Suleyman Tolga Yavuz

Wider neck circumference is related to severe asthma in children

Obesity is an established risk factor for asthma in children. Measures of central obesity are reported to be more associated with the severity of asthma in adults. The aim of the study was to investigate the association between fat distribution, which is determined by anthropometric measures including neck circumference (NC) and asthma severity in children.

Association of wider neck circumference and asthma in obese children

BACKGROUND Obesity is a well-established risk factor for asthma. Previous studies have reported that central obesity is associated with asthma. OBJECTIVE To investigate the association between fat distribution, which is determined by anthropometric measures, including neck circumference (NC), and asthma in school-aged children. METHODS Children diagnosed as having asthma were enrolled along with controls who were admitted to our outpatient department with allergic symptoms, such as rhinitis, urticaria and atopic dermatitis. Anthropometric measures, including height, weight, NC, waist circumference, and hip circumference, were obtained. Skin prick tests, blood eosinophil counts, and serum total IgE level measurements were performed. RESULTS A total of 196 children (92 male [46.9%]) were included. Asthma was present in 102 patients (52.1%). Ninety-one of the patients (46.4%) were overweight, and 45 patients (22.9%) were obese. The NC of children with asthma was significantly higher than that of children in the control group. Grades defined according to NC percentiles were also significantly different between groups. In children with asthma, the prevalence of children with an NC higher than the 90th percentile (grade 6) was more frequent when compared with controls. The median NC of obese-overweight children with asthma was significantly higher compared with obese-overweight controls without asthma. Results of multivariable logistic regression analysis revealed that the presence of an NC in the greater than 90th percentile was associated with asthma in obese-overweight children. CONCLUSION This study found that NC, which is a simple anthropometric measure, is associated with asthma in obese children.

Anaphylaxis to gonadorelin acetate in a girl with central precocious puberty.

Abstract Gonadotropin-releasing hormone analogues are generally regarded as safe drugs. Gonadorelin acetate has been widely used for the diagnosis of central precocious puberty, and life-threatening reactions to gonadorelin acetate are extremely rare. Herein, we described – to the best of our knowledge – the first pediatric case in which severe anaphylaxis was encountered after intravenous gonadorelin acetate administration. An 8-year-old girl who was diagnosed with central precocious puberty was receiving triptorelin acetate treatment uneventfully for 6 months. In order to evaluate the efficacy of the treatment, an LH-RH stimulation test with gonadorelin acetate was planned. Within 3 min after intravenous administration of gonadorelin acetate, she lost consciousness and tonic seizures began in her hands and feet. She was immediately treated with epinephrine, diphenhydramine, and fluids. Her vital signs recovered within 30 min. Based on the results, anaphylaxis should be anticipated and the administration of these drugs should be performed in a setting that is equipped to deal with systemic reactions.

Relation of insulin resistance to neurocognitive function and electroencephalography in obese children.

Abstract Background: Childhood obesity may lead to neuronal impairment in both the peripheral and the central nervous system. This study aimed to investigate the impact of obesity and insulin resistance (IR) on the central nervous system and neurocognitive functions in children. Methods: Seventy-three obese children (38 male and 35 female) and 42 healthy children (21 male and 21 female) were recruited. Standard biochemical indices and IR were evaluated. The Wechsler Intelligence Scale for Children-Revised (WISC-R) and electroencephalography (EEG) were administered to all participants. The obese participants were divided into two groups based on the presence or absence of IR, and the data were compared between the subgroups. Results: Only verbal scores on the WISC-R in the IR+ group were significantly lower than those of the control and IR– groups. There were no differences between the groups with respect to other parameters of the WISC-R or the EEG. Verbal scores of the WISC-R were negatively correlated with obesity duration and homeostatic model assessment-insulin resistance (HOMA-IR) values. EEGs showed significantly more frequent ‘slowing during hyperventilation’ (SDHs) in obese children than non-obese children. Conclusions: Neurocognitive functions, particularly verbal abilities, were impaired in obese children with IR. An early examination of cognitive functions may help identify and correct such abnormalities in obese children.

General and disease-specific scales in children with asthma and their parents

ObjectiveTo investigate and compare the efficiency of general and disease-specific life quality scales in children with asthma.MethodsChildren with asthma, and their parents completed the Childhood Asthma Control Test (C-ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory (PedsQL), and also underwent spirometry.Results82 children (55 males) with a median (IQR) age of 10.1 (8.9-10.5) years were included. C-ACT, PAQLQ and PedsQL child scores were significantly higher in children with controlled asthma.ConclusionsQuality of life in children, assessed using diseasespecific quality of life measures, is better for children with good asthma control.

