Eosinophilic granulomatosis with polyangiitis is a rare, necrotizing systemic vasculitis associated with asthma and hypereosinophilia. Its cause and pathophysiology are still being elucidated.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 23 Σεπτεμβρίου 2017
An atypical presentation of cardiac tamponade and periorbital swelling in a patient with eosinophilic granulomatosis with polyangiitis: a case report
Whole exome sequencing in inborn errors of immunity: use the power but mind the limits.
Purpose of review: Next-generation sequencing, especially whole exome sequencing (WES), has revolutionized the molecular diagnosis of inborn errors of immunity. This review summarizes the generation and analysis of next-generation sequencing data. Recent findings: The focus is on prioritizing strategies for unveiling the potential disease-causing variant. We also highlighted oversights and imperfections of WES and targeted panel sequencing, as well as the need for functional validation. Summary: The information is crucial for a judicious use of WES by researchers, but even more so by the clinical immunologist. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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The absence of an association between Interleukin 1β gene polymorphisms and recurrent aphthous stomatitis (RAS)
Source:Archives of Oral Biology, Volume 84
Author(s): Zuzanna Ślebioda, Anna Kowalska, Marta Rozmiarek, Ewa Krawiecka, Elżbieta Szponar, Barbara Dorocka-Bobkowska
ObjectivesRecurrent aphthous stomatitis (RAS) is a chronic, ulcerative disease with a probable polygenic mode of inheritance and complex etiology with a strong immunological background. The aim of the present study was to determine the possible association between two single nucleotide polymorphisms (SNPs) of the IL-1β gene: IL-1β−511 T>C (rs16944) and IL-1β+3954C>T (rs1143634) and RAS susceptibility in a moderately large group of patients.DesignOne hundred and four patients with minor, major and herpetiform RAS and 75 healthy volunteers were genotyped at IL-1β−511 T>C (rs16944) and IL-1β+3954C>T (rs1143634) using the PCR-RFLP approach. The results were statistically analysed with chi-square test and test of difference between two rates of structure, with p<0.05 assumed to be a statistically significance level (Statistica 10, StatSoft®, Kraków, Poland).ResultsThere were no statistically significant differences in the genotype distribution for the IL-1β C[+3954]T polymorphism between the RAS and control groups. The frequency of IL-1β*T[-511]/*T[–511] homozygotes among the patients was significantly higher when compared to our study control (p<0.0347). The results after stratification into carriers and non-carriers of C and T alleles did not clearly indicate which SNP may be considered a risk factor for RAS.ConclusionsThe genetic association between the studied SNPs of the IL-1β gene and RAS remains controversial and requires further investigation.
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Dental erosion in archaeological human remains: A critical review of literature and proposal of a differential diagnosis protocol
Source:Archives of Oral Biology, Volume 84
Author(s): Isabelle Coupal, Arkadiusz Sołtysiak
ObjectiveAlthough studies of dental wear on archaeological human remains have largely focused on mechanical wear (attrition and abrasion) in the past, chemical wear (erosion) is being increasingly identified as a separate form of wear. This paper aims to review the current state of research and to develop a protocol that may be universally used by biorchaeologists to specifically identify dental erosion.Design and resultsA critical review of literature has been done in order to highlight the issues related to diagnosis of dental erosion in archaeological human remains. The bodies of work based on the analysis of both modern and archaeological dentitions raise their separate problems. In addition to a need to re-evaluate symptoms of dental erosion, notably dentin 'cupping', it is apparent that no specific protocol is adapted from medical to archaeological sciences. Authors rather rely on tooth wear indices and photographs of modern clinical cases for diagnosis. Furthermore, the diagenetic chemical alternation has rarely been considered as a bias.ConclusionsHere we suggest a three-step protocol: the primary method is the microscopic identification of dental erosion by SEM, followed by the exclusion of taphonomic aetiology on surrounding bone and soil pH analysis. Archaeologists should also explore possible causative agents of wear using archaeological and historic knowledge about the population being analyzed.
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In vitro and in vivo anti-microbial activity evaluation of inactivated cells of Lactobacillus salivarius CECT 5713 against Streptococcus mutans
Source:Archives of Oral Biology, Volume 84
Author(s): Ana I. Sañudo, Roberto Luque, Mª Paz Díaz-Ropero, Juristo Fonollá, Óscar Bañuelos
ObjectiveDefining the etiology of dental caries is a complex problem. The microbiological approach has included Streptococcus mutans as one of the bacterial species involved in this disease. This research investigates the inhibitory effects of heat-inactivated Lactobacillus salivarius CECT 5713 against S. mutans using in vitro and in vivo assays.DesignOn the one hand, the effect of non-viable L. salivarius CECT 5713 on the in vitro adhesion of S. mutans to hydroxyapatite discs was evaluated. On the other hand, levels of Streptococcus mutans, amount of salivary flow and salivary pH before and after taking the rinse with the non-viable L. salivarius CECT 5713 in healthy volunteers were assessed (self-controlled open-label pilot study).ResultsThe levels of S. mutans seemed to decrease in the in vitro and in vivo assays (p<0.05). The in vitro effect of non-viable L. salivarius was maintained until 36 months of storage. In addition, the reduction of S. mutans salivary concentration in the volunteers was statistically significant from the third day until two weeks of treatment.ConclusionsHeat-inactivated L. salivarius CECT 5713 prevents S. mutans adhesion to hydroxyapatite and could be used as a strategy to reduce the salivary concentration of this oral pathogen.
