Suna Asilsoy

Evaluation of chronic cough in children.

Chronic cough in children is among the problems that lead to frequent consultations with a doctor. In this study, we attempted to research the reasons for chronic cough by an evaluation method using the guidelines that were suggested for children by the American College of Chest Physicians (ACCP) in 2006. We studied 108 children between 6 and 14 years of age who had a cough that lasted for > 4 weeks. The patients were reevaluated during the second to fourth weeks, and until either the cough terminated or resolved. Twenty-five percent of the patients received diagnoses of asthma and asthma-like symptoms, 23.4% received diagnoses of protracted bronchitis, 20.3% received diagnoses of upper airway cough syndrome (UACS), and 4.6% received diagnoses of gastroesophageal reflux disease. Asthma and asthma-like symptoms, protracted bronchitis, and UACS were detected in order of frequency as the reason for chronic cough in children. We concluded that the 2006 ACCP guidelines for the management of chronic cough in children are effective and can be successfully utilized in a nonaffluent study setting.

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

Serum total and free carnitine levels in children with asthma

BackgroundSerum carnitine is decreased in recurrent pulmonary infections. We aimed to evaluate serum carnitine levels in asthmatic children.MethodsStudy group consisted of children with stable asthma and those with acute asthma attacks, while control group included healthy children. Attack severity was determined by the pulmonary score system. Total and free carnitine levels were studied in one blood sample from the control group and stable asthmatics and in two samples from children with acute asthma exacerbation during and after the attack.ResultsAll the 40 patients in the study group had moderate asthma including 30 with acute attack (13 mild and 17 moderate) and 10 with stable asthma. Carnitine levels were significantly lower in acute attack asthmatics than in the stable asthmatics and controls, while there was no significant difference between the latter two groups. Carnitine levels were not different between asthmatics with mild and moderate attack, and were similar during and after an acute attack.ConclusionsSerum carnitine levels decrease in children with moderate asthma during exacerbation of asthma and shortly thereafter. Further studies are needed to evaluate the effect of carnitine treatment on serum carnitine level.

Common features of anaphylaxis in children.

OBJECTIVE We aimed to establish the characteristics of anaphylaxis in childhood. METHODS Forty-four patients who had experienced anaphylaxis in a period of 10 years (from 1999 to 2009), were included in the study. Parameters analysed were age, gender, concomitant allergic disease, trigger, setting, clinical symptoms, treatment, prognosis and prophylaxis. RESULTS The total numbers of anaphylaxis cases were 44 in a ten-year period. The ages of patients ranged from 3 to 14 years (11.50 ± 3.87 years) and the majority were male. 33 of the patients (75%) had a concomitant allergic disease. The trigger was determined in 93.2% of the cases, being most frequent: food (27.3%), and SIT (25%), followed by bee sting, medications and others. Respiratory (95.5%), dermatological (90.9%), cardiovascular (20.5%), neuropsychiatric (25%), and gastrointestinal (11.4%) symptoms were seen most frequently. For anaphylaxis triggered by food, the duration of anaphylactic episode was significantly longer (p<0.05). No biphasic reaction was observed during these attacks. Of our patients, only one developed respiratory failure and cardiac arrest due to SIT, and intensive care support was required. DISCUSSION As a trigger for anaphylaxis, the frequency of SIT is so high that it cannot be described by the study group including patients who were followed up in an outpatient allergy clinic.

Perceptions of Parents and Physicians Concerning the Childhood Asthma Control Test

Background. The Childhood Asthma Control Test (C-ACT) has been proposed to be a simple, patient-based test that is able to reflect the multidimensional nature of asthma control. In this analysis, the aim was to evaluate the perceptions of physicians and caregivers concerning C-ACT and its predictive value for future asthma-related events. Method. In a multicenter prospective design, 368 children aged 4–11 years with asthma who were either well- or not well-controlled were included in the study. The study participants were evaluated during three visits made at 2-month intervals and the Turkish version of C-ACT was completed each month. Parents completed questionnaires concerning their perception of asthma (before and after the study) and the C-ACT (after the study). Physicians completed a survey about their perception of a control-based approach and the C-ACT. Results. The C-ACT scores increased from visit 1 to visit 3, with improvement seen in all domains of the test. At the end of the study period, the parents more strongly agreed that asthma could be controlled completely and that asthma attacks and nocturnal awakenings due to asthma were preventable (p < .05). Most of the parents reported that the C-ACT helped them to determine asthma treatment goals for their children and also that the C-ACT improved communication with their physicians. The physicians indicated that a control-centered approach was more convenient (95%) and simpler (94.5%) than a severity-centered approach and provided better disease control (93.4%). A higher C-ACT score was associated with a decreased risk of asthma attack and emergency department admittance in the 2 months following the administration of C-ACT. Conclusion. Our findings indicated that the C-ACT improved both parental outlook on asthma control and the communication between the physician and parents. There was a good correlation between the C-ACT score and the level of asthma control achieved, as described by the physician. Additionally the C-ACT score was predictive of future asthma-related events. These findings suggest that the C-ACT may have an important role in asthma management in the future.

