Evaluation of children with juvenile idiopathic arthritis in southeastern Turkey: a single center experience.

BACKGROUND: The aim of this study was to investigate the disease characteristics of children with juvenile idiopathic arthritis (JIA) in southeast Turkey. METHODS: The International League of Associations for Rheumatology (ILAR) criteria were used to diagnose JIA. Hospital records of the Pediatric Rheumatology Unit, of the Dicle University Hospital, were reviewed retrospectively and demographic, clinical and laboratory data were recorded. RESULTS: Totally 213 children (103 boys, 110 girls), with an age range of 1.6-18 years were enrolled. The mean age of the disease onset was 8.1 years. Polyarticular type was the most common (42.3%) presentation. The frequencies of other JIA subtypes were as follows: oligoarticular 37.1%, systemic 8.9%, enthesitis-related arthritis (ERA) 10.8% and psoriatic arthritis 0.9%. The knees (74.2%) and ankles (54.0%) were the most commonly affected joints. Uveitis was found in 4.2% of patients. Anti-nuclear antibodies were positive in 11.7% and HLA-B27 in 2.8% of patients. Active disease was seen in 57 (26.7%) patients at the last visit. CONCLUSION: In the present study, polyarticular JIA was the predominant subtype and there were fewer patients with positive ANA or uveitis compared to previous studies. Hippokratia 2015, 19 (1): 63-68.

Pediatric poisonings in southeast of Turkey: epidemiological and clinical aspects.

Current detailed information about the causes, management, and clinical course of acute childhood poisonings in Turkey is scarce. Therefore, we have conducted a descriptive study of children presenting with acute poisoning to the pediatric emergency department of Dicle University Hospital throughout an 8-month period. Two hundred unselected children with poisoning were evaluated in terms of clinical, epidemiological and socioeconomic aspects. The mean age of patients was 5.7 +/- 4.0 years. The majority of the patients (n = 108, 54%) were aged from 13 months to 4 years (P < 0.05). In majority of patients (66.5%, n = 133), poisonings were accidental. Intentional poisonings accounted for 3.5% (n = 7) and food poisoning accounted for 30% (n = 60) of all cases. The families had more than three children in 129 (97%) of accidentally poisoned and in seven (100%) of intentionally poisoned patients, six were girls and one was a boy. The parents of most patients were uneducated. Furthermore, more than two third of families had low level of income. In all, 171 patients (85.5%) were discharged after an observation period of 24 h. Four patients died. In conclusion, factors such as low educational level of parents, presence of more than three children in the family, and low income increase the incidence of childhood poisonings. The low educational level of girls increases the incidence of intentional poisoning.

Pamidronate treatment in acute vitamin D intoxication.

Management with glucocorticoid, high iv fluid saline intake, furosemide and calcitonin may not result in a favorable reduction of hypercalcemia and may cause several side effects in infants with acute vitamin D intoxication. The bisphosphonate pamidronate, a specific inhibitor of bone resorption through osteoclast mediation was successfully used in a 6-month old infant with acute vitamin D intoxication managed in the Pediatric Emergency and Intensive Care Unit, after an ineffective trial of hydration, furosemide, calcitonin and prednisolone. After a double infusion of pamidronate on two consecutive days (1 mg/kg/day), an early and safe correction of hypercalcemia/hypercalciuria was supplied. Pamidronate therapy may be considered in patients with hypercalcemia secondary to acute vitamin D poisoning.

Pulmonary functions in atopic and nonatopic asthmatic children.

