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  • 1
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    Dysfunctional Bronchial Cilia Are a Feature of Chronic Obstructive Pulmonary Disease (COPD)
    Informa UK Limited ; 2021
    In:  COPD: Journal of Chronic Obstructive Pulmonary Disease Vol. 18, No. 6 ( 2021-11-02), p. 657-663
    Details
    In: COPD: Journal of Chronic Obstructive Pulmonary Disease, Informa UK Limited, Vol. 18, No. 6 ( 2021-11-02), p. 657-663
    Type of Medium: Online Resource
    ISSN: 1541-2555 , 1541-2563
    URL: Article
    DOI: 10.1080/15412555.2021.1963695
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2178243-X
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  • 2
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    A real-life comparative effectiveness study into the addition of antibiotics to the management of asthma exacerbations in primary care
    European Respiratory Society (ERS) ; 2021
    In:  European Respiratory Journal Vol. 58, No. 1 ( 2021-07), p. 2003599-
    Details
    In: European Respiratory Journal, European Respiratory Society (ERS), Vol. 58, No. 1 ( 2021-07), p. 2003599-
    Abstract: Asthma exacerbations are major contributors to asthma morbidity and mortality. They are usually managed with bronchodilators and oral corticosteroids (OCS), but clinical trial evidence suggests that antibiotics could be beneficial. We aimed to assess whether treatment of asthma exacerbations with antibiotics in addition to OCS improved outcomes in larger, more representative routine-care populations. Method A retrospective comparative effectiveness study into managing asthma exacerbations with OCS alone versus OCS plus antibiotics was conducted using the Optimum Patient Care Research Database. The dataset included 28 637 patients; following propensity score matching 20 024 adults and 4184 children were analysed. Results Antibiotics in addition to OCS were prescribed for the treatment of asthma exacerbations in 45% of adults and 32% of children. Compared to OCS alone, OCS plus antibiotics was associated with reduced risk of having an asthma/wheeze consultation in the following 2 weeks (children hazard ratio (HR) 0.84 (95% CI 0.73–0.96), p=0.012; adults HR 0.86 (95% CI 0.81–0.91), p 〈 0.001), but an increase in risk of a further OCS prescription for a new/ongoing exacerbation within 6 weeks in adults (HR 1.11 (95% CI 1.01–1.21), p=0.030), but not children. Penicillins, but not macrolides, were associated with a reduction in the odds of a subsequent asthma/wheeze consultation compared to OCS alone, in both adults and children. Conclusion Antibiotics were frequently prescribed in relation to asthma exacerbations, contrary to guideline recommendations. Overall, the routine addition of antibiotics to OCS in the management of asthma exacerbations appeared to confer little clinical benefit, especially when considering the risks of antibiotic overuse.
    Type of Medium: Online Resource
    ISSN: 0903-1936 , 1399-3003
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1183/13993003.03599-2020
    DOI: 10.1183/13993003.03599-2020.Supp1
    DOI: 10.1183/13993003.03599-2020.Shareable1
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2021
    detail.hit.zdb_id: 2834928-3
    detail.hit.zdb_id: 1499101-9
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  • 3
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    Role of maternal tryptophan metabolism in allergic diseases in the offspring
    Wiley ; 2021
    In:  Clinical & Experimental Allergy Vol. 51, No. 10 ( 2021-10), p. 1346-1360
    Details
    In: Clinical & Experimental Allergy, Wiley, Vol. 51, No. 10 ( 2021-10), p. 1346-1360
    Abstract: Nicotinamide (vitamin B3) is a metabolite of tryptophan and dietary precursor of enzymes involved in many regulatory processes, which may influence fetal immune development. Objective We examined whether maternal plasma concentrations of nicotinamide, tryptophan or nine related tryptophan metabolites during pregnancy were associated with the risk of development of infant eczema, wheeze, rhinitis or allergic sensitization. Methods In the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study, we analysed the associations between maternal plasma levels of nicotinamide, tryptophan and tryptophan metabolites at 26–28 weeks of gestation and allergic outcomes collected through interviewer‐administered questionnaires at multiple time‐points and skin prick testing to egg, milk, peanut and mites at age 18 months. Multivariate analysis was undertaken adjusting for all metabolites measured and separately adjusting for relevant demographic and environmental exposures. Analyses were also adjusted for multiple comparisons using the false discovery method. Results Tryptophan metabolites were evaluated in 976/1247 (78%) women enrolled in GUSTO. In multivariate analysis including all metabolites, maternal plasma 3‐hydrokynurenine was associated with increased allergic sensitization at 18 months (AdjRR 2.6, 95% CI 1.3–5.2 for highest quartile) but the association with nicotinamide was not significant (AdjRR 1.8, 95% CI 0.9–3.6). In analysis adjusting for other exposures, both 3‐hydrokynurenine and nicotinamide were associated with increased allergic sensitization (AdjRR 2.0, 95% CI 1.1–3.6 for both metabolites). High maternal plasma nicotinamide was associated with increased infant eczema diagnosis by 6 and 12 months, which was not significant when adjusting for all metabolites measured, but was significant when adjusting for relevant environmental and demographic exposures. Other metabolites measured were not associated with allergic sensitization or eczema, and maternal tryptophan metabolites were not associated with offspring rhinitis and wheeze. Conclusions and Clinical Relevance Maternal tryptophan metabolism during pregnancy may influence the development of allergic sensitization and eczema in infants.
