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Biomedical subjects

T J David

Publications and source records attributed to T J David.

At least 37 records · Page 2Linked to original sources
PubMed2000

Atopic eczema is associated with delayed maturation of the antibody response to pneumococcal vaccine.

The aim of this study was to investigate a previously undocumented observation, that children with atopic eczema under 9 years of age tended to have a poor antibody response to Pneumococcal vaccination. Thirty-five children (mean age 8.8 years, range 3-16 years) with moderate to severe atopic eczema but no history of systemic infection were studied retrospectively. Pneumococcal antibody responses after immunization with Pneumovax II were compared with a hospital control group consisting of 36 children (mean age 6.0 years, range 3-16 years) with recurrent upper respiratory tract infections. Only 17% of children with atopic eczema aged 3-8 years responded to Pneumovax. This response was significantly poorer than that of the controls (57%) (odds ratio 0.20, 95% confidence interval (CI) 0.05-0.84, P = 0.03). There were no significant differences in the levels of total IgG2, the component of IgG associated with protective antibody responses to Pneumococcus between the two groups. Delay in maturation of the total IgG and IgG2 antibody response to Pneumococcus is a feature in this group of children with moderately severe atopic eczema.

Adolescent↗
PubMed2000

Oxalate and calcium excretion in cystic fibrosis.

BACKGROUND: A patient with cystic fibrosis (CF) and repeated calcium oxalate renal stones prompted us to investigate other children for risk factors for this recognised complication of CF. METHODS: Twenty four hour urinary excretion of calcium, oxalate, and glycolate was measured in children with CF and no symptoms of renal tract stones. Normal diet and treatments were continued. RESULTS: In 26 children (aged 5-15.9 years) oxalate excretion was correlated with age; 14 of 26 children had oxalate excretion above an age appropriate normal range. There was a positive correlation between oxalate excretion and glycolate excretion. Mean calcium excretion was 0.06 mmol/kg/24 h with 21 of 24 children having calcium excretion below the normal range. CONCLUSIONS: Hyperoxaluria may reflect malabsorption although correlation between excretion of oxalate and glycolate suggests a portion of the excess oxalate is derived from metabolic processes. The hypocalciuria observed here may protect children with CF from renal stones.

Adolescent↗
PubMed2000

Adverse reactions and intolerance to foods.

Food allergy is a form of adverse reaction to food in which the cause is an immunological response to a food. Common food triggers are eggs, cow's milk, peanuts and fish. Food allergy is mot common in young infants, most of whom grow out of the allergy by the age of 5 years. The exception is allergy to peanuts, which is life-long. The term food intolerance does not imply any specific type of mechanism, and is defined as a reproducible adverse reaction to a specific food or food ingredient. Mechanisms for food intolerance comprise immunological reactions (i.e. food allergy), enzyme defects, pharmacological effects, irritant effects, and toxic reactions. Despite the popular phobia of food additives and food processing, and the obsession for so-called natural foods, the greatest dangers come from naturally occurring foods and food ingredients.

Food Hypersensitivity↗
PubMed2000

Hypothalamic-pituitary-adrenal function and glucocorticoid sensitivity in atopic dermatitis.

OBJECTIVES: Topical glucocorticoids (GCs) fail to produce a clinical response in some children with atopic dermatitis (AD), suggesting that GC resistance may be present. To determine whether such resistance is generalized or specific to diseased skin, hypothalamic-pituitary-adrenal (HPA) axis function has been assessed in children with moderate to severe AD, who showed a variable response to treatment with topical GC. STUDY DESIGN: Thirty-five patients (.7-18.7 years old; median: 9.3 years) with AD requiring topical GCs from infancy underwent a low-dose adrenocorticotrophin hormone (ACTH; Synacthen) test (LDST) (500 ng/1.73 m(2) ACTH). Groups 1 (7 patients), 2 (17 patients), and 3 (4 patients) used mild, moderate, or potent/very potent topical preparations, respectively. Group 4 (7 boys with severe, treatment-resistant disease) had received GC in at least 1 form (inhaled +/- intranasal +/- oral) in addition to varying potencies of topical GC. Fourteen healthy subjects (3.8-17.3 years old) served as control subjects. Group 4 patients had a daytime plasma cortisol profile and 08.00 hours measurement of plasma ACTH and its precursors. RESULTS: The response to ACTH for groups 1 and 2 did not differ from that of control subjects. Group 3 had lower peak, increment, and area under curve cortisol responses than those in controls, whereas group 4 had lower baseline, peak, and area under curve cortisol responses. Eight patients failed the LDST (peak cortisol <500 nmol/L and increment <200 nmol/L): controls = 0/14, group 1 = 0/7, group 2 = 1/17, group 3 = 4/4, and group 4 = 3/7. Treatment score (based on GC potency, area treated, and duration) was the only factor to influence peak cortisol response on LDST (r(2) = 24%). In group 4, only 1 of 7 patients had a cortisol profile within the normal range but he failed the LDST. In the 5 subjects with an 08.00 hours cortisol <300 nmol/L, the matched ACTH level was inappropriately low. CONCLUSIONS: HPA suppression was rarely found in children or adolescents with moderate to severe AD who used mild or moderately potent topical GCs over many years. However, HPA suppression was common in those receiving potent topical GC preparations or a combination of GC routes of administration. In those with severe AD, evidence of HPA suppression but lack of clinical response to GC treatment excluded significant generalized GC resistance. This would suggest that localized resistance to GCs within the diseased skin may be part of the aetiopathogenesis of severe AD.

Administration, Topical↗
PubMed1999

The core content of the undergraduate curriculum in Manchester.

