Behavioral characteristics and parental stress in elementary school children with bronchial asthma and allergic rhinitis

PURPOSE: The aim of this study was to investigate the differences in behavioral characteristics and parental stress between allergic and nonallergic elementary school children. METHODS: Ninety-one elementary school children who had allergic disease were enrolled (asthma, n=27; allergic rhinitis, n=35; combined, n=29). Also one hundred six nonallergic elementary school children were enrolled for the control group. The Korean Child Behavior Check List (K-CBCL) and Korean Parenting Stress Index-Short Form (K-PSI-SF) were completed by their mothers. RESULTS: According to the analysis of K-CBCL, the score for Internalizing, anxious/depressed and somatic complaints were significantly higher in the combined group than in the control group. The score for Diagnostic and Statistical Manual of Mental Disorders (DSM)-affective problems in the combined group and DSM-somatic problems were significantly higher in the asthma group than in the control group. According to the analysis of K-PSI-SF, the score for parental distress was significantly higher in the allergic rhinitis group than in the control group. The scores for behavioral problems and parental stress were significantly correlated to allergic disease groups. CONCLUSION: Behavioral problems and parental stress were significantly associated with asthma and allergic rhinitis. The results of this study suggest the importance of psychosocial support for mothers and children with allergic diseases.

Factors associated with serum vitamin D levels in children with recurrent wheezing less than 3 years old

PURPOSE: We evaluated the relationship between laboratory/clinical factors and vitamin D levels in recurrent wheezers less than 3 years old. METHODS: We retrospectively analyzed clinical data and laboratory factors (25-hydroxyvitamin D, complete blood count, C-reactive protein, glutamic oxaloacetic transaminase, glutamyl purovic transaminase, alkaline phosphatase [ALP], eosinophil counts, and serum IgE IgG, IgA, IgM) of 84 children less than 3 years who had experienced wheezing episodes at least 3 times. RESULTS: Children in the normal group (1.4+/-0.9 years) were younger than those in the deficient (2.2+/-1.2 years) and insuffient (2.3+/-1.0 years) groups (P=0.010). Glutamyl purovic transaminase were higher in the normal group (24.5+/-19.4 IU/L) than in the deficient (16.0+/-4.7 IU/L) and insufficient (15.3+/-4.5 IU/L) groups (P=0.009). ALP were higher in the deficient (791.4+/-180.8 IU/L) and insufficient (770.4+/-251.2 IU/L) groups than in the normal group (631.9+/-127.0 IU/L, P=0.034). Total IgE levels were higher in the deficient group (171.9+/-212.1 kU/L) than in the normal group (43.7+/-58.3 kU/L, P<0.05), and the rate of sensitization to aeroallergens was higher in the insufficient group (36.1%) than in the normal group (10%, P<0.05). CONCLUSION: Among children with recurrent wheezing less than 3 years old, low vitamin D levels may be associated with older age, total IgE, ALP level, glutamic pyruvate transaminase level, and rate of sensitization to aeroallergens.

Usefulness of Influenza Rapid Antigen Test in Influenza A (H1N1) / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to examine the sensitivity and specificity of the influenza rapid antigen test, in comparison with reverse transcription polymerase chain reaction (RT-PCR), according to the time of the test from symptom onset and the clinical manifestations in the patients tested for suspected infection of the influenza A (H1N1) at a second hospital. METHODS: A total of 529 pediatric patients, aged between 6 and 12 years old, who visited the emergency department from October 1, 2009 to December 31, 2009, received the influenza rapid antigen test and RT-PCR. We examined the sensitivity and specificity of the influenza rapid antigen test in comparison with RT-PCR according to the time of the test from symptom onset (72 hours) and clinical manifestations (fever, cough, rhinorrhea.nasal obstruction, sore throat, gastrointestinal symptoms, and general symptoms) in a retrospective study based on hospital charts. RESULTS: The sensitivity of the influenza rapid antigen test at elapsed times of less than 24 hours, 24 to 48 hours, and 48 to 72 hours after the onset of the symptoms was 53.9%, 61.4%, and 62.1% respectively. When the elapse time was greater than 72 hours, the sensitivity was 31.6%; thus, the sensitivity of the influenza rapid antigen test tended to decrease with elapsed time. The sensitivity of the test was 79% in patients presenting with gastrointestinal symptoms, which was the highest, but there was no statistical difference according to the clinical manifestations of the patients. CONCLUSION: Our study suggests that more accurate results might be gained when the influenza rapid antigen test is performed within 72 hours after symptom onset.

The Evaluation of an Education Program for Using an Inhaler Devices in Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.

