Search

Background: Hydrocortisone butyrate (HCB) is currently marketed as a cream, ointment, and solution. A new lotion formulation of hydrocortisone butyrate 0.1% (Locoid[R] lotion) has been developed and evaluated. Objective: The objective of this study was to evaluate the efficacy and safety of HCB 0.1% lotion compared to the vehicle in subjects aged 3 months to less than 18 years with mild to moderate atopic dermatitis (AD). Methods: In this multicenter double-blind study, 284 subjects with mild to moderate AD were randomized 1:1 to receive HCB 0.1% lotion or the vehicle for a duration of 4 weeks. 'Treatment success' was defined as those subjects with a final Physician Global Assessment (PGA) score of 0 or 1 that had at least a 2-point reduction in the PGA score from baseline to day 29. Safety was assessed by monitoring adverse events. Results: Analyses of the final PGA score showed a significant treatment effect (P Limitations: The study did not assess the durability of the treatment effects (ie, safety and efficacy) after completion of the 4-week treatment period nor the potential need for longer term therapy given the chronic nature of AD. Conclusion: Results demonstrate the safety and efficacy of HCB 0.1% lotion in the treatment of mild to moderate AD in children 3 months to 18 years of age., Introduction Topical corticosteroids have become the cornerstone of treatment for a variety of inflammatory dermatoses, including atopic dermatitis (AD), eczema, and psoriasis. A wide selection of topical corticosteroid products is [...]

Objectives. We designed an Internet-based surveillance network that linked community clinic diagnoses with viral isolation rates and admission patterns at a related children's hospital. We hypothesized that community surveillance would successfully predict subsequent hospital admissions and laboratory viral isolations. Secondarily, we expected the network to monitor trends in disease and that posting this information on a Web site would be useful to physicians in dally practice. Study Design. Data were collected from December 1999 through August 2000. Information was summarized and posted weekly on a Web site. Active public piloting of the site took place during August 2000, after which the project was evaluated through an electronic mail survey. The predictive ability of the community surveillance data was evaluated by multivariate linear regression. Results. Increases in the community diagnosis of most syndromes under surveillance, including lower respiratory infections (adjusted [R.sup.2] = 0.7086) and gastroenteritis (adjusted [R.sup.2] = 0.6532) successfully predicted an increase in subsequent hospital admissions. Community surveillance also successfully predicted laboratory isolation of associated viral organisms. Physicians completing the evaluation (N = 11) indicated that the site provided information useful in daily practice for both physician and parent education. Conclusions. An Internet-based surveillance network linking a hospital with community physicians is beneficial to the hospital in predicting waves of severe cases requiring admission and reciprocally provides useful information to physicians in daily practice regarding the incidence and cause of seasonal disease in the community. Pediatrics 2002;109:414-418; communicable disease, computer communication networks, surveillance, viral illness, seasonal illness., Physicians in individual or small group practices cannot afford to identify the cause of all apparent viral illnesses in their patient population because of inadequate resources. Parents are often told, [...]

The varicella vaccine appears to be both safe and effective in preventing chicken pox. Different lots were tested in two groups of children with an over 93% positive antibody response rate in both. In group one, 137 with a positive response were followed for 10 years. In the second, 129 showed positive responses and were followed for 6 years. Only 2% to 3% of children responding to the vaccine developed chicken pox. Compared to the estimated yearly chicken pox rate in unvaccinated children, these children showed up to an 81% reduction in yearly disease rates., ABSTRACT. Background. Studies in Japan and the United States have shown that varicella vaccine is both safe and efficacious. In 1984, we undertook a 10-year prospective study using a research lot of Oka/Merck varicella vaccine to assess antibody persistence and breakthrough chickenpax rates. In 1987, we began a similar prospective study with lots made in production facilities that ended after 6 years because many children were given a second dose. The purpose of this study is to report humoral antibody persistence and breakthrough chickenpox rates after 6 to 10 years of prospective follow-up. Methods. One hundred forty-three seronegative children received a research lot (950 plaque-forming units/ dose) with 97.9% seroconversion by an assay for fluorescent antibody to membrane antigen (PA MA). One hundred thirty-eight children received production lots (1145 to 3265 plaque-forming units/dose) with 93.5% seroconversion. Yearly chickenpox exposure surveys were completed by phone, and children were seen by a study nurse whenever chickenpox was suspected. A subset in each group had serum collected every 2 years and tested for FAMA antibody. Results. In the research group there have been 25 cases of chickenpox in 137 seroconverters in a period of more than 10 years (yearly rate of 1.7%). In the production lot group there have been 22 cases of chickenpox in 129 seroconverters in a 6-year period (yearly rate of 2.8%). In the research group the median titer rose from 1:16 to 1:64 between 1 and 10 years. In the production group, the median titer did not change between 1, 2, and 4 years. Median antibody titers were compared between the research and production groups at 1, 2, and 4 years and did not differ. The rate of development of modified chickenpox has not increased with time since vaccination, and neither has the case severity. Children with FAMA liters 8 at 6-weeks' postvaccination were four times more likely to develop chickenpox than those with titers [is greater than or equal to]64. Conclusions. 1) Modified chickenpox has occurred in approximately 2% to 3% of vaccinees per year, regardless of the vaccine lot given. 2) FAMA titers have risen between 1 and 10 years in research lot recipients and remained the same in production lot recipients. 3) The likelihood of modified chickenpox developing is inversely related to the 6-week postvaccination FAMA titer. Pediatrics 1997;100:761-766; varicella vaccine, chickenpox, varicella zoster., ABBREVIATIONS. FAMA, fluorescent antibody to membrane antigen; pfu, plaque-forming units; ELISA, enzyme-linked immunosorbent assay; VZV, varicella zoster virus; PV, postvaccination. In March 1995, the twenty-one-year development and testing phase for [...]

