Risk Factors for Exacerbations in School-Age Children with Asthma.

INTRODUCTION: Awareness of risk factors for asthma exacerbation can reduce the morbidity and mortality of the disease. The current study aimed to investigate the risk factors associated with current asthma exacerbations in school-age children. METHODS: This study enrolled children who were admitted to a tertiary outpatient paediatric allergy and asthma department and were diagnosed with asthma. Patients and their caregivers underwent an interviewer-administered questionnaire, which obtained information regarding the demographic features and parameters to determine environmental exposures along with previous disease history. Laboratory examinations, including complete blood count with differential, total IgE levels, skin prick tests, and pulmonary function tests, were also performed. RESULTS: A total of 431 children (288 male, 66.8%) with a median age (interquartile range) of 8.1 (6.3-11.2) years were included, among whom 265 (61.5%) had aeroallergen sensitization. Asthma was controlled, partially controlled, and uncontrolled in 154 (35.7%), 53 (12.3%), and 143 (33.2%) patients, respectively. A total of 81 patients (18.8%) experienced asthma exacerbation. Multivariate logistic regression analysis revealed that a history of asthma exacerbation within the last year (odds ratio [confidence interval]) (20.73 [9.95-43.20]; p < 0.001), a shorter asthma duration (<2.5 years) (2.58 [1.44-4.61]; p = 0.001), and a lack of regular controller therapy (4.12 [1.54-10.98]; p = 0.005) were associated with current asthma exacerbation. DISCUSSION/CONCLUSION: Awareness of risk factors for asthma exacerbation may help physicians treat school-age children with asthma by providing prompt and rational interventions in order to prevent asthma exacerbations.

Hepatic and splenic 18 F-FDG blood clearance rates (Ki) in hepatic steatosis and diabetes mellitus.

AIM: The study aim was to investigate the relationships of blood glucose level (BGL) with hepatic and splenic blood FDG clearances (Ki) in patients with diabetes mellitus (DM) and/or hepatic steatosis (HS). METHODS: This was a retrospective study of 238 patients, including 92 with type 2 DM (DM2) and 11 with type 1 DM (DM1), having routine whole body FDG PET/CT. Patients with lymphoma were excluded. Patients were divided into the following groups: HS-DM-, HS-DM2+, HS+DM-, HS+DM2+ and 2 DM1 groups (hypoglycaemic and hyperglycaemic). ROI were placed over liver and spleen for measurement of SUVmax , and left ventricular cavity (LV) for measurement of SUVmean . Tissue SUVmax was divided by LV SUVmean . This division, giving Z, eliminates bias from the whole body metric used to calculate SUV and renders SUVmax a closer surrogate of Ki. HS was diagnosed when hepatic unenhanced CT was ≤40 HU. RESULTS: In all patients, individual hepatic Z and individual splenic Z correlated significantly with individual BGL. Highest mean hepatic Z and highest mean BGL were recorded in HS+ DM2+ group and lowest in hypoglycaemic DM1 group. Patients with DM1 and hyperglycaemia showed low hepatic Z in relation to BGL. Hepatic and splenic Z correlated inversely with CT density in patients without DM but not in those with DM2. CONCLUSION: As BGL increases, hepatocyte glucokinase is up-regulated. This includes patients with HS and DM2 but not DM1. We speculate that in HS and DM2, up-regulation results from insulin resistance and hyperinsulinaemia. The data also support a hepato-splenic metabolic axis.

Hepato-splenic axis: hepatic and splenic metabolic activities are linked.

