Effect of BCG vaccine on tuberculin skin tests in 7-11-year-old children.

AIM: To determine the effect of Bacillus Calmette Guerin (BCG) vaccination on tuberculin skin test responses in 7-11-year-old children, and also to clarify whether the number of vaccinations and the time interval between vaccination and tuberculin skin test have an effect on the test responses. METHOD: 1200 primary school children were evaluated for the presence and number of BCG scars. They were then given 5 TU PPD-S intra-dermally. Seventy-two hours after the application of tests, PPD indurations were measured. RESULTS: Mean indurations were 3.7 +/- 3.9, 6.5 +/- 5.4 and 9.2 +/- 7.1 mm in children with no scar, one scar and two scars, respectively. No statistical difference was found between mean induration of children with one scar and those with two scars. CONCLUSION: The effect of the number of BCG vaccinations and the time interval between vaccination and tuberculin skin test application on tuberculin skin test responses was statistically insignificant.

Does passive smoke exposure trigger acute asthma attack in children?

The relationship between asthma and passive smoking has been well established. However, it is still not clear whether an acute asthma attack can be induced by acute smoke exposure. The specific aims of this study were: 1- To assess the degree of smoke exposure through urinary cotinine levels in asthmatic children during and 4 weeks after asthma attacks and, 2- To evaluate the reliability of parental questionnaires in asthmatic children by comparing the data obtained from cotinine measurements and parental reports. Thirty-two consecutive asthmatic children who were admitted to the emergency clinic were included in the study. Parents were asked to complete a questionnaire about their smoking habits and housing conditions. Urinary cotinine and creatinine levels were measured in children during and 4 weeks after the acute asthma attack. The mean age of the patients was 5.7 +/- 3.2 years. The mean attack rate was 3.5 +/- 3.8 per year. Thirty-eight percent of the patients were taking no preventive treatment. In 80 % of patients, urinary cotinine and creatinine ratios (CCR) were significantly above the non-exposed, non-smoker levels. However, CCR levels during acute asthma attacks were not higher than those measured 4 weeks after the acute attack (314.6 +/- 299.1 vs. 203.8 +/- 165.2 ng/mg respectively, p > 0.05). Although parental reports of passive smoke exposure was 71 %, CCR levels revealed that 81 % and 97 % of children were exposed to passive smoke during acute attacks and asymptomatic periods, respectively. In conclusion, although the proportion of children with acute asthma attacks who were exposed to passive smoking was high, the degree of passive smoke exposure was not higher during acute attacks. Parental questionnaires were found to be unreliable in reporting passive smoke exposure in asthmatic children during acute attacks.

Does passive smoke exposure trigger acute asthma attack in children?

The relationship between asthma and passive smoking has been well established. However, it is still not clear whether an acute asthma attack can be induced by acute smoke exposure. The specific aims of this study were: 1- To assess the degree of smoke exposure through urinary cotinine levels in asthmatic children during and 4 weeks after asthma attacks and, 2- To evaluate the reliability of parental questionnaires in asthmatic children by comparing the data obtained from cotinine measurements and parental reports. Thirty-two consecutive asthmatic children who were admitted to the emergency clinic were included in the study. Parents were asked to complete a questionnaire about their smoking habits and housing conditions. Urinary cotinine and creatinine levels were measured in children during and 4 weeks after the acute asthma attack. The mean age of the patients was 5.7 ± 3.2 years. The mean attack rate was 3.5 ± 3.8 per year. Thirty-eight percent of the patients were taking no preventive treatment. In 80 % of patients, urinary cotinine and creatinine ratios (CCR) were significantly above the non-exposed, non-smoker levels. However, CCR levels during acute asthma attacks were not higher than those measured 4 weeks after the acute attack (314.6 ± 299.1 vs. 203.8 ± 165.2 ng/mg respectively, p > 0.05). Although parental reports of passive smoke exposure was 71 %, CCR levels revealed that 81 % and 97 % of children were exposed to passive smoke during acute attacks and asymptomatic periods, respectively. In conclusion, although the proportion of children with acute asthma attacks who were exposed to passive smoking was high, the degree of passive smoke exposure was not higher during acute attacks. Parental questionnaires were found to be unreliable in reporting passive smoke exposure in asthmatic children during acute attacks (AU)

