Müjdat M. Başaran

Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children.

BACKGROUND The role of topical corticosteroids in the treatment of acute sinusitis has not been established in children. OBJECTIVE An attempt was made to determine the impact of topical corticosteroids as an adjunct to antibiotic treatment in the management of childhood sinusitis. METHODS In a double-blind, placebo-controlled study, 151 children with sinusitis were recruited from a general pediatric outpatient clinic and 89 completed a 3-week trial. Treatment consisted of amoxicillin-clavulanate potassium, 40 mg/kg/d tid, combined with bid nasal spray of either budesonide, 50 micrograms, to each nostril (n = 43) or placebo )n = 46_ for 3 weeks. Patients maintained daily symptom cards throughout the study and were examined by the same physician each week. RESULTS Clinical symptoms and signs decreased significantly in both treatment groups in comparison to baseline (P < .01). We detected a significant improvement in the scores of the cough and nasal discharge at the end of second week in the budesonide group when compared with placebo (P < .05). Friedman nonparametric repeated measures ANOVA test revealed a significant decrease in the total weekly scores of cough during the second week of budesonide treatment (P < .001) in contrast to continuous decline during the second and third weeks in the placebo group (P < .001 and P < .05, respectively). While the nasal discharge score decreased significantly during the second week in the budesonide group (P < .01), no significant effect on the nasal discharge score was observed in the placebo group. CONCLUSION These data suggest that topical corticosteroids may be a useful ancillary treatment to antibiotics in childhood sinusitis and effective in reducing the cough and nasal discharge earlier in the course of acute sinusitis.

Comparison of sucrose and human milk on pain response in newborns

Abstract The aim of this study was to compare the analgesic effect of 2 ml 25% sucrose and human milk in a group of healthy term newborns. Healthy infants (n = 102) were randomly allocated to receive one of three solutions (sucrose, human milk, sterile water) 2 min prior to taking a heel prick blood sample. The median values of crying time, recovery time and percentage change in heart rate at 1, 2 and 3 min were recorded in response to the heel prick. Median crying times were 36, 52, and 62 s in the sucrose, placebo and human milk groups, respectively (P = 0.0009). In the sucrose group, there was a significant reduction in crying time compared to human milk and placebo groups. Similarly, the median recovery time in the sucrose group (72 s) was shorter than that in the human milk (112 s) and placebo groups (124 s) (P = 0.004). The percentage change in heart rate at 1, 2 and 3 min was also significantly lower in the sucrose group (P = 0.008, P = 0.01, P = 0.002 at 1, 2, and 3 min respectively). Conclusion The orosensorial antinociceptive effect of human milk is not as effective as an analgesic as a 25% sucrose solution.

Impact of Mycobacterium vaccae immunization on lung histopathology in a murine model of chronic asthma

Background Therapeutic modalities of asthma have not been proved to be successful in reversing the already established chronic changes of airways.

The effectiveness of high-dose inhaled budesonide therapy in the treatment of acute asthma exacerbations in children

BACKGROUND International guidelines recommend the use of systemic steroids for the treatment of acute asthma attack if it has not been resolved within 24 to 36 hours of home management with regular beta2 mimetic inhalation. Such therapy for infrequent exacerbations is unlikely to have serious systemic effects. Unfortunately, many patients receiving frequent courses are potentially at risk for corticosteroid-induced side effects such as adrenal suppression, depression of linear growth, and osteoporosis. OBJECTIVE To decrease the use of frequent oral corticosteroid courses in children, this study was designed to evaluate the efficacy of high-dose inhaled steroids in comparison with oral steroids, in the therapy of acute asthma exacerbations in children. METHODS Sixty children who have experienced an acute exacerbation of asthma unresponsive to home management with regular use of inhaled beta2 mimetics, yet not severe enough to hospitalize, were randomized to be treated with either high-dose inhaled budesonide (1,600 microg daily) or oral methylprednisolone (1 mg/kg daily) plus medium-dose inhaled budesonide (800 microg daily, both in addition to inhaled terbutaline, 2,000 microg daily). Pre- and posttreatment pulmonary index scores, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow 25% to 75% (FEF25%-75%) were evaluated. RESULTS The mean number of decrease in pulmonary index score was 2.61 +/- 1.12 in the high-dose budesonide-receiving group (group I) and 1.90 +/- 1.08 in the oral steroid-receiving group (group II). There was a statistically significant difference between the two groups, in favor of group I (P = .038). No statistically significant difference was detected between the two groups with respect to the increase in lung function test measurements (FEV1, FEV1/FVC, FEF25%-75%; P = .790, .959, .819, respectively). CONCLUSIONS Short-term high-dose budesonide therapy can be considered an alternative for children who are experiencing an acute asthma attack that is unresponsive to home management with regular use of an inhaled beta2 mimetic, yet who are not severe enough to hospitalize.

Efficacy of Aminophylline in the Treatment of Acute Asthma Exacerbation in Children

BACKGROUND The role of aminophylline (ethylene diamine salt of theophylline) in the treatment of acute exacerbation of asthma has not been well established in children. OBJECTIVE The aim of the study was to determine the additional therapeutic benefit of intravenous aminophylline in the treatment of children hospitalized for acute asthmatic exacerbation and treated with inhaled bronchodilators and glucocorticoid therapy. METHODS Thirty-eight children aged from 2 to 16 years (mean age 5.64 +/- 3.31), admitted for acute exacerbation of asthma, participated in a prospective, randomized, double-blind, placebo-controlled study. All the subjects received methylprednisolone, administered intravenously, and nebulized salbutamol. The treatment group received intravenous aminophylline therapy and the placebo group received 0.9% saline solution for 24 hours. RESULTS The number of salbutamol nebulizations needed and the clinical asthma scoring were recorded both at onset and at the end of 24 hours. There was no significant difference in either the mean number of nebulizations or the clinical asthma scores between the two groups (P = .7843, P = .8452). CONCLUSION Intravenous aminophylline (ethylene diamine salt of theophylline) demonstrated no additional beneficial effect to the combination of beta adrenergic agonists and glucocorticoid treatment in acute asthma attack in children.

