Repeated dose inhaled budesonide versus placebo in the treatment of croup

OBJECTIVE: To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL-1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup. METHOD: Eighty-two children hospitalised with croup received either 2 mg 4 mL-1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge. RESULTS: Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02). CONCLUSION: Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.     

Practical Belief Scales Among Private General Dental Practitioners

BACKGROUND: Practice beliefs have been related to service rate variation. The aims of this study were to replicate practice belief scales in Australia and investigate associations with dentist and practice characteristics and services. METHODS: A random sample of Australian dentists completed mailed questionnaires (response rate 60.3 per cent). RESULTS: Private general practitioners (n = 345) provided service data from a typical day. Eight practice belief items were recorded on a five-point Likert scale, yielding four factor-based scales. Approximately 85 per cent of responses were on the agreement side of the midpoint for the scales of Information giving and Patient influence, 45 per cent for Preventive orientation and approximately 10 per cent for Controlling active disease rather than developing better preventive advice. Capital city dentists had higher agreement with the Preventive orientation scale, while males and older dentists showed less disagreement with the Controlling active disease item (Mann-Whitney, Kruskal-Wallis P < 0.05). Those agreeing with the scales (that is scores < or = the median) showed (Poisson regression P < 0.05): a higher rate of crown and bridge, a rate ratio (RR) of 1.31, but lower rates of extraction (RR = 0.76) and prosthodontic services (RR = 0.64) for the Information giving scale; a higher rate of restorative (RR = 1.22) and total services per visit (RR = 1.06) for the Preventive orientation scale; a higher rate of preventive services (RR = 1.14), but a lower rate of crown and bridge services (0.78) for the Patient influence scale; and higher rates of crown and bridge (RR = 1.40) and prosthodontic (RR = 1.59) but lower rates of periodontic (RR = 0.60) and extraction services (RR = 0.62) for the Controlling active disease item. CONCLUSIONS: These findings confirm the factor structure of practice beliefs and demonstrate small to moderate associations with variation in service rates.     

THE OCULAR AND PERIOCULAR FEATURES OF MULTICENTRIC RETICU-LOHISTIOCYTOSIS WITH PARAPROTEINEMIA A report of two cases

Two patients with atypical multicentric reticulohistiocytosis are reported. Skin rigidity with mobile rubbery nodules, and telangiectases, are typical of this disease and occurred around the eyes and elsewhere. One patient also had subconjunctival nodules and corneal crystal formation probably due to her paraproteinaemia.
Some literature on this disease and on the occurrence of corneal crystal deposition in dysproteinaemia is reviewed.     

Superficial mycoses and HIV infection in Yaounde

The incidence of superficial infections in patients with human immunodeficiency virus (HIV) is increasing in Yaounde. To determine the prevalence of superficial mycoses in HIV-positive subjects, a study was carried out in different hospital settings in Yaounde over a period of 18 months. Clinical observations were followed by the culture of samples on Sabouraud's glucose agar. Of the 148 HIVab-positive patients examined, 79 (44 males and 35 females) had at least one superficial mycosis (53%). The clinical presentations and the causative organisms did not differ from those found in immunocompetent individuals. The main lesions were oral candidiasis (77%), tinea corporis (21%), tinea versicolor (15%), tinea pedis (13%) and tinea inguium (12%). Trichophyton rubrum and Candida albicans were the organisms most commonly isolated. These results indicate the benefit of studying superficial mycoses for optimal management of HIV patients.     

周期性压力下椎间盘细胞中肌动蛋白的变化及其意义

目的探讨在周期性压力下,体外培养的椎间盘细胞中的肌动蛋白的变化及其意义。方法采用10只5～6周龄、体重为25～30kg的猪的椎间盘进行体外细胞的分离和培养,对细胞施加周期性液压,通过对细胞的形态学观察及Western免疫印迹和免疫荧光实验,检测在周期性压力下椎间盘细胞中的肌动蛋白的变化。结果纤维环细胞和髓核细胞经1MPa、1Hz,持续每天3h加压,3d后髓核细胞的存活率大于90%,纤维环细胞的存活率大于85%,加压后的纤维环细胞和髓核细胞体积均缩小,由多角形转变为细长形。Western免疫印迹结果显示,肌动蛋白在纤维环细胞和髓核细胞中的表达均明显减少,以髓核细胞为著。免疫荧光结果显示,肌动蛋白由正常纤维环细胞和髓核细胞内的疏松排列转变为受压细胞内的紧密排列,髓核细胞的体积明显缩小,其中的肌动蛋白在细胞膜周围紧密排列。结论体外培养的单层椎间盘细胞在受力状态下,肌动蛋白的表达减少,细胞的体积缩小,并且肌动蛋白在细胞内重排列。这可能是激发细胞内或细胞表面信号传导的重要机制。