Evaluation of thyroid gland function in children with obstructive apnea hypopnea syndrome.

Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and thyroid function abnormalities, such as hypothyroidism and Hashimoto's thyroiditis, usually have closely resembling clinical features. Differentiation between these disorders is made more difficult because hypothyroid patients are also at risk for secondary sleep-disordered breathing. The aim of our study is to evaluate the prevalence of thyroid function abnormalities in children with OSAHS. Forty-four children (15 females: 29 males), 2.5-14.5 (7.43±2.98) years old were studied with overnight polysomnography. Biochemical screening of thyroid gland function was also carried out. Patients were judged to have OSAHS based mainly on the evaluation of Apnea Hypopnea index per hour of sleep (AHI). 15/44 (34.1%) children had mild OSAHS, 17/44 (38.6%) moderate and 12/44 (27.3%) severe OSAHS. Hypothyroidism was recorded only in 5/44 (11.4%) and Hashimoto's thyroiditis in 3/44 (6.8%) of OSAHS patients. Two patients with hypothyroidism showed mild and three severe OSAHS, while from the 3 children with Hashimoto's thyroiditis one presented mild, one moderate and one severe degree of OSAHS. Although the majority of studies in bibliography worldwide do not consider necessary the systemic evaluation of thyroid gland function in patients with breathing disorders during sleep, it seems that in children this type of screening is required for the differential diagnosis between primary sleep apnea and hypothyroid sleep-disordered breathing in order to differentiate these two conditions. Therefore, the laboratory investigation of thyroid gland function could be considered necessary.

Normal peak nasal inspiratory flow rate values in Greek children and adolescents.

BACKGROUND AND AIM: Peak Nasal Inspiratory Flow Rate (PNIFR) is a clinical trial that has been instituted in clinical practice in order to determine the extent of nasal airway patency and it is used to assess the degree of nasal obstruction. This study attempts to provide tables referring to normal values of PNIFR in children and adolescents. PATIENTS AND METHODS: Three thousand one hundred and seventy pupils aged between 5-18 years, were selected to enter the study. Children with acute or chronic upper airway obstruction, such as acute obstructive pulmonary disease or allergic rhinitis and children below the 3rd percentile for weight and/or height were excluded from the study. All children that took part in the study were subjected to PNIFR measurements by using a portable Youlten Peak Flow meter. RESULTS: A continuous increase of PNIFR values for boys and girls in relation to age increase was recorded. PNIFR values were higher in boys compared to girls and this difference was statistically significant until the age of 12. CONCLUSION: Normal ranges for PNIFR standards are of great importance for the study of nasal patency, evaluation of the degree of nasal obstruction and application of treatment. This is the first time that a detailed description of PNIFR standards becomes available for the Greek population of children and adolescents.

Human neutrophil elastase in RSV bronchiolitis.

Acute bronchiolitis is the most common lower respiratory tract infection in young children and may be life-threatening in those with underlying cardiac or respiratory conditions. We evaluated the nasal and serum levels of human neutrophil elastase (HNE) in patients with acute respiratory syncytial virus (RSV) bronchiolitis and investigated the correlation of these levels with illness severity. Fifty-one patients (28 boys, 23 girls) with acute bronchiolitis positive for RSV by direct immunoenzyme assay in nasal secretions (Group A) were studied. Thirty healthy children (17 boys, 13 girls) constituted the control group (Group B). Subjects in both groups were matched for age and gender. The ages (mean+/-SE) in Groups A and B were 4.5+/-0.41 and 5.0+/-0.65 mo, respectively. Venous blood and nasal secretions were taken from patients in group A on 1, 5, and 15 days after admission and once from controls (Group B) for determinations of HNE in nasal lavage and serum, as well as white blood counts (WBC). The peripheral blood eosinophil and neutrophil counts were elevated in 22/51 patients (43.1%) and 15/51 patients (29.4%), respectively. In nasal lavage specimens, neutrophils represented>or=75% and eosinophils>2% of all cells in 42/51 (82.0%) patients and 11/51 (21.5%) patients, respectively. There was strong correlation between the level of HNE and the percentage of neutrophils in nasal lavage (r=0.92). The mean nasal HNE concentrations of the patients on 1, 5, and 15 days after admission were higher than those of Group B (p<0.0001, p<0.001, p<0.001, respectively). Mean serum HNE concentrations on 1, 5, and 15 days after admission were higher in Group A than in Group B (p<0.0001, p<0.0001, p<0.0001, respectively). Nasal and serum HNE concentrations showed no correlations with the clinical score of disease severity (r=0.28 and r=0.29, respectively). This study shows that (a) serum and nasal HNE concentrations were significantly higher in RSV bronchiolitis patients than in controls, (b) they did not return to normal after the respiratory symptoms had improved, and (c) they showed no significant correlations with clinical score of severity. The results indicate that neutrophils contribute significantly to airway inflammation in these subjects and HNE levels in serum and nasal lavage may be useful markers of inflammation in acute RSV bronchiolitis.

