Prescribing for persistent cough in children

BACKGROUND/AIMS: Both ethanol and gamma aminobutyric acid (GABA) have been reported to inhibit hepatic regenerative activity in the rat. Because alcoholic beverages contain appreciable amounts of GABA, we documented whether the inhibitory effects of alcohol on the liver are derived from ethanol alone or the combination of ethanol plus GABA. METHODS: Adult male Sprague-Dawley rats (n=6/group) were treated with either ethanol (3 g/kg), GABA (500 mg/kg) or ethanol plus GABA (3 kg and 500 mg/kg, respectively), beginning 1 h prior to a 70% partial hepatectomy and continued every 4 h thereafter for a total of 24 h. Rats were then sacrificed and hepatic regenerative activity was documented by 3H-thymidine incorporation into hepatic DNA. RESULTS: DNA synthesis was significantly inhibited by ethanol (-37%, p<0.005) and GABA (-19%, p<0.05). Maximum inhibition was achieved with the combination of ethanol plus GABA (-52%, p<0.001). To determine whether the additive effects of ethanol plus GABA were mediated by ethanol-induced enhancement of hepatic GABA(A) receptor activity, additional rats (n=6/group) receiving the combination of ethanol plus GABA were pre-treated with a single injection of either ciprofloxacin (50 mg/kg), a GABA(A) receptor antagonist, or an equal volume of saline. In these experiments, ciprofloxacin pre-treatment prevented the inhibitory effects of the ethanol plus GABA combination. CONCLUSIONS: The results of this study indicate that the combination of ethanol plus GABA has a greater inhibitory effect on hepatic DNA synthesis following partial hepatectomy than ethanol alone. The clinical implication of this finding is that, when standardized for ethanol content, not all alcoholic beverages would be expected to have the same inhibitory effect on hepatic regeneration.     

Helicobacter pylori and hypergastrinemia in children with recurrent abdominal pain

Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups. The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group, aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50 children in the control group, 32 were seropositive (64%) for Hp IgG (P > 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels in 62 Hp-seropositive children (60.4 ng/l) were not different from those in 30 Hp-seronegative children (57.3 ng/l) and those in 42 children with RAP (58.2 ng/l) were also not significantly different from those in 50 healthy children (62.9 ng/l). Thus, no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population.     

Increased sensitivity of the cough reflex in progressive systemic sclerosis patients with interstitial lung disease

Cough is a common presenting symptom of interstitial lung disease (ILD). The aim of this study was to examine the cough reflex in patients with progressive systemic sclerosis (PSS), with and without associated ILD. The cough reflex to inhalation of chloride deficient solutions and capsaicin was determined in patients with PSS with associated ILD (n=12), compared to patients with PSS without ILD (n=12). In addition, patients with a chronic dry cough (n=12) and healthy subjects (n=10) without cough were studied. Cough responses to inhalation of isotonic solutions containing 150, 75, 37.5 and 0 mM Cl- ions and of capsaicin (0.9-500 mM) were measured. PSS patients with ILD reported a significantly higher cough score than PSS patients without ILD (p<0.03). ILD patients coughed more than those without ILD to Cl- of 37.5 and 0 mM (19.1+/-5.0 vs 6.2+/-1.9 coughs x min(-1) (p<0.03), and 29.2+/-5.0 vs 14.1/-4.1 coughs x min(-1) (p<0.04), respectively). The log concentration of capsaicin causing two or five coughs was lower in PSS with ILD compared to PSS without ILD (0.74+/-0.15 mM vs 2.12+/-0.26 mM; p<0.002). Patients with chronic dry cough had a similar degree of response to low-chloride and capsaicin solutions as patients with PSS and ILD, whilst healthy controls had a similar degrees of response to PSS patients. There is an increased cough reflex in patients with interstitial lung disease, which may represent sensitization of airway sensory nerves. This may be the basis for the chronic dry cough in patients with interstitial lung disease.     

