Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods: A Cross-sectional study.

BACKGROUND: Less invasive and noninvasive methods are emerging for haemodynamic monitoring. Among them is Capstesia, a smartphone app that, from photographs of a patient monitor showing invasive arterial pressure, estimates advanced haemodynamic variables after digitising and analysing the pressure curves. OBJECTIVE: The aim of this study was to compare the level of agreement between the analysis of the signals obtained from the patient monitor and a photograph of the same images using the Capstesia app. DESIGN: Cross-sectional study. SETTING: Araba University hospital (Txagorritxu), Vitoria-Gasteiz, Alava, Spain, from January to February 2015. PATIENTS: Twenty patients (229 images) who had an arterial catheter (radial or femoral artery) inserted for haemodynamic monitoring. INTERVENTION: Snapshots obtained from the patient monitor and a photograph of these same snapshots using the Capstesia application were assessed with the same software (MATLAB, Mathworks, Natick, Massachusetats, USA) for evaluating the level of concordance of the following variables: pulse pressure variation (PPV), cardiac output (CO) and maximum slope of the pressure curve (dP/dt). Comparison was made using interclass correlation coefficients with corresponding 95% confidence intervals, and Bland-Altman plots with the corresponding percentages of error. MAIN OUTCOME MEASURES: (PPV). Secondary outcome: CO and maximum slope of the pressure curve [dP/dt]. RESULTS: The interclass correlation coefficients for PPV, CO and max dP/dt were 0.991 (95% confidence interval 0.988 to 0.993), 0.966 (95% confidence interval 0.956 to 0.974) and 0.962 (95% confidence interval 0.950 to 0.970), respectively. In the Bland-Altman analysis, bias and limits of agreement of PPV were (0.50% +/- 1.42) resulting in a percentage of error of 20% for PPV. For CO they were 0.19 +/- 0.341, with a 13.8% of error. Finally bias and limits of agreement for max dP/dt were 1.33 +/- 77.71, resulting in an error of 14.20% CONCLUSIONS: Photograph of the screenshots obtained with the Capstesia app show a good concordance with analysis of the original screenshots. Either approach could be used to monitor the haemodynamic variables assessed. (C) 2016 European Society of Anaesthesiology

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A Defective Inflammatory Response May Underlie Cases of Atopic Dermatitis

Abstract

An investigation of atopic dermatitis (AD) proposes an association between susceptibility to developing allergic contact sensitization (ACS) and a possible defect in the delayed hypersensitivity inflammatory response.¹ Current research supports the predominant pathogenesis of AD to be T-helper cell 2 (Th2)-mediated Type I hypersensitivity response and allergic contact dermatitis (ACD) to be a T-helper cell 1 (Th1)-mediated Type IV hypersensitivity response.²

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Filaggrin gene mutations and the distribution of filaggrin in oral mucosa of patients with oral lichen planus and healthy controls

Abstract

Background

Lichen planus (LP) is a chronic inflammatory disease of unknown etiology affecting the skin and oral mucosa. Oral lichenoid lesions (OLL), like oral contact reactions, may resemble oral lichen planus (OLP) both clinically and histopathologically. As OLP and OLL are hyperkeratotic diseases and filaggrin is essential to keratinization the distribution of filaggrin may be altered in these lesions.

Objectives

To investigate if patients with OLP/OLL have 1) altered distribution of filaggrin in the oral mucosa, 2) a higher incidence of mutations in the filaggrin gene (FLG) and 3) active dermatoses, apart from cutaneous LP, than healthy controls; and 4) patients with OLP/OLL and a defect in the FLG have more widespread oral lesions and report more symptoms than OLP/OLL patients without a concomitant defect in the FLG.

Methods

49 Caucasian patients (42 women and 7 men, mean age 61.0±10.3years), with symptomatic OLP, OLL or stomatitis, and 29 matched healthy controls underwent a clinical oral and dermatological examination, oral mucosal biopsy and filaggrin genotyping (testing for R2447X, R501X, 2282del4). Smear tests for Candida spp. were performed in all patients to exclude oral candidiasis. Immunohistochemistry were performed using poly- and monoclonal filaggrin antibodies.

Results

The immunoreactivity for filaggrin was significantly more intense in the oral mucosa in the patients with OLP/OLL compared to healthy controls (p=0.000025). No difference was noted in the incidence of defects in the FLG and active dermatoses between patients and healthy controls. No difference was noted in extension and number of symptoms reported by patients with OLP/OLL with or without a concomitant defect in the FLG.

Conclusion

OLP/OLL is associated with an altered distribution of filaggrin in the oral mucosa independently of defects in the FLG. Patients with OLP/OLL did not display more active dermatoses other than cutaneous LP when compared to healthy controls.

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Hidradenitis suppurativa association at the time of, or subsequent to, diagnosis of inflammatory bowel disease in a large U.S. patient population

Abstract

Hidradenitis Suppurativa (HS) is a progressive, chronic, inflammatory disease resulting in nodules, abscesses, sinus tracts, and scarring. Although an association is reported for diagnosis of inflammatory bowel disease (IBD), including Crohn's Disease (CD) and ulcerative colitis (UC),[1-7] prior to HS, a pathogenic link is not established.

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5-Fluorouracil 0.5%/Salicylic Acid 10%

http://orlnow.blogspot.gr/2016/12/5-fluorouracil-05salicylic-acid-10-in.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Management of Carotid Body Tumor in pediatric patients: A case report and review of the literature

Publication date: Available online 20 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Apanisile Ifeoluwa, István Lázár, Éva Szövördi, Tamás Karosi
Carotid body tumors (CBTs) are rare types of extra-adrenal paragangliomas, which originate from the neuroendocrine cells of the adventitial layer of carotid bifurcation. An 8-year-old girl was admitted to our department with left-sided and pulsating neck swelling, which progressively grew over several months. The patient had no family history of CBTs. Computed tomography (CT) and CT angiography (CTA) scans revealed a contrast material enhancing, hypervascularized mass involving the left carotid bifurcation, internal carotid artery (ICA), and external carotid artery (ECA), respectively. Preoperative embolization and surgical resection were performed. Histopathological examination later confirmed a benign CBT. Current follow-up examination revealed no evidence of residual or recurrent tumor. A systemic review of the literature indicates that early diagnosis, and experienced multi-disciplinary management is required in case of unilateral, resectable forms of CBTs with no distant metastasis, in order to provide a long-time survival of patients. Surgical intervention of unilateral, solitary CBTs with preoperative embolization is a relatively safe procedure, allowing complete tumor removal with minimal morbidity and low recurrence rate.



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Topical corticosteroids (TCSs) or topical calcineurin inhibitors in the Treatment of Atopic Dermatitis in the Pediatric Population

http://orlnow.blogspot.gr/2016/12/topical-corticosteroids-tcss-or-topical.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com