Endobronchial nocardiosis in an 11-year-old child

Pulmonary nocardiosis is a rare infection and overwhelmingly limited to immunocompromised individuals. Endobronchial nocardiosis is even more rare. Nocardiosis is rarely seen in immunocompetent hosts mostly as cutaneous infection. Here we report an immunocompetent child with endobronchial nocardiosis presenting as nonresolving pneumonia and lung abscess. To our knowledge, this is the first case reported in the literature of endobronchial nocardiosis in a child.

Cardiovascular risk factors, carotid artery intima media thickness, and HSCRP levels in patients with impaired glucose metabolism

AIM

The aim of this paper was to compare serum high sensitivity C-reactive protein (HsCRP) levels and carotid artery intima-media thickness (CIMT) of patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) with that in control subjects.

METHODS

Ninety-six subjects with prediabetes, 48 with IFG, of mean age 50.7±11.3 years, and 48 with IGT, of mean age 50.9±12.3 years, were enrolled, along with 44 age-, sex-, and body mass index-matched controls with normal glucose tolerance. Serum HsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) was evaluated. High-resolution B-mode ultrasonography was performed.

RESULTS

Serum HsCRP levels were significantly elevated in pre-diabetic patients when compared with that of control subjects. Median HsCRP values were 3.1 mg/L in IFG group, 3.47 mg/L in IGT group, and 1.5 mg/L in the controls (P<0.001). CIMT was significantly higher in pre-diabetic groups than that in the control group (IFG: 0.612±0.09; IGT: 0.625±0.1; control: 0.517±0.09, P<0.001). CIMT and HsCRP levels were similar in pre-diabetic groups. CIMT values were positively correlated with HsCRP (r=0.793, P=0.000), age (r=0.435, P=0.000), waist-hip ratio (r=0.170, P=0.044), fasting plasma glucose (r=0.302, P=0.000), HOMA-IR (r=0.173, P=0.041), and low-density lipoprotein cholesterol (r=0.168, P=0.047) levels.

CONCLUSION

Both IFG and IGT were associated with increased cardiovascular risk as assessed by serum hsCRP levels and CIMT. In contrast to previous studies, risk appears to be the same in the two categories of prediabetes.

The protective effects of taurine on experimental acute pancreatitis in a rat model

The aim of this study was to investigate the protective effects of taurine (Tau) on experimental acute pancreatitis (AP) in a rat model by measuring cytokines and oxidant stress markers.

Forty rats were randomly divided into four groups: sham, AP, Tau and AP + Tau. AP was induced with sodium taurocholate. No treatment was given to the AP. All rats were killed 5 days later. Pancreatic tissues of rats and blood samples were obtained.

Tau treatment significantly decreased serum amylase activity ( p < 0.001), total injury score ( p < 0.001), malondialdehyde levels ( p < 0.001) and myeloperoxidase (MPO) activity ( p < 0.001). There was no significant difference between the Tau and AP + Tau groups in serum and pancreatic tumor necrosis factor-α, interleukin (IL)-1β and IL-6 levels ( p = 1.000). Histopathologic scores in the AP + Tau and Tau groups were significantly lower compared with the AP group (both p < 0.001).

These results showed that Tau reduces lipid peroxidation, amylase and MPO activities and the concentrations of proinflammatory cytokines secondary to AP and also increases superoxide dismutase and glutathione peroxidase activities in rats with sodium taurocholate-induced AP. It also has a marked ameliorative effect at histopathologic lesions. With these effects, Tau protects the cells from oxidative damage, reduces inflammation and promotes regression of pancreatic damage.

Classic kaposi sarcoma with pulmonary involvement mimicking endobronchial tuberculosis in a child

Kaposi' sarcoma (KS) is a low-grade vascular neoplasm and classic KS, a subtype of KS, is extremely rare in children. Childhood pulmonary involvement in classic KS has not been reported in the literature. We describe an HIV-seronegative pediatric case with a fulminant course of classic KS with pulmonary involvement mimicking endobronchial tuberculosis.