注射用胸腺肽治疗反复呼吸道感染患儿临床疗效

目的 探讨注射用胸腺肽治疗小儿反复呼吸道感染患儿临床疗效.方法 采用随机开放对照法,治疗组应用注射用胸腺肽,当感染时加用少量激素.对照组单用注射用羟氨苄青毒素.结果 注射用胸腺肽组较对照组呼吸道感染的次数减少,使用抗生素时间缩短,与对照组比较明显缩短(P<0.05).注射用胸腺肽组有效率为96.8%,对照组有效率为78.1%.且无明显副作用.结论 胸腺肽治疗反复呼吸道感染患儿是有效和安全的.     

Atopic allergy and immunoglobulins in children with adenoids and recurrent otitis media

From 274 adenoidectomized children 1-16 years of age two groups were selected: children with a history of recurrent otitis media and/or otosalpingitis (middle ear effusion) and those in which nasal obstruction was the main symptom. In all, 154 children were subjected to an allergy investigation including history, skin tests, eye tests, determination of IgE and RAST, blood eosinophils and immunoglobulins G, A and M. No increased incidence of immunoglobulin deficiency was found in either group in comparison with unselected children. A family history of atopic disease and/or otitis media was highly overrepresented, especially in the children with recurrent otitis media as the reason for the adenoidectomy. Atopic diseases had occurred in 24.4% of the children. Furthermore, in both groups there was a high incidence of positive skin and eye tests. An increased incidence of eosinophila, positive RAST tests and elevated IgE levels were also found. In all, 39.6% of the children had two or more laboratory findings characteristic of the atopic state but no significant difference was found between the two groups. Possible connections between atopic allergy and recurrent otitis media are discussed.     

The cellular immune response to Bordetella pertussis in two children with whooping cough

There is increasing evidence that the cellular immune response to Bordetella pertussis plays an important role in the immune protection. Particularly in animal models, Bordetella pertussis-specific T-cells have been shown to confer immunity. In this case report, we therefore investigated the cellular immune response to whole cell Bordetella pertussis bacteria, to the pertussis antigens filamentous hemagglutinin and pertussis toxoid defined by lymphoproliferation and cytokine secretion. Two children with whooping cough were compared to three individuals vaccinated against whooping cough with a whole cell pertussis vaccine. In contrast to the vaccinated controls, the cellular immune response to Bordetella pertussis in children with whooping cough was characterized by a strong proliferation of T cells to whole pertussis bacteria as well as to filamentous hemagglutinin and pertussis toxoid. This response was defined by a marked Th-1 type T cell response with IFN-gamma secretion to all Bordetella pertussis antigens. However, in the control individuals IFN-gamma was secreted only to whole cell Bordetella pertussis bacteria and filamentous hemagglutinin but not to pertussis toxoid. A Th-2 type cytokine response could not be detected in any condition. Our observations suggest that in the immune defense of a natural Bordetella pertussis infection, the Th-1 specific T cell response to filamentous hemagglutinin and particularly to pertussis toxoid may play a major role.     

Effect of prokinetics in children with recurrent nocturnal retrosternal pain

BACKGROUND: Children rarely present with vague complaints of nocturnal recurrent retrosternal or upper-abdominal, epigastric, pain. Dysmotility of the upper gastrointestinal tract, including gastro-oesophageal reflux, might be at the origin of these manifestations. OBJECTIVE: To evaluate the clinical effect of prokinetics (cisapride) in children with recurrent nocturnal retrosternal pain, and to measure the effect of cisapride with a combined oesophageal ambulatory 24 h pH and pressure monitoring. PATIENTS: Twelve children, mean age 9.5 years (range 4.1-14.0 years), with nocturnal recurrent retrosternal pain for more than 6 months, occurring at least three times a week. METHODS: Single-blinded prospective study, with two periods of 2-3 weeks during which cisapride was administered, alternated with two placebo periods of the same duration. Clinical evaluation, and assessment with oesophageal pH and pressure monitoring. RESULTS: Cisapride was related to a temporary relief of the symptoms in 10/12 children. The improvement was demonstrated through a normalization of pH monitoring, and an increase in amplitude and duration of the contractions in the lower oesophagus. CONCLUSION: Cisapride improves complaints of recurrent nocturnal retrosternal pain in children.     

