Asthma: specific clinical and functional characteristics in childhood. Results of a national program in Romanian asthmatic children.

UNLABELLED: Childhood asthma presents with specific clinical and functional characteristics. The aim of our study was the description of a large cohort of asthmatic children. It was also to assess their outcome with maintenance therapy according to guidelines, and to analyze the relationship with baseline's characteristics. We focused particularly on clinical and functional pediatric specificities. METHODS: Prospective study driven on asthmatic children, without treatment, recruited during a hospitalization for exacerbation or a visit for uncontrolled asthma, treated according to GINA guidelines and followed for one year. RESULTS: 412 children (mean age: 11.6 years +/- 2.7), were included. The level of severity was: intermittent asthma for 30% and persistent asthma for 70% (40.5% mild, 28% moderate, 1.5% severe). Mean prebeta2-FEV1 was 88.5% +/- 10.5 (PV) with mean beta2-reversibility of 10.8% +/- 7.8 (> 12% for 42% patients). 374 patients ended the study. After one year, we observed an improvement of clinical symptoms (p < 0.0001), rate of hospitalization (p < 0.0001), and lung function (mean prebeta2-FEV1: 91.2% +/- 7.9, p < 0.001). Asthma control was obtained for only 24.6%. Multivariate analysis show that decrease of symptoms was significantly related to younger age, higher level of initial severity and number of days of hospitalization. CONCLUSION: This study confirms pediatric specificities of asthma, as a normal FEV1 level and a limited beta2-reversibility of FEV1, and the large part of uncontrolled asthma after one year of treatment. It emphasizes the risk of undertreatment in a strategy based on severity. It argues for the regular assessment of control as now recommended, taking into account the pediatric asthma specificities.

[Clinical and therapeutical correlations in Moraxella catarrhalis respiratory infection in children]. / Corelatii clinico-terapeutice în infectia respiratorie cu Moraxella catarrhalis la copil.

In childhood recurrent respiratory infection with Moraxella catarrhalis have high incidence demonstrated by multiple risk factors association (atopia, immunsuppresion, chronic diseases, malnutrition) that makes this common bacteria pathogen. The study was carried on 56 children (0-16 years old). Authors try to find correlations between clinical signs and microbiological markers that determine recurrent respiratory infection with Moraxella catarrhalis. Treatment consisted of association between "target" antibiotherapy and immunomodulation drugs. Efficacy of this treatment was proven by decreased numbers of recurrent infection (in 35% cases comparing to 53% selected cases for immunomodulation), improvement of evolution of chronic diseases, decreased number of days and price of hospitalisation.

Antioxidant enzymes levels in children with juvenile rheumatoid arthritis.

UNLABELLED: Pathogenic mechanism of chronic inflammation is associated with increased production of superoxide anion and hydrogen peroxide. In the neutralization process of that anions, superoxid dismutase (SOD), catalase (CAT), and glutation peroxidase (GPx) are key enzymes. Aim of study consists of establishing of some clinic-biological correlations in JRA chronic inflammation in childhood between clinical status and determination of lipoperoxidation products and antioxidative enzymes in the blood. MATERIAL AND METHODS: Blood samples were obtained from 20 patients admitted in 2nd Clinic of Pediatrics, 4-6 months after onset of disease, diagnosed with JRA, oligoarticular form (6 cases), poliarticular form (9 cases) and systemic form (5 cases), as compared to 10 control subjects. SOD, CAT, GPx were measured comparing with malonildialdehyde (MDA), seric glutation (GSH) and usual inflammatory tests (ESR, fibrinogen, CRP). Determinations were repeated after 6 weeks of treatment. RESULTS: In all our cases, level of antioxidant enzymes (CAT, GPx) was decreased at time of diagnosis, concomitant with increased MDA, SOD and inflammatory tests. In most of cases, after 6 weeks of correct anti-inflammatory treatment, levels of enzymatic antioxidant markers were still decreased, as compared to usual inflammatory tests that came back to normal. Persistent decreased antioxidant enzymatic activity was found in cases that need immunomodulatory activity (Methotrexat). CONCLUSIONS: Determination of antioxidant enzymes level can be considered an evolution marker in JRA. More studies are necessary to find if antioxidant potential of blood can be used as following marker for immunosuppressive therapy.

[Childhood toxoplasmosis today]. / Toxoplasmoza copilului în actualitate.