BACKGROUND: we examined how lung function and certain clinical and laboratory characteristics in asthmatic children were changed according to skin test positivity to aeroallergens. METHODS: a skin prick test was conducted using standardized extracts of 10 different allergens in 56 children with bronchial asthma, aged 5-15 years, in Dicle University Hospital. Lung function was measured by Microplus spirometer. RESULTS: among the 56 subjects, asthma was classified as mild in 16, moderate in 42 and severe in 3. At least one skin prick test was positive (monosensitized) in 35 subjects (62 %) and positive reactivity to two or more aeroallergens (polysensitized) was found in 17 subjects (30 %). Positive skin test reactions to aeroallergens were associated with a decrease (as percentage of the predicted decrease) in FEV1, FVC and PEF values. Significant differences were also found between prick test-positive and -negative asthmatics in duration of breastfeeding (8.5 5 months vs 15 7 months, respectively, p < 0.007), age at which cow's milk had been started (5.7 1.6 vs 10.5 5.4, p = 0.004); total serum IgE concentration (350 221 IU/ml vs 234 164 IU/ml, p = 0.02), age at onset of asthma symptoms (2.5 1.9 years vs 4.1 2.2 years) and number of asthma attacks per year (7.0 3.1 vs 5.2 3.5, p = 0.012). When one-way ANOVA and a post-Hoc test were used, asthma attacks were more frequent and severe and allergic conjunctivitis symptoms were more frequent in the polysensitized group than in the nonsensitized and monosensitized groups (p = 0.03). CONCLUSIONS: children with positive skin prick test results, especially those with combined sensitivity to dust mite, cat and dog, were at increase risk of more severe asthma.

Asthmatic children and risk factors at a province in the southeast of Turkey.

BACKGROUND: The prevalence of asthma appears to be on the increase and the risk factors are not well established. Environmental and demographic characteristics of asthmatic children were investigated to identify the risk factors accompanying asthma. METHODS: 140 asthmatic children aged at 3-15 years were compared with 96 age-matched control subjects admitted to the paediatric outpatient clinics of Dicle University Hospital. Information about the children were obtained from parents and patients'charts. RESULTS: Patients with asthma were most frequently admitted in May-June and November-January months. Association of the disease with allergic rhinitis was found in 84 children (60 %), allergic conjunctivitis in 63 (45 %), atopic dermatitis in 29 (21 %) and gastrointestinal symptoms in 18 (13 %). Mean age of the cases was 6.8 3.3 and 6.9 3.2 years (p > 0.05); male to female ratios were 91/49 and 43/53 (p = 0.002) in the study and control groups, respectively. There were significant differences at number of cases stated to have any symptoms induced by air pollution (25.6 %, 3.1 %, p < 0,001), exercise (47.5 %, 4.2 %, p < 0.001) and cold exposure (33 %, 15.6 %, p = 0.03), but not by damp, dust, indoor smoking, foods, drugs, and animal contact (p > 0.05) between the study and the control groups, respectively. Family history of atopy was 66 % and 8.4 %, (p < 0.001) in the study and control groups, respectively. Family crowding index, duration of breast feeding, parental education and number of consanguineous married parents were not different between both groups. History of upper respiratory tract infections were more frequent in asthmatic children than controls. Children with an earlier age of onset ( 5 years. CONCLUSIONS: Many risk factors, both individual and environmental are associated with asthmatic children in Diyarbakr. Among many risk factors that aggrevating asthma in children in Diyarbakr, air pollution, cold exposure and upper respiratory infections are preventable.

Pulmonary functions in atopic and nonatopic asthmatic children

Background: we examined how lung function and certain clinical and laboratory characteristics in asthmatic children were changed according to skin test positivity to aeroallergens. Methods: a skin prick test was conducted using standardized extracts of 10 different allergens in 56 children with bronchial asthma, aged 5-15 years, in Dicle University Hospital. Lung function was measured by Microplus spirometer. Results: among the 56 subjects, asthma was classified as mild in 16, moderate in 42 and severe in 3. At least one skin prick test was positive (monosensitized) in 35 subjects (62 %) and positive reactivity to two or more aeroallergens (polysensitized) was found in 17 subjects (30 %). Positive skin test reactions to aeroallergens were associated with a decrease (as percentage of the predicted decrease) in FEV1, FVC and PEF values. Significant differences were also found between prick test-positive and -negative asthmatics in duration of breastfeeding (8.5 ± 5 months vs 15 ± 7 months, respectively, p < 0.007), age at which cow's milk had been started (5.7 ± 1.6 vs 10.5 ± 5.4, p = 0.004); total serum IgE concentration (350 ± 221 IU/ml vs 234 ± 164 IU/ml, p = 0.02), age at onset of asthma symptoms (2.5 ± 1.9 years vs 4.1 ± 2.2 years) and number of asthma attacks per year (7.0 ± 3.1 vs 5.2 ± 3.5, p = 0.012). When one-way ANOVA and a post-Hoc test were used, asthma attacks were more frequent and severe and allergic conjunctivitis symptoms were more frequent in the polysensitized group than in the nonsensitized and monosensitized groups (p = 0.03). Conclusions: children with positive skin prick test results, especially those with combined sensitivity to dust mite, cat and dog, were at increase risk of more severe asthma (AU)

