Bronchoscopy and Bronchoalveolar Lavage in Children with Lower Airway Infection and Most Common Pathologic Microorganisms Isolated The study represents a review of most common pathologic microorganisms with persistent lung infiltrates in the bronchoalveolar lavage (BAL) of paediatric patients. The aim of the paper was to present the results of bronchoscopy and broncho-alveolar lavage in children with persistent lung infiltrates and most common pathologic microorganisms isolated in bronchoalveolar lavage. This is a prospective and retrospective study. Information on the paediatric findings and BAL results of bronchoscopy were obtained from the hospital records. The records of fifty patients were analyzed. All patients had persistent lung infiltrates (lower airway infection). BAL was performed in the middle lobe and lingula by bronchoscope (Olympus 3,5 mm) and sent for microbiological analysis. There was no serious desaturation during bronchoscopy. Bronchoscopy was performed under general anesthesia (sedation, propofol, midazolam, morphium). The most common pathologic microorganisms identified in BAL were: Streptococcus α haemoliticus (16%), Pseudomonas aeruginosa (12%) followed by Candida albicans (10%) and Klebsiella pneumoniae (8%). Our study results have shown that bronchoscopy with BAL is recommended for isolating bacteria as causes of lung infection and is particularly suitable for proving pneumonias caused by microorganisms. Bronhoskopija i bronhoalveolarna lavaža kod dece sa infekcijom donjih disajnih puteva i najčešće izolovanim patogenim mikroorganizmima Ova studija predstavlja pregled najčešćih patoloških mikroorganizama koji su uzročnici plućnih in-filtrata, izolovanih u bronhoalveolarnom lavatu (BAL) pedijatrijskih bolesnika. Cilj rada bio je da prikaže rezultate bronhoskopije i BAL-a kod dece sa perzistentnim plućnim infiltratima i izolovane patološke mikroorganizme kod BAL-a. Studija je prospektivna i retrospektivna. Analizirani su mikrobiološki nalazi u BAL-u kod 50 hospitalizovane dece. Sva ispitivana deca imala su perzistentne plućne infiltrate (infekcije donjih disajnih puteva). BAL je rađen u srednjem lobusu ili linguli sa bronhoskopom 3,5mm (Olympus). Bronhoskopija je rađena u opštoj anesteziji (sedacija propofol, midazolam, morfijum). Uzorak je dat na mikrobiološki pregled (biogram i antibiogram, bojenje po Gramu). Nije bilo ozbiljnijeg pada saturacije tokom izvođenja bronhoskopije. Najčešće izolovani mikrobiološki patogeni u BAL-u su: Streptococcus α haemoliticus (16%), Pseudomonas aeruginosa (12%), Candida albicans i Klebsiella pneumoniae (8%). Naši rezultati su pokazali da je bronhoskopija sa BAL-om metoda izbora za izolovanje bakterija koje su uzročnici plućnih infekcija donjih delova respiratornog trakta kod dece.

Lymphocyte Subsets in Bronchoalveolar Lavage Fluid of Children with Lung Infiltrates The analysis of the subpopulation of lymphocytes - CD4+, CD8+ lymphocytes in bronchoalveolar lavage (BAL) of paediatric patients can provide useful information related the lung parenchyma. The aim of the paper was to analyze the results of bronchoscopy of patients presenting with persistent lung infiltrates and to find out of the diagnostic yield and complication rate of this procedure. The study is a retrospective one. The data related to paediatric findings and BAL results of the bronchoscopies were retrieved from the hospital records. BAL was performed in tracheobronchial airways (middle lobe) by bronchoscope and sent to analysis of CD4+, CD8+ lymphocytes. Bronchoscopy was performed under general anesthesia (sedation, propofol, midazolam, morphium). The records of seven patients were analyzed. All patients presented with persistent lung infiltrate (atelectasis and pneumonia). 71% of the patients with lung infiltrates in our study were below the age of 5. Our study results showed that CD4+, CD8+ lymphocytes in BAL in the studied group showed a small percentage of CD8+ lymphocytes as an immune response in 8-10% of patients, while the cellular response of CD4 +lymphocytes in the sample itself was present up to 14% in the entire group of the diseased children. There was no serious desaturation during bronchoscopy. Bronchoscopy with BAL findings of lymphocyte populations is important in the early identification of inflammation and it helps in therapeutic strategies and monitoring of inflammatory response to the given therapy. Subpopulacija limfocita u bronhoalveolarnoj lavaži kod pedijatrijskih bolesnika sa plućnim infiltratom Analiza subpopulacija limfocita u bronhoalveolarnoj lavaži (BAL) kod pedijatrijskih bolesnika može nam pružiti korisne informacije o dešavanju u parenhimu pluća. Cilj rada bio je analiza rezultata bronhoskopije i BAL-a kod bolesnika sa perzistentnim plućnim infiltratima i stope komplikacija kod ove procedure. Ovo je retrospektivna studija. Podaci o pedijatrijskim nalazima i rezultatima BAL bronhoskopija uzeti su iz bolničke evidencije. BAL je izvršena bronhoskopom unutar traheobronhalnog stabla (srednji lobus) i upućena na CD4+, CD8+ limfocita. Za vreme bronhoskopije nije zabeležena ozbiljnija desaturacija. Bronhoskopija je urađena u opštoj anesteziji (propofol, midazolam, morfijum). Analizirano je ukupno 17 istorija bolesti. Svi bolesnici imali su perzistentne plućne infiltrate (atelektazu i upalu pluća). 71% bolesnika sa plućnim infiltratima bili su mlađi od 5 god. Rezultati naše studije pokazali su da CD4+, CD8+ limfociti u BAL-u na datoj grupi pokazuju mali procenat CD8+ limfocita kao imunu reakciju kod 8-10% bolesnika, dok je ćelijska reakcija CD4+ limfocita u samom uzorku bila zabeležena kod 5%, odnosno 14% bolesnika u čitavoj grupi obolele dece. Bronhoskopija sa BAL-om je značajna metoda u identifikaciji imunog odgovora u plućima i primeni adekvatne terapije.

