Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?

OBJECTIVE: To compare lung ultrasound (LUS) with auscultation findings in children with clinical suspicion of pneumonia. PATIENTS AND METHODS: A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y) with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patient's clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial). For LUS examinations a combined transthoracic - transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC) diameter was measured, and 95% confidence intervals (CI) of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemar's test. RESULTS: LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemar's test showed a statistically significant difference between LUS and auscultation. CONCLUSIONS: LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.

Clinical and radiological characteristics of unrecognised foreign body aspiration into respiratory tract in children.

INTRODUCTION: Diagnosing of foreign body aspiration in children is often postponed. The aim of this study was to evaluate complications, clinical signs and radiological presentation of respiratory illness arising from unrecognized foreign body aspiration in pediatric population. MATERIAL AND METHODS: The study sample consisted of 33 patients aged from one to 18 years who had undergone bronchoscopy for foreign body removal over the 10 years' period (from 2000 to 2010). Neither their parents nor the pediatricians who had treated these patients before admission to hospital recognized the acute aspiration event. All the children were treated unsuccessfully for a period exceeding 10 days. The retrospective analysis included the history of foreign body aspiration, patients' age, kind of aspirated foreign body, clinical manifestations that led to hospitalization, radiographic findings and the time lapse from the first symptoms to diagnosis proven by endoscopic intervention. RESULTS: The majority of the foreign bodies were organic (93.93%). Broncho-obstructive syndrome, which was the most frequent clinical presentation, was found in 18 (54.55%) patients; pneumonia was diagnosed in 10 (30.30%) patients, four children were referred to hospital due to infiltrative changes with acute broncho-obstructive syndrome and only one child (3.03%) had persistent productive cough. Radiological findings (chest X-rays) were pathological in all patients. Rigid bronchoscopy was performed in 16 (48.49%) patients 10 days after presenting the first symptoms of respiratory illness, in 6 (18.18%) patients within 10-21 days' period and in 11 (33.33%) patients 3 weeks after the first respiratory symptom. CONCLUSION: Unrecognized foreign body aspiration results in various clinical manifestations and non-responsiveness to the standard therapy applied.

[Perinatal tuberculosis--diagnostic and therapeutic approach].

INTRODUCTION: The number of people suffering from tuberculosis has increased rapidly in the whole world over the past three decades. The classical age distribution of disease has also changed. According to the epidemiological data the number of pregnant women having tuberculosis has also risen with the resulting increase in the incidence of perinatal tuberculosis. PREGNANCY AND TUBERCULOSIS: The presentation of tuberculosis in pregnancy varies. The effects of tuberculosis on pregnancy depend upon various factors: site and extent of the disease. nutritional status and immune status of mother, concomitant diseases, stage of pregnancy when the treatment started and others. A delay between the onset and diagnosis occurs regularly. Treatment response, time to clearance of bacilli from sputum. and prognosis are similar to non pregnant women. PRINATAL TUBERCULOSIS: Perinatal tuberculosis is extremely rare if the mother is effectively treated in pregnancy. but disease is usually fatal if untreated. Diagnosis of perinatal tuberculosis is very often problematic and difficult. The reason of this is the fact that the initial manifestations of disease are nonspecific and may be delayed. In practice, congenital and early neonatal infections have almost the same mode of presentations, treatment and prognosis. Epidemiological data on the active tuberculosis in mother or some other family member are of the utmost importance in diagnoing tuberculosis. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Tuberculin tests are negative in at least 75% of cases. CONCLUSION: If the condition is recognised and treated according to existing tuberculosis protocols, the outcome is favourable.

Recurrent infections and cows-milk hypersensitivity in a 2-year-old girl with hyper immunoglobulin E syndrome.

The hyperimmunoglobulin E syndrome is a rare complex primary immunodeficiency characterized by high serum IgE levels, eczema, and recurrent infections. We present a case of 2-years-old girl with eczema and repeated bacterial skin and lung infections since the period of infancy. The patient also had eosinophilia, high serum levels of IgE, and cows-milk hypersensitivity. We describe the case, in order to illustrate the difficulty of establishing the diagnosis hyper-immunoglobulin E syndrome in a toddler.

Persistent wheezing as manifestation of esophageal tubular duplication cyst.

Duplications of esophagus are rare congenital anomalies and the second most common duplications of the gastrointestinal tract. This form of bronchopulmonary foregut malformation may appear as a cystic mediastinal mass. On chest radiographs they may be visible as middle or posterior masses. On CT they are well marginated and oppose the esophagus. Usually they are asymptomatic, unless they become infected or cause obstruction. We report a case of thoracic tubular duplication cyst in a 10-month-old boy who presented with persistent wheezing that was unsuccessfully treated in out-patient services.

The influence of inhaled fluticasone on bone metabolism and calciuria in asthmatic children.

BACKGROUND: Inhaled corticosteroids have become the first-line medication for treatment of childhood asthma. Possible adverse effects, such as those on bone metabolism and urinary excretion of calcium are in the focus of interest. We investigated the influence of inhaled fluticasone on bone metabolism and renal excretion of calcium, sodium, and potassium in asthmatic children. METHODS: Thirty asthmatic patients (mean age 12.24 ± 2.75 years) treated with 200-250 µg/day inhaled fluticasone were enrolled in the study. Prior to the initiation of therapy, as well as 12 weeks after following parameters were measured: serum sodium, potassium, calcium, phosphorus, creatinine, alkaline phosphatase, osteocalcin, intact parathyroid hormone levels, first-spot morning urine calcium/creatinine ratio, sodium/potassium ratio, and daily renal calcium excretion rate. RESULTS: Serum electrolytes, alkaline phosphatase, parathyroid hormone, osteocalcin levels, as well as urinary calcium, sodium, and potassium excretion were within normal ranges. There was no statistical difference between values of those parameters prior and 12 weeks after initiation of the therapy. CONCLUSIONS: Treatment with 200-250 µg/day inhaled fluticasone, in asthmatic children aged 9-16, during 12 weeks, did not affect serum osteocalcin level and renal excretion of calcium, sodium, and potassium.

