Papers by Yvonne Belessis
Journal of Cystic Fibrosis, Mar 1, 2013
Objectives: To determine the safety and efficacy of stoss therapy on vitamin D levels over a 12 m... more Objectives: To determine the safety and efficacy of stoss therapy on vitamin D levels over a 12 month period in children with cystic fibrosis and vitamin D deficiency (b 75 nmol/L). Study design: Retrospective chart review of 142 paediatric CF patients from 2007 till 2011. Results: Thirty eight children received stoss therapy and 37 children with vitamin D deficiency were not treated and served as a control group. The stoss treated group had a significant and sustained increase in 25-hydroxyvitamin D levels measured at 1, 3, 6 and 12 months post treatment compared to controls (94.
Journal of Cystic Fibrosis, Jun 1, 2023
Pharmacological Research, Jun 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Paediatric Respiratory Reviews, 2006
In studied group mean values of resistance (kPa/l/s) were: R5 0.675 AE 0.36 and R10 0.59 AE 0.23 ... more In studied group mean values of resistance (kPa/l/s) were: R5 0.675 AE 0.36 and R10 0.59 AE 0.23 in females, R5 0.42 AE 0.22 and R10 0.35 AE 0.2 in males; reactance (kPa/ l/s): X5 À0.33 AE 0.22 and X10 À0.15 AE 0.19 in females, X5 À0.14 AE 0.08 and X10 À0.026 AE 0.05 in males. Obtained mean values of TLCOSB were: 3.69 AE 2.5 L in females (control group: 6.8 AE 1.2 L, p < 0.05) and 7.11 AE 1.8 L (control group: 8.17 AE 2.6 L, p = 0.25). Strong correlation of reactance (X) and diffusion factor for carbon monoxide (TLCOSB) was revealed in all groups, with highest values in studied female group (r = 0.93, p < 0.05).
The Lancet Respiratory Medicine, Aug 1, 2022
Journal of Cystic Fibrosis, Jul 1, 2016
Background: Early detection of bacterial pathogens in the lower airway is an important part of ma... more Background: Early detection of bacterial pathogens in the lower airway is an important part of managing CF. This study aimed to assess the diagnostic accuracy of oropharyngeal suction (OPS) samples in obtaining airway bacterial cultures in young children with cystic fibrosis (CF), and the level of child distress caused by obtaining OPS samples. Methods: Young children with CF undergoing broncho-alveolar lavage (BAL) as part of concurrent research or routine annual surveillance were studied. OPS was performed by stimulating a cough and suctioning the back of the oropharynx in the awake child to replicate clinical practice. BAL of the right upper, middle and lingula lobes was then performed. Samples were sent for standard bacterial culture. The child's distress during OPS was rated using the Groningen Distress Scale (1 = calm, 2 = timid/nervous, 3 = serious distress but still under control, 4 = serious distress with loss of control, 5 = panic). Results: There were 65 paired samples obtained from 39 children (21 boys, mean age on day of first sampling was 34.1 months, SD 19.1 months). For Pseudomonas aeruginosa, specificity, sensitivity, NPV and PPV with 95% CI were 98% (87-99), 75% (20-96), 98% (91-98) and 60% (15-93%) respectively. In all age groups combined, median level of distress was 3 (IQR 2-4), with distress highest in 2 and 3 year olds, with a median of 4 (IQR 3-4). Conclusion: OPS has diagnostic utility in determining the absence of organisms in the lower airway, with specificity for P.aeruginosa detection of 98%. However, a positive OPS result is not necessarily a good indicator of lower airway infection. Distress levels were high during OPS, mostly in 2 and 3 year olds.
Journal of Pediatric Gastroenterology and Nutrition, Apr 1, 2014
Journal of Medical Virology, Mar 14, 2017
This article has been accepted for publication and undergone full peer review but has not been th... more This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as
Journal of Cystic Fibrosis, Jun 1, 2017
with a larger number of patients are needed, but from our preliminary data we can suggest that A.... more with a larger number of patients are needed, but from our preliminary data we can suggest that A. Xilosoxidans and S. Maltophilia seem to cause more severe lung damage than other infections. Given these facts it might be appropriate to start treatment even in asymptomatic patients in the attempt to prevent pulmonary damage.