Antecedentes: examinamos cómo se modificaban las funciones pulmonares y algunas características clínicas y de laboratorio en niños asmáticos en función de su reacción positiva a los aeroalergenos en las pruebas cutáneas. Métodos: se realizó una prueba de punción cutánea (prick test) utilizando extractos estandarizados de 10 alergenos distintos en 56 niños con asma bronquial, de edades comprendidas entre 5 y 15 años en el hospital de la Universidad de Dicle. Las funciones pulmonares se midieron con un espirómetro Microplus. Resultados: el asma de 16 de dichos sujetos se clasificó como leve, en 42 de los casos, como moderada, y en 3 de grave. Por lo menos una prueba de punción cutánea fue positiva (monosensibilizados) en 35 sujetos (62 %), y se detectó una reacción positiva a dos o más alergenos (polisensibilizados) en 17 susjetos (30 %). Reacciones positivas a los aeroalergenos asociadas con una disminución en los valores de volumen espiratorio forzado en el primer segundo (VEMS/FEV1), capacidad vital forzada (CVF/FVC) y flujo espiratorio máximo (FEM/PEF). También se detectaron diferencias significativas entre los asmáticos con prueba de punción cutánea positiva y negativa en la duración de la lactancia materna (8,5 ± 5 meses vs 15 ± 7 respectivamente, p < 0,007); en los meses de vida a los que se comenzó a tomar leche de vaca (5,7 ± 1,6 vs 10,5 ± 5,4, p = 0,004); en concentración total en suero de inmunoglobulina E (350 ± 221 IU/ml vs 234 ± 164 IU/ml, p = 0,02); en la edad de la aparición de los síntomas asmáticos (2,5 ± 1,9 años vs 4,1 ± 2,2 años); y en el número de ataques de asma anuales (7,0 ± 3,1 vs 5,2 ± 3,5, p = 0,012). Los análisis de varianza unidireccional ANOVA y post-Hoc mostraron que el grupo de polisensibilizados sufría ataques de asma más frecuentes y graves y síntomas frecuentes de conjuntivitis alérgica que los grupos no sensibilizados y monosensibilizados (p = 0,03). Conclusión: los niños con resultados positivos a las pruebas de punción cutánea, especialmente los que muestran sensibilidad combinada a los ácaros del polvo, perros y gatos, presentaban un riesgo mayor de padecer asma más grave (AU)