Elastin-derived peptides and anti-elastic antibodies in children with recurrent or obstructive bronchitis

The aim of the study was to examine the effects of bronchitis on elastin-derived peptides (EP) and antielastin antibodies (AEAb) in serum. Using an ELISA technique, these parameters were assessed in children aged 6 months to 15 years: 36 had recurrent bronchitis (RB), 34 had obstructive bronchitis (OB) and 37 were healthy children (C). A comparison of the levels of the investigated compounds in the acute phase (I) and stage without signs of diseases (II) was studied. The EP data show non-significant changes in the RB and OB groups in comparison with group C. Children with OB had significantly lower levels of AEAb in IgA, IgG and IgM class antibodies, while those with RB in the IgG class in comparison with group C in both examinations. In examination 1, AEAb in IgA and IgM classes were significantly lower in children with OB than with RB.     

Factors associated with fathers' caregiving activities and sensitivity with young children.

A multifactorial model was used to identify child, sociodemographic, paternal, and maternal characteristics associated with 2 aspects of fathers' parenting. Fathers were interviewed about their caregiving responsibilities at 6, 15, 24, and 36 months, and a subset was videotaped during father-child play at 6 and 36 months. Caregiving activities and sensitivity during play interactions were predicted by different factors. Fathers were more involved in caregiving when fathers worked fewer hours and mothers worked more hours, when fathers and mothers were younger, when fathers had more positive personalities, when mothers reported greater marital intimacy, and when children were boys. Fathers who had less traditional child-rearing beliefs, were older, and reported more marital intimacy were more sensitive during play. These findings are consistent with a multifactorial and multidimensional view of fathering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contamination sensitivity in young children.

In Experiment 1, to examine contamination sensitivity, children ages 36 to 47 months were shown juice that had been in contact with a cockroach. In contrast to previous research suggesting that young children do not have the cognitive prerequisites to understand the invisible nature of contamination, most children indicated that the juice was not good to drink even though the cockroach had been removed, leaving no trace. Children made accurate evaluations of others' responses to this type of incident and inferred actions to protect others. The purpose of Experiment 2 was to determine whether contamination sensitivity may be guided by an implicit knowledge of the distinction between appearance and reality. Children ages 30 to 42 months were presented with a piece of moldy bread. The bread was then covered by a breakfast spread. In contrast to a control group that was given fresh bread without mold, most responded that the bread would not be good to eat even after the mold was concealed by the spread. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Airway response of children with primary ciliary dyskinesia to exercise and beta2-agonist challenge

In primary ciliary dyskinesia (PCD), chest physiotherapy for airway clearance is essential. Exercise and inhaled beta2-agonists can produce bronchodilation thereby augmenting physiotherapy. However, both can also cause bronchoconstriction, and the effects of these stimuli in PCD are not known. In a preliminary study, the mean coefficients of variation for forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) in children with PCD were determined. They were 5.4%, 4.4% and 8.4%, respectively. Twelve children with PCD and 12 normal children performed pulmonary functions under resting conditions; during and after a validated treadmill exercise test; and before and 15 min after 200 microg of inhaled salbutamol. At baseline, FEV1, FVC, forced mid-expiratory flow (FEF25-75%) and PEFR were significantly reduced in the PCD group compared with the control group. Exercise produced a significant increase in PEFR in the PCD group. There was no significant difference between the groups in response to salbutamol. Within the PCD group, exercise produced a significantly greater increase in PEFR than beta2-agonist therapy. In conclusion, in children with primary ciliary dyskinesia there is evidence of obstructive pulmonary disease. In these children, exercise is a more potent stimulus for bronchodilation than by inhaled beta2-agonists. Enhancement of airway clearance may best be achieved by encouraging patients to exercise before physiotherapy rather than by inhaling beta2-agonists, but the effects of each should be assessed for each individual before instigating treatment.     

