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Atopic dermatitis (AD), a chronic, relapsing, inflammatory skin disease that is characterized by intense pruritus and eczematous lesions with up to 90% of patients presenting with mild to moderate disease. Current topical treatments for AD have not changed in over 15 years and are associated with safety concerns. In AD, overactivity of phosphodiesterase 4 (PDE4), leads to inflammation and disease exacerbation. Crisaborole Topical Ointment, 2%, is a novel, nonsteroidal, topical anti-inflammatory PDE4 inhibitor currently being investigated for the treatment of mild to moderate AD. Preliminary studies in children and adults demonstrated favorable efficacy and safety profiles. Crisaborole may represent an anti-inflammatory option that safely minimizes the symptoms and severity of AD and that can be used for both acute and long-term management.

Same-day discharge after endoscopic biliary sphincterotomy (ES) is a common clinical practice, but there have been few data to guide appropriate selection of patients. Using a prospective, multicenter database of complications, we examined outcomes after same-day discharge as it was practiced by a variety of endoscopists and evaluated the ability of a multivariate risk factor analysis to predict which patients would require readmission for complications.A 150-variable database was prospectively collected at time of ES, before discharge and again at 30 days in consecutive patients undergoing ES at 17 centers. Complications were defined by consensus criteria and included all specific adverse events directly or indirectly related to ES requiring more than 1 night of hospitalization.Six hundred fourteen (26%) of 2347 patients undergoing ES were discharged on the same day as the procedure, ranging from none at 6 centers to about 50% at 2 centers. After initial observation and release, readmission to the hospital for complications occurred in 35 (5.7%) of 614 same-day discharge patients (20 pancreatitis and 15 other complications, 3 severe). Of the same-day discharge patients, readmission was required for 14 (12.2%) of 115 who had at least one independently significant multivariate risk factor for overall complications (suspected sphincter of Oddi dysfunction, cirrhosis, difficult bile duct cannulation, precut sphincterotomy, or combined percutaneous-endoscopic procedure) versus 21 (4.2%) of 499 without a risk factor (odds ratio 3.1: 95% confidence interval [1.6, 6.3], p0.001). Of complications presenting within 24 hours after ES, only 44% presented within the first 2 hours, but 79% presented within 6 hours.Same-day discharge is widely utilized and relatively safe but results in a significant number of readmissions for complications. For patients at higher risk of complications, as indicated by the presence of at least one of five independent predictors, observation for 6 hours or overnight may reduce the need for readmission.

This study was conducted to assess the acceptance of grapefruit juice which has undergone a debittering process. The sensory effect of debittering and the sensory attributes of sourness, sweetness, bitterness, and aftertaste were appraised, and the correlation between chemical and sensory analyses of the debittered juice were identified. The effect of added grapefruit flavor on perception of sweetness and sourness was statistically significant. Both the level of bitterness and storage duration of grapefruit were shown to influence the way judges perceived bitterness and sweetness. Storage study showed no difference in aftertaste, which may increase consumers buying interest in debittered juice with a high level of bitterness (450 ppm).

Currently, a wide variety of bio-occlusive dressing materials are available. In general, these dressing materials provide a moist wound healing environment that has been shown to promote healing in both human and animal studies. To effectively use these dressings the clinician must have a full understanding of the properties of the materials as well as the pathophysiology of the particular wound. Most recently, a "new" biosynthetic dressing material, the alginates, has become available.To highlight proper use of alginate dressings for the management of acute and chronic wounds.Case study and literature review.Alginates were shown to be effective in a wide variety of acute and chronic wounds.Alginates possess several unique properties that should prove useful to the dermatologic surgeon as well as the dermatologist. Proper patient selection and use of this "new" dressing material, as well as a review of the literature is presented.

We performed a prospective controlled trial of a monthly journal club to determine if it would increase pediatric residents' knowledge of clinical epidemiology and biostatistics.Intervention residents received two didactic sessions before the journal club started. Eight monthly journal club sessions followed. Pediatric residents at another institution served as controls. Intervention and control residents completed a pre- and post-test on clinical epidemiology and biostatistics.Neither the intervention nor the control group showed a significant change in test scores over the 9-month period.A more intensive and more structured approach is needed to effectively teach clinical epidemiology and biostatistics to residents.

Cyanoacrylate tarsorrhaphy is an easily administered, painless technique for the temporary management of corneal epithelial defects. We have used the technique in 17 patients to treat persistent epithelial defects and exposure keratitis, as well as following epikeratophakia, allowing the tarsorrhaphy to remain in place for 1 to 15 days (mean, 5.7 days). Eleven of the 17 patients required only one application of cyanoacrylate; five had additional cyanoacrylate applied at the time of the original tarsorrhaphy to produce more extensive lid closure; and one required additional cyanoacrylate on day 3 to produce more extensive lid apposition.

Restriction enzyme analysis of cytomegalovirus deoxyribonucleic acid (DNA) has been used to characterise virus isolates and has provided information on patterns of viral transmission. It was shown that virus isolated from a congenitally infected infant was unlikely to have originated from the 13 congenitally infected children with whom the mother, a nurse, had been in contact. Of nine mother and infant pairs, from whom cytomegalovirus was isolated, seven yielded strains that were indistinguishable for mother and child; one pair showed minor differences and one was clearly distinguishable. Virus isolates from seven children attending a day nursery were typed, and only siblings were excreting similar strains of cytomegalovirus. Further examples of the application of this technique to studies of cytomegalovirus in a family environment are given. It is concluded that characterisation of virus strains by restriction analysis of DNA is a valuable epidemiological tool.

From 8 August through 5 December 1977, 110 laboratory-documented cases (78 confirmed, 32 presumptive) of St. Louis encephalitis (SLE) occurred in 20 counties throughout central-south Florida. Most cases were initially identified through an active surveillance system involving repeated contact of hospital infection control officers. This outbreak had three characteristics that are unusual for SLE epidemics in the eastern United States: it lacked an urban focus, a disproportionate number of cases affected young males, and the epidemic period extended into December. There was no significant difference between attack rates for blacks and whites. Males were significantly more often affected than females. Because of the time required for laboratory confirmation of cases, most outbreak control measures were initiated after the outbreak was declining. Reporting of clinically suspected SLE cases to initiate epidemic mosquito control should improve the timeliness of control measures in future outbreaks.

In order to improve the immune status of girls in our medical clinic, we conducted a prospective sero-survey to identify susceptibles and developed a system for vaccinating non-immune girls. Over an 18-month period, 481 inner-city adolescents were screened. Susceptibility rate defined by a titer less than 1:8 was 12 per cent and did not differ significantly with regard to age or race. Nine months into the study period, the State of Wisconsin enacted a "no immunization-no school" law. The susceptibility rate dropped from 22 per cent prior to the enactment of the law, to 5 per cent after. Of the 60 girls identified as susceptible, 54 (90 per cent) kept their follow up appointments for vaccinations. Enforced state immunization laws appear to be effective in lowering rubella susceptibility.

Staphylococcal enterotoxin F (SEF) has previously been shown to be a marker for toxic-shock syndrome (TSS)-associated strains of Staphylococcus aureus, whereas the serologic absence of antibody to SEF (anti-SEF) has been shown to be a marker for susceptibility of persons to TSS. In this study, anti-SEF was measured by radioimmunoassay in 689 banked sera obtained from Wisconsin residents during 1960, 1970, and 1980. The prevalence of anti-SEF as estimated by logistic regression analysis was 47%, 58%, 70%, 88%, 96%, and 99% at ages one, five, 10, 20, 30, and 50 years, respectively. Evidence for the transplacental transfer of anti-SEF is also presented. Despite the reported increased incidence of TSS occurring during the past five years, with a preponderance of cases occurring among women, no significant differences in the prevalence of anti-SEF were noted between sexes or longitudinally between the years 1960, 1970, and 1980. These data enhance our understanding of the epidemiology of TSS and further identify the population that may be susceptible to TSS.

One hundred and seventeen children and 41 teachers in day nurseries were screened for cytomegalovirus (CMV) viruria over a period of one year. Thirty two (27%) children and two (5%) teachers were found to be excreting virus on at least one occasion. Restriction endonuclease typing showed that virus strains isolated from the children were dissimilar, with the exception of those from sibling pairs and one unrelated pair. The virus isolate from one teacher matched those from two unrelated children, while the isolate from another teacher could not be distinguished from that from a sibling pair. The CMV serological state of the 41 teachers was not significantly different from 500 matched controls and no seroconversions occurred. It is concluded that although transmission of CMV among children and teachers may occur in day nurseries, the dissimilarity of most of the virus strains indicates that infection predominantly occurs outside. Furthermore, teachers in day nurseries showed no evidence of an increased risk of past CMV infection when compared with matched controls.

In Minneapolis, 107 cases of hepatitis A were identified and traced primarily to consumption of cold sandwiches served for lunch in a department store's popular basement restaurant. A sandwich-maker in the restaurant was the index patient. The date of onset of her illness and the dates of food consumption and onset of illness of infrequent restaurant patrons were consistent with accepted periods of infectivity and incubation for hepatitis A. Because the sandwich-maker frequently touched her hands to her mouth when she worked, and because we could not find evidence for fecal, airborne, or other modes of transmission, we believe that she may have contaminated food with infectious oropharyngeal secretions. The secondary attack rate was much lower among household contacts who received immune serum globulin than among those who had not.

Aflatoxin levels were determined in serum and urine of 17 patients with Reye's syndrome and in control subjects. No significant difference in aflatoxin levels was found for the two groups. However, 23% of all persons studied had levels of aflatoxin indicative of recent exposure. Aflatoxin levels were associated with ingestion of cornmeal and corn bread but not peanut-containing products. This prevalence of aflatoxin may be of public health importance.

