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1.
Selva Kumar Chinnakkannan Meenu Singh Rashmi Ranjan Das Joseph L. Mathew Akshay Kumar Saxena 《Indian pediatrics》2017,54(1):21-24
Objective
To study the point prevalence of allergic rhinitis and sinusitis in childhood asthma and to examine the relationship among them.Methods
In 250 children (age <13 y) with mild-to-moderte asthma, allergic rhinitis was diagnosed by clinical plus nasal eosinophilia criteria, and sinusitis was diagnosed clinically plus confirmation by computerized tomography scan.Results
The point prevalence of allergic rhinitis was 13.6%, and of sinusitis was 2%. On multivariate analysis, allergic rhinitis, sinusitis, and family history were significantly associated with asthma severity.Conclusions
Allergic rhinitis is common in childhood asthama, but sinusitis is rare.2.
Yuanming Wang Chuling Li Yaxiong Xu Deyu Xu Gang Yang Fang Liao Xianglin Luo 《Indian journal of pediatrics》2018,85(10):872-876
Objectives
To identify the expression of IL-33 during SLIT (Sublingual immunotherapy) in AR (Allergic rhinitis) children.Methods
Thirty children received house dust mite (HDM) allergen extract for SLIT and thirty children received placebo in this study. Serum and nasal lavage samples of cases and controls were collected at different time points during SLIT. Interleukin (IL)-33 and other cytokines were estimated in these samples by enzyme-linked immuno sorbent assay (ELISA). Peripheral blood mononuclear cells (PBMC) were prepared and stimulated with rhIL-33 (with or without other stimulators) at different time points during SLIT.Results
The present results showed that both serum and nasal lavage of IL-33 levels decreased significantly after 12 mo treatment and this trend maintained at least until 24 mo. The decreased nasal IL-33 level was positively correlated to local Th2 cytokines and increased IL-10 expression at 2 y post SLIT treatment. In vitro experiments showed that IL-33 promotes IL-4 and IL-5 and inhibits IL-10 expression by peripheral blood mononuclear cells (PBMCs) in AR.Conclusions
Decreased IL-33 expression during SLIT may contribute to low Th2 response and enhanced Regulatory T cell cytokines expression. Thus, IL-33 maybe an important predictor during SLIT.3.
Oktay Sari Umit Aydogan Mustafa Gulec Yusuf Cetin Doganer Suleyman Tolga Yavuz 《Indian pediatrics》2017,54(1):25-27
Objective
To investigate and compare the efficiency of general and disease-specific life quality scales in children with asthma.Methods
Children with asthma, and their parents completed the Childhood Asthma Control Test (C-ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory (PedsQL), and also underwent spirometry.Results
82 children (55 males) with a median (IQR) age of 10.1 (8.9-10.5) years were included. C-ACT, PAQLQ and PedsQL child scores were significantly higher in children with controlled asthma.Conclusions
Quality of life in children, assessed using diseasespecific quality of life measures, is better for children with good asthma control.4.
Background
Plastic bronchitis is characterized by formation of extensive obstructive endobronchial casts and high recurrence rates.Case characteristics
Two children (1-year-old girl, 7-year-old boy) who had recurrent episodes of respiratory distress with acute worsening. Bronchoscopy revealed membrane-like casts. Both children were managed with nebulized N-acetylcysteine in addition to management for asthma.Outcome
Symptom-free without recurrence for more than 9 months of follow-up.Message
Nebulized N-acetylcysteine may be helpful in prevention of recurrence of plastic bronchitis due to asthma.5.
