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Rising trend of allergic rhinitis prevalence among Turkish schoolchildren

OBJECTIVES To assess the time trends and possible risk factors associated with allergic rhinitis symptoms in schoolchildren from Denizli, Turkey. METHOD Two identical cross-sectional surveys were performed in the 13- to 14-yr age group at intervals of six years using ISAAC questionnaire. Possible risk factors were also asked and the children completed questionnaires by self. RESULTS A total of 4078 children (response rate 75%) in the 2008 and 3004 children (response rate, 93.8%) in 2002 were included. The lifetime prevalence of rhinitis, 12-month prevalence of rhinitis, prevalence of associated itchy eye in the previous 12 months and doctor diagnosed allergic rhinitis prevalence were increased from 34.2% to 49.4% (POR=1.87, 95% CI=47.8-50.9 and p ≤ 0.001), from 23.5.0% to 32.9% (POR=1.59, 95% CI=31.4-34.3 and p ≤ 0.001), from 9.6% to 14.9% (POR=1.64, 95% CI=13.8-16.0 and p ≤ 0.001), and from 4.3% to 7% (POR=1.67, 95% CI=6.2-7.8 and p ≤ 0.001) respectively. Severe interference with daily activity in the previous 12 months did not change. In multivariate analysis, history of family atopy, stuffed toys, high annual family income, presence of allergy in mother, father and accompaniment of children to their parents after school hours in textile industry were found as risk factors in 2008 study. CONCLUSION The prevalence of allergic rhinitis increased significantly in 2008. Family history of atopy, stuffed toys, high annual family income and accompaniment of children to their parents in textile industry were found as risk factors for doctor diagnosed allergic rhinitis.

The Prevalence of Asthma Diagnosis and Symptoms is Still Increasing in Early Adolescents in Turkey

BACKGROUND This study was performed to evaluate the time trends in prevalence of asthma and related factors in Denizli, Turkey. METHODS Two cross-sectional surveys were performed, 6 years apart (2002 and 2008) using the ISAAC protocol, in the 13-14 age groups and comparisons were made between the results. RESULTS Lifetime prevalence of wheeze, 12 month prevalence of wheeze, and the prevalence of wheeze after exercise in the previous 12 months were significantly increased respectively from 10.2% to 13.4% (POR = 1.37, 95%CI = 1.18-1.58, p < 0.001), from 5.0% to 6.2% (POR = 1.26, 95%CI = 1.02-1.55, p = 0.016) and from 9% to 10.2% (POR = 1.15, 95%CI = 0.98-1.35, p = 0.046) in 2008 study. Doctor diagnosed asthma prevalence also increased significantly from 2.1% to 12.9 (POR = 6.80, 95%CI = 5.22-8.85, p < 0.001). Prevalence of sleep disturbed by wheeze in the last 12 months; but, never woken with wheezing (POR = 1.62, 95%CI = 1.26-2.09, p = < 0.001) and less than one night per week (POR = 1.58, 95%CI = 1.06-2.36, p = 0.013) were significantly increased in 2008 study. Severe attacks of wheeze limiting speech in the last year was increased from 1.3% to 2.2% (POR = 1.67, 95%CI = 1.14-2.43, p = 0.004). The number of wheeze attacks in the previous 12 months was increased significantly for 4-to-12 attacks (POR = 1.54, 95%CI = 1.03-2.32, p = 0.02) in 2008 study. However, prevalence of waking with cough in the last 12 months did not change. While history of family atopy and domestic animal at home were found as significant risk factors for asthma in 2002 study, male gender, history of family atopy and stuffed toys were found significant in 2008. CONCLUSIONS The prevalence of asthma symptoms were increased in Denizli. History of family atopy, male gender and stuffed toys were important risk factors for asthma in 2008.

Prevalence of asthma, local risk factors and agreement between written and video questionnaires among Turkish adolescents

BACKGROUND There is currently no standard tool for the measurement of asthma in epidemiological studies. The objectives of this study were to determine the prevalence of asthma, to describe the potential local risk factors, and to assess the agreement between written and video questionnaires in 13- to 14-year-old schoolchildren. METHODS We performed a cross-sectional study involving 5427 adolescents in 26 schools. Prevalence of asthma symptoms were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC) written and video questionnaire. The adolescents were asked additional questions for risk factors of asthma. RESULTS The prevalence of lifetime wheeze, wheeze in the last 12 months and doctor-diagnosed asthma with written questionnaire were found as 13.5%, 6.3% and 11.2% respectively. Prevalence of lifetime wheeze, wheeze in the last 12 months, wheeze after exercise in the last 12 months, with video questionnaire were found as 9.6%, 5.5%, 11.9% and 1.9% respectively. The proportion of total agreement between the two questionnaires was high (0.77-0.81) with poor kappa value (0.25-0.50). In multivariate analysis, family history of atopy, stuffed toys and accompaniment of children to their parents after school hours in textile industry were found as risk factors for asthma. In addition kind of bird, such as canary was found as a risk factor. CONCLUSION Prevalence of asthma is moderate in Turkey. Agreement between the two questionnaires was high. Accompaniment of children to their parents in textile industry is a newly-described risk factor for asthma.

