Anastasia Garoufi

National and Kapodistrian University of Athens, Athínai, Attica, Greece

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Publications (52)127 Total impact

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    ABSTRACT: Objectives: Cystatin-C is considered a more sensitive and specific marker of kidney function than creatinine since it can diagnose patients with earlier-stage of renal dysfunction. The aim of this study is to determine the levels of Cystatin-C in healthy children and adolescents as well as any correlations to age, gender, body-mass index (BMI) and blood pressure (BP). Design and methods: Cystatin-C was measured in 536 healthy Greek children and adolescents (295 males and 241 females) using a nephelometric immunoassay. Additionally, the age, body mass index and blood pressure was recorded for each subject. Results: Overall, the mean serum Cystatin-C level was 0.79±0.10mg/L. Cystatin-C was found to be statistically significantly lower in females than in males (p<0.001) as well as in prepubertal children compared to adolescents (p<0.001). Higher values of Cystatin-C were observed in subjects with increased BMI (p<0.001). Neither systolic nor diastolic blood pressure was found to significantly affect Cystatin-C levels. Conclusions: The levels of Cystatin -C were statistically significantly higher in males, compared to age-matched females and also positively correlated with age and BMI.
    No preview · Article · Oct 2015 · Clinical biochemistry
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    ABSTRACT: Background Hepatitis A is an indolent disease with a varying clinical spectrum and consequences. Little is known about the immune response to hepatitis A virus (HAV) vaccination in children with Periodic Fever, Aphtous Stomatitis, Pharyngitis, Adenitis Syndrome (PFAPA). Objectives To assess the sero-protective efficacy and safety of immunization against hepatitis A in PFAPA patients, not previously exposed to HAV, and compare these to healthy controls. Methods Matched case control study including patients with PFAPA and controls. All subjects received two doses of the inactivated anti-HAV vaccine at zero and six months. Seroconversion and seroprotection rates and anti-HAV-IgG antibodies were assessed at enrollment,1 month after the first dose and 1 and 12 months after the last dose. Exclusion criteria were infection or disease flare concomitant or up to ten days prior to immunization, known liver disease or immunodeficiency, and serum testing positive for HAV-infection. Clinical,demographic data and medications used were collected for each patient. Onset of PFAPA symptoms within a week from vaccination was defined as a flare. Results 28 patients with a mean age of 4.4 years completed the study. Thirteen (46%) patients received NSAIDS, 9 (32%) received NSAIDS+steroids, 3 (10%) patients received steroids and 3 did not receive any treatment at the time of PFAPA flares. The control group consisted of 76 healthy individuals (mean age 4.75 years). A month after primary vaccination 92.9% of patients and 77.6% of the controls attained seroprotection (p=0.07), while rates further increased to 100% and and 96.1% a month after the second dose respectively (p=0.2). In both groups, seroprotection rates remained elevated 12 months following completion of the study (100% vs 95%).Seroconversion rates measured at timely intervals were satisfactory for both groups. No statistically significant difference was detected amongst the two groups. Mean anti-HAV IgG concentration at 4 weeks was 110mIU/ml in the patient and 96mIU/ml in the control group while it reached 223mIU/ml and 218mIU/ml after the second dose respectively, and at 18 months it was 278 mIU/ml in the patient group and 245 mIU/ml in the control group. Mean IgG concentration was not statistically different between patient and control groups at 1 month after the first dose (p=0.3), 1 month after the second dose (p=0.8) and at 18 months after initial vaccination (p=0.2). Subgroup analysis of the PFAPA group showed that the use of steroids or NSAIDS did not affect sero-conversion and seroprotection rates or mean antibody titers. Overall four (14.2%) patients in the PFAPA group developed a flare (one after the first dose, three after the second dose). The use of steroids did not seem to affect the development of flare. Mild adverse events were noticed in 6 (17%) patients and 15 (21%) controls. Conclusions Two doses of HAV vaccine are safe and effective in the vast majority of children with PFAPA. In fact, patients with PFAPA boosted a better immune response at all time points compared to their healthy counterparts. Nevertheless, a proportion of these patients developed a flare. Systemic illness should not preclude from completion of the vaccination schedule in cases where anti-HAV vaccine is mandatory, provided the parents are aware of the possibility of a flare. Larger prospective studies are required to verify the aforementioned results. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases

