Pediatric Pulmonology

Metallic foreign body ingestion in children is a common occurrence, especially among children aged below five years, and frequently involves items like coins, batteries and small toys. Most metallic objects pass through the digestive system without complications, certain objects such as batteries, multiple magnets, sharp and pointed objects require prompt intervention due to risk of serious injuries.

This is a 5-year-old male child with no history of mental instability, was reported to have ingested an oval metallic object but in a stable condition. He was referred for abdominal radiographs from a peripheral facility. These radiographs demonstrated oval metallic density opacity in the upper abdomen measuring about 10mm x 10mm in dimension but noted to descend inferiorly on the lateral projection. No intestinal obstructive features demonstrated currently. No any other abnormality demonstrated. The parents were advised to consult a pediatric surgeon/gastroenterologist for expertise management and prevent associated injury and complication.

We report a case of oval shaped metallic density foreign body ingestion in a 5-year-old mentally stable child due to its peculiar presentation

Background: Asthmatic patients may benefit from exercise training, although the effects of a combined aerobic and resistance training program are still poorly investigated in children and adolescents. Objective: To analyze the effects of a combined exercise training (resistance and aerobic) program on aerobic fitness, lung function, asthma control and quality of life in a group of mild-moderate asthmatic children with exercise symptoms. Methods: This was a 12-week randomized controlled trial including children and adolescents diagnosed with mild-moderate asthma and presenting exercise-induced symptoms. The intervention group (IG) performed the exercise training (resistance and aerobic) 3 days/week, for 60 minutes. The control group (CG) followed routine clinical orientations. The main outcomes were cardiorespiratory fitness, muscle strength, lung function, quality of life, asthma control, and functional tests after 3 months of the intervention. Results: Fifty-three patients (IG = 25 and CG = 28) with a mean age of 11.5 ± 2.6 years were included. No significant differences were found between groups regarding lung function, asthma control, quality of life, and functional tests. Ventilatory equivalent for oxygen consumption at ventilatory threshold (P = .025; p 2 η = 0.083), peak oxygen consumption (P = .008; p 2 η = 0.116) and test duration (P = .014; p 2 η = 0.1) presented greater improvements in the IG. In addition, improvements were observed in leg press (P < .001; p 2 η = 0.36), hamstring curl (P = .001; p 2 η = 0.217), high row (P = .003; p 2 η = .167), low row (P = .009; p 2 η = 0.128) and quadriceps leg extension (P = .015; p 2 η = 0.108) in the IG. Conclusion: Combined exercise training (resistance and aerobic) improved cardiorespiratory fitness and muscle strength in children and adolescents with controlled asthma and exercise symptoms.

OBJECTIVE We have measured peak inspiratory flow (PIF), inspiratory capacity (IC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and other functional parameters in COPD patients to investigate which PIF&#39;s patients generate with maximal effort, through three different resistances, representing Diskus, Nexthaler and Turbuhaler. PATIENTS AND METHODS Forty patients with COPD were enrolled in this study. All patients were examined: pulmonary function tests, including flow/volume spirometry and N2-wash out, were conducted. MIP and MEP were measured. PIF was measured using the In-check DIAL; patients inhaled through the device set for the optimal Turbuhaler resistance, Nexthaler resistance and Diskus resistance. The relationship between lung function parameters and PIF was studied. RESULTS The mean PIF through Nexthaler resistance was significantly higher than the Turbohaler resistance. We have found a mild correlation between PIF and MIP and between PIF, IC and...

Learning potential can be used to assess and provide direction for action in diverse populations in modern educational
settings. This study examined the relationship between the EHPAP dynamic evaluation scale and cognitive abilities
(linguistic development, specific cognitive abilities, and executive functioning) in typically developing preschool children.
Linear regression models indicated that children’s cognitive abilities formed part of the prediction of their independent
performance in tasks before and after mediation. The abilities that formed part of the predictions were related to general
linguistic development, specific cognitive functions, and executive functioning. Age as a predictive factor only contributed to
verbal planning. This study examined the contribution of these variables in different EHPAP scales.

Background: Reducing the number of zero-dose children in Nigeria requires a context-specific understanding of the factors driving under-immunization at individual and community levels. This study identifies barriers and enablers to immunization uptake among caregivers of children under two in high-burden zero-dose communities in Kano and Lagos States, Nigeria. Methods: We followed a qualitative methods approach, conducting 40 focus group discussions (FGDs) among caregivers in the urban communities of Ungogo and Alimosho in Kano and Lagos states, respectively, peri-urban communities of Gezawa in Kano state and rural communities of Ikorodu in Lagos state. Vignettes, gender analysis, and concept-testing of interventions were integrated into the FGD guides to minimize social desirability and explore gendered factors. FGDs were pretested, translated into local languages, audio-recorded, transcribed, and back-translated into English. Thematic analysis was performed using NVivo software. Results: We identified high recognition of the importance of childhood immunization among our study communities, despite inadequate immunization uptake. The main barriers to immunization uptake found in this study were gender-skewed decision-making in childhood vaccination between caregivers, prevalent misconceptions about immunization, prioritization of unmet socioeconomic needs over immunization, and past negative experiences with immunization and health services. Enablers included effective community mobilization, involvement of religious and traditional leaders, positive attitudes of well-trained health workers, reliable fixed and outreach immunization services, and material incentives for caregivers. Caregivers preferred community-based strategies, especially those engaging community and religious leaders. Conclusion: While similar barriers and enablers are inherent in global vaccine rejection, two-way community engagement for collective action, vaccination awareness campaigns, and engagement of cultural and traditional leaders, including fathers, offer promising strategies for improving immunization uptake in Nigeria.

Although “fetal programming” has been extensively studied in many organs, there is only limited information on pulmonary effects in the offspring following intrauterine growth restriction (IUGR). We aimed to determine the effects of nutrient restriction on the lung structure and lung lipid differentiation programs in offspring using an animal mode of maternal food restriction (MFR). We utilized a rodent model of 50% MFR from day 10 of gestation to term and then using lung morphology, Western blotting, Real Time RT‐PCR and Oil Red O staining, lung structure and development of the offspring were examined at postnatal days (p) 1, p21, and 9 months (9M). At postnatal day 1, MFR pups weighed significantly less compared to control pups, but at p21 and 9M, they weighed significantly more. However, lung weight, expressed as a percentage of body weight between the two groups was not different at all time‐points examined. The MFR group had significantly decreased alveolar number and significa...