Objective: Nail technicians and hairdressers may be exposed to chemicals with potential reproductive effects. While studies have examined birth defects in children of hairdressers, those in children of nail technicians have not been evaluated. We investigated associations between selected birth defects and maternal occupation as a nail technician or hairdresser versus a non-cosmetology occupation during pregnancy.Methods: We analysed population-based case-control data from the multisite National Birth Defects Prevention Study, 1997-2011. Cases were fetuses or infants with major structural birth defects; controls were live-born infants without major birth defects. Expert raters classified self-reported maternal jobs as nail technician, combination nail technician-hairdresser, hairdresser, other cosmetology work or non-cosmetology work. We used logistic regression to calculate adjusted ORs and 95% CIs for associations between occupation during pregnancy and birth defects, controlling for age, smoking, education and race/ethnicity.Results: Sixty-one mothers worked as nail technicians, 196 as hairdressers, 39 as combination nail technician-hairdressers and 42 810 as non-cosmetologists. The strongest associations among nail technicians included seven congenital heart defect (CHD) groups (ORs ranging from 2.7 to 3.5) and neural tube defects (OR=2.6, CI=0.8 to 8.4). Birth defects most strongly associated with hairdressing included anotia/microtia (OR=2.1, CI=0.6 to 6.9) and cleft lip with cleft palate (OR=2.0, CI=1.1 to 3.7). All oral cleft groups were associated with combination nail technician-hairdresser work (ORs ranging from 4.2 to 5.3).Conclusions: Small samples resulted in wide CIs. Still, results suggest associations between maternal nail technician work during pregnancy and CHDs and between hairdressing work and oral clefts. [ABSTRACT FROM AUTHOR]

Immunizing 6-month-old infants in epidemic areas who are born to mothers vaccine-immune to the measles virus but with a low titer of measles antibody may be indicated. Little risk of immune tolerance was discovered in this small study of 34 infants. The Advisory Committee on Immunization Practices recommends that 6-month-old infants in epidemic areas be immunized against measles. In nonepidemic areas, infants are usually immunized against measles at 15 months. The study compared the antibody levels of immunized 6-month-olds to immunized 15-month-olds, and found that 74% of infants aged 6 months and 100% of 15-month-olds showed antibodies to the measles virus. The 6-month-olds were reimmunized at 15 months, after which all were found to have antibodies to measles., Hypothesis. The low titer of measles antibody in infants of mothers with vaccine-induced immunity may allow immunization against measles before 15 months of age. Methods. Six- and 15-month-old infants born to mothers 30 years of age with no history of measles were recruited. Infants enrolled at 6 months of age were immunized with monovalent measles vaccine (Attenuvax), and maternal serum and infant pre- and postvaccination sera were obtained. Those enrolled for primary vaccination at 15 months of age received either Attenuvax (N = 12) or M-M-[R.sub.II], (N = 3). Six-month-old infants were revaccinated with M-M-[R.sub.II], at 15 months of age, pre- and postrevaccination sera were again obtained. Three antibody assays were used: a measles neutralizing assay (NT) and two enzyme immunoassays (EIA) for measles IgG and measles IgM. Results. Among primary vaccinees, 14 of 19 infants aged 6 months (74%) developed NT antibody, as did 15 of 15 infants aged 15 months (100%). The reciprocal geometric mean titer of 6-month-old seroresponders was 23.3, significantly lower than that of the 15-month-old primary vaccinees (87.7, P < .001). Primary seroconversion rates by EIA were 53% for 6-month-old infants and 100% for those aged 15 months. Revaccination of infants who had received Attenuvax at 6 months of age resulted in 100% NT positivity; the geometric mean titer rose to equal that of the group given primary immunization at 15 months of age. Measles IgM antibody was detected in 10 of 14 infants tested 1 month after primary vaccination at 15 months, but was not detected in any of the revaccinated infants after the second dose at 15 months of age (P < .001). Conclusions. 1) Immunization with measles vaccine in infants born to vaccine-immune mothers at 6 months of age induced NT antibody in 74% of infants. 2) Revaccination of prior 6-month-old vaccinees at 15 months resulted in antibody titers equivalent to 15-month-old vaccinees. 3) Lack of an IgM response following revaccination suggests that even seronegative infants may be primed to respond on re-exposure to measles. Pediatrics 1994;93:939-944; measles vaccine, vaccine immunogenicity.

