Biomedical subjects

Kostas N Priftis

Publications and source records attributed to Kostas N Priftis.

13 recordsLinked to original sources

PubMed2006

Prevalence of asthma among schoolchildren in Patras, Greece: four questionnaire surveys during 1978-2003.

BACKGROUND: The prevalence of asthma and wheezing has risen during the past four decades. Recent reports suggest that the "asthma epidemic" has reached a plateau. OBJECTIVE: To examine further trends in the prevalence of childhood diagnosed asthma and wheezing in an urban environment in Greece. METHODS: A population-based cross-sectional parental questionnaire survey was repeated among third-grade and fourth-grade school children (8-10 years) of public primary schools in 2003 in the city of Patras, Greece, by using methods identical to that of surveys conducted in 1978 (completed questionnaires, n = 3003), 1991 (n = 2417) and 1998 (n = 3076). RESULTS: 2725 questionnaires were completed in the 2003 survey. The prevalence rates of current asthma and/or wheezing in 1978, 1991, 1998 and 2003 were 1.5%, 4.6%, 6% and 6.9%, respectively (p for trend <0.001). The lifetime prevalence of asthma and/or wheezing in the three more recent surveys was 8%, 9.6% and 12.4%, respectively (p for trend <0.001). The male:female ratios of current asthma and/or wheezing in the four surveys were 1.14:1, 1.15:1, 1.16:1 and 1.22:1, respectively. The proportion of those with wheezing diagnosed with asthma has increased during the study period, more so among non-current children with asthma. CONCLUSIONS: Our findings show a continuous increase in the prevalence of asthma and wheezing among preadolescent children in Patras, Greece, over 25 years, albeit at a decelerating rate. There seems to be a true increase in wheezing, despite some diagnostic transfer, particularly among younger children. The male predominance of the disease has persisted in the population of this study.

Asthma↗

PubMed2006

Adrenal function improves in asthmatic children on inhaled steroids: a longitudinal study.

BACKGROUND/AIMS: Asthmatic children on long-term treatment with inhaled corticosteroids (ICS) may exhibit mild adrenal suppression. We aimed to test the hypothesis that baseline adrenal function of some asthmatic children might be lower than that of others and that this difference might be accentuated by ICS therapy. METHODS: A low-dose Synacthen test was performed in 41 prepubertal asthmatic children placed on long-term inhaled budesonide (400 microg/day) prior to the onset of ICS treatment, 6 and 12 months later. Five children withdrew before the 6- and another 2 before the 12-month follow-up. RESULTS: Low adrenal function was demonstrated in 4 children (9.8%) upon recruitment and in another 8 at the 6-month evaluation (22.2%). Adrenal function normalized in the aforementioned 4 children at the 6-month evaluation, while 6 (17.6%) exhibited suppressed adrenal function at the 12-month evaluation. Three of these patients had also exhibited adrenal suppression at the 6-month visit. A significant improvement in peak cortisol values from baseline to the 6- and 12-month evaluation (95% confidence intervals: -283.9 to -69.0 and -239.8 to -50.8, respectively) was evident when children with suppressed adrenal response at the second or third evaluation were excluded. CONCLUSIONS: In many asthmatic children, adrenal response improves on long-term ICS. The expected adrenal suppression of certain patients on maintenance ICS appears to constitute a separate phenomenon.

Administration, Inhalation↗

PubMed2006

Association of weather conditions with childhood admissions for wheezy bronchitis or asthma in Athens.

BACKGROUND: The association between asthma morbidity and meteorological conditions is well documented, but it is not clear to what extent more specific meteorological variables are implicated. OBJECTIVES: This study was aiming to investigate whether there is any association between specific meteorological conditions and the seasonal variation and the rate of asthma admissions among children in Athens. METHODS: Data were obtained retrospectively from hospital registries of the three main Children's Hospitals in Athens during a 23-year period (1978-2000). The meteorological database consisted of mean monthly values of eight meteorological variables. The whole period studied was divided into three time periods: 1978-1987, 1988-1993 and 1994-2000. RESULTS: A clear seasonal trend with a permanent pattern was detected. There were more monthly asthma admissions in winter-spring and autumn for younger children, as well as a lower peak in winter and autumn and a major one in May for older children, without significant differences in between the three time periods. The results of a multiple regression analysis revealed that relative humidity and atmospheric pressure were predictors of up to 56.7% (1988-1993) and 59.2% (1994-2000) monthly asthma admissions among younger children. No relation of the time trend in asthma admissions during the periods studied for any age group with any of the meteorological variables was detected. CONCLUSIONS: Our results indicate a constant seasonal variability in asthma admissions among children in Athens, whereas relative humidity and atmospheric pressure are the more implicated meteorological variables for younger asthmatic children.

