Cream versus ointment: Randomized single-blinded study on the adherence to treatment with topical methylprednisolone aceponate.

BACKGROUND: Overall adherence in the treatment of chronic dermatoses is poor. Textbooks state an adherence dependence on galenics. TRIAL DESIGN: Prospective, randomized, parallel-grouped, single-blinded (investigator), monocentric clinical trial (phase IV) on the adherence to treatment of chronic mild to moderate hand eczema with topical methylprednisolone aceponate (MPA, Advantan®) in different vehicles. OBJECTIVES AND ENDPOINTS: Primary objective was the assessment of the adherence depending on vehicle type in patients with chronic hand eczema. Secondary objective was improvement after a 4-week treatment period. Primary Endpoint Adherence is defined as the percentage of patients applying at least aimed daily dose. Prescribed daily dose was defined as the planned number of applications per day (1) * surface (measured) * aimed amount per application (mg/cm2 ). Truly applicated daily dose was evaluated as individual mean amount per dose * individual mean number of applications per day. Adherence was assumed, if truly applicated daily dose is at least 75% of the prescribed daily dose and the individual mean number of applications per day is at least 0.85. Secondary Endpoint Efficacy was measured by improvement of Hand Eczema Severity Index (HECSI) and Investigator's Global Assessment (IGA) after a 4-week treatment period and in addition to Quality of Life in Hand Eczema Questionnaire (QOLHEQ) and Visual Analogue Scale (VAS) to assess pruritus. METHODS: Number of participants randomized to each group 40, 80 total. Group 1 MPA-C: Methylprednisolone aceponate 0.1% cream and barrier repair emollient (Bepanthen® Sensiderm). Group 2 MPA-FO: Methylprednisolone aceponate 0.1% fatty ointment and barrier repair emollient (Bepanthen® Sensiderm). Adherence to treatment was compared via Fisher's exact test. RESULTS: Of the patients, 48% were adherent according to our definition. There was no significant difference between MPA-C (42.1%) and MPA-FO (54.1%; p = 0.36; group difference-12.0%, 95% CI-34.3%-11.5%). Generalized-linear-model-analysis of adherence to study treatment with factors emollient use, treatment, time and treatment-time interaction showed a parallel between adherence and amount of emollient use (odds ratio 1.74, p = 0.0038; 95% CI-1.22-2.52). Improvement of hand eczema was seen according to clinical scores without remarkable differences between the groups. CONCLUSIONS: No dependence of adherence on galenics of topical treatment of chronic hand eczema could be proved. Patients who use more emollient tend to be more adherent to the topical treatment.

Improved extraction of avocado oil by application of sono-physical processes.

Ultrasound treatment is known to increase the oil extractability in olive and palm oil processes. This work examined the effect of ultrasound conditioning of avocado puree on oil extractability and quality, at low (18+40kHz) and high (2MHz) frequencies, at litre-scale. Other ultrasound parameters evaluated included high frequency effect (0.4, 0.6, and 2MHz; 5min; 90kJ/kg) and sonication time (2.5-10min at 2MHz), without malaxation. Finally, a megasonic post-malaxation intervention was assessed at selected malaxation times (15, 30, and 60min). Both low and high frequency ultrasound treatments of the non-malaxed avocado puree improved extractability by 15-24% additional oil recovery, with the highest extractability achieved after 2MHz treatments, depending on the fruit maturity and oil content. There was no preferential improvement on oil extractability observed across high frequencies, even though extractability increased with sonication time. Ultrasound treatment also showed a positive effect after puree malaxation. Oils obtained from sonicated purees showed peroxide and free fatty acid values below the industrial specification levels and an increase in total phenolic compounds after 2MHz treatment. High frequency ultrasound conditioning of avocado puree can enhance oil separation and potentially decrease the malaxation time in industrial processes without impacting on oil quality.