Abscess with osteomyelitis of the clivus after adenoidectomy: An uncommon complication of a common procedure

Publication date: Available online 26 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Moreddu, C. Le Treut, J.-M. Triglia, R. Nicollas




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P275 Refractory hypereosinophilia manifesting as nodular sclerosis classical hodgkin lymphoma—a case presentation

The differential of hypereosinophilia is broad and includes atopy, infection, malignancy, and in rare cases of exclusion, hypereosinophilic syndrome (HES). Thorough evaluation is necessary to elucidate the cause and prevent sequelae of hypereosinophilia.

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P283 Pneumococcal osteomyelitis: a rare diagnosis suggestive of immune deficiency

Despite routine immunization with pneumococcal conjugate vaccines, Streptococcus pneumoniae is still a significant cause of bacteremia, pneumonia and meningitis. Osteoarticular pneumococcal infections are very rare, accounting for less than 5% of all invasive pneumococcal diseases (IPD).

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P282 Recurrent candidal esophagitis in an otherwise healthy host

Candida Albicans is a yeast that naturally colonizes the skin and mucosa. Chronic Mucocutaneous Candidiasis Syndrome (CMCS) presents with recurrent superficial candida infection, and is associated with other clinical manifestations such as autoimmunity or bacterial infections. Chronic Mucocutaneous Candidaisis Disease (CMCD) is a new entity in which patients present solely with superficial candidiasis. Here we present an interesting case of CMCD.

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P337 Remission of cow’s milk allergy during rituximab therapy: a case report

Food allergy has no known treatment. However, novel therapies are being studied in the hope of promoting tolerance. This case report describes the remission of food allergy during rituximab therapy.

http://ift.tt/2zaon8d

P222 Effects of immunoglobulin e concentration, eosinophil concentration, and atopy status on benralizumab efficacy in asthma

We investigated the efficacy of the anti-eosinophilic monoclonal antibody benralizumab for patients with severe, uncontrolled asthma by high versus low serum IgE concentrations and atopy status.

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OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module

Drug rash eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe hypersensitivity reaction. Due to challenges in case identification, DRESS epidemiology remains poorly characterized in the US. We used the electronic health record (EHR) allergy module to identify and describe DRESS syndrome cases in an integrated US healthcare system.

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P280 Severe combined immunodeficiency in cartilage hair hypoplasia

Cartilage Hair Hypoplasia (CHH) is associated with immune deficiency, which is a leading cause of mortality in these patients. Newborn screening (NBS) utilizing T-cell receptor excision circles (TRECs) is critical for early diagnosis of severe combined immunodeficiency (SCID), enabling prompt treatment and decreased morbidity/mortality.

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OR002 Testing strategies for immediate and delayed reactions to cephalosporins

Similar to penicillin allergy up to 8% of the general population are labeled as cephalosporin allergic; however, specific and validated testing strategies to manage immediate and delayed cephalosporin hypersensitivities are not well defined.

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P206 Effect of inhaled corticosteroid use on weight (BMI) in moderate to severe asthmatic pediatric patients

The effect of inhaled corticosteroids (ICS) on weight (BMI) in moderate to severe asthmatic pediatric patients has not been established. Obesity has been shown to decrease response to ICS as well as increase the risk of worse asthma symptoms.

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OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals

Intramuscular epinephrine is the primary treatment for anaphylaxis. Delays in administration of epinephrine have been associated with increased mortality in anaphylaxis. Despite numerous publications regarding this topic, interdisciplinary recognition, primary treatment and epinephrine administration route choices remain inconsistent. We hypothesize that a multidisciplinary quality improvement project is required to address common misconceptions in order to facilitate the preparedness to recognize and treat anaphylaxis appropriately.

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P296 Hypogammaglobulinemia in a patient with Turner’s Syndrome (TS) and celiac disease

Turner's syndrome (TS), a rare chromosomal disorder that affects females, is characterized by loss of one of the X chromosomes. This case report demonstrates a patient with TS who has hypogammaglobulinemia and celiac disease.

http://ift.tt/2iBRhHc

OR004 Safe and effective implementation of chemotherapy outpatient desensitizations

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasing as cancer rates are rising. Desensitization protocols allow patients to receive first-line therapy despite HSRs, but are often performed in the inpatient setting for close monitoring by trained personnel and to mitigate risk. We aimed to evaluate a safe and effective strategy for performing desensitizations in the outpatient setting, with a focus on decreasing delays in medication administration, patient inconvenience, and overall treatment time.

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P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma

Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort.

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OR005 A penicillin skin testing initiative in an outpatient allergy practice

The penicillin allergy label has significant clinical implications and there is renewed interest in penicillin allergy de-labeling. We identified the clinical characteristics of all penicillin-allergic patients presenting to an outpatient allergy practice, and offered all qualifying patients penicillin skin testing (PST).

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P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA)

Mepolizumab has been used as an adjuvant therapy for refractory EGPA. We report biopsy confirmed EGPA using conventional doses of Mepolizumab for induction treatment.

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OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)

We designed a written plan called Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporate validated pictograms with written instructions. Using a patient-centered approach, we aimed to assess the impact of the Kids' CAP on anaphylaxis recognition and treatment and to determine its perceived usefulness.

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P345 New onset concurrent eosinophilic gastritis in patients with eosinophilic esophagitis: a case series

Eosinophilic Esophagitis (EoE) is thought to be a disease limited to the esophagus.

http://ift.tt/2iCY4ka

OR101 Outcomes of patients with aspirin-exacerbated respiratory disease on omalizumab

The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. However, some patients are unable to undergo or fail desensitization, and treatment with omalizumab is an option although efficacy data is scarce.

