Respiratory virus infections in decedents in a large, urban medical examiner's office.

OBJECTIVE: Most respiratory virus surveillance relies on medically attended respiratory illness, but an understanding of the true patterns of infection independent of care-seeking behaviour would enhance clinical and public health responses to respiratory virus outbreaks. We evaluated the potential of decedent surveillance by estimating the burden of respiratory virus infection in decedents in a large, urban medical examiner's office. STUDY DESIGN: Observational. METHODS: In 2020-2022, we tested nasopharyngeal swabs from 4121 decedents in Detroit, Michigan for 15 respiratory viruses, including SARS-CoV-2, respiratory syncytial virus, and influenza virus A and B. We analysed infection prevalence over time and by age, sex, race/ethnicity, and manner of death. RESULTS: Of 4113 valid tests, 30.2% were positive for at least one virus, and 6.1% were positive for multiple viruses. All viruses were detected except for influenza A/H1N1 and influenza B. The most prevalent viruses were SARS-CoV-2 (15.7%), rhinovirus (11.2%), and adenovirus (4.9%), which were detected in all months. Most viruses exhibited decreasing prevalence with age, higher prevalence among Black and Hispanic than among White decedents and lower prevalence among deaths from natural causes; SARS-CoV-2 was a notable exception to the patterns by age and manner of death, instead reflecting community trends in catchment counties. CONCLUSIONS: There was high prevalence and diversity of respiratory viruses in decedents entering a large, urban medical examiner's office. Decedent surveillance could offer a clearer picture of the true underlying burden of infection, motivating public health priorities for intervention and vaccine development, and augmenting data for real-time response to respiratory virus outbreaks.

A 380-kb Duplication in 7p22.3 Encompassing the LFNG Gene in a Boy with Asperger Syndrome.

De novo genomic aberrations are considered an important cause of autism spectrum disorders. We describe a de novo 380-kb gain in band p22.3 of chromosome 7 in a patient with Asperger syndrome. This duplicated region contains 9 genes including the LNFG gene that is an important regulator of NOTCH signaling. We suggest that this copy number variation has been a contributive factor to the occurrence of Asperger syndrome in this patient.

The Dynamic Anaerobic Reactor & Integrated Energy System (DARIES) model: model development, validation, and sensitivity analysis.

The Dynamic Anaerobic Reactor & Integrated Energy System (DARIES) model has been developed as a biogas and electricity production model of a dairy farm anaerobic digester system. DARIES, which incorporates the Anaerobic Digester Model No. 1 (ADM1) and simulations of both combined heat and power (CHP) and digester heating systems, may be run in either completely mixed or plug flow reactor configurations. DARIES biogas predictions were shown to be statistically coincident with measured data from eighteen full-scale dairy operations in the northeastern United States. DARIES biogas predictions were more accurate than predictions made by the U.S. AgSTAR model FarmWare 3.4. DARIES electricity production predictions were verified against data collected by the NYSERDA DG/CHP Integrated Data System. Preliminary sensitivity analysis demonstrated that DARIES output was most sensitive to influent flow rate, chemical oxygen demand (COD), and biodegradability, and somewhat sensitive to hydraulic retention time and digester temperature.

Airway obstruction at time of symptoms prompting use of reliever therapy in children with asthma.

BACKGROUND: In asthma treatment, doses of inhaled corticosteroids are often adapted to symptoms and need for bronchodilators. However, in cross-sectional studies in emergency room settings, lung function and respiratory symptoms are not always concordant. Available longitudinal data are based on written peak flow diaries, which are unreliable. Using home spirometry, we studied prospectively whether mild respiratory symptoms, prompting reliever therapy are accompanied by a clinically relevant drop in lung function in children with asthma. METHODS: For 8 weeks, children with asthma scored symptoms and measured peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV(1)) on a home spirometer twice daily. Additional measurements were recorded when respiratory symptoms prompted them to use bronchodilators. RESULTS: The mean difference between symptom free days and at times of symptoms was 6.6% of personal best for PEF (95% CI: 3.2-10.0; p = 0.0004) and 6.0% of predicted for FEV(1) (95% CI: 3.0-9.0; p = 0.0004). There was complete overlap in PEF and FEV(1) distributions between symptom free days and at times of symptoms. CONCLUSIONS: Although statistically significant, the degree of airway narrowing at times of respiratory symptoms, prompting the use of reliever therapy, is highly variable between patients, limiting the usefulness of home spirometry to monitor childhood asthma.

[Treatment of asthma in children: revised international guidelines not suitable for use in the Netherlands]. / Behandeling van astma bij kinderen: herziene internationale richtlijnen niet geschikt voor gebruik in Nederland.

The most recent revision of the Global Initiative for Asthma (GINA) guidelines for the treatment of asthma propose to classify and monitor the disease based on asthma control. This concept is attractive but not evidence based. Based on methodological shortcomings the revised GINA guidelines fail to meet the standards for evidence-based guidelines. Inhaled corticosteroids are and remain the cornerstone of asthma management in children. Extensive explanation to children and their parents, intensive followup, and instruction of and adherence to a correct inhalation technique are key factors in effective treatment of asthma in children.

