Web platform using digital image processing and geographic information system tools: a Brazilian case study on dengue.

BACKGROUND: Dengue fever is endemic in Asia, the Americas, the East of the Mediterranean and the Western Pacific. According to the World Health Organization, it is one of the diseases of greatest impact on health, affecting millions of people each year worldwide. A fast detection of increases in populations of the transmitting vector, the Aedes aegypti mosquito, is essential to avoid dengue outbreaks. Unfortunately, in several countries, such as Brazil, the current methods for detecting populations changes and disseminating this information are too slow to allow efficient allocation of resources to fight outbreaks. To reduce the delay in providing the information regarding A. aegypti population changes, we propose, develop, and evaluate a system for counting the eggs found in special traps and to provide the collected data using a web structure with geographical location resources. METHODS: One of the most useful tools for the detection and surveillance of arthropods is the ovitrap, a special trap built to collect the mosquito eggs. This allows for an egg counting process, which is still usually performed manually, in countries such as Brazil. We implement and evaluate a novel system for automatically counting the eggs found in the ovitraps' cardboards. The system we propose is based on digital image processing (DIP) techniques, as well as a Web based Semi-Automatic Counting System (SCSA-WEB). All data collected are geographically referenced in a geographic information system (GIS) and made available on a Web platform. The work was developed in Gama's administrative region, in Brasília/Brazil, with the aid of the Environmental Surveillance Directory (DIVAL-Gama) and Brasília's Board of Health (SSDF), in partnership with the University of Brasília (UnB). The system was built based on a field survey carried out during three months and provided by health professionals. These professionals provided 84 cardboards from 84 ovitraps, sized 15 × 5 cm. In developing the system, we conducted the following steps: i. Obtain images from the eggs on an ovitrap's cardboards, with a microscope. ii. Apply a proposed image-processing-based semi-automatic counting system. The system we developed uses the Java programming language and the Java Server Faces technology. This is a framework suite for web applications development. This approach will allow a simple migration to any Operating System platform and future applications on mobile devices. iii. Collect and store all data into a Database (DB) and then georeference them in a GIS. The Database Management System used to develop the DB is based on PostgreSQL. The GIS will assist in the visualization and spatial analysis of digital maps, allowing the location of Dengue outbreaks in the region of study. This will also facilitate the planning, analysis, and evaluation of temporal and spatial epidemiology, as required by the Brazilian Health Care Control Center. iv. Deploy the SCSA-WEB, DB and GIS on a single Web platform. RESULTS: The statistical results obtained by DIP were satisfactory when compared with the SCSA-WEB's semi-automated eggs count. The results also indicate that the time spent in manual counting has being considerably reduced when using our fully automated DIP algorithm and semi-automated SCSA-WEB. The developed georeferencing Web platform proves to be of great support for future visualization with statistical and trace analysis of the disease. CONCLUSIONS: The analyses suggest the efficiency of our algorithm for automatic eggs counting, in terms of expediting the work of the laboratory technician, reducing considerably its time and error counting rates. We believe that this kind of integrated platform and tools can simplify the decision making process of the Brazilian Health Care Control Center.

Global plant trait relationships extend to the climatic extremes of the tundra biome.

The majority of variation in six traits critical to the growth, survival and reproduction of plant species is thought to be organised along just two dimensions, corresponding to strategies of plant size and resource acquisition. However, it is unknown whether global plant trait relationships extend to climatic extremes, and if these interspecific relationships are confounded by trait variation within species. We test whether trait relationships extend to the cold extremes of life on Earth using the largest database of tundra plant traits yet compiled. We show that tundra plants demonstrate remarkably similar resource economic traits, but not size traits, compared to global distributions, and exhibit the same two dimensions of trait variation. Three quarters of trait variation occurs among species, mirroring global estimates of interspecific trait variation. Plant trait relationships are thus generalizable to the edge of global trait-space, informing prediction of plant community change in a warming world.

Effects of the novel antiarrhythmic agent azimilide on experimental atrial fibrillation and atrial electrophysiologic properties.