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P329 Utility and safety of the intermittent oral immunotherapy, step-up method, for severe food allergy patients

Although Oral Immunotherapy (OIT) is a hopeful treatment for severe food allergy patients, its usefulness and safeness is still unclear. We evaluated the utility and safety of our intermittent OIT protocol, Step-up method.

http://ift.tt/2iCY3N8

OR011 Safety of multi-dose immunotherapy vials after routine use

Recent proposed changes to US Pharmaceutical General Chapter <797> (USP <797>) have prompted discussion regarding the safety of multi-dose immunotherapy extract vials after routine use. We present evidence to support the argument that currently accepted aseptic protocols for handling and administration of multi-dose immunotherapy extract maintenance vials during routine patient care does not result in risk of microbial growth and that changes as suggested by the proposed USP <797> guidelines are not needed.

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A solitary reddish nodule on the lower leg

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The association of HLA B*15:02 allele and Stevens–Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population

Abstract

Background

The presence of HLA-B*15:02 allele is considered a risk factor for development of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in patients taking aromatic anticonvulsant drugs like carbamazepine and phenytoin. The genetic association is ethnicity specific. Testing for HLA-B*15:02 allele is suggested as a prerequisite before starting carbamazepine in certain ethnic groups. There are only a few/no studies from south India on HLA association of SJS/TEN.

Aims

To identify any association between HLA-B*15:02 allele and SJS/TEN induced by carbamazepine/phenytoin among native population.

Methods (including settings, design, and statistical analysis used)

A case–control study done in a tertiary care center at Kottayam in Kerala state of south India. Cases were 12 native patients who developed SJS/TEN owing to aromatic anticonvulsant drugs (phenytoin – 8; carbamazepine – 4), and controls were 11 persons tolerant to these drugs from unrelated families of the same ethnic group. HLA-B typing was done by PCR SSP method.

Results

There was only one HLA-B*15:02 carrier among cases and controls. He/she had SJS/TEN induced by carbamazepine.

Conclusions

Association of HLA-B*15:02 with phenytoin-induced SJS/TEN is rare in the population studied. The one limitation of the study was the small sample size.

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Lichen planus pigmentosus and its variants: review and update

Abstract

Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger. LPP along Blaschko's lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.

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Exacerbation of Darier disease by peg-interferon beta-1a in a patient suffering from multiple sclerosis

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Clinical and radiological improvement in idiopathic calcinosis cutis with topical 25% sodium metabisulfite

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Bullous eruption in a patient with B-cell chronic lymphocytic leukemia: a diagnostic challenge

http://ift.tt/2i9m9ej

Dermoscopy in vitiligo: diagnosis and beyond

Abstract

Background

Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity.

Aim

To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity.

Methods

Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings.

Results

Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo.

Conclusion

Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.

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The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study

Summary

Background

Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia.

Aims

The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients.

Methods

The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed.

Results

Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation.

Conclusions

This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.

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Exogenous pigmentation of skin and nail caused by a millipede in a patient with plantar psoriasis

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Adipose Triglyceride Lipase Gene Polymorphisms is Not Associated with Free Fatty Acid Levels in Chinese Han Population

Metabolic Syndrome and Related Disorders Nov 2017, Vol. 15, No. 9: 474-479.


http://ift.tt/2y77prr

Forced expiratory values in 1 second corresponding to Pediatric Respiratory Assessment Measure and Acute Asthma Intensity Research Score values during pediatric acute asthma exacerbations

Acute asthma exacerbations are one of the most frequent reasons for emergency department (ED) visits and hospitalizations. Expert panel guidelines recommend measurement of percent-predicted forced expiratory volume in 1 second (FEV1) or peak expiratory flow for exacerbation severity assessment and treatment decision making.1 These guidelines categorize exacerbation severity according to percent-predicted FEV1 as mild to moderate (FEV1 ≥40%) and severe (FEV1 <40%), but acute care facilities that treat pediatric exacerbations generally do not have the equipment or personnel for such measures of lung function.

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Paternal gonadal mosaicism as cause of a puzzling inheritance pattern of activated PI3-kinase delta syndrome

Birth defects caused by de novo chromosomal abnormalities resulting in single-gene defects occur in approximately 5% of all live births.1 Affected offspring have a broad range of illnesses, including primary immunodeficiency diseases, a genetically heterogeneous group of disorders presenting with a clinical spectrum of mild to severe infections, often complicated by autoimmunity and malignancies.2 Most primary immunodeficiency diseases are monogenic diseases with a Mendelian inheritance pattern.

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Bee moth (Galleria mellonella) allergy

We present a case of bee moth (Galleria mellonella) allergy with new clinical and immunologic features. While taking part in trout fishing games during the past year, a 34-year-old amateur fisherman with no personal history of allergic diseases experienced several attacks of rhinoconjunctivitis and late asthmatic reactions. Symptoms of rhinoconjunctivitis began when starting to fish and persisted during the day. This was followed by mild wheezing and dyspnea during the following night. Symptoms worsened during the most recent fishing excursion, and mild breathing difficulty tends to last until the night of the next day.

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Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma

Asthma is one of the most prevalent chronic conditions in children, affecting 8.4% of American children and adolescents (approximately 6.2 million) in 2015.1 Although previous studies have found that poor asthma control is associated with impaired physical, psychological, and social aspects of health-related quality of life (HRQoL),2 some studies have suggested that impaired psychological aspects of HRQoL (ie, anxiety and depressive symptoms) cause poor asthma control.3 The effects of impaired HRQoL domains (eg, fatigue, pain, mobility, and peer relationships) in addition to anxiety and depressive symptoms on subsequent asthma outcomes in pediatric populations have been inadequately studied.