Adolescent↗

PubMed2006

Different effects of urban and rural environments in the respiratory status of Greek schoolchildren.

We hypothesized that asthma symptoms and lung function of schoolchildren living in Athens urban area are adversely affected as compared to others living in a rural environment, over a period of 8 years. We recruited 478 and 342 children aged 8-10 years living within a short radius around the urban and rural area monitoring stations, respectively. Respiratory health was assessed by a parent-completed questionnaire in three phases: 1995-1996 (phase-1), 1999-2000 (phase-2), 2003-2004 (phase-3) and by spirometry in phases-1 and 2. Reported asthma and wheeze did not differ in the two areas, whereas cough was more prevalent in the urban area in phase-1. Children from the rural environment had lower levels of percent-predicted forced vital capacity (FVC%) in phase-1 and higher of percent-predicted-forced expiratory flow at mid-FVC (FEF(50)%) in both phases. Independent associations were detected between FVC% as-well-as FEF(50)% and residential area. High FVC% was associated with outdoor systemic athletic activities; there was lower FVC% growth in the urban versus the rural area. Nitrogen dioxide and sulfur dioxide were higher in the urban area, whereas ozone concentrations differed less between the two areas. These results suggest that long-term exposure to urban environment is associated with sub-clinical airway narrowing and slower rate of FVC growth.

Air Pollution↗

PubMed2006

The effect of vitamin K supplementation on biochemical markers of bone formation in children and adolescents with cystic fibrosis.

INTRODUCTION: Impaired vitamin K status in cystic fibrosis (CF) has been considered as a newly emerged pathogenetic factor for reduced bone mineral density (BMD). OBJECTIVES: Our aim was to evaluate the effectiveness of vitamin K supplementation in managing bone formation abnormalities in children and adolescents with CF. MATERIALS AND METHODS: The statuses of vitamins K and D in relation to biochemical markers of bone metabolism and BMD were examined in 20 CF children receiving vitamin D supplements but not vitamin K supplements. Laboratory tests were carried out at the beginning of the study period and after 1 year of vitamin K supplementation (10 mg single oral dose/week) and the results were compared; the results were also compared with those of 25 healthy controls. RESULTS AND DISCUSSION: Ten of the CF patients had BMD z-score<or=2.5 (n=5) or between -1 and -2.5 (n=5). Biochemical tests on patients before vitamin K supplementation revealed that the levels of osteoblastic activity markers, namely, bone alkaline phosphatase (BAP), serum osteocalcin (Gla-OC), serum carboxy-terminal propeptide of type I procollagen (PICP) and serum amino-terminal propeptide of type I procollagen (PINP), were significantly reduced compared with those of the controls. These patients had also lower 25-hydroxy-vitamin D (25(OH)D) and vitamin K serum levels, higher undercaboxylated osteocalcin (Glu-OC) and parathormone (PTH) levels and a higher calcium to creatinine ratio (Ca/Cr) than the controls. Vitamin K intake was associated with an increase in Gla-OC, PINP, PICP levels and a decrease in Glu-OC levels. PTH levels were lower after vitamin K supplementation without any difference in BMD z-scores. CONCLUSION: Our data indicate that vitamin K supplementation may have a beneficial role in bone health in CF children.

Adolescent↗

PubMed2006

Bronchial hyperresponsiveness, atopy, and bronchoalveolar lavage eosinophils in persistent middle lobe syndrome.

