Publications

Obstructive sleep apnea syndrome (OSAS) in child-hood is characterized by intermittent partial or complete collapse of the upper airway (obstructive hypopnea or apnea). Airflow reduction or even cessation may be as-sociated with lung hypoventilation and hypoxemia or compromise normal sleep architecture.Definitions in pediatricsThe term obstructive sleep related breathing disorders includes a variety of pathologic conditions ranging from primary snoring and upper airway resistance syndrome to obstructive sleep apnea- hypopnea syndrome.Apnea: It is defined as absence of oral and nasal air-flow for at least two respiratory cycles. Central apnea is characterized by absence of respiratory effort, whereas obstructive apnea is characterized by continuous respi-ratory effort without airflow. Mixed apneas have both central and obstructive features without intervention of normal respiration.Obstructive apnea is considered clinically significant regardless of presence of desaturation or arousals. Cen-tral apnea is clinically significant only if it is followed by hemoglobin desaturation by at least 3% or by an arousal. It is also evaluated as significant when it lasts more than 20 seconds, regardless of presence of arousal or desatura-tion.Hypopnea is defined as reduction in airflow wave-form width by at least 50% compared to width recorded at the longest period of normal sleep, for at least two re-spiratory cycles. Clinically significant hypopneas have duration greater than two respiratory cycles and are as-sociated with hemoglobin desaturation by at least 3% or with an arousal.Primary snoring describes presence of snoring with-out apnea or hypopnea, hypercapnia, hypoxemia, high arousal index, disruption of normal sleep architecture or daytime symptoms.

Aging is associated with a progressive decrement in the basal activity of the hypothalamic-pituitary-thyroid axis in male Fischer 344/N rats. The aim of this study was to determine whether stress influences the activity of this axis in young and old rats. As prolactin and growth hormone share some regulatory mechanisms with thyrotropin-releasing and thyroid-stimulating hormones, which are influenced by stress, the plasma levels of these two hormones were also determined during immobilization (Immo). To accomplish this, young (3-month-old) and old (23-month-old) male 344/N Fischer rats were immobilized for 2 h; blood was collected by cannulation from the tail artery at different intervals during Immo (0, 5, 30, 60, and 120 min), and brains were removed at the end of Immo. The basal plasma levels of thyroid-stimulating hormone were similar in both groups, but were significantly and progressively inhibited by Immo in young, but not in old rats. The baseline plasma levels of total triiodothyronine were slightly lower in old than in young rats; Immo caused a significant decrease of total triiodothyronine levels only in the young animals. The baseline plasma levels of free triiodothyronine were similar and were not altered by Immo in either age group. The paraventricular nucleus thyrotropin-releasing hormone mRNA levels were lower in old than in young rats under basal conditions; under stress they were significantly inhibited in young, but remained unchanged in old rats. The basal thyroid-stimulating hormone beta mRNA levels in the anterior pituitary were significantly lower in old than in young rats, but were not affected by Immo in either age group. The plasma prolactin levels were similar at baseline and were significantly increased by Immo in both age groups, but significantly more in old than in young rats. The plasma growth hormone levels were also similar at baseline; they were significantly decreased by Immo to a similar extent in both age groups. In summary, these data indicate that the stress-induced decrease in plasma thyroid-stimulating hormone is in part mediated at the level of the hypothalamic thyrotrophin-releasing hormone neuron and that this phenomenon is attenuated in the aged rat.

Healthy eating has gained ground in people's daily lives in modern society. However, an overwhelming preoccupation with healthy eating can lead to a pathological form setting the ground for orthorexia nervosa. This study aimed to validate the Greek version of the Eating Habits Questionnaire (EHQ) in adults 18 to 65 years old. The EHQ evaluates orthorexia nervosa traits. An online survey was conducted among adults of the general Greek population by administrating a battery of self-report instruments. The IPIP Big-Five personality questionnaire, Beck's Depression Inventory, the Obsessive-Compulsive Inventory-Revised, the Bulimic Investigatory Test, the Edinburg BITE, and the Eating Attitudes Test-13 were used. Internal consistency, test-retest reliability, and convergent and criterion validity were examined. A total of 551 adults (92.2% females) voluntarily participated in the study. Results suggest that the Greek version of the instrument has good psychometric properties. Analysis revealed a 3-factor model explaining 48.20% of the total variance. Cronbach's alphas ranged between 0.80 to 0.82, indicating good internal consistency. The test-retest reliability analysis showed no statistically significant difference between the measurements of the first and the post-2 weeks. Correlations with other eating disorder-related constructs were found to be weak to moderate. Body mass index was not significantly correlated with neither of the three EHQ subscales. The Greek version of EHQ is a robust instrument that could be used in clinical practice and research in the field of eating disorders in Greece.

