Erkan Cakir

Arg753Gln polymorphism of the human Toll-like receptor 2 gene from infection to disease in pediatric tuberculosis

The aim of this study is to examine the occurrence of the Arg753Gln polymorphism of the Toll-like receptor 2 (TLR2) gene in Turkish children with pulmonary and/or extrapulmonary tuberculosis (TB) disease compared with that in healthy children with latent TB infection (LTBI) and to assess the risk of progression from LTBI to active TB disease in children. The Arg753Gln polymorphism of the TLR2 gene was studied in 198 TB patients compared with 200 ethnically and age-matched children with LTBI. The culture confirmed TB patients were more frequently Arg753Gln heterozygous [odds ratio (OR) 5.05, 95% confidence interval (95% CI) 2.61-9.76, p = 0.00], and Gln allele frequency was significantly higher in the patient group (13.86% vs 3.5%, OR 4.40, 95% CI 2.34-8.30, p = 0.00). We also showed that the frequencies of the heterozygous Arg753Gln genotype and the Gln allele were significantly higher in patients with pulmonary TB alone and in patients with definitive pulmonary plus extrapulmonary TB than in children with LTBI. Our data suggest that the Arg753Gln polymorphism of the TLR-2 gene influences the speed of progression from infection to TB disease in children. Further investigations are needed to clarify whether this polymorphism has a strong impact on susceptibility to TB in children.

Flexible bronchoscopy for diagnosis and follow up of childhood endobronchial tuberculosis.

Background: In this study, our aim was to determine the clinical and bronchoscopic outcome of the endobronchial tuberculosis (ETB). Methods: Patients with suspected tuberculosis (TB) or TB patients with an inadequate response to 8 weeks of antituberculosis treatment were enrolled in the study. Results: Seventy patients were included to the study and 118 flexible bronchoscopies were performed. ETB was present in 33 (47%) patients. There was isolated compression in 14 cases, caseous lesions in 13, granuloma formation in 6, polypoid lesions in 2, adenopathy protrusion in 1, and mucosal erosion in 1 case. The mean duration of bronchoscopic resolution of endobronchial lesions was 5.50 ± 2.74 months. Mycobacterium tuberculosis was isolated from gastric lavage in 10% and from bronchoalveolar lavage in 12.8% of 70 cases. When both of the procedures were performed concurrently, the isolation rate increased to 20%. Transient hypoxia resolving with nasal O2 was observed in 3 patients as a complication of bronchoscopy. Conclusions: Bronchoscopy offered a safe and rapid means of confirming the diagnosis of ETB.

Home Ventilation for Children with Chronic Respiratory Failure in Istanbul

Background: The number of children on home mechanical ventilation (HMV) has increased markedly in Europe and North America but little is known about the HMV use and outcomes in children in Turkey. Objective: To review clinical conditions and outcome of children who were discharged from the hospital on respiratory support. Methods: Thirty-four patients assessed at the Marmara University Hospital in Istanbul who had been receiving ventilatory support at home for more than 3 months were included in the study. Results: Thirty-four patients with a median age of 5.1 years were discharged home with ventilatory support. HMV was started in 2001 at our institution and the number of children treated has increased substantially since then (2001: n = 1, 2002: n = 3, 2003: n = 3, 2004: n = 2, 2005: n = 14, 2006: n = 11).Ventilatory support was started at a median age of 1.8 years and continued for 13 months. Eleven (32.4%) patients received invasive mechanical ventilation via tracheostomy and 23 (67.6%) patients received noninvasive mechanical ventilation. Sixteen children (47.1%) were on noninvasive mechanical ventilation via nasal mask while 7 (20.6%) used a face mask. Seven (20.6%) patients received ventilatory support for 24 h and 27 (79.4%) patients were supported only during sleep. Twenty-four (70.6%) children received supplemental oxygen in addition to ventilatory support. Three patients successfully came off ventilatory support; 11 patients died during follow-up. None of the patients had home nursing and there were no life-threatening complications. Conclusions: A rapidly rising trend of HMV use in chronic respiratory failure (CRF) has been observed in this study. HMV can be safely applied in selected children with CRF with close monitoring and proper follow-up in developing countries despite the lack of home nursing.

Relationship between Toll-Like Receptor 8 Gene Polymorphisms and Pediatric Pulmonary Tuberculosis

Objectives: Genetic variants in Toll-like receptors (TLRs) are considered a potential indicator for host susceptibility to and outcome of several infectious diseases including tuberculosis. The aim of this study was to determine whether −129 C/G and Met1Val polymorphisms of TLR8 were associated with pediatric pulmonary tuberculosis in Turkish population. Methods: The −129 C/G and Met1Val polymorphisms were studied in 124 children with pulmonary tuberculosis compared to 150 age-matched healthy control subjects. Results: We did not identify any statistically significant differences between the patients with TB and control groups with regard to the frequency of genotypes GG or G/(−), CG, and CC or C/(−); and alleles G and C at rs3764879 (p > 0.05). We found a strong association with genotype A/(−) at rs3764880 with susceptibility to pulmonary TB in males (OR 2.87, 95%CI 1.38–5.98, p = 0.007). Conclusions: Our results provide evidence, for the first time, of a role for the TLR8 gene in susceptibility to pulmonary TB in male children. Additional research to verify our results are necessary. Tuberculosis in children presents particularly difficult challenges, but research priorities and advances in pediatric tuberculosis could provide wider insights and opportunities for tuberculosis control.

