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Varghese D, Ferris K, Lee B, Grigg J, Pinnock H, Cunningham S. Outdoor air pollution and near-fatal/fatal asthma attacks in children: A systematic review. Pediatr Pulmonol 2024; 59:1196-1206. [PMID: 38477643 DOI: 10.1002/ppul.26932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, observational studies have demonstrated an association between high levels of air pollution and asthma attacks in children. It remains unclear whether and to what extent exposure may be associated with increased near-fatal/fatal attacks. OBJECTIVE To systematically review the evidence for an association between ambient outdoor air pollution and fatal and/or near-fatal asthma (NFA). METHODS Following Cochrane methodology, we searched MEDLINE, EMBASE, Web of Science, Scopus, and Open Grey electronic databases for studies reporting the association of fatal/NFA and air pollution (particulate matter [PM], sulfur dioxide, nitrogen dioxide, black carbon and ozone [O3]) in children. NFA was defined as requiring intensive care unit (ICU) management. RESULTS Two reviewers independently screened 1358 papers. A total of 276 studies identified asthma attacks related to air pollution, 272 did not meet inclusion criteria after full-text review. Four observational studies described fatal/NFA, of which three addressed NFA. PM2.5 (per 12.5 µg/m3 increase) and O3 (per 22 ppb increase) were associated with NFA in one study (PM2.5, relative risk: 1.26, confidence interval [CI] [1.10-1.44]), O3 (1.19 [1.01-1.40]). PM10 was associated with ICU admission in the context of thunderstorm asthma. Elemental carbon was associated equally with NFA that did not require an ICU admission (p = 0.67). Studies of fatal asthma including children did not demarcate age within the analysis. CONCLUSIONS Ozone and PM2.5 have been associated with NFA in children but synthesis is limited by the paucity of studies and methodological heterogeneity. Poor reporting of severities of asthma attacks hinders the assessment of whether outdoor air pollution is associated with an increased number of NFA/fatal attacks in children.
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Affiliation(s)
- Deepa Varghese
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kathryn Ferris
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bohee Lee
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jonathan Grigg
- The Blizard Institute, Queen Mary's University, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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2
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Walker R, Ferris K, Scott M, McMahon N, Szabo A, Dick AC, Christie S, Mallett P. Perioral swelling in a previously well child. Arch Dis Child Educ Pract Ed 2022; 107:372-374. [PMID: 33931499 DOI: 10.1136/archdischild-2020-319223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/22/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rowena Walker
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland
| | - Kathryn Ferris
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland
| | - Maura Scott
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland
| | - Naomi McMahon
- Paediatric Gastroenterology, RBHSC, Belfast, N. Ireland
| | - Andras Szabo
- Paediatric Gastroenterology, RBHSC, Belfast, N. Ireland
| | - Alistair C Dick
- Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, Antrim, N.Ireland
| | - Sharon Christie
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland
| | - Peter Mallett
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland
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3
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Mullan K, Ferris K, Thompson A, Loughran C. ALLERGIC CONTACT DERMATITIS TO A COMMON TOPICAL ACNE TREATMENT - AN UNFAMILIAR MIMIC OF ANGIOEDEMA. Ulster Med J 2022; 91:167-169. [PMID: 36474842 PMCID: PMC9720594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K Mullan
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - K Ferris
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland,Centre for Medical Education, Queens University Belfast
| | - A Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland,Corresponding Author- Dr.Andrew Thompson ()
| | - C Loughran
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
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4
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Ferris K, Cowan M, Williams C, McAteer S, Glancy C, Callaghan S. How to interpret skin prick tests and serum-specific IgE in children and young people with food allergy. Arch Dis Child Educ Pract Ed 2022; 107:207-211. [PMID: 34230062 DOI: 10.1136/archdischild-2020-320562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/03/2022]
Abstract
Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.