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Facial skeleton asymmetry and its relationship to mastication in the Early Medieval period (Great Moravian Empire, Mikulčice, 9th–10th century)
Source:Archives of Oral Biology, Volume 84
Author(s): Alexandra Ibrová, Ján Dupej, Petra Stránská, Petr Velemínský, Lumír Poláček, Jana Velemínská
ObjectivesThe aim of this study was to analyse the relationship of mastication and directional asymmetry (DA) of upper facial skeleton in Early Medieval sample from the Mikulčice settlement (Czech Republic).DesignThe settlement is divided into two burial areas of presumably different socioeconomic status: the castle and the sub-castle. The material consisted of 193 individuals (125 castle, 68 sub-castle). The relationship of facial skeleton DA and mastication was analysed by examining tooth wear and mandibular shape by means of 3D geometric morphometrics. Tooth wear of premolars and molars was evaluated using appropriate scoring systems. 3D coordinates of 35 mandibular landmarks were scanned using MicroScribe G2X digitizing system.ResultsThe results did not reveal any significant differences in tooth wear DA or mandible DA values between burial areas or sexes. Mandibular shape, however, differed significantly between burial areas and sexes. Directional changes of mandibular landmarks supported a right chewing side preference in the sample. Significant relationship between upper facial skeleton DA and mandible DA was recorded.ConclusionsDifferences in subsistence between burial areas and sexes did not translate into differences in mandible DA and dental wear. However, mandibular shape analysis revealed prominence of areas affected by masticatory muscles in individuals from the castle. Higher consumption of tough material, such as meat, has been proposed as possible explanation. The right side was found to be preferential for chewing. The relationship between upper facial skeleton DA and mandible DA was concluded to be the result of the compensatory and adaptive function of mandible.
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Aims & Scope/Editorial board
Source:Archives of Oral Biology, Volume 83
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Optimizing concentration of titanium tetrafluoride solution for human dentine remineralization
Source:Archives of Oral Biology, Volume 83
Author(s): Peng Wang, Jianghong Gao, Danyang Wang, Malcolm L. Snead, Juedan Li, Jianping Ruan
ObjectiveThe aim of the present study was to select the optimal concentration of TiF4 solution to facilitate the remineralization of early dentine caries lesions.DesignSixty human dentine specimens were cut and randomly divided into 6 groups (1%, 2%, 3%, 4% TiF4 groups, 2.712% NaF group and distilled deionized water (DDW) control group). Artificial dentine caries-like lesions were created. After being subjected to fluoride treatment and immersed in remineralizing solution for 2weeks, the specimens were observed by microCT, scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). Data were analysed using linear regression analysis (P<0.05).ResultsThe lesion depths of the specimens treated by 2% TiF4 solution were statistically less than those of the other groups. Further, the greyscale values of these lesion areas were greater. The 3% and 4% TiF4 solutions caused further lesion demineralization. The 2.712% NaF solution seemed to be detrimental to remineralization during the experimental time, as the subsurface area remained hypomineralized with a thick precipitation layer on the surface.ConclusionsThe 2% TiF4 solution demonstrated better remineralizing potency than did the other treatments.
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Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: A systematic review
Source:Archives of Oral Biology, Volume 83
Author(s): Karim Elhennawy, David John Manton, Felicity Crombie, Paul Zaslansky, Ralf J. Radlanski, Paul-Georg Jost-Brinkmann, Falk Schwendicke
ObjectivesTo systematically assess and contrast reported differences in microstructure, mineral density, mechanical and chemical properties between molar-incisor-hypomineralization-affected (MIH) enamel and unaffected enamel.MethodsStudies on extracted human teeth, clinically diagnosed with MIH, reporting on the microstructure, mechanical properties or the chemical composition and comparing them to unaffected enamel were reviewed. Electronic databases (PubMed, Embase and Google Scholar) were screened; hand searches and cross-referencing were also performed.ResultsTwenty-two studies were included. Fifteen studies on a total of 201 teeth investigated the structural properties, including ten (141 teeth) on microstructure and seven (60 teeth) on mineral density; six (29 teeth) investigated the mechanical properties and eleven (87 teeth) investigated the chemical properties of MIH-affected enamel and compared them to unaffected enamel. Studies unambiguously found a reduction in mineral quantity and quality (reduced Ca and P content), reduction of hardness and modulus of elasticity (also in the clinically sound-appearing enamel bordering the MIH-lesion), an increase in porosity, carbon/carbonate concentrations and protein content compared to unaffected enamel.Findingswere ambiguous with regard to the extent of the lesion through the enamel to the enamel-dentin junction, the Ca/P ratio and the association between clinical appearance and defect severity.ConclusionsThere is an understanding of the changes related to MIH-affected enamel. The association of these changes with the clinical appearance and resulting implications for clinical management are unclear.Clinical significanceMIH-affected enamel is greatly different from unaffected enamel. This has implications for management strategies. The possibility of correlating the clinical appearance of MIH-affected enamel with the severity of enamel changes and deducing clinical concepts (risk stratification etc.) is limited.
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Parathyroid hormone-related peptide (1–34) reduces alveolar bone loss in type 1 diabetic rats
Source:Archives of Oral Biology, Volume 83
Author(s): Wen Zhang, Su-Zhen Wu, Jian Zhou, Hong-Min Chen, Ye-Li Gong, Fang-Fang Peng, Bai-Fang Zhang
ObjectiveTo investigate the role of parathyroid hormone related protein (PTHrP) in diabetic periodontitis.MethodsAfter injected with 55mg/kg streptozotocin, diabetic rats were treated subcutaneously with low-dose (40μg/kg, once daily for 5days per week), middle-dose (80μg/kg) or high-dose (160μg/kg) PTHrP(1–34) peptide. Treatment continued for 12 weeks. Changes in periodontal tissues were confirmed by micro-computerized tomography assay and H&E analysis. We used tartrate resistant acid phosphatase (TRAP) staining to identify osteoclast cells. The expression of TNF-α, IL-1β and IL-6 was assessed by immunohistochemistry and Western blot.ResultsTooth-supporting structure loss was observed in periodontal tissues of diabetic rats. PTHrP (1–34) attenuated alveolar bone loss, especially in the middle-dose and high-dose group. Whereas TNF-α, IL-1β and IL-6 protein levels were increased in the diabetic gingival tissues, PTHrP (1–34) treatment inhibited the increase of IL-1β and IL-6, but had no effect on TNF-α.ConclusionType 1 diabetes increased the susceptibility to periodontal disease. Intermittent administration of PTHrP (1–34) exhibited an inhibitory effect on alveolar bone resorption and the gingival inflammation in periodontal tissues of diabetic rats.