IgG antibodies to pollen allergens in children with rye-grass lung sensitivity

This study determined the changes in the amount (Abt) and relative avidity (Krel) of antibody to a purified rye-grass pollen extract during the rye-grass pollen season in 15 asthmatic children. For the group, there was a significant rise in Abt pre- to mid-season and fall mid- to post-season (p less than 0.05), but no consistent changes in Krel values during the study were seen. Asthmatic children with and without bronchial reactivity to rye-grass pollen extract showed similar Abt and Krel changes during the study.     

UL-scanning of children with recurrent abdominal pain--a diagnostic gain?

Treatment of hypertension has reduced the incidence of stroke, heart failure and renal failure. However, the incidence of coronary heart disease is not reduced to the same degree. Many of the drugs advocated as first-line drugs in the step-wise therapy have been shown to cause carbohydrate intolerance and it is an independent risk factor in the development of coronary heart disease. It is thus important to identify the antihypertensive drugs that may cause deterioration in glucose tolerance. Cicletanine, the first derivative of the furopyridines, is a new class of antihypertensive agents. It acts directly on vascular endothelium cells by increasing prostacyclin synthesis. It also decreases intracytosolic calcium levels in smooth muscles. The purpose of this study is to evaluate the effects of Cicletanine on insulin release in rat isolated pancreas by the perfusion technique adapted from Loubatieres and co-workers (1972). Doses used were based on therapeutic peak plasma concentration. Diazoxide was used as a positive control ie a known insulin suppressant. Cicletanine at 1/10 and equivalent therapeutic concentrations (0.5 microgram/mL and 5.0 micrograms/mL) did not suppress insulin release. However, at concentration exceeding 10X its therapeutic levels (50 micrograms/mL) it begins to suppress insulin release. In conclusion, Cicletanine did not inhibit insulin release at concentrations within the therapeutic range.     

The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain

The plicae are synovial septa remaining in adult life that existed in early fetal life. The suprapatellar plica separates the suprapatellar pouch from the knee joint. The plica syndrome has clinical significance, which has been occasionally overlooked, but the pathophysiology of symptomatic plicae may be hard to explain. To evaluate the clinical significance of the suprapatellar plicae, the authors reviewed 34 cases in 23 patients with vague pain around the knee and a total septum of the suprapatellar plica at arthroscopic examination from September 1991 to December 1993. The follow-up period was from 6 months to 2 years and 9 months. The most common presenting symptom was chronic mild knee pain, aggravated by prolonged squatting or standing, with other patients reporting recurrent swelling, instability, giving-way, or a feeling of snapping. The objective findings include palpable band on the superomedial side, audible snapping, and local tenderness, but there were no significant abnormal findings in the laboratory. The radiographic findings were few, with sclerosis of the articular surface of the patella in 2(6%), malalignment in 1(3%), and mild degenerative change in 4 cases(12%). Five of 11 patients evaluated by bone scan had increased uptake around the patellofemoral joint, and 7 of 13 knees had a relatively small suprapatellar bursa on conventional arthrogram or pneumoarthrogram. At arthroscopy, a suprapatellar plicae with complete septum was identified in 30 of 34 cases (88%) and associated lesions presented as meniscal tears, loose body, and discoid meniscus without tear. The complete plicae were surgically excised under arthroscopic control in 30 patients and the results were excellent in 22 patients (73%), good in 5 (17%), and poor in 3 (10%)at 17 months follow-up; there were no failures. In our opinion, the complete suprapatellar plica is clinically significant in patients who have equivocal diagnosis of knee problems and further studies of the pathophysiology of complete suprapatellar plica are needed.