Translational genomics for human diseases: toward a new era of precision medicine

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Systemische Therapien der Psoriasis und Psoriasisarthritis

Zusammenfassung

Die Psoriasis vulgaris ist eine der häufigsten chronischen Hauterkrankungen. Über 25 % der betroffenen Personen benötigen aufgrund der massiven Ausprägung der Symptome und/oder einer deutlichen Einschränkung der Lebensqualität eine wirksame systemische Therapie. Dank intensiverer Forschung und erfolgreicher Zusammenarbeit zwischen akademischen und industriellen Einrichtungen haben sich unsere Behandlungsmöglichkeiten für die Psoriasis in den letzten Jahren enorm erweitert. Insbesondere ermöglichen uns zielgerichtete Therapien eine personalisierte Medizin. Diese Übersichtsarbeit beschreibt das Spektrum der systemischen Therapien bei Psoriasis und Psoriasisarthritis und thematisiert Wirksamkeit, Sicherheit und Besonderheiten der einzelnen Substanzen.

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Pustulöse Psoriasis

Zusammenfassung

Eine Reihe pustulöser Hauterkrankungen teilen klinische, pathogenetische und epidemiologische Aspekte mit der Psoriasis vulgaris, und ihre Einordung als eigene klinische Entitäten oder Unterformen der Psoriasis ist weiterhin umstritten, was sich auch in der Vielzahl ihrer Bezeichnungen widerspiegelt. Hierzu gehören die generalisierte pustulöse Psoriasis mit ihren Sonderformen, die Acrodermatitis continua suppurativa, die akute Pustulosis palmoplantaris, die Psoriasis pustulosa palmoplantaris sowie pustulöse Varianten der vorwiegend durch TNF-Blocker getriggerten paradoxen psoriasiformen Dermatitis. In diesem Beitrag werden Erkenntnisse zu Epidemiologie, klinischem Bild, Pathogenese, Genetik und Therapie dieser pustulösen Hauterkrankungen dargestellt.

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Multiple, schwärzliche, brennende Papeln an beiden Fußsohlen einer 20-jährigen Patientin

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The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Abstract

Purpose

Cholecystectomy, which is one of the most common surgical procedures, is also performed in the emergency setting. A number of risk scores have been introduced in recent studies; moreover, over the last few years literature has focused on surgical patients with frailty syndrome. The aim of the present study is to evaluate whether frailty syndrome and the risk scores are correlated with morbidity, post-operative hospital stay and the ICU admission rate following emergency cholecystectomy.

Methods

Eighty-five consecutive patients of >65 years of age who underwent cholecystectomy were selected from 2306 emergency procedures for inclusion in the present study. The patients were assessed for frailty syndrome and their scores were calculated on the basis of chart review. Univariate analyses were performed to compare severe frailty patients to intermediate frailty and robust patients. ROC and logistic regression analyses were performed with the end-points of morbidity, hospital stay and ICU admission.

Results

In addition to having worse ASA, inflammatory and risk values than robust patients, frailty syndrome patients also had higher rates of morbidity and ICU admission and longer hospitalization periods. A logistic regression analysis showed that the P-Possum was independently correlated with morbidity. Frailty and open surgery were independently correlated with longer hospitalization, whereas ICU admission was correlated with worse ASA and P-Possum values.

Conclusions

Frailty syndrome significantly impacts the length of hospitalization in patients undergoing emergency cholecystectomy. Although the ORs were limited, the P-Possum value was independently associated with the outcome.

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Are family medicine residents physically active? And do they counsel their chronically ill patients about physical activity? A cross-sectional study among residents of the family medicine joint program, eastern province, Saudi Arabia

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Malak Audah Al Shammari.
Background: Physical activity is a major factor in both preventing chronic illness and in controlling it in already diseased patients. It has been established that a physically active physician may be more likely to counsel patients about the benefits of physical activity and patients tend to adhere to exercise regimens when advised by a physician they think of as a role model. Objective: To determine the amount of physical activity the family medicines residents adhere to and to determine if family medicine residents practice what they counsel to their patients regarding physical activity. Materials and Methods: All family medicine residents in all of the training levels were recruited to take part in the International Physical Activity Questionnaire (IPAQ) survey voluntarily. Levels of physical activity were divided into three categories: low, moderate, and high, according to the guidelines of data processing of the IPAQ. Section two of the survey assessed whether residents in fact counseled patients with chronic prevalent diseases (coronary artery disease, diabetes mellitus, obesity, etc.) about physical activity and the ranking of the most important health determinants according to them. Result: The sample size consisted of 80 participants, all residents of the program from R1 to R4. We have found that the majority >70% of them had low level of physical activity. The majority (96%) did counsel their patients about physical activity especially when the patient had diabetes. Conclusion: Although residents of the joint family medicine program of the eastern province of the Kingdom of Saudi Arabia were not, self-reportedly, physically active themselves, they were active in patient counseling regarding the importance of physical activity in achieving global health and well-being.


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Treatment of plantar fasciitis with dexamethasone with lidocaine hydrochloride

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Sumit Kalra.
Background: Plantar heel pain is a commonly occurring foot complaint. Various electrotherapy modalities are frequently utilized as a treatment. Objective: To determine the effects of a combination of dexamethasone with lidocaine hydrochloride for the treatment of patients with plantar fasciitis (PF). Materials and Methods: A total of 40 patients suffering from PF were divided into two groups; Group A received iontophoresis with distilled water along with 4 mg/mL dexamethasone and 2 cm3 of lidocaine hydrochloride (4% lidocaine hydrochloride), and Group B received iontophoresis with distilled water. Both groups received stretching of plantar fascia and calf muscles, followed by ultrasound for 5 min. Treatment for each patient was for a period of 2 weeks with 3 sessions per week. Result: Group A showed significant decrease in symptoms of PF posttreatment. Conclusion: Iontophoresis with lidocaine hydrochloride showed better results in decreasing symptoms of PF as compared to iontophoresis with distilled water only.


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