Tuba Tuncel

Change of mean platelet volume values in asthmatic children as an inflammatory marker

BACKGROUND Asthma is the most common chronic disease of childhood in industrialised countries. T helper-2 (Th-2) cells, mast cells and eosinophils have a role in inflammation of asthma. Recently it was shown that platelets also play a role in asthma. Mean platelet volume shows platelet size and reflects platelet activation. OBJECTIVE The aim of this retrospective study is to evaluate levels of mean platelet volume in asthmatic patients during asymptomatic periods and exacerbations compared with healthy controls. METHODS The study consisted of 100 asthmatic patients (male/female: 55/45, mean age: 8.2±3.3) and 49 age and sex matched healthy children as a control group. RESULTS Mean platelet volume values of asthmatic patients during asymptomatic period were 7.7±0.8fL while mean platelet volume values in asthmatics during exacerbation were 7.8±0.9fL. Comparison of mean platelet volume values of asthmatic patients and healthy controls both in acute asthmatic attack and asymptomatic period showed no difference (p>0.05). Comparison of mean platelet volume values at asthmatic attack and asymptomatic period also had no difference (p>0.05). The presence of atopy, infection, eosinophilia, elevated immunoglobulin E, and severity of acute asthmatic attack did not influence mean platelet volume values. CONCLUSION The results of our study suggest that mean platelet volume values may not be used as a marker in bronchial asthma, although prospective studies with larger number of patients are needed to evaluate the role of mean platelet volume in asthma.

The role of mean platelet volume predicting acute exacerbations of cystic fibrosis in children

OBJECTIVE: The aim of this study is to evaluate the relationship between acute exacerbations and the mean platelet volume (MPV) trend in children with cystic fibrosis (CF), to predict the exacerbations. METHODS: A total of 46 children with CF and 37 healthy children were enrolled in the study. White blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), and mean corpuscular volume (MCV) were retrospectively recorded. RESULTS: Our study population consisted of 25 (54.3%) males and 21 (45.7%) females with CF and 20 (54.0%) males and 17 (46.0%) females in the healthy control group. The mean age of the CF patients was 6.32 ± 4.9 years and that of the healthy subjects was 7.02 ± 3.15 years. In the acute exacerbation period of CF, the MPV values were lower and WBC and platelet counts were higher than those in the healthy controls (P = 0.00, P = 0.00, P = 0.00, respectively). Besides, in acute exacerbation, the MPV values were lower and the WBC count was higher than the values in the non-exacerbation period (P 0= 0.01, P = 0.00, respectively). In the non-exacerbation period MPV was lower and platelet count was higher when compared to healthy subjects (P = 0.02, P = 0.04, respectively). CONCLUSION: This study suggests that MPV might be used as a simple, cost effective, diagnostic, predictive indicator for platelet activation in pediatric CF patients related to chronic inflammation, which might be helpful to discriminate or estimate exacerbations.

A neglected problem of developing countries: Noncystic fibrosis bronchiectasis

BACKGROUND: Bronchiectasis has been defined as the abnormal and permanent dilation of the bronchi. It is still an important problem in many developing countries. AIM: The aim of this study was to identify the chacteristics and underlying etiology of children followed with the diagnosis of noncystic fibrosis bronchiectasis. MATERIALS AND METHODS: Children with bronchiectasis confirmed with high-resolution computed tomography were enrolled into the study. The data of the patients, including symptoms of the disease, age at the onset of symptoms, findings of physical examination, labrotory investigations performed in order to identify the etiology of bronchiectasis, etiology of bronchiectasis if found, radiologic findings and treatment modalities were noted. RESULTS: Sixty-six children between 1 and 17 years were included in the study retrospectively. Forty-four of them were males (66.7%) and 22 (33.3%) were females. The most common presenting symptoms were cough (100%) and sputum expectoration (50%). An underlying etiology was identified in 44 (66.7%) of the study subjects. The four most common underlying causes were found as infections (21.2%), asthma (16.7%), aspiration syndromes and/or gastroesophageal reflux disease (9.1%) and immunodeficiency syndromes (7.6%), respectively. CONCLUSION: Identifying an underlying etiology will have a significant effect on the management of noncystic fibrosis bronchiectasis. Defining the cause of bronchiectasis may also decrease its incidence, progression and complications.

