Aggelos Tsalkidis

The effect of obesity on pulmonary lung function of school aged children in Greece

Obesity impacts on many issues of pulmonary medicine, where it is debated if obesity is linked to asthma, atopy or altered lung function tests. Our study aimed to investigate primarily the effect of obesity on the lung function tests and secondary the possible link of obesity with atopy and asthma in a large cohort of children in Greece.

Comparative Efficacies of Procalcitonin and Conventional Inflammatory Markers for Prediction of Renal Parenchymal Inflammation in Pediatric First Urinary Tract Infection

OBJECTIVES To compare the reliability of procalcitonin (PCT) with conventional laboratory parameters in predicting for renal parenchymal inflammation (RPI). METHODS The study cohort consisted of 57 children who were admitted for a first-episode urinary tract infection. All patients underwent measurement of the leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT. RPI was evaluated by technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy within 7 days of admission. If the first DMSA findings were abnormal, another analysis was performed 6 months later. The cutoff points for ESR, CRP, and PCT were established by comparing the areas under their receiver operating characteristic curves. Statistical analysis was performed using 1-way analysis of variance. RESULTS Of the 57 children, 27 were diagnosed with RPI on the basis of positive DMSA results. The ESR, CRP, and PCT levels were significantly greater (P < .001) in the patients with RPI than in those without RPI. In contrast, the leukocyte count was the same in both groups (P > .05). PCT was a more sensitive and specific marker for differentiating upper and lower urinary tract infection than ESR and CRP. Persistent lesions at the site of previous RPI were found in 12 patients in the follow-up DMSA analysis, with total regression evident in the remaining 15. The PCT levels were significantly greater in those with persistent renal lesions than in those with total regression (P = .005). CONCLUSIONS Serum PCT is a more reliable biologic marker than the ESR, CRP, or leukocyte count for the early prediction of RPI in children with a first episode of urinary tract infection. In addition, the greater the elevation of PCT at admission, the more positive the correlation for subsequent permanent renal damage.

Asthma, lung function and sensitization in school children with a history of bronchiolitis.

Background: The purpose of the present retrospective study was to investigate the association of school‐age asthma with acute‐bronchiolitis and examine the influence of potential risk factors.

Acute Tc-99m DMSA Scan for Identifying Dilating Vesicoureteral Reflux in Children: A Meta-analysis

Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators have claimed that because acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan results are abnormal in the presence of dilating vesicoureteral reflux, a normal DMSA-scan result makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. To evaluate the accuracy of acute-phase DMSA scanning in identifying dilating (grades III through V) vesicoureteral reflux documented by VCUG in children with a first febrile UTI, we performed a meta-analysis of the accuracy of diagnostic tests as reported from relevant studies identified through the PubMed and Scopus databases. Patient-based and renal unit–based analyses were performed. Overall, 13 cohort studies were identified. Nine studies involved patients younger than 2 years, 3 involved children aged 16 years or younger, and 1 involved exclusively neonates. Girls constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity rates of DMSA scanning were 79% and 53%, respectively, for the patient-based analysis (8 studies) and 60% and 65% for the renal unit–based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.71 and 0.67. Marked statistical heterogeneity was observed in both analyses, as indicated by I2 test values of 91% and 87%, respectively. Acute-phase DMSA renal scanning cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.

Serum copper and zinc concentrations in healthy children aged 3–14 years in greece

Zinc (Zn) and copper (Cu) are essential trace elements in people, being required for functional activity of several enzyme systems. In this study, we determined Cu and Zn concentrations in the serum of 105 healthy children randomly selected, aged 3–14 yr, residing in a region of Greece (Thrace), and we investigated their association with childrens gender, age, height, weight, and nutritional habits. The mean levels of Zn and Cu were 15.01±2.95 μmol/L and 26.18±5.47 μmol/L, respectively, with no significant difference between boys and girls. A significant positive correlation was found between age and Zn levels, and a negative one was found between age and Cu levels. Both Zn and Cu levels tended to increase with height, whereas Zn levels significantly decreased with increasing body mass indent (BMI). The consumption of meat, milk, and eggs were independent determinants for higher Zn levels, and the consumption of legumes and fruits were independent determinants for higher Cu levels. A significant negative correlation was found between Zn and Cu levels. In conclusion, our study, the first one evaluating the serum status of Cu and Zn in healthy Greek children, identified significant correlations of Zn and Cu levels with their age, height, BMI, and nutritional habits.