Chun-Hui He Xing Li Jun-Hong Lin Qiang Xiao Jia-Lu Yu Ying-Fen Liu Wen-Hui Jiang Chen Chen Li Deng Jie Zhou 《World journal of pediatrics : WJP》2017,13(6):560-565
Background
Inhaled corticosteroids (ICSs) for treating asthma are controversial because of their negative effects on the growth of asthmatic children and without clearly defined withdrawal strategy. A 2-year ICS step-down and withdrawal strategy has been developed for asthmatic children receiving 3-year subcutaneous immunotherapy (SCIT).Methods
Eleven children were included into the SCIT group and 13 children into the ICS group. ICSs were discontinued when children met the following criteria: requiring only 1 puffper day, with good control, for at least 6 months; having a forced expiratory volume in 1 second (FEV1)/forced vital capacity ≥80%; and SCIT discontinued for ≥24 months. The main endpoints were the results of both the childhood asthma control test (C-CAT) and the methacholine bronchial provocation test.Results
In the SCIT group, all the 11 children had ICS discontinued, with one child developed asthma attack after pneumonia and received ICS again after completion of SCIT. In the ICS group, five children discontinued ICS and developed asthma attacks later and received ICS again; the other eight children developed severe symptoms during ICS step-down. Thus, the discontinuation of ICS was only achieved in the SCIT group. The dose of methacholine that caused a decrease of 20% in FEV1 continued to improve after discontinuation of ICS for the SCIT group and presented better results than the ICS group (P=0.050). After completion of SCIT, the C-CAT had improved significantly after 30 months of treatment compared with the ICS group (P<0.05).Conclusions
In the present study, we developed a 2-year step-down and withdrawal strategy from ICSs strategy for allergic asthma children receiving SCIT; the strategy was efficacious and safe.6.
AT Kaaviyaa Vidya Krishna TS Arunprasath Padmasani Venkat Ramanan 《Indian pediatrics》2018,55(11):969-971
Objective
To study the association between asthma control and serum 25OH Vitamin D levels in children with moderate persistent asthma on preventer therapy.Methods
Children aged 6–18 years, with moderate persistent asthma, on preventer therapy for ≥2 months were included. Control was categorized as good, partial or poor as per GINA guidelines. Serum 25 (OH) Vitamin D levels were measured and their relationship with the level of control was studied.Results
Out of 50 children enrolled, 22 had well-controlled asthma, and 21 had partially controlled asthma. Vitamin D was deficient in 30 children and insufficient in 18 children. Children with vitamin D deficiency had significantly less wellcontrolled asthma as compared to those with insufficient or sufficient levels of 25 (OH) vitamin D (13.3% vs 88.9 % vs 100%).Conclusion
Vitamin D deficiency is associated with suboptimal asthma control.7.
Objective
To quantitatively summarize the evidence from observational studies on the relation between pediatric asthma and food allergy.Methods
A literature search was conducted in Medline and EMBASE (August 2016). Two independent reviewers appraised the studies and extracted the estimates of interest. Methodological quality of the included studies was assessed using National Heart Lung and Blood Institute (NHLBI) Quality Assessment Tools. Data were pooled using random-effects meta-analysis.Results
A total of 32 relevant studies were identified but only 8 studies met the inclusion criteria. Using random-effect model, food allergy showed strong association with asthma in children (OR = 2.87 [95% CI: 2.05–4.00]; P < 0.0001).Conclusions
This study suggested that food allergy is associated with an increased risk of asthma in children.8.
Background
Synovial arteriovenous malformation is rare.Case characteristics
We present three children with recurrent monoarthritis secondary to synovial arteriovenous malformation.Outcome
Two children underwent excision of arteriovenous malformation. Another child had diffuse arteriovenous malformation, which was inoperable.Message
Synovial arteriovenous malformations should be considered in the differential diagnosis of monoarthritis, especially of the knee.9.
Objective
To study the association between serum vitamin D levels and levels of asthma control in children aged 5-15 years.Methods
Children with physician-diagnosed asthma who were under follow-up for at least 6 months were enrolled. Participants were categorized into three asthma control groups as per standard guidelines, and their serum 25-hydroxy vitamin D levels and pulmonary function tests were compared.Results
Out of 105 children with asthma enrolled in the study, 50 (47.6%) were controlled, 32 (30.5%) were partly controlled and 23 (21.9%) were uncontrolled. Median (IQR) serum vitamin D levels in these three groups were 9.0 (6.75, 15) ng/mL, 10 (6.25, 14.75) ng/mL and 8 (5, 10) ng/mL (P=0.24), respectively.Conclusion
We did not observe any association of serum 25-hydroxy vitamin D levels with the level of control of childhood asthma.10.
