Growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula in infants with cow's milk protein allergy.

Objective: To evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow's milk protein allergy (CMPA). Methods: A total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z-scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5). Results: From baseline to visit 2 and visit 3, WFA z-scores (from -0.60 ± 1.13 to -0.54 ± 1.09 at visit 2, and to -0.44 ± 1.05 at visit 3, p < 0.001) and WFL z-scores (from -0.80 ± 1.30 to -0.71 ± 1.22 at visit 2, and to -0.64 ± 1.13 at visit 3, p = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%). Conclusions: In conclusion, eHCF was well-accepted and tolerated by an intended use population of infants ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction.

Factors affecting formula compliance of infants with IgE mediated cow's milk protein allergy during the pandemic.

Introduction: Cow's milk protein allergy (CMPA) is the most commonly encountered food allergy in the world, usually seen in infants under the age of 2 years. This study aims to determine the factors including COVID-19 affecting formula compliance of CMPA patients. Methods: This study is a prospective, observational study based on 10 different Paediatric Allergy-Immunology clinics in Turkey. Patients aged between 6 months and 2 years, who were followed up with IgE-mediated CMPA treatment or newly diagnosed and using breast milk and/or formula were included in the study. The sociodemographic characteristics of the patients, their symptoms, the treatments they received, and the effects of the COVID-19 pandemic on adherence to formula were evaluated with a questionnaire administered to the parents. Results: The compliance rate for formula-based treatment was 30.8% (IQR: 28.3, SD: 21.86). The number of patients with a single and multiple food allergy was 127 (51.6%) and 71 (28.9%), respectively. Breastfeeding duration, daily amount of prescribed formula and addition of sweetener to the formula were found to reduce compliance (p = 0.010, p = 0.003, and p = 0.004, respectively). However, it was determined that the patient's height, weight, age at diagnosis, and age of formula onset did not have a significant effect on compliance. Conclusion: It was found that the duration of breastfeeding, the increase in the daily amount of formula requirement, and the addition of sweeteners had adverse effects on formula compliance. There was no significant correlation between the formula adherence of CMPA patients and the pandemic.

The first serological detection of West Nile virus infection among residents living in northern Turkey.

BACKGROUND & OBJECTIVES: West Nile virus (WNV) is transmitted by a mosquito-borne virus whose natural reservoir is birds. Humans and horses are considered accidental hosts. Even if the vast majority of WNV infections in humans have asymptomatic or mild disease settings, serious neurological disorders with lethal outcomes can also be observed in around 1% of the cases. We aimed to serologically investigate the presence of WNV in humans living in Black sea of Turkey, and to obtain epidemiological data that will contribute to the implementation of public health policies to control and prevent potentially other life-threatening arboviral infections. METHODS: In the current study, a total of 416 human sera were collected from native patients of Samsun and its boroughs attending Samsun Training and Research Hospital; these sera were tested for WNV with pooling method, using anti-IgM and IgG ELISA commercial kits. All pools that were found positive for both IgM and IgG were individually retested for the detection of positive WNV sera. After that, all positive samples were tested using real-time PCR to detect the presence of WNV-RNA particles. RESULTS: Total seropositivity rates of WNV in terms of IgM and IgG were found as 0.96% and 0.72%, respectively. No presence of WNV-RNA could be detected in positive samples. INTERPRETATION & CONCLUSION: According to the data, further studies should be conducted to better understand the epidemiological dynamics of WNV in Turkey. It is recommended that other antigenically related flaviviruses which can give cross-reaction with WNV should also be investigated.

Palivizumab prophylaxis, respiratory syncytial virus and subsequent development of asthma.

