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Papadopoulou-Legbelou K, Kavga M, Desli E, Fotoulaki M. Multisystem inflammatory syndrome in a child with low inflammatory markers, persistent hyponatremia, and natriuresis. Hippokratia 2022; 26:83-85. [PMID: 37188049 PMCID: PMC10177853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare complication after infection with Coronavirus disease 2019 (COVID-19), and the differential diagnosis from Kawasaki disease is predominantly based on patients' older age and positive anti-SARS-CoV-2 antibodies in most cases. CASE DESCRIPTION We report an "atypical" case of MIS-C in a 3.5-year-old child, with relatively low levels of inflammatory markers, persistent hyponatremia, and hypoalbuminemia, along with exceptionally high levels of brain natriuretic peptide (BNP) and myocardial dysfunction. Persistent hyponatremia was mainly related to natriuresis, while BNP elevation was a marker of the disease severity, reflecting abnormal cardiac function. CONCLUSION Low inflammatory markers in children under the age of five years should not exclude a possible diagnosis of MIS-C. HIPPOKRATIA 2022, 26 (2):83-85.
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Affiliation(s)
- K Papadopoulou-Legbelou
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - M Kavga
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - E Desli
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - M Fotoulaki
- 4th Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Greece
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Papadopoulou-Legbelou K, Kavga M, Fotoulaki M. Protein-losing enteropathy after Fontan operation: enteric capsule findings and management with atrial pacing. Hippokratia 2017; 21:208. [PMID: 30944518 PMCID: PMC6441340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - M Kavga
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Greece
| | - M Fotoulaki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Greece
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Mavroudi A, Karagiannidou A, Xinias I, Cassimos D, Karantaglis N, Farmaki E, Imvrios G, Fotoulaki M, Eboriadou M, Tsanakas J. Assessment of IgE-mediated food allergies in children with atopic dermatitis. Allergol Immunopathol (Madr) 2017; 45:77-81. [PMID: 27717723 DOI: 10.1016/j.aller.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/06/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course. AIM The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD. METHODS Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods. RESULTS Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity. CONCLUSIONS In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.
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Lambropoulos V, Fotoulaki M, Kepertis C, Neofytou A, Spyridakis I. An unusual foreign body within the appendix. Med J Malaysia 2016; 71:298-299. [PMID: 28064301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ingestion of foreign bodies consist a quite common problem in the pediatric age group. Usually most of them traverse the gastrointestinal tract without complications and only in rare cases they get trapped within the appendix. This case report describes the ingestion of the tip of a mercury thermometer by a six-year-old girl. An elective appendicectomy was performed in order to avoid further complications. To the best of our knowledge, this is the first reported case of the tip of a thermometer within the appendix.
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Affiliation(s)
- V Lambropoulos
- Sarawak Heart Center, Cardiology Department, Kota Samarahan, 94300 Sarawak, Malaysia.
| | - M Fotoulaki
- Aristotle University of Thessaloniki G.H Papageorgiou, 2nd Department of Pediatric Surgery, Greece.
| | - C Kepertis
- Aristotle University of Thessaloniki G.H Papageorgiou, 4th Department of Pediatrics, Greece
| | - A Neofytou
- Aristotle University of Thessaloniki G.H Papageorgiou, 2nd Department of Pediatric Surgery, Greece
| | - I Spyridakis
- Aristotle University of Thessaloniki G.H Papageorgiou, 2nd Department of Pediatric Surgery, Greece
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Munck A, Colombo C, Kashirskaya N, Ellemuter H, Fotoulaki M, Houwen R, Wilschanski M. 191 Prospective multinational DIOS survey: concomitant risk factors and treatment alternatives. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fotoulaki M, Iakovou I, Karanika P, Sotiriadou F, Tenzidou K, Konstantinidis I. 203 Vitamin D3 deficiency as a predisposing factor for nasal polyposis in patients with cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Xinias I, Mavroudi A, Fotoulaki M, Tsikopoulos G, Kalampakas A, Imvrios G. Wireless Capsule Endoscopy Detects Meckel's Diverticulum in a Child with Unexplained Intestinal Blood Loss. Case Rep Gastroenterol 2012; 6:650-9. [PMID: 23139657 PMCID: PMC3493004 DOI: 10.1159/000343593] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, affecting about 2% of the population. Most cases of Meckel's diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn's disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.