    Type of Medium: Online Resource
    ISSN: 0954-7894 , 1365-2222
    URL: Issue
    URL: Article
    DOI: 10.1111/cea.v51.10
    DOI: 10.1111/cea.13953
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2186232-1
    detail.hit.zdb_id: 2004469-0
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  • 4
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    Nutritional status, intake, and outcomes in critically ill children with bronchiolitis
    Wiley ; 2020
    In:  Pediatric Pulmonology Vol. 55, No. 5 ( 2020-05), p. 1199-1206
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 55, No. 5 ( 2020-05), p. 1199-1206
    Abstract: Optimal nutrition in children with severe bronchiolitis remains poorly described. We aimed to describe nutritional status and practices in children with severe bronchiolitis requiring admission to the pediatric intensive care unit (PICU), and explore their associations with outcomes. Methods We conducted a retrospective study on patients with bronchiolitis requiring PICU stay from 2009 to 2014. Demographics, medical data, and baseline weight‐for‐length Z‐scores (WLZ) were collected. In patients requiring more than 48 hours of PICU stay, nutritional intake data in the first 3 days of PICU stay were collected. Underfeeding and overfeeding were defined as the median energy intake of less than 80% and more than 120% of requirements, respectively. Protein adequacy was defined as intake of more than 1.5 g/kg/d. Primary and secondary outcomes of interest were the duration of PICU stay and mechanical ventilation (MV), respectively. Results Seventy‐four patients were included, with a median PICU stay of 4.9 days (interquartile range 2.0‐8.2). Low WLZ at baseline was associated with longer duration of PICU stay (adjusted β : 4.33 [95% confidence interval [CI], 0.49‐8.18] ; P  = .028) and MV days (adjusted β : 4.87 [95% CI, 1.56‐8.18]; P  = .008) compared to appropriate WLZ. In patients with ≥48 hours PICU stay, protein adequacy was significantly associated with greater PICU (adjusted β coefficient, 6.35 [95% CI, 1.66‐11.0]; P  = .009) and MV days (adjusted β coefficient, 5.22 [95% CI, 1.06‐9.38]; P  = .015). Conclusion Among bronchiolitis patients admitted to the PICU, low WLZ at admission was associated with a longer duration of PICU stay and MV. Protein adequacy was associated with longer PICU and MV days in children with ≥48 hours of PICU stay.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v55.5
    DOI: 10.1002/ppul.24701
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1491904-7
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  • 5
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    Nasal high‐mobility group box 1 and caspase in bronchiolitis
    Wiley ; 2018
    In:  Pediatric Pulmonology Vol. 53, No. 12 ( 2018-12), p. 1627-1632
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 53, No. 12 ( 2018-12), p. 1627-1632
    Abstract: Nasal biomarkers have potential to add objectivity to the clinical assessment of the child with bronchiolitis. We aim to study, if nasal caspase and high‐mobility group box 1 protein (HMGB1) levels differ between patients who were hospitalized and those discharged from the emergency department (ED), among patients with bronchiolitis. Methods Using an observational cross‐sectional study design, we recruited patients younger than 24 months presenting to the ED from September 1, 2015 to May 31, 2017 with a diagnosis of acute bronchiolitis. We described the patients’ clinical severity measured by the modified respiratory index score (RIS), and performed standardized collection and analysis of nasal caspase and HMGB1 levels. Results Among 85 patients recruited, the median age was 5.0 months (interquartile range, IQR 3.3‐7.2) and the median modified RIS score was 3 (IQR 2‐4). Hospitalized patients had a 2.4‐fold higher HMGB1 level than patients who were discharged from the ED (2.558 μg/mL [IQR 1.038‐5.125] vs 1.056 μg/mL [IQR 0.409‐2.395] , P  = 0.0013). There was no difference in median caspase level between hospitalized and discharged patients. The Area Under the Receiver Operating Characteristics curve predicting hospitalization was 0.7021 for HMGB1 compared to 0.5709 for RIS in this bronchiolitis cohort. Conclusions Our study findings show that nasal HMGB1 levels significantly differentiate between young children with bronchiolitis who were hospitalized compared to those fit for discharge. This exploratory study holds potential for future research on nasal HMGB1 for severity stratification in young children with acute bronchiolitis.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v53.12
    DOI: 10.1002/ppul.24183
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1491904-7
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  • 6
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    Concordance between bronchial hyperresponsiveness, fractional exhaled nitric oxide, and asthma control in children
    Wiley ; 2016
    In:  Pediatric Pulmonology Vol. 51, No. 10 ( 2016-10), p. 1004-1009
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 51, No. 10 ( 2016-10), p. 1004-1009
