Predictive Value of Neutrophil-Lymphocyte Ratio and Other Inflammation Indices in Febrile Seizures in Children.

Objective: There is increasing evidence for the effect of inflammation on the etiology of febrile seizure (FS) patients. We aimed to investigate the role of easily accessible inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte-platelet ratio (NLPR), and pan-immune-inflammation value (PIV) in febrile seizure. Methods: A total of 300 children, including 100 with febrile convulsions (FS), 100 febrile controls (FCs), and 100 healthy controls (HCs), were included in this retrospective study. The FS group was compared with the FC and HC groups in terms of these inflammatory indexes. Results: Between the FS group and the FC group, the neutrophil count was significantly higher in the FS group (p = 0.001) and the lymphocyte count was significantly lower (p < 0.001). The NLR (p < 0.001), SII (p < 0.001), SIRI (p < 0.001), NLPR (p < 0.001), and PIV (p < 0.001) were significantly higher in the FS group than in both the FC and healthy control groups. The optimal cut-off values for predicting FS in febrile conditions were 3.59> for NLR, >870.47 for SII, >1.96 for SIRI, 0.96> for NLPR, and >532.75 for PIV. Conclusions: The inflammatory indices are inexpensive, easily accessible hematological markers that can contribute to the diagnosis of FS.

Evaluation of Growth in Children with Inflammatory Bowel Disease.

OBJECTIVE: This study aimed to evaluate changes in growth parameters in children diagnosed with inflammatory bowel disease (IBD). METHODS: The data of children with IBD between 2010 and 2018 were retrospectively reviewed. Anthropometric measurements (height, weight, and BMI [body mass index]), and clinical and laboratory data were evaluated at diagnosis and follow-up (1st and 2nd year). Patients' growth was assessed by calculating weight-for-age, height-for-age, BMI-for-age, and growth velocity z-scores. RESULTS: Thirty-six patients (46.2%) had Crohn's disease (CD), and 42 (53.8%) had ulcerative colitis (UC). Weight-for-age, height-for-age, and BMI-for-age z-scores significantly increased over the follow-up period in the CD patients (p < 0.05). Growth velocity z-scores were also significantly higher in the second year compared to the first year in the CD patients (p < 0.001). Improvements in weight-for-age, height-for-age, and BMI-for-age z-scores were not significant over the two-year follow-up in the UC patients (p > 0.05). Growth velocity z-scores in the UC patients were higher in the second year compared to the first year, but this difference was not significant (p = 0.115). CONCLUSIONS: The growth parameters showed improvement after a two-year follow-up. Regular anthropometric measurements, along with clinical and laboratory markers, should be used to monitor treatment response, which can help achieve optimal growth in children with IBD.

The Skin Sebum and Moisture Levels of Children with Allergic Diseases: How Predictive Are They for House Dust Mite Allergy?

The aim was to evaluate the prediction of house dust mite allergy in children diagnosed with allergic disease based on their skin moisture and sebum levels. This is a case-control study including children with asthma, allergic rhinitis (AR), and atopic dermatitis (AD) and a healthy control group. The participants' skin moisture and sebum levels were measured non-invasively using a digital device. A total of 421 patients and 143 healthy children were included. The median value of skin moisture percentage was statistically significantly lower in asthma, AR, and AD patients compared to the control group (p < 0.001 for each). The median value of skin sebum percentage was significantly lower in asthma and AD patients compared to the control group (p = 0.002 and p = 0.003, respectively). ROC analysis was performed to assess the predictive value of skin moisture percentage for house dust mite allergy in respiratory allergic diseases (asthma and AR) and AD separately. Using a cut-off point of 35.5% for skin moisture in asthma and AR patients, the sensitivity and specificity were 81.3% and 56.5%, respectively. Although the specificity is low, the high sensitivity value is promising. The non-invasive measurement of skin sebum and moisture could provide convenience to clinicians in the diagnosis and management of allergic diseases.

Evaluation of Sleep Quality in Asthmatic Children with the Paediatric Sleep Questionnaire (PSQ).