The comparative study of two groups of children suffering from acquired or congenital toxoplasmosis, being in hospital during two different decades (1979-1985--39 children and 1991-1997--117 children) proved: the fact that atypical or subclinical manifestations of the acquired toxoplasmosis (54%) draws our attention to the systematic research of the infection with Toxoplasma gondii, especially at the groups with increased risk now that the frequency of the diseases generating immunodeficiency; the increased frequency of congenital toxoplasmosis (5% in the first group, 8% in the second group) and especially of the invalidating of screening tests to the pregnant women; the therapeutic arsenal limited by the rate price/toxicity/medical resistance, must be individualized for each case, taking into account the increased number of other associated diseases (chronic hepatitis B 7%, TB 17%, HIV infection 5%); Rovamicine treatment at the second group had similar results to those obtained by administrating Pirimetamine--Trimetoprim to the children from the first group.

[Idiopathic thrombocytopenic purpura in infants and small children (1 to 3 years old)]. / Purpura trombocitopenica idiopatica la sugar si la copilul mic (1-3 ani).

In infant and young children (1-3 yrs), I.T.P. (idiopathic thrombocytopenic purpura) is an acute, self-limited disease in 6 months since the diagnosis. The treatment with intravenous immunoglobulins or corticosteroids will be administered in severe forms of disease(predicted by the severity of hemorrhage and thrombocytes less than 10 G./l). A retrospective study of 29 cases with I.T.P. in infants and young children shows that 22 out of 29 were acute I.T.P., 7 out of 29 were recurrent I.T.P., in which 3 cases were chronic I.T.P. Post-hemorrhage associated anemia was present in 10 out of 29 cases, in which 3 cases was severe. Prolonged bleeding time appears only in severe I.T.P. Values of thrombocytes less than 10 G/l were met in 6 cases of acute I.T.P. and in 3 cases with recurrent I.T.P., there was no predictable correlation between the very low value in the time of diagnosis and the following clinical course of the disease. Neonatal I.T.P. (history of maternal I.T.P) had a favourable clinical course after i.v. immunoglobulins treatment (1 case) and a trend to chronicity (1 case) probably due to platelet antiphospholipid antibodies. Postvaccinal I.T.P. is a rare and benign complication. Only 5 of 29 cases had spontaneous remission. The clinical course was towards complete remission in 22 out of 29 cases with i.v. immunoglobulins and/or corticosteroid therapy. In conclusion, view the natural history of disease and the unvariables responses to treatment, spontaneous bleeding cannot be predicted only by platelet count in I.T.P.-Infant-low age (1-3 yrs).

[Recurrent respiratory manifestations in atopic dermatitis in small children]. / Manifestari respiratorii recurente în dermatita atopica la copilul mic.

The aim of the present study was the retrospective analysis (in the last 5 years) of 89 children, aged between 3 and 24 months of life, diagnosed with atopic dermatitis (D.A.) and wheezing, in comparison with a second group of 31 children admitted in the Paediatric Clinic for recurrent wheezing (R.W.) without atopic cutaneous signs. Evaluating the therapeutical response on the basis of the clinical and biological features for each child, we have noticed for the first group (with D.A.), the followings: 30% of patients didn't experience a favourable outcome and were complicated with "severe" asthma; 54% of subjects have manifested airway hyperreactivity (nocturnal and early morning cough); 81% of children have associated allergic rhinitis. The observations in the second group have suggested that, only in 12% of patients with R.W. has been manifested asthma as a major complication. The main risk factors for asthma in the first group were as follows: precocious atopic eczema, personal or family history of atopy, nourishment with non-maternal milk and passive smoke. We consider that asthma at infants and children is underestimated because of the difficulties of diagnosis at this age.

[The specific serological profile in hepatitis B virus infection in children]. / Profil serologic particular în infectia cu virusul hepatitei B la copii.

UNLABELLED: Hepatitis B virus infection (HBV) has a very well known specific serologic profile. In the last years the molecular biology methods reveal some "particular serological profiles" by genomic mutation. One particular profile consists in the absence of anti-HBc total antibodies simultaneously with the presence of HBsAg. Our tested group consists of 372 children aged 0.1 to 15 years. The presence of HBsAg was determined by ELISA "sandwich" and confirmed by neutralisation test. For HIV infection we used two ELISA tests (competitive and indirect) and the Western Blot test for confirmation. Of the total, there were 13 children HBsAg positive and without anti-HBc antibody (3.49% respectively), 7 of the 13 children (53.8%) were dystrophic and 4 were HIV positive (30.76%). From 372 cases, 104 were HBsAg positive (27.9%) and 53 (14.2%) of them had chronic hepatitis. CONCLUSIONS: 1. The particular serologic profile requires the testing of all serological markers specific for HBV. 2. This particular serologic profile is correlated with HIV positive status and dystrophy.