Background The pediatrician plays an important role in contributing to the management of children with food allergies. Antihistamine drugs are used to control or alleviate the allergy symptoms like, skin rash or hives and breathing difficulties, by counteracting the effects of histamine. Dexamethasone is a potent corticosteroid and it acts as an anti-inflammatory and immunosuppressant. Adrenaline or epinephrine is the drug of choice for treating anaphylaxis.

Food allergy most often begins in the first 1 to 2 years of life with the process of sensitization, by which the immune system responds to specific food proteins. Symptoms of a food allergy reaction commonly involve localized hives and worsening eczema, with moderate-to-severe atopic dermatitis a frequent comorbid condition of food allergy. Acute urticaria is much more likely to be caused by food allergy than is chronic urticaria.

diagnosed clinically as having acute appendicitis were recruited.60%were males, mean age 28±6years. Patients with previous medical, surgical or gynecological complaints, severe debilitating diseases like hypertension, diabetes, obesity, blood dyscrasias, anemia or previous surgeries were excluded from the study. All the patients later underwent either elective or emergency appendicectomy and the preoperative leukocyte count was compared with histopathology findings of resected appendix. Results: Total leukocyte count (TLC) was calculated in each case individually and was compared with the histopathological report from the laboratory accordingly. The sensitivity and specificity of WBC count was calculated by standard formula and was found to be 82.4% and 78.7% respectively. The positive predictive value of WBC count (raised TLC) in diagnosing acute appendicitis was 93.8% showing that raised TLC along with clinical history is really a diagnostic marker for this condition. Conclusion: Clinical history and physical examination are the key factors in diagnosing acute appendicitis as radiological findings are not much helpful. Although WBC count and raised TLC is not a standard criteria for diagnosing acute appendicitis, but still it is one of the strong predictor of this acute condition in emergency room and should strongly be considered while making the diagnosis of acute appendicitis.

The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment (2). The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR ( cystic fibrosis transmembrane conductance regulator) genes (3), which result in the production of hyper-viscous mucus and chloride malabsorption in the sweat glands ducts (5,6). Bronchial thickening and plugging and ring shadows suggesting bronchiectasis, segmental or lobar atelectasis are often. Computer tomography of the chest can be used to detect and localize thickening of bronchial airways walls, mucus plugging, hyperinflation and early bronchieactasiae. Pulmonary therapy: the object is to clear secretions from airways and to control infection (7). The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Day before admission in the hospital had a higher bodily temperature, cough and difficult breathing. She already treated conservatively (Ceftazidim, Ceftriakson, Kloksacillin) Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics), therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteria pseudomonas aeruginosa--a typical bacteria for chronically sick C. F. patient. A pseudomonas therapy was prescribed according to the sensitive antibiogram, during which bronchoscopy was given locally on changes mucous pulmozyme and garamycin. Flexible bronchoscopy was performed as therapeutic. Local bronchoscopy findings:by aspiration of tracheo-bronchal truncus it was found hyperemia and a lot of mucous sticky secretion inside of tracheobronchal tree, especially middle lobe right side, lingual and basals part of the lungs. It was performed broncho-alveolar lavage and given steroids on the place of changed inflamed mucous membrane of the bronchi. It was also given pulmozyme to destroid mucous and make better spontaneously expectorations. Control chest x ray was performed and it was better.