Reference values for peak flow and FEV1 variation in healthy schoolchildren using home spirometry.

Current reference values for diurnal peak flow variation in healthy children (median 8.2%; 95th percentile 31%) are so high that considerable overlap exists with those of asthmatic children. These values have been obtained using written peak flow diaries, which are unreliable. The aim of the present study was to obtain reliable reference values for the variation in peak flow and forced expiratory volume in one second (FEV(1)) in healthy schoolchildren using home spirometry with electronic data storage. Healthy schoolchildren (n = 204; 100 males) aged 6-16 yrs measured their peak flow and FEV(1) twice daily for 2 weeks using an electronic home spirometer. The variation in peak flow and FEV(1) were calculated as a diurnal amplitude as a percentage of the day's mean. The mean peak flow variation was 6.2% (95th percentile 12.3%) and the mean FEV(1) variation was 5.7% (95th percentile 11.8%). Using home spirometry with electronic data storage, healthy schoolchildren show considerably less peak flow and forced expiratory volume in one second variation than previously reported on the basis of written peak flow diaries. Being the 95th percentiles of the distributions in healthy children, a peak flow variation of 12.3% and an forced expiratory volume in one second variation of 11.8% are suggested as cut-off values for disease when using home spirometry.

[Pustular and vesicular skin eruptions in newborns]. / Puistjes en blaasjes bij pasgeborenen.

Four neonates with vesicopustular skin eruptions, 1 girl and 3 boys, were diagnosed with feeding blisters, bullous impetigo, erythema toxicum neonatorum and transient neonatal pustular melanosis, respectively. The neonate with bullous impetigo was treated with antibiotics; the remaining neonates were not treated. The neonate with transient neonatal pustular melanosis developed hyperpigmentation, whereas the other neonates recovered without sequelae. Skin lesions in neonates are common and frequently cause parental concern. Most causes of neonatal pustular and vesicular skin eruptions are benign and transient. However, some skin lesions must be recognised and treated rapidly. Therefore it is important to identify these neonatal skin eruptions based on a thorough history of the mother and child and clinical presentation. Skin culture may be helpful in some cases.

Home spirometry and asthma severity in children.

The usefulness of peak expiratory flow monitoring is disputed because of the unreliability of written peak flow diaries. The aim of the present study was to examine the relationship of peak flow and forced expiratory volume in one second (FEV1) variation to other estimates of asthma severity in children, using an electronic home spirometer with automatic data storage. Over a 3-month period, 36 children with mild-to-moderate persistent asthma recorded peak flow and FEV1 electronically twice daily and noted an asthma severity score in a written diary. Bronchial responsiveness was assessed at the beginning and bronchodilator response and asthma-specific quality of life at the end of the study. Variations in peak flow correlated significantly but weakly to bronchial responsiveness and bronchodilator response, but not to the asthma severity score or quality-of-life scores. Within-individual correlations between asthma severity scores and home spirometry indices and between peak flow and FEV1 were highly variable. In conclusion, variations in peak flow and forced expiratory volume in one second, obtained by home spirometry, show poor concordance with other indices of disease activity and with each other. This limits the usefulness of home spirometry in childhood asthma.

[Treatment of asthma in children: more than merely 'puffing']. / Astmabehandeling bij kinderen: meer dan alleen 'puffen'.

Five children, four boys aged 6, 9, 12 and 13 years and one girl aged 6 years, had persistent asthmatic symptoms despite maintenance treatment with inhaled corticosteroids and short-acting bronchodilators on demand. One of them required the addition of a long-acting beta 2-agonist to become symptom-free. The other four patients did not need to step up their asthma medication after correction of poor inhaler technique, treatment of dysfunctional breathing, treatment of allergic rhinitis, and elimination of passive cigarette-smoke exposure, respectively. All current guidelines on the treatment of asthma in children advise, in case of persistent asthmatic symptoms despite inhaled corticosteroids and short-acting bronchodilators, the addition of long-acting beta 2-agonists. However, various factors may play a role in the persistence of asthma despite adequate therapy and these factors should be evaluated before stepping up the medication.

[Perinatal pertussis: from mother to child]. / Perinatale pertussis: van moeder naar kind.

Two infants, a girl, aged four weeks, and a boy, aged three weeks, came to our attention with poor feeding and weight loss. Later the typical cough of pertussis appeared. Serological testing confirmed that both patients' mothers had recently had pertussis. One mother suffered from severe and typical coughing periods even throughout labour. Despite the vaccination program in the Netherlands, each year new-born infants with pertussis require hospitalisation. Pertussis during the neonatal period is seldom described. Adults can suffer from pertussis, even when they have been vaccinated in childhood. They then become contagious for unvaccinated infants. Pertussis during the neonatal period is an insidious disease with sometimes severe complications. If pertussis is suspected in mothers with new-born infants or pregnant women towards the end of the pregnancy, they should be treated with antibiotics to prevent pertussis in the new-born infant.