Elastin peptides derived from the elastin-rich connective tissue of the fish cardiac arterial bulb (bulbus arteriosus) represent a distinctive, highly bioavailable source of extracellular matrix (ECM) repair substrates for the respiratory system.
Targeted enzymatic hydrolysis yields low-molecular weight peptides (≈500-700 Da) that are efficiently absorbed via PepT1 and retain the cross-linking amino acids desmosine and isodesmosine - the molecular “fingerprints” essential for elastin network reconstruction.

Functionally homologous to alveolar recoil and pulmonary vascular compliance, these peptides act through a triad of mechanisms:
(i) substrate provision for tropoelastin synthesis and cross-linking;
(ii) signaling modulation (elastin-derived peptide/EBP-integrin pathways) that supports balanced matrix turnover; and
(iii) protective effects that dampen elastase/MMP overactivation and oxidative stress. Collectively, these actions target key structures - alveoli, airways, interstitium, and pulmonary vasculature - where chronic inflammation and oxidative injury degrade elastin fibers, lower tissue compliance, and drive fibrotic remodeling.

In the pulmonary interstitium, incorporation of desmosine / isodesmosine-containing fragments helps rebalance collagen-elastin composition and counter fibroblast over-activation, supporting anti-fibrotic trajectories.

In the vascular wall, these peptides reinforce elastin cross-linking (LOX/LOXL axis), improve compliance, and help preserve repair outcomes by anti-protease and antioxidant activity, complementing vasodilator / anti-proliferative pharmacotherapies.

This structural-first, protection-enabled framework provides a translational rationale for nutritional interventions aimed at restoring ECM integrity and function across COPD, IPF, pulmonary hypertension, and post-COVID-19 respiratory sequelae.

Objective: To isolate and cultivate human primary epithelial cells from airways À Bronchial (HBE), Tracheal (HTE) and Nasal (HNEC) À to drug efect evaluation in Cystic Fibrosis (CF) treatment. Methodology: A. HBEs were isolated from CF patient's explanted lung and the HTEs were isolated from healthy donor's explanted trachea fragments, according to the following steps: 1a. It was made a lobe dissection. 2a. Bronchia and tracheas fragments were subjected to enzymatic washes containing antibiotics cocktail. 3a. The HBEs and HTEs were scraped from the bronchi and trachea. 4a. Seeded in P-100 plates for cell culturing in BEGM. 5a. After one week the cells were transferred to a plate containing six porous membrane filters. B. HNECs were collected from 3 patients with CF and were performed the following steps: 1b. Nasal brushing in both patient's nostrils to collect the material. 2b. Placed in appropriate culture medium. 3b. Centrifuged and seeded cells into T25 bottles with irradiated fibroblasts and rho kinase inhibitor. 4b. Cells grown until reaching 60-70% confluency and transferred to filters like step 5a. In filters the cells were cultured for 21 days in an ALI medium for cell differentiation and to form a polarized epithelium to allowing the evaluation of the CFTR function. Results: HBEs and HTEs cells growth up to 80% confluence in 1 week and the HNECs took one month to reach the 70% confluence. In filters, at the end of 21 days the HBEs cells seeded on the plate 1 and 2 showed a mean resistence of 1374 AE 185 and 1406 AE 379, respectively. The HTEs cells seeded on the plate 3 and 4 demonstrated a mean resistence of 1581 AE 46 and 1570 AE 51, respectively. Finally the HNECs of patients 1, 2 and 3 had a mean resistance per plate of 1347 AE 373, 1731 AE 466 and 3924 AE 278, respectively. Conclusion: The technique of isolation and cultivation of primary bronchial, tracheal and nasal cells from CF patients has been successfully performed for the first time in Brazil.

The airway epithelium represents a primary site for the introduction and deposition of potentially pathogenic microorganisms into the body, through inspired air. The epithelial mucosa is an important component of the innate immune system that recognizes conserved structures in microorganisms and initiates appropriate signaling to recruit and activate phagocytic cells to the airways. This review focuses on how airway epithelial cells sense and respond to the presence of bacterial pathogens. The major signaling cascades initiated by epithelial receptors that lead to phagocyte recruitment to the airways as well as the ability of the epithelium to regulate inflammation are discussed. Pediatr Pulmonol. 2008; 43:11–19. © 2007 Wiley‐Liss, Inc.

Lung function measurement is difficult in unsedated infants; tidal breathing parameters are a useful non-invasive surrogate, but even these measurements cause disturbance from applying a facemask. We investigated a novel volumetric vest system (FloRight), which measures volume changes of the respiratory system from changes in the magnetic fields induced by current-carrying coils around the entire chest and abdomen. Using a facemask and ultrasonic flowmeter as comparator, we assessed the validity and repeatability of tidal breathing parameters measured by FloRight in 10 healthy newborn infants during natural sleep. We also assessed the effect of a facemask on tidal volume and tidal expiratory flow parameters. To assess the ability of the FloRight system to detect disease, we compared the healthy infants with 11 infants suffering from bronchopulmonary dysplasia. Tidal parameters with the FloRight vest corresponded closely with facemask measurements. Mean difference, mask minus vest, for tidal volume was 0.096mL (p<0.05), with limits of agreement +4.5 to -4.3mL. Coefficient of repeatability was similar for mask and vest measurements. Tidal volume measured by FloRight with mask in place (20.6mL) was significantly higher than without mask (16.1mL), but tidal expiratory flow parameters were not altered. FloRight measurements of tidal parameters were markedly different between the two groups of infants, with tidal volume per Kg sigificantly higher and tidal expiratory flow parameters significantly lower. Our findings suggest that the FloRight system is able to measure tidal breathing parameters accurately, in healthy newborn infants, without prior calibration on the infant. It appears to have at least sufficient sensitivity to detect severe respiratory disease.

