The Role of Substance P, Neurokinin A, Neuropeptide Y, and Cortisol in Assessing Neonatal Pain.

Introduction: Our aim was to investigate biomarkers of neonatal pain and their association with two pain scales. Methods: This prospective study included 54 full-term neonates. Levels of substance P (SubP), neurokinin A (NKA), neuropeptide Y (NPY), and cortisol were recorded and two pain scales (Premature Infant Pain Profile [PIPP] and Neonatal Infant Pain Scale [NIPS]) were used. Results: A statistically significant decrease in the levels of NPY (p = 0.02) and NKA (p = 0.03) was detected. A significant increase in NIPS scale (p < 0.001) and PIPP scale (p < 0.001) postpainful intervention was also detected. There was a positive correlation between cortisol and SubP (p = 0.01), NKA and NPY (p < 0.001) and between NIPS and PIPP (p < 0.001). A negative correlation was found for NPY with SubP (p = 0.004), cortisol (p = 0.02), NIPS (p = 0.001) and PIPP (p = 0.002). Conclusions: Novel biomarkers and pain scales may help in designing an objective tool for the quantification of neonatal pain in the everyday practice.

The Association between CFTR Gene Mutation Heterozygosity and Asthma Development: A Systematic Review.

Asthma is caused by complex interactions between environmental and genetic factors. Various genes have been implicated as potential risk factors in the development of asthma; among them is cystic fibrosis transmembrane conductance regulator (CFTR) gene. The aim of this systematic review was to investigate the association of CFTR mutation heterozygosity with the development of asthma, by updating the existing data with recent studies' findings. Therefore, a systematic review of the literature was conducted on Pubmed, ESBCO (Cinahl) and Scopus Databases up to December 2022. After the eligibility assessment, 17 studies were included in this review. Nine of them supported a lack of relationship between CFTR mutation heterozygosity and asthma susceptibility, and eight reported a positive association. Consequently, more extensive research is needed through high-quality studies to provide valid evidence and highlight the clinical benefits of identifying CFTR mutations in asthma patients, their impact on asthma severity, or treatment perspectives.

Assessment and management of asthma exacerbations in an emergency department unit.

BACKGROUND: The Pediatric Respiratory Assessment Measure (PRAM) score is a useful tool for the assessment of asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in children, assessed with the PRAM score and having mild-moderate asthma exacerbation, who were treated with salbutamol delivered via a metered-dose inhaler and spacer (MDI/S). METHODS: The study population consisted of children aged 3-16 years with mild-moderate asthma exacerbations. All children received 1mg/kg prednisolone p.o. (max 40 mg) and 4-6 puffs of salbutamol via MDI/S. RESULTS: Fifty patients participated in the study. Admission was associated positively with the initial PRAM score (OR: 18.91, CI: 2.42-123.12, P = 0.005) and negatively with the improvement in PRAM score (OR: 0.52, CI: 0.01-0.78, P = 0.032). CONCLUSION: PRAM is a reliable tool that can be used effectively to estimate the asthma exacerbation severity.

The Role of the Gut Microbiome in Cow's Milk Allergy: A Clinical Approach.

Cow's milk allergy (CMA) is the most prevalent food allergy (FA) in infancy and early childhood and can be present with various clinical phenotypes. The significant increase in FA rates recorded in recent decades has been associated with environmental and lifestyle changes that limit microbial exposure in early life and induce changes in gut microbiome composition. Gut microbiome is a diverse community of microbes that colonize the gastrointestinal tract (GIT) and perform beneficial functions for the host. This complex ecosystem interacts with the immune system and has a pivotal role in the development of oral tolerance to food antigens. Emerging evidence indicates that alterations of the gut microbiome (dysbiosis) in early life cause immune dysregulation and render the host susceptible to immune-mediated diseases later in life. Therefore, the colonization of the gut by "healthy" microbes that occurs in the first years of life determines the lifelong health of the host. Here, we present current data on the possible role of the gut microbiome in the development of CMA. Furthermore, we discuss how gut microbiome modification might be a potential strategy for CMA prevention and treatment.

The Expansion of the Hellenic Food Thesaurus; Allergens Labelling and Allergens-Free Claims on Greek Branded Food Products.

