Clinical Profile, Co-Morbidities and Health Related Quality of Life in Pediatric Patients with Allergic Rhinitis and Asthma

Background: Co-existence of allergic rhinitis (AR) and bronchial asthma (BA) is well known. We planned to study the clinical profile of patients with AR & BA, the associated co-morbidities and the effect of AR &/ or BA on health related quality of life (HRQOL) in Pediatric patients. Methods: Patients attending the Pediatric out-patients department and Pediatric Chest Clinic of tertiary care center were enrolled. The sample size included 100 subjects with BA & AR (Group 1) with control groups of 60 asthmatic children (Group 2) & 40 children suffering from AR (Group 3). The patients were subjected to a questionnaire & a through physical examination and the details were recorded in a pre-designed proforma. General medical, environmental, occupational, personal & family history was procured along with examination of respiratory system. The standard heath related quality of life (HRQOL) parameters were studied. Findings: The study was conducted over a period of 13 months (February 2004 to March 2005). 200 patients between ages of 3 to 15 years (mean 7.95 years) were enrolled (100 patients with BA and AR- group 1, 60 patients with asthma alone- group 2 and 40 patients with AR alone- group 3. Dust, smoke, outdoor dust, holi festival, winter season, exercise, and smoking by father were important exacerbating factors in all the three groups. Additionally, diwali festival and family history of asthma were important in Group 2 (BA); while pollen, weeds, diwali festival and family history of allergic rhinitis were important causes of exacerbation in group 3 (AR). Cough was commonly seen in all three groups. Wheezing, sneezing, itching throat, rhinorrhea, watering, altered taste, and nasal block was common in patients in group 1 while wheezing was important symptom in patients in group 2 (BA). Sneezing, itching throat, rhinorrhea, watering, altered taste, and nasal block were common symptoms in patients in group 3 (AR). Conjunctivitis, pharyngitis, and post-nasal drip were common co-morbidities seen in groups 1 and 3. Deviated nasal septum and inferior turbinate hypertrophy were commonly seen in group 1, narrow nasal valve in group 2 (BA) and allergic shiners, darrier’s line, deviated nasal septum and inferior turbinate hypertrophy were common in group 3 (AR). Sensation, emotion and cognition were affected in groups 1 and 3 while mobility and self-care remained unaffected in all three groups. Conclusions: Dust and smoke were the commonest trigger factor in all the three study groups. Family history is important in patients with asthma and AR. Wheezing was the commonest symptom in groups 1 and 2 while sneezing was predominant in groups 3 and 1. Pharyngitis was the commonest co-morbid association. Deviated nasal septum and inferior turbinate hypertrophy were commonly seen in group 1 and 3; while allergic shiners and darrier’s line were additional in group 3 (AR). Sensation, emotion and cognition were affected in groups 1 and 3

Case Report - Kocher-debre-semelaigne syndrome with pericardial effusion

We report a 10-year-old female child with hypothyroidism and limb muscle pseudohypertrophy (i.e., Kocher-Debre-Semelaigne syndrome) with pericardial effusion. The child presented with generalized swelling, breathlessness and difficulty in walking and in getting up from sitting position (of chronic duration). She had bradycardia, dull facies, marked hypertrophy of both calf muscles and nonpitting edema of legs. Pericardial effusion was detected clinically and confirmed on investigations. Muscle pseudohypertrophy was a striking feature, and hypothyroidism was confirmed on thyroid studies. The response to thyroxine replacement was excellent, with resolution of the pericardial effusion and clinical improvement. The unusual presence of pericardial effusion in Kocher-Debre-Semelaigne syndrome is discussed in the report