Volume 85 | Number 3 | September - October - November - December 2022
Four monthly publication of the Greek Paediatric Society
162
EDITORIAL
Stelios Antoniadis
164
AWARDED PAPER
Adolescent health care services in a secondary regional hospital: data from the 2018-2021 time period, after the transition of care from internists to paediatricians.
Valentina Diamantidou, Alexandra Tsiftsaki, Eleni P Kotanidou, Aikaterini Parisi, Tomazos Soumakis, Aimilia Kuriakopoulou, Sofia Terekidou, Nikoleta Kazakou, Sofia Chrusostomidou
174
REVIEW ARTICLES
Role of presepsin and proadrenomedullin in the diagnosis and outcome of infections in neonates and children.
Department of Pediatrics, General Hospital of Kilkis, Kilkis, Greece
Adolescent health care services in a secondary regional hospital: data from the 2018-2021 time period, after the transition of care from internists to paediatricians
Valentina Diamantidou*, Alexandra Tsiftsaki*, Eleni P Kotanidou, Aikaterini Parisi, Tomazos Soumakis, Aimilia Kuriakopoulou, Sofia Terekidou, Nikoleta Kazakou, Sofia Chrusostomidou
Abstract
Background: Since October 2018, health care of adolescents aged 14-16 years in Greece, was assigned to the Paediatricians.
Aim: The recording of morbidity data in aged 14-16 years who sought health services from a Secondary Hospital in the three years period 2018-2021.
Material - Method: The records of the Outpatient Clinics (Regular & Emergency) of the Pediatric Clinic Secondary Hospital were studied retrospectively, during the aforementioned period.
Results: During the study period, 791 adolescents (48.4% boys) aged 14.81±0.6 years, sought health services. The majority of adolescents lived in cities (63.8%), while 5.1% were adolescent-refugees. Among them 76% (n=608/791) were admitted to the Emergency Departments while only 20.5% of adolescents (n=162/791) came to an Outpatient Clinic after an appointment and 2.6% (n=21/791) were referred by a primary health care center. The most common cause of seeking medical care was the symptoms of a respiratory infection (30.4%), while the less common causes were abdominal pain (9.5%), fever (7.3%) and allergic reactions (5.6%). Among the adolescents who came to the Outpatient Clinic, the most common reason for attending was the issuance of a school health card. Admission to the Paediatric Clinic was recommended to 11.5% of the adolescents who were examined. The most common cause of hospitalization was a fainting/fainting-like episode (19.7%) followed by alcohol intoxication (11.3%), gastrointestinal infection (11.3%) and thoracic pain (9.9%). The mean duration of hospitalization was 2.8±1 days.
Conclusions: The majority of adolescents, aged 14-16, seek health services from the Emergency Departments of our hospital due to infections, as observed in childhood. Causes related to the psychosomatic changes of adolescence and high-risk behaviors are following.
Keywords: adolescent, adolescence, health care, hospitalization, hospital, pediatrician, pediatrics
*Valentina Diamantidou and Alexandra Tsiftsaki have equally contributed to this study (co-first authorship).
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Correspondence
Athanasios Tragiannidis
S. Kyriakidi 1, 54636, Thessaloniki
Τ. +302310994804
Ε. atragian@auth.gr atragian@hotmail.com
Role of presepsin and proadrenomedullin in the diagnosis and outcome of infections in neonates and children
Despite the advances in recent years, infections are still a main cause of morbidity and mortality in infants and children. The presence of biomarkers, as C-reactive protein that has widely been used in the last decades and procalcitonin that has been studied in the last 2 decades are helpful for diagnosis and outcome of severe infections in neonates and children. Nevertheless, there is a need for the use of newer biomarkers for screening, diagnosis, course and outcome of infections. Additionally, the role of biomarkers could help in the stratification of patients in risk groups and as monitoring of therapy response and rational use of antibiotics. Therefore, aim of the present review was the study of current literature regarding the newer biomarkers as presepsin and prodrenomedullin. Presepsin is a glycoprotein expressed in monocytes and phagocytes and its levels are increased within 2 hours after initiation of inflammation. Its role has been studied in neonates and children with sepsis and in febrile neutropenia episodes of children with cancer and has been shown that is a reliable marker of early sepsis in neonates. Proadrenomedullin is the precursor peptide of adrenomedullin released from various tissues as vascular endothelium as a response to stress and has an anti-inflammatory, antimicrobial and vasoregulatory effect. Its role has been studied in respiratory infections of pediatric patients and in febrile neutropenia episodes of children with malignancy. According to current literature these biomarkers play a role in outcome and course of severe infections in childhood.
