Özlem Tezol

Impulse oscillometry in acute and stable asthmatic children: a comparison with spirometry

Abstract Objective: Lung function tests have attracted interest for the diagnosis and follow-up of childhood asthma in recent years. For patients who cannot perform forced expiratory maneuvers, impulse oscillometry (IOS), performed during spontaneous breathing, may be an alternative tool. Methods: Thirty-five acute, 107 stable asthmatic and 103 healthy children who presented to our clinic performed IOS followed by spirometry before and after salbutamol inhalation. The mean baseline and reversibility of IOS and spirometry parameters were compared between the groups. Correlation analyses were undertaken within the asthmatics, and the healthy controls separately. To distinguish the three groups, the sensitivity and specificity of baseline and reversibility values of IOS and spirometry were computed. When spirometry was taken as the gold standard, the discriminating performance of IOS to detect the airway obstruction and reversibility was investigated. Results: The mean absolute values of Zrs, R5, R5−R20, X5, X10, X15, Fres, AX, and all spirometric parameters, and the mean reversibility values of R5, R10, Fres, AX and forced expiratory volume in one second were different between the groups and the highest area under curve values to discriminate the groups was obtained from area of reactance (AX) and ΔAX. Zrs, all resistance (including R5−R20) and reactance parameters, Fres and AX were correlated with at least one spirometric parameter. Spirometric reversibility was detected by ≤−22.34 and ≤−39.05 cut-off values of ΔR5 and ΔAX, respectively. Conclusions: IOS has shown a highly significant association with spirometric indices and reversibility testing. It may be a substitute for spirometry in children who fail to perform forced expiratory maneuvers.

Bayley- III Scores of Children with Congenital Anomalies of the Kidney and Urinary Tract

Objective: Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common causes of chronic renal failure in children. Although data about the growth failure and cognitive impairment in children with end-stage renal disease are available, there are insufficient data about the developmental screening in infanthood of children with CAKUT. The aim of this study is to evaluate the neurodevelopment of children with CAKUT using the Bayley Scales of Infant and Toddler Development Screening Test, Third Edition (Bayley-III). Materials and Methods: The cognitive, language, receptive communication, expressive communication, global motor, gross motor, and fine motor scores of children aged 1–41 months diagnosed with CAKUT (n=30) were compared with healthy controls (n=32). Results: There was no significant difference between groups with regard to the age, height, weight, head circumference, body mass index, mid-arm circumference, triceps skinfold thickness and the language, expressive communication, receptive communication, gross motor, fine motor, and global motor scores (p>0.05). Maternal age, the weight at birth, and the educational level of mothers were similar in both groups (p>0.05). There was no significant relationship between the educational level of mothers, iron deficiency anemia, and Bayley-III scores (p>0.05). Cognitive scores of children with CAKUT were significantly lower than scores of the control group (p=0.04). Cognitive scores of patients with recurrent urinary tract infection were lower than −1 standard deviation value. Conclusion: This study demonstrated that children with CAKUT who have a recurrent urinary tract infection history have delayed cognitive developmental outcomes compared with healthy children, as assessed using Bayley-III. The neurodevelopment of these children should be closely followed up and supported in the early period.

Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers

BACKGROUND The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. METHODS Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. RESULTS 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003). CONCLUSION IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.

The Etiological Evaluation of Patients with Chronic Urticaria in Childhood

Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhood chronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiology of chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years who attended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests for atopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1 years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as having chronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were; autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumatic carditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7% had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody (ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites. 2 Arıkoğlu T ve ark.Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhood chronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiology of chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years who attended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests for atopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1 years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as having chronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were; autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumatic carditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7% had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody (ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites. Autologous serum skin test (ASST) results were positive in 37.8% of the patients. The comparison of patients with positive and negative ASST showed no statistically significant differences in terms of age, gender, presence of atopy, autoimmune disease, ANA positivity, presence of antithyroid antibody and H. pylori positivity. Among the causes of physical urticaria, dermographism, cholinergic urticaria, delayed pressure urticaria, and cold and solar urticaria were found in 45%, 32.4%, 8.7%, 8% and 4.7%, respectively. Conclusion: The etiology of childhood chronic urticaria is mainly related to autoimmunity and physical urticaria. Identification of clinical features and possible causes will contribute to a better management of chronic urticaria in children.

İnfantlarda Sık Hışıltı Gelişimini Öngörmede Erken Yaşam Belirteçleri; Gizemli Bir Yolda Eski Dost, ‘’Eozinofil’’ ile Devam Etmek

Objective: In most cases of asthma, wheezing symptoms start in early childhood. Although there are studies evaluating the factors that play a role in the development of childhood asthma, the predictive markers for frequent wheezing in early childhood are still unclear. The aim of our study was to investigate the relation between the wheezing episodes and the familial, prenatal, and postnatal risk factors, and the sensitivity of serum eosinophilic cationic protein (ECP) and eosinophil levels for predicting frequent wheezing. Materials and Methods: Fifty-seven children with acute wheezing and fifty healthy children aged between 1-36 months were included in the study. The children who had ≥ 3 episodes of wheezing in the next year after presentation were classified as the frequent wheezing group and those with fewer episodes were classified as the infrequent wheezing group. Administration of a comprehensive questionnaire about risk factors for wheezing; blood sampling for serum total IgE, ECP, eosinophil count, food and inhaled specific IgE levels and RSV/adenovirus serology; and skin prick tests were performed. Oral provocation tests were applied in cases of suspected food allergy. Results: Male gender (p=0.024), low socioeconomic level (p=0.046), initiation of milk formula (p=0.009) and eggs (p=0.018) before the fourth month, the presence of mold / humidity at home (p=0.023), eczema (p<0.001), and atopy (p=0.017) rates were significantly higher in the frequent wheezing group. The children with serum ECP levels ≥7.9 μg/L at enrollment had higher risk of frequent wheezing than those with serum ECP<7.9 μg/L (p=0.008). The sensitivity of ECP ≥7.9 μg/L for frequent wheezing was 75.9% and the specificity was 68.7%. Similarly, serum total IgE (≥154 IU/ml) and total eosinophil count (≥390 /mm3) were found to be significantly higher in infants in the frequent wheezing group than the other groups (p=0.049, p=0.019). The multivariate analysis showed that the risk of frequent wheezing was 6.6 fold higher in children with a serum ECP level ≥7.9 μg /L and 5.3 fold higher in the presence of RSV / Adenovirus infection (p=0.026, p=0.038, respectively). Conclusion: In conclusion, our study suggested that the increase in serum ECP levels and the presence of RSV / Adenovirus infection significantly increased the risk of frequent wheezing in children with acute wheezing attacks.