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Paediatric pulmonology and allergology
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Ronald Dahl, Leif Bjermer. Nordic consesnsus report on asthma management Anna Stefanovic, Rolanda Valinteliene, Jolanta Asembergiene, Jolanta Maciuleviciene, Vytautas Jurkuvenas. Antimicrobial therapy of respiratory tract infections in Lithuanian hospitals and polyclinics. Stanislovas Maknavicius. Mediastinal tumors in children. Aurelija Dautartiene, Ruta Dubakiene. House dust mites distribution in stuffed toys. Valdone Miseviciene, Jurgis Bojarskas. Investigation of serum eosinophil cationic protein as a marker of eosinophil activation in wheezing children. Aleksnadras Balbieris, Remigijus Valdemaras Nargela, Genius Alfonsas Norvaisas, Arturas Andziulis. Quality of life measurements in asthmatic patients. Vilija Bubnaitiene. Sudden Infant Death Sydrome. Jolanta Kudzyte, Jurgis Bojarskas. Diagnostic aspects of asthma in children. Algimantas Vingras, Aurelija Lataitiene, Vida Tamkeviciene, Albina Kiuduliene, Rima Sabaliene. From thory to practice: real situation of diagnostics and treatment of asthma in primary care. Edvardas Danila, Regina Aleksoniene, Remigijus Nargela, Broncislovas Satkauskas, Elena Bernotiene. Overlooked bronchial foreign bodies: presentation, diagnosis, complications. Ausra Kaminskaite, Birute Purvaneckiene. The causes and results of the tratment of drug resistant tuberculosis. Ieva Laimute Indrejaityte, Iveta Skurvydiene, Arunas Valiulis. Hepatobiliary disease in cystic fibrosis. Albinas Naudziunas. HIV, AIDS and tuberculosis. Allergic Rhinitis and its Impact on Asthma (ARIA) |
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Nordic consensus report on asthma management
Ronald Dahl, Leif Bjermer
The work with the Nordic consensus report on asthma management astarted some years ago. The Nordic countries have common socieoeconomic conditions. We acknowledge the international as well as other European guidelines providing valuable recommendations. Nevertheless, we felt the need to combine the common Nordic experiences in order to have a local statement of asthma and asthma care, based upon Nordic clinical science and tradition. The work has been rewarding and we acknowledge many valuable contributions from paediatricians, allergologists and lung physicians in all Nordic countries. The response has so far been positive and we feel that the present material reflects the main opinion of Nordic physicians taking care of asthma patients of all ages. However, the asthma and allergy research field is rapidly developing. Thus, this document should merely be regarded as a time-limited contribution to the continuing scientific discussion of this fascinating field. (Nordic Consensus Report on Asthma Management; 94 (4): 299-327, 2000, Respiratory Medicine, by permission of WB Sounders 09546111). |
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Antimicrobial therapy of respiratory tract infections in Lithuania hospitals and polyclinics
Anna Stefanovic, Rolanda Valinteliene, Jolanta Asembergiene, Jolanta Maciulveiciene, Vytautas Jurkuvenas
The objective of the study was to describe prescription of antimicrobials to treat respiratory tract infection (RTI) in Lithuanian hospitals and polyclinics. The prevalence study was carried out in 14 randomly selected hospitals and 20 polyclinics. There were 4428 cases of upper and lower respiratory tract infections in adult and children analyzed. It was found out that 82.2 perc. of patients with RTI were treated with antimicrobials. Lower RTI (90.0 perc.) were more frequently treated with antimicrobials than upper RIT (79.4 per.): 93.1 perc. and 81.1 perc. in polyclinics, and 81.6 perc. and 53.6 perc. in hospitals. Children with RTI (lower RTI – 80.6 perc., upper RTI – 91.6 perc.) were more frequently treated with antimicrobials than adult patients (lower RTI – 72.7 perc., upper RTI – 88.3 perc.). There were differences in the lists of antimicrobials prescribed in polyclinics and hospitals. The biggest contributors in polyclinics are broad spectrum penicillines (32.1 perc.) and macrolides (19.3 prec.), in hospitals – penicillines (35.7 perc.) and broad spectrum penicillines (20.3 perc.). It turned out that 89.9 perc. of patients in hospitals and 99.0 perc. in polyclinics received antimicrobials without any microbiological examination. |
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Mediastinal tumors in children
Stanislovas Maknavicius
In majority of cases, mediastinal tumors were diagnosed accidentally, because of increased lymphatic nodes of the neck, bronchitis, compression or obstruction symptoms of respiratory tract. Postero-anterior and lateral X-ray examination, CT, MR, sonoscopy, bronchoscopy and histological examination are used to make the correct diagnosis. Chemotherapy depends on histological structure of the tumor. In period of 1980-2000 we treated 206 children with mediastinal tumors: 159 malignant, 33 benign and 14 cases of malformations similar to tumors. 5 patients were operated on, 1 patient underwent punctional biopsy. Tumor extirpation, biopsy, mediastinal or neck lymphonodes biopsy for histological diagnose elucidation and chemotherapy following the operation.