OBJECTIVES: This study was designed to evaluate how the atrial electrophysiological and antiarrhythmic effects of azimilide compare with those of the specific rapid delayed rectifier (IKr) blocker dofetilide. BACKGROUND: Azimilide, a new class III drug, was initially believed to be a highly selective blocker of the slow delayed rectifier (IKs), but recent studies suggest that azimilide potently blocks IKr. Thus, it has been suggested that azimilide's in vivo effects may simply be due to IKr blockade. METHODS: Dose regimens producing stable effects over time were developed, and two dose levels of azimilide (10 and then 20 mg/kg) or dofetilide (0.08 and then 0.16 mg/kg) were administered to morphine/chloralose-anesthetized dogs during sustained vagal atrial fibrillation (AF). Epicardial mapping was used to measure conduction velocity and AF cycle length. RESULTS: Azimilide terminated AF in 13/14 dogs (93%), while dofetilide terminated AF in 6/12 (50%, P < 0.05). While dofetilide had strong reverse use-dependent effects on atrial ERP (e.g. at lower doses, dofetilide increased ERP by 51 +/- 3% at a basic cycle length, BCL, of 400 ms and by 17 +/- 3% at a BCL of 200 ms), azimilide's effects on ERP were rate-independent (ERP increased at lower dose by 38 +/- 6%, BCL 400 ms; 35 +/- 10%, BCL 200 ms). Neither drug affected conduction. CONCLUSIONS: Azimilide is effective against experimental AF, and increases ERP with a frequency dependence different from the IKr blocker dofetilide, suggesting that azimilide's actions on atrial tissue cannot be attributed exclusively to IKr block, and that effects on other currents (such as IKs) are likely to be important.

A experiência vivida de mulheres na conjugalidade contemporânea: uma perspectiva fenomenológico-existencial / The women's lived experience in contemporary conjugality: a phenomenological-existential perspective / La experiencia vivida de mujeres en la conyugalidad contemporánea: una perspectiva fenomenológico-existencial

Este artigo é resultado de uma pesquisa de mestrado que teve como objetivo compreender como as mulheres experienciam os atuais papéis que assumem nas relações conjugais contemporâneas e no exercício da maternidade, e quais os sentidos que atribuem a essas vivências. A partir da fenomenologia-existencial de Jean-Paul Sartre e das inestimáveis contribuições de Simone de Beauvoir sobre a situação da mulher, foi possível compreender como se desenvolve o projeto de ser das colaboradoras deste estudo, mulheres de classe média, trabalhadoras, vivendo em situação de relação conjugal, e com filhos, residentes em Fortaleza, Ceará. Para a coleta de dados foi utilizada a entrevista fenomenológica com a pergunta disparadora "como é ser mulher?". Para a análise dos resultados foi utilizado o método Progressivo-Regressivo. Os resultados mostram que, mesmo com a instrução formal e a independência financeira das mulheres, os papéis femininos na conjugalidade têm sofrido poucas modificações com relação ao acúmulo de responsabilidades que recaem sobre elas. A crença em uma essência feminina perpassa a experiência vivida por essas mulheres na maternidade, na relação conjugal e no mercado de trabalho, indicando que ainda há diversos obstáculos à resolução dos problemas sociais que atravessam a história de vida dessas mulheres.

This article is the result of a master's research that aimed to understand how women experience the roles in contemporary conjugality and in the exercise of motherhood, and what the senses they attribute to these experiences. From the existential-phenomenology of Jean-Paul Sartre and the invaluable contributions of Simone de Beauvoir about the situation of women, it was possible to understand how is developed the being project of the collaborators of this study, middle-class women, workers, living a relationship, and with children, residents in Fortaleza, Ceará. For data collect, the phenomenological interview was used with a triggering question "how is being a woman?". For the analysis of the results, the Progressive-Regressive method was used. The results show that, even with a formal instruction and a financial independence of women, their roles in conjugal relationships have undergone few modifications in relation to the increase of responsibilities that fall on them. The idea that there is a feminine essence permeates the experience lived by these women in motherhood, in the contemporary conjugality and in the job market, pointing out that there are still many obstacles to solve social problems through the life history of these women.