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Affiliation(s)
- Kathryn Ferris
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK .,Centre for medical education, Queen's University Belfast, Belfast, UK
| | - Marianne Cowan
- Paediatric Allergy, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
| | - Christine Williams
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
| | - Sinead McAteer
- Paediatric Allergy, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
| | - Caoimhe Glancy
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
| | - Sheila Callaghan
- Paediatric Allergy, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
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5
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Donnelly S, Ferris K, Kennedy N, Bourke T, O'Donoghue D. Patient and public involvement in paediatric medical education. Arch Dis Child Educ Pract Ed 2022; 108:205-209. [PMID: 35501048 DOI: 10.1136/archdischild-2021-322443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
The benefits of involving patients and the public in medical education are well documented, however there is a need to further explore how this can be translated to the setting of paediatric medical education. This article aims to identify how organisations can facilitate the involvement of paediatric patients and their parents/carers.While involving children in research can present challenges, we describe examples where organisations have successfully involved young people in clinical research and selection of research topics.Involving paediatric patients and their parents/carers in medical education helps develop a patient centred approach to practice for medical students. Participation of paediatric patients in objective structured clinical examination (OSCE) examinations is employed by many medical schools, however allowing them the ability to provide a 'global score' may have the potential to assess skills such as communication and empathy in addition to medical knowledge.The Royal College of Paediatrics and Child Health (RCPCH) have provided a framework on how to involve children in health services, addressing practical considerations such as funding and facilities. This framework could be applied by organisations seeking to actively involve children in paediatric medical education. Potential barriers and facilitators are explored in this article.During the COVID-19 pandemic, involving young people and their families in medical student teaching became challenging. We describe virtual bedside teaching sessions which actively involved paediatric patients and their families, which showed that many patients and parents prefer virtual consultations.Involving paediatric patients and their families in medical education is strongly advocated by the General Medical Council (GMC) and RCPCH. Organisations should actively seek out opportunities to become involved in the development of medical education resources as we describe in this paper.
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Affiliation(s)
- Sinead Donnelly
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Kathryn Ferris
- Wellcome-Wolfson Institute for Experimental Medicine (Clinical research fellow), Queen's University Belfast, Belfast, UK
| | - Neil Kennedy
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Thomas Bourke
- Centre for Medical Education, Queens University Belfast, Belfast, UK.,Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Dara O'Donoghue
- Department of Child Health, Centre for Medical Education, Queens University Belfast, Belfast, UK.,Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, UK
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6
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Waterfield T, Watson C, Moore R, Ferris K, Tonry C, Watt A, McGinn C, Foster S, Evans J, Lyttle MD, Ahmad S, Ladhani S, Corr M, McFetridge L, Mitchell H, Brown K, Amirthalingam G, Maney JA, Christie S. Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study. Arch Dis Child 2021; 106:680-686. [PMID: 33172887 PMCID: PMC7656901 DOI: 10.1136/archdischild-2020-320558] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Studies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity, test timing and selection bias. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection. DESIGN This multicentre observational cohort study, conducted between 16 April to 3 July 2020 at 5 UK sites, recruited children of healthcare workers, aged 2-15 years. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms. RESULTS 1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms prior to testing. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariable analysis four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10.9 (95% CI 6.1 to 19.6); fatigue OR=16.8 (95% CI 5.5 to 51.9); gastrointestinal symptoms OR=6.6 (95% CI 3.0 to 13.8); and changes in sense of smell or taste OR=10.0 (95% CI 2.4 to 11.4). DISCUSSION Children demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-2 antibody positivity. TRIAL REGISTRATION NUMBER NCT0434740.
