspx#nthash. 284ahUjC.dpuf).
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Pubmed, The Cochrane
e-mail:
Correspondence
Tsakona Pelagia
Orfanidou 20 N. Moudania
Chalkidiki 63200, Mailbox 121
M. 6977634831
e-mail: ptsakona@yahoo.gr
Stress management among families of children and adolescents with type 1diabetes mellitus. Review of literature
Pelagia
Tsakona, Alexandra Papadopoulou-Xristara, Kiriaki Tsiroukidou, Anastasios Vamvakis, Maria Papagianni
Abstract
Objective: Search for methods used to manage anxiety among families of children and adolescents with type 1 diabetes mellitus.
Data sources: Search for relevant studies published since 2011 in Pubmed, Cochrane Library and Scopus using key words: type 1 diabetes mellitus, treatment, family stress management and glycemic control.
Study Selection: In total, 247 papers were identified in the initial search. Finally, 8 studies that used methods which met the criteria of intervention in stress management in parents and children were selected for bibliographic review.
Conclusions: The methods used for stress management were mainly designed by psychologists and aimed to reduce the psychological impact of the disease as well as to manage unpleasant feelings such as fear, confusion, anxiety or depression. Most studies include parental behavioral education for stress reduction or control, which is associated to metabolic control and glucose levels of children and adolescents.
Key words: type 1 diabetes mellitus, treatment, family stress management, glycemic control.
Pelagia Tsakona
Alexandra PapadopoulouXristara
Post-graduated studies in pediatrics physiotherapy, Department of physiotherapy, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki
Kiriaki Tsiroukidou
Anastasios Vamvakis
Maria Papagianni
Endocrine unit, 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki
NHW = non-Hispanic whites, NHB = non-Hispanic blacks, H = Hispanics, API = Asians/ Pacific Islands, AI = American Indians.
Πηγή: SEARCH for Diabetes in Youth Study.
Greyetal (17), (2011)
Sassmann et al (18), (2012)
DASS, PS, SDQ, HbA1c
Monaghan et al (19) (2011)
Pateraki et al (20) (2015)
HbA1c,
Tsiouli et al (21) (2014)
Robinson et al (22) (2016)
44 Γονείς Cortisol, PSS, PSI-SF, HbA1c, Lifestyle
Gupta et al (23) (2017)
36 παιδιά (3-5 ετών)
BDI-II, SEDSM-P, PSI, DBRS, DI, PMDC, HbA1c
QOL, PIP, HbA1c
Christie et al (24) (2014)
362 Παιδιά (10-16 ετών)
QOL, HbA1c
τους 12 μήνες.
• Οιγονείςκαιοινέοιπουπαρακολούθη σαντοπρόγραμμαπεριγράφουνβελτιωμ ένεςοικογενειακέςσχέσεις, γνώση και κατανόηση, μεγαλύτερη εμπιστοσύνη
και αυξημένη αυτοπεποίθηση για τη
διαχείριση του διαβήτη.
• 24 μήνες μετά την παρέμβαση, σχεδόν οι μισοί από τους νέους συμμετέχοντες ανέφεραν ότι οι εκπαιδευτές, τουςενέπνευσαννασυνεχί σουντηνπροσπάθειάτουςμεπερισσότερ
CES-D: Center for Epidemiologic Studies Depression Scale, DASS: Depression, Anxiety and Stress Scale, DBRS: Diabetes Behavior Rating Scale, DQoL: Diabetes Quality of Life scale, DI: Diabetes Interview, BDI-II: The Beck Depression Inventory, Second Edition, IDDM: Insulin-Dependent Diabetes Mellitus, PIP: The Pediatric Inventory for Parents, PMDC: The Parental Monitoring of Diabetes Care scale, PS: Parent Stress, PSI: The Parenting Style Index, PSI-SF: Parenting Stress Index-Short Form, PSS: Perceived Stress Scale, QOL: Quality of Life, SDQ: Strengths and Difficulties Questionnaire, SEDSM-P: The Self-Efficacy for Diabetes Self-Management Scale-Parent
