Andrea Stroux

Preconceptional factors associated with very low birthweight delivery in East and West Berlin: a case control study

BackgroundVery low birthweight, i.e. a birthweight < 1500 g, is among the strongest determinants of infant mortality and childhood morbidity. To develop primary prevention approaches to VLBW birth and its sequelae, information is needed on the causes of preterm birth, their personal and social antecedents, and on conditions associated with very low birthweight. Despite the growing body of evidence linking sociodemographic variables with preterm delivery, little is known as to how this may be extrapolated to the risk of very low birthweight.MethodsIn 1992, two years after the German unification, we started to recruit two cohorts of very low birthweight infants and controls in East and West Berlin for a long-term neurodevelopmental study. The present analysis was undertaken to compare potential preconceptional risk factors for very low birthweight delivery in a case-control design including 166 mothers (82 East vs. 84 West Berlin) with very low birthweight delivery and 341 control mothers (166 East vs. 175 West).ResultsMultivariate logistic regression analysis was used to assess the effects of various dichotomous parental covariates and their interaction with living in East or West Berlin. After backward variable selection, short maternal school education, maternal unemployment, single-room apartment, smoking, previous preterm delivery, and fetal loss emerged as significant main effect variables, together with living in West Berlin as positive effect modificator for single-mother status.ConclusionVery low birthweight has been differentially associated with obstetrical history and indicators of maternal socioeconomic status in East and West Berlin. The ranking of these risk factors is under the influence of the political framework.

Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies.

ObjectivesThe aim of this study was to perform phantom measurements to prove the feasibility of single-source dual-energy computed tomography (DECT) of the extremities using a volume scan mode. In addition, we, for the first time, wanted to determine which concentrations of monosodium urate (MSU) in gout and calcium pyrophosphate (CP) in pseudogout are needed to detect or distinguish these soft tissue depositions with DECT. Materials and MethodsWe created a hand-shaped plastic phantom assembled with a descending order of concentrations of MSU (6.25%–50%) and CP (1.56%–50%) with similar attenuation in conventional computed tomographic (CT) images. Dual-energy imaging was done on a standard 320-row CT scanner with acquisition of 2 volumes: one at 80 and the other at 135 kV. Using linear regression analysis, dual-energy gradients were calculated for MSU and CP. Thereafter, we selected a specific region of interest on the dual-energy graph to color-code MSU and CP on the images. Three blinded readers scored 10 scans of the randomly equipped phantom, corresponding to 60 samples, to determine the sensitivity and specificity of this technique. Receiver operating characteristics analysis was done to determine the diagnostic power. ResultsWe found a dual-energy gradient for MSU of 1.020 ± 0.006 and for CP of 0.673 ± 0.001. Assessment of the randomized phantom scans indicates reliable detection of MSU at concentrations of 12.5 % or higher and that of CP at 6.25 % or higher, corresponding to deposits with mean Hounsfield unit values of 59.8 for MSU and 101.1 for CP. The sensitivity for MSU ranged from 83.3% to 97.3% at 15/90 mA (135/80 kV) and from 86.7% to 97.3% at 100/570 mA. Specificity was 96.7% to 100% in 15/90 mA and 100% in 100/570 mA of scans. However, there was inferior sensitivity for CP owing to lower concentrations. In the receiver operating characteristics analysis, the area under the curve for MSU ranged from 0.867 to 0.947 at 15/90 mA and from 0.867 to 0.919 at 100/570 mA and that for CP from 0.659 to 0.745 and from 0.718 to 0.750, respectively. ConclusionsThis phantom study shows that single-source DECT allows detection and characterization of crystal deposits when present in soft tissue at relatively low concentrations. Further studies in patients have to prove its benefits in diagnostic imaging and treatment monitoring as well as its significance compared with dual-source CT systems.

Children with Dry Skin and Atopic Predisposition: Daily Use of Emollients in a Participant-Blinded, Randomized, Prospective Trial

Background: Dry skin reflects a skin barrier defect which can lead to atopic dermatitis. Little is known about the distinct effects of emollient use in children with dry skin and atopic predisposition. Objectives: We investigated the effects of daily application of pressed ice plant juice (PIPJ)-based emollients and petrolatum-based emollients. Methods: Children aged 2-6 years with dry skin and atopic predisposition were randomized into 2 groups: group 1 received emollients containing PIPJ and natural lipids, while group 2 received petrolatum-based emollients. Skin condition and biophysical properties of the skin barrier were assessed at inclusion and weeks 4, 12 and 16. Results: Skin condition improved significantly in all children. Comparing the groups, children treated with emollients containing PIPJ showed significantly higher stratum corneum hydration values and significantly lower transepidermal water loss values at week 16 on the forearm and forehead. A significant decrease in skin pH was noted in group 2 on the forearm and forehead; group 1 showed a stable course. Conclusion: Early intervention with emollients in children with dry skin condition and atopic predisposition may improve their skin condition during daily emollient application. PIPJ-based formulations may be helpful to maintain skin barrier integrity.