To The Editor Cystic fibrosis (CF) and asthma are not always easily distinguished and both can coexist in the same patient. 1 Reduced pulmonary function, bronchial hyperreactivity, eosinophilia, and elevated IgE levels are common to both. Specific IgE for at least one aeroallergen, present in 67% by skin tests and 80% by radioallergosorbent test (RAST), indicates that subjects with CF should be evaluated and treated for coexisting allergy. Patients with CF (n=40, median age: 7.3 years) were investigated for allergic bronchopulmonary aspergillosis (ABPA) by thoracic computed tomography, skin prick/puncture testing (SPT) for aeroallergens, blood eosinophil counts, sputum culture, total serum IgE levels and serum specific IgE to Aspergillus fumigatus (AF) (Immuno CAP ® ). 4 SPTs were positive in 50% of the patients, and positive in 30% for D. pteronyssinus. However, a positive response to AF was observed in 9/40 (23%) and specific IgE ≥0.35 kU/L in 10 (25%) patients. There was a correlation between SPT and specific IgE (p<0.0001). Allergic rhinitis was observed in 22 (55%) patients and 2 had sputum culture positive for Aspergillus sp., despite negative SPT/specific IgE being for its antigens. Three patients had a diagnosis of ABPA (Criteria from CF Foundation, USA) with radiological changes (infiltrates and/or bronchiectasis), and of which two of them presented serological ABPA. Aguiar, Damaceno and Forte found serum specific IgE for Aspergillus in 18.6% of their patients (n=86) with CF, as well as positive allergic cutaneous tests (ACT) in 29.5% of them (n=78), results which are similar to those in the present study. The objective was to know the IgE sensitization index to the AF fungus in cystic fibrosis with serum IgE levels by immunofluoroenzymatic assay and SPT. The SPT technique is not described -probably prick test -, and was considered positive if wheal diameter was ≥3 mm. The presence of allergic diseases and sensitization to other allergens were not evaluated in these patients, which could be a confounding factor in the interpretation of total IgE and SPT results. Although AF sensitization is crucial for the diagnosis of ABPA in cystic fibrosis, it is necessary to differentiate lung colonization by Aspergillus, allergic sensitization and clinically proven ABPA. Patients with CF should be periodically examined for ABPA, and those sensitized should be monitored more often. Clinical deterioration, high total IgE, and Aspergillus-specific IgE are the minimal criteria for ABPA. Monitoring by SPT and serology, as suggested 5 and in agreement with what was observed in this study 4 , are useful for the diagnosis of ABPA in fibrocystic patients.

Low adherence to cystic fibrosis (CF) treatment is associated with poor health outcomes, while knowledge of the disease and medication regimen can positively influence adherence. This study's purpose was to develop and validate a questionnaire to help determine CF medication knowledge of pediatric patients and caregivers. Our questionnaire had 37 items: 22 selected-response and 15 open-response questions. We used validation processes from the Standards for Educational and Psychological Testing. CF experts analyzed validity evidence based on content. Then, the questionnaire was field tested with 17 pediatric patients and 18 caregivers. The correlation between age and medication knowledge was medium (r = .33), but was not significant (P = .189). Cronbach's α for the overall test was .84. Participants thought the questionnaire was important and suitable, with a few minor suggestions to improve wording. Strong validity evidence indicates the questionnaire could be used to assess medication knowledge and allow more personalized education to improve adherence.

C ommunity-acquired pneumonia (CAP) is one of the most common reasons for hospitalization in otherwise healthy Canadian children. The introduction of effective vaccinations, such as the pneumococcal conjugate vaccines, to the routine immunization schedule, has led to decreased rates of illness and, possibly, changes in the epidemiology of CAP in Canada. Unfortunately, in many children diagnosed with pneumonia, no causative agent can be isolated and up to date local data regarding the most common causes of pneumonia are difficult to obtain. The 2011 national guideline from the Canadian Paediatric Society (CPS) (1) and international guideline from the Infectious Diseases Society of America (2) recommend high-dose amoxicillin as the first-line treatment for otherwise healthy children with CAP who can be treated with oral antibiotics (1,2). This recommendation was initiated before the widespread introduction of the 13-valent pneumococcal conjugate vaccine to immunization schedules, when penicillin-resistant serotype 19A disease was a rising concern. We sought to determine the appropriateness of this recommendation in our setting based on our current local Streptococcus pneumoniae susceptibility patterns.

Background Mechanical ventilation causes diaphragmatic atrophy and reduces diaphragmatic efficiency. Patients with diaphragmatic dysfunction have longer mechanical ventilation durations and intensive care unit stay. There is currently a scarcity of data on the effect of different modes of mechanical ventilation on diaphragmatic function and ultrasound-guided assessment of diaphragmatic efficiency. Results Sixty mechanically ventilated patients were randomly divided into four equal groups (15 each): patients were ventilated using either assist control pressure-controlled mode (group A), synchronized intermittent mandatory ventilation pressure-controlled mode (group S), bi-level-positive airway pressure mode (group B) or pressure support ventilation mode (group P). The primary outcome was to assess the diaphragmatic excursion, while the secondary outcomes were to assess the diaphragmatic thickness fraction and the duration of the ICU stay. Patients in the P group had the highest diaph...

Background: During the COVID-19 pandemic, the need for noninvasive respiratory support devices has dramatically increased, sometimes exceeding hospital capacity. The full-face Decathlon snorkeling mask, EasyBreath ® (EB ® mask), has been adapted to deliver continuous positive airway pressure (CPAP) as an emergency respiratory interface. We aimed to assess the performance of this modified EB ® mask. Methods: CPAP set at 5, 10, and 15 cmH 2 O was delivered to 10 healthy volunteers with a high-flow system generator set at 40, 80, and 120 L min -1 and with a turbine-driven ventilator during both spontaneous and loaded (resistor) breathing. Inspiratory CO 2 partial pressure (PiCO 2 ), pressure inside the mask, breathing pattern and electrical activity of the diaphragm (EAdi) were measured at all combinations of CPAP/flows delivered, with and without the resistor. Results: Using the high-flow generator set at 40 L min -1 , the PiCO 2 significantly increased and the system was unable to maintain the target CPAP of 10 and 15 cmH 2 O and a stable pressure within the respiratory cycle; conversely, the turbine-driven ventilator did. EAdi significantly increased with flow rates of 40 and 80 L min -1 but not at 120 L min -1 and with the turbine-driven ventilator. Conclusions: EB ® mask can be safely used to deliver CPAP only under strict constraints, using either a high-flow generator at a flow rate greater than 80 L min -1 , or a highperformance turbine-driven ventilator.

