25 (OH) D3 levels, incidence and recurrence of different clinical forms of BPPV

Publication date: Available online 11 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sinisa Maslovara, Silva Butkovic Soldo, Anamarija Sestak, Katarina Milinkovic, Jasna Rogic-Namacinski, Anamarija Soldo
IntroductionBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks.ObjectivesThe aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with BPPV and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of BPPV.MethodsThe study included 40 patients who came to the regular medical examination, diagnosed with PC-BPPV based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level.ResultsThe average serum level of 25-OH D3 among respondents was 20.78ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without BPPV recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis.ConclusionsThere were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.



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Recurrence of melanocytic lesions after laser treatment: benign versus malignant upon dermoscopy

Abstract

The treatment of pigmented lesions includes several approaches depending on the nature of the cutaneous lesion to be treated. When considering melanocytic lesions, a balance between therapeutic aspects and cosmetic concerns for aesthetic sites have to be taken into account, with particular attention for the differential diagnosis between benign and malignant.^1-3 In particular, the increasing awareness for good cosmetic results lead to the development of less invasive techniques, although they hamper the histological assessment, which is the gold standard for the diagnosis of melanocytic lesions.

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Baldness and scalp melanoma

Abstract

Nearly 20% of melanomas occur on the head and neck area¹ but only 2-5% arise on the scalp.² Several studies reported a worse prognosis of scalp melanoma compared to other body sites, being unclear the reason for this phenomenon.³ Melanoma and non-melanoma skin cancer of the scalp are most frequent in bald men older than 65 years.

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Secukinumab demonstrates greater sustained improvements in daily activities and personal relationships than ustekinumab in patients with moderate-to-severe plaque psoriasis: 52-week results from the CLEAR study

Abstract

Background

Psoriasis can greatly impact patients' lives by influencing clothing worn as well as by impairing sexual functioning. Secukinumab, a human monoclonal antibody selectively neutralizing interleukin-17A, has demonstrated good efficacy and safety in the treatment of moderate-to-severe psoriasis and psoriatic arthritis with a rapid onset of action and sustained response.

Objective

This analysis using the CLEAR study, a phase 3b double-blind study comparing the efficacy and safety of secukinumab versus ustekinumab in adults with moderate-to-severe plaque psoriasis, evaluated the treatment effects on patient's daily activities and personal relationships.

Methods

Impact on daily activities (interference with home/shopping/garden, and influence on clothes worn) and impact on personal relationships (problems with partner/others, and sexual difficulties) as well as their corresponding subscales were selected from the Dermatology Life Quality Index scale and evaluated for patients treated with secukinumab vs. ustekinumab from the CLEAR study. Treatment differences in mean scores and proportions of responders (score = 0, indicating no impact) were evaluated through 52 weeks. Time to response was evaluated through week 16.

Results

Significant differences between secukinumab and ustekinumab were observed for daily activities and personal relationship at week 16 and sustained through Week 52 (Week 52 response rates for daily activities: 82.9% vs. 73.5%, including interference with home/shopping/garden: 88.5% vs. 78.2%, and influence on clothes worn: 85.6% vs. 74.4%; personal relationship: 86.1% vs. 73.7%, including problems with partner/others: 86.6% vs. 74.8%, and sexual difficulties: 88.5% vs. 74.3%; all P < 0.01). The median time to response was 4 weeks for secukinumab versus 8 weeks for ustekinumab for daily activities and personal relationships (both P < 0.05).

Conclusion

Secukinumab treatment helps patients with moderate-to-severe plaque psoriasis have a more normal life faster when compared to ustekinumab, by providing greater and sustained improvement in clothing choice and sexual functioning.

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Increased expression of the interleukin-36 cytokines in lesions of hidradenitis suppurativa

Summary

Background

Hidradenitis suppurativa (HS) is a recalcitrant chronic skin disease with poorly understood immunopathogenic mechanisms. Previous studies reported that the interleukin-36 (IL-36) cytokines (IL-36α, IL-36β, IL-36γ, and IL-36 receptor antagonist [IL-36RA]) are important players in the pathogenesis of psoriasis (PS).

Objective

We aim to determine whether the IL-36 cytokines are upregulated in HS patients. For this purpose, we analysed local expression and systemic levels of the IL-36 cytokines in HS patients and compared the results to healthy donors and PS patients.

Methods

Skin biopsies from healthy donors and HS and PS patients were analysed for expression of the IL-36 cytokines by immunohistochemistry and semiquantitative real-time PCR. The enzyme-linked immunosorbent assay (ELISA) was used to measure systemic levels of the IL-36 cytokines in the serum of the three donor groups.

Results

The agonists IL-36α, IL-36β, and IL-36γ were found to be upregulated in HS both systemically and lesionally, while the IL-36RA was not differently regulated in comparison to healthy donors.

Conclusion

Our findings suggest that the agonistic IL-36 isoforms are upregulated in HS. The relevance of the enhanced production of IL-36 cytokines in HS pathogenesis remains to be determined.

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Compression therapy for venous leg ulcers: Risk factors for Adverse Events and Complications, Contraindications. A review of present Guidelines

Abstract

Introduction

The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently there is a lack of clarity on contra-indications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients.

Methods

The project aimed to optimize prevention, treatment and maintenance approaches by recognizing contra-indications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. A literature review was conducted of current guidelines on venous leg ulcer prevention, management and maintenance.

Results

Searches took place February 29 to April 30, 2016, were prospectively limited to publications in the English and German languages and publication dates were between January 2009 and April 2016. Twenty Guidelines, clinical pathways and consensus papers on compression therapy for venous leg ulcer treatment and for venous disease, were included. Guidelines agreed on the following absolute contraindications: Arterial occlusive disease, heart failure and ankle brachial pressure index (ABPI) < 0.5, but gave conflicting recommendations on relative contraindications, risks and adverse events. Moreover definitions were unclear and not consistent.

Conclusions

Evidence based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression.

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Self-diagnosed drug allergies: the belief of patients

Abstract

The term of "drug allergy" (DA) may include true hypersensitivity or non-allergic reactions. The rate of self-reporting DA ranges from 4.7% to 11% regardless of age. When patients report a DA, the medical team often decides a full and definitive elimination of the incriminated drug from future therapy, which deeply affects medical care.

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