Este artículo es el resultado de una investigación de maestría que tuvo como objetivo comprender cómo las mujeres experimentan los actuales papeles que asumen en las relaciones conyugales contemporáneas y en el ejercicio de la maternidad, y cuáles los sentidos que atribuyen a esas vivencias. A partir de la fenomenología-existencial de Jean-Paul Sartre y de las inestimables aportaciones de Simone de Beauvoir sobre la situación de la mujer, fue posible comprender cómo se desarrolla el proyecto de ser de las colaboradoras de este estudio, mujeres de clase media, trabajadoras, viviendo en situación de relación conyugal, y con hijos, residentes en Fortaleza, Ceará. Para la recolección de datos se utilizó la entrevista fenomenológica con la pregunta disparadora "cómo es ser mujer?". Para el análisis de los resultados se utilizó el método Progresivo-Regresivo. Los resultados muestran que, incluso con la instrucción formal y la independencia financiera de las mujeres, los papeles femeninos en la conyugalidad han sufrido pocas modificaciones con respecto a la acumulación de responsabilidades que recaen sobre ellas. La creencia en una esencia femenina atraviesa la experiencia vivida por esas mujeres en la maternidad, en la relación conyugal y en el mercado de trabajo, indicando que todavía hay diversos obstáculos a la resolución de los problemas sociales que atraviesan la historia de vida de esas mujeres.

Calcium blocker lacidipine and carotid arteriolar vasodilation in healthy volunteers.

Systemic and carotid hemodynamics were studied in 10 healthy male volunteers before and after short-term administration of a 4 mg dose of the calcium entry-blocker lacidipine in a placebo-controlled, double-blind, crossover study. Hemodynamic parameters of the right common carotid artery were measured before and at 1 1/2 and 3 hours after dose administration by means of pulsed Doppler flowmetry. In addition, systemic hemodynamic parameters were calculated from cardiac impedance measurements at the same time. In comparison with placebo, lacidipine produced a significant decrease in blood pressure, together with systemic and carotid arteriolar dilatation. Heart rate increased sharply, whereas carotid arterial diameter and tangential tension did not change. The study provided evidence that the calcium entry-blocker lacidipine produces systemic and carotid arteriolar vasodilation and that the heart rate baroreflex response after administration of calcium inhibitor is not associated with a significant modification of the geometry of carotid arterial wall.

Pindolol availability in hypertensive patients with normal and impaired renal function.

Intravenous and oral pharmacokinetics of pinlolol were studied in 18 hypertensive patients-9 with normal renal function and 9 with impaired renal function. Analysis of data showed that a linear two-compartment model was suitable to describe the pindolol kinetics. Compared with patients with normal renal function, patients with chronic renal failure exhibited: (1) unchanged transfer rate constants and distribution volumes and (2) decreased total body clearance with decreased renal clearance and unchanged nonrenal clearance. Analysis of oral data by the Loo-Riegelman method showed that the pindolol absorption kinetic was not first order. Compared with patients with normal renal function, patients with chronic renal failure exhibited decreased fraction of dose effectively absorbed and increased initial rate of absorption. The initial rate of absorption was inversely correlated with the creatinine clearance. The study disclosed evidence that absorption was modified in chronic renal failure.

Guanfacine kinetics in patients with hypertension.

Guanfacine kinetics were studied in 19 patients with hypertension after single and repeated oral doses. The single-dose study was performed in two homogeneous groups who received 2 mg (n = 9) and 4 mg (n = 10). The plasma concentrations were fitted in a two-compartment open model with first-order absorption. After a lag time of 0.8 hr, the absorption occurred rapidly (t 1/2 congruent to 0.53 hr). The fast and slow elimination phases occurred with t 1/2s of 2 and 19 hr. At therapeutic levels the percent of drug in red blood cells (55%) was independent of total drug concentration. Peak plasma levels had small interindividual variations. Comparison of kinetic parameters and AUC at the two doses studied demonstrated that their bioavailability was equal and the kinetics were linear. In a multiple-dosing study, performed in the same subjects, the plasma levels at steady state were in good agreement with the predicted values (p less than 0.001) and proportional to daily dosage. A single method based on four blood samples collected after 24, 28, 32, and 36 hr allows a reasonable prediction of the effective steady-state plasma levels during chronic dosing with guanfacine.

Mycobacterium tuberculosis and its purified protein derivative activate expression of the human immunodeficiency virus.