The most common COVID-19 infection clinical features in pediatric patients are similar to those of other pulmonary diseases, i.e., fever, cough, and shortness of breath. Information about the characteristics of coinfection and superinfection in COVID-19 cases can reduce misdiagnosis and differentiate CO-VID-19 from other pulmonary infections. Objective To observe the characteristics of pneumonia in children with suspected/confirmed COVID-19. Methods This descriptive study used medical record data of children hospitalized from 1 January 2020 -31 January 2021 to describe the characteristics of pneumonia in suspected and confirmed COVID-19 cases in Haji Adam Malik Hospital, Medan, North Sumatera. Pneumonia-related findings, such as clinical symptoms, chest X-ray, and blood test results, were collected. Results There were 27 confirmed and 34 suspected COVID-19 children. Most of them were aged 6-8 years. Pneumonia was significantly associated with COVID-19. In confirmed COVID-19 cases, fever persisted after 3 days, with cough and shortness of breath. Patients did not have flu symptoms, but had below normal SpO 2 (81-90%). The occurrence of lung rhonchi was significant in confirmed COVID-19 group. Chest X-ray results showed lung opacity in all confirmed COVID-19 patients. Mean white blood cell (WBC) count was significantly lower in COVID-19 confirmed (3.49x103/µL) vs. suspected group (17.9 x103/µL) (P=0.011). Mean CRP was significantly higher in COVID-19 confirmed (26.5 mg/L) vs. suspected group (4 mg/L). Conclusion Pneumonia with confirmed COVID-19 cases present with longer fever and lower SpO2. Patients are presented with lung ronchi, had lower WBCcount, and higher CRP. Chest X-ray shows opacity and consolidation.

Aim: The present study aimed to detect and relate alteration in reaction of plasma leptin and pulmonary functions (forced vital capacity "FVC" and forced expiratory volume in the first second "FEV1") in obese adolescent schoolboys and schoolgirls to aerobic training. Material and Method: Sixty obese secondary school students with body mass index (BMI) of 30 kg/m2 or greater, with age range of 15 to 18 years participated in this study. Participants were allocated into two equal groups based on their gender: 30 schoolgirls (Group A) and 30 schoolboys (Group B). All subjects in both groups practiced moderate-intensity aerobic training program using a stationary cycle ergometer for a period of 4 months 5 days a week. Plasma leptin levels and pulmonary functions (FVC and FEV1) were measured in all students' before and after the program started. Participants were chosen from thirteen Secondary Schools, Jeddah, Saudi Arabia. They received training program at Pediatric Out-Patient Clinic, King Abdul-Aziz Hospitals. The study was conducted between June 2015 and May 2016. Results: After 4 months of aerobic exercise program, there was a significant decrease (p < 0.05) in leptin and significant improvement in pulmonary functions in both groups. Moreover, there was a significant difference (p < 0.05) in both groups in leptin levels with favor to girls group. In contrast, there was a significant difference (p<0.05) in both groups in pulmonary functions with favor to boys group. Discussion: Following aerobic exercise program, pulmonary functions were improved in obese adolescent schoolboys more than in obese adolescent schoolgirls. In contrast, serum leptin hormone values were improved in obese adolescent schoolgirls more than in schoolboys.

Objective: Strengthening the immune system constitutes an important part of struggling with COVID-19. The aim of this study was to evaluate the approaches of the teachers to strengthen their immunity during COVID-19 pandemic period in Turkey. Methods: This descriptive study was performed on teachers via social media between 15 and 23 June, 2020. Results: Of 500 participants, 47.4% stated that they gained weight during COVID-19 pandemic period. Vegetable and fruit consuming (52.8%), praying (36.2%) and sunbathing (26.0%) were the most common methods to strengthen immunity. Of the teachers, 46.2% were confident about their knowledge on immunity strengthening methods and only 61.2% stated that they would like to be trained. Discussion: Lifestyle changes strengthening immunity may help to come over Covid-19 pandemic period with less harm. In-service training should be provided to the teachers who would constitute a good sample for the society.

Flow limitation during forced exhalation and gas trapping during high-frequency ventilation are affected by upstream viscous losses and by the relationship between transmural pressure (Ptm) and cross-sectional area ( A tr) of the airways, i.e., tube law (TL). Our objective was to test the validity of a simple lumped-parameter model of expiratory flow limitation, including the measured TL, static pressure recovery, and upstream viscous losses. To accomplish this objective, we assessed the TLs of various excised animal tracheae in controlled conditions of quasi-static (no flow) and steady forced expiratory flow. A tr was measured from digitized images of inner tracheal walls delineated by transillumination at an axial location defining the minimal area during forced expiratory flow. Tracheal TLs followed closely the exponential form proposed by Shapiro (A. H. Shapiro. J. Biomech. Eng. 99: 126–147, 1977) for elastic tubes: Ptm = K p[( A tr/ A tr0)− n − 1], where A tr0 is A tr at Ptm = ...

The Division of Lung Diseases of the National Heart, Lung and Blood Institute (NHLBI) recently held a workshop to identify gaps in our understanding and treatment of childhood lung diseases and to define strategies to enhance translational research in this field. Leading experts with diverse experience in both laboratory and patient‐oriented research reviewed selected areas of pediatric lung diseases, including perinatal programming and epigenetic influences; mechanisms of lung injury, repair, and regeneration; pulmonary vascular disease (PVD); sleep and control of breathing; and the application of novel translational methods to enhance personalized medicine. This report summarizes the proceedings of this workshop and provides recommendations for emphasis on targeted areas for future investigation. The priority areas identified for research in pediatric pulmonary diseases included: (1) epigenetic and environmental influences on lung development that program pediatric lung diseases, ...

Background: The novel coronavirus ( SARS CoV 19) is responsible for the pandemic infection after starting in 2019 in Wuhan city /China, several small studies were done since then to determine the effects of smoking on the severity, outcome & mortality of patients with COVID-19 but the results were inconclusive, this study aims to assess the impact of active smoking on severity and outcome in patients with COVID-19 infection in Mosul city/Iraq. Methods: A prospective cohort study was conducted on 160 patients ( 80 patients were active smokers & 80 non-smoker patients) who have been diagnosed with COVID-19 infection by using real-time PCR, the study was done at Ibn-Sina teaching hospital in Mosul city/Iraq from May 2020 until December 2020.

Central alveolar hypoventilation is rarely encountered. This case report describes a young woman who was recently diagnosed with hypertension and ischemic heart disease. She presented to the emergency room with hypercapnic respiratory failure, for which she was mechanically ventilated. This was preceded by an acute upper respiratory tract infection. She was initially suspected to have Guillain-Barré syndrome, but further investigations ruled out neuromuscular or autoimmune disorders. Sleep-related hypoventilation was suspected after she experienced recurrent apneas at night that resulted in re-intubation. Polysomnographic studies confirmed episodes of central apnea and hypopnea during sleep, with significant carbon dioxide retention and oxygen desaturations. She required nocturnal ventilation via a tracheostomy tube until a diaphragmatic pacer could be placed. Using bi-level positive airway pressure and average volume-assured pressure support together with the diaphragmatic pacer, adequate ventilation during sleep was achieved.