The concept of a hepato-splenic axis has recently been put forward. We aimed to investigate whether hepatic and splenic metabolic activities are linked, and if splenic metabolic activity is increased in non-alcoholic fatty liver disease (NAFLD). Blood clearance rates of phosphorylated 18F-fluorodeoxyglucose were measured in the spleen and liver from dynamic PET using Gjedde-Patlak-Rutland graphical analysis and abdominal aorta for input function in 59 patients undergoing routine PET/CT. Plot gradient (Ki), which represents blood clearance, was divided by intercept (V(0)), which represents tissue FDG distribution volume, and multiplied by blood glucose to give glucose uptake rate per unit tracer distribution volume (MRglu). In addition, liver-to-spleen raw count rate ratio was plotted against time, and gradient (b) divided by intercept (A) to obtain hepatic-to-splenic blood clearance ratio independent of aortic input function. Hepatic steatosis was inferred when hepatic CT density was ≤40 HU. There was no difference in splenic MRglu between 8 patients with inactive lympho-proliferative disease (LPD) as identified by negative PET/CT, 25 with non-haematological malignancy and 13 with normal PET/CT. It was significantly increased in 13 with active LPD, who were therefore excluded, along with 3 more with type-2 diabetes mellitus. Splenic MRglu was higher in patients with hepatic steatosis (4.0±1.6; n = 12) than without (2.6±1.7 µmol/min/100 ml; P = 0.02) and correlated inversely with hepatic CT density (r = -0.49; P<0.001). Hepatic and splenic Ki/V(0) correlated (r = 0.52; P<0.01) in 22 patients in whom the correlation coefficient between b/A and hepatic-to-splenic Ki/V(0) ratio was 0.99 and in whom, therefore, input function errors in graphical analysis could be discounted. In men, splenic longitudinal diameter correlated significantly with hepatic CT density (r = -0.35; P = 0.046), hepatic MRglu (r = 0.44; P = 0.005) and splenic MRglu (r = 0.35; P = 0.046). Splenic Ki/V(0) correlated positively with blood glucose, suggesting sensitivity to insulin. We conclude that hepatic and splenic metabolic activities are linked and that a speculative mechanism, which deserves further investigation, is shared insulin sensitivity. Splenic MRglu and spleen size are increased in NAFLD.

Evaluation of Etanercept Treatment in Newborn Rat Model with Hyperoxic Lung Injury.

BACKGROUND: Many factors contribute to the development of BPD basically by increasing inflammation in preterm lungs. However, premature neonates have insufficient anti-inflammatory capacity. We aimed to evaluate the effect of etanercept, an anti-TNF agent, on BPD development in newborn rat model with hyperoxia-induced lung injury. METHODS: Thirty-two newborn rats were divided into 3 groups as control group (Group 1, n = 11), hyperoxia + placebo group (Group 2, n = 10), and hyperoxia + etanercept group (Group 3, n = 11). Histopathological and biochemical analysis were performed in order to assess inflammation and oxidative stress. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities, and malondialdehyde (MDA) levels were studied, histopathological scoring and radial alveolar count were applied in lung tissue. Lamellar body membrane protein, vascular endothelial growth factor (VEGF), nuclear factor-kappaB (NF-κB) gene expressions were studied in immunohistochemical evaluation of tissue samples. All three groups were compared with each other in terms of all parameters. RESULTS: SOD and GSH-Px activities were significantly higher, whereas MDA levels were lower in group 3, compared to group 2 (p < 0.001). Histopathological scores were lower, lamellar body membrane protein expression and radial alveolar count were higher in group 3 (p < 0.05). NF-κB expression was higher in group 2, but lower in group 3 in comparison with group 1. Expression of VEGF was decreased in group 2 but came close to group 1 with etanercept treatment in group 3. CONCLUSIONS: We found etanercept treatment to be protective in newborn rats with hyperoxia-induced lung damage.

The diagnosis of parotid lesions.

KEY POINTS: • Importance of appropriate preoperative diagnosis of parotid tumours. • The reasons why FNAC and USCB are the preferred diagnostic method. • USCB as the diagnostic biopsy tool of choice in many institutions.

Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: a prevalence study in Turkey.

BACKGROUND: Cytomegalovirus (CMV) infections are the leading cause of infectious hearing loss and central nervous system disease among children worldwide. In this study, we aimed to determine the birth prevalence of congenital CMV infection in live-born infants in Turkey. METHODS: In total, 944 consecutive live-born infants born from 926 pregnant women were included in this study. CMV-DNA was investigated in saliva samples of all newborns within the first 3 days after birth using TaqMan-based real-time PCR. RESULTS: The birth prevalence of congenital CMV infection in live-born infants was 1.91% (18/944), and all congenitally infected infants were asymptomatic at birth. The prevalence of congenital CMV infection was 16.7% (3/18) in twin pregnancies and 1.32% (12/908) in single pregnancies (p = 0.002). Genotyping analysis showed glycoprotein B-1 (gB1) to be the most frequently detected genotype at 83.3%. CONCLUSION: The study results suggest that the majority of congenital CMV infection in Turkey occurs following nonprimary maternal infection. We believe that congenital CMV infection and its long-term effects have been underestimated in our country, as infected infants are usually asymptomatic at birth.

High serum 25-hydroxyvitamin D levels are associated with pediatric sepsis.

