Toxocara seropositivity in Sri Lankan children with asthma

Background:  Toxocariasis occurs in humans due to infection with Toxocara canis or T. cati, the nematode parasites of dogs and cats, respectively. The relationship between toxocariasis and asthma is complex, with some studies demonstrating that children with asthma were more likely to be Toxocara seropositive as compared to non-asthmatic children, and other studies indicating no such significant relationship. The aim of the present study was to investigate Toxocara seropositivity and its association with asthma in a selected group of Sri Lankan children.
Methods:  Two groups of children were studied: group 1 included 100 children with confirmed bronchial asthma who were on regular inhaler steroid treatment for asthma; group 2 included 96 children who did not have physician-diagnosed asthma or upper respiratory tract infections, attending the same hospital. Diagnosis of Toxocara seropositivity was based on IgG Toxocara Microwell Serum Elisa Kits. Enzyme-linked immunosorbent assay was regarded as positive for a reading of 0.3 optical density units. Stool samples were examined for helminth ova.
Results:  Toxocara seropositivity in children with asthma was 29% and this was significantly more than Toxocara seropositivity among non-asthmatic children ( P  < 0.001). Toxocara seropositivity was identified as a significant risk factor of asthma in a univariate model. Eosinophilia was seen in a significantly higher proportion of non-asthmatic and asthmatic children who were Toxocara seropositive. Toxocara seropositivity, however, was not identified as a significant risk factor in a multivariate model.
Conclusions:  The analysis confirmed previously identified risk factors for asthma but there was no association between the helminth parasitic infection, toxocariasis and bronchial asthma in children.     

Risk factors for childhood asthma in Fernando de Noronha: a case control study

Fernando de Noronha Island, because of its ecological characteristics,has virtually no atmospheric pollution that could cause asthma. Nevertheless, asthma prevalence in children younger than 6 years old is 11.22%. 17 asthmatic children and 68 healthy ones were included in this case control study (1:4 case/controls) conducted in a closed community free from atmosphere pollution. Maternal asthma and exposure to smoking were more frequently associated with asthmatic children than with controls, the risk of asthmatic syndrome being respectively 6.9 and 4.6 times bigger. As for breastfeeding no protective effect was found in both cases and controls.     

Risk factors for childhood sledding injuries: a case-control study.

We report the results of a case-control study designed to identify modifiable risk factors for childhood sledding injuries. Cases included all children injured while sledding (n = 17) during a five-day winter storm who presented for care to a Seattle pediatric emergency department. Two controls were chosen randomly for each case from children who presented to the same emergency department during the ensuing two months for any illness that did not require hospitalization. To qualify as controls, children had to have sledded during the same five-day period but not sustained an injury requiring medical attention. Data were collected on cases and controls using a telephone questionnaire. Analysis of risk factors revealed a significant increase in risk of injury for children who sledded in streets versus those who sledded in a park (OR = 5.1; 95% CI = 1.1-24.1), those who sledded without adult supervision (OR = 5.6; 95% CI = 1.1-26.9), and those whose parents had an annual income > or = $50,000 (OR = 5.7; 95% CI = 1.5-20.8). No difference in risk of injury was found regarding the type of sled used, the number of children, or their position on the sled or for those children with a history of prior sledding experience. We conclude that safe alternatives to sledding in the streets and an increase in adult supervision may reduce the number of childhood sledding injuries.     

Risk factors for developing wheezing and asthma in childhood.

Wheezing lower respiratory tract illness in infancy and asthma share the clinical findings of wheezing and respiratory distress. Although the link between wheezing lower respiratory tract illness in infancy and the subsequent development of asthma is a limited one, both conditions do share some common risk factors, including exposure to environmental tobacco smoke, difficult living conditions (low socioeconomic class, crowding, allergen exposure), and increased risk in males. The impact of baseline lung function on wheezing lower respiratory tract illness risk is substantial and may be independent of airway reactivity. In contrast, the development of chronic airway inflammation mediated by allergic sensitization plays a central role in the development of persistent asthma. Although the endogenous risks for these two outcomes may be fixed, it is clear that caregivers may help to reduce or eliminate the exogenous risks listed earlier by parental education and improvement of the living conditions of young children.     

