[Show abstract][Hide abstract] ABSTRACT: Atopic dermatitis (AD) is the most common childhood inflammatory skin disorder. The purpose of this study was to elucidate the knowledge level of daycare center teachers about AD and related factors. Study subjects were 297 teachers (287 female, 10 male) from 20 randomly selected daycare centers in Istanbul. The knowledge level of teachers was assessed using a questionnaire with 21 questions about AD. The teachers were asked nine additional questions about demographic and other characteristics of the child care centers and about themselves. The mean age of the teachers was 26.4 ± 8.1 years (range 20-53 yrs). The mean score for the 21 questions was 71.4 ± 12.1 (68%) from a maximum of 105 points. The response rate of teachers rate for each question ranged from 54% to 90%. The completely true response rate for each question ranged from 3.0% to 66.7%. The knowledge level of the teachers was related to the number of children in the daycare center, but not to sex, age, education level, family history of atopy, teacher's monthly salary, location, or whether the daycare center was public or private. Although teachers in daycare centers have some knowledge about AD, widespread educational programs for teachers about AD may help to improve the understanding of the disease and the quality of life of affected children in daycare centers.
[Show abstract][Hide abstract] ABSTRACT: Pollen concentrations in the atmosphere of Istanbul, a city located between two continents, has been monitored for 1 year as part of a larger research program. The sampling sites were located in two different continents: the Asian part (AS) and the European part (EP). The sampling was performed in AS and EP of the city by using Hirst type volumetric method, and pollen grains of 58 and 62 taxa were identified in the two parts, respectively. The pollen spectrum reflected the floristic diversity of the region. The main pollen producers at the sites were characterized by some allergenic pollen and were identified as Cupressaceae/Taxaceae, Urticaceae, Pistacia sp., Quercus sp., Platanus sp., Fraxinus sp., and Xanthium sp. These pollen types contributed to the total pollen sum with a percentage of more than 80% at both monitoring sites. The highest amount of pollen grains was recorded in April. The greatest number of species was recorded in May, when 42 types (AS) and 44 types (EP) were present.
[Show abstract][Hide abstract] ABSTRACT: Munchausen by proxy (MBP) is a severe form of abuse in which a caregiver simulates or fabricates illness in another person, primarily the elderly and children, which can even result in death.
We report two siblings who were victims of MBP, one of whom died. A very rare diagnosis, cicatricial pemphigoid was suspected in the 2-year-old girl who was first abused. She was hospitalized twice, for 3 and 4 months, respectively. Her second hospitalization ended with her death. MBP was diagnosed after the second sibling's admission with similar atypical signs and symptoms. It was realized that a household-cleaning product, sodium hydroxide, was administered repeatedly by oral route to the children by their own mother.
Physicians must consider the diagnosis of MBP whenever they are confronted with unusual, persistent or recurrent signs and symptoms in a child.
Child Care Health and Development 08/2007; 33(4):496-9. DOI:10.1111/j.1365-2214.2007.00731.x · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul.
A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004.
Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms.
Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.
International Journal of Pediatric Otorhinolaryngology 04/2007; 71(3):463-71. DOI:10.1016/j.ijporl.2006.11.013 · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Asthma is a common chronic illness in childhood. The aim of the study was to examine time trends in the prevalence of asthma using the ISAAC questionnaire in 6- to 12-year-old schoolchildren in Istanbul and factors affecting asthma prevalence.
Two cross-sectional surveys were performed, 9 years apart (1995 and 2004) using the ISAAC protocol. The survey conducted in 1995 was repeated in 2004 using the same questionnaire in the same age group, in the same schools in the same season. The 2500 questionnaires were distributed to the children to be completed by their parents at home.
A total of 2387 children (response rate 95.5%) in the 2004 study and 2216 children (response rate 94.3%) in 1995 were included in the final analysis. The overall lifetime prevalence of wheeze increased from 15.1% to 25.3%; prevalence odds ratio (POR) = 1.91, 95% confidence interval (95% CI) = 1.64-2.21, and P < 0.001. The overall 12-month prevalence of wheeze increased from 8.2% to 11.3%; POR = 1.43, 95% CI = 1.18-1.75, and P < 0.001. The prevalence of asthma increased significantly from 9.8% to 17.8%; POR = 1.99, 95% CI = 1.67-2.36, and P < 0.001. In both 1995 and 2004, family history of asthma, eczema diagnosed by a physician, food allergy diagnosed by a physician, frequent otitis, frequent sinusitis were associated significantly with high risk for asthma.
In the 9-year period from 1995 to 2004, the prevalence of asthma symptoms has increased in 6- to 12-year-old schoolchildren in Istanbul. Risk factors affecting asthma prevalence remained unchanged during the 9-year period.
[Show abstract][Hide abstract] ABSTRACT: Childhood obstructive sleep apnea (OSA) affects 1-3% of preschool children. If left untreated, it can result in serious morbidity including growth retardation, cor pulmonale, and neurocognitive deficits, such as poor learning and behavioral problems. Early recognition and treatment is important to prevent morbidity and sequela and to provide better quality of life both for the child and his or her family members. The purpose of this study was to elucidate the knowledge and attitude physicians have about pediatric OSA, using the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) questionnaire.