    Abstract: Previous studies on association between level of asthma control, markers of airway inflammation and the degree of bronchial hyperresponsiveness (BHR) have yielded conflicting results. Our aim was to determine the presence and severity of BHR and the concordance between BHR, asthma control, and fractional exhaled nitric oxide (FeNO) in children with asthma on therapy. Methods In this cross‐sectional observational study, children (aged 6–18 years) with asthma on British Thoracic Society (BTS) treatment steps 2 or 3, underwent comprehensive assessment of their asthma control (clinical assessment, spirometry, asthma control test [ACT], Pediatric Asthma Quality of Life Questionnaire [PAQLQ] ), measurement of FeNO and BHR (using mannitol dry powder bronchial challenge test [MCT], Aridol™, Pharmaxis, Australia). Results Fifty‐seven children (63% male) were studied. Twenty‐seven children were on BTS treatment step 2 and 30 were on step 3. Overall, 25 out of 57 (43.8%) children had positive MCT. Of note, 9 out of 27 (33.3%) children with clinically controlled asthma had positive MCT. Analyses of pair‐wise agreement between MCT (positive or negative), FeNO ( 〉 25 or ≤25 ppb) and clinical assessment of asthma control (controlled or partially controlled/uncontrolled) showed poor agreement between these measures. Conclusions A substantial proportion of children with asthma have persistent BHR despite good clinical control. The concordance between clinical assessment of asthma control, BHR and FeNO was observed to be poor. Our findings raise concerns in the context of emerging evidence for the role of bronchoconstriction in inducing epithelial stress that may drive airway remodeling in asthma. Pediatr Pulmonol. 2016;51:1004–1009. © 2016 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v51.10
    DOI: 10.1002/ppul.23426
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 1491904-7
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  • 7
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    Allergic rhinitis and non‐allergic rhinitis in children in the tropics: Prevalence and risk associations
    Wiley ; 2012
    In:  Pediatric Pulmonology Vol. 47, No. 10 ( 2012-10), p. 1026-1033
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 47, No. 10 ( 2012-10), p. 1026-1033
    Abstract: The age‐related comparative prevalence of allergic rhinitis (AR) and non‐allergic rhinitis (NAR) in children is poorly defined. We aimed to characterize AR and NAR in children. Methods This study enrolled children with chronic rhinitis who presented to a tertiary paediatric center for a diagnostic skin prick test (SPT). Parents completed a medical history questionnaire for their child, including disease activity for asthma and rhinitis. Sociodemographic data was obtained and all participants underwent a common inhalant SPT panel. A positive SPT indicated AR. Results From March 2001 to March 2009, 6,660 children (64% male) were enrolled (aged 6 months to 19 years, mean 7.82 years). Only 3.7% (249) of the children were 〈 2 years old, and almost 30% of these had AR. Most children with AR (73%) presented after age 6. Males were more likely to have AR (vs. NAR) (OR 1.5; CI 1.39–1.77). Antihistamine and salbutamol use did not differ between children with AR and NAR. Children with AR were more likely to require adjunct therapy with inhaled corticosteroids (51.2% vs. 43.2%, P   〈  0.001), have drug hypersensitivity (especially antipyretic drugs) (2.5% vs. 1.3%, P  = 0.384) or an asthma admission (9.1% vs. 6.0%, P   〈  0.001). Conclusions AR is more common in male children, is relatively rare below the age of 2 years, and accounts for two‐thirds of all childhood chronic rhinitis and 73.3% of all chronic rhinitis in school‐aged children (≥6 years old). Children with AR have more severe rhinitis symptoms and more often suffer from asthma‐related events and admissions. Pediatr Pulmonol. 2012. 47:1026–1033. © 2012 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v47.10
    DOI: 10.1002/ppul.22554
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 1491904-7
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  • 8
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    Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore
    Springer Science and Business Media LLC ; 2020
    In:  BMC Pediatrics Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Pediatrics, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. Methods We performed a retrospective review of ED attendances and hospital admissions among children 〈  18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). Results We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline ( p   〈  0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p   〈  0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p   〈  0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p   〈  0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p  〈  0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p   〈  0.001). Conclusions We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.
