The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia

Background: Prospective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors. Objective: The aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey. Methods: Fifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated. Results: A total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05). Conclusion: Childhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma (AU)

Common features of anaphylaxis in children

Objective: We aimed to establish the characteristics of anaphylaxis in childhood. Methods: Forty-four patients who had experienced anaphylaxis in a period of 10 years (from 1999 to 2009), were included in the study. Parameters analysed were age, gender, concomitant allergic disease, trigger, setting, clinical symptoms, treatment, prognosis and prophylaxis. Results: The total numbers of anaphylaxis cases were 44 in a ten-year period. The ages of patients ranged from 3 to 14 years (11.50 ± 3.87 years) and the majority were male. 33 of the patients (75%) had a concomitant allergic disease. The trigger was determined in 93.2% of the cases, being most frequent: food (27.3%), and SIT (25%), followed by bee sting, medications and others. Respiratory (95.5%), dermatological (90.9%), cardiovascular (20.5%), neuropsychiatric (25%), and gastrointestinal (11.4%) symptoms were seen most frequently. For anaphylaxis triggered by food, the duration of anaphylactic episode was significantly longer (p < 0.05). No biphasic reaction was observed during these attacks. Of our patients, only one developed respiratory failure and cardiac arrest due to SIT, and intensive care support was required. Discussion: As a trigger for anaphylaxis, the frequency of SIT is so high that it cannot be described by the study group including patients who were followed up in an outpatient allergy clinic (AU)

Common features of anaphylaxis in children.

OBJECTIVE: We aimed to establish the characteristics of anaphylaxis in childhood. METHODS: Forty-four patients who had experienced anaphylaxis in a period of 10 years (from 1999 to 2009), were included in the study. Parameters analysed were age, gender, concomitant allergic disease, trigger, setting, clinical symptoms, treatment, prognosis and prophylaxis. RESULTS: The total numbers of anaphylaxis cases were 44 in a ten-year period. The ages of patients ranged from 3 to 14 years (11.50 ± 3.87 years) and the majority were male. 33 of the patients (75%) had a concomitant allergic disease. The trigger was determined in 93.2% of the cases, being most frequent: food (27.3%), and SIT (25%), followed by bee sting, medications and others. Respiratory (95.5%), dermatological (90.9%), cardiovascular (20.5%), neuropsychiatric (25%), and gastrointestinal (11.4%) symptoms were seen most frequently. For anaphylaxis triggered by food, the duration of anaphylactic episode was significantly longer (p<0.05). No biphasic reaction was observed during these attacks. Of our patients, only one developed respiratory failure and cardiac arrest due to SIT, and intensive care support was required. DISCUSSION: As a trigger for anaphylaxis, the frequency of SIT is so high that it cannot be described by the study group including patients who were followed up in an outpatient allergy clinic.

The long-term outcomes of persistent childhood allergic asthma: a cross-sectional study from western Anatolia: childhood persistent asthma in western Anatolia.

BACKGROUND: Prospective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors. OBJECTIVE: The aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey. METHODS: Fifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients' records. The factors influencing remission at the end of 10 years follow-up were evaluated. RESULTS: A total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p>0.05). CONCLUSION: Childhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.

The effects of magnetic field on the biomechanics parameters of soleus and extensor digitorum longus muscles in rats with streptozotocin-induced diabetes.

BACKGROUND: The aim of this study was to determine the effects of the magnetic field (MF) on the isometric contractile characteristics of the soleus and extensor digitorum longus (EDL) muscles in rats both with and without diabetes. METHODS: Biomechanical parameters were recorded in vitro from Wistar rats without diabetes (Group I, n=20), rats without diabetes exposed to MF (Group II, n=20), rats with streptozotocin-induced diabetes (Group III, n=20), and rats with diabetes exposed to MF (Group IV, n=20). Muscle strips were taken from the distal tendon soleus and EDL muscles of rats killed by decapitation. The muscles were hung in organ baths containing Krebs solution (pH 7.4) with a gas mixture of 95% O2 and 5% CO2. Then the muscles were triggered to direct supramaximal stimulation with 0.05 Hz frequency square pulses for periods of 0.5 ms to obtain control values. The contractile parameters were also determined for two muscles of the four groups. Later, the tension-frequency relationship was determined by applying stimulating pulses of 10, 20, 50, and 100 Hz to the muscles. RESULTS: Diabetes caused a certain amount of decrease in the contractile force of the two muscles compared with that of control values. However, MF increased the contractile force of the two muscles in rats both with and without diabetes. The isometric contraction forces obtained by different stimulating frequencies showed a significant linear increase in the tetanic contraction (P<0.05). Diabetes increased the contraction time of the isometric twitch tension compared with that of the control group with a statistically significant difference (P<0.05). MF decreased the contraction time of the two muscles of rats without diabetes (P<0.05) but increased that of rats with diabetes (P>0.05). CONCLUSION: In our study, these results suggest that MF exposure regulates the isometric contractile characteristics of the soleus and EDL muscles of rats with diabetes, positively.