Mechanical ventilation is a common procedure performed in pediatric intensive care units, with over 20% of patients requiring invasive ventilator support. The most common indication for endotracheal intubation and ventilation in the pediatric population is respiratory failure either due to respiratory embarrassment or neurologic pathology. Despite the use of ventilation modes that are lung protective in the pediatric population, complications of mechanical ventilation occur frequently. These include atelectasis, post-extubation stridor, perioral tissue damage, ventilator associated pneumonia, mucus plugging, pneumothorax, pneumomediastinum, and ICU neuromyopathy. The purpose of this review is to discuss the risk factors, presentation and management of complications associated with mechanical ventilation in the pediatric population.

Pulmonary exacerbations (PEx) in Cystic Fibrosis (CF) are associated with an increased morbidity and even mortality. We investigated whether early detection of PEx in children with CF is possible by electronic home monitoring of symptoms and lung function. During this one-year prospective multi-centre study, 49 children with CF were asked to use a home monitor three times a week. Measurements consisted of a respiratory symptom questionnaire and assessment of Forced Expiratory Volume in one second (FEV1). Linear mixed-effects and multiple logistic regression analyses were used. In the 2 weeks before a PEx, the Respiratory Symptom Score (RSS) of the home monitor increased (p = 0.051). The FEV1 as percentage of predicted (FEV1%pred) did not deteriorate in the 4 weeks before a PEx. Nevertheless, the FEV1%pred at the start of exacerbation was significantly lower than the FEV1%pred in the non-exacerbation group (mean difference 16.3%, p = 0.012). The combination of FEV1%pred and RSS had a...

Introduction: Following the Covid-19 pandemic, the face-to-face meetings are delayed to a future date , which is still not clear. However, seminars, meetings, and conferences are necessary for updating our knowledge and skills. The web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behavior when webinars present at the Covid-19 pandemic era. Methods: Between December 2017 – July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviors such as content views, engagement time, total unique attendees, average engagement time, and the number of audience to leads. Data were split into two groups; group-1 is webinars before Covid-19 (before March 2020), group-2 is the webinars during Covid-19. Results: Total broadcast time and total page view number were found to...

analyzed by ELISA. Data was analyzed using one way ANOVA with post-hoc test and MetaboAnalyst-2. Results: Principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed increased concentrations of amino acids; aspartic, leucine/isoleucine (Leu-Ile) and valine but reduced concentrations of methionine, methionine-phenylalanine (Met-Phe) and Phe-Tyr (phenylalanine-tyrosine). They also showed increased acylcarnitines; C4-OH(C3-DC), C0-Carnitine, C2-Carnitine, C5-Carnitine, C5-DC, C18-Carnitine and C16: 1. There was no significant difference between IGDM and IPGDM except in C6-carnitine which was significantly lower in IPGDM. IDMs have significantly lower cord blood ferritin than controls (p < 0.001). Cord blood ferritin was negatively correlated with maternal HbA1C (r¼-0.314; p ¼ 0.026), maternal body mass index (r¼-0.452; p ¼ 0.001) and birth weight (r¼-0.42; p ¼ 0.002). There was no significant correlation between cord blood ferritin and studied metabolites. We report that IDMs have alterations in amino acid concentrations and carnitine shuttle at birth and have low inutero iron stores. Low in-utero iron stores in IDMs is not related to amino acid and acylcarnitine concentrations at birth.

Asthma morbidity has increased dramatically in the past decade, especially among poor and minority children in the inner cities. The National Cooperative Inner-City Asthma Study (NCICAS) is a multicenter study designed to determine factors that contribute to asthma morbidity in children in the inner cities. A total of 1,528 children with asthma, ages 4 to 9 years old, were enrolled in a broad-based epidemiologic investigation of factors which were thought to be related to asthma morbidity. Baseline assessment included morbidity, allergy evaluation, adherence and access to care, home visits, and pulmonary function. Interval assessments were conducted at 3, 6, and 9 months after the baseline evaluations. Over the one-year period, 83% of the children had no hospitalizations and 3.6% had two or more. The children averaged 3 to 3.5 days of wheeze for each of the four two-week recall periods. The pattern of skin test sensitivity differed from other populations in that positive reactions to cockroach were higher (35%) and positive reactions to house dust mite were lower (31%). Caretakers reported smoking in 39% of households of children with asthma, and cotinine/ creatinine ratios exceeded 30 ng/mg in 48% of the sample. High exposure (>40 ppb) to nitrogen dioxide was found in 24% of homes. Although the majority of children had insurance coverage, 53% of study participants found it difficult to get follow-up asthma care. The data demonstrate that symptoms are frequent but do not result in hospitalization in the majority of children. These data indicate a number of areas which are potential contributors to the asthma morbidity in this population, such as environmental factors, lack of access to care, and adherence to treatment. Interventions to reduce asthma morbidity are more likely to be successful if they address the many different asthma risks found in the inner cities.

Polymorphonuclear leukocytes (PMNs) are a central part of the human innate immunity and they are dominating the response against bacterial infections in the cystic fibrosis (CF) lung. However, the opportunistic pathogen Pseudomonas aeruginosa can evade destruction by PMNs and may thus cause persistent infections in immuno-compromised patients. In the present in vitro study, interactions between P. aeruginosa (in the sessile and planktonic modes of growth) and PMNs were analyzed by means of DNA microarray based transcriptomics. We found that the P. aeruginosa wild type biofilms, in contrast to planktonic cultures and quorum sensing (QS) deficient strains, respond to PMN exposure in a rather aggressive manner. The response does not involve protective mechanisms such as those involved in oxidative stress. Rather it is dominated by an up-regulation of QS controlled virulence determinants such as those encoded by pqs, phz, rhlAB, lecB and lasB, all of which are able to cripple and eliminate eukaryotic cells. Our data supports a model by which P. aeruginosa recognizes the presence of PMN's and channels this information through the QS system. Consequently, it strengthens the view that QS plays a key role in P. aeruginosa recognition and evasion of components of the host defense.

