Total oxidant and antioxidant status and paraoxonase 1 levels of children with noncystic fibrosis bronchiectasis

Background/aim: To evaluate total oxidant status (TOS), total antioxidant capacity (TAC), and paraoxonase 1 (PON1) levels in children with noncystic fibrosis (CF) bronchiectasis (BE), and to compare these levels with those of healthy controls. The study parameters were also evaluated according to some demographic, anthropometric, and clinical characteristics, as well as lung functions. Materials and methods: Enrolled in the study were 118 children with non-CF BE and 68 healthy controls. Serum TOS, TAC, and PON1 levels were determined. Lung function tests were performed by spirometry. Results: Serum TOS was higher in the patients [median 9.54 (IQR 25­75 = 7.05­13.30) µmol H2O2 Eq/L] than in the healthy subjects [6.64 (5.45­9.53) µmol H2O2 Eq/L] (P < 0.001). TAC was higher in patients with non-CF BE [1.07 (1.0­1.07) mmol Trolox Eq/L] than in the healthy controls [0.87 (0.77­0.98) mmol Trolox Eq/L] (P < 0.001). In addition, serum PON1 levels were significantly higher in the patients [106.5 (42.5­154.2) U/L] than in the controls [47.7 (27.5­82.1) U/L] (P < 0.001). The patients with low FEV1 had decreased TAC when compared to those who had normal FEV1 in non-CF BE. Conclusion: The present study demonstrated that compared with the control group the children with non-CF BE had elevated oxidative status, antioxidant defenses parameters, and PON1 values.

Effect of montelukast monotherapy on oxidative stress parameters and DNA damage in children with asthma.

BACKGROUND: There is ample knowledge reported in the literature about the role of oxidative stress in asthma pathogenesis. It is also known that the interaction of reactive oxygen species with DNA may result in DNA strand breaks. The aim of this study was to investigate if montelukast monotherapy affects oxidative stress and DNA damage parameters in a population of pediatric asthma patients. METHODS: Group I consisted of 31 newly diagnosed asthmatic patients not taking any medication, and group II consisted of 32 patients who had been treated with montelukast for at least 6 months. Forty healthy control subjects were also enrolled in the study. Plasma total oxidant status (TOS) and total antioxidant status (TAS) were measured to assess oxidative stress. DNA damage was assessed by means of alkaline comet assay. RESULTS: The patients in both group I and group II had statistically significant higher plasma TOS (13.1 ± 4 and 11.1 ± 4.1 µmol H2O2 equivalent/liter, respectively) and low TAS levels (1.4 ± 0.5 and 1.5 ± 0.5 mmol Trolox equivalent/liter, respectively) compared with the control group (TOS: 6.3 ± 3.5 µmol H2O2 equivalent/liter and TAS: 2.7 ± 0.6 mmol Trolox equivalent/liter; p < 0.05). DNA damage was 18.2 ± 1.0 arbitrary units (a.u.) in group I, 16.7 ± 8.2 a.u. in group II and 13.7 ± 3.4 a.u. in the control group. There were statistically significant differences only between group I and the control group (p < 0.05). CONCLUSIONS: According to the findings, montelukast therapy makes only minimal but not statistically significant improvement in all TOS, TAS and DNA damage parameters.

Response to Disodium Etidronate Treatment in Three Siblings with Pulmonary Alveolar Microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic genetic lung disease in childhood with no proven therapy. It is characterized by the deposition of calcium phosphate microliths within the alveolar air spaces. The effect of disodium etidronate (DE) treatment on PAM is controversial. We report 3 siblings (an 11-year-old boy and 4-year-old twin girls) with PAM diagnosed by chest X-ray, thoracic high-resolution computed tomography, technetium-99m bone scan and bronchoalveolar lavage fluid findings. After the administration of DE (200 mg/day) for a 1-year period, 2 siblings showed radiological improvement, while 1 sibling did not. No drug side effects were observed within the treatment period.