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Mechanisms involved in facial heat hyperalgesia induced by endothelin-1 in female rats
Source:Archives of Oral Biology, Volume 83
Author(s): Rafael Fernandes de Souza, Luana Lechenakoski de Oliveira, Carina Fernanda Mattedi Nones, Renata Cristiane dos Reis, Erika Ivanna Araya, Caroline Machado Kopruszinski, Giles Alexander Rae, Juliana Geremias Chichorro
ObjectivePronociceptive responses to endothelins in the trigeminal system seem to be mediated by ETA and ETB receptors, which have been shown to be expressed in neurons of the trigeminal ganglion of humans and rats. The present study aimed to evaluate the ability of endothelin-1 (ET-1) to induce facial heat hyperalgesia in female rats, the contribution of ETA and ETB receptors to this response, as well as the mechanisms underlying heat hyperalgesia induced by ET-1.DesignET-1 (100pmol/50μL) was injected into the upper lip and heat hyperalgesia was evaluated for up to 6h. Facial heat hyperalgesia induced by ET-1 was assessed in rats pre-treated locally with BQ-123 or BQ-788 (selective ETA and ETB receptor antagonists, respectively, 30nmol/50μL); BCTC (TRPV1 receptor antagonist; 300μg/50μL); anti-NGF (3μg/50μL); K252a (TrkA inhibitor, 1μg/50μL); or in rats that received intraganglionar resiniferatoxin injection (RTX, 200ng/10μL) to promote C-fibers ablation.ResultsET-1 induced facial heat hyperalgesia that persisted up to 6h and was prevented by BQ-123, BQ-788 or by intraganglionar RTX injection. Likewise, local pre-treatment with BCTC abolished ET-1 induced facial heat hyperalgesia up to 3h. Local pre-treatment with anti-NGF or K252a was effective to prevent ET-1 induced heat hyperalgesia.ConclusionsIn conclusion, ET-1 is able to induce heat hyperagelsia in trigeminal primary afferents of female rats, which is mediated by ETA and ETB receptors. Activation of TRPV1 receptors and NGF-signaling pathways may contribute to heat hyperalgesia induced by ET-1.
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Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer☆
Source:Oral Oncology, Volume 74
Author(s): Matthew C. Ward, Chirag Shah, David J. Adelstein, Jessica L. Geiger, Jacob A. Miller, Shlomo A. Koyfman, Mendel E. Singer
ObjectiveNivolumab is the first drug to demonstrate a survival benefit for platinum-refractory recurrent or metastatic head and neck cancer. We performed a cost-utility analysis to assess the economic value of nivolumab as compared to alternative standard agents in this context.Materials and methodsUsing data from the CheckMate 141 trial, we constructed a Markov simulation model from the US payer's perspective to evaluate the cost-effectiveness of nivolumab compared to physician choice of either cetuximab, methotrexate or docetaxel. Alternative strategies considered included: single-agent cetuximab, methotrexate or docetaxel, or first testing for PD-L1 to select for nivolumab. Costs were extracted from Medicare and utilities from the literature and CheckMate. Probabilistic sensitivity analysis (PSA) was used to evaluate parameter uncertainty. $100,000/QALY was the primary threshold for cost-effectiveness.ResultsWhen comparing nivolumab to the standard arm of CheckMate, nivolumab demonstrated an incremental cost-effectiveness ratio (ICER) of $140,672/QALY. When comparing standard therapies, methotrexate was the most cost-effective with similar results for docetaxel. Nivolumab was cost-effective compared to single-agent cetuximab (ICER $89,786/QALY). Treatment selection by PD-L1 immunohistochemistry did not markedly improve the cost-effectiveness of nivolumab. Factors likely to positively impact the cost-effectiveness of nivolumab include better baseline quality-of-life, poor tolerability of standard treatments and/or a lower cost of nivolumab.ConclusionsNivolumab is preferred to single-agent cetuximab but requires a willingness-to-pay of at least $150,000/QALY to be considered cost-effective when compared to docetaxel or methotrexate. Selection by PD-L1 does not markedly improve the cost-effectiveness of nivolumab. This informs patient selection and clinical care-path development.
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Extracapsular extension is associated with worse distant control and progression-free survival in patients with lymph node-positive human papillomavirus-related oropharyngeal carcinoma
Source:Oral Oncology, Volume 74
Author(s): Jeffrey Shevach, Adam Bossert, Richard L. Bakst, Jerry Liu, Krzysztof Misiukiewicz, Jessica Beyda, Brett A. Miles, Eric Genden, Marshall R. Posner, Vishal Gupta
ObjectivesTo determine the prognostic utility of pathologic extracapsular extension (ECE) in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC).Materials and MethodsRetrospective analysis was performed on patients who underwent surgery for primary HPV-related OPSCC and received adjuvant radiotherapy (RT) between 2006 and 2015. Locoregional control (LRC), distant control (DC), progression-free survival (PFS) and overall survival (OS) were compared between the groups with and without ECE using univariate Kaplan-Meier and multivariate Cox regression survival analyses.Results75 patients were identified and ECE was demonstrated on the surgical pathology of 26 patients. ECE(+) patients more frequently received chemotherapy (76.9% vs. 32.7%; p<0.0001) and RT doses>66Gy (76.9% vs. 16.3%; p<0.001). With a median follow-up of 29months, patients with ECE had a significantly worse 5-year DC rate than those without ECE (76.7% vs. 97.9%; p=0.046), and patients with ECE had a significantly worse 5-year PFS (54.5% vs. 93.6%; p=0.021) than those without ECE. On multivariate Cox regression analysis, ECE was independently prognostic of worse DC (hazard ratio: 8.26; 95% confidence interval: 1.24–55.21; p=0.029) and worse PFS(HR: 4.64; 95% CI: 1.18–18.29; p=0.028). There was no statistically significant difference in 5-year LRC (93.3% vs. 95.7%) or OS (66.9% vs. 97.0%) between ECE(+) and ECE(−) patients, respectively.ConclusionThis study suggests that ECE is independently prognostic of worse DC and PFS in patients who undergo surgery prior to adjuvant RT for primary HPV-related OPSCC.