Carotid body tumor in a 13-year-old child: Case report and review of the literature

Carotid body tumor (CBT), an extra-adrenal paraganglioma, represents an uncommon entity arising in chemoreceptor tissue located at the carotid bifurcation. Only a few cases have been reported in the literature in the pediatric age group less than 14 years of age, primarily as case reports. Surgical excision is advisable in almost all ages, however, in childhood, it is known to carry risks and difficulties due to the smaller size of the involved anatomical structures. We report an unusual case of a large (50 x 43 x 30 mm) carotid paraganglioma of Shamblin type III in a 13-year-old female, living at high altitude until the age of 9 years. This cervical mass was present, but smaller in size, several years before admission. However, an intense hypoxic stimulus at high altitude for 2 months at the age of 13 years probably induced a fast growing period of the lesion. The tumor was removed en bloc with the involved carotid segments and vascular continuity was restored by means of a common carotid to internal carotid saphenous vein interposition graft. No malignant behavior or regional metastatic spread of the resected mass was demonstrated. Furthermore, no inheritance pattern between family members was confirmed. A clinical update on CBTs in childhood a propos of this case report is undertaken.

Acute abdomen in children due to extra-abdominal causes.

Background: Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra‐abdominal organs or systems. The aim of the present study was to establish the most common extra‐abdominal causes of acute abdominal pain.

A case of immune thrombocytopenic purpura after influenza vaccination: consequence or coincidence?

The researchers describe the case of a earlier healthy 3-year-old boy, who developed immune thrombocytopenic purpura (ITP) 26 days after immunization with the second dose of seasonal influenza vaccine. He recovered quickly and uneventfully within 2 days after receiving a single dose of intravenous immunoglobulin. Review of the medical literature showed that symptomatic thrombocytopenia occurs in a substantial number of children and adults who require hospitalization for complicated natural influenza infection, particularly avian influenza. In contrast, it is exceptionally rare after influenza immunization, as only few case reports describe such an association in adults but not in children. As the risk of thrombocytopenia after natural influenza seems to be much higher than after immunization, annual influenza vaccination is advised for patients with personal history of ITP who at risk of influenza-related complications owing to underlying medical problems.

Epilepsy impact on aspects of school life of children from different cultural populations in Thrace, Greece

Epilepsy influences the school life of children. The aims of this study were to (1) assess absenteeism and participation in sports activities, (2) investigate whether parents inform school and children inform their classmates, and (3) determine which factors influence these school aspects. Children from both Christian and Muslim families were enrolled and different cultural variables were prospectively documented. A total of 62 children with epilepsy (mean age: 10.2+/-3.3 years, range: 6-18) participated in the present study. Univariate analysis and multivariate logistic regression models were used to explore potential factors that could influence school life. Absenteeism was correlated with shorter disease duration, severity, lower parental educational level, and knowledge of epilepsy. Age>12 was associated with nonparticipation in activities. Schools were informed by 84% of families, and classmates, by 22.6% of children. In conclusion, better knowledge of epilepsy resulted in fewer missed school days. The majority of children did not discuss their disease, and children from the two populations with different religions did not differ significantly in the school aspects examined. These findings suggest a probable positive effect of educational programs on the issue of daily school life.

Effect of passive smoking on lung function and respiratory infection

ObjectiveTo study the effect of environmental tobacco smoke to children’s health and more specifically to the development of respiratory tract infections and also its influence to their respiratory function.MethodsWe studied 586 children from the district of west Thrace in Greece aged 5–14 years, randomly selected from 20 primary and 10 secondary schools in regards their exposure to tobacco smoke, and its possible relation with respiratory tract infections. We assessed respiratory function by spirometry. Epidemiological data were also analysed.ResultsChildren who were exposed to environmental tobacco smoke had higher risk for upper and lower respiratory tract infections in comparison to children who lived in a smoke free environment (3 fold and 2 fold, respectively. Their lung function was also reduced with decreased values of FEV1, FEF50, PFR (values p<0.001).ConclusionPassive smoking has an unfavorable effect in respiratory function of children and predisposes them to respiratory tract infections. Every effort should be undertaken in order to avoid exposure of children to environmental tobacco smoke.