Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

Objectives

Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement.

Study Design

Prospective validation study.

Methods

A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ² and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded.

Results

The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus.

Conclusion

The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy.

Level of Evidence

2b. Laryngoscope, 2018

https://ift.tt/2DWB885

Response to Editorial

https://ift.tt/2BOMCZR

Does metformin usage improve survival in head and neck squamous cell carcinoma? A population-based study

Abstract

Background

We sought to expand upon preliminary data suggesting that metformin confers a survival benefit to patients with head and neck squamous cell carcinoma (HNSCC).

Methods

A large-scale retrospective cohort study of all patients in Ontario diagnosed with squamous cancer of the larynx, hypopharynx, and nasopharynx between Dec 1st 2007 to Dec 1st 2012 was undertaken. The Institute for Clinical and Evaluative Sciences was accessed to obtain patient demographic, treatment and outcome information. We included patients on metformin at the time of diagnosis. Kaplan Meier methods and Cox Regression models were used.

Results

Patients taking metformin at the time of diagnosis had a higher comorbid status but were otherwise similar to patients without metformin usage. Using multivariate analysis, neither overall survival nor disease specific survival was improved in patients on metformin (OS: HR 1.123, p = .338; DSS: HR 1.048, p = .792).

Conclusions

No survival advantage was observed in patients with HNSCC taking metformin at the time of diagnosis.

https://ift.tt/2QDTDFa

Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media

Abstract

Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.

https://ift.tt/2Qa90pe

Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media

Abstract

Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.

https://ift.tt/2Qa90pe

Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2FZybGm

The Outcome of Multidisciplinary Management of Carotid Body Tumors: Retrospective Cohort Study

Abstract

Background

Carotid body tumor (CBT) is a rare paraganglionic hyper-vascular tumor of the carotid body. The standard treatment for CBTs is surgery, but it involves risk. The study is aimed to assess the CBTs and evaluate the outcome of multidisciplinary management.

Materials and Methods

A retrospective cohort study included patients with CBTs who were managed by surgical excision between May 2006 and April 2018. A multidisciplinary team was established to excise the tumor completely with minimal neurovascular compromise.

Results

The study comprised of 32 patients in the age group of 23–65 years. The main presentation was a unilateral painless neck mass. Six cases (18.75%) were Shamblin I, 10 (31.25%) Shamblin II and 16 (50%) Shamblin III. Complete excision was performed for all cases. Ligation of the external carotid artery was done in 15 cases (46.88%) and repair of the internal carotid artery in 6 (18.75%). Postoperative cranial nerve complications occurred in six patients (18.75%): four transient hypoglossal pareses and two hoarseness of voice. Histopathologically, one case (3.125%) was malignant. No recurrence was detected through the follow-up period.

Conclusion

A multidisciplinary approach is essential for management of CBTs. Early diagnosis and surgical resection minimize morbidity and carry good surgical outcome.

Trial Registration Number

ChiCTR1800018722 (Agency: Chinese Clinical Trial Registry).

https://ift.tt/2PhTd2u

Standardized laboratory monitoring with use of isotretinoin in acne

-The optimal timing of laboratory tests for patients on isotretinoin treatment for acne is uncertain.-In this series, although abnormalities in serum lipids in patients receiving isotretinoin were not infrequent, they were mild to moderate, and were generally noted around the second month of treatment.-For healthy patients on isotretinoin, we recommend that a lipid panel and liver function test be performed at baseline and at month 2, when peak dosing is achieved. Further testing should be considered if a significant abnormal value is noted.

https://ift.tt/2Q9YMVH

Pemphigus and hematologic malignancies: A population-based study of 11,859 patients

•Hematologic malignancies have been reported sporadically in patients with pemphigus.•In the current study, significant associations were observed between pemphigus and chronic leukemia, multiple myeloma, and non-Hodgkin lymphoma.•Further research is needed to confirm these findings in other cohorts.

https://ift.tt/2RwbGdn

The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP)

The incidence of zoster is increased in many autoimmune diseases. This study found a significantly increased zoster incidence in dermatomyositis and cutaneous lupus erythematosus compared with a control group.Physicians should be aware of this risk and consider administering the vaccine against zoster to these patients if not contraindicated.

https://ift.tt/2QcYHAQ

Trends of skin cancer mortality after transplantation in the United States: 1987 to 2013

- -Organ transplant recipients are at high risk of skin cancer mortality.-This study defines population-based mortality from skin cancer posttransplantation and identifies recipients at increased risk of skin cancer mortality.-These findings can guide dermatologists in adopting skin cancerescreening protocols specific to the identified high- risk categories.

https://ift.tt/2Rx39Hf

Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: A Danish nationwide population-based cohort study

•Active cancers and inflammation increase the risk for venous thromboembolism. It is unknown whether this applies to mycosis fungoides and parapsoriasis.•Patients with mycosis fungoides and parapsoriasis have increased risk for venous thromboembolism.•These findings should increase awareness of comorbidities as part of the disease spectrum in patients with mycosis fungoides and parapsoriasis.

https://ift.tt/2QcHmru

Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: a prospective clinical study

In this prospective, randomized, double-blind, controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on early healing of soft tissue after mandibular third molar (M3) surgery.

https://ift.tt/2zHOD8N

Orthognathic Surgery in “Older” Adults with Hemi-Mandibular Elongation: Long-Term Occlusion Outcomes

The purpose of this study was to describe a consecutive series of subjects with HME who underwent orthognathic correction after 26 years of age. The investigators hypothesized that for this group of HME subjects, bimaxillary orthognathic correction would result in a favorable initial and long-term occlusion.

https://ift.tt/2PhoGSr

Development process of traumatic heterotopic ossification of the temporomandibular joint in mice

Heterotopic ossification (HO) means the formation of ectopic bone in muscles, tendons, ligaments, and other soft tissues(Amar et al., 2015). HO is divided into acquired nongenetic HO and inherited genetic HO (Xu et al., 2018). For the rare genetic HO, fibrodysplasia ossificans progressiva (FOP) involves endochondral ossification, while progressive osseous heteroplasia (POH) and Albright hereditary osteodystrophy (AHO) leads to HO through intramembranous ossification(Shore and Kaplan, 2010). Neurogenic trauma-induced HO is a common type of acquired nongenetic HO and occurs through both intramembranous and endochondral ossification(Huang et al., 2018).