Anaphylaxis caused by honey ingestion in an infant.

case of a florist with rhinoconjunctivitis and asthma due to sensitisation to Freesia, which is from the same family as the gladiolus. Ordoqui 6 reported a case of a florist, who has worked with plants for 18 years. He refers respiratory symptoms upon exposure to gladiolus and carnation, with positive prick test to these plants, specific IgE by ELISA on patient serum, and positive bronchial challenges. The immuno-blotting showed two proteins of 40 and 47 kDa on carnation extract, but nothing for the gladiolus extract. In order to determinate the prevalence of occupational asthma and sensitisation to workplace allergens in greenhouse flowers and/or ornamental plant growers, Monsó 7 et al. studied a population of 39 growers, and found three cases of occupational asthma. The growers were sensitised to various moulds in one case; to gladiolus spp. in the second; and to Aspergillus and different flowers (including gladiolus) the patient cultivated in the third. In summary, we present a case of rhinoconjunctivitis and asthma due to sensitisation to gladiolus proteins, and on the basis of in vitro test, we identified three proteins of 70, 52 and 21 kDa. as the main allergens causing sensitisation in this patient, data which, to the best of our knowledge, have never been reported.

Beneficial effects of erythropoietin on airway histology in a murine model of chronic asthma

BACKGROUND Erythropoietin (EPO) is originally defined as a haematopoietic growth factor, but also has anti-inflammatory effects through cytokine modulation. This anti-inflammatory and cytokine modulating effect has not been investigated for the treatment of asthma. We aimed to determine the beneficial effects of erythropoietin on lung histology of murine model of chronic asthma. METHODS Thirty-five BALB/c mice were divided into five groups: I; II; III; IV; and control group. All groups except control group were sensitised and challenged with ovalbumin. Mice with experimentally induced asthma in Group I received saline; Group II EPO 500IU/kg; Group III EPO 1000IU/kg; and Group IV dexamethasone 1mg/kg intraperitoneally once a day in the last five days of the challenge period. Animals were sacrificed 24h after the last administration of study drugs. Histological findings of airways were evaluated by light and electron microscopic examination. RESULTS All histological parameters of asthma in the group treated with a high dose of EPO (Group III) were significantly ameliorated when compared with the group treated with saline (Group I). In comparison to the group treated with low dose of EPO (Group II) and the group treated with saline (Group I), basement membrane thicknesses and number of mast cells were significantly lower in the group treated with low dose of EPO (Group II). All histological parameters were similar between the group treated with high dose of EPO (Group III) and the group treated with dexamethasone (Group IV) except higher number of mast cells in the group treated with high dose of EPO (Group III). Additionally, the results of all histological parameters in the group treated with high dose of EPO (Group III) were significantly better when compared with the group treated with low dose of EPO (Group II). CONCLUSIONS We found that EPO ameliorated histological changes of chronic murine model of asthma. Further studies are needed to evaluate the efficacy of EPO in the treatment of asthma.

Beneficial effects of arginase inhibition and inhaled L-arginine administration on airway histology in a murine model of chronic asthma.