Twenty cases of gastrointestinal perforations not associated with necrotizing enterocolitis or a bowel obstruction (GPNN) were reviewed. Fifteen infants suffered perforations during cycle ventilation. Perforations were localized in the stomach, duodenum, ileum, and jejunum. To determine if the type of mechanical ventilation used (ie, face mask, nasal prongs, or endotracheal tube) was associated with GPNN, a matched case-control analysis was performed. Case and control infants were matched by means of Apgar scores, gestational age, and length of time on ventilatory support. The Mantel-Haenszel estimate for estimating odds-ratios was used to determine that infants ventilated with nasal prongs or face mask were more likely to develop a gastrointestinal perforation than control infants ventilated with endotracheal tubes (odds-ratio greater than or equal to 29.6). This risk was associated with both upper gastrointestinal perforations (odds-ratio greater than or equal to 21.0) and lower gastrointestinal perforations (odds-ratio greater than or equal to 15.3). Routine use of mechanical ventilation with either nasal prongs or face mask appears to be associated with an unacceptable risk of gastrointestinal perforations in sick neonates.

National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but now with influenza A (H3N2). Cases of Reye syndrome in whites tend to be distributed throughout all age groups whereas a large percentage of cases in blacks have been reported in infants less than 1 year of age in three of the past four years. Nationally, there has been a decline in the case-fatality ratio in recent years.

Several epidemiologic markers (species, slime production and antimicrobial susceptibility) were examined for 256 isolates of coagulase-negative staphylococci (C-S) obtained from clinical specimens in a 1-year period. The medical records of the 169 pediatric patients from whom the C-S were obtained were reviewed and divided into infected (N = 11) and uninfected (N = 158) groups. The phenotypic traits of strains associated with infection included: (1) slime production (P = 0.014); (2) slime-positive Staphylococcus epidermidis (P = 0.002); and (3) resistance to penicillin (P = 0.03), oxacillin (P less than 0.001), clindamycin (P = 0.003), chloramphenicol (P less than 0.001) and trimethoprim/sulfamethoxazole (P less than 0.001). Infected patients were significantly older (P = 0.006) than uninfected patients. Simultaneous isolation of the same strain of C-S from the aerobic and anaerobic bottles of a single blood culture increased the probability of sepsis (P = 0.004). The combination of these patient and laboratory data may be useful in determining the clinical significance of C-S recovered from pediatric patients.

Congenital cataracts and other ocular media opacities are a leading cause of preventable childhood blindness. Because of the importance of early recognition and treatment of congenital media opacities in newborn infants, we designed a study to determine the ability of relatively inexperienced examiners to detect such ocular abnormalities with either of two instruments. Eight third-year medical students examined eight children and young adults with ocular media opacities and eight age-matched normal subjects with an ophthalmoscope or a retinoscope. With respect to detection of abnormalities requiring referral to an ophthalmologist, there was an underreferral rate of 7% and overreferral rate of 5%. There was no significant difference between instruments. Based on an estimated incidence of congenital cataracts of 0.4%, the positive predictive value of this screening in the population of newborn infants is 18.7% and the negative predictive value is 99.96%. Therefore, overreferral is unavoidable in the effort to detect infants with congenital media opacities. We conclude that this examination can be easily taught and accurately performed with the readily available ophthalmoscope. The importance and technique of examining the red reflex should be stressed in the training of those caring for newborns.

The 1976-77 influenza surveillance in Wisconsin consisted of three major areas of study. Serum and virus isolation specimens were obtained from the practicing medical community and from epidemiologic studies. From all sources 1,132 throat specimens were tested by egg and tissue culture inoculations. Three isolations similar to A/New Jersey/8/76 were recovered from pig farm associated patients. One contact with one of the isolate patients seroconverted to A/New Jersey suggesting patient to patient spread. Serological monitoring of 1,361 patients showed no other A/New Jersey activity in the state. In addition 31 influenza B/Hong Kong and 8 A/Victoria isolates have been recovered as well as 34 B and 11 A seroconversions. A surveillance using primarily syphilis serology premarital serums has been conducted from August 29, 1976 through April 23, 1977. No significant influenza A activity in the state was recognized by this study. However, increased herd immunity from vaccination was detected. The last phase of this surveillance was an evaluation of the mass immunization program and the efficacy of the vaccines. Two-hundred-ninety individuals contributed pre- and post-vaccine serums to this study. Eighty-three percent of those persons with a pre-vaccine titer of 1:80 or less to A/New Jersey/8/76 developed a post-vaccine titer four-fold or greater to that virus type. Those who received vaccine containing A/Victoria/3/75 were less responsive. Refractiveness to vaccine antibody stimulation was greater than or equal to 1:160 for A/New Jersey and less than or equal to 1:40 with A/Victoria.

During routine planned extracapsular cataract extraction, rupture of the inferior zonules was noted while performing the superior portion of the anterior capsulotomy. After the nucleus expression and cortical aspiration, a Sheets glide was placed in the anterior chamber between the anterior and posterior capsule, deep into the capsular bag. This provided a platform for the performance of a controlled inferior capsulotomy in the face of weakened zonular support.

The 50, 10, and 1% human infective doses of poliovirus type 1 vaccine administered orally to 32 infants were estimated to be 72, 39, and 20 tissue culture infective doses, respectively.