The first section of the OSAKA-KIDS questionnaire, which includes 18 items presented in a true-or-false format, was developed to assess the knowledge physicians have about pediatric OSA. The second section, including five items, was developed to assess attitudes and was measured on a five-point Likert scale ranging from 1 to 5.
A total of 230 questionnaires were completed by physicians: 138 (60.3%) pediatricians, 70 (30.5%) general practitioners and 21 (9.2%) pulmonologists. The mean total knowledge score was 66.7%. The knowledge score positively correlated with having sub-specialty training (r=0.205, P=0.002) and negatively correlated with having a higher degree (r=-0.283, P<0.001). The mean total attitude score was 3.4. The knowledge score positively correlated with the attitude score (r=0.27, P<0.001).
This study shows that among physicians there are deficits in knowledge about childhood OSA and its treatment. More focused educational programs are needed within medical schools and within pediatric residency and post-graduate training programs.
Sleep Medicine 11/2006; 7(7):580-4. DOI:10.1016/j.sleep.2006.04.004 · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the cases of 4-year-old identical twin sisters who presented with severe atopic dermatitis with intractable skin manifestations and multiple food allergies. Netherton syndrome (NS) (OMIM 256500) was suspected due to very high serum IgE levels, growth retardation, severe food allergies and typical hair finding (trichorrhexis invaginata). A definite diagnosis was made by genetic analysis. Our cases are unique in being the first identical twins with NS diagnosed by a novel mutation in the SPINK5 gene. NS should be considered in differential diagnosis in children who have generalized erythema with intractable eczematous lesions and elevated levels of IgE.
European Journal of Pediatrics 10/2006; 165(9):594-7. DOI:10.1007/s00431-006-0141-0 · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the prevalence of asthma among 4-17 years old school children and to determine the relationship between frequent tonsillitis, tonsillar hypertrophy and asthma-related symptoms. A total of 2,000 school children, aged 4-17 years, in Denizli were surveyed using the ISAAC questionnaire; the size of the tonsils was evaluated by physical examination. A total of 1,784 questionnaires were completed giving an overall response rate of 89.2%. The prevalence of lifetime wheezing, 12-month wheezing and lifetime doctor-diagnosed asthma were 16.4%, 6.2% and 1.7%, respectively. The prevalence of frequent tonsillitis and tonsillar hypertrophy were 19.9% and 3.4%, respectively. Tonsillar hypertrophy was positively correlated with a history of frequent tonsillitis. Frequent tonsillitis and tonsillar hypertrophy could be evaluated as risk factors for asthma due to their significant association with asthma-related symptoms.
Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand 06/2006; 24(2-3):129-34. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate rhinomanometric responses to nasal allergen provocation in children with allergic rhinitis sensitized to house dust mite. We studied 51 children, aged 6-16 years (mean: 11.5 +/- 2.6 years), with clinical symptoms of perennial allergic rhinitis without asthma and 20 non-atopic healthy controls in the same age range (mean: 11.8 +/- 3.8 years). All of the patients had positive skin prick test (SPT) results and serum specific IgE above 0.70 kU/l to Dermatophagoides pteronyssinus (Dp). Nasal provocation testing (NPT) was performed with increasing concentrations of Dp extracts and the nasal response was evaluated by active anterior rhinomanometry. A 100% increase of resistance in one or both nasal cavities was considered positive. There was a statistically significant difference of baseline nasal resistance (total, right and left sides) between the control and the patient groups (p < 0.001). A positive response to house dust mite allergens was recorded in 47/51 (92.2%) patients by rhinomanometry. The NPT presented no significant correlation with age, weight, height, SPT diameter, serum total and specific IgE levels to Dp and baseline nasal airway resistance values. This study suggests that a nasal provocation test with allergen is unnecessary in children with positive skin prick test and serum IgE specific to house dust mite. The rhinomanometric response to the allergen provocation does not correlate with the diameter of the skin prick test and the level of serum specific IgE.
Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand 06/2006; 24(2-3):117-21. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to elucidate the asthma knowledge level of primary school teachers in Istanbul, and factors associated with this subject. Seven hundred and ninety-two teachers from 73 randomly selected primary schools in Istanbul were included in this study. Although Istanbul primary school teachers generally have a satisfactory knowledge on asthma, they lack knowledge on triggers of asthma attacks and on the management of the disease. The knowledge level of the teachers was related to gender but was not related to age, education level, length of tenure, location of primary school and county. We think that an asthma education program is needed for Turkish teachers to increase their understanding about what asthma is, its impact and how to meet the needs of a child with asthma to achieve improved wellbeing and school attendance.
Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand 04/2006; 24(1):9-15. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An 8.5-year-old girl who presented with chronic cough and hemoptysis underwent a CT scan of the chest showing diffuse mediastinal and parenchymal infiltration and pleural effusion, and laboratory findings showed disseminated intravascular coagulation. Disseminated lymphangiomatosis was diagnosed after an open-lung biopsy. She was treated by systemic steroids, interferon, tamoxifen, chemotherapy, and radiation but died of respiratory failure and disseminated intravascular coagulation 2 years after the diagnosis. This patient represents a rare presentation of diffuse pulmonary lymphangiomatosis together with disseminated intravascular coagulation, involving both the mediastinum and pulmonary parenchyma, in a child.
[Show abstract][Hide abstract] ABSTRACT: H1 antihistamines are first line drugs in the treatment of allergic rhinitis and chronic idiopathic urticaria and widely used in children as well as in adults. Although first-generation antihistamines are effective in relieving allergic symptoms, they are not preferred because of their sedative side effects. The earliest "second generation" antihistamines, terfenadine and astemizole, non-sedating alternatives to the first generation counterparts are not commonly used due to their potential arythmogenic effects. The newer second-generation antihistamines such as loratadine, fexofenadine, mizolastine, ebastine, cetirizine, levocetirizine and desloratadine have been shown to be efficacious and well tolerated with additional anti-inflammatory effects and lacking cardiotoxic potential activity in adults. The early treatment of atopic children study, the long term clinical trial with cetirizine of infants with atopic dermatitis demonstrated that cetirizine delayed the onset of asthma in patients sensitized to grass pollen or house dust mite; and also reduced the duration and the amount of topical steroids used in the treatment of atopic dermatitis. In the Preventia I study, which was designed to evaluate the efficacy of loratadine in reducing the number of respiratory infections in young children at risk of recurrent infections, loratadine was not found to be significantly different from placebo. Both drugs were found to have a similar safety profile to that of placebo confirming their long-term use in infants and children. Pediatric formulation of desloratadine, which has favorable effect on nasal congestion, is marketed worldwide now. The effectiveness of new antihistamines in the treatment of urticaria in pediatric age group is based on extrapolation of adult studies performed in this area. Further studies with new antihistamines are needed for their evidence-based use in children with urticaria and atopic dermatitis.
[Show abstract][Hide abstract] ABSTRACT: Spondylocostal dysostoses are a group of rare inherited disease with a heterogeneous disorder of vertebral segmentation defects and rib anomalies, which lead to respiratory problems predicting the clinical outcome. Spiral CT with three-dimensional (3D) imaging provides exact measurement of the bony rib cage. We report a case of an infant with spondylothoracic dysostosis, a phenotype of spondylocostal dysostoses, and 3D spiral CT findings of his rib cage since it may contribute to the surgical planning.
The Indian Journal of Pediatrics 05/2005; 72(4):367. · 0.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although there is evidence of a positive association between asthma and obesity in adults and children, very little is known about the role of leptin in asthmatic children.
The aims of this study were to evaluate the relation between leptin and parameters of atopy and asthma in children.
Body mass index (BMI) and serum leptin levels were measured in 102 (37 female, 65 male; mean age, 5.9 +/- 3.4 years) asthmatic and 33 (14 female, 19 male; mean age, 6.1 +/- 3.4 years) healthy children. Skin prick tests, total serum IgE, and pulmonary function tests were performed and were completed.
A significant difference was observed in serum leptin levels between asthmatic and healthy children. Median (interquartile range) levels were 3.53 (2.06-7.24) ng/mL and 2.26 (1.26-4.71) ng/mL, respectively (P=.008). Subgroup analysis revealed that this difference in leptin levels was confined entirely to boys: 3.09 (1.99-7.51) ng/mL in boys with asthma versus 1.52 (1.06-3.17) ng/mL in boys without asthma (P=.003). By logistic regression analysis, we found that leptin was a predictive factor for having asthma (odds ratio, 1.98; CI, 1.10-3.55; P=.021), whereas sex, age, or BMI were not. In a stepwise multiple regression analysis including sex (P=.001), age (P=.016), BMI (P <.001), and asthma (P=.022), all of these variables were found to affect log leptin levels (R2=0.404). There was no significant sex difference in serum leptin levels among asthmatic children, whereas healthy boys had significantly lower leptin levels than healthy girls (P=.019). Atopic asthmatic subjects had significantly higher leptin levels than nonatopic asthmatic subjects (P=.038) with similar BMI. A significant, but weak, correlation was observed between leptin levels and IgE in the overall group of asthmatic children (r=0.231; P=.019). Again, this correlation was confined entirely to boys (r=0.319; P=.010). There was no relation between leptin levels and skin prick tests, pulmonary function tests, passive smoking, birth weight, and duration of breast-feeding.
Our findings suggest that leptin may play a role in atopic asthma. High serum leptin levels in asthmatic boys may partly explain the higher prevalence of childhood asthma in male sex.
Journal of Allergy and Clinical Immunology 08/2004; 114(2):254-9. DOI:10.1016/j.jaci.2004.03.053 · 11.48 Impact Factor