Coexisting micronutrient deficiencies among Sri Lankan pre-school children: a community-based study

Assessing micronutrient status in children may also have the benefit of addressing the problems of various micronutrient deficiencies with a unified programmatic approach on a public health scale. A cross‐sectional survey in the Galle district of the micronutrient and anthropometric status of 248 children of ages 3–5 years was performed to determine the prevalence of micronutrient deficiencies [iron, zinc (Zn), folate, calcium, caeruloplasmin, iodine, vitamin A and vitamin D] and the extent to which multiple micronutrient deficiencies coexist. The prevalence of anaemia [haemogbolin (Hb) < 110.0 g L^?1] was 34.0% in males and 33.0% in females (overall 33.5%, gender difference, P = 0.92). In anaemic children, 7.0% of males and 15.0% of females were iron deficient (serum ferritin < 15.0 µg L^?1). Folate deficiency (<3.00 ng mL^?1) was found in 41.0% and 33.0% of male and female, respectively, whereas Zn deficiency (<9.95 µmol L^?1) occurred in 57.0% and 50.0% of male and female, respectively. Serum vitamin D deficiency (<35.0 nmol L^?1) was found in 26% and 25% of male and female, respectively. Anaemic males had a 3.0‐fold (95% confidence interval (CI) 1.1–8.3) and 2.3‐fold (95% CI 0.8–6.6) greater risk of being underweight and thin, whereas the risk among anaemic females was 0.7‐fold (95% CI 0.3–1.8) and 0.9‐fold (95% CI 0.3–2.6) for being underweight and thin. Only 7.3% of the subjects did not have any micronutrient deficiency, 38.3% were deficient in two micronutrients, 17.7% had three micronutrient deficiencies and 6.0% had four or more micronutrient deficiencies. Multiple micronutrient deficiencies are prevalent in Sri Lankan pre‐school children and established baseline data for future studies.     

Risk factors for childhood poisoning: a case-control study in Greece.

OBJECTIVES: To identify child or family related risk factors for unintentional childhood poisoning in Greece and to explore whether product specific poisonings might have special features that make them amenable to preventive interventions. SETTING: A case-control study was undertaken in Athens, Greece in 1995. Cases were 100 consecutive children brought with poisoning to the emergency clinics of the two university affiliated children's hospitals. For every case two age, gender, and hospital matched controls were chosen from among children brought to the outpatient clinics of these hospitals on the same date. METHODS: All children and their guardians were interviewed by the same person using a standard questionnaire that covered demographic, socioeconomic, behavioral, and past injury characteristics. Information was also obtained concerning type and conditions of poisoning for cases. Statistical analysis was undertaken by modeling the data using conditional logistic regression. RESULTS: Socioeconomic factors were not important risk indicators in these data but children living with other than both parents were at increased risk (odds ratio (OR) = 4.7, p = 0.08), as were children with a history of previous poisoning that required medical care (OR = 5.1, p = 0.05). Unintentional poisonings caused by chewing or swallowing cigarettes were concentrated in families where both parents were smokers. CONCLUSIONS: Absence of a parent appears to be associated with increased likelihood of childhood poisoning. The importance of product accessibility is underlined by the concentration of tobacco poisoning among children of parents who were both smokers. In the cultural context of this study, sociodemographic factors do not appear to represent demonstrable risk factors. Instead, control of childhood poisoning should be concentrated on safe packaging, storage, and disposal of potentially hazardous products.     

Risk factors for childhood asthma and recurrent wheezy bronchitis

Using cross-sectional data of an epidemiological study, risk factors for asthma and recurrent wheezy bronchitis were investigated in 1812 primary school children. Children with asthma (n=63) had a similar pattern but a higher frequency of chronic respiratory symptoms than those with recurrent wheezy bronchitis (n=136). Logistic regression analyses showed similar risk factors for both disorders, however, more pronounced for asthma. Prematurity was a significant risk factor for asthma and for recurrent wheezy bronchitis. Children with asthma more often had a family history of paternal or maternal asthma and their mothers tended to be younger. Effects of paternal asthma and prematurity were also found when the atopic status of the child (defined as skin test positivity to any of seven aero allergens) was taken into account. Next to genetic effects, adverse circumstances in early life seem to be important for the development of asthma. In school children recurrent wheezy bronchitis and asthma seem to be similar disorders which differ in quantitative but not qualitative aspects.     

Cystic fibrosis presenting as kwashiorkor in a Sri Lankan infant.

Growth failure is a common presentation of patients with pancreatic insufficient cystic fibrosis. However, full blown kwashiorkor is extremely rare. Cystic fibrosis is also considered to be rare in the South Asian population. This report describes a Sri Lankan infant with cystic fibrosis who presented with clinical features of severe kwashiorkor.     

Patterns of disease in Sri Lankan dengue patients.

BACKGROUND: Dengue is the most important mosquito borne viral infection in the world. Nearly 90% of infections occur in children. At present, prospective information on clinical and laboratory findings in South Asian children with dengue is generally lacking. AIM: To describe patterns of clinical disease in a cohort of children hospitalised with dengue during a major dengue epidemic in Sri Lanka. RESULTS: A total of 104 children were studied during a three month period. Eighteen had dengue fever (DF) and 86 had dengue haemorrhagic fever (DHF). Of those with DHF, 34, 23, 27, and 2 had DHF grade I, II, III, and IV respectively. Based on dengue serology testing, 13 of the DF patients had a primary infection and 5 had secondary dengue infections. In contrast, 68 of the children with DHF had secondary and 18 had primary dengue infections. Oral candidiasis was seen in 19 children. The odds ratio for children with secondary dengue infection to develop DHF was 9.8 (95% CI 3.1 to 31.2). CONCLUSION: Studies on patterns of paediatric dengue disease in different regions should help clinicians and health administrators make more informed and evidence based health planning decisions. It should also help towards mapping out dengue trends on a global scale. Oral candidiasis has not been previously documented in children suffering with acute dengue in Sri Lanka or elsewhere. Studying underlying reasons for this manifestation during future dengue epidemics may provide useful leads in understanding overall dengue pathogenesis.     

Cystic fibrosis presenting as kwashiorkor in a Sri Lankan infant

Growth failure is a common presentation of patients with pancreatic insufficient cystic fibrosis. However, full blown kwashiorkor is extremely rare. Cystic fibrosis is also considered to be rare in the South Asian population. This report describes a Sri Lankan infant with cystic fibrosis who presented with clinical features of severe kwashiorkor.     

Environmental factors and childhood asthma

Indoor allergens are potent triggers for acute and chronic pediatric asthma. Environmental control measures of these allergens should be considered first-line treatment measures. Allergen avoidance can produce changes in disease activity and symptoms that can be beneficial before any medical intervention is implemented. In addition to allergen avoidance, studies evaluating other exposures, such as endotoxin and diet, in the pathogenesis of asthma are in progress. Understanding the complex relationships between exposure and allergy/asthma development is vitally important to the development of potentially more effective primary and secondary prevention strategies.     

