Παιδιατρική | Τόμος 77 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος - Μάρτιος 2014

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  • 1Volume 77 | Number 1 Volume 77 | Number 1 January-February-March 2014January-February-March 2014

    www.e-child.gr

    77 | 1 77 | 1 -- 2014-- 2014

    PaediatrikiJ o u r n a l o f t h e G r e e k P a e d i a t r i c S o c i e t y

  • 2

    - . , . , . , .

    : ,

    - : , , & .

    - (GIS) . , , , - , ,

    A , , , , , ,

    G212A , , , --, , -, -

    IRF4 , , , , ,

    , , , , , , ,

    - Duchenne , , , , ,

    e-mail: grammateia@e-child.gr

    :http://e-child.gr/publications/instructions-to-authors

    IE E 15,15451, . T.: 2107771140e-mail: grammateia@e-child.gr

    E : 40E, : 20

    E E

    77 1 -- 2014

    .

    . .

    M. . . . . . . K-. . -. . . . -. -

    10

    06

    24

    36

    44

    58

    70

    82

    90

    102

  • 3SHORT ABSTRACT

    REVIEW ARTICLESImmunoparalysis a serious entity in critically ill in PICUA. Tsialla, E. Nikaina, M. Charisi, L. Sianidou

    Children of assisted reproduction: from the side of the child psychiatristLazaratou Helen, Rapti Konstantina.

    Attention Deficit-Hyperactivity disorder: characteristics, causes, diagnosis and treatment. A bibliographical reviewTsakoumis Georgios

    EPIDEMIOLOGICAL STUDIESChildhood obesity investigation with geographical mapping information systems (GIS) in Lamia areaBarbouni Anastasia, Apostolara Paraskevi, Kalogirou Sofia, Barbouni Dimitra, Panagiotopoulou Amalia, Merakou Kyriakoula

    Non-Invasive Mechanical Ventilation in severe bronchiolitisAnargyroula Prezerakou, leoniki Papazoglou, ristea Patsoura, Fotini Zafeiro-poulou, Filippia Nikolaou, Patritcia Bonos, John Papadatos

    ORIGINAL ARTICLESSerum apelin levels in obese children and adolescents and their association to the G212A polymorphism of the apelin receptor geneEleni Kotanidou, Kalirhoe Kalinderi, Smaragda Efraimidou, Eufimia Papadopou-lou-Alataki, Liana Fidani, Maria Eboriadou-Petikopoulou, Assimina Galli-Tsinop-oulou

    Expression of IRF4 gene in healthy children and in children with leukemiaMaria Adamaki, Archontis Zampogiannis, Anastasia Athanasiadou, Marianna Tzanoudaki, Spyros vlachopoulos, Maria Moschovi

    Quality of life in children and adolescents with different stages of chronic kidney diseaseJohn Dotis, Nikoleta Printza, Chrysa Gkogka, Stella Stabouli, Stamatia Antoniou, Antigoni Pavlaki, Nick Kontodimopoulos, Fotios Papachristou

    Skeletal status and bone metabolism of disabled adolescents with Duch-ennes muscular dystrophyArtemis Doulgeraki, Helen Athanasopoulou, Marina Katsalouli, Konstantinos Skiadas, Domna Deligianni, Ioannis Monopolis

    Trimonthly publication of the Greek Paediatric Society

    PaediatrikiVolume 76 Number 1 January-February-March 2014

    PresidentA. Constantopoulos

    Editorial board

    DirectorG. S. Varlamis

    MembersS. AndronikouE. GalanakisA. EvangeliouL. ThomaidouM. KanariouA. KapogiannisS. Kitsiou-TzeliE. MantadakisP. Panagiotopoulou-GartaganiA. PapadopoulouV. PapaevagelouA. PapathanassiouA. Siamopoulou-MavridouA. Syrigou-Papavasiliou

    Manuscript submissione-mail: grammateia@e-child.gr

    Instructions to authors:http://e-child.gr/publications/instructions-to-authors

    OwnerGreek Paediatric Society15, Mpakopoulou st.GR - 15451, . PsychikoTel.: +302107771140e-mail: grammateia@e-child.gr

    Annual subscriptionAll foreign countries: US$50

    CONTENTS

    10

    06

    24

    36

    44

    58

    70

    82

    90

    102

  • 4 e-mail: grammateia@e-child.gr

    :http://e-child.gr/publications/instructions-to-authors

    IE E 15,15451, . T.: 2107771140e-mail: grammateia@e-child.gr

    E : 40E, : 20

    E E

    77 1 -- 2014

    .

    . .