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Extraskeletal osteosarcoma in the parotid gland: A case report
Source:Auris Nasus Larynx
Author(s): Takao Hamamoto, Takashi Kono, Hiromi Furuie, Tsutomu Ueda, Sachio Takeno, Katsuhiro Hirakawa, Koji Arihiro
Extraskeletal osteosarcoma is a very rare tumor and accounts for 4–5% of all osteosarcomas. We describe a 47-year-old Japanese man who presented with a right parotid tumor. The patient underwent total resection with postoperative radiotherapy; however, the tumor recurred in the lung, whereupon he underwent chemotherapy and partial lung resection. After surgery, a hemorrhagic brain metastasis appeared; this tumor was extirpated to prevent bleeding into the brain, after which additional chemotherapy was administered. Nevertheless, the patient developed additional metastases and died 17 months after the total parotidectomy. This tumor was unique in that it arose in the parotid gland; this case provides an instructional example of an extremely rare manifestation of this type of tumor.
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Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy: Our Experience
Abstract
To report operative findings, postoperative course, and postimplantation performance in patients with cochlear malformations who underwent cochlear implantation. Seventeen patients with malformations which included enlarged vestibular aqueduct (n = 6), Mondini's dysplasia (n = 5) common cavity deformity (n = 3) and incomplete partition type 2 (n = 3) underwent cochlear implantation with Nucleus 22 straight array device at our center. Operative findings described facial nerve anatomy and cerebrospinal fluid leak. Standard tests of speech perception were used to evaluate the postoperative performance for each subject. Operative findings included cerebrospinal fluid leak (thirteen patients) all of which were repaired successfully with graft. None had abnormal facial nerve anatomy. No surgical complications occurred. All the patients except two with common cavity had complete insertion. Electrode thresholds and discomfort levels were variable for several months after implantation. All patients demonstrated improved performance after implantation. Patients with enlarged vestibular aqueduct fared better than patients with other inner ear malformations. Cochlear implantation can be a successful method of rehabilitation in patients with congenital deafness who have cochlear malformations.
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Chronic IL-33 expression predisposes to viral-induced exacerbations of asthma by increasing type-2 inflammation and dampening antiviral immunity
Source:Journal of Allergy and Clinical Immunology
Author(s): Rhiannon B. Werder, B Biomed Sci, Vivian Zhang, Jason P. Lynch, Natale Snape, John W. Upham, Kirsten Spann, Simon Phipps
BackgroundRhinovirus infection triggers acute exacerbations of asthma. IL-33 is an instructive cytokine of type-2 inflammation whose expression is associated with viral load during experimental rhinovirus infection of asthmatic subjects.ObjectiveTo determine whether anti-IL-33 therapy is effective during disease progression, established disease, or viral exacerbation using a preclinical model of chronic asthma and in vivo human primary airway epithelial cells (AECs).MethodsTo model disease onset, progression, and chronicity, mice were exposed to pneumonia virus of mouse and cockroach extract in early-life and later-life, then challenged with rhinovirus. Interventions included anti-IL-33 or dexamethasone at various stages of disease. AECs were obtained from asthmatic and healthy patients, and treated with anti-IL-33 following RV infection.ResultsAnti-IL-33 decreased type-2 inflammation in all phases of disease; however, the ability to prevent airway smooth muscle growth was lost after the progression phase. After the chronic phase, IL-33 levels were persistently high and rhinovirus challenge exacerbated the type-2 inflammatory response. Treatment with anti-IL-33 or dexamethasone diminished exacerbation severity and anti-IL-33, but not dexamethasone, promoted antiviral IFN expression and decreased viral load. RV replication was higher and IFN-lambda lower in asthmatic compared to healthy AECs. Anti-IL-33 lowered RV replication and increased IFN-λ at the gene and protein level.ConclusionAnti-IL-33 or dexamethasone suppressed the magnitude of type-2 inflammation during a rhinovirus-induced acute exacerbation, however only anti-IL-33 boosted antiviral immunity and lowered viral replication. The latter phenotype was replicated in RV infected human AECs, suggesting that anti-IL-33 therapy has the additional benefit of enhancing host defence.
Teaser
Using a preclinical model of chronic asthma and primary human AECs we show that anti-IL-33 boosted IFNs and lowered RV replication, suggesting that in addition to attenuating type-2 inflammation, anti-IL-33 therapy may enhance host defence.http://ift.tt/2hqW5uP
Sleep disordered breathing in Bardet-Biedl Syndrome
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Jeffrey C. Yeung, Umakanth A. Katwa, Gi Soo Lee
IntroductionBardet-Biedl Syndrome (BBS) is an autosomal recessive ciliopathy, and obesity is among its defining characteristics. Consequently, the incidence of sleep disordered breathing (SDB) in this population is expected to be high. Due to its relative rarity, the nature of SDB in this population is poorly described. The objective of this study was to review a single institutional experience in the assessment and management of SDB in patients with BBS.MethodsRetrospective chart review of tertiary care, academic pediatric hospital.Results20 patients with BBS were evaluated over a 25-year period. Median age at initial consultation was 69 months; half of these patients were referred before the diagnosis of BBS was made. Eighteen of twenty patients had symptoms of sleep-disordered breathing. Median follow-up duration was 17.5 months. A wide range of polysomnographic outcomes was observed, including obstructive apnea-hypopnea indexes of 0–195 events/hour. Patients were managed with adenotonsillectomy and/or non-invasive positive pressure ventilation.ConclusionsSDB is commonly seen in BBS. These patients should be routinely screened for OSA and if present, a polysomnogram should be obtained. Based on patient characteristics, the failure rate of primary surgical intervention, namely adenotonsillectomy, is expected to be high. Further investigation into the role of ancillary diagnostic testing is still needed.