To examine the effects of Mycobacterium tuberculosis on human immunodeficiency virus type 1 (HIV-1) expression, the monocytoid cell line U1 containing integrated provirus was incubated with the H37Ra strain of M. tuberculosis. This resulted in heightened expression of virus in supernatant that was partially inhibited by antibody to tumor necrosis factor-alpha (TNF-alpha). Purified protein derivative (PPD) prepared from M. tuberculosis also could activate HIV expression, and this was less affected by anti-TNF antibody. PPD could activate the HIV promoter in both U937, the monocytoid cell line from which U1 was derived, and Jurkat, a CD4+ lymphoid line. Activation was abolished by mutations in the nuclear factor (NF)-kB binding domains. Jurkat cells transfected with a plasmid construct linking 8 NF-kB binding domains to the chloramphenicol acetyltransferase (CAT) gene showed increased activity of the reporter gene after activation with PPD. Transcriptional activation of HIV expression by mycobacteria and mycobacterial products may enhance propagation of HIV in monocytoid and lymphoid cells. This may result in accelerated HIV disease progression in persons coinfected with M. tuberculosis.

Pharmacokinetics and hepatic extraction ratio of pindolol in hypertensive patients with normal and impaired renal function.

The intravenous and oral pharmacokinetics and the hepatic extraction ratio of pindolol were determined in 24 hypertensive patients with normal or impaired renal function. In patients with normal renal function, the total clearance was the sum of equal parts of the renal and nonrenal clearances. The nonrenal clearance was found to be equal to the hepatic clearance directly measured from the hepatic extraction ratio. Compared to patients with normal renal function, patients with chronic renal failure exhibited (i) unchanged K12 and K21 and nonrenal clearances, and (ii) significantly decreased values in half-life of the beta phase, Kel, and total renal clearance. The renal clearance was positively correlated (P less than 0.01) to the creatinine clearance. Bioavailability was significantly reduced (P less than 0.01) in the patients with renal failure. Assuming that the nonrenal clearance was equal to the hepatic clearance, the study provides evidence that, in patients with renal insufficiency, (i) no increased metabolism accompanies the decrease in renal function, and (ii) decreased availability is due to reduced absorption.

Clinical and histologic observations of sites implanted with intraoral autologous bone grafts or allografts. 15 human case reports.

The cases reported in this paper were treated at 7 different clinical centers and present clinical and histologic observations from 15 patients and 21 human biopsies. The biopsies were taken from extraction sockets or dental implant sites which were grafted with either autologous intra-oral bone (6 sites), demineralized freeze-dried bone (DFDBA) (7 sites), or mineralized freeze-dried bone (MFDBA) (7 sites), or a combination of autologous bone, DFDBA and a barrier membrane (1 site). Six sites were grafted with DFDBA and augmented with expanded polytetrafluoroethylene (ePTFE) barrier membranes. Biopsies for histological evaluation were taken 4 to 13 months after implantation. A bone scoring system of 0 to 4 was used to evaluate the sections for dead implanted particles or the presence of vital bone. A bone score of 3 indicated the presence of dead implant material, blood vessels, islands of cartilage, osteoblasts, and new bone formation. A score of 4 indicated total replacement of the implanted material by the host bone. The average bone score for sites which received autologous bone was 2.33; for DFDBA sites, 0.98; and MFDBA was 0.18. The over-riding histologic characteristic of sites implanted with DFDBA or MFDBA was retention of non-vital graft particles within fibrous connective tissue. Biopsies taken adjacent to the host bed demonstrated incorporation of the allografts (osteoconduction). Sites grafted with autologous bone chips also demonstrated non-vital bone chips surrounded by vital host bone (osteoconduction). Sites which received barrier membranes did not appear to improve or impair bone healing of the augmented sites. Autologous bone chips harvested from within the oral cavity as well as allografts may serve as biologic fillers, but do not apparently contribute to osteoinduction. Autologous bone will eventually be resorbed and replaced by the host. DFDBA and MFDBA are resorbed very slowly and apparently do not contribute to osteoinduction. Allografts apparently are not resorbed by osteoclasts and therefore their continued use around dental implants is questioned.

Gap and tight junctions in tunicates. Study in conventional and freeze-fracture techniques.