Effects of rivastigmine on cognitive function in patients with traumatic brain injury.

OBJECTIVE: To compare the efficacy and safety of rivastigmine (3 to 6 mg/day) vs placebo over 12 weeks in patients with traumatic brain injury and persistent cognitive impairment. METHODS: This prospective, randomized, double-blind, placebo-controlled study was conducted in 157 patients at least 12 months after injury. The primary efficacy measures were the Cambridge Neuropsychological Test Automated Battery (CANTAB) Rapid Visual Information Processing (RVIP) A' subtest and the Hopkins Verbal Learning Test (HVLT). The primary efficacy outcome was the proportion of patients who demonstrated 1.0 SD or greater improvement from baseline at week 12 on CANTAB RVIP A' or HVLT. RESULTS: The percentage of responders at week 12 on either the CANTAB RVIP A' or HVLT was 48.7% for rivastigmine and 49.3% for placebo (p = 0.940). Furthermore, for the overall study population, there were no significant differences for any of the secondary efficacy variables. In a subgroup of patients with moderate to severe memory impairment (n = 81), defined as 25% impairment or greater on HVLT at baseline, rivastigmine was significantly better than placebo for a number of measures, including the proportion of HVLT responders and CANTAB RVIP mean latency. CONCLUSIONS: Rivastigmine was safe and well tolerated in patients with traumatic brain injury with cognitive deficits. Rivastigmine shows promising results in the subgroup of patients with traumatic brain injury with moderate to severe memory deficits.

Early results of valved bovine jugular vein conduit for right ventricular outflow tract reconstruction.

OBJECTIVE: Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose. METHODS: Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT. RESULTS: There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 +/-10.18 mmHg) and at the follow-ups (mean 12.916 +/-12.33 mmHg). There was not a trend towards an increase in the gradients following discharge. CONCLUSION: The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.

Sialic acid is a marker of lung injury following lower extremities ischemia/reperfusion.

OBJECTIVE: This study tests whether sialic acid is a mediator of the lung injury following lower extremity ischemia/reperfusion (I/R). Design. Prospective randomised study. MATERIALS AND METHODS: Thirty-one Sprague-Dawley rats were randomised into four groups: group 1, aorta was exposed but not clamped; group 2, aorta clamped for 3 h, followed by 1 h of reperfusion; group 3, 50 mg/kg pentoxifylline administrated before the aorta was clamped; and group 4, 1 mg/kg dexametasone administrated before the aorta was clamped. Serial arterial blood samples for blood gas, tumor necrosis factor-alpha (TNF-alpha), and total SA (TSA) assay were obtained. The lungs were removed and histologically examined for evidence of injury. RESULTS: Groups 2, 3, and 4 had significantly higher peak serum TSA concentrations compared with groups 1 (group 1 vs. 2, p=0.001; group 1 vs. 3, p=0.002; group 1 vs. 4, p=0.001). Group 3 had lower peak serum TSA concentration. Groups 2 and 4 had significantly higher peak serum TNF-alpha concentrations (p=0.0001) compared with groups 1 and 3. Group 3 had lower peak serum TNF-alpha concentration. Lower TSA and TNF-alpha levels are associated with lesser degrees of lung injury. CONCLUSIONS: TSA and TNF appear during events that lead to lung injury following lower extremity I/R.

Pericardial flap aortopexy: an easy and safe technique in the treatment of tracheomalacia.

A 5-month-old boy who had been operated for esophageal atresia and tracheoesophageal fistula was presented with recurrent life-threatening apneic spells, expiratory stridor and difficulty in feeding. Diagnosis of tracheomalacia was confirmed by bronchoscopy and pericardial flap aortopexy was performed. Pericardial flap aortopexy is a relatively simple procedure with minimal risk to the aorta. Minimal dissection is required and there are no sutures placed in the aortic wall, thus avoiding the risk of tears.

Do not underestimate atrial septal defect!

Atrial septal defect (ASD) is one of the simplest cases among the surgically correctable congenital cardiac diseases. Easiness of the correction usually causes underestimation of the pathology. Angiography as well as echocardiography might be misleading in some cases. The preliminary diagnosis of the presented case was secundum ASD. During operation an unusual type of partial anomalous pulmonary venous connection (PAPVC) was noticed. Pulmonary veins of the entire left lung were draining to the right atrium directly. There was no other coexisting cardiac pathology including atrial septal defect. To our knowledge, there is no similar case in the literature. ASD is a well known congenital cardiac disease. Coexisting anomalies increase the surgical importance of the defect. Cardiologists should suspect and search for even the rarest pathologies during preoperative evaluation to prevent diagnostic misinterpretations and surgical surprises. Trying to explore the relations of cardiac chambers and define the pathology during extracorporeal circulation is time consuming. Despite this, a routine and meticulous exploration should not be neglected to prevent unexpected results.

