Aquagenic pruritus in polycythemia vera: a cross-sectional study

http://ift.tt/2gX7ZwX

Cutaneous dermatomyositis disease course followed over time using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI)

Limited studies describe the longitudinal course of cutaneous dermatomyositis (DM).

http://ift.tt/2zs3KR0

SELF-HEALING JUVENILE CUTANEOUS MUCINOSIS: Clinical and histopathologic findings of nine cases: the relevance of long-term follow-up

Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder and the pathogenesis and long-term prognosis are unknown.

http://ift.tt/2gX8183

The Art of Being in Two Rooms at One Time: Ethical Issues with Overlapping Surgery

http://ift.tt/2zrauyw

Effect of secukinumab on quality of life and psoriasis-related symptoms: a comparative analysis versus ustekinumab from the CLEAR 52-week study

Secukinumab has demonstrated greater sustained skin clearance versus ustekinumab through Week 52, greater improvement in symptoms and health-related quality of life (HRQOL), and comparable safety profile.

http://ift.tt/2z0Bp84

The spectrum of manifestations in DSP (desmoplakin) SR6 domain mutations: immunophenotyping and response to ustekinumab

The immune abnormalities underlying the ichthyoses are poorly understood.

http://ift.tt/2gX84Rh

Increased proportion of a CD38highIgD+ B cell subset in peripheral blood is associated with clinical and immunological features in patients with primary Sjögren's syndrome

Publication date: Available online 20 October 2017
Source:Clinical Immunology
Author(s): Eriko Ishioka-Takei, Keiko Yoshimoto, Katsuya Suzuki, Ayumi Nishikawa, Hidekata Yasuoka, Kunihiro Yamaoka, Tsutomu Takeuchi
We investigated the correlation between the increased proportion of peripheral B cell subsets and clinical and immunological features in primary Sjögren's syndrome (pSS). We found that the proportion of CD19⁺ B cells was significantly increased in pSS as compared with HC and was correlated with serum IgG levels. Moreover, in vitro IgG production by CD19⁺ B cells was significantly increased in pSS and was positively and significantly correlated with serum IgG levels. FACS analysis revealed that the proportions of peripherally CD38^highIgD⁺ B cells and CD38^highIgD⁻ B cells were significantly increased in pSS. In addition, the proportion of CD38^highIgD⁺ B cells positively correlated with ESSDAI scores and serum levels of IgG, anti-Ro/SSA and anti-La/SSB antibodies while that of CD38^highIgD⁻ B cells showed no correlation with these parameters. Our data suggest that increased proportion of CD38^highIgD⁺ B cells in pSS is involved in IgG overproduction including autoantibodies, and correlates with disease progression.



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Transoral robotic surgery-based therapy in patients with stage III-IV oropharyngeal squamous cell carcinoma

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Young Min Park, Hye Ryun Kim, Byoung Chul Cho, Ki Chang Keum, Nam Hoon Cho, Se-Heon Kim
ObjectiveTORS-based therapy including chemotherapy or RTx was administered to patients with stage III-IV OPSCC. We analyzed the oncological and functional outcomes of stage III-IV OPSCC patients who underwent TORS-based therapy.Materials and methodsBetween May 2008 and May 2016, 80 patients participated in this clinical trial.ResultsA negative margin was identified in 66 patients (82.5%) and a positive margin in 14 (17.5%). TNM stages were III in 13 patients (16.3%) and IV in 67 patients (83.8%). Of the patients, 13 received surgery alone, 28 had adjuvant RTx and 39 had adjuvant CCRTx. At last follow-up, 67 patients had no evidence of disease, seven were alive with disease, and six had died. Local recurrence developed in 2 patients and regional recurrence in 10. Five-year overall survival was 88.8%, disease-specific survival was 89.9%, and recurrence-free survival was 78.3%. The 5-year disease-specific survival of OPSCC patients with p16+ disease was 93.2%, which was higher than 89.0% of patients with p16− disease, but the difference was not statically significant. On multivariate analysis, only extranodal extension showed a significant relationship with recurrence-free survival on Cox regression analysis.ConclusionTORS-based therapy showed excellent oncological and functional outcomes for treatment of stage III-IV OPSCC. For advanced T stage OPSCC, clear margins were obtained using TORS-based therapy and patients with clear margins showed good local control. Risk stratification of patients based on pathological information obtained after surgery and decision about additional treatment based on the information helped improve OS and DSS of OPSCC patients.