Comparisons of Clinical Features among Influenza A (H1N1) and Seasonal Influenza A and B during 2009 to 2010 at a Single Institution / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to compare the clinical features of pediatric patients who were diagnosed with influenza A (H1N1) or seasonal influenza A and B during 2009 and 2010 at a single institution. METHODS: Among children who visited the Dong-A University Hospital with fever (>37.8degrees C) and acute respiratory symptoms from September 2009 to February 2010, 1,004 children who were diagnosed with influenza A (H1N1) or seasonal influenza A and B by reverse transcription-polymerase chain reaction (RT-PCR) were enrolled. Monthly incidence, fever duration before diagnosis, symptoms (fever, cough, rhinorrhea, sore throat, headache, vomiting, abdominal pain, diarrhea, seizure, and dyspnea) and signs (rales, wheezing) were reviewed retrospectively in each group based on medical records. RESULTS: Influenza A (H1N1) was detected in 944 patients (94.0%), followed by seasonal influenza A in 42 (4.2%) and seasonal influenza B in 8 (1.8%). The positive rate of influenza infection was highest in November 2009 (n=557, 55.5%). Mean duration of fever before RT-PCR was 1.6 days (range, 1.5 to 1.8 days). Except fever, cough was the most common symptom (n=792, 78.9%), followed by rhinorrhea in 407 patients (40.5%). Rales and wheezing were detected in 16 patients (1.6%) and 19 (1.9%), respectively. Significant differences were observed for the number of patients who had cough, headache, vomiting, and wheezing among the three groups (P<0.05). CONCLUSION: Although the incidence of cough, headache, vomiting, and wheezing differed significantly among the three groups, the number of patients in each group was too different to compare the results.

The Clinical Experience of Pediatric Flexible Bronchoscopy at a Single Institution / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to investigate the indications, bronchoscopic findings, results of bronchoalveolar lavage, and complications and to report the clinical features of using flexible bronchoscopy for respiratory diseases in children. METHODS: We studied 105 patients who underwent flexible bronchoscopy at the Department of Pediatrics, Dong-A University Medical Center from June 2001 to June 2008. A bronchoalveolar lavage (BAL) was performed if need, and the BAL fluid was cultured for bacteria and fungi. We performed an acid-fast bacilli (AFB) smear and culture. RESULTS: The most common indication for flexible bronchoscopy was suspected pulmonary tuberculosis (37 cases, 35.2%). The most common abnormal finding was excessive secretion, which was found in 53 cases (50.4%). BAL bacterial cultures were performed in 10 of 38 cases, and Hemophilus influenza was the most common organism and was found in three cases (7.8%). There were 17 AFB culture-positive cases (49.3%) among the 37 suspected pulmonary tuberculosis cases. Among these 17, the Tb-polymerase chain reaction (Tb-PCR) was conducted for four cases (23.5%) but only two cases (50%) were positive. TB-specific antigen-induced interferon-gamma was performed in four cases (23.5%), and all four cases (100%) were positive. CONCLUSION: Pediatric flexible bronchoscopy has made it possible to vary the indication and subjects. It was also safe and effective if used carefully. Further study should be conducted to develop safe and useful technology to overcome the limitations.

Comparison of Immune Response between Pediatric Bronchial Asthma and Sinusitis / 소아알레르기및호흡기학회지

PURPOSE: Bronchial asthma and sinusitis have been grouped together and classified as one airway-related disease, with the same underlying inflammatory etiology. Through serological examination, we ascertained a difference in the immune response between bronchial asthma and sinusitis. METHODS: We measured the peripheral blood eosinophil count, total IgE and specific IgE to 7 aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Alternaria, cockroach, cat, dog and pollen), and interleukin (IL)-4 and interferon (IFN)-gamma of 118 school-aged patients who visited Dong-A University Medical Center and Busan Medical Center from March 2005 to February 2008. We divided these patients into 31 diagnosed with sinusitis (Group A), 36 diagnosed with bronchial asthma (Group B), and 51 diagnosed with both sinusitis and asthma (Group C). RESULTS: The peripheral blood eosinophil count and total IgE were markedly lower in group A. Dermatophagoides pteryonyssinus and Dermatophagoides farinae had higher sensitization rates than other aeroallergens in groups B and C. The sensitization rates to Alternaria and dog were higher in group C than in group B, and the sensitization rates to cat and pollen were higher in group B than in group C. In group C, clinical symptoms occurred evenly and allergic rhinitis was concurrent, similar to group B; however, the sensitivity of the bronchial provocation test was higher than in group B. Serum IL-4 in group B and C were significantly higher than in group A (P<0.001), and serum IFN-gamma was significantly higher in group A than in group C (P<0.027). CONCLUSION: Bronchial asthma was primarily related to IL-4 and Th2 cytokines, while sinusitis was primarily related to IFN-gamma and Th1 cytokines. According to the degree of association between the 2 diseases, various immune responses were observed.

