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Paediatriki
Volume 84 | Number 2 | May - June - July - August 2021
Four monthly publication of the Greek Paediatric Society
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EDITORIAL
Stelios Antoniadis
110 AWARDED PAPER
Exploration of individuation process related factors in adolescents with chronic illness
Ioannidou Maria, Hatziagorou Elpis, Adramerina Alkistis, Teli Aikaterini, Pergantou Helen, Zilikis
Nikolaos, Vorria Panagiota, Economou Marina
120
REVIEW ARTICLES
Childhood venous thromboembolism
Marina Economou, Panagiotis Zymaris
130
Chronic Pain in Children. An Interdisciplinary Approach
Filomeni Armakola, Potamiti Eleni
144
Monitoring pediatric advanced life support “m–PALS”
Antonopoulos Stavros, Grivas Grigorios, Kalaras Georgios, Tsakiri Dimitra, Papadima Christina
152 CASE REPORTS
Venous Thoracic Outlet Syndrome in Three Greek Children: a Single-Centre Experience
Athina Dettoraki, Aikaterini Michalopoulou, Georgios Charalampopoulos, Loukia Ioannidou, Nikolaos Liassis, Dimitrios Maras, Helen Pergantou
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Α case of seronegative autoimmune encephalitis associated with Human Herpesvirus-7 (HHV-7) Evangelos Christou, Sotiria Mastrogianni, Theodora Bachou, Theodoros Tsikrikas, Stella Mouskou, Konstantinos Voudris, Dimitrios Delis
168 FROM THE HISTORY OF MEDICINE
Alfred François Donné (1801-1878) and his pioneering studies on infant nutrition and health
Aristidis G. Diamantis
174 BETWEEN COLLEAGUES
Stelios Antoniadis
176 BOOK PRESENTATION
Stelios Antoniadis
180
INSTRUCTIONS TO AUTHORS
ΕΠΙΣΤΟΛΗ
e-mail: mar_ioan@yahoo. com Τ.
Correspondence
Ioannidou Maria
Gripari, 57010 Pefka, Thessaloniki
e-mail: mar_ioan@yahoo. com Τ. +306945995950
Exploration of individuation process related factors in adolescents with chronic illness
Ioannidou Maria, Hatziagorou Elpis, Adramerina Alkistis, Teli Aikaterini, Pergantou Helen, Zilikis Nikolaos, Vorria Panagiota, Economou Marina
Abstract
Background: Modern research has so far highlighted 4 main individuation profiles during adolescence. However, profiles of chronically ill adolescents haven’t been sufficiently studied to date, nor how these profiles may be connected to their functionality or to parental upbringing practices. The present study attempts to fill this gap.
Ioannidou Maria
Adramerina Alkistis
Teli Aikaterini
Economou Marina
1st Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
Hatziagorou Elpis
3rd Pediatrician Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki
Pergantou Helen Bleeding Disorders' Unit, "Agia Sophia" Hospital, Athens
Zilikis Nikolaos
3rd Psychiatric Department, School of Medicine, Faculty of Health
Sciences, Aristotle University of Thessaloniki
Vorria Panagiota
School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki
Methods: The study participants were 46 adolescent patients, 23 suffering with hemophilia and 23 with asthma. The control group consisted of 29 adolescents without chronic illness. Study evaluation included information given by a parent as well as one school teacher. The study used a questionnaire exploring individuation profiles, internalizing and externalizing ability questionnaires, self-perception and self-esteem questionnaires, and questionnaires regarding parental upbringing practices. Data concerning academic performance were evaluated.
Results: Patients manifested 3 individuation profiles which shared common patterns with control group (avoidance, functional dependence, secure) and a unique profile (detached). In chronic illness group profiles that reflect a healthy individuation, correlated to absence of parental rejection and maternal overprotection, and had a lower frequency as compared to controls. On the contrary, avoidant profile was present in a higher percentage, correlated to the above mentioned parameters and was also connected to low conduct self-perception. In patient group ambivalent profile was missing whereas detached profile was present.
Conclusions: The study reveals that chronically ill adolescents manifest a more intense need of maintaining emotional bonding with their parents, while a healthy process of individualization either appears in lower rates or is delayed in this group.