BACKGROUND: Respiratory syncytial virus (RSV) infection is a disease commonly encountered during childhood and it may relapse. An experience in the early childhood would induce asthma development in the future. Palivizumab has a proven efficacy for the RSV prophylaxis so it may prevent asthma. Our aim was to evaluate the possible protective effect of palivizumab on the development of asthma by using the modified Asthma Predictive Index (mAPI). METHODS: This study's data consist of 339 children between 2 to 5 years of age followed up in healthy children unit from 2008 to 2011. Cases were evaluated in terms of wheezing frequency and characteristic features. Evaluations were performed among three groups; palivizumab-treated children born preterm (group 1), palivizumab-untreated children born preterm (group 2) and term newborn children (group 3) with equal number of patients in each group (N.=113). RESULTS: Frequency of the answers about children's experienced wheezing times was significant between groups (P=0.003). A significant difference was found between the groups in terms of the clinician who diagnosed asthma (P=0.045). The groups were compared in terms of the mAPI positivity and a significant difference was found among the groups (P=0.001). Group 1 had lowest and group 3 had highest positivity. Group 1 and group 3 were different (P=0.000), group 2 was found higher than group 1, but was similar to group 3 (P=0.628). CONCLUSIONS: This study supports the benefit of administration of palivizumab to premature children to reduce the risk of asthma development.

Association between Maternal and Infantile Markers of Cobalamin Status During the First Month Post-Delivery.

OBJECTIVE: Exclusively breast-fed infants born to vitamin B12 (cobalamin, cbl)-deficient mothers can develop symptoms within a few months following delivery. The authors aimed to assess the relationship between maternal and infantile markers of cbl status. METHODS: In 240 full-term infants (age, 2-30 d) admitted to Samsun Maternity and Child Health Hospital and their mothers, complete blood count testing and serum cbl, folate and plasma total homocysteine (tHcy) measurements were performed. In the mothers, serum ferritin and holotranscobalamin (holoTC) levels were measured additionally. RESULTS: Among the infants, 146 (60.8%) had cbl deficiency (serum cbl <259 pg/mL), whereas 184 (76.7%) mothers had a low cbl level (serum cbl <300 pg/mL). When cbl deficiency was defined as a serum holoTC level < 40 pmol/L, 152 (63.3%) mothers were found as deficient. In addition, 147 (61.3%) infants had an elevated tHcy level (>10 µmol/L), in 35 (23.8%) of these 147 infants tHcy level being markedly elevated (>20 µmol/L). None of the infants had folate deficiency. In the correlational analysis between maternal and infantile markers associated with cbl status, the strongest correlation was observed between maternal holoTC and infantile tHcy (r = -0.49, p < 0.001), followed by the correlation between maternal tHcy and infantile tHcy (r = 0.47, p < 0.001). The weakest correlations were found between maternal cbl and infantile cbl (r = 0.28, p < 0.001), and between maternal cbl and infantile tHcy (r = -0.25, p < 0.001). CONCLUSIONS: Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.

Hepatitis B seroprevalence in children and women and the impact of the hepatitis B vaccination program in the Black Sea Region of Turkey.

INTRODUCTION: This study aimed to determine the seroprevalence of hepatitis B virus (HBV) infection in children and females in the middle Black Sea Region of Turkey and to assess the impact of the universal infant hepatitis B vaccination program started in 1998. METHODOLOGY: The laboratory records of 12,057 patients who attended the Samsun Maternity and Children's Hospital between January 2007 and November 2009 were evaluated retrospectively. In this period, hepatitis B surface antigen (HBsAg), the antibody to hepatitis B surface antigen (anti-HBs), was studied from serum samples using the enzyme linked immunosorbent assay method. RESULTS: In the total population, HBsAg seropositivity was found to be 3.8% (456/12010); anti-HBs was 32.6% (3526/10800). HBsAg was 3.5%, in the 0-14 year age group, 8.2% in the 15-18 group, 3.3% in the 19-49 group, and 8.0% in the over 49 group. The seropositivity of HBsAg decreased by half in patients between zero and 14 years of age (4.2%) who were included in the universal vaccination program when compared with those in the 15-18 year group (8.2%) who were not included in the program. There was a significant difference in HBsAg seropositivity between boys (5.8%) and girls (3.9%) (p <0.05). CONCLUSIONS: According to the hepatitis B seroprevalence records of our region, HBsAg was 3.5% in the 0-14 year age group, 8.2% in the 15-18 year group. It may therefore be suggested that, since 1998, the vaccination program in our region has been successful.