Masallah Baran Yeliz Cagan Appak Gokhan Tumgor Miray Karakoyun Tunc Ozdemir Gokhan Koyluoglu 《Indian pediatrics》2018,55(3):216-218
Objective
The aim of this study was to examine the etiology of gallstones in children and responses to ursodeoxycholic acid (UDCA) treatment.Methods
74 children with cholelithiasis were recruited, and underwent ultrasonography to detect gallstones. All relevant clinical information was recorded in a structured proforma.Results
The commonest risk factor was a family history of gallstones. Most children responded to UDCA treatment in the first six months; children with hemolytic diseases showed no response to UDCA.Conclusion
UDCA treatment may be useful before surgery in asymptomatic patients of cholelithiasis without hemolytic diseases.11.
Abhijeet Botre Vrajesh Udani Neelu Desai Spoorthy Jagadish Milind Sankhe 《Indian pediatrics》2017,54(8):678-680
Background
Management of refractory status epilepticus in children is extremely challenging.Case characteristics
Two children with medically refractory status epilepticus, both of whom had lesional pathology on MRI and concordant data on EEG and PET scan.Intervention
Emergency hemispherotomy performed in both patients. A complete, sustained seizure freedom obtained postoperatively.Message
Emergency surgery is a treatment option in selected cases of drug refractory status epilepticus with lesional pathology and concordant data.12.
Background
Inflammatory myofibroblastic tumors of the trachea are rare childhood quasi-neoplastic lesions.Case characteristics
7-year-old boy with recurrent episodes of cough, breathing difficulty and wheeze, initially treated as asthma.Intervention
CT chest and flexible bronchoscopy revealed a mass lesion of the trachea, which was excised by diode laser through the ventilating bronchoscope. Histopathology confirmed it as the inflammatory myofibroblastic tumor.Message
Use of laser ensured complete endotracheal excision of the tumor.13.
Guang-Qiao Zeng Jia-Ying Luo Hui-Min Huang Pei-Yan Zheng Wen-Ting Luo Ni-Li Wei Bao-Qing Sun 《World journal of pediatrics : WJP》2015,11(3):219-225
Background
Although the number of studies on allergic diseases in the general population of southern China is increasing, only a few have addressed food allergy (FA) in children in this region. The present study aimed to investigate the prevalence, clinical manifestations, spectrum of allergens, and related risk factors of FA in preschool children in Guangdong Province, southern China.Methods
A random cluster-sampling method was used to select 24 kindergartens from 12 cities in Guangdong Province. The parents or guardians of the children were requested to complete a questionnaire on general information and data regarding FA diagnosis and symptoms in the children and their first-degree relatives. Thereafter, the Chi-square test, multivariate regression analysis, and Spearman’s rank-order correlation coefficient analysis were performed to identify statistically significant differences.Results
Analysis of 2540 valid questionnaires revealed an FA prevalence rate of 4%. Adverse food reactions were due to the consumption of shrimp (4.4%), crab (3.2%), mango (2.3%), cow’s milk and dairy products (1.9%), and eggs (1.4%). Logistic regression analysis indicated that a history of FA and a history of allergic rhinitis in the first-degree relatives were the major factors leading to FA in children.Conclusions
The incidence of FA in children in Guangdong Province is higher than that commonly believed. An individual’s genetic background is an important risk factor for FA. Hence, mitigation of the impact of lifestyle and environmental factors should be carefully considered to reduce the incidence of childhood FA.14.
Background
Immunodeficient children are more prone for invasive cryptococcal infections.Case characteristics
A 2-year-old boy with disseminated cryptococcosis was evaluated for underlying immunodeficiency without success.Intervention/outcome
Child was managed successfully.Message
Immunocompetent children with disseminated cryptococcosis can present diagnostic or therapeutic challenge in resource-limited settings.15.
