Publications by authors named "Kostas Priftis"

112 Publications

Study of Xbal and Pvull polymorphisms of estrogen receptor alpha (ERα) gene in girls with precocious/early puberty.

Endocrine 2021 May 4. Epub 2021 May 4.

Pediatric Endocrinology Unit, Third Department of Pediatrics, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Purpose: Studies examining association of estrogen receptor alpha (ERα) polymorphisms with early puberty are scarce and results are controversial; data in Caucasian girls are lacking. Main objective was to determine association of Xbal and Pvull polymorphisms of ERα gene in Greek girls with precocious/early puberty METHODS: We studied 107 girls with idiopathic precocious/early puberty and 81 young women with pubertal maturation within normal age (controls). Pubertal stage, height SDS (HSDS), and BMI z-score were determined in patients. In controls, height was measured and menarcheal age was self-reported. All participants in the study were genotyped for XbaI and PvuII polymorphisms of the ERα gene.

Results: There was no significant difference in XbaI and PvuII polymorphisms between patients and controls. Homozygous, xx and pp, girls had an earlier onset of puberty, although non-significant, than heterozygous or with no polymorphisms p = 0.9; in girls with pubertal onset <7 years, the association tended to become significant, p = 0.09. Girls with xxpp genotype were significantly taller, HSDS 1.63, p = 0.014. In controls, homozygosity for Xbal (xx) and PvuII (pp) was associated with significantly earlier menarche than in women with no polymorphism, p = 0.013 and p = 0.026, respectively, and xxpp genotype was associated with taller adult height, p = 0.017.

Conclusion: XbaI and PvuII polymorphisms are not related to idiopathic precocious/early puberty. Early pubertal girls homozygous for both polymorphisms presented earlier onset of puberty, although statistically non-significant, and taller height than girls heterozygous or without these polymorphisms. Homozygosity for both polymorphisms is associated with earlier menarche and taller adult height.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12020-021-02695-0DOI Listing
May 2021

Parental Education and the Association between Fruit and Vegetable Consumption and Asthma in Adolescents: The Greek Global Asthma Network (GAN) Study.

Children (Basel) 2021 Apr 16;8(4). Epub 2021 Apr 16.

Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Background: Evidence suggests that nutritional factors, such as consumption of fruits and vegetables, along with socioeconomic factors such as parental education level, are associated with asthma prevalence. Our study examined the role of parental education in the association between fruit and vegetable consumption and adolescent asthma.

Methods: 1934 adolescents (mean age: 12.7 years, standard deviation: 0.6 years, boys: 47.5%) and their parents were voluntarily enrolled and completed a validated questionnaire assessing current asthma status, fruit and vegetable consumption and parental educational level. Participants were categorized as high or low intake for five food groups: fruits, cooked vegetables, raw vegetables, all vegetables (cooked and raw), and all three food groups together (fruits and all vegetables).

Results: Adolescents who were high consumers of all three food groups (fruits, cooked and raw vegetables) were less likely to have asthma, adjusted for several confounders (adjusted odds ratio (aOR): 0.53, 95% confidence interval (CI): 0.25-0.97). Moreover, in adolescents who had parents with tertiary education and were in the high consumption of all three food groups, the inverse association was almost twofold higher than the one for adolescents with parents of primary/secondary education (aOR: 0.35, 95% CI: (0.21-0.89) and aOR: 0.61, 95% CI: (0.47-0.93) respectively).

Conclusions: Our findings highlight the importance of the adoption of a diet rich in fruits and vegetables for all asthmatic adolescents and emphasize the important role of parental influences in this association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/children8040304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071508PMC
April 2021

Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis.

J Clin Med 2020 Dec 11;9(12). Epub 2020 Dec 11.

Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5-16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9124009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764222PMC
December 2020

Tracheomalacia and bronchomalacia in children: response to the ERS statement.

Eur Respir J 2019 12 19;54(6). Epub 2019 Dec 19.

Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.02271-2019DOI Listing
December 2019

ERS statement on tracheomalacia and bronchomalacia in children.

Eur Respir J 2019 09 28;54(3). Epub 2019 Sep 28.

Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece.

Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.00382-2019DOI Listing
September 2019

A prospective study on the epidemiology and clinical significance of viral respiratory infections among pediatric oncology patients.

Pediatr Hematol Oncol 2019 Apr 19;36(3):173-186. Epub 2019 Jun 19.

a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece.

Respiratory infections in oncology are both common and potentially severe. However, there is still a gap in the literature, regarding the epidemiology of viral respiratory infections in children with cancer. We prospectively enrolled 224 patients, from September 2012 to August 2015. The cohort included children with hematologic or solid malignancies receiving chemotherapy, or undergoing hemopoietic stem cell transplantation, outpatients/inpatients exhibiting signs/symptoms of febrile/afebrile upper/lower respiratory infection. Viral infection was diagnosed by detection of ≥1 viruses from a sample at time of enrollment, using the CLART kit (GENOMICA, Spain). Α detailed questionnaire including demographics and medical history was also completed. Samples were processed in batches, results were communicated as soon as they became available. Children recruited in whom no virus was detected composed the no virus detected group. Viral prevalence was 38.4% in children presenting with respiratory illness. A single virus was found in 30.4%, with RSV being the most frequent. Viral coinfections were detected in 8%. Children with viral infection were more likely to be febrile upon enrollment and to present with lower respiratory signs/symptoms. They had longer duration of illness and they were more likely to receive antibiotics/antifungals. Only 22% of children with influenza received oseltamivir. Mortality was low (2.7%), however, pediatric intensive care unit (PICU) admission and death were correlated with virus detection. In our study mortality was low and PICU admission was related to virus identification. Further research is needed to clarify whether antibiotics in virus-proven infection are of value and underline the importance of oseltamivir's timely administration in influenza.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08880018.2019.1613462DOI Listing
April 2019

Effectiveness of an educational program for children and their families on asthma control treatment adherence.

J Asthma 2020 05 23;57(5):567-573. Epub 2019 Mar 23.

Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.

Τo investigate the effect of an asthma care educational program for children and adolescents with asthma, on adherence to asthma control treatment and on clinical indices. Individuals newly diagnosed with asthma, aged 4-16 years, randomized to the intervention and control group. The participants were monitored for 6 weeks. At baseline, before the initiation of inhaled corticosteroids/long-acting beta-agonist (ICS/LABA), the intervention group attended the educational program; the control group received the usual care. Both groups were equipped with electronic monitoring devices for measuring adherence. Spirometry, exhaled nitric oxide fraction (FeNO), and asthma control test (ACT) score were measured in both groups in the pre and post-ICS/LABA initiation visit. Seventy-eight participants were enrolled in this study ( = 39 to each group). Median percentage of adherence was 73% for the total sample, and 80% and 68% in intervention and control group, respectively ( < 0.001). In multivariate analysis, the program was positively associated with improved adherence ( < 0.001). ICS/LABA had a positive effect on spirometric indices, FeNO, and ACT score, whilst the educational program did not improved significantly the above variables. Establishing and increasing adherence is challenging. An asthma care educational program is associated with greater short-term adherence during a period of active monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02770903.2019.1585873DOI Listing
May 2020

Retrospective study identified fish and milk as the main culprits in cases of food protein-induced enterocolitis syndrome.

Acta Paediatr 2019 10 25;108(10):1901-1904. Epub 2019 Mar 25.

Allergology and Pulmonology Unit, 3rd Paediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Aim: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated food allergy, which is confined to the gastrointestinal tract and occurs most frequently in the first year of life. Our aim was to examine the clinical features, causative agents and outcomes of Greek children with FPIES.

Methods: This was a five-year (2013-2017) retrospective study, based on chart reviews of 78 children with FPIES from six Greek paediatric allergy centres.

Results: Only five children needed an oral food challenge (OFC) for diagnosis, but 54 children (69%) had OFCs to monitor tolerance development. The most common problems were fish and milk, which affected affecting 42 (54%) and 25 (35%) of children, respectively. The median age of tolerance based on the results of the negative OFCs occurred by 34.0 (26.6-58.4) months. Fish and milk were tolerated by 24 (57%) and 13 (52%) of children by 43.8 and 24.3 months, respectively. Coexisting IgE sensitisation to the offending food was related to delayed tolerance.