Branded food composition databases (BFCDs) are valuable information tools that meet multiple user needs. Recently, recognising allergies and intolerances as an emerging concern for various stakeholders, BFCDs evolve to embed information on allergens. This study aims to expand the Greek BFCD, HelTH, to include allergen information for its 4002 products. A new file was added to the structure of HelTH, and data were curated to record label information. In 68.4% of products, at least one allergen was present in the ingredient list and in 38.9% at least one allergen in a precautionary statement. Milk (38.8%), gluten (32.7%), and soybeans (17.4%) were most commonly declared in the ingredient list; nuts (18.3%), eggs (13.1%), and milk (12.2%) were most commonly declared in precautionary statements. Allergen-free claims were present in 5.3% of the products and referred mostly on gluten and milk. In general, no statistically significant differences were identified between the nutritional composition of allergen-free claimed products and their equivalents. This study delivers an expanded BFCD that provides organised and detailed allergen information; new insights on the presence of food allergens in branded foods and issues of concern regarding allergen declaration that need to be addressed in order to improve label information.

Does Adherence to the Mediterranean Diet Have a Protective Effect against Asthma and Allergies in Children? A Systematic Review.

Dietary pattern may potentially impact on the pathogenesis of asthma and allergies. The Mediterranean Diet (MD) has significant health benefits due to its antioxidant and anti-inflammatory properties. The aim of this systematic review was to investigate the effectiveness of adherence to the MD against asthma and allergies in childhood. Hence, a systematic literature search was conducted on PubMed, ESBCO (Cinahl), Scopus, and the Cochrane Library databases up to 26 January 2022. The total number of articles obtained, after the initial search on the databases was conducted, was 301. Twelve studies were included, after the removal of duplicates and screening for eligibility. Our findings indicated a protective role of the MD against childhood asthma, but they also imply that the MD probably does not affect the development of allergies. Nevertheless, the heterogeneity and limitations of the studies highlight the need for randomized controlled trials that will focus on the pediatric population and hopefully provide more robust evidence.

Effectiveness of an educational program for children and their families on asthma control treatment adherence.

Objective: Τo investigate the effect of an asthma care educational program for children and adolescents with asthma, on adherence to asthma control treatment and on clinical indices.Methods: Individuals newly diagnosed with asthma, aged 4-16 years, randomized to the intervention and control group. The participants were monitored for 6 weeks. At baseline, before the initiation of inhaled corticosteroids/long-acting beta2-agonist (ICS/LABA), the intervention group attended the educational program; the control group received the usual care. Both groups were equipped with electronic monitoring devices for measuring adherence. Spirometry, exhaled nitric oxide fraction (FeNO), and asthma control test (ACT) score were measured in both groups in the pre and post-ICS/LABA initiation visit.Results: Seventy-eight participants were enrolled in this study (n = 39 to each group). Median percentage of adherence was 73% for the total sample, and 80% and 68% in intervention and control group, respectively (p < 0.001). In multivariate analysis, the program was positively associated with improved adherence (p < 0.001). ICS/LABA had a positive effect on spirometric indices, FeNO, and ACT score, whilst the educational program did not improved significantly the above variables.Conclusions: Establishing and increasing adherence is challenging. An asthma care educational program is associated with greater short-term adherence during a period of active monitoring.

Adherence to the Mediterranean diet and inflammatory markers in children with asthma.

INTRODUCTION: There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes associated with asthma. METHODS: We measured serum IL-4, IL-33, and IL-17, in 44 asthmatic and 26 healthy children, 5-15 years old. Their adherence to MD was estimated with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) score. RESULTS: KIDMED score did not differ between the two groups (P=0.59) and was not correlated with any of the three measured cytokines. However, when the analysis was restricted only to asthmatic children, the KIDMED score was correlated with IL-4, IL-33, and IL-17 (Beta: -0.56, P=0.007; Beta: 0.57, P=0.010; Beta: -0.62, P=0.017, respectively). CONCLUSION: Our results indicate that MD can modulate the production of some of the main inflammatory mediators of asthma, in asthmatic children.

Interventions on Adherence to Treatment in Children With Severe Asthma: A Systematic Review.

Introduction: Poor adherence to inhaled medication is a commonly encountered problem among children with asthma. However, there is a relatively paucity of data regarding the adherence of children with severe asthma, as well as the merit of any interventions to improve this adherence. Objectives: The aim of this systematic review was to identify the available literature on the rate of adherence and the influence of interventions in improving adherence to controller inhaled medication, in children with severe asthma. Methods: A systematic literature search was performed in MEDLINE/PubMed, Cochrane Library, and Scopus databases. Studies were included in the present review if their target population were children and/or adolescents with severe asthma and presented data on medication adherence before and after a given intervention. Results: A total of seven studies, conducted in USA, Canada, and UK, and published between 2012 and 2018, met the inclusion criteria. Adherence to controller medication was assessed via either objective or subjective measures (questionnaires), or a combination of them. Interventions included communication during pediatric visits and audio-taped medical visits, individualized care programs, electronic monitoring devices, interactive website and peak-flow prediction with feedback. Adherence rates for the baseline (before intervention) or for the control groups ranged from 28 to 67%. In general, there was a significant improvement of adherence after intervention with rates increasing to 49-81%. Conclusion: Adherence rate in children with severe asthma is not satisfactory but it can be improved after proper interventions. Nevertheless, the heterogeneity among adherence assessment tools, and the variety of interventions, in combination with the lack of studies focusing on severe asthma, highlight the need for further research in this field.

