Publications by authors named "George Vartzelis"

27 Publications

  • Page 1 of 1

Evaluation of Genotypes and Epidemiology of Spinal Muscular Atrophy in Greece: A Nationwide Study Spanning 24 Years.

J Neuromuscul Dis 2020 ;7(3):247-256

Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens.

Background: Promising genetic treatments targeting the molecular defect of severe early-onset genetic conditions are expected to dramatically improve patients' quality of life and disease epidemiology. Spinal Muscular Atrophy (SMA), is one of these conditions and approved therapeutic approaches have recently become available to patients.

Objective: Analysis of genetic and clinical data from SMA patients referred to the single public-sector provider of genetic services for the disease throughout Greece followed by a retrospective assessment in the context of epidemiology and genotype-phenotype associations.

Methods: Molecular genetic analysis and retrospective evaluation of findings for 361 patients tested positive for SMA- and 862 apparently healthy subjects from the general population. Spearman rank test and generalized linear models were applied to evaluate secondary modifying factors with respect to their impact on clinical severity and age of onset.

Results: Causative variations- including 5 novel variants- were detected indicating a minimal incidence of about 1/12,000, and a prevalence of at least 1.5/100,000. For prognosis a minimal model pertaining disease onset before 18 months was proposed to include copy numbers of NAIP (OR = 9.9;95% CI, 4.7 to 21) and SMN2 (OR = 6.2;95% CI, 2.5-15.2) genes as well as gender (OR = 2.2;95% CI, 1.04 to 4.6).

Conclusions: This long-term survey shares valuable information on the current status and practices for SMA diagnosis on a population basis and provides an important reference point for the future assessment of strategic advances towards disease prevention and health care planning.
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http://dx.doi.org/10.3233/JND-190466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836056PMC
January 2020

allele impact on pediatric multiple sclerosis in a Hellenic cohort.

Mult Scler J Exp Transl Clin 2020 Jan-Mar;6(1):2055217320908046. Epub 2020 Feb 24.

Demyelinating Diseases Unit & Director of Immunogenetics Laboratory, First Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece.

Background: Pediatric-onset multiple sclerosis (POMS) is considered a complex disease entity with many genetic and environmental factors implicated in its pathogenesis. Linkage studies in Caucasian adult populations consistently demonstrate the major histocompatibility complex and its (human leukocyte antigen) polymorphisms as the genetic locus most strongly linked to MS.

Objective: To investigate the frequencies and possible clinical and imaging correlations of alleles in a Hellenic POMS sample.

Methods: Fifty POMS patients fulfilling the IPMSSG (International Pediatric Multiple Sclerosis Study Group) criteria were enrolled using 144 adult-onset MS (AOMS) patients and 246 healthy controls for comparisons. genotyping was performed with standard low-resolution sequence-specific oligonucleotide (SSO) techniques. Clinical and imaging correlations with specific alleles were also examined.

Results: The genotype was significantly higher in POMS patients compared to both the AOMS population (26% vs. 12.5%,  = 0.042) and the general population (26% vs. 12.6%,  = 0.004). -positive POMS patients had significantly more relapses (6.9 ± 4.9 vs. 4.2 ± 4.4,  = 0.005) and more thoracic spinal cord lesions than negative patients (61.5% vs. 27%,  = 0.043).

Conclusion: In our Hellenic population, allele confers increased risk for POMS and it is also correlated with possibly increased disease activity, expanding the existing knowledge on associations and POMS.
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http://dx.doi.org/10.1177/2055217320908046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040929PMC
February 2020

Vigabatrin-Induced Encephalopathy in a 5.5-Month-Old Girl with Infantile Spasms due to Tuberous Sclerosis.

Case Rep Pediatr 2019 25;2019:7249237. Epub 2019 Aug 25.

2nd Pediatric Department of National and Kapodistrian University of Athens, Children's Hospital "P. & A. Kyriakou", Athens, Greece.