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Affiliation(s)
- Thomas Waterfield
- Queen's University Belfast Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK
- Emergency Department, Children's Health Ireland at Temple Street, Dublin D01 YC67, Ireland
| | - Chris Watson
- Queen's University Belfast Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK
| | - Rebecca Moore
- General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | | | - Claire Tonry
- Queen's University Belfast Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK
| | - Alison Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Claire McGinn
- General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Steven Foster
- Emergency Department, Royal Hospital for Children, Glasgow, UK
| | | | - Mark David Lyttle
- Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Shazaad Ahmad
- Department of Virology, Manchester Medical Microbiology Partnership, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Michael Corr
- Belfast Health and Social Care Trust, Belfast, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
| | - Kevin Brown
- Virus Reference Department, Public Health England, Colindale, UK
| | - Gayatri Amirthalingam
- Immunisation,Hepatitis & Blood Safety Department, Public Health England Immunisation and Countermeasures Division, London, UK
| | - Julie-Ann Maney
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Sharon Christie
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK
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7
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Corr M, Christie S, Watson C, Maney J, Fairley D, Ladhani SN, Lyttle MD, McFetridge L, Mitchell H, Shields MD, McGinn C, McKenna J, Mallett P, Ferris K, Rowe-Setz G, Moore R, Foster S, Evans J, Waterfield T. Seroprevalence of SARS-CoV-2 antibodies in children of United Kingdom healthcare workers: a prospective multicentre cohort study protocol. BMJ Open 2020; 10:e041661. [PMID: 33444212 PMCID: PMC7678379 DOI: 10.1136/bmjopen-2020-041661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/18/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A novel coronavirus SARS-CoV-2 has been responsible for a worldwide pandemic. Children typically have very mild, or no, symptoms of infection. This makes estimations of seroprevalence in children difficult. Research is therefore required to determine the seroprevalence of SARS-CoV-2 antibodies in children. The primary objective of this study is to report the seroprevalence of SARS-CoV-2 IgM and/or IgG antibodies in healthy children at baseline, 2 months and 6 months. This is the only longitudinal UK study of seroprevalence in an exclusively paediatric population. Determining the changing seroprevalence is of vital public health importance and can help inform decisions around the lifting of paediatric specific social distancing measures such as school closures and the cancellation of routine paediatric hospital services. METHODS AND ANALYSIS 1000 healthy children of healthcare workers aged between 2 and 15 years will be recruited from five UK sites (Belfast, Cardiff, Glasgow, London and Manchester). The children will undergo phlebotomy at baseline, 2 months and 6 months to measure IgM and/or IgG positivity to SARS-CoV-2. A sample size of 675 patients is required to detect a 5% change in seroprevalence at each time point assuming an alpha of 0.05 and a beta of 0.2. Adjusted probabilities for the presence of IgG and/or IgM antibodies and of SARS-CoV-2 infection will be reported using logistic regression models where appropriate. ETHICS AND DISSEMINATION Ethical approval was obtained from the London - Chelsea Research Ethics Committee (REC Reference-20/HRA/1731) and the Belfast Health & Social Care Trust Research Governance (Reference 19147TW-SW). Results of this study will be made available as preprints and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT0434740; Results.
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Affiliation(s)
- Michael Corr
- Department of Nephrology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Sharon Christie
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | - Chris Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Julieann Maney
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | - Derek Fairley
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, Queen's University Belfast School of Mathematics and Physics, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, Queen's University Belfast School of Mathematics and Physics, Belfast, UK
| | - Michael David Shields
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Claire McGinn
- General Paediatrics, Belfast Health and Social Care Trust, Belfast, UK
| | - James McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Peter Mallett
- General Paediatrics, Belfast Health and Social Care Trust, Belfast, UK
| | - Kathryn Ferris
- General Paediatrics, Belfast Health and Social Care Trust, Belfast, UK
| | - Gala Rowe-Setz
- General Paediatrics, Belfast Health and Social Care Trust, Belfast, UK
| | - Rebecca Moore
- General Paediatrics, Belfast Health and Social Care Trust, Belfast, UK
| | - Steven Foster
- Emergency Department, Royal Hospital for Children, Glasgow, UK
| | - Jennifer Evans
- Paediatric Infectious Disease and Immunology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Tom Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
- Emergency Department, Children's Health Ireland, Dublin, Ireland
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8
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Sloane C, Mallett P, Ferris K, Bennison C, Moriarty P. Delayed Access and Uptake of Care for Children During Covid-19. Ir Med J 2020; 113:140. [PMID: 35603457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- C Sloane