Most cases of middle lobe syndrome (MLS) in children are considered to be due to asthma and may recover spontaneously; however, in persistent MLS, repeated episodes of infection often institute a vicious cycle that may lead to persistent symptoms and bronchial hyperresponsiveness (BHR). The present study was undertaken to investigate whether asthma, as an underlying diagnosis, is predictive of a favorable outcome of children with persistent MLS. We evaluated 53 children with MLS who underwent an aggressive management protocol that included fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). These patients were compared to two other groups: one consisting of children with current asthma but no evidence of MLS (N = 40) and another of non-asthmatic controls (N = 42), matched for age and sex. Prevalence of sensitization (>or=1 aeroallergen) did not differ between patients with MLS and "non-asthmatics" but was significantly lower than that of "current asthmatics." A positive response to methacholine bronchial challenge was observed with increased frequency among children with MLS when compared to "current asthmatic" and non-asthmatic children. Multivariate logistic regression analysis revealed a positive correlation between an increased number of eosinophils in the BAL fluid (BALF) and a favorable outcome, whereas no correlation was detected between sensitization or BHR and BAL cellular components. In conclusion, children with MLS have an increased prevalence of BHR, even when compared to asthmatics, but exhibit prevalence of atopy similar to that of non-asthmatics. An increased eosinophilic BALF count is predictive of symptomatic but not radiographic improvement of MLS patients after aggressive anti-asthma management.

Asthma↗

PubMed2006

Quantification of siderophages in bronchoalveolar fluid in transfusional and primary pulmonary hemosiderosis.

Transfusional iron overload may occur in the lungs. We hypothesized that quantitating siderophages in the bronchoalveolar fluid (BALF) of heavily transfused patients may prove to be a useful tool in determining lung iron overload in transfusion-dependent patients. The study included six patients (7-20 years) with thalassemia major (TM) who had received multiple blood transfusions, one with hereditary spherocytosis (four blood transfusions) and one with sickle cell disease (never transfused); they were compared to three children with idiopathic pulmonary hemosiderosis (IPH) (2.5-7.0 years) as positive controls. Fiberoptic bronchoscopy with bronchoalveolar lavage was performed in seven patients under general anesthesia for elective surgery and the rest were bronchoscoped electively under sedation. Spirometry was also performed in eight patients. There was no significant difference between children with TM and IPH in siderophages as percentage of total count (95% CI -31.0 to 1.5, P = 0.068). There were positive relationships between both mean serum ferritin values during the preceding year and the total number of units of transfused blood, and percent siderophage count among multiply transfused patients (P = 0.010, P = 0.052, respectively); similar findings were noted for the Golde score (P = 0.001, P = 0.031, respectively). None of the patients showed lung function impairment. In conclusion, in this small study, we found that the BALF of multiply transfused patients with benign hematological disorders contain similar numbers of siderophages to that of patients with IPH; this is strongly suggestive of secondary pulmonary hemosiderosis. The correlation between the patients' serum ferritin, and the BALF siderophages suggests that the later may serve as a marker of pulmonary iron overload in patients requiring blood transfusion and appear to be more sensitive than standard pulmonary function tests.

Adolescent↗

PubMed2006

Increased glycosaminoglycans in the urine of asthmatic children on inhaled corticosteroids.

Increased extracellular matrix (ECM) deposition in the airway wall contributes to the airway remodeling in asthmatics. Glycosaminoglycans (GAGs) are polysaccharides attached to a protein core in order to form proteoglycans, a component of the ECM. In this study, we investigated the possible influence of long-term treatment with inhaled corticosteroids (ICS) on urinary GAGs levels of asthmatic children. Seventy asthmatic children (41 boys), aged 6.8-12.5 yr, participated in the study. About 44 were treated with inhaled budesonide via turbuhaler for 2-35 months (median 12 months) and 26 were on relief medications. About 30 healthy controls were also studied. GAGs were precipitated from early morning urine samples, collected, isolated and quantified using uronic acid-carbazole reaction and expressed as uronic acid (UA) in microg/g/Cr(u)/m2. Urinary GAGs values did not differ significantly between controls and asthmatics but significant differences were found between children on ICS and asthmatics on relief medications (p < 0.001). There was a positive correlation between the daily dose of inhaled budesonide and the urinary GAGs values (r = 0.32, p = 0.037) whereas a threshold distinguishing 'low' vs. 'high' doses of ICS was found to be at 300 microg/m2 per day with a significant difference in urinary GAGs secretion (p = 0.006). Our data show that urinary GAGs secretion is reduced in asthmatic children that used only relief medication but it is increased in those on long-term treatment with ICS. A dose dependent effect of ICS was also detected.