Polymorphism in the p2x7 gene increases susceptibility to extrapulmonary tuberculosis in Turkish children.

The P2X7 gene polymorphisms have been linked to increased risk for pulmonary and extrapulmonary tuberculosis in some populations. In this study, the genotype and allelic frequencies 1513A→C variant within the P2X7 gene was significantly higher than in the healthy controls (P = 0.035, P = 0.041). This is the first study demonstrating that the 1513A→C polymorphism is associated with extrapulmonary tuberculosis in children.

Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children

BACKGROUND Persistent wheezing is a common problem in early childhood and leads to a diagnostic dilemma, excessive investigations, drug administration and additional cost. OBJECTIVE To determine the efficacy and the safety of FOB in children with persistent wheezing despite bronchodilator and inhaled steroid therapy. METHODS Patients with persistent wheezing that lasted at least 6 weeks and did not respond to bronchodilator and inhaled steroid therapy and to whom flexible bronchoscopy was performed were included to the study. RESULTS Between 1997 and 2009; 113 patients were enrolled to the study. Sixty-three percent of the children were male. Median age was 14 months at presentation and median duration of symptoms was 5 months. Bronchoscopy revealed pathological findings in 48% of the patients. Thirty-eight patients had malacia disorders, 14 had foreign body aspiration and two had external compression of airways which were later diagnosed as vascular ring. Major and minor complications were not seen in 92% of the patients while transient hypoxia was seen in 6%, stridor in 1% and tachycardia in 1% of the patients. CONCLUSION Flexible bronchoscopy provided rapid and definitive diagnosis for our patients with persistent wheezing without any major complications. This study is one of the largest studies concerning persistent wheezing. Early bronchoscopic evaluation can reduce cost by providing rapid and accurate diagnosis and preventing unnecessary investigations and drug administration. Flexible bronchoscopy is a safe procedure and should be considered in the evaluation of children with persistent wheezing.

Sudden infant death syndrome: How much mothers and health professionals know

Background:  Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS.

The Effect of Obesity Degree on Childhood Pulmonary Function Tests

BACKGROUND Childhood obesity has become a global epidemic. It is related to several chronic diseases such as essential hypertension, type 2 diabetes mellitus, and renal disease. The relationship between the degree of obesity and lung functions is well defined in adults, but limited information is available about the childhood period. AIMS This study aims to determine the impact of the degree of obesity on the pulmonary functions of school children and adolescents. STUDY DESIGN Cross sectional study. METHODS Included in the study were a total of 170 school children and adolescents (9-17 years old) referred to our paediatric outpatient clinic. Of these subjects, 42 were lean and non-obese (BMI % <85), 30 subjects were overweight (BMI % >85, <95), 34 subjects were obese (BMI % >95, <97), and 64 subjects were morbidly obese (BMI % >97). Anthropometric measurements were taken and spirometry was performed on all subjects. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced vital capacity 25-75 (FEV25-75) and peak expiratory flow (PEF) were used to measure the ventilatory functions for all the subjects. RESULTS The groups showed no significant differences in age or gender. Despite no statistically significant differences in FEV1, FVC, or FEV1/FVC, there were significant reductions in PEF (p<0.001) and FEV25-75 (p<0.001) in the overweight, obese and morbidly obese subjects, when compared with those who were non-obese. CONCLUSION Overweight, obese and morbidly obese children have no obstructive abnormalities compared with healthy lean subjects.

An Unusual Case of Chylothorax Complicating Childhood Tuberculosis

Endobronchial tuberculosis (EBTB) and chylothorax are rare clinical disorders. The concurrence of these two disorders as manifestations of childhood pulmonary tuberculosis has not been reported. We report a 4‐month‐old boy presenting with chylothorax as the initial presentation of tuberculosis that has been successfully treated with octreotide, antituberculosis drugs and steroid therapy. Pediatr Pulmonol. 2008; 43:611–614.

Cathelicidin (LL-37) and human β2-defensin levels of children with post-infectious bronchiolitis obliterans

The antimicrobial peptides (AMPs) human β‐defensins and cathelicidin (LL‐37) are key factors in innate and adaptive immune responses of the respiratory tract and play an important role in many respiratory diseases. No data are available in the literature about the levels of these AMPs in paediatric patients with post‐infectious bronchiolitis obliterans (BO). This study aimed to determine human β‐defensin 2 (hBD2) and LL‐37 levels and compare between post‐infectious BO patients and the control group.