- al Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - P Mallett
- al Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - K Ferris
- al Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - C Bennison
- al Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - P Moriarty
- al Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
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9
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Hamill L, Ferris K, Kapande K, McConaghy L, Douglas I, McGovern V, Shields MD. Exhaled breath temperature measurement and asthma control in children prescribed inhaled corticosteroids: A cross sectional study. Pediatr Pulmonol 2016; 51:13-21. [PMID: 25917297 DOI: 10.1002/ppul.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Exhaled breath temperature (EBT) reflects airways (both eosinophilic and neutrophilic) inflammation in asthma and thus may aid the management of children with asthma that are treated with anti-inflammatory drugs. A new EBT monitor has become available that is cheap and easy to use and may be a suitable monitoring device for airways inflammation. Little is known about how EBT relates to asthma treatment decisions, disease control, lung function, or other non-invasive measures of airways inflammation, such as exhaled nitric oxide (ENO). OBJECTIVE To determine the relationships between EBT and asthma treatment decision, current control, pulmonary function, and ENO. METHODS Cross-sectional prospective study on 159 children aged 5-16 years attending a pediatric respiratory clinic. EBT was compared with the clinician's decision regarding treatment (decrease, no change, increase), asthma control assessment (controlled, partial, uncontrolled), level of current treatment (according to British Thoracic Society guideline, BTS step), ENO, and spirometry. RESULTS EBT measurement was feasible in the majority of children (25 of 159 could not perform the test) and correlated weakly with age (R = 0.33, P = <0.01). EBT did not differ significantly between the three clinician decision groups (P = 0.42), the three asthma control assessment groups (P = 0.9), or the current asthma treatment BTS step (P = 0.57). CONCLUSIONS & CLINICAL IMPLICATIONS EBT measurement was not related to measures of asthma control determined at the clinic. The routine intermittent monitoring of EBT in children prescribed inhaled corticosteroids who attend asthma clinics cannot be recommended for adjusting anti-inflammatory asthma therapy.
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Affiliation(s)
- Laura Hamill
- Centre of Infection & Immunity, Queen's University Belfast, Northern Ireland, UK
| | - Kathryn Ferris
- Centre of Infection & Immunity, Queen's University Belfast, Northern Ireland, UK
| | - Kirsty Kapande
- Centre of Infection & Immunity, Queen's University Belfast, Northern Ireland, UK
| | - Laura McConaghy
- Centre of Infection & Immunity, Queen's University Belfast, Northern Ireland, UK
| | - Isobel Douglas
- Royal Belfast Hospital for Sick Children, Belfast Health Social Care Trust, Belfast, Northern Ireland, UK
| | - Vincent McGovern
- Royal Belfast Hospital for Sick Children, Belfast Health Social Care Trust, Belfast, Northern Ireland, UK
| | - Michael D Shields
- Centre of Infection & Immunity, Queen's University Belfast, Northern Ireland, UK.,Royal Belfast Hospital for Sick Children, Belfast Health Social Care Trust, Belfast, Northern Ireland, UK
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10
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Hamill L, Ferris K, Kapande K, McConaghy L, Douglas I, McGovern V, Shields MD. Response to letter by Popov, Todor regarding our paper: Exhaled breath temperature measurement and asthma control in children prescribed inhaled corticosteroids: A cross sectional study. Pediatr Pulmonol 2016; 51:93. [PMID: 26524608 DOI: 10.1002/ppul.23300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/11/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Laura Hamill
- Queen's University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom
| | - Kathryn Ferris
- Queen's University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom
| | - Kirsty Kapande
- Queen's University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom
| | - Laura McConaghy
- Queen's University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom
| | - Isobel Douglas
- Royal Belfast Hospital for Sick Children, Royal Hospitals Group, Belfast, United Kingdom
| | - Vincent McGovern
- Royal Belfast Hospital for Sick Children, Royal Hospitals Group, Belfast, United Kingdom
| | - Michael D Shields
- Queen's University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom.,Royal Belfast Hospital for Sick Children, Royal Hospitals Group, Belfast, United Kingdom
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11
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Abstract
A 77-year-old edentulous man presented to the accident and emergency department with a sudden onset of sharp right-sided abdominal pain. The patient reported a change in his bowel habit with constipation over a 6 month period but did not report any significant choking event or ingestion of a foreign body in the preceding months. On examination the patient was maximally tender with guarding over McBurneys point. CT scan showed an abnormal segment of distal ileum with a 3 cm high attenuation focus which had penetrated the bowel wall. At laparotomy the patient was found to have a perforation of his distal ileum caused by an ingested toothpick. Patients wearing dental plates or dentures are at higher risk of toothpick ingestion due to impaired palatal sensation. CT scanning, in the appropriate setting, may aid diagnosis and lower operator risk of sharp related injury at the time of operation.