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Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO2 laser approach
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Grégoire B. Morand, Karma Lambercy, Pierre Guilcher, Kishore B. Sandu
ImportanceOesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser.ObservationsPharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up.Conclusion and relevancePharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.
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Application of endoscopy in otology: Changes over the last 8years in Korean Otological Society
Source:American Journal of Otolaryngology
Author(s): Se-Joon Oh, Eui-Kyung Goh, Hyun-Min Lee, Jae-Hoon Jung, Il Joon Moon, Jong-Woo Chung, Il-Woo Lee
ObjectivesDespite the worldwide availability of endoscope in otology, it still has not replaced the microscopic surgery as it has for nose surgery. In 2008, we administered a questionnaire on the preference of using otoscopes in Korea. In light of the worldwide availability of endoscopic ear surgery, we have now conducted a more detailed survey to determine if this preference has changed over 8years.Subjects and methodsA questionnaire consisting of 10 questions was used to survey members of the Korean Otological Society who were actively performing middle ear surgery. The responses to this questionnaire were compared to those from 2008. The study also determined the preference for endoscope use based on the surgeon's experience.ResultsThe mean surgical experience of the otologists was 12.7years. Endoscopy for tympanoplasty and tympanomastoidectomy increased over a period of 8years. In the outpatient clinic, the use of endoscopy also increased; over 8-year period, it surpassed the microscope as the most preferred diagnostic tool in the outpatient clinic. Greater than half of the operating rooms were equipped with endoscopic sets; however, only 4.5% of otologists acknowledged having endoscopic instruments.ConclusionEndoscopy for surgery and in outpatient clinic assessment increased in otology in Korea; however, endoscopes have consistently been used as an adjuvant to the microscope to improve visualization of the tympanic cavity rather than as a tool for totally endoscopic ear surgery.
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Fulminant myocardial bleeding: another clinical course of vascular Ehlers-Danlos Syndrome
Vascular Ehlers-Danlos Syndrome (vEDS) is a dominantly inherited connective tissue disorder characterised by colon rupture and arterial aneurysm, dissection and rupture. A patient was diagnosed with vEDS after a spontaneous colon rupture when he was brought to our institute because of sudden chest pain. An ECG revealed wide regional ST elevation, which was initially suggestive of acute myocarditis. On the second day, haemodynamics suddenly deteriorated because of a rapid accumulation of bloody pericardial effusion, and the patient died. Autopsy revealed an excessive spontaneous myocardial haemorrhage owing to fragility, which suggested an underlying disease—vEDS.
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Congenital melanocytic nevus mimicking a turban tumour in an 18-year-old Filipino male
Congenital melanocytic nevi (CMN) are nevi that are present at birth or arise within the first few weeks of life. They are often found on the trunk, head and neck and extremities. We report herein an unusual presentation of a CMN as a cerebriform tumour presenting as secondary cutis verticis gyrata on the scalp of an 18-year-old Filipino male.
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Microbubble-enhanced ultrasound to demonstrate urethral transection in a case of penile fracture
A 47-year-old man attended the emergency department following trauma during sexual intercourse after which he developed penile swelling and haematuria several hours later. A penile fracture was suspected but given the slightly atypical history, ultrasound was performed to look for a fracture. Given the history of haematuria, both a standard Doppler ultrasound and a microbubble-enhanced retrograde ultrasound urethrogram were performed. The Doppler confirmed the suspected diagnosis of penile fracture, and microbubble urethrogram demonstrated a urethral injury. This facilitated prompt surgical treatment and helped guide the surgical approach. Retrograde microbubble enhanced ultrasound urethrogram is a novel technique that can be used in conjunction with standard ultrasound to confirm the presence of a concurrent urethral rupture in penile fracture.
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Case of methaemoglobinaemia caused by tree oils and kerosene
We report a case of a young man who allegedly consumed 100 mL of an indigenous pesticide which is used for the killing of rats in households in India. The constituents were azadirachtin oil (40%), tea oil (15%), pine oil (25%) and kerosene oil (20%). He presented to us with shortness of breath and altered sensorium and was found to have fMetHb (fraction of methaemoglobin) level of 80%, which has been postulated to have a fatal outcome. He responded to a low dose of methylene blue along with intravenous vitamin C and the level of fMetHb came down to 20% within 1 hour. His sensorium improved markedly with a decrease in fMetHb to non-toxic levels and he was discharged 5 days after admission. A literature review pertaining to these constituents individually or in combination causing methaemoglobinaemia is discussed in the context of this case.
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Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture
Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.
Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.
We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture.
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Endoscopic surgical management of a large Morel-Lavallee lesion
The Morel-Lavallée lesion is a closed degloving injury that usually occurs following high-energy trauma. We present a case demonstrating endoscopic management of this lesion. A 44-year-old man fell from scaffolding. Initial assessment demonstrated no significant injury. An ultrasound scan 2 days post injury revealed a large fluid collection along the lateral right thigh. This subsequently became infected and did not respond to antibiotic therapy.
Due to the extent of the lesion, we were reluctant to perform a traditional open drainage. An endoscopic probe was inserted at the proximal and distal poles of the lesion and the wound debrided.
This resulted in a rapid improvement in symptoms and a complete resolution of the lesion at 1 year postsurgery, with no wound-associated morbidity.
This is only the second description of endoscopic debridement of a large, acute Morel-Lavallée lesion, with an excellent outcome.
http://ift.tt/2wNOFHz
Disseminated herpes zoster causing acute respiratory distress syndrome in an immunocompetent patient
Disseminated cutaneous varicella herpes zoster with visceral involvement is rare and seen almost exclusively in immunocompromised patients. We describe an unusual case of fulminant herpes zoster (HZ) in a healthy, immunocompetent 37-year-old woman. She initially presented to an urgent care centre with a classic HZ rash localised to her neck, and upper respiratory symptoms and was treated with prednisone and cephalexin. Within 1 week, the rash became diffuse and her clinical status rapidly deteriorated with development of severe acute respiratory distress syndrome. Varicella zoster infection was confirmed via skin biopsy, bronchial viral PCR and serology for varicella antibodies. She was successfully treated with intravenous acyclovir and aggressive supportive care. Though physicians readily recognise typical zoster infection, this case reminds clinicians that HZ infection can be fulminant and potentially life-threatening in younger, immunocompetent individuals. Early recognition and antiviral therapy is important to reduce morbidity and mortality.