[The prevalence of HBsAg in hospitalized children as a marker of hepatitis B virus infection]. / Prevalenta AgHBs la copii spitalizati, ca marker al infectiei cu virusul hepatitei B.

UNLABELLED: The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) in hospitalised children, as specific marker for hepatitis B virus (HBV) infection. Our study group consists of 517 children, 68 of them diagnosed with chronic hepatitis. For HBsAg determination we used an ELISA test (Labsystems); for some children we also tested by ELISA the following markers: the antibodies and anti-hepatitis C virus (HCV) antibodies. From 517 children 24.28% were HBSAg positive and 75% of children with chronic hepatitis were positive for the same marker. Almost 100% of chronic active hepatitis (CAH) patients was positive for HBSAg. CONCLUSIONS: 1. The prevalence of HBsAg was much higher as compared with the healthy population prevalence; it is a clear prove that HBV infection has an important role in chronic hepatitis appearance. 2. For all HBsAg positive patients, it is necessary to determine other markers like HBeAg-anti-HBe antibodies system as well as markers for other viral hepatitis (HDV, HCV). 3. The anti-HBV infection vaccine will reduce significantly the prevalence of HBV and HDV infections; 4. Biological molecular technique, like PCR will be necessary in our country, in the future, even the price is so high, to monitoring the IFN treatment for chronic infection as unique solution for these patients.

[The current and future outlook in immunosuppressive therapy for children]. / Actualitati si perspective în terapia imunosupresiva la copil.

The various cell proportions that form the immune system intervene in the activation of autoreactive cells and in the occurrence of the associated inflammatory process. Advances of the study of the mechanism involved in the autoimmunity, and the development of new immunosuppressive agents used for transplantations have deeply modified the therapeutic approaches. The classic treatment of autoimmune diseases has relied on corticosteroids and immunosuppressive drugs. Now, these new treatments are evaluated on animal models, then controlled in clinical trials. Cyclosporin A has been shown to be effective in several autoimmune diseases. Intravenous immunoglobulins, cytokines, and anticytokines, immunotoxins, monoclonal anti-leukocyte antibodies (CD4, CD25) and soon peptide vaccination constitute the new types of treatments.

The nitroblue tetrazolium test in the estimation of urinary and serum leukocyte metabolism in urinary infections. A preliminary note.

For the study of leukocyte metabolism in the serum and the urine from 52 patients with urinary infections, the Nitroblue Tetrazolium (NBT) test was used for a qualitative estimation of leukocyturia. It was observed that 26 of the 52 patients (50%) presented higher values of NBT positive urinary neutrophils than in the control group. The NBT test might be useful in the estimation of the cellular immune response in the course of urinary infections.

Clinico-biologic aspects and evolutive tendencies in sacroiliitis.

A group of 103 patients with radiologic changes of sacroiliitis were investigated and followed up over a mean period of 3.5 years. The biologic explorations (nonspecific inflammatory tests, humoral immunologic determinations and serum fibronectin assay) as well as sacroiliac and spine radiographic examinations, were repeated every 6th-12th months. In 32 patients (31%) clinical, biologic and radiologic signs of evolutive disease, were detected. In such cases, sacroiliitis representing in fact a form of onset of ankylosing spondylitis, the HLA-B27 phenotype was also determined and was found present in 8 cases. Of the biologic tests the decrease of serum fibronectin proved the most significantly correlated with evolutive tendency of sacroiliitis.

Immunological determinations in the cord serum and aspects of the neonatal adaptation.

We have determined the immunograms and the titers of anti-influenza antibody in the cord serum of 112 newborns. The immunologic parameters have been correlated with signs of adaptation in the immediate neonatal period. The immunograms showed an increase of the values of IgG and the presence of IgM and IgA in the cord serum, at levels according with the increase of the titer of anti-influenza antibodies. The presence of IgM and IgA in the cord serum at high levels is the expression of an active process of antibody synthesis in these foetuses as the consequence of an intrauterine infection. In our study, maternal influenza was implicated in the stimulation of the foetus immune system and in the alteration of neonatal adaptation.

Aspects of tonus modulation in guinea pig tracheal muscle.

We have studied the tonus of the tracheal muscle (tracheal spiral) gathered from guinea pig and kept in Tyrode solution at 38 degrees C, continuously oxygenated. Tonus variations were recorded by a tension transducer on an xy recorder. After administration of histamine (H) in the organ bathroom, we observed an increase of tonus, with large spontaneous movements of the tracheal muscle. Blocking the beta-adrenergic receptors with propranolol (Pr) suppressed the effect of adrenaline (Adr) but did not influence the effects of II and acetylcholine (Ach) The reaction to II was more diminished in the presence of fosfobion (ATP) in the organ bathroom.