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Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.

http://ift.tt/2zIa4nu

Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.

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Clinicopathologic features of 28 cases of nail matrix nevi (NMNs) in Asians: Comparison between children and adults

Clinical distinction between nail matrix nevus (NMN) and subungual melanoma (SUM) can be challenging. More precise delineation of the clinicodermoscopic characteristics specific for NMNs is needed.

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Prevalence and clinicopathologic characteristics of multiple myeloma with cutaneous involvement: A case series from Korea

Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of a clonal proliferation of tumor cells. Cutaneous involvement of MM is very rare and remains poorly understood.

http://ift.tt/2zT2V4W

Comorbidities in rosacea: A systematic review and update

Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.

http://ift.tt/2zT2YOa

Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center

Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder.

http://ift.tt/2xpClhT

Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations

Langerhans cell histiocytosis (LCH) is a disorder of myeloid neoplasia of dendritic cells that affects 1 in 200,000 children <15 years of age and even fewer adults. LCH presents with a spectrum of clinical manifestations. High-risk stratification is reserved for infiltration of blood, spleen, liver, and lungs. After decades of debate on the disease pathogenesis, a neoplastic mechanism is now favored on the basis of LCH cell clonality, rare cases of familial clustering, and recent evidence of mutations involving the Ras/Raf/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinase) pathway in lesional biopsy specimens.

http://ift.tt/2xs0DrA

Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

Abstract

Background

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide–eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars.

Methods

One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed.

Results

At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure.

Conclusions

The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement.

Trial registration

ChiCTR-TRC-14004938. Registered 13 July 2014.

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Dermatology Guideline Authors Take Big Payments From Industry

Dermatology clinical practice guideline authors often receive large payments from industry and don't always fully disclose them, researchers report.
Reuters Health Information

http://ift.tt/2i8j6Dm

Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire

Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect a...

http://ift.tt/2gNg7Dw

Human immunodeficiency virus infection acquired through a traditional healer’s ritual: a case report

Globally, over 36 million people were infected with human immunodeficiency virus by the end of 2015. The Sub-Saharan African region home to less than one-fifth of the global population disproportionately harbo...

http://ift.tt/2i76Xyo

RItA: The Italian severe/uncontrolled asthma registry

Abstract

Background

The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care.

Methods

493 adult patients from 27 Italian centres (recruited in 2011-2014) were analyzed.

Results

Mean age was 53.8yrs. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40yrs); the mean age for asthma symptoms onset was 30.2yrs and for asthma diagnosis 34.4yrs. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, 16.0% oral corticosteroids.

Mean FEV₁% pred of 75.1%, median values of 300/mm³ of blood eosinophil count, 323 kU/l of serum total IgE, 24 ppb of FENO were shown.

Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), allergic conjunctivitis (30.2%).

55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, 7.3% hospitalizations.

Factors associated with exacerbation risk were: obesity (OR, 95%CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30 - borderline), nasal polyps (1.86, 0.88-3.89 - borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67 - borderline), anti-IgE use in a protective way (0.26, 0.12-0.53).

Comparisons to severe asthma multicentre studies and available registries showed data consistency across European and American populations.

Conclusions

An international effort in the implementation of SUA patients registries could help to better understand the clinical features and to manage severe asthma, representing a non negligible socio-economic burden for health services.

This article is protected by copyright. All rights reserved.

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Cockroach is a major cross-reactive allergen source in shrimp-sensitized rural children in southern China

Abstract

Background

Little is known about the prevalence of food allergy (FA) in China.

Objective

To investigate the prevalence of FA and its disparity between urban and rural areas in southern China.

Methods

Europrevall questionnaire responses were obtained from 5,542 school-age-children in urban Guangzhou and 5,319 in rural Shaoguan. A case-control study enrolled 190 children with adverse reactions (ARs) after food intake as cases, and 212 controls in Guangzhou; 116 cases and 233 controls in Shaoguan. These subjects underwent skin-prick test (SPT) and serum IgE measurements to food and inhalant allergens. Allergen extracts from shrimp, house dust mite (HDM), and cockroach were prepared for IgE cross-relativity testing in 23 Guangzhou and 20 Shaoguan shrimp-sensitized subjects.

Results

The prevalence of ARs to shrimp was higher in Guangzhou than Shaoguan children (3.5% vs. 1.4%, p<0.001). However, sensitization rate to shrimp (SPT: 3.7% vs. 11.2%, p=0.015; IgE: 12.6% vs. 36.2%, p<0.001) and cockroach (SPT: 5.3% vs. 33.5%; IgE: 2.6% vs. 27.6%, p<0.001) were lower in Guangzhou. A significant correlation between shrimp and HDM/cockroach IgE was found in Shaoguan children. The proportions of positive IgE to tropomyosin (Pen a 1, Der p 10) were lower than 7.4% in both areas. Cockroach allergen has a significantly higher inhibition rate of binding to IgE to house-dust-mite allergens in Shaoguan sera.

Conclusions

Shrimp is a common allergic food in southern China. Higher proportion of shrimp sensitization in rural subjects could be explained by cross-reactive to cockroach. Tropomyosin was not a major allergen responding for the cross-reactivity.

This article is protected by copyright. All rights reserved.