    M. . . . . . . K-. . -. . . . -. -

    108

    122

    O . , , , , ,

  • 5108

    122

    Trimonthly publication of the Greek Paediatric Society

    PaediatrikiPresidentA. Constantopoulos

    Editorial board

    DirectorG. S. Varlamis

    MembersS. AndronikouE. GalanakisA. EvangeliouL. ThomaidouM. KanariouA. KapogiannisS. Kitsiou-TzeliE. MantadakisP. Panagiotopoulou-GartaganiA. PapadopoulouV. PapaevagelouA. PapathanassiouA. Siamopoulou-MavridouA. Syrigou-Papavasiliou

    Manuscript submissione-mail: grammateia@e-child.gr

    Instructions to authors:http://e-child.gr/publications/instructions-to-authors

    OwnerGreek Paediatric Society15, Mpakopoulou st.GR - 15451, . PsychikoTel.: +302107771140e-mail: grammateia@e-child.gr

    Annual subscriptionAll foreign countries: US$50

    CONTENTS

    CASE REPORTSAcute Necrotizing Encephalopathy of childhood. Two case reports and re-view of the literature Prezerakou Anargyroula, Grigorakou Maria nastasia, Kyriakoulis Costas, Baba-nelou Aikaterini, Matrogianni Sotiria, Vasilopoulos Athanasios

    OBITUARY

    Volume 76 Number 1 January-February-March 2014

  • 6

    . , . , . , . . - .

    A. Tsialla, E. Nikaina, M. Charisi, L. Sianidou. Immunoparalysis a serious entity in criti-cally ill in PICU

    . HLA-DR ex vivo TNF-, . , HLA-DR ex vivo TNF- . .

    , . : .

    Lazaratou Helen, Rapti Konstantina. Children of assisted reproduction: from the side of the child psychiatrist.

    . . . - : , , & .

    Tsakoumis Georgios. Attention Deficit-Hyperactivity disorder: characteristics, causes, di-agnosis and treatment. A bibliographical review.

    . 3-5% , 2-3 , . , , .

    , , , , , . (GIS) . .

    Barbouni Anastasia, Apostolara Paraskevi, Kalogirou Sofia, Barbouni Dimitra, Panagio-topoulou Amalia, Merakou Kyriakoula. Childhood obesity investigation with geographi-cal mapping information systems (GIS) in Lamia area.

    940 (GIS)

  • 7 . (GIS) .

    A , , , , , , . .

    Anargyroula Prezerakou, leoniki Papazoglou, ristea Patsoura, Fotini Zafeiropoulou, Filippia Nikolaou, Patritcia Bonos, John Papadatos. Non-Invasive Mechanical Ventilation in severe bronchiolitis.

    , , , .

    , , , -, , -, -. G212A .

    Eleni Kotanidou, Kalirhoe Kalinderi, Smaragda Efraimidou, Eufimia Papadopoulou-Al-ataki, Liana Fidani, Maria Eboriadou-Petikopoulou, Assimina Galli-Tsinopoulou. Serum apelin levels in obese children and adolescents and their association to the G212A poly-morphism of the apelin receptor gene.

    . . . , G212A , GA/GG .

    , , , , , . IRF4 .

    Maria Adamaki, Archontis Zampogiannis, Anastasia Athanasiadou, Marianna Tzanouda-ki, Spyros vlachopoulos, Maria Moschovi. Expression of IRF4 gene in healthy children and in children with leukemia.

    Interferon Regu-latory Factor 4 . IRF4, .

    SHORT ABSTRACTS

  • 8 .

    , , , , , , , . .

    John Dotis, Nikoleta Printza, Chrysa Gkogka, Stella Stabouli, Stamatia Antoniou, Anti-goni Pavlaki, Nick Kontodimopoulos, Fotios Papachristou. Quality of life in children and adolescents with different stages of chronic kidney disease.

    . . , .

    , , , , , . Duchenne.

    Artemis Doulgeraki, Helen Athanasopoulou, Marina Katsalouli, Konstantinos Skiadas, Domna Deligianni, Ioannis Monopolis. Skeletal status and bone metabolism of disabled adolescents with Duchennes muscular dystrophy.

    11 Duchenne . Duchenne. D, .

    , , , , , . O . .

    Prezerakou Anargyroula, Grigorakou Maria nastasia, Kyriakoulis Costas, Babanelou Ai-katerini, Matrogianni Sotiria, Vasilopoulos Athanasios. Acute Necrotizing Encephalopa-thy of childhood. Two case reports and review of the literature.

    2 , , .

    -

  • 9SHORT ABSTRACTS

  • 10

    . . . , .. ,

    . , .. ,

    A. TsiallaE. NikainaL. SianidouPICU Pentelis Children Hospital, Athens

    M. CharisiFirst Paediatric Department Pentelis Children Hospital, Athens

    -

    . , . , . , .

    - - . H - . - HLA-DR ex vivo TNF-, . , HLA-DR ex vivo TNF- . . . .

    : , , HLA-DR, TNF-, , -

    Immunoparalysis a serious entity in critically ill in PICU

    A. Tsialla, E. Nikaina, M. Charisi, L. Sianidou

    Proper immunologic balance between pro- and anti-inflammatory forces is neces-sary for recovery from critical illness. Persistence of a marked compensatory anti-in-flammatory innate immune response following an insult such as sepsis or trauma is termed immunoparalysis. This state of acquired immunodeficiency can be quantified through the measurement of monocyte cell-surface HLA-DR expression or through analysis of the capacity of whole blood to produce TNF- upon ex vivo stimulation with endotoxin. Critically ill patients demonstrating prolonged, severe reductions in monocyte HLA-DR expression or ex vivo TNF- production are at high risk for the development of nosocomial infection and death. Reversal of immunoparalysis can be accomplished through the administration of immunostimulatory agents or taper-ing of exogenous immunosuppression. Intriguing evidence suggests that this may be associated with improved clinical outcomes. Immune monitoring protocols are needed to identify patients who may benefit from immunomodulatory trials in the pediatric intensive care unit.

