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Background: The relationship between asthma severity and atopy is complex. Many studies have failed to show significant relationships between clinical severity or lung function and markers of atopic sensitisation. Aim: To determine whether increasing asthma severity is related to atopic sensitisation in a population of children with asthma. Methods: A total of 400 children (7–18 years) with asthma were recruited as part of a multicentre study of the genetics of asthma. Detailed phenotypic data were collected on all participants. Associations between measures of asthma severity and atopic sensitisation were sought using multilevel models allowing variation at the individual and family level. Results: Children recruited to the study had a range of asthma severities, with just over a third having mild persistent asthma. The logarithm of total serum IgE was associated with increased asthma severity score, decreased FEV1, increased airways obstruction, risk of hospital admission, and inhaled steroid use. Increasing skin prick test reactivity to a panel of seven aeroallergens was associated with increased risk of hospital admission, use of an inhaled steroid, and airways obstruction. The results remained highly significant after corrections for age, gender, and birth order. Conclusions: In children with asthma, increasing atopy is associated with increasing asthma severity. However, the relationships between asthma severity and skin prick tests, and asthma severity and total serum IgE values, appear subtly different. [ABSTRACT FROM AUTHOR]

Background: Despite national guidelines for asthma treatment, many children have troublesome symptoms. Aim: To assess the extent to which the use of inappropriate inhaler devices contributes to this problem. Methods: Of 14 81 3 questionnaires distributed to schoolchildren, 6996 (47%) were returned identifying 1444 children using asthma inhalers. Inhalers were categorized as age appropriate or inappropriate according to national guidelines and were compared with those used by 75 patients attending a hospital clinic. Results: A total of 35% of "schools" and 4% of "clinic" children reported using an inappropriate inhaler device. Most were using metered dose inhalers alone. Twenty four per cent of "schools" children ⩽5 years old did not use a spacer. Both children and parents overestimated the child's ability to use their inhaler. Conclusions: Large numbers of children are given inhalers they cannot use. To improve asthma care we must ensure that prescriptions reflect the age and ability of the child. Recent recommendations by the Department of Health in England and Wales stress the importance of seamless care between primary and secondary services. As the management of childhood asthma is guided primarily by secondary care providers, it is therefore imperative that general pediatricians know the difficulties and issues which are occurring in the community. This will enable them to lead and support necessary change. [ABSTRACT FROM AUTHOR]

Presents a study on the diagnosis and management of scalp ringworm in England. History of scalp ringworn, or tinea capitis, in Great Britain; Resurgence of cases over the past several years in Great Britain, Europe, and North America; Suggestions for diagnosis and management of the epidemic.

Introduction NICE guidelines recommend a Mantoux threshold of 15 mm induration to trigger investigation for tuberculosis (TB), with IGRA tests used as second line in selected groups. Little data are available about the role of the two tests in the diagnosis of active TB. Emerging evidence suggests IGRA tests may be more sensitive in identifying TB infection in children. Aim To explore the relationship between Mantoux and IGRA in children attending a paediatric TB clinic in Manchester. Hypothesis A Mantoux threshold of ≥15 mm induration under-estimates TB infection in children. Method All children aged 0-17 years referred to the TB service at Central Manchester Foundation Trust between Jan 2009 and May 2011 were included. Initial screening included symptom review and Mantoux testing. Based on induration at 48-72 h, Mantoux tests were defined as negative <6 mm or positive ≥6 mm for those with no prior BCG, and negative <10 mm, borderline 10 to ≥15 mm or positive ≥15 mm for those with prior BCG. Children with borderline or positive Mantoux test results, or in whom there was clinical concern, were referred for consultant assessment and/or IGRA (Quantiferon Gold). Data were collected retrospectively from case notes. Results 976 children were referred. 756 completed initial assessment (388 (51%) male, mean age 6.2±4.6 years, range 0.16-16.36 years). BCG history was known in 754 (99.7%; 516 BCG). 403 patients were discharged without intervention, 63 were offered BCG vaccination, two were referred elsewhere and 288 were referred for consultant assessment. Of these 288, 108 were notified with TB, 46 received chemoprophylaxis, 117 received no treatment, 5 received BCG and 12 failed to attend. 252 children had paired Mantoux and IGRA. Of these, 18/44 (41%) of those with a borderline Mantoux had a positive IGRA. 126/252 had TB infection (91 active and 35 latent TB)--see Abstract P175 table 1. A Mantoux threshold of ≥15 mm identified 77 (61%) children with TB infection, IGRA identified 92 (73%) and the two tests combined identified 100 (79%) children. Conclusion Using a Mantoux threshold of ≥15 mm induration significantly underestimates the number of children with TB infection compared with using Mantoux and IGRA together. [ABSTRACT FROM AUTHOR]

Reports a case in which cutaneous metastases from a melanoma imitated herpes zoster, a presentation known as zosteriform metastasis, which also occurs with other neoplasms. Percentages of metastases from all primary neoplasms and from malignant melanoma which involve the skin; Case report of an aged man who presented with painful, pruritic vesicles on the background of erythema on the right frontal area of the scalp; Observation that the most common primary sources of malignant tumors of the skin are the breast, stomach, lung, and uterus; Theory that herpes zoster might induce infiltration of malignant cells in a Koebner-like phenomenon; Value of histological examination in the management of skin lesions which do not respond to treatment.

Focuses on family genetic studies. Requirements in conducting family genetic studies; Aetiology of non-participation of families; Common reasons for non-recruitment of certain families.

Background Tuberculosis cases in Greater Manchester (GM) have increased annually since 2004. The Paediatric TB clinic at Royal Manchester Children's Hospital has grown since its inception in 2004, but it is unclear as to whether this is due to a true increase in cases or a change in referral patterns. At the same time the uptake of BCG vaccine is sub-optimal. Objectives To investigate the incidence, epidemiology and BCG vaccination eligibility and status of childhood tuberculosis cases in GM between 2006 and 2010. Methods All children (≤16 years) notified through the Enhanced Tuberculosis Surveillance System between 1 January 2006 and 31 December 2010 were identified. Vaccination records were obtained from Primary Care Child Health Systems. Missing data were supplemented with examination of case-notes. Eligibility for BCG vaccine was determined by place of birth and ethnicity. Results 215 children (89 male; mean age 8.8 years) were notified over the 5 years. A rise of 64.5% in overall number of cases was reported from 2006 to 2010. Pakistanis comprised 39.1% of TB cases, Black Africans 28.8% and white British 14.9%. The majority of children were UK-born (60.5%). Of non-UK born cases 67.1% entered the UK within 2 years of their diagnosis. Of 130 UK-born children, 111 were deemed eligible for BCG vaccination. Of these 85 (75.6%) received the vaccine. Of 85 children born outside the UK, vaccination status could not be determined in 8, and one child was ineligible for vaccination. Vaccination was confirmed in 53% of non-UK born children (BCG record or BCG scar). In children who had not received BCG, although the number of cases was very small, a threefold higher risk of more severe forms of infection (military, CNS involvement) was identified. Conclusion There has been a significant rise in incidence of Paediatric TB in GM over the last 5 years. The reason for this remains unclear. However, BCG vaccination uptake rates were poor (75% of UK born individuals and 67% overall). Systems for identifying eligible children and immunising them need to be reviewed and strengthened both for high risk neonates and children entering the country. [ABSTRACT FROM AUTHOR]