Journal of Cystic Fibrosis, Jun 1, 2013
Objectives: Mediastinal lymph node progression and its implications on lung function of cystic fi... more Objectives: Mediastinal lymph node progression and its implications on lung function of cystic fibrosis patients are not extensively described. The present study analyzes these aspects in an adult population. Methods: The presence of lymphadenopathy and the lung functional indices were retrospectively recorded in patients who underwent chest CT scan, for usual disease progression control. The same indices were recorded again in patients for whom chest CT scan was repeated. Results: A total of 154 patients underwent a chest CT: 83 (38%) patients showed mediastinal lymphadenopathy. A second chest CT scan was performed for 80 individuals out of 154: 61 (76%) had lymphadenopathy (42 confirmed previous finding; 19 new cases; 6 turned negative). No difference in lung function data was observed in patients with and without lymph nodes at the time of the first CT: FEV1 = 68% IQR 47.5-85.5% vs. 64% IQR 53.5-83.0 p = 0.94; FVC = 80.7% IQR 67.5−95% Vs 83% IQR 72.5-91.0%, p = 0.89. At follow up, values of FVC% were significantly lower in patients with lymph nodes at the first CT: 71.0% IQR 55.25-88.75% vs 84.0% IQR 80.0-100.5%, p = 0.035. The annual lung function decline was greater for patients with lymphadenopathy in comparison with patients without this finding; FVC: −3.28% (IQR −5.25, −1.24) vs. −0.33% (IQR −2.7, −1.62) p = 0.006; FEV1: −2.8% (IQR −4.5; −2.8) vs. −1.29% (IQR −2.57, 0.48) p = 0.02. Conclusion: Mediastinal lymphadenopathy becomes more frequent as the disease progresses and it is associated with at a more rapid functional decline; this finding might be an useful tool in the research of a prognostic score in the adult patients with cystic fibrosis. WS19.2 Sinus pathogens in children with cystic fibrosis: Do they relate to lower respiratory tract pathogens and is eradication successful?
Journal of Cystic Fibrosis, 2018
Background: The pathogenesis of gut inflammation, bacterial dysbiosis and increased rates of mali... more Background: The pathogenesis of gut inflammation, bacterial dysbiosis and increased rates of malignancy in CF is unclear. Fecal M2-pyruvate kinase (M2-PK) is a biomarker indicative of cellular proliferation that may be raised in intestinal malignancy and inflammation. Biomarkers, including M2-PK, may be useful in assessing effects of novel therapies on the gastrointestinal tract. Methods: M2-PK was measured in stools collected from patients with CF and HC (0-10 years). Linear mixed model analysis was used. Results: M2-PK levels did not significantly change in children with CF (36 patients, 77 samples) (P = 0.998) or HC (45 patients, 45 samples) (P = 0.21), over the age range 0-10 years. Patients with CF had elevated M2-PK compared to HC (median [IQR;
Archives of Disease in Childhood, Apr 14, 2011
The aim of this study was to determine if once daily insulin detemir reverses decline in weight a... more The aim of this study was to determine if once daily insulin detemir reverses decline in weight and lung function in patients with cystic fi brosis (CF). 12 patients with early insulin defi ciency and six with CF related diabetes (aged 7.2-18.1 years) were treated for a median of 0.8 years. Changes in weight and lung function following treatment were compared to pretreatment changes. Before treatment, the change in weight SD score (ΔWtSDS), percentage of predicted forced expiratory volume in 1 s (Δ%FEV 1) and percentage of predicted forced vital capacity (Δ%FVC) declined in the whole study population (−0.45±0.38, −7.9±12.8%, −5.8±14.3%) and in the subgroup with early insulin defi ciency (−0.41±0.43, −9.8±9.3%, −6.8±10.3%). Following treatment with insulin ΔWtSDS, Δ%FEV 1 and Δ%FVC signifi cantly improved in the whole study population (+0.18±0.29 SDS, p=0.0001; +3.7±10.6%, p=0.007; +5.2±12.7%, p=0.013) and in patients with early insulin defi ciency (+0.22±0.31 SDS, p=0.003; +5.3±11.5%, p=0.004; +5.8±13.4%, p=0.024). Randomised controlled trials are now needed.
