effect of serum levels of vitamin C on asthmatic children: a systematic review

Introduction: Asthma is a chronic inflammatory airway disorder that is distinguished by coughing, wheezing, and dyspnea. It is the most common chronic disease among children. Epidemiological trials have suggested that there may be a correlation between vitamin C intake and the incidence of asthma. Specifically, according to these studies, a rapid increase in the occurrence of asthma may be caused by a decreased intake of dietary antioxidants and various vitamins such as vitamin C. A systematic review was performed to determine the role that vitamin C, in terms of both dietary intake and serum levels, had on asthma in children

Methods: PubMed and Scopus databases were searched for studies that provide information on the effects of vitamin C on asthma in children aged between 1 and 17 years. The inclusion criteria specified that the studies involved needed to be cohort and case series involving at least ten patients. Exclusion criteria were non-English articles, case reports, and articles involving children who were aged below or above the age 1 and 17 respectively

Result: A total of 13 studies involving 6503 patients met the inclusion criteria. Dietary vitamin C intake was lower in people with asthma than in those without asthma. Lower quantity dietary intakes and serum levels of vitamin C were also associated with increased incidents of asthma

Conclusion: According to the extracted data, a relatively low dietary intake of vitamin C is associated with an increased risk of asthma and wheezing. Moreover, asthmatic patients who consumed vitamin C exhibited an improvement in their diseases

Vitamin D and respiratory disorder

The active form of vitamin D is synthesized in some body organs following sun exposure and dietary intake. Vitamin D exhibits its major and critical effects not only through regulation of calcium and phosphate metabolism but also by influencing on respiratory and immune system. Serum concentrations of 25-hydroxyvitamin D below the optimum limit lead to vitamin D insufficiency or maybe deficiency. These inappropriate concentrations of vitamin D lead to different types of pulmonary diseases such as viral and bacterial respiratory infection, asthma, chronic obstructive pulmonary disease, and cancer. In this review we described the association between vitamin D deficiency and severe therapy resistant asthma. We also reviewed the underlying molecular mechanism of vitamin D deficiency in children with severetherapy resistant asthma. Based on current information, future clinical trial are needed to study the role of vitamin D supplementation on different groups of patients with severe asthma including infants, children of school age, and ethnic minorities

Chronic recurrent multifocal osteomyelitis; manifestation, imaging and diagnosis

Chronic recurrent multifocal osteomyelitis [CRMO] is an inflammatory bone disease usually affecting children. A 9-year old boy presented with recurrent lower extremities pain and discomfort lasting for two years. In every time, symptoms vanished after several weeks. The patient received antibiotics only in one period of bone pain. In other occasions the patient didn't received any antibiotics. In last episode of bone pain, symptoms disappeared by use of naproxen. In patient's X-rays, there were multifocal areas of sclerosis with a wide transitional zone accompanied by a fine periosteal reaction. Regarding his history and MRI, bone scan findings were more in favor of active inflammatory process in the involved regions. In needle biopsy and bone curetting of left and right tibiae, osteonecrosis, mild inflammatory fibrosis, and scattered chronic inflammatory cells consistent with chronic osteomyelitis were noticed. No malignant neoplastic tissue was identified. In 2-year follow-up, diagnosis of CRMO was confirmed by serial laboratory tests, three-phase bone scan, CT and MRI findings. This diagnosis was proved by pathology evaluation following needle bone biopsy

Synbiotics in children with cow's milk allergy: a randomized controlled trial

Cow's milk protein allergy usually occurs in infants within the first months of life. It can affect several organs, but gastrointestinal symptoms are the most clinical symptoms observed. The most effective treatment is restricting the cow 's milk protein in mother and infant's diet. Lactobacillus GG supplementation in infant could be effective through modulation of the immune system and the gut microflora. Thirty two breastfed infants with Cow's milk protein allergy were enrolled in a double-blinded randomized controlled trial in which they received Synbiotic [n=16] or placebo [n=16] once a day for one month, simultaneously with Cow's milk protein restriction in mother and infant's diet. Clinical gastrointestinal symptoms [vomiting, colic, rectal bleeding and diarrhea], head circumference, body length and weight were recorded at the beginning, the end of the first and third month of study. Percentage of increment in head circumference and weight were statistically more in synbiotic group compared with placebo group at the end of the first and third month of study. There was no significant difference in resolution of clinical gastrointestinal symptoms [vomiting, colic, rectal bleeding or diarrhea] and percentage of increment in body length. Synbiotic supplementation in infants may improve increment of head circumference and weight gain, but has no effect on resolution of clinical symptoms

Synbiotic for prevention of antibiotic-associated diarrhea in children: a randomized clinical trial

Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea. In this randomized controlled trial, 218 patients [111 in the synbiotic and 107 in the placebo group] aged 6 months to 14 years with respiratory tract infection and/ or otitis media who needed antibiotic treatment in outpatient setting, were enrolled. They received 1 billion Colony Forming Unit of seven probiotics species plus Fructooligosaccharide in form of powder or placebo [matched for size, shape, and volume] for 7 days. Amoxicillin, Amoxicillin-clavalanic acid, cefixim and Azithromicin were the most common drugs used by physcicians Mothers recorded stool frequency and consistency daily for 7 days. We found no significant difference [P>0.05] in occurrence of diarrhea between synbiotic and placebo groups. This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease

Characteristics and outcome of three forms of autoimmune hepatitis in Iranian children