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Affiliation(s)
- David Mark
- Department of General Surgery, Ulster Hospital, Belfast, UK.
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12
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Abstract
As part of a national study of the U.S. dairy cow population, fecal samples were collected from representative cows on 91 dairies and 97 cull dairy cow markets in 19 states. Salmonella spp. were recovered from 5.4% of milk cows, 18.1% of milk cows expected to be culled within 7 days, and 14.9% of culled dairy cows at markets. On a premise basis, Salmonella shedding in milk cows was detected on 21.1% of dairies and 66% of cull dairy cow markets. The percentage of herds with at least one cow with detectable Salmonella fecal shedding was higher during the sampling period from May through July, in herds with at least 100 milk cows, and in herds in the South region. The most common Salmonella serogroups isolated were E (30.8% of isolates) and C1 (28.6%); the most common serotypes isolated were Salmonella Montevideo (21.5% of isolates), Salmonella Cerro (13.3%), and Salmonella Kentucky (8.5%). Fecal shedding of Salmonella Typhimurium or Salmonella Typhimurium var. copenhagen was infrequent (2.8% of isolates). Most isolates (88.9%) were susceptible to all 17 antimicrobials evaluated; multiple resistance was an infrequent occurrence. This study provides information describing the distribution of Salmonella fecal shedding from dairy cows on farm and at markets and will serve as a baseline for future studies.
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Affiliation(s)
- S J Wells
- Department of Clinical and Population Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul 55108, USA.
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13
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Schlosser W, Hogue A, Ebel E, Rose B, Umholtz R, Ferris K, James W. Analysis of Salmonella serotypes from selected carcasses and raw ground products sampled prior to implementation of the Pathogen Reduction; Hazard Analysis and Critical Control Point Final Rule in the US. Int J Food Microbiol 2000; 58:107-11. [PMID: 10898467 DOI: 10.1016/s0168-1605(00)00293-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In July 1996, the US Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), published the Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems final rule to improve food safety of meat and poultry products. The final rule established, among other requirements, pathogen reduction performance standards for Salmonella for food animal carcasses and raw ground products. The final rule is to be fully implemented in three stages in successively smaller federally inspected meat and poultry slaughter and processing establishments. Implementation began in January 1998 and was completed in January 2000. Samples of carcasses of four species of food animals (cattle, swine, chickens, turkeys), and raw ground product from each of these species, were collected by FSIS from establishments prior to implementation of the final rule and cultured for Salmonella. This paper reports Salmonella serotype results of samples collected from June 1997 through August 1998. These results represent a baseline for future comparisons.
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Affiliation(s)
- W Schlosser
- Food Safety and Inspection Service, Washington, DC, USA.