    Type of Medium: Online Resource
    ISSN: 1471-2431
    URL: Article
    DOI: 10.1186/s12887-020-02469-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041342-7
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  • 9
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    Combination of slide tracheoplasty and side-to-side bronchoplasty for complex congenital tracheobronchial stenosis
    Oxford University Press (OUP) ; 2021
    In:  Interactive CardioVascular and Thoracic Surgery Vol. 33, No. 1 ( 2021-06-28), p. 155-157
    Details
    In: Interactive CardioVascular and Thoracic Surgery, Oxford University Press (OUP), Vol. 33, No. 1 ( 2021-06-28), p. 155-157
    Abstract: Congenital tracheal stenosis is a rare but serious condition with high mortality and morbidity. We present a 6-month-old patient with complex congenital tracheal stenosis involving the trachea, carina and right bronchus intermedius, which was corrected with a combination of slide tracheoplasty and side-to-side bronchoplasty.
    Type of Medium: Online Resource
    ISSN: 1569-9285
    URL: Article
    DOI: 10.1093/icvts/ivab058
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2096257-5
    detail.hit.zdb_id: 3167862-2
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  • 10
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    An Infant Formula with Large, Milk Phospholipid-Coated Lipid Droplets Supports Adequate Growth and Is Well-Tolerated in Healthy, Term Asian Infants: A Randomized, Controlled Double-Blind Clinical Trial
    MDPI AG ; 2022
    In:  Nutrients Vol. 14, No. 3 ( 2022-02-01), p. 634-
    Details
    In: Nutrients, MDPI AG, Vol. 14, No. 3 ( 2022-02-01), p. 634-
    Abstract: Lipids are essential for healthy infant growth and development. The structural complexity of lipids in human milk is not present in infant milk formula (IF). A concept IF was developed mimicking more closely the structure and composition of human milk fat globules. The current study evaluates whether a concept IF with large, milk phospholipid-coated lipid droplets (mode diameter 3 to 5 μm) is equivalent to standard IF with regard to growth adequacy and safety in healthy, term Asian infants. In this randomized, double-blind, controlled trial, infants were randomized after parents decided to introduce formula. Infants received a standard IF with (Control) or without the specific prebiotic mixture scGOS/lcFOS (9:1 ratio; Control w/o prebiotics), or a Concept IF with large, milk phospholipid-coated lipid droplets and the prebiotic mixture. A group of 67 breastfed infants served as a reference. As a priori defined, only those infants who were fully intervention formula-fed ≤28 days of age were included in the equivalence analysis (Control n = 29; Control w/o prebiotics n = 28; Concept n = 35, per-protocol population). Primary outcome was daily weight gain during the first four months of life, with the difference between the Concept and Control as the key comparison of interest. Additionally, adverse events, growth and tolerance parameters were evaluated. Equivalence of daily weight gain was demonstrated between the Concept and Control group after additional correction for ethnicity and birthweight (difference in estimated means of 0.1 g/d, 90%CI [−2.30, 2.47]; equivalence margin +/− 3 g/d). No clinically relevant group differences were observed in secondary growth outcomes, tolerance outcomes or number, severity or relatedness of adverse events. This study corroborates that an infant formula with large, milk phospholipid-coated lipid droplets supports adequate growth and is well tolerated and safe for use in healthy infants.
    Type of Medium: Online Resource
    ISSN: 2072-6643
    URL: Article
    DOI: 10.3390/nu14030634
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2518386-2
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