Asthma and Allergy "Epidemic" and the Role of Vitamin D Deficiency.

The increase in asthma and allergies prevalence that has been recorded in many countries during the last decades, and the reemergence of vitamin D (VD) deficiency in many populations worldwide, renders fairly plausible the assumption of an underlying association between these two conditions and justifies the research effort invented in this issue. Indeed, there is growing body of evidence from epidemiological, laboratory, and clinical studies, suggesting that such an association does exist. The hypothesis of low levels of VD leading to compromised fetal programming and impairment of various immune functions involved in asthma and allergic disorders, stands as the most credible explanation of this presumed association. However, the evidence is not yet definite and there are some conflicting results among studies. As a consequence, no safe conclusions can be drawn yet, and more research is required in order to fully clarify the involvement of VD deficiency in the pathogenesis of asthma and allergies, and decide if VD has a role to play in the prevention and therapy of these disorders.

OC35 - Child Friendly Healthcare Initiative, implementation project in a paediatric department in Greece.

UNLABELLED: Theme: Accreditation and quality improvement. INTRODUCTION: Child Friendly Healthcare Initiative (CFHI) aims to improve quality of experience and health care given to children and families by improving realisation of children's rights and reducing unnecessary fear, anxiety and suffering during and because of health care. AIM: To present results of preliminary CFH assessment. METHODS: Implementation was initiated in a paediatric department of a University Hospital in Athens, Greece, consisting of a 37-bed ward, Outpatient Clinic and Emergency Department. For the preliminary assessment of the CFHI tool No1, which is for parents-caregiverschildren and health workers, this was translated into Greek. 112 parents-caregivers and six children were interviewed by an independent interviewer. In total, 24 health workers - 5 paediatricians, 11 residents and 8 nurses - responded to the CFHI tool No 1. RESULTS: Issues highlighted were mostly about CFH Standard 3 and Standard 7. Suggestions for improvement in all Standards were suggested. CONCLUSIONS: Preliminary assessment revealed the quality of care needs improvement. The next step is the training health workers, planning and making improvements.

OC36 - Diagnostic approach of primary cilia dyskinesia: Greek experience.

UNLABELLED: Theme: Complex health care and chronic disease management. INTRODUCTION: Primary Cilia Dyskinesia (PCD) is a rare, genetically heterogeneous disease that causes chronic pulmonary inflammation and progressive loss of lung function due to the dysfunction of cilia. AIM: To present the Greek experience in development and implementation of standardized operational procedures (SOP) in diagnostic testing of PCD. METHODS: After special training, SOP consisting of nasal NO (nNO) measurement, high speed videomicroscopy (HVM), transmission electron microscopy (TEM) and shipment of the sample for high resolution immunofluorescence (IF) microscopy in difficult cases, were applied. RESULTS: From September 2014 until December 2015 197 tests were performed to 147 suspected patients. 17 patients were finally diagnosed with PCD. CONCLUSIONS: PCD is a rare disease that can be diagnosed through SOP. Early diagnosis and appropriate treatment of PCD will reduce not only the morbidity and mortality to patients, but also the burden of healthcare costs.

Does Vitamin D Deficiency Epidemic Parallel with Allergy and Asthma Epidemic?

Vitamin D (VD) deficiency has re-emerged, after more than hundred years, as a public health problem worldwide. Asthma and allergic disorders constitute another major public health problem with studies having recorded increasing prevalences worldwide since the decade of the 60s. Most of the available experimental and epidemiologic evidence point towards a causal association between low levels of VD and the development of asthma and allergic disorders, and imply a role of VD deficiency on the currently high prevalences of asthma and allergic diseases. The proposed, but still largely hypothetical, underlying mechanism is that VD affects the programming of the fetus and it also has a central modulating role in immune functions involved in asthma and allergic disorders. However, the evidence is not yet clear, since there are studies which support that VD supplementation during pregnancy may promote the development of asthma and allergic disorders. More researches, and especially randomized clinical trials, are required in order to draw safe conclusions and define the role of VD in the prevention or even therapy of asthma and allergic disorders.