https://ift.tt/2zEWML7

Coincidence of craniocerebral and craniofacial injuries

To determine the incidence of craniocerebral injuries in patients who experienced upper facial or midfacial traumas associated with the disorders of consciousness. To find which types of craniofacial traumas predisposed to craniocerebral injuries. To analyze a relationship between the site of the force application and the type of resultant craniocerebral injury.

https://ift.tt/2PflSFe

No change in the teaching of oral and maxillofacial surgery to medical students

We read with interest the recent paper by Hamid et al.1 We commend them for publishing an excellent paper that further highlights the lack of teaching about oral and maxillofacial surgery (OMFS) and lack of awareness of the specialty among medical students.2 Their findings echo our own, as we showed that 72% (183/253) of English medical students and 85% (318/374) of Irish medical students3 had no exposure to it. Several years on, it seems that this has remained a trend, with 89% (178/200) of students1 having had no clinical exposure.

https://ift.tt/2BQuO0t

Oncocytic cystadenoma and oncocytic cysts of the parotid gland occurring synchronously with a pleomorphic adenoma

Synchronous tumours that arise ipsilaterally in the parotid gland are rare. We describe what is to our knowledge the first report of both oncocytic cysts and an oncocytic cystadenoma adjacent to a pleomorphic adenoma of the parotid gland.

https://ift.tt/2KSzWUq

Treatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report

Conservative treatment of odontogenic tumours with decompression or marsupialisation is not common, but can be done successfully in those with a cystic pattern. We present a calcifying epithelial odontogenic tumour that was treated by tube decompression and subsequent enucleation.

https://ift.tt/2BPOCkv

Treatment of clinically amyopathic dermatomyositis

Summary

Dermatomyositis is an unusual auto‐immune condition (where the body's immune system doesn't function correctly) where a characteristic rash is associated with muscle inflammation. However, some patients have the skin disease without associated muscle disease, which is called amyopathic dermatomyositis, and there is no set agreement about the best way to treat these patients. The authors, based in Cardiff, Wales, reviewed the literature concerning the treatment of patients with amyopathic dermatomyositis. They identified eighteen case series (information from more than one patient) and 42 case reports (information from just one patient), but no randomised controlled trials, which are the gold‐standard of research. Antimalarials, such as hydroxychloroquine, were most commonly used, but ineffective in 55% of patients. Other drugs included topical and systemic corticosteroids, methotrexate, dapsone, mycophenolate mofetil and topical tacrolimus. Intravenous immunoglobulin led to improvement or even remission in the greatest number of patients with dermatomyositis with or without muscle involvement. The authors emphasise the need for more robust, unbiased studies to assess the efficacy of treatment in this condition.

https://ift.tt/2PfNBWj

Cognitive and visual diagnostic errors in dermatology

Summary

This review (part 1 of 2) from New York in the USA is concerned with the heuristic techniques ('heuristics') used to make diagnoses. A heuristic approach to problem‐solving is one that relies on a practical method rather than a logical one. Examples include a 'guesstimate', 'unwritten rule', 'gut feeling' or just recognising something. Heuristics often work as shortcuts in the way a diagnosis is made. One way in which doctors make diagnoses is from experience: experienced doctors instantly recognise psoriasis because they have seen lots of it; they don't need to tick off every feature every time. If the diagnosis is not immediately obvious, then they may switch to a more logical approach, such as putting together a set of clinical signs. The first method is simpler and quicker but more prone to errors, especially in the hands of the inexperienced. The inexperienced may, therefore, be obliged to use the second method, sometimes laboriously. Often we use a mixture of the two, but we make mistakes with both: a proportion of the consistent level of incorrect diagnosis in medicine may be due to our own thinking processes. Over forty types of heuristic are listed. If doctors have already reached a diagnosis, for example, they may stop prematurely, ignore more subtle information and fail to consider alternatives (the 'anchoring heuristic'). For dermatologists, heuristics including colour, site, shape and texture are important, but 12 images illustrate how they can be led astray. Humans do better with purely visual information, which seems good news for radiologists and histopathologists.

https://ift.tt/2zFz4OA

Dermatomyositis: a slow path towards targeted therapies or will conventional therapies prevail?

https://ift.tt/2PfNzxF

通过光动力治疗实现人皮肤的 MRSA 非殖民化治疗

Summary

作为医院感染的来源之一, 患者皮肤表面(载体)存在潜在有害细菌, 它们不会产生感染, 但在某些条件下可能传播给其他人。皮肤表面生活的细菌也会导致湿疹恶化。目前去除这些微生物(细菌)皮肤的方法包括给患者使用局部抗生素(皮肤上的)或口服抗生素(口服),但随着时间的推移, 这种策略被认为导致了抗生素耐药性, 这意味着抗生素不再能杀死细菌。本文中描述的是由德国雷根斯堡大学的一个小组进行的研究。他们使用切掉的猪和人体皮肤样本, 在样本中加入耐药细菌,如耐甲氧西林葡萄球菌或 MRSA, 然后用一种化学溶液对皮肤进行处理, 这种化学溶液的作用是增加对光的敏感性。皮肤样本随后暴露在光源下,这一过程被称为光动力激活。他们发现这种技术可以在不损害皮肤细胞的情况下, 大量减少细菌的数量。作者建议,这一过程现在应该作为一种更安全的方法来研究, 以减少表面细菌运输, 而不增加细菌耐药性的风险,也不损害皮肤。

https://ift.tt/2zFUtaB

外阴佩吉特病的相关恶性肿瘤

Summary

外阴佩吉特病(VPD)是一种罕见的皮肤疾病,常见于绝经后的白人女性,它会引起外阴周围的皮肤瘙痒或灼烧。这种疾病有不同的类型,并且在过去,所有类型的 VPD 都与乳腺、肠道和泌尿系统的恶性肿瘤(如癌症)有关。这项来自荷兰的研究着眼于皮肤非侵入性 VPD, 其中在诊断时它只影响皮肤。研究人员想知道,与一般人群(没有 VPD 的人)相比,这种类型的 VPD 是否确实增加了患乳腺癌、肠道或泌尿系统恶性肿瘤的风险,并且评估是否所有 VPD 患者都应该进行常规的恶性肿瘤筛查。从荷兰的全国病理报告档案中获得了 2000 年至 2015 年期间任何类型 VPD 患者的肿瘤学(癌症)历史数据。从荷兰癌症登记处获得了随访数据和来自普通人群的对照组。在 VPD 患者中, 76.9% 诊断为皮肤非侵入性 VPD。研究人员发现,虽然其他类型的 VPD 可能与恶性肿瘤有关,但皮肤非侵入性 VPD 组患乳腺、肠道或泌尿道恶性肿瘤的风险并未增加。这表明,在诊断为皮肤非侵入性 VPD 的患者中,对这些恶性肿瘤的常规筛查可能没有必要。