A 5.5-month-old female infant with tuberous sclerosis complex presented with infantile spasms and was treated with vigabatrin. As her condition did not improve, she was given adrenocorticotropic hormone (ACTH) intramuscularly which stopped the spasms and improved the electroencephalogram (EEG) abnormalities. However, she developed encephalopathy with apathy, drowsiness, and generalized slowing in the EEG. Discontinuation of vigabatrin quickly improved her symptoms and reversed the EEG slowing. A high index of suspicion is required in order to diagnose vigabatrin-induced encephalopathy, especially as the underlying disorders of these patients can be erroneously considered the cause of the observed encephalopathy.
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http://dx.doi.org/10.1155/2019/7249237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732644PMC
August 2019

Rituximab as Rescue Therapy for Aggressive Pediatric Multiple Sclerosis.

Case Rep Pediatr 2019 21;2019:8731613. Epub 2019 Jul 21.

First Department of Neurology, "Eginition" Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Multiple sclerosis is a chronic, debilitating disease. Almost one in ten patients with MS has a history of disease onset during childhood. Although numerous therapeutic options exist for adult MS, the available treatments for pediatric patients are still limited. One of the emerging therapies is rituximab, a monoclonal anti-CD20 chimeric antibody that can deplete the CD20+ lymphocyte populations. A 12-year-old boy presented with ataxia, paresthesias, and headache while his brain MRI showed numerous T2 contrast-enhancing lesions. Gamma globulin, steroids, and cyclophosphamide failed to intercept his disease, and he progressed to a rapid clinical and radiological deterioration. Treatment with rituximab reversed the disease course in a dramatic fashion, leading to complete remission.
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http://dx.doi.org/10.1155/2019/8731613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679848PMC
July 2019

Long-term preservation of measles and rubella specific-IgG antibodies in children with enthesitis related arthritis on anti-TNFα treatment: a prospective controlled study.

Rheumatology (Oxford) 2019 09;58(9):1686-1688

Infectious Diseases Unit, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece.

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http://dx.doi.org/10.1093/rheumatology/kez096DOI Listing
September 2019

Immunogenicity and side-effects of the inactivated hepatitis A vaccine in periodic fever, aphthous stomatitis, pharyngitis, and adenitis patients.

Pediatr Int 2019 Jan;61(1):104-106

Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, University of Athens, Athens, Greece.

The aim of this study was to compare the immunogenicity and side-effects of hepatitis A virus (HAV) vaccination between periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) patients and healthy controls who have not been previously exposed to HAV. A prospective observational study was carried out of 28 PFAPA patients and 76 controls who received two doses of the vaccine. Immunogenicity was expressed as seroconversion and seroprotection rates; mean HAV-immunoglobulin G concentration was measured at 0, 1, 7 and 18 months. Side-effects were defined as incidence of adverse events and the effect of vaccination on PFAPA symptoms. All participants were seronegative and seroconverted at 1 month. One month after primary vaccination, 92.9% of PFAPA patients and 77.6% of the controls attained seroprotection, while the rates increased to 100% and 96.1%, respectively, 1 month after the second dose. Seroprotection rates remained adequate 1 year after completion of vaccination. In conclusion, two doses of the inactivated HAV vaccine are well-tolerated and effective in children with PFAPA.
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http://dx.doi.org/10.1111/ped.13719DOI Listing
January 2019

Risk Factors Associated With Accelerated Rubella IgG Antibody Loss in Previously Vaccinated, Treatment-Naive Patients With Juvenile Systemic Lupus Erythematosus: A Prospective Study.

Arthritis Rheumatol 2019 06 8;71(6):1022-1023. Epub 2019 Apr 8.

P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens, Athens, Greece.

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http://dx.doi.org/10.1002/art.40831DOI Listing
June 2019

Antibody status against measles in previously vaccinated childhood systemic lupus erythematosus patients: a prospective case-control study.

Rheumatology (Oxford) 2018 Aug;57(8):1491-1493

Infectious Diseases Unit, Second Department of Pediatrics, P. & A. Kyriakou Children's Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.