BACKGROUND Increased arginase activity in the airways induces reduced bioavailability of L-arginine and cause deficiency of bronchodilatating and anti-inflammatory nitric oxide (NO). Therefore, arginine and arginase inhibitors may have therapeutic potential in the treatment of asthma. Using a murine model of asthma, we aimed to investigate the effects of inhaled L-arginine and arginase inhibitor Nω-hydroxy-nor-L-arginine (nor-NOHA) and co-treatment on airway histology of asthmatic lung tissue. METHODS Forty-two BALB/c mice were divided into six groups: I (control), II (placebo), III, IV, V and VI. All mice except for control group were sensitised by an intraperitoneal injection of ovalbumin with alum adjuvant and then challenged with an aerosol of ovalbumin on three days of the week for eight weeks beginning from the 21st day of the study. Lung histology and bronchoalveolar lavage cell (BAL) counts were evaluated after treatment with inhaled L-arginine, nor-NOHA, l-arginine-nor-NOHA combination, budesonide and placebo. Interleukin(IL)-4 and IL-5 levels are determined in lung homogenates with ELISA. RESULTS L-Arginine group was similar to budesonide group in lowering all histological parameters. Results of groups treated with nor-NOHA were also similar to budesonide group except for epithelial thickness. The number of eosinophils in BAL decreased significantly in groups receiving study drugs. Decrease was only noted in IL-4 levels in group receiving nor-NOHA. CONCLUSION We demonstrated that inhaled l-arginine administration alleviated all histological parameters similar to budesonide and treatment with arginase inhibitor improved not all but some of the pathological changes in chronic asthma. Combination therapy had no additive effect on either treatment.

The Effect of Rupatadine on Lung Histopathology in a Murine Model of Chronic Asthma

Introduction. Rupatadine is a new second-generation antihistamine with H1 receptor antagonist activity and platelet-activating factor antagonist properties. This study aimed to investigate the effect of rupatadine on histologic changes in the lungs in a murine model of chronic asthma. Materials and Methods. Thirty-five BALB/c mice were divided into five groups of seven mice each: group I (control), group II (placebo [saline]), group III (dexamethasone 1 mg · kg−1·d−1), group IV (rupatadine 3 mg·kg−1 d−1), and group V (rupatadine 30 mg·kg−1·d−1). Groups II through V were sensitized and challenged with ovalbumin and treated once per day via the oral route (gavage). Animals were sacrificed 24 h after the last treatment was administered. Airway histopathology was evaluated using light and electron microscopy in all groups. Results. There were no significant differences observed in any of the histologic parameters between groups II and IV. There were significantly thinner basement membrane, subepithelial smooth muscle layer, and epithelia were significantly thinner in group V than in group II (p < .05). There were no statistically significant differences in the thicknesses of the basement membrane, subepithelial smooth muscle layer and epithelia between groups III and V. Conclusion. Rupatadine had a beneficial effect on histologic changes in a chronic murine model of asthma.

Chlamydia pneumoniae infection presenting with angioedema in an adolescent.

