Athanassios Chatzimichael

Democritus University of Thrace, Komotina, East Macedonia and Thrace, Greece

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Publications (34)40.61 Total impact

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    ABSTRACT: Between late May and July 2012, 105 children (62 boys) originating from two cities of Thrace were examined because of fever, headache, and abdominal pain. Thirty-three of them were hospitalized. They had normal hemograms, and mild to moderate CSF pleocytosis. Echovirus30 was isolated from fecal and CSF samples. Among confirmed cases of echoviral illness, the meningitis attack rate was 51.9%.
    The Pediatric Infectious Disease Journal 03/2013; · 3.57 Impact Factor
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    ABSTRACT: Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin.
    Case reports in pediatrics. 01/2013; 2013:721871.
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    ABSTRACT: Objective. Childhood asthma is a frequent cause of absenteeism that affects school performance. We aimed to investigate the impact of asthma on absenteeism and school performance level of elementary and high school students. Methods. Data about sociodemographics, absenteeism, and academic achievement were obtained from 1539 students attending 98 schools in Greece. School performance was assessed for the last two years of school attendance using parents' and teachers' reports and grade point average promotion. Results. The mean of the days of absence of students with asthma was higher compared to the healthy students (6.2 ± 11.7 versus 0.3 ± 3.1, resp., P < 0.001). Students with reduced healthcare use presented less absenteeism than those with increased healthcare use for asthma (4.3 ± 8.6 versus 12.4 ± 17.0 days, resp., P < 0.001). Asthma and healthcare use for asthma accounted for an overall estimated variability in absence days of 13.8% and 9%, respectively. Absenteeism was associated with poor school performance for the last two years of school (P = 0.002) and with lower grade point promotion in elementary school students (P = 0.001) but not in high school students (P = 0.316). Higher level of parental education was associated with better school performance (P < 0.001). Asthma was associated with a decreased possibility for excellent performance (OR = 0.64, P = 0.049, 95%CI = 0.41-1.00) in elementary students. Students with asthma using inhalers were four times more likely to perform excellently in elementary school (OR = 4.3, P = 0.028, 95%CI = 1.17-15.95) than their asthmatic peers with alternative asthma treatments. Conclusions. Asthma and increased healthcare use enhance school absenteeism. Inhaled steroid use and the higher parental education level were the most important predicting factors for good school performance in elementary school asthmatic children.
    BioMed research international. 01/2013; 2013:762805.
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    ABSTRACT: Despite the fact that sunlight-dependent skin synthesis is the major mechanism for vitamin D synthesis in vivo, vitamin D-deficiency rickets continues to occur in exclusively breastfed infants in Greece. We present such a case in a 5-month-old infant who presented with afebrile seizures and whose mother was underexposed to sunlight due to veiling for religious reasons. Additionally, we briefly but thoroughly review the relevant medical literature. A high index of suspicion is required for nutritional rickets, when seizures occur in exclusively breastfed infants whose mothers have inadequate exposure to sunlight.
    Pediatrics & Neonatology 12/2012; 53(6):384-6. · 0.93 Impact Factor
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    ABSTRACT: Abstract Objective: Breastfeeding is recognized as an important public health issue with substantial social and economic implications. Moreover, the growth of exclusively breastfed babies differs from that of their formula-fed counterparts. The purpose of this study was to evaluate the physical growth of exclusively breastfed and self-weaned boys and girls of Greece 0-36 months of age. Subjects and Methods: The physical growth of children was monitored from birth up to 36 months of age. Body weight, length/height, and head circumference were recorded. The study population included 101 boys and 105 girls who were recruited consecutively from a private breastfeeding clinic in the second largest city of Greece and through La Leche League groups throughout the country during 2000 to 2005. All infants were exclusively breastfed for ≥6 months. Anthro software ( www.who.int/childgrowth/software/en/index.html ) was used to compare the data of our study population and the World Health Organization standards for weight, length/height, and head circumference for age. Results: Male and female infants at 12 months had almost tripled their weight (192% and 190% increase, respectively) and had increased their length (height) by 48% and 47%, respectively, and head circumference had increased by 35% and 33%, respectively. In both sexes the relative length/height and the head circumference-for-age increase rates were higher from the first to the second month of life than at any other period. Conclusions: Long-term exclusively breastfed infants grow normally. Hence, no recommendations for the interruption of lactation and/or supplementation with formula are justified.
    Breastfeeding Medicine 09/2012; · 1.65 Impact Factor
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    ABSTRACT: Clinical manifestations of deep venous thrombosis (DVT) tend to overlap with those of deep-seated musculoskeletal infections (MSIs). Consequently, the incidence of DVT as a complication of MSI may be underestimated. The objective of this study was to evaluate the incidence, clinical features, and outcomes of MSI-related DVT in children. We systematically reviewed relevant studies retrieved from PubMed and Scopus databases. Overall, 93 children with MSIs who developed DVT were identified from 28 retrospective studies. The majority were boys. Osteomyelitis was the most frequent MSI (69/74, 93%). Staphylococcus aureus was the predominant pathogen (83/93, 89%); 61% of these isolates were methicillin-resistant S. aureus (MRSA). Pulmonary involvement, presumably due to septic emboli, was observed in 65% of the included children. Four children died due to multiple organ failure and two due to respiratory distress. In two of the three studies providing comparative data, MRSA infections were observed significantly more frequently in children who developed DVT compared to those who did not. Yet, the respective differences observed for methicillin-susceptible S. aureus (MSSA) infections were non-significant in these three studies. Despite the inclusion of many case reports and the retrospective design of the evaluated studies, our findings suggest that boys seem to be more frequently affected by MSIs complicated by DVT. Moreover, MRSA seems to be more frequently associated with DVT compared to MSSA. Pulmonary involvement appears to be a frequent complication. Prospective studies are needed in order to further clarify this issue.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 02/2012; 16(4):e236-43. · 2.17 Impact Factor
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    ABSTRACT: Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.
    Case reports in pediatrics. 01/2012; 2012:353812.
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    ABSTRACT: Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.
    Case Reports in Pediatrics. 01/2012; 2012;2012:353812.
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    A. Kotini, A. Tsalkidis, P. Anninos, A. Chatzimichael
    09/2011; , ISBN: 978-953-307-680-5
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    ABSTRACT: A 3 years old boy with a history of surgery for orchidopexy was admitted to our hospital with fever and abdominal pain. Clinical examination and laboratory investigations revealed urinary tract infection with renal involvement. Ultrasonography demonstrated a solitary left kidney and raised the suspicion of a fusion anomaly. Voiding cystography disclosed grade III vesicoureteral reflux and technetium-99m dimercaptosuccinic acid scintigraphy revealed right to left crossed renal ectopia with fusion (L-shaped kidney). The patient is undergoing standard follow-up for the early detection of possible renal complications. In conclusion, L-shaped kidney is a rare entity and the (99m)Tc-DMSA scintigraphy played an important role on timely diagnosis.
    Hellenic journal of nuclear medicine 09/2011; 14(3):300-3. · 0.68 Impact Factor
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    ABSTRACT: Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators have claimed that because acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan results are abnormal in the presence of dilating vesicoureteral reflux, a normal DMSA-scan result makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. To evaluate the accuracy of acute-phase DMSA scanning in identifying dilating (grades III through V) vesicoureteral reflux documented by VCUG in children with a first febrile UTI, we performed a meta-analysis of the accuracy of diagnostic tests as reported from relevant studies identified through the PubMed and Scopus databases. Patient-based and renal unit-based analyses were performed. Overall, 13 cohort studies were identified. Nine studies involved patients younger than 2 years, 3 involved children aged 16 years or younger, and 1 involved exclusively neonates. Girls constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity rates of DMSA scanning were 79% and 53%, respectively, for the patient-based analysis (8 studies) and 60% and 65% for the renal unit-based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.71 and 0.67. Marked statistical heterogeneity was observed in both analyses, as indicated by I(2) test values of 91% and 87%, respectively. Acute-phase DMSA renal scanning cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.
    PEDIATRICS 06/2011; 128(1):e169-79. · 4.47 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the bacterial pathogens involved in pediatric urinary tract infections (UTIs) in a tertiary general hospital located in the Thrace province of Northern Greece over a 69-month period (1/2003 to 9/2008), and their antibiotic susceptibility patterns. A total of 622 episodes of UTIs in 508 children were identified. Median age of all children was 16 months (range 1 month to 14 years). Boys were significantly younger than girls (9 months vs. 24 months). Escherichia coli was the most common uropathogen and responsible for 69.1% of UTIs. Approximately half of E. coli isolates were resistant to ampicillin and 20.5% to trimethoprim/sulfamethoxazole (TMP/SMX). E. coli resistance to second-generation and third-generation cephalosporins was <4%, to aminoglycosides <8%, and to nitrofurantoin 4.4%. Pediatric E. coli urine isolates were significantly more resistant to ampicillin and ticarcillin and more sensitive to quinolones compared to adult E. coli uropathogens identified in the same hospital. E. coli resistance to ampicillin and amoxicillin/clavulanic acid was significantly higher in boys 12-23 months-old compared to girls of the same age. In conclusion, nitrofurantoin is a very good choice for chemoprophylaxis. Amoxicillin/clavulanic acid, second-generation cephalosporins, and TMP/SMX are appropriate choices for oral empirical treatment of UTIs. Parenteral aminoglycosides and second and third-generation cephalosporins are excellent treatment choices for inpatient therapy. Finally, sex and age are additional factors that should be taken into account when choosing empirical therapy for children with UTIs.
