Background: Sex education refers to the increase in knowledge about sex and relationships and it extends beyond human physiology or reproductive system. The goal of sex education is to improve young people’s sexual health and overall quality of life. However, in Greece sex education is still not included as a compulsory course in schools. In cases where it is implemented this is done in a non-systematic way and it depends on secondary school teachers’ interest. The aim of this study was to explore the needs of secondary school pupils in regards to sex education.
Methods: A cross-sectional study using an online questionnaire among pupils of a convenient sample.
Results: Τhe total sample was 300 secondary school pupils. The majority were female (51.64%). Several pupils recognized the importance of sex education in schools (43.75%) and they stated that there were no sex education programs in their schools (81.25%). The majority knew the term “contraceptive methods” (72.50%), while most of the participants had not consulted any health professionals about sexual health issues (61.25%). The participants expressed the desire to have further information about issues of reproductive health (25.49%) and adolescence and sexuality (25.49%). They believed that the most appropriate person to implement sex education interventions would be a specialized health professional (39.22%).
Conclusions: Greek secondary school pupils understand the importance of sex education and the lack of proper information regarding sexual and reproductive health issues, and they expressed the need of sex health education in school by health professionals.
Keywords: Sex education, sexual and reproductive health, secondary schools, Secondary school pupils.
Maria-Eleni Annaki
Trisevgeni Trantali
Anastasia Barbouni
Areti Lagiou
Evanthia Sakellari
Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica
Βιβλιογραφία
1. UNESCO. [Webpage, Internet]. International Guidelines on Sexuality Education: An Evidence Informed Approach to Effective Sex, Relationships and HIV/STI Education, 2009: https://reliefweb.int/report/world/international-guidelines-sexuality-education-evidenceinformed-approach-effective-sex
2. World Health Organization Regional Office for Europe and BZgA [Webpage, Internet]. Standards for Sexuality Education in Europe A framework for policy makers, educational and health authorities and specialists, 2010: https://www.bzga-whocc.de/en/publications/ standards-for-sexuality-education/
3. World Health Organization [Webpage, Internet]. Sexual and Reproductive Health and Research (SRH), Defining sexual health, 2022: https://www.who.int/teams/sexual-andreproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexualhealth
4. Lameiras-Fernández, M., Martínez-Román, R., Carrera-Fernández, M.V., & RodríguezCastro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. Int J Environ Res Public Health [Internet] 2021 Mar: Webpage: https://www.mdpi.com/16604601/18/5/2555.
5. Leung, H., Shek, D., Leung, E., & Shek, E. Development of Contextually-relevant Sexuality Education: Lessons from a Comprehensive Review of Adolescent Sexuality Education Across Cultures. Int J Environ Res Public Health [Internet]. 2019 Feb: Webpage: https:// www.mdpi.com/1660-4601/16/4/621
6. Santeli, J. et al. Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact. J Adolesc Health [Internet]. 2017 Sept: Webpage: https://www. jahonline.org/article/S1054-139X(17)30260-4/fulltext
7. Hall, K., Sales, J., Komro, K., & Santelli, J. The State of Sex Education in the United States. J Adolesc Health [Internet]. 2016 Jun: Webpage: https://www.jahonline.org/article/S1054139X(16)30004-0/fulltext
8. Rabbitte, M. & Enriquez M. The Role of Policy on Sexual Health Education in Schools: Review. JOSN [Internet]. 2018 Jul: Webpage: https://journals.sagepub.com/ doi/10.1177/1059840518789240
9. Καδιγιαννόπουλος,
Α. Η σεξουαλική αγωγή στη δευτεροβάθμια εκπαίδευση στον ελλαδικό χώρο. Αρχεία Ελληνικής Ιατρικής [Internet]. 2020 Αυγ: Webpage: https://www.mednet.gr/archives/2020-2/pdf/267.pdf 10. Vassilikou, K. & Ioannidi-Kapolou, E. Sex education and sex behaviour in Greek adolescents: a research review. Social Cohesion and Development [Internet]. 2014 Apr: Webpage: https://ejournals.epublishing.ekt.gr/index.php/SCAD/article/view/8912
13. Johnson, B., Harrison, L., Ollis, D., Flentje, J., Arnold, P. & Bartholomaeus, C. ‘It is not all about sex’: Young people’s views about sexuality and relationships education. Report of Stage 1 of the Engaging Young People in Sexuality Education Research Project. Adelaide: University of South Australia. [Internet]. 2016, Webpage: https://www.shinesa.org. au/media/2016/05/%E2%80%98It-is-not-all-about-sex%E2%80%99-EYPSE-Research-Report. pdf