Tuberculin skin test positivity without tuberculosis contact: A major challenge in childhood.

AIM: Worldwide, tuberculin skin tests (TSTs) commonly give false positive results for those who had been given the Bacillus-Calmette-Guerin vaccine such as is routinely administered in Turkey. This study aimed to evaluate the patients referred to us who had positive TSTs despite lack of tuberculosis (TB) disease contacts. METHODS: Between September 2011 and September 2012, 183 patients were prospectively evaluated for differential diagnosis of TST positivity despite lack of TB disease contact. They were then followed up by us to determine an accurate diagnosis. RESULTS: Among our patients' most common symptoms indicating a need for TST were chronic cough, productive cough or sputum expectoration, and recurrent or persistent wheezing. Chest x-rays were taken of all patients, and the findings were noted. Interferon gamma release assays were performed on 75% of the patients, of which 96% were negative for TB. The most common final diagnoses were asthma (44%), allergic rhinitis (13%), bronchopneumonia (11%) and reactive lymphadenitis (6.5%). Further evaluations for TB were required of 36 patients, and TB disease was established in 12 of them (6.5%). CONCLUSIONS: In patients who had had no known TB contact, the most common symptom indicating need for TST was chronic cough; the most common diagnoses were asthma and allergic rhinitis. Cavitary lesions, haemoptysis, persistent infiltration, pleural effusion and thoracic lymphadenopathy despite antibiotherapy should alert physicians to the possibility of TB.

Can appropriate diagnosis and treatment of childhood asthma reduce excessive antibiotic usage?

INTRODUCTION: This study compared the frequency of antibiotic usage and the number of asthma episodes before and after the diagnosis and treatment of pediatric asthma patients who were followed up by specialists. SUBJECTS AND METHODS: Included in this study were 334 patients (211 males and 123 females) of 2-16 years of age who were diagnosed with asthma and followed up for at least 1 year in our clinic. The frequency of antibiotic usage and the number of asthma episodes in the year prior to diagnosis and treatment were compared to these same variables after 1 year of follow-up by specialists. RESULTS: The median age was 84 months (range: 24-192) and 212 (63%) children were at school or in day care centers. Atopy and a family history of asthma were present in 200 (60%) of the patients, and 137 (41%) reported that at least one member of their household smoked. Antibiotics were used a median number of 7 times [interquartile range (IQR) = 6] in the year before the asthma diagnosis, and 2 times (IQR = 3) during the year after treatment (p < 0.001). The mean number of asthma episodes before diagnosis, i.e. 4 (IQR = 8) was reduced to 0 (IQR = 2) in the year after treatment when the patients were followed up by specialists (p < 0.001). CONCLUSION: This study shows that appropriate diagnosis and treatment of childhood asthma significantly reduce the frequency of antibiotic usage and the number of asthmatic episodes.

Serum paraoxonase 1 activity and oxidative stress in pediatric patients with pulmonary tuberculosis.

OBJECTIVES: The aim of this study was to determine the oxidative stress and paraoxonase 1 (PON1) levels in children with pulmonary tuberculosis (TB) compared to healthy controls, and to examine the association of demographical with oxidative stress. SUBJECTS AND METHODS: Forty children diagnosed with pulmonary TB and 40 age- and gender-matched healthy controls were enrolled in the study. Serum total antioxidant status (TAS), total oxidant status (TOS) and PON1 levels were measured. The oxidative stress index (OSI) was calculated to indicate the degree of oxidative stress. RESULTS: The TAS levels were lower (1.73 ± 0.5 vs. 2.54 ± 1.2 µmol Trolox Eq/l) while TOS levels were significantly higher (26.9 ± 14.4 vs. 13.4 ± 7.7 µmol H2O2 Eq/l) in the TB group than in the controls (p < 0.001). The OSI was significantly higher in the TB group than in the controls (21.2 ± 5.1 vs. 6.5 ± 4.9 units, p = 0.006). Serum PON1 levels were significantly lower in the TB group than in the controls (14.2 ± 13.2 vs. 28.4 ± 17.3 U/l, p < 0.001). The lower PON1 levels correlated with TAS and OSI levels but not with anthropometric parameters (r = 0.264, p = 0.018 and r = -0.255, p = 0.023, respectively). CONCLUSION: The TOS and OSI levels were higher and the TAS and PON1 levels were lower in pediatric patients with pulmonary TB when compared to healthy controls. This indicates greater oxidative stress in the patients.