Conclusion: Fish and milk were the most common food allergies in our series of Greek children with FPIES. Cases with IgE sensitisation to the food trigger took longer to resolve their allergies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.14779DOI Listing
October 2019

Helical multi-detector CT scan as a tool for diagnosing tracheomalacia in children.

Pediatr Pulmonol 2019 01 28;54(1):47-52. Epub 2018 Nov 28.

Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background/aims: Tracheomalacia (TM) is not an unusual diagnosis in pediatric respiratory clinics. The aim of this study was to assess the accuracy of paired static end-inspiratory/end-expiratory helical multi-detector CT scan (MDCT) in detecting TM.

Methods: FB was performed in 28 children suspected of TM on the grounds of presence of recurrent episodes of vibrating cough and a need for more specific diagnostic information. Children diagnosed with flexible bronchoscopy (FB) as having TM were further investigated with MDCT. The cross-sectional area ratio of the trachea during end-expiration and end-inspiration, at the level of maximum end-expiration collapse (CSR), determined the basis for the MDCT diagnosis of TM. FB and MDCT were also performed in five children who suffered from mainly dry-but not honking, barking, or vibrating-cough for more than 3 months, and served as controls.

Results: The diagnosis of TM was established bronchoscopically in 26 out of 28 children. CRS was significantly smaller in patients (0.59 ± 0.14) compared with controls (0.85 ± 0.11) (P = 0.001). The optimal CSR cut-off point for TM diagnosis, as it was estimated by the ROC curve, was ≤0.705 (95%CI: ≤0.635-≤0.850) with a sensitivity 84.6% (95%CI: 65.1-95.6), and specificity 100.0% (95%CI: 47.8-100.0).

Conclusions: MDCT can effectively diagnose TM in the majority of children and can be used as an alternative to FB. In children, the established criterion of CSR ≤0.5 should be replaced by CSR ≤0.7 that seems to be a more appropriate threshold.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.24188DOI Listing
January 2019

Interventions on Adherence to Treatment in Children With Severe Asthma: A Systematic Review.

Front Pediatr 2018 21;6:232. Epub 2018 Aug 21.

Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.

Poor adherence to inhaled medication is a commonly encountered problem among children with asthma. However, there is a relatively paucity of data regarding the adherence of children with severe asthma, as well as the merit of any interventions to improve this adherence. The aim of this systematic review was to identify the available literature on the rate of adherence and the influence of interventions in improving adherence to controller inhaled medication, in children with severe asthma. A systematic literature search was performed in MEDLINE/PubMed, Cochrane Library, and Scopus databases. Studies were included in the present review if their target population were children and/or adolescents with severe asthma and presented data on medication adherence before and after a given intervention. A total of seven studies, conducted in USA, Canada, and UK, and published between 2012 and 2018, met the inclusion criteria. Adherence to controller medication was assessed via either objective or subjective measures (questionnaires), or a combination of them. Interventions included communication during pediatric visits and audio-taped medical visits, individualized care programs, electronic monitoring devices, interactive website and peak-flow prediction with feedback. Adherence rates for the baseline (before intervention) or for the control groups ranged from 28 to 67%. In general, there was a significant improvement of adherence after intervention with rates increasing to 49-81%. Adherence rate in children with severe asthma is not satisfactory but it can be improved after proper interventions. Nevertheless, the heterogeneity among adherence assessment tools, and the variety of interventions, in combination with the lack of studies focusing on severe asthma, highlight the need for further research in this field.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fped.2018.00232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110874PMC
August 2018

Adherence to the Mediterranean diet and inflammatory markers in children with asthma.

Allergol Immunopathol (Madr) 2019 May - Jun;47(3):209-213. Epub 2018 Jul 3.

Children's Respiratory and Allergy Clinic, 3(rd) Dept of Paediatrics, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Athens, Greece.

Introduction: There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes associated with asthma.

Methods: We measured serum IL-4, IL-33, and IL-17, in 44 asthmatic and 26 healthy children, 5-15 years old. Their adherence to MD was estimated with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) score.

