Bimatoprost ophthalmic solution in facial vitiligo

Summary

Background

Vitiligo is one of the commonest pigmentary disorders characterized by destruction of melanocytes.

Aim

To evaluate the efficacy of topical bimatoprost ophthalmic solution in stable facial vitiligo.

Material and methods

Eight cases of stable facial vitiligo were treated with bimatoprost 0.03% ophthalmic solution once daily for 12 weeks. Photographic records were taken at 2 weeks follow-up along with dermoscopic (Polarized, 10×) evaluation.

Results

Four cases had excellent repigmentation, two cases had partial repigmentation and two cases had poor response.

Conclusion

Bimatoprost seems to be promising in treating stable vitiligo but large-scale studies are required.

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Post operative palatal cleft with synechia of tonsillar pillar and uvula – Could vascular ischemia be the etiology?

Publication date: Available online 6 October 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Surendra B. Patil, Shree Harsh
Post operative cleft of palate is a known complication of palatal split surgery. We present a post operative case of nasopharyngeal angiofibroma who presented with nasal twang in voice. Examination revealed cleft of soft palate with fusion of left side of uvula with the left tonsillar pillar. He underwent reconstruction of the left tonsillar pillar, left side of uvula and pushback palatoplasty. The aim of this article is to bring this unusual complication of palatal split surgery and it's management.



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Unilateral Nasal Obstruction.

Unilateral Nasal Obstruction.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 05;:

Authors: Mikals SJ, McCuiston AM, Ramanathan M

PMID: 28983574 [PubMed - as supplied by publisher]

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Viral Diagnostics

Viral Immunology , Vol. 0, No. 0.


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A Possible Association Between Hearing Loss and Zika Virus Infections.

A Possible Association Between Hearing Loss and Zika Virus Infections.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 05;:

Authors: Mittal R, Fifer RC, Liu XZ

PMID: 28983567 [PubMed - as supplied by publisher]

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Zika Virus: Immune Evasion Mechanisms, Currently Available Therapeutic Regimens, and Vaccines

Viral Immunology , Vol. 0, No. 0.


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Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data: Negative Margin Rates and Neck Dissection Yield.

Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data: Negative Margin Rates and Neck Dissection Yield.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 05;:

Authors: Schoppy DW, Rhoads KF, Ma Y, Chen MM, Nussenbaum B, Orosco RK, Rosenthal EL, Divi V

Abstract
Importance: Negative margins and lymph node yields (LNY) of 18 or more from neck dissections in patients with head and neck squamous cell carcinomas (HNSCC) have been associated with improved patient survival. It is unclear whether these metrics can be used to identify hospitals with improved outcomes.
Objective: To determine whether 2 patient-level metrics would predict outcomes at the hospital level.
Design, Setting, and Participants: A retrospective review of records from the National Cancer Database (NCDB) was used to identify patients who underwent primary surgery and concurrent neck dissection for HNSCC between 2004 and 2013. The percentage of patients at each hospital with negative margins on primary resection and an LNY 18 or more from a neck dissection was quantified. Cox proportional hazard models were used to define the association between hospital performance on these metrics and overall survival.
Main Outcomes and Measures: Margin status and lymph node yield at hospital level. Overall survival (OS).
Results: We identified 1008 hospitals in the NCDB where 64 738 patients met inclusion criteria. Of the 64 738 participants, 45 170 (69.8%) were men and 19 568 (30.2%) were women. The mean SD age of included patients was 60.5 (12.0) years. Patients treated at hospitals attaining the combined metric of a 90% or higher negative margin rate and 80% or more of cases with LNYs of 18 or more experienced a significant reduction in mortality (hazard ratio [HR] 0.93; 95% CI, 0.89-0.98). This benefit in survival was independent of the patient-level improvement associated with negative margins (HR, 0.73; 95% CI, 0.71-0.76) and LNY of 18 or more (HR, 0.85; 95% CI, 0.83-0.88). Including these metrics in the model neutralized the association of traditional measures of hospital quality (volume and teaching status).
Conclusions and Relevance: Treatment at hospitals that attain a high rate of negative margins and LNY of 18 or more is associated with improved survival in patients undergoing surgery for HNSCC. These surgical outcome measures predicted outcomes independent of traditional, but generally nonmodifiable characteristics. Tracking of these metrics may help identify high-quality centers and provide guidance for institution-level quality improvement.

PMID: 28983555 [PubMed - as supplied by publisher]

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Hypothesis: RNA and DNA Viral Sequence Integration into the Mammalian Host Genome Supports Long-Term B Cell and T Cell Adaptive Immunity

Viral Immunology , Vol. 0, No. 0.


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Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay for Children With Special Health Care Needs.

Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay for Children With Special Health Care Needs.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 05;:

Authors: Appachi S, Banas A, Feinberg L, Henry D, Kenny D, Kraynack N, Rosneck A, Carl J, Krakovitz P

Abstract
Importance: Children with special health care needs (CSHCN) have disproportionate health care utilization. Previous studies have demonstrated that a primary medical home improves health care outcomes for this population.
Objective: To elucidate if enrollment in a multidisciplinary aerodigestive clinic improves outcomes and reduces health care costs by decreasing admissions and inpatient days.
Design, Setting, and Participants: A retrospective medical record review of 113 patients with aerodigestive disorders enrolled in a pediatric multidisciplinary clinic from June 2009 to December 2013 was performed. Of the 113 particpants, 58 (51.3%) were male, 59 (52.2%) had a tracheostomy, and 90 (80.5%) had a gastrostomy tube during their enrollment period. Patient ages at enrollment ranged from 0 to 20 years, with 59 (52.2%) ranging from 0 to 5 years, 23 (20.4%) ranging from 6 to 10 years, 18 (15.9%) ranging from 11 to 15 years, and 13 (11.5%) being 16 years or older.Admissions data before and after enrollment in a pediatric multidisciplinary clinic were examined.
Main Outcomes and Measures: The main outcomes studied were changes in admissions and inpatient days before and after enrollment. Financial data were also examined to determine the reduction in technical direct cost.
Results: The admissions data for 113 children were analyzed. No significant difference in number of admissions per year was seen with enrollment with a median difference of -0.30 admissions per year (range, -10.6 to 6.7 admissions per year; 95% CI, -3.5 to 2.9). However, there was a significant decrease seen in inpatient days per year following enrollment, with a median decrease of 4.1 inpatient days per year (range, -80 to 283.3 inpatient days per year; 95% CI, 0.33 to 91.0). When examining aerodigestive admissions alone, the median number of aerodigestive hospital days avoided per patient was 0.57 days per month, or 6.8 days per year, representing a 70% reduction in technical direct cost.
Conclusions and Relevance: These findings indicate that for children with special health care needs, enrollment in a multidisciplinary aerodigestive clinic may improve health care outcomes by decreasing technical direct cost by 70% and significantly decreasing patient hospital days by an estimated 1 week per year. Furthermore, coordinated aerodigestive care in a medical home setting may lower health care expenditures from a systems-based perspective.

PMID: 28983551 [PubMed - as supplied by publisher]

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Cognitive Dysfunction and Single Nucleotide Polymorphisms in Hepatitis C Virus-Infected Persons: A Systematic Review

Viral Immunology , Vol. 0, No. 0.


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Großes Missverständnis bei Pflichtarbeitszeit

Ärzte, die ihre Praxisnachfolge dadurch organisieren, dass sie ihren Arztsitz an ein MVZ abgeben, müssen seit 2016 dort mindestens drei Jahre als Angestellter weiterarbeiten. Dabei haben sie bei der Reduktion ihrer Arbeitszeit aber mehr Spielraum als gedacht.

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Rubella Seropositivity in Pregnant Women After Vaccination Campaign in Brazil's Federal District

Viral Immunology , Vol. 0, No. 0.


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Antibiotika: Weniger ist mehr!

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CRISPR-Cas Technology in Viral Therapeutics

Viral Immunology Oct 2017, Vol. 30, No. 8: 547-547.


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Haben Sie auch eine fachliche Frage?

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Enhanced Immune Response to Rabies Viruses by the Use of a Liposome Adjuvant in Vaccines

Viral Immunology , Vol. 0, No. 0.


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Rationale Antibiotikatherapie in der HNO-ärztlichen ambulanten Versorgung

Kaum ein anderes gesundheitspolitisches Thema wird derzeit so intensiv und auf höchster politischer Ebene diskutiert wie die Antibiotikaresistenzentwicklung und die Gefahren, die sich daraus ergeben. Welche Konsequenzen hat die fortschreitende Resistenzentwicklung für die tägliche Praxis und wie lässt sich eine rationale Antibiotikatherapie in der ambulanten Versorgung häufiger Infektionen im HNO-Bereich gestalten?

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Hepatitis C Virus-Associated Extrahepatic Manifestations in Lung and Heart and Antiviral Therapy-Related Cardiopulmonary Toxicity

Viral Immunology , Vol. 0, No. 0.


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A point mutation in the extracellular domain of CD4 completely abolishes CD4 T cell development in C57BL/6 mouse

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Huijie Wang, Saichao Li, Tianzhu Chao, Xugang Wang, Lijin Shi, Lichen Zhang, Yinming Liang, Qianqian Zheng, Liaoxun Lu
In this study, we performed ENU mutagenesis and multi-parameter flow cytometric analysis in C57BL/6 mice to uncover novel genes or alleles regulating immune cell development. We identified a novel mutant allele of Cd4 gene which completely blocked development of a major subset of T cells named CD4 T cell. Our data for the first time showed experimentally in mice the critical role of the first extracellular domain, by obtaining mice with a loss of function mutation from Ile to Asn at the position 99 of CD4 (I99N). Interestingly, such CD4^I99N mutant protein can be expressed on the surface of human cells, and the mRNA stability could be also affected by this point mutation, suggesting that absence of CD4 T cells in mice rooted in the deficiency in function and expression of CD4. In addition, we used this novel CD4 T cell deficient model as recipient mice for adoptive transfer experiment, and showed that it could be an optimal model for study of CD4 T cells.



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Was steckt hinter der Schwellung?

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Polymerase Chain Reaction-Based Detection Method Is Suitable for Dengue Infection During Epidemics

Viral Immunology , Vol. 0, No. 0.


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Gleichgewichtsstörungen im Überblick

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Fowl Aviadenovirus 9 dUTPase Plays a Role in Regulation of the Host Immune Response

Viral Immunology , Vol. 0, No. 0.


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Parotisläsionen: Feinnadelbiopsie weist der Therapie den Weg

Die Feinnadelaspirationsbiopsie kann in der Diagnostik von Läsionen der Glandula parotis weitaus nützlicher sein als oftmals angenommen.

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Dengue Virus and Its Relation to Human Glycoprotein IIb/IIIa Revealed by Fluorescence Microscopy and Flow Cytometry

Viral Immunology , Vol. 0, No. 0.


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Misshandeltes Kind: Was dem HNO-Arzt auffallen sollte

Ein Säugling mit Wunden im Rachenbereich, ein Schulkind mit Blutergüssen am Ohr, ein Kleinkind mit ständig wiederkehrender therapieresistenter blutiger Otorrhö: Werden dem HNO-Arzt solche Fälle vorgestellt, sollte er die Möglichkeit einer Kindesmisshandlung in Betracht ziehen.

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Whole Blood-Based Multiplex Immunoassays for the Evaluation of Human Biomarker Responses to Emerging Viruses in Resource-Limited Regions

Viral Immunology , Vol. 0, No. 0.


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Diese Regeln gelten für die Abdingung

Der dreieinhalbfache Satz ist nicht immer die Höchstgrenze für die Gebühren in der GOÄ. Ärzte dürfen für persönliche Leistungen durchaus eine höhere Vergütung mit dem Patienten vereinbaren. Für diese sogenannte Abdingung gelten allerdings besondere Spielregeln.

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Response to Joob and Wiwanitkit re: “Genetic Polymorphisms of Tumor Necrosis Factor Alpha and Susceptibility to Dengue Virus Infection in a Mexican Population”

Viral Immunology , Vol. 0, No. 0.


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Inhaltsverzeichnis

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Chapter 4 Chemical components and nutrition

Publication date: 2018
Source:Kent's Technology of Cereals
Author(s): Kurt A. Rosentrater, A.D. Evers




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Bienengift-SIT: individualisierte Präparateauswahl

Bienengift enthält eine Vielzahl von Majorallergenen. Das dürfte auch Auswirkungen auf die Präparateauswahl für die spezifische Immuntherapie haben. Eine Antikörperstudie untersuchte jetzt die Majorallergen-Zusammensetzung verschiedener SIT-Präparate.

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The Effect of a Pediatric Intensive Care Severity-Tiered Pathway for Status Asthmaticus on Quality Measures and Outcomes

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Extravasationsmukozele

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Influence of the Polymorphism C-509T in the TGFB1 Gene Promoter on the Response to Montelukast

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Editorial Board/ Publication Information

Publication date: October 2017
Source:Molecular Immunology, Volume 90





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Medizintechnik ist längst im Visier von Cyberkriminellen

Es gibt auch bei vernetzten Medizinprodukten kein System ohne Sicherheitslücken. Diese ernüchternde Bilanz zogen Experten bei einer Veranstaltung des Verbands der Elektrotechnik (VDE) zur Cybersecurity in der Medizin. Die gesamte Medizintechnikbranche ist ein potenzielles Ziel von Cyberkriminellen.

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„Bürokratie und Fremdsteuerung lassen Ärzte ausbrennen“

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The archaic roles of the lamprey NF-κB (lj-NF-κB) in innate immune responses

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Peng Su, Xin Liu, Yue Pang, Chang Liu, Ranran Li, Qiong Zhang, Hongfang Liang, Hao Wang, Qingwei Li
The nuclear factor-kappa B (NF-κB) is a pleiotropic transcription factor regulating the expression of genes involved in various biological processes including the immune response and inflammation. Lamprey is regarded as a key species to provide meaningful clues for understanding the evolution of immune system; nevertheless, no information about lamprey NF-κB is reported. Thus, we have characterized a NF-κB homolog in lamprey (lj-NF-κB) for the deeper understanding of the role it played in lamprey immune system. The sequence and 3D structure analyses demonstrate that lj-NF-κB contained a Rel homology domain (RHD) and seven ankyrin repeats domains (ANKs), which would exhibit functional similarities to NF-κB superfamily proteins. This hypothesis was further proved by experiments. We found that the RHD of lj-NF-κB could interact with a mammalian κB response element, translocate to the nucleus to modulate gene (IL-6, IL-1β and TNF-α) expression, and the nuclear localization signals (NLS) was essential for the nuclear translocation. Furthermore, the ANKs of lj-NF-κB are the inhibition signal for the RHD of lj-NF-κB. The present results allow us to surmise that the lj-NF-κB should play a key role in immune response of lamprey, and the function of NF-κB has been maintained during evolution.



