The association of obesity and obesity-related conditions with carotid extra-medial thickness in children and adolescents.

BACKGROUND: Carotid extra-medial thickness (EMT) and carotid intima-media thickness (cIMT) provide information concerning vascular changes. OBJECTIVES: In this study, we aimed to evaluate the association between carotid EMT and obesity and its metabolic complications in children. METHODS: The study included 38 obese subjects and 30 age-matched and sex-matched healthy controls aged between 7 and 17 years. For all subjects, complete blood count, fasting blood glucose, serum insulin, aspartate aminotransferase, alanine aminotransferase, HDL cholesterol, total cholesterol and triglyceride levels were measured. The carotid EMT and cIMT were measured by an expert radiologist in all patients. RESULTS: Body mass index (BMI) (28.8 ± 3 vs. 18.1 ± 2.2, p < 0.001), total cholesterol (167.9 ± 34.8 mg dL-1 vs. 150.5 ± 28.1 mg dL-1 , p = 0.029), homeostatic model assessment of insulin resistance (HOMA-IR) (4.3 vs. 1.7, p < 0.001), cIMT (0.51 ± 0.08 mm vs. 0.45 ± 0.06 mm, p < 0.001) and carotid EMT (0.74 ± 0.11 mm vs. 0.64 ± 0.1 mm, p < 0.001) were significantly higher in obese subjects than in controls, while HDL cholesterol (41.6 ± 6.5 mg dL-1 vs. 49.5 ± 7.5 mg dL-1 , p < 0.001) was lower in obesity group. Among the obese subjects, the HOMA-IR values (4.7 vs. 3.6, p = 0.027), cIMT (0.54 ± 0.07 mm vs. 0.49 ± 0.07 mm, p = 0.039) and carotid EMT (0.79 ± 0.1 mm vs. 0.7 ± 0.1 mm, p = 0.013) were significantly higher in post-pubertal children compared with prepubertal children. BMI, cut-off values of HOMA-IR and cIMT were significantly associated with increased carotid EMT (p < 0.001, p = 0.023 and p < 0.001, respectively). The only independent risk factor affecting carotid EMT was BMI (p < 0.001). CONCLUSION: We have found that carotid EMT is associated with cIMT, obesity and insulin resistance and the assessment of carotid EMT may provide additional information concerning early vascular disease.

Confirmed penicillin allergy among patients receiving benzathine penicillin prophylaxis for acute rheumatic fever.

BACKGROUND: Beta-lactam antibiotics are the most frequent drugs prescribed in children worldwide. Acute rheumatic fever (ARF) is the major cause of acquired heart disease among children and adolescents. Recurrences due to inadequate penicillin prophylaxis are responsible for chronic valvular lesions requiring surgery. The fear of a severe allergic reaction is the leading cause of discontinuing prophylaxis. OBJECTIVE: In this study, we aimed to reveal the frequency of adverse events and real allergic reactions to benzathine penicillin among children who are followed in our paediatric cardiology clinic with a diagnosis of ARF. MATERIALS METHODS: The children who were followed with a diagnosis of ARF between January 2005 and December 2011 were searched for a history of penicillin allergy. Patients with a positive history were evaluated in our paediatric allergy clinic. Skin tests and provocation tests were performed with parental consent. RESULTS: In total 535 children with a diagnosis of ARF were analysed for the study. Median follow up period was 24 months (12-36) [median (%25-75)]. Eleven of our 535 (11/17.641 injection) ARF patients were suspected to have allergic reactions after 17.641 penicillin injections but only one (0.18%) was diagnosed to have penicillin allergy after detailed evaluation. CONCLUSION: Our data suggest that the frequency of penicillin allergy is much lower than suspected among children on penicillin prophylaxis for ARF. Consequently, penicillin prophylaxis should not be given up without proper evaluation of drug allergy.

The relationship between gastro-oesophageal reflux disease and asthma during childhood.

BACKGROUND: The relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD. METHOD: Subjects who were evaluated by 24h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE. RESULTS: A total of 204 subjects (49.5% male) with a mean age of 7.8±4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p=0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p=0.001). CONCLUSION: Although, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.

The effect of oral contraceptives on current wheezing in young women.

BACKGROUND: Emerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults. METHODS: A questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis. RESULTS: A total of 487 subjects aged between 11.3 and 25.6years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25-4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year. CONCLUSION: Young women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health.

Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey.

