Association of serum vitamin D levels, IL-17a Levels with disease severity among 3- to 18-year-old children with asthma in the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Background.</strong> Previous studies show that Vitamin D has an inverse relationship with asthma severity, symptoms, exacerbations, medication usage, and a direct relationship with lung function. IL-17A was found to be increased in asthmatics, which was inhibited by Vitamin D. Associations found between vitamin D, IL-17A, and asthma may support the future role of vitamin D in the treatment of asthma in children.</p><p style="text-align: justify;"><strong>Objective.</strong> To compare vitamin D and IL-17A levels between children with and without asthma and determine their association with asthma severity</p><p style="text-align: justify;"><strong>Study Design.</strong> Cross-sectional study</p><p style="text-align: justify;"><strong>Methods.</strong> There were 44 participants, aged 3 to 18 years: 22 with asthma (12 non-severe, 10 severe) and 22 without asthma. Participants with any disease-altering vitamin D metabolism, intake of vitamin D supplementation, and recent infection were excluded. Serum vitamin D and IL-17A levels were measured in all participants.</p><p style="text-align: justify;"><strong>Results.</strong> There was no significant difference in mean vitamin D levels between participants with asthma (29.6 ± 12.6 ng/mL) and without asthma (27.6 ± 9.5 ng/mL) (p = 0.55) as well as between participants with non-severe asthma (29.8 ± 14.0 ng/mL) and severe asthma (29.4 ± 11.5 ng/mL) (p = 0.95). The overall prevalence of hypovitaminosis D (< 30ng/mL) is 61.4%; 59.1% among those with asthma and 63.6% without asthma. The prevalence of vitamin D insufficiency and/or deficiency did not significantly differ between those with and without asthma (all p-value > 0.05); prevalence ratios were: 1.05 for vitamin D insufficiency, 0.58 for vitamin deficiency, and 0.92 for vitamin D insufficiency and deficiency combined. There was also no significant difference in the prevalence of vitamin D insufficiency and/or deficiency between severe and non-severe asthma (all p-values > 0.05), with prevalence ratios: 0.74 for vitamin D insufficiency, 0.50 for vitamin D deficiency, and 0.75 for vitamin D insufficiency and deficiency combined. Serum IL-17A levels were below the minimum detectable levels in 96% of the participants using the MILLIPLEX Map Human TH17 Magnetic Band Panel; hence, could not be analyzed.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The mean serum vitamin D levels do not differ between children with asthma and healthy controls. There was no significant relationship between mean vitamin D levels and asthma severity. There was no association between the prevalence of vitamin D insufficiency and/or deficiency and asthma and its severity. The overall prevalence of hypovitaminosis D in this study is 61.4%. Serum IL-17A levels were undetectable in 96% of the study population.</p>

The yield of Acid-Fast Bacilli (AFB) and tuberculosis (TB) culture in the microbiologic diagnosis of childhood tuberculosis using sputum induction: A randomized controlled trial with interrupted time series

@#<p style="text-align: justify;"><strong>Objectives:</strong> This study aims to determine the diagnostic yield and safety of sputum induction with hypertonic saline in the microbiologic confirmation of childhood tuberculosis (TB) in a tertiary hospital in the Philippines.</p><p style="text-align: justify;"><strong>Methods:</strong> This is a randomized controlled trial with an interrupted time series in the control group. One hundred twelve (112) pediatric patients (4-18 years old) with clinical findings suggestive of TB were enrolled in the study. Patients were randomized into two groups composed of 56 patients each. Group A patients underwent sputum induction. Group B patients underwent spontaneous expectoration followed by sputum induction. The microbiologic yield for acid-fast bacilli and TB culture were determined and analyzed.</p><p style="text-align: justify;"><strong>Results:</strong> Among the patients randomized to Group A, microbiologic confirmation for TB was 8/56 patients (14.3%) after sputum induction. For patients randomized to Group B, microbiologic yield was 4/56 patients (7.1%) from spontaneous expectoration; after sputum induction, the microbiologic yield increased to 5/56 patients (8.9%). There is insufficient evidence of statistical significance in microbiologic yield on parallel analysis of the two separate groups (p=0.22). Furthermore, for patients randomized to Group B, the increase in microbiologic yield after sputum induction compared to spontaneous expectoration did not reach statistical significance (p=1.000). The procedure was well-tolerated among children; no serious adverse events were observed.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Sputum induction is a feasible and safe method of specimen collection for microbiologic diagnosis of TB among children. While the microbiologic yield increased after sputum induction compared to spontaneous expectoration, the additional yield does not seem to be significant.</p>