Influence of Sunflower Seed Oil on the Skin Barrier Function of Preterm Infants: A Randomized Controlled Trial

Background: Inadequate skin care may increase morbidity in preterm infants. Skin care practices that support skin maturation have barely been investigated. Objectives: To investigate the effect of sunflower seed oil (SSO) on skin barrier development in low-birth-weight premature infants. Methods: 22 preterm infants (<48 h after birth, 1,500-2,500 g) were randomized into group C (control) and group SSO, receiving daily SSO application during the first 10 postnatal days, followed by no intervention. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH and sebum were measured <48 h after birth and on postnatal days 5, 11 and 21 on the forehead, abdomen, thigh and buttock. Results: Skin pH decreased, while sebum remained stable in both groups. In group C, TEWL remained stable; in group SSO, TEWL increased significantly on the abdomen, leg and buttock until day 11, followed by a decrease after SSO application had been stopped. Abdomen SCH remained stable in group C, but continuously decreased in group SSO until day 21. Conclusion: SSO application may retard postnatal skin barrier maturation in preterm infants.

Keratometry, optic disc dimensions, and degree and progression of glaucomatous optic nerve damage.

PurposeTo evaluate whether keratometric readings as a measure of corneal shape are associated with optic disc dimensions and with the degree and rate of perimetric progression of chronic open-angle glaucoma or ocular hypertension. MethodsThe hospital-based observational study included 1826 eyes of 936 patients with ocular hypertension, patients with chronic open-angle glaucoma, or normal individuals. For 733 ocular hypertensive or glaucomatous eyes, follow-up examinations were performed with a mean follow-up time of 58.0±34.7 months. Observation procedures were keratometry, morphometric optic disc analysis, tonometry, and perimetry. ResultsIn the normal study group, area of the neuroretinal rim, alpha zone and beta zone of parapapillary atrophy, and retinal vessel diameter were not significantly associated with keratometric readings. In the entire study population, the optic disc area was significantly (P<0.001; r=−0.27) correlated with low keratometric readings as expressed in diopters. Keratometric readings were significantly (P<0.001 adjusted for age, intraocular pressure, baseline damage, and corneal asphericity) smaller in the normal-pressure glaucoma group than in the normal study group and in the groups with ocular hypertension or primary and secondary open-angle glaucoma. Rate of perimetric progression was not significantly associated with low keratometric readings, either in simple or in multiple Cox regression analysis, controlling for baseline damage, ocular hypertension, age, corneal asphericity, and intraocular pressure. ConclusionsLarge optic disc area is statistically significantly, but clinically weakly, correlated with low keratometric readings (diopters). In Caucasian individuals with ocular hypertension and patients with chronic open-angle glaucoma, the rate of development or progression of glaucomatous visual field defects is not significantly associated with keratometric readings.

Single source dual-energy computed tomography in the diagnosis of gout: Diagnostic reliability in comparison to digital radiography and conventional computed tomography of the feet

OBJECTIVESnTo investigate the diagnostic value of single-source dual-energy computed tomography (SDECT) in gouty arthritis and to compare its capability to detect urate depositions with digital radiography (DR) and conventional computed tomography (CT).nnnMETHODSnForty-four patients who underwent SDECT volume scans of the feet for suspected gouty arthritis were retrospectively analyzed. SDECT, CT (both n=44) and DR (n=36) were scored by three blinded readers for presence of osteoarthritis, erosions, and tophi. A diagnosis was made for each imaging modality. Results were compared to the clinical diagnosis using the American College of Rheumatology (ACR) classification criteria.nnnRESULTSnThe patient population was divided into a gout (n=21) and control (n=23) group based on final clinical diagnosis. Osteoarthritis was evident in 15 joints using CT and 30 joints using DR (p=0.165). There were 134 erosions detected by CT compared to 38 erosions detected by DR (p<0.001). In total 119 tophi were detected by SDECT, compared to 85 tophi by CT (p=0.182) and 25 tophi by DR (p<0.001). SDECT had best diagnostic value for diagnosis of gout compared to DR and conventional CT (sensitivity and specificity for SDECT: 71.4% and 95.7%, CT: 71.4% and 91.3% and DR: 44.4% and 83.3%, respectively). For all three readers, Cohens kappa for DR and conventional CT were substantial for all scoring items and ranged from 0.75 to 0.77 and 0.72-0.76, respectively. For SDECT Cohens kappa was good to almost perfect with 0.77-0.84.nnnCONCLUSIONSnSDECT is capable to detect uric acid depositions with good sensitivity and high specificity in feet, therefore diagnostic confidence is improved. Using SDECT, inter-reader variance can be markedly reduced for the detection of gouty tophi.