Keywords: adolescence, individuation profile, chronic illness, upbringing practices
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Correspondence
Panagiotis Zymaris
Mitropolitou Aimilianou 8, Ampelokipoi-menemeni, Thessaloniki
e-mail: zymarisp@gmail.com Τ. +306984248265
Childhood venous thromboembolism
Marina Economou, Panagiotis Zymaris
Abstract
Venous thromboembolism (VTE) in children is an increasing problem, the incidence of which is calculated at approximately 30-60 cases every 10,000 hospital admissions, compared to 5 cases reported in the ‘90s. This dramatic increase seems to be multifactorial, correlated to increased survival of children with prothrombotic conditions (cancer, congenital heart disease), increased use of invasive techniques, increased presence of acquired thrombophilic factors (obesity, smoking, contraceptives) and, also, better recognition due to availability of newer diagnostic means. In the vast majority of cases, pediatric VTE concerns hospitalized patients with underlying conditions that require aggressive treatment and prolonged hospitalization and is associated with increased morbidity and mortality. Identification of related risk factors and selection of appropriate treatment is of great importance. Treatment options, essentially, derive from adjustment of clinical data obtained from adults, due to lack of clinical studies in the pediatric population. Aim of the present review is to highlight the risk factors for VTE occurrence in childhood in order to raise awareness to clinicians and promote early diagnosis and appropriate treatment.
Keywords: venous thromboembolism, central venous catheter, anticoagulation therapy, thrombophilia
Marina Economou
1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Panagiotis Zymaris
School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
ΦΘΕ:
PICCs: peripherally inserted central catheters ΗΧΜΒ:
ASH: American Society of Hematology
CHEST: American College of Chest Physicians
(25).
Νοσηλεία ≥7 ημερών (2 βαθμοί)
Αντισυλληπτικά p.o (2 βαθμοί)
Sharathkumar et al. Branchford et al.
Atchison et al.
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e-mail: armakolaf@yahoo.gr Τ.
Correspondence
Filomeni Armakola
e-mail: armakolaf@yahoo.gr
Τ. +306945159595
Chronic pain in children. An interdisciplinary approach
Filomeni Armakola, Potamiti Eleni
Abstract
Chronic musculoskeletal pain in children is a difficult-to-manage clinical entity that can result from a variety of factors, the pathophysiological basis of which varies. Chronic pain can lead to inability impairment and eventually disability, limiting activity and complicating the activity of daily living of children who experiencing pain. Proper and timely diagnosis is crucial and quite often it is set by exclusion when it comes to chronic pain syndromes in children. Rehabilitation starts during hospital stay and continues with the referral to a specialized rehabilitation center by therehabilitation team, led by the treating physician, which aims for optimal results. The supervision of a physician and the specialized physiotherapist, hydrotherapist, occupational therapist and psychologist in synergy with the parents - caregivers of the child in pain has been proven to offer the best results so far. Alternative or complementary therapies can be used to relieve pain not covered by conventional medicine or to achieve gradual discontinuation of the medication.
Keywords: chronic musculoskeletal pain, interdisciplinary team, rehabilitation, complementary therapies
Filomeni Armakola
Potamiti Eleni
Centre of Early Intervention and Rehabilitation, Children’s General Hospital
“P & A Kyriakou”
1–3
13–18
https://www.starship.org.nz/guidelines/paediatricpain-assessment/
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“m-PALS”
European Pediatric Advanced Life Support (EPALS)
European Resuscitation Council (ERC)
Correspondence
Antonopoulos Stavros Korinthou St. 191, P.O. 21200
e-mail: paidiatros.antonopoulos@gmail.com
T. +306932291092
Monitoring pediatric advanced life support “m-PALS”
Antonopoulos Stavros; Grivas Grigorios; Kalaras Georgios; Tsakiri Dimitra; Papadima Christina;
Abstract
A review of the Greek and international literature reveals the lack of existing monitoring flowcharts and at the same time the need to create a system for monitoring advanced life support for children. There are various treatment algorithms for managing and dealing with emergencies in both adults and children. In children, Advanced Pediatric Life Support (APLS), European Pediatric Advanced Life Support (EPALS) of the European Resuscitation Council (ERC), and a subcategory of Advanced Trauma Life Support (ATLS) are related to pediatric trauma. The explicit instruction of these algorithms is to assess and evaluate vital functions and therapeutic interventions. However, no patient assessment chart is provided in any of the manuals of these algorithms. Various attempts have been made to create algorithms for an emergency situation such as APLS, Triage system without however having a standardized system for monitoring specific parameters and interventions. In cases where the algorithm-monitoring process has been applied in clinical practice such as diabetic ketoacidosis or dehydration, it has been an invaluable and much needed tool for the clinician. Taking into account the above and evaluating the necessity for such a monitoring tool, we propose the "m-PALS" as an invaluable asset for the health care worker who deals with pediatric emergency patients in his daily practice.
