Publication date: Available online 24 November 2017
Source:Piel
Author(s): Aniza Giacaman, Oriol Corral-Magaña, José Antonio Salinas Sanz, Ana Martín-Santiago
Παρασκευή 24 Νοεμβρίου 2017
Diagnóstico y tratamiento de la esclerosis tuberosa
Ex-vivo flush of the limb allograft reduces inflammatory burden prior to transplantation
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kavit Amin, Alexandra L. Ball, Chandanpreet Chhina, Rebecca J. Edge, John P. Stone, William R. Critchley, Jason K. Wong, James E. Fildes
BackgroundPassenger leukocytes and inflammatory debris transferred from the donor limb to the recipient can induce allorecognition, which activates the host immune response. This is the first study to evaluate whether the transfer of this inflammatory burden can be reduced via post-preservation flush prior to revascularisation, and whether this is influenced by ischaemia.MethodsBilateral forelimbs from the same pig were procured and infused with preservation flush and stored on ice. Each limb from the same pig underwent a post-preservation intravascular flush with isotonic solution at either 2 or 6hrs. Venous effluent underwent flow cytometry to phenotype leukocyte populations, with additional quantification of cytokines and cell-free DNA.ResultsWe identified large populations of viable leukocytes in the flush effluent (8.65x108 ±3.10x108 cells at 2hrs and 1.02x109 ±2.63x108 at 6hrs). This comprised T cells, B cells, NK cells and monocytes. Post-preservation flush yielded significant concentrations of pro-inflammatory cytokines including IL-6, IL-18, GM-CSF, IL-1β, IL1α and CXCL-8 and mitochondrial DNA. The regulatory cytokine, IL-10 was undetectable.ConclusionsThis study supports the finding that a post-preservation flush removes leukocytes and inflammatory components that are responsible for direct presentation. This study also gives an indication of how ischaemia impacts on the inflammatory burden transferred to the recipient upon reperfusion.
Doxiciclina, una alternativa efectiva, bien tolerada y de bajo coste como tratamiento de primera línea del penfigoide ampolloso
Publication date: Available online 24 November 2017
Source:Actas Dermo-Sifiliográficas
Author(s): D. Morgado-Carrasco, C. Riquelme-Mac Loughlin, X. Fustà-Novell, P. Iranzo
Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center
Source:Annales de Chirurgie Plastique Esthétique
Author(s): K. Khoshim, B. Hersant, C. Hotz, M. SidAhmed-Mezi, J.P. Meningaud
IntroductionThere is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon.Materials and methodsThis was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed.ResultA total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**).ConclusionThe mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient.
Comparison between anterior segmental osteotomy versus conventional orthodontic treatment in root resorption: a radiographic study using cone-beam computed tomography
Abstract
Background
Patients who received orthodontic treatment are likely to have apical root shortening. It appears that external apical root resorption results from a combination of patient-related risk factors such as genetic influences, systemic factors, and orthodontic treatment-related factors. Regarding the fact that the anterior segmental osteotomy (ASO) has been known for its possibility of complementing external apical root resorption and of buffering periodontal problems, it has been the preferred treatment. However, the studies on the efficacy of ASO in preserving the root are not sufficient. In this study, we compared the amount of root resorption between the patients who only received orthodontic treatment and the patients who received orthodontic treatment with ASO.
Methods
This study included 28 patients (the number of incisor = 198) who received orthodontic treatment with or without ASO. We categorize them into groups A and B by the type of orthodontic treatment (group A: conventional orthodontic treatment; group B: orthodontic treatment with ASO). Cone-beam computed tomographic and cephalometric evaluations were retrospectively performed on the radiographs taken for the diagnosis of the treatment before treatment and at the end of active treatment.
Results
In group B, root resorption itself and its rate both turned out to have significantly lower than those in group A. Also, the change of incisal angle is significantly smaller in group B than in group A. On the other hand, in group A, the change of incisal angle was positively correlated with the change of AP (anteroposterior) position. In group B, the change of incisal angle was negatively correlated with the duration of the orthodontic treatment. In group B, amount of root resorption (mm) was positively correlated with the duration of the orthodontic treatment.
Conclusions
The results show lesser root resorption and shorter treatment duration with ASO than with conventional orthodontic treatment. Therefore, if the indications are accurately determined, ASO can be an effective treatment option when the amount of root resorption is expected to be high, especially in late adults.
Treatment of dental implant displacement into the maxillary sinus
Abstract
Background
Displacement of dental implants into the maxillary sinus is rare, but it primarily occurs in patients with severe pneumatization of the maxillary sinus and/or deficiency of the alveolar process. Some complications such as the infection of the paranasal sinuses and formation of the oroantral fistula can be followed by the displacement of a dental implant. Therefore, the displaced implant has to be removed immediately with surgical intervention show and another plan for rehabilitation should be considered.
Main body
The conventional procedure for the removal of a displaced implant from the maxillary sinus involves sinus bone grafting and new implant placement performed in two or more steps with a significant time gap in between. Simplification of these surgical procedures can decrease the treatment duration and patient discomfort.