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http://dx.doi.org/10.1093/rheumatology/key142DOI Listing
August 2018

Immunogenicity and safety of the inactivated hepatitis A vaccine in children with juvenile idiopathic arthritis on methotrexate treatment: a matched case-control study.

Clin Exp Rheumatol 2017 Jul-Aug;35(4):711-715. Epub 2017 Jul 13.

Second Department of Paediatrics, P. & A. Kyriakou Children's Hospital, University of Athens, Greece.

Objectives: To describe the immunogenicity and side effects of immunisation against hepatitis A virus (HAV) in JIA patients on methotrexate treatment, who have not been previously exposed to HAV.

Methods: Case-control study performed in JIA patients and healthy controls matched on age and gender. The subjects received two doses of inactivated anti-HAV vaccine (720 mIU/ml) intramuscularly at 0 and 6 months. Seroconversion, seroprotection rates and anti-HAV-IgG titres were measured at 1, 7 and 18 months. Children were monitored for adverse events.

Results: 83 JIA patients and 76 controls were enrolled in the study. At one month, seroprotection rates were lower in children with, as compared to those without JIA (48.2% vs. 65%; p=0.05). At 7 and 18 months, rates of seroprotection rose significantly and were similar in both groups. The titre of anti-HAV-IgG was lower in children with JIA than healthy children at all time points (p<0.001). Vaccines were well tolerated.

Conclusions: Two doses of inactivated HAV vaccine were well tolerated and immunogenic in most immunosuppressed children with JIA; however, a single dose of HAV vaccine was insufficient to induce seroprotection in half of the patients. Further studies are required to analyse the long-term immunity against HAV in this population and optimal HAV immunisation regimen.
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August 2017

Decreased antibodies against hepatitis A in previously vaccinated treatment naïve juvenile SLE patients: a prospective case control study.

Clin Exp Rheumatol 2017 May-Jun;35(3):544-545. Epub 2017 Mar 8.

Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, University of Athens, Greece.

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August 2017

Congenital Cataracts, Facial Dysmorphism, and Neuropathy Syndrome: Additional Clinical Features.

Pediatr Neurol 2017 02 21;67:e5-e6. Epub 2016 Nov 21.

First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.pediatrneurol.2016.11.001DOI Listing
February 2017

The response to the inactivated Hepatitis A vaccine in children with autoinflammatory diseases: a prospective observational controlled study.

Rheumatology (Oxford) 2016 09 15;55(9):1705-6. Epub 2016 Jun 15.

Second Department of Paediatrics, P. & A. Kyriakou Children's Hospital, University of Athens, Athens, Greece.

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http://dx.doi.org/10.1093/rheumatology/kew239DOI Listing
September 2016

Weight gain in children on oxcarbazepine monotherapy.

Epilepsy Res 2016 May 16;122:110-3. Epub 2016 Mar 16.

Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece.

Background: Studies of the effect of oxcarbazepine (OXC) on body growth of children with epilepsy are rare and their results are controversial. To the contrary, many studies have shown significant weight gain following valproate (VPA) treatment.

Purpose: To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy.

Method: Fifty-nine otherwise healthy children, aged 3.7-15.9 years, with primary generalized, partial or partial with secondary generalization seizure disorder, were included in the study. Twenty six children were placed on OXC and thirty three on VPA monotherapy. Body weight (BW), height and body mass index (BMI) as well as their standard deviation scores (SDS), were evaluated prior to as well as 8 months post initiation of OXC or VPA therapy.

Results: Eight months post OXC-treatment, BW, SDS-BW, BMI and SDS-BMI increased significantly. The increase was similar to that observed in the VPA group. An additional 15.4% of children in the OXC group and 21.2% in the VPA group became overweight or obese. The effect of both OXC and VPA therapy on linear growth did not reach statistical significance.

Conclusion: Similarly to VPA, OXC monotherapy resulted in a significant weight gain in children with epilepsy. Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy.
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http://dx.doi.org/10.1016/j.eplepsyres.2016.03.004DOI Listing
May 2016

Plasma Folate, Vitamin B12 and Homocysteine Levels in Children with Solid Tumors at Diagnosis; Results from a Pediatric Referral Centre.

Indian J Pediatr 2016 May 14;83(5):483-4. Epub 2015 Sep 14.

Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, Medical School, Athens University, Athens, Greece.

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http://dx.doi.org/10.1007/s12098-015-1892-2DOI Listing
May 2016

Insertion of an extra copy of Xq22.2 into 1p36 results in functional duplication of the PLP1 gene in a girl with classical Pelizaeus-Merzbacher disease.

BMC Med Genet 2015 Sep 2;16:77. Epub 2015 Sep 2.

Inserm U1141, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Robert Debré, Paris, France.

Background: Pelizaeus-Merzbacher disease (PMD) is an X-linked dysmyelinating disorder characterized by nystagmus, hypotonia, ataxia, progressive spasticity, and cognitive decline. PMD classically results from a duplication of a genomic segment encompassing the entire PLP1 gene. Since the PLP1 gene is located in Xq22, PMD affects mostly boys.

Methods And Results: Here we report the case of a girl with typical PMD. Copy number analysis of the PLP1 locus revealed a duplication of the entire gene and FISH analysis showed that the extra copy of the PLP1 gene was actually inserted in chromosome 1p36. This insertion of an additional copy of PLP1 in an autosome led to a functional duplication irrespective of the X-inactivation pattern. Subsequent overexpression of PLP1 was the cause of the PMD phenotype observed in this girl. Further sequencing of the breakpoint junction revealed a microhomology and thus suggested a replication based mechanism (such as FoSTeS or MMBIR).

Conclusion: This case emphasizes the susceptibility of the PLP1 locus to complex rearrangement likely driven by the Xq22 local genomic architecture. In addition, careful consideration should be given to girls with classical PMD clinical features since they usually experience complex PLP1 genomic alteration with a distinct risk of inheritance.
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http://dx.doi.org/10.1186/s12881-015-0226-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557901PMC
September 2015

Pyoderma gangrenosum with systemic and pulmonary involvement in a toddler.

Pediatr Int 2015 Jun;57(3):505-6

Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, Medical School, Athens University, Athens, Greece.

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http://dx.doi.org/10.1111/ped.12648DOI Listing
June 2015

Postinfectious Rhabdomyolysis in a 5-Year-Old Boy: When to Look a Little Deeper.

Pediatr Emerg Care 2015 Dec;31(12):851-2

From the *Second Department of Pediatrics, University of Athens Medical School and †Department of Pediatric Neurology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece.

Unlabelled: We report on a 5-year-old boy with recurrent severe postinfectious rhabdomyolysis who, after systematic stepwise evaluation, was found to have the adult form of carnitine palmityl transferase II (CPT II) deficiency directly by blood mutation analysis. Timely diagnosis of CPT II deficiency in this case prevented further potentially devastating episodes of rhabdomyolysis by avoiding triggering factors.

Conclusion: Although most cases of rhabdomyolysis are nonrecurrent and benign, a metabolic myopathy, such as CPT II deficiency, should be suspected in children with episodic muscle necrosis and paroxysmal myoglobinuria.
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http://dx.doi.org/10.1097/PEC.0000000000000308DOI Listing
December 2015

Markedly decreased antibody titers against hepatitis B in previously immunised children presenting with juvenile idiopathic arthritis.

Clin Exp Rheumatol 2013 Nov-Dec;31(6):969-73. Epub 2013 Jun 26.

2nd Department of Academic Pediatrics, Medical Faculty, University of Athens, Athens, Greece.

Objectives: Hepatitis B is a vaccine preventable disease with intermediate endemicity in Greece. Patients with juvenile idiopathic arthritis (JIA) on immunomodulating therapy are prone to infection or reactivation of hepatitis B virus (HBV). The aim of this study is to define the immune status against HBV in children newly-diagnosed with JIA.

