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  • 1
    Publication Date: 2014-09-17
    Description: Commentary on: Keeney GE , Gray MP, Morrison AK, et al .. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics 2014 ; 133 : 493 –9 Context Standard of care for emergency department (ED) treatment of children with acute asthma exacerbation includes systemic steroids. 1 Traditionally, the systemic steroid course of choice has been a 5-day burst of oral prednisone or prednisolone. Recent studies have begun to show that a shorter course of dexamethasone may have comparable efficacy. 2–4 Dexamethasone is an attractive alternative to prednisone and prednisolone because of its longer duration of metabolic effect and subsequent shorter treatment duration. Others have touted the palatability of dexamethasone over that of prednisone and prednisolone, as well as potentially improved clinical outcomes and cost savings due to superior compliance with the shorter treatment course dexamethasone requires. 5 Methods This was a review of randomised...
    Keywords: Clinical trials (epidemiology), Immunology (including allergy), Asthma
    Print ISSN: 1356-5524
    Electronic ISSN: 1473-6810
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 2
    Publication Date: 2013-12-06
    Description: Background Epidemiological studies on the effect of urban air pollution on childhood asthma have shown conflicting results and so far no consistent association has emerged. However, a common limitation in previous studies has been exposure misclassification leading to uncertainties in risk estimates.The aim of this study was to analyse the effects of long-term exposure to particulate matter (PM 10 ) and nitrogen dioxide (NO 2 ) on the prevalence of asthma and wheeze within a population-based birth cohort—the Manchester Asthma and Allergy Study (MAAS). Methods The prevalence of asthma and current wheeze within the cohort (N=1185) was determined through parental questionnaires at ages 3, 5, 8 and 11 years. The typical monthly PM 10 and NO 2 exposure of each child was estimated through a novel microenvironmental exposure model from birth to age 11. The association between exposure and asthma or wheeze was analysed using generalised estimating equations and multiple logistic regression. Results The range of asthma prevalence was 15.2–23.3%, with the lowest prevalence at age 3 and the highest at age 5. The prevalence of current wheeze decreased from ages 3 to 8 (23.7–18%). The mean NO 2 exposure decreased from the 1st year of life (21.7 µg/m 3 ) to the 11th year of life (16.0 µg/m 3 ). The mean PM 10 exposure showed a smaller decrease (12.8 –10.7 µg/m 3 ). The statistical analysis showed no significant association between the exposures and either outcome. Conclusions No evidence of a significant association between long-term exposure to PM 10 and NO 2 and the prevalence of either asthma or wheeze was found.
    Keywords: Epidemiologic studies, Air pollution, Environmental issues
    Print ISSN: 0143-005X
    Electronic ISSN: 1470-2738
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 3
    Publication Date: 2012-09-08
    Description: Background Little is known about the stem cell organisation of the normal oesophagus or Barrett's metaplastic oesophagus. Using non-pathogenic mitochondrial DNA mutations as clonal markers, the authors reveal the stem cell organisation of the human squamous oesophagus and of Barrett's metaplasia and determine the mechanism of clonal expansion of mutations. Methods Mutated cells were identified using enzyme histochemistry to detect activity of cytochrome c oxidase (CCO). CCO-deficient cells were laser-captured and mutations confirmed by PCR sequencing. Cell lineages were identified using immunohistochemistry. Results The normal squamous oesophagus contained CCO-deficient patches varying in size from around 30 μm up to about 1 mm. These patches were clonal as each area within a CCO-deficient patch contained an identical mitochondrial DNA mutation. In Barrett's metaplasia partially CCO-deficient glands indicate that glands are maintained by multiple stem cells. Wholly mutated Barrett's metaplasia glands containing all the expected differentiated cell lineages were seen, demonstrating multilineage differentiation from a clonal population of Barrett's metaplasia stem cells. Patches of clonally mutated Barrett's metaplasia glands were observed, indicating glands can divide to form patches. In one patient, both the regenerating squamous epithelium and the underlying glandular tissue shared a clonal mutation, indicating that they are derived from a common progenitor cell. Conclusion In normal oesophageal squamous epithelium, a single stem cell clone can populate large areas of epithelium. Barrett's metaplasia glands are clonal units, contain multiple multipotential stem cells and most likely divide by fission. Furthermore, a single cell of origin can give rise to both squamous and glandular epithelium suggesting oesophageal plasticity.
    Print ISSN: 0017-5749
    Electronic ISSN: 1468-3288
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 4
    Publication Date: 2015-11-25
    Description: Background Countries with culturally accepted consanguinity provide a unique resource for the study of rare recessively inherited genetic diseases. Although hereditary hearing loss (HHL) is not uncommon, it is genetically heterogeneous, with over 85 genes causally implicated in non-syndromic hearing loss (NSHL). This heterogeneity makes many gene-specific types of NSHL exceedingly rare. We sought to define the spectrum of autosomal recessive HHL in Iran by investigating both common and rarely diagnosed deafness-causing genes. Design Using a custom targeted genomic enrichment (TGE) panel, we simultaneously interrogated all known genetic causes of NSHL in a cohort of 302 GJB2 -negative Iranian families. Results We established a genetic diagnosis for 67% of probands and their families, with over half of all diagnoses attributable to variants in five genes: SLC26A4 , MYO15A , MYO7A , CDH23 and PCDH15 . As a reflection of the power of consanguinity mapping, 26 genes were identified as causative for NSHL in the Iranian population for the first time. In total, 179 deafness-causing variants were identified in 40 genes in 201 probands, including 110 novel single nucleotide or small insertion–deletion variants and three novel CNV. Several variants represent founder mutations. Conclusion This study attests to the power of TGE and massively parallel sequencing as a diagnostic tool for the evaluation of hearing loss in Iran, and expands on our understanding of the genetics of HHL in this country. Families negative for variants in the genes represented on this panel represent an excellent cohort for novel gene discovery.
    Keywords: Clinical genetics
    Print ISSN: 0022-2593
    Electronic ISSN: 1468-6244
    Topics: Medicine
    Published by BMJ Publishing Group
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