Individual studies have suggested the utility of fractional exhaled nitric oxide (FeNO) measurement in detecting cough-variant asthma and eosinophilic bronchitis in patients with chronic cough. The aim of this study was to clarify a correlation of cough reflex sensitivity and fractional exhaled nitric oxide in asthmatic children. 25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement – capsaicin aerosol in doubling concentrations (from 0.61 to 1250 µmol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Fractional exhaled nitric oxide (FeNO) measurement was included. Asthmatic children (11 boys and 14 girls, mean age 9±1 years) and control group (unconfirmed diagnosis of asthma) (6 boys and 9 girls, mean age 8±1 years) were included into the study. FeNO vs. C2 in asthma (Spearman´s rank correlation: -0.146, p=0.49); FENO vs. C5 in asthma (Spearman´s rank correlation: -0.777, p=0.71). We found that there is no correlation between cough reflex sensitivity and fractional exhaled nitric oxide either in children with asthma or in the control group.
New knowledge about the neural aspects of cough has revealed
a complex network of pathways that initiate cough. The effect of
inflammation on cough neural processing occurs at multiple
peripheral and central sites within the nervous system. Evidence
exists that direct or indirect neuroimmune interaction induces
a complex response, which can be altered by mediators released
by the sensory or parasympathetic neurons and vice versa. The
aim of this study was to clarify changes of cough reflex sensitivity
– the activity of airway afferent nerve endings - in asthmatic
children. 25 children with asthma and 15 controls were submitted
to cough reflex sensitivity measurement - capsaicin aerosol in
doubling concentrations (from 0.61 to 1250 µmol/l) was inhaled
by a single breath method. Concentrations of capsaicin causing
two (C2) and five coughs (C5) were reported. Asthmatic children'
(11 boys and 14 girls, mean age 9 ± 1 yrs) cough reflex sensitivity
(geometric mean, with the 95 % CI) for C2 was 4.25 (2.25-8.03)
µmol/l vs. control C2 (6 boys and 9 girls, mean age 8 ± 1 yrs) was
10.61 (5.28-21.32) µmol/l (p=0.024). Asthmatic children' C5 was
100.27 (49.30-203.93) µmol/l vs. control C5 56.53 (19.69-162.35)
µmol/l (p=0.348). There was a statistically significant decrease of
C2 (cough threshold) in the asthmatic patients relative to controls
(p-value for the two-sample t-test of log(C2) for the one-sided
alternative, p-value = 0.024). The 95 % confidence interval for the
difference of the mean C2 in asthma vs. control, [1.004, 6.207].
For C5, the difference was not statistically significant (p-value =
0.348). There was a statistically significant decrease of cough
reflex sensitivity (the activity of airway afferent nerve endings) -
C2 value in the asthmatic children relative to controls.
The SARS-CoV-2 pandemic has indeed been one of the most significant problems facing the world in the last decade. It has affected (directly or indirectly) the entire population and all age groups. Children have accounted for 1.7 % to 2 % of the diagnosed cases of COVID-19. COVID-19 in children is usually associated with a mild course of the disease and a better survival rate than in adults. In this review, we investigate the different mechanisms which underlie this observation. Generally, we can say that the innate immune response of children is strong because they have a trained immunity, allowing the early control of infection at the site of entry. Suppressed adaptive immunity and a dysfunctional innate immune response is seen in adult patients with severe infections but not in children. This may relate to immunosenescence in the elderly. Another proposed factor is the different receptors for SARS-CoV-2 and their differences in expression between these age groups. In infants and toddlers, effective immune response to viral particles can be modulated by the pre-existing non-specific effect of live attenuated vaccines on innate immunity and vitamin D prophylaxis. However, all the proposed mechanisms require verification in larger cohorts of patients. Our knowledge about SARS-CoV-2 is still developing.
Fibroblast growth factor 21 (FGF21) is one of the members of endocrine arm of FGF family. Its actions as a glucose and lipids metabolism regulator are widely known. Although the mechanism of FGF21 action in kidneys is still under investigation, FGF21 was considered as a marker of early kidney function decline. While many researchers focused on adult subjects in this matter, there are no data regarding children. Therefore, we have investigated the relationship between plasma or urine FGF21 levels and kidney function in a group of 42 pediatric patients with chronic kidney disease (CKD). Anthropometrical parameters and blood pressure were taken, routine biochemical tests were performed. The concentration of FGF21 in serum and urine was determined by enzyme immunoassay. The results revealed significantly higher serum FGF21 concentration among children from CKD group. However, serum FGF21 level was not related to gender, proteinuria, eGFR or renal replacement therapy. Urine FGF21 concentration correlated negatively with albuminuria and positively with eGFR. Documented negative correlation of FGF21 fractional excretion and eGFR is not enough to support the role of FGF21 as a biomarker for predicting kidney disease progression in children and adolescents. Other mechanisms including local kidney FGF21 production or enhanced excretion due to higher extrarenal production may result in higher urine FGF21 concentrations.