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14
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Abstract
Fecal samples were collected from 4,361 dairy cows on 91 dairy operations between 26 February and 8 July 1996. Fecal samples were cultured for Escherichia coli O157, and positive isolates were probed for verotoxin-producing genes. A total of 52 (1.2%) fecal samples on 22 (24.2%) operations were positive for verotoxin-producing E. coli O157. Herds in which samples were collected on or after 1 May 1996 were significantly more likely to test positive than herds sampled before that date (odds ratio = 7.7). Herds maintained on farms on which alleyways were flushed with water to remove manure were 8.0 times more likely to have samples test positive for verotoxin-producing E. coli O157 than were herds maintained on farms cleaned by use of other methods of manure removal.
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Affiliation(s)
- L Garber
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, Veterinary Services, Centers for Epidemiology and Animal Health, Fort Collins, Colorado 80521, USA.
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Losinger WC, Garber LP, Smith MA, Hurd HS, Biehl LG, Fedorka-Cray PJ, Thomas LA, Ferris K. Management and nutritional factors associated with the detection of Salmonella sp. from cattle fecal specimens from feedlot operations in the United States. Prev Vet Med 1997; 31:231-44. [PMID: 9234447 DOI: 10.1016/s0167-5877(96)01143-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a convenience sample of 100 feedlot operations (included in the United States Department of Agriculture: Animal and Plant Health Inspection Service 1994 Cattle on Feed Evaluation), up to 25 cattle fecal samples were collected and tested for the presence of Salmonella from each of two pens (the pen which contained the most-recent arrivals, and the pen with cattle that had been on feed the longest). One or more Salmonella spp. were recovered from 38 (38.0%) of the 100 feedlots, 52 (26.0%) of the 200 pens and 273 (5.5%) of the 4977 fecal samples collected. Multivariable logistic regression indicated that feeding tallow and feeding whole cottonseed or cottonseed hulls within seven days prior to fecal sample collection was associated with an increased risk of finding Salmonella in a pen. Variables not found to be significantly associated with the detection of Salmonella in a pen included region, operation size, use of sprinklers, time on feed, type of cattle in the pen, number and concentration of cattle in a pen, feeding probiotics, and various other feeds.
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Affiliation(s)
- W C Losinger
- United States Department of Agriculture, Animal and Plant Health Inspection Service, Fort Collins, CO 80521, USA
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Harris IT, Fedorka-Cray PJ, Gray JT, Thomas LA, Ferris K. Prevalence of Salmonella organisms in swine feed. J Am Vet Med Assoc 1997; 210:382-5. [PMID: 9057923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test feed and feed ingredients on swine farms for Salmonella organisms and to analyze data from these farms to determine risk factors associated with Salmonella organisms in the feed and feed ingredients. DESIGN Epidemiologic survey and retrospective case-control study. SAMPLE POPULATION 30 swine farms. PROCEDURE Samples of feed and feed ingredients and information regarding herd characteristics were collected from 30 swine farms. Samples were tested for Salmonella organisms, and data compiled from herd information forms were examined for associated risk factors between herd characteristics and isolation of Salmonella organisms. RESULTS Salmonella organisms were isolated from 36 of 1,264 (2.8%) feed and feed ingredient samples and from 14 of 30 (46.7%) farms. Thirteen Salmonella sp serotypes and 2 untypeable isolates were cultured. Recovery of Salmonella organisms from at least 1 feed or feed ingredient on a farm was significantly associated with 6 herd characteristics (lack of bird-proofing, using farm-prepared feed for finishing-age pigs rather than purchased feed, and housing pigs in facilities other than total confinement in the growing, finishing, gestating, and breeding stages of production, respectively). Isolation of Salmonella sp was not associated with a history of salmonellosis on a farm. CLINICAL IMPLICATIONS Salmonella organisms were readily isolated from samples of feed and feed ingredients, illustrating that salmonellae are ubiquitous in a farm environment. Implementing sanitary and pest-control measures continues to be a prudent recommendation. Salmonella serotypes found in feed and feed ingredients have the potential to cause disease in pigs that consume the feed or, ultimately, in people that consume pork.