BACKGROUND: Food allergy, which becomes an important public health problem, can lead to important morbidity and mortality. Patients with food allergies are more likely to first present to their primary care physicians. We aimed to determine the knowledge of primary care physicians with regard to management of food allergies and anaphylaxis. METHODS: Primary care physicians were surveyed via a questionnaire aimed to document their knowledge and attitudes about food allergy and anaphylaxis management. RESULTS: A total of 297 participants completed questionnaires, 55.6% of which were female. Participating physicians had a mean of 17.0 ± 6.1 years of experience. Participants answered 47.2% of knowledge-based items correctly. Overall, participants fared poorly with regard to their knowledge on the treatment of food allergies and anaphylaxis. For example while 60.7% knew that a child can die from the milk allergy reaction, only 37.5% were aware that a child with IgE mediated milk allergies cannot eat yoghourts/cheese with milk. Besides, 53.1% of them chose epinephrine as their first treatment of choice in case of anaphylaxis, yet only 16.6% gave the correct answer about its dosage. Nearly a third of participants (36.7%) felt they were knowledgeable enough regarding the management of patients with food allergies, while 98.2% extended their request for future periodic educational meetings on allergic disorders. CONCLUSION: Knowledge of food allergy and anaphylaxis among primary care physicians was unsatisfactory. Provision or periodic educational programmes should be aimed at improving the standard of practice as acknowledged by the participants.

Hydrocortisone acetate alone or combined with mupirocin for atopic dermatitis in infants under two years of age - a randomized double blind pilot trial.

BACKGROUND: The skin of patients with atopic dermatitis (AD) is heavily colonized with Staphylococcus (S.) aureus, even at uninvolved sites. Toxins secreted by the majority of S. aureus on the skin behave as superantigens and can directly influence the disease activity, although clinical signs of bacterial superinfection might be absent. OBJECTIVES: This study was conducted to compare the efficacy of hydrocortisone cream, combined with mupirocin or alone with emmolient ointment for the treatment of mild to moderate AD in infants between six months and two years of age. MATERIALS AND METHODS: A total of 83 patients with mild to moderate AD were randomized to receive hydrocortisone, hydrocortisone+ mupirocin or emmolient ointment twice daily in one week and followed-up for 8 weeks, in a blind study. Efficacy evaluation made by SCORAD and eczema area and severity index (EASI) at baseline, day 7, and weeks 2, 4, and 8. Possible adverse events were recorded to evaluate safety. RESULTS: At the end of study, 65% (17 of 26) of the patients were treated successfully with hydrocortisone ointment based on SCORAD and EASI scores. Also there was a significant improvement in patients combined with mupirocin ointment [74% (20 of 27)]. The percent improvement from baseline in EASI scores was also significantly greater in hydrocortisone and combined group compared with emmolient-treated patients (36%) (p = 0.0187, p = 0.012 respectively). CONCLUSIONS: Monotherapy with hydrocortisone ointment is the main treatment in infants with mild to moderate AD and combination with mupirocin is safe and effective often needed because of possible Staphylococcus carriage.

The prevalence of allergic contact sensitization of practicing and student nurses.

BACKGROUND: Contact dermatitis (CD) is a significant problem among nurses. Although there are reports about the prevalence of CD from different parts of the world, data about its frequency in Turkey and about allergic contact sensitization among nurses is insufficient. OBJECTIVE: To define the frequency and patterns of allergic contact sensitization and related symptoms in practicing and student nurses. METHODS: There were 123 nurses in our hospital practicing in the in-patient clinics. All were invited to participate in the study. 69 working-in nurses and 79 student nurses participated in the study. The main reason for refusal of nurses was that they were usually having a shower daily after a hard working day and they had to postpone having a bath for 3 days if they had a patch test on their back. A ready-to-use patch test system (TRUE test(R)) with 29 standardized test substances was applied to all of the participants. History about symptoms of CD and allergic diseases was investigated by questionnaire. RESULTS: While 34.8% (24/69) of practicing nurses had symptoms of CD, 19% (15/79) of student nurses reported the symptoms (p = 0.039). The most prevalent positive reaction was to nickel sulfate followed by thimerosal. There was no difference for positive reaction rates between practicing and student nurses. Nurses who had symptoms of CD were older than those without symptoms (p = 0.003). The participants with symptoms of CD were more frequently from practicing nurses (p = 0.047). CONCLUSION: CD is more frequent in practicing nurses than student nurses; allergic contact sensitization is not. This may be attributed to the length of occupation that is also correlated well with the length of exposure to the occupational irritants.