Rare case of an abdominal mass presenting as acute abdomen: torsion of the vermiform appendix.

Torsion of the vermiform appendix is a rarely observed acute abdominal emergency. The clinical manifestations are similar to acute appendicitis. It should be included in the differential diagnosis if a patient presents with intermittent abdominal pain and an acute abdominal emergency. Here, we describe a 4-year-old male patient with a mass located in the right lower abdominal quadrant, whose clinical findings were consistent with an acute abdomen. The gangrenous appendix was found in the pelvic cavity and its stump was twisted clockwise. A 1.5-cm fecalith was detected in the appendix lumen and appendectomy was performed.

Tobacco use among working adolescents and high school students in Turkey: evaluating the effect of the national tobacco control policy.

BACKGROUND: In our previous published study conducted in 2006 before the national tobacco control program (NTCP), we found that working adolescents (WA) more frequently consumed cigarettes than high school students (HSS). The objective of the present study was to compare the smoking status of WA and HSS before and after the NTCP. METHODS: A questionnaire including questions about the participant`s socio-economic level and smoking status was administered. RESULTS: There were 668 subjects in the 2006 study and 869 subjects in the 2015 study. When we compared the 2015 results with the 2006 study, while there was a significant decline in the ever smokers (p < 0.001), there was no difference in current smokers in both the female and male WA groups. In the HSS group, there was a significant decline in ever smokers (p < 0.01), for both females and males. While there was a significant decline in current female smokers (p=0,002), no significant decrease was found in current male smokers (p > 0.05) in the HSS group. CONCLUSIONS: After the initiation of the NTCP, we have not seen a reduction in the smoking rates of both female and male WA and male HSS. The NTCP should particularly focus on the adolescent group in Turkey.

Evaluation of nasal fluid ß-defensin 2 levels in children with allergic rhinitis.

AIM: Knowledge about the role of the innate immune system in the pathogenesis of allergic diseases has been expanding in recent years. Defensins are antimicrobial peptides that are components of the innate immune system. Defensins have strong efficacy against bacterial, viral, and fungal infections. Moreover, they have regulatory functions in many physiologic processes such as antitumoral immunity, chemotaxis, inflammation, and wound healing. In this study, we aimed to investigate ß-defensin 2 levels in the nasal fluids of children with allergic rhinitis. MATERIAL AND METHODS: Study and control groups consisted of 28 patients with newly diagnosed allergic rhinitis who were not taking any medication, and 23 healthy children. Skin prick tests were performed on patients with allergic rhinitis and disease severity was assessed using the total symptom score. Nasal fluid samples were obtained using a modified polyurethane sponge absorption method from patients and control subjects. Nasal fluid ß-defensin 2 levels were determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The median value of nasal fluid ß-defensin 2 levels were 173.8 pg/mL (interquartile range; 54.8-205.9 pg/mL) in allergic rhinitis group and 241.6 pg/mL (163.5-315.2 pg/mL) in the control group. There was a statistically significant difference between the two groups (p=0.01). Moreover, nasal fluid ß-defensin 2 levels showed a significant negative correlation with total symptom scores (rho= -0.78, p<0.001). CONCLUSIONS: Children with allergic rhinitis have reduced nasal fluid ß-defensin 2 levels compared with controls, and ß-defensin 2 levels were negatively correlated with disease severity. A more definite understanding of the roles of defensins and other antimicrobial peptides in allergic inflammation can open up new horizons in the management and treatment of these common diseases.