    International Urology and Nephrology 06/2011; 43(2):549-55. · 1.33 Impact Factor
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    ABSTRACT: Spinal epidural abscess (SEA) is a rare infection associated with well-established risk factors mainly in adults. We describe an 11-year-old girl without any known risk factors who presented with fever and localized spinal tenderness in the lumbar area and was diagnosed with spinal MRI as suffering from a posterior SEA extending between T11 and L4. She was successfully managed with sequential intravenous and oral antibiotics along with minimally invasive surgery without laminectomy. Methicillin-sensitive Staphylococcus aureus was the responsible pathogen isolated at surgery. Immediate institution of antibiotics, spinal MRI, and well-timed neurosurgical consultation are mandatory for a favorable outcome in cases of SEA in children.
    European Journal of Pediatrics 03/2011; 170(7):945-8. · 1.91 Impact Factor
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    E Mantadakis, S Thomaidis, A Chatzimichael
    Hippokratia 01/2011; 15(2):190. · 0.59 Impact Factor
  • Elpis Mantadakis, Zoe Bezirgiannidou, George Martinis, Athanassios Chatzimichael
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    ABSTRACT: Hemolysis and hemoglobinuria after direct exposure to cold has rarely been reported in paroxysmal cold hemoglobinuria (PCH). The authors describe a 2.5-year-old boy with PCH (Donath-Landsteiner autoimmune hemolytic anemia), in whom 16 days after presentation, the hemoglobinuria and hemolysis recurred, when he was subjected to physical cooling, as a means to control fever associated with hospital-acquired croup. The hemolysis resolved with warmth, and administration of dexamethasone. PCH should be suspected in children with hemolytic anemia and positive direct antiglobulin test for complement. Avoidance of cold in the recovery period is imperative to prevent recurrences, whereas a short course of corticosteroids may be of benefit in suppressing the antibody production.
    Journal of Pediatric Hematology/Oncology 11/2010; 33(1):40-2. · 0.97 Impact Factor
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    ABSTRACT: SUMMARY: The researchers describe the case of a earlier healthy 3-year-old boy, who developed immune thrombocytopenic purpura (ITP) 26 days after immunization with the second dose of seasonal influenza vaccine. He recovered quickly and uneventfully within 2 days after receiving a single dose of intravenous immunoglobulin. Review of the medical literature showed that symptomatic thrombocytopenia occurs in a substantial number of children and adults who require hospitalization for complicated natural influenza infection, particularly avian influenza. In contrast, it is exceptionally rare after influenza immunization, as only few case reports describe such an association in adults but not in children. As the risk of thrombocytopenia after natural influenza seems to be much higher than after immunization, annual influenza vaccination is advised for patients with personal history of ITP who at risk of influenza-related complications owing to underlying medical problems.
    Journal of Pediatric Hematology/Oncology 08/2010; 32(6):e227-9. · 0.97 Impact Factor
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    International Urology and Nephrology 06/2010; · 1.33 Impact Factor
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    ABSTRACT: The authors describe the case of a 70-day-old boy who was mistakenly diagnosed as suffering from acute hepatitis B, when he presented with persistent unconjugated hyperbilirubinemia and transaminasemia and was found to be seropositive for the hepatitis B surface antigen. The antigenemia was transient and related to his recent immunization with Infanrix-Hexa. Caution is required during interpretation of a positive HBsAg test that is obtained within 28 days after vaccination against hepatitis B.
    European Journal of Pediatrics 02/2010; 169(9):1139-41. · 1.91 Impact Factor
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    ABSTRACT: Erythema nodosum (EN) is the most frequent type of panniculitis in childhood. Although frequently idiopathic, it may be associated with a wide variety of conditions ranging from infections, to sarcoidosis, to collagen vascular diseases to drugs. We present an 8-year-old boy who developed EN during the course of febrile gastroenteritis due to salmonella enteritidis. He received intravenous ampicillin 150 mg/kg/day divided in equal doses every six hours for 10 days. The skin lesions gradually disappeared, and he recovered fully without sequelae. Salmonellosis should be considered in the differential diagnosis of EN in children with gastrointestinal symptoms, and stool cultures should be performed when indicated.
    Hippokratia 01/2010; 14(1):51-3. · 0.59 Impact Factor
  • G Vaos, K Kambouri, S Gardikis, D Cassimos, A Chatzimichael
    Acta Paediatrica 10/2009; 98(9):1391, 1538-40. · 1.97 Impact Factor