Asthmatic children and risk factors at a province in the southeast of Turkey

Background: The prevalance of asthma appears to be on the increase and the risk factors are not well established. Environmental and demographic characteristics of asthmatic children were investigated to identify the risk factors accompanying asthma. Methods: 140 asthmatic children aged at 3-15 years were compared with 96 age-matched control subjects admitted to the paediatric outpatient clinics of Dicle University Hospital. Information about the children were obtained from parents and patients'charts. Results: Patients with asthma were most frequently admitted in May-June and November-January months. Association of the disease with allergic rhinitis was found in 84 children (60 %), allergic conjunctivitis in 63 (45 %), atopic dermatitis in 29 (21 %) and gastrointestinal symptoms in 18 (13 %). Mean age of the cases was 6.8 ± 3.3 and 6.9 ± 3.2 years (p > 0.05); male to female ratios were 91/49 and 43/53 (p = 0.002) in the study and control groups, respectively. There were significant differences at number of cases stated to have any symptoms induced by air pollution (25.6 %, 3.1 %, p < 0,001), exercise (47.5 %, 4.2 %, p < 0.001) and cold exposure (33 %, 15.6 %, p = 0.03), but not by damp, dust, indoor smoking, foods, drugs, and animal contact (p > 0.05) between the study and the control groups, respectively. Family history of atopy was 66 % and 8.4 %, (p < 0.001) in the study and control groups, respectively. Family crowding index, duration of breast feeding, parental education and number of consanguineous married parents were not different between both groups. History of upper respiratory tract infections were more frequent in asthmatic children than controls. Children with an earlier age of onset (≤ 5 years) in the study group was more frequently associated with allergic rhinitis in comparison with the asthmatic children with an age of onset > 5 years. Conclusion: Many risk factors, both individual and environmental are associated with asthmatic children in Diyarbak¿r. Among many risk factors that aggrevatig asthma in children in Diyarbak¿r, air pollution, cold exposure and upper respiratory infections are preventable (AU)

Antecedentes: La prevalencia del asma parece ir en aumento y los factores de riesgo no parecen quedar muy claros. Se investigaron las características medioambientales y demográficas de un número de niños asmáticos para identificar los factores de riesgo que acompañan al asma. Métodos: 140 niños asmáticos de edades comprendidas entre los 3 y los 15 años fueron comparados con 96 sujetos de las mismas edades admitidos en el hospital pediátrico de día de la Universidad de Dicle. La información sobre los niños se obtuvo a través de los padres y la historia clínica de los pacientes. Resultados: Los pacientes con asma acudían con más frecuencia en los meses de mayo-junio y de noviembre-enero. La enfermedad se asoció con rinitis alérgica en 84 niños (60 por ciento), con conjuntivitis alérgica en 63 niños (45 por ciento), dermatitis atópica en 29 niños (21 por ciento) y síntomas gastrointestinales en 18 niños (13 por ciento). La edad media de los casos era de 6,8 ñ 3,3 y 6,9 ñ 3,2 años (p > 0,05); la relación entre varones y mujeres fue de 91/49 y de 43/53 (p = 0,002) en los grupos de estudio y los controles, respectivamente. Hubo diferencias importantes entre el número de casos en los que existían síntomas inducidos por la contaminación del aire (25,6 por ciento, 3,1 por ciento, p 0,05) entre los grupos estudiados y los controles, respectivamente. La historia familiar de atopia fue del 66 y del 8,4 por ciento (p 5 años. Conclusión: En Diyarbakir, los niños asmáticos se asocian con muchos factores de riesgo, tanto individuales como medioambientales. Entre muchos de los factores de riesgo que agravan el asma de los niños de Diyarbakir, la contaminación del aire, la exposición al frío y las infecciones de las vías respiratorias altas son evitables (AU)

Lamivudine and interferon-alpha combination treatment of childhood patients with chronic hepatitis B infection.

BACKGROUND: The aim of our study was to compare the efficacy of combined interferon-alpha and lamivudine in children with chronic hepatitis B infection and two durations of treatment (6 and 12 months). METHODS: Combination of interferon-alpha 2b (10 MU/m2 of body surface) and lamivudine 4 mg/kg (maximum, 100 mg) were given synchronously to 30 patients for 6 months (Group 1) and to 27 patients for 12 months (Group 2). Biochemical, virologic and serologic features were compared between two groups at the end of therapy and 6 months after therapy. RESULTS: Hepatitis B e antigen clearances were 33 and 59% at the end of treatment and 37 and 56% 6 months after therapy in Groups 1 and 2, respectively (P > 0.05). Hepatitis B virus DNA clearances were 97 and 100% at the end of treatment and 97 and 96% 6 months after therapy in Groups 1 and 2, respectively (P > 0.05). In both groups normalization of alanine aminotransferase was maintained at the end of therapy and 6 months after therapy (P < 0.05). Sustained complete responses were obtained in 20 and 37% of patients at the end of therapy and 6 months after therapy, respectively (P = 0.07). CONCLUSIONS: When the combination of large dosage interferon-alpha 2b and lamivudine therapy in children was compared at the end of therapy and 6 months after therapy, normalization of alanine aminotransferase and the clearances of hepatitis B e antigen and hepatitis B surface antigen in both groups were directly proportional to the duration of treatment. However, the higher complete response rate at 12 months of combination therapy was not statistically different from that at 6 months.