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A Phase 2a Randomized Controlled Study to Evaluate the Pharmacokinetic, Safety, Tolerability, and Clinical Effect of Topically Applied Umeclidinium in Subjects with Primary Axillary Hyperhidrosis

Abstract

Background

Hyperhidrosis is a common medical condition which can have a significant impact on quality of life. Umeclidinium (UMEC) is a long acting muscarinic antagonist (LAMA) developed as a dermal formulation.

Objectives

This 2-week, double-blind, randomized, vehicle-controlled study evaluated systemic exposure, safety, and tolerability of topically administered UMEC in subjects with primary axillary hyperhidrosis. Clinical effect was a secondary objective, measured by gravimetry and the hyperhidrosis disease severity scale (HDSS). Vehicle was included to evaluate safety.

Methods

Twenty-three subjects were randomized to either 1.85% UMEC (N=18) or vehicle (N=5) once daily.

Results

Measurable plasma concentrations were observed in 78% of subjects after treatment. Nine subjects (50%) on UMEC and 2 subjects (40%) on vehicle reported AEs, most commonly application site reactions. At Day 15, 7 subjects (41%) in UMEC and 2 subjects (40%) in vehicle had at least a 50% reduction in sweat production. Eight subjects (47%) in UMEC and 1 subject (20%) in vehicle had at least a 2-point reduction in HDSS. No comparisons of treatment arms were planned prospectively.

Conclusions

The measurable exposure, acceptable safety, and preliminary clinical activity observed in this proof-of-concept study suggest the potential clinical utility of topical UMEC in subjects with axillary hyperhidrosis.

This article is protected by copyright. All rights reserved.

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The implementation of knowledge dissemination in the prevention of occupational skin diseases

Abstract

Background

Occupational skin diseases (OSD) have a high medical, social, economic and political impact. Knowledge dissemination from research activities to key stakeholders involved in health care is a prerequisite to make prevention effective.

Objectives

To study and prioritize different activity fields and stakeholders that are involved in the prevention of OSD, to reflect on their inter-relationships, to develop a strategic approach for knowledge dissemination and to develop a hands-on tool for OSD prevention projects

Methods

Seven different activity fields that are relevant in the prevention of OSD have been stepwise identified. This was followed by an impact analysis. Fifty-five international OSD experts rated the impact and the influence of the activity fields for the prevention of OSD with a standardized questionnaire.

Results

Activity fields identified to have a high impact in OSD prevention are the political system, mass media and industry. The political system has a strong but more indirect effect on the general population via the educational system, local public health services or the industry. The educational system, mass media, industry and local public health services have a strong direct impact on the OSD "at risk" worker. Finally, a hands-on tool for future OSD prevention projects has been developed that addresses knowledge dissemination and different stakeholder needs.

Conclusion

Systematic knowledge dissemination is important to make OSD prevention more effective and to close the gap between research and practice. This paper provides guidance to identify stakeholders, strategies and dissemination channels for systematic knowledge dissemination which need to be adapted to country-specific structures, for example the social security system and health care systems. A key for successful knowledge dissemination is building linkages among different stakeholders, building strategic partnerships and gaining their support right from the inception phase of a project.

This article is protected by copyright. All rights reserved.

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Reflectance confocal microscopy identification of subclinical basal cell carcinomas during and after vismodegib treatment

Abstract

Background

Recently, it has been shown that reflectance confocal microscopy (RCM) could identify subclinical basal cell carcinoma (BCC) during vismodegib treatment of locally-advanced BCC.

Objectives

To evaluate specificity and sensitivity of clinical, dermoscopic and RCM examination for BCC in patients with multiple BCCs treated by vismodegib.

Methods

94 BCCs had 710 clinical, dermoscopic and RCM examinations during 72 weeks of vismodegib treatment. 38 were biopsied at the end of the treatment. Sensitivity and specificity for these 38 lesions were calculated. BCC diagnoses of clinical, dermoscopic and RCM examination on all the 710 investigations were compared using Chi- 2 test.

