Jon Couriel

The Open University (UK) · Arts and humanities

Background A serious adverse effect of corticosteroid therapy is adrenal suppression. Our aim was to identify genetic variants affecting susceptibility to corticosteroid-induced adrenal suppression. Methods We enrolled children with asthma who used inhaled corticosteroids as part of their treatment from 25 sites across the UK (discovery cohort), a...

Background: Recurrent wheeze and breathlessness are common in people with cystic fibrosis, and bronchodilators are commonly prescribed. Despite their wide-scale and often long-term use, there is limited objective evidence about their efficacy in cystic fibrosis (CF). Objectives: To evaluate the effectiveness of inhaled bronchodilators in people wit...

Background: Children with empyema are managed at our center using a protocol-driven clinical care pathway. Chemical fibrinolysis is deployed as first-line management for significant pleural disease. We therefore examined clinical outcome(s) to benchmark standards of care while analyzing disease severity with introduction of the pneumococcal conjug...

There are no reports of the use of an integrated care pathway (ICP) to facilitate the management of pleural empyema in children. Our aim is to assess pleural empyema management in our institute, to establish an ICP and to review the impact of this on the patient journey. Data were collected about management strategies, pain control and length of ho...

Objectives Corticosteroids are known to cause adrenal suppression. The aim of this study was to assess clinical factors affecting responses to a Low Dose Short Synacthen Test (LDSST) in asthmatic children using corticosteroids.DesignPatients were recruited from secondary care paediatric asthma populations within the UK.PatientsAsthmatic children (5...

Introduction and Objectives In our centre patients are managed using a protocol-driven integrated-care pathway. Intra-pleural urokinase is administered via a fine bore chest-drain as primary therapy for significant pleural disease. We analysed patient outcomes with this approach to benchmark standards of care whilst examining patterns of disease se...

Rationale: Mutations in genes encoding proteins important in the function and metabolism of pulmonary surfactant are recognized causes of lung disease. Clinical genetic testing is available for these disorders, but children with phenotypes consistent with surfactant dysfunction and no identifiable mutations in the known causative genes have been r...

To examine serum cortisol responses to a simplified low dose short Synacthen test (LDSST) in children treated with inhaled corticosteroids (ICS) for asthma and to compare these to early morning salivary cortisol (EMSC) and cortisone (EMSCn) levels. EMSC and EMSCn samples were collected for three consecutive days. On day three Synacthen 500ng/1.73m(...

Recent developments in the techniques available to measure lung function in children have greatly improved our understanding of lung development in both health and disease. In everyday clinical practice, lung function tests can provide objective information about the severity and progression of disease and the response to treatment. Although spirom...

Oesophageal atresia-tracheo-oesophageal fistula has featured in paediatric surgery since its beginnings. The first successful primary repair was in 1941. With overall survival now exceeding 90% in dedicated centres, the emphasis has changed to reducing morbidity and achieving improvements in the quality of life. An overview of current and emerging...

Recent research has greatly improved our understanding of the pathophysiology of pulmonary hypertension. There is increasing recognition that pulmonary hypertension is an important complication of many childhood respiratory diseases including cystic fibrosis, interstitial lung diseases, upper airways obstruction and disorders of the respiratory mus...

Childhood mortality has decreased markedly over the last three decades. A study was undertaken to determine trends in deaths from respiratory illness in children in England and Wales. Mortality data collected by the Office for National Statistics were analysed. The data included all deaths registered from all causes in children aged between 28 days...

People with cystic fibrosis are often given drugs to open up their airways when they are breathless or wheezy. The drugs are given either by metered dose inhalers or nebulisers. We looked at how well these drugs worked in both children and adults. We included 18 trials in the review. Some of these used beta-2 agonist bronchodilators and some used a...

Cardio-pulmonary manifestations of systemic lupus erythematosus (SLE) are well recognized in adults. We report the occurrence of clinically significant cardio-pulmonary disease in a cohort of predominantly Caucasian children with SLE. All children with SLE attending the Royal Liverpool Children's NHS Trust between 1995 and 2003 were reviewed. Of 29...

Recent developments in the techniques available to measure lung function in children have greatly improved our understanding of lung development in both health and disease. In everyday clinical practice, lung function tests can provide objective information about the severity and progression of disease and the response to treatment. Although spirom...

The aim of the present study was to determine the economic impact in the UK of wheezing disorders in preschool children. Health, societal and family-borne costs were calculated for a sample of 94 preschool children who attended hospital with a primary diagnosis of wheeze or asthma during 1998/1999. Sample costs were calculated using data from a str...

The care of adolescents with asthma has been largely neglected, yet adolescents have particular needs that differ from those of children or adults with asthma. There are over 800,000 teenagers in the UK who suffer from asthma and underdiagnosis and poor treatment are common. The prevalence and level of morbidity from asthma in adolescents are as hi...

Asthma continues to be a common childhood chronic illness managed principally in primary care. Self-management requires co-ordinated efforts of young people, carers and health professionals. Non-compliance occurs even when parents are supervising care, suggesting that decisions are made on the basis of beliefs that contrast with professional advice...

Background: Asthma continues to be a common childhood chronic illness managed principally in primary care. Self-management requires co-ordinated efforts of young people, carers and health professionals. Non-compliance occurs even when parents are supervising care, suggesting that decisions are made on the basis of beliefs that contrast with profess...

The child with recurrent chest infections presents the clinician with a difficult diagnostic challenge. Does the child have a simply-managed cause for their symptoms, such as recurrent viral respiratory infections or asthma, or is there evidence of a more serious underlying pathology, such as bronchiectasis? Many different disorders present in this...

