The reliability and validity of Turkish version of Childhood Asthma Control Test.

INTRODUCTION: The reliability and validity of Turkish version of Childhood Asthma Control Test (C-ACT). PURPOSE: The management of asthma is an important as well as difficult issue of physician's daily practice particularly in busy clinical settings. C-ACT was created to identify asthma control levels in children aged 4-11 years. Our aim was to evaluate the reliability, validity and responsiveness of C-ACT in a Turkish sample of children with asthma. METHOD: In this multicenter study, 368 children were enrolled. C-ACT was completed every month by parents and patients who were evaluated in 3 visits within 2 month intervals. At each visit, physicians interpret the control level and decided for the treatment step as established in GINA guidelines. RESULTS: The internal consistency reliability of the Turkish version of C-ACT (C-ACT1 to C-ACT5) was found to be 0.82, 0.83, 0.82, 0.82 and 0.80, respectively (reliability statistics, Cronbach's alpha). Test-retest reliability was 0.71. There was significant correlation between C-ACT and physician's assessment of asthma control at visit 1 (r = 0.65, P < 0.001). CONCLUSIONS: Turkish version of C-ACT is an accurate and reliable tool to evaluate asthma control in children aged 4-11 years. Its widespread use may facilitate appropriate assessment of asthma control and may lead to decrease the number of uncontrolled patients.

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.

The influence of duration of breastfeeding on bone mass in postmenopausal women of different age groups.

This study examines the influence of duration of breastfeeding on bone mineral density (BMD) and investigates the relationship between duration of breastfeeding and bone mass at four sites in postmenopausal women of different ages. A total of 509 postmenopausal women aged 45-86 years were included in the study. Patients were divided into three groups: never breastfed (n=67), < 96 months (n=157) and > or = 96 months (n=285); they were further classified into two age groups, 40-59 years (n=233) and 60-80 years (n=276). In all patients and in the 40-59 year age group, BMD of the spine was found to be significantly lower in the never-breastfed group, while BMD of the trochanter was significantly lower in the > or = 96 month breastfeeding group. BMD of the spine and femur tended to decrease with longer breastfeeding in all groups, while BMD of the spine and trochanter tended to decrease with longer breastfeeding in the 40-59 year group. Of patients in the 60-80 year group who had never breastfed, spinal BMD was significantly higher than that of the > or = 96 month group, while in the > or = 96 month group trochanter BMD was significantly lower than in other groups. In the never-breastfed group, ward's triangle BMD was significantly higher than that of other groups. There was a significant correlation between duration of breastfeeding and BMD of the spine, neck, trochanter and ward's triangle. The study suggests that duration of breastfeeding has an effect on BMD, and extended breastfeeding leads to lower BMD.

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.

Pulmonary alveolar microlithiasis: a rare familial inheritance with report of six cases in a family. Contribution of six new cases to the number of case reports in Turkey.

Pulmonary alveolar microlithiasis (PAM) is a lung disease characterized by deposits of calcium within the alveoli. Our aim was to emphasize the familial character and the clinical features of the disease, and to draw attention to the increasing number of Turkish patients reported in the world. We detected 6 cases of PAM. Three cases had been diagnosed 4 years earlier, and 3 new cases were detected during the screening of the family members. All patients were male and the mean age was 11.5 ranging between 5 and 29 years. Five of the patients were cousins and the other one was their uncle. Radiographic studies showed a sand-like appearance in all patients. One case showed small subpleural bullae and bronchiectatic changes in both lower lobes in recent high-resolution CT scans, while his CT performed 4 years ago showed only sand-like appearance. The cases were diagnosed with the demonstration of microliths by bronchoalveolar lavage in 5 patients and transbronchial biopsy in 1. Recently reported cases from Turkey have constituted a considerable percentage among all cases in the world. In conclusion, (1) our patients constitute one of the largest series of cases reported in one family in the world. The disease seems to have familial and racial characteristics. The Turkish race has to be further investigated for genetic transmission. (2) Contrary to female predominance in previous reports, all 6 cases were male and 5 of them were below 12 years of age. (3) The disorder may show rapid progression in some cases probably due to the severity of the genetic disturbance.

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.

Colon injuries in children.