https://ift.tt/2Pig3XJ

Sleep disturbance in psoriasis

Summary

Psoriasis is a common skin disease that affects 4‐5% of people worldwide. Psoriasis can be recognized by red, scaly areas on the skin, most often on the elbows, knees, scalp, and lower back. Given these physical symptoms, one could suspect that people with psoriasis may have difficulty sleeping. This study from Copenhagen, Denmark aimed to examine sleep disturbance in psoriasis. The study included 179 patients with psoriasis and 105 people without psoriasis, who all completed questionnaires on sleep quality. Twenty‐five per cent of the patients with psoriasis had difficulty sleeping and over half of them could be classified as poor sleepers. These numbers were much higher than what was what found in the people without psoriasis. Also, the authors found out that itchy skin was the main explanation for the reduced sleep quality in patients with psoriasis.

https://ift.tt/2zCVsZ6

Diagnostic heuristics: metacognition and other fixes

Summary

The shortcuts in thinking that humans use to solve problems ('heuristics', covered in an earlier review) are not always perfect, and in medicine this can lead to errors in diagnosis. So, how to recognize what is happening and try to combat it? In this review (part 2 of 2) the authors from the USA suggest ways of getting doctors 'to think about the way they think' (an approach known as metacognition) during the process of diagnosis. A number of strategies are considered: for instance, learning to pay more attention to – and acting more readily on – gut feelings of uncertainty, and being more aware of when to take time out to look at possibly uncertain diagnoses from different angles ('What else could it be?' 'Why does this not fit?' 'Let's discuss it with a colleague.'). Even being more consciously aware of when the work environment is too demanding or distracting (the phone never stops ringing, emails are constantly coming in, fatigue is kicking in, etc.) is an important skill. Reflecting on personal errors in diagnosis is another simple, practical example, as is asking for feedback from patients about what worked and what didn't. High risk professions have used checklists for a long time: does medicine need to catch up? Finally, the authors comment that experience can be a two‐edged sword: although experienced doctors generally use heuristics more effectively in diagnosis than inexperienced ones (see part 1), this can be undermined if they also 'become less likely to seek outside opinions or use reference materials'.

https://ift.tt/2PigoJK

皮肌炎的发病机制

Summary

皮肌炎是一种不常见的疾病,其特点是肌肉皮疹和炎症,可导致严重的虚弱,有时会造成呼吸和吞咽困难。在这项研究中,来自威尔士加的夫的作者回顾了这种潜在严重疾病的成因。与其他自身免疫性疾病一样,皮肌炎被认为是由遗传和环境因素共同作用的结果。一些基因(如 HLA B 类等位基因)与皮肤肌炎有关,并且特定基因与产生独特抗体密切相关,而这些抗体又与特定类型的疾病有关。一些环境因素触发皮肤肌炎的发展。其中包括紫外线、维生素 D 缺乏、感染和潜在的癌症(尤其是老年人)。药物(尤其是他汀类药物)可以引起肌炎(肌肉炎症),而全身类固醇可引起肌肉无力,但症状通常在减少药物后有所改善。皮肌炎涉及多种免疫因素。肌肉活检显示有炎症,其中有大量被称为淋巴细胞和巨噬细胞的 T 细胞,他们导致组织损伤。此外,一些自体抗体似乎针对肌肉,也会损害肌肉细胞。有增加血液中的一些细胞因子(TNFα 等分子)也会引发炎症。因此,许多不同的遗传因素和环境因素结合在一起可以触发皮肌炎的发展。

https://ift.tt/2zCXxEb

英国儿童移植人群皮肤癌随访研究

Summary

众所周知,接受肝或肾移植的成年人更容易患皮肤癌。这是因为为了防止移植器官的排斥反应而服用的药物还会降低人体对癌症的抵抗力。但我们对于接受过器官移植的儿童(儿科器官移植接受者,POTR)患皮肤癌的风险则知之甚少。在这项研究中,英国伯明翰的研究人员调查了 45 名在儿童时期进行肝脏或肾脏移植后患皮肤癌的患者。10 年前,当没有发现皮肤癌时,同样的患者也接受了检查。他们的平均年龄现在是 24 岁,移植后的时间从 15 年到 26 年不等。在种族上, 34 人是白人, 7 人是有色人种。同样,没有发现皮肤癌或可疑的病变,但 45 人中有 41 人的痣明显多于 10 年前,71% 的痣出现在阳光照射部位,尤其是手臂。其中 11 个人的痣超过 50 个,这个数字过高,表明患黑色素瘤皮肤癌的风险增加。尽管之前曾获得关于防晒的建议,因为有皮肤癌的风险,但 78% 的人经历过晒伤,特别是那些在国外度假的人, 22% 的人承认用过日光浴浴床。那些经常被晒伤的人腿部和背部的痣更多。奇怪的是,那些手臂上有更多痣的人使用了更多的防晒霜,但这些对他们的日光曝晒量来说可能不足的。移植后 15‐26 年,这些 POTR 中没有患皮肤癌,这是令人鼓舞的,并且与其他显示移植后 12‐19 年 POTR 中首次出现癌症的研究相比,这项研究要好得多。然而,我们没有理由自满:这些年轻人仍然处于危险之中,并且显然需要更好的、年龄适宜的防晒教育。