    Key words: Immunoparalysis; monocyte; HLA-DR; TNF-; mortality; nosocomial in-fection

    A B S T R A C T

  • 11

    , . 15236, e-mail: alexandra_tsialla@yahoo.gr

    CorrespondenceAlexandra TsiallaPalaia Penteli, 15236e-mail: alexandra_tsialla@yahoo.gr

    , , . ( ) ( , , ). , . . , / . / - [1,2]. , .

    , / / . / - . . , , . . . , . . , / C3 , (3,4) ( 1).

    REVIEW ARTICLES

    1

    . , HLA-DR ; o TNF-. HLA-DR TNF-

  • 12

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    , . , , , - . . - . (LPS) LPS .

    / , . . , . -: CD4 ( 70% ) / CD8+ ( 30%) / . , CD4 CD8 , . , (, ). , . , (MHC/HLA). /MHC CD4+ (HLA DR/ MHC) . (MHC Class I) CD8+. . - . , , , , , . , CD4+ : H1, TH2, (reg). , - TH1 . , (IFN ) . , .

  • 13

    (, ). H2 , , ( IL-10 TGF-) . reg CD4+ . , CD25 Foxp3 , (TGF-) (IL 10)[5]. , . , , , . . .

    SIRS ( , , ). . . . (SIRS Systemic Inflammatory Response Syndrome) ( 1)[6].

    HLA-DR:

    TNF-: tumor necrosis factor-aex vivo:

    SIRS: Systemic Inflammatory Re-sponse Syndrome -

    LPS: -

    CARS: Compensatory Anti-in-flammatory Response Syndrome -

    MODS: Multiple organ dysfunc-tion syndrome -

    GM-CSF: Granulocyte- mac-rophage colony stimulating factor

    rhGM-CSF: Recombinant Human GM-CSF - GM-CSF

    G-CSF: Granulocyte colony - stimulating factor

    VAP: Ventilator associated pneu-monia -

    1: SIRS

    38,5C

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    (12109 cells/L) >10%

  • 14

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    HLA-DR/ MHC . HLA-DR . HLA- DR . HLA-DR CD14+ , HLA-DR ( %). HLA-DR

  • 15

    , ex vivo LPS. TNF- LPS, [7,8]. ex vivo . , LPS, , TNF- . , TNF-

  • 16

    Y

    . Le Tulzo et al 48 HLA-DR 6 [17]. . , Volk et al , [18]. [19,20]. . Westendorp et al , 1997, ex vivo LPS- 190 [21]. TNF- IL-10 ex vivo LPS , , - .

    . . 1986, Polk et al 20 - [10]. HLA-DR . HLA-DR CARS . HLA-DR . Majetschak et al 1999 TNF- [22]. TNF- 90 . TNF-.

    . . 1990, Volk et HLA-DR 247 [23]. HLA-DR

  • 17

    Monneret et al 2006, HLA-DR , 93 shock [25]. HLA-DR >30% , ( 3).

    3

    HLA-DR . 86 shock HLA-DR 1-2 . 3-4 HLA-DR .*p < 0.001 (Mann Whitney test). Data represent median (25th 75th %). Data from Monneret G, Lepape A, Voirin N, et al. Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock. Intensive Care Med. Aug 2006;32(8):11751183

    Lukaszewicz et al, 2005 913 . HLA-DR . HLA-DR

  • 18

    [27]. HLA-DR SIRS . HLA-DR - , - , . 36 2006 [28]. ex vivo LPS IL-10. IL-10 . ex vivo TNF- , .

    V. . [29], . (, ) TH2 [30]. 1990, Settmacher et al HLA-DR [31]. , HLA-DR 30%. , Reinke et al 45 - [32]. 90% (30/33). , 8% (01/12) . Hoffman et al 13 HLA-DR [33]. >30% . HLA-DR .

    in vitro -IL-10 - [28], IL-12 [34], GM-CSF [23,34,35] flt3-ligand [36]. O Hershman et al 1989 HLA-DR ex vivo TH1 IFN- [37]. ex vivo GM-CSF - Flohe et al 2003 [38].

    Y

  • 19

    16 , . , GM-CSF . HLA-DR ex vivo LPS- TNF-. GM-CSF TNF- , , HLA-DR . GM-CSF , , MODS. MODS ( ) GM-CSF. , Lendemans et al ex vivo IFN- GM-CSF HLA-DR LPS [39]. . 1997 Kox et al HLA-DR ex vivo TNF- IFN-, 100 g HLA-DR >50% [40]. HLA-DR . ( 28 ) , , 40%. 88% Volk et [41]. 2002 Nakos et al IFN- 21 HLA-DR (BAL) [42]. 100 g IFN- . , IFN- HLA-DR , IL-1...

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