A randomized trial of granulocyte-macrophage colony-stimulating factor in neonates with sepsis and neutropenia.

OBJECTIVES: To determine whether adjunctive therapy with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival and to assess its safety compared with conventional therapy in a control group. STUDY DESIGN: This prospective, randomized, controlled trial was performed in 60 infants with neutropenia and clinical signs of sepsis. A subcutaneous injection of rhGM-CSF (5 microgram/kg/day) was administered to 30 of the patients for 7 consecutive days. Hematologic parameters (absolute neutrophil, eosinophil, monocyte, lymphocyte counts, and platelet number) and outcome were compared with 30 conventionally treated (control) patients. RESULTS: Twenty-five patients from the GM-CSF-treated group and 24 from the conventionally treated group had early-onset sepsis (3 days' postnatal age). There was no difference between groups in terms of birth weight; gestational age; gender; maturity; maternal age; and incidence of prolonged rupture of membranes, maternal hypertension, or severity of sepsis. All neonates tolerated GM-CSF well with no adverse reactions. The absolute neutrophil count on day 7 was significantly increased in the GM-CSF-treated group compared with the conventionally treated group: 8088 +/- 2822/mm(3) versus 2757 +/- 823/mm(3). The mean platelet count was significantly higher on days 14 in the GM-CSF-treated group compared with conventionally treated group: 266 867 +/- 55 102/mm(3) versus 229 200 +/- 52 317/mm(3). Hematologic parameters were otherwise similar between groups before treatment and on day 28. Twenty-seven neonates in the rh-GMCSF group and 21 in the control group survived to hospital discharge. The mortality rate in the rhGM-CSF group (10%) was significantly lower than in the conventionally treated group (30%). CONCLUSION: Treatment with rhGM-CSF is associated with an increase in absolute neutrophil, eosinophil, monocyte, lymphocyte, and platelet counts and decreased mortality in critically ill septic neutropenic neonates. These results suggest that rhGM-CSF may be effective in the treatment of neonatal sepsis with neutropenia, and further randomized trials are needed to confirm its beneficial effects.

Serum levels of IL-1 beta, sIL-2R, IL-6, IL-8, and TNF-alpha in febrile children with cancer and neutropenia.

Serum levels of interleukin-1 beta (IL-1beta), soluble interleukin 2 receptors (sIL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) were measured to predict some characteristics of febrile episodes in children with cancer and neutropenia. Forty-eight episodes of febrile neutropenia were determined in 23 pediatric cancer patients, including 35 febrile episodes without identifiable source, 7 episodes of bacteremia due to Gram-negative organisms and 4 due to Gram-positive organisms, and 2 fungal infections. Interleukin-6, sIL-2R, and IL-8 levels were significantly higher at the beginning of the febrile episodes than those of controls (p < 0.001, p < 0.001, and p < 0.001). Interleukin-6, slL-2R, and IL-8 levels were higher in patients with bacteremia due to Gram-negative organisms than in those with Gram-positive ones (p = 0.042, p = 0.006, and p = 0.023, respectively). TNF-alpha and IL-1beta levels were similar in febrile episodes and controls (p > 0.05). In conclusion, sIL-2R, IL-6, and IL-8 levels may be helpful in the prediction of infection in febrile cancer patients with neutropenia and measurements of IL-1beta and TNF-alpha were not useful for identifying the presence and the type of infection in febrile neutropenic episodes in children.

Prevalence of asthma and other allergic disorders among schoolchildren in Diyarbakir, Turkey.