https://ift.tt/2Ph3oUE

Editor's Choice

https://ift.tt/2zEvO62

Photodynamic therapy for basal cell carcinoma

Summary

This is the largest systematic review to‐date which compares the treatment of basal cell carcinoma (BCC) with a treatment called photodynamic therapy (PDT) and alternative treatments. PDT is an established treatment option for low‐risk BCC.  PDT involves putting a cream on the skin and leaving it for 3 hours. Then a red light is shone on it; this often causes pain for a few minutes but few other side effects.  At least two treatment sessions are needed.  In our study we only used evidence from high quality studies (Randomised Control Trials) and only looked at studies which included treatments for low‐risk BCC types (superficial and nodular).  The main medical databases were searched to find all suitable studies. The benefits of treatments were compared, using previously‐agreed criteria. The differences between how often treatments would cure (effectiveness), how the area would look after treatment (cosmetic result), and the side‐effects, including pain, were compared at different times. Imiquimod and fluorouracil creams are applied regularly to the BCC over 4‐6 weeks. The creams cause discomfort which increases with time.  The peak pain from PDT was higher than imiquimod and fluorouracil, although the combined discomfort from imiquimod and PDT appeared similar. Cure rates between fluorouracil and PDT were comparable although rates with imiquimod were higher than PDT applied once. The cosmetic result with both creams was similar to PDT. Cryosurgery (freezing with liquid nitrogen) is a convenient quick treatment.  Cure rates were similar to PDT, although the cosmetic results were poorer. Surgical excision, where the tumour is cut out and the skin stitched, showed the highest cure rates. The cosmetic result after PDT was as good or better than other treatments. Our review showed that PDT is an effective treatment for low‐risk BCC, with excellent cosmetic results and safety.

https://ift.tt/2PhIXqW

Laser treatments in early wound healing to improve scar formation

Summary

For decades, lasers have been used to treat scars on the skin. In recent years, doctors have started using lasers during the actual wound healing process, rather than after the scar has formed, to try to minimise the scar developing. However, there is not yet a set method for exactly how this should best be done. In this study, from Germany and Denmark, 30 patients having skin surgery had half of their wound treated with a type of laser called 1540 nm NAFL, immediately before surgery, at suture removal and six weeks after surgery. The other half of the wound did not get any laser treatment. Three months later the scars were assessed by experts and by the patients and using different scales. NAFL‐treated halves were less red, more pliable and smoother compared to untreated halves. The authors conclude that three NAFL‐treatments provided in early wound healing may improve scar formation, although NAFL‐treated wounds did not heal without any scarring. It may be necessary to leave longer than three months after surgery to properly assess the scar formation and how well the treatment works.

https://ift.tt/2zEvLHo

蕈样肉芽肿/ Se´zary综合症中的感染性事件

Summary

感染是晚期蕈状肉芽肿 (MF) 或 Sezary 综合征 (SS) 患者死亡的主要原因之一。然而,对于哪种类型的感染是最常见的,以及不同的危险因素,最新数据却很少。因此,这项来自法国的研究查看了 71 名 MF 或 SS 患者的记录。在 40 名患者中记录了 80 起感染事件(即患者遭受感染的事件),包括 28 起皮肤和软组织感染和 25 起肺炎。51.8% 的感染病例需要患者住院治疗。记录了 11 例与感染相关的死亡。SS 比 MF 具有更高的感染风险。该研究确认了感染性事件作为 MF 和 SS 患者发病率和死亡率的主要原因的重要性。一种叫做金黄色葡萄球菌的细菌造成了 78% 的细菌感染,并且 22% 的感染对甲氧西林(一种抗生素)有抗药性,这是在开抗生素处方时需要考虑的一个事实。该研究概述了预防感染的可能方法,如特定的疫苗和药物。

https://ift.tt/2PjJlVI

Technology and the dermatologist: clinical resources at our fingertips

https://ift.tt/2zGkZ3v

银屑病严重程度的定义

Summary

由于各种原因,衡量患者的银屑病严重程度非常重要。例如,它使医生能够选择正确的治疗水平,然后观察治疗效果如何,它还使研究人员能够对相似患者的不同疗法进行比较。一些被称为全身疗法的治疗方法作用于全身而不仅仅是皮肤,它们只适用于"中度至重度"疾病患者。银屑病严重程度的测量通常基于两种不同的评分系统:银屑病面积和严重指数 (PASI) 和皮肤病生活质量指数 (DLQI)。PASI 用于记录患者银屑病的发红程度、厚度和范围,并用于衡量疗效(PASI 分值降低,即表示症状减轻)。DLQI 包含 10 个问题,涉及皮肤病患者在过去一周内关于生活质量 (QoL) 的各个不同方面(包括症状和感觉、日常活动、休闲、工作或学习、人际关系以及治疗的副作用)受到皮肤病影响的感受。分数越高说明 QoL 受到的损害越大。然而,并不是所有的指南都对如何结合 DLQI 和 PASI 的结果给出了相同的建议;例如,有些指南认为 DLQI 和 PASI 的评分都 >10 表明是中度至重度银屑病,而其他指南则认为 DLQI 或 PASI 的评分 >10 表明是中度至重度银屑病。在这项来自德国的研究中,研究人员同时基于或者分别基于 PASI 和 DLQI 对 3274 名患者的数据进行了分析。PASI 和 DLQI >10的患者比例为 14.0%,但 45.3% 的患者至少达到 PASI 或 DLQI >10。因此,为了更可靠的治疗和保健规划,作者提议了一个国际标准化。

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Documenting and defining psoriasis severity: an ongoing challenge

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Relapse of porphyria cutanea tarda after treatment

Summary

Porphyria cutanea tarda (PCT) is a skin disease causing a rash and sunlight sensitivity. Patients affected by this condition can be treated by removing some of their blood, or with a medication that is also used to prevent and treat malaria (antimalarials). In this study, the authors compared the effectiveness of these quite different treatment approaches. They included data on patients, from previous clinical studies, who were treated for PCT and monitored for at least one year after their symptoms had cleared. They aimed to assess PCT disease recurrence (i.e. the symptoms returning) either by skin rash, sunlight sensitivity or an elevation in a certain blood test. Authors included data on patients from 5 clinical studies in which patients received high dose of antimalarial medication, 5 clinical studies in which patients received low dose antimalarial medication and 3 clinical studies in which patients were treated by removing some of their blood. While one third of the patients treated with either high or low dose antimalarial medication experienced disease recurrence, only one fifth of patients treated by removing blood experienced such disease recurrence. Their study showed that if 100 patients were followed for one year, disease recurrence will happen in 8 patients receiving high dose antimalarials, 17 patients receiving low dose antimalarials, and 5 patients undergoing blood removal. The authors concluded that the recurrence is lowest if the PCT is treated by blood removal. However, larger studies are needed to better define recurrence rate of PCT after treatment with one of the two treatments.