Does behavioral improvement with haloperidol or trazodone treatment depend on psychosis or mood symptoms in patients with dementia?

OBJECTIVES: Several previous studies have examined the effects of pharmacological interventions for agitated behavior in patients with dementia. However, the choice of medication in clinical practice continues to be directed largely by local pharmacotherapy culture rather than empirical treatment guidelines. We examined the relationship between behavioral improvement and co-occurring delusions and mood symptoms in patients with dementia who were treated with haloperidol, an antipsychotic medication, or trazodone, a serotonergic antidepressant. DESIGN: Randomized, double-blind, parallel-group, 9-week treatment trial. SETTING: Inpatient geropsychiatry unit. PARTICIPANTS: Twenty-eight patients with dementia and agitated or aggressive behaviors. INTERVENTION: Haloperidol 1 to 5 mg/day or trazodone 50 to 250 mg/day. MEASUREMENTS: Cohen-Mansfield Agitation Inventory (CMAI), Hamilton Depression Rating Scale (Ham-D), and delusional thoughts subscale and hallucinations subscale of the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). RESULTS: CMAI scores improved in each treatment group over the 9 weeks of treatment (P < .001 in each group). Within the haloperidol treatment group, CMAI improvement was not associated with baseline delusional thoughts score or with change in delusional thoughts score over the course of treatment. Within the trazodone treatment group, CMAI improvement was associated with baseline score on total Ham-D (r = -0.60, P = .02), Ham-D items measuring subjective mood symptoms (r = -0.50, P = .07), and Ham-D items measuring neurovegetative signs (r = -0.49, P = .08). CMAI improvement was also associated with improvement in Ham-D total score over the course of treatment (r = 0.62, P = .02). CONCLUSIONS: Mild depressive symptoms in patients with dementia and agitated behavior are associated with greater behavioral improvement by trazodone-treated patients. In contrast, the presence of delusions in concert with behavioral disturbance does not necessarily predict greater behavioral improvement with haloperidol treatment than in subjects without signs of psychosis.

Salbutamol or mist in acute bronchiolitis.

BACKGROUND: The role of bronchodilators in the treatment of bronchiolitis remains controversial. METHODS: A double-blind, placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol. One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were randomized to three groups as follows: (i) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline; (ii) saline was nebulized to 52 patients in group II and (iii) in group III 52 patients received mist in a tent. All three groups were administered oxygen during the procedures. Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more. Respiratory rate, heart rate, oxygen saturation and presence of cyanosis, wheezing, retractions were recorded before and after each treatment. RESULTS: The decrease in the respiratory score was 5.2 +/- 1.8, 0.82 +/- 2.4 and 1.7 +/- 1.3 in group I, II and III, respectively. The decrease in group I was significantly higher than in the other groups. Heart rate was similar between groups. Oxygen saturation decreased in group I without reaching statistical significance. CONCLUSIONS: Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis.

Deposition profile of antibacterial anodic silver in root canal systems of teeth.

Electrically activated silver was shown to have an antibacterial effect in vitro and in vivo. In this study the effect of placing a silver anode in the root canal systems of teeth was examined to establish a base for treatment of infected teeth. Pure silver wires were placed in the main canals of extracted human teeth (n = 26) whose roots were partly submerged in a lactated Ringer's solution. Seventeen microamperes of anodic direct current were applied to one group of silver wires (n = 15) for 4 days. Then the wires were removed and the roots of both group teeth were cut into six sections and demineralized Silver concentrations of the root sections and their bathing solutions were measured with an atomic absorption spectrophotometer. In the anode group, the electrically activated silver concentrations (range, 1-30 micrograms/microL) exceeded the antibacterial levels (minimum inhibitory concentration, 0.1 micrograms/microL Ag) in all sections, particularly in the middle and lower sites of the root. The amount of anodic silver that leaked out of the root was found as to be 0.4 +/- 0.2 micrograms/microL in the fluid medium. This was 10 to 100-fold higher than that found in the nonactivated controls.

A double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia.

The authors compared the efficacy and side effects of trazodone and haloperidol for treating agitated behaviors associated with dementia. Twenty-eight elderly patients with dementia and agitated behaviors were randomly assigned to double-blind treatment with either trazodone (50-250 mg/day) or haloperidol (1-5 mg/day) for 9 weeks. There was no significant difference in improvement between the medication groups. Adverse effects, however, were more common in the group treated with haloperidol. Improvement in individual areas suggested that repetitive, verbally aggressive, and oppositional behaviors responded preferentially to trazodone, whereas symptoms of excessive motor activity and unwarranted accusations responded preferentially to haloperidol. These results indicate that moderate doses of trazodone and haloperidol are equally effective for treatment of overall agitated behaviors in patients with dementia, but specific symptoms may respond preferentially to a particular agent.