AIM: To identify the core content for the new undergraduate medical curriculum in Manchester. METHOD: The initial step was to produce a list of 'index clinical situations' (ICSs), for which a newly graduated doctor must have a required level of competence. Using repeated consultation with consultants and general practitioners involved in medical education in the North-West of England, a list of 215 ICSs was agreed. Specialists and generalists were then asked to identify the components of the knowledge base and the performance (skills) base for each ICS. The knowledge base was divided into technical (biomedical facts/concepts) and contextual (effect/management of disease within the individual, family and society) domains. The performance base was divided into intellectual (problem solving and decision making) and interpersonal (history, examination, communication and procedural skills) domains. RESULTS: Forty specialties were consulted and 11,021 items (defined as a piece of knowledge, a concept or a skill) were identified. There was considerable overlap in the items listed, such that when the returns for each ICS were amalgamated, the 215 ICSs contained 6434 items with a mean of 34 +/- 14.2 per situation (range 6-85). UTILISATION: We have used the defined ICSs in the design of the trigger material used in the weekly problem-based learning sessions. Over 4 years almost all (207/215, 96%) of the ICS are covered, with many being revisited at several points in the curriculum.

Competency-Based Education↗
PubMed1998

Flucloxacillin in the treatment of atopic dermatitis.

Although colonization of atopic dermatitis by Staphylococcus aureus is universal and bacterial infection is common, it is not known whether antibiotic therapy is helpful in eczematous children who do not have any signs suggestive of bacterial infection. Fifty children aged 1-16 years with atopic dermatitis took part in a randomized double-blind placebo-controlled study of 4 weeks treatment with oral flucloxacillin, with an 8-week follow-up period. The change in the mean of the log10 of the counts/cm2 of S. aureus after 4 weeks of treatment was significantly different for patients receiving treatment, compared with the change for those receiving the placebo (P = 0.008). However, the difference in the change at 14 days after stopping treatment was not significant (P = 0.32). Methicillin-resistant strains of S. aureus were cultured from five children during or after treatment. Flucloxacillin did not improve the symptoms or clinical appearance of atopic dermatitis and only temporarily changed skin colonization by S. aureus.

Adolescent↗
PubMed1998

Side to side comparison of topical treatment in atopic dermatitis.

OBJECTIVES: To document and evaluate the outcome of side to side comparisons of different corticosteroids in determining the most effective topical treatment for individuals admitted to hospital for control of atopic dermatitis. METHODS: Retrospective case note study of 82 admissions (66 children) to a children's hospital for treatment of atopic dermatitis between 1 June 1993 and 31 October 1995. Different topical corticosteroid ointments were applied to the two sides of the body. The outcome measure was a comparison between the two sides, to see whether one treatment was better than the other. RESULTS: More potent topical corticosteroid preparations appeared more effective than weaker preparations on 25 occasions, there was no difference on 20 occasions, and on seven occasions a weaker preparation appeared more effective. Incorporation of an antimicrobial agent did not appear to increase the efficacy of a preparation. CONCLUSIONS: The management of atopic dermatitis is bedevilled by considerable spontaneous fluctuations in severity, leading to uncertainty as to whether a new treatment is beneficial; a coincidental flare up of the skin lesions may be wrongly attributed to a particular treatment, which is then discarded. Comparing different topical treatments simultaneously on opposite sides of the body is a feasible and rational way to determine the optimum treatment for an individual with atopic dermatitis.

Administration, Topical↗
PubMed1998

Linear growth in prepubertal children with atopic dermatitis.

OBJECTIVE: To define the evolution of prepubertal growth in atopic dermatitis and the factors influencing that growth pattern. METHODS: Height and height velocity over two years, weight, triceps and subscapular skin fold thickness, and bone age were assessed in 80 prepubertal patients with atopic dermatitis and a control group of 71 healthy prepubertal school children. RESULTS: Height standard deviation scores (SDS) and height velocity SDS did not differ between patients and controls, and were not influenced by body surface area affected by atopic dermatitis, topical glucocorticoid potency, or coexisting asthma. However, height SDS (r = -0.37) and height velocity SDS (r = -0.31) correlated inversely to age in patients but not in controls. A greater proportion (z = 2.84) of patients than controls had year 2 height velocity SDS less than -1.96. Patients had a mean delay in bone age of 0.22 years and 0.41 years at the beginning of year 1 and year 2 of the study, respectively. The delay in bone age correlated positively with age (r = 0.39) and duration of atopic dermatitis (r = 0.39), and negatively with height SDS (r = -0.51) and height velocity SDS (r = -0.38). CONCLUSIONS: Prepubertal children with atopic dermatitis are not short compared with controls. However, as they approach the teenage years their height velocity decreases, the proportion of children with extremely low height velocity increases, and the delay in bone age increases. These features are consistent with the pattern of growth seen in people with constitutional growth delay.

Administration, Topical↗
PubMed1998

Exacerbation of atopic dermatitis after bacillus Calmette-Guérin vaccination.

In two children with atopic dermatitis, routine vaccination with bacillus Calmette-Guérin (BCG) was followed by severe exacerbation of skin disease. If the sequence is cause and effect, a possible mechanism is stimulation of a Th2 lymphocyte cytokine profile by the vaccine, with migration of activated lymphocytes to inflamed skin. In children with active atopic dermatitis, BCG vaccination is best deferred until remission.

Age Factors↗
PubMed1998

Dietary management of atopic eczema: is this justified?

The role of food allergens in triggering atopic eczema remains controversial. Certain foods can cause acute hypersensitivity reactions, which are more common in atopic individuals, but this does not necessarily imply that these allergens cause or trigger eczema. This article discusses the evidence for and against dietary intervention as a treatment for patients with atopic eczema.

Allergens↗