Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review.

This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.

Sudden infant death syndrome: how much mothers and health professionals know.

BACKGROUND: Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS. METHODS: A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health-care professionals were interviewed by the same investigator. RESULTS: Only 39% of mothers were aware of SIDS. Forty-six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed-sharing with their infants. Seventy-three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed-sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001). CONCLUSION: Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.

Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children.

BACKGROUND: Persistent wheezing is a common problem in early childhood and leads to a diagnostic dilemma, excessive investigations, drug administration and additional cost. OBJECTIVE: To determine the efficacy and the safety of FOB in children with persistent wheezing despite bronchodilator and inhaled steroid therapy. METHODS: Patients with persistent wheezing that lasted at least 6 weeks and did not respond to bronchodilator and inhaled steroid therapy and to whom flexible bronchoscopy was performed were included to the study. RESULTS: Between 1997 and 2009; 113 patients were enrolled to the study. Sixty-three percent of the children were male. Median age was 14 months at presentation and median duration of symptoms was 5 months. Bronchoscopy revealed pathological findings in 48% of the patients. Thirty-eight patients had malacia disorders, 14 had foreign body aspiration and two had external compression of airways which were later diagnosed as vascular ring. Major and minor complications were not seen in 92% of the patients while transient hypoxia was seen in 6%, stridor in 1% and tachycardia in 1% of the patients. CONCLUSION: Flexible bronchoscopy provided rapid and definitive diagnosis for our patients with persistent wheezing without any major complications. This study is one of the largest studies concerning persistent wheezing. Early bronchoscopic evaluation can reduce cost by providing rapid and accurate diagnosis and preventing unnecessary investigations and drug administration. Flexible bronchoscopy is a safe procedure and should be considered in the evaluation of children with persistent wheezing.

The prevalence of headache and its association with socioeconomic status among schoolchildren in istanbul, Turkey.

OBJECTIVE: The etiology and pathogenesis of migraine and other types of headache are still under discussion. An interaction of organic, psychological, and psychosocial factors is operative. In this study, we aimed to determine the prevalence of headache and its association with socioeconomic status among schoolchildren. STUDY DESIGN: A cross-sectional study was performed on 2669 schoolchildren via a parental questionnaire. Socioeconomic status was determined according to the Turkish socioeconomic status scale. RESULTS: The mean age of the students was 8.2 +/- 2.4 years. The headache prevalence was 46.2% (95% CI: 44.3-48.1). The prevalence of migraine was 3.4% (95% CI: 2.8-4.1), the prevalence of probable migraine was 8.7% (95% CI: 7.6-9.8), and that of non-migraine headache was 34.1% (95% CI: 32.3-35.9). Multivariate analysis revealed that older age, being a girl, having a family history of headache, and exposure to passive smoking at home were independently associated with headache. There was an inverse association between socioeconomic status and all 3 types of headaches after adjusting for age, sex, family history of headache, and presence of passive smoking. When the group with the lowest socioeconomic status was taken as the reference category, the odds ratios for the highest socioeconomic group were 0.33 (95% CI: 0.16-0.69, P = .003) for the migraine, 0.30 (95% CI: 0.11-0.89, P = .029) for the probable migraine, and 0.34 (95% CI: 0.16-0.72, P = 0.005) for the non-migraine headache. CONCLUSION: Headache is more common among children with lower socioeconomic groups. Social causation can play a role in the pathogenesis of headache.

Efficacy of salbutamol and ipratropium bromide in the management of acute bronchiolitis--a clinical trial.

BACKGROUND: A wide range of drugs are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited. OBJECTIVES: To investigate the efficacy of ipratropium bromide and salbutamol in the treatment of patients with moderate-severe bronchiolitis. METHODS: Sixty-nine infants with moderate-severe bronchiolitis hospitalized at their first episode of wheezing or crepitations in the chest were enrolled in a prospective, double-blind, placebo-controlled trial. Patients were randomly assigned to receive nebulized salbutamol, ipratropium bromide or placebo. Main outcome measures were changes in oxygen saturation rates and clinical scores and duration of hospitalization. RESULTS: In the bronchodilator groups, clinical scores were better compared to the placebo group at 30 min (8.4 +/- 1.3 vs. 7.5 +/- 0.8, p < 0.05). Bronchodilator groups had also significantly lower clinical scores (7.3 +/- 1.2 vs. 5.9 +/- 1.1, p < 0.0001, and 5.3 +/- 1.4 vs. 4.5 +/- 1.6, p = 0.006, respectively) and higher oxygen saturation rates compared to the placebo group at 8 and 24 h (89.6 +/- 2.4 vs. 94.3 +/- 4.4, and 92.2 +/- 2.6 vs. 95.9 +/-4.4, respectively, p < 0.0001). Improvement rates and duration of hospitalization were not statistically different among groups. CONCLUSIONS: Clinical scores and oxygen saturation levels improved more rapidly in the bronchodilator groups than in the placebo group up to 24 h, but these drugs did not have a sufficient effect to change the natural course of the disease.

Prevalence of headache and its association with sleep disorders in children.

An association between headache and sleep disturbances has been reported in previous studies, but there is a lack of research examining this relationship in a community sample of children in order to reveal the magnitude of the problem. Among 32 District Educational Directorates in Istanbul, nine school districts and within each district eight schools were randomly selected. A questionnaire consisting of sociodemographic variables and evaluating headache and sleep disturbances was sent to students' homes to be completed by their parents. The prevalence of headache was 31.4% (95% confidence interval: 29.5-33.4%). Migraine prevalence was 3.3%, whereas nonmigraine headache prevalence was 28.1%. The prevalence of headache was similar between males and females (29.6% vs 33.3%, P > 0.05). The frequency of headache increased with age for both sexes. Snoring, parasomnias, sweating during sleep, and daytime sleepiness were more common among children with migraine compared with nonmigraine and no headache groups. Headaches are common among schoolchildren. Because children with migraine headaches have a high prevalence of sleep disturbances, they should always be evaluated for the presence of sleep problems.