This study was performed to describe the prevalence rates of allergic diseases among children in southeast Anatolia. A questionnaire survey of children six to 15 years old was conducted using a modified version of the Turkish translated ISAAC protocol, with additional questions concerning sociodemographic and environmental characteristics of children that could be potential risk factors for allergic disorders. Questionnaires were distributed to parents of all children aged below 11 years and to children themselves aged over 11 for completion. A total of 3,040 children returned the questionnaires. The lifetime prevalence rates of asthma, wheezing, allergic rhinitis and atopic dermatitis were 14.1%, 22.4%, 12.9%, and 7.8%, respectively. The prevalence of wheezing, rhinitis and chronic rash in the last 12 months were 14.7%, 39.9%, and 11.8%, respectively. The prevalence rates of symptoms and diagnoses of allergic disorders were similar in boys and girls. Passive smoking, pet ownership, number of household and socioeconomic status were not significant risk factors for allergic diseases. Family history of atopy was the most prominent risk factor for all types of allergic diseases, high prevalence rates of asthma, rhinitis and eczema exist among schoolchildren in southeast Anatolia.

Passive smoking and expired carbon monoxide concentrations in healthy and asthmatic children

Background: carbon monoxide (CO) in expired air has been reported to be an indirect measurement for the quantity of passive smoking. Since endogen CO is produced in inflammatory processes and inflammation is the main pathogenetic mechanism of asthma, it was aimed to investigate the relationship between the intensity of passive smoking and CO concentration in expired air of healthy and asthmatic children. Methods and Results: the study was performed in the outpatient pediatrics clinics and day care centers. Knowledge about indoor smoking habits were obtained from parents. The exhaled CO concentrations were measured by a portable device in 235 healthy (mean age, 4.4 ± 2.3 years) and 54 asthmatic (mean age, 4.5 ± 1.7 years) children. Children with no smoking parents had the lowest exhaled CO concentrations. Significant relationships were found between the number of smoking cigarettes in the house and exhaled CO concentrations in both healthy (p = 0.003) and asthmatic (p = 0.01) children. Carbon monoxide concentrations were higher in asthmatic children than healthy ones (mean ± SD, 1.32 ± 1.50 ppm and 0.86 ± 1.35 ppm, respectively, p = 0.028) if their parental smoking habits were not taken into account. Asthmatic children of non- smoking parents had higher CO concentrations than healthy subjects of non-smoking parents (1.05 ± 1.55 ppm vs 0.37 ± 0.53 ppm, p = 0.01). On the other hand, asthmatic children who has no smoking parents and did not receive inhaled steroids had significantly higher CO concentrations (1.75 ± 1.45 ppm) than those who received steroids (0.58 ± 0.65 ppm, p = 0.024). Conclusions: exhaled CO can be used as an indicator of passive smoking in children. Higher expired CO of asthmatic children may reflect inflammation of the lung in asthma (AU)

Antecedentes: se ha comunicado que el monóxido de carbono (CO) en aire espirado es una medición cuantitativa indirecta de la inhalación pasiva de humo de tabaco. Como se produce CO endógeno en procesos inflamatorios y la inflamación es el principal mecanismo patógeno del asma, propusimos investigar la relación entre la inhalación pasiva de humo de tabaco y la concentración de CO en el aire espirado por niños sanos y asmáticos.Métodos y resultados: el estudio se realizó en clínicas ambulatorias de pediatría y guarderías infantiles. Se obtuvo información de los padres acerca del hábito de fumar en el domicilio. Las concentraciones de CO exhalado se midieron con un dispositivo portátil en 236 niños sanos (edad media 4,4 ñ 2,3 años) y 53 niños asmáticos (edad media 4,5 ñ 1,7 años). Los niños cuyos padres no fumaban tuvieron las menores concentraciones de CO exhalado. Se encontró una relación significativa entre el número de personas que vivían en casa y fumaban y las concentraciones de CO exhalado en niños sanos (p = 0,03) y asmáticos (p = 0,01). Las concentraciones de monóxido de carbono fueron más elevadas en los niños asmáticos que en los sanos (media ñ DE, 1,32 ñ 1,50 ppm y 0,86 ñ 1,35 ppm, respectivamente, p = 0,028), independientemente del hecho de fumar o no los padres. Los hijos asmáticos de padres no fumadores tuvieron concentraciones más elevadas de CO que los hijos sanos de padres no fumadores (1,05 ñ 1,55 ppm vs 0,37 ñ 0,53 ppm, p = 0,01). Por otro lado, los niños asmáticos cuyos padres no fumaban y que no utilizaban esteroide inhalados tuvieron concentraciones de CO significativamente mayores (1,75 ñ 1,45 ppm) que los que utilizaban esteroides (0,58 ñ 0,65 ppm, p = 0,024).Conclusiones: el CO exhalado puede utilizarse como un indicador de la inhalación pasiva de humo de tabaco en niños. Las mayores concentraciones de CO espirado en niños asmáticos pueden reflejar inflamación pulmonar producida por el asma. (AU)