14. Pound P., et al. What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views. BMJ OPEN [Internet]. 2017: Webpage: https:// bmjopen.bmj.com/content/7/5/e014791
15. Fakinos, M. Sexuality education in Greek schools: Student experience and
recommendations. Electronic Journal of Human Sexuality [Internet]. 2010 May: Webpage: http://www.ejhs.org/volume13/GreekSchools.htm
16. Ajayi, A., & Okeke, S. Protective sexual behaviours among young adults in Nigeria: influence of family support and living with both parents. BMC Public Health [Internet]. 2019 Jyly: Webpage: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-0197310-3
17. Matziou, V., Perdikaris, P., Petsios, K., Gymnopoulou, E., Galanis, P., & Brokalaki, H. Greek students’ knowledge and sources of information regarding sex education. Int Nurs Rev [Internet]. 2009 Sep: Webpage: https://onlinelibrary.wiley.com/doi/10.1111/j.14667657.2009.00727.x
18. Pound, P., Langford, R. & Campbell, R. What do young people think about their schoolbased sex and relationship education? A qualitative synthesis of young people's views and experiences. BMJ [Internet]. 2016 Sept: Webpage: https://bmjopen.bmj.com/content/6/9/ e011329
19. Mavroforou, A., Koumantakis, E. & Michalodimitrakis, E. Adolescence and Abortion in Greece: Women’s Profile and Perceptions. J Pediatr Adolesc Gynecol [Internet]. 2004 Oct: Webpage: https://www.sciencedirect.com/science/article/pii/ S1083318804001329?via%3Dihub
20. Federal Centre for Health Education (BZgA) and International Planned Parenthood Federation European Network (IPPF,EN) [Webpage, Internet]. Sexuality Education in Europe and Central Asia, State of the Art and Recent Developments, An Overview of 25 Countries, 2018: https://www.bzga-whocc.de/fileadmin/user_upload/Dokumente/BZgA_IPPFEN_ ComprehensiveStudyReport_Online.pdf
21. Ezer, P., Kerr, L., Fisher, C., Waling, A., Rosalind, B., & Lucke, J. School-based relationship and sexuality education: what has changed since the release of the Australian Curriculum?. Sex Education [Internet]. 2020 Feb: Webpage: https://www.tandfonline.com/doi/full/10.108 0/14681811.2020.1720634
22. UNESCO [Webpage, Internet]. International technical guidance on sexuality education An evidence-informed approach, 2018: https://www.unfpa.org/sites/default/files/pub-pdf/ ITGSE.pdf
23. Ioannou, C. Combating homophoBic and transphobic bullying in schools, National Report: Greece [Internet]. 2016: Webpage: https://www.hombat.eu/wp-content/uploads/2018/08/ HOMBAT_NATIONAL_REPORT_EL_English_Left_Aligned.pdf
24. Γερούκη,
2011.
25. Kordoutis, P. Condom use in greek young adults’ dating relationships: The role of sexual debut condom use and relationship characteristics. Psychology: The journal of the Hellenic Psychological Society [Internet]. 2020 Oct: Webpage: https://ejournals.epublishing.ekt.gr/ index.php/psychology/article/view/23500
26. Kyilleh, J., Tabong P. & Koolan B. Adolescents’ reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana. BMC Int Health Hum Rights [Internet]. 2018 Jan: Webpage: https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-018-0147-5
27. Abdurahman, C., Oljira, L., Hailu, S. & Mengesha, M.M. Sexual and reproductive health services utilization and associated factors among adolescents attending secondary schools. Reproductive Health [Internet]. 2022 July: Webpage: https://reproductive-health-journal. biomedcentral.com/articles/10.1186/s12978-022-01468-w
28. Matos, M.G., Gaspar, T., Cruz, J. & Nevez, A.M. New Highlights About Worries, Coping, and Well-Being During Childhood and Adolescence. Psychology Research [Internet]. 2013 May: Webpage: https://www.researchgate.net/profile/Ana-Neves-26/publication/244622929_ New_Highlights_About_Worries_Coping_and_Well-Being_During_Childhood_and_ Adolescence/links/543007400cf29bbc1273ee14/New-Highlights-About-Worries-Copingand-Well-Being-During-Childhood-and-Adolescence.pdf
29. Directorate-General for Employment, Social Affairs and Inclusion (European Commission). [Webpage, Internet]. Sexuality education across the European Union
An overview, 2021: https://op.europa.eu/en/publication-detail/-/publication/5724b7d8764f-11eb-9ac9-01aa75ed71a1
Background: Vaccination practices are one of the most successful achievements of medicine, with national vaccination programs triumphing over many serious diseases. However, many people remain hesitant about vaccination, posing a challenge for public health. Fear of needles and discomfort during vaccination are key factors influencing parents' decisions to vaccinate their children. To address this challenge, we present VaccineHero, an extended reality (XR) application aimed at reducing anxiety and negative emotions associated with vaccination.