Results

RCM was extremely more sensitive than dermoscopy and clinical examination and slightly less specific (sensitivity of 95%, 35% and 33% and specificity of 81%, 88% and 86% for RCM, dermoscopy and clinical examination, respectively) for the identification of residual BCC in the 38 biopsied cases. Considering all the 710 observations, RCM correctly diagnosed more BCCs than dermoscopy and clinical examination.

Conclusion

RCM is a non-invasive technique that can detect subclinical residual BCC during and after vismodegib treatment helping the clinician to identify incomplete tumor regression.

This article is protected by copyright. All rights reserved.

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Defining the actinic keratosis field: a literature review and discussion

Abstract

Background

Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking.

Objectives

The objective of this review is to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological, and clinical characteristics.

Methods

Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms.

Results

A total of 32 review articles and 47 original research articles provided evidence of sun-induced molecular (including genetic and immunological), and histological skin changes in the sun-exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as 'reliable or very reliable' indicators of AK field based on expert opinion, whereas 'sand paper' was deemed a 'moderately reliable' indicator.

Conclusion

This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion.

This article is protected by copyright. All rights reserved.

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Increased prevalence of diabetes mellitus in bullous pemphigoid patients during the last decade

Abstract

Bullous pemphigoid (BP) is a rare autoimmune blistering disease. The association between BP and diabetes mellitus (DM) has been previously reported with inconsistent results^1-4. Dipeptidyl peptidase (DPP)-IV inhibitors, approved in Europe by EMA in 2007 to treat type-2 DM, are antihyperglycemic drugs that could induce BP disease^5-9.

This article is protected by copyright. All rights reserved.

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Development of tripe palms and soles in a patient with long pre-existing systemic mastocytosis and newly developed non-small cell lung cancer

Abstract

A 71-year old woman with systemic mastocytosis presented to our department with an apoplectic insult one year ago and a 100 pack year smoking history. Skin manifestation of mastocytosis had started at the age of 50 years accompanied by a substantial increase of serum tryptase since the age of 60. Bone marrow involvement was confirmed 16 years later. Therapy of mastocytosis included antihistamines, montelukast, sodium cromoglycate, and PUVA therapy, all with limited success.

This article is protected by copyright. All rights reserved.

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Apremilast for the treatment of moderate to severe palmoplantar psoriasis: results from a double-blind, placebo-controlled, randomized study

Abstract

Background

Palmoplantar psoriasis is a variant of psoriasis vulgaris which can severely impair quality of life.

Objectives

The main objectives of this double-blind, placebo-controlled, randomized study were to assess the efficacy and impact on quality of life and work productivity of apremilast for the treatment of moderate to severe palmoplantar psoriasis.

Methods

A total of 100 patients with moderate to severe palmoplantar psoriasis were randomized to either apremilast 30mg bid or placebo for 16 weeks. At Week 16, all patients received apremilast 30mg bid until Week 32. The primary endpoint was the proportion of patients who achieved a Palmoplantar Psoriasis Physician Global Assessment (PPPGA) of 0/1 at Week 16.

Results

There was no significant difference in the proportion of patients who achieved a PPPGA of 0/1 at Week 16 between patients randomized to apremilast (14%) and placebo (4%; p=0.1595). After 32 weeks of treatment with apremilast, 24% of patients achieved a PPGA of 0/1. In addition, apremilast was superior to placebo in achieving Palmoplantar Psoriasis Area Severity Index (PPPASI) 75 (apremilast: 22%; placebo: 8%; p=0.0499), in improving PPPASI (apremilast: -7.4±7.1; placebo: -3.6±5.9; p=0.0167), Dermatology Life Quality Index score (apremilast: -4.3±5.1; placebo: -0.8±4.5; p=0.0004), and in reducing activity impairment (apremilast: -11.0±22.3; placebo: 2.5±25.5; p=0.0063).

Conclusion

Despite the absence of a significant difference between apremilast and placebo in proportion of patients achieving a PPPGA of 0/1, the presence of significant differences observed for several secondary endpoints suggest that apremilast may have a role in the treatment of moderate to severe palmoplantar psoriasis.

This article is protected by copyright. All rights reserved.