Predictors for multiple hospital admissions in children with asthma.

BACKGROUND: Asthma is one of the most frequent causes of preventable hospital admissions among children. OBJECTIVES: To identify preventable risk factors for future hospital admissions. Some of the environmental and patient characteristics of children who were hospitalized more than once with an acute asthma attack were investigated. DESIGN, SETTING AND PATIENTS: An analysis was performed of 140 children with asthma, aged three to 15 years, admitted to the Department of Pediatrics at Dicle University Hospital, Diyarbakir, Turkey, over three years, followed for a maximum of 48 months. Associations between hospital admissions and probable predictors (clinical findings, laboratory studies and a detailed case history) were analyzed. RESULTS: The asthma admissions were higher in boys than in girls (male to female ratio 1.86). Of 140 children, 30 (21.4%) had multiple admissions, defined as a mean of more than one admission per year during the follow-up period. The following factors were associated significantly with the frequency of hospital admission for asthma attacks when analyzed using a Chi2 test: indoor cigarette smoking (odds ratio [OR] 2.55), maternal smoking (OR 4.05), symptoms of dermal atopy (OR 2.96), symptoms of allergic conjunctivitis (OR 2.68), age less than five years (OR 5.12) and use of inhaled corticosteroids during the follow-up (OR 0.37). With multi-variate logistic regression analysis, among other factors, only maternal smoking (r=0.29, P=0.017) and age less than five years (r=-0.32, P=0.012) were significant effective factors for the multiple hospital admissions. No significant association with the frequency of hospital admission was found for sex, serum total immunoglobulin E, history of frequent upper respiratory tract infections or number of family members. CONCLUSIONS: Prevention of indoor smoking, especially maternal smoking, may be effective in decreasing hospital admissions in children with asthma. Children less than five years of age are more likely to be hospitalized than are children five years of age or greater.

Parental history of migraine and bronchial asthma in children.

BACKGROUND: a possible association between migraine and various allergic disorders have been reported. It was aimed in this study to inquire the association between bronchial asthma in children and parental history of migraine. METHODS AND RESULTS: parental history of allergic diseases and migraine were inquired among 140 asthmatic children (91 males, 49 females) and 110 age and sex matched control subjects who had not any allergic or hypersensitivity disorders, followed-up at Pediatric outpatient clinics of Dicle University Hospital. While 13 of 140 asthmatic children (9.3%) had parental history of migraine, 2 of 110 control subjects (1.8%) had parental migraine history. Difference between asthmatic and control subjects was significant (OR: 5.5, 95% Cl: 1.3-25.0). Children who had parental history of migraine also had significantly more frequent parental history of asthma, eczema and particularly allergic rhinitis (p=0.007). CONCLUSIONS: our results suggest that children are at increased risk of asthma if their parents have a history of migraine. Migraine in one generation and asthma in the next lead to the conclusion that the two disorders may have a relationship to a common denominator.

