Use of Medicaid and housing data may help target areas of high asthma prevalence

Objective: To determine if there was a significant difference between mold contamination and asthma prevalence in Detroit and non-Detroit Michigan homes, between newer and older homes, and if there is a correlation between mold contamination and measures of Medicaid use for asthma in the 25 Detroit zip codes. Methods: Settled dust was collected from homes (n = 113) of Detroit asthmatic children and from a representative group of Michigan homes (n = 43). The mold contamination for each home was measured using the Environmental Relative Moldiness Index (ERMI) scale and the mean ERMI values in Detroit and non-Detroit homes were statistically compared. Michigan Medicaid data (13 measures related to asthma) in each of the 25 zip codes in Detroit were tested for correlation to ERMI values for homes in those zip codes. Results: The mean ERMI value (14.5 ± 8.0) for Detroit asthmatic childrens' homes was significantly (Student's t-test, p < 0.001) greater than the mean ERMI value (2.1 ± 6.2) for the non-Detroit homes. Detroit homes > 60 years old had significantly (p = 0.01) greater mean ERMI values than Detroit homes ≤ 60 years old (15.87 vs. 11.25). The percentage of children that underwent spirometry testing for their persistent asthma (based on Medicaid data) was significantly, positively correlated with the mean ERMI values of the homes in the 25 zip codes. Conclusions: Applying Medicaid-use data for spirometry testing and locating a city's older housing stock might help find foci of homes with high ERMI values.     

Coal mine dust lung disease in the modern era

Coal workers’ pneumoconiosis (CWP), as part of the spectrum of coal mine dust lung disease (CMDLD), is a preventable but incurable lung disease that can be complicated by respiratory failure and death. Recent increases in coal production from the financial incentive of economic growth lead to higher respirable coal and quartz dust levels, often associated with mechanization of longwall coal mining. In Australia, the observed increase in the number of new CWP diagnoses since the year 2000 has necessitated a review of recommended respirable dust exposure limits, where exposure limits and monitoring protocols should ideally be standardized. Evidence that considers the regulation of engineering dust controls in the mines is lacking even in high‐income countries, despite this being the primary preventative measure. Also, it is a global public health priority for at‐risk miners to be systemically screened to detect early changes of CWP and to include confirmed patients within a central registry; a task limited by financial constraints in less developed countries. Characteristic X‐ray changes are usually categorized using the International Labour Office classification, although future evaluation by low‐dose HRCT) chest scanning may allow for CWP detection and thus avoidance of further exposure, at an earlier stage. Preclinical animal and human organoid‐based models are required to explore potential re‐purposing of anti‐fibrotic and related agents with potential efficacy. Epidemiological patterns and the assessment of molecular and genetic biomarkers may further enhance our capacity to identify susceptible individuals to the inhalation of coal dust in the modern era.     

Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence

Allergic rhinitis is estimated to affect 10%-20% of pediatric population and it is caused by the IgE-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient’s daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy (SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.     

Pulmonary effects of intermittent,seasonal exposure to high concentrations of cotton dust

AIM: To quantify the exposure levels and to assess pulmonary reactions associated with exposure to cotton dust and its biological contaminants. METHODS: All employees (51 male workers) of a ginning industry as well as 51 referent unexposed subjects from clerical staff of an educational center were investigated. Atmospheric concentrations of cotton dust and bioaerosols were measured. Furthermore, bacterial and fungal genera and species were identified by an expert microbiologist and an experienced mycologist. A standard respiratory symptom questionnaire was filled out for the subjects and they underwent multiple spirometry tests, at the beginning and at the end of work season as well as prior to (pre-exposure base line values) and at end of the first shift of workweek (post exposure). RESULTS: Gram negative bacteria including Enterobacter agglomerans and Pseudomonas spp. were found to be the dominant bacterial species and genera, respectively. Similarly, dominant fungi were identified to be Mucor sp. Rhizopus sp. and Aspergillus niger. Mean atmospheric concentrations of cotton dust in ginning and outdoor areas were found to be 35.2 and 6.8 mg/m³, respectively. The prevalence rates of cough, phlegm, wheezing, dyspenea and grade 1/2 byssinosis among the exposed subjects were significantly higher than their corresponding values for the unexposed employees (P < 0.05). Additionally, significant differences were noted in the mean baseline value (preshift) of vital capacity, forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity ratio of the exposed subjects when compared with those of their referent counterparts. Similarly, significant cross shift decrements were noted in most parameters of pulmonary function of the exposed subjects. CONCLUSION: Seasonal exposure to cotton dust induces both acute, partially reversible, and chronic irreversible decrements in the lungs’ functional capacities as well as increased prevalence of respiratory symptoms.     