Young syndrome, also known as sinusitis-infertility syndrome, represents a rare yet clinically significant congenital disorder predominantly affecting adult males. It is classically characterized by a triad of chronic rhinosinusitis, bronchiectasis, and obstructive azoospermia despite preserved spermatogenesis. The syndrome bears phenotypic similarities to primary ciliary dyskinesia and cystic fibrosis but is pathophysiologically distinct due to the presence of normally functioning cilia and absence of vas deferens agenesis. Thick, viscous mucus, likely due to abnormal secretory epithelial function, plays a central role in both respiratory and reproductive tract manifestations. The etiological basis remains incompletely defined, though genetic predispositions and past environmental exposures, particularly to mercury, have been proposed.
Clinically, the diagnosis hinges on a high index of suspicion in adult males with concurrent chronic sinopulmonary disease and infertility. Radiologic imaging, pulmonary function testing, semen analysis, and exclusion of differential diagnoses such as cystic fibrosis and Kartagener syndrome are integral to evaluation. While there is no definitive cure, management is focused on symptomatic treatment of respiratory infections, otolaryngologic complications, and infertility. Therapeutic interventions range from airway clearance strategies and antibiotics to advanced reproductive technologies such as intracytoplasmic sperm injection (ICSI) following sperm retrieval. Microsurgical techniques may offer fertility restoration in select cases. Although the condition typically does not shorten lifespan, recurrent infections and infertility impose a significant burden on quality of life.
This review provides a comprehensive overview of the current understanding of Young syndrome, including its pathogenesis, clinical features, diagnostic strategies, differential diagnoses, and evidence-based management approaches. We emphasize the importance of multidisciplinary care and patient-centered strategies in optimizing long-term outcomes in this underrecognized condition.

Objective: Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that is increasingly used in the daily practice of intensive care units (ICUs) with its sedative, analgesic, anxiolytic, and immunoprotective effects. In this study, we aimed to analyze whether Dexmedetomidine improves the outcomes in patients treated in ICU. Design: A retrospective study Place and Duration of Study: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to February 2021 Methodology: The medical records of the patients were analyzed retrospectively. We included 134 patients in the study, in 45 of whom the treatment regimen included dexmedetomidine and 89 of whom were not treated with dexmedetomidine. Patients treated with DEX were defined as the “patient group”, whereas patients not treated with DEX were defined as “control group” and the parameters were compared between these groups. Obtained data were analyzed in the biostatis...

Race and Upper Airway Dynamics in Children-Pinto et al children with OSAS do not obstruct while awake. In addition, OSAS persists in a proportion of children after anatomic factors are corrected, e.g., following adenotonsillectomy. These facts indicate the importance of the neuromotor component in maintaining upper airway patency. Most studies evaluating the epidemiology and pathophysiology of racial differences in OSAS have relied on polysomnograms, questionnaires or radiological evaluations, and have focused on anatomic factors. However, to our knowledge there are no studies evaluating upper airway dynamic responses during sleep in different racial groups in order to determine any potential physiological differences behind the different prevalence of OSAS in African American versus Caucasian children. Upper airway dynamic studies during sleep have shown that normal children have an upper airway that is resistant to collapse, and that upper airway collapsibility increases with age. The understanding of normal upper airway dynamics has led to extensive research in pediatric and adult OSAS. We hypothesized that non-obese, non-snoring African American children would have different upper airway dynamic function and a more collapsible upper airway during sleep compared to age and gender-matched Caucasians. A retrospective analysis of data from previous research studies was performed. All subjects had been enrolled as controls and had been studied by the senior author (CLM) using the same techniques. 14 Following screening to ensure no symptoms of OSAS or other medical conditions, subjects underwent a baseline polysomnogram to ensure normalcy. They then underwent a repeat sleep study on a separate night during which upper airway dynamic function was assessed using activated and hypotonic techniques.

The American Thoracic Society Pediatric Core Curriculum updates clinicians annually in pediatric pulmonary disease in a 3 to 4 year recurring cycle of topics. The 2019 course was presented in May during the Annual International Conference. An American Board of Pediatrics Maintenance of Certification module and a continuing medical education exercise covering the contents of the Core Curriculum can be accessed online at www.thoracic.org.

The American Thoracic Society Pediatric Core Curriculum updates clinicians annually in pediatric pulmonary disease in a 3 to 4 year recurring cycle of topics. The 2019 course was presented in May during the Annual International Conference. An American Board of Pediatrics Maintenance of Certification module and a continuing medical education exercise covering the contents of the Core Curriculum can be accessed online at www.thoracic.org.

SummaryObjectiveTo identify novel risk factors and corroborate previously identified risk factors for mean annual decline in FEV1% predicted in a large, contemporary, United States cohort of young cystic fibrosis (CF) patients.MethodsRetrospective observational study of participants in the EPIC Observational Study, who were Pseudomonas‐negative and ≤12 years of age at enrollment in 2004–2006. The associations between potential demographic, clinical, and environmental risk factors evaluated during the baseline year and subsequent mean annual decline in FEV1 percent predicted were evaluated using generalized estimating equations.ResultsThe 946 participants in the current analysis were followed for a mean of 6.2 (SD 1.3) years. Mean annual decline in FEV1% predicted was 1.01% (95%CI 0.85–1.17%). Children with one or no F508del mutations had a significantly smaller annual decline in FEV1 compared to F508del homozygotes. In a multivariable model, risk factors during the baseline year ass...

UvA-DARE is a service provided by the library of the University of Amsterdam () UvA-DARE (Digital Academic Repository) Transcutaneous electromyography of the diaphragm Monitoring breathing and the effect of respiratory support in preterm infants de Waal, C.G. Publication date 2018 Document Version Other version License Other Link to publication Citation for published version (APA): de Waal, C. G. (2018). Transcutaneous electromyography of the diaphragm: Monitoring breathing and the effect of respiratory support in preterm infants. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website.

Pulmonary function studies were performed in 11 neonatal intensive care survivors both during infancy and later in childhood. Lung function was compared with the respiratory support given in the neonatal period. The mean ± SE thoracic gas volume was 96 ± 4% predicted in infancy and rose to 122 ± 8% predicted during childhood (P &lt; 0.005). The specific airway conductance (SGaw) in infancy was 57 ± 7% predicted and rose to 90 ± 8% predicted in childhood (P &lt; 0.0025). Abnormalities in SGaw were found only in ventilated infants, and there was a negative logarithmic correlation between the treatment score in the neonatal period and the SGaw in both infancy and childhood. The data indicate a long‐term improvement in airway conductance of moderately affected infants with the development of mild hyperinflation in childhood possibly resulting from residual small airway abnormalities despite a symptomless clinical course. The residual abnormalities in prematurely born infants were in pro...