Methods: Case-control prospective study including 89 JIA patients and 89 controls matched for age and gender. Eighty-nine JIA patients were included in the study (22 males), with a mean age of 6.8 years. Sera were tested for hepatitis B surface antigen, hepatitis B core antibody, and anti-HBs. Patients with anti-HBs titers ≥10 IU/L were considered immune. Data were analysed with SPSS 18.0 version.

Results: In the JIA group 55% were HBV immune (anti-HBs level ≥10 IU/L) while in the control group 92% were immune against HBV (p<0.001). Antibody levels in the patient group were significantly lower compared to the control group. The mean concentration of anti-HBs levels in JIA patients was 18.3 IU/L versus 82.6 IU/L in the control group (p<0.001).

Conclusions: Antibody titers against HBV in fully vaccinated JIA patients due to start treatment are significantly lower compared to matched healthy children in this study. Diagnosis of JIA and older age were associated with the absence of protective antibodies. Although there is no evidence to support the introduction of a booster HBV dose in healthy children who mount low antibody response following immunisation, further studies are required to address this question in patients with JIA.
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March 2014

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

Pediatr Infect Dis J 2013 Sep;32(9):1023-4

From the *Second Department of Pediatrics, University of Athens Medical School, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece; †Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; and ‡Department of Pediatric Neurology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece.

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.
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http://dx.doi.org/10.1097/INF.0b013e318292bf72DOI Listing
September 2013

Bartonella henselae Infection: An Uncommon Mimicker of Autoimmune Disease.

Case Rep Pediatr 2013 17;2013:726826. Epub 2013 Jan 17.

Second Department of Academic Pediatrics, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece ; Department of Paediatrics, MITERA Childrens' Hospital, 15237 Athens, Greece.

We present a case of a seven-year-old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease. The patient presented with rash, biquotidian fever, night sweats, and arthralgias. There was no antecedent history of cat contact. Investigations showed increased inflammatory markers, leukocytosis, thrombocytosis, hypercalcemia, and raised angiotensin-converting enzyme. Interferon-gamma releasing assay for tuberculosis infection was negative. Abdominal imaging demonstrated multifocal lesions of the liver and spleen (later proved to be granulomata), chest X-ray showed enlarged hilar lymph nodes, and ophthalmology review revealed uveitis. Clinical, laboratory, and imaging features pointed towards sarcoidosis. Subsequently, raised titers (IgM 1 : 32, IgG 1 : 256) against Bartonella confirmed the diagnosis of B. henselae infection. She was treated with gentamycin followed by ciprofloxacin; repeat investigations showed complete resolution of findings. The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case, however, exhibited certain unusual findings such as the coexistence of acute ocular and systemic involvement in an immunocompetent host. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed on children with prolonged fever even in the absence of contact with cats in countries where bartonellosis is prevalent.
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http://dx.doi.org/10.1155/2013/726826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562603PMC
February 2013

Functional and behavioral outcome of bacterial meningitis in school-aged survivors.

Pediatr Int 2011 Jun;53(3):300-2

First Department of Pediatrics, Aghia Sofia Children's Hospital, University of Athens, Athens, Greece.

Background: Bacterial meningitis is a serious infection with high morbidity and a significant risk for neurological and functional sequelae. The purpose of this study was to assess children and teenagers with a history of bacterial meningitis for functional and behavioral problems.

Methods: Thirty children and teenagers who suffered bacterial meningitis beyond the age of 6 months were compared against 30 healthy controls for functional and behavioral problems. Both groups were assessed using the Child Behavior Checklist by Achenbach for abilities and behavioral problems.

Results: No significant difference was found between the two groups.

Conclusion: School-aged survivors of bacterial meningitis beyond the first 6 months of life have a very good prognosis with regards to competence and behavior.
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http://dx.doi.org/10.1111/j.1442-200X.2011.03387.xDOI Listing
June 2011

Williams syndrome with a "twist".