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Treatment of prurigo with methotrexate: a multicenter retrospective study of 39 cases Running head: Treatment of prurigo with methotrexate

Abstract

Background

Prurigo is a common primary pruritic condition. Treatment is challenging. Methotrexate (MTX) is effective for the treatment of pruriginous dermatoses, but its use in prurigo has been little studied.

Objectives

To investigate the efficacy and safety of MTX in the treatment of difficult-to-treat prurigo.

Methods

Patients from six university dermatology departments treated with MTX between 2006 and 2016 for difficult-to-treat prurigo (i.e. with failure to conventional therapies) were included in this retrospective multicenter study. Patients with other pruritic dermatoses were excluded. Clinical efficacy was recorded after 3, 6, and 12 months of treatment: 1/ subjective efficacy, i.e. evaluation of the pruritus by the patient and 2/ objective efficacy, i.e. assessment of cutaneous lesions by the physician: complete or almost complete remission (CR) (healing of lesions), partial remission (PR) (incomplete improvement of lesions), or failure (no improvement or worsening). The overall response rate (ORR) included CR and PR.

Results

Thirty-nine patients with previous failure of topical steroids, H1-antihistamine drugs, or phototherapy were included. The median weekly dose of MTX was 15 mg (range 5-25 mg). The median follow-up was 16 months (2-108). The mean time between onset of MTX and objective efficacy was 2.4 +/- 1.2 months and the mean duration of response was 19 +/- 15 months. The ORR was 91% at three months (n=36, CI95% [81.2%-100.8%], CR 44%), 94% at six months (n=32, CI95% [85.7%-102.2%], CR 56%), and 89% at 12 months (n=28, CI95% [77.4%-100.6%], CR 57%). Seven patients stopped MTX because of failure, and five because of the discovery of hepatocarcinoma (n=1), elevated transaminases (n=1), infectious pneumonitis (n=1), or gastrointestinal symptoms (n=2).

Conclusion

MTX is a therapeutic option in difficult-to-treat prurigo.

This article is protected by copyright. All rights reserved.

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Gram-negative bacterial toe web infection – a systematic review

Abstract

Gram-negative bacterial toe web infection (GNBTWI) is a frequent therapeutic challenge in clinical practice with high recurrence rates and frequent need of systemic drugs.

The aim of this systematic review was to provide an updated overview and evidence-based data on pathogens, risk-factors and treatment of GNBTWI along with promoting a consistent international terminology.

This systematic review is based on a search in PubMed database for English and German articles published between 1980 and 2016. A total of 7 articles were considered appropriate for inclusion in this review regarding to treatment and outcome.

Throughout the medical literature, a variety of terms for bacterial toe web infections is used. Only few data on the incidence of GNBTWI were published. GNBTWI has been shown to have a significant male predominance. Pseudomonas aeruginosa is the most commonly identified organism beside a high mixed infection rate. We identified the following predisposing factors: interdigital tinea, occlusion and humidity, history of self-medication with antifungals, antibiotics, and glucocorticosteroids. As for treatment, debridement of macerated skin lesions and the hyperkeratotic rim showed good response in three published cases. Bacteriological workup of swabs including an antibiogram is recommended for identification of the proper topical and systemic therapy. Autosensitization dermatitis and frequent recurrences are common complications of GNBTWI.

Despite the fact, that GNBTWI is an accepted disease entity, scarce data on GNBTWI exist in the medical literature. Randomized controlled trials are missing though needed for evidence-based therapy. To facilitate communication and exchange of updates of GNBTWI, we promote the suggested terminology for bacterial toe web diseases.

This article is protected by copyright. All rights reserved.

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Reply to “Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts”

Absract

I read with great interest a preliminary study on new treatment for common warts conducted by Kolk et al.¹ The authors studied, for the first time, the clinical response of common warts to topical application of a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on the patients' lower back. Basically, topical therapy for a common dermatosis is generally welcomed particularly if showed a higher degree of safety profile and less potential off-target adverse effects. Though promising, few queries should be addressed by the authors.

This article is protected by copyright. All rights reserved.

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Sedation After Cardiac Surgery With Propofol or Dexmedetomidine: Between Scylla and Charybdis?