To define the clinical features, biochemical and histological findings and outcome of three forms of autoimmune hepatitis. In a cross sectional study between November 2001 to January 2008 in Tehran and Mashhad university of medical sciences, 61 children who diagnosed as AIH [40 girls and 21 boys] have been analyzed for their clinical, serological, and histological data. Variables analyzed included age, sex, clinical presentation, hepatic function, immunoglobulins, autoimmunity markers, histology and clinical evolution. According to the auto-antibodies profile, AIH patients were classified as type I AIH [ANA or smooth-muscle antibodies or both positive], type II [anti-LKM-1 positive] and type III [antibody negative]. We analyzed data of 61 children with AIH. 51 patients [median age: 10 [0.7-14] years had anti-nuclear and/or smooth muscle antibody [ANA/ASMA or both], 5 [median age: 7 [2-8] years] had liver/kidney microsomal antibody [LKM-1]. 5 patients had no detectable autoantibody. At presentation: 60% had jaundice or symptoms of acute hepatitis; LKM-1 positive were younger. Interface hepatitis was seen in 100% and fibrosis +/- cirrhosis were found in 70%. Frequency of AIH was 2:1 in girls. Type 1 was the most frequent diagnosis [83%] and was more frequent in older children. Relapse and treatment failure were common in type II. AIH may have different clinical presentation in children. Althout most of cases may have high inflammatory activity or cirrhosis, good response to treatment and remission may accur

Determine efficacy of a short course of montelukast in children with intermittent asthma and viral infection

Mild intermittent asthma is common in children and viral infections are responsible for the majority of exacerbations. As leukotrienes are potent inflammatory mediators, some studies have shown that Montelukast, a leukotriene receptor antagonist, may be effective on reduction of asthma symptom. To determine whether a short course of Montelukast in asthmatic children with common cold would modify the severity of an asthma episode. Children, aged 6-12 years with intermittent asthma participated in this randomized, double-blind, placebo-controlled clinical trial. Treatment with Montelukast or placebo was initiated at the onset of viral upper respiratory tract infection and continued for 7 days. Primary outcomes included the clinical manifestation: duration of episodes, daily symptom, nights symptoms and activity limitation. Secondary outcomes included the need for beta agonist usage, oral prednisolone, physician visit, hospital admission and school absence. A total of 187 children with intermittent asthma were randomized, 93 to Montelukast group and 94 to placebo group. Montelukast significantly decreased the cough by 17.3% [P<0.001], nighttime awakenings by 5.4% [P=0.01], interference with normal activity by 6% [P<0.01], time off from school by 6% [P<0.01], beta-agonist usage by 17.2% [P<0.001] and doctor visits by12.2% [P<0.01] compared to placebo. Whereas there was a non significant reduction in wheezing, tachypnea, respiratory distress, asthma exacerbation, oral prednisolone and hospitalization [P=0.8]. A short course of Montelukast, introduced at the first sign of a viral infection, results in a reduction in cough, beta-agonist use and nights awakened, time off from school and limitation of activity. More studies are needed to evaluate the optimal dose and duration of treatment

Kawasaki disease presenting as acute clinical hepatitis

Kawasaki disease is a systemic vasculitis of children. Among gastrointestinal symptoms of this disease jaundice occurs uncommonly. We present a 23 month boy with icter and clinical hepatitis and final diagnosis of kawasaki disease

Effect of a new synbiotic mixture on atopic dermatitis in children: a randomized-controlled trial

Atopic dermatitis [AD] is the most common chronic relapsing skin disease seen in infancy and childhood. The intestinal microbiota play an important role in immune development and may play a role in the development of allergic disorders. Manipulation of the intestinal microbiota by synbiotics may therefore offer an approach to the prevention or treatment of AD and allergic diseases. We studied the clinical and immunologic effects of a new symbiotic [a mixture of seven probiotic strains of bacteria and Fructooligosaccharide] in infants and children with AD. In a randomized, double-blind, placebo-controlled study, 40 infants and children aged 3 months to 6 years with AD received either a synbiotic or placebo for 8 weeks. The Severity Scoring of Atopic Dermatitis [SCORAD] index was recorded at baseline and also at 4 and 8 weeks of treatment. There was no significant difference between the probiotic and placebo group in baseline characteristics including sex, age, family history, corticosteroid usage and prick testing. Mean age was 23 months. The synbiotic group showed a significantly greater reduction in SCORAD than did the placebo group [P=0.001]. No specific effect was demonstrated of the probiotics employed on cytokine profile [P=0.4, P=0.6]. Egg white was the most common [45%] allergen followed by peanut and cow's milk. This study provides evidence that a mixture of seven strains of probiotics and Fructooligosaccharide can clinically improve the severity of AD in young children. Further studies are needed to investigate the effects on underlying immune responses and the potential long term benefits for patients with AD

comparison between traditional yogurt and probiotic yogurt in non-inflammatory acute gastroenteritis

To compare the traditional yogurt and probiotic yogurt in improving acute noninflammatory gastroenteritis. A double blinded case-control clinical trial, performed in 100 patients aged 6 months to 12 years of age from October 2008 to September 2009 in Ghaem and Dr. Sheikh Hospitals in Mashhad, Iran. The patients were assigned to the following groups: the case group received a probiotic yoghurt and the control group received the ordinary yogurt. There were statistically significant differences between the case and control groups in reducing frequency of diarrhea in the first [p= 0.000], second [p=0.013], third [p=0.028], and fourth [p=0.022], therapy. Also, there was a significant difference [p=0.000] in discontinuation of diarrhea between the case and control groups. Acute non- inflammatory gastroenteritis improvement is accelerated by probiotic yogurt consumption