Hypertension Caused by Renal Arteriovenous Fistula

We describe a case of secondary hypertension caused by renal arteriovenous fistula. An 8-year old girl was hospitalized with a severe headache, vomiting, and seizure. Renal angiography demonstrated multiple renal arteriovenous fistula and increased blood renin concentration in the left renal vein. Thus, left renal arteriovenous fistula and renin induced secondary hypertension were diagnosed. Her blood pressure was well controlled by medication with angiotensin converting enzyme inhibitor.

Perinatal outcomes according To chorionicity in Twin Gestations

PURPOSE: The purpose of this study was to assess the natural history and perinatal outcomes of twin gestations according to chorionicity. METHODS: We retrospectively reviewed the medical records of 99 monochorionic (MC) and 206 dichorionic (DC) twin gestations delivered at Il Sin Christian Hospital in Busan between January 2002 and December 2007. The incidences of twin-to-twin transfusion syndrome (TTS) and selective intrauterine growth restriction (sIUGR), as well as perinatal morbidity and mortality, were evaluated. RESULTS: MC twins had a lower gestational age (35.7 vs. 36.6 weeks, P=0.03) at birth and a higher incidence of intrauterine fetal loss (10% vs. 1.5%, P<0.001) than DC twins. The incidence of intrauterine fetal loss was higher in MC sIUGR than in DC sIUGR (19% vs. 2.5%, P=0.025) twins. The number of admissions to the neonatal intensive care unit (NICU; 31% vs. 16%, P=0.042), and the incidence of periventricular leukomalacia (7% vs. 0%, P=0.031), and respiratory distress syndrome with surfactant treatment (27% vs. 11%, P=0.049) were higher in MC than DC twins. The incidences of sIUGR and TTS were 21 and 9% among the MC twins. The incidences of intrauterine fetal loss were higher in MC twins with TTS [6 of 9 (67%)] or sIUGR [4 of 21 (19%)] than uncomplicated MC twins (P<0.001). The frequency of admission to the NICU (P=0.001), the length of hospital stay (P=0.033), the prevalence of periventricular leukomalacia (P=0.011), and intraventricular hemorrhage (P=0.007) were also higher in MC with TTS or sIUGR than in uncomplicated MC twins. CONCLUSION: The incidence of neonatal complications was higher in MC twins, especially those gestations complicated by TTS or sIUGR.

A comparative study on iron deficiency anemia based on feeding patterns of nine-month-old infants / 소아과

PURPOSE: This study was conducted to evaluate the red cell indices and frequency of iron deficiency anemia based on the feeding patterns of nine-month-old infants. METHODS: Blood tests were performed on 253 nine-month-old infants, who visited Il Sin Christian Hospital for health checkups from January to December 2007. Their parents answered telephonic questions regarding their feeding patterns and weaning foods. RESULTS: Three infants groups were created according to feeding patterns before they started weaning foods. One group was exclusively breast-fed (48.6%), another had mixed feeding (27.3%), and the third had artificial milk feeding (24.1%). Red cell indices (hemoglobin, hematocrit, MCV, MCH) of the breast-fed group were comparatively lower than those of the other two groups (P<0.05). Twenty-five infants (9.9%) were diagnosed with iron-deficiency anemia. According to feeding patterns, the frequency of anemia was highest in the breast-fed group. Six infants who started weaning foods before six months of age (113 infants) were diagnosed with iron-deficiency anemia (5.3%), and nineteen who started after six months of age (140 infants) were diagnosed with iron-deficiency anemia (13.6%). CONCLUSION: When nine-month old infants visit hospitals for health check-ups, pediatricians must consider their feeding pattern and weaning foods histories, and then recommend screening blood tests for iron-deficiency anemia.

Positive seroconversion rate of hepatitis B antibody after hepatitis B vaccination by birth weight and gestational age / 대한주산의학회잡지

OBJECTIVE: Previous studies have reported that the immune response of hepatitis B vaccine is decreased in preterm or low birth weight babies compared to healthy term babies. To evaluate this notion, we investigated the positive seroconversion rate of hepatitis B antibody after hepatitis B vaccination according to gestational age and birth weight. METHODS: We retrospectively studied medical records about the positive seroconversion rate of a total of 968 infants who were given DNA recombinant hepatitis B vaccine as scheduled at Il Sin Christian Hospital, Busan from January 2002 to Mar 2007. RESULTS: The postive seroconversion failure rate (non-responder or poor-responder) of hepatitis B antibody by gestational age was 15.6% (28 weeks, 32 weeks, 1,000 g, 1,500 g, 2,000 g). CONCLUSION: The seropositive rate of hepatitis B antibody after hepatitis B vaccination decreased as the gestational age and the birth weight decreased. And gestational age more than 37 weeks and birth weight above 2,000 g were independently associated with a higher seropositive rate of hepatitis B antibody after hepatitis B vaccination.