Growth and other factors affecting peak expiratory flow in Greek children.

AIM: The estimation of peak expiratory flow (PEF) in children is a very easy and practical way to check lung function and helps in the diagnosis, treatment follow-up and evaluation of the development of chronic obstructive pulmonary disease. METHODS: Using a Mini-Wright flowmeter (Clement Clarke International Ltd, England), we studied the Peak Expiratory Flow (PEF) of 7,067 healthy Greek children of age range 6-17 years. All the children have a height ranging between mean value+/-2 Standard Deviations for age and sex. RESULTS: The results were correlated with age, weight, height and triceps skinfold thickness. The mean value of PEF was higher in boys than in girls at all ages, except from the age of 12-13 years. Our results have shown a very strong relationship between PEF and age up to the age of 11 years (P<0.005) but we didn't find such a relationship in older children as regards PEF and height (P<0.001). No positive correlation between PEF and weight or between PEF and triceps skinfold, was found (P > or =0.05). Moreover, a considerable difference in PEF values was found in the various groups of every age and sex according to height. CONCLUSIONS: These results indicate that height should always be considered in order to estimate PEF value. The values of this study (mean and percentiles) were compared to those of other studies. Finally, we recommend that the results of this study should be used as standards for Greek children.

Clinical evaluation and changes of the respiratory epithelium function after administration of Pidotimod in Greek children with recurrent respiratory tract infections.

BACKGROUND: Several studies have been conducted on young children with recurrent respiratory infections using several compounds (synthetic derivates or lyophilized bacterial extracts) causing improvement in the clinical process. METHODS: We conducted a prospective, randomized study comparing the clinical results and the changes of the respiratory epithelium function after the administration of immunostimulating drug (Pidotimod) to children with respiratory infections over a 9 month period. A total of 32 children (group A) were randomly assigned to receive Pidotimod therapy while a second group of 18 children (group B) weren't. All the children in group A received Pidotimod (400 mg x 2 daily) for fifteen days and 400 mg daily for the next twenty days. The proper function of the ciliary respiratory epithelium in all children was checked, using the Edicol Orange and CaH PO4 2H2O, coloring method before the therapeutic intervention and after the first and the sixth month. RESULTS: 87.5% of group A, responded exceptionally well to treatment presenting two or less infections in the nine month period, whereas only 33.3% of group B showed improvement (p<0.001). In group A, the clearance of the respiratory epithelium, from a primary 37 minutes decreased to 32 minutes in the first month and 19'5" six months after the therapy. In group B, the corresponding time was decreased from a primary 36'4" to 34'2" and 31' respectively (p=0.01). CONCLUSIONS: Our results suggest that Pidotimod therapy is a reliable, simple and safe approach to treat children with recurrent respiratory infections and it can reduce the frequency of such infections as a result of improvement of the ciliary respiratory epithelium.

Ultrastructural study of bronchial epithelium in chronic respiratory diseases.

The fine structure of bronchial epithelium in thirty-six patients, thirty-one men and five women, suffering from chronic obstructive pneumonopathy or bronchial carcinoma was studied. No remarkable alterations were found with electron microscopy, in most non-smokers in contrast to the smokers who presented destruction of the epithelial cells and loss of the cilia or many pathological cilia with an abnormal microtubular configuration and irregular orientation. The severity, however, of the alterations was not related to the severity of smoking and to the presence of bronchial cancer.

Arterial blood pressure serum lipids and cardiovascular complications in families of hypertensive children.

The arterial blood pressure (B.P.), the cardiovascular complications and the type of hyperlipoproteinemia were studied in 98 families of hypertensive children (group A) and in 100 families of normotensive children (group B). In group A, hypertension was found in 27% of the parents and 47.4% of grandparents, whereas in group B in 7.5% and 22.5% respectively. In siblings of hypertensive children hypertension was found in 13.5% as apposed to 5.4% of those of normotensive children. Cardiovascular complications were recorded in 27.5% in the parents and grandparents of group A and in 12% in group B. Hyperlipoproteinemia with obvious preponderance of type II (IIa, IIb) and IV was found in 58.5% of parents in group A and 21.1% in group B.