Vitamin D and Cystic Fibrosis Lung Disease.

Vitamin D has been increasingly recognized as being involved in a wide spectrum of biological actions, including significant immunomodulatory effects. The cystic fibrosis (CF) airways are characterized by dysregulated and disproportionately increased, in relation to the underlying bacterial stimuli, inflammatory responses. Vitamin D downregulates pro-inflammatory cytokines and chemokines that promote tissue destruction, and which are abundant in CF lungs. However, despite mounting evidence for a pathophysiological role of Vitamin D in CF airways inflammation, there are only a few clinical reports supporting a relevance of Vitamin D insufficiency with CF airways damage, and so it is early to assign an indisputable causal role to Vitamin D. The present review will examine the current literature regarding the association of Vitamin D status with CF lung disease, and comment on the therapeutic implications accruing from these relations.

Blunted perception of dyspnea in asthmatic children: A potential misleading criterion.

Dyspnea (or breathlessness) is a symptom describing a perceived experience of breathing discomfort. Children's awareness of dyspnea is variable and there is only a poor correlation between the objective respiratory distress measurements and the subjectively awareness of dyspnea. Those who do not perceive dyspnea may not be motivated to comply with their daily prophylactic treatment. Since dyspnea is the main symptom of asthma, and disease management is based largely on the description of symptoms between clinic visits, unreliable symptom report may mislead decision-making for long-term treatment of asthma. Thus, therapeutic decisions should not be taken solely on patients' perception and description of dyspnea.

Perception of dyspnea in children with asthma.

The subjective experience of discomfort in breathing, termed dyspnea (or breathlessness), is a symptom with multifactorial causes of highly complex and largely undefined psycho-physiologic mechanism(s). There are at least three discrete qualities of dyspnea likely corresponding to different types of respiratory stress and separate underlying mechanisms. Perception of dyspnea can be measured by diverse means; however, none of these scales has been standardized in children. In general, the same degree of bronchoconstriction causes various levels of perception of dyspnea in different patients. There are large discrepancies among patients in subjective rating of the severity of dyspnea and objective measurement of lung function. Since reporting symptoms is an integral part of therapeutic management of asthma, poor perception of dyspnea may lead to delayed diagnosis and undertreatment of the disease.

Parents' satisfaction concerning their child's hospital care.

AIM: To explore parents' satisfaction concerning their child's care during hospitalization and its determinants. METHODS: A descriptive, non-experimental correlational design was used. The data collection was based on interviews using a 63 item questionnaire, the Swedish Pyramid Questionnaire. The parents of 206 children (hospitalized in two pediatric and two surgical units) participated in the study. RESULTS: The independent t-test results demonstrated that the parents showed greater satisfaction with staff attitudes and medical treatment, whereas they were less satisfied with the information concerning routines and the staff work environment. The stepwise multiple regression analysis revealed that adequacy of care, adequate pain management, parents' involvement in care, a trusting relationship, and staff attitudes were the most important determinants of parental satisfaction. CONCLUSION: Interventions in pediatric care should include measurements of parental and child satisfaction as a tool to assess the quality of care.

Assessment of self-reported self-esteem in healthy and diabetic children and adolescents in Greece.

BACKGROUND: The aim of the present study was to evaluate any possible negative effect of diabetes on the self-esteem of children and adolescents with diabetes. METHODS: Self-esteem was evaluated using the Culture-Free Self-Esteem Inventory (CFSEI-2) in 144 patients with Type 1 diabetes mellitus (T1DM; 7-18 years of age) treated in a diabetes center and compared against that of 136 healthy children and adolescents. RESULTS: Self-esteem was correlated with age (P = 0.017), but not with diabetes (P = 0.886). The median CFSEI-2 score for both healthy and diabetic children was 22. There was no significant correlation between self-esteem and sex, body mass index (BMI), physical exercise, HbA1c or parental educational level. According to Spearman's rank correlation coefficient (r(s)), there was a significant association between age and self-esteem (r(s) = -0.15). Conversely, although BMI (r(s) = -0.09) and treatment duration (r(s) = -0.107) had a slight negative effect on self-esteem and the duration of physical exercise (r(s) = 0.11) and parental education (r(s) = 0.07) seemed to have a positive effect, the associations did not reach statistical significance. CONCLUSIONS: Self-esteem in diabetic children is mainly affected by their age, level of physical activity and level of family support. These findings emphasize the need to discriminate between glycemic control and diabetic adjustment.