Risk factors for the persistence of respiratory symptoms in childhood asthma

OBJECTIVE To evaluate the parameters which could predict the persistence of respiratory symptoms in asthmatic children who have been treated with a considerably uniform therapy. METHODS A retrospective review was performed on the records of 279 children with asthma. An end of study visit, results of spirometry and prick tests completed the data. The mean age at referral and at final visit was 6.2 +/- 3.7 years and 8.9 +/- 4.1 years, respectively; and the children were followed up for a mean of 3 +/- 1.2 years. RESULTS Eighty-five of the 279 patients (30%) experienced no respiratory symptoms in the previous 12 months. There was no significant difference between those with and without current respiratory symptoms with respect to age, sex, age at onset of symptoms, duration of followup, age at referral, therapeutic choice, severity of asthma and duration of symptoms at referral. For subjects with current respiratory symptoms the initial serum total IgE level, and the percentage of RAST/prick test positivity was significantly higher than those without current respiratory symptoms (P = 0.0027, P = 0.011, respectively). Although the initial FEF 25%-75%, FEV1, and FEV1/FVC was significantly lower in those with current respiratory symptoms (P = 0.003; P = 0.005; and P = 0.04, respectively), there was no statistically significant difference between lung functions of the two groups at the end of followup. The persistence of respiratory symptoms was significantly predicted by initial FEF25%-75% and sensitivity to allergens (P = 0.03 and P = 0.04, respectively). CONCLUSIONS We concluded that the risk factors for the persistence of respiratory symptoms in our patient population have been low FEF25%-75% value and sensitivity to allergens at referral.

Inhaled Corticosteroids and Bone Density of Children with Asthma

In this cross-sectional study we aimed to compare anteroposterior (AP) spine and total body bone mineral density (BMD) measurements of children with asthma treated with long-term inhaled budesonide (n = 52, mean age 6.4 ± 2.2 yr, M/F = 22/30) (Group I) with those of asthmatic children who had never received treatment with inhaled corticosteroids (Group II) (n = 22, mean age 6.8 ± 2.2, M/F = 10/12). Boys and girls were comparable for age, weight, height, cumulative corticosteroid (CS) dosage, duration of disease and inhaled corticosteroid (ICS) treatment within each group. The mean total accumulated dosage of budesonide for children in Group I was 154.0 ± 135.3 mg (mean daily dosage = 419 ± 154 µg) and the mean treatment duration was 13.0 ± 9.8 months. The two groups were comparable with respect to age, gender, weight, height, Tanners stage and duration of disease. There was no significant difference between subjects in the two groups for total (p = 0.214) and (AP) spine BMD results (p = 0.661), respectively. Our results provide additional support for the safety of ICS therapy on bone density of asthmatic children.

The Impact of in Vivo Calmette-Guérin Bacillus Administration on in Vitro IgE Secretion in Atopic Children

To investigate whether a preexisting T helper (TH) 2 type immune response could be suppressed by Calmette-Guérin Bacillus (BCG) immunization in atopic children with asthma, we determined interferon (IFN)-γ, interleukin (IL)-2, IL-4, and IL-5 and total IgE level in the supernatant of peripheral blood mononuclear cells (PBMC) of six atopic and five nonatopic children in response to phytohemagglutinin A (PHA), purified protein derivate (PPD), and Dermatophagoides pteronyssinus II allergen (Der p II) both before and after BCG vaccination. IL-5 level in response to Der p II was significantly higher in the atopic group than in the nonatopic group both before and after BCG vaccination (p = 0.004, p = 0.009, respectively). In the atopic group, IgE levels determined in PPD and Der p II stimulated and unstimulated culture supernatants decreased significantly after BCG vaccination (p = 0.028, p = 0.026, p = 0.046, respectively), whereas in the nonatopic group (p = 0.041) BCG vaccination resulted in a significant decrease in IgE level only in response to Der p II stimulation. We concluded that in vivo BCG administration can downregulate both spontaneous and stimulated in vitro IgE secretion from PBMC of atopic children.

Heat-Killed Mycobacterium bovis-Bacillus Calmette Guerin-Suppressed Total Serum IgE Response in Ovalbumin-Sensitized Newborn Mice

To determine the impact of bacillus Calmette Guerin (BCG) vaccination on IgE production in ovalbumin (OVA)-sensitized newborn mice, four groups (I, II, III, IV) of BALB/c mice were immunized on the first day of life with live BCG, killed BCG, BCG diluent, and saline, respectively. No injection was applied to mice in group V (control). All mice except group V were sensitized and challenged with OVA in the fourth and sixth weeks, respectively, and serum total IgE levels were determined at 8 weeks, 2 weeks after the second OVA challenge. IgE levels of all groups were significantly higher than the control group except for group II (p = 0.95). Mice in group II showed significantly lower IgE values than group IV and I (p = 0.007 and p = 0.003, respectively). We concluded that heat-killed BCG may downregulate IgE response to OVA in newborn mice.

Pharyngeal colonization with Haemophilus influenzae type b among healthy Turkish infants and children

Background : An absence of Haemophilus influenzae type b (Hib) disease surveillance and epidemiological data on the pharyngeal carriage of Turkish children causes delay in the introduction of conjugated Hib vaccination into proposed national vaccination programs.