CD163 levels, pro- and anti-inflammatory cytokine secretion of monocytes in children with pulmonary tuberculosis.

OBJECTIVES: Childhood tuberculosis (TB) comprises an important part of the world's TB burden. Monocytes set up the early phase of infection because of innate immune responses. Understanding the changes in monocyte subsets during multisystem infectious diseases may be important for the development of novel diagnostic and therapeutic strategies. The aim of this study was to evaluate the monocyte phenotype together with the cytokine secretion profiles of children with pulmonary tuberculosis. STUDY DESIGN: Thirteen patients with pulmonary TB were enrolled as study group, and 14 healthy subjects as control group. Surface expressions of CD16, CD14, CD62L, CD163, CCR2, and HLA-DR of monocytes were analyzed by flow cytometry. The presence of IFN-γ, TNF-α, IL-10, IL-12, IL-23, and soluble form of CD163 (sCD163) in the antigen- and LPS-stimulated whole blood culture supernatants were detected using ELISA and Luminex. RESULTS: Higher percentages of CD14++ CD16+ and CD14+ CD16++ monocyte subsets, and CCR2, CD62L and CD163 expression on circulating monocytes in children with pulmonary tuberculosis were obtained. Diminished levels of ESAT-6/CFP-10-induced IL-10 and increased levels of TB-antigen and LPS-stimulated sCD163 were found in childhood with pulmonary TB. CONCLUSIONS: High expression of CD14++ CD16+ , CD14+ CD16++ , CD14+ CCR2+ , and CD14+ CD62L+ cells in childhood TB, and monocyte-derived cytokines reflected both pro- and anti-inflammatory profiles. Higher sCD163 and CD14+ CD163+ monocytes might help physicians in the differential diagnosis of pulmonary TB in children. Pediatr Pulmonol. 2017;52:675-683. © 2016 Wiley Periodicals, Inc.

Cathelicidin (LL-37) and human ß2-defensin levels of children with post-infectious bronchiolitis obliterans.

INTRODUCTION: The antimicrobial peptides (AMPs) human ß-defensins and cathelicidin (LL-37) are key factors in innate and adaptive immune responses of the respiratory tract and play an important role in many respiratory diseases. No data are available in the literature about the levels of these AMPs in paediatric patients with post-infectious bronchiolitis obliterans (BO). This study aimed to determine human ß-defensin 2 (hBD2) and LL-37 levels and compare between post-infectious BO patients and the control group. METHOD: The patients diagnosed with post-infectious BO between September 2012 and 2013 and age- and-gender matched healthy controls were enrolled in this multi-center study. Serum hBD2 and LL37 levels were determined with the enzyme-linked immunosorbent assay method. RESULTS: Sixty-three post-infectious BO patients and 65 healthy children (median age 73 ± 55 and 78.74 ± 36.32 months, respectively) were enrolled in the study. The mean of hBD2 levels in patients and the control group were 1.06 ± 0.24 and 0.67 ± 0.72 ng/mL, respectively (P < 0.001). The mean of LL-37 levels in patients and the control group were 72.13 ± 29.06 and 50.10 ± 21.98 ng/mL, respectively (P < 0.001). No correlation was found between these AMPs levels and chronological age, age at the time of diagnosis, gender, Z-scores of weight and length, hospitalization numbers, the disease history before diagnosis and 25-OH D vitamin levels. CONCLUSION: This is the first study to demonstrate the higher levels of serum hBD2 and LL-37 levels in paediatric post-infectious BO patients. These AMPs may have important roles in the immune systems and pathogenesis of these patients.

Flexible Fiberoptic Bronchoscopy Through the Laryngeal Mask Airway in a Small Premature Infant.

