Risk Factors of Recurrent Wheezing in Children Under 5 Years of Age.

Objective: To identify risk factors which may lead to the occurrence of recurrent wheezing in children under five years of age. Material and Method: A cross-sectional study was conducted in children under 5 years old at the Out Patient Department at Naresuan University Hospital, from October 2013 to October 2014. Fifty-five children who had signs and symptoms of recurrent wheezing were assigned to the study group, whereas another fifty-five children matching on age and sex with the case who had no symptoms of recurrent wheezing were assigned to the control group. All of the parents completed the given questionnaires. Descriptive data analysis were statistically conducted to understand the characteristics of the study groups. The risk factors were analysed using both bivariate and multivariate statistical analyses which included all the important predictors with a statistically significant level of p<0.05. Results: Mean age in the study group was 36.1 months and in the control group 25.0 months. The mean weights and heights showed no difference between the case and control groups. Bivariate analysis showed that upper respiratory tract infection [odds ratio (OR) 7.273; 95% confidence interval (CI) 2.277-23.232)], lower respiratory tract infection (OR 5.332; 95% CI 2.326-12.225), passive smoking (OR 2.368; 95% CI 1.094-5.129), and day care center attendance (OR 2.590; 95% CI 1.168-5.745) were the risk factors of recurrent wheezing. Multivariate logistic regression analysis indicate that lower respiratory tract infection [adjusted odds ratios (aOR) 0.241; 95% CI 0.088-0.659] was the most important risk factor leading to recurrent wheezing. Conclusion: Lower respiratory tract infection, upper respiratory tract infection, passive smoking and day care center attendance were found to be risk factors of recurrent wheezing in children under five years of age, with lower respiratory tract infection being the most risk. Targeted surveillance of these risk factors should reduce the incidence of recurrent wheezing. This is especially important for high risk patients such as asthma patients.

Hemoglobin Analysis in the First Year of Life.

BACKGROUND AND OBJECTIVES: In newborns and infants during their first year of life, there is a dynamic change in the fraction of hemoglobin (Hb). To apply Hb analysis as a phenotypic diagnosis of thalassemia in newborns and infants, we need normal values of each Hb fraction for reference. METHODS: Seventeen cord bloods from normal deliveries were collected for analysis. One hundred and thirty-seven infants from the pediatric outpatient clinic were recruited and were categorized by their ages into a series of short periods (month±2 weeks). Both alpha and beta thalassemia carriers detected were excluded. Samples with an Hb level less than 10.0 g/dL were also excluded. The proportion of Hb A (α2ß2), A2 (α2δ2), and F (α2γ2) was obtained from high-performance liquid chromatography and analyzed according to its categorized periods. RESULTS: There were 90 (58.4%) specimens left for evaluation. The percentage of Hb A, A2, and F gradually changed with increasing age. The percentage of Hb A was 21.14±7.04% (mean±SD) in cord blood and increased substantially to 83.38±1.31% at the sixth month. The level was sustained thereafter. The incremental pattern of Hb A2 was similar to Hb A. The value was 0.32±0.19% at the beginning and reached a plateau with 2.78±0.25% at the sixth month. The percentage of Hb F started at 78.39±7.59% in cord blood and decreased rapidly in the first 6 months. CONCLUSIONS: The data possibly can be applied as quick guidance for interpretation of Hb analysis in newborns and infants during their first year of life.

Human disease from influenza A (H5N1), Thailand, 2004.

Influenza A (H5N1) is endemic in poultry across much of Southeast Asia, but limited information exists on the distinctive features of the few human cases. In Thailand, we instituted nationwide surveillance and tested respiratory specimens by polymerase chain reaction and viral isolation. From January 1 to March 31, 2004, we reviewed 610 reports and identified 12 confirmed and 21 suspected cases. All 12 confirmed case-patients resided in villages that experienced abnormal chicken deaths, 9 lived in households whose backyard chickens died, and 8 reported direct contact with dead chickens. Seven were children <14 years of age. Fever preceded dyspnea by a median of 5 days, and lymphopenia significantly predicted acute respiratory distress syndrome development and death. Among hundreds of thousands of potential human cases of influenza A (H5N1) in Asia, a history of direct contact with sick poultry, young age, pneumonia and lymphopenia, and progression to acute respiratory distress syndrome should prompt specific laboratory testing for H5 influenza.