* Objective. - To compare the efficacy of 3-day vs 10-day treatment with a combination of amoxicillin and clavulanate potassium for children with uncomplicated urinary tract infections and to determine the role of host factors, including vesicoureteral reflux, and of bacterial virulence factors, including adhesins, in treatment outcome. Design. - Randomized, double-blind, controlled trial. Setting. - A pediatric infectious diseases clinic at an urban medical center. Patients. - Thirty-seven children with uncomplicated urinary tract infections. Interventions. - Treatment with 3 days or 10 days of antibiotics at a dosage of 20 mg/kg per day of amoxicillin and 5 mg/kg per day of clavulanate potassium in three divided doses. Measurements and Main Results. - The success rate for 10-day treatment was 82% (14/17) compared with 55% (11/20) for 3-day treatment (P=.09). Among the 35 patients infected with Escherichia coli, all 10 patients infected with adhesin-negative isolates were treated successfully regardless of the duration of treatment, whereas only 14 (56%) of the 25 infections involving adhesin-positive isolates were clinically cured (P=.015). Two of the three failures in the 10-day treatment group were in patients with reflux. Conclusions. - We conclude that 3-day treatment with amoxicillin and clavulanate is insufficient for afebrile childhood urinary tract infections and that both bacterial and host factors affect treatment outcome. (AJDC. 1993;147:1090-1093), Three-day treatment with amoxicillin and clavulanate potassium appeared to be insufficient compared with 10-day treatment in afebrile childhood urinary tract infections. Both bacterial factors, such as adhesins, and host factors, such as vesicoureteral reflux, were variables in the outcome of treatment. A randomized, double-blind, controlled trial was conducted among 37 children with uncomplicated urinary tract infections at a pediatric infectious diseases clinic in an urban medical center. The children were treated with a drug regimen of either 3 or 10 days of antibiotics at a dosage of 20 mg/kg per day of amoxicillin and 5 mg/kg per day of clavulanate potassium in three divided doses. The 10-day treatment had a success rate of 82%, compared with 55% for the 3-day treatment.

* Objective.--To determine the accuracy of measuring antenatal renal pelvic diameter for prediction of renal abnormalities. Research Design.--Prospective evaluation of all pregnant women undergoing ultrasonography. Setting.--A teaching hospital providing primary and referral maternity care. Participants.--Fifty-six pregnant women with suspected fetal hydronephrosis or cystic lesions identified from 7500 ultrasonograms over 3 years. Methods.--Antenatal renal pelvic diameter was measured in the anteroposterior dimension. Neonates underwent postnatal ultrasonography after day 3 of life; if the results were abnormal, a cystogram and renal diuretic scan were obtained. Results.--None of 50 kidneys 1.5 mm or smaller in anteroposterior pelvic diameter had obstruction; 11 (79%) of 14 kidneys larger than 15 mm were obstructed or demonstrated vesicoureteral reflux. Of 12 kidneys believed to be multicystic before birth, five (42%) proved to have hydronephrosis. Conclusions.--Since the majority of fetuses with suspected hydronephrosis proved to be normal, parents should not be unduly alarmed by the physician. Renal pelvic diameter of more than 15 mm is strongly predictive of hydronephrosis. Since severe hydronephrosis is treatable and can be mistaken for a multicystic kidney antenatally, full radiologic evaluation is needed soon after birth. (AJDC. 1992;146:1181-1184)

Objectives: To examine the association of occupational exposure to high-level disinfectants (HLDs) with risk of miscarriage among nurses.Methods: Our study included women who enrolled in the Nurses' Health Study 3 (2010-2020) and had at least one pregnancy during follow-up. Occupational exposure to HLDs was self-reported at baseline. Every 6 months, a follow-up questionnaire was sent to participants asking for detailed information on pregnancies. We used a discrete-time Cox model to calculate the HRs and 95% CIs of miscarriage according to exposure to HLDs.Results: Our study included 2579 nurses with a median of 5.6 years of follow-up (range: 1-9 years), and we documented 768 (19%) cases of miscarriage among 3974 pregnancies. Compared with women with no HLD exposure, the HRs of miscarriage were 1.08 (95% CI: 0.87 to 1.34) for past users and 0.84 (95% CI: 0.68 to 1.04) for HLD users. Compared with women with no HLD exposure, duration, frequency, and type of HLD and use of exposure controls were not associated with risk of miscarriage. When restricting to pregnancies that occurred within 12 months of HLD use, occupational exposure to unspecified types of HLD was significantly associated with higher risk of miscarriage (HR=1.78; 95% CI: 1.08 to 2.93).Conclusions: We observed no associations between occupational use of HLDs and miscarriage, except when we restricted to pregnancies occurring within 12 months of assessed baseline exposure. Given the observational design and limited sample size, results should be interpreted cautiously. [ABSTRACT FROM AUTHOR]