Radiotherapy in breast cancer patients is limited by lung tissue tolerance. Two complications involving the lung are known: radiation pneumonitis (RP) and radiation fibrosis. The aim of the study was to evaluate the pattern of bronchoalveolar lavage (BAL) in patients with RP after radiotherapy for breast cancer in symptomatic and asymptomatic patients. Sixty-five female patients (mean age 58.3 yrs) with RP after radiotherapy for breast cancer were included in the study. The majority of patients had previous breast surgery (mastectomy or lumpectomy and axillary dissection) and received doses of radiations of 45-50Gy. All patients had adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil, and epirubicin or methotrexate. All patients had an infiltrate or consolidation on chest radiography confined to the upper lobe of the irradiated lung, as marker of RP. Based on the presence or absence of symptoms, we divided the patients in 2 groups: 49 patients (75.4%) with symptomatic RP (fe...

Background: Thyroid peroxidase (TPO) gene mutations are one of the most common causes of thyroid disorders. Objective: To investigate the effect of genetic polymorphisms in the TPO promoter region on gene expression in early-diagnosed hyperthyroid patients. Methods: Genomic DNA was extracted from 100 blood samples (75 hyperthyroid patients and 25 healthy controls), then the TPO promoter region was amplified and sequenced for genotyping rs2071399, rs2071400, and rs2071403 SNPs. Total RNA was also isolated, and cDNA synthesis was performed to determine quantitatively the expression of TPO by using qPCR. The level of TPO antibodies in serum was determined by using an enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of hyperthyroidism in women was significantly higher than in men, as were serum levels of TPO-Abs. There was a significant increase in serum TPO-Abs in hyperthyroid patients (235.29 IU/ml) compared with healthy controls. Genotypes of three SNPs (rs2071399 G/A, rs2071400 C/T, and rs2071403 A/G) in the TPO promoter region were TPO rs2071399 AG and GG, and rs2071400 CT and TT genotypes were more frequent in hyperthyroid patients. There are no significant differences between rs2071403 polymorphic and non-polymorphic genotypes among hyperthyroid patients and healthy controls. The rs2071399 G/A and rs2071400 C/T gene promoter polymorphism significantly down-regulated constitutive TPO gene expression in hyperthyroid patients, but rs2071403 A/G has no major effect on gene expression. Conclusion: There was an association between the mutation in the promoter region of TPO and the incidence of hyperthyroidism.

Objectives: To evaluate the risk factors of recurrent pulmonary exacerbation and poor prognosis in children with idiopathic pulmonary hemosiderosis (IPH). Methods: In this multicenter study, 54 patinets with diagnosis of IPH included. Medical records were retrospectively reviewed from three tertiary care hospitals between 1979 and 2019. Also, current information and the long-term progress of patients was determined by contacting the families by telephone. Results: A total of 54 children were included. The median age of onset of symptoms was 4.5 ± 3.8 years. The median time from onset to diagnosis was 0.9 years ± 2.2. The mean number of recurrent episodes per child in the recurrence-positive group was 3.55 (1-15). Univariate analysis demonstrated that patients presenting with hypoxia or requiring transfusion at the time of presentation had significantly more recurrence episodes (P=0.002). Multivariate analysis showed that the presence of hypoxia at the time of initial presentation was a significant independent predictor of recurrent episodes (P=0.027). The median follow-up was 3.3 ± 4.8 years (0.75 months-27 years). There was a significant relationship between the presence of hypoxia, transfusion history, ANA positivity, and elevated transaminases at the time of initial evaluation and treatment response. Conclusions: The present study provides important information on the clinical course and outcome of pediatric IPH, and substantial information regarding factors that affect recurrent exacerbations and prognosis. Demonstrating of hypoxia as an independent risk factor in recurrence episodes could be guide physicians in the planning of treatment strategies.

BackgroundPseudo‐Bartter syndrome (PBS) is a rare complication of cystic fibrosis (CF) and there are limited data in the literature about it. We aimed to compare clinical features and accompanying findings of patients with PBS in a large patient population.MethodsThe data were collected from the Cystic Fibrosis Registry of Turkey where 1170 CF patients were recorded in 2017. Clinical features, diagnostic test results, colonization status, complications, and genetic test results were compared in patients with and without PBS.ResultsTotally 1170 patients were recorded into the registry in 2017 and 120 (10%) of them had PBS. The mean age of diagnosis and current age of patients were significantly younger and newborn screening positivity was lower in patients with PBS (P &lt; .001). There were no differences between the groups in terms of colonization status, mean z‐scores of weight, height, BMI, and mean FEV1 percentage. Types of genetic mutations did not differ between the two groups....

BackgroundRespiratory viruses (RVs) are frequently present in the airways of patients with cystic fibrosis (CF) during pulmonary exacerbations (PEx).Method and ObjectivesThis prospective, longitudinal study was performed to examine the role of RVs in acute exacerbations in children with CF. Sputum samples or additional midturbinate swabs were tested from all children using a polymerase chain reaction panel. The primary aims of the study were to determine the prevalence and etiologic role of RVs in exacerbations of CF and to compare changes with RV‐positive and RV‐negative infections. The secondary aims were to determine the predictive factors for RV‐related exacerbations.ResultsFrom 50 patients with PEx, 23 (48.9%) sputum samples were virus‐positive. With a combination of sputum and swab, viral positivity increased to 56%. The virus‐positive group presented more frequently with hypoxia (oxygen saturation &lt;93%) than the virus‐negative group (P = .048). Virus‐positive exacerbations...