Bronchoscopic evaluation of unexplained recurrent and persistent pneumonia in children

BACKGROUND

Persistent or recurrent pneumonia in children can pose a significant challenge to paediatricians and respiratory physicians.

AIM

The aim of this study is to determine the role of flexible bronchoscopy (FB) in evaluation of recurrent or persistent pneumonia that remain otherwise unexplained by non-invasive diagnostic tests in children.

METHODS

Retrospective evaluation of patients who underwent FB with an indication of recurrent or persistent pneumonia from 1997 to 2011.

RESULTS

Among 2600 FB procedures, 434 (17%) were performed with the indication of recurrent or persistent pneumonia. There were 237 (54%) boys. Median age at presentation was 84 months, and median duration of symptoms was 9 months. FB led to specific diagnosis in 33% of the cases. The most common diseases diagnosed by FB were malacia disorders (n: 32, 7%), aspirated foreign body (n: 30, 7%), endobronchial tuberculosis (n: 20, 5%), congenital airway anomalies (n: 14, 3%), mucus plugs (n: 14, 3%), pulmonary haemosiderosis (n: 12, 3%) and middle lobe syndrome (n: 11, 3%). During FB, only 6% of the patients had minor complications such as transient hypoxia, stridor and tachycardia.

CONCLUSIONS

In our study, FB proved to be a safe and effective tool in evaluation of children with persistent or recurrent pneumonia. FB is indicated for children with recurrent or persistent pneumonia where the underlying diagnosis remains unclear even after non-invasive diagnostic tests.

Comparing the Smoking Status of Working Adolescents with Adolescents Enrolled in High School in Turkey

Smoking is one of the most important public health problems. There is limited data about the smoking status of working adolescents. In this study we aimed to compare the smoking status of working adolescents with adolescents enrolled in high school in Turkey. Workers were recruited from a vocational training center, and control subjects were from a local high school. Questionnaires about socioeconomic status and smoking were applied. Eight hundred and two participants (436 workers) were included in the study. The mean age of the participants was 16.8 years. Smoking frequencies were 40% and 21% for the workers' group and the control group, respectively (P<0.001). Adolescent workers were more frequently exposed to second-hand smoke at home. Working [odds ratio (OR): 2.49, 95% confidence interval (CI): 1.81-3.43], age over 17 (OR: 1.77, 95% CI: 1.28-2.44), and male sex (OR: 1.57, 95% CI: 1.00-2.44) were found to be significantly effective on smoking in the logistic regression analysis. Working adolescents had significantly higher smoking rates and exposed to second-hand smoke at home than high school students. Further studies are needed to explore the reasons of higher smoking rates in working adolescents than in high school students.

MUC1 and bcl-2 expression in preinvasive lesions and adenosquamous carcinoma of the lung

BACKGROUND

Adenosquamous carcinoma of the lung involves both adenocarcinoma and squamous cell carcinoma, each comprising at least 10% of the tumor. Atypical adenomatous hyperplasia (ADH), bronchiolar columnar cell dysplasia (BCCD), basal cell dysplasia (BCD), columnar cell dysplasia (CCD), bronchial epithelial dysplasia with transitional differentiation (BEDT) and squamous dysplasia (SD) are preinvasive lesions. The aim of this study is to define the preinvasive lesions and evaluate the role of MUC1, bcl-2, and the preinvasive and invasive components of adenosquamous carcinoma.

METHODS

A group of 31 patients with adenosquamous carcinoma of the lung were selected. The ratio of squamous to glandular differentiation, the associated preinvasive lesions, the features of peritumoral tissue, the stroma of the tumor, necrosis, perineural and vascular invasion were analyzed. For the immunohistochemical study, blocks containing squamous cell carcinoma, adenocarcinoma and preinvasive lesions were selected. MUC1 and bcl-2 analyses were performed by the immunoperoxidase method using the avidin-biotin complex.

RESULTS

Associated preinvasive lesions amd SD, BCCD, BEDT, AAH and CCD were observed in 24, 6, 3, 1 and 6 cases, respectively. Expression for MUC1 was positive in the squamous component of 30 cases, the adenocarcinoma component of 27 cases and in 34 preinvasive lesions. A strong correlation was found between MUC-1 expression in the squamous component and tumor localization (p = 0,01). The positive expression of Bcl-2 in the adenocarcinomatous component was correlated with the presence of preinvasive lesions (p = 0,01).