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The entrapped twin: a case of fetus-in-fetu
Fetus-in-fetu (FIF) is a rare entity in which malformed parasitic twin grows inside the body of its twin. It is most commonly presented with mass in the abdomen. We present a case of a 15-year-old boy who presented with abdominal mass since infancy. Radiological investigations are suggestive of FIF. Intraoperatively, malformed fetus in a sac was found and excised. Postoperatively the patient recovers well and was put on follow-up.
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Nasofrontal dermoid sinus
Description
A 19-year-old woman presented with recurrent episodes of headache and intermittent caseous discharge from a midline pit near the rhinion, since childhood. There was no fever, nausea, vomiting or seizure. Physical examination revealed a widened nasal bridge and a midline aperture with a protruding hair. Patient's neurological examination was normal. A contrast-enhanced CT scan of the head showed a small hypodense lesion at the anterior basifrontal region. T1-weighted MRI images identified a hyperintense intracranial lesion, which showed suppression with fat suppression sequences. T2-weighted images also revealed a high signal lesion modelling the cerebral parenchyma (figure 1), with a small tract going up to the nasal bridge (figure 2). The patient was diagnosed with a nasofrontal dermoid cyst with the extracranial nasal sinus tract and surgical excision was proposed. The histopathological analysis confirmed the previous diagnosis.
Figure 1
Coronal T2-weighted MRI image showing a hyperintense...
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Successful treatment using rituximab in a patient with refractory polymyositis complicated by scleroderma renal crisis
Corticosteroids are the first-line treatment for patients with inflammatory myopathies. Myositis can be a clinical feature of scleroderma (polymyositis–scleroderma overlap syndrome), and treatment of this syndrome is a challenge for clinicians because moderate to high doses of corticosteroids are considered a risk factor for development of acute kidney injury in affected patients. We report here the case of a 56-year-old woman with scleroderma who developed polymyositis and was successfully treated with rituximab. Initial treatment of the polymyositis with prednisolone 40 mg/day was rapidly tapered to 2.5 mg/day due to development of scleroderma renal crisis, for which four weekly infusions of rituximab (500 mg; off-label) were given. She responded well to rituximab in addition to prednisolone 2.5 mg/day. Rituximab may improve inflammatory myopathies, even in cases where high-dose corticosteroids should be avoided due to complications. Rituximab should be considered as a treatment option in cases of refractory polymyositis.
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Extreme bony pelvic deformity in a renal transplant patient
A 35-year-old female renal transplant recipient was referred to the metabolic bone clinic because of a 15 cm loss of height. She was noted to have thoracic kyphosis and vertebral X-ray confirmed a wedge fracture of the eighth thoracic vertebra. She was managed accordingly but on subsequent follow-up mentioned in passing that her gynaecologist had been unable to obtain a cervical smear for routine screening. This led to further questioning, and the patient reported intermittent urinary stress incontinence, feelings of vaginal fullness and severe dyspareunia. It became apparent that these symptoms had been ongoing for 4 years, but the patient had not brought them to the attention of a healthcare practitioner due to feelings of embarrassment and her religious beliefs. These complaints prompted radiological investigation, which revealed extensive bony pelvic deformity, thought to be an extreme manifestation of chronic kidney disease mineral and bone disorder.
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Rapidly enlarging lipoma
Lipoma is a common subcutaneous tumour composed of fat tissue. It may occur as a sporadic solitary lesion or as multiple lesions. They often grow very slowly. They vary between 2 and 10 cm in size. There are rarely any subjective symptoms. Lipomas do not usually require treatment unless they are big enough to be symptomatic. We reported a 75-year-old man with a rapidly enlarging and ulcerated mass on his right upper thigh.
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Asymptomatic pyogenic liver abscesses secondary to Fusobacterium nucleatum and Streptococcus vestibularis in an immunocompetent patient
A 66-year-old male patient presented with symptoms and signs of L4/5 radiculopathy. He was found to be anaemic with elevated inflammatory markers and deranged hepatic enzymes. Imaging revealed lumbar canal stenosis and the presence of pyogenic liver abscesses from which Fusobacterium nucleatum and Streptococcus vestibularis were isolated. The hepatic abscesses were attributed to asymptomatic diverticular perforation. Multiple coexisting incidental infections were discovered, including oesophageal candidiasis, Helicobacter pylori, stool cultures positive for Strongyloides stercoralis, and sputum cultures positive for Enterobacter cloacae, Escherichia coli and Mycobacterium avium. Extensive investigations for possible underlying immunosuppression were negative.
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Severe unicuspid aortic valve stenosis: VACTERL association
Description
A 24-year-old man with a known history of horseshoe kidney leading to end-stage renal disease, scoliosis and small ventricular septal defect consistent with VACTERL association, who presented with worsening dyspnoea on exertion. Transthoracic echocardiogram (TTE) showed a unicuspid aortic valve (UAV) with severe aortic stenosis (AS) (valve area of 0.6 cm2 and mean gradient of 44 mm Hg). TTE also showed moderate aortic insufficiency and severely reduced left ventricular systolic function with estimated ejection fraction of 20%. Transoesophageal echocardiography (TEE) confirmed a UAV with single commissure located anteriorly (figure 1A–D; online and ) and severe AS (figure 1B, C). In preparation for surgical repair, chest CT angiogram showed dilated ascending aorta measuring 4 cm with no evidence of aortic dissection. The patient underwent aortic valve replacement surgery with 21 mm CarboMedics mechanical valve. TEE showed a well-seated prosthesis without evidence of paravalvular leak (figure 1E). The patient...