1. Craig Prof. ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2014;15(SUPPL.20):4-17. doi:10.1111/pedi.12186
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Correspondence
Dragoumi Pinelopi
49 Konstantinoupoleos St.
PO Box 54642, Thessaloniki
T. +302313312501
Κ. +306944913556
e-mail: ezlouis@gmail.com
Rare neurologic complications of thyroidopathy in children: Hashimoto encephalopathy
Evangelia Blana, Pinelopi Dragoumi, Dimitrios I. Zafeiriou
Abstract
Hashimoto's encephalopathy is a rare complication of autoimmune thyroiditis characterized by a variety of symptoms of encephalopathy, increased antibody titers against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg) and a positive response to corticosteroid therapy. The purpose of this review is to present the pathogenesis, the clinical presentation, the diagnostic approach as well as the treatment opportunities of the disease in childhood. The exact cause of the disease has not yet been elucidated, but an autoimmune or inflammatory pathogenic background is suspected. The clinical picture of the Hashimoto encephalopathy is nonspecific and may include mental disorder, seizures, psychiatric manifestations, moving disorders and coma. The major neuropsychiatric manifestations include confusion, visual and auditory hallucinations, amnesia, rapidly progressive dementia, behavioral disorders, disorders of consciousness, headache and poor school performance. The most common immunological finding is the presence of anti-thyroid antibodies in combination with normal thyroid gland function. Diagnosis requires exclusion of other causes of encephalopathy and is based on laboratory, neuroimaging and neurophysiological results. Most patients respond to high dose corticosteroid therapy and therefore corticosteroids are the first-line treatment. In the case of non-response to corticosteroids, immunosuppressive agents as well as plasmapheresis may be used. As the disease is often underdiagnosed, a high rate of suspicion is required to avoid long-term complications that are more common in the pediatric population and include mental disorders, drug-resistant epileptic seizures and low school performance.
Key words: encephalopathy, antithyroid antibodies, corticosteroid-responsive encephalopathy
Evangelia Blana
Pinelopi Dragoumi
Dimitrios I. Zafeiriou
1st Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration Hospital of Thessaloniki, Greece
tal Intermittent Rhythmic Delta Activity,
Schäuble
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Τ:
Κ:
e-mail: lsdogou@writeme.com
Correspondence
Triantafyllia Sdogou
Thivon & Papadiamantopoulou, 11527, Goudi, Greece
Τ: +302107467476
Κ: +306934135413
e-mail: lsdogou@writeme.com
Galactosemia: an inborn error of metabolism of Neonatal Screening
Triantafyllia Sdogou, Evridiki Drogari, Kleopatra Schulpi
Summary
Galactosemia is an inborn error of the carbohydrate of galactose metabolism. Three enzymes are necessary for this function, galactose – 1- phosphate uridyl transferase (GALT), galactokinase (GALK), uridine diphosphate UDP galactose 4 epimerase (GALE). The most severe enzyme deficiency is the deficiency of GALT (classical galactosemia). The symptoms of these disorder include liver dysfunction, hypoglycaemia, eye cataract, seizures, sepsis (E.coli), mental retardation. The other enzyme deficiencies GALK and GALE present mild to moderate symptoms such as eye cataract. The only treatment of all enzyme types of galactosemia is galactose free diet.
Key words: galactosemia, galactose, classical galactosemia, galactokinase, epimerase
Triantafyllia Sdogou
Evridiki Drogari
Unit for Metabolic Disorders, Choremio Research Institute, First Department of Pediatrics School of Medicine, National and Kapodistrian University of Athens, “Agia Sofia” Children’s Hospital, Greece
Kleopatra Schulpi
Inborn Errors of Metabolism Department, Institute of Child Health, “Agia Sofia” Children’s Hospital, Athens, Greece
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in the United States: looking back, looking around, and looking ahead. JIMD Rep. 2015;15:7993.