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House dust mites distribution in stuffed toys
Aurelija Dautartiene, Ruta Dubakiene
The aim of this study was to examine dust sample from the stuffed toys, to obtain house dust mites, their distribution and abundance during year seasons and children sensitivity to D.pt and D.far allergens. 21 dust sample form the stuffed toys in children dwellings was collected, 66,66 perc. of them were containing mites. 9 house dust mites species were found. The most frequent of all species were Dermatophagoides pteronyssinus (60,3 perc.) and D.farinae (13,97 perc.). In the block houses dust, mites were obtained 84,62 perc. of cases, in stone houses – 50 perc.. D.pteronyssinus mites were found during all seasons, but the greatest numbers – 1000 mites / 1g of dust – were in autumn. The skin prick testing with D.pt and D.far allergens was made to 18 children in whose stuffed toys dust mites were obtained. The sensitivity to this allergens was no fixed. |
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Investigations of serum eosinophil cationic protein as a marker of eosinophil activation in wheezing children
Valdone Miseviciene, Jurgis Bojarskas
Bronchiolitis or wheezy bronchitis is very common in early childhood. However, most children will outgrow their symptoms before school – age and only 40 perc of affected children will have asthma. Asthma is an inflammatory disease where activation of eosinophils is a key event. Serum eosinophil cationic protein is accepted as a marker of eosionphil activation, and is suggested to reflect pulmonary inflammation in asthma. Various studies indicate that serum ECP may be used as a predictor of asthma in young wheezing children. The article presents results of serum ECP investigations in wheezing children less than 3 years old treated in Kaunas Medical University hospital, Clinic of Children Diseases. We tried to determine whether the parameters of eosinophil inflammation could predict episodes of recurrent wheezing and the development of asthma in those investigated children. We assessed the sensitivity asn specificity of serum ECP, using the cutoff level of 19,9 mcg/l in the diagnosis of asthma to be 68 perc. and 92-96 perc. respectively.
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Quality of life measurement in asthma
Aleksandras Balbieris, Remigijus Valdemaras Nargela, Genius Alfonsas Norvaisas, Arturas Andziulis
Assessment of Quality of Life by St. George hospital respiratory questionnaire and standard spirometry has been performed for 602 patients with bronchial asthma. The aim of study was to evaluate the reliability of questionnaire results and to determine their correlation with the investigated parameter of spirometry. The results cofirmed significant association between the different indicators of questionnaire. Positive correlation was observed between St. George hospital respiratory questionnaire and following parameters of spirometry: TOTAL and IMPACT vs. Gensler index and FEW1 perc.; mean ACTIVITY vs. both parameters of spirometry. Correlation of clinical symptoms with investigated parameters was not significant. According to the impact of the symptoms of disease for QOL, patients evaluated their condition as more severe than the doctors would do evaluating the results of spirometry. TOTAL index is them most reliable indicator for correlation of QOL impairment with objective state of patient.
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Sudden Infant Death Syndrome
Vilija Bubnaitiene
This article summarizes facts about sudden infant death syndrome (SIDS), which is the leading cause of infant mortality in many developed countries and is not recognized problem in Lithuania. Most researchers believe that babies who die of SIDS are born with one or more brainstem abnormalities that make them especially vulnerable to stresses that occur in the normal life of an infant. SIDS is an unexpected, usually occurring in otherwise apparently healthy infant from 1 month to 1 year of age. 95 perc. deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between 2 and 4 months of age. A SIDS death occurs quickly and is often associated with sleep, with no signs of suffering. More deaths are reported in the fall and winter and there is a 60 to 40 percent male-to-female ratio. A death is diagnosed as SIDS only after all other alternative has been eliminated: SIDS is a diagnosis of exclusion. Experts still cannot predict which babies will die from SIDS, but recent research has provided direction for identifying those infants who may have an increased risk of dying from SIDS.
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Diagnostics Aspects of Asthma in Children
Jolanta Kudzyte, Jurgis Bojarskas
Wheezing and abnormally noisy breathing is one of the commonest respiratory symptoms in children and may be due to a wide variety of problems located in the respiratory pathways. Asthma is the commonest cause of generalized wheezing in children and bronchiolitis is the commonest cause in infants, but noisy breathing may also be due to a congenital anomaly, genetic disorder, acquired disease or a combination of these factors. Therefore the differential diagnosis is import if the correct management is to be applied. Each condition has certain typical clinical features, changes on the plain chest radiograph and response to medication. This series of simple algorithms serves as a general guide to the correct diagnosis.