Despite major advances in intensive care, sepsis continues to be a major cause of morbidity and mortality. Vitamin D is involved in various physiologic functions, including cellular responses during infection and inflammation. The aim of this study was to evaluate diagnostic value of 25-hydroxyvitamin D in childhood sepsis because it can be fatal if diagnosis delayed. The study included 40 children with sepsis and 20 children without sepsis (control group). We included only the patients with high probable sepsis, judged by clinical and laboratory findings, including positive blood culture. Blood samples were collected from patients with sepsis before treatment (pre-treatment group) and 48-72 hours later (post-treatment group). Treatment varied from ampicillin-sulbactam to cephalosporin. Blood samples were collected from control group once on admission. Serum 25-hydroxyvitamin D levels were significantly higher in sepsis (pre-treatment group) than control group (74 ± 8 ng/ml vs. 28 ± 12 ng/ml, p = 0.01) and the serum 25-hydroxyvitamin D levels were decreased to 44 ± 5 ng/ml (p = 0.01) after treatment. Moreover, we found significant positive correlation between 25-hydroxyvitamin D and each of well-know sepsis markers, C-reactive protein, tumor necrosis factor-α and interleukin-6. A cut-off point of 20 ng/mL for serum 25-hydroxyvitamin D showed 84% sensitivity and 76% specificity for sepsis diagnosis. This is the first study evaluating the diagnostic role of vitamin D in pediatric sepsis, thereby suggesting that serum 25-hydroxyvitamin D level can be used as a diagnostic marker for sepsis with high sensitivity and specificity.

Associations between erythrocyte membrane fatty acid compositions and insulin resistance in obese adolescents.

BACKGROUND/OBJECTIVE: Cytokines released from the adipose tissue and fatty acids (FAs) derived from lipolysis or uptake of fats go in to competition with glucose to be uptaken from the liver leads to insulin resistance (IR). We aimed to show the associations among serum lipid profile, FA compositions and IR. METHODS: Anthropometrical measurements, biochemical parameters and erythrocyte membrane (EM) FA levels of 95 obese adolescents (41 with IR) and 40 healthy controls were compared. RESULTS: LDL-C, fasting insulin levels, HOMA-IR were significantly higher and HDL-C levels were significantly lower in obese patients than in controls (p=0.013, p<0.001, p<0.001 and p<0.001, respectively). EM C 24:0, C 16:1 ω7 and C 22:1 ω9 FA levels were significantly higher, while C 20:5 ω3 (EPA) levels were significantly lower in obese subjects than in controls (p<0.001, p=0.018, p<0.001, p=0.043 and p<0.001, respectively). Moreover, when obese subjects divided into two groups according to the presence of IR; EM C 16:1 ω7 levels were still significantly higher and EPA levels were still significantly lower in both obese subjects with and without IR compared to controls (p<0.001 for both). CONCLUSION: Saturated FA intake should be decreased because of its role in the development of obesity and IR, and ω-3 group FA intake should be increased.

uPAR, IL-33, and ST2 values as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes.

Preterm premature rupture of membranes (PPROM) is defined as rupture of membrane that happens before the onset of labor and 37 weeks. Subclinical intrauterine infection is major etiological factor in the pathogenesis that increases mortality and morbidity associated with PPROM. This study was performed to evaluate the levels of maternal serum urokinase plasminogen activator receptor (uPAR), ST2 and interleukin (IL)-33 in PPROM and its relation with maternofetal infectious and morbidity. A total of 74 pregnant women, of which 49 with PPROM between 24 and 34 weeks gestation, and 25 normal pregnant women without PPROM were included in the study. Study group was seperated into 2 subgroups as PPROM and PPROM-histological chorioamnionitis (PPROM-HC). The blood samples were taken before the any medication. The mean serum IL-33, ST2, and uPAR values in the PPROM-HC group were significantly higher than PPROM and control group. The cut-off values of IL-33, ST2, and uPAR were determined as 5.2, 2 and 6.4 ng/mL, respectively. A cut-off value of IL-33 of 5.2 ng/mL, the cut-off of ST2 of 2 ng/mL and the cut-off of uPAR of 6.4 ng/mL showed similar sensitivity, specificity to IL-6 and the better sensitivity and specificity as compared to C-reactive protein and total leucocyte count in predicting infection in PPROM. We evaluated the predictive value of uPAR, ST2 and IL-33 in PPROM and we concluded that all of them can be used as reliable biomarkers to determine infection without any clinical signs but it is necessary to be studied in different cohort groups and infectious diseases.