Fadil Ozturk

Foreign body aspiration in childhood: evaluation of diagnostic parameters.

Background Foreign body aspiration (FBA) is one of the most important preventable causes of childhood mortality and morbidity. Objective The aim of this study was to define the clinical and radiological features of FBA and investigate the diagnostic value of various parameters used to diagnose FBA. Methods The medical records of 147 children who were admitted to the hospital with a diagnosis of suspected FBA were examined. The sensitivity and specificity of the parameters used for the diagnosis of FBA and their predictive values were calculated. Results Of the patients, 75.5% were younger than 3 years, and 61.2% were male. Peak incidence was found in 18 months. A negative bronchoscopy rate of 19.7% was found, and 92.6% of these patients were younger than 3 years. The parameter with the highest diagnostic value was the presence of aspiration history (the sensitivity and positive and negative predictive values were 97%, 89%, and 80%, respectively). No significant difference was found in the classic triad of FBA (sudden onset of cough, wheezing, and unilaterally decreased breath sounds) between patients with and without FBA. The specificity and positive predictive value of the classic triad were high, and the sensitivity and negative predictive value were low (85% and 78%, and 13% and 19%, respectively). Conclusions Especially, male children younger than 3 years have an increased risk of FBA. Neither clinical symptoms nor the radiological findings alone are sufficiently specific and sensitive in diagnosing FBA. The most important factor for diagnosis is the presence of aspiration history.

Cardiac involvement due to Salmonella typhi infections in children

Sixty-six patients with Salmonella typhi infections were evaluated in terms of cardiological events in the Department of Pediatrics of Ondokuz Mayis University Hospital for a period of 14 years. Cardiac involvement is described in three cases of typhoid fever during that time. One patient had myocarditis only but another two cases had myocarditis and pericarditis. In addition to antibiotic therapy, pericardiocentesis and pericardiectomy were used. We present three cases of myocarditis caused by Salmonella typhi infections.

Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children

OBJECTIVE A prospective study was carried out to determine the sensitivity and specificity of reflux symptoms and laryngeal findings to diagnose laryngopharyngeal reflux (LPR) and gastro-esophageal reflux (GER) in children with asthma by comparing the results of double probe pH monitorization and to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence. METHODS A total of 50 patients (23 girls, mean age 10.8±0.4 years) with mild to moderate persistent asthma were included in this study. The patients were divided in two groups according to the asthma control status as controlled (n=27) vs. uncontrolled asthma (n=23). All patients completed the reflux symptom questionnaire and then they underwent flexible fiberoptic laryngoscopy and 24h double probe (pharyngeal and esophageal) pH monitorization. Laryngopharyngeal and gastroesophageal reflux were defined according to the double probe pH meter results. RESULTS The prevalences of LPR and GER were 70% and 46% in asthmatic patients, respectively. The reflux symptom score and LPR disease index were not useful to predict LPR or GER. There was no association between asthma control status and LPR and GER. Vocal nodule seems to be a valuable sign to evaluate LPR in asthmatic children. CONCLUSIONS The reflux symptom score and LPR disease index do not seem reliable to diagnose LPR and GER in children with asthma. The frequency of LPR and GER are independent of asthma control, atopy and long acting beta agonist usage.

Exhaled Carbon Monoxide Levels in Children with Bronchial Asthma

Exhaled carbon monoxide (eCO) has been proposed as a potential marker of oxidative stress in the asthmatic airways. This study was conducted to investigate eCO levels in different asthma groups in children. Exhaled CO was measured electrochemically in 117 asthmatic and 45 non-asthmatic, non-atopic healthy children between the ages of 6 to 16 years. Exhaled CO levels in viral associated wheeze were similar to healthy controls. However, all symptomatic patients with either persistent or seasonal asthma had higher eCO values (mean ± SD) (2.05 ± 0.9 parts per million (ppm) and 2.30 ± 0.8 ppm) as compared to controls (0.94 ± 0.5 ppm, p < 0.001, p < 0.001, respectively), viral associated wheeze (1.19 ± 0.4 ppm, p < 0.001, p < 0.001, respectively), and symptom-free seasonal asthmatics (1.45 ± 0.6 ppm, p < 0.01, p < 0.001, respectively). In symptom-free seasonal asthmatics eCO levels that were measured at the specific pollen season, were higher than the controls (p < 0.001) and the viral associated wheeze (p < 0....

