Efficacy and safety of inhaled steroids in children with asthma: a comparison of fluticasone propionate with beclomethasone

Inhaled corticosteroids are indicated in children who have mild persistent asthma. Fluticasone propionate is a newer corticosteroid agent with higher potency compared with previous generations. However, still few dose-ranging studies have been investigated for optimal dosing of inhaled corticosteroids particularly in children with regard to the tolerability and safety of the drug. The primary purpose of this study was to compare and evaluate the efficacy and safety of fluticasone with beclomethosone in the treatment of childhood asthma unresponsive to non-steroidal medications and also in persistent, moderate and severe asthma. Seventy children, aged 6 to 14 years were enrolled in an open randomized trial with a parallel group design. Fiftytwo children with moderate, severe or persistent asthma received fluticasone 100 micro g twice daily for 12 weeks compared with 18 asthmatic children on beclomethasone 200 micro g daily. The outcome was assessed by data on questionnaires, changes in clinical symptoms, and results of peak flowmetery [PEFR]. Moreover, safety was assessed by 24 hour urinary cortisol measurement at the beginning of the study and comparison of the data with urinary cortisol at the end of 12 weeks. A total of 70 children between 6 to 14 years [33 girls and 37 boys] were randomized to start treatment with fluticasone or beclomethasone. From 70 children 13[18.6%] had a history of contact with pets during their life. At the beginning in beclomethasone group: 88.9% had cough, 88.9% had post exercise cough, 66.7% had dyspnea and 72.2% had wheezing. In Fluticasone group: 75% had cough,76.9% had post exercise cough, 46.2% had dyspnea and 59.6% had wheezing. After 3 months of therapy in beclomethasone group: cough was seen in 16.7%, post exercise cough in 11.1%, dyspnea in 11.1%, wheezing in 16.7% and in fluticasone group: cough in 15.4%, post exercise cough in 11.1%, dyspnea in 1.9% and wheezing in 3.8%.Data showed a better improvement in clinical signs of patients with fluticasone [p < 0.05]. Pulmonary function tests revealed better lung function in fluticasone group [p < 0.05]. In addition, 24 hours urinary cortisol level was measured at the beginning and after 12 weeks of therapy and it was within the normal range for both drugs. Fluticasone produced significantly greater improvement in lung function and control of asthma symptoms compared to beclomethasone and is efficient in the treatment of persistent, moderate and severe asthma in children. In addition these improvements were achieved with no greater degree of cortisol suppression compared with beclomethasone

Transmission of Mycobacterium tuberculosis to households of tuberculosis patients: a comprehensive contact tracing study

Tuberculosis [TB] continues to be a major health problem in developing countries. Contact investigation is the most appropriate strategy to interrupt transmission and subsequent development of TB. This cross-sectional study was conducted to assess the impact of contact screening on case-finding by using tuberculin skin test chest radiography. Contacts of smear-positive patients with pulmonary TB [index cases] were diagnosed and registered in our center during 2002 - 2004. Contacts, defined as household members living with index cases for >30 days, were screened by sputum examination, tuberculin skin test, and chest radiography. Sixty-eight patients with smear-positive pulmonary TB were considered as index cases. A total of 224 close contacts with index cases [an average of 3 contacts for each index case] were detected. Age among contacts ranged from 6 months to 74 years. Eighty-three percent of contacts were Iranians and 17% were Afghans. Abnormal radiographs were seen in 49.6% of contacts. Sixteen point five percent of contacts had a positive tuberculin skin test of >10 mm; 7.6% had a positive sputum smear. The mean - SD age of Iranian contacts [29.1 +/- 16.6 years] was significantly [P < 0.001] higher than that of Afghans [18.6 +/- 14.1 years]. Cavitary formation, nodular pattern, and infiltration were found to have a strong association with a positive sputum smear for acid fast bacilli [100%, 100%, and 87%, respectively]. The rate of TB in contacts was higher than other similar studies. Earlier detection and treatment of adults with TB could interrupt transmission and be a step towards eliminating childhood TB. Contact control and source-case investigations should be emphasized for TB control. Novel strategies are needed to maximize the number of contacts who are not only identified and evaluated, but also completely treated

Lung abscess in children: a 12-year study in national research institute of tuberculosis and lung disease

Background: Lung abscess is a rare and jeopardizing disease particularly in children. Early diagnosis of the disease can prevent further complications. Delay in diagnosis not only increases the mortality, but also can lead to severe complications along with the need for surgical intervention. Hence, we decided to evaluate the clinical and para-clinical features of our cases to estimate the magnitude of the problem

Materials and Methods: Data was obtained based on a retrospective study from 1992 to 2004, during a 12-year period in our centre. All the children who were admitted in NRITLD with lung abscess were enrolled in the study. Data was collected and analysed considering their age, gender, underlying disease, and aspiration history

Results: A total of 17 children were identified including 12 boys and 5 girls. 12[70%] children were under 10 years of age. Nine had a history of interstitial lung disease while 12 children had history of aspiration. The most common complaints were cough [94%], fever [82%], and sputum [82%]. Leukocytosis was observed in 76.5% of the cases while 70% showed shift to the left in their blood analysis. 60% of the cases were diagnosed only by CT-scan without any other evaluation. Gram positive organisms [Streptococcus pneumonia 11.6% and Staphylococcus aureus 5.8%] were the most prevalent organisms involved in our cases

Conclusion: According to this study, lung abscess is more prevalent in boys. The most common symptoms are cough, fever, and sputum. Furthermore, we suggest CT scan for diagnosing the disease because of its valuable role in detecting lung abscess in early stages

Primary and acquired drug resistance in childhood tuberculosis

Background: Increased rates of multidrug-resistant tuberculosis [MDR-TB] have been reported from developing countries. We evaluated the incidence of drug resistance in children in order to determine the magnitude of the problem, in our region

Objective: To determine the resistance pattern of Mycobacterium tuberculosis to four anti-tuberculosis drugs in childhood pulmonary tuberculosis at National Research Institute of Tuberculosis and Lung Disease [NRITLD] which is a referral centre in Tehran. Treatment of the patients was based on the DOTS strategy according to the WHO protocols since 1989

Materials and Methods: Retrospective analysis of all cases of pulmonary tuberculosis with positive M. tuberculosis culture who had referred to paediatrics ward from January 1999 to August 2004. M. tuberculosis sensitivity testing was performed by the Lowenstein-Jensen medium for isoniazid [INH], rifampicin [RMP], streptomycin [SM], and ethambutol [EMB]

Results: Among 350 children [0-15years] with confirmed tuberculosis, 7 children had resistance to at least one of the four anti-TB drugs. Out of the 7 patients, 6 were Afghan refugees and one patient was Iranian. Among those 85.7% had resistance to RMP, 71.4% to INH, 57.1% to SM, and 28.6% to EMB .In addition, 28.5% of patients had resistance to all four drugs [RMP, INH, SM, EMB], 14.2% to INH, RMP, SM, 28.5% to INH, RMP and 14.2% had resistance to each of SM and RMP. In this study 2% of children with TB had resistance out of which primary resistance was detected in 57.1%. Secondary resistance was found in 42.9% of cases who had previous history of anti-TB therapy

Conclusion: According to 2% prevalence of drug resistance in children and high resistance to RMP in our study, more aggressive interventions should be considered. Further management and supervision in DOTS implementation is highly recommended to prevent transmission of resistant tuberculosis