No abstract available

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Descriptive Statistics: Reporting the Answers to the 5 Basic Questions of Who, What, Why, When, Where, and a Sixth, So What?

Descriptive statistics are specific methods basically used to calculate, describe, and summarize collected research data in a logical, meaningful, and efficient way. Descriptive statistics are reported numerically in the manuscript text and/or in its tables, or graphically in its figures. This basic statistical tutorial discusses a series of fundamental concepts about descriptive statistics and their reporting. The mean, median, and mode are 3 measures of the center or central tendency of a set of data. In addition to a measure of its central tendency (mean, median, or mode), another important characteristic of a research data set is its variability or dispersion (ie, spread). In simplest terms, variability is how much the individual recorded scores or observed values differ from one another. The range, standard deviation, and interquartile range are 3 measures of variability or dispersion. The standard deviation is typically reported for a mean, and the interquartile range for a median. Testing for statistical significance, along with calculating the observed treatment effect (or the strength of the association between an exposure and an outcome), and generating a corresponding confidence interval are 3 tools commonly used by researchers (and their collaborating biostatistician or epidemiologist) to validly make inferences and more generalized conclusions from their collected data and descriptive statistics. A number of journals, including Anesthesia & Analgesia, strongly encourage or require the reporting of pertinent confidence intervals. A confidence interval can be calculated for virtually any variable or outcome measure in an experimental, quasi-experimental, or observational research study design. Generally speaking, in a clinical trial, the confidence interval is the range of values within which the true treatment effect in the population likely resides. In an observational study, the confidence interval is the range of values within which the true strength of the association between the exposure and the outcome (eg, the risk ratio or odds ratio) in the population likely resides. There are many possible ways to graphically display or illustrate different types of data. While there is often latitude as to the choice of format, ultimately, the simplest and most comprehensible format is preferred. Common examples include a histogram, bar chart, line chart or line graph, pie chart, scatterplot, and box-and-whisker plot. Valid and reliable descriptive statistics can answer basic yet important questions about a research data set, namely: "Who, What, Why, When, Where, How, How Much?"

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“Houston, We Have a Problem!”: The Role of the Anesthesiologist in the Current Opioid Epidemic

No abstract available

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Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that postsurgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical- and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use after surgery and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery and proceed with an analysis of the extent to which opioid-sparing perioperative interventions (eg, nerve blockade) have been shown to reduce the risk of chronic opioid use after surgery. We then conclude with a discussion of future research directions.

http://ift.tt/2gyBKar

The Opioid Crisis in the United States: Chronic Pain Physicians Are the Answer, Not the Cause

No abstract available

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Neurosurgical Intensive Care

No abstract available

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Do Not Resuscitate and the Surgical Patient: Not a Contradiction in Terms

No abstract available

http://ift.tt/2ywbHYF

Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions

An overreliance on opioids has impacted all types of pain management, making it undoubtedly a root cause of the "epidemic" of prescription opioid abuse in the United States. Yet, an examination of the statistics that led the US Centers for Disease Control and Prevention to declare that prescription opioid abuse had reached epidemic levels shows that the abuse occurrences and deaths are arising outside the hospital or hospice setting, which strongly implicates the outpatient use of opioids to treat chronic pain. Such abuse and related deaths are occurring in chronic pain patients themselves and also through diversion. Overprescribing to outpatients has afforded distressed and vulnerable individuals access to these highly addictive drugs. The focus of this article is on what we have learned since opioid treatment of chronic pain was first popularized at the end of the 20th century and how this new information can guide chronic pain management in the future.

http://ift.tt/2yHv948

Venovenous Bypass Associated With Acute Kidney Injury Prevention in Liver Transplantation: An Ode to the Retrospective Data Researcher

No abstract available

http://ift.tt/2gyrRtm

Reducing Mortality in Acute Kidney Injury

No abstract available

http://ift.tt/2gyBsjR

The Perioperative Surgical Home Is Not Just a Name

No abstract available

http://ift.tt/2yxgOYy

A Limitation of Intensive Care Unit Sedation Using Volatile Anesthetics

No abstract available

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Tracking Speckles: Overcoming Conventions to Evaluate Right Ventricular Function

No abstract available

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Women and Leadership in Anesthesiology: Can We “Lean In” Further?