Chlamydia pneumoniae is a rare causative infectious agent for acute urticaria or angioedema; however it has not been associated with chronic urticaria. We report a case with angioedema as an initial presentation that led to diagnosis of Chlamydia pneumoniae infection. A 13-year-old boy was admitted to a medical centre with a complaint of non-pitting swelling around the right eyelid and upper lip concurrently with asthma exacerbation. Although he had taken systemic antihistamine and corticosteroid for angioedema, his symptoms had continued in the following days. He had no tongue swelling or laryngeal edema on his otolaryngeal examination. Laboratory tests, including complete blood count, biochemical analyses, thyroid hormones, stool and urine analysis and cultures, complement (C3, C4) and total immunoglobulin (Ig) E levels, were normal. Serological tests were found compatible with acute chlamydial infection with positive antiChlamydia pneumonia IgM and anti-Chlamydia pneumonia IgG titer of 1/512. According to the diagnosis of acute Chlamydia pneumonia infection, oral clarithromycin treatment was adjusted. After the second dose of the treatment, the marked edema around his eyes and lips started to regress in the fourth day of hospitalization. Pulmonary symptoms were controlled with salbutamol inhalation in addition to clarithromycin. After 4 weeks, antichlamydia IgG showed a rise in a titer up to 1/2048. His skin prick tests for aeroallergens, mite, animal dander and latex were negative. He had no symptoms in his follow-up period. Angioedema is an acute self-limited non-pitting edema that involves the face, lips, tongue and larynx. The major causes of angioedema are foods, infections, insect bites, environmental allergens, physical stimuli and drugs for children, respectively. Investigations to clarify the cause of the urticaria/angioedema should be based on clinical history and physical examination. Extensive routine work-up is not endorsed for mild cases that are responding to conventional treatment. When the resolution of symptoms cannot be achieved by proper treatment, the infectious causes and related serological tests might be considered. Histamine, one of the main cytokines, plays a role in the pathogenesis of angioedema, and is synthesized by histidine decarboxylase (HDC) from L-histidine. According to the results of an experimental study, infection with Chlamydia pneumonia causes increased HDC activity and the enzyme activity is directly correlated with interleukin (IL)-3, IL-4 and interferon (IFN)gamma levels in the bronchial epithelial cells. The results of this study might explain the association between local histamine and other pro-inflammatory cytokine production in angioedema and Chlamydia infection. Specific diagnosis of Chlamydia pneumonia infection is based on isolation of the organism in culture but such a method is rarely performed because of technical difficulties. Polymerase chain reaction (PCR) testing is the most promising method, but this assay is not commercially available. The microimmunofluorescence (MIF) technique is the only currently acceptable method in which acute infection is defined by a fourfold increase in IgG titer or an IgM titer of 16 or greater. Thus, the diagnosis is accomplished by elevated titers of IgM for Chlamydia pneumonia in the symptomatic period for our patient. The fourfold increase in IgG titer after 4 weeks supported acute Chlamydia pneumoniae infection. Elimination of suspected agent or trigger is the principle management approach for urticaria and/or angioedema. Treatment with intravenous corticosteroids, antihistamines or subcutaneous epinephrine should lead to rapid resolution of symptoms and prevent potential airway intubation and need of care in the intensive care unit. In the published reports, Chlamydia pneumoniae has been described as an infectious cause for chronic urticaria. We suggest that it might be a causative agent for acute urticaria or angioedema. Children who do not respond to conventional urticarial treatment might have an infectious cause and a serological test might be helpful to identify the underlying cause of such cases.

Expectoration of a foreign body at the late period: A case report.

Foreign body (FB) aspiration is a relatively common problem in children, particularly during the first 3 years of life. It is an emergency condition and the removal of the FB by bronchoscopy is the primary treatment. Children with undiagnosed retained foreign bodies may present with respiratory symptoms including recurrent or persistent wheezing, with or without respiratory failure. Spontaneous expectoration of a FB is a rare occurrence. Herein, we present a case that was diagnosed with FB aspiration during investigation for persistent wheezing and who expectorated part of a sunflower seed 2 months after aspiration.

The Effects of Suplatast Tosilate Treatment and Prophylaxis on Lung Histopathology in a Mouse Model of Chronic Asthma

Introduction Suplatast tosilate is a medication that inhibits TH2-type cytokines. We aimed to investigate the effects of suplatast tosilate treatment and prophylaxis on lung histopathology and cytokine levels in a mouse model of chronic asthma. Materials and Methods Forty-two BALB/c mice were divided into 6 groups: group I (control), group II (vehicle control), group III (dexamethasone), group IV (prophylaxis with suplatast tosilate), group V (treatment with suplatast tosilate), and group VI (prophylaxis and treatment with suplatast tosilate). All of the groups, except for the control and vehicle control groups, were sensitized and challenged with ovalbumin. The mice in the study groups, except those in the group receiving suplatast tosilate for prophylaxis only, were treated with study drugs. After the mice were killed, IL-4, IL-5, and interferon-γ levels were quantified in the lung tissue, which were examined histologically by light and electron microscopy. Results There were significant improvements in all histopathological parameters in the group treated with suplatast tosilate compared with the vehicle control group. Similar improvements were observed when the group receiving prophylaxis and treatment with suplatast tosilate was compared with the vehicle control as well. There were no significant differences between the group receiving only prophylaxis with suplatast tosilate and the vehicle control group. Cytokine levels were significantly higher in the vehicle control group when compared with the control group. Although all of the groups had lower cytokine levels than those of the vehicle control group, the differences were not statistically significant. Conclusions Treatment with suplatast tosilate was effective in improving all histopathological parameters in a mouse model of chronic asthma. It was observed that the use of prophylactic suplatast tosilate was ineffective and had no additional effects when administered together with treatment.