Frontiers in Pediatrics, Mar 19, 2020
Background: Reflux aspiration secondary to gastroesophageal reflux disease (GERD) is one of the c... more Background: Reflux aspiration secondary to gastroesophageal reflux disease (GERD) is one of the causes of chronic gastrointestinal and respiratory morbidity in children with esophageal atresia (EA). Currently there are no simple, validated non-invasive tests for the diagnosis of reflux aspiration in children. Objectives: The aim of this pilot study was to investigate pepsin detected in exhaled breath condensate (EBC) and saliva as a potential non-invasive marker of reflux aspiration in children with EA. Methods: EBC and saliva samples were prospectively collected from children with EA aged between 5 and 18 years attending a multidisciplinary EA Clinic. Pepsin in the samples was assayed by two methods, a commercial lateral flow device, the Peptest TM and an enzyme-linked immunosorbent assay (ELISA) and correlated with validated gastrointestinal and respiratory symptom questionnaires and objective measures of GERD and respiratory function. Results: EBC were collected from 18 children with EA, 15/18 also provided salivary samples. Pepsin was not detected in any of the EBC samples using the Peptest TM and only 1/14 (7.1%) samples by the ELISA. However, pepsin was detected in 33 and 83% of saliva samples when analyzed with Peptest TM and the ELISA respectively. Salivary pepsin levels were significantly higher in children with reflux symptoms or wheeze. Pepsin was detected by the Peptest TM in the saliva of 5/5 (100%) children with histological evidence of reflux esophagitis compared with 0/2 (0%) in children with normal histology (p = 0.048). Conclusions: Salivary pepsin was detected in a large proportion of children with EA and was significantly associated with GERD symptoms or wheeze. The role of salivary pepsin as a potential non-invasive marker of reflux aspiration in children with EA needs further validation in future studies with larger cohorts.
Diabetes Care, Nov 12, 2009
OBJECTIVE-Progressive -cell loss causes catabolism in cystic fibrosis. Existing diagnostic crite... more OBJECTIVE-Progressive -cell loss causes catabolism in cystic fibrosis. Existing diagnostic criteria for diabetes were based on microvascular complications rather than on cystic fibrosisspecific outcomes. We aimed to relate glycemic status in cystic fibrosis to weight and lung function changes. RESEARCH DESIGN AND METHODS-We determined peak blood glucose (BG max) during oral glucose tolerance tests (OGTTs) with samples every 30 min for 33 consecutive children (aged 10.2-18 years). Twenty-five also agreed to undergo continuous glucose monitoring (CGM) (Medtronic). Outcome measures were change in weight standard deviation score (wtSDS), percent forced expiratory volume in 1 s (%FEV1), and percent forced vital capacity (%FVC) in the year preceding the OGTT. RESULTS-Declining wtSDS and %FVC were associated with higher BG max (both P ϭ 0.02) and with CGM time Ͼ7.8 mmol/l (P ϭ 0.006 and P ϭ 0.02, respectively) but not with BG 120 min. A decline in %FEV1 was related to CGM time Ͼ7.8 mmol/l (P ϭ 0.02). Using receiver operating characteristic (ROC) analysis to determine optimal glycemic cutoffs, CGM time above 7.8 mmol/l Ն4.5% detected declining wtSDS with 89% sensitivity and 86% specificity (area under the ROC curve 0.89, P ϭ 0.003). BG max Ն8.2 mmol/l gave 87% sensitivity and 70% specificity (0.76, P ϭ 0.02). BG 120 min did not detect declining wtSDS (0.59, P ϭ 0.41). After exclusion of two patients with BG 120 min Ն11.1 mmol/l, the decline in wtSDS was worse if BG max was Ն8.2 mmol/l (Ϫ0.3 Ϯ 0.4 vs. 0.0 Ϯ 0.4 for BG max Ͻ8.2 mmol/l, P ϭ 0.04) or if CGM time above 7.8 mmol/l was Ն4.5% (Ϫ0.3 Ϯ 0.4 vs. 0.1 Ϯ 0.2 for time Ͻ4.5%, P ϭ 0.01). CONCLUSIONS-BG max Ն8.2 mmol/l on an OGTT and CGM time above 7.8 mmol/l Ն4.5% are associated with declining wtSDS and lung function in the preceding 12 months.
Diseases of The Esophagus, Jun 1, 2019
Diseases of the Esophagus (43-59 kcal/kg). Only 31/55 (56%) participated in organized activities ... more Diseases of the Esophagus (43-59 kcal/kg). Only 31/55 (56%) participated in organized activities compared to 80% in a corresponding healthy group. The PedsQL total score and sub score physical health (both for adolescent and for proxy) correlated significantly to GER symptoms (r =-0.461, P < 0.001) and dysphagia assessed by EAT-10 (r = −0.329, P = 0.015). The PedsQL total score did not correlate with SDS-HFA, SDS-BMI, energy intake, or participation in organized activities. Conclusion: The presence of dysphagia and GER symptoms seem to influence health-related QOL, with a negative impact on the physical domain. Physical development and energy intake were not related to quality of life.