Nebulization with saline solution, although commonly used to
alleviate respiratory symptoms, particularly in children, is often
questioned concerning its effectiveness. In this study, we
investigated the effects of isotonic saline nebulization on lung
function in 40 children (mean age of 14±1 years) suffering from
different types of airway disorders. Measurements were carried
out directly before and up to 15 min after nebulization, for six
days in a row, always on the same day time in the morning. The
children were divided into two study groups according to the
baseline ratio of forced expired volume in one second/forced vital
capacity (FEV1/FVC), below and above 80 %. We found
significant improvements after saline nebulization in FEV1, midexpiratory flow at 50 % and 75 % of FVC (MEF50 and MEF75),
and peak expiratory flow (PEF) in the group with the baseline
FEV1/FVC less than 80 %. In contradistinction, children with an
index greater than 80 % displayed no appreciable changes in the
lung function variables when compared with the baseline level
before saline nebulization. We conclude that isotonic saline
nebulization might mitigate the functional signs of threatening
pulmonary obstruction and as such may be clinically useful in
pediatric patients with mild respiratory problems.
Toxoplasmosis is a potentially fatal complication after hematopoietic cell transplantation (HCT). Pre-transplant seropositivity of graft recipient to Toxoplasma gondii (Nicolle et Manceaux, 1908) is an important factor for disease reactivation after HCT. As toxoplasmosis epidemiology varies all over the world, we performed a Polish nationwide retrospective cohort study to determine the seroprevalence of toxoplasmosis in donors and pediatric allogeneic and autologous HCT recipients and the incidence of clinically evident toxoplasmosis in this patient group. Polish adult donors had higher anti-T. gondii seroprevalence than Polish pediatric donors (28% vs 8%; OR = 4.4; p = 0.02) and allo-HCT recipients (28% vs 17%; OR = 1.9; p = 0.01). Clinically apparent disease occurred in 1% of allo-HCT recipients: it was diagnosed by PCR as cerebral and/or ocular toxoplasmosis and successfully treated with antiprotozoal therapy. Regarding current practice, no prospective screening for infection of T. gondii in pediatric HCT centres is being performed, but, vast majority of HCT pediatric patients are receiving anti-T. gondii active prophylaxis. Since pre-HCT T. gondii serology was not assessed in all HCT; recipients, we propose this test should be a standard practice. Standardisation of management with infection of T. gondii in children after HCT is needed.
Midazolam is a short acting sedative with small number of adverse effects. Administered orally, it is currently the most common form of conscious sedation in children. The objective of this paper is to describe effect of midazolam administered to children during dental treatment on their vital signs, and to monitor changes in children’s behavior. We described values of vital signs and behavior in 418 sedations conducted in 272 children between 1-12 years of age. To achieve the following results, we used data from 272 all first-time sedations. After administration of midazolam arterial blood pressure and blood oxygen saturation decreased by values which were not clinically significant. The heart rate increased, with values staying within the limits of physiological range. The speed of onset of midazolam’s clinical effects depends on age and dose. The lower age and dose correlated with the higher behavior score. The effectiveness of midazolam treatment is 97.8 %. Unwillingness of child to receive midazolam is predictor for disruptive behavior during sedation. 1.8 % of all sedation cases showed paradoxical reactions. The administration of midazolam in dose of 0.5 mg per 1 kg of child’s body weight is safe and could be recommended for dental treatment in pediatric dentistry., Jana Vasakova, Jana Duskova, Jitka Lunackova, Klara Drapalova, Lucie Zuzankova, Luboslav Starka, Michaela Duskova, Zdenek Broukal., and Obsahuje bibliografii
Obesity is characterized by chronic, low-grade systemic inflammation. Obesity may also be associated with chronic cough. The aim of this pilot study was to clarify relation of cough reflex sensitivity and body mass index (BMI) in children with chronic cough. Altogether 41 children having symptoms of chronic cough were submitted to cough reflex sensitivity measurement. We assessed the relation of cough reflex sensitivity (CKR) due to BMI. Cough reflex sensitivity was defined as the lowest capsaicin concentration which evoked two (C2) or five (C5) coughs. Capsaicin aerosol in doubling concentrations (from 0.61 to 1250 µmol/l) was inhaled by a single breath method (KoKo DigiDoser; nSpire heath Inc, Louisville, CO, USA), modified by the addition of an inspiratory flow regulator valve (RIFR; nSpire heath Inc, Louisville, CO, USA). BMI was calculated. Pulmonary function was within normal range. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (22 boys and 19 girls, mean age 6.8 years) cough reflex sensitivity (median, with the InterQuartile Range) for C2 was 19.5 (73.4) µmol/l; for C5 it was 78.1 (605.5) µmol/l. We have noticed statistically significant relation of the cough reflex sensitivity (C5) and body mass index (P<0.0001); however, the effect size was small, R2 =0.03. Increase of body mass index in one unit is associated with -34.959 µmol/l decrease of C5. We did not find a statistically significant relation between C2 and BMI (P=0.41). The median value of CKR (C2) in boys is not statistically significantly different than the median value of CKR (C2) in girls (P-value 0.5). The median value of CKR (C5) in boys is not statistically significantly different than the median value of CKR (C5) in girls (P-value 0.5). Increase of body mass index in children suffering from chronic cough relates to decrease of cough reflex sensitivity (C5 value).