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Legionnaires' Effect on Smell

Condition:   Legionnaires' Disease
Intervention:   Other: The University of Pennsylvania Smell Identification Test (UPSIT)
Sponsor:   University of Pennsylvania
Recruiting

http://ift.tt/2izL7Yf

Adjuvant Pembrolizumab for Patients With Locally Advanced Esophageal Squamous Cell Carcinoma at High Risk of Recurrence

Condition:   Esophageal Squamous Cell Carcinoma
Intervention:   Drug: Pembrolizumab
Sponsors:   National Taiwan University Hospital;   Merck Sharp & Dohme Corp.
Not yet recruiting

http://ift.tt/2zayUQE

Perioperative Tonsillectomy Protocol Development

Condition:   Tonsillitis
Interventions:   Drug: Acetaminophen and High-Dose Dexamethasone;   Drug: Acetaminophen and Low-dose Dexamethasone;   Drug: Placebo and Low-dose Dexamethasone
Sponsor:   London Health Sciences Centre
Not yet recruiting

http://ift.tt/2iDCtYF

Phase I/II Trial of Epacadostat, Intralesional SD101, Radiotherapy in Patients With Lymphoma

Conditions:   Advanced Solid Tumors;   Lymphoma
Interventions:   Drug: epacadostat;   Drug: SD-101;   Radiation: Radiotherapy
Sponsor:   University of California, Davis
Not yet recruiting

http://ift.tt/2z80qOJ

EPR Tumor Oximetry With CE India Ink

Conditions:   Neoplasms, Malignant;   Breast Neoplasm;   Carcinoma, Basal Cell;   Carcinoma, Squamous Cell;   Melanoma;   Skin Neoplasm;   Head and Neck Neoplasms
Interventions:   Device: Carlo Erba Ink Injection;   Other: EPR Oximetry Measurement
Sponsors:   Harold M. Swartz;   National Cancer Institute (NCI)
Recruiting

http://ift.tt/2iDCkV7

Effect of Post-operative Ibuprofen After Surgery for Chronic Rhinosinusitis

Condition:   Chronic Rhinosinusitis (Diagnosis)
Interventions:   Drug: Ibuprofen 400 mg;   Drug: Acetaminophen 650 mg;   Drug: OxyCODONE 5 Mg Oral Tablet
Sponsor:   University of Washington
Recruiting

http://ift.tt/2iBDwIs

Multidisciplinary Clinic Management of Head and Neck Cancer

This cohort study evaluates a single-day, single-appointment, multidisciplinary head and neck clinic model for reduction in treatment delay and comprehensiveness of cancer care.

http://ift.tt/2iBOiP2

Reconstruction—The Final Dimension in Head and Neck Surgery

This Special Communication of the 2017 Hayes Martin Lecture discusses the state of the art and future directions in reconstructive head and neck surgery.

http://ift.tt/2z9b7R4

Outcomes After Transoral Robotic Surgery for Oropharyngeal Cancer

This study compares functional speech, swallowing, and quality-of-life outcomes between patients with oropharangeal cancer who underwent transoral robotic surgery onlyand those who underwent transoral robotic surgery and received adjuvant radiotherapy or chemoradiotherapy.

http://ift.tt/2iBOca8

Aggressive-Appearing Pediatric Parotid Mass

A young boy had an enlarging right facial mass; a computed tomographic scan showed a discrete necrotic mass in the right parotid gland, and fine-needle aspirate yielded a cellular sample with spindloid features. What is your diagnosis?

http://ift.tt/2za2INp

Perineural and Angiolymphatic Invasion in Oropharyngeal Carcinoma

This study examines the prevalence and prognostic significance of perineural invasion and angiolymphatic invasion in human papillomavirus–positive oropharyngeal squamous cell carcinoma.

http://ift.tt/2iDBcRn

Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire

Abstract

Background

Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect against HPV-related head and neck cancer (HNC) in addition to HPV-related cervical and anogenital disease. While the association between HPV infection and cervical cancer is widely understood, its relation to HNC is less well known. The purpose of this study was to better understand HPV counseling practices for infection and vaccination in relation to HNC of primary care physicians (PCPs), Obstetricians/Gynecologists (OBGYNs), and Otolaryngology - Head and Neck Surgeons (OHNSs) in Canada.

Methods

A Canada-wide electronic questionnaire regarding counseling practices on HPV infection, transmission, and vaccination was designed and distributed to PCPs, OBGYNs, and OHNSs across Canada through electronic and paper-based methods. Basic Descriptive statistics were used to analyze responses.

Results

In total, 337 physicians responded (239 family physicians, 51 OHNSs, 30 OBGYNs, and 17 pediatricians). Three out of four PCPs reported routine counseling of their patients regarding HPV infection, transmission, and vaccination. Among this group, 68% reported "never" or "rarely" counseling patients that HPV can cause HNC. The most commonly reported reason that PCPs cited for not counseling was a lack of knowledge. The majority of OHNSs (81%) and OBGYNs (97%) counseled patients regarding HPV infection, transmission, and vaccination. However, very few OHNSs (10%) regularly counseled patients with HPV-related HNC about HPV-related anogenital cancer. Similarly, very few OBGYNs (18%) regularly counseled patients with HPV related cervical/anogenital cancer about HPV related HNC.

Conclusions

The rate of counseling on HPV infection, transmission, and vaccination in relation to HNC among PCPs is low. The most common reason is a lack of knowledge. Specialists rarely counsel patients with confirmed HPV-related cancer about other HPV-related malignancies. More research is needed on the relationship between different HPV-related cancers in order to better inform counseling practices.

