Young and exhausted

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complicated disease characterized by extreme fatigue of at least six months duration. It is necessary to rule out the organic cause of CFS in the pediatric patient in order not to overlook the preventable or the treatable condition. In our case report we present a case of a patient with a surprising origin OF CFS/ME diagnosed by cardiopulmonary exercise testing.

Cough reflex sensitivity in adolescents with diabetic autonomic neuropathy

Objective

Diabetic autonomic neuropathy (DAN) is one of the chronic complications of diabetes mellitus which can involve one or more organ systems. DAN without apparent symptoms is more often in childhood and adolescence. While heart rate variability (HRV) and Ewing's battery of cardiovascular tests are regarded as a gold standard for the diagnosis of DAN, the examination of cough reflex sensitivity (CRS) is another possibility. The aim of this study was to compare HRV and CRS in children with diabetes mellitus.

Materials and methods

Sixty one patients (37 girls, 24 boys) aged 15-19 suffering from diabetes mellitus type 1 completed the study. Based on HRV, patients were divided into 2 groups - with DAN (n = 25) and without DAN (n = 32), 4 patients were excluded because of ambiguous results. CRS was studied in each patient by inhalation of gradually increasing concentration of capsaicin.

Results

Subjects with DAN required a significantly higher concentration of capsaicin needed to evoke 2 coughs (median 625 μmol/l, IQR 68.4-625.0 μmol/l vs. median 29.3 μmol/l, IQR 9.8-156.3 μmol/l, P < 0.001) and 5 coughs (median 2500.0 μmol/l, IQR 1250.0-2500.0 μmol/l vs. median 312.5 μmol/l, IQR 117.2-625.0 μmol/l, P < 0.001) compared with those without DAN. Moreover, a strong negative correlation between HRV and CRS was established.

Conclusion

Diabetes mellitus lowers the cough response. Cough reflex sensitivity appears to be another sensitive method for the evaluation of DAN in diabetes.

Cough reflex sensitivity in various phenotypes of childhood asthma

Cough is a major symptom in some children with asthma, but the relationship between cough and the severity of asthma is defined insufficiently. As cough represents common problem of pediatrics, several objective methods for its assessment were developed. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important tools for studying cough. In the present study, we aimed to study the CRS in various phenotypes of childhood asthma. We found that, in general, CRS was increased in asthmatic children compared with controls. The most evident increase of CRS was observed during acute asthma exacerbation, in children suffering from asthma with concomitant allergic rhinitis, and in atopic asthmatics. Interestingly, we noted a significant decline in lung function after capsaicin CRS. Various laboratory and clinical characteristics of asthmatic children influence cough sensitivity to a different extent. Cough reflex sensitivity measurement can add valuable information beside the commonly used spirometric and inflammometric methods in the management of asthmatic children.

Inhibition of guanylyl cyclase in the airways hyperreactivity

BACKGROUND

The majority of nitric oxide (NO) effects in the respiratory system are mediated via the stimulation of soluble guanylyl cyclase with subsequent generation of the second messenger--cyclic guanosine monophosphate (cGMP).

OBJECTIVES

We were interested in the effect of non-selective soluble guanylyl cyclase inhibitor--methylene blue on the exogenous irritant-induced bronchial hyperreactivity.

METHODS

Male guinea pigs were used in the experiment. The animals received non-selective soluble guanylyl cyclase inhibitor--methylene blue in a dose of 50 or 100 mg/kg b.w. 30 minutes before inhalation of the exogenous irritant--toluene vapours. The toluene exposition lasted three consecutive days during two hours in in vivo conditions. The monitoring of tracheal and lung tissue strips reactivity changes was carried out in in vitro conditions. The brochoconstrictor mediators histamine and acetylcholine in the cumulative doses (10(-8)-10(-3) mol/l) were used in the experiment.

RESULTS

The methylene blue pretreatment induced the decrease of tracheal and lung tissue smooth muscle contraction amplitude increased by exogenous irritant--toluene. We recorded different smooth muscle response depending on the doses of inhibitor. Methylene blue in a dose of 50 mg/kg b.w. affected mainly tracheal smooth muscle, in a dose of 100 mg/kg b.w. mainly the lung tissue.

CONCLUSION

The interaction between nitric oxide and soluble guanylyl cyclase can be important for bronchial reactivity changes. The changes depended on the dose of inhibitor and on the type of respiratory system tissue (trachea, lung). We can summarise that changes of the airways reactivity are not only evoked by NO/cGMP pathway but probably by any other mechanisms (Fig. 5, Ref. 26).