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PHACE syndrome in a child with segmental IH of face
Description
An 8-month-old female infant was referred for paediatric and dermatology consultation for evaluation of a facial haemangioma with progressive growth since the first days of life. The observation showed a large segmental infantile haemangioma (IH) over the right face (figure 1), a small vulvar haemangioma and exotropia of the right eye.
Figure 1
Right facial segmental infantile haemangioma at the level of the mandible, with extension to the lower lip.
Due to the segmental appearance of the facial IH, we prompted the investigation of PHACE syndrome, an acronym corresponding to a set of alterations: Posterior fossa anomalies, Haemangioma, Arterial lesions, Cardiac abnormalities/coarctation of the aorta alterations and Eye anomalies.1
The MR angiography showed an absence of the right internal carotid artery, with circulation assured through the circle of Willis (figure 2). Ophthalmology assessment revealed microphthalmia and...
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A rare highly aggressive tumour: lymphoepithelioma-like thymic carcinoma
Lymphoepithelioma-likethymic carcinoma is a rare neoplasm that presents with compressive symptoms or as an incidental radiological finding of an anterior mediastinal mass. It is an aggressive carcinoma with a high rate of invasion, metastasis and recurrence. Its diagnosis usually carries a poor prognosis largely due to propensity for late diagnosis. To date, guidance for treatment remains limited. This is a case of lymphoepithelioma-like thymic carcinoma in a young male adult who presented initially with back pain. Despite prompt initiation of chemotherapy with cisplatin, doxorubicin and cyclophosphamide, he had a complicated hospital course leading to demise within 2 months of diagnosis.
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Dog bites and diabetic peripheral neuropathy: a dangerous combination
All animal bites have the potential to cause significant infection. In the UK, dogs are the most common source of bites. Incidence of hospital attendances attributable to dog bites has risen over the last decade. Patient groups at particular risk of bites and/or complications of infection include those at extremes of age, immunosuppressed and patients with diabetes. We report the case of a patient with diabetic peripheral neuropathy, who was admitted on two separate occasions with unprovoked bites to his toes whilst asleep, by his pet dog. He ultimately required terminalisation of the affected digits. Although unusual, this mechanism of injury has been previously described in literature. However, we are unaware of cases reporting multiple separate incidences involving the same patient and animal. We present this case to highlight the perils of untrained pet ownership in diabetic patients with peripheral neuropathy and the importance of prompt medical and surgical treatment of injuries.
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When all else fails: supervised treatment in outpatient for schizophrenia (STOPS)
This was about a case of a patient requiring admission to psychiatry ward twice a year for relapse schizophrenia due to medication non-compliance. Medication adherence was previously monitored by her husband. However, following the death of her husband, she stopped treatment. The lack of insight and poor family support further contributed to her relapse. She presented with positive and negative symptoms of schizophrenia during her relapse, neglecting her hygiene and oral intake. She was also found to have anaemia as a result of poor diet when she was in relapse. Community psychiatry services had attempted to ensure compliance with postdischarge plan but failed as patient was not present every home visits. Supervised treatment in outpatient for schizophrenia (STOPS) provided an alternative method to ensure compliance in this patient. Patient has remained in remission for 1 year since the use of STOPS.
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Aftermath of induced inflammation: acute periaortitis due to nivolumab therapy
Description
A 57-year-old man with medical history of left upper lobe metastatic squamous cell carcinoma of lung and seizures due to brain metastasis was admitted with acute-onset low back pain. Patient also had a known history of infrarenal aortic and left common iliac artery aneurysm stable on regular surveillance CT over the past 3 years with the most recent CT scan 1 month prior to presentation showing no signs of inflammation around the infrarenal aneurysmal aorta as seen in figure 1. Positron emission tomography 1 year prior to presentation did not show signs of inflammation in the region of aortic aneurysm as shown in figure 2. For his metastatic lung cancer, he was initially started on carboplatin and gemcitabine therapy but unfortunately had progression of cancer in left lung on the regimen. Subsequently, he was placed on nivolumab therapy. After being on the medication for 9 months, patient presented with acute...
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Confusion and abdominal symptoms following a rugby tackle
A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding. An emergency splenectomy was performed, which confirmed the rupture of an enlarged spleen with blood loss of almost 2 L into the peritoneal cavity. The patient made a full recovery following surgery. A subsequent histological examination revealed granulomatous inflammation characteristic of infectious mononucleosis. This unique case illustrates that physically fit patients with early hypovolaemic shock can present with symptoms mimicking concussion.
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Sterigmatocystin and aflatoxin B 1 contamination of corn, soybean meal, and formula feed in Japan
Abstract
Sterigmatocystin (STC) and aflatoxin B1 (AFB1) were analyzed in 246 corn samples, 126 soybean meal samples, and 861 formula feed samples from the Japanese market between April 2010 and March 2015. The detection rate, the highest concentration, and the mean concentration of STC were respectively 14%, 6.4 μg/kg, and 1.2 μg/kg for corn; 14%, 1.1 μg/kg, and 0.63 μg/kg for soybean meal; and 43%, 9.1 μg/kg, and 0.97 μg/kg for formula feed. The detection rate, the highest concentration, and the mean concentration of AFB1 were respectively 46%, 24 μg/kg, and 3.9 μg/kg for corn; 30%, 6.7 μg/kg, and 1.1 μg/kg for soybean meal; and 47%, 20 μg/kg, and 1.6 μg/kg for formula feed. A weak negative correlation between the STC and AFB1 concentrations was observed: there was a high concentration of AFB1 in samples that contained a lower concentration of STC and vice versa. Spearman's rank correlation coefficient showed a weak negative correlation of − 0.30 (p < 0.001, n = 128) for corn and − 0.23 (p < 0.001, n = 575) for formula feed. In conclusion, no correlation was observed between the mean concentrations of STC contamination in formula feed (0.97 μg/kg) and in corn (1.2 μg/kg) and the blending rate (approximately 50%). The rate of STC contamination in the formula feed (43%) was higher than that in corn (14%). Therefore, it is likely that ingredients other than corn contribute to the contamination of formula feed with STC. In this study, regarding STC, problematic samples were not found.