Intercellular junctions have been investigated in epidermis and pharyngeal epithelium of larvae and adults of various species of tunicates with conventional and freeze-fracture techniques. Gap and tight junctions were found, similar to those observed in vertebrate tissues. Gap junctions were frequent in glandular epithelia and in larval tissues. They were interpreted as ways of intercellular communication in these developing tissues. They were also particularly numerous in Phallusia pharyngeal cells. Tight junctions were found preferentially in adult pharyngeal and epidermal epithelia, where they were arranged in strands of distinct particles forming a belt-like network at the apical part of cells. These junctions were interpreted as providing a tight barrier between the internal medium and the external environment. In larvae, tight junctions were found only between epidermal cells of the tail. These junctions thus characterized completely differentiated tissues, where they might play, in tunicates and in vertebrates, the same role as septate junctions do in invertebrates.

[Clinical pharmacology of the antihypertensive action of guanfacine]. / Pharmacologie clinique de l'action antihypertensive de la guanfacine.

The clinical pharmacology of a central antihypertensive drug, guanfacine, was studied in sustained essential hypertension. The study of the haemodynamics, performed in 7 patients demonstrated a significant decrease in blood pressure and a fall in heart rate (less than the one observed with clonidine): the peripheral resistances remained unchanged after 4 days treatment. A clinical trial was carried out in 20 patients with sustained essential hypertension. Guanfacine was given orally (2 to 4 mg/day) during 2 months; the results of this study confirmed the antihypertensive effect of the drug. The most frequent side effects were dryness of the mouth and sleepiness. Guanfacine kinetics were studied in patients after single and repeated oral doses. The plasma concentrations were fitted in a two compartments open model with first order absorption. Steady state plasma level during a long term treatment can be determined with the predicted values derived from simulation of the initial individual kinetic studies. For a 2 mg dosage the biological half-life was 22.8 +/- 3.6 h. Guanfacine kinetics were linear according to the dosage. In moderate permanent essential hypertension guanfacine can be easily prescribed in monotherapy at a posology of 2 to 4 mg/day.

[Effect of the time of ingestion of 300 mg of ranitidine on cicatrization of duodenal ulcer in crisis (ingestion after dinner versus ingestion at bedtime]. / Effet de l'horaire de prise de 300 mg de ranitidine sur la cicatrisation de l'ulcère duodénal en poussée (prise en fin de repas du soir versus prise au coucher).

Recent studies have shown that a single dose of ranitidine given for 2 weeks at 6 p.m. resulted in a higher healing rate of duodenal ulcer than the same dose given at 10 p.m. Our study was designed to confirm these results in a large population in France. Three hundred and fifty patients with endoscopically proven duodenal ulcer were randomly assigned to open treatment with ranitidine 300 mg, immediately after dinner (dinner group), or at bedtime (bedtime group). Endoscopy was performed after 2 and 4 weeks. Forty six patients were excluded from analysis (default: 3, date of endoscopies not respected: 43). Of the 304 patients analysed (mean age: 45.5 years, sex ration M/F: 3.2), 146 received ranitidine after dinner, 158 at bedtime. Age, sex, ethnic groups, smoking habits and alcohol consumption were comparable in the two groups. At endoscopy, before treatment, the mean diameter of ulcers was greater in the bedtime group than in the dinner group (bedtime: 9.6 mm, dinner: 7.9 mm). Healing rates after 2 weeks were 58 p. 100 in the dinner group and 40 p. 100 in the bedtime group (p = 0.002). After 4 weeks treatment, cumulative healing rates were 87.5 p. 100 and 83.5 p. 100, respectively. Smoking had an influence on healing after 2 weeks but not after 4 weeks of treatment. In conclusion, a single dose of 300 mg of ranitidine resulted in a higher healing rate of duodenal ulcer when given immediately after dinner than when given at bedtime.

[Intermittent treatment or preventive treatment of recurrence in duodenal ulcer disease? A controlled, double-blind study with 150 mg ranitidine daily for one year]. / Traitement des poussées ou traitement préventif des récidives dans la maladie ulcéreuse duodénale? Etude contrôlée en double aveugle d'une prise quotidienne de ranitidine 150 mg pendant un an.