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Gelungenes Werk zur Molekularen Allergiediagnostik

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Evaluation of the adjuvant effect of agonists of toll-like receptor 4 and 7/8 in a vaccine against leishmaniasis in BALB/c mice

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Mosayeb Rostamian, Hamid M. Niknam
There is no effective vaccine against human leishmaniasis. Achieving successful vaccines seems to need powerful adjuvants. Separate or combined use of toll like receptor (TLR) agonists as adjuvant is a promising approach in Leishmania vaccine research. In present study, we evaluated adjuvant effect of separate or combined use of a TLR7/8 agonist, R848 and a TLR4 agonist, monophosphoryl lipid A (MPL) beside soluble Leishmania antigen (SLA) in BALB/c mice. Mice were vaccinated three times by SLA with separate or combined TLR7/8 and TLR4 agonists and were then challenged by Leishmania major. Delay type hypersensitivity, lesion development, parasite load, and cytokines (interferon gamma, and interleukin-10) response were assessed. Results showed: 1) MPL can slightly assist SLA in parasite load reduction, but it is not able to increase SLA ability in evoking DTH and cytokine responses or decreasing lesion diameter. 2) R848 does not affect the DTH response and parasite load of mice vaccinated with SLA, but it decreases/inhibits cytokine responses induced by SLA, leading to increase lesion diameter. 3) MPL neutralized inhibitory effect of R848. In overall, these data emphasize that MPL slightly assists SLA to make a more potent vaccine, but R848 is not a good adjuvant to induce T cell-dependent immune response in BALB/c mice, and therefore combination of these TLR agonists in the current formulation, is not recommended for making a more powerful adjuvant.

Graphical abstract

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Systemtherapie der Vitiligo

Zusammenfassung

Die systemische medikamentöse Behandlung der Vitiligo beschränkt sich derzeit vorwiegend auf adjuvante Maßnahmen zur Wirkungssteigerung einer UV-Licht-Therapie. In diesem Beitrag werden neue Ansätze für eine systemische Therapie der Vitiligo vorgestellt, die derzeit in klinischer Erprobung sind. Dazu gehören das α‑MSH-Analogon Afemelatonide sowie orale Immunsuppressiva, wie die Januskinasen(JAK)-Inhibitoren, die gezielt Interferon-α-abhängige autotoxische Entzündungsreaktionen hemmen. Im Jahr 2015 sind erste Publikationen über den erfolgreichen systemischen Einsatz von Januskinasen(JAK)-Inhibitoren Tofacitinib und Ruxolitinib bei Vitiligo erschienen, für deren Wirksamkeit Untersuchungen an Tiermodellen der Vitiligo sowie die Charakterisierung neuer Biomarker im Serum von Vitiligopatienten sprechen. Das Spektrum der systemischen Therapiemöglichkeiten bei Vitiligo wird sich dadurch möglicherweise erweitern. Die topische antientzündliche Therapie und Bestrahlungen mit UV-Licht bleiben aber die wichtigsten Komponenten der Vitiligobehandlung, die häufig kombiniert werden. Die entscheidenden Zielparameter für eine wirksame Therapie der Vitiligo sind Ausmaß und Dauer der Repigmentierung, Anhalten der Progression, Vermeidung von Nebenwirkungen und die Besserung der Lebensqualität der Patienten.

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Pigmentstörungen

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Missempfindungen und Schwellungszustände der Zunge

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Nichtmelanozytärer Hautkrebs

Zusammenfassung

„Non-melanoma skin cancer" (NMSC, nichtmelanozytärer Hautkrebs) ist die häufigste Malignität der hellhäutigen Bevölkerung mit enormer sozioökonomischer Bedeutung. Historisch als unheilbar und „noli me tangere" bezeichnet, werden heute verschiedene nichtmelanozytäre kutane Neoplasien unter NMSC zusammengefasst. Die häufigsten, das Basalzellkarzinom, das spinozelluläre Karzinom und aktinische Keratosen als In-situ-Karzinome, werden zunehmend auch als Keratinozytenkarzinome bezeichnet. Pathogenese und Risikofaktoren von NMSC sind relativ gut verstanden, sodass neben multiplen Therapieoptionen verschiedene Präventionsansätze verfügbar und im Kontext der Anerkennung als Berufskrankheit (BK 5103) essenziell wichtig sind. Hierzu besteht großer allgemeiner Konsens in der dermatologischen Fachwelt; bei Hochrisikogruppen ist entsprechendes Wissen jedoch noch gering, sodass die Entwicklung zielgruppenorientierter Aufklärungs- und Präventionsstrategien dringend erforderlich ist.

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Okulokutaner und okulärer Albinismus