Risk factors for early bronchiolitis at asthma during childhood: case-control study of asthmatics aged 4 to 12 years]

The group of general paediatrics of the French Paediatrics Society conducted a case-control study in order to verify the link between the occurrence of an acute bronchiolitis early during the first year of life, more specifically during the first trimester, and asthma during later childhood. METHODS: Parents of 4-to-12-year-old children answered a questionnaire during a general paediatrics visit. Exposition was attested by a diagnosis of bronchiolitis mentioned on the personal health record of the child. Environmental factors and medical history, obtained from the parents and by checking the health record of the child, were studied using multivariate analysis. RESULTS: Nineteen paediatricians included 80 children with asthma and 160 controls. Fifty-four per cent of asthmatic children had a medical history of bronchiolitis during the first year of life versus 17% of control children (P < 0.001). Mean age of bronchiolitis occurrence was 6.6 months in both groups (P = 0.98). Multivariate analysis showed that occurrence of bronchiolitis during the first year of life was significantly more frequent in asthmatic children (P < 0.001, OR = 5.6, IC95 = [2.6-11.6]) but this effect was not observed during the first trimester of life. CONCLUSION: Bronchiolitis during the first year of life was significantly related to later asthma in 4-to-12-year-old children treated by general paediatricians. On the other hand, a very early bronchiolitis during the first trimester of life did not appear, in our set of data, as a contributive factor to explain asthma in later childhood.     

Risk factors for childhood overweight: a prospective study from birth to 9.5 years

OBJECTIVES: To ascertain risk factors for the development of overweight in children at 9.5 years of age. STUDY DESIGN: This was a prospective study of 150 children from birth to 9.5 years of age, with assessment of multiple hypothesized risk factors drawn from research reports. RESULTS: Five independent risk factors for childhood overweight were found. The strongest was parent overweight, which was mediated by child temperament. The remaining risk factors were low parent concerns about their child's thinness, persistent child tantrums over food, and less sleep time in childhood. Possible mechanisms by which each of these factors influence weight gain are outlined. Two different pathways to childhood overweight/obesity were found, depending on degree of parental overweight. CONCLUSIONS: There is evidence of considerable interaction between parent and child characteristics in the development of overweight. Several of the identified risk factors are amenable to intervention possibly leading to the development of early prevention programs.     

Patterns of disease in Sri Lankan dengue patients

Background

Dengue is the most important mosquito borne viral infection in the world. Nearly 90% of infections occur in children. At present, prospective information on clinical and laboratory findings in South Asian children with dengue is generally lacking.

Aim

To describe patterns of clinical disease in a cohort of children hospitalised with dengue during a major dengue epidemic in Sri Lanka.

Results

A total of 104 children were studied during a three month period. Eighteen had dengue fever (DF) and 86 had dengue haemorrhagic fever (DHF). Of those with DHF, 34, 23, 27, and 2 had DHF grade I, II, III, and IV respectively. Based on dengue serology testing, 13 of the DF patients had a primary infection and 5 had secondary dengue infections. In contrast, 68 of the children with DHF had secondary and 18 had primary dengue infections. Oral candidiasis was seen in 19 children. The odds ratio for children with secondary dengue infection to develop DHF was 9.8 (95% CI 3.1 to 31.2).

Conclusion

Studies on patterns of paediatric dengue disease in different regions should help clinicians and health administrators make more informed and evidence based health planning decisions. It should also help towards mapping out dengue trends on a global scale. Oral candidiasis has not been previously documented in children suffering with acute dengue in Sri Lanka or elsewhere. Studying underlying reasons for this manifestation during future dengue epidemics may provide useful leads in understanding overall dengue pathogenesis.     

Risk factors for obesity in childhood survivors of suprasellar brain tumours: a retrospective study

