Qualifying exams for medical students: are both major finals and continuous assessment necessary?
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Education, Medical, Undergraduate↗
Biomedical subjects
F Carswell
Publications and source records attributed to F Carswell.
Does natural sensitisation in eczema occur through the skin?
The specificities of serum IgE for the faecal and body antigens of the house-dust mite, Dermatophagoides pteronyssinus, were compared in 69 children with various combinations of asthma, eczema, and/or rhinitis. The concentration of IgE antibodies to the mite body was higher in those with eczema than in those with asthma, but the concentrations of IgE antibodies to the faecal allergen were not significantly different. The ratio of the serum concentration of anti-mite-body IgE to anti-faecal IgE was significantly greater in the children with eczema than in the children with asthma. The results in 4 subjects with rhinitis (2 with and 2 without eczema) support the view that IgE antibodies to the mite body are characteristic of eczema. Sensitisation to mite body and mite faecal particles may occur by different processes; the allergens of mite bodies may penetrate the skin, whereas faecal allergen may enter the body by other route(s).
Adolescent↗
Reduced morbidity in cystic fibrosis.
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Australia↗
Preschool wheezing and prognosis at 10.
Information was collected at birth and at 5 and 10 years of age on the national cohort of children born in one week of April 1970 (the Child Health and Education Study). For 11 465 children, information on wheezing attacks before 5 years was compared with reports of wheezing occurring in the 12 months before the interview at 10 years. Of 2345 children who had had at least one wheezing attack before their fifth birthday, 80% (1869) were free of wheeze at 10 years; only 8% of children who had just one wheezing attack by 5 years wheezed in their 10th year. The more attacks the child had had by the age of 5 the higher the risk of continuing to wheeze at the age of 10, but there were no major differences in prognosis according to the age of the first attack. Half of the children who had been labelled asthmatic at the age of 5 were wheezing at the age of 10 compared with an eighth of those with wheezing not so labelled. There was little evidence to suggest that the prognosis of wheezing with bronchitis was markedly different from that of children with other episodes of wheezing provided they were not said to be asthmatic. A longer follow up is necessary to ascertain whether remission at the age of 10 is followed by relapse later.
Age Factors↗
Lanthanum penetration of the trachea after the immediate response of sensitized rats to aerosol antigen.
Inbred rats were sensitized by the intraperitoneal injection of 10 micrograms DNP19-ovalbumin (DNP-OA). These rats were compared both in their responses to 10 min of aerosol challenge with DNP-OA or bovine gamma globulins (BGG) and with other rats similarly 'sensitized' with saline and subsequently challenged with DNP-OA. Lanthanum (1%) in the fixative permitted the identification by transmission electron microscopy of electron-dense lanthanum in the tracheal epithelium. Planimetry showed 59% of the intercellular membranes in the tracheal epithelium of the group sensitized and challenged with DNP-OA were stained with lanthanum versus 39% in the saline-sensitized and 26% in the BGG-challenged. X-ray energy probe microanalyses confirmed that significantly more lanthanum had penetrated in the group sensitized and challenged with DNP-OA than in the other two groups. In this group the magnitude of the change in respiratory pattern produced by challenge was directly related to the quantity of the lanthanum in the epithelium. Our findings show that increased permeability of the intercellular spaces occurs in immediate pulmonary hypersensitivity, probably as a result of the opening of the tight intercellular junctions and suggests that this change of permeability may be involved in producing the physiological response.
Animals↗
Thirty deaths from asthma.
The features associated with 30 childhood deaths from asthma in the period 1962-83 are reviewed. There was an annual death rate of 0.47/100 000 population at risk in the later part of this period in Avon county. Asthma deaths occurred in chronic severe sufferers at night and, although there was usually time for effective treatment, inadequate management probably contributed to the deaths, with deficiencies in corticosteroid treatment being a major feature. Twelve of the 30 patients who died had never attended hospital. A greater proportion of girls died than would have been predicted from the proportion attending hospital. The survey indicates a need for more effective education of laymen and doctors on asthma.
Adolescent↗
Respiratory functional changes on intratracheal challenge of sensitized rats.
Inbred PVG/c rats were sensitized to DNP19-ovalbumin by intraperitoneal injection. Sensitized rats when challenged with antigen developed characteristic brief interruptions of expiratory flow ('expiratory notching'). The functional residual capacity fell in rats challenged with antigen or saline but the fall was greater in those sensitized rats challenged with antigen. No greater alterations in respiratory rate, minute volume, airways resistance or dynamic compliance occurred on antigen as compared with saline challenge of sensitized rats, suggesting that the expression of immediate respiratory hypersensitivity in the rat is different from the asthmatic response in humans. The expiratory notching was reduced if an additional airways resistance was added in series to the tracheostomy tube. This may be explained as a result of reduction in the dynamic compression which normally produced the expiratory notching.
Airway Resistance↗
A drug identification chart for the asthma clinic.
In a disease such as asthma, where the patient may be supervised from both the GP's surgery and a hospital clinic, there are likely to be problems in the physician appreciating the complete therapy the patient is actually receiving. Accordingly, the indicated drug identification chart was designed and its use in the asthma clinic at Bristol Children's Hospital examined.
Asthma↗
Report of the British Society for Immunology Working Party on Clinical Immunology: 1984. Guidelines for training the physician immunologist.
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Allergy and Immunology↗
Serum and sputum concentrations of ceftazidime in patients with cystic fibrosis.
