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Comparative study of respiratory function tests in children from a rural and an urban community in Mexico
Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85
is still controversial, especially regarding the timing, type, and duration of antibiotic treatments. This study aimed to find the type of bacteria causing acute rhinosinusitis and their resistancy to antibiotics. Methods: This was a cross sectional study at the Department of Child Health, Department of ENT FMUI – CMH, and Tebet Public Health Center, Jakarta. Subjects were children aged 6 years old and above recruited consecutively. Clinical examination, paranasal sinus x-ray, and nasoendoscopy were performed on all subjects. The presence of acute rhinosinusitis was assessed clinically using EP3OS 2007 criteria, while definitie diagnosis was established if bacteria could be isolated from the sinus fluid or secret. Results: Eighty-two subjects fulfilled the clinical criteria of acute rhinosinusitis, of which 40 were assessed to have acute rhinosinusitis based on nasoendoscopy examination. Of those 40 subjects, 31 had positive sinus fluid culture results. The most common bacteria found was Staphylococcus aureus (50%) followed by Streptococcus pneumoniae (41%), which were sensitive to amoxicillin–clavulanate and chloramphenicol. Trimethoprim– sulfametoxazole was effective against S. aureus in vitro, but not for S. pneumoniae. Conclusions: Staphylococcus aureus and Streptococcus pneumoniae were the most common bacteria causing acute rhinosinusitis in children. The bacteria are still sensitive to oral amoxicillin– clavulanate and chloramphenicol. Keywords: acute rhinosinusitis, bacteria, resistance test O05-241 Case report: Intrapulmonary teratoma (IPT) mimicking empyema: A missed diagnosis in primary care B.K.R. Reddy1 , K.S. Sanjay2 , M. Rajashekhar2 . 1 National University Hospital Pulmonology and Sleep, Singapore, Singapore; 2 Indira Gandhi Institute of Child Health Pediatric, Bangalore, India Introduction: Germ cell tumors are seen in both gonadal and extragonadal locations. The most common sites in children include sacrococcygeal, ovary, testicle, brain and mediastinum. Case report: A 12-year-old boy presenting with fever, cough and hurried breathing was diagnosed as empyema and treated with intercostal drainage by a primary care physician. In view of persistent drainage of fluid, it was retained for 3 months with antitubercular treatment. He was referred to a tertiary care centre for CT scan after in view of persisting fever, weight loss and a draining sinus in the chest wall. Systemic examination revealed pallor, grade III clubbing, decreased air entry and chest movements on the right side. The same areas were dull on percussion and had bronchial breathing. Chest X-ray revealed a homogenous opacity on the right side with a fluid level. CT chest was done which revealed a well circumscribed peripherally enhancing multiloculated cystic fluid and soft tissue density lesion with fat components, well defined multiple calcified tooth like structures and bone pieces. A right sided thoracotomy with excision of tumour was done and tumour was excised en-bloc. A white-gray colored, well circumscribed, and thick capsulated mass was removed. Histopathological examination showed areas of fat, bone, teeth and lung tissue with normal skin tissue on the covering and with occasional neural tissue present, suggestive of a mature teratoma. Discussion: IPT should be considered a differential diagnosis when investigating a cavitary lung lesion, in adolescents, not explained by more common disorders.
