Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

[Growth charts: Impact on the prevalence of nutritional disorders]. / Tablas de crecimiento: impacto sobre la prevalencia de los trastornos nutritivos.

INTRODUCTION: The references used to assess child growth in Spain are the graphs of the Orbegozo Foundation and the charts of the World Health Organization (WHO). The objective of this study is to analyze the differences between the two charts for weight, height and body mass index, and assess their relevance to identify growth or nutritional problems. MATERIAL AND METHODS: The values of the extreme percentiles of height, weight and body mass index for each sex from 0 to 10 years in both charts are compared. For each value Absolute differences and Z scores are calculated for each value. To evaluate the impact on the prevalence of the various nutritional or growth disorders the location of the value of the respective percentiles of in each of the charts were assessed. RESULTS: Significant differences were observed between the 3th percentile of height and weight, 97th of weight, and 85th and 97th of body mass index. Marked differences were observed for the extreme values of body mass index. During the first years, the Orbegozo charts overestimate the prevalence of malnutrition (between 2% and 19% depending on age and sex) compared to the WHO charts. In subsequent ages Orbegozo underestimates WHO between 0.7% and 2.89%. Orbegozo underestimates the prevalence of overweight (between 2.5% and 14.8%) compared to the WHO charts. The 97th percentile of Body mass index in the Orbegozo charts corresponds in most cases with WHO percentiles above 99.99%. CONCLUSION: The two charts analyzed have significant differences from a clinical and the public health point of view, in the estimation of overweight/obesity and malnutrition.

[Validation of the tympanic thermometer in primary care]. / Validación del termómetro timpánico en atención primaria.

OBJECTIVE: The aim of the study is to validate a tympanic thermometer (TT) use in primary care. PATIENTS AND METHODS: Validation study phase IV of the tympanic thermometer ThermoScan Pro LT. Measurements are compared to axillary temperature (AT) measured with a glass mercury thermometer. 412 subjects 6 months to 15 years old attended in primary care clinics were studied. Exclusion criteria were middle ear conditions, intense crying or sweating. The highest of the three measurements in each ear was used to calculate sensitivity and specificity of the TT and to analyse the concordance with AT. The impact of ambient temperature, age, gender, cerumen, presence of a febrile condition and the examiner on the results was assessed. RESULTS: Sensitivity of TT to detect fever (AT > 38 degrees C) was 89.7% (95% IC: 81.8-97.5) and specificity 90.7% (95% IC: 87.7-93.7). As a mean TT measures 0.5 degree C higher than AT but there was a high dispersion of the data (-1.59-0.6 degrees C). Accuracy of TT was influenced by the sex of the patient (p = 0.029), examiner (p < 0.01), presence of a febrile condition (p < 0.01) and positioning of the patient (p = 0.026). Repeatability coefficient was 0.34 degree C for the right ear and 0.42 degree C for the left. CONCLUSION: The sensitivity of the TT to detect fever was adequate, though there was a poor concordance with AT and had an important variation among repeated measurements in the same ear.