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Intranodal Palisaded Myofibroblastoma in a Submandibular Lymph Node

Intranodal palisaded myofibroblastoma (IPM), also known as "intranodal hemorrhagic spindle cell tumor with amianthoid fibers," is a rare benign mesenchymal tumor originating from smooth muscle cells and myofibroblasts, often with the presence of amianthoid fibers. Usually IPM affects inguinal lymph nodes, but three cases have been described in the submandibular and cervical lymph nodes. We report a new case of a 44-year-old women with submandibular mass. Cervical ultrasound showed a suspect right submandibular adenomegaly. The patient underwent an excision of the submandibular mass. Histological features of the tumor include an encapsulated fusocellular proliferation, with nuclear palisading, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. In the light of these results, we made the diagnosis of IPM. No recurrence was found 5 years after surgery.

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Körperdysmorphe Störung

Zusammenfassung

Menschen mit einer körperdysmorphen Störung (KDS) machen sich übermäßig Sorgen und beschäftigen sich exzessiv mit einer objektiv nichtexistenten – oder zumindest von anderen als unerheblicher Defekt angesehenen – Veränderung in ihrem Erscheinungsbild. Sie können vor ihren eigenen Augen nicht bestehen, fühlen sich hässlich, sind überzeugt, dass ihre Nase, ihr Körperbau, ihre Haut sie entstellen. Je mehr sie sich mit ihrem Aussehen beschäftigen, umso mehr richtet sich der Blick auf die scheinbaren Schönheitsmakel und verfestigt sich der Eindruck der eigenen Unattraktivität. Die Betroffenen empfinden sich nicht als krank; vielmehr sind sie überzeugt, dass es ein körperlicher Makel ist, der sie immer wieder vor den Spiegel zwingt. Solche Patienten suchen einen Hautarzt auf, manche auch einen plastischen Chirurgen, um ihrem Schönheitsideal näherzukommen – dieses bleibt aber für die Patienten aufgrund ihrer verzerrten Körperwahrnehmung unerreichbar.

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Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars—A randomized controlled trial

Summary

Background

Microneedling with dermaroller and glycolic acid peels is commonly used for treatment of acne scars.

Objective

To compare efficacy of microneedling alone versus combination of microneedling with serial 70% glycolic acid peel in management of atrophic acne scars.

Methods & Materials

Sixty patients with atrophic acne scars were randomized into group 1 receiving microneedling at 0, 6, and 12 weeks and group 2 receiving microneedling at 0, 6, and 12 weeks along with 70% glycolic acid peel at 3, 9, and 15 weeks. Acne scar scoring was performed by a blinded observer using ECCA (Echelle d'evaluation clinique des cicatrices d'acne) scoring at baseline and after 22 weeks. Additionally, patients were asked to grade the improvement in acne scars and skin texture on visual analogue scale (VAS).

Results

Of 60 patients, 52 completed the 22-week study period. The decrement from baseline in mean ECCA score was more in group 2 as compared to group 1 (39.65±2.50 vs 29.58±0.18; P<.001). Group 2 also showed more improvement in skin texture as compared to group 1 on VAS.

Conclusion

Addition of sequential 70% glycolic acid peel to microneedling gives better scar improvement as compared to microneedling alone. In addition to this, it also improves skin texture.

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Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

Objective: To report a case of recurrent vitreous hemorrhage from an optic nerve retinal arterial macroaneurysm (ONRAM) successfully treated with intraoperative endolaser. Patient and Methods: A 92-year-old woman on oral aspirin and warfarin anticoagulation for atrial fibrillation developed three episodes of dense vitreous hemorrhage from an ONRAM. Due to failure of the vitreous hemorrhage to clear spontaneously, a total of three pars plana vitrectomy (PPV) procedures were performed along with a 1.25-mg intravitreal bevacizumab injection after the third episode of hemorrhage. During the third PPV procedure, a 25-gauge 532-nm green diode laser endoprobe was used to deliver low-power (100 mW) and long-duration (500 ms) laser spots directly on the ONRAM to induce intraoperative shrinkage of the ONRAM. Results: After the endolaser treatment, the macroaneurysm showed involution due to fibrosis without any adverse effects on retinal circulation or visual field defect. No recurrence of vitreous hemorrhage was noted after 2 years of follow-up. Conclusion: Oral anticoagulant use may have been responsible for the atypical clinical course in our patient. Laser photocoagulation, including intraoperative endolaser photocoagulation, may be considered in selected cases of symptomatic ONRAMs.
Case Rep Ophthalmol 2017;8:503–509

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Diagnostic and Therapeutic Approach in a Case of Severe Post-Traumatic Hyphema with Subtotal Iridodialysis

Purpose: To report our diagnostic ultrasound-based approach and surgical strategy in a case of severe blunt trauma with complete hyphema, 270° iris disinsertion, and traumatic subluxated cataract. Case Report: A 70-year-old male was referred to our hospital for a blunt trauma in his right eye. A complete examination revealed visual acuity consisting in light perception, a complete hyphema, and an intraocular pressure of 45 mm Hg with moderate pain. Our diagnostic approached was ultrasound based with B-scan examination showing some vitreous hemorrhage and ultrasound biomicroscopy showing a large iris disinsertion of 270° with the iris entirely dislocated in the inferior sector of the anterior chamber. The patient was hospitalized and a systemic and topical treatment was started to lower intraocular pressure. Our surgery consisted in a single-step approach with removal of traumatic cataract with scleral fixation of an intraocular lens and iridoplasty. Conclusion: In our patient, the single-step surgery, supported by anterior and posterior ultrasound imaging, achieved a satisfactory anatomical and functional outcome.
Case Rep Ophthalmol 2017;8:496–502

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Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report