CONCLUSIONS

Squamous dysplasia was the most frequent preinvasive lesion of adenosquamous carcinomas. MUC1 and bcl-2 expression levels were strongly associated with preinvasive lesions in adenosquamous carcinomas.

Endobronchial findings of hydatid cyst disease: a report of five pediatric cases

Hydatid disease is still an important public health problem throughout the world. Diagnosis of the disease is generally based on clinical and radiological findings. Evaluation of pulmonary disorders by flexible bronchoscopy (FOB) is a rapidly developing facility, but diagnostic and therapeutic FOB for pulmonary hydatid cysts is still controversial. This study examines the findings of endobronchial hydatid cyst disease in five pediatric patients from Turkey, and clinical experience about this subject is reviewed. All our patients presented with unusual symptoms of the disease, and for all of them, diagnosis had been delayed using current diagnostic methods. As a result of our experience, it can be reported that the endobronchial appearance of the hydatid cyst membrane is whitish-yellow, and it is difficult to differentiate it radiologically from some other common causes of endobronchial lesions in childhood, such as endobronchial tuberculosis, foreign body aspirations, mucous plaques, and granulation scars. The findings of these cases show that, hydatid cyst should also be kept in mind in differential diagnosis of endobronchial lesions. In the diagnosis of pulmonary hydatid cyst in children without typical clinical and radiological findings of the disease, FOB examination is a valuable diagnostic procedure.

An unusual case of foreign body aspiration mimicking cavitary tuberculosis in adolescent patient: thread aspiration

Foreign body aspiration continues to be a serious problem in childhood and adolescent period with significant rate of morbidity and rarely mortality. Half of the foreign body aspiration cases have no history of aspiration. The main foreign bodies inhaled are food fragments and different kinds of metallic objects. A 12-year-old girl was referred to the pediatric pulmonology department for chronic cough and hemoptysis. She had persistent infiltration and cavitary lesion mimicking cavitary tuberculosis. There was no contact history with tuberculosis in her family and acid resistant bacillus was not found in the sputum examination. Flexible bronchoscopy was performed for persistent infiltration and hemoptysis and inflamed thread was found in right lower lobe bronchus. This is the first case of thread inhalation mimicking cavitary tuberculosis in an adolescent patient.

Seroconversion status after single dose and double doses of varicella vaccination in children with leukemia

Although varicella is a benign self-limiting disease in healthy children, it can be fatal when it occurs in immunocompromised hosts. Despite that immunosuppressed children are suggested to require 2 doses of vaccine to achieve seroconversion, conflicting results are reported in the literature. The aim of this study was to investigate the seroconversion status and mean antibody titers at first year after single dose and double doses of varicella vaccination in acute lymphoblastic leukemia patients. Patients with leukemia in remission for at least 1 year who were seronegative for varicella-zoster virus immunoglobulin G (IgG) were vaccinated. Titers above the cutoff level (0.65) were accepted as seroconversion. Seventeen patients were vaccinated with single dose whereas 24 patients were vaccinated with double doses. Mean prevaccination antibody titers were 0.56 ± 0.05 in patients with single dose and 0.51 ± 0.08 in patients with double doses (P > .05, Student t test). The mean antibody titers at first year were 0.61 ± 0.05 in patients with single-dose vaccination (P > .05, Wilcoxon signed-rank test) and 1.48 ± 0.04 in patients with double doses (P < .001, Wilcoxon signed-rank test). Seroconversion after single-dose vaccination was achieved in 29% of patients (n = 5/17) and in 75% of patients with double doses (n = 18/24) at first year (P = .004, chi-square test). These results suggest that seroconversion after single-dose vaccination might not persist at first year in malignancy patients. Double doses should be applied in order to provide long-term seroconversion.