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e-mail:
Correspondence
Paraskevi Karagianni
Ring Road, Municipality of Pavlos Melas, N. Efkarpia, 56403, Thessaloniki
T. 302313323360
e-mail: karagpar@gmail.com
Congenital chylothorax as a cause of hydrops fetalis in a premature neonate: case report and short literature review
Maria Papadopoulou, Paraskevi Karagianni, Christos Tsakalidis, Maria Lithoxopoulou, Georgios Mitsiakos, Vasiliki Soubasi-Griva
Abstract
Chylothorax is characterized by pathological lymph (chyle) accumulation in pleural space. It is extremely rare among children, but is the most common cause of pleural effusion among neonates. We present a case of a female late premature neonate that was born with generalized subcutaneous edema and prenatal diagnosis of right pleural effusion (hydrops fetalis). The analysis of the pleural fluid along with the essential laboratory and imaging investigation to establish the diagnosis of congenital chylothorax are outlined. Congenital chylothorax may have as a result congenital anomalies of the lymphatic system (lymphangiectasia, lymphangioma, atresia of thoracic duct), may accompany genetic syndromes (Down, Turner, Noonan etc) or may be idiopathic. It presents with severe respiratory distress and mortality during the first postnatal hours, dullness in the thoracic percussion and diminished unilateral/ bilateral breath sounds. Prognosis depends on prompt diagnosis and treatment, on the possible underlying cause and on the potential complications (malnutrition, secondary immunosuppresion). Initial management includes enteric medium chain triglycerides formula feeding or modified breast milk. Resistant cases seem to have a good response to octreotide administration, but further data are needed. Surgical management is necessary in case of non response to conservatory treatment options.
Key words: hydrops fetalis, congenital chylothorax, pleural effusion, medium chain triglycerides formula, octreotide
Maria Papadopoulou
Paraskevi Karagianni
Christos Tsakalidis
Maria Lithoxopoulou
Georgios Mitsiakos
Vasiliki Soubasi-Griva
2nd Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “Papageorgiou”
(Turner, Noonan, Down, Ehlers-Danlos, X-linkedmuotubularmyopathy) (1,4).
(TutorJD,
Βιβλιογραφία
1. Attar MA, Donn SM. Congenital chylothorax. Semin Fetal Neonatal Med [Internet]. 2017;22(4):234–9.
Webpage: http://www.sciencedirect.com/science/article/pii/S1744165X17300409
2. Bialkowski A, Poets CF, Franz AR. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child - Fetal Neonatal Ed [Internet]. 2015 Feb 18;100(2):F169 LP-F172.
Webpage: http://fn.bmj.com/content/100/2/F169.abstract
3. Brock, Whitney; Bradshaw W. Congenital Chylothorax: A Unique Presentation of Nonimmune Hydrops Fetalis in a Preterm Infant. Adv Neonatal Care. 2016;16(2):114–23.
4. Tutor JD. Chylothorax in Infants and Children. Pediatrics [Internet]. 2014 Apr 1;133(4):722 LP-733.
Webpage:http://pediatrics.aappublications.org/content/133/4/722.abstract
5. Dubin, Patricia; King, Isabelle; Gallagher P. Congenital Chylothorax. Curr Opin Paediatr. 2000;12(5):505–9.
6. Perisson C, Nathan N, Larroquet M, Corvol H. An idiopathic congenital chylothorax: surgery or conservative management? BMJ Case Rep [Internet]. 2014;2014. Webpage: http://europepmc.org/articles/PMC4009891
7. Chemaou A, Ayachi M, Ailal F, Najib J. Chylothorax idiopathique chez un nourrisson. Prise en charge et évolution. Arch Pédiatrie [Internet]. 2012;19(7):711–3.
Webpage: http://www.sciencedirect.com/science/article/pii/S0929693X12002163
8. Foo N-H, Hwang Y-S, Lin C-C, Tsai W-H. Congenital Chylothorax in a Late Preterm Infant and Successful Treatment With Octreotide. Pediatr Neonatol [Internet]. 2017 Sep
24;52(5):297–301.
Webpage: http://dx.doi.org/10.1016/j.pedneo.2011.06.011
9. Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev [Internet]. 2010;(9).
Webpage: http://dx.doi.org/10.1002/14651858.CD006388.pub2
10. Yin R, Zhang R, Wang J, Yuan L, Hu L, Jiang S, et al. Effects of somatostatin/octreotide treatment in neonates with congenital chylothorax. Medicine (Baltimore) [Internet]. 2017 Jul 21;96(29):e7594.
Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521940/
e-mail: gi.dimitriou23@ gmail.com
Correspondence
Georgia Dimitriou
Amaliados 8, Ampelokipoi
Athens 11523
T. +306976703413
e-mail: gi.dimitriou23@ gmail.com
Convulsion with mild gastroenteritis: a case report of a benign clinical entity
Georgia Dimitriou, Alexia-Eleutheria Palioura, Vaios Katsaros, Stavros Antonopoulos
Abstract
Background: A remarkable clinical entity, convulsions with mild gastroenteritis without electrolyte imbalance or known meningoencephalitis occurs in children with normal psychomotor development.
Case Report: A 3-year-old boy with free medical history and a 2-day history of gastroenteritis presented with a 2-minute episode of afebrile generalized tonic seizures. On physical examination, he had a positive Brudzinski sign, GCS 15/15 and the initial laboratory tests, including cerebrospinal fluid, were normal. The child, even though treated with ceftriaxone, experienced a second episode of afebrile generalized tonic-clonic seizures lasting a few minutes. Acyclovir was added and the child was transferred to a tertiary hospital center, where further laboratory investigation, brain CT and EEG were performed without revealing positive findings. On arrival to the tertiary hospital the child presented a third episode of afebrile generalized tonic-clonic convulsions and got treated with phenytoin. During his 6-day hospitalization he remained asymptomatic and despite stopping the antiepileptic treatment within four days the child did not repeat seizures. His psychomotor development also remained normal.
Conclusion: Convulsions with acute gastroenteritis constitutes an entity with excellent prognosis and therefore could be considered as benign. Early recognition leads to avoidance of unnecessary examinations and chronic anti-epileptic treatment.
Key words: convulsions, gastroenteritis, benign, rotavirus
Georgia Dimitriou
Alexia-Eleutheria Palioura Pediatrics Residents
Vaios Katsaros
Pediatric Department of General Hospital of Messinia, Kalamata Greece
Stavros Antonopoulos
Pediatric Department of General Hospital of Argolida, Argos Greece
Βιβλιογραφία
1. Kang B, Kwon YS. Benign convulsion with mild gastroenteritis. Korean J Pediatr 2014;57(7):304-309
2. Verrotti A, Tocco AM, Coppola GG, Altobelli E, Chiarelli F. Afebrile benign convulsions with mild gastroenteritis: a new entity? Acta Neurol Scand. 2009;120:73–79. [PubMed]
3. Hung JJ, Wen HY, Yen MH, Chen HW, Yan DC, Lin KL, et al. Rotavirus gastroenteritis associated with afebrile convulsion in children: clinical analysis of 40 cases. Chang Gung Med J. 2003;26:654–659.[PubMed]
4. Morooka K. Convulsions and mild diarrhea. Shonika (Tokyo) 1982;23:131–137.
5. Narchi H. Benign afebrile cluster convulsions with gastroenteritis: an observational study. BMC Pediatr. 2004;4:2. [PMC free article] [PubMed]
6. Caraballo RH, Ganez L, Santos Cde L, Espeche A, Cersosimo R, Fejerman N. Benign infantile seizures with mild gastroenteritis: study of 22 patients. Seizure. 2009;18:686–689. [PubMed]
7. Ramig RF. Pathogenesis of Intestinal and Systemic Rotavirus Infection. J. Virol 2004;78(19):10213-10220
8. Nishimura S, Ushijima H, Nishimura S, Shiraishi H, Kanazawa C, Abe T,et al. Detection of rotavirus in cerebrospinal fluid and blood of patients with convulsions and gastroenteritis by means of the reverse transcription polymerase chain reaction. Brain and Development 1993;15(6):457-459
9. Díaz Y, Chemello ME, Pena F, Aristimuno OC, Zambrano JL, Rojas H, et al. Expression of nonstructural rotavirus protein NSP4 mimics Ca2+ homeostasis changes induced by rotavirus infection in cultured cells. J Virol. 2008;82:11331–11343. [PMC free article] [PubMed]
10. Dong Y, Zeng C Q.-Y., Ball JM, Estes MK, Morris AP. The rotavirus enterotoxin NSP4 mobilizes intracellular calcium inhuman intestinal cells by stimulating phospholipase C-mediatedinositol 1,4,5-trisphosphate production. Proc. Natl. Acad. Sci. USA 1997;94:3960-3965