Journal of Cystic Fibrosis, Jun 1, 2007
For children with CF the requirement to adhere to intense therapy may impair their lifestyle and ... more For children with CF the requirement to adhere to intense therapy may impair their lifestyle and interaction with their peers. Our multidisciplinary team explored techniques to transfer the responsibility for the care from the parent to the child, thereby giving the child the tools to navigate the social, familial and medical surroundings. Adherence to therapies therefore will originate from the child and not by coercion from the outside. Child friendly support groups integrating art, written expression and craft allow an individualized, nonverbal mode of communication. The children share and offer support and advice, the team communicates the message to the children that they continue to help building a trusting and secure relationship between staff and patient. Methods: Girls, 9−12 y, 7 meetings, 90 min. (intro. 10 minutes, activity 30−45 min., discussion/conclusion 25−30 min.), clinic days, hygienic measures. Specific topics: responsibility, confidentiality, clinic visits, my daily schedule, my identity/name, coping strategies. The group work helped the children to integrate the intensive daily therapeutic regiment into their everyday normative lifestyle. The facilitators acquainted themselves with the patients on an intensive level, evaluating and monitoring their individualized needs. The staff was counseled on how to deal with the individual personality of the child. The group offered the opportunity to share feelings, cope with strategies and enhanced the confidence/self-esteem of the children. The participants reported their satisfaction and anticipation for continued similar experiences. No cross infection of pseudomonas occurred. Support groups can act as a powerful therapeutic setting for children with CF to enhance the self-image. Support groups can be created while adhering to hygienic regulations.
Pediatric Pulmonology, Jan 28, 2013
Childhood granulomatosis with polyangiitis (cGPA), previously known as Wegener's granulomatosis, ... more Childhood granulomatosis with polyangiitis (cGPA), previously known as Wegener's granulomatosis, is a rare, potentially fatal necrotizing vasculitis, the symptoms of which overlap with infection. We present a 16-year-old girl who, following 6 months of treatment for persistent middle ear effusion with progressive sensorineural hearing loss, developed rapidly progressing pneumonia, with pleural effusion, and multiple cavitatory lung lesions. Investigations demonstrated high titer c-ANCA and nasal septal biopsy confirmed the diagnosis of cGPA. This case highlights the difficulty in diagnosing cGPA and the potentially life-threatening consequences of failing to do so.
Journal of Cystic Fibrosis, Jul 1, 2020
Background: Recent standards of care mention chest radiography (CR) but not chest computed tomogr... more Background: Recent standards of care mention chest radiography (CR) but not chest computed tomography (CT) in routine annual follow-up of children with cystic fibrosis (CF). To minimise radiation risk, CT or CR should only be performed if they impact clinical decision making. We investigated whether in addition to a wide range of commonly used clinical parameters, chest CT and/or CR in routine follow-up of CF patients influence clinical decisions. Methods: 36 web based clinical vignettes (i.e. case simulations) were designed using clinical data from patients aged 8-18 years, randomly selected from two CF centres in The Netherlands. In a randomized cross-over design, clinicians assessed eight vignettes and suggested therapeutic/diagnostic management on two occasions, with a ten-week interval. Radiological information (CT or CR) was included at only one of the two assessments, in random order. Any differences in management could be attributed to information from CT or CR, and were compared by McNemar analysis. Results: 44 European and Australian clinicians completed a total of 143 CT vignette pairs and 167 CR vignette pairs. CT was associated with a significant increase in antifungal treatment (Risk Ratio (RR) 2.8 (1.3-6.0, p = .02)), bronchoscopies (RR 1.6 (1.1-2.5, p = .04)), mycobacterial cultures (RR 1.3 (1.0-1.5, p = .02)), and 'need for hospitalization' (i.e. intravenous antibiotics and/or bronchoscopy) (RR 1.4 (1.0-1.9, p = .03)). CR led to a significant increase in inhaled antibiotics only (RR 1.3 (1.0-1.6, p = .04)). Conclusions: CT but not CR, at routine biennial follow-up was associated with several changes in treatment and/or diagnostic testing, including the need for hospitalization.
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Papers by Yvonne Belessis