Administration, Inhalation↗

PubMed2005

Serum eosinophil cationic protein and CD23 in acute RSV bronchiolitis.

BACKGROUND: Elevated concentrations of eosinophil cationic protein (ECP) have been found in acute viral wheezing during infancy. Furthermore, RSV infection has been suggested to stimulate type-2 cytokine responses. The aim of this study was to test whether serum ECP and soluble CD23 levels, which are markers of eosinophil and IgE responses, respectively, are elevated in infants hospitalized for acute respiratory syncytial virus (RSV) bronchiolitis. MATERIAL/METHODS: Fifty-five infants aged 1-12 months (median: 4.2 months) consecutively hospitalized for acute bronchiolitis were divided into two groups: RSV-positive (n=26) and RSV-negative patients (n=29). Serum ECP (s-ECP), soluble CD23 (sCD23), and total IgE were measured in all patients and in 23 asymptomatic infants (controls). RESULTS: Lower s-ECP levels were detected in the RSV-positive group (5.4+/-4.3 ng/dl) compared with controls (9.38+/-5.95 ng/dl, p=0.02), but they did not differ significantly from the values of RSV-negative patients (7.8+/-5.7 ng/dl). There was a trend to higher s-ECP values in patients with a positive family history of atopy and/or a history of atopic dermatitis in the RSV-positive group (p=0.06). No differences in sCD23 and total IgE levels among the groups were detected. No correlation between total IgE and sCD23 values was observed. CONCLUSIONS: There is no evidence from our data to suggest that either RSV-positive or RSV-negative acute bronchiolitis is associated with significant eosinophil-mediated degranulation. There is no evidence from the sCD23 data to support the hypothesis that IgE antibody responses are prominent during the acute illness.

Bronchiolitis, Viral↗

PubMed2005

Subjective and objective nasal obstruction assessment in children with chronic rhinitis.

OBJECTIVE: The present study was undertaken, to test the hypothesis that schoolchildren on long-term treatment for chronic rhinitis under-report their nasal congestion. METHODS: Ninety-seven children aged 8.3-15.5 years (median 12.7) with non-purulent perennial rhinitis, for 1.4-8.5 years (median 2.8) self-graded their nasal blockage as "severe" (group-A), "moderate" (group-B), "mild" (group-C) or "absent" (group-D). An additional 48 normal children served as controls (group-E). Subsequently active anterior rhinomanometry for total nasal airway resistance (TNAR) measurement and decongestion test (>20% TNAR fall) were employed as objective means of nasal congestion. RESULTS: Mean pre-decongestion TNAR values did not show any significant difference between the group-A, -B and -C; significant differences were observed between group-A and -D (p=0.04) and between all groups as compared to -E. Positive decongestion test was detected in 57.1%, 53.8%, 48.3%, 32.3% and 10.4% of children in group-A, -B, -C, -D and -E, respectively (group-A, -B, -C versus -E p<0.001, group-D versus -E p=0.03). CONCLUSIONS: Schoolchildren on long-term treatment for perennial rhinitis frequently under-report their symptom of nasal stuffiness.

Adolescent↗

PubMed2005

Bronchial hyper-responsiveness in selective IgA deficiency.

Secretory IgA in mucosal secretions has a broad protective function. The insufficient protection provided by the respiratory mucosa in children with selective IgA deficiency (sIgAD) might facilitate the development of bronchial hyper-responsiveness (BHR) and consequently asthma symptoms. This study was conducted to clarify the prevalence of BHR in sIgAD children and the relationship with atopic status. A cohort of 20 children (group A) aged 6.4-20.1 yr (median: 12.6) with sIgAD (serum IgA <6 mg/dl) were evaluated for BHR using inhaled hypertonic saline test as well as for atopy by skin prick testing (SPT) to eight common aero-allergens. Seventy other children with normal levels of serum IgA, but sensitized to aero-allergens (group B) and 102 with normal IgA and negative SPTs (group C) were also evaluated. Baseline spirometry demonstrated that forced vital capacity (FVC) values in group A were significantly lower than in C. Forced expiratory volume in 1 s values were similar in all groups, but impairment of the forced expiratory flow over the middle half of the FVC was detected in group B. The prevalence of BHR was similar among group A (30.0%) and group B (35.7%) (p = 0.79) but they differed from group C (5.9%) (p = 0.005). An association between BHR and reported current (p = 0.001) but not lifetime asthma symptoms among group A was also observed. There was no association between atopy and BHR in group A but only to mites' sensitization (p = 0.03). In conclusion, these results indicate that sIgAD constitutes a risk factor for development of BHR but it appears to be related to sensitization to mites.