  • No preview · Article · May 2015 · Epilepsy research
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    ABSTRACT: Childhood lead poisoning remains a critical environmental health concern because even low blood lead levels (BLLs) can result in permanent adverse health effects. Social factors and living conditions have been correlated with BLLs. There is no recent survey about the prevalence of elevated BLLs among children in Greece. The purpose of this study was to assess BLLs among children aged 6-36 months born and living in Greece and to evaluate their association with demographic, socio-economic and housing conditions. In a cross-sectional hospital-based study including 814 randomly selected children aged 6-36 months, BLLs and haematological parameters were evaluated. A questionnaire investigating demographic and socio-economic conditions was completed in all children. Statistical analysis was performed using STATA for Windows v.8.5, and P < 0.05 was considered statistically significant. The mean BLLs of the population were 2.78 (SD = 2.34) µg/dl, and the median was 2.02 µg/dl; 11.7% had BLLs above 5 µg/dl, while 15 children (1.8%) exceeded 10 µg/dl. Being a toddler, being Roma or Asian, living in an industrial/low-income neighbourhood or in an old house, using traditional herbs and/or spices and having a mother with a manual occupation were independent risk factors for elevated BLLs. Lead exposure remains a threat for optimal health especially for toddlers and children of socio-economically disadvantaged families living in Greece. A nationwide survey to assess lead exposure in children is necessary to guide prevention governmental policies. © 2015 John Wiley & Sons Ltd.
    No preview · Article · May 2015 · Child Care Health and Development
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    ABSTRACT: This study assessed the presence of specific antibodies for coeliac disease in outpatients suffering from eating disorders before and after nutritional intervention. We also evaluated whether those patients should undergo regular screening for coeliac disease. The sample consisted of 154 patients with a mean age of 16.7 years - ranging from one to 19-years-of age - suffering from eating disorders. Serology screening for coeliac disease and total immunoglobulin A (IgA) levels was evaluated in the 154 children before the nutritional intervention and in 104 patients after the intervention. The patients consumed an adequate amount of gluten in both phases. Post-intervention evaluation revealed that 92 patients (88.5%) achieved a normal body weight, while the remaining 12 (11.5%) became obese. Postprandial abdominal discomfort and pain were resolved. The serology tests were negative in all patients, before and after intervention. None displayed IgA deficiency. To the best of our knowledge, this was the first prospective study where patients underwent a screening serology for coeliac disease before and after nutritional intervention. No indication of the coexistence of eating disorders and coeliac disease was documented and the patients in our study were unlikely to require regular screening for coeliac disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2015 · Acta paediatrica (Oslo, Norway: 1992). Supplement
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    ABSTRACT: : 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. 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.
    No preview · Article · Dec 2014 · Pediatric Emergency Care
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    ABSTRACT: Background Small dense low density lipoprotein-cholesterol (sdLDL-C) molecules are more atherogenic compared with large buoyant ones. Phytosterols-enriched diets are effective in decreasing total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) concentrations in hyperlipidemic children without significant adverse effects. Limited data on the impact of such a diet on sdLDL-C levels is available in adults while there are no reports concerning children. The purpose of this study is to prospectively evaluate the effect of the daily consumption of 2 g of plant sterols on sdLDL-C levels in children with hypercholesterolemia. Methods Fifty-nine children, 25 with LDL-C ≥ 3.4 mmol/l (130 mg/dl) and 34 with LDL-C < 3.4 mmol/l, aged 4.5-15.9 years, were included in the study. A yogurt-drink enriched with 2 g of plant sterols was added to the daily diet of hypercholesterolemic children and 6–12 months later lipid profiles were reassessed. Direct quantitative methods were used to measure LDL-C and sdLDL-C levels. Results The consumption of plant sterols reduced sdLDL-C significantly (p < 0.001), but levels remained higher compared with controls (p < 0.001). TC, LDL-C, non high density lipoprotein-cholesterol (NonHDL-C) and apolipoprotein B (ApoB) levels also decreased significantly (p < 0.05). The median reduction of sdLDL-C and LDL-C was 16.6% and 13%, respectively. These variables decreased >10% in sixteen children (64%), independently from baseline levels, sex, age and body mass index (BMI). High density lipoprotein-cholesterol (HDL-C), lipoprotein a [Lp(a)], and triglycerides (TGs) levels remained unaffected. Conclusions Plant sterols decrease sdLDL-C significantly and may be beneficial for children with hypercholesterolemia.
    Full-text · Article · May 2014 · Italian Journal of Pediatrics
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    ABSTRACT: Studies evaluating the effect of levetiracetam (LEV) on haematological parameters in patients with epilepsy are very limited. Clinical trials have also reported an unexplained increased incidence of pharyngitis and rhinitis in LEV-treated patients. The objective of this study was to evaluate prospectively the changes in haematological parameters in children treated with LEV monotherapy. White blood cell, neutrophils, lymphocytes, monocytes, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular hemoglobin concentration and platelets were measured in 22 children (13 females, mean age 6,70 ± 4,23 years) with epilepsy, before and after 2 and 6 months of LEV monotherapy. Lymphocyte count was significantly decreased at 6 months (p = 0.019) of treatment and this effect was not dose dependent. One child (4,5%) at 2 months and four children (18%) at 6 months of treatment had lymphocyte count below 10th percentile for age. There were no significant alterations in the other parameters evaluated during the study. LEV monotherapy may significantly decrease lymphocyte count at six months of treatment in children with epilepsy. Further prospective studies are needed to investigate the effect of LEV on haematological parameters and the possible association with the higher incidence of infections reported in children receiving LEV.
    No preview · Article · May 2014 · Epilepsy research