Relapsing Polychondritis in a Nine-Year-Old Child Presenting with Subglottic Stenosis

Relapsing polychondritis (RP) is a rare multisystem disorder characterized by inflammation and destruction of cartilaginous tissue. Atypical initial symptoms and signs may cause difficulties in the diagnosis of RP for pediatricians. In this article, we report a 9-year-old male who presented with stridor and hoarseness indicating upper respiratory tract involvement in the setting of chronic polyarthralgia. Flexible bronchoscopy revealed subglottic stenosis. Increasing awareness of early respiratory manifestations of RP will prevent life-threatening complications.

Relationship between toll-like receptor 8 gene polymorphisms and pediatric pulmonary tuberculosis

Objectives: Genetic variants in Toll-like receptors (TLRs) are considered a potential indicator for host susceptibility to and outcome of several infectious diseases including tuberculosis. The aim of this study was to determine whether −129 C/G and Met1Val polymorphisms of TLR8 were associated with pediatric pulmonary tuberculosis in Turkish population.

Methods: The −129 C/G and Met1Val polymorphisms were studied in 124 children with pulmonary tuberculosis compared to 150 age-matched healthy control subjects.

Results: We did not identify any statistically significant differences between the patients with TB and control groups with regard to the frequency of genotypes GG or G/(−), CG, and CC or C/(−); and alleles G and C at rs3764879 (p > 0.05). We found a strong association with genotype A/(−) at rs3764880 with susceptibility to pulmonary TB in males (OR 2.87, 95%CI 1.38–5.98, p = 0.007).

Conclusions: Our results provide evidence, for the first time, of a role for the TLR8 gene in susceptibility to pulmonary TB in male children. Additional research to verify our results are necessary. Tuberculosis in children presents particularly difficult challenges, but research priorities and advances in pediatric tuberculosis could provide wider insights and opportunities for tuberculosis control.

The incidence of non-proliferative and precancerous lesions of reduction mammoplasty: evaluation of 273 cases

BACKGROUND

Reduction mammoplasty (RM) is one of the most commonly performed plastic surgery procedures to treat symptomatic macromasty or to correct asymmetry. Occult breast carcinomas were rarely defined in RM specimens. There are few studies aiming to define the incidence of non-proliferative and precancerous lesions.

MATERIAL AND METHODS

We evaluated the pathological findings of the RM specimens that have been submitted to our Center for the last 6 years (2005-2011).

RESULTS

A total of 273 cases with bilateral RM were enrolled to the study. Of them, 229 cases had pathological changes. Eight cases (2.9%) had atypical ductal/lobular hyperplasia. One case (0.3%) had lobular carcinoma in situ; however, no invasive breast carcinoma was detected. Other pathological findings included fibrocystic changes, fibrosis, adenosis, fibroadenoma (without complex features), mastitis and duct ectasia.

CONCLUSIONS

Pathological examination of the RM specimens is quite important to define the lesions precancerous of breast carcinoma. Unknown occult breast lesions could be identified and early interventions may be taken into account.

Oxidative stress markers are not valuable markers in lean and early age of polycystic ovary syndrome patients

BACKGROUND

Early atherosclerosis and increased risk of cardiovascular diseases (CVD) have been reported in patients with polycystic ovary syndrome (PCOS). Oxidative stress is an accepted risk factor for the development of CVD.

AIM

To evaluate the association between oxidative stress markers [ischemia-modified albumin (IMA), total antioxidant status (TAS), and total oxidant status (TOS) levels], carotid intima- media thickness (CIMT), endocrine and metabolic parameters in patients with PCOS. MATERIALS, SUBJECTS, AND METHODS: We studied 52 patients with PCOS and 36 age- and body mass index (BMI)-matched controls. The diagnosis of PCOS was made according to the Rotterdam criteria. Metabolic, hormonal parameter and IMA, TAS, TOS levels were measured.

RESULTS

No statistically significant difference was determined in relation to age, BMI and waist-hip ratio, IMA, TAS, and TOS levels between groups. Mean IMA level was higher in PCOS patients, however, statistical significant difference was not observed. Mean CIMT and homeostasis model assessment of insulin resistance levels were significantly higher in patients with PCOS than in control subjects.