Hallucination development with montelukast in a child with asthma: case presentation.

Leukotriene receptor antagonists(montelukast) have been used for many years in the treatment of asthma both acute and chronic stages. They are accepted commonly as safe but mostly possible side effects are ignored. However, montelukast also could lead to important adverse reactions like hallucinations. In literature only 2 reports have been found about hallucinations with it. One is a study which reports 3 patients from 48 children and the other is a 29 year-old case report. In our case, psychiatric adverse reactions of montelukast,especially hallucinations are reported similarly. We are presenting a child who had visual hallucinations after starting to use montekulast and after stopping the medicine these complaints disappeared in 48 hours. Although it is a safe drug, it should not be forgotten that it has psychiatric side effects which may be missed easily especially in children.

Herpes simplex type I infection and atopy association in Turkish children with asthma and allergic rhinitis.

This study investigated the association between HSV-1 infection and atopy by comparing seropositivity to HSV-1 in atopic children with asthma and allergic rhinitis and in non-atopic children. Totally 249 children randomly selected from the university outpatient pediatric clinics were prospectively enrolled in the study between September 1 and November 30, 2007. Serum samples were examined using the virus neutralization test (VNT) for HSV-1 Immunoglobulin G(IgG) seropositivity. Skin prick tests (SPTs) were performed to determine atopic status. The results showed that HSV-1 IgG seropositivity was significantly higher in atopic children (56.8%) with asthma and allergic rhinitis than in the age-matched non-atopic children group (30.4%) (p<0.001). Although the occurrence of atopy was higher in seropositive girls (57%) than in seropositive boys (47%), the difference was not significant (p=0.329). These results support a possible relationship between the atopic status of children with asthma and allergic rhinitis and HSV-1 infection.

The efficacy of montelukast monotherapy in moderate persistent asthmatic children.

Although current guidelines place single leukotriene receptor antagonists use as a therapeutic option in mild persistent asthma, there is still uncertainty about its place. In this study efficiency of montelukast monotherapy in children with moderate persistent asthma was evaluated. Children (age 6 to 16) with persistent moderate asthma were treated prospectively with budesonide combined with montelukast (n=20), or only montelukast (n=15) during six months. Asthma symptoms and exacerbations were obtained from diary data. This study suggests that both treatments were effective and well tolerated. It could be concluded that sole montelukast treatment in children with moderate persistent asthma is effective.

Distribution of HSV-1 IgG antibodies by two methods comparing in Turkish atopic children.

Herpes Simplex Virus Type 1 (HSV-1) is a ubiquitous pathogen. Other than known diseases, HSV-1 may have an important role in the pathogenesis of atopy by causing immortality of th2 cells. From June 1st to July 31st 2006, seventy five blood samples were collected from atopic children referred to the allergy clinic of the hospital. The bloods samples were used to detect HSV-1 IgG antibodies by Enzyme-Linked Immunosorbent Assay and Virus Neutralization Test. HSV-1 IgG antibody seroprevalence in atopic children was found high, 62.6% by Enzyme-Linked Immunosorbent Assay and 57.3% by Virus Neutralization Test. Thus Virus Neutralization Test sensitivity was 92.15% and specificity was 100% regarding to the Enzyme-Linked Immunosorbent Assay technic. Although Enzyme-Linked Immunosorbent Assay was more sensitive than Virus Neutralization Test, there was no significant difference between two technics (p > 0.05) in detecting HSV-1 IgG antibodies in serum.