Atrial septal defect in a patient with congenital disorder of glycosylation type 1a: a case report

Atrial septal defect often become more severe when encountered in genetic syndromes. Congenital disorder of glycosylation type 1a is an inherited metabolic disorder associated with mutations in PMM2 gene and can ...

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Author’s response to Letter-to-the-editor regarding “Are the Epworth Sleepiness Scale and Stop-Bang Model effective at predicting the severity of obstructive Sleep Apnoea (OSA); in particular OSA requiring treatment?”

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Reply to the letter concerning “Revision adenoidectomy in children: a population-based cohort study in Taiwan”

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A prospective 52-week randomised controlled trial of patient-initiated care consultations for patients with psoriasis

Abstract

Background

Treatment and care of moderate to severe psoriasis requires lifelong consultations with a dermatologist with close monitoring of systemic treatment.

Objectives

To investigate the effect of patient-initiated care consultations (PICC) for patients with psoriasis in a dermatology outpatient clinic.

Methods

A prospective randomised controlled trial with patients in well-controlled systemic treatment randomised to either 1) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or 2) routine care, where they participated in a consultation every 12-16 weeks. The primary outcome was the Dermatology Life Quality Index (DLQI). Other outcomes were safety, patient adherence and satisfaction with healthcare assessed at baseline and after 52 weeks.

Results

150 patients were included, with 58.0% treated with biologicals, 37.3% with methotrexate and 4.7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI 0.28 (95% CI, -0.35–0.9) or Psoriasis Area Severity Index -0.24 (95% CI, -0.84–0.36). Patients in the PICC group requested 63.1% fewer consultations with a dermatologist, mean ±SD 2.5 ±0.1 vs. 5.1 ±0.6, (p=0.001). Patient adherence and safety with treatment monitoring was equal between groups, but the PICC group was significantly better at attending consultations than the control group (p=0.003).

Conclusion

PICC offers additional clinical benefits compared to routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment and patients report high quality of life and satisfaction with healthcare.

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Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: A systematic review and meta-analysis

BACKGROUND Much uncertainty exists as to whether peri-operative goal-directed therapy is of benefit. OBJECTIVES To discover if peri-operative goal-directed therapy decreases mortality and morbidity in adult surgical patients. DESIGN An updated systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase and the Cochrane Library were searched up to 31 December 2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult surgical patients allocated to receive goal-directed therapy or standard care were eligible for inclusion. Trauma patients and parturients were excluded. Goal-directed therapy was defined as fluid and/or vasopressor therapy titrated to haemodynamic goals [e.g. cardiac output (CO)]. Outcomes included mortality, morbidity and hospital length of stay. Risk of bias was assessed using Cochrane methodology. RESULTS Ninety-five randomised trials (11 659 patients) were included. Only four studies were at low risk of bias. Modern goal-directed therapy reduced mortality compared with standard care [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.50 to 0.87; number needed to treat = 59; N = 52; I2 = 0.0%]. In subgroup analysis, there was no mortality benefit for fluid-only goal-directed therapy, cardiac surgery patients or nonelective surgery. Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95% CI, 0.51 to 0. 92; number needed to treat = 38), acute kidney injury (OR 0. 73; 95% CI, 0.58 to 0.92; number needed to treat = 29), wound infection (OR 0.48; 95% CI, 0.37 to 0.63; number needed to treat = 19) and hospital length of stay (days) (−0.90; 95% CI, −1.32 to −0.48; I2 = 81. 2%). No important differences in outcomes were found for the pulmonary artery catheter studies, after accounting for advances in the standard of care. CONCLUSION Peri-operative modern goal-directed therapy reduces morbidity and mortality. Importantly, the quality of evidence was low to very low (e.g. Grading of Recommendations, Assessment, Development and Evaluation scoring), and there was much clinical heterogeneity among the goal-directed therapy devices and protocols. Additional well designed and adequately powered trials on peri-operative goal-directed therapy are necessary. Correspondence to Dr Matthew A. Chong, MD, Department of Anesthesia and Perioperative Medicine, University Hospital – London Health Sciences Centre, 339 Windermere Road, C3-108, London, ON, Canada N6A 5A5 E-mail: matthew.a.chong@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Comparative efficacy of two anti-aging products containing retinyl palmitate in healthy human volunteers

Summary

Background

No study yet described the comparative efficacy of two over-the-counter (OTC) anti-aging products in Asian subjects using the techniques involving analysis of living skin.

Aim

We sought to evaluate the anti-aging efficacy of two commercial formulations containing retinyl palmitate using a high-resolution UVA video camera.

Method

Total 11 healthy male volunteers, agreed to participate in this single-blind split-face design study with the mean age of 25.5 years. Every night, volunteers applied one type of cream on the left side and other type of cream on the right side of the face, as directed according to the study design for 60 days. Measurements of the parameters were taken at 0, 1st, 7th, 15th, 30th, and 60th day of study period using noninvasive UVA video camera Visioscan^® VC98. Cream applied on right side of the face labeled as "R" and on the left side as "L."

Results

Sixty-day use of the creams showed significant improvement in SELS parameters of the skin. Percent change in skin wrinkling (SEw) parameter calculated after 60 days was −6.68% after applying cream R and −8.27% after applying cream L.

Conclusion

We concluded that constituents in both creams have potentially influenced skin surface parameters, thus indicating that, these creams as a better option to lessen the effects of aging on facial skin on long-term application.

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The use of natural ingredients in innovative Korean cosmeceuticals

Summary

Background

The cosmeceutical industry is an ever-growing and in demand market, especially in Asia. Korea has been on the forefront of creating the newest generation and most innovative cosmeceuticals products including ingredients such as snail secretions, starfish powder, botanical extracts, green tea, and red ginseng. Given their increasing prevalence in the cosmeceutical industry, scientists have been conducting investigations into these extracts and their properties.

Objective

To summarize the current literature surrounding multiple natural ingredients found in Korean cosmeceutical products.

Methods

A review of the literature surrounding natural ingredients found in Korean cosmeceuticals was conducted using PubMed (U.S. National Library of Medicine).

Results

Multiple natural extracts have been found to have antiaging, antitumor, and antimelanogenic effects making them useful additives in current cosmeceutical products.

Conclusion

With the public's increasing awareness of cosmeceutical products, it is important for physicians to understand the properties of these extracts in order to inform patients correctly and ensure patient safety.

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