S81
O06-282 Comparative study of respiratory function tests in children from a rural and an urban community in Mexico R. Luis1 , L.G. Gochicoa-Rangel2 , G. Cantu´ Gonzalez ´ 2 , J.L. Alonso 2 Gomez ´ , L. Torre-Bouscoulet2 , D. Mart´ınez-Briseno ˜ 3 . 1 Centro Medico “Santa Teresa”, Texcoco, Estado de Mexico, Mexico; 2 Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas Fisiologia Respiratoria, Mexico, D.F., Mexico; 3 Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas Departamento de Investigaci´ on en Epidemiolog´ıa y Ciencias Sociales en Salud, Mexico, D.F., Mexico Background: Children living in rural areas have higher incidence of respiratory diseases compared to those in urban zones. Reasons could be related to restricted access to health care, but also to anthropometric differences that can affect lung function. The purpose of this study was to investigate if there are any differences in respiratory function test between children from a rural and urban community. Methods: Comparative study carried out in an urban and a rural town in Mexico. Children’s parents answered a questionnaire that explored respiratory health; we obtained anthropometric measures. Spirometry, maximal inspiratory and expiratory pressure (MIP, MEP) measure, and impulse oscillometry (IOS) were performed to those who did not have any respiratory health problems detected in the questionnaire. Results: 694 children were included; 463 (66.7%) from a rural area; 350 (50.5%) female; average age of 9.1 years (SD 2.3). There were differences between children in weight, height and BMI. We performed spirometries to fifty-two children, MIP and MEP in 174 and IOS in 192. Children from the rural area have higher percentages of predicted values in FEV1 (p = 0.002) and FVC (p = 0.0004). They also have lower MIP (p = 0.049), MEP (p = 0.0001), and reactance (x) at 5 Hz (p = 0.049). Resistances were not different. Conclusions: Our results suggest that children living in rural areas have lower MIP, MEP and x 5 Hz. It is required to investigate if there is any nutritional or environmental conditions that explain these dissimilarities and if these contribute to more respiratory-related diseases and mortality in rural areas. O07-185 Indications for enucleation in children with severe airway obstruction due to pulmonary tuberculosis P. Goussard1 , R.P. Gie2 , J.T. Janson3 , S. Kling2 , S. Andronikou4 , G.J. Roussouw3 . 1 University of Stellenbosch Pediatrics, Cape Town, South Africa; 2 Stellenbosch University Department of Pediatrics and Child Health, Cape Town, South Africa; 3 Stellenbosch University Department of Cardiothoracic Surgery, Cape Town, South Africa; 4 University of Witwatersrand Radiology, Johannesburg, South Africa Introduction: A small group of children present with life threatening airway obstruction due to lymph node compression caused by Mycobacterium tuberculosis (MTB). Transthoracic surgical decompression (enucleation) of the enlarged mediastinal lymph glands is required to relieve the airway obstruction in a number of children. The proportion of children requiring enucleation of to relieve the airway obstruction is not described. Aim: Primary aim is to describe the indications for enucleation in children with severe airway obstruction due to lymph node obstruction caused by MTB. Secondary aim was to compare the need for enucleation in HIV negative and HIV-positive children as well as in drug susceptible and drug resistant MTB. Patients and Methods: Prospective, comparative study was completed over a 7-year period at Tygerberg Children’s Hospital, Western Cape, South Africa. Children (1 month to 13 years) with clinical and radiological signs of significant airway obstruction were studied. Enucleation was indicated in the following groups: 1. Severe life threatening airway obstruction. 2. Severe airway obstruction but not responding to 1 month’s medically treatment.
is still controversial, especially regarding the timing, type, and duration of antibiotic treatments. This study aimed to find the type of bacteria causing acute rhinosinusitis and their resistancy to antibiotics. Methods: This was a cross sectional study at the Department of Child Health, Department of ENT FMUI – CMH, and Tebet Public Health Center, Jakarta. Subjects were children aged 6 years old and above recruited consecutively. Clinical examination, paranasal sinus x-ray, and nasoendoscopy were performed on all subjects. The presence of acute rhinosinusitis was assessed clinically using EP3OS 2007 criteria, while definitie diagnosis was established if bacteria could be isolated from the sinus fluid or secret. Results: Eighty-two subjects fulfilled the clinical criteria of acute rhinosinusitis, of which 40 were assessed to have acute rhinosinusitis based on nasoendoscopy examination. Of those 40 subjects, 31 had positive sinus fluid culture results. The most common bacteria found was Staphylococcus aureus (50%) followed by Streptococcus pneumoniae (41%), which were sensitive to amoxicillin–clavulanate and chloramphenicol. Trimethoprim– sulfametoxazole was effective against S. aureus in vitro, but not for S. pneumoniae. Conclusions: Staphylococcus aureus and Streptococcus pneumoniae were the most common bacteria causing acute rhinosinusitis in children. The bacteria are still sensitive to oral amoxicillin– clavulanate and chloramphenicol. Keywords: acute rhinosinusitis, bacteria, resistance test O05-241 Case report: Intrapulmonary teratoma (IPT) mimicking empyema: A missed diagnosis in primary care B.K.R. Reddy1 , K.S. Sanjay2 , M. Rajashekhar2 . 1 National University Hospital Pulmonology and Sleep, Singapore, Singapore; 2 Indira Gandhi Institute of Child Health Pediatric, Bangalore, India Introduction: Germ cell tumors are seen in both gonadal and extragonadal locations. The most common sites in children include sacrococcygeal, ovary, testicle, brain and mediastinum. Case report: A 12-year-old boy presenting with fever, cough and hurried breathing was diagnosed as empyema and treated with intercostal drainage by a primary care physician. In view of persistent drainage of fluid, it was retained for 3 months with antitubercular treatment. He was referred to a tertiary care centre for CT scan after in view of persisting fever, weight loss and a draining sinus in the chest wall. Systemic examination revealed pallor, grade III clubbing, decreased air entry and chest movements on the right side. The same areas were dull on percussion and had bronchial breathing. Chest X-ray revealed a homogenous opacity on the right side with a fluid level. CT chest was done which revealed a well circumscribed peripherally enhancing multiloculated cystic fluid and soft tissue density lesion with fat components, well defined multiple calcified tooth like structures and bone pieces. A right sided thoracotomy with excision of tumour was done and tumour was excised en-bloc. A white-gray colored, well circumscribed, and thick capsulated mass was removed. Histopathological examination showed areas of fat, bone, teeth and lung tissue with normal skin tissue on the covering and with occasional neural tissue present, suggestive of a mature teratoma. Discussion: IPT should be considered a differential diagnosis when investigating a cavitary lung lesion, in adolescents, not explained by more common disorders.