Diurnal Intraocular Pressure Profiles in Chronic Open-Angle Glaucoma.

PurposeTo evaluate day-and-night intraocular pressure (IOP) profiles in normal and glaucomatous eyes. DesignHospital-based clinical observational study. MethodsThe study included 3561 day-and-night profiles of IOP measurements performed by Goldmann applanation tonometry on 1408 eyes of 720 normal Caucasian subjects or chronic open-angle glaucoma patients. ResultsFor all groups except the secondary open-angle glaucoma group, IOP was highest at 7 a.m., followed by noon and 5 p.m., and finally at 9 p.m. or midnight. In secondary open-angle glaucoma, mean measurements did not vary significantly during day and night. The profile amplitude (mean: 5.5 2.8 mm Hg) was significantly (P < 0.001) higher in the secondary open-angle glaucoma group than in the normal-pressure glaucoma group and the normal group. The two latter groups did not vary significantly (P = 0.47) in profile amplitude. Expressed as percentage of the mean IOP, the IOP amplitude did not vary significantly between any of the study groups. The inter-eye IOP difference for any measurement time was significantly (P < 0.001) smaller than the IOP profile amplitude. ConclusionsTreated secondary open-angle glaucoma eyes did not exhibit the normal day-and-night pressure profile which was usually shown in normal eyes and eyes treated for other types of chronic open-angle glaucoma. The day-and-night IOP amplitude in absolute terms is highest in secondary open-angle glaucoma. In relative terms, the IOP amplitude did not vary significantly between the various types of chronic open-angle glaucoma. Inter-eye IOP differences were significantly (P < 0.001) smaller than the IOP profile amplitude.

Reduction of Inflammatory and Noninflammatory Lesions with Topical Tyrothricin 0.1% in the Treatment of Mild to Severe Acne Papulopustulosa: A Randomized Controlled Clinical Trial.

Background/Aims: Antibiotic-induced drug resistance requires new approaches in topical acne treatment. Tyrothricin is known to produce no resistance. In this study, it was tested for the first time in topical acne treatment. The efficacy and tolerability of topical tyrothricin 0.1% was evaluated. Methods: A randomized, active comparator-controlled, exploratory, observer-blind clinical study was conducted in 24 patients with acne papulopustulosa. Randomization on a split-face was either tyrothricin versus clindamycin + benzoyl peroxide (BPO) (n = 12) or tyrothricin versus BPO 5% (n = 12). The main outcome was change in inflammatory and noninflammatory lesion counts. Results: The mean differences in inflammatory lesion counts from baseline were -12.3 (95% CI: -20.5 to -4.1) in clindamycin + BPO, -10.2 (95% CI: -15.3 to -5.0) in BPO 5%, and -7.7 (95% CI: -11.7 to -3.7) in tyrothricin. Tyrothricin reduced noninflammatory lesions (mean difference: -6.5 (95% CI: -11.6 to -1.4) and caused less product-related adverse events (n = 31) compared to BPO (n = 37) and clindamycin + BPO (n = 20). Conclusion: The results indicate that tyrothricin might be a candidate for treating acne and it seems to be more tolerable than both comparator treatments.

Iris colour, optic disc dimensions, degree and progression of glaucomatous optic nerve damage.

Purpose:u2002 To evaluate whether iris colour influences size and shape of the optic nerve head and risk for glaucoma progression.

Children with Dry Skin and Atopic Predisposition: Outcome Measurement with Validated Scores for Atopic Dermatitis.

Background: Dry skin is a common skin condition in childhood. Few studies exist investigating the influence of daily skin care on dry skin in infants at risk of developing atopic dermatitis (AD). We aimed to assess the effect of skin care on dry skin in this special cohort using validated scores for AD and analysis of skin microtopography. Methods: 43 children were randomized to group 1 (G1) and group 2 (G2) and 22 infants to group 3 (G3). During 16 weeks, G1 and G3 applied daily a plant-based emollient and G2 a petrolatum-based emollient. The core outcome was assessed by Severity Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). The influence on the parents life was evaluated by a questionnaire and microtopography by Visioscan® VC 98. Results: The SCORAD index declined significantly until week (W) 16 in all groups (p ≤ 0.041). The sleeplessness score analyzed by PO-SCORAD was highly reduced after W12 in G1 and after W16 in G2 (p ≤ 0.030). The influence on the parents anxiety was reduced in G3 at W12 and W16 (p = 0.016). The Visioscan parameter scaliness strongly diminished at W4 (p ≤ 0.049) and W16 (p ≤ 0.013) in all groups. Conclusions: This trial demonstrates improved skin conditions and sleep following daily emollient application in infants and children having dry skin and being at risk of AD. Especially parents of infants showed a reduced fear that their children might develop AD. Further studies are required to investigate the preventive effect of daily emollient therapy in this special cohort evaluating the outcome measures used in this trial.