The pharmacokinetic parameters of ceftazidime were assessed in six cystic fibrotic patients during eight courses administered for acute exacerbations of pulmonary infection. In order to assess the initial and steady state concentrations of ceftazidime at a dose of 35 mg/kg and to determine the levels found after a higher dose, each ten day course of ceftazidime consisted of eight doses of 35 mg/kg followed by 22 doses of 50 mg/kg, all administered at 8-hourly intervals. Samples of blood and sputum were collected following the 1st, 8th and 9th doses for ceftazidime assay. The mean peak serum concentrations of ceftazidime were 97, 110 and 147 mg/l respectively with corresponding mean concentrations in sputum of 2.7, 2.6 and 1.6 mg/l. The mean clearance rate was calculated on a two compartment model to be 197 ml/min/50 kg lean body mass, the mean volume of distribution was 281/50 kg lean body mass and the mean half life was 1.57 h. There were large inter-patient differences in the pharmacokinetic parameters, however, which suggests that the clinical condition of the patient affects the pharmacokinetics of ceftazidime in cystic fibrosis. In all the patients, even after the doses of 50 mg/kg, the trough serum concentrations were low. Samples of blood were also collected for adverse effects before, during and after each course; there was no evidence of renal, hepatic or haematological changes in response to the drug.
Adolescent↗
Immediate hypersensitivity, IgE and asthma.
Twenty-one asthmatic and twenty-two non-asthmatic children and nine asthmatic adults from two different rural areas of Tanzania, and eight asthmatic children from Dar-es-Salaam were surveyed by questionnaires, skin testing and the measurement of serum IgE. Asthma was significantly commoner in female rural children (four males, fifteen females). The rural asthmatic children apparently had less skin reactivity (in seven of nine tests) and lower specific (in two of four tests) and total serum IgE than age-, sex- and village-matched controls. This pattern of asthma in rural children in the tropics represents a different type of asthma from that found in temperate zones. In contrast, the adult rural asthmatics and the urban children seemed to have the pattern of increased skin reactivity and serum IgE found in asthmatic patients from temperate climates.
Asthma↗
Bronchial lability and skin reactivity in siblings of asthmatic children.
Seventy five children with asthma (42 boys and 33 girls; age range 4 years 2 months to 15 years) and 75 of their siblings (37 boys and 38 girls; age range 4 years 3 months to 17 years 8 months) were studied to elucidate the mechanisms involved in the increased prevalence of asthma in boys, a prevalence that tends to disappear after puberty. Immediate cutaneous hypersensitivity to five allergens and maximum fall in peak expiratory flow rate after six minutes of treadmill running (bronchial lability) were determined in patients and siblings. There was no significant difference between boys and girls in skin test reactivity to single or multiple allergens in the sibling group. The percentage fall in peak expiratory flow rate after exercise was significantly greater in male than in female siblings and when a positive test was defined as a fall after exercise of either 10% or 15% of the rate before exercise the number of positive tests was significantly greater in boys. The results suggest that more boys than girls in this age group have asthma because their bronchial lability is greater, and not because more boys are atopic.
Adolescent↗
Double-blind comparisons of slow-release theophylline, ketotifen and placebo for prophylaxis of asthma in young children.
Clinical trials of slow-release theophylline and ketotifen as prophylaxis against asthma in 18 young children suggested that both drugs had some efficacy. The theophylline was more effective and produced reduction in salbutamol usage as well as an increase in peak expiratory flow rates. Transient nausea and vomiting was commoner during theophylline treatment but did not usually necessitate discontinuing therapy.
Asthma↗
Deoxyribonucleic acid output in the sputum from cystic fibrosis patients.
The deoxyribonucleic acid (DNA) content of sputum from cystic fibrosis patients was examined to establish if it was likely to be a useful indicator of worsening clinical condition. The assay was reproducible (coefficient of variation 4.2%) and added DNA could be demonstrated. Added antibiotics did not influence the result. The daily DNA content in the sputum showed similar variations to the weight, but the DNA output (content X weight/24 h) was perhaps a more sensitive indicator of clinical status. There was a weak, negative correlation between DNA output and peak expiratory flow rate.
Cystic Fibrosis↗
Sulphasalazine-induced systemic lupus erythematosus in a child.
A case is reported of lupus syndrome in a 13-year-old girl with ulcerative colitis treated with sulphasalazine. She had antibodies to nuclear factor and double-stranded DNA. The clinical pattern resembled drug-induced systemic lupus erythematosus and has resolved since her sulphasalazine was discontinued. Sulphasalazine-induced lupus syndrome has never been reported in a child. The history illustrates the role of sulphasalazine in the development of this syndrome.
Adolescent↗
A controlled comparison of slow-release theophylline, ketotifen and placebo in the prophylaxis of asthma in young children.
A double blind crossover comparison of slow-release theophylline, ketotifen and placebo was carried out in 18 young children with perennial asthma. Theophylline significantly reduced symptoms and increased the mean peak expiratory flow rate. Transient nausea and vomiting was commoner during theophylline treatment but did not usually necessitate discontinuance of therapy.
Administration, Oral↗
The dose of house dust mite antigen (P1) inhaled by infants aged one month.
A survey of the habitats occupied by 12 infants of one month of age revealed that approximately 10% of their day was spent in conditions of potential exposure to the major (P1) allergen of the house dust mite, Dermatophagoides pteronyssinus. A respiratory pump which reproduced the minute ventilation of an infant was placed in representative infant habitats. The P1 allergen trapped by the filter in this pump was measured as an estimate of infants' allergen intake. Detectable P1 intake was only present when there was active air disturbance (bed making and vacuuming). The average P1 intake was approximately 3 ng P1/24 hours. Comparison of this P1 intake with that which sensitizes in other situations suggests that it is usually inadequate to sensitize infants.
Allergens↗