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Infections in mycosis fungoides and Sézary syndrome are a frequent cause of morbidity and contribute to mortality. What can be done?

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Quality of life evaluation in lymphoedema

Summary

The lymphatic system is a network of small vessels draining clear fluid (lymph) from all bodily tissues. Many different disorders, including birth defect, infection and malignancy (cancer), can cause blockage of the system, resulting in chronic swelling, usually affecting arms or legs. This "lymphoedema" causes considerable discomfort and affects many aspects of the patient's life. Health‐related quality of life (QOL) is an important measure in health care, but to date the only QOL measure for patients with lymphoedema has been the Freiburg Life Quality Assessment for lymphoedema (FLQA‐L) ‐ a reliable measure but just too detailed for regular use in clinical practice, having 92 questions. This study from Germany aimed to create a more user‐friendly version. First, they re‐analysed the original FLQA‐L data and identified 33 questions which appeared most informative, covering 5 domains: physical impairments, daily life, social life, mental health and therapy. This shorter version (FLQA‐LS) was then mailed out to 348 lymphoedema patients at 33 clinics; 91% were women and the average age was 57 years. 295 patients completed the questionnaire. The items scoring highest (meaning having the highest impact) were "anxiety about a possible worsening of the disease", "feeling pain in the arm or leg", "joint pain" and "time‐consuming treatments", while impairment of social life showed the lowest values. Statistical analysis of the results showed good correlations with other general health related QOL scores. The FLQA‐LS appears to be a valuable assessment tool for patients with lymphoedema and now needs to be tested in patients over time.

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Screening for associated malignancies in vulval Paget disease clarified

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Optic neuritis as the initial clinical presentation of limbic encephalitis: a case report

Limbic encephalitis is characterized by rapid onset of working memory deficit, mood changes, and often seizures. The condition has a strong paraneoplastic association, but not all cases are invariably due to t...

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Issue Information

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Volume Contents

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Issue Information

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Allergen-specific IgE and IgG4 patterns among patients with different allergic diseases

In addition to allergen-specific IgE (sIgE), allergen-specific IgG4 (sIgG4) antibodies are also involved in the immune response resulting from an allergen exposure. The aim of our study was to analyze sIgE and...

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Omalizumab in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA): single-center experience in 18 cases

Data are limited regarding the effectiveness of omalizumab in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Our aim was to evaluate the clinical and functional effectiveness of omalizumab...

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Impact of a digital health intervention on asthma resource utilization

Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on a...

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Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three due to reverse causation?

Abstract

Background

Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication.

Objective

To explore the role of reverse causation in risk factors of asthma symptoms.

Methods

We compared two sets of multilevel logistic regression analyses, using (i) individual‐level exposure data and (ii) school‐level average exposure (i.e. prevalence), in two different age groups. In individual‐level analyses, reverse causation is a possible concern if individual‐level exposure statuses were changed as a result of asthma symptoms or diagnosis. School‐level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels.

Results

There were 131,924 children age 6‐7 years (2,428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual‐level analyses (fully‐adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97‐2.16), early life antibiotic use (1.65; 1.58‐1.73), and open fire cooking (1.44; 1.26‐1.65). In school‐level analyses these risk factors again showed increased risks.

There were 238,586 adolescents age 13‐14 years (2,072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual‐level analyses (fully‐adjusted) were for current paracetamol use (1.80; 1.75‐1.86), cooking on an open fire (1.32; 1.22‐1.43), and maternal tobacco use (1.23; 1.18‐1.27). In school‐level analyses these risk factors again showed increased risks.

Conclusions & clinical relevance

These analyses strengthen the potentially causal interpretation of previously reported individual‐level findings, by providing evidence against reverse causation.

This article is protected by copyright. All rights reserved.

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Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Background

Opioid‐based analgesics are routinely prescribed after elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence‐based approach.

Methods

Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing attitudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0‐100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2‐week period.

Results

Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills after surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills left over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0‐94) on day 0, 26.5 (range, 0‐86) on day 1, 8.5 (range, 0‐85) on day 3, and 3 (range, 0‐52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively.

Conclusion

Postoperative pain after elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly afterward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication after rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse.

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Salvage laryngectomy and laryngopharyngectomy: A multicenter review of outcomes associated with a reconstructive approach

Abstract

Background

Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy.

Methods

Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12‐month speech and swallowing function.

Results

Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12‐month "understandability of speech" and "nutritional mode" scores compared to vascularized tissue augmentation without muscle.

Conclusion

Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.

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Medication related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab- a review

Publication date: Available online 3 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Rebecca King, Nikki Tanna, Vinod Patel

Abstract

The link between medication related osteonecrosis of the jaw (MRONJ) and bone modulating therapies such as bisphosphonates and denosumab is well established and the number of reported cases is increasing. The development of novel medications in cancer therapy, autoimmune and bone conditions has led to further cases of MRONJ being reported. However, in addition to this group of medications there are increasingly new agents in cancer therapy, such as anti-angiogenics agents that have now also been implicated in the development of MRONJ. As these newer agents with similar mechanisms are routinely used, the numbers of reported cases will likely rise further.

This paper aims to identify and summarise the drugs indicated in MRONJ aside from bisphosphonates and denosumab. A wide range of medications classed as tyrosine kinase inhibitors, monoclonal antibodies, mammalian target of rapamycin inhibitors, radiopharmaceuticals, selective estrogen receptor modulators and immunosuppresants have been implicated in MRONJ.

It remains crucial that oral health care providers are aware of these new medications and their associated risks in order to manage patients appropriately.

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Salivary Gland Anlage Tumor: Molecular Profiling Sheds Light on a Morphologic Question

Publication date: Available online 3 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Scott M. Peters, Andrew T. Turk

Abstract

Objective

: The salivary gland anlage tumor (SGAT), previously described as a squamous proliferative lesion or "congenital pleomorphic adenoma," is a rare, benign entity that presents within the first months of life. It occurs almost exclusively in the nasopharynx or posterior nasal cavity, and demonstrates a biphasic composition of epithelial and mesenchymal elements. Although the clinical and histologic features of SGAT are well described, its etiology remains poorly understood. SGAT is currently considered a hamartoma rather than a neoplasm, partly due to its benign behavior and lack of reported recurrence following treatment. However, investigators have not yet evaluated this concept using genomic methods.