Methods – Results: VaccineHero provides children with an enjoyable experience through virtual reality, using 90s-themed storytelling and 3D graphics. Children take on the role of a hero, the VaccineHero, and explore a fantastical world during vaccination. This technology distracts children, thus reducing the fear and pain usually associated with vaccination. The application uses VR devices on Android phones and synchronizes with the doctor via Miracast, allowing the doctor to monitor and coordinate the process. VaccineHero was developed using the Unity platform and the C# programming language, incorporating special effects, music, and animations to enhance the overall experience.
Conclusions: VaccineHero not only improves the experience of children during vaccination but can also be adapted for other medical procedures, helping both children and adults who face difficulties or phobias related to needles and medical procedures.
1. Cassimos, D.C.; Effraimidou, E.; Medic, S.; Konstantinidis, T.; Theodoridou, M.; Maltezou, H.C. Vaccination Programs for Adults in Europe, 2019. Vaccines 2020, 8, 34.
2. World Health Organization. Ten Threats to Global Health in 2019. Available online: https:// www.who.int/news-room/spotlight/ ten-threats-to-global-health-in-(2019) (accessed on 4 August 2023).
3. Hough-Telford, C.; Kimberlin, D.W.; Aban, I.; Hitchcock, W.P.; Almquist, J.; Kratz, R.; “et al”. Vaccine delays, refusals, and patient dismissals: A survey of pediatricians. Pediatrics 2016, 138, e20162127
4. Taddio, A.; Appleton, M.; Bortolussi, R.; Chambers, C.; Dubey, V.; Halperin, S.; “et al”. Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline. Coll. Emerg. Med. Team 2010, 182, E843–E855.
5. Wallace, M.; Antonopoulos, S.; Poulopoulos, V. VACS: VAccination disComfort Scale. Clin. Pract. 2022, 12, 1078–1091.
6. Javaid, M.; Haleem, A. Virtual reality applications toward medical field. Clin. Epidemiol. Glob. Health 2020, 8, 600–605.
7. Javaid, M.; Haleem, A. Industry 4.0 applications in medical field: A brief review. Curr. Med. Res. Pract. 2019, 9, 102–109.
8. Bracq, M.-S.; Michinov, E.; Jannin, P. Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals: A Systematic Review. Simul. Healthc. 2019, 14, 188–
194
9. Taddio, A.; Ilersich, A.; McMurtry, C.M.; Bucci, L.M.; MacDonald, N.E. Foodborne and Animal Contact Disease Outbreaks: Managing pain and fear: Playing your CARDs to improve the vaccination experience. Can. Commun. Dis. Rep. 2021, 47, 87
10. Esfahani, M.S.; Sheykhi, S.; Abdeyazdan, Z.; Jodakee, M.; Boroumandfar, K. A comparative study on vaccination pain in the methods of massage therapy and mothers’ breast feeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan. Iran. J. Nurs. Midwifery Res. 2013, 18, 494–498
11. Golestan, M.; Sadrebafghi, M.; Karbasi, S.A.; Eslami, Z.; Hashemi, A.; Mirnaseri, F.; ‘et al’ Comparison Pain relieving effects of glucose and water in neonates. Iran. J. Pediatr. 2006, 16, 441–446.
12. Piazza, J.R.; Merkel, S.; Rothberg, B.; Gargaro, J.; Kullgren, K. Understanding both sides of the blood draw: The experience of the pediatric patient and the phlebotomist. Patient Exp. J. 2022, 9, 35–45.
Correspondence
Alexios Mavroudis MD,Msc.
Erithrou stavrou terma
c.p 22131, Tripoli
Arcadia, Greece
T. +306978699611
e-mail: alexis.mavroudis@ yahoo.gr
Eosinophilia in the neonatal age. Pathophysiology and Clinical Diagnosis
Αlexios Mavroudis
Summary
Eosinophilia is a common finding in the neonatal age and poses diagnostic challenges for physicians. It encompasses a wide spectrum of physiological or pathological conditions related to the maternal age, low birth weight, and more broadly to the biological individuality of the infant, as well as environmental factors. In the literature, the fundamental cause of it has not yet been clarified, but it is considered to be associated with developmental biology and the pathology of hospitalized infants in intensive care units -there are studies on the internet that confirm this finding. The purpose of this review is to study the immunological mechanisms of eosinophilia in infants, resulting in knowledge of the diagnostic subject, which will determine the therapeutic options. At the molecular level, eosinophilic cytolysis (Extracellular trap cell death, -ETosis) is primarily described as a key factor of inflammation in target cells. Simultaneously, a large network of eosinophil-derived cytokines (IL-5, IL-3, and GM-CSF) is enhanced, resulting in the production and migration of eosinophilic cells to peripheral tissues. This is a unique event that connects neonatal pathology with the biological identity and function of eosinophilic cells. Therefore, the clinical pediatrician is able to understand the pathophysiology of neonatal diseases, while at the same time achieving a more rational differential diagnosis by accurately and reliably interpreting distinct pathological conditions.