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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An Evidence-Based Approach to the Prescription Opioid Epidemic in Orthopedic Surgery

Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level. The main components of our program include (1) guidelines for managing patients who are opioid tolerant and/or have a substance abuse disorder; (2) education programs for patients, emphasizing the role of opioids in recovery after elective orthopedic surgery; (3) education programs for prescribers of controlled substances, including clinical and regulatory aspects; (4) the development of surgery-specific prescribing recommendations for opioid-naive patients; and (5) mechanisms to modify prescribing habits to limit unnecessary prescribing of controlled substances.

http://ift.tt/2gznm1V

High-Sensitivity Cardiac Troponin T Improves the Diagnosis of Perioperative MI

BACKGROUND: BACKGROUND:The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperative MI. METHODS: METHODS:In this ancillary study of the Vitamins in Nitrous Oxide trial, readjudicated incidence rates of myocardial injury (new isolated cTn elevation) and MI were compared when diagnosed by contemporary cTnI versus hscTnT. We probed various relative (eg, >50%) or absolute (eg, +5 ng/L) hscTnT change metrics. Inclusion criteria for this ancillary study were the presence of a baseline and at least 1 postoperative hscTnT value. RESULTS: RESULTS:Among 605 patients, 70 patients (12%) had electrocardiogram changes consistent with myocardial ischemia; 82 patients (14%) had myocardial injury diagnosed by contemporary cTnI, 31 (5.1%) of which had an adjudicated MI. After readjudication, 67 patients (11%) were diagnosed with MI when using hscTnT, a 2-fold increase. Incidence rates of postoperative myocardial injury ranged from 12% (n = 73) to 65% (n = 393) depending on the hscTnT metric used. Incidence rates of MI using various hscTnT change metrics and the presence of ischemic electrocardiogram changes, but without event adjudication, ranged from 3.6% (n = 22) to 12% (n = 74), a >3-fold difference. New postoperative hscTnT elevation, either by absolute or relative hscTnT change metric, was associated with an up to 5-fold increase in 6-month mortality. CONCLUSIONS: CONCLUSIONS:The use of hscTnT compared to contemporary cTnI increases the detection rate of perioperative MI by a factor of 2. Using different absolute or relative hscTnT change metrics may lead to under- or overdiagnosis of perioperative MI.

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Outcomes of pediatric delayed facial palsy after head trauma

To analyze clinical outcomes of delayed facial palsy after head trauma in the pediatric population.

http://ift.tt/2xbeUsx

Use of oral antidepressants in patients with chronic pruritus: A systematic review

Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new treatment options such as oral antidepressants.

http://ift.tt/2gtOVWM

Progressive reticulate skin pigmentation and anonychia in a patient with bone marrow failure

An 18-year-old man presented to the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland, with dyspigmentation and nail dystrophy. His birth history was notable for intrauterine growth restriction (IUGR) and microcephaly. He was hospitalized at 6 weeks of age for respiratory distress and was found to have severe anemia, dilated cardiomyopathy, and cerebellar atrophy (Fig 1). At age 1 year he developed oral leukoplakia and esophageal strictures requiring multiple dilations. By age 3 he developed thrombocytopenia that progressed to multilineage bone marrow failure (BMF).

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Obesity and risk for incident rosacea in US women

The relationship between obesity and rosacea is poorly understood.

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Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

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Traumatic subungual neuroma

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Death by Gun Violence-A Public Health Crisis.

Death by Gun Violence-A Public Health Crisis.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 09;:

Authors: Bauchner H, Rivara FP, Bonow RO, Bressler NM, Disis MLN, Heckers S, Josephson SA, Kibbe MR, Piccirillo JF, Redberg RF, Rhee JS, Robinson JK

PMID: 29052718 [PubMed - as supplied by publisher]

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Preservation of Stem Cells in Androgenetic Alopecia

Abstract

Androgenetic alopecia is characterized by progressive, patterned hair loss from the scalp that occurs in both men and women. Suggested that genetically predisposed hair follicles are target for androgen-stimulated follicle miniaturization, with gradual replacement of terminal hairs by vellus hairs. We aimed at evaluating the expression of stem and progenitor cell markers using IHC in scalp biopsies from affected and unaffected areas of patients with AGA.

This article is protected by copyright. All rights reserved.

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Molecular Targets for Pain Management: More Than Just Mu

No abstract available

http://ift.tt/2hUlmxG

Basic/Translational Development of Forthcoming Opioid- and Nonopioid-Targeted Pain Therapeutics

Opioids represent an efficacious therapeutic modality for some, but not all pain states. Singular reliance on opioid therapy for pain management has limitations, and abuse potential has deleterious consequences for patient and society. Our understanding of pain biology has yielded insights and opportunities for alternatives to conventional opioid agonists. The aim is to have efficacious therapies, with acceptable side effect profiles and minimal abuse potential, which is to say an absence of reinforcing activity in the absence of a pain state. The present work provides a nonexclusive overview of current drug targets and potential future directions of research and development. We discuss channel activators and blockers, including sodium channel blockers, potassium channel activators, and calcium channel blockers; glutamate receptor–targeted agents, including N-methyl-D-aspartate, α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, and metabotropic receptors. Furthermore, we discuss therapeutics targeted at γ-aminobutyric acid, α2-adrenergic, and opioid receptors. We also considered antagonists of angiotensin 2 and Toll receptors and agonists/antagonists of adenosine, purine receptors, and cannabinoids. Novel targets considered are those focusing on lipid mediators and anti-inflammatory cytokines. Of interest is development of novel targeting strategies, which produce long-term alterations in pain signaling, including viral transfection and toxins. We consider issues in the development of druggable molecules, including preclinical screening. While there are examples of successful translation, mechanistically promising preclinical candidates may unexpectedly fail during clinical trials because the preclinical models may not recapitulate the particular human pain condition being addressed. Molecular target characterization can diminish the disconnect between preclinical and humans' targets, which should assist in developing nonaddictive analgesics.

http://ift.tt/2xcQajW

Unraveling the Mystery of THC: Cannabinoids and Neuropathic Pain

No abstract available

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Selective Cannabinoids for Chronic Neuropathic Pain: A Systematic Review and Meta-analysis

BACKGROUND: BACKGROUND:There is a lack of consensus on the role of selective cannabinoids for the treatment of neuropathic pain (NP). Guidelines from national and international pain societies have provided contradictory recommendations. The primary objective of this systematic review and meta-analysis (SR-MA) was to determine the analgesic efficacy and safety of selective cannabinoids compared to conventional management or placebo for chronic NP. METHODS: METHODS:We reviewed randomized controlled trials that compared selective cannabinoids (dronabinol, nabilone, nabiximols) with conventional treatments (eg, pharmacotherapy, physical therapy, or a combination of these) or placebo in patients with chronic NP because patients with NP may be on any of these therapies or none if all standard treatments have failed to provide analgesia and or if these treatments have been associated with adverse effects. MEDLINE, EMBASE, and other major databases up to March 11, 2016, were searched. Data on scores of numerical rating scale for NP and its subtypes, central and peripheral, were meta-analyzed. The certainty of evidence was classified using the Grade of Recommendations Assessment, Development, and Evaluation approach. RESULTS: RESULTS:Eleven randomized controlled trials including 1219 patients (614 in selective cannabinoid and 605 in comparator groups) were included in this SR-MA. There was variability in the studies in quality of reporting, etiology of NP, type and dose of selective cannabinoids. Patients who received selective cannabinoids reported a significant, but clinically small, reduction in mean numerical rating scale pain scores (0–10 scale) compared with comparator groups (−0.65 points; 95% confidence interval, −1.06 to −0.23 points; P = .002, I2 = 60%; Grade of Recommendations Assessment, Development, and Evaluation: weak recommendation and moderate-quality evidence). Use of selective cannabinoids was also associated with improvements in quality of life and sleep with no major adverse effects. CONCLUSIONS: CONCLUSIONS:Selective cannabinoids provide a small analgesic benefit in patients with chronic NP. There was a high degree of heterogeneity among publications included in this SR-MA. Well-designed, large, randomized studies are required to better evaluate specific dosage, duration of intervention, and the effect of this intervention on physical and psychologic function.

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Themed Issue on the Opioid Epidemic: What Have We Learned? Where Do We Go From Here?

No abstract available

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