Results: KIDMED score did not differ between the two groups (P=0.59) and was not correlated with any of the three measured cytokines. However, when the analysis was restricted only to asthmatic children, the KIDMED score was correlated with IL-4, IL-33, and IL-17 (Beta: -0.56, P=0.007; Beta: 0.57, P=0.010; Beta: -0.62, P=0.017, respectively).

Conclusion: Our results indicate that MD can modulate the production of some of the main inflammatory mediators of asthma, in asthmatic children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.aller.2018.04.007DOI Listing
August 2019

Editorial: The Parallel March of Asthma and Allergy in Childhood: A Multi-Perspective Approach.

Front Pediatr 2018 9;6:135. Epub 2018 May 9.

Pediatric Allergy and Pulmonology Units, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca Bio-health Research Institute, University of Murcia, Murcia, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fped.2018.00135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954088PMC
May 2018

Key paediatric messages from the 2017 European Respiratory Society International Congress.

ERJ Open Res 2018 Apr 25;4(2). Epub 2018 May 25.

Dept of Paediatrics, Sapienza University of Rome, Rome, Italy.

In this article, the group chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting findings presented at the 2017 ERS International Congress, which was held in Milan, Italy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00165-2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968195PMC
April 2018

ERS statement: interventional bronchoscopy in children.

Eur Respir J 2017 Dec 14;50(6). Epub 2017 Dec 14.

Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy

Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.00901-2017DOI Listing
December 2017

Prenatal Maternal Stress and the Risk of Asthma in Children.

Front Pediatr 2017 20;5:202. Epub 2017 Sep 20.

3rd Department of Pediatrics, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Emerging evidence indicate that maternal prenatal stress (MPS) can result in a range of long-term adverse effects in the offspring. The underlying mechanism of MPS is not fully understood. However, its complexity is emphasized by the number of purportedly involved pathways namely, placental deregulated metabolism of maternal steroids, impaired maturation of fetal HPA axis, imbalanced efflux of commensal bacteria across the placenta, and skewed immune development toward Th2. Fetal programming probably exerts a pivotal role in the end result of the above pathways through the modulation of gene expression. In this review, we highlight the current knowledge from epidemiological and experimental studies regarding the effects of MPS on asthma development in the offspring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fped.2017.00202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611367PMC
September 2017

Pediatric flexible and rigid bronchoscopy in European centers-Availability and current practice.

Pediatr Pulmonol 2017 Nov 14;52(11):1502-1508. Epub 2017 Sep 14.

Pediatric Department, Charles University Prague and University Hospital Motol, Prague, Czech Republic.

Aim: Eighteen years have passed since the last European survey concerning practices in pediatric bronchoscopy was conducted. Therefore, members of the European Respiratory Society (ERS) Pediatric Bronchology Group 7.7, initiated the "European Pediatric Bronchoscopy Survey 2015," which aimed to assess the current state of this evolving diagnostic and therapeutic procedure in the field of pediatric respiratory medicine.

Method: A questionnaire was sent to national representatives of 44 European countries with the request to distribute it to all centers performing pediatric bronchoscopies. Questions concerned the following areas of interest: number of procedures, personnel and technical equipment, indications, complications, anesthesia, and diagnostic possibilities.

Results: In total, 198 European centers from 33 European countries participated in the survey. From 2012 to 2014 a total of 57 145 bronchoscopies were reported. Both flexible and rigid techniques were available at most of the centers. The most frequently mentioned indications were suspected aspiration, infection, radiographic abnormalities, airway obstruction, and cough. Hypoxemia, airway obstruction, and cough were the most common complications mentioned, followed by airway hemorrhage. Most centers were able to perform bronchoalveolar lavage (BAL) and endobronchial biopsies and some performed more special procedures, such as transbronchial biopsies. Interventions like balloon dilation, laser procedures, or stent placement were less common and rarely available.

Conclusion: Compared to the 1997 survey, our results suggest that pediatric bronchoscopy has become more widely available and established in Europe. Different practices in individual countries suggest that more effort should be put on standardizing bronchoscopic procedures across Europe.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.23823DOI Listing
November 2017

Prenatal Stress Enhances Susceptibility to Allergic Diseases of Offspring.