1. S E Sullivan, D A Calhoun. Eosinophilia in the neonatal intensive care unit. Clin Perinatol 2000 Sep;27(3):603-22.
2. Chloe E. Opper, MD; Kristina L. Simeonsson, MD, MSPH; Karin Hillenbrand, MD, MPH. Eosinophilia. Pediatr Rev(2022)43(8):476–478.
3. J E Parrillo, A S Fauci. Human eosinophils. Purification and cytotoxic capability of eosinophils from patients with the hypereosinophilic syndrome. Blood.1978 Mar;51(3):45773.
4. Kun Li, Ya-Guang Peng, Ruo-Hua Yan, Wen-Qi Song, Xiao-Xia Peng, Xin Ni. Agedependent changes of total and differential white blood cell counts in children. Chinese Medical Journal 2020;133(16).
5. Joo Yun Yang, MD, Jihei Cha, MD, So-Yeon Shim, MD, PhD, Su Jin Cho, MD, PhD, Eun Ae Park, MD, PhD. The relationship between eosinophilia and bronchopulmonary dysplasia in premature infants at less than 34 weeks’ gestation. Korean J Pediatr 2014;57(4):171-177.
6. Sandra E. Juul, MD, PhD, Jamie W. Haynes, MD, Ronald J. McPherson, PhD. Evaluation of Eosinophilia in Hospitalized Preterm Infants. Journal of Perinatology 2005;25:182–188.
7. A.Mανουρά,
Ελλάδος. 2001;13:124-131.
8. Ole Bæka, Kristoffer Jarlov Jensena, Andreas Andersena, Carlito Baléa, Cesario Martinsa, Sofie Biering-Sorensena “et al” Seasonal and sex-specific variations in haematological parameters in 4 to 5.5-month-old infants in Guinea-Bissau,West Africa. Trans R Soc Trop Med Hyg 2017;111:30–37.
9. RD Christensen, J Jensen, A Maheshwari and E Henry. Reference ranges for blood concentrations of eosinophils and monocytes during the neonatal period defined from over 63 000 records in a multihospital health-care system. Journal of Perinatology 2010;30:540–545.
10. Sharma SC. Eosinophil count in premature infants. Indian J Pediatr 1982;49:119-21.
11. Ami Aoki, Kiyoshi Hirahara, Masahiro Kiuchi, Toshinori Nakayama. Eosinophils: Cells known for over 140 years with broad and new functions. Allergol Int. 2021 Jan;70(1):3-8.
12. Michael E Wechsler, Ariel Munitz, Steven J Ackerman, Matthew G Drake, David J
Jackson, Andrew J Wardlaw et al. Eosinophils in Health and Disease: A State-of-the-Art Review. Mayo Clin Proc. 2021 Oct;96(10):2694-2707.
13. Julia L M Dunn, Marc E Rothenberg. 2021 year in review: Spotlight on eosinophils. J Allergy Clin Immunol. 2022 Feb;149(2):517-524.
14. Helene F. Rosenberg. The immunobiology of eosinophils—it's a whole new world out there: an interview with Dr. Peter F. Weller. J Leukoc Biol. 2008 April ; 83(4): 822–823.
15. Jeremy A. O’Sullivan, PhD and Bruce S. Bochner, MD. Eosinophils and EosinophilAssociated Diseases: an Update. J Allergy Clin Immunol. 2018 February ; 141(2): 505–517.
16. Μελέτης Ι. Χρ. Το
39,1981.p.16-24.
17. Timothée Fettrelet, Lea Gigon, Alexander Karaulov, Shida Yousefi and Hans-Uwe Simon. The Enigma of Eosinophil Degranulation. Int. J. Mol. Sci. 2021 Jun 30;22(13):70-91.
18. Evelyn L Angulo, Elizabeth M McKernan, Paul S Fichtinger, Sameer K Mathur. Comparison of IL-33 and IL-5 family mediated activation of human eosinophils. PLoS One 2019 Sep 6;14(9).
19. Simon P Hogan, Helene F Rosenberg, Redwan Moqbel, Simon Phipps, Paul S Foster, Paige Lacy. Eosinophils: biological properties and role in health and disease. Clin Exp Allergy 2008 May;38(5):709-50.
20. Hisashi Sasaki, Jun Miyata, Akiko Irie, Ayako Kuwata, Yuji Kouzaki, Shigeharu Ueki et al. Case Report: Eosinophilic Bronchiolitis With Eosinophil ETosis in Mucus Plugs Successfully Treated With Benralizumab. Front Pharmacol. 2022 Jan 13:12:826790.
21. Eosinophil ETosis and DNA Traps: a New Look at Eosinophilic Inflammation. Curr Allergy Asthma Rep. 2016 Jul;16(8):54.
