Anastasia Garoufi

Transverse Myelitis in 2 Patients With Bartonella henselae Infection (Cat Scratch Disease)

Cat scratch disease is usually a benign, self-limiting condition. Neurological manifestations are uncommon and may consist of encephalopathy, seizures, and coma. This report describes 2 cases of transverse myelitis: 1 case in a 46-year-old man who had lymph node biopsy and serological testing results that were positive for Bartonella henselae and 1 case in a 13-year-old adolescent boy who had serological testing results that were positive for B. henselae. These are 2 of the only 3 cases of transverse myelitis associated with cat scratch disease that have been reported since the causative organism was first reported.

ASSOCIATION OF LUPUS ANTICOAGULANT WITH TRANSIENT ANTIBODIES TO PROTHROMBIN IN A PATIENT WITH HYPOPROTHROMBINEMIA

Lupus anticoagulant (LA) is an acquired inhibitor usually associated with thrombotic tendency and rarely with hemorrhagic manifestations, except in cases of LA with hypoprothrombinemia. In vitro LA is manifested with a prolongation in the activated partial thromboplastin time (l). LA is heterogeneous in nature and appears to be phospholipid-dependent (2). In most of the cases these antibodies recognize protein phospholipid complexes or proteins such as (32Glycoprotein I (~2GPI) or prothrombin which can be reconfigured on other surfaces (plastic or phospholipids) and can be expressed as a neo-epitope (3-6). Antibodies associated with LA may

Cystatin-C levels in healthy children and adolescents: Influence of age, gender, body mass index and blood pressure.

OBJECTIVES Cystatin-C is considered a more sensitive and specific marker of kidney function than creatinine since it can diagnose patients with earlier-stage of renal dysfunction. The aim of this study is to determine the levels of Cystatin-C in healthy children and adolescents as well as any correlations to age, gender, body-mass index (BMI) and blood pressure (BP). DESIGN AND METHODS Cystatin-C was measured in 536 healthy Greek children and adolescents (295 males and 241 females) using a nephelometric immunoassay. Additionally, the age, body mass index and blood pressure was recorded for each subject. RESULTS Overall, the mean serum Cystatin-C level was 0.79 ± 0.10 mg/L. Cystatin-C was found to be statistically significantly lower in females than in males (p < 0.001) as well as in prepubertal children compared to adolescents (p < 0.001). Higher values of Cystatin-C were observed in subjects with increased BMI (p < 0.001). Neither systolic nor diastolic blood pressure was found to significantly affect Cystatin-C levels. CONCLUSIONS The levels of Cystatin-C were statistically significantly higher in males, compared to age-matched females and also positively correlated with age and BMI.

Incomplete Kawasaki disease with intermittent fever and retropharyngeal inflammation.

Kawasaki disease is a systemic vasculitis of unknown etiology, presenting typically in infants and young children. We report a rare case of incomplete Kawasaki disease in a 15-month-old male infant presenting with symptoms mimicking retropharyngeal abscess and intermittent fever.

Acute renal failure in a child with thrombocytopenic purpura caused by acute Epstein-Barr virus infection after treatment with anti-D immunoglobulin.

Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in Rh(D)-positive nonsplenectomized patients. Severe hemolysis and acute renal failure are extremely rare complications that may be aggravated by the presence of an acute EBV infection. It is believed that anti-D immunoglobulin triggers an unusual virus-induced immune response causing hemolysis. We present a 4-year-old girl with ITP caused by an acute EBV infection that developed acute kidney injury following treatment with anti-D immunoglobulin. The patient recovered completely from thrombocytopenia and renal dysfunction. Intravascular hemolysis and acute kidney injury are consistent with anti-D immunoglobulin mechanism of action. Pediatric patients treated with anti-D immunoglobulin for ITP should be closely monitored for signs and symptoms of hemolysis that may be aggravated by the presence of EBV infection leading to impaired renal function.

Hypercalciuria in children with febrile convulsions

Abstract 
 Background : The purpose of the present study was to investigate whether idiopathic hypercalciuria may be implicated in the pathogenesis of febrile convulsions.

A toddler with acute flaccid paralysis due to West Nile virus infection.

We report on a 2-year-old boy with acute flaccid paralysis due to West Nile neuroinvasive disease. Serum and cerebrospinal fluid serology as well as nerve conduction studies were consistent with the diagnosis. He received intravenous immunoglobulin and showed gradual improvement and complete recovery of his muscle strength, gait and deep tendon reflexes.

Atrial natriuretic peptide in children with idiopathic hypercalciuria

Abstract We measured plasma atrial natriuretic peptide (ANP) levels in 30 children with idiopathic hypercalciuria (IH) and 19 normal controls (NC). A calcium (Ca) loading test was performed in all patients to determine the type of IH. Subsequently plasma ANP, cAMP and renin activity (PRA), serum total and ionized Ca, intact parathyroid hormone, aldosterone, and 1,25-dihydroxyvitamin D as well as urine Ca, cAMP, and electrolytes were determined in all subjects. The mean (SD) plasma ANP levels were significantly lower in patients with renal hypercalciuria (RH) [21.4 (4.8) pg/ml] than in those with absorptive hypercalciuria (AH) [26.8 (7.6) pg/ml, P<0.05] and NC [27.6 (6.6) pg/ml, P<0.01]. PRA was significantly lower in AH [2.9 (1.3) ng/ml per hour] than in RH patients [7.8 (6.8) ng/ml per hour, P<0.01] and in NC [6.8 (4.6) ng/ml per hour, P<0.005]. Serum aldosterone values were significantly lower in AH [14.5 (11.4) ng/dl] than in RH patients [25.4 (14.1) ng/dl, P<0.05] and in NC [32.6 (20.5), P<0.001]. The lower plasma ANP levels in RH than in AH patients and in NC may be due to Ca depletion. The lower PRA and serum aldosterone levels in AH than in RH patients and in NC may be attributed to Ca excess.

Associations between obesity, adverse behavioral patterns and cardiovascular risk factors among adolescent inhabitants of a Greek island

Abstract Background: Excess weight, unhealthy lifestyle habits and their sequelae have become a well-recognized public health problem in most countries. The objective of the study was to examine the relationship of adolescent overweight/obesity with behavioral habits and their association with blood pressure (BP) and lipid profile. Methods: Anthropometric parameters, lifestyle, BP and lipid profile of 736 adolescents were evaluated cross-sectionally. The classifications of normal weight, overweight and obese were based on BMI z-scores. Results: About 42.1% of adolescents were overweight/obese, 11.3% were smokers, 33.2% consumed alcohol and 34% reported low activity. Males began smoking earlier, consumed alcohol more often, exercised less and spent more screen time than females. Alcohol consumption was more prevalent among smokers and was associated with higher BP and dyslipidemia. Smokers exercised less intensely and had lower high density lipoprotein-cholesterol (HDL-C) than non-smokers. Obesity was a risk factor for higher BP and dyslipidemia. Longer screen time was associated with higher triglycerides, while intense physical activity with lower systolic BP. Conclusions: Obesity is related to an adverse lipid and BP profile during adolescence. Clustering of hazardous habits was observed, which is known to aggravate the cardiovascular risk.

Too short stature, too many stigmata

Dyskeratosis congenita (DC) is a rare disease characterised by bone marrow failure and skin manifestations. Patients with DC may exhibit short stature that is not usually related to growth hormone (GH) deficiency. Replacement treatment with GH should be done cautiously as it can predispose to haematological malignancy. We present a 10-year-old boy with DC and GH deficiency.