La relación entre el asma y el consumo pasivo de tabaco está bien establecida. Sin embargo, todavía no está claro si una exposición aguda al humo del tabaco puede inducir un ataque agudo de asma. Los objetivos concretos de este estudio fueron: 1) determinar el grado de exposición al humo del tabaco mediante los niveles de cotinina en orina de niños asmáticos durante y 4 semanas después de un ataque de asma, y 2) establecer la fiabilidad de los cuestionarios rellenados por los padres de niños asmáticos comparando los datos obtenidos mediante la medición de la cotinina con lo declarado por los padres. El estudio se realizó sobre 32 niños asmáticos que ingresaron consecutivamente en urgencias. Se pidió a los padres que rellenasen un cuestionario sobre sus hábitos de consumo de tabaco y las condiciones de su vivienda. Se midieron los niveles de cotinina y creatinina en orina de los niños durante y 4 semanas después del ataque agudo de asma. La media de edad de los pacientes era de 5,7 ñ 3,2 años. El promedio anual de ataques era de 3,5 ñ 3,8. El 38 por ciento de los pacientes no seguía ningún tratamiento preventivo. En el 80 por ciento de los pacientes, los cocientes de cotinina y creatinina en orina (CCC) eran significativamente superiores a los de los niños no fumadores pasivos. Sin embargo, los CCC durante el ataque agudo de asma no resultaron superiores a los niveles medidos 4 semanas después del ataque (314,6 ñ 299,1 frente a 203,8 ñ 165,2 ng/mg respectivamente, p > 0.05). Si bien el consumo pasivo de tabaco era del 71 por ciento según los padres, los CCC revelaron que el 81 por ciento y el 97 por ciento de los niños estuvieron expuestos a un consumo pasivo de tabaco durante los ataques agudos y los períodos asintomáticos, respectivamente. En conclusión, aunque un alto porcentaje de los niños que sufrieron un ataque agudo estuvieron expuestos a un consumo pasivo de tabaco, el grado de exposición no fue superior durante el ataque agudo. Asimismo, se constató que los cuestionarios realizados a los padres no son fiables para determinar el consumo pasivo de tabaco de los niños asmáticos durante los ataques agudos (AU)

A rare syndrome in the differential diagnosis of hepatosplenomegaly and pancytopenia: report of identical twins with Griscelli disease.

White, identical twin boys aged 3 months were referred to our centre with persisting fever, mouth ulcers, hepatosplenomegaly, pancytopenia and failure to thrive. The parents were first cousins and there was a history of a sibling with similar manifestations who had died. The infants had silvery-grey hair and pigment clumps on the hair shafts, and skin biopsy showed accumulation of melanocytes on melanosomes. Bone marrow revealed hypercellularity and haemophagocytosis. HLH-94 chemotherapy (initial therapy with daily dexamethasone and etoposide, maintenance with dexamethasone pulses, etoposide and cyclosporin A) was started. Though partial haematological remission was achieved, one of the boys died on the 34th day following aspiration pneumonia. No pathogen could be identified. The second boy responded to therapy but had a haematological relapse and died 68 days after first being admitted. Genetic study revealed a 5 bp deletion in the RAB27A gene (510 del AAGCC in exon 5). Transient haematological remission can be achieved with chemotherapy but allogeneic bone marrow transplantation is the only curative therapy in Griscelli disease, as in other familial haemophagocytic syndromes. Identification of the mutation also provides an opportunity for prenatal diagnosis.

Postpartum maternal levels of hemoglobin A1c and cord C-peptide in macrosomic infants of non-diabetic mothers.

OBJECTIVE: This study was designed to test the hypothesis that macrosomia in infants born to non-diabetic mothers is associated with an increased incidence of hyperinsulinemia and normal maternal glucose regulation in late pregnancy. METHODS: Twenty mothers and their macrosomic infants were chosen as the study group, and 20 mothers with their appropriate-for-gestational-age infants were chosen as the control group. RESULTS: No difference in postpartum mean hemoglobin A1c levels was observed between the mothers of macrosomic infants and those of control infants. Cord plasma C-peptide levels were significantly higher in macrosomic than in control infants. CONCLUSIONS: This study revealed that macrosomic infants of non-diabetic mothers were significantly more likely to have hyperinsulinemia than were normal-sized infants, and this hyperinsulinemia was not caused by dysregulation in glucose metabolism.