22. Dent G. Eosinophil chemotaxis. Methods Mol Biol. 2014;11(78):101-10.
24. Anna Carolina Boni Rolima, Marley Aparecida Lambertb, Juliana Policastro, Grassano Borgesa, Samira Ali Abbasa , José Orlando Bordina Blood Cells Profile in Umbilical Cord of Late Preterm and term Newborns. Rev Paul Pediatr. 2019;37(3):264-274.
25. Mai Rabie El-Sheikh, Amira Youssef Ahmed, Abd El-Rahman Mohamed ELMashad, Ibrahim Ibrahim Talaye, Eslam El-Sayed El-Hawary. Eosinophil count and tumor necrosis factor α in response to phototherapy treatment of neonatal hyperbilirubinemia: a cross sectional study. Ital J Pediatr 2022 Jun 20;48(1):103.
27. Julie Hibbert, Tobias Strunk, Elizabeth Nathan, Amy Prosser, Dorota Doherty, Karen Simmer et al. Composition of early life leukocyte populations in preterm infants with and without late-onset sepsis. PLoS ONE. 2022;17(3): e0264768.
28. Lila S Wahidi, Jan Sherman, Mindy M Miller, Habib Zaghouani, Michael P Sherman. Early Persistent Blood Eosinophilia in Necrotizing Enterocolitis Is a Predictor of Late Complications. Neonatology. 2015;108(2):137-42.
29. Karen A Ravin, Michael Loy. The Eosinophil in Infection. Clin Rev Allergy Immunol 2016 Apr;50(2):214-27.
30. Margaret R. Hammerschlag. Chlamydial and Gonococcal Infections in Infants and Children. Clinical Infectious Diseases 2011;53(S3):S99–102.
31. L Patel, B Garvey, S Arnon and IAG Roberts. Eosinophilia in newborn infants. Acta Pgdiatr 1994;83:p.797-801.
32. Elisavet Parlapani, Charalampos Agakidis & Thomais, Karagiozoglou–Lampoudi. Anthropometry and Body Composition of Preterm Neonates in the Light of Metabolic Programming. J Am Coll Nutr. 2018 May-Jun;37(4):350-359.
33. Emma L. Gibson, M.D., Yvonne Vaucher, M.D., and James J. Corrigan. Eosinophilia in premature to weight gain. The Journal of Pediatrics. VoL 95, No. 1, pp. 99-101.C. A. Lindemans, J. L. Kimpen, B. Luijk, J. Heidema, D. Kanters, C. K. van der Ent et al. Systemic eosinophil response induced by respiratory syncytial virus. British Society for Immunology, Clinical and Experimental Immunology. 144:409–417.
34. Kate E. Oberlin MD, Sahand Rahnama‐Moghadam MD, Ahmed K. Alomari MD, Anita N. Haggstrom. Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review. Pediatric Dermatology. 2019;00:1–6.
35.
2015:p.88-89.
36. Pierce MR, Bancalari E. The role of inflammation in the pathogenesis of bronchopulmonary dysplasia. Pediatr Pulmonol 1995;19:371-8.
37. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9.
38. Raghavender B, Smith JB. Eosinophil cationic protein in tracheal aspirates of preterm infants with bronchopulmonary dysplasia. J Pediatr 1997;130:944-7.
39. J K Weltman, A S Karim. IL-5: biology and potential therapeutic applications. Expert Opin Investig Drugs 2000 Mar;9(3):491-6.
41. Evan S Dellon, Jonathan M Spergel. Biologics in eosinophilic gastrointestinal diseases. Ann Allergy Asthma Immunol. 2023 Jan;130(1):21-27.
42. Gonca Vardar, Mine Ozdil, Sinan Tufekci. Awareness or neglecting the diagnosis of cow milk protein allergy in the neonatal period. Asia Pac J Clin Nutr 2023;32(2):257-264.
43. Naiman J, Oski F, Allen F, et al: Hereditary eosinophilia: Report of a family and review of the literature. Am J Hum Genet 1964;(16):195.
44. Rickles FR, Miller DR. Eosinophilic leukemoid reaction. Report of a case, its relationship to eosinophilic leukemia, and review of the pediatric literature. J Pediatr 1972 Mar;80(3):41828.
45. Jose D, Gatti R, Good R Eosinophilia with Pneurnocystis cuvinii pneumonia and immune deficiency syndromes. J Pediatr 1971;(79):748.
46. Hall J, Levin J, Kuhn J, et al: Thrombocytopenia with absent radius (TAR). Medicine 1969; (48):4-11.
47. Mehrizi A, Rowe R Eosinophilia in patients with congenital cardiovascular malformations. J Pediatr 1966 (68):475.
48. Justin T. Schwartz and Patricia C. Fulkerson. An Approach to the Evaluation of Persistent Hypereosinophilia in Pediatric Patients. September 2018;(9):19-44.