Parental history of migraine and bronchial asthma in children

Background: a possible association between migraine and various allergic disorders have been reported. It was aimed in this study to inquire the association between bronchial asthma in children and parental history of migraine. Methods and results: parental history of allergic diseases and migraine were inquired among 140 asthmatic children (91 males, 49 females) and 110 age and sex matched control subjects who had not any allergic or hypersensitivity disorders, followed-up at Pediatric outpatient clinics of Dicle University Hospital. While 13 of 140 asthmatic children (9.3%) had parental history of migraine, 2 of 110 control subjects (1.8%) had parental migraine history. Difference between asthmatic and control subjects was significant (OR: 5.5, 95% CI: 1.3-25.0). Children who had parental history of migraine also had significantly more frequent parental history of asthma, eczema and particularly allergic rhinitis (p = 0.007). Conclusions: our results suggest that children are at increased risk of asthma if their parents have a history of migraine. Migraine in one generation and asthma in the next lead to the conclusion that the two disorders may have a relationship to a common denominator (AU)

Antecedentes: se ha comunicado una posible asociación entre la migraña y diversas alteraciones alérgicas. Se emprendió este estudio para investigar la asociación entre el asma bronquial infantil y los antecedentes paternos de cefalea vascular.Métodos y resultados: se estudiaron los antecedentes paternos de enfermedad alérgica y migraña de 140 niños asmáticos (91 niños y 49 niñas) y un grupo control de 110 niños de edades y distribución sexual similar, sin alteraciones alérgicas o de hipersensibilidad. El seguimiento de ambos grupos fue llevado a cabo en el ambulatorio del Hospital Universitario de Dicle. Trece de los 140 niños asmáticos (9,3 por ciento) tuvieron antecedentes paternos de migraña frente a 2 de los 110 controles (1,8 por ciento). La diferencia entre los asmáticos y controles fue significativa (OR: 5,5; 95 por ciento CI: 1,3-25,0). Los niños con antecedentes paternos de migraña también tuvieron una mayor frecuencia de antecedentes paternos de asma, eccema y, sobre todo, rinitis alérgica (p = 0,007).Conclusión: nuestros resultados sugieren que los hijos de padres que tienen una historia de migraña tienen mayor riesgo de padecer asma. La presentación de migraña en una generación y asma en la siguiente que ambos trastornos pueden relacionarse con un factor común. (AU)

Passive smoking and expired carbon monoxide concentrations in healthy and asthmatic children.

BACKGROUND: Carbon monoxide (CO) in expired air has been reported to be an indirect measurement for the quantity of passive smoking. Since endogen CO is produced in inflammatory processes and inflammation is the main pathogenetic mechanism of asthma, it was aimed to investigate the relationship between the intensity of passive smoking and CO concentration in expired air of healthy and asthmatic children. METHODS AND RESULTS: The study was performed in the outpatient pediatrics clinics and day care centers. Knowledge about indoor smoking habits were obtained from parents. The exhaled CO concentrations were measured by a portable device in 235 healthy (mean age, 4.4 +/- 2.3 years) and 54 asthmatic (mean age, 4.5 +/- 1.7 years) children. Children with no smoking parents had the lowest exhaled CO concentrations. Significant relationships were found between the number of smoking cigarettes in the house and exhaled CO concentrations in both healthy (p = 0.003) and asthmatic (p = 0.01) children. Carbon monoxide concentrations were higher in asthmatic children than healthy ones (mean +/- SD, 1.32 +/- 1.50 ppm and 0.86 +/- 1.35 ppm, respectively, p = 0.028) if their parental smoking habits were not taken into account. Asthmatic children of non-smoking parents had higher CO concentrations than healthy subjects of non-smoking parents (1.05 +/- 1.55 ppm vs 0.37 +/- 0.53 ppm, p = 0.01). On the other hand, asthmatic children who has no smoking parents and did not receive inhaled steroids had significantly higher CO concentrations (1.75 +/- 1.45 ppm) than those who received steroids (0.58 +/- 0.65 ppm, p = 0.024). CONCLUSIONS: Exhaled CO can be used as an indicator of passive smoking in children. Higher expired CO of asthmatic children may reflect inflammation of the lung in asthma.