Fumaric acid esters in combination with a 6-week course of narrow-band UVB provides for an accelerated response as compared to fumaric acid esters monotherapy in patients with moderate to severe plaque psoriasis: A randomized prospective clinical study

Abstract

Background

Fumaric acid esters are (FAE) safe and effective in patients with moderate to severe psoriasis but have a slow onset of action. A short-term combination with narrow-band UVB (NB UVB) may substantially accelerate the therapeutic response in the induction phase of treatment.

Objectives

To assess the synergistic effect of a 6-week course of NB UVB phototherapy in addition to fumaric acid esters in adult patients with moderate to severe plaque psoriasis.

Methods

In this randomized, assessor-blinded trial patients with a Psoriasis Area and Severity Index (PASI) of ≥10 and a body surface area (BSA) of ≥10 were randomized to either monotherapy with FAE (n=16) or a combination of FAE with NB UVB (n=14). The primary outcome parameter of the study was the mean PASI reduction after 6 weeks of treatment. In addition, the PASI 75 response, the psoriasis log-based area and severity index (PLASI) and the dermatology life quality index (DLQI) were assessed as secondary outcome measures.

Results

Thirty patients (19 males, 11 females; median age 52 years, IQR 36;56) were analysed. The mean reduction in PASI after 6 weeks was significantly greater with the combination treatment as compared to FAE monotherapy (p=0.016). This was paralleled by a much faster improvement in DLQI in the combination group than in the FAE monotherapy group.

Conclusions

Adding a 6-week course of narrow-band UVB to FAE both accelerates and augments the therapeutic response during the early phase of treatment and increases quality of life in patients with moderate-to-severe plaque psoriasis.

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The importance of dermoscopy for the diagnosis of acquired bilateral telangiectatic macules: the angioid streak pattern reveals underlying chronic liver disease

Abstract

Background

Acquired bilateral telangiectatic macules (ABTM) are a newly recognized disease entity, which manifest as multiple telangiectatic pigmented macules confined mostly to the upper arms.

Objectives

To evaluate clinical and dermoscopic features in a group of 50 patients with ABTM and to determine the diagnostic usefulness of dermoscopy in ABTM

Methods

Patients were selected from two tertiary teaching hospitals in Korea (Pusan National University Hospitals [Busan and Yangsan]). Fifty patients (41 males and 9 females; mean age 48.1 years; range 26-78 years) with ABTM were included in the study. The dermoscopic findings were graded using a 4-point scale: none (0), mild (1), moderate (2), and severe (3). In addition, the results of 23 patients with and 27 patients without chronic liver disease (CLD) were compared to determine whether the presence of CLD affect dermoscopic findings.

Results

Three distinct dermoscopic patterns were observed; brown pigmentations, telangiectasia (linear-irregular vessels) and an angioid streak pattern. Brown pigmentation in the group without CLD had higher severity score than those in CLD group (mean score: 2.00 vs 1.48, P =0.033). However, mean telangiectasia severity score was higher in the CLD group (2.14 vs 1.39, P < 0.001). The angioid streak pattern was more severe and more common in patients with CLD than in those without (1.37 vs 0.35 (P < 0.001) and 63.0% vs. 26.1%, respectively).

Conclusion

Detailed observations with dermoscopy can provide first clues of the presence of ABTM and underlying chronic liver disease.

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Disfiguring facial mycoses- a diagnostic and therapeutic challenge

Some fungal infections may lead to devastating destruction of face, sometimes followed by fatal consequences. Conidiobolus coronatus is a rare, but serious emerging fungal pathogen of humans, causing Conidiobolomycosis, commonly infecting nasal mucosa and with potential to extend to involve vital structures such as brain and eyes. Treatment of this infection is extremely difficult and can cause significant disfiguring sequale, unless aggressively treated. We illustrate an interesting case, encountered within a short space of time affected by such infections and emphasize the need for thorough evaluation, investigation and aggressive initial treatment to achieve a good clinical response.

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Prevalence of papular urticaria caused by flea bites and associated factors in children 1–6 years of age in Bogotá, D.C.

Papular urticaria is a chronic inflammatory disease caused by exposure to arthropod bites. The disease has been reported in children attending medical centers, but the causes as the risk factors associated wit...

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A shared decision-making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Objectives/Hypothesis

Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy.

Study Design

Prospective, single-blind, randomized controlled trial.

Methods

We enrolled consecutive patients meeting inclusion criteria who were referred to our multidisciplinary upper airway center. Study patients used a shared decision-making tool whereas controls did not. Measures of decisional conflict (SURE [Sure of myself, Understanding information, Risk benefit ratio, Encouragement], CollaboRATE, and the Decisional Conflict Scale [DCS]) were obtained pre- and postvisit.

Results

We assessed 50 families (study group = 24, controls = 26). The mean age was 8.8 ± 6.6 years, 44% were female, 86% were white, and the mean obstructive apnea-hypopnea index was 12.7 ± 15.6 events/hour. The previsit mean DCS score was similar for controls (42.7) and study patients (40.8) (P = .38). The postvisit mean DCS score for controls was 13.3 and for study patients 6.1 (P = .034). Improvement in this score was greater in the study group (P = .03). At previsit evaluation, 63% of controls and 58% of study patients were unsure about their options. Postvisit, this improved to 4.1% and 0%, respectively.

Conclusions

Families counseled regarding treatment options using shared decision-making tools had significantly less decisional conflict than those who did not use these tools. These positive outcomes suggest that clinicians should consider integrating this approach into clinical practice.

Level of Evidence

1b Laryngoscope, 2017

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Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings

Objectives/Hypothesis

Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF).

Study Design

Anatomical cadaver and radiological study plus case study.

Methods

Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair.

Results

Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm²). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm² to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications.

Conclusions

Radio-anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum.

Level of Evidence

NA Laryngoscope, 2017

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Three-dimensional endoscopy for endoscopic salvage nasopharyngectomy: Preliminary report of experience

Background

Prospective, observational study to assess the efficacy of salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma (NPC) via the endoscopic endonasal approach using a three-dimensional (3D) high-definition endoscopic system.

Methods

Between 2016 and 2017, 30 patients with recurrent NPC were recruited. Patient demographics, tumor characteristics, and perioperative data were recorded. Instrument ergonomics and perceived advantages were assessed by the operating, assisting, and observing surgeons.

Results

The majority (70%) of patients received radiotherapy alone as the initial treatment for NPC, and tumor recurred after a mean interval of 16.8 months. The tumor (T) classifications of the recurrent (R) tumors were: RT1: 46.7%; RT2: 33.3%; and RT3: 20.0%. The mean operative time was 293.3 minutes, and no conversion to open approach was necessary. Internal carotid artery dissection was required in nine patients, and the resection and repair of dura was required in six patients. The most common method of reconstruction was free vastus lateralis flap (46.7%). Microscopically clear resection margins were achieved in 73.3% of patients. The mean hospital stay was 6.8 days. There was no hospital mortality. One patient developed minor secondary hemorrhage, whereas the other developed transient contralateral vocal cord paralysis. On quantitative assessment, surgeons noticed a significant advantage of the 3D system with regard to depth and size perception, anatomy identification, and hand–eye coordination, whereas there was no significant difference in terms of strain sensation and dizziness.

Conclusion

The 3D high-definition endoscopic system improves the precision of endoscopic nasopharyngectomy, particularly when dissection of the internal carotid artery and dura is required.

Level of Evidence

4. Laryngoscope, 2017

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