Endocr Metab Immune Disord Drug Targets 2017 Nov;17(4):255-263

Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, "Attikon" Hospital, University of Athens School of Medicine, Athens, Greece.

Background And Objectives: Maternal prenatal stress (MPS) may result in a range of longterm consequences in the offspring among which there is susceptibility to allergic diseases. This review presents the current knowledge on the pathways through which MPS may affect the fetus, and the existing evidence regarding the association between MPS and development of allergy in the offspring.

Result And Discussion: A pivotal mediator triggered in response to stress is the release of glucocorticoids (GC). GC may affect gene expression through binding to GC receptors, thus affecting fetal development in general, and allergic vulnerability in particular. A series of recent findings also indicate that MPS may affect the fetus programming of immune functions and lead to vulnerability of the immune system. MPS may hinder the gradual process in the offspring's cytokine production towards a Th1 type immune response. Prenatal factors may also influence the intrauterine microbiome and thereby the maternal bacteria transferred into the fetal gastrointestinal tract. The imbalances of intestinal microbiota in infancy could result in deviations in the development of systemic immune function, predisposing to allergic sensitization. Epidemiological studies in humans also suggest that there is an association of MPS and allergic vulnerability of the offspring.

Conclusion: Although the existing evidence support a relationship of MPS with allergic predisposition of the offspring, further studies are needed to elucidate whether the association is dependent on the type of stress and whether it involves any type of allergic predisposition or not.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871530317666170912160646DOI Listing
November 2017

ERS statement on protracted bacterial bronchitis in children.

Eur Respir J 2017 08 24;50(2). Epub 2017 Aug 24.

School of Pediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Subiaco, Australia.

This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.02139-2016DOI Listing
August 2017

Role of vitamin D in cystic fibrosis and non-cystic fibrosis bronchiectasis.

World J Clin Pediatr 2017 Aug 8;6(3):132-142. Epub 2017 Aug 8.

Maria Moustaki, Ioanna Loukou, Cystic Fibrosis Unit, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece.

Bronchiectasis is usually classified as cystic fibrosis (CF) related or CF unrelated (non-CF); the latter is not considered an orphan disease any more, even in developed countries. Irrespective of the underlying etiology, bronchiectasis is the result of interaction between host, pathogens, and environment. Vitamin D is known to be involved in a wide spectrum of significant immunomodulatory effects such as down-regulation of pro-inflammatory cytokines and chemokines. Respiratory epithelial cells constitutively express 1α-hydroxylase leading to the local transformation of the inactive 25(OH)-vitamin D to the active 1,25(OH)-vitamin D. The latter through its autocrine and paracrine functions up-regulates vitamin D dependent genes with important consequences in the local immunity of lungs. Despite the scarcity of direct evidence on the involvement of vitamin D deficiency states in the development of bronchiectasis in either CF or non-CF patients, it is reasonable to postulate that vitamin D may play some role in the pathogenesis of lung diseases and especially bronchiectasis. The potential contribution of vitamin D deficiency in the process of bronchiectasis is of particular clinical importance, taking into consideration the increasing prevalence of vitamin D deficiency worldwide and the significant morbidity of bronchiectasis. Given the well-established association of vitamin D deficiency with increased inflammation, and the indicative evidence for harmful consequences in lungs, it is intriguing to speculate that the administration of vitamin D supplementation could be a reasonable and cost effective supplementary therapeutic approach for children with non-CF bronchiectasis. Regarding CF patients, maybe in the future as more data become available, we have to re-evaluate our policy on the most appropriate dosage scheme for vitamin D.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5409/wjcp.v6.i3.132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547424PMC
August 2017

An obesity-preventive lifestyle score is negatively associated with pediatric asthma.

Eur J Nutr 2018 Jun 9;57(4):1605-1613. Epub 2017 Apr 9.

Pediatric Allergy and Pulmonology Units, Third Department of Pediatrics, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece.

Purpose: Lifestyle (diet and physical activity) may increase asthma risk, but evidence in this area is lacking. The aims of the present study were to calculate an obesity-preventive lifestyle score comprising of eating and physical activity behaviors and investigate the overall effect of lifestyle on asthma in children.

