Fotios Kirvassilis

High resolution computed tomography of the chest in cystic fibrosis (CF): is simplification of scoring systems feasible?

The purpose of this study was to simplify HRCT scoring systems (SS) for CF by selecting representative HRCT parameters. Forty-two consecutive patients with CF underwent baseline and follow-up chest HRCT. Three radiologists evaluated 84 HRCTs employing five SS. “Simplified” HRCT SS were formed by selection of parameters exhibiting statistically significant relations with FEV1. Pulmonary function tests (PFTs) and nutrition (IBW%) were recorded. Regression analysis, Pearson correlation and T-test were used for statistical analysis. Three HRCT parameters were selected for the formation of “simplified” HRCT SS (severity of bronchiectasis, bronchial wall thickening, atelectasis-consolidation) using regression analysis. There was excellent correlation between each “simplified” and corresponding complete score (0.892 < r < 0.0967, p < 0.0001) or the remaining four complete scores (0.786 < r < 0.961, p < 0.0001). Strong correlation was found among the five “simplified” scores (0.803 < r < 0.997, p < 0.0001). Comparing baseline complete and “simplified” scores with corresponding follow-up ones, significant worsening was observed (p < 0.0001). PFTs and IBW% did not change significantly. HRCT scores correlated moderately with FVC and FEV1, but there was no correlation with FEF25-75 and IBW%. “Simplified” HRCT SS are as reliable as the complete ones and detect progression of lung disease earlier than clinical parameters. They are easy to use and could be adopted in clinical practice.

Efficacy and safety of the combination fluticasone propionate plus salmeterol in asthmatic preschoolers: An observational study

ABSTRACT Background: Inhaled Corticosteroids (ICS) are the cornerstone of asthma management in pediatric patients. However, in some cases, asthma is not adequately controlled on ICS alone. Long-acting beta2-agonists (LABA) are one of the available additional therapies but their use has rarely been studied among children younger than 5 years. Objective: The aim of this observational study was to evaluate the efficacy and safety of the combination of fluticasone propionate and salmeterol (FP/SA) in asthmatic children younger than 5 years of age. Methods: A retrospective study of 796 children under the age of 5 years (2.87 ± 1.22 years, 64.2% males), who were treated with FP/SA was conducted. Hospitalization rates, frequency of wheezing, exercise induced asthma, nocturnal wheeze and drug-related side-effects were recorded through childrens medical records. Results: The children had previously received short-acting β2-agonists (73%), ICS (17%), montelukast (1%), and ICS with montelukast (2%). Mean duration of therapy with FP/SA was 12.45 ± 9.14 months. After adjusting for age, gender, and duration of treatment, a 89% reduction was recorded in annual hospitalization rates (from 27.13% before treatment to 3.01% after FP/SA therapy, p < 0.001), a 71% reduction in incidence of exercise-induced asthma (36.8% vs. after 10.6%, p < 0.001), a 81% reduction in nocturnal asthma (33.7% vs. after: 6.4%, p < 0.001), as well as in frequency of wheezing (p < 0.01),. No previous treatment carry-on effect was observed. No major drug-related side-effects occurred in the study group. Conclusions: Combination therapy (FP/SA) is well-tolerated and highly effective in asthmatic children under the age of 5 years.

Technology depended children. Quality of life, days of hospitalization and cost effect from a home care program

Background: Home care has been reported to improve the quality of life (QoL) and reduce length of hospitalization and cost of technology depended children. Aim: To evaluate QoL, length of hospitalization and the cost for our National Health System, of the children with chronic respiratory problems who entered a home care program. Patients-Method: Technology depended children with chronic respiratory problems, entered prospectively in a hospital based home care program. QoL DISABKIDS questionnaire for children and the equivalent for parents were completed. DISABKIDS questionnaire for children with cerebral palsy was completed from the parents of the children with cerebral palsy. The days and the cost of hospitalization one year before and after their entry in the program were counted. Results: 30 children, mean age 6.85 years, entered the study. QoL questionnaire completed from the parents of the children with cerebral palsy didn9t show improvement a year later (p=0.275). QoL of the children and their parents with other disorders improved a year later (children: t(9)=3.674, p=0.005), (parents: t(9)=4.146, p=0.002). Median days of hospitalization of the year before the intervention were 16.5, and after were 4.5, (Wilcoxon z= -2, 764, p= 0,006). The median cost of hospitalization the year before the intervention was 3538.30€ and after 2009.50€, (Wilcoxon Z=-2.619, p=0.009). Conclusions: Entry on a home care program of the children with technology depended chronic respiratory problems, significantly reduced days of hospitalization and the cost for our Health System. QoL improved significantly, but not for children with respiratory problems due to cerebral palsy.

Is there a correlation between bronchiolitis and urinary tract infection

Increased incidence of urinary tract infection (UTI) has been reported among children with bronchiolitis. The aim of the study was to evaluate the incidence of UTI among children with RSV bronchiolitis. We retrospectively examined for positive urinary culture, the records of all children The records of 241 children examined (174 bronchiolitis, 26 viral wheeze and 41 respiratory tract infection). Kruskal Wallis chi-square test compared the incidence of positive urine culture among the three groups revealed no significant difference (p=0.455). 64/174 children who were admitted for bronchiolitis, were tested for RSV: 36/64 were found positive. 17/36 were urine cultured and 2/17 (11%) had positive urine culture, while 0% had positive urine culture from non RSV bronchiolitis (p=0.634). UTI was not detected to have higher incidence among children with bronchiolitis. No correlation was found between positive urine culture and RSV bronchiolitis.