11. Ruiz MC, Cohen J, Michelangeli F. Role of Ca2+in the replication and pathogenesis of rotavirus and other viral infections. Cell Calcium. 2000;28:137–149. [PubMed]
12. Kawashima H, Inage Y, Ogihara M, Kashiwagi Y, Takekuma K, Hoshika A, et al. Serum and cerebrospinal fluid nitrite/nitrate levels in patients with rotavirus gastroenteritis induced convulsion. Life Sci. 2004;74:1397–1405. [PubMed]
13. Diaz JR, Banasaz M, Istrate C, Buesa J, Lundgren O, Espinoza F, et al. Role of Nitric Oxide During Rotavirus Infection. JournalofMedicalVirology78:979–985(2006)
14. Kim G, Byeon JH, Lee D, Jeong HJ, Eun B. Norovirus in benign convulsions with mild gastroenteritis. Ital J Pediatr 2016; 42: 94
15. Cusmai R, Jocic-Jakubi B, Cantonetti L, Japaridze N, Vigevano F. Convulsions associated with gastroenteritis in the spectrum of benign focal epilepsies in infancy: 30 cases including four cases with ictal EEG recording. Epileptic Disord. 2010;12:255–261. [PubMed]
16. Park SH, Kim YO, Kim HK, Kim HS, Kim BY, Cheon KR, et al. Incidence of benign convulsions with mild gastroenteritis after introduction of rotavirus vaccine. BrainDev. 2015 Jun;37(6):625-30 [PubMed]
e-mail: tsergent@med.uoa.gr
Correspondence
Theodoros N. Sergentanis
Mesogeion 24, 11527, Athens
Τ. +302107710824
e-mail: tsergent@med.uoa.gr
A brief review of the low fertility rates phenomenon in Greece
Panagiota Panagiotou, Theodoros N. Sergentanis, Artemis Tsitsika
Abstract
Background: The low fertility rates phenomenon in Greece seems to be continuously growing during the last thirty five years. This brief narrative review aims to present the current situation in our country, to compare roughly the facts with other European countries, to exam the causes of the phenomenon and describe its consequences, as well as to propose some remedial strategies. Methods: A comprehensive review of the literature has been implemented; We searched on European and Greek statistics databases, on the publications of the Laboratory of Social and Demographic Analysis of the University of Thessaly, in conferences΄ proceedings. The “snowball procedure” was followed.
Results: We found out that the fertility rate in Greece is decreasing since the 80s. A possible but reversible cause of low fertility rates is the delayed mean age of women at birth of first child, as well as the childbirth almost exclusively within marriage in Greece. The high number of abortions as well as the current unfavourable socioeconomic conditions intensified the phenomenon. All the above resulted in the appearance of a new phenomenon in the Greek society, this of “childlessness”.
Conclusions: In order to cope with the phenomenon, strategies for the socioeconomic reinforcement of Greek women are needed, mainly during sensitive periods of their life such as motherhood. Greek women have to be reinforced in taking care of the dependent members of the family too. Secondly Greek citizens need to be informed and educated, as far as values and conditions that support childbirth are concerned. Last but not least, the phenomenon must be studied in depth through the conduction of regular and evidence based demographic and social studies.
Key words: Lowfertilityrate, Greece, childlessness
Panagiota Panagiotou
Theodoros N. Sergentanis
Artemis Tsitsika
Adolescent Health Unit, Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital
1.
Βόλος, Τεύχος 27, 2016
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διαφθορά/ απληστία, εκμετάλλευση/ βία, τρομοκρατία/ πολέμους/ εγκλήματα κατά της ανθρωπότητας/ εκτοπισμούς, γενοκτονίες/ ναυάγια, προσφυγιά”. Παρακαλάει τον Θεό να γίνει το θέλημα του, αναγνωρίζοντας την αδυναμία των ανθρώπων. Σιγά-σιγά
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