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Notes: Fifty-five strains, either authentic or ex-type, of seven Malassezia species were investigated for in vitro susceptibility to various concentrations (0·03–64·0 µg/mL) of three azole drugs, ketoconazole, voriconazole and itraconazole, as well as the allylamine terbinafine, using the agar dilution method. All strains of the seven Malassezia species were susceptible to the three azole drugs at low concentrations. M. furfur, M. sympodialis, M. slooffiae, M. pachydermatis, M. globosa, M. obtusa and M. restricta were most sensitive to ketoconazole and itraconazole, with minimum inhibitory concentrations (MICs) ranging from ≤ 0·03 to 0·125 μg/mL. The recently introduced antifungal, voriconazole, was also very effective, with MIC80 values ≤ 0·03 μg/mL for 80% of strains. MICs of terbinafine against the seven Malassezia species ranged from ≤ 0·03 to 64·0 μg/mL. There were variations in susceptibility of the seven Malassezia species to ketoconazole, voriconazole, itraconazole and terbinafine. Strains of M. furfur, M. globosa and M. obtusa were more tolerant to terbinafine than the remaining Malassezia species; M. sympodialis was highly susceptible. M. furfur strains tested with terbinafine ranged from highly susceptible to relatively resistant. Correct identification of Malassezia species could facilitate selection of appropriate antifungal therapy.

Notes: In an open, multicentre evaluation carried out in Brazil, Canada and South Africa we have demonstrated that fluconazole 8 mg kg−1 once weekly is effective in tinea capitis caused by Trichophyton and Microsporum species. There were 61 children, aged (mean ± SE) 5·0 ± 0·3 years; weight (mean ± 5·6) 20·0 ± 0·9 kg; 41 males, 20 females; one Asian, 57 Black, one Caucasian and two Hispanic. The organisms were Trichophyton violaceum (33 patients), T. tonsurans (11) and Microsporum canis (17). The extent of tinea capitis at pretherapy was: mild (18 patients), moderate (30) and severe (13). Patients with tinea capitis due to Trichophyton species were initially treated for 8 weeks with an extra 4 weeks of fluconazole if clinically indicated. All 44 patients with tinea capitis due to Trichophyton species were completely cured (clinically and mycologically) when evaluated 8 weeks after completion of active treatment, following 8 weeks of once weekly dosing in 35 patients and 12 weeks of once weekly dosing in nine patients. In Microsporum canis tinea capitis, an extra 4 weeks was administered at week 12 in patients where it was clinically indicated at the time. Sixteen of 17 patients with M. canis tinea capitis were completely cured (clinically and mycologically) when evaluated 8 weeks following the end of treatment when given for 8, 12 and 16 weeks in 12, one and three patients, respectively. Overall, complete cure (clinical and mycological) occurred in 60 of 61 patients at follow-up 8 weeks from the end of therapy. The duration of once weekly fluconazole in the 60 patients was 8 weeks (47 patients), 12 weeks (10 patients) and 16 weeks (three patients), respectively. Clinical adverse effects consisted of a mild, reversible gastrointestinal complaint in three (4·9%) of 61 children. A laboratory abnormality with elevated liver function tests was observed in one (5·9%) of 17 patients; this was asymptomatic, and reversible. No patient discontinued therapy. The data suggest that once weekly fluconazole dosing is effective, safe and associated with high compliance when used to treat tinea capitis.

Notes: In an open multicentre study we have demonstrated that itraconazole pulse therapy, 5 mg/kg per day, is effective and safe in the management of tinea capitis in 10 children (seven boys, three girls, mean age: 6.6 years, age range 4–11 years). The causative organisms were Trichophyton tonsurans (six cases), T. violaceum (two cases), T. soudanense (one case) and Microsporum gypseum (one case). Each pulse of drug therapy lasted 1 week with 2 weeks off between consecutive pulses. One, two and three pulses produced complete, clinical and mycological, cure in one, six and three patients, respectively. The children tolerated the treatment well and there were no clinical or laboratory adverse effects. This 1-week pulse therapy regimen resulted in a high degree of compliance. The preliminary results of this study are promising and need to be evaluated in a larger sample of patients.