Perceptions of Parents and Physicians Concerning the Childhood Asthma Control Test

Background. The Childhood Asthma Control Test (C-ACT) has been proposed to be a simple, patient-based test that is able to reflect the multidimensional nature of asthma control. In this analysis, the aim was to evaluate the perceptions of physicians and caregivers concerning C-ACT and its predictive value for future asthma-related events. Method. In a multicenter prospective design, 368 children aged 4–11 years with asthma who were either well- or not well-controlled were included in the study. The study participants were evaluated during three visits made at 2-month intervals and the Turkish version of C-ACT was completed each month. Parents completed questionnaires concerning their perception of asthma (before and after the study) and the C-ACT (after the study). Physicians completed a survey about their perception of a control-based approach and the C-ACT. Results. The C-ACT scores increased from visit 1 to visit 3, with improvement seen in all domains of the test. At the end of the study period, the parents more strongly agreed that asthma could be controlled completely and that asthma attacks and nocturnal awakenings due to asthma were preventable (p < .05). Most of the parents reported that the C-ACT helped them to determine asthma treatment goals for their children and also that the C-ACT improved communication with their physicians. The physicians indicated that a control-centered approach was more convenient (95%) and simpler (94.5%) than a severity-centered approach and provided better disease control (93.4%). A higher C-ACT score was associated with a decreased risk of asthma attack and emergency department admittance in the 2 months following the administration of C-ACT. Conclusion. Our findings indicated that the C-ACT improved both parental outlook on asthma control and the communication between the physician and parents. There was a good correlation between the C-ACT score and the level of asthma control achieved, as described by the physician. Additionally the C-ACT score was predictive of future asthma-related events. These findings suggest that the C-ACT may have an important role in asthma management in the future.

Childhood allergic disorders in Samsun, Turkey: discrepancy between reported and diagnosed

Schoolchildren (n = 1310) randomly selected from 32 schools in Samsun, Northern Turkey, were screened using the International Study of Asthma and Allergies in Childhood questionnaire. The prevalence of wheezing and current (last 12 months) wheezing were 21% and 14%, respectively: 2.3% of this group had received the diagnosis of asthma by a physician. Allergic skin rash was described in 17.3% and rhinitis in 44.7%, while 2.6% had been diagnosed with eczema and 10.5%, with allergic rhinitis. Respiratory symptoms were more common among 6–7‐yr‐old children compared with those aged 13–14 yr, and tended to be more prevalent in urban and coastal regions. The discrepancy between the rate of allergic symptoms and diagnosed allergic disorders may indicate a need for increased public and professional awareness and screening for allergic disorders in this area.

Students' unchanging smoking habits in urban and rural areas in the last 15 years.

Smoking is the main preventable public health problem particularly for youth worldwide. The aim of the present study was to determine the prevalence of smoking habits among students at secondary and high schools, and to compare the findings with those of a study conducted 15 years ago in the same area.

Assessment of skills using a spacer device for a metered-dose inhaler and related independent predictive factors in caregivers of asthmatic preschool children

The correct use of inhalation devices is essential for successful therapy. We aimed to evaluate the skills in the use of a spacer device with an metered‐dose inhaler (MDI) and factors that influence this skill in asthmatic preschool childrens caregivers.

Cerebral abscess in children with cyanotic congenital heart disease

The cerebral abscess still occurs in children with cyanotic congenital heart disease. Mortality and morbidity have not yet been reduced in spite of new antibiotics and surgical techniques. We describe our experience with 185 patients having cyanotic congenital heart disease (117 with tetralogy of Fallot, 23 with complete transposition, 9 with tricuspid atresia, 4 with total abnormal venous return, 10 with double-inlet ventricle, 15 with double-outlet right ventricle and 7 with common arterial trunk) who have been followed regularly in our department. Their ages ranged between 3 years and 15 years. During the period of follow-up, cerebral abscess developed in 7 cases. Six of them had tetralogy of Fallot and one had complete transposition. One patient died before surgery could be performed. Operation was carried out in 6 patients and one died in the early postoperative stage. The others were as healthy as could be expected. Alpha-hemolytic streptococcus was isolated from the abscess in one patient, and Enterobacter in another. The abscesses were localized in the occipito-parietal region in 2 cases, the fronto-parietal region in 2 cases, and the parietal, temporal and occipital regions in one case each. Physical examination was normal apart from fever in 5 patients and, in these patients, the cause of fever could not be explained. Neurologic evaluations were all within normal range. If fever occurs unexpectedly in a patient with cyanotic congenital heart disease, therefore, it is important to rule out the possibility of a cerebral abscess.