Flexible bronchoscopy (FB) can be used safely for wider indications in children. Ultra-thin bronchoscopes are used for premature or newborn infants and are of limited diagnostic value. Bronchoscopes with a suction channel, may lead to problems when the nasal passage is narrow, particularly in patients under 2.5 kg. In addition, it may cause bronchospasm and hypoxia in small infants during the procedure because of an almost complete obstruction of the airway. A laryngeal mask airway (LMA) may prevent both bronchospasm and hypoxia because it does not need a nasal route. In addition, the LMA allows positive pressure ventilation during the procedure. We performed FB with a 3.7 mm bronchoscope through the LMA in a 75-day-old and 1910 g premature baby with atelectasis. This is the first and successful FB experience in such a small premature infant reported in the literature using a 3.7 mm bronchoscope through the LMA.

Beneficial effects of methylene blue on the acute phase of corrosive esophageal burn in rats.

INTRODUCTION: The aim of the article is to investigate the beneficial effects of methylene blue (MB) on the acute phase of experimental corrosive esophageal burns. MATERIALS AND METHODS: A total of 21 male Sprague-Dawley rats were allocated into three groups with an equal number in each group. In Group 1 (control), the esophageal lumen was irrigated with saline. In Groups 2 (untreated) and 3 (MB treatment), the distal esophagus was burned with 30% NaOH solution. In Group 3, MB was applied locally on the distal esophageal lumen (30 mg/kg) 90 minutes after the burn. In all the groups, animals were humanely killed at the end of the 7th day. Distal esophageal specimens were obtained for histopathological and biochemical examinations. RESULTS: MB increased the tissue superoxide dismutase levels and the total antioxidant status, whereas it decreased the levels of the total oxidant status with significant attenuation of histopathological damage. CONCLUSION: MB might have reduced the tissue damage in corrosive esophagitis because of its antioxidant effects.

A Difficult Case of Hodgkin Lymphoma with Differential Diagnosis of Tuberculosis and Sarcoidosis.

We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin's lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated.

Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm.

BACKGROUND: This study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups. METHOD: Five hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups. RESULTS: The mean age was 5.4 ± 3.8 years (2-months-17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24.9 %), asthma-like symptoms (19 %), protracted bacterial bronchitis (PBB) (11.9 %), and upper airway cough syndrome (9.1 %). However, psychogenic cough was the second most common diagnosis in the subjects over 6 years of age. CONCLUSION: Asthma and asthma-like symptoms were the most common diagnosis in children. Different age groups in children may have a different order of frequencies. Psychogenic cough should be thought of in the common causes especially in older children.

Nontuberculous pulmonary cavitary diseases of childhood.

We describe the demographic, clinic and radiologic features of nontuberculous cavitary pulmonary diseases in 42 patients with a mean age of 91.1±6.8 months. Infectious etiology was the most common cause (64%), including necrotizing pneumonia (n=15), ruptured hydatid cyst (n=5), lung abscess (n=5) and fungal infection (n=2). Other causes were bronchiectasis, congenital anomalies, foreign body aspiration, sarcoidosis and tumor.

[The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy]. / A influência das manobras de suporte das vias aéreas sobre a visibilidade da glote em fibrobroncoscopia pediátrica.

INTRODUCTION: Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. MATERIALS AND METHODS: In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I-II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. RESULTS: Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05). CONCLUSION: All airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.

The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy.

INTRODUCTION: Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. MATERIALS AND METHODS: In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I-II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. RESULTS: Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05). CONCLUSION: All airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.

Paraphenylene diamine hair dye poisoning: an uncommon cause of rhabdomyolysis.

Paraphenylene daimine (PPD) is a kind of aromatic amine that is widely used in several industrial products. Women also use PPD added to henna (Lawasonia alba) as a hair dye. Though rare in Western countries, PPD poisoning is quite common in East Africa, India and Middle Eastern countries because it is a traditional product at these countries. Different pathologies were described as caused by PPD ingestion including angioedema of head and neck, rhabdomyolysis, and acute renal failure. The authors report a case of systemic poisoning with PPD that lead to angioedema resulting in tracheostomy and rhabdomyolysis.