Pok-yu Chow

Childhood sleep‐disordered breathing and its implications for cardiac and vascular diseases

Objective: To systematically evaluate the recent literature regarding the relationship between childhood sleep‐disordered breathing (SDB)/obstructive sleep apnoea (OSA) and cardiovascular diseases in children.

Effect of a structured asthma education program on hospitalized asthmatic children: A randomized controlled study

Background: The aim of this study was to compare the effectiveness of an intensive asthma education program (group B) with that of a standard asthma education program (group A).

An update on childhood snoring

Habitual snoring or daily snoring is a symptom of sleep‐disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. Conclusion: Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive.

A brief report on the normal range of forehead temperature as determined by noncontact, handheld, infrared thermometer.

Background Noncontact forehead temperature measurement by handheld infrared thermometer was used as a screening tool for fever. However, the accuracy data and normal range of forehead temperature determined by this method were not available. Methods The temperature readings from 3 handheld infrared thermometers were validated against an electronic thermometer. Normal range of forehead temperature was determined by measuring the forehead temperature in 1000 apparently healthy subjects. Results Significant differences were detected in readings obtained by the 3 different handheld infrared thermometers (analysis of covariance, P < .001) The most accurate one was chosen, and the normal range of forehead temperature in 1000 subjects detected by this method was 31.0°C to 35.6°C. Conclusions Our study shows that commercially available, handheld infrared thermometers require individual validation. Forehead temperature in excess of 35.6°C is suggestive of fever. Further studies are required to confirm accuracy of this value in detecting fever.

A randomized controlled trial of azithromycin and amoxycillin/clavulanate in the management of subacute childhood rhinosinusitis.

Objective: Subacute childhood rhinosinusitis is a disorder commonly seen in children with allergic rhinitis. Antibiotics have been recommended as a major component of the treatment regime. The objective of the present study was to compare the effectiveness of a 3‐day course of azithromycin and a 2‐week course of amoxycillin/clavulanate in the treatment of subacute childhood rhinosinusitis.

Improvement in quality of life after adenotonsillectomy in a child with Prader Willi syndrome

IntroductionWe report a child with Prader Willi syndrome who developed obstructive sleep apnea (OSA). This patient underwent surgical treatment for OSA. There was improvement not only on her OSA but in her quality of life score as well. This report highlights the need for a comprehensive assessment in the management of patients with Prader Willi syndrome.

A randomized placebo-controlled trial of traditional Chinese medicine as an add-on therapy to oral montelukast in the treatment of mild persistent asthma in children

OBJECTIVES Traditional Chinese medicine are commonly used for treatment of asthma. However, there are only very limited data about its efficacy in children. Therefore, we aimed to determine the efficacy of augmented Yu Ping Feng San (aYPFS) as an add-on to oral montelukast compared with montelukast alone for treatment of mild persistent asthma in children. DESIGN A single centre, placebo-controlled, double-blinded, randomized control trial was carried out. Participants with age 6-18 years who had mild persistent asthma were randomized according to random number list to receive either aYPFS plus montelukast for 24 weeks or placebo plus montelukast for 24 weeks. Primary outcome measure was lung function parameters. Secondary outcome measures were Asthma Control Test™ (ACT™) and Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores, symptom-free days, short-acting β2-agonist use, use of rescue oral corticosteroids, days of hospitalization for asthma and number of emergency consultation with GPs or AED department. RESULTS Twenty-eight participants were randomized to aYPFS group and twenty-nine to placebo group. There was no significant difference in baseline characteristics. There was significant improvement in ACT™ score in aYPFS group (up to 6.9% change from baseline) (p=0.016) but not in the control group. There were no significant differences between groups in other primary and secondary outcome parameters. Dropout because of adverse effects is comparable in both groups. CONCLUSION Traditional Chinese medicine aYPFS as an add-on to montelukast improved symptoms of asthma control. Further studies with larger sample size are needed to evaluate its efficacy and safety in childhood asthma.

Possible Confounding Factors in an Oral Probiotics Trial: Breast Milk

ing formula: HOMA-IR (insulin [mU/L] glucose [mmol/L])/ 22.5. Weight loss was achieved in the patients by physical exercise, a low-fat, high-carbohydrate diet, and behavioral therapy. Of the 5 children losing weight, 4 (patients 1, 3, 4, and 5) were initially treated with metformin over 6 months and none with insulin. None of the patients needed medication after weight loss. An important question is how adipose tissue can lead to insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. The adipose tissue–derived hormones adiponectin, visfatin, and leptin are thought to be the link between insulin resistance and adipose tissue.5,6 Although increasing leptin levels are hypothesized to impair insulin sensitivity, decreasing adiponectin levels are postulated to decrease insulin sensitivity. In the meanwhile, we could demonstrate in additional studies of obese children that a reduction of 0.5 SDS BMI ( 30% reduction of the overweight) was associated with a significant increase in adiponectin concentrations and a significant decrease in leptin levels parallel to an improvement of insulin sensitivity.7,8 These findings integrate with the clinical data of improvement in insulin sensitivity resulting from a reduction of overweight by 30%. We have to keep in mind that the sample sizes in the Santoro et al study and of our diabetic patients are very small. Probably a lower degree of weight loss will lead to significant improvement of insulin sensitivity in larger collectives, as well. However, we can conclude that at least a reduction of 30% overweight or 0.5 SDS BMI based on the German BMI percentile2 (which is a reduction of BMI of 2 or a stable weight over a 1-year period among growing children) is associated with a clinically relevant improvement of insulin sensitivity in obese children, obese children with impaired glucose tolerance, and obese children with type 2 diabetes mellitus.