COVID-19 derives from infection with Coronavirus [severe acute respiratory syndrome (SARS)-CoV-2] and is associated with high morbidity and mortality due to release of a storm of pro-inflammatory cytokines and thrombogenic agents resulting in destruction of the lungs. Many reports indicate that a considerable number of patients who are positive for SARS-CoV-2 are asymptomatic or have mild symptoms. However, increasing evidence suggests that many such patients who either recovered from or had mild symptoms after COVID-19 exhibit diffuse, multiorgan, symptoms months after the infection. These symptoms include malaise, myalgias, chest tightness, brain fog and other neuropsychiatric symptoms that were originally reported in children and named Multisystem Inflammatory Syndrome (MIS-C). Now the US Center for Disease Control (CDC) announced the recognition of a similar condition in adults, named Multisystem Inflammatory Syndrome (MIS-A). The symptoms characterizing these conditions are very similar to those associated with Mast Cell Activation Syndrome (MCAS, US ICD-110 code D89.42-idiopathic mast cell activation syndrome). Hence, the possibility of MCAS should be evaluated in any patient with MIS and/or multisystem inflammatory symptoms. In either case, these syndromes should be addressed with liposomal formulation (in olive pomace oil) of the flavone luteolin (e.g. PureLut® or FibroProtek®) together with the antihistamine rupatadine, which also has anti-platelet activating factor (PAF) activity and inhibits mast cells that have been implicated in the pathogenesis of cytokine storms in COVID-19.

Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a multi-system disease and the extent to which simultaneously modeling growth and nutrition markers improves PE predictive accuracy is unknown. Furthermore, it is unclear which routinely collected clinical indicators of growth and nutrition in early life predict PE onset in CF. Methods: Using a longitudinal cohort of 17,100 patients aged 6-20 years (US Cystic Fibrosis Foundation Patient Registry;-2015), we fit a univariate joint model of lung-function decline and PE onset and contrasted its predictive performance with a class of multivariate joint models that included combinations of growth markers as additional submodels. Outcomes were longitudinal lung function (forced expiratory volume in 1 s of % predicted), percentiles of body mass index, weight-for-age and height-for-age and PE onset. Relevant demographic/clinical covariates were included in submodels. We implemented a univariate joint model of lung function and time-to-PE and four multivariate joint models including growth outcomes. Results: All five joint models showed that declining lung function corresponded to slightly increased risk of PE onset (hazard ratio from univariate joint model: 0.97, P < 0.0001), and all had reasonable predictive accuracy (cross-validated area under the receiver-operator characteristic curve > 0.70). None of the growth markers alongside lung function as outcomes in multivariate joint modeling appeared to have an association with hazard of PE. Jointly modeling only lung function and PE onset yielded the most accurate (area under the receiveroperator characteristic curve = 0.75) and precise (narrowest interquartile range) predictions. Dynamic predictions were accurate across forecast horizons (0.5, 1 and 2 years) and precision improved with age. Conclusions: Including growth markers via multivariate joint models did not yield gains in prediction performance, compared to a univariate joint model with lung function. Individualized dynamic predictions from joint modeling could enhance physician monitoring of CF disease progression by providing PE risk assessment over a patient's clinical course.

Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbation (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a multi-system disease and the extent to which simultaneously modeling growth and nutrition markers improves PE predictive accuracy is unknown. Furthermore, it is unclear which routinely collected clinical indicators of growth and nutrition in early life predict PE onset in CF. Methods: Using a longitudinal cohort of 17,100 patients aged 6-20 years (US Cystic Fibrosis Foundation Patient Registry; 2003-2015), we fit a univariate joint model of lung-function decline and PE onset and contrasted its predictive performance with a class of multivariate joint models that included combinations of growth markers as additional submodels. Outcomes were lo...

Knowledge of the behavioral and eating habits of overweight or obese children contributes to the development of prevention and therapeutic programs. Objective: Analyze the data obtained from a questionnaire designed to detect eating disorders in children and adolescents with a Body Mass Index (BMI) Ͼ percentile (PC) 90 (Rolland Cachera), and compare them to the rest of the sample studied. Method: A total of 1971 cases (1231 females and 740 males; age range 10 -19.9 yrs) were evaluated in the period 1998 -2001. The Eating Disorder Examination Questionnaire (EDEQ-4), consisting of 34 questions grouped in 5 subscales, was used. Responses and demographic data were assessed for all the sample. Subscale scores of the cases (C) were compared with those of the control group (c). Results: 26.43% of the sample (nϭ521) had a BMI Ͼ 90 PC. Subscales scores (C vs c) were: 1-Eating restraint: 0.97 Ϯ 1.0 vs 0.51 Ϯ 0.82 (pϭ0.0000). 2-Eating concern: 0.90 Ϯ 1.02 vs 0.49 Ϯ 0.72 (pϭ0.0000). 3-Shape concern: 1.75 Ϯ 1.45 vs 0.97 Ϯ 1.07 (pϭ0.0000). 4-Weight concern: 1.69 Ϯ 1.43 vs 0.87 Ϯ 1.08 (pϭ0.0000). 5-Bulimia: 0.51 Ϯ 0.58 vs 0.3 Ϯ 0.46. Relevant responses to the EDE-Q-4 questions (V cs c) were: a) Attempt to restrain intake: 22. 26% vs 10% (pϭ0.0000); b) Compliance with dietary rules: 20.7 % vs 11.46% (pϭ0.0000); c) Fear of gaining weight: 34.35% vs 17.54% (pϭ0.0000); d) Binge eating: 10.9% vs 8.62% (NS); e) Feeling fat: 46.5% vs 16.62% (pϭ0.0000); f) Overeating: 12% vs 1.5%; g) Loss of control over eating: 1.3% vs 0.5% (NS); g) Purging behavior (vomiting, laxative or diuretic abuse) was reproted by neither group; h) Influence of weight on self-evaluation: 23% vs 13% (pϭ0.000); i) Influence of body shape on self-evaluation: 24% vs. 21.5% (NS); j) Physical activity: 2% vs 1.8% practised exercise more than 3 times a week in order to lose weight, and a 80% of the total sample did not exercise. Conclusion: In the group of overweight and obese children and adolescents, self-evaluation was influenced by body weight. Although they had greater fear of gaining weight, they did not exercise, and only 22% restrained their food intake.

The importance of infection in the pathogenesis of cystic fibrosis (CF) lung disease has been long recognized, and the use of antibiotics targeting bacteria identified in cultures of respiratory specimens has played a critical role in improving outcomes for individuals with CF. Over the past $15 years, the use of culture-independent methods to assess airway microbiology in CF has revealed complex and dynamic CF airway bacterial communities. Recent areas of investigation of the CF lung microbiome have included exploring how bacterial community structures change over time, particularly with respect to disease progression or pulmonary exacerbation, and in response to antibiotic therapies. This review will discuss what has been learned from these studies as well as how these findings offer opportunities to further refine management of CF airway infection.