2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
Lemonia Skoura
University Microbiology Laboratory, AHEPA Hospital, Thessaloniki
ΣΥΝΤΟΜΟΓΡΑΦΙΕΣ
PCT: προκαλσιτονίνη
TNF: παράγοντας
νέκρωσης των όγκων
ADM: αδρενομεδουλλίνη
Pro-ADM:
προαδρενομεδουλλίνη
Baraka
Βιβλιογραφία
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Correspondence
Koutsaftiki Chrysi
Sof. Venizelou 77, Halandri, PC 15232
T. +306970061238
E. kochrysa@yahoo.com
"Long-Post COVID-19" syndrome in children and adolescents
Background: COVID-19 infection in the vast majority of children is of mild or moderate severity and mortality is almost zero. However, symptoms from various systems may persist, re-emerge, or recur for months after the acute phase, representing the Long COVID-19 syndrome that has been described primarily in adults.
Purpose-Objectives: The present review aims to evaluate the symptoms-conditions described and defined in the international literature as Long-Post COVID (LPC), as well as to capture the frequency, in different age groups of children. In addition, an attempt is made to record the major risk factors, the possible pathophysiological mechanisms and to highlight ways of management.
Method: Studies of the international literature, published in PubMed database, as well as articles from other sources were reviewed. Particular emphasis was placed on systematic reviews and meta-analyses published in the year 2022, reflecting accumulated experience. The search was made in September 2022.
Results: The most common symptoms are: headache, fatigue, cognitive disorders as well as myalgias/arthralgias. The frequency varies a lot, depending on the study, while it seems that almost all studies presented many methodological problems. Pathophysiologically, the activation of cytokines and other immunologic mechanisms seem to dominate. At the same time, many children with a negative history of infection also showed symptoms such as anxiety, sleep disturbances, headaches and decline in mental functions, attributed to the pandemic itself.
Conclusions: It is necessary to clarify the syndrome, in order to assess the actual risk that children face, so as to prepare health workers for its best management, but also to assess the necessity of universal vaccination of children against the new coronavirus as well as the evaluation of measures to safeguard public health.
Paediatric department, “Rafina” Health Care Centre, Rafina-Attika, Greece
Sergentanis Theodoros
Merakou Kyriakoula
Kornarou Eleni
Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
Μεθοδολογία
((long-Covid) OR (long-Covid symptoms) OR (long Hauler*) OR (post-Covid-19) OR (postacute Covid-19 syndrome) OR (post-acute Covid-19 symptoms) OR (Covid-19 sequelae) OR (chronic Covid-19 syndrome) OR (post-infectious Covid-19) OR (post Covid-19 recovery syndrome) OR (Post-acute sequelae of Sars-CoV-2 infection) OR (post Covid-19 recovery syndrome)) AND (pediatr* OR paediat* OR kids OR young OR infant OR adolesc*).
οργανισμούς WHO, Centers for Disease Control and Prevention (CDC), και τους βρετανικούς National Institute for Health and Care Excellence (NICE), UK National Institute for Health Research (NIHR) καθώς και CLoCk Consortium όπως
World Health Organization
Centers of Disease Control and Prevention
National Institute for Health and Care Excellence (NICE)
National Institute for Health Research (NIHR)
ως Long-Covid τα σημεία και τα συμπτώματα εκείνα που συνεχίζουν ή αναπτύσσονται μετά την οξεία COVID-19. Δηλαδή επίμονα συμπτώματα της λοίμωξης (ongoing symptomatic COVID-19) που διαρκούν από 4 έως 12 εβδομάδες αλλά και συμπτώματα μετά τη λοίμωξη (post-COVID-19 syndrome) που
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"pathophysiology".