Considering the high prevalence of sleep-related breathing disorders (SRBD) in asthmatic patients, we aimed to compare asthmatic children and healthy children in terms of SRBD according to Paediatric Sleep Questionnaire (PSQ) scores. A questionnaire covering sociodemographic characteristics of the patients and the PSQ, which evaluates sleep quality and consists of 22 questions, was administered. During the data collection process, 180 patients in the patient group and 170 patients in the control group were included. The patient group showed statistically significantly higher total scores and subscale scores for snoring, sleepiness, and inattention compared to the control group. Statistically significant correlations were found between the sleepiness subscale and body mass index z score in a negative direction and between age at presentation and duration of asthma in a positive direction. Our findings endorse employing the PSQ as a screening instrument in the outpatient environment to ensure timely referral of asthma patients to a sleep specialist for SRBD evaluation. Considering the widespread occurrence of snoring and asthma, this tool could aid in identifying patients with an elevated risk of SRBD and expedite the scheduling of nocturnal polysomnography for these children.

Seasonal pattern of emergency department visits by children with asthma.

Background: It is important to understand the factors associated with seasonal asthma attacks among children so we can evaluate them appropriately. Aim: The study examined the seasonal variation of asthma-related emergency department visits by children in Istanbul. Methods: This descriptive study examined all paediatric patients with asthma who visited the paediatric emergency department of a tertiary hospital in Istanbul, Türkiye, between January 2017 and December 2022. Asthma diagnosis was based on physical examination and clinical history of the patients and asthma-related visits during winter, spring, summer, and autumn were considered repeated measurements. Data analysis was done using SPSS 25.0. Results: Visits by asthmatic children to the emergency department constituted 4.9% of all visits. Some 56.9% of the asthmatic children were male and 43.1% were female. Asthma-related emergency department visits were 10.4% in 2017 and 3.6% in 2022. Visits to paediatric emergency departments due to asthma decreased from 19 685 in 2017 to 7485 in 2022. Between 2017 and 2022, children aged 0-5 years represented the highest proportion of visits (64-72.8%). Asthmatic children aged 0-5 years and 6-11 years were admitted to the hospital mostly in January (13.5%, 13.5%) and December (12.8%, 14.0%). In the age group 12-18 years, the visits occurred mostly in January (11.9%) and March (11.2%). Conclusion: The frequency and number of asthma-related visits to the paediatric emergency department decreased over the 6-year period of this study. There were increases in visits in October, November, December, and January, and decreases in June, July and August.

Evaluation of the predictive value of total IgE and absolute eosinophil levels on allergy test positivity.

OBJECTIVE: Atopic diseases are the most common chronic conditions in childhood. The best treatment for allergic disease is possible with early diagnosis. The purpose of the study was to assess the predictive value of total immunoglobulin E (IgE) and eosinophil levels for allergy test positivity in patients diagnosed with asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). METHODS: Pediatric patients between 0 and 18 years old diagnosed with asthma, AR, AD, and FA were included in the study. Demographic characteristics of the patients, total IgE, eosinophil (absolute and %) values, specific igE (SPIGE), and skin prick test (SPT) results were recorded. RESULTS: The data of 2665 patients were evaluated in the study. Of the patients, 58.6% were male, whereas 41.4% were female. The median age of the children was significantly higher both in SPT-positive and SPIGE-positive patients (p<0.001). If the criteria positivity is accepted as total IgE value is ≥104.5 (for AD: 86.5, asthma: 116.5, AR: 120.5, FA: 42.5) and absolute eosinophil ≥500 and/or eosinophil (%) ≥5%; test positivity was higher for each disease and all patients (p<0.001). CONCLUSION: Total IgE and eosinophil levels can be used to identify atopy in patients with symptoms of AD, asthma, and AR. Total IgE and eosinophil values are suitable and easily obtainable parameters for better evaluation of health-care resources for the diagnosis and follow-up of atopic illnesses.

Retrospective evaluation of adverse reactions after subcutaneous allergen-specific immunotherapy in children with house dust mite allergy.

OBJECTIVE: Although it is accepted as an effective and safe treatment way, side effects can be observed as a result of subcutaneous immunotherapy (SCIT). In our study, it was aimed to evaluate the local and systemic reactions in children after SCIT and the factors that may be associated with these reactions. METHODS: Our study included 138 house dust mite allergic patients with asthma and/or allergic rhinitis who underwent SCIT in the Pediatric Allergy and Immunology Outpatient Clinic between November 2013 and April 2022. Sociodemographic, clinical, laboratory features, and development of adverse reactions after SCIT were analyzed from patient files. RESULTS: The median age of 138 patients was 9.0 years. About 56.5% (n=78) were male, 43.5% (n=60) were female. Of the patients, 55.1% (n=76) had asthma and allergic rhinitis. A total of 7366 SCIT injections were administered to all patients in our clinic. The total number of observed adverse reaction was 118. 50.7% of the patients (n=70) experienced at least one adverse reaction after SCIT. The rate of development of adverse reactions per injection was 1.6% (local: 1.0%, large local: 0.1%, systemic: 0.5%). CONCLUSION: Although serious systemic reactions and death were not observed in our patients; care should be taken in terms of the development of adverse reactions during SCIT in children.