49. Antonia Manoura, Eletheria Hatzidaki, Eftihia Korakaki, Marina Mitsaki, Vasiliki Valari and Christine Giannakopoulou. Eosinophilia in sick neonates Haematologia 2002;(32):31–37.
e-mail: alexis.mavroudis@
Correspondence
Alexios Mavroudis MD,Msc.
Erithrou stavrou terma
c.p 22131, Tripoli Arcadia, Greece
T. +306978699611
e-mail: alexis.mavroudis@ yahoo.gr
Evans Syndrome. Contemporary Hematological Biopathology in childhood
Αlexios Mavroudis
The pathology of Evans syndrome is not fully understood and is a combination of genetic, environmental and immunological factors. It is a rare disorder and presents a chronic, relapsing progression in its natural course. However, because it is characterized by great clinical and immunological heterogeneity, there is a limitation in research. Mainly, a primary or secondary etiology is established and in combination with other factors (infections, neoplasms, pharmaceutical substances, atmospheric pollution) it causes oxidative stress and destabilization of immune tolerance resulting in the dysregulation of T and B lymphocytes, the production of autoantibodies against cellular blood series and manifestations of thrombocytopenia. The molecular fingerprint of the disease expresses increased circulating T-follicular helper cells (cTfh) associated with chronic T-cell activation/ exhaustion and decreased CD4+ helper T cells and memory B cells with a transcriptional switch to immunoglobulin G. At the same time, increased levels of TGF-β favor the differentiation of the Th17 subset, which enhances the autoimmune response by producing a large number of inflammatory cytokines. It is a unique event of deregulation of immune homeostasis activating factors. However, the progress of science has helped to be able to make a quick diagnosis and provide alternative treatments to deal with it. Next-generation staining represent a milestone in the diagnostic approach while establishing guidelines for future treatment strategies.
1. V Koneti Rao, Evans syndrome: pathology and genomic hubris, Blood 2022 Jan 20;139(3):312-313.
2. Nikolaj Mannering, Dennis Lund Hansen, Henrik Frederiksen, Evans syndrome in children below 13 years of age - A nationwide population based cohort study, PLoS One 2020 Apr 9;15(4):e0231284.
3.Nathalie Aladjidi, Thomas Pincez, Frédéric Rieux-Laucat, Diane Nugen, Paediatriconset Evans syndrome: Breaking away from refractoryimmune thrombocytopenia, Br J Haematol. 2023;203:28–35.
4.Fayhan J. Alroqi, Louis-Marie Charbonnier, Safa Baris, Ayca Kiykim, Janet Chou, Craig D. Platt, MD et al, Exaggerated T Follicular Helper Cell Responses in LRBA Deficiency
Κατάλογος
Ig: Immunoglobulin
Ανοσοσφαιρίνη
ΙL: Interleukin
Ιντερλευκίνη
ITP: Immune trombocytopenia
Aνοσοθρομβοπενία
KRAS: Kirsten rat sarcoma virus
Iός
Kirsten
LRBA:
Lipopolysaccharideresponsive beige like anchor protein Πρωτεΐνη
MHC: Major
Hystocompatibility
ΝGS: Next generation sequencing Aλληλούχιση
NK: Natural killer
PIK3CD:
Phosphatidylinositol-4,5Bisphosphate 3-Kinase
Catalytic Subunit Delta
SBT: Sequencing based typing
Aλληλούχιση
Sanger
STAT: Signal transducer and activator of transcription
Due to Failure of CTLA4-Mediated Regulation, J Allergy Clin Immunol. 2018 March ; 141(3): 1050–1059.
5. Deepak Kumar, Chengyu Prince, Carolyn M. Bennett, Michael Briones, Laura Lucas, Athena Russell et al, T-follicular helper cell expansion and chronic T-cell activation are characteristic immune anomalies in Evans syndrome, Blood 2022 Jan 20;139(3):369-383.
6. Maurizio Miano, Daniela Guardi, Alice Grossi, Elena Palmisani, Francesca Fioredda, Paola Terranova, Underlying Inborn Errors of Immunity in Patients With Evans Syndrome and Multilineage Cytopenias: A Single-Centre Analysis, Front Immunol. 2022 May 17:13:869033.
7. Βλαχογιαννόπουλος
εξ`αποστάσεως, ΕΚΠΑ.
8. Yao Huang, Zhe Chen, Hui Wang, Xin Ba, Pan Shen, Weiji Lin et al, Follicular regulatory T cells: a novel target for immunotherapy? Clin Transl Immunology 2020 Feb 14;9(2):e1106.
9. Wilma Barcellini, Francesco Zaja, Anna Zaninoni, Francesca Guia Imperiali, Marta Lisa Battista, Eros Di Bona et al, Low-dose rituximab in adult patients with idiopathic autoimmune hemolytic anemia: clinical efficacy and biologic studies, Blood 2012 Apr 19;119(16):3691-7.