Methods: A cross-sectional case-control study was carried out in 514 children (217 asthma cases and 297 healthy controls). Data were collected on medical history, anthropometry, dietary intake, and physical activity. We constructed an overweight/obesity-preventive score (OPLS) using study-specific quartile rankings for nine target lifestyle behaviors that were either favorable or unfavorable in preventing obesity (i.e., screen time was an unfavorable lifestyle behavior). The score was developed using the recommendations of the Expert Committee of American Academy of Pediatrics. Score values ranged from 0-18 points; the higher the score, the more protective against high body weight.

Results: The OPLS was negatively associated with obesity indices (BMI, waist circumference, and hip circumference), (p < 0.05). Control children had a higher score when compared to asthma cases (9.3 ± 2.7 vs. 8.6 ± 2.9, p = 0.007). A high OPLS was protective against physician-diagnosed asthma (OR 0.92; 95% CI 0.86-0.98, p = 0.014), adjusted for several confounders. The OPLS was no longer protective after adjustment for BMI.

Conclusion: Higher adherence to an obesity-preventive lifestyle score-consistent with several behaviors for the prevention of childhood overweight/obesity-is negatively associated with obesity indices and lowers the odds for asthma in children. Lifestyle behaviors that contribute to a higher body weight may contribute to the obesity-asthma link. These findings are hypothesis-generating and warrant further investigation in prospective intervention studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00394-017-1446-7DOI Listing
June 2018

Food Protein Induced Proctocolitis: A Benign Condition with an Obscure Immunologic Mechanism.

Endocr Metab Immune Disord Drug Targets 2017 ;17(1):32-37

Paediatric Allergy and Pulmonology Units Third Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.

Food protein-induced proctocolitis (FPIP) is the most common colonic manifestation of food allergy in infants, accounting for up to 60% of exclusively breast-fed children. The causative foods derived from the mother's diet, which are then excreted in her milk. The suggested risk factors for the development of FPIP are an immature immune system, altered intestinal permeability and other factors that activate local immune function, such as genetic susceptibility in combination with particularly sensitizing foods. FPIP is an enhanced immune responsiveness of some infants to very small amounts of food antigens, inducing an inflammatory mucosal response, mediated by T cells.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871530316666170331165356DOI Listing
April 2018

Key paediatric messages from the 2016 European Respiratory Society International Congress.

ERJ Open Res 2017 Jan 17;3(1). Epub 2017 Jan 17.

Dept of Paediatrics, Sapienza University of Rome, Rome, Italy.

In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00127-2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279069PMC
January 2017

Key paediatric messages from Amsterdam.

ERJ Open Res 2016 Apr 29;2(2). Epub 2016 Apr 29.

Dipartimento di Pediatria e Neuropsichiatria Infantile, Ospedale Policlinico Umberto I, Rome, Italy.

The Paediatric Assembly of the European Respiratory Society (ERS) maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly's Groups highlight the key messages from the abstracts presented at the Congress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00020-2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005169PMC
April 2016

OC36 - Diagnostic approach of primary cilia dyskinesia: Greek experience.

Nurs Child Young People 2016 May;28(4):79-80

3rd Dept of Paediatrics, 'Attikon' Hospital, Greece.

Unlabelled: Theme: Complex health care and chronic disease management.

Introduction: Primary Cilia Dyskinesia (PCD) is a rare, genetically heterogeneous disease that causes chronic pulmonary inflammation and progressive loss of lung function due to the dysfunction of cilia.

Aim: To present the Greek experience in development and implementation of standardized operational procedures (SOP) in diagnostic testing of PCD.

Methods: After special training, SOP consisting of nasal NO (nNO) measurement, high speed videomicroscopy (HVM), transmission electron microscopy (TEM) and shipment of the sample for high resolution immunofluorescence (IF) microscopy in difficult cases, were applied.

Results: From September 2014 until December 2015 197 tests were performed to 147 suspected patients. 17 patients were finally diagnosed with PCD.

Conclusions: PCD is a rare disease that can be diagnosed through SOP. Early diagnosis and appropriate treatment of PCD will reduce not only the morbidity and mortality to patients, but also the burden of healthcare costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7748/ncyp.28.4.79.s67DOI Listing
May 2016

Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings.