CONCLUSION

Our study has shown that although CIMT levels, showing CVD risk, were higher in PCOS patients, TAS and TOS oxidative stress markers were found to be similar between groups, IMA was higher in PCOS patients however the difference was not reach statistical significant. The present results suggest that CIMT increases before the state of ischemia and shows preischemic state of vasculature, while oxidative stress markers are considered to be indicators of ischemia and reperfusion injury in progressive vascular disease. Further studies are needed to show the association between oxidative stress markers, CVD and PCOS.

Arg753Gln polymorphism of the human Toll-like receptor 2 gene from infection to disease in pediatric tuberculosis

The aim of this study is to examine the occurrence of the Arg753Gln polymorphism of the Toll-like receptor 2 (TLR2) gene in Turkish children with pulmonary and/or extrapulmonary tuberculosis (TB) disease compared with that in healthy children with latent TB infection (LTBI) and to assess the risk of progression from LTBI to active TB disease in children. The Arg753Gln polymorphism of the TLR2 gene was studied in 198 TB patients compared with 200 ethnically and age-matched children with LTBI. The culture confirmed TB patients were more frequently Arg753Gln heterozygous [odds ratio (OR) 5.05, 95% confidence interval (95% CI) 2.61-9.76, p = 0.00], and Gln allele frequency was significantly higher in the patient group (13.86% vs 3.5%, OR 4.40, 95% CI 2.34-8.30, p = 0.00). We also showed that the frequencies of the heterozygous Arg753Gln genotype and the Gln allele were significantly higher in patients with pulmonary TB alone and in patients with definitive pulmonary plus extrapulmonary TB than in children with LTBI. Our data suggest that the Arg753Gln polymorphism of the TLR-2 gene influences the speed of progression from infection to TB disease in children. Further investigations are needed to clarify whether this polymorphism has a strong impact on susceptibility to TB in children.

Sudden infant death syndrome: how much mothers and health professionals know

BACKGROUND

Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS.

METHODS

A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health-care professionals were interviewed by the same investigator.

RESULTS

Only 39% of mothers were aware of SIDS. Forty-six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed-sharing with their infants. Seventy-three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed-sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001).

CONCLUSION

Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.

Chronic eosinophilic pneumonia with mucous plugs in a child

Chronic eosinophilic pneumonia is a rare cause of chronic lung disease in children. A 7-year-old girl who attended our clinics with cough and sputum lasting for 5 years, has been evaluated for bilateral alveolar infiltration and ground-glass opacities. Peripheral eosinophilia was detected in total cell blood count. Flexible bronchoscopy showed mucous plugs. Bronchoalveolar lavage fluid and cell block of mucous plugs determined hypereosinophilia. Chronic eosinophilic pneumonia was confirmed after the elimination of other eosinophilic lung diseases and the case was accepted to be idiopathic. She showed a dramatic response to oral corticosteroids. This is the first reported case of chronic eosinophilic pneumonia presenting with mucous plugs in children described to date in the literature.

Invasive respiratory aspergillosis is a treatable disease with early diagnosis and aggressive therapy

This study aimed to document outcome of invasive respiratory aspergillosis (IRA) in pediatric malignancy patients. Patients with febrile neutropenia episodes followed between January 2003 and May 2007 were enrolled. Antifungal therapy was added to those who were still febrile on the 5th day of febrile neutropenia treatment. Patients were screened with computerized tomographies. IRA was identified in 22 of 98 patients. There were 13 males and the mean age was 97 months. Proven infection was established in 3, probable in 7, and possible in 12 patients. Liposomal amphotericin B was administered to all patients and was successful in 10 patients. Modifications with caspofungin or voriconazole were done in liposomal amphotericin B failures. The median duration of antifungal therapy was 5.5 months. The median follow-up time was 29 months. There was no evidence of IRA in 12 patients after completion of cancer chemotherapy. Six patients died due to underlying disease, whereas IRA was either in remission or stable disease. Four patients were lost due to IRA. The remission rate for IRA was 82%. Survival at 37 months was 55% (95% confidence interval 25-47 months). The amount of time that absolute neutrophil count after initiation of treatment for IRA remained at zero was found to be an independent prognostic factor on survival (P = .01). These results suggest that early diagnosis and aggressive treatment may increase the successful outcome of IRA.

Polymorphism in the p2x7 gene increases susceptibility to extrapulmonary tuberculosis in Turkish children

The P2X7 gene polymorphisms have been linked to increased risk for pulmonary and extrapulmonary tuberculosis in some populations. In this study, the genotype and allelic frequencies 1513A-->C variant within the P2X7 gene was significantly higher than in the healthy controls (P = 0.035, P = 0.041). This is the first study demonstrating that the 1513A-->C polymorphism is associated with extrapulmonary tuberculosis in children.

Unusual presentation of hydatid cyst: diagnosis with bronchoscopy

Hydatid disease is one of the major health problems in countries where hydatidosis is endemic. Atypical radiological findings may lead to misdiagnosis or delay in diagnosis in these patients. A 13-year-old boy was presented who admitted to the hospital with a history of cough and hemoptysis for six months. He had a non-resolving pneumonia. Bronchoscopy showed endobronchial lesion and the diagnosis of hydatid disease was confirmed by pathological examination.

The prevalence and risk factors of asthma and allergic diseases among working adolescents

Certain occupational groups are known to be at particularly high risk of developing allergic diseases. The objective of the present study was to evaluate the prevalence of allergic diseases among working adolescents. The International Study of Asthma and Allergies in Childhood questionnaire was used. Four hundred and thirty six adolescents working in motor, lathe-finish, coiffure and textile and 366 high school students as control group were enrolled to the study. Mean age was 16.8 +/- 1.2 years and 82.9% of them were male. There was no significant difference among groups for ever and current wheezing while doctor diagnosed asthma was higher in lathe- finish group (p = 0.036). Family history of allergy, history of allergic rhinitis, and active smoking were found to be risk factors for asthma and related symptoms. Working in coiffure (p = 0.054), and textile (p = 0.003) were significant risk factors for ever allergic rhinitis. Working in lathe finish (p = 0.023), coiffure (p = .002), and textile (p < 0.001) were associated with a higher risk for current allergic rhinitis. Working in coiffure was a risk factor for ever eczema (p = 0.008) and doctor diagnosed eczema (p = 0.014). It was concluded that working in lathe-finish was associated with doctor diagnosed asthma and active smoking was a risk factor for asthma and related symptoms. Working in coiffure, textile and lathe- finish were risk factors for rhinitis, and working in coiffure was a risk factor for eczema. Preventive measures should be taken at the onset of employment in order to prevent or reduce the detrimental effects of exposures in these occupational groups.

Diaphragmatic paralysis after pediatric heart surgery: usefulness of non-invasive ventilation

Diaphragmatic paralysis after cardiac surgery is an important complication especially in infants. We report a child who developed diaphragmatic paralysis, atelectasis, bronchomalasia and respiratory failure following cardiac surgery. Ventilatory support alleviated respiratory distress in this child. This report illustrates the usefulness of invasive and non-invasive ventilatory support for a pediatric patient with diaphragmatic paralysis.

Primary mediastinal haemangiopericytoma--an unusual cause of massive haemoptysis in a young woman

We report a case of primary mediastinal haemangiopericytoma in a 29-year-old female patient who presented with haemoptysis, cough and dyspnea. Computed tomography showed a 9 x 6 x 5 cm mass in the left posterior mediastinum. Bronchoscopic examination failed to obtain biopsy because of massive bleeding. The patient underwent left thoracotomy. Mediastinal mass and left lower lobe resection was performed despite the persistent bleeding. The lower lobe bronchus had been infiltrated by the tumour. Microscopic examination revealed a highly cellular tumour composed of round to fusiform cells, surrounded by thin walled endothelium lined vascular channels with a staghorn appearance. Immunohistochemical and molecular techniques rule out other soft tissue tumours which have a haemangiopericytoma-like vascular pattern. The patient is alive and free from tumour recurrence 6 months post-operatively.