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Affiliation(s)
- I T Harris
- Enteric Diseases and Food Safety Research Unit, USDA, Ames, IA 50010, USA
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Ferris K. Acts of commission, omission, and demission or pulling the plug. J R Soc Med 1995; 88:364. [PMID: 7629779 PMCID: PMC1295257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Lee LA, Threatt VL, Puhr ND, Levine P, Ferris K, Tauxe RV. Antimicrobial-resistant Salmonella spp isolated from healthy broiler chickens after slaughter. J Am Vet Med Assoc 1993; 202:752-5. [PMID: 8454507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Of 105 Salmonella organisms of any serotype selected from a sample of 1,824 serotyped salmonellae isolated during a nationwide bacteriologic survey of healthy broiler chickens after slaughter, 60 (57%) were resistant to 1 or more antimicrobial agents and 47 (45%) were resistant to 2 or more agents. Highest resistance was to tetracycline (45%), streptomycin (41%), sulfisoxazole (19%), gentamicin (10%), and trimethoprim/sulfamethoxazole (8%). Additional isolates of S typhimurium, heidelberg, agona, and enteritidis were selected from the sample of 1,824 isolates for testing because of the high frequency with which these 4 serotypes are isolated from human patients. The highest frequency of resistance among 104 isolates of S heidelberg, 92 isolates of S typhimurium, and 30 isolates of S agona was to streptomycin (33 to 57%), sulfisoxazole (33 to 50%), tetracycline (26 to 50%), and gentamicin (13 to 40%); 51 to 63% of these isolates were resistant to 1 or more agents and 37 to 59% were resistant to 2 or more agents. Resistance to ampicillin among these 3 serotypes was uncommon (0 to 4%). In contrast, 15 of 19 tested isolates (79%) of S enteritidis were resistant to ampicillin and 13 of the 19 isolates (68%) were resistant only to ampicillin. This pattern of resistance was associated with a specific bacteriophage type and indicated the potential role of bacterial clones in determining the frequency and patterns of antimicrobial resistance in populations of broiler chickens. Resistance to gentamicin and trimethoprim/sulfamethoxazole was higher than that previously reported and is of public health concern because of the frequency with which these drugs are used to treat bacterial infections in human patients.
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Affiliation(s)
- L A Lee
- Enteric Diseases Branch, Centers for Disease Control, Atlanta, GA 30333
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Altekruse S, Koehler J, Hickman-Brenner F, Tauxe RV, Ferris K. A comparison of Salmonella enteritidis phage types from egg-associated outbreaks and implicated laying flocks. Epidemiol Infect 1993; 110:17-22. [PMID: 8432319 PMCID: PMC2271964 DOI: 10.1017/s0950268800050639] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Infections due to Salmonella enteritidis are increasing worldwide. In the United States, between 1985 and 1989, 78% of the S. enteritidis outbreaks in which a food vehicle was identified implicated a food containing raw or lightly cooked shell eggs. Under a US Department of Agriculture regulation published in 1990, eggs implicated in human food-borne S. enteritidis outbreaks were traced back to the source flock. The flock environment and the internal organs of a sample of hens were tested for S. enteritidis. We compared the S. enteritidis phage types of isolates from 18 human, egg-associated outbreaks and the 15 flocks implicated through traceback of these outbreaks. The predominant human outbreak phage type was recovered from the environment in 100% of implicated flocks and from the internal organs of hens in 88% of implicated flocks we tested. The results support the use of phage typing as a tool to identify flocks involved in human S. enteritidis outbreaks.