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Affiliation(s)
- I Xinias
- Third Pediatric Department and Pediatric Surgery Clinic, Hippocration Hospital, Thessaloniki, Greece
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Ioannou H, Fotoulaki M, Augoustides-Savvopoulou P. 227 Plasma citrulline levels in cystic fibrosis patients. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sotiriadou F, Fotoulaki M, Argentou N, Nousia-Arvanitakis S, Chitiroglou P, Tsitouridis I, Speletas M. 273 TGF-p and SMAD proteins participate in the fibrotic process of liver disease in cystic fibrosis. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hatziagorou E, Fotoulaki M, Kioumis J, Keramidiotis A, Vasilaki K, Tsaousis V, Kanavakis E, Tsanakas J. CF registry in Northern Greece. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ioannou H, Fotoulaki M, Vasilaki K, Augoustides-Savvopoulou P. Plasma amino acid levels in cystic fibrosis patients. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sotiriadou F, Fotoulaki M, Chitiroglou P, Vassilaki K, Tsitouridis I, Nousia-Arvanitakis S. Hepatic tissue TGF-β and SMAD proteins as markers of the fibrosing process in cystic fibrosis: a pilot study. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fotoulaki M, Schuchman EH, Simonaro CM, Augoustides-Savvopoulou P, Michelakakis H, Panagopoulou P, Varlamis G, Nousia-Arvanitakis S. Acid sphingomyelinase-deficient Niemann-Pick disease: novel findings in a Greek child. J Inherit Metab Dis 2007; 30:986. [PMID: 17876723 DOI: 10.1007/s10545-007-0557-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 07/24/2007] [Accepted: 07/31/2007] [Indexed: 11/29/2022]
Abstract
Niemann-Pick Disease (NPD) is a heterogeneous group of autosomal recessive disorders characterized by progressive accumulation of sphingomyelin and cholesterol in lysosomes. Six types of NPD have been described based on clinical presentation and involved organs. The primary defect in NPD types A and B is a deficiency of lysosomal acid sphingomyelinase (ASM). We present a case of a 5-year-old boy with type B NPD who had severe clinical manifestations, including heart involvement. He was first admitted to the hospital at 2 months because of vomiting, refusal to feed, lethargy, hepatomegaly and mild transaminasaemia. Liver biopsy at 12 months showed lipid accumulation and fibrosis. Investigations for lysosomal storage disorders revealed increased plasma chitotriosidase (549 nmol/h per ml, normal value 0-150). At 18 months, no detectable ASM activity was observed in cultured fibroblasts (normal range 23-226 nmol/h per mg protein) confirming NPD B. Pulmonary involvement was detected with high-resolution computerized tomography which revealed reticulonodular infiltrations and thickening of the interlobular septa. At 2 years growth retardation and kyphosis were noted. At 2.5 years he manifested neurodevelopment regression, indicating CNS involvement. Cardiac involvement (grade III mitral valve insufficiency) developed at 4 years and heart failure at 5 years. Genetic analysis revealed two mutations: a H421Y mutation that is common in Saudi Arabian and Turkish patients, and a W32X mutation, which has been found in other Mediterranean patients.
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Affiliation(s)
- M Fotoulaki
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Giourtzis S, Fotoulaki M, Tramma D, Lafazanis V, Nousia-Arvanitakis S. 398 Renal function in relation to age in cystic fibrosis. J Cyst Fibros 2007. [DOI: 10.1016/s1569-1993(07)60365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tzetis M, Kaliakatsos M, Fotoulaki M, Papatheodorou A, Doudounakis S, Tsezou A, Makrythanasis P, Kanavakis E, Nousia-Arvanitakis S. Contribution of the CFTR gene, the pancreatic secretory trypsin inhibitor gene (SPINK1) and the cationic trypsinogen gene (PRSS1) to the etiology of recurrent pancreatitis. Clin Genet 2007; 71:451-7. [PMID: 17489851 DOI: 10.1111/j.1399-0004.2007.00788.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute recurrent/chronic pancreatitis (CP) is a complex multigenic disease. This is a case-control study consisting of 25 Greek patients with CP and a control population of 236 healthy Greek subjects. The whole coding area and neighboring intronic regions of the three genes were screened. Seventeen of 25 patients (68%) had mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene: nine compound heterozygotes with either mild or severe mutations and eight heterozygotes. Four patients (16%) carried CFTR-modulating haplotypes V470-TG11-T5 and V470-TG12-T7. All were negative for PRSS1 gene mutations, while variants c.486C/T and c.738C/T were found in nine patients each, three homozygotes for the minor alleles. Two carried SPINK1 gene mutation p.N34S, one being transheterozygote with CFTR mutation p.F1052V. The promoter variant -253T>C was found in four individuals (one homozygous for the minor allele), all four being transheterozygotes with mutations in the CFTR gene as well. Finally two carried c.272C/T in the 3' untranslated region, one being a p.N34S carrier as well. In total, 80% (20/25) of patients had a molecular defect in one or both of the CFTR and SPINK1 genes, suggesting that mutations/variants in the CFTR plus or minus mutations in the SPINK1, but not the PRSS1 gene, may confer a high risk for recurrent pancreatitis.
