The EPICure study: comparison of pediatric spirometry in community and laboratory settings.

RATIONALE: Accuracy of spirometry testing is a prerequisite for its use as an objective outcome measure in large epidemiological studies. We compared spirometry measurements obtained by trained pediatricians in a variety of school settings with those obtained in the laboratory by respiratory physiologists. METHODS: Following a 3-day training course, three pediatricians carried out spirometry in children born extremely preterm (EP) and age matched controls in schools across the UK and Ireland (The EPICure study). A subgroup had repeated measurements in the laboratory. Spirometric flows and volumes were expressed as Z-scores. Bland-Altman analysis was used to calculate within-subject differences. RESULTS: Fifty children (40% boys), 37 (74%) of whom were born EP, with a mean age 10.8 years had paired spirometry results (average interval between tests: 20.3 weeks). There was no statistically significant difference between any of the outcome variables: mean (95% CI of difference) in Z-scores [school-laboratory]) being 0.0 (-0.1; 0.1) for FEV(1), 0.1 (-0.1; 0.3) for FVC, -0.1 (-0.3; 0.1) for FEF(25-75), and 0.0 (-0.3; 0.1) for FEV(1)/FVC. Within individuals, the 95% limits of agreement for repeated measures were within +/- 1 Z-score for FEV(1) and FVC, and within +/- 1.5 Z-score for FEF(25-75) and FEV(1)/FVC. CONCLUSION: With appropriate training, quality control, and support, pediatric spirometry can reliably be performed outside the lung function laboratory.

A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma.

BACKGROUND: Melasma is an acquired, chronic hypermelanosis for which therapy remains a challenge. OBJECTIVES: To compare the efficacy and safety of a triple combination [TC: fluocinolone acetonide 0.01%, hydroquinone (HQ) 4%, tretinoin 0.05%] vs. HQ 4% after 8 weeks of treatment of moderate to severe facial melasma in Asian patients. METHODS: This was a multicentre, randomized, controlled, investigator-blinded, parallel comparison study. East and South-East Asian patients aged 18 years or older, with a clinical diagnosis of moderate to severe melasma, were enrolled in this study. Patients were enrolled at baseline and treated daily for 8 weeks with TC cream (one application at bedtime) or HQ cream (twice daily). There were four study visits: at baseline and weeks 2, 4 and 8. The primary efficacy variable was the melasma global severity score (GSS). Other outcome measures included Melasma Area and Severity Index, global improvement and patient satisfaction. Safety was assessed through the reporting of adverse events. RESULTS: TC had superior efficacy to HQ for the primary variable: 77/120 patients (64.2%) on TC had GSS 'none' or 'mild' at week 8 vs. 48/122 patients (39.4%) on HQ (P < 0.001). The secondary efficacy variables confirmed these results. Patient satisfaction was in favour of TC (90/127, 70.8%, vs. 64/129, 49.6%; P = 0.005). More patients had related adverse events on TC (63/129, 48.8%) than on HQ (18/131, 13.7%) but most were mild and none was severe. CONCLUSIONS: Efficacy in Asians and patient satisfaction were superior with the fixed TC than with HQ 4%.

Patch testing with 20% Dermatophagoides pteronyssinus/farinae (Chemotechnique) antigen.

BACKGROUND: Patch testing with dust mite antigens might identify mite-sensitive individuals, particularly those with atopic dermatitis who can benefit from avoidance measures. Currently available dust mite allergens have not been well studied. OBJECTIVE: To determine the proper dilution of 20% Dermatophagoides pteronyssinus/farinae mix antigen (Chemotechnique, Malmo, Sweden) for use in closed patch testing. METHODS: Eighteen nonatopic, healthy control subjects were patch-tested to the 20% concentration, yielding 15 (83%) positive reactions, most showing a decrescendo or persistent pattern suggesting an inordinately high number of false positive reactions. Dilutions of 1.25% to 0.1% in white petrolatum were used in patch testing 8 atopic dermatitis and 11 respiratory atopy patients, and 12 nonatopic controls. RESULTS: Positive reaction rates to the 0.25% and 0.1% concentrations, respectively, were 87.5% and 62.5% for atopic dermatitis, 54% and 18% for respiratory atopy, and 33% and 8% for healthy controls. Using Fisher's exact test, the 0.1% dilution was shown to significantly differentiate rates of positivity among the 3 groups, particularly between atopic dermatitis subjects and healthy controls. CONCLUSION: We find that a 0.1% dilution of 20% D. pteronyssinus/farinae mix antigen (Chemotechnique) to be useful in identifying mite-allergic individuals with atopic dermatitis.

Direct determination of some phenothiazine sedatives in greyhound urine by fluoroimmunoassay.

Antibodies have been raised in rabbits to a chlorpromazine sulfoxide-bovine serum albumin immunogen and the resulting antiserum used to develop a magnetizable solid-phase antibody fluoroimmunoassay for the detection of sulfoxide metabolites of commonly used phenothiazine and thioxanthine neuroleptics. These assays were used to screen metabolite levels in the urine of a greyhound following oral medication with chlorpromazine in order to assess the potential of these assays as simple screens for detecting exposure of racing greyhounds to such sedatives. The urine samples were also screened for neuroleptic content using an established radioreceptor assay and by TLC. The immunoassay described represents a relatively simple, sensitive and group-specific alternative method for screening for medication with phenothiazine and structurally similar sedatives in urine samples.

Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma.

Melasma is a macular hypermelanosis of the sun-exposed areas of the face and neck. The clinical efficacy of azelaic acid (20%) and hydroquinone creams (2%) in the treatment of this benign pigmentary disorder was compared in a randomized, double-blind study with 155 patients of Indo-Malay-Hispanic origin. The creams were applied twice daily. A broad spectrum sunscreen was used concomitantly. Over a period of 24 weeks, 73% of the azelaic acid patients, compared with 19% of the hydroquinone patients, had good to excellent overall results, as measured by the reduction of melasma pigmentary intensity and lesion size. Transient mild to moderate irritant reactions were initially seen with both test drugs.

A specific ELISA method for determining chloroquine in urine or dried blood spots.

Reported is an enzyme-linked immunosorbent assay (ELISA) that has been optimized and validated for the determination of chloroquine in urine or dried blood spots. The assay employs antisera raised in sheep to a chloroquine derivative conjugated to keyhole limpet haemocyanin and chloroquine conjugated to porcine thyroglobulin adsorbed onto the wells of a microtitration plate. The competitive binding of the antiserum to the wells was monitored using an alkaline-phosphatase-conjugated second antibody and a specific substrate. The assay exhibits no cross-reactivity with known chloroquine metabolites, other antimalarials, and commonly used drugs. The method was used to determine chloroquine in dried blood spot extracts and urine from a patient who was receiving a prescribed prophylactic chloroquine regimen. The drug was detected in the urine for 17 weeks and in the dried blood spots for 4 weeks after termination of the therapy.