Zusammenfassung

Albinismus wird unterteilt in die okulokutane (OCA) und die okuläre Form (OA). Differenzialdiagnostisch abzugrenzen sind seltene, häufig mit Infektanfälligkeit und neurologischen Symptomen assoziierte Syndrome mit partiellem Albinismus. Der OCA ist eine autosomal-rezessiv vererbte Erkrankung der Melaninbiosynthese, die zu vollständigem oder partiellem Verlust von Melanin in Haut, Haarfollikeln und Augen führt. Von den heute bekannten 7 Subtypen (OCA 1–7) sind 4 (OCA1–4) gut charakterisiert. Ihnen liegen Mutationen in Genen zugrunde, die für Tyrosinase – Schlüsselenzym der Melaninsynthese – und für weitere Proteine codieren. Diese spielen eine wichtige Rolle für die katalytische Aktivität der Tyrosinase sowie die Struktur und die Funktion von Melanosomen. Klinische Symptome und Krankheitsverlauf bei Vorliegen dieser Subtypen, insbesondere Art und Ausmaß der Pigmentierung von Haut und Haaren sowie Schwere der Augenbeteiligung, zeigen eine ausgeprägte Variabilität, die die phänotypische Klassifizierung erschwert. In der Therapie stehen konsequenter UV-Lichtschutz zur Hautkrebsprophylaxe und regelmäßige Vorsorgeuntersuchungen im Vordergrund. Die albinismustypischen Augenveränderungen erfordern die frühzeitig einsetzende Diagnostik und Betreuung durch spezialisierte ophthalmologische Einrichtungen. Neue Strategien zur systemischen Behandlung von Subtypen des Albinismus sind in präklinischer Erprobung. Der OA ohne Hautbeteiligung wird X‑chromosomal vererbt, ist wesentlich seltener und durch reduzierte Pigmentierung von Retina und Iris mit Bildung von Makromelanosomen und Makulahypoplasie mit z. T. erheblicher Visusverschlechterung gekennzeichnet. Die typischen Augensymptome des OA wie Nystagmus und Blendempfindlichkeit können in unterschiedlicher Ausprägung bei allen OCA-Formen auftreten.

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Hyaluronan als Schlüssel zur schnelleren Wundheilung in humanen 3‑D-Vollhautmodellen

Zusammenfassung

Hintergrund

Die Wundheilung kann in 3 Phasen unterteilt werden. 1) Exsudationsphase, 2) Granulationsphase, 3) Regenerationsphase. Der Regenerationsphase kommt besondere Bedeutung zu mit dem Ziel, die natürliche Barrierefunktion der Haut schnellstmöglich wiederherzustellen. Ziel der Studie war die Analyse der Reepithelisierungskinetik von unbehandelten sowie mit 0,5 % Natriumhyaluronat (NHA) behandelten humanen 3‑D-Vollhautmodellen.

Methodik

Es wurden 10 µl der Testsubstanz 2‑mal täglich topisch appliziert. Die Analyse der Reepithelisierungskinetik erfolgte an den Tagen 2 bis 6. Die Beurteilung des Einflusses der Testsubstanz auf die Immunantwort erfolgte durch Quantifizierung von IL-1α und IL-10.

Ergebnisse

Die 2‑mal tägliche Applikation von 0,5 % NHA resultiert in einer erhöhten Reepithelisierungsgeschwindigkeit zu allen Zeitpunkten (p < 0,001). Diese Beobachtung geht einher mit einer geringeren Expression von IL-10 sowie einer erhöhten Expression von IL-1α an den Tagen 2 bis 4 (p < 0,001).

Diskussion

Die Behandlung der humanen Hautmodelle mit NHA zeigte eine – verglichen mit unbehandelten Modellen – signifikant erhöhte Reepithelisierungsgeschwindigkeit des verwundeten Gewebes und führte zu einem schnelleren Wundschluss. Es liegt die Vermutung nahe, dass die Herunterregulation von IL-10 zu einer durch IL-1α mediierten, erhöhten Immunantwort führt und in der schnelleren Wundheilung resultiert. Folgestudien werden zeigen, ob die schnellere Wundheilung sowie die Modulation der Immunantwort durch die Applikation von NHA auch in vivo belegt werden kann.

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Dermatoskopisch auffällige Pigmentläsion an der Stirn eines jungen Patienten

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Praxisorientierte Schmerztherapie in der Dermatologie

Zusammenfassung

Je früher eine Schmerztherapie beginnt, desto höher ist die Wahrscheinlichkeit, eine Chronifizierung zu vermeiden. Dermatologische Patienten in stationärer Behandlung weisen nicht nur gehäuft ein hohes Alter und eine damit assoziierte Multimorbidität auf, sondern leiden aufgrund distinkter Hauterkrankungen unter damit einhergehenden charakteristischen Schmerzen. Der klinisch tätige Arzt hat in vielen Fällen wenig Erfahrung, dafür aber etliche Bedenken im Umgang mit Analgetika. Bislang wurde sich an der Stufenleiter der World Health Organization (WHO) zur Therapie von chronischen Schmerzen orientiert, die die Schmerzintensität in den Vordergrund stellt. Im vorliegenden Beitrag wird ein gut umsetzbares Konzept zur Schmerztherapie vorgestellt, das die Schmerzqualität fokussiert. Diese gibt Informationen darüber, ob es sich um neuropathische oder nozizeptive Schmerzen handelt, die anschließend differenziert behandelt werden können. Primäres Ziel soll sein, den fachdermatologischen Behandlern ein Konzept an die Hand zu geben, mit dessen Hilfe die initiale Schmerztherapie ihrer Patienten begonnen werden kann. Diese zügige Einleitung einer individualisierten Schmerztherapie kann das Risiko für eine Chronifizierung der Schmerzen reduzieren, die die Lebensqualität insbesondere der dermatologischen Patienten zusätzlich zur oft vorliegenden Stigmatisierung durch die Dermatose schwer beeinträchtigen kann.