  • No preview · Article · Jan 2014 · Health
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    D Maritsi · A Soldatou · G Papaioannou · A Garoufi

    Full-text · Article · Dec 2013 · Pediatric Rheumatology
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    ABSTRACT: To evaluate prospectively the changes and possible associations in lipid and thyroid profiles in children treated with oxcarbazepine (OXC) monotherapy. Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), lipoprotein (a) [Lp(a)], free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH) and gamma-glutamyltransferase (GGT) concentrations were measured in 23 children with epilepsy, before and at 8 and 18 months of OXC monotherapy. Total cholesterol was significantly increased at 8 months (P = 0.033), whereas LDL-C was significantly increased at 8 and 18 months (P < 0.001 and P = 0.004, respectively) of treatment. Lp(a) was significantly increased at 8 months (P = 0.042) and borderline significantly increased at 18 months (P = 0.050) of treatment. FT4 was significantly decreased at 8 and 18 months (P < 0.001 and P = 0.002, respectively), and TSH levels were significantly increased at 8 and 18 months (P = 0.002 and P = 0.001, respectively) of OXC monotherapy. GGT levels were significantly increased at 8 and 18 months (P < 0.001) of treatment. There were no significant alterations in HDL-C, TGs and FT3 levels during the study. Significant positive correlations were found between GGT and LDL-C levels at 8 (r = 0.468, P = 0.024) and 18 months (r = 0.498, P = 0.016), and between TSH and TC at 18 months (r = 0.508, P = 0.013) of treatment. OXC monotherapy may cause significant and persistent alterations in lipid and thyroid profiles in children with epilepsy. The increase in LDL-C and TC levels may be associated with liver enzymes induction and thyroid dysfunction. Further long-term prospective studies are required to confirm these findings and to determine their clinical significance.
    Preview · Article · Oct 2013 · European Journal of Neurology