10. Sylvain Audia, Natacha Grienay, MorganeMounier, MarcMichel and Bernard Bonnotte, Evans’ Syndrome: From Diagnosis to Treatment, J Clin Med 2020 Nov 27;9(12):3851.
11. Jérôme Hadjadj, Nathalie Aladjidi, Helder Fernandes, Guy Leverger, Aude MagérusChatinet, Fabienne Mazerolles et al. Pediatric Evans syndrome is associated with a high frequency of potentially damaging variants in immune genes, Blood. 2019 Jul 4;134(1):9-21.
12. Kchouk M, Gibrat JF, Elloumi M. Generations of Sequencing Technologies: From First to Next Generation. Biol Med. 2017;9:1-8.
13. Christian P Kratz, Tim Niehues, Sigrid Lyding, Andreas Heusch, Gisela Janssen, Ulrich Göbel, Evans syndrome in a patient with chromosome 22q11.2 deletion syndrome: a case report, Pediatr Hematol Oncol. 2003 Mar;20(2):167-72.
14. Thomas Pincez, Bénédicte Neven, Hubert Ducou Le Pointe, Pascale Varlet, Helder Fernandes, Neurological Involvement in Childhood Evans Syndrome. Journal of Clinical Immunology, 2019, 39 (2), pp.171-181.
15. Anna Da ˛browska, Elz˙bieta Grzes´k, Anna Urban’, Marta Mazalon, Grzegorz Grzes´k, Jan Styczynski, Extended List of Warning Signs in Qualification to Diagnosis and Treatment of Inborn Errors of Immunity in Children and Young Adults, J Clin Med. 2023 May 11;12(10):3401.
TGF: Transforming
TNFRSF: Tumor necrosis
Correspondence
Helen-Gkamprielle
Voutsinou
Nafpliou 90 16674 Athens Μ +306986641048
e-mail:eleni25v@gmail.com
Pediatric Poisonings in the Emergency Department and the contribution of the Pediatric Nurse
Voutsinou H.G., Papatsani G., Goupiou A., Grammatikas G., Iacovidou N.
Abstract
Background: Pediatric poisonings are a phenomenon of global interest in the field of research due to the increased mortality. The pediatric emergency department accepts many admissions of cases of poisoning (of various kinds) that can have potentially serious complications. The purpose of this review is to highlight this issue, the response of pediatric emergencies and the contribution of the pediatric nurse to its prevention and treatment. Methods: It is a descriptive review based on international and domestic literature of the last ten years.
Results: The most common types of poisoning seem to be, in order, overconsumption of drugs, chemicals, household cleaning products, even with parents present at home and abroad it is highlighted the inhalation of polluted air. In most of children's poisonings that come to the ED, administration of activated charcoal and proper antidote is mentioned as the main treatment method.
Voutsinou H.G.
School Nurse 13o School of Glyfada, Athens
Papatsani G.
Nurse ICU, Metropolitan General Hospital of Athens
Goupiou A.
Nurse ICU, General Hospital of Athens
“Georgios Gennimatas”
Grammatikas G.
Nurse, General Pediatric Hospital of Patras “Karamandaneio”
Iacovidou N.
Neonatal doctor, Headmistress of Master’s Program
“Resuscitation” and NICU of Araiteeio Hospital
Conclusions: Research has shown childhood poisoning to be a vital Public Health issue. In addition to the education of the child and the parents, it is also necessary to raise the awareness of society, to establish an action plan out of and in hospital and to highlight the important role of the Pediatric Nurse.
1. Soave, P. M. et al. (2022) “Acute poisoning in children admitted to pediatric emergency department: a five-years retrospective analysis,” Acta bio-medica : Atenei Parmensis, 93(1), p. e2022004. doi: 10.23750/abm.v93i1.11602.
2. Bacha, T. and Tilahun, B. (2015) “A cross-sectional study of children with acute poisoning: A three-year retrospective analysis,” World journal of emergency medicine, 6(4), pp. 265–269. doi: 10.5847/wjem.j.1920-8642.2015.04.003.
3. Gummin, D. D. et al. (2021) “2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report,” Clinical toxicology (Philadelphia, Pa.), 59(12), pp. 1282–1501. doi: 10.1080/15563650.2021.1989785.
4. Κέντρο Δηλητηριάσεων, ΓΝΑ Παίδων Αθηνών «Παναγιώτης και Αγλαΐα Κυριακού»,2017: http://0317.syzefxis.gov.gr
5. Mowry, J. B. et al. (2015) “2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report,” Clinical toxicology (Philadelphia, Pa.), 53(10), pp. 962–1147. doi: 10.3109/15563650.2015.1102927.