Interleukin-12/-23 receptor beta 1 deficiency in an infant with draining BCG lymphadenitis

Bacille Calmette-Guérin (BCG) vaccine and environmental nontuberculous mycobacteria (NTM) are weakly pathogenic mycobacteria in mankind. These intracellular pathogens may cause diffuse disease in severely immunocompromised patients, but they may cause disseminated disease in patients with poorly defined immunodeficiencies regarded as otherwise healthy. A wide variety of viruses, bacteria, fungi and protozoa may cause infections in severely immunocompromised patients but infection with these agents apart from salmon ellosis is rare in otherwise healthy children with no overt immunodeficiency. Cell-mediated immunity, in which interaction between T lymphocytes and macrophages is fundamental, is crucial for host defense against intracellular pathogens such as Mycobacterium and Salmonella species. In this setting the most important step is activation of macrophages by type 1 cytokines: interferon (IFN)-g in particular. In recent years inherited diseases of IFN-g production or failure to respond to IFN-g action, resulting in increased susceptibility to infection by weakly pathogenic mycobacteria such as BCG and environmental mycobacteria (EM) have been reported, termed ‘Mendelian susceptibility to mycobacterial disease’ (MSMD). These patients present with BCG disease, EM infection, non-typhoidal salmonellosis or, rarely, tuberculosis. Mutations in five genes encoding the basic proteins of the type 1 cytokine cascade, namely, IFN-gR1, IFN-gR2, IL-12/IL-23Rb1, IL-12/IL-23p40 and STAT1, have been found. Here we present an infant admitted for diarrhea and fever, who developed draining BCG lymphadenitis on follow up, whose IL-12/IL-23Rb1 expression was <1% and who had an R486X mutation on the12th exon of the IL-12/IL-23Rb1 gene.

Does bee pollen cause to eosinophilic gastroenteropathy

Bee pollen is given to children by mothers in order to strengthen their immune systems. There are no studies related with the side effects of bee polen in the literature. In this article, the literature was reviewed by presenting a case of allergic eosinophilic gastropathy related with bee polen. A 5-year old child was admitted due to abdominal pain. Edema was detected on the eyelids and pretibial region. In laboratory investigations, pathology was not detected in terms of hepatic and renal causes that would explain the protein loss of the patient diagnosed with hypoproteinemia and hypoalbuminemia. Urticaria was detected during the follow-up visit. When the history of the patient was deepened, it was learned that bee pollen was given to the patient every day. The total eosinophil count was found to be 1 800/mm(3). Allergic gastroenteropathy was considered because of hypereosinophilia and severe abdominal pain and endoscopy was performed. Biopsy revealed abundant eosinophils in the whole gastric mucosa. A diagnosis of allergic eosinophilic gastropathy was made. Bee polen was discontinued. Abdominal pain and edema disappeared in five days. Four weeks later, the levels of serum albumin and total eosinophil returned to normal.

Cyclosporin Treatment Improves Skin Findings in Omenn Syndrome

Omenn syndrome is a combined immunodeficiency characterized by a generalized erythematous skin rash, enlarged lymph nodes, hepatosplenomegaly, severe susceptibility to infections, eosinophilia, and hyperimmunoglobulinemia E. A 3‐month‐old girl was admitted to our hospital with a history of recurrent sepsis. Physical examination revealed severe erythroderma, hepatosplenomegaly, lymphadenopathy, and failure to thrive. Laboratory findings revealed leukocytosis, lymphocytosis with high CD3 T‐cells, a high CD4:CD8 ratio, absence of CD19 B‐cells, high eosinophil count, and low immunoglobulin levels. A heterozygote RAG1 gene mutation was found. She had itchy, scaling, ichthyosiform erythroderma and protracted diarrhea. Cyclosporin treatment up to 10 mg/kg effectively resolved erythroderma and lowered total eosinophil counts, and she gained weight during treatment. Since extensive erythroderma with generalized itching causes patient discomfort in Omenn syndrome, cyclosporin treatment can be considered while waiting for treatment with hematopoietic stem cell transplantation.

Effects of Air Quality and Climate Change on Airway Hyperreactivity in Children (A Multi-Centered Study)

The clinical effects of environmental pollution and climate change on respiratory health is a contemporary debate issue. In this study, the sulfur dioxide (SO 2 ), particulate matter (PM 10 ) levels, and climate conditions in the city of Izmir, have been taken together with the patients with asthma or acute bronchiolitis, who admitted to the children’s emergency departments of the four university/education-research hospitals in Izmir. From September 1, 2007 until August 31, 2008, the 22,467 patients who admitted to these centers because of airway hyperreactivity, were of age 3.05±1.57 on the average, and the male/female ratio was 1.7. Among the patients, 79.3% were having acute bronchiolitis, and 20.7% an asthma attack. As SO 2 and PM 10 levels increase, the daily asthma attacks, patients with acute bronchiolitis, and total of patients with hyperactivity, were observed to increase (p<0.001). In addition, the numbers in the following five days after the increase of air pollution rate, were observed to increase statistically significantly (p<0.001). The number of asthma and acute bronchiolitis patients applying to emergency, was negatively correlated with daily average temperature, but positively correlated with relative humidity, actual air pressure, and sea- level pressure levels (p<0.001). Reflecting on the increase of asthma and acute bronchiolitis in developed societies, there is a necessity of effective reliefs such as effectively monitoring the within-city air quality, taking the industrial centers out of the city, promoting public transportation, and preserving the natural life.

A different cause for respiratory disorder in children: cases with pulmonary Langerhans cell histiocytosis

In children, complaints of a respiratory disorder are very frequent. Etiology of respiratory illness is a broad spectrum that varies from a simple viral infection to a malignant disorder. Pulmonary Langerhans cell histiocytosis (PLCH) is one of these entities and it is truly rare in children. The aim of this study is to evaluate our patients with PLCH.