[Possibilities of the primary and secondary prophylaxis in treatment of childhood asthma].

INTRODUCTION: The natural course of asthma is unpredictable and appears to be unaffected by any therapeutic strategy. Under such circumstances, the attention must be focused on the opportunities for prevention of a disease which is chronic, life long and incurable, even thought it can be very effectively controlled. During the past decades, a lot of a studies have been performed and started, in which relatively large numbers of children were included and followed prospectively to determine the incidence of risk factors for asthma in childhood. All these studies have contributed significant new information. The levels of prevention must be considered in all patients. There are two main separate components to the strategy. PRIMARY PROPHYLAXIS: Primary prophylaxis (time course of allergic sensitization, timing of exposure to allergens, influence of tobacco smoke, maternal health and allergen exposure) is introduced before there is any evidence of sensitization to factors which might have caused the disease. There is increasing evidence that allergic sensitization is a very common precursor to the development of asthma. SECONDARY PROPHYLAXIS: Secondary prophylaxis (allergen avoidance, hygiene hypothesis) is important after primary sensitization to allergen has occurred, but before there is any evidence of asthma. CONCLUSION: In this article the authors reviewed all results of studies about primary and secondary prophylaxis of asthma and its influence on the course of disease.

[Childhood asthma and risk factors].

INTRODUCTION: This article summarizes the contribution of epidemiology to the understanding of childhood asthma. The first task in epidemiology is to determine prevalence and incidence of any disease. PREVALENCE: Epidemiological investigations are aimed at evaluating hypotheses about causes of disease by defining demographic characteristics of a certain population as well as by determining possible effects of environmental factors. In spite of some limitations, data obtained by epidemiological investigations have been valuable in confirming both the increasing incidence of asthma and the differences in prevalence in certain population groups. The observance of this phenomenon has led to much speculation and a lot of attempts to identify the reasons behind the rising prevalence. RISK FACTORS: Epidemiological studies have identified risk factors for the development of childhood asthma and provided insight into natural history of disease and prognosis. Factors ranging from increased numbers of immunizations to increased air pollution have been suggested, but subsequent analysis has failed to provide the supporting evidence to implicate most of these possibilities. The concept known as the hygiene hypothesis has gained some support from epidemiological studies. CONCLUSION: The development of asthma as well as its severity are affected by numerous factors and their interactions can he explained by the heterogeneous nature of this disease.

[Diagnostic value of certain methods for isolation of Mycobacterium tuberculosis in children with suspected pulmonary tuberculosis].

INTRODUCTION: The aim of this study was to find out if bronchoalveolar lavage (BL) is better than gastric lavage (GL) or sputum (SP) examination for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis. MATERIAL AND METHODS: The study included a group of 30 children with suspected pulmonary tuberculosis, aged 6 months to 18 years. Gastric lavage was done on 4 consecutive mornings after overnight fast. Sputum was examined in 12 patients older than 10 years, (4 consecutive samples). BL was performed on the same day as the last GL and SP, using a rigid bronchoscope. Specimens were examined for the existence of BL acid fast bacilli (AFB) and culture for Mycobacterium tb. RESULTS: Out of 30 cases, Mycobacterium tb was grown in 13 BL sampies (43.33%), and in 10 GL samples from the same patients (33.33%). Comparative analysis of microbiological samples of sputum and bronchoalveolar lavage fluid in 12 children showed that 6 patients had SP+ cultures and 6 patients had SP-cultures of Mycobacterium tb. All SP+ patients where also BL+, but 1 SP- patient was BL+. Smear examination of BL fluid samples was positive for AFB in 10 patients with positive cultures for Mycobacterium tb. CONCLUSION: The results of our study indicate that BL examination is better than GL and SP examination for bacteriological diagnosis of childhood tuberculosis.

Novel homozygous p.E64D mutation in DJ1 in early onset Parkinson disease (PARK7).

Mutations in the parkin gene have been identified as a common cause of autosomal recessive inherited Parkinson disease (PD) associated with early disease manifestation. However, based on linkage data, mutations in other genes contribute to the genetic heterogeneity of early-onset PD (EOPD). Recently, two mutations in the DJ1 gene were described as a second cause of autosomal recessive EOPD (PARK7). Analyzing the PARK7/DJ1 gene in 104 EOPD patients, we identified a third mutation, c.192G>C (p.E64D), associated with EOPD in a patient of Turkish ancestry and characterized the functional significance of this amino acid substitution. In the patient, a substantial reduction of dopamine uptake transporter (DAT) binding was found in the striatum using [(18)F]FP-CIT and PET, indicating a serious loss of presynaptic dopaminergic afferents. His sister, homozygous for E64D, was clinically unaffected but showed reduced dopamine uptake when compared with a clinically unaffected brother, who is heterozygous for E64D. We demonstrate by crystallography that the E64D mutation does not alter the structure of the DJ1 protein, however we observe a tendency towards decreased levels of the mutant protein when overexpressed in HEK293 or COS7 cells. Using immunocytochemistry in contrast to the homogenous nuclear and cytoplasmic staining in HEK293 cells overexpressing wild-type DJ1, about 5% of the cells expressing E64D and up to 80% of the cells expressing the recently described L166P mutation displayed a predominant nuclear localization of the mutant DJ1 protein.