Background: Chronic retinal necrosis (CRN) is a rare chronic granular necrotizing retinitis that was first described in 2013. CRN is characterized by intraocular inflammation accompanied by occlusive vasculitis, granular retinitis, and slowly progressing necrosis around the retina in a host with partial immune dysfunction. Cytomegalovirus (CMV) is reported to be a causative agent. There are several ocular complications such as retinal detachment and neovascular glaucoma; however, there has been no description of a clinical manifestation of neovascular glaucoma in CRN. We herein present a case of severe neovascular glaucoma in association with CRN. Case Presentation: An 80-year-old man was referred to our hospital with poor control of inflammation and intraocular pressure (IOP). The IOP in his left eye was 29 mm Hg. Anterior chamber cells (2+) and keratic precipitates were observed. In the peripheral retina, vitreous opacities and granular necrotizing retinitis were noticed. Fluorescein angiography revealed extensive retinal nonperfusion area from the macula lesion to the periphery. PCR analysis of aqueous humor showed the presence of CMV. A diagnosis of CRN was made soon afterwards. Antiviral drug and systemic corticosteroid were administered. The treatment temporally resolved the symptom; however, panretinal photocoagulation and intravitreal injection of bevacizumab were performed to treat iris neovascularization. During the follow-up, trabeculectomy was performed because of poor IOP control. At the final visit, severe uncontrolled neovascular glaucoma caused hyphema, and his left eye lost light perception. Conclusion: The prognosis of CRN is poor because of severe neovascular glaucoma and careful observation and active treatments are necessary.
Case Rep Ophthalmol 2017;8:489–495

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Secukinumab-induzierter subakut-kutaner Lupus erythematodes

Zusammenfassung

Wir berichten über eine 52-jährige Patientin, die unter der Therapie mit Secukinumab einen medikamenteninduzierten subakut kutanen Lupus erythematodes („drug induced lupus erythematodes" [SC-DILE]) entwickelte. Unter einer lokalen Therapie mit einem Steroid der Klasse 3 zeigte sich innerhalb von 4 Wochen eine wesentliche Besserung. Die Systemtherapie wurde auf Ustekinumab umgestellt. DILE („drug induced lupus erythematodes") ist eine seltene, aber zu bedenkende Nebenwirkung unter Biologikatherapie bei 0,5–1 % aller Patienten, die auch bei IL(Interleukin)-17-Blockade auftreten kann. Eine Umstellung der Biologikatherapie ist in den meisten Fällen notwendig.

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Juvenile pityriasis rubra pilaris: successful treatment with methotrexate

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Keeping an Open Mind: Cognitive Bias in the Evaluation of an Infant with Posterior-Lateral Rib Fractures

A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma.

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HLA-Cw6 and psoriasis

Abstract

Psoriasis is a multifactorial disease with a strong genetic background. HLA-Cw6 is one of the most strongly associated psoriasis susceptibility allele. It is repeatedly observed to affect disease course, phenotypic features, severity, comorbidities, and treatment outcomes. To the best of our knowledge, the roles of HLA-Cw6 in psoriasis have not yet been thoroughly reviewed. The worldwide frequency of HLA-Cw6 allele varies greatly, with HLA-Cw6 allele frequency being generally higher in Caucasians compared to Asians. The allele is associated with Type I early onset psoriasis. Stress, obesity, and streptococcal pharyngitis are commonly observed in HLA-Cw6 positive patients. Phenotypically, HLA-Cw6 is found to be associated with guttate psoriasis in some studies. In addition, patients carrying the allele are more likely to have arm, leg, trunk involvement, and Koebner's phenomenon. Psoriatic arthritis patients with HLA-Cw6 more often have early onset and tend to show cutaneous symptoms before musculoskeletal symptoms. HLA-Cw6 positive patients have been shown to be more responsive to methotrexate and ustekinumab in several studies. However, this difference in ustekinumab efficacy was only moderate in a post hoc analysis of phase III pivotal study. HLA-Cw6 positivity also tends to be less frequent in high-need patients who failed conventional therapy. Small studies have also investigated the role of HLA-Cw6 in remission of psoriasis during pregnancy, photosensitivity and atherosclerosis as comorbidity of psoriasis. Given the diverse nature of psoriasis pathogenesis, as well as the difference of HLA-Cw6 positivity in different ethnic groups, more studies are needed to confirm the role of HLA-Cw6 in psoriasis.

This article is protected by copyright. All rights reserved.

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The role of the microbiome in psoriasis: moving from disease description to treatment prediction?

Abstract

With several million microbes per cm² of skin, the task of mapping the physiological cutaneous microbiome is enormous. Indeed, the reliance on bacterial culture to identify cutaneous bacterial communities has led to a systematic under-appreciation of cutaneous microbial diversity, potentially limiting our understanding of common inflammatory skin diseases including psoriasis.

However, based heavily on developments in molecular biology and bioinformatics, including next generation sequencing, the last decade has witnessed a marked increase in our understanding of the extent and composition of the cutaneous microbiome. It is already clear that skin-specific (skin site and skin microenvironment), individual-specific (hygiene, sex, age, and hormonal status), disease-specific (atopic eczema, acne) and genetic factors can all influence the cutaneous microbiome, albeit to varying and, as yet ill-defined, extents. This review briefly describes the process of 16S ribosomal RNA sequencing, before charting our current understanding of the cutaneous microbiome in health and the alterations (dysbiosis) associated with chronic inflammatory diseases with particular reference to psoriasis. The possibility and clinical relevance of intra-individual cross-talk between the various microbiomes is discussed and potential mechanisms underpinning the interactions between resident skin flora and the immune system are highlighted. We outline how the power of microbiome studies can be harnessed to provide new insights into disease pathogenesis and treatment selection. Ultimately, in the age of personalized medicine, the integration of cutaneous microbiome signatures and comprehensive disease and drug response endotypes will herald a novel approach in the clinical management of chronic, multi-system inflammatory diseases.

