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Biomedical subjects

J de Blic

Publications and source records attributed to J de Blic.

At least 37 records · Page 2Linked to original sources
PubMed2004

Knowledge, attitudes, and behavior of the parents of asthmatic children in Maputo.

Asthma is increasing in frequency worldwide. The education of affected children and their parents is fundamental for the management of the disease. The aim of our study was to describe the knowledge, attitudes, and behavior of the parents of asthmatic children. We studied 152 adults accompanying asthmatic children to consultations in the pediatrics department of Maputo Central Hospital (Mozambique). In general, knowledge about asthma was poor: 11% of the adults thought that asthma was contagious and transmitted from person to person, and 4% thought that it was transmitted by contaminated food. More than half the parents thought that the child could not lead a normal life even during the periods between attacks. A large proportion of the parents thought that asthma could be cured by medical treatment in 7% of cases and by alternative treatment in 43% of cases. The precipitating factors were well identified by the adults, but they had an inaccurate perception of the symptoms of an asthma attack. The actions of the various classes of drugs used were poorly understood. Education programs for both the children and their parents should be developed to improve the management of asthmatic children. Surveys of this type facilitate the targeting of such programs.

Adult↗
PubMed2003

[Latex allergy in children].

UNLABELLED: The aim of our study was to determine the prevalence of latex allergy and the clinical features of children with latex allergy. PATIENTS AND METHODS: We prospectively investigated 243 children consulting in our allergy out-patients unit during 1 year. Parents answered a questionnaire, and children underwent skin prick tests with common allergens and latex. Latex-specific serum immunoglobulin E was determined by CAP test in children with latex sensitization. The results were compared in children with and without latex allergy. RESULTS: The prevalence of latex allergy was 1.3%. A family history of atopy (75%) and a personal history of previous surgery was associated with latex allergy (P < 0.0001). In children with latex allergy, the frequency of sensitization to inhaled and food allergens, atopic dermatitis, rhinitis and conjunctivitis was higher than in children without latex allergy (P < 0.05). Avocado allergy was the food allergy most commonly associated with clinical symptoms. Balloon was the most common latex product causing symptoms (60%). CONCLUSIONS: Due to its potential severe consequences, latex allergy should be investigated in children who had undergone multiple surgical procedures and in the children with pollen-food allergy syndrome. Avoidance of latex is an important preventive measure.

Adolescent↗
PubMed2003

[Prevention of asthma and allergic diseases in children].

Allergic diseases have become a major public health problem in industrialized countries, justifying the development of prevention programs. A review of the literature on allergens and atopic symptoms, age of primary sensitization and other factors associated with allergic diseases development is presented and is followed by a discussion on prevention measures. The most recent physiopathological and immunological data indicate that persistent asthma and allergic diseases in adults may be associated with events in early childhood. The parallel increase in autoimmune and allergic diseases has been correlated with regulatory mechanism defects, contradicting the previous theory that involved a predominantly Th1 or Th2 pathway. The primary prevention of asthma and allergic diseases thus appear to be somewhat utopian. Indeed based on recent results, the risk of developing allergies appears to be related to modern "clean" lyfestyles. Secondary prevention is probably necessary, possibly through specific immunotherapy. Tertiary prevention must also be considered. Passive smoking must be prevented as it can alter the development of the respiratory system and promote allergen sensitization. Randomized, controlled, prospective studies are needed to evaluate the efficacy of the preventive measures.

Allergens↗
PubMed2003

Flexible endoscopy of paediatric airways.

Paediatric fibreoptic bronchoscopy is used for ever wider indications, and increasingly used in many contexts, including paediatric and neonatal intensive care. The report of this Task Force contains an overview on the current applications of paediatric bronchoscopy. The report discusses the facilities and equipment needed for the procedure, including the newly developed bronchoscopes which are allowing intervention even in very small children. The indications of both flexible and rigid bronchoscopes in the context of newer and smaller flexible endoscopic equipment are also considered. The care of the instruments, including disinfection and sterilisation, is fully documented. Patient management is described, including the relative merits of conscious sedation and general anaesthesia, as well as special settings for the procedure, including the needs in intensive care. Special procedures, increasingly performed bronchoscopically are described. These include bronchoalveolar lavage, endobronchial and transbronchial biopsy, laser therapy, bronchography, and endoscopic intubation and drug therapy. Finally, neonatal bronchoscopy is discussed, and the ethics of bronchoscopic procedures, including bronchoscopic research in children. Advances in instrumentation, and also improved anaesthetic techniques, allow fibreoptic bronchoscopy to be safely performed in even very small, sick infants, provided proper precautions are taken.