  • No preview · Article · Sep 2013 · European Journal of Paediatric Neurology

  • No preview · Article · Sep 2013
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    ABSTRACT: 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. 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. 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). 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.
    No preview · Article · Jun 2013 · Clinical and experimental rheumatology
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    ABSTRACT: Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in Rh(D)-positive nonsplenectomized patients. Severe hemolysis and acute renal failure are extremely rare complications that may be aggravated by the presence of an acute EBV infection. It is believed that anti-D immunoglobulin triggers an unusual virus-induced immune response causing hemolysis. We present a 4-year-old girl with ITP caused by an acute EBV infection that developed acute kidney injury following treatment with anti-D immunoglobulin. The patient recovered completely from thrombocytopenia and renal dysfunction. Intravascular hemolysis and acute kidney injury are consistent with anti-D immunoglobulin mechanism of action. Pediatric patients treated with anti-D immunoglobulin for ITP should be closely monitored for signs and symptoms of hemolysis that may be aggravated by the presence of EBV infection leading to impaired renal function.
    No preview · Article · Jun 2013 · Pediatric emergency care
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    ABSTRACT: In children and adolescents with cardiovascular risk factors, the assessment of subclinical target-organ damage is of paramount importance. This study investigated factors associated with carotid intima-media thickness (cIMT) in adolescents. A cross-sectional study was performed in 448 apparently healthy adolescents recruited from schools (mean age 14 ± 2.2 years, 211 boys), which involved cIMT measurements (common carotid artery) and assessment of lipid profile, glucose, and blood pressure (BP). The prevalence of overweight/obesity was 28.1%/12.7% and of BP ≥95th percentile 19.6%. Left cIMT was correlated with age (r = 0.10), waist circumference (WC) (0.15), and BP (0.21/0.13, systolic/diastolic) (all P < 0.05). Right cIMT was correlated with waist to hip ratio (WHR) (0.10), whereas the mean of left and right cIMT was correlated with WC (0.12), WHR (0.12), and systolic BP (0.14) (all P < 0.05). After the age of 13 years, boys tended to have higher cIMT than girls, which was significant in the 13-15 years subgroup (P < 0.05). In stepwise multivariate analysis (independent variables: age, gender, WC, WHR, body mass index z-score, lipid parameters, glucose, BP), left cIMT was independently associated with systolic BP; right cIMT with WHR; mean left and right cIMT with WC. Adolescents with BP ≥90th percentile had higher left cIMT than those <90th percentile (0.63 ± 0.09 vs. 0.61 ± 0.09 mm respectively, P < 0.05). Central adiposity and systolic BP appear to be independently associated with increased cIMT values in apparently healthy adolescents. Left side cIMT appears to be superior to right side measurements in terms of association with cardiovascular risk factors.
    Preview · Article · May 2013 · Obesity
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    ABSTRACT: We report on a two-year-old boy with acute flaccid paralysis (AFP) due to West Nile neuroinvasive disease (WNND). Serum and cerebrospinal fluid serology as well as nerve-conduction studies were consistent with the diagnosis. He received intravenous immunoglobulin (IVIG). The patient showed gradual improvement and complete recovery of his muscle strength, gait and deep tendon reflexes.
    No preview · Article · Mar 2013 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Kawasaki disease is a systemic vasculitis of unknown etiology, presenting typically in infants and young children. We report a rare case of incomplete Kawasaki disease in a 15-month-old male infant presenting with symptoms mimicking retropharyngeal abscess and intermittent fever.
    No preview · Article · Dec 2011 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Background and aims: Epidemiological studies indicate that children with intrauterine growth retardation (IUGR) are at increased risk of developing metabolic syndrome and cardiovascular disease in adult life. The aim of this prospective study was to assess the prevalence of insulin resistance and lipid disorders in children with IUGR.
    Preview · Article · Nov 2011 · Pediatric Research
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    ABSTRACT: Background and aims: Plasma Brain Natriuretic Peptide (BNP) is recognized as a reliable marker for cardiac dysfunction. Recent studies postulate that intracerebral epileptic activity may trigger BNP secretion by heart or by brain. This prospective study aimed to evaluate BNP concentrations, before and after valproate sodium (VPA) or ox-carbamazepine (OX-CMZ) monotherapy, in children with idiopathic epilepsy.
    Preview · Article · Nov 2011 · Pediatric Research