The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze. A prospective, randomised, partially blinded, controlled trial was designed at two secondary care centres. Over a 13 month per...

This is the protocol for a review and there is no abstract. The objectives are as follows: The aims of this review are to: 1. Evaluate the effectiveness of inhaled bronchodilators in children and adults with cystic fibrosis 2. If bronchodilators are shown to be effective, to assess which drug and dosage regimen are most effective and to identify th...

Symptomatic adrenal insufficiency, presenting as hypoglycaemia or poor weight gain, may occur on withdrawal of corticosteroid treatment but has not previously been reported during inhaled corticosteroid treatment. This case series illustrates the occurrence of clinically significant adrenal insufficiency in asthmatic children while patients were on...

Many children experience uncontrolled symptoms or inappropriate, ineffective treatment because of the over- and underdiagnosis of asthma. Keys to accurate diagnosis are good clinical history and awareness of other causes of respiratory symptoms that can mimic asthma.

Aim: To discern the availability of the Internet to patients attending clinics and surgeries in North Manchester General Hospital, UK. Method: A multidisciplinary group designed a questionnaire to be distributed to patients attending the authors' clinics between each October and November for five years. Results: The data from 1998 and 1999 are...

Aim: To discern the availability of the Internet to patients attending clinics and surgeries in North Manchester General Hospital, UK. Method: A multidisciplinary group designed a questionnaire to be distributed to patients attending the authors' clinics between each October and November for five years. Results: The data from 1998 and 1999 are pres...

Certainty about the extent to which bronchiolitis causes wheeze remains elusive. Children who wheeze after bronchiolitis may have pre-existing airway abnormalities but it is possible that infection with RSV causes further damage. The host's immune response and the immunogenicity of the virus itself have important roles in determining the severity o...

Two children with prolidase deficiency, an inborn error of proline metabolism, developed clinical and immunological abnormalities consistent with a diagnosis of systemic lupus erythematosus (SLE). The first child died from septicaemia, and SLE was only diagnosed during his terminal illness. As a result of this diagnosis his cousin, who was already...

Prolidase deficiency (McKusick 170100) is an inborn error of amino acid metabolism that results in a dysmorphic phenotype, mental retardation, skin rashes or ulceration, splenomegaly, anaemia and recurrent infections. Iminopeptiduria is the characteristic biochemical abnormality and the diagnosis can be confirmed by enzyme assay on leukocytes, eryt...

We report a 5 year prospective study of episodes of rotavirus, subgenus F adenovirus, and astrovirus gastroenteritis diagnosed by electron or immune electron microscopy in a single regional virology laboratory. Of 1426 total infections, the numbers in each category were 1117 (78.3%), 254 (17.8%), and 20 (7.9%), respectively. Using restriction endon...

Between January 1981 and December 1986 3829 low birthweight (less than 2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of...

Subjective scores of ‘wheeze’ or ‘tightness in the chest’ were compared with the forced expiratory volume in 1 s (FEV1) in 40 asthmatic children before and after administration of nebulized salbutamol. Symptom scores were poor predictors of the degree of airways obstruction. Many children underestimated their improvement after salbutamol. The resul...

We attempted to measure the distribution of ventilation in 24 children who had cystic fibrosis (CF) and 58 control subjects (ages 3.9-6.8 years) using the multiple breath nitrogen washout (MBNW) test. Moment analysis was performed on the MBNW curve, and the first and second moment ratios were derived. Only 40 (49%) of the children were able to comp...

Fetal scalp electrodes of various designs are used widely for continuous intrapartum fetal heart rate monitoring. Minor lacerations of the scalp are common, and 1.0-4.5% of infants may develop scalp ulceration or abscess. We describe two cases in which there was penetration of the subarachnoid space with leakage of cerebrospinal fluid associated wi...

Maximum expiratory flows, maximum inspiratory and expiratory pressures, and lung volumes were measured in 248 8-yr-old and 215 12-yr-old healthy school children. Eight-year-old girls had smaller total lung capacity but higher volume-corrected expiratory flows than boys. Maximum expiratory flow and total lung capacity increased more in girls than in...

The ventilatory response to acute hypercapnia was studied in 68 parents of victims of sudden infant death syndrome and 56 control subjects. Tidal volume, inspiratory time, and total respiratory cycle time were measured before and immediately after a vital capacity breath of 13% CO2 in oxygen. Instantaneous minute ventilation, mean inspiratory flow...

The usefulness of maximal expiratory and inspiratory flow-volume (F-V) loops was assessed in ten children with clinical evidence of tracheal or laryngeal obstruction. Normal values from 514 healthy children are presented. Measurement of maximal flow, and expiratory/inspiratory flow ratios and observation of the characteristic contours of the F-V lo...

Lung function was studied in 20 children, aged 8-17 years, who had successfully repaired oesophageal atresia with tracheo-oesophageal fistula. Spirometry and plethysmography showed mild restrictive lung disease. Airways obstruction was assessed using maximal expiratory and inspiratory flow-volume loops in air and after breathing a helium-oxygen mix...

Partial upper airway obstruction occurring weeks or months after prolonged endotracheal intubation is an uncommon but well-recognized phenomenon and is usually secondary to fibrotic scarring and stenosis in the subglottic region. Three patients who were seen over a 12-month period with severe obstruction are reported. All were born at approximately...

Three patients with severe upper airway obstruction due to subglottic cysts and their subsequent progress and management are described. The relationship of the lesions to intubation in the neonatal period is discussed.