A curvilinear nomogram of peak expiratory flow rate for the young.

OBJECTIVE: Peak expiratory flow rates (PEFRs) differ among populations and between times. The new EU scale of the mini-Wright flow-meter has been introduced since 2004. This study updated the PEFR nomograms with the new scale for Chinese children and adolescents (aged 6-19 years) in Hong Kong. METHODS: A convenience sample was recruited from 34 primary care practices (patients' companions/children) and four schools. Standardization workshops were run for the physicians, and the proper use of the flow-meter was demonstrated to students prior to the data collection. Brand new meters were used. For each sex, the linear regression model was used to determine the relationship between PEFR and the variables of age and body height. The open-source software PyNomo was used to generate the nomograms. RESULTS: After excluding 66 participants with past/current history of respiratory tract diseases, heart disease, incomplete data, and poor effort, PEFRs were collected from 798 males and 794 females. The PEFR had a linear relationship with age but a curvilinear relationship with height. The regression equations for predicted PEFR were ln(PEFR) = 1.810256*ln(height) + 0.038297*age - 3.734139 for males and ln(PEFR) = 1.525509*ln(height) + 0.033275*age - 2.368592 for females. The corresponding nomograms were constructed. They were tested with 230 patients in primary care; 9.6% (12 males and 10 females) had PEFR less than the predicted value by ≥20%. CONCLUSION: The body height was a stronger determinant than age for PEFR. The predicted PEFR with these determinants bear a curvilinear relationship.

Atopic dermatitis complicated by methicillin-resistant Staphylococcus aureus infection.

INTRODUCTION: Staphylococcus aureus colonization/infection is commonly associated with disease severity in children with atopic dermatitis. The present report is a three-year retrospective chart review of five cases (comprising three boys and two girls, aged 9-15 years at referral) of methicillin-resistant S. aureus (MRSA) in children with moderate-to-severe atopic dermatitis. The review period spanned 2004-2007. All had longstanding severe disease, high IgE and eosinophil counts. Generalized erythema and a peculiar fishy odor were frequently observed by parents and physicians when MRSA was isolated during some of the episodes of exacerbation. All had tried various combinations of topical and systemic steroids, topical immunomodulants, traditional Chinese medicine and courses of antibiotics-without lasting relief. All specimens of MRSA had in-vitro sensitivity to vancomycin, with corresponding clinical correlates of disappearance of the erythema and fishy odor. CONCLUSION: A fishy odor and facial/generalized erythema in a patient with atopic dermatitis should alert the physician to screen for MRSA. The organism is rarely isolated, even among children with moderate-to-severe atopic dermatitis, and is usually sensitive to vancomycin.

Dominantly-inherited lop ears.

We describe a four-generation Chinese family that included five members who had an isolated bilateral lop ear anomaly. The presentation suggested a dominant mode of inheritance. The absence of male-to-male transmission does not exclude an X-linked dominant mode of inheritance. Since the phenotypic anomaly of the male proband was no more severe than the affected female members, an autosomal dominant mode of inheritance is most likely.