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A novel method to assess the potential role of sweating abnormalities in the pathogenesis of AD
Abstract
Background
Although atopic dry skin is believed to be caused by defects in skin genes important for maintaining skin barrier function, the role of sweat in atopic dermatitis (AD) has been apparently underestimated. Given the great capacity of sweat to maintain and increase skin hydration, defective sweating responses may be a logical place to look for changes that predispose individuals to the disease.
Methods
We investigated how disease process and sweating defects progress from early asymptomatic stages to the onset of clinically apparent disease by employing the impression mold technique, which allows an accurate quantification of individual sweat gland/duct activity in relation to skin surface topography. Insensible and sensible sweating responses under baseline conditions and after thermal stimulus, respectively, were measured in various stages of AD patients and healthy controls.
Results
In controls, under baseline conditions sweat ducts/glands at the dermal folds secreted basal levels of sweat (insensible sweating), thereby maintaining skin hydration. Not only such insensible sweating but also sensible sweating markedly decreased even in the earliest asymptomatic stage and the decrease was followed by compensatory hyperhidrosis at the ridge: leakage of sweat into the dermis could represent the initial event resulting in the decreased sweating and inflammation. The defects eventually progressed involving all of the ducts/glands to develop systemic dry skin.
Conclusion
AD skin is characterized by varying degrees of functional impairment of sweat ducts/glands depending on the stage and this defect would be among the reasons for the inability of AD patients to maintain skin hydration.
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Nanoparticles prepared from porcine cells support the healing of cutaneous inflammation in mice and wound re-epithelialization in human skin
Abstract
Previous reports have demonstrated that cell-derived nanoparticles (CDNPs) composed of bovine or porcine protein complexes exerted therapeutic effects against viral infections and cancer in mice and humans. Based on these observations, we asked whether CDNPs would improve inflammatory skin disorders. To address this, we utilized two distinct mouse models of cutaneous inflammation: the autoimmune skin blistering disease epidermolysis bullosa acquisita (EBA) as an example of an autoantibody-induced cutaneous inflammation, and Leishmania major (L. major) infection as an example of a pathogen-induced cutaneous inflammation. In both models, we observed that CDNPs increased mRNA expression of the Th2 cytokine IL-4. Clinically, CDNPs decreased inflammation due to EBA and increased L. major-specific IgG1 levels without major effects on infected skin lesions. In addition, CDNPs supported the growth of keratinocytes in human skin cultures. In vitro studies revealed that CDNPs were taken up predominantly by macrophages, leading to a shift towards the expression of anti-inflammatory cytokine genes. Altogether, our data demonstrate that treatment with porcine CDNPs may be a new therapeutic option for the control of autoimmune-mediated inflammatory skin disorders.
This article is protected by copyright. All rights reserved.
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Transglutaminases in autoimmune and inherited skin diseases: The phenomena of epitope spreading and functional compensation
Abstract
Transglutaminases (TGs) are structurally and functionally related enzymes that modify the posttranslational structure and activity of proteins or peptides, and thus are able to turn on or switch off their function. Depending on location and activities, TGs are able to modify the signaling, the function and the fate of cells and extracellular connective tissues. Beside mouse models also human diseases enable us to appreciate the function of various TGs. In this paper skin diseases induced by genetic damages or autoimmune targeting of these enzymes will be discussed. TG1, TG3 and TG5 contribute to the cutaneous barrier and thus to the integrity and function of epidermis. TGM1 mutations relate to autosomal recessive ichthyosis subtypes, TGM5 mutations to a mild epidermolysis bullosa phenotype and as novelty TGM 3 mutation to uncombable hair syndrome will be discussed. Autoimmunity to TG2, TG3 and TG6 may develop in a few of those genetically determined individuals who lost tolerance to gluten, and manifest as celiac disease, dermatitis herpetiformis or gluten-dependent neurological symptoms, respectively. These gluten responder diseases commonly occur in combination. In autoimmune diseases the epitope spreading is remarkable, while in some inherited pathologies a unique compensation of the lost enzyme function is noted.
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The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: A randomised controlled study
Abstract
Background
Scratching and itch are common clinical signs of atopic dermatitis (AD). Studies of adult patients have shown that a decrease in scratching behaviour results in regression of inflammation and improved healing of the skin.
Objectives
This study aimed to investigate whether a modified habit reversal treatment (HR) protocol could be used for the treatment of scratching in children to improve skin status.
Methods
The study is a single-blind, randomised controlled trial of 39 patients who started with registration a week before randomisation into one of two groups (intervention, control). The participants in the intervention group received a habit-breaking therapy of their scratching behaviour (i.e. HR) in addition to a potent steroid (mometasone furoate), whereas the patients in the control group received the steroid alone. The patients were assessed by an independent dermatologist after the first week of registration (baseline assessment) and then after three and eight weeks post-treatment. The primary efficacy variable was a change in objective SCORAD (SCORing Atopic Dermatitis).
Results
At the end of the three-week treatment period, the change in mean objective SCORAD was significantly (p=0.027) higher in the intervention group -31.9 (SD 9.5) compared with the control group -23.8 (SD 10.1). After the eight-week follow-up, the change in mean objective SCORAD was significantly (p=0.0038) higher in the intervention group -31.7 (SD 10.4) than in the control group -19.7 (SD 9.4).
Conclusions
The treatment of scratching with the HR method in combination with a potent steroid was found to significantly improve skin status after 3 and 11 weeks.
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EAACI Guidelines on Allergen Immunotherapy: Allergic Rhinoconjunctivitis
Abstract
Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology and it may have a disease modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergy Immunotherapy". It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass-tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children.
This article is protected by copyright. All rights reserved.
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