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Affiliation(s)
- M Tzetis
- Department of Medical Genetics, Medical School, Athens University, Athens, Greece.
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Stylianoul C, Galli-Tsinopoulou A, Koliakos G, Fotoulaki M, Nousia-Arvanitakis S. 304 Fasting ghrelin and leptin levels in Cystic Fibrosis adolescents: relationship with body composition. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nousia-Arvanitakis S, Fotoulaki M, Economou H, Xefteri M, Galli-Tsinopoulou A. Long-term prospective study of the effect of ursodeoxycholic acid on cystic fibrosis-related liver disease. J Clin Gastroenterol 2001; 32:324-8. [PMID: 11276276 DOI: 10.1097/00004836-200104000-00009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS To evaluate the efficacy of UDCA in arresting the progression of the early multifocal hepatic lesion to overt CF-related NBC. BACKGROUND Focal biliary cirrhosis is an early hepatic pathologic change related to the ion transport defect in cystic fibrosis. The factors involved in the progression of focal to nodular biliary cirrhosis are not clear. Ursodeoxycholic--a hydrophilic, nontoxic, choleretic, and hepatoprotective exogenous bile acid--has been reported to be effective in the management of cholestatic liver disease. STUDY For 10 years at 6-month intervals, 70 individuals with cystic fibrosis (38 men and 32 women; age range, 2--29 years) were examined using hepatosplenomegaly, liver function tests, and ultrasound liver scan. Patients demonstrating evidence of liver involvement at the onset or during the study received ursodeoxycholic acid 20 mg/kg body weight. RESULTS After the administration of ursodeoxycholic acid, the progression of nodular biliary cirrhosis ultrasound changes was arrested, hepatic function was preserved, and no variceal bleeding was observed. No case of focal biliary cirrhosis progressed to nodular biliary cirrhosis. Furthermore, the multifocal, multilobular changes suggestive of focal biliary cirrhosis on ultrasound scan were reversed to normal. CONCLUSION Ursodeoxycholic acid is effective in improving cholestasis and hepatic dysfunction in nodular biliary cirrhosis and, also, in reversing the early sonography findings suggestive of focal biliary cirrhosis. It is speculated that ursodeoxycholic acid may prove to affect the natural history of cystic fibrosis-related liver disease.
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Kokori H, Fotoulaki M, Giannakopoulou C, Hatzidaki E, Tantros S, Sbyrakis S. Intravenous immunoglobulin treatment in a girl with juvenile dermatomyositis. Pediatr Int 1999; 41:696-7. [PMID: 10618894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- H Kokori
- Department of General Paediatrics, University of Crete, Greece
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Fotoulaki M, Nousia-Arvanitakis S, Augoustidou-Savvopoulou P, Kanakoudi-Tsakalides F, Zaramboukas T, Vlachonikolis J. Clinical application of immunological markers as monitoring tests in celiac disease. Dig Dis Sci 1999; 44:2133-8. [PMID: 10548368 DOI: 10.1023/a:1026651224985] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate anti-gliadin (IgA-AGA and IgG-AGA), endomysial (IgA-EmA), and anti-reticulin (Ig-ARA) antibodies for monitoring celiac disease (CD) patients while on gluten-free and gluten-containing diets. Sera from 30 confirmed CD patients (13 boys, 17 girls), 1-24 years old, were examined for antibodies using ELISA (AGA) and Immunofluorescence (EmA, ARA) at 1, 3, 6, 9, and 12 months following institution of gluten-free diet and also at 3 and 6 months after challenge with gluten. One month following the exclusion of gluten from the diet, most antibodies are still positive. Twenty-three to 43% of antibodies remained positive by the end of the third month. At 6 and 9 months, 17% and 10% were positive, respectively. At 12 months no positive antibodies were detected. After gluten challenge, positive IgA-AGA and IgA-EmA titers were already demonstrated at 3 months (90% and 86%, respectively), while Ig-ARA titers showed a slow increase. Finally IgG-AGA responded with a slow decrease of titers to gluten-free diet levels and a fast increase upon provocation. The morphology of the intestine at diagnosis and during the periods of gluten-free diet and gluten challenge corresponds with the antibody titers. On the basis of these results, immunological markers may be applied to follow-up CD patients. IgA-AGA and IgA-EMA appear to be the most sensitive to dietary changes in gluten and correlate best with intestinal mucosal morphology.
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Affiliation(s)
- M Fotoulaki
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Greece
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