Airway Obstruction↗
PubMed2002

[Risk factors for early bronchiolitis at asthma during childhood: case-control study of asthmatics aged 4 to 12 years].

UNLABELLED: The group of general paediatrics of the French Paediatrics Society conducted a case-control study in order to verify the link between the occurrence of an acute bronchiolitis early during the first year of life, more specifically during the first trimester, and asthma during later childhood. METHODS: Parents of 4-to-12-year-old children answered a questionnaire during a general paediatrics visit. Exposition was attested by a diagnosis of bronchiolitis mentioned on the personal health record of the child. Environmental factors and medical history, obtained from the parents and by checking the health record of the child, were studied using multivariate analysis. RESULTS: Nineteen paediatricians included 80 children with asthma and 160 controls. Fifty-four per cent of asthmatic children had a medical history of bronchiolitis during the first year of life versus 17% of control children (P < 0.001). Mean age of bronchiolitis occurrence was 6.6 months in both groups (P = 0.98). Multivariate analysis showed that occurrence of bronchiolitis during the first year of life was significantly more frequent in asthmatic children (P < 0.001, OR = 5.6, IC95 = [2.6-11.6]) but this effect was not observed during the first trimester of life. CONCLUSION: Bronchiolitis during the first year of life was significantly related to later asthma in 4-to-12-year-old children treated by general paediatricians. On the other hand, a very early bronchiolitis during the first trimester of life did not appear, in our set of data, as a contributive factor to explain asthma in later childhood.

Age of Onset↗
PubMed2002

[Difficult asthma in children].

Difficult asthma in children is defined as the persistence of exacerbations or frequent symptoms requiring rescue bronchodilator, or persistent airway obstruction in spite of treatment with inhaled steroid >/= 800 microg/d beclomethasone or equivalent and beta-2 long acting agonist. Management of difficult asthma in children first requires to identify conditions that may mimic asthma, asthma with bad compliance to treatment, and difficult asthma in relation with avoidable factors that worsen symptoms. The pathological bases of genuine difficult asthma remain unknown. Different patterns have been described according to the cells that are involved (eosinophil, neutrophil), the degree of airway remodeling, or the distal localization of the lesions. Difficult asthma requires specialized management including airway inflammation evaluation. Studies on bronchoalveolar lavage and bronchial mucosa biopsies will perhaps help to better understand the pathophysiology and to improve the management.

Asthma↗
PubMed2002

Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures.

Complications of flexible bronchoscopy (FB) were prospectively evaluated during 1,328 diagnostic procedures in children, not in intensive care units. A total 92.8% of the procedures were performed in conscious patients under sedation and 7.2% under deep sedation. Supplementary oxygen was provided in approximately 80% of cases via endoscopic face mask (n=783) or nasal prongs (n=290). At least one complication was recorded in 91 cases (6.9%). Minor complications (n=69; 5.2%) included moderate and transient episodes of desaturation (n=15), isolated excessive coughing (n=22), excessive nausea reflex with coughing (n=20), transient laryngospasm (n=6) and epistaxis (n=6). Major complications (n=22; 1.7%) included oxygen desaturation to <90%, either isolated (n=10) or associated with laryngospasm (n=6), coughing (n=4), bronchospasm (n=1), and pneumothorax (n=1). Major complications involving oxygen desaturation were associated with age <2 yrs (13 of 529 versus 8 of 778) and laryngotracheal abnormalities (7 of 85 versus 14 of 1,222). The overall frequency of complications was similar in conscious (6.7%) but sedated patients and patients under deep (7.3%) sedation. However, the frequency of transient desaturation was significantly higher in children undergoing FB under deep sedation. Transient fever after bronchoalveolar lavage was observed in 52 of 277 cases (18.8%). Flexible bronchoscopy is a safe procedure with <2% major complications. Careful analysis of indications and clinical status for each patient, and proper anaesthesia and monitoring during the examination ensure that the procedure is successful, with a minimum of complications.

Adolescent↗
PubMed2001

Relationship between bronchial responsiveness and clinical evolution in infants who wheeze: a four-year prospective study.