Association of neck circumference and pulmonary function in children

BACKGROUND Childhood obesity leads to many complications including impaired respiratory function. There are various anthropometric parameters related to obesity. OBJECTIVE To investigate the correlation between anthropometric indices and pulmonary function test results in children without asthma. METHODS Children without any respiratory disorders were enrolled in this study. Anthropometric measurements, such as height, weight, neck circumference (NC), and waist circumference, were obtained from the enrollees and body mass index was calculated. Afterward, pulmonary function tests were performed using spirometry. RESULTS A total of 178 children (106 boys, 59.5%) with a mean age of 9.7 years were included the study. NC was above the 90th percentile in 65 children. Importantly, pulmonary parameters, such as forced expiratory volume during the first second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC), were lower in subjects with a large NC. Similarly, waist circumference was above the 90th percentile in 67 children, and FEV1/FVC was significantly lower in children with a large waist circumference. Moreover, there was a statistically significant negative correlation among FEV1, FEV1/FVC, and body mass index SD score. Also, multivariable linear regression analysis showed that an NC above the 90th percentile was associated with lower FEV1 and FEV1/FVC values. CONCLUSION We identified NC as a novel anthropometric index that is strongly correlated with respiratory functions in children. Therefore, close monitoring of respiratory symptoms, particularly in children with obesity and a large NC, could help with early and prompt determination of respiratory complications of obesity.

Association of vitamin D status and premature adrenarche

Vitamin D, an important factor in calcium‐phosphate homeostasis, has recently been suggested to play an important role in the pathogenesis of numerous chronic conditions such as hyperandrogenism. The aim of this study was to investigate the relationship between vitamin D status and premature adrenarche (PA).

Early initiated feeding versus early reached target enteral nutrition in critically ill children: An observational study in paediatric intensive care units in Turkey

Although early enteral nutrition (EN) is strongly associated with lower mortality in critically ill children, there is no consensus on the definition of early EN. The aim of this study was to evaluate our current practice supplying EN and to identify factors that affect both the initiation of feeding within 24 h after paediatric intensive care unit (PICU) admission and the adequate supply of EN in the first 48 h after PICU admission in critically ill children.

A rare complication of wasp sting: acute cervical dystonia

Dear Editor: Neurological complications following wasp stings are rare, and the exact pathogenic mechanisms of these complications are not very clear. A 4-year-old boy was admitted to our clinic with the complaints of stiffness of the neckmuscles and involuntary deviation of the head and gaze to the left. Awasp had stung him on the left ear 20 h before admission. He had pain, local swelling, and redness at the sting site, lasting a few hours. On physical examination, vital signs and anthropometric measurements were in normal ranges. The patient had involuntary pulling of the neck to the left side and sustained contractions of the neck muscles. Remainder of the systemic and neurologic examinations revealed no abnormality. Routine biochemical analyses were normal, including blood count, serum glucose, inflammatory markers, electrolytes, liver and renal function tests, and thyroid hormones. Cranial and cervical magnetic resonance imaging (MRI) and the video electroencephalogram (EEG) recorded on sleep and wakefulness showed no abnormality. He was managed conservatively with fluid replacement and antihistamines, and the symptoms relieved totally within 8 h. The potential causes of dystonia such as drug-induced dystonia, toxins (e.g., carbon monoxide), benign paroxysmal torticollis, and cervical cord abnormalities (e.g., syringomyelia, tumor, trauma) were ruled out by appropriate investigations [1–3]. Besides, dystonic reactions can mimic a partial seizure. The video EEGmonitoring excluded a seizure disorder in the patient. There has been only one case report of acute dystonia after wasp sting till date [4]. The exact pathogenesis of the development of neurological complications following wasp sting is unclear, but may involve direct neurotoxic effect of venom due to vasoactive substances such as phospholipase, hyaluronidese, mellitin, mast cell degranulating peptid, or mastoparan-C. Other implicated mechanisms include IgE-mediated immediate hypersensitivity and delayed immunological responses to wasp venom antigens leading to autoimmune reaction by antigenic cross-reactivity to human myelin basic protein. In our case, serum-specific IgE levels to wasp venom antigens were found negative 1 month after his discharge. However, there are no available laboratory tests to precisely document the direct neurotoxic effect or the autoimmune reactions. Latency period between the wasp sting and onset of neurological complications varies from hours to weeks [5]. The point of interest in this case report is the occurrence of acute cervical dystonia in a normal healthy child following a wasp sting, which is a very unusual complication, and to our knowledge, this is the second case of this type. Neurological complications due to wasp stings are extremely rare and symptoms may start within several hours or days in contrast to immediate immune-mediated reactions and may be fatal in cases particularly with central nervous system * Suleyman Tolga Yavuz styavuz@yahoo.com

P06 - Pulmonary functions are affected during pollen season in children with allergic rhinitis

Results Thirty patients (17 male, 56.7%) with a median age of 11.5 (8.7-13.6) years were included. 12 patients (40%) had mild allergic rhinitis, whereas 18 (60%) had moderate-persistent allergic rhinitis interfering with daily activities. There was no significant difference at spirometric parameters including forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1) and FEV1/FVC ratio, which obtained in and out of pollen season. However, the forced expiratory flow between the 25 and 75% of the vital capacity (FEF25-75) (100 (91-96) vs. 91 (83-104)) and peak expiratory flow (PEF) (92 (83-97) vs. 82 (76-94)) values were significantly lower in pollen season when compared with the values obtained out of pollen season. Conclusion Pulmonary functions may be affected in children with pollen-induced allergic rhinitis during pollen season even if they have no history and symptoms of bronchial asthma.