This article is protected by copyright. All rights reserved.

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Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis

BACKGROUND:Death and anoxic brain injury from unrecognized postoperative respiratory depression (PORD) is a serious concern for patient safety. The American Patient Safety Foundation has called for continuous electronic monitoring for all patients receiving opioids in the postoperative period. These recommendations are based largely on consensus opinion with currently limited evidence. The objective of this study is to review the current state of knowledge on the effectiveness of continuous pulse oximetry (CPOX) versus routine nursing care and the effectiveness of continuous capnography monitoring with or without pulse oximetry for detecting PORD and preventing postoperative adverse events in the surgical ward. METHODS:We performed a systematic search of the literature databases published between 1946 and May 2017. We selected the studies that included the following: (1) adult surgical patients (>18 years old); (2) prescribed opioids during the postoperative period; (3) monitored with CPOX and/or capnography; (4) primary outcome measures were oxygen desaturation, bradypnea, hypercarbia, rescue team activation, intensive care unit (ICU) admission, or mortality; and (5) studies published in the English language. Meta-analysis was performed using Cochrane Review Manager 5.3. RESULTS:In total, 9 studies (4 examining CPOX and 5 examining continuous capnography) were included in this systematic review. In the literature on CPOX, 1 randomized controlled trial showed no difference in ICU transfers (6.7% vs 8.5%; P = .33) or mortality (2.3% vs 2.2%). A prospective historical controlled trial demonstrated a significant reduction in ICU transfers (5.6–1.2 per 1000 patient days; P = .01) and rescue team activation (3.4–1.2 per 1000 patient days; P = .02) when CPOX was used. Overall, comparing the CPOX group versus the standard monitoring group, there was 34% risk reduction in ICU transfer (P = .06) and odds of recognizing desaturation (oxygen saturation [SpO2] 1 hour) was 15 times higher (P

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Perioperative Patient Blood Management to Improve Outcomes

Anemia is common in elective surgery and is an independent risk factor for morbidity and mortality. Historical management of anemia has focused on the use of allogeneic blood transfusion but this in itself is not without risk. It too has been independently associated with morbidity and mortality, let alone the costs and relative shortage of this resource. In recognition of this, patient blood management (PBM) shifts the focus from the product to the patient and views the patient's own blood as a resource that should be conserved and managed appropriately as a standard of care. It consists of 3 pillars: the optimization of red blood cell mass; reduction of blood loss and bleeding; and optimization of the patient's physiological tolerance toward anemia. Integration of these 3 pillars in the form of multimodal care bundles and strategies into perioperative pathways should improve care processes and patient outcome. Preoperative anemia is most commonly caused by functional iron deficiency and should be treated with oral iron, intravenous iron, and/or recombinant erythropoietin. An individualized assessment of the thrombotic risk of discontinuing anticoagulant and antiplatelet medication should be balanced against the risk of perioperative bleeding. Neuraxial anesthetic techniques should be considered and minimally invasive surgery undertaken where appropriate. Cell salvage should be used if significant blood loss is anticipated and pharmacological treatments such as tranexamic acid and fibrin sealants have been shown to reduce blood loss. Point of care tests can guide the perioperative management of dynamic coagulopathy. Blood testing sampling should be performed only when indicated and when taken, sample volume and waste should be minimized. Restrictive blood transfusion thresholds and reassessment after single unit transfusion should be incorporated into clinical practice where appropriate. For PBM to become standard practice in routine surgical care, national health care quality change initiatives must set the agenda for change but the patient-centered approach to PBM should be delivered in a way that is also hospital centered. Characterization of the current practice of PBM at each hospital is crucial to facilitate the benchmarking of performance. Barriers to effective implementation such as lack of knowledge should be identified and acted on. Continuous audit of practice with a focus on transfusion rates and patient outcomes can identify areas in need of improvement and provide iterative feedback to motivate and inspire the main stakeholders. Accepted for publication September 8, 2017. The authors declare no conflicts of interest. Funding: None. Reprints will not be available from the authors. Address correspondence to Neel Desai, FRCA, Department of Anaesthetics, Royal Free Hospital, Pond St, London, NW3 2QG, London, United Kingdom. Address e-mail to neel_d83@hotmail.com. © 2017 International Anesthesia Research Society

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Incidence of Anaphylaxis Associated With Sugammadex

We retrospectively investigated the incidence of potential sugammadex-induced anaphylaxis at a single center in Japan over a period of 3 years. The overall incidence of intraoperative hypersensitivity reaction was 0.22% (95% confidence interval [CI], 0.17%–0.29%), and the incidence of anaphylaxis was 0.059% (95% CI, 0.032%–0.10%). The total number of patients who received sugammadex during the study period was 15,479, and the incidence of anaphylaxis associated with sugammadex was 0.039% (n = 6; 95% CI, 0.014%–0.084%). This result implies that the incidence of sugammadex-associated anaphylaxis could be as high as that for succinylcholine or rocuronium. A prospective study, including testing for identification of cause, is necessary to confirm the exact incidence of sugammadex-induced anaphylaxis; however, the present finding calls attention to this potential. Accepted for publication September 12, 2017. Funding: This work was funded by the Department of Anesthesiology, Jikei University School of Medicine. The authors declare no conflicts of interest. The findings of this study were presented in part at the Annual Meeting of the Japanese Society of Anesthesiologists in Fukuoka, Japan, May 27, 2016, and the Annual Meeting of the American Society of Anesthesiologists in Chicago, IL, October 22, 2016. Reprints will not be available from the authors. Address correspondence to Hiroshi Sunaga, MD, Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minatoku, Tokyo 105-8461, Japan. Address e-mail to hs-031@jikei.ac.jp. © 2017 International Anesthesia Research Society