Notes: There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared to non-psoriatics. We therefore measured the prevalence of toenail onychomycosis in psoriatics and non-psoriatics attending dermatologists'offices. None of the patients had a referring diagnosis of onychomycosis. The prevalence of pedal onychomycosis in psoriatics (n = 561) was 13%. The odds of patients with psoriasis having onychomycosis was 56% greater than non- psoriatics of the same age and sex (P= 0·02). In the psoriatics, when the toenails were clinically abnormal, the prevalence of onychomycosis was 27%. The odds of developing onychomycosis increased with age (P 〈 0·0001) and the odds of men developing onychomycosis was 2·5 times that of women (P= 0·0001). The duration of psoriasis did not significantly affect the odds of developing onychomycosis. The fungal organisms recovered from psoriasis subjects with onychomycosis were similar to those in the normal population with onychomycosis (P = 0·58).

Notes: At the one-stop carpal tunnel syndrome clinic, patients undergo neurophysiological studies followed by clinical assessment by the orthopaedic consultant on the same day. Patients with paraesthesia or numbness in the median nerve distribution for greater than three months duration without a history of a previous soft tissue neck injury were selected for assessment in the one-stop carpal tunnel syndrome clinic based on a proforma completed by their general practitioners. Data of patients attending the one-stop carpal tunnel syndrome clinic over a ten-month period were compared with that over the same period from a conventional hand clinic. A total of 77 patients attended the one-stop carpal tunnel syndrome clinic over a ten-month period. The mean time from referral to surgery was 23 weeks in this group compared to 44 weeks for a conventional clinic. On average, the one-stop carpal tunnel syndrome clinic reduced the time from referral to surgery by 21 weeks. The one-stop carpal tunnel syndrome clinic is convenient and cost effective for patients and hospitals.

Notes: The thrust of this paper is to develop a comprehensive software selection criterion and view information technology related issues in supply chain management. This paper furnishes implicit details of decision support systems, software solutions and factors associated with selection of IT applications for supply chain management. It entails the components of decision support systems and evolution of supply chain management softwares. A brief discussion of the functioning of various modules of the supply chain package is presented. This paper also proposes the use of percentage based weighted Tree in order to choose appropriate supply chain solution(s).

Notes: Background One of the most troublesome features of atopic dermatitis (AD) is its chronic relapsing nature, and there is a lack of published evidence on the best treatment strategy for long-term management of the disease. Objectives To compare an intermittent dosing regimen of fluticasone propionate (FP) cream 0·05% (twice per week) with its vehicle base in reducing the risk of relapse when added to regular daily emollient in adult and paediatric subjects with stabilized AD. Methods Subjects (aged 3 months to 65 years) with moderate or severe AD were enrolled into an open-label Stabilization Phase of up to 4 weeks on daily emollients plus FP twice daily. Those subjects who achieved ‘treatment success’ (Global Assessment Score ≤ 2, erythema, pruritus, and papulation/induration/oedema scores ≤ 1) entered the double-blind Maintenance Phase. They continued with regular emollients and were randomized at a 2 : 1 ratio to either intermittent FP or vehicle, once daily 4 days per week for 4 weeks followed by once daily 2 days per week for 16 weeks. Subjects who relapsed on intermittent FP were discontinued from the study. Those who did not relapse continued for an additional 24 weeks on intermittent dosing for safety monitoring. Results A total of 372 (247 paediatric, 125 adult) subjects were enrolled into the Stabilization Phase. Of these, 348 (231 children, 117 adults) were randomized into the Maintenance Phase. Analysis of the primary efficacy parameter showed that subjects receiving intermittent FP cream (twice per week), in addition to regular daily emollients in the Maintenance Phase, were 7·7 times less likely to have an AD relapse than subjects receiving intermittent vehicle cream/emollients [Mantel–Haenszel (MH) estimate of the odds ratio, 95% confidence interval (CI) 4·6, 12·8; P 〈 0·001]. Paediatric subjects were 8·1 times less likely to have an AD relapse (95% CI 4·3, 15·2; P 〈 0·001) and adult subjects were 7·0 times less likely to have an AD relapse (95% CI 3·0, 16·7; P 〈 0·001). For subjects receiving intermittent FP cream/emollient, the median time to relapse could not be estimated as the majority remained controlled at 20 weeks. For those receiving intermittent vehicle/emollient, the median time to relapse was 4·7 weeks. For paediatric and adult groups, this was 5·1 and 4·1 weeks, respectively. Median exposure to FP for all subjects was 337 days. There was only one study drug-related adverse event (acne) and there were no reports of skin thinning or atrophy associated with the use of FP cream in paediatric or adult subjects. Conclusions In paediatric and adult subjects, once stabilized with regular FP treatment, the risk of relapse of AD can be significantly reduced by extended intermittent dosing with FP cream in addition to regular emollient therapy.