The Effect of House Dust Sensitization on Skin Sebum and Moisture in Children with Allergic Respiratory Diseases.

This study aimed to investigate the levels of skin moisture and sebum in children with a house dust allergy without skin symptoms. This was a case-control study involving children, aged 0-18 years, who were being followed up for an allergic airway disease in a pediatric allergy clinic. Age, gender, hemogram parameters, and IgE values were evaluated. The skin moisture and sebum percentages of the patients and control group were measured by a non-invasive bioimpedance method using a portable digital skin moisture and sebum measurement device on the cubital fossa. The median value of the skin moisture percentage in the house dust mite allergy-positive patient group was significantly lower than that in the house dust mite allergy-negative patients and the control group (p < 0.001). The house dust mite allergy-positive patient group had the lowest skin sebum content. However, there was no statistical significance among the groups in terms of skin sebum percentage (p = 0.102). In the study, children with a house dust allergy were found to have lower levels of skin moisture and sebum. The regular use of moisturizers for children with a house dust allergy should be kept in mind as an effective solution to protect the skin barrier and reduce skin symptoms.

Evaluation of Neuropsychiatric Effects of Montelukast-Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis.

Drug-induced neuropsychiatric effects are important for disease management. We aim to evaluate the neuropsychiatric effects of montelukast-levocetirizine combination therapy in children. This descriptive study was conducted with children aged 2-5 years, diagnosed with asthma and allergic rhinitis, who began to receive montelukast and levocetirizine combination therapy. The respiratory and asthma control test for children (TRACK), Rhino Conjunctivitis Scoring System (RCSS), and common neuropsychiatric effects (irritable behavior, hallucinations, headaches, nightmares, sleep disorders, behavioral and mood disorder, restlessness, depression) were ascertained by the questionnaire applied before and 4 weeks after the treatment. Parents answered on behalf of their children. The most common finding before and after treatment was irritable behavior. While irritable behavior was observed in 82.4% (n = 56) of children before the treatment, this percentage was 63.2% (n = 43) after the treatment (p = 0.004). The percentage of children who developed at least one neuropsychiatric symptom after treatment was 22.1% (n = 15). There was no significant effect of age, gender, RCSS, TRACK, or allergy test positivity on the development of neuropsychiatric symptoms (p > 0.05). According to the results, at least one neuropsychiatric finding developed in approximately one in five children. Identifying risk factors will enable more careful treatment or consideration of alternative treatments for children at higher risk in the clinical follow-up period.

Does the severity of diabetic ketoacidosis in children with type 1 diabetes change during the COVID-19 pandemic? A single-center experience from a pediatric intensive care unit.

OBJECTIVE: During the COVID-19 pandemic, health-care services for diseases other than COVID-19 were interrupted, and patient referrals to health institutions were postponed due to their fear of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and laboratory findings of COVID-19 in patients with Type 1 Diabetes Mellitus (T1DM) hospitalized in our pediatric intensive care unit (PICU) with the diagnosis of diabetic ketoacidosis (DKA) during the pandemic period, and the impact of the pandemic on these findings. METHODS: We retrospectively evaluated 55 children aged from 1 month to 18 years old, diagnosed with DKA, and followed up at Istanbul Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital PICU between April 2020 and December 2021. RESULTS: A total of 55 patients with DKA as a complication of T1DM were admitted to the PICU during the COVID-19 pandemic. While there was no significant difference in pH and HCO3 values between those with newly diagnosed T1DM and those with previously-diagnosed T1DM, the HbA1c ratio of newly diagnosed DMs was significantly higher. Of the 55 patients, 4 were COVID-19 PCR positive, and two patients had COVID-19 antibody positivity. When COVID-19 positive patients were compared with negative patients, no significant difference was found between the hospital stay, glucose, HbA1c, lactate, pH, and HCO3 values. CONCLUSION: Higher HbA1c levels of newly diagnosed patients presenting with DKA may be associated with delayed admission to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed patients with T1DM. In conclusion, our results, emphasize the importance of physician's and family's awareness of the symptoms of diabetes in terms of early diagnosis and prevention of DKA during public health measures due to COVID-19.