Aminophylline in the emergency department. Maximizing safety and efficacy

An experimental technique designed to predict theophylline doses needed to attain therapeutic theophylline concentrations in 43 emergency department (ED) patients was compared with a standard conventional regimen in 46 ED patients. The experimental protocol utilized a computer-assisted dosage prediction program that incorporated baseline theophylline concentration rapidly obtained using a bedside assay. The standard protocol used conventional loading and infusion rates, as well as an estimate of time of last theophylline dose based on patient history. Plasma theophylline concentrations, estimated 1 and 6 hours after commencement of aminophylline therapy in each regimen, were compared. The experimental protocol was equally rapid but much more accurate in achieving targeted theophylline concentrations. Experimental dosage prediction was associated with a higher proportion of theophylline concentrations in the therapeutic range at 1 (81 percent vs 26 percent; p less than 0.001) and 6 hours (91 percent vs 37 percent; p less than 0.001). There was a trend toward fewer toxic concentrations recorded at 1 (0 percent vs 7 percent; p = 0.27) and 6 hours (0 percent vs 10 percent; p = 0.08). This protocol, which was performed quickly and without difficulty by residents in a busy hospital ED, offers an opportunity to improve the efficacy and decrease the toxicity of theophylline use in asthma emergencies.     

Principles and pitfalls in the analysis of prenatal treatment effects in multiparous species.

Developmental studies often assess the effect of treatment of the pregnant mother on offspring. The use of multiparous species such as rats and mice in such studies creates a special set of design and analysis problems. These arise for two reasons. First, the availability of many offspring per litter tempts the experimenter to inflate sample size by treating scores from several pups per litter as independent observations. Second, large litter size seldom makes it practical to measure exposure effects in all offspring of an exposed dam. Such studies commonly involve two-stage sampling: Drawing a random sample of dams for treatment, then drawing a second sample of pups per dam for neurobehavioral measurements. In this article, such sampling was modeled by two different simulations. The first, a standard Monte-Carlo approach, sampled from random-normal distributions for litter mean and within-litter variability. The second simulation sampled without replacement from actual data on weight of all pups in a series of 39 nontreated rat litters. These mutually-supportive approaches demonstrate that litter effects, even over as few as three litters, are generally large and statistically meaningful. Consequently, statistical significance tests are sensitive to litter effects. Inflation of sample size by treating as few as 2 pups per litter as independent measurements can almost triple the nominal 0.05 alpha level. Furthermore, two-stage sampling increases the within-treatment error term and correspondingly reduces statistical power relative to one-stage sampling.(ABSTRACT TRUNCATED AT 250 WORDS)     

Distinctive immunoglobulin E anti-house dust allergen-binding specificities in a tropical Australian Aboriginal community

BACKGROUND: There is evidence that the specificity of the IgE binding in allergy tests can vary for different populations. OBJECTIVE: We aimed to examine the allergenic specificity of IgE binding in sera from house dust mite (HDM)-atopic subjects in a tropical Australian Aboriginal community. METHODS: Sera shown to contain IgE antibodies to an HDM extract of Dermatophagoides pteronyssinus were examined for IgE binding to a panel of nine purified HDM allergens from this mite species by quantitative microtitre assays. IgG antibody binding (IgG1 and IgG4) was also measured. RESULTS: The IgE-binding activity in the sera from the Aboriginal community was not directed to the expected major groups 1 and 2 HDM allergens but instead to the group 4 amylase allergen. There was also little IgE binding to the potentially cross-reactive tropomyosin (Der p 10) or arginine kinase (Der p 20) allergens. The IgG4 antibody was rarely detected and limited to the Der p 4 allergen. IgG1 antibody binding was frequently measured to all the allergens regardless of an individual's atopic status, whereas in urban communities it is restricted to the major allergens and to atopic subjects. CONCLUSION: The high IgE anti-HDM response of Australian Aboriginals predominantly bound Der p 4 and not the Der p 1 and 2 allergens, showing a distinctive allergy that could affect the disease outcome and diagnosis.     

Limitations of a thermal camera in measuring surface temperature of laser-irradiated tissues

Thermal cameras are used in research laboratories to measure tissue temperature during laser irradiation. This study was an evaluation of the accuracy of a 3-5 microns thermal camera and two 8-12 microns cameras in detecting the maximum temperatures of small targets. The size of the targets was within the range of laser spot diameters which are used for vessel welding, angioplasty, and dermatology. The response to a sharp thermal edge was measured and analyzed for the three cameras, which had a scanning rate of 30 frames per second. The response of the 3-5 microns camera to reference black body targets of different sizes was also studied. It was found that the detector system required an average of 2.44 microseconds to reach 90% of maximum step response for the 8-12 microns system and 5.85 microseconds for the 3-5 microns system. With a 3 x telescope and a 9.5 inch focal distance close-up lens, the 3-5 microns camera underestimated the temperature of targets smaller than 2.0 mm because of its slow detector response. Although the 8-12 microns camera provides more accurate measurements due to its faster detector response, it still underestimates the temperature of targets smaller than 900 microns, when similar magnification and focal distance are used. Methods to compensate for the inaccuracies are discussed, including empirical correction factors and the inverse filtering technique.     

Clinical features of the exploding head syndrome.

Fifty patients suffering from the "exploding head syndrome" are described. This hitherto unreported syndrome is characterised by a sense of an explosive noise in the head usually in the twilight stage of sleep. The associated symptoms are varied, but the benign nature of the condition is emphasised and neither extensive investigation nor treatment are indicated.     

Bladder cancer and occupational exposure to polycyclic aromatic hydrocarbons

The association between occupational exposure to polycyclic aromatic hydrocarbons (PAH) and bladder cancer development was investigated in a population-based case-control study carried out in the Bormida valley, Italy. One hundred and twenty-one male cases and 342 male controls, matched age, were collected from local hospitals. Occupational exposure to PAH and aromatic amines (AA) was evaluated by means of a job exposure matrix, constructed specifically for this study. Subjects considered as sharing a "definite exposure to PAH" showed an increased risk even after adjustment for cigarette smoking and exposure to AA (OR = 2.14, 95% CL 0.82-5.60). No elevation in risk was found for the category "possible exposure to PAH" (OR = 1.05, 95% CL 0.45-2.44). The findings of this study are consistent with previous studies indicating PAH as a risk factor for bladder cancer. A possible residual confounding effect due to AA impurities is discussed.     

Measuring maternal mortality: An overview of opportunities and options for developing countries

Background  

There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.     

Reduction of nickel-induced contact hypersensitivity reactions by topical tea tree oil in humans

Objective and Design: Whilst the anti-microbial properties of tea tree oil (TTO) are established, the anti-inflammatory effects of TTO in human skin remain largely anecdotal and require evaluation. This study examined the effect of topically applied TTO on nickel-induced contact hypersensitivity reactions in human dorsal skin.Treatment: TTO (100%), a 5% TTO lotion, a placebo lotion (no TTO), or 100% macadamia oil were applied at days 3 and 5 after nickel exposure.Methods: The flare area and erythema index were measured on days 3, 5 and 7. The regulatory effects of TTO were also investigated on the proliferative response to nickel or polyclonal mitogens by peripheral blood mononuclear cells from nickel-sensitive and control subjects.Results: TTO (100%) significantly reduced the flare area and erythema index when compared to the nickel-only sites. With respect to the erythema index, the anti-inflammatory effects were predominantly, but not exclusively, seen in a subgroup of nickel-sensitive subjects with a prolonged development phase of nickel-induced contact hypersensitivity response. The 5% TTO lotion, the placebo lotion and the 100% macadamia oil were all without significant effect. TTO significantly inhibited proliferation to nickel but not to non-specific polyclonal mitogens by peripheral blood mononuclear cells from nickel-sensitive subjects.Conclusions: Topical application of 100% TTO may have therapeutic benefit in nickel-induced contact hypersensitivity in human skin. The mode of action of TTO requires further investigation, but may be an effect on the antigen presenting cells or the antigen presenting process in nickel-induced contact hypersensitivity, as well as vascular changes associated with this response.Received 14 February 2004; returned for revision 30 June 2004; accepted by J. S. Skotnicki 13 September 2004