Case Rep Med 2010 16;2010:726845. Epub 2010 Jun 16.

Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1H 3JH, UK.

Williams syndrome is a rare genetic condition with multisystemic involvement, caused by a microscopic deletion in the chromosome band 7q11.23. We describe the first case of a toddler with Williams syndrome who developed Benign Paroxysmal Torticollis (BPT), a benign dystonic disorder of unknown aetiology.
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http://dx.doi.org/10.1155/2010/726845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892695PMC
July 2011

Too short stature, too many stigmata.

BMJ Case Rep 2010 Nov 18;2010. Epub 2010 Nov 18.

Second Department of Pediatrics, 'P&A Kyriakou' Children's Hospital, Athens University, Athens, Greece.

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.
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http://dx.doi.org/10.1136/bcr.06.2010.3087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028073PMC
November 2010

New GLUT-1 mutation in a child with treatment-resistant epilepsy.

Epilepsy Res 2009 Apr 23;84(2-3):254-6. Epub 2009 Feb 23.

Child Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, United States.

Mutations in the human glucose transporter type I (GLUT-1) gene may result in a phenotype of epilepsy, developmental delay, and movement abnormalities. We present a previously unreported mutation, c.1454 C>T (pPro485Leu) as a likely cause of intractable infantile-onset epilepsy and mild developmental delay in an 11-year-old girl. CSF:serum glucose ratio was 45%. She has had clinical improvement on a modified Atkins diet. Our patient helps further refine the phenotype of Glut-1 deficiency and reveals a new pathologic mutation.
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http://dx.doi.org/10.1016/j.eplepsyres.2009.01.004DOI Listing
April 2009

Intracranial hypertension in pediatric patients with acute lymphoblastic leukemia.

Pediatr Blood Cancer 2009 Mar;52(3):418-20

Department of Pediatric Neurology, St George's Hospital, London, UK.

Acute lymphoblastic leukemia (ALL) remains one of the most common malignancies of childhood. Between April 1999 and August 2004, 9 of 207 patients treated at a Tertiary Oncology Service for ALL presented with Intracranial Hypertension (IH). Seven of the patients met the diagnostic criteria for Idiopathic Intracranial Hypertension (IIH). Four of the patients were treated with cerebrospinal fluid (CSF) drainage alone and four required Acetazolamide. Two of the four patients who were treated with Acetazolamide required subsequently a lumbar-peritoneal (LP) shunt. One patient succumbed to his disease before receiving any specific treatment.
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http://dx.doi.org/10.1002/pbc.21861DOI Listing
March 2009

Lemierre's syndrome and defensive antibiotic prescribing tactics: lessons to be had.

Clin Pediatr (Phila) 2008 Jun;47(5):510-3

Royal Preston Hospital, Preston, Lancashire, UK.

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http://dx.doi.org/10.1177/0009922807311738DOI Listing
June 2008

Radiological follow-up of pediatric pneumonia: principle and practice.

Clin Pediatr (Phila) 2007 Mar;46(2):160-2

Royal Preston Hospital, Preston, Lancs, UK.

A study was undertaken to evaluate the trends in radiological follow up of childhood pneumonia among consultant pediatricians throughout the United Kingdom. A questionnaire was sent to 120 consultant pediatricians. Among the 88 respondents, 18% would carry out a repeat chest radiograph on follow-up of all their patients admitted with pneumonia, whereas 78% would perform the investigation selectively. Among the criteria for selection, persistence of symptoms and collapse or effusion were cited, although a considerable number would repeat a chest radiograph in children with lobar pneumonia. The mean timing of a repeat chest radiograph was 5.5 weeks after presentation (range 2-12 weeks). Only 23% of the respondents worked in units with written guidelines for the follow-up of children with pneumonia. Written guidelines, specifying the categories of children who would benefit from follow-up chest radiographs, should be present and implemented in all pediatric departments.
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http://dx.doi.org/10.1177/0009922806290055DOI Listing
March 2007