Swab cloths as a tool for revealing environmental contamination by Q fever in ruminant farms

Q fever is a zoonotic abortive disease of ruminants mostly transmitted by inhalation of aerosols contaminated by Coxiella burnetii. Clusters of cases or even epidemics regularly occur in humans but, to date, there is no consensus about the best way to carry out outbreak investigations in order to identify potential farms at risk. Although environmental samples might be useful during such investigations, there are few baseline data on the presence of C. burnetii in the environment of ruminant farms. We thus investigated dust samples from cattle, sheep and goat farm buildings in order to (a) estimate C. burnetii detection frequency and bacterial loads in the environment, and (b) determine whether this environmental contamination is associated with series of abortions attributed to Q fever. We considered 113 herds with a recent abortive episode potentially related (n = 60) or not (n = 53) to C. burnetii. Dust was sampled using a swab cloth and tested by a quantitative PCR method targeting the IS1111 gene. Coxiella burnetii DNA was detected on 9 of 50 cattle farms, 13 of 19 goat farms and 30 of 40 sheep farms. On 16 cloths, bacterial loads were higher than 10⁸ genome equivalents, levels as high as in infectious materials such as placentas and aborted foetuses. Overall, the probability of detecting C. burnetii DNA was higher on small ruminant farms than cattle farms, in herds suspected of Q fever and in large herds. We conclude that swab cloths are a putative indicator of contamination of ruminant farms by C. burnetii.     

中国台湾省新竹市市售食物孳生粉螨的初步调查

目的 了解台湾地区储藏食物粉螨的孳生情况。 方法 采用直接镜检法对采集带回的样本螨进行分离,再将挑出的螨制成玻片标本置于显微镜下观察、鉴定。结果 共从采集的39种市售样本中分离出13种粉螨,隶属于6科11属,即粗脚粉螨（Acarus siro）、腐食酪螨（Tyrophagus putrescentiae）、长食酪螨（Tyrophagus longior）、椭圆食粉螨（Aleuroglyphus ovatus）、伯氏嗜木螨（Caloglyphus berlesei）、纳氏皱皮螨（Suidasia nesbitti）、河野脂螨（Lardoglyphus konoi）、害嗜鳞螨（Lepidoglyphus destructor）、棕脊足螨（Gohieria fuscus）、拱殖嗜渣螨（Chortoglyphus arcuatus）、甜果螨（Carpoglyphus lactis）、粉尘螨（Dermatophagoides farinae）、屋尘螨（Dermatophagoides pteronyssinus）。结论 台湾省新竹市市售食物中发现粉螨孳生,应采取相关措施控制粉螨的孳生。     

NOS2基因单核苷酸多态性与单纯尘螨过敏性鼻炎相关性研究

目的 本研究探讨NOS2基因单核苷酸多态性（single nucleotide polymorphism,SNP）与单纯尘螨过敏性鼻炎（house dust mite-sensitive allergic rhinitis,HDM-sensitive AR）发生的相关性。方法 研究募集了HDM-sensitive AR患者385例和健康对照受试者424例。采集外周静脉血,提取基因组DNA。Sequenom iPLEX MassARRAY质谱法对NOS2基因上的6个标签SNPs（rs2297516,rs7406657,rs3794764,rs2872753,rs2779249,rs3794766）进行基因分型。结果 等位基因分析显示6个SNPs的等位基因频率在HDM-sensitive AR组与正常对照组间差异无统计学意义。基因型分析显示rs3794764的（AA+AG）基因型分布在HDM-sensitive AR患者组和正常对照组间差异存在统计学意义（P=0.047）,相对GG基因型是HDM-sensitive AR的危险因素（OR=1.413,95% CI：1.005~1.987）。多元线性回归分析显示在健康对照人群中rs3794766基因型与血清总IgE浓度具有显著相关性（P=0.019,β=-0.131,95% CI：-0.229~-0.021）。结论 NOS2基因可能是中国汉族人群HDM-sensitive AR的易感基因。