Rozchod rodičů je proces, který dlouhodobě ovlivňuje životy všech zúčastněných. Cílem studie je popsat rozchod rodičů z pohledu dítěte. Vnímání rodiny dětmi jsme zkoumali pomocí metody FAST. Děti stavěly typickou, ideální a konfliktní reprezentaci rodiny. Porovnávali jsme skupinu 15 dětí v situaci rozchodu rodičů a skupinu 19 dětí ve stabilním rodinném prostředí bez vážných rodičovských konfliktů, průměrný věk dětí z obou skupin je 9,5 let (rozpětí 5-15 let). Zajímali jsme se o členství v rodině, kohezi a popis konfliktů v rodině. Děti v situaci rozchodu rodičů popisovaly nižší kohezi nejenom ve vztahu mezi rodiči, ale i mezi sebou a oběma rodiči. To je v souladu se zjištěními, která poukazují na horší kvalitu rodičovství po rozchodu rodičů. Děti, jejichž rodiče se v době sběru dat rozcházeli, zahrnovaly do rodiny příbuzné nad rámec primární rodiny. Členství těchto lidí v rodině ale nebylo trvalé. Zdá se, že tyto děti hledají oporu v dalších vztazích v širší rodině, nebo nahrazují kvalitu (zhoršení vztahů po rozchodů rodičů) kvantitou ve vztazích. Popisují také rodinné konflikty s horším výsledkem a nepopisují účinné strategie řešení konfliktů. and The divorce of parents is a situation which in the long term affects life of everyone involved. The aim of this study is to describe the parents’ divorce from the child’s point of view. The perception of the family by children was examined by the FAST method. The children presented a typical, an ideal and a conflict representation of the family. We compared the group of 15 children in a divorce situation with the group of 19 children in stable family environment without significant parental conflicts. The average age of children in both groups was 9,5 years (range 5 – 15 years). We were interested in the family members, cohesion and the description of family conflicts. Children in parents’ divorce described a lower cohesion not only in the parents’ relationship but also between themselves and both parents. This supports the spillover concept in the family and is in harmony with findings, which point out the inferior quality of parenthood after the divorce. Children, whose parents were in the process of divorce during the collecting of data, included into the family also relatives outside the primary family. However, their membership in the family was not permanent. It seems that these children are seeking for support in relationships within the extended family or they substitute the quality (the worsening of quality after the divorce) by quantity in relationships. They also describe family conflicts with worse results, and they don’t describe effective strategies of solving conflicts.
Fatty acid (FA) profiles as potentially relevant components of Crohn’s disease (CD) have been insufficiently analysed. We sought to explore the plasma profiles of n-3 and n-6 polyunsaturated fatty acids (PUFAs) in newly diagnosed untreated active CD. We included 26 consecutive CD pediatric patients (<19 years) and 14 healthy controls (HCs). Disease characteristics, including inflammatory markers, dietary histories, and the Pediatric Crohn’s Disease Activity Index (PCDAI), were obtained. The profiles of plasma FAs in plasma lipid classes were analysed by gas chromatography with FID detection of methyl esters. The erythrocyte sedimentation rate, C-reactive protein level and fecal calprotectin level (all p<0.001) were significantly higher in CD patients than in HCs. Most changes were observed in plasma phospholipids (PLs), such as a higher content of n-3 and changes in n-6 long-chain PUFAs in the CD group. The CD group had a lower ratio of n-6/n-3 PUFAs in PLs (p<0.001) and triacylglycerols (TAGs) (p<0.01). Correlations of the FA content in plasma PLs with disease activity scores of CD were also observed, which were positive for the sum of monounsaturated fatty acids (MUFAs) as well as oleic acid (18:1n-9) (both p<0.05). The metabolism of PUFAs is significantly altered even in treatment-naïve newly diagnosed active pediatric CD, and the content of major FAs in PLs correlates with disease activity and inflammatory markers, thus probably contributing to the still unclear early disease pathogenesis., Jan Schwarz, Marek Vecka, František Stožický, Renáta Pomahačová, Barbora Staňková, Eva Tvrzická, Marcela Kreslová, Romana Zahálková, Josef Sýkora., and Obsahuje bibliografii