The acute effects of volcanic ash on pulmonary function in children

To evaluate the acute effects of the Mt. Pinatubo volcanic ash on pulmonary function, we studied 103 school children with ages ranging from 12 to 17 years and residing in Metro Manila where about 2.0 cm of ash had fallen. All study participants were involved in a previous study wherein their baseline pulmonary functions were measured. Two weeks after ash exposure, outcome variables measured included respiratory symptoms, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal midexpiratory flow (MMEF), and peak expiratory flow rate (PEFR). Data on composition and particulate size of volcanic ash were obtained. Ashfall exposure produced only transient and tolerable respiratory symptoms, the most common being rhinorrhea, sneezing and cough. Mean fall in FVC was-0.06468+-0.207 liters and-0.0681 +-0.207 liters for FEV1. Males showed a greater decrease in these measurements compared to females. These differences were statistically significant but small and may not be clinically significant. Also, measures of pulmonary function did not correlate with a history of exposure to cigarette smoke nor with the presence of respiratory symptoms. The presence of a demonstrable but minimal adverse effect on pulmonary function may be partly due to precautionary measures taken during the ashfall. It is ideal to repeat pulmonary function tests on the population periodically to document any long-term exposure-related decline in pulmonary function and to validate the present observations against new spirometric measurements at a time of re-exposure and almost nil or absent ashfall exposure. Studies must be done in communities closer to the volcano where these observed changes in pulmonary function may be magnified The widespread destruction caused by the series of eruptions of Mt. Pinatubo in Castillejos, Zambales from May to August, 1991 has raised not only economic concerns but questions on environmental and health aspects as well. With its major eruption on June 15 to 16, 1991, volcanic ash was spawned far with a radius of 850 kilometers from the vent. Typhoon winds prevailing at that time facilitated the spread of volcanic ash to more populated areas as far as Palawan to the south and even as far as Cambodia to the west Analysis of volcanic ash yielded a predominance of respirable particles smaller than 10 micra in diameter and the minerals, silicon dioxide and aluminum oxide. Experience with clinical effects on the respiratory system of volcanic ashfall is rather limited. Recent reports have have dealt mostly on the May 1980 eruption of Mt. St. Helens in Washington, USA, where the composition of volcanic ash was comparable to that spewed by Mt. Pinatubo After eruption of Mt. St. Helens, there was note of an increase in medical consultations for wheezy bronchitis among young children. Questions raised included the possibility of silicosis developing in the exposed population and also on the acute effects of the ash, both in persons with pre-existing lung disease and, as a non-specific irritant, in normal individuals. Johnson, et. al 2 studied the pulmonary function of children residing within a 90 mile radius from the volcano 1 week after the eruption and did not find a significant decrease from normal values. A similar study by Buist et al.,3 on children attending a summer camp situated close to the volcanic site did not show either a within-day or between-day effect on lung function even among children with pre-existing lung diseases In Metro Manila, there were anecdotal reports of increased respiratory symptoms among residents, including school children, after the Mt. Pinatubo eruption caused volcanic ash fall. This study aims to evaluate the acute effects of inhaled volcanic ash on the pulmonary function of school children in Metro Manila Average ashfall in Metro Manila located 180 aerial kilometers from Mt. Pinatubo was 2.0 cm., average ashfall in areas within a 10 kilometer radius from the volcano was 50 cm.