This 1-year study compared two pragmatic strategies in long-term management of duodenal ulcer: continuous treatment with ranitidine 150 mg after dinner and treatment of duodenal ulcer attacks with ranitidine 300 mg and placebo in the interval. A multicentric, randomized double-blind study was conducted in 399 patients, 197 in the ranitidine group and 202 in the placebo group. Efficacy was judged by the prevalence of ulcer-pain recurrences; secondary criteria were the prevalence of endoscopic recurrences, complications and the number of facultative visits, hospitalizations and days off work related to duodenal ulcer disease. Both groups were similar with regard to main epidemiologic features and number of drop-outs (10.5 percent). Fifty-two patients were withdrawn for symptomatic or endoscopic relapses: 6 in the ranitidine group, 46 in the placebo group (p less than 0.05). Sixty-six percent of the patients remained asymptomatic at one year in the ranitidine group versus 33 percent in the placebo group (p less than 0.001). Seventeen patients with ranitidine (8.6 percent) and 59 with placebo (29.2 percent) experienced at least one endoscopic recurrence (p less than 0.05). In the placebo group, 8 complications were observed (bleeding = 5, duodenal stenosis = 3), and none in the ranitidine group (p less than 0.005). Patients with ranitidine had significantly less facultative visits and endoscopies, number of days off work, and hospitalizations (p less than 0.05). Tolerance was good (5 percent side-effects, all minor) and identical in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemodynamic effects of labetalol on the humeral artery of the hypertensive patient. A double-blind study versus placebo]. / Effets hémodynamiques du labétalol sur l'artère humérale du sujet hypertendu. Etude en double-aveugle contre placebo.

Forearm arterial hemodynamics, including measurements of brachial artery diameter and compliance with pulsed Doppler velocimetry were determined before and after acute administration of labetalol in patients with sustained essential hypertension. Labetalol caused a significant and rapid drop in blood pressure with a decrease in forearm vascular resistance and an increase in brachial blood flow. Brachial artery diameter did not change while arterial compliance significantly increased. The study provided evidence that labetalol caused a shift of the pressure-brachial artery diameter curve toward lower values of blood pressure, indicating a pharmacological effect of alpha and beta blockade on the hypertensive arterial wall.

[Use of a slow-release form of salbutamol in the treatment of threatened premature labor. A comparative study of 52 randomized cases compared with the immediate release form]. / Utilisation d'une forme "retard" de salbutamol dans le traitement des menaces d'accouchement prématuré. Etude comparative de 52 cas randomisés avec la forme à libération immédiate.

A randomised study was carried out to compare the effect of ordinary salbutamol with controlled release salbutamol as far as the sedative effect on the uterine muscle was concerned. Modifying the molecule for salbutamol gives it characteristics of a true "retard" form. This makes it possible to prescribe 2 tablets a day in 2 doses to copy the sedative effect on uterine muscle achieved when the treatment is given intravenously in cases of threatened onset of labour. The study was a double blind one with a placebo being used in two parallel groups after the populations had been compared for similar characteristics as far as the past history, the body build and the number of pregnancies was concerned. This made it possible to show that the two forms are strictly comparable and that there are no adverse side effects. This form of "retard" salbutamol seems to be particularly useful in repeated attacks of threatened premature labour and makes it likely that it will be taken more regularly with the avoidance of peaks in plasma and therefore improved tolerance. Furthermore, the action is longer and effective overnight.

[Usefulness of salmeterol in nocturnal asthma: a comparative study with theophylline-ketotifen association. A French multicenter group]. / Apport du salmétérol dans l'asthme nocturne: étude comparative à l'association théophylline LA-kétotifène. Groupe Multicentrique Français.

Ninety-six patients with nocturnal asthma (FEV1 = 60-90% pred, reversibility greater than or equal to 15%, at least 2 awakenings in the week preceding the trial) were included in a double-blind, randomized, crossover, multicenter study which compared the efficacy and side effects of inhaled salmeterol (50 micrograms morning and evening) to the association theophylline-ketotifen (300 mg and 1 mg morning and evening, respectively). The trial included a run-in period of 14 days and 2 periods of successive treatment of 28 days each. The efficacy was expressed in terms of therapeutic success, defined by the total disappearance of nocturnal symptoms during the treatment week. A statistically significant difference (p less than 0.01) was found between salmeterol and the association for this criteria: during the first period, 46% of subjects treated by salmeterol did not present nocturnal awakenings during the last treatment week by comparison with 15% of subjects taking the association; during the second period, corresponding figures were 39% for salmeterol by comparison with 26% for the association. Differences were also significant, favoring salmeterol, for other criteria (lung function tests, extra-need for salbutamol). Side effects were 5 times more frequent for the association (p less than 0.004). Salmeterol is clearly superior to the association theophylline-ketotifen in the treatment of nocturnal asthma.