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Affiliation(s)
- S Altekruse
- Food and Drug Administration, Washington, DC 20204
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Selander RK, Beltran P, Smith NH, Helmuth R, Rubin FA, Kopecko DJ, Ferris K, Tall BD, Cravioto A, Musser JM. Evolutionary genetic relationships of clones of Salmonella serovars that cause human typhoid and other enteric fevers. Infect Immun 1990; 58:2262-75. [PMID: 1973153 PMCID: PMC258807 DOI: 10.1128/iai.58.7.2262-2275.1990] [Citation(s) in RCA: 169] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Multilocus enzyme electrophoresis was employed to measure chromosomal genotypic diversity and evolutionary relationships among 761 isolates of the serovars Salmonella typhi, S. paratyphi A, S. paratyphi B, S. paratyphi C, and S. sendai, which are human-adapted agents of enteric fever, and S. miami and S. java, which are serotypically similar to S. sendai and S. paratyphi B, respectively, but cause gastroenteritis in both humans and animals. To determine the phylogenetic positions of the clones of these forms within the context of the salmonellae of subspecies I, comparative data for 22 other common serovars were utilized. Except for S. paratyphi A and S. sendai, the analysis revealed no close phylogenetic relationships among clones of different human-adapted serovars, which implies convergence in host adaptation and virulence factors. Clones of S. miami are not allied with those of S. sendai or S. paratyphi A, being, instead, closely related to strains of S. panama. Clones of S. paratyphi B and S. java belong to a large phylogenetic complex that includes clones of S. typhimurium, S. heidelberg, S. saintpaul, and S. muenchen. Most strains of S. paratyphi B belong to a globally distributed clone that is highly polymorphic in biotype, bacteriophage type, and several other characters, whereas strains of S. java represent seven diverse lineages. The flagellar monophasic forms of S. java are genotypically more similar to clones of S. typhimurium than to other clones of S. java or S. paratyphi B. Clones of S. paratyphi C are related to those of S. choleraesuis. DNA probing with a segment of the viaB region specific for the Vi capsular antigen genes indicated that the frequent failure of isolates of S. paratyphi C to express Vi antigen is almost entirely attributable to regulatory processes rather than to an absence of the structural determinant genes themselves. Two clones of S. typhisuis are related to those of S. choleraesuis and S. paratyphi C, but a third clone is not. Although the clones of S. decatur and S. choleraesuis are serologically and biochemically similar, they are genotypically very distinct. Two clones of S. typhi were distinguished, one globally distributed and another apparently confined to Africa; both clones are distantly related to those of all other serovars studied.
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Affiliation(s)
- R K Selander
- Institute of Molecular Evolutionary Genetics, Mueller Laboratory, Pennsylvania State University, University Park 16802
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Beltran P, Musser JM, Helmuth R, Farmer JJ, Frerichs WM, Wachsmuth IK, Ferris K, McWhorter AC, Wells JG, Cravioto A. Toward a population genetic analysis of Salmonella: genetic diversity and relationships among strains of serotypes S. choleraesuis, S. derby, S. dublin, S. enteritidis, S. heidelberg, S. infantis, S. newport, and S. typhimurium. Proc Natl Acad Sci U S A 1988; 85:7753-7. [PMID: 3051004 PMCID: PMC282271 DOI: 10.1073/pnas.85.20.7753] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Variation in the chromosomal genomes of 1527 isolates of eight common serotypes (O and H antigen profiles) of Salmonella was assessed by analysis of electrophoretically demonstrable allelic polymorphism at 23 metabolic enzyme loci. Seventy-one distinctive electrophoretic types, representing multilocus genotypes, were identified. A basically clonal population structure was indicated by the presence of strong linkage disequilibrium among enzyme loci, the association of each serotype with a relatively small number of multilocus enzyme genotypes, and the global distribution of certain genotypes. For each of six of the serotypes, 83-96% of isolates were members of a single clone. The occurrence of each of four serotypes (S. derby, S. enteritidis, S. infantis, and S. newport) in isolates of clones belonging to several evolutionary lineages, some of which are distantly related, suggests that the horizontal transfer and recombination of chromosomal genes mediating expression of cell-surface antigens has been a significant process in the evolution of the salmonellae. Two divergent clone clusters of S. derby differ in the relative frequency with which they cause disease in birds versus mammals, and two major lineages of S. newport differ in the frequency with which their clones are associated with disease in humans versus animals.
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Affiliation(s)
- P Beltran
- Department of Biology, Pennsylvania State University, University Park 16802
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