Keywords: "m-PALS", APLS, EPALS, algorithm, monitoring
Antonopoulos Stavros
Grivas Grigorios
Kalaras Georgios
Tsakiri Dimitra
Papadima Christina Department of Pediatrics
General Hospital Argolidas, Argos
-Behavior
(hypoxia, hypokalaemia/hyperkalaemia, hypothermia/hyperthermia, hypovolaemia, tension pneumothorax, tamponade, thrombosis, toxins)
-Body Color
(Work of breathing)
(Tidal volume)
(Oxygenation)
o
o
o
(Pulse) – Καρδιακή Συχνότητα
(Peripheral Perfusion)
(Pulses Volume)
o Αρτηριακή Πίεση (Blood Pressure)
o Προφόρτιο (Preload)
επισημαίνεται στο
D. ΝΕΥΡΟΛΟΓΙΚΟ (D):
o Allergy (Αλλεργίες)
o Medication (Φαρμακευτική
o Past History (Ατομικό
o Last Meal (Τελευταίο
o Environment/
Hypoxia (Υποξία)
Hypokaleaemia/Hyperkalaemia (Υπο-Υπερκαλιαιμία,
Hypothermia/Hyperthrmia (Υπο-Υπερθερμία)
Hypovolaemia (Υπογκαιμία)
Tension Pneumothorax (υπό
Tamponade (Καρδιακός
Thrombosis (Θρόμβωση)
Toxins (Τοξίνες
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7. World Health Organization 2016, UPDATED GUIDELINE
Paediatric emergency triage, assessment and treatment
Care of critically ill children
8. ERC GUIDELINES. European Paediatric Advanced Life Support
2015 EDITION
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Section 6. Paediatric life support on behalf of the Paediatric life support section Collaborators
Resuscitation 2015 Oct;95:223-48.
10. Karl Disque. Pediatric Advanced Life Support: Provider Handbook
Satori Continuum Publishing; 2020
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American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Circulation 2015 Nov 3;132(18 Suppl 2):S526-42
12. Ian K. Maconochie, Richard Aickin, Mary Fran Hazinski, Dianne L. Atkins, Robert Bingham, Thomaz Bittencourt Couto, Anne-Marie Guerguerian, Vinay M. Nadkarni, Kee-Chong Ng, Gabrielle A. Nuthall, Gene Y.K. Ong, Amelia G. Reis, Stephen M. Schexnayder, Barnaby R. Scholefield, Janice A. Tijssen, Jerry P. Nolan, Peter T. Morley, Patrick Van de Voorde, Arno L. Zaritsky, Allan R. de Caen. Pediatric Life Support
2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations On behalf of the Pediatric Life Support Collaborators
Circulation. 2020 Oct 20;142(16_suppl_1):S140-S184.