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Tretinoin

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Panorama Dermatologische Praxis

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Cardiovascular Risk in Psoriasis [Free article]

M.P. González García
Actas Dermosifiliogr 2017;108:701

Full text - PDF

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On the Use of Phototherapy in the Management of Photodermatoses [Free article]

D. de Argila Fernández-Durán
Actas Dermosifiliogr 2017;108:702

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Knowledge Of Preservatives: A Key Competence In Dermatology [Free article]

J. Tercedor
Actas Dermosifiliogr 2017;108:702-3

Full text - PDF

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Skin Cancer and the Dermatologist: Reflections on the Position Taken by the Spanish Society of Medical Oncology (SEOM) [Free article]

D. Moreno-Ramírez, E. Nagore, R. Botella-Estrada, G. Carretero, S. Puig, P. Redondo, M.A. Rodrígurez-Prieto, E. Samaniego, O. Sanmartín, J. Malvehy
Actas Dermosifiliogr 2017;108:704-7

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Novel Immunologic Approaches to Melanoma Treatment [Free article]

I. Escandell, J.M. Martín, E. Jordá
Actas Dermosifiliogr 2017;108:708-20

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Advances in the Immunobiological Therapies for Advanced Melanoma [Free article]

M.C. Pérez Gago, O. Saavedra Santa Gadea, L. de la Cruz-Merino
Actas Dermosifiliogr 2017;108:721-8

Abstract - Full text - PDF

http://ift.tt/2ysyWCj

Reconstruction Techniques of Choice for the Facial Cosmetic Units [Free article]

F. Russo, M. Linares, M.E. Iglesias, J.L. Martínez-Amo, F. Cabo, J. Tercedor, R. Costa-Vieira, T. Toledo-Pastrana, J.M. Ródenas, V. Leis
Actas Dermosifiliogr 2017;108:729-37

Abstract - Full text - PDF

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Cardiovascular Risk Factors and Carotid Intima-Media Thickness in a Colombian Population With Psoriasis [Free article]

A. Argote, O. Mora-Hernández, L. Milena Aponte, D.I. Barrera-Chaparro, L.M. Muñoz-Ruiz, L. Giraldo-Mordecay, D. Camargo
Actas Dermosifiliogr 2017;108:738-45

Abstract - Full text - PDF

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Platelet-Rich Plasma for the Treatment of Photodamage of the Skin of the Hands [Free article]

J.O. Cabrera-Ramírez, A.G. Puebla-Mora, A. González-Ojeda, D. García-Martínez, J.A. Cortés-Lares, A.R. Márquez-Valdéz, G.I. Contreras-Hernández, J. Bracamontes-Blanco, J.A. Saucedo-Ortíz, C. Fuentes-Orozco
Actas Dermosifiliogr 2017;108:746-51

Abstract - Full text - PDF

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Successful short desensitization treatment protocol with narrowband UVB phototherapy (TL-01) in polymorphic light eruption [Free article]

A. Combalia, C. Fernández-Sartorio, X. Fustà, D. Morgado-Carrasco, S. Podlipnik, P. Aguilera
Actas Dermosifiliogr 2017;108:752-7

Abstract - Full text - PDF

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PD1 inhibitors and hair repigmentation: A desirable new side effect

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Refractory pityriasis rubra pilaris treated with etanercept, adalimumab, or ustekinumab: A retrospective investigation

Abstract

Pityriasis rubra pilaris (PRP) is a rare, difficult to treat papulosquamous disorder that responds variably to retinoids and immunosuppression. Successful use of biologics for treating PRP has been described in the literature by case reports and a limited number of case series. To provide additional data, we retrospectively analyzed cases of PRP treated with biologics at our institution. We identified seven patients with a clear diagnosis of PRP treated with adalimumab, etanercept, and/or ustekinumab at our institution from January 1, 2014 to April 1, 2017. Six of seven patients had type I, adult acquired PRP, and one had type V atypical juvenile PRP. In response to tumor necrosis factor (TNF)-α inhibition, two patients had marked responses (>75% improvement in involved body surface area), while three patients failed to show any improvement on a TNF-α inhibitor. In two cases of PRP refractory to TNF-α inhibition, ustekinumab resulted in a partial response (<75% improvement) in one patient and no response in the other. Compared to other published data, our cohort was substantially more resistant to treatment with biologics, a finding which may provide valuable perspective for dermatologists managing refractory PRP in the future.

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Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials

Nonsteroidal anti-inflammatory drugs (NSAIDs) play a role in pain relief, especially in postoperative pain caused by inflammation. They have demonstrated significant opioid dose-sparing effects, which help in reducing postoperative effects and opioid side effects. The objective of this meta-analysis was to explore the role of NSAIDs in reducing postoperative pain at different time intervals and provide reference for medication after lumbar spine surgery by a meta-analysis of randomized controlled trials (RCT).

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Zika virus and autoimmunity. One-step forward.