Recurrent illness involving wheezing during the first years of life is transient in most children. The role of bronchial hyperresponsiveness as a factor influencing the persistence of wheezing from infancy to school age remains unknown. In a prospective study we investigated whether infants who wheezed and subsequently developed persistent asthma differed from infants who wheezed and later became asymptomatic either in the initial degree of bronchial hyperresponsiveness or in the persistence of bronchial hyperresponsiveness with age. One hundred and twenty-nine infants with three or more wheezing episodes before 2 yr of age were followed during 4 yr with a clinical evaluation and a methacholine challenge performed every 6 mo until the child was 4 yr old and once per year thereafter. The clinical score significantly improved with time in most children. The proportion of children with persistent wheezing after 2 and 4 yr of follow-up was only 31% and 20%, respectively. Persistent wheezers had significantly lower VmaxFRC values at initial evaluation and higher SRaw values at the end of follow-up than infants who became asymptomatic. We used transcutaneous oxygen tension (PtcO(2)) to measure the response to methacholine. No significant difference in PD(15) PtcO(2) between groups with subsequently different clinical progression was observed at initial evaluation. Bronchial hyperresponsiveness persisted 4 yr later in all children but children with persistent wheezing showed significantly lower PD(15) PtcO(2) values than children who became asymptomatic, as early as 30 mo of age. However, an acceptable early PD(15) PtcO(2) cut-off point predictive for subsequent clinical progression could not be identified. The level of bronchial hyperresponsiveness in infants who wheezed was not predictive of the persistence of asthma 4 yr later.

Asthma↗
PubMed2001

Anaphylaxis to the 23-valent pneumococcal vaccine in child: a case-control study based on immediate responses in skin tests and specific IgE determination.

Injections of the 23-valent pneumococcal vaccine are usually well tolerated. Skin tests (prick and intradermal) and a self-made RAST with pneumococcal vaccine and phenol were performed in a child reporting a severe anaphylactic reaction induced by a 23-valent pneumococcal vaccine, and in ten control children, including one child with a well-tolerated vaccination, and nine non-vaccinated children. Skin tests and RAST with the vaccine were positive in the child reporting anaphylaxis, and negative in nine of the control children. Intradermal test with the vaccine was slightly positive in a non-vaccinated child with negative RAST. Skin tests and RAST with phenol were negative in all the children. These results suggest that immediate responses in skin tests and specific IgE determination have a good diagnostic value in children reporting severe reactions suggestive of IgE-dependent hypersensitivity to pneumococcal vaccine.

Anaphylaxis↗
PubMed2001

Spontaneous pneumomediastinum in children.

SUMMARY. Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema, and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma.

Adolescent↗
PubMed2001

Increased eosinophil cationic protein levels in bronchoalveolar lavage from wheezy infants.

Although studies examining the serum suggest a role for eosinophils in wheezing episodes in infants and toddlers, the presence of a chronic eosinophilic inflammation within their airways remains to be demonstrated. In this study we investigated whether eosinophil cationic protein (ECP) levels are increased in BAL fluid (BALF) from infants and toddlers with recurrent wheezing episodes, during an asymptomatic period. The levels of ECP in BALF were quantitated by radioimmunoassay in 61 children (36 with severe recurrent episodes of wheezing and 25 who were non-wheezy), aged 6-36 months, in whom flexible bronchoscopy was clinically indicated. BALF eosinophil counts were < or = 1% in all patients and did not differ in wheezers, compared to non-wheezers. In contrast, ECP levels in BALF were > or = 2.2 micrograms/l in 18 of 36 (50%) wheezy infants but in only three of 25 (12%) control infants (p < 0.01). Neutrophil counts were significantly higher in the wheezer group than in the non-wheezer group (8.1 x 10(3) cells/ml vs. 3.0 x 10(3) cells/ml). ECP levels in the BALF were not correlated with the absolute number of eosinophils (r = 0.03; p = 0.8) but were correlated with the absolute number of neutrophils (r = 0.54; p = 0.001). There was no association between high ECP levels in BALF and the atopic status of the wheezers. In conclusion, ECP levels are increased in BALF from young children with recurrent wheezing episodes, even during relatively quiescent periods, suggesting a chronic increased cell activation in the lower airways.

Blood Proteins↗
PubMed2001

Increased bronchoalveolar lavage CD8 lymphocyte subset population in wheezy infants.

Episodes of wheezing are very common in infancy but, despite their high prevalence, their mechanism is still poorly understood. To better understand the airway inflammation of wheezing infants, we examined cells of the bronchoalveolar lavage (BAL), focusing on the phenotype of lymphocytes and macrophages by using cytofluorimetry. Twenty-one wheezers (mean age 15.4 months) and seven non-wheezers (mean age 24.1 months) were studied. BAL was collected at fiberoptic bronchoscopy. Total and differential cell counts were similar in both populations. Eosinophils were not detected in the BAL fluid. The cell-surface markers CD2, CD3, CD4, CD7, CD8, CD19, and CD45 were studied for the lymphocyte sub-population analysis. The cell-surface markers CD14, CD54, CD62L, and human leucocyte antigen (HLA)-DR were studied for the macrophage sub-population analysis. A significant increase in the CD8(+) lymphocyte population (p = 0.03) was observed in wheezers (median 43.1%, 25-75% percentile: 30.1-54.9%), as compared to non-wheezers (median 29.3%, 25-75% percentile: 13.5-34.7%). A significantly (p = 0.04) decreased expression of HLA-DR (mean fluorescence intensity [MFI]) was detected in the macrophage population of the wheezers (median MFI, 7,016; range 2135-7986), as compared to non-wheezers (median MFI, 8,369; range: 6478-8860). The results of the present study suggest that viral infection may have induced a CD8(+) response in BAL cells.

Blood Proteins↗
PubMed2001

Blood histamine levels (BHL) in infants and children with respiratory and non-respiratory diseases.

BACKGROUND: Blood histamine levels are decreased after severe allergic reactions and in various chronic diseases. AIMS: To study blood histamine levels in infants and children with acute infectious and non-infectious, non-allergic, disease. METHODS: Blood histamine levels were investigated by a fluorometric method in infants and children admitted to hospital with bronchiolitis, non-wheezing bronchitis, acute infections of the urinary tract, skin and ear-nose-throat, gastroenteritis, or hyperthermia of unknown aetiology. Results of blood histamine levels and white blood cell counts were compared with those obtained for children recovering from benign non-infectious, non-allergic illnesses. RESULTS: As compared with control children, white blood cell numbers were significantly increased in children with acute infections of the urinary tract, skin and ear-nose-throat, and were significantly decreased in children with gastroenteritis. Blood histamine levels were significantly lower in children with gastroenteritis and hyperthermia than in children with other diseases and control children. It was not possible to correlate blood histamine levels and the number of blood basophils. CONCLUSIONS: BHL are significantly decreased in infants and children with acute gastroenteritis and hyperthermia of unknown aetiology. The mechanisms responsible for the decrease in blood histamine levels in children with gastroenteritis and hyperthermia are discussed.

Child, Preschool↗
PubMed2001

Cardiopulmonary exercise testing in children: an individualized protocol for workload increase.

OBJECTIVES: To investigate the feasibility of individualized workload increments, as used in adults, for exercise testing in children; and to investigate whether this individualized protocol makes it possible to satisfy the usual criteria for maximal exercise (clinical exhaustion, predicted maximum heart rate [HRmax], oxygen uptake [O(2)] plateau, maximal respiratory exchange ratio > 1.1). DESIGN: Prospective clinical study. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Ninety-two children aged 5 to 17 years with various cardiac and respiratory diseases (33 with asthma, 11 with bronchopulmonary dysplasia, 6 with cystic fibrosis, 10 with congenital heart disease, and 32 miscellaneous). INTERVENTIONS: Individualized maximal incremental exercise testing. The increase in workload was adapted to the individual and was calculated from predicted maximal oxygen uptake (O(2)max) for each child. The test lasted 10 to 12 min. RESULTS: The exercise test was well tolerated by all children and was maximal in all but seven patients. A total of 65.7% of children reached the predicted O(2)max and 68.4% satisfied the criteria for a O(2) plateau at peak exercise. The predicted HRmax was achieved in all but two children. The mean maximal respiratory exchange ratio was 1.06. CONCLUSION: The individualized protocol for increasing workload, based on O(2) rather than power, was well tolerated by children. In our view, the best two criteria for assessing the maximality of the tests were clinical exhaustion and HRmax, especially if the O(2) plateau was not reached. These results suggest that individualized protocols could be used instead of standardized tests for exercise testing in children.

Adolescent↗
PubMed2000

Prevalence of DSM IV anxiety and affective disorders in a pediatric population of asthmatic children and adolescents.

A series of 82 children and adolescents with moderate and severe persistent asthma was studied. Their psychopathological problems were compared to those of 82 healthy subjects, matched for age, sex and socio-economic status. The patients completed the Child Depression Inventory, an inventory of fears and anxiety (ECAP) and the Coopersmith Self Esteem Inventory. Parents of asthmatic children filled in the Child Behavior Check List to assess their social competence. The patients were examined with the revised Kiddie Schedule for Affective Disorders and Schizophrenia. There were more anxiety symptoms in the asthmatic group than in the control group. Asthmatics were not significantly more depressed than controls and their self-esteem was as good. We found 29 anxiety disorders, four affective disorders and four disruptive behavior disorders. Generalized anxiety disorder was the main diagnosis (n=24). The asthmatic subgroup presenting anxiety and affective disorders had poorer self esteem, fewer activities and worse social competence than other asthmatics and controls. Adolescents did not seem to have more emotional disturbances than younger patients. Girls did not have more DSM IV anxiety or affective disorders than boys.

Activities of Daily Living↗