BACKGROUND/PURPOSE: Colonic injuries are rare in childhood, but when they do occur, they are mostly associated with penetrating abdominal injuries. The primary repair of colon injuries without stoma is still controversial within surgical experience, and the potential risk factors affecting morbidity and mortality is not sufficiently known. METHODS: Between 1985 and 1997, 34 children presenting with traumatic colonic perforations were reevaluated by analyzing the relationship between the overall morbidity and mortality and the potential risk factors. RESULTS: Of the 34 children in the case study, 27 boys and 7 girls, there were 7 (21%) isolated colonic injuries. The remaining 27 (79%) patients showed colonic injuries most frequently associated with the small bowel, the liver, and the bladder. Localization of injury was distributed thus: 21% in the right colon, 29% in the transverse colon, and 50% in the left colon. Primary repair, with or without intestinal resection, was performed in 27 (79%) of the patients. In total, postoperative complications occurred in 10 (29%) of the patients. Risk factors such as age, abdominal contamination, and associated abdominal organ injuries were found significant in these complications, however, the mechanism of injury, shock, blood transfusion, and localization of injury were not correlated significantly to postoperative complications. "'Flint's Colon Grading System" was used to ascertain the sensitivity of trauma scoring systems for postoperative complications. CONCLUSION: Colonic wounds can be repaired primarily without the need of colostomy in the majority of cases in children when the required selections are established.

Characteristics of pediatric urolithiasis in south-east Anatolia.

BACKGROUND: Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south-east Turkey. METHODS: The study population consisted of 81 children (52 girls) with urolithiasis at a mean age of 6.2 +/- 4.2 years who were followed up for 1-32 months. RESULTS: Metabolic disorders, anatomical defects and infection stones were found to be the etiological factor in 34.6, 29.6 and 22.2% of patients, respectively, while 13.6% of patients were considered idiopathic. Of all patients, 28.4% were admitted with acute renal failure (ARF) and 72.8% had urinary tract infection. Recurrence was seen in 19.8% of patients at presentation. The localization of the stone was found to be in the upper urinary tract, the lower urinary tract or both in 65.4, 14.8% and 17.3% of patients, respectively. Patients with multiple and bilateral stones had a higher risk for ARF than the others. The risk for chronic renal failure was significantly higher in children with multiple, bilateral or recurrent stones and with ARF at presentation. CONCLUSIONS: Early diagnosis and management of renal stones and urinary tract infections is necessary to prevent the development of ARF or chronic renal failure and to improve the quality of a patient's life.

The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis.

In spite of the increasing evidence that passive smoking increases the incidence of respiratory infections and bronchial hyper-responsiveness, the information about whether exposure to sudden heavy smoke enhances the development of acute respiratory infections in children remains inadequate. In this study, to quantitate the level of exposure to environmental tobacco smoke, in 28 children (age ranging 2-18 months) with respiratory syncytial virus (RSV) bronchiolitis and in 30 children (age ranging between 2-15 months) with non-respiratory symptoms, the serum levels of cotinine, the major metabolite of nicotine, were measured at admission to the emergency department. Parents were asked to fill in a questionnaire about the housing conditions and their smoking habits. Serum samples were taken again from the children with RSV bronchiolitis at their second visit at 1 month after discharge from the hospital. The children with RSV bronchiolitis had higher levels of serum cotinine (mean of 10.8 ng/ml) in the acute stage, compared with post-bronchiolitis stage (mean of 7.4 ng/ml). Moreover, patients admitted with non-respiratory symptoms had significantly lower levels of serum cotinine (mean of 3.9 ng/ ml) than both phases of patients with RSV bronchiolitis. Children with RSV bronchiolitis were found to have higher levels of cotinine when either the mother or both of the parents smoked, than the children with non-smoker parents. In conclusion, children admitted to the hospital with RSV bronchiolitis were shown to be acutely exposed to more cigarette smoke after 1 month and much more than the children admitted for non-respiratory diseases. These findings may imply that sudden heavy cigarette smoke exposure may predispose to an acute respiratory infection.

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.

CT of the brain in tuberculous meningitis. A review of 289 patients.

PURPOSE: In this retrospective study, CT findings of 289 patients with tuberculous meningitis (TBM) are presented and diagnostic criteria are discussed. MATERIAL AND METHODS: The medical records of patients who were diagnosed as having central nervous system tuberculosis were investigated. Cranial CT investigations of 289 patients with TBM were reviewed. Of these 289 patients, 214 were children and 75 adults; 157 patients were male and 132 were female. CT images were obtained with and without i.v. contrast administration. RESULTS: CT findings were normal in 35 patients and abnormal in 254. The abnormalities were hydrocephalus (172 children, 32 adults), parenchymal enhancement (56 children, 6 adults), contrast enhancement of basal cisterns (32 children, 17 adults), cerebral infarct and focal or diffuse brain edema (29 children, 10 adults), and tuberculoma (9 children, 5 adults). CONCLUSION: CT is pathologic in the great majority of patients with TBM and is helpful in assessing the complications associated with the disease.