S81
O06-282 Comparative study of respiratory function tests in children from a rural and an urban community in Mexico R. Luis1 , L.G. Gochicoa-Rangel2 , G. Cantu´ Gonzalez ´ 2 , J.L. Alonso 2 Gomez ´ , L. Torre-Bouscoulet2 , D. Mart´ınez-Briseno ˜ 3 . 1 Centro Medico “Santa Teresa”, Texcoco, Estado de Mexico, Mexico; 2 Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas Fisiologia Respiratoria, Mexico, D.F., Mexico; 3 Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas Departamento de Investigaci´ on en Epidemiolog´ıa y Ciencias Sociales en Salud, Mexico, D.F., Mexico Background: Children living in rural areas have higher incidence of respiratory diseases compared to those in urban zones. Reasons could be related to restricted access to health care, but also to anthropometric differences that can affect lung function. The purpose of this study was to investigate if there are any differences in respiratory function test between children from a rural and urban community. Methods: Comparative study carried out in an urban and a rural town in Mexico. Children’s parents answered a questionnaire that explored respiratory health; we obtained anthropometric measures. Spirometry, maximal inspiratory and expiratory pressure (MIP, MEP) measure, and impulse oscillometry (IOS) were performed to those who did not have any respiratory health problems detected in the questionnaire. Results: 694 children were included; 463 (66.7%) from a rural area; 350 (50.5%) female; average age of 9.1 years (SD 2.3). There were differences between children in weight, height and BMI. We performed spirometries to fifty-two children, MIP and MEP in 174 and IOS in 192. Children from the rural area have higher percentages of predicted values in FEV1 (p = 0.002) and FVC (p = 0.0004). They also have lower MIP (p = 0.049), MEP (p = 0.0001), and reactance (x) at 5 Hz (p = 0.049). Resistances were not different. Conclusions: Our results suggest that children living in rural areas have lower MIP, MEP and x 5 Hz. It is required to investigate if there is any nutritional or environmental conditions that explain these dissimilarities and if these contribute to more respiratory-related diseases and mortality in rural areas. O07-185 Indications for enucleation in children with severe airway obstruction due to pulmonary tuberculosis P. Goussard1 , R.P. Gie2 , J.T. Janson3 , S. Kling2 , S. Andronikou4 , G.J. Roussouw3 . 1 University of Stellenbosch Pediatrics, Cape Town, South Africa; 2 Stellenbosch University Department of Pediatrics and Child Health, Cape Town, South Africa; 3 Stellenbosch University Department of Cardiothoracic Surgery, Cape Town, South Africa; 4 University of Witwatersrand Radiology, Johannesburg, South Africa Introduction: A small group of children present with life threatening airway obstruction due to lymph node compression caused by Mycobacterium tuberculosis (MTB). Transthoracic surgical decompression (enucleation) of the enlarged mediastinal lymph glands is required to relieve the airway obstruction in a number of children. The proportion of children requiring enucleation of to relieve the airway obstruction is not described. Aim: Primary aim is to describe the indications for enucleation in children with severe airway obstruction due to lymph node obstruction caused by MTB. Secondary aim was to compare the need for enucleation in HIV negative and HIV-positive children as well as in drug susceptible and drug resistant MTB. Patients and Methods: Prospective, comparative study was completed over a 7-year period at Tygerberg Children’s Hospital, Western Cape, South Africa. Children (1 month to 13 years) with clinical and radiological signs of significant airway obstruction were studied. Enucleation was indicated in the following groups: 1. Severe life threatening airway obstruction. 2. Severe airway obstruction but not responding to 1 month’s medically treatment.