6. Air pollution and child health: prescribing clean air (2018) Who.int. World Health Organization. Available at: https://www.who.int/publications/i/item/WHO-CED-PHE-18-01 (Accessed: June 25, 2024)
7. Xiang Y, Zhao W, Xiang H, Smith GA. ED visits for drug-related poisoning in the United States, 2007. Am J Emerg Med. 2012;30(2):293–301
8. Dayasiri, M. B. K. C., Jayamanne, S. F. and Jayasinghe, C. Y. (2017) “Risk factors for acute unintentional poisoning among children aged 1–5 years in the rural community of Sri Lanka,” International journal of pediatrics, 2017, pp. 1–9. doi: 10.1155/2017/4375987.
9. Müller, D. and Desel, H. (2013) “Common causes of poisoning: etiology, diagnosis and treatment,” Deutsches Arzteblatt international, 110(41), pp. 690–9; quiz 700. doi: 10.3238/ arztebl.2013.0690
10. Κουτσούκου
410.
11. Heikal S, Appelboam A. Emergency management of poisoning. Update in Anaesthesia 2012;28(1):253-260.
12.
13. World Report on Children Injury Prevention. World Health Organization, Geneva: https:// www.who.int/violence_injury_prevention/child/injury/world_report/en/
14. Tobaiqy, M. et al. (2020) “Frequency and management of acute poisoning among children attending an emergency department in Saudi Arabia,” Pharmacy (Basel, Switzerland), 8(4), p. 189. doi: 10.3390/pharmacy8040189.
15. Poison control and unintentional poisoning (no date) Who.int. Available at: https://www. who.int/data/gho/data/themes/topics/indicator-groups/poison-control-and-unintentionalpoisoning/ (Accessed: June 25, 2024)
16. Alruwaili, N.D.; Halimeh, B.; Al-Omar, M.; Alhatali, B.; Sabie, I.I.; Alsaqoub, M. An epidemiological snapshot of toxicological exposure in children 12 years of age and younger in Riyadh. Ann. Saudi Med. 2019, 39, 229–235.
17. Paediatric Nursing Associations of Europe PNAE 2005. Position statement on the regulation of paediatric nurses in Europe Position statement on the Regulation of Paediatric Nurses in Europe http://www2.rcn.org.uk/cyp
18.
19. Rutledge T. & Merritt L., 2017. Pediatric Nurse Practitioners in the Emergency Department: Implications for Education and Research. Journal of Pediatric health care. 31(6):729-733. https://doi.org/10.1016/j.pedhc.2017.04.001
20. Lee, J.; Fan, N.C.; Yao, T.C.; Hsia, S.H.; Lee, E.P.; Huang, J.L.; Wu, H.P. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr. Neonatol. 2019, 60, 59–67.
21. Gaw, C. E. et al. (2023) “Characteristics of fatal poisonings among infants and young children in the United States,” Pediatrics, 151(4). doi: 10.1542/peds.2022-059016.
ΣΥΝΑΔΕΛΦΙΚΑ
1.
2.
3. Βραβευμένες
4. Ερευνητικές μελέτες
5.
6.
7. Επίκαιρα θέματα
τραπεζών
8. Θέματα εκπαίδευσης και οργάνωσης υγείας
9. Ενδιαφέρουσες περιπτώσεις
10. Σύντομα νέα
11. Βραχείες δημοσιεύσεις
12. Επιστολές προς τη σύνταξη
13.
14.
•
International Committee of Medical Journal Editors/ Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (www.icmje.org και www.icmje.org/icmje.pdf).
Cumulated Index Medicus [List of Journals Indexed in Index Medicus (www.nlm.nih.goν/bsd/ uniform_requirements.html)].
1999;59:272-279.
Proesmans W. Bartter syndrome and its neonatal νariant. Eur J Pediatr 1997;156:669-679.
Flyvbjerg Α. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Ιnt 1997;52 (60 Suppl):S12-S19. Χωρίς
National Institutes of Health Consensus Deνelopment Conference. Neurofibromatosis conference statement. Arch Neurol1988;45:575-578.
Προσδιορισμός τύπου άρθρου:
Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.
Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701.
Clark AG, Barratt ΤΜ. Steroid-responsiνe nephrotic syndrome. Ιn: Barratt ΤΜ, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.
Σύγγραμμα ή μονογραφία:
Gorlin RJ, Cohen ΜΜ, Leνin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford Uniνersity Press; 1990.
Δημοσίευση
Bauer ΑW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.
Διδακτορική διατριβή: Παπαδόπουλος
Αθηνών; 1979.
Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Μο): Washington Univ.;1995.
III. CD-ROM
Andersoη SC, Poulsen ΚΒ. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.
IV. ΣΤΟ ΔΙΑΔΙΚΤΥΟ Άρθρο σε περιοδικό: Abood S. Quality improνement initiatiνe in nursiηg homes: the ΑΝΑ acts in an adνisory role. Am J Nurs [Internet]. 2002 Jun:
Μονογραφία: Foley ΚΜ, Gelbaηd Η, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001.
Webpage: http://www.nap.edu/books/0309074029/html Ιστοσελίδες: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Ιnc.; 2002: http://www.cancer-pain.org/
