Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, double-blinded, and placebo-controlled clinical trial

OBJECTIVE

To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB).

STUDY DESIGN

We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (<12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization.

RESULTS

One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47).

CONCLUSIONS

Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.

The activation energy for nanocrystalline diamond films deposited from an Ar/H2/CH4 hot-filament reactor

In this work we have investigated the effect of substrate temperature on the growth rate and properties of nanocrystalline diamond thin films deposited by hot filament chemical vapor deposition (HFCVD). Mixtures of 0.5 vol% CH4 and 25 vol% H2 balanced with Ar at a pressure of 50 Torr and typical deposition time of 12 h. We present the measurement of the activation energy by accurately controlling the substrate temperature independently of other CVD parameters. Growth rates have been measured in the temperature range from 550 to 800 degrees C. Characterization techniques have involved Raman spectroscopy, high resolution X-ray difractometry and scanning electron microscopy. We also present a comparison with most activation energy for micro and nanocrystalline diamond determinations in the literature and propose that there is a common trend in most observations. The result obtained can be an evidence that the growth mechanism of NCD in HFCVD reactors is very similar to MCD growth.

Application of Fourier analysis to clinical study of patterns of tissue movement

An analysis is made of the kinetics of human liver parenchyma in response to mechanical impulses arising in the heart and aorta, and the results are applied to predicting the time course of the correlation between two time-separated A-scans derived from various regions of the liver. Such predictions are found to correspond well with data derived clinically, both from volunteers and from patients with liver metastases, using a commercial, real-time sector scanner. On the basis of Fourier spectral features of the clinically derived correlation patterns, a clear quantitative separation was demonstrated between the kinetic response of three classes of tissue: normal liver in volunteers, metastatic deposits in liver of cancer patients, and histologically normal liver regions in the same patients.

Ultrasonic study of in vivo kinetic characteristics of human tissues

A method is described for quantifying tissue movement in vivo from the computation of correlation coefficient between pairs of A-scans with appropriate time separation. The method yields quantifiable and repeatable secondary patterns of soft tissue movement in response to primary cardiac movement in a given subject, shows consistently different results as between normal livers and a variety of abdominal tumours, and is sensitive to either progress or therapeutically-induced regression of malignant disease. While the results reported here have been obtained using somewhat simple and crude equipment, the method is well suited to implementation on a commercial real-time scanner.