Obsessive compulsive disorder in a woman with left basal ganglia infarct: A case report.

This report presents a syndrome resembling obsessive convulsive disorder (OCD) secondary to a stroke in the left basal ganglia. The patient's syndrome is virtually identical to those that have been described in bilateral damage of the basal ganglia. However, the stroke described in this case report is located unilaterally in the left basal ganglia. In addition, experience in treating a patient with OCD induced by structural damage of basal ganglia is presented.

The Neurobehavioral Rating Scale: reliability in patients with dementia.

Precise measurement of cognitive, psychiatric, and behavioral symptoms is essential to understanding clinical, pathophysiologic, and treatment aspects of Alzheimer's disease and other dementing illnesses. The Neurobehavioral Rating Scale (NRS) is a 28-item observer-rated instrument that measures a broad range of cognitive and noncognitive symptoms. The interrater reliability of the NRS was examined in 15 patients with dementia. The correlation coefficient for the NRS total scores was .93. Coefficients for NRS factor scores and individual item scores were also satisfactory. Correlations for measures of subjectively experienced symptoms were acceptable, but less robust than measures of cognition and observable behavior. These results support the reliability of the NRS for multidimensional assessment of patients with dementia.

Effects of static magnetic field on specific adenosine-5'- triphosphatase activities and bioelectrical and biomechanical properties in the rat diaphragm muscle.

In this study, we aimed to clarify the effects of chronically applied static magnetic field (200 Gauss) on specific ATPase activities and bioelectrical and biomechanical responses in isolated rat diaphragm muscle. The mean activities of Na(+)-K+ ATPase and Ca2+ ATPase determined from the diaphragm homogenates were significantly higher in the magnetic field exposed group (n = 20), but that of Mg2+ ATPase was nonsignificantly lower compared to the control group (n = 13). Resting membrane potential, amplitude of muscle action potential, and overshoot values (mean +/- SE) in the control group were found to be -76.5 +/- 0.6, 100 +/- 0.8, and 23.5 +/- 0.6 mV, respectively; these values were determined to be -72.8 +/- 0.4, 90.3 +/- 0.5, and 17.2 +/- 0.4 mV in the magnetic field-exposed group, respectively. The latency was determined to increase in the experimental group, and all the above-mentioned bioelectrical differences between the groups were significant statistically. Force of muscle twitch was found to decrease significantly in the magnetic field-exposed group, and this finding was attributed to the augmenting effect of magnetic field on Ca2+ ATPase activity. These results suggest that magnetic field exposure changes specific ATPase activities and, thence, bioelectrical and biomechanical properties in the rat diaphragm muscle.

Valve replacement due to tricuspid valve anomalies in corrected transposition.

Left atrioventricular (A-V) valve anomalies are very frequent in corrected transposition, but left A-V valve replacement has seldom been reported. These anomalies are an important cause of morbidity and mortality in these patients, and due to anatomical presentation valve replacement may be difficult. We present 4 cases of left A-V valve replacement with emphasis given to Ebstein's anomaly of the left A-V valve.

An unusual case of cor triatriatum.

Cor triatriatum (CT) is a rare congenital cardiac anomaly. A case is presented of subdivided left atrium, corrected surgically, which can be considered a type of CT not previously reported.

De Vega's tricuspid annuloplasty: analysis of 195 patients.

In the years 1984-1989, 195 De Vega tricuspid annuloplasties were performed in association with mitral or mitral-aortic valve procedures. Preoperatively, 9 patients (4.6%) were in New York Heart Association functional class II, 124 (63.6%) were in class III, and the remaining 62 (31.8%) were in class IV. Tricuspid insufficiency was recognized by routine digital palpation of the tricuspid valve during the operation in 42 (21.5%) of the patients. Hospital mortality rate was 7.6% (15 patients). Late deaths occurred in 6 (3.0%) cases during a follow-up period of 3 to 72 months (mean 42 months). 8 patients (4.1%) required reoperation. Tricuspid annuloplasty failure was observed in 4 patients (2%). These valves were replaced with biological valves in three patients and with a mechanical valve in one patient. 112 of the survivors (64.3%) were evaluated by echocardiography and/or right ventriculography. Analysis of postoperative data showed that in 84 of the 112 patients (75%) tricuspid regurgitation disappeared completely after annuloplasty, 88% of surviving patients were in functional class I or II. For the series presented actuarial survival rate at 6 years was 79.1% +/- 14.4%. In the light of this study we recommend De Vega's annuloplasty as the method of choice for moderate to severe functional tricuspid insufficiency.