Background
Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood. Severe central nervous system (CNS) involvement is rare in HSP.Case characteristics
Three children with features of HSP presented with seizures and CNS dysfunction.Observation
All three children had abnormalities on neuroimaging; 2 had complete remission but one was left with severe neurological damage.Message
HSP patients may rarely present with CNS involvement with a prolonged course requiring aggressive treatment.16.
Background
The clinical management of intravenous immunoglobulin-resistant Kawasaki disease shock syndrome (KDSS) is obscure.Case characteristics
Three children presented with intravenous immunoglobulin-resistant KDSS complicated with myocarditis.Outcome
All cases were successfully managed with steroid pulse therapy.Message
Steroid pulse therapy is effective in immunoglobulin-resistant KDSS.17.
Background
Disorders of the thyroid function of mother and child can not only irreversibly inhibit maturation of the central nervous system, but may also affect growth and puberty.Objectives
Review of the consequences of thyroid function disorders on the growth of children and adolescents and the relevance of adequate treatment.Materials and Methods
This article summarises the current literature concerning the effect of thyroid hormone disorders of mother and child and their therapy on growth.Results
Every untreated manifestation of congenital or acquired hypothyroidism is associated with a delay of growth and skeletal maturation. In children presenting with acquired hyperthyroidism, height is shifted towards higher values and skeletal maturation is accelerated. Approximately 20?% of children and adolescents with Down syndrome develop primary hypothyroidism, frequently manifesting within the first months of life (approximately 5.5?%). Adequate treatment of the thyroid disorder can normalise growth disorders. About 6?% of children with growth hormone deficiency develop abnormally low free thyroxin (fT4) levels in serum during growth hormone treatment due to increased conversion of T4 to T3. There is no indication for treatment after excluding secondary hypothyroidism.Conclusions
Early diagnosis and timely, adequate treatment of thyroid function disorders of mother and child are essential to achieving growth that is as age-appropriate as possible in affected children and adolescents18.
Background
Gastrointestinal bleeding in children has diverse etiologies.Case characteristics
Two children (age 3y and 7y) with recurrent gastrointestinal bleeding. Computed tomography demonstrated features of chronic pancreatitis but no vessel abnormality. Conventional angiography revealed bleeding from gastroduodenal artery in both cases.Outcome
Coil embolization of gastroduodenal vessels was performed, and there was no recurrence of bleeding.Message
Hemosuccus pancreaticus is to be considered in children with chronic pancreatitis presenting with recurrent gastrointestinal bleeding and conventional angiography with coil embolization is helpful.19.
Manoja Kumar Das Vidyut Bhatia Anupam Sibal Abha Gupta Sarath Gopalan Raman Sardana Reeti Sahni Ankur Roy Narendra K Arora 《Indian pediatrics》2017,54(12):1012-1016
Objective
To document the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic parameters among normalweight and overweight schoolchildren.Design
Cross-sectional study.Setting
Thirteen private schools in urban Faridabad, Haryana.Participants
961 school children aged 5-10 years.Methods
Ultrasound testing was done, and 215 with fatty liver on ultrasound underwent further clinical, biochemical and virological testing.Outcome measures
Prevalence of fatty liver on ultrasound, and NAFLD and its association with biochemical abnormalities and demographic risk factors.Results
On ultrasound, 215 (22.4%) children had fatty liver; 18.9% in normal-weight and 45.6% in overweight category. Presence and severity of fatty liver disease increased with body mass index (BMI) and age. Among the children with NAFLD, elevated SGOT and SGPT was observed in 21.5% and 10.4% children, respectively. Liver enzyme derangement was significantly higher in overweight children (27% vs 19.4% in normal-weight) and severity of fatty liver (28% vs 20% in mild fatty liver cases). Eleven (8.1%) children with NAFLD had metabolic syndrome. Higher BMI (OR 35.9), severe fatty liver disease (OR 1.7) and female sex (OR 1.9) had strong association with metabolic syndrome.Conclusions
22.4% of normal-weight and overweight children aged 5-10 years had fatty liver. A high proportion (18.9%) of normal-weight children with fatty liver on ultrasound indicates the silent burden in the population.20.