Adolescent↗

PubMed2005

The role of timely intervention in middle lobe syndrome in children.

STUDY OBJECTIVES: Middle lobe syndrome (MLS) in children is characterized by a spectrum of clinical and radiographic presentations, from persistent or recurrent atelectasis to pneumonitis and bronchiectasis of the right middle lobe (RML) and/or lingula. This study was undertaken to evaluate the effect of early intervention, including fiberoptic bronchoscopy (FOB), in the development of bronchiectasis in MLS. DESIGN: Children with atelectasis of the RML and/or lingula persisting for > 1 month or recurring two or more times despite conventional treatment underwent high-resolution CT (HRCT) scanning and FOB. Appropriate treatment and follow-up were provided, and the effect of the duration of symptoms on clinical outcome and the development of bronchiectasis was investigated. The patient cohort was retrospectively reviewed. PATIENTS: We evaluated 55 children with MLS. The median age at diagnosis, duration of symptoms, and duration of clinical deterioration before diagnosis were 5.5 years (range, 3 months to 12 years), 14.5 months (range, 3 to 48 months), and 8 months (range, 3 to 36 months), respectively. MEASUREMENTS AND RESULTS: FOB revealed marked obstruction in two children (ie, a foreign body and an endobronchial tumor) and positive findings for a culture of BAL fluid in 49.1% of patients. The remaining 53 patients were followed up for a median duration of 24 months (range, 5 to 96 months). The clinical outcome was "cure" in 60.4% of patients, "improvement" in 32.1% of patients, and "no change" in the remaining patients. Bronchiectasis was documented prior to FOB by HRCT scan in 15 patients (27.3%). The duration of the deterioration of symptoms prior to presentation positively correlated with the development of bronchiectasis (p = 0.03) and an unfavorable clinical outcome (ie, improvement or no change) [p = 0.02]; a positive correlation was also found between the duration of symptoms and the development of bronchiectasis (p = 0.04). CONCLUSIONS: Timely medical intervention in patients with MLS that includes FOB with BAL prevents bronchiectasis that may be responsible for an ultimately unfavorable outcome.

Bronchiectasis↗

PubMed2003

Effects of bracing on lung function in idiopathic juvenile kyphosis.

Although considerable information is available on the effects of bracing on lung function in kyphoscoliosis, there is a paucity of data on idiopathic juvenile kyphosis (IJK). The present study was designed to investigate the immediate effect of bracing on lung function in children and adolescents with mild-to-moderate IJK. Spirometry, measurement of lung volumes, and arterial oxyhemoglobin saturation (SaO(2)) were performed in 24 patients, 9-17 years of age, who were treated with a corrective brace for mild-to-moderate IJK (Cobb angle, 46-75 degrees ). Children were studied when braced and unbraced. When children were unbraced, mean percent predicted values (+/-standard deviation) for total lung capacity (TLC), vital capacity (VC), functional residual capacity (FRC), and forced expiratory volume in 1 sec (FEV(1)) were 100.0% (+/-13.0%), 92.7% (+/-14.2%), 108.2% (+/-20.4%), and 95.0% (+/-16.3%), respectively. With the brace on, significant reductions occurred in all lung function measurements: TLC decreased by 9.5% (P < 0.001), VC by 9.3% (P = 0.001), FRC by 14.2% (P = 0.005), and FEV(1) by 8.9% (P = 0.009). SaO(2) decreased from 96.2% (+/-1.6%) to 95.2% (+/-1.4%) (P = 0.027). An inverse relationship was observed between pre- and postbracing change in TLC and Cobb angle children (P = 0.021). Our findings indicate that corrective bracing in mild-to-moderate IJK results in mild lung restriction and a clinically insignificant drop in SaO(2). The effect of bracing on TLC decreases as the severity of kyphosis increases in these patients.

Adolescent↗