BMJ Open Respir Res 2016 28;3(1):e000136. Epub 2016 Apr 28.

Section of Respirology, Dept of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba , Canada.

Background: The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes.

Methods: Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds.

Results: The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine.

Conclusions: Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjresp-2016-000136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854017PMC
May 2016

An international registry for primary ciliary dyskinesia.

Eur Respir J 2016 Mar 8;47(3):849-59. Epub 2015 Dec 8.

Dept of General Paediatrics, Paediatric Pulmonology Unit, University Children's Hospital Muenster, Münster, Germany.

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder leading to chronic upper and lower airway disease. Fundamental data on epidemiology, clinical presentation, course and treatment strategies are lacking in PCD. We have established an international PCD registry to realise an unmet need for an international platform to systematically collect data on incidence, clinical presentation, treatment and disease course.The registry was launched in January 2014. We used internet technology to ensure easy online access using a web browser under www.pcdregistry.eu. Data from 201 patients have been collected so far. The database is comprised of a basic data form including demographic and diagnostic information, and visit forms designed to monitor the disease course.To establish a definite PCD diagnosis, we used strict diagnostic criteria, which required two to three diagnostic methods in addition to classical clinical symptoms. Preliminary analysis of lung function data demonstrated a mean annual decline of percentage predicted forced expiratory volume in 1 s of 0.59% (95% CI 0.98-0.22).Here, we present the development of an international PCD registry as a new promising tool to advance the understanding of this rare disorder, to recruit candidates for research studies and ultimately to improve PCD care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.00776-2015DOI Listing
March 2016

Towards the standardisation of lung sound nomenclature.

Eur Respir J 2016 Mar 2;47(3):724-32. Epub 2015 Dec 2.

Children's Respiratory and Allergy Unit, Third Dept of Paediatrics, "Attikon" Hospital, University of Athens Medical School, Athens, Greece.

Auscultation of the lung remains an essential part of physical examination even though its limitations, particularly with regard to communicating subjective findings, are well recognised. The European Respiratory Society (ERS) Task Force on Respiratory Sounds was established to build a reference collection of audiovisual recordings of lung sounds that should aid in the standardisation of nomenclature. Five centres contributed recordings from paediatric and adult subjects. Based on pre-defined quality criteria, 20 of these recordings were selected to form the initial reference collection. All recordings were assessed by six observers and their agreement on classification, using currently recommended nomenclature, was noted for each case. Acoustical analysis was added as supplementary information. The audiovisual recordings and related data can be accessed online in the ERS e-learning resources. The Task Force also investigated the current nomenclature to describe lung sounds in 29 languages in 33 European countries. Recommendations for terminology in this report take into account the results from this survey.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.01132-2015DOI Listing
March 2016

Many children aged two to five years have a persistent presence of respiratory viruses in their nasopharynx.

Acta Paediatr 2016 Feb 8;105(2):e89-92. Epub 2015 Dec 8.

Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, University General Hospital 'Attikon', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.13259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159633PMC
February 2016

Blunted perception of dyspnea in asthmatic children: A potential misleading criterion.

World J Clin Pediatr 2015 Aug 8;4(3):38-40. Epub 2015 Aug 8.

Konstantinos Douros, Barbara Boutopoulou, Kostas N Priftis, 3 Department of Pediatrics, "Attikon" Hospital, University of Athens School of Medicine, 12462 Athens, Greece.

Dyspnea (or breathlessness) is a symptom describing a perceived experience of breathing discomfort. Children's awareness of dyspnea is variable and there is only a poor correlation between the objective respiratory distress measurements and the subjectively awareness of dyspnea. Those who do not perceive dyspnea may not be motivated to comply with their daily prophylactic treatment. Since dyspnea is the main symptom of asthma, and disease management is based largely on the description of symptoms between clinic visits, unreliable symptom report may mislead decision-making for long-term treatment of asthma. Thus, therapeutic decisions should not be taken solely on patients' perception and description of dyspnea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5409/wjcp.v4.i3.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526836PMC
August 2015