[Show abstract][Hide abstract] ABSTRACT: Asthma is a systemic disease, which affects various body systems. We aimed to assess the impact of clinical asthma phenotypes on myocardial performance in asthmatic children using tissue Doppler imaging (TDI).
We enrolled 58 children with moderate persistent asthma and 62 age- and sex-matched healthy controls. Asthmatic children were classified according to clinical asthma phenotypes into shortness of breath group (n = 26) and wheezy group (n = 32). Pulmonary function tests, and conventional and TDI echocardiography were performed.
TDI echocardiography assessment of the studied groups showed that asthmatic children as a group had significant left and right ventricular dysfunction when compared with healthy controls. Children in the shortness of breath group had a significant diastolic dysfunction of both ventricles in the form of lower tricuspid and mitral annular early myocardial diastolic velocity (Em), early to late myocardial diastolic velocity (Em/Am) ratio, and prolonged isovolumetric relaxation time when compared with wheezy group (P < 0.001). In the shortness of breath group, TDI-derived myocardial performance index (MPI) of both ventricles was significantly higher when compared with wheezy group (P < 0.001) reflecting global myocardial dysfunction. Conventional echocardiography of both ventricles showed RV diastolic dysfunction in the form of a significantly lower tricuspid E/A ratio in the shortness of breath group when compared with wheezy group.
Clinical asthma phenotypes have an impact on myocardial function especially those presented with shortness of breath. Thus, measurement of MPI by TDI can detect subclinical changes in the cardiac performance in asthmatic children.
[Show abstract][Hide abstract] ABSTRACT: To examine the efficacy and tolerability of tizanidine for the treatment of dysfunctional voiding in children compared with those of doxazosin.
A total of 40 children with dysfunctional voiding were enrolled in a prospective, randomized, 2-parallel group, flexible-dose study. The evaluations were performed in accordance with the International Children's Continence Society guidelines. The children were followed up after 1 week and then monthly for 6 months for the clinical, urine culture, and urodynamic parameters. The degree of improvement was assessed using a satisfaction scale that ranged from 0 (no improvement at all) to 10 (total improvement).
A total of 40 patients with a mean±SD age of 7±2.6 years were enrolled. The clinical and urodynamic parameters were comparable between both groups. At the last follow-up visit, both groups had had similar improvement in the severity of symptoms, satisfaction scale, and noninvasive flowmetry parameters. In the doxazosin group, urge episodes was the only symptom that showed a significant reduction compared with the baseline values (P=.028). However, the incidence of nocturnal enuresis, urgency attacks, and daytime incontinence were significantly reduced compared with baseline in the tizanidine group (P=.003, P=.008, and P=.017, respectively). Adverse effects were recorded in 6 patients (15%). Epigasteric pain was reported in 2 children (10%) who received doxazosin. In the tizanidine group, a loss of appetite was noted in 2 children (10%), epigastric pain in 1 (5%), and headache in 1 (5%).
Tizanidine could be a safe and effective treatment of children with dysfunctional voiding due to pelvic floor/skeletal sphincter dysfunction. More placebo-controlled trails with larger sample sizes are needed.