Aim: To characterize postdiagnosis changes in body mass index (BMI) among childhood survivors of suprasellar brain tumours, and to determine the risk factors associated with obesity. Methods: We conducted a retrospective analysis of 46 children (16 boys and 30 girls) with median (IQR) age of 7.49 (3.47–11.59) years at tumour diagnosis, and followed up for 3.93 (1.68–7.27) years. Survival analyses were used to identify risks of developing obesity. Results: There were no sex differences in age at tumour diagnosis, duration of follow‐up, tumour types, endocrinopathies, treatment modalities or baseline BMI SDS. In the first year after tumour diagnosis, ΔBMI SDS (median; IQR) was greater in girls (1.32; 0.07–2.08) than in boys (0.48; ?0.40 to 0.89) (p = 0.01). At diagnosis, 3/46 children (6%) were obese; this increased to 20/46 (43%) by last follow‐up (p < 0.001) and was more common in girls (17/30; 57%) than in boys (3/16; 19%). Female gender (hazard ratio 5.0, 95% CI 1.2–21.7; p = 0.04) and greater than average baseline BMI (hazard ratio 4.7, 95% CI 1.1–20.8; p = 0.02) were risk factors for subsequent obesity. Conclusion: Accurate prediction of obesity risk is important and would allow early targeted intervention in high‐risk patients.     

Defining Obesity Using a Biological End Point in Sri Lankan Children

Objective

To identify the percentage of body fat mass (FM) that would define obesity among Sri Lankan children.

Methods

A cross-sectional study was conducted among 5–15 y old children in the district of Colombo. FM was assessed using Bio Impedance Assay (BIA). After a 12 h overnight fast, blood was drawn for fasting blood glucose (FBS) and lipid profile. Oral-glucose-tolerance test (OGTT) was done along with 2 h random blood sugar (RBS). Metabolic syndrome (MetS) was diagnosed by a high waist circumference (WC) with ≥2 metabolic derangements [FBS/RBS, high density lipoprotein-cholesterol (HDL-C), triglyceride, and systolic and diastolic blood pressure (SBP/DBP)]. Receiver-Operator Characteristics (ROCs) were drawn to determine the best %FM that predicted MetS.

Results

Nine hundred twenty children were studied (547 boys). Fifteen (1.6 %) had MetS. Ninety five (10.3 %) had two and 16(1.7 %) had ≥3 metabolic derangements. MetS in boys was associated with %FM of 28.6 (sensitivity 1.000; specificity 0.870) and in girls 33.7 (sensitivity 0.875; specificity 0.808).

Conclusions

FM associated with adverse health outcomes in this population is comparable to other available data. A %FM of 28.6 % for boys and 33.7 % for girls would be acceptable cutoff limits.

     

Effect of parity on phalangeal bone mineral density in post-menopausal Sri Lankan women: a community based cross-sectional study

There is paucity of studies related to parity and bone mineral density in South Asian countries. We recruited 713 healthy, community dwelling post-menopausal women from seven provinces in Sri Lanka for this survey. The number of pregnancies, including miscarriages beyond 20 weeks of gestation, was recorded. Women with diseases and those who have taken drugs that can affect bone mineral density (BMD) were excluded ( n  = 15). Phalangeal BMD and bone mineral content (BMC) were measured using AccuDEXA in 713 women. Mean (SE) BMD of nulliparous women ( n  = 32), women with one to two pregnancies ( n  = 284), three to four pregnancies ( n  = 290) and more than four pregnancies ( n  = 107) were 0.437(0.014), 0.454(0.005), 0.455(0.005) and 0.417(0.006) g/cm², respectively ( P  < 0.001). Corresponding mean (SE) BMCs were 1.30(0.063), 1.41(0.021), 1.43(0.022) and 1.32(0.033) g, respectively ( P  < 0.001). Women with more than four pregnancies were older and lighter when compared with other groups. When results were adjusted for current age and current weight, differences in mean BMD and BMC between groups became non-significant. BMD of nulliparous women remained low in all analyses. We report a significant difference in unadjusted phalangeal BMD in women categorized according to their parity. Women with one to four pregnancies had the highest phalangeal BMD and BMC, while multi-parous (more than four pregnancies) and nulliparous women had lower values. However, in an adjusted analysis, the differences in BMD and BMC were partially explained by the differences of age and body weight between the groups and the unique effect of parity was difficult to determine. Women with lower BMD may have a higher risk of future fractures.