Study Design

: In the current study, we present three cases of SGAT on which we performed whole-exome sequencing (WES).

Results

: Examination of sequence data, with specific attention to variants affecting 964 cancer-related genes, showed no plausible driver-type alterations.

Conclusion

: The lack of apparent driver mutations supports the classification of this entity as a hamartomatous (non-neoplastic) process.

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Genetic alteration of Exon 5 of PTEN gene in Indian subjects with ameloblastoma

Publication date: Available online 3 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr. Bhaskar Narayan, Dr. Aadithya B. Urs, Dr. Jeyaseelan Augustine, Dr. Hanspal Singh, Dr. Sunil Kumar Polipalli, Mr. Somesh Kumar, Dr. Seema Kapoor

Abstract

Background

PI3K/Akt/mTOR pathway is one of the signalling pathways that are associated with the pathogenesis of ameloblastoma. Phosphatase and tensin homolog (PTEN) controls cell migration and proliferation. It monitors the level of the Akt and maintains cellular integrity. The present study was aimed to study the genetic alteration of Exon 5 of PTEN gene in Indian subjects with ameloblastoma.

Methods

Total DNA was extracted from twenty cases of formalin fixed paraffin embedded tissue samples of solid multicystic ameloblastoma (SMA) and 10 cases of normal tooth germ. Exon 5 of the PTEN gene which accounts for most genetic alteration in many tumors was assessed for its role in the pathogenesis of ameloblastoma.

Results

Five out of twenty cases of SMA showed genetic alteration. Three of these cases (15%) showed silent mutation, one case (5%) showed change in amino acid sequence from valine to glutamic acid and one case (5%) showed nonsense mediated mRNA decay.

Conclusion

The present study showed 25% somatic mutational frequency in the 5^th exonic region of the PTEN gene. This may indicate its role in the pathogenesis of ameloblastoma.

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Amide proton transfer MRI detects early changes in nasopharyngeal carcinoma: providing a potential imaging marker for treatment response

Abstract

Purpose

To determine if treatment of nasopharyngeal carcinoma (NPC) induces early changes in amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI), and to perform a preliminary evaluation of APTw imaging in response assessment.

Methods

Sixteen patients with NPC planned for treatment with radiotherapy and/or chemotherapy underwent APTw imaging of the primary tumour pre-treatment and 2-week intra-treatment. Difference in pre- and intra-treatment APT mean (APT_mean) was compared using the Wilcoxon signed rank test. Differences in APT_mean and percentage change (%Δ) in APT_mean were compared between responders and non-responders based on the outcome at 6 months, using the Mann–Whitney U test.

Results

APT_mean decreased in 9/16 (56.3%) and increased in 7/16 (43.7%) with no significant difference between the pre- and intra-treatment APT values for the whole group (p > 0.05). NPC showed response in 11/16 (68.8%) and non-response in 5/11 (31.2%). There were significant differences between the %Δ of responders and non-responders for APT_mean (p = 0.01). Responders showed %Δ decrease in APT_mean of − 23.12% while non-responders showed a %Δ increase in APT_mean of + 102.28%.

Conclusion

APT value changes can be detected in early intra-treatment. Intra-treatment %Δ APT_mean shows potential in predicting short-term outcome.

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Surgeons successfully perform full face transplant

With the help of innovative techniques, surgeons at New York University Langone Health have successfully conducted a full face transplant.

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Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: a prospective clinical study

Publication date: Available online 3 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Ibrahim Murat Afat, Emine Tuna Akdoğan, Onur Gönül

Abstract

Purpose

In this prospective, randomized, double-blind, controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on early healing of soft tissue after mandibular third molar (M3) surgery.

Patients and Methods

In total, 60 patients aged 18–30 (mean 22.3), 22 male and 38 female, were included in this study. After surgical extraction of the impacted M3, L-PRF was applied to the socket in the L-PRF group (n = 20), and a combination of L-PRF and HA was applied in the L-PRF+HA group (n = 20). Nothing was applied in the control group (n = 20). The primary outcome variable was healing score for the mucosa over the extraction socket on the 7th, 14th, and 21st days. Secondary outcome variables were frequencies of postoperative complications: hemorrhagic complications, alveolar osteitis (AO), and postoperative wound infection.

Results

Mean healing scores for the mucosa on the 7th, 14th, and 21st days for both the L-PRF group and the L-PRF+HA group were significantly better than those for the control group. The ratio of alveolar osteitis for the control group was 1:20 and the ratio of postoperative wound infection for the control group was 1:20. There were no cases of alveolar osteitis or postoperative wound infection in the L-PRF and L-PRF+HA groups. No hemorrhagic complications were observed in this study.

Conclusion

The results of this study suggest that L-PRF alone and when combined with HA can be an effective way to improve soft tissue healing, and could be used to prevent postoperative alveolar osteitis and infection after M3 surgery. Further studies with larger study groups are necessary.

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Nail pitting and splinter hemorrhage possibly induced by zolpidem

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Comparison of 2‐D shear wave elastography with clinical score in localized scleroderma: A new method to increase the diagnostic accuracy

Abstract

There is no established diagnostic criteria or widely accepted severity classification of localized scleroderma (LS) by imaging. Acoustic radiation force impulse (ARFI) technology by normalized mean shear wave velocity (SWV) may be as a probing tool for diagnosing and staging LS accurately and objectively. Fifty‐six patients with LS of inflammatory (n = 21), sclerotic (n = 24) and atrophic (n = 11) stage and 30 healthy controls were evaluated on the basis of pathological results. Dermal thickness, ARFI quality (elastography score) and quantity (mean SWV) were measured by ultrasonography (US), diagnosis and stage performances of LS using the dermal thickness, elastography score and mean SWV compared with modified localized scleroderma skin severity index (mLoSSI) were evaluated. Significant differences in the dermal thickness, elastography score and mean SWV were found between the normal adult and LS patients; for diagnosing LS, the area under the receiver–operator curves (AUROC) of the dermal thickness, elastography score, mean SWV and mLoSSI were 0.93 ± 0.03, 0.95 ± 0.01, 0.93 ± 0.03 and 0.93 ± 0.02, respectively. Compared with the dermal thickness, the elastography score and mLoSSI, the AUROC and the specificities of mean SWV for differentiating sclerotic from inflammatory stage and atrophic from sclerotic LS increased significantly, especially by normalized mean SWV (AUROC, 0.84 ± 0.06 and 0.83 ± 0.07; specificity, 85.71% and 91.67%). As non‐invasive methods, mean SWV and dermal thickness by US may provide reliable information to diagnose and stage LS compared with mLoSSI especially by normalized mean SWV.