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From theory to practice: real situation of diagnostic and treatment of asthma in primary care
Algimantas Vingras, Aurelija Lataitiene, Vida Tamkeviciene, Albina Kiuduliene, Rima Sabaliene
The prevalence of bronchial asthma (BA) in childhood is increasing in Lithuania. Purpose of this study was to find out child’s age at which BA is diagnosed most frequently, diseases the child was ill before diagnosis of BA, offending factors and principles of treatment. Two hundred seventy nine patients participated in the study, which consisted of retrospective analysis of case histories and interviews with their parents. BA was diagnosed most frequently at the age of 3-6 years. Mild BA was diagnosed in 40.5 perc. of cases, moderate – 48.4 perc. and severe – 11.1 perc. Half of the patients were ill with allergic-atopic disease during infancy. Comparison of morbidity with respiratory infections during infancy and one year before the diagnosis of BA showed that during infancy upper respiratory infections and acute bronchitis were prevailing. During the whole year before the diagnosis of BA morbidity with obstructive bronchitis was more frequent 1.6 times and with pneumonia 2.9 times. One year before the diagnosis of BA every third child had been ill with obstructive bronchitis 4-6 times. Physicians’ and patients’ opinion about the triggers of BA exacerbation differed considerably – by 169 (60.6 perc.). Patients do not take into account such factors as house dust, mould, fuel and tobacco smoke. In 48.7 perc. of cases people living together with the patient smoke at household. Two hundred forty one patient (86.6 perc.) sees his doctor regularly. The others correct the treatment themselves. Regular use of medications was noted by 262 (93.6 perc.) of patients. Cromones are the most frequently used medications during regular treatment – 138 (52.7 perc.). Inhaled corticosteroids are used to a lesser extent – 108 (41.2 perc.). Spacers are used by 104 (37.3 perc.) of patients. All of them are 7 years old and younger, and only 6 patients older than 7 years. Peekflowmeters are used only by 48 (17.2 perc.) of patients. In conclusion, more attention should be paid to the collaboration between physicians and patients’ families. Inhaled corticosteroids are used insufficiently.
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Overlooked bronchial foreign bodies: presentation, complications, diagnosis Edvardas Danila, Regina Aleksoniene, Remigijus Nargela, Bronislovas Satkauskas, Elena Bernotiene Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, complications, and diagnostic of overlooked bronchial foreign body in adults. We analyzed 19 adult patients with obscure or indirect. The initial clues for foreign body aspiration in adults are usually obscure or indirect. The most common symptoms were chronic cough, sputum production and fever. Chest radiograph demonstrate the foreign body in one case (5 perc.). The most common foreign body was bone fragment. Flexible fibreoptic bronchoscopy removed the foreigh body in 17 (89 perc.) cases.
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The causes and treatment results of drug resistant tuberculosis Ausra Kaminskaite, Birute Purvaneckiene
Multidrug-resistant tuberculosis treatment results of 32 patients ages 45±21 after intensive phase are analyzed in this article. The investigation was performed in Republic Santariskiu tuberculosis and lung disease hospital in 1999-2000. 68.8 perc. patients became smear-negative by treatment DOTS-plus regimens after 3-4 months. Number of smear-negative cases was somewhat different in separate groups according tuberculosis registration category (p>0.1): new case – 66.7 perc., relapse – 71.4 perc., treatment failure – 75 perc., chronic tuberculosis – 63.7 perc. Effectivless treatment was in spread destructive tuberculosis. The main cause of multidrug-resistant tuberculosis is treatment default (50 perc.). Only measure is known today to stopped development of multidrug-resistant tuberculosis is DOTS method recommended by World Health Organization. |
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Hepatobiliary lesions in cystic fibrosis Ieva Laimute Indrejaityte, Iveta Skurvydiene, Arunas Valiulis
Hepatic lesions are being found in approximately 30 perc. of patients with cystic fibrosis. They occur mostly in the third decade of life. Lithuanian CF population is relatively young. The aim of our work was to find out early markers of hepatic lesion in CF patients and to evaluate their diagnostic informativity. We investigated 89 children with CF (median age 10.7±0.64 years). We examined the patients physically, tested their blood for liver enzymes and examined their liver by ultrasound. Liver enlargement was found in approximately 70 perc. patients (boys 63 perc., age up to 5 years – 60 perc.0. Liver enzymes assay was not diagnostically informative. Almost all patients with liver enlargement had changeso n liver ultrasound examination: hyperechogeneity – 78 perc., periportal hyperechogeneity – 28 perc. In 18.5 perc. of cases of younger patients with liver enlargement steatosis was found. The results of our study with strong evidence suggest that liver ultrasound examination is a valuable and informative diagnostic method to find out minor hepatic lesions in young children with cystic fibrosis. |
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HIV, AIDS and tuberculosis Albinas Naudziunas
HIV-related tuberculosis (TB/HIV) is common in various populations, especially in sub-Saharan Africa and, increasingly, in Asia and South America. A few a cases of HIV and TB are registered in Lithuania. Clinical features suspicious of HIV coinfection in TB patients: sexually transmitted disease, herpes zoster, recurrent pneumonia, weight loss (>10 kg or >20 perc. of original weight), diarrhoea (>1 month), pain on swallowing (suggests oesophageal candida), burning sensation of feet (peripheral sensory neuropathy), pruritic popular rash, Kaposis sarcoma, symmetrical generalized lymphadenopathy, oral candidiasis, persistent painful genital ulceration. |
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September, 2001, Vol. IV, No.3 (p. 1363-1512)
