Asthma control affects school absence, achievement and quality of school life: a multicenter study.

INTRODUCTION AND OBJECTIVES: Asthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children. MATERIALS AND METHODS: From January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child's disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life. RESULTS: 507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child's asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters. CONCLUSION: School interventions are important to improve asthma management.

Frequency and clinical features of pollen-food syndrome in children

Background: Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. Objective: The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). Method: This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. Results: Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n = 13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95% CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. Conclusion: PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed

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Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS: Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS: 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION: HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.

Frequency and clinical features of pollen-food syndrome in children.

BACKGROUND: Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. OBJECTIVE: The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). METHOD: This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. RESULTS: Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n=13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. CONCLUSION: PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.

Successful desensitization to etoposide in a preschool pediatric patient

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Role of laryngoscopy in children with respiratory complaints and suspected reflux

Background: In recent years, laryngopharyngeal reflux (LPR) in children has been taken into consideration. Objective: The aim of this study was to assess the laryngoscopic findings in children diagnosed LPR and/or gastro-oesophageal reflux (GERD).Methods: The findings of 49 patients with at least one or more respiratory complaint such as chronic cough, wheezing, hoarseness, recurrent laryngitis, and throat clearing/postnasal discharge suggesting LPR were evaluated retrospectively. The diagnosis of LPR + GERD or GERD was done by the clinical history and 24 h double-probe pH monitoring and/or scintigraphy. Results: Thirty eight out of 49 patients examined by laryngoscopy underwent 24 h double-probepH monitoring and/or scintigraphy. Thirty of them were diagnosed as LPR + GERD or GERD by any test positivity. Twelve of 30 patients diagnosed with LPR + GERD or GERD had a positive laryngeal finding on the examination of fibre optic laryngoscopy. The most common finding with eight cases was arytenoid erythema A sensitivity of 40% and specificity of 50% for the laryngoscopy in the diagnosis of LPR/GERD were found. Conclusion: In children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together(AU)

Role of laryngoscopy in children with respiratory complaints and suspected reflux.

BACKGROUND: In recent years, laryngopharyngeal reflux (LPR) in children has been taken into consideration. OBJECTIVE: The aim of this study was to assess the laryngoscopic findings in children diagnosed LPR and/or gastro-oesophageal reflux (GERD). METHODS: The findings of 49 patients with at least one or more respiratory complaint such as chronic cough, wheezing, hoarseness, recurrent laryngitis, and throat clearing/postnasal discharge suggesting LPR were evaluated retrospectively. The diagnosis of LPR+GERD or GERD was done by the clinical history and 24 h double-probe pH monitoring and/or scintigraphy. RESULTS: Thirty eight out of 49 patients examined by laryngoscopy underwent 24 h double-probe pH monitoring and/or scintigraphy. Thirty of them were diagnosed as LPR+GERD or GERD by any test positivity. Twelve of 30 patients diagnosed with LPR+GERD or GERD had a positive laryngeal finding on the examination of fibre optic laryngoscopy. The most common finding with eight cases was arytenoid erythema A sensitivity of 40% and specificity of 50% for the laryngoscopy in the diagnosis of LPR/GERD were found. CONCLUSION: In children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together.

Erythrocyte zinc levels in children with bronchial asthma.

Zinc deficiency may be suspected to play a role in the pathogenesis, control, and severity of asthma because of its antioxidant, antiapoptotic, and anti-inflammatory effects. We aimed to investigate whether there was any relationship between erythrocyte zinc levels and childhood asthma. The erythrocyte zinc levels of 67 asthmatic and 45 healthy children were analyzed in this case-control study. The mean concentrations of erythrocyte zinc were 1215.8 ± 145.1 µg/dl in asthma patients and 1206.9 ± 119.5 µg/dl in controls with no significant difference (P = 0.472). The erythrocyte zinc level was below 1,000 µg/dl in 6 asthmatic patients (8.9%) and 2 control group patients (4.4%). There was no relationship between erythrocyte zinc levels and duration of follow-up, severity, and control of the asthma (P > 0.05). On the other hand, patients hospitalized for an asthma attack had significantly lower erythrocyte zinc levels compared with nonhospitalized patients and the control group (P = 0.000 and P = 0.004 respectively). This study's findings indicate that asthmatic children are not a risk group for zinc deficiency. We emphasize that checking zinc levels in children who are hospitalized for an asthma attack may be useful.

VACTERL-H associated with central hypothyroidism: a case report.

The VACTERL-H syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTERL-H has previously not been reported.

Skin prick test results of child patients diagnosed with bronchial asthma.

BACKGROUND: The pathogenesis of asthma is associated with both genetic and environmental factors. Allergen sensitization is an important risk factor in asthma development. AIM: To evaluate sensitivity to allergens by using the skin prick test in patients with a diagnosis of bronchial asthma. METHOD: Patients with a diagnosis of bronchial asthma followed-up at the Ministry of Health, Diskapi Children's Diseases Training and Research Hospital in Ankara (Turkey) between January 1995 and March 2000 were included. Sensitivity to allergens, as determined by the skin prick test, was evaluated retrospectively. RESULTS: The files of a total of 3025 children (63.3 % boys) with bronchial asthma, aged 3 months to 16 years were evaluated. Of the total, 1667 patients with a diagnosis of bronchial asthma and 1358 with bronchial asthma plus allergic rhinitis were under follow-up. Of the 3025 asthmatic patients, 1902 had undergone the skin prick test and 60.3 % of these patients were atopic. The most common allergens were house dust mite [726 patients (63.3 %)], followed by pollens [565 patients (49.3 %)]. The most common allergen within this group was grass pollens [348 patients (30.3 %)]. CONCLUSIONS: Atopy was an important risk factor in our patients and the most common allergens were aeroallegens. The development of sensitization could be delayed by early precautions.

A novel Fryns "Anophthalmia-plus" syndrome associated with primary hypothyroidism.

A novel Fryns "anophthalmla-plus" syndrome associated with primary hypothyroidism: Here, we report a newborn male with "anophthalmia-plus" syndrome and primary congenital hypothyroidism. To our knowledge this is the first case of 'anophthalmia-plus' syndrome associated with congenital hypothyroidism in the literature up to date.

Neonatal purpura fulminans due to homozygous protein C deficiency.

Severe and recurrent purpura fulminans developed in a Turkish boy at 1 week of age. Initial coagulation studies performed were compatible with disseminated intravascular coagulation. Subsequent investigations showed that the patient had homozygous and his healthy parents had heterozygous protein C deficiency. The episodes of purpura fulminans were controlled by infusions of fresh frozen plasma and heparinization. Oral anticoagulant therapy was given in the symptom-free period.

Hypospadias in a patient with Kabuki make-up (Niikawa-Kuroki) syndrome.

A patient showing the typical facies and other signs of Kabuki make-up syndrome (KMS) was also found to have hypospadias, a finding previously reported only once in a patient with KMS.