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Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II Adductor Canal Nerve Block—A Systematic Review and Meta-analysis

BACKGROUND:Adductor canal block (ACB) has emerged as an effective analgesic regional technique for major knee surgeries in the last decade. Its motor-sparing properties make it particularly attractive for ambulatory knee surgery, but evidence supporting its use in ambulatory arthroscopic knee surgery is conflicting. This systematic review and meta-analysis evaluates the analgesic effects of ACB for ambulatory arthroscopic knee surgeries. METHODS:We conducted a comprehensive search of electronic databases for randomized controlled trials examining the analgesic effects of ACB compared to control or any other analgesic modality. Both minor arthroscopic and anterior cruciate ligament reconstruction (ACLR) surgeries were considered. Rest and dynamic pain scores, opioid consumption, opioid-related adverse effects, time to first analgesic request, patient satisfaction, quadriceps strength, and block-related complications were evaluated. Data were pooled using random-effects modeling. RESULTS:Our search yielded 10 randomized controlled trials comparing ACB with placebo or femoral nerve block (FNB); these were subgrouped according to the type of knee surgery. For minor knee arthroscopic surgery, ACB provided reduced postoperative resting pain scores by a mean difference (95% confidence interval) of −1.46 cm (−2.03 to −0.90) (P

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No Significant Association Between the Transfusion of Small Volumes of Leukocyte-Depleted Red Blood Cells and Mortality Over 7 Years of Follow-up in Patients Undergoing Cardiac Surgery: A Propensity Score Matched Analysis

BACKGROUND:The impact of red blood cell (RBC) transfusion on long-term clinical outcome is controversial. METHODS:We prospectively recorded follow-up data of 6124 cardiac surgical patients who received no transfusion (RBC− group) or 1–2 units of leukocyte-depleted RBC (RBC+ group) at our institution. The primary end point was overall mortality up to 7 years after cardiac surgery; secondary end point was coronary artery revascularization during follow-up. To correct for nonrandomized group assignment, propensity score (PS) matching was performed. A subgroup analysis was also performed in patients with preoperative anemia. RESULTS:PS matching was possible in 4118 patients. During a mean follow-up of 4.05 years (range, 0.0–7.3 years), 140 patients (14.6%) died in the RBC− group and 173 (17.2%) died in the RBC+ group. The hazard ratio for the RBC+ group versus the RBC− group was 1.00 (95% confidence interval, 0.79–1.25; P = .969). The number of revascularizations was 96 (9.9%) and 125 (10.6%), respectively, with a hazard ratio of 1.21 (95% confidence interval, 0.92–1.58; P = .166) for the RBC+ group. Preoperative anemia was not a risk factor for postoperative mortality, even when patients were transfused. CONCLUSIONS:This PS-matched analysis does not provide evidence for an association of the transfusion of small volumes of leukocyte-depleted RBCs with an increased postoperative mortality in cardiac surgical patients. Moreover, preoperative anemia could not be identified as a risk factor for increased postoperative mortality. Accepted for publication September 6, 2017. Funding: This work was supported by the Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University of Bochum, Germany. The authors declare no conflicts of interest. The first two authors contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Armin Zittermann, PhD, Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University of Bochum, Georgstr 11, D-32545 Bad Oeynhausen, Germany. Address e-mail to azittermann@hdz-nrw.de. © 2017 International Anesthesia Research Society

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Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study

Abstract

Introduction

Plaque psoriasis is a chronic skin disease where genital involvement is relatively common. Yet health care providers do not routinely evaluate psoriasis patients for genital involvement and patients do not readily initiate discussion of it.

Methods

A qualitative study of 20 US patients with dermatologist-confirmed genital psoriasis (GenPs) and self-reported moderate-to-severe GenPs at screening was conducted to identify key GenPs symptoms and their impacts on health-related quality of life (HRQoL).

Results

Patients had a mean age of 45 years, 55% were female, and patients had high rates of current/recent moderate-to-severe overall (65%) and genital (70%) psoriasis. Patients reported the following GenPs symptoms: genital itch (100%), discomfort (100%), redness (95%), stinging/burning (95%), pain (85%), and scaling (75%). Genital itching (40%) and stinging/burning (40%) were the most bothersome symptoms. Impacts on sexual health included impaired sexual experience during sexual activity (80%), worsening of symptoms after sexual activity (80%), decreased frequency of sexual activity (80%), avoidance of sexual relationships (75%), and reduced sexual desire (55%). Negative effects on sexual experience encompassed physical effects such as mechanical friction, cracking, and pain as well as psychosocial effects such as embarrassment and feeling stigmatized. Males reported a higher burden of symptoms and sexual impacts. Other HRQoL impacts were on mood/emotion (95%), physical activities (70%), daily activities (60%), and relationships with friends and family (45%). These impacts significantly affected daily activities. Physical activities were affected by symptoms and flares, and increased sweat and friction worsened symptoms. Patients reported daily practices to control outcomes.

Conclusion

The high level of reported symptoms and sexual and nonsexual impacts reflects the potential burden of moderate-to-severe GenPs. GenPs can impact many facets of HRQoL and providers should evaluate their patients for the presence of genital psoriasis and its impact on their quality of life.

Funding

Eli Lilly and Company.

http://ift.tt/2izzwZb