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Diana M. Monsalve, Yovana Pacheco, Yeny Acosta-Ampudia, Yhojan Rodríguez, Carolina Ramírez-Santana, Juan-Manuel Anaya
Zika virus (ZIKV) infection has been associated with the development of Guillain-Barré syndrome (GBS) and idiopathic thrombocytopenic purpura (ITP). Whether ZIKV infection is related to other autoimmune diseases is unknown. Therefore, an association study to evaluate rheumatic and thyroid autoimmunity in patients with ZIKV disease was conducted through a panel of 14 autoantibodies. In addition, a literature review on ZIKV, and GBS and ITP was performed. Our results disclosed a lack of rheumatoid and thyroid autoimmunity in patients with ZIKV disease. A total of 272 cases of GBS related to ZIKV were retrieved from the literature, the majority of them being males (54.8%). Electrophysiological findings indicated acute inflammatory demyelinating polyneuropathy as the most frequent subphenotype (75.7%). Up to date, twenty-four cases of ITP in patients with ZIKV disease have been published. Although a few fatal cases have been observed, most of the reported patients responded well to immunomodulatory treatment. A review of the mechanisms incriminated into the development of autoimmune phenomenon in ZIKV disease indicates molecular mimicry as the most plausible one. Nevertheless, more research aimed at deciphering ZIKV disease pathogenesis and its relationship with autoimmunity is warranted.



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Novelties in the field of autoimmunity – 1st Saint Petersburg congress of autoimmunity, the bridge between east and west

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Shani Dahan, Yahel Segal, Abdulla Watad, Shir Azrielant, Asaf Shemer, Dror Maymon, Yuri I. Stroev, Polina A. Sobolevskaya, Elena A. Korneva, Miri Blank, Boris Bilburd, Ora Shovman, Howard Amital, Michael Ehrenfeld, Amir Tanay, Shay Kivity, Elon Pras, Joav Chapman, Jan Damoiseaux, Ricard Cervera, Chaim Putterman, Iziaslav Shapiro, Luc Mouthon, Roberto Periconne, Nicola Bizzaro, Omry Koren, Gabriela Riemekasten, Valeriy A. Chereshnev, Vadim I. Mazurov, Mark Goloviznin, Victor Gurevich, Leonid P. Churilov, Yehuda Shoenfeld




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Cogan syndrome: Characteristics, outcome and treatment in a French nationwide retrospective study and literature review

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Charlotte Durtette, Eric Hachulla, Matthieu Resche-Rigon, Thomas Papo, Thierry Zénone, Bertrand Lioger, Christophe Deligny, Marc Lambert, Cédric Landron, Jacques Pouchot, Jean Emmanuel Kahn, Christian Lavigne, Benoit De Wazieres, Robin Dhote, Guillaume Gondran, Edouard Pertuiset, Thomas Quemeneur, Mohamed Hamidou, Pascal Sève, Thomas Le Gallou, Anne Grasland, Pierre-Yves Hatron, Olivier Fain, Arsène Mekinian
BackgroundCogan syndrome is mainly treated with corticosteroids. We aimed to determine the place of DMARDs and biologic-targeted treatments.



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The inter-observer reading variability in anti-nuclear antibodies indirect (ANA) immunofluorescence test: a multicenter evaluation and a review of the literature

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): A. Rigon, M. Infantino, M. Merone, G. Iannello, A. Tincani, I. Cavazzana, N. Caraballese, A. Radice, M. Manfredi, P. Soda, A. Afeltra
Recently there has been an increase demand for computer-aided diagnosis (CAD) tools to sup- port clinicians in the field of Indirect ImmunoFluorescence (IIF), as the novel digital imaging reading approach can help to overcome the reader subjectivity. Nevertheless, a large multicenter evaluation of the inter-observer reading variability in this field is still missing. This work fills this gap as we evaluated 556 consecutive samples, for a total of 1679 images, collected in three laboratories with IIF expertise using HEp-2 cell substrate (MBL) at 1:80 screening dilution ac- cording to conventional procedures. In each laboratory, the images were blindly classified by two experts into three intensity classes: positive, negative, and weak positive. Positive and weak pos- itive ANA-IIF results were categorized by the predominant fluorescence pattern among six main classes. Data were pairwise analyzed and the inter-observer reading variability was measured by Cohen's kappa test, revealing a pairwise agreement little further away than substantial both for fluorescence intensity and for staining pattern recognition (k=0.602 and k=0.627, respec- tively). We also noticed that the inter-observer reading variability decreases when it is measured with respect to a gold standard classification computed on the basis of labels assigned by the three laboratories. These data show that laboratory agreement improves using digital images and comparing each single human evaluation to potential reference data, suggesting that a solid gold standard is essential to properly make use of CAD systems in routine work lab.



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Autoimmune comorbidity in chronic spontaneous urticaria: a systematic review

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Pavel Kolkhir, Elena Borzova, Clive Grattan, Riccardo Asero, Dmitry Pogorelov, Marcus Maurer
Background and ObjectiveNumerous autoimmune diseases (AIDs) have been linked to chronic spontaneous urticaria (CSU). Here, we provide the first extensive and comprehensive evaluation of the prevalence of AIDs in patients with CSU and vice versa.MethodsA Pubmed and Google Scholar search was performed to identify studies reporting the prevalence of various AIDs in CSU and vice versa published before April 2017.ResultsThe prevalence of individual AIDs in CSU is increased (≥1% in most studies vs ≤1% in general population). AIDs with relatively high prevalence in the general population are also quite common in CSU patients, whereas those with low prevalence remain a rare finding in CSU. The rates of comorbidity in most studies were ≥1% for insulin-dependent diabetes mellitus, rheumatoid arthritis (RA), psoriasis and celiac disease (CD), ≥2% for Graves' disease, ≥3% for vitiligo, and ≥5% for pernicious anemia and Hashimoto's thyroiditis. Organ-specific AIDs are more prevalent in CSU than systemic (multiorgan or non organ-specific) AIDs. More than 2% of CSU patients have autoimmune polyglandular syndromes encompassing autoimmune thyroid disease (ATD) and vitiligo or pernicious anemia. Antithyroid and antinuclear antibodies are the most prevalent AID-associated autoantibodies in CSU. More than 15% of CSU patients have a positive family history for AIDs. The prevalence of urticarial rash in AID patients is >1% in most studies. This rash is more prevalent in eosinophilic granulomatosis with polyangiitis, ATD, systemic lupus erythematosus, RA and CD.ConclusionsCSU patients have an increased risk of AIDs, especially adult female patients with a positive family history and a genetic predisposition for AIDs, who should be screened for signs and symptoms of AIDs.



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Interleukin-22 in human inflammatory diseases and viral infections

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Arezoo Gowhari Shabgah, Jamshid Gholizadeh Navashenaq, Omid Gohari Shabgah, Hamed Mohammadi, Amirhossein Sahebkar
Interleukin-22 (IL22) is one of the members of IL10 family. Elevated levels of this cytokine can be seen in diseases caused by T lymphocytes, such as Psoriasis, Rheumatoid arthritis, interstitial lung diseases. IL22 is produced by different cells in both innate and acquired immunities. Different types of T cells are able to produce IL22, but the major IL22-producing T-cell is the TCD4. TH22 cell is a new line of TCD4 cells, which differentiated from naive T cells in the presence of TNFα and IL6; 50% of peripheral blood IL22 is produced by these cells. IL22 has important functions in host defense at mucosal surfaces as well as in tissue repair. In this review, we assess the current understanding of this cytokine and focus on the possible roles of IL-22 in autoimmune diseases.



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Uveitis: diagnostic work-up. A literature review and recommendations from an expert committee

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Pascal Sève, Patrice Cacoub, Bahram Bodaghi, Salim Trad, Jérémie Sellam, David Bellocq, Philip Bielefeld, Damien Sène, Gilles Kaplanski, Dominique Monnet, Antoine Brézin, Michel Weber, David Saadoun, Christophe Chiquet, Laurent Kodjikian
PurposeDiagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis.MethodsRecommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only.ResultsDiagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients >40 years-old). Other investigations prescribed in the absence of orientation are usually unhelpful.ConclusionsA strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.



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Rheumatic diseases and autoimmune vascular dementia

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Fabiola Atzeni, Nicolò Pipitone, Luca Iaccarino, Ignazio Francesco Masala, Ronen Weiss, Alessandra Alciati, Andrea Doria, Joab Chapmanand, Piercarlo Sarzi-Puttini
Vascular dementia (VD) comes second after Alzheimer's disease (AD) as a cause of impaired cognition. VD is not a specific nosological entity, but rather a syndrome encompassing a number of diseases caused by impaired supply of blood to the brain. Systemic autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, vasculitis and antiphospholipid syndrome (APS) can be associated with dementia. VD is often related to the presence of traditional cardiovascular risk factors, but it may also be associated with a host of disorders affecting the brain blood vessels, neuronal cells, or both. It is important to entertain in the differential diagnosis of VD, to recognize and to cure them accurately in order to preserve life's quality of our patients.



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Lymphangiomatous Polyp Presenting as Tonsillar Mass

A 19-year-old female presented to ENT OPD of Dhulikhel Hospital, Kathmandu University Hospital, with history of foreign body sensation in throat for 2 weeks and mass in left tonsil for 1 week. There is no history of difficulty swallowing or recurrent throat infection. Physical examination revealed a pedunculated mass arising from upper pole of left tonsil. Bilateral tonsillectomy was done under general anaesthesia. Grossly, 2.5 × 1.5 × 1 cm polypoidal mass, soft in consistency, was found to be attached to left tonsil. Histopathology report was consistent with lymphangiomatous polyp of tonsil. Postoperative period was uneventful and she was normal during her follow-up at 1 month with bilateral healthy tonsillar fossa.

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Evans Syndrome Complicated by Intratubular Hemoglobin Cast Nephropathy

Evans syndrome (ES) is a rare autoimmune disorder whose exact pathophysiology is unknown. It is characterized by the simultaneous or subsequent development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Intravascular hemolysis, with hemoglobinemia, is known to produce acute kidney injury; however, the development of intratubular hemoglobin casts (hemoglobin cast nephropathy) in the setting of acute hemolysis is uncommon. Likewise, the association of ES and acute renal failure is equally uncommon. We present a case of a 7-year-old girl with ES who developed acute kidney injury in the setting of intravascular hemolysis and had widespread intratubular hemoglobin casts.

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