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Case of pityriasis rubra pilaris progressed to generalized erythroderma following blockade of interleukin‐17A, but improved after blockade of interleukin‐12/23 p40

Abstract

We report herein a case of a 72‐year‐old man with pityriasis rubra pilaris (PRP) that was refractory to conventional therapies. His skin lesions progressed to generalized erythroderma despite anti‐interleukin (IL)‐17A antibody therapy. Topical corticosteroids, emollients, systemic retinoid, methotrexate, cyclosporin and phototherapy yielded no therapeutic response. However, blockade of IL‐12/23 p40 dramatically improved his cutaneous lesions. Complete remission was achieved 4 weeks after the first injection of ustekinumab and maintained for more than 48 weeks. Our data indicate that IL‐12 was associated with the onset of PRP in this patient, rather than IL‐23. IL‐12 is critical for the differentiation of T‐helper (Th)1 cells. Thus, the Th1 pathway may be associated with the onset of PRP.

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Improvement of porphyria cutanea tarda following treatment of hepatitis C virus by direct‐acting antivirals: A case report

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Nrf2/ARE pathway inhibits inflammatory infiltration by macrophage in rats with autoimmune myositis

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Yutao Liu, Yuan Gao, Jing Yang, Changhe Shi, Yanlin Wang, Yuming Xu

Abstract

Background

Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterized by muscle disorders. We conducted this study to detect whether NF-E2-related factor 2 (Nrf2) pathway inhibit inflammatory infiltration by macrophage in experimental autoimmune myositis (EAM) rat model.

Methods

CD163 levels were examined by immunohistochemistry (IHC), while serum creatine kinase (CK), reactive oxygen species (ROS), and serum monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels were determined by enzyme linked immunosorbnent assay (ELISA), both in IIM patients and EAM rat. We also detected MCP-1, TNF-α, IL-6, and Nrf2 levels by Realtime quantitative PCR (RT-PCR) in patients' muscles, and MCP-1, TNF-α, IL-6, and Nrf2, HO-1, NQO-1 levels by RT-PCR and Western blot in EAM rats' muscles. EAM macrophages were separated, and Nrf2 over-expression macrophages were constructed. ROS level and cell migration were detected by flow cytometer and transwell assay respectively. Then, levels of MCP-1, TNF-α, IL-6, Nrf2, Heme oxygenase-1 (HO-1) and NAD(P)H: quinine oxidoreductase 1 (NQO-1) were detected by RT-PCR and Western blot.

Results

Results showed that EAM rats were histopathologically inflammatory cell infiltration. Levels of CD163, serum CK and ROS, serum/muscle MCP-1, TNF-α and IL-6 increased and muscle Nrf2 level decreased in IIM patients and EAM rats. Cell migration ability and levels of ROS, MCP-1, TNF-α, IL-6, and plasma Nrf2 were down-regulated, and total/nucleus Nrf2, HO-1, NQO-1 were up-regulated notably when Nrf2 over-expressed.

Conclusion

Nrf2 inhibited EAM macrophage infiltration by activating Nrf2/ARE pathway which could induce ROS degradation and inhibit pro-inflammatory factors expression.

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Water‐related dermatoses

Abstract

Water‐related dermatoses are a spectrum of diseases that are associated with water exposure. They result either from the direct influence of water or after injury from water inhabitants. In this review, clinical entities that manifest after water exposure (aquagenic pruritus, aquagenic urticaria, and aquagenic wrinkling of the palms) will be discussed with particular focus on the reported pathogenesis. Aquatic organisms and activities can be linked to cutaneous injuries that require identification and distinct management. Marine and freshwater dermatoses were summarized to provide physicians with easy access to the causative organism, method of injury, and appropriate management.

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Basal cell carcinoma of the vulva: a case report and systematic review of the literature

Abstract

The vulva is an unusual site for basal cell carcinoma (BCC). Vulvar BCC accounts for <1% of all BCCs and <5% of all vulvar malignancies. We report the case of an 83 year‐old woman who presented with a 2‐month history of a tender labial growth, with histopathology confirming nodular BCC. We conducted a systematic literature review of the characteristics of reported cases of vulvar BCCs. A comprehensive systematic review of articles indexed for MEDLINE and Embase yielded 96 reports describing 437 patients with 446 BCCs of the vulva. The mean age at presentation was 70 (range 20–100). Most women had no underlying vulvar disease. Approximately 60% of cases were of the nodular subtype. Treatment approach varied widely with over half of cases treated with wide local or local excision. Mohs micrographic surgery (MMS) for vulvar BCC was first reported in 1988 with seven total MMS cases reported. Twenty‐three cases of recurrence have been reported; 21 of these cases after local excision but none following MMS. Vulvar BCC is a rarely reported cancer that affects older women predominantly. MMS represents a promising treatment for BCC in this anatomic location.

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Rethinking the female predominance in hidradenitis suppurativa

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Use of platelet‐rich plasma to suspend noncultured epidermal cell suspension improves repigmentation after autologous transplantation in stable vitiligo: a double‐blind randomized controlled trial

Abstract

Background

Noncultured epidermal cell suspension (NCES) is an effective surgical modality for stable vitiligo which involves transplantation of the basal layer of epidermal cells onto the dermabraded vitiliginous patch. Platelet‐rich plasma (PRP) has growth factors which may stimulate melanocyte migration and proliferation of keratinocytes and fibroblasts. The objective of this study was to compare the extent of repigmentation achieved by transplantation of NCES suspended in PRP with that of NCES suspended in phosphate buffered saline (PBS).