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Emergency Medicine Journal (EMJ), 2015;0:1–9. DOI: 10.1136/emermed-2014-204363
Correspondence
Helen Pergantou
Thivon & Papadiamantopoulou 1, 11527
e-mail: hpergantou@gmail. com Τ. +302132013756
Venous thoracic outlet syndrome in three greek children: a single-centre experience
Athina Dettoraki, Aikaterini Michalopoulou, Georgios Charalampopoulos, Loukia Ioannidou, Nikolaos Liassis, Dimitrios Maras, Helen Pergantou
Athina Dettoraki
Aikaterini Michalopoulou
Loukia Ioannidou
Helen Pergantou
Haemophilia Centre/ Haemostasis and Thrombosis Unit, “Aghia Sophia” Children’s Hospital, Athens, Greece
Georgios Charalampopoulos
Nikolaos Liassis
Affidea-Evroiatriki Psychikou”, Imaging Centre, Athens, Greece
Dimitrios Maras
Department of Vascular Surgery, Red Cross Hospital of Athens, Greece
Thoracic outlet syndrome (TOS) has not yet been thoroughly studied in children and adolescents and remains a controversial issue in the field of surgery. It constitutes a syndrome of entrapment of neurovascular structures as they pass through the anatomical space of the thoracic outlet. We describe three cases of children and adolescents diagnosed with TOS within a year’s time in our Unit: 1) a 14-year-old girl with sudden onset of pain and oedema of left upper arm (thrombosis of left axillo-subclavian vein and filling defect in both subclavian veins due to an elongated transverse process of the seventh cervical vertebra), 2) a 13-year-old swimming champion girl with sudden onset of right arm oedema and 3) an eight-year-old girl with left arm discomfort (already on anticoagulation treatment due to cerebral sinovenous thrombosis) and complete outflow interruption of the left subclavian vein. All three patients have been on anticoagulation for 18, 6 and 4 months respectively, with no further symptoms. Conclusion: These three cases underline the necessity for physicians’ awareness concerning TOS diagnosis in children and adolescents with a high clinical suspicion and highlights the possibility of a satisfactory clinical outcome of pediatric TOS under conservative treatment initially with regular follow-ups and surgery planning in the best timing and on an age-appropriate occasion for the affected children.
Keywords: Thoracic Outlet Syndrome, thrombosis, adolescents, thrombophilia, Doppler scanning.
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Correspondence
Evangelos Christou
e-mail: va.xristou@gmail.com
Τ. +306982889279
Α case of seronegative autoimmune encephalitis associated with Human Herpesvirus-7 (HHV-7)
Evangelos Christou, Sotiria Mastrogianni, Theodora Bachou, Theodoros Tsikrikas, Stella Mouskou, Konstantinos Voudris, Dimitrios Delis
Abstract
Background: During the last ten years, an increased number of patients presenting with acute encephalitis is being observed, a finding that attributes to autoimmune mechanisms. Despite the fact that autoantibodies usually target neuronal cell surface or synaptic proteins in central nervous system, in many cases they remain undetectable, constituting a future diagnostic and therapeutic challenge. HHV-7 is proven to be a neurotropic virus, causing various neurological complications mostly in adult population.
Methods: We present the case of a 10- year-old girl, with confirmed active HHV-7 infection of central nervous system, who developed acute seronegative autoimmune encephalitis.
Conclusion: To our best knowledge, there is no literature concerning pediatric cases of autoimmune encephalitis following HHV-7 infection.
Keywords: HHV-7 infection, acute encephalitis, seronegative autoimmune encephalitis
Evangelos Christou
Theodora Bachou
Dimitrios Delis
First Pediatric Department, General Children’s Hospital
“Panagiotis and Aglaia Kyriakou, Athens, Greece
Sotiria Mastrogianni
Stella Mouskou
Konstantinos Voudris
Neurology Department, General Children’s Hospital
“Panagiotis and Aglaia Kyriakou, Athens, Greece and
Theodoros Tsikrikas
Intensive Care Unit, General Children’s Hospital “Panagiotis and Aglaia Kyriakou, Athens, Greece
Bickerstaff
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Alfred François Donné (18011878)
du
du pus, du mucus, et sur ceux des humeurs de
et chimico-microscopiques
Bouillaud (1796-1881)
Pierre-Charles-Alexandre Louis (1787-1872),
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(Recteur de l'Université de Montpellier)
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(1822-1895),
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II. ΒΙΒΛΙΑ Κεφάλαιο σε βιβλίο: Clark AG, Barratt ΤΜ. Steroid-responsiνe nephrotic syndrome. Ιn: Barratt ΤΜ, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.
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IV. ΣΤΟ ΔΙΑΔΙΚΤΥΟ Άρθρο σε περιοδικό:
Abood S. Quality improνement initiatiνe in nursiηg homes: the ΑΝΑ acts in an adνisory role. Am J Nurs [Internet]. 2002 Jun:
Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
Μονογραφία: Foley ΚΜ, Gelbaηd Η, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001.
Webpage: http://www.nap.edu/books/0309074029/html
Ιστοσελίδες: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Ιnc.; 2002: http://www.cancer-pain.org/ Πίνακες
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