E.
Correspondence
Georgios Katsaras
End of Egnatia Str, 58200, Edessa T. +306939193901
E. gkatsaras84@gmail.com
Lithiasis of the urinary system in childhood
Anastasios Vladikas, Anastasia Anastasiou, Miguel Shkira, Georgios Katsaras
Abstract
Urolithiasis in children is not a common disease in developed countries. However, in recent years its incidence has been steadily increasing, while wrong diagnosis can lead to chronic kidney disease.
Methods: Extensive literature review in the international databases PubMed and Scopus took place, in which the key terms used were "pediatric urolithiasis", "epidemiology", "metabolic factors", "pathophysiology".
Results: Metabolic, genetic, anatomical, dietary, and environmental factors are to blame for this increase. The typical clinical symptomatology of renal colic that characterizes lithiasis in adults is present in only 50% of children with urolithiasis. Microscopic or macroscopic hematuria is the most common finding and affects up to 90% of patients. In younger children the main symptom may be only recurrent urinary tract infections. The majority of renal stones in children are calcium oxalate or calcium phosphate.
Conclusions: Urolithiasis is a significant problem with increasing frequency in childhood, which requires the pediatrician to be alert for early diagnosis. Investigation of possible anatomical abnormalities is required, as well as a thorough metabolic control to avoid recurrences. Patients should be monitored frequently by specialists and depending on the underlying cause, the appropriate intervention should be performed.
Paediatric Department, General Hospital of Pella - Hospital Unit of Edessa, Edessa
Anastasia Anastasiou
Health Care Center of Edessa, Edessa
Pediatric Nephrology Department, 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki
Tamm-Horsfall (THP), οι γλυκοζαμινογλυκάνες (GAGs), οι
(Bikunin), η καλγκρανουλίνη και η οστεοποντίνη (OPN) (9–11).
Μεταβολικοί παράγοντες κινδύνου Οι κύριοι μεταβολικοί παράγοντες κινδύνου περιλαμβάνουν την υπερασβεστιουρία, την υπεροξαλουρία, την υπερουρικοζουρία, την κυστινουρία, την ξανθινουρία, την υποκιτρουρία και την υπομαγνησιαιμία (Πίνακας 1) (4,5).
Πίνακας 1: Μεταβολικοί παράγοντες κινδύνου
Υπερασβεστιουρία
Νορμοασβεστιαιμική υπερασβεστιουρία
Ιδιοπαθής υπερασβεστιουρία
Άπω σωληναριακή νεφρική οξέωση
Χρήση διουρητικών
Μονογονιδιακές διαταραχές
Υπερδιέγερση
Μυελώδης σπογγοειδής νεφρός
Υπερασβεστιαιμική υπερασβεστιουρία
Πρωτοπαθής υπερπαραθυρεοειδισμός
Υπό/υπέρ θυρεοειδισμός
Ακινητοποίηση
Μεταστατική νόσος των οστών
Σύνδρομο Cushing
Υπερβιταμίνωση D ή A
Επινεφριδιακή ανεπάρκεια
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Correspondence
Elpidoforos Mantadakis
Department of Pediatrics, University General Hospital of Alexandroupolis
T. +302551351424
Ε. emantada@med.duth.gr
Symptomatic thrombocytopenia as the initial manifestation of infectious mononucleosis: A case report and literature review
Infectious mononucleosis is an acute infectious syndrome that is usually caused by the Epstein-Barr virus (EBV). It usually manifests with fever, sore throat, cervical lymphadenopathy, and myalgias, while the discovery of hepatosplenomegaly during clinical examination is common. The presence of mild to moderate thrombocytopenia is a frequent complication of the disease, as it has been observed in up to one-third of children with infectious mononucleosis. The case of a 6.5-year-old boy with symptomatic thrombocytopenia (ecchymoses, petechiae, wet purpura), with a platelet count of 5,000/μL, as the initial manifestation of EBV-related infectious mononucleosis is presented, and the relevant medical literature is reviewed.
Department of Pediatrics, University General Hospital of Alexandroupolis
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