The role of stress in the natural history of major depression has been a subject of intense scrutiny, particularly in light of the 20th century discoveries of some of the biological mediators of stress responses. In this paper we present evidence suggesting the hypothesis that an abnormality in the counterregulation of generalized stress responses underlies critical aspects of the pathophysiology of major depression. In particular, we focus on the role of inadequate glucocorticoid restraint of the central nervous system (CNS) components of the adrenocortical and adrenergic systems, i.e. the corticotropin releasing hormone (CRH) components of the adrenocortical and adrenergic systems, i.e. the corticotropin releasing hormone (CRH) and locus ceruleus-norepinephrine (LC-NE) systems. We believe that this hypothesis not only helps explain many of the observed abnormalities in the syndrome of major depression, but also provides a biological basis for subtyping this syndrome.

Aim The aim if this study is to evaluate parental readiness to implement changes in specific life‐style behaviours for preventing or reducing obesity in children. Methods Eighty‐seven parents of overweight or obese children participated in this cross‐sectional study. Parents completed a questionnaire for the assessment of their perceptions about their children's weight and their readiness to take action in general, as well as in relation to ten obesogenic life‐style behaviours. The transtheoretical model with the five stages of change (precontemplation, contemplation, preparation, action and maintenance) was used for this assessment. A total readiness score was calculated for the 10 behaviours. Results A total of 4.6% of parents were in the precontemplation–contemplation stage for overall weight management. However, this percentage was greater for particular behaviours, such as allowing children to self‐regulate their food intake, having family meals, reducing screen time and increasing physical activity. Child's body mass index, paternal education level and parental perception about child's excessive weight being attributed to over‐consumption of sweets and salty snacks were significantly associated with total readiness score. Conclusions The results of the present study indicate that the high readiness for general action reported by parents of overweight/obese children does not necessarily imply their readiness to engage in changes in specific life‐style behaviours.

Exposure to parental smoking (EPS) has been associated with increased asthma symptoms and airway hyperreactivity. Aim of the present study was to evaluate prospectively the effects of EPS on pulmonary function and symptoms in children with asthma. Methods: Urine cotinine-to-creatinine ratio (UCCRR) was used as an indirect measure of EPS, while FEV1 and asthma exacerbations were the main outcome variables. Subjects were evaluated at baseline and 2 years after an intervention to eliminate EPS. Results: 78 children (6-14 y.o.) were recruited. Subjects with history of EPS (n=38) had significantly lower FEV1 and higher UCCRR compared to those without such history (90.6±11.1 vs 96.4±12.6% predicted, p=0.046; and 25.3±21.3 vs. 14.1±11.7 ng/mg; p=0.005). Two years later, 31 children were re-evaluated; subjects with a decrease in UCCRR were similar regarding FEV1 compared to those with an increase in UCCRR (100.1±9.4 vs. 105.4±14.7% predicted, p=0.299). However, there was a trend for reduced frequency of asthma exacerbations: from 3.2±2.1/year to 0.7±1.1, p=0.073 in children with reduced UCCRR. Conclusions: History of EPS is associated with decreased airway function. Reduction in urinary cotinine levels within 2 years is accompanied by a trend for improvement in asthma exacerbations but not in airway function.

Massage therapy is one of the oldest touch therapies, and it has been used for many conditions. We have systematically reviewed articles on infant massage to evaluate its effects on maternal distress, and also on mother-infant relationship. Infant massage has been known to benefit mothers and infants regarding several health variables such as depression, parenting stress, weight gain for the infant, hormones and anxiety as well as functionality of the immunity system. However, tactile-only stimulation must be distinguished from multisensory interventions that include a tactile component, for tactile-only stimulation without social contact is associated with higher levels of stress, and it is also overstimulating for infants. The significance of this systematic review lies in the important role of massage therapy in human health, as it highlights a crucial yet often underestimated effect in psychological and biosomatical variables.

Achondroplasia (ACH), an autosomal dominant skeletal dysplasia, occurs in approximately 1:20,000 births. On the other hand, 47,XXY aneuploidy (Klinefelter syndrome [KS]) is the most common sex chromosome disorder, with a prevalence of approximately 1:600 males. To the best of our knowledge, only five cases of patients presenting both ACH and KS have been reported to date in the international literature. However, none of these cases has been longitudinally followed during the entire childhood.We report a male patient with ACH and KS, diagnosed in early infancy because of his typical phenotype of ACH. The diagnosis was confirmed by molecular analysis revealing a de novo heterozygous 1138 G-to-A mutation of the FGFR3 gene. During his first assessment, a karyotype was performed, which also revealed coexistence of KS. He was followed by our pediatric endocrinology team until the age of 16 years, then he was gradually transferred to adult endocrine care.This is the first reported case with both conditions that was diagnosed in infancy and was longitudinally followed by a pediatric endocrinology team regularly, from infancy to late adolescence. With a typical phenotype of ACH, it is striking and noteworthy that he did not develop the classical endocrine complications of a child with KS, neither did he necessitate testosterone supplementation during his pubertal development, due to his normal virilization and testosterone levels.