Methods

Twenty‐one patients of stable vitiligo with at least two lesions of comparable size were included. The two vitiligo patches were randomized to receive NCES suspended in PRP or PBS. Postoperatively after 1 week, patients were given heliotherapy for 15 minutes daily.

Results

At 6 months follow‐up, mean repigmentation by area method in PRP arm was 75.6 ± 30% SD and in non‐PRP arm was 65 ± 34% SD (P = 0.0036). Patient satisfaction by visual analogue scale at 6 months also showed better results in PRP arm (P = 0.001). Assessment by three independent observers showed better repigmentation in PRP side both at 3 and 6 months.

Conclusions

Suspending NCES in PRP can result in significantly greater mean repigmentation and patient satisfaction than suspending in PBS.

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Atypical presentation of necrobiosis lipoidica in a pediatric patient

Abstract

Necrobiosis lipoidica (NL) is a rare chronic granulomatous inflammatory skin disease characterized by brownish‐red papules and yellowish plaques with atrophic centers, which usually affect the legs, bilaterally. The average age of onset is 30‐40 years, and there are very few reported cases of necrobiosis lipoidica in children. A nondiabetic girl aged 14 years presented to our clinic with a history of an asymptomatic, 7 × 5‐cm single red plaque over her back in the interscapular area, which had started 5 years ago. Her laboratory tests were normal. A histopathologic evaluation confirmed the diagnosis of NL, and local treatment with clobetasol propionate twice daily was administrated. The patient will be followed up to monitor plasma glucose levels and evaluation of the lesion. Herein, we report a pediatric patient without diabetes mellitus who had NL in an atypical location and review the literature in view of the clinical features, complications, and treatment regimens for NL in children.

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Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis

Abstract

Background

Understanding the importance of the barrier function of the skin of preterm and term neonates is crucial in effective neonatal skin and diaper care. This literature search aimed to review the development of different practices in neonatal care to maintain skin barrier function, in turn preventing diaper dermatitis.

Methods

We performed two quantitative literature searches of English language studies: an initial literature search of studies published in the last 5 years was conducted using Cinahl, Medline, Embase, British Nursing Index, and DelphiS, followed by a second search of publications from 1990 to 2017 using the National Institute of Clinical Excellence Health Databases Advanced Search using key words, synonyms, and Boolean phrasing. Titles and abstracts were reviewed for relevance.

Results

One hundred ten studies were analyzed for the purpose of this review; however, data are of variable quality. Guidance can be drawn from the existing literature relating to best practice options for diaper area cleansing methods, diaper type selection, and use of barrier creams. More research is required into the benefit or otherwise of diaper‐free time.

Conclusions

Super‐absorbent diapers reduce moisture at skin level and reduce diaper dermatitis. Barrier creams carry benefit both in prevention and cure but do not provide a substitute for frequent diaper changes. The literature does not demonstrate superiority of one cleansing method over another, but neither the use of wipes nor water increases diaper dermatitis prevalence. Further studies are required to explore the potential benefit of diaper‐free time, taking due consideration of the practicalities, particularly for vulnerable neonates within the Intensive Care setting.

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Neurocognitive function in moderate–severe pediatric atopic dermatitis: A case–control study

Abstract

Background/Objectives

Epidemiological studies have shown an increased prevalence of attention deficit hyperactivity disorder (ADHD) in children with atopic dermatitis (AD), but many of the features of ADHD may occur as a result of the poor sleep and itch distraction associated with AD.

Methods

A case–control study was performed in children aged 6‐17 years with moderate/severe AD compared with age‐/sex‐matched healthy controls. Participants were screened for ADHD using Vanderbilt assessments.

Results

Seventeen patients with AD and 18 controls completed the study. Two children with AD (11.7%) and one control (5.56%) met screening criteria for ADHD via parent‐completed Vanderbilt assessments; AD patients were not significantly more likely to screen positive for ADHD (P = 0.47), or comorbid behavior disorders (P = 0.23). However, AD patients were more likely than controls to exhibit ADHD‐associated behaviors, most significantly inattention.

Conclusions

Our AD cohort did not have a significantly increased prevalence of ADHD. Certain neurocognitive symptoms are increased in children with moderate‐to‐severe AD compared to controls.

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The use of subcutaneous immunoglobulins in the treatment of dermatomyositis

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British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018

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Predictive factors of patients’ general quality of life after nasal septoplasty

Abstract

Purpose

Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery.

Methods

60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation—NOSE, Sino nasal outcome test 22—SNOT-22), sleep quality (Epworth Sleepiness Scale—ESS), olfactory function (Threshold Discrimination Identification—TDI score), voice quality (Nasalance score and Voice Handicap Index—VHI), stress (SQ test) and emotional status (Beck Depression Index—BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory—GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow).

Results

From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47–22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12–14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery.

Conclusions

Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.

https://ift.tt/2zEQiM5

Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case–control study using a national sample cohort

Abstract

Introduction

The previous studies suggested an association between osteoporosis and sudden sensory neural hearing loss (SSNHL). The aim of the present study was to evaluate the association between osteoporosis and benign paroxysmal positional vertigo (BPPV).

Materials and methods

Data from the Korean National Health Insurance Service-National Sample Cohort of participants who were ≥ 50 years old were collected from 2002 to 2013. A total of 13,484 BPPV participants were matched with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia to 53,936 controls. In both the BPPV and control groups, the previous histories of osteoporosis were evaluated. Crude (simple) and adjusted odds ratios (ORs) of osteoporosis for BPPV were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted according to age, sex, and BPPV frequency.

Results

A total of 18.64% (2514/13,464) of the BPPV group and 12.21% (6589/53,936) of the control group had a history of osteoporosis (P < 0.001). The adjusted OR of osteoporosis for BPPV was 1.29 (95% CI = 1.23–1.35, P < 0.001). In the subgroup analysis according to age and sex, the ≥ 70-year-old men did not demonstrate a high adjusted OR of osteoporosis for BPPV. All other age and sex subgroups demonstrated high adjusted ORs of osteoporosis for BPPV.

Conclusions

Osteoporosis increased the risk of BPPV in the population aged ≥ 50 years. The OR of osteoporosis was higher in the frequent BPPV group than in the less frequent BPPV group.

https://ift.tt/2RwyA4g