Eosinophilic granulomatosis with polyangiitis (churg-strauss syndrome) without respiratory symptoms in a boy

Eosinophilic granulomatosis with polyangiitis or Churg-Strauss Syndrome (CSS) is rare in children. It is characterized by eosinophilia, extravascular necrotizing granuloma, and eosinophilic infiltration of multiple organs particularly lungs, but may also involve the gastrointestinal tract, heart, and the kidneys.

Intracardiac thrombus in a child with behçet’s disease

Behcet’s disease (BD) is recognized as a systemic vasculitis involving both arteries and veins of any size and characterized by recurrent oral aphthous ulcers, genital ulcers, and uveitis and skin lesions. The mean age of onset is in the fourth decade.

What is the association of acute renal failure, angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker in a young patient?

A 13-year-old girl was admitted to the hospital with unconsciousness and oliguria. She had also suffered from vomiting and weakness for 7 days. Her medical history was remarkable for delay in motor skills and mental retardation. No other investigation was performed until 2 months previously when she visited another clinic for complaints of palpitation, fatigue and sweating. For hypertension and obesity, treatment with ramipril and losartan plus hydrochlorothiazide was started. She was confused and mildly dehydrated; blood pressure, 97/50 mmHg; pulse, 97/min. She was an overweight child with a body mass index of 28 kg/m. Serum urea nitrogen 135 mg/dL (48.18 mmol/L), creatinine 7.2 mg/dL (636.48 μmol/L) and uric acid 13.3 mg/dL (791.08 μmol/L) were high and other biochemical parameters with urinalysis were normal. Her urine output was 250 mL in the previous 24 h. All medications were stopped, and she was followed with appropriate intravenous fluid. On the fifth day, the renal function test and the urine output were normal. After recovery of renal function completely, severe hypertension occurred within several days, and the mean systolic and diastolic pressure, without significant differences between the lower and upper extremities, were 180 and 120 mmHg. All biochemical markers, electrolytes, plasma catecholamines, cortisol and thyroid hormones, serum renin activity, aldosterone, serum complements, anti-ds-DNA, ANA and vanillylmandelic acid in 24-h urine and abdominal/renal Doppler ultrasonography were normal. An echocardiography showed mild left ventricle hypertrophy without coarctation. Grade 2 hypertensive retinopathy was documented by fundoscopic examination. She was very endearing, friendly, loquacious and empathetic associated with her typical facial features (Figure 1). Question

1200 The Correlation Between Renal Damage and Clinical and Laboratory Findings in Children with Acute Pyelonephritis

Objective The aim of this study was to determine the risk factors such as age, sex, duration of fever, voiding dysfunction, constipation, history of recurrent UTI, the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), polymorphonuclear leukocytes (PNL), platelet count, mean platelet volume (MPV), serum urea, creatinine, proteinuria, type of microorganisms, presence of vesicoureteral reflux(VUR) for the development of renal damage in patients with acute pyelonephritis. Material and Methods A total of 197 children (44 boys, 153 girls) were enrolled in the study, mean age was 4.7±4.0 years (1 month-16 years). Ultrasonography, renal cortical scintigraphy (RCS) with 99mTc-Dimercaptosuccinic acid and voiding cystourethrography were performed in all patients. The patients were grouped by age according to presumed risk of renal damage: high risk(≤1 year), moderate risk(1–5 years), and low risk (>5 years). Results Renal lesions on RCS were detected in 91 patients. Abnormal RCS were found in 35% of infants younger than 1 year, in 57% of children between 1–5 years and in 42% of children older than 5 years. Abnormal RCS was found in 66% of the children with VUR and in 42.7% of those without VUR(p=0.005). There was a significant positive correlation between abnormal RCS and VUR, duration of fever (>2 days), history of recurrent UTI, high levels of ESR, CRP, WBC, and PNL at the presentation. Conclusion The patients with VUR were 2.6 times more likely to have renal damage. The risk of renal damage should be considered in all age groups.