Conclusions
In this review, we discuss the anatomical characteristics of the maxillary sinus and the complications associated with implant displacement into the sinus.
Infectious Complications following Breast Reconstruction Using Tissue Expanders in Patients with Atopic Dermatitis
Summary: Infectious complications represent one of the most prominent factors contributing to tissue expander (TE) loss in breast reconstruction procedures. Several patient characteristics that increase the risk for surgical-site infection or TE infection have been reported, but no study has focused on the relationship between atopic dermatitis (AD) and TE infection or surgical-site infection. Recently, we investigated 203 cases of breast reconstruction surgeries performed using TEs and noted that all 3 patients who had AD developed infectious complications that ultimately led to TE removal. Considering its pathophysiology, it is likely that patients with AD relatively easily develop infectious complications due to barrier dysfunction, abnormalities in innate immune responses, or colony formation by Staphylococcus aureus. Particular caution should be exercised for breast reconstruction using man-made materials in cases complicated by AD.The net effects of medical malpractice tort reform on health insurance losses: the Texas experience
In this paper, we examine the influence of medical malpractice tort reform on the level of private health insurance company losses incurred. We employ a natural experiment framework centered on a series of tor...
Treatment of melasma: The journey ahead
Rashmi Sarkar, Pallavi Ailawadi
Indian Journal of Dermatology 2017 62(6):447-449
Indian Journal of Dermatology 2017 62(6):447-449
Medical management of melasma: A review with consensus recommendations by Indian pigmentary expert group
Rashmi Sarkar, Narendra Gokhale, Kiran Godse, Pallavi Ailawadi, Latika Arya, Nilendu Sarma, RG Torsekar, VK Somani, Pooja Arora, Imran Majid, G Ravichandran, Mohan Singh, Sanjeev Aurangabadkar, Shehnaz Arsiwala, Sidharth Sonthalia, T Salim, Swapnil Shah
Indian Journal of Dermatology 2017 62(6):450-469
Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).
Indian Journal of Dermatology 2017 62(6):450-469
Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).
Author's reply
P Ravindra Babu, AJ S Pravin, Gaurav Deshmukh, Dhiraj Dhoot, Aniket Samant, Bhavesh Kotak
Indian Journal of Dermatology 2017 62(6):559-561
Indian Journal of Dermatology 2017 62(6):559-561
Chemical peels in melasma: A review with consensus recommendations by Indian pigmentary expert group
Rashmi Sarkar, Shehnaz Arsiwala, Neha Dubey, Sidharth Sonthalia, Anupam Das, Latika Arya, Narendra Gokhale, RG Torsekar, VK Somani, Imran Majid, Kiran Godse, G Ravichandran, Mohan Singh, Sanjeev Aurangabadkar, T Salim, Swapnil Shah, Surabhi Sinha
Indian Journal of Dermatology 2017 62(6):470-476
Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.
Indian Journal of Dermatology 2017 62(6):470-476
Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.
A fatal case of febrile ulceronecrotic mucha-habermann disease which presenting as toxic epidermal necrolysis
Chenjing Xing, Hong Shen, Junzhu Xu, Zehu Liu, Jun Zhu, Aie Xu
Indian Journal of Dermatology 2017 62(6):567-567
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta, is an inflammatory dermatosis of unknown etiology manifested by ulcerative and necrotic lesions accompanied by systemic manifestations. The mortality rate of FUMHD is about 15%. It is reported here a case of FUMHD presenting as toxic epidermal necrolysis that resulted in multiple organ failure and death.
Indian Journal of Dermatology 2017 62(6):567-567
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta, is an inflammatory dermatosis of unknown etiology manifested by ulcerative and necrotic lesions accompanied by systemic manifestations. The mortality rate of FUMHD is about 15%. It is reported here a case of FUMHD presenting as toxic epidermal necrolysis that resulted in multiple organ failure and death.
Lasers in melasma: A review with consensus recommendations by Indian pigmentary expert group
Rashmi Sarkar, Sanjeev Aurangabadkar, T Salim, Anupam Das, Swapnil Shah, Imran Majid, Mohan Singh, G Ravichandran, Kiran Godse, Shehnaz Arsiwala, Latika Arya, Narendra Gokhale, Nilendu Sarma, RG Torsekar, Sidharth Sonthalia, VK Somani
Indian Journal of Dermatology 2017 62(6):477-482
Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
Indian Journal of Dermatology 2017 62(6):477-482
Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
Cutaneous cysts with nail dystrophy in a young female: A classical association
Romana Ghosh, Kingshuk Chatterjee, Jayanta Kumar Barua, Anupam Roy
Indian Journal of Dermatology 2017 62(6):553-556
Pachyonychia Congenita (PC) refers to a group of autosomal dominant disorders with variable clinical presentations. While nail dystrophy and plantar keratoderma are the most consistent features in all the variants, a myriad of other manifestations has been observed. This report highlights a case of young female presenting with multiple asymptomatic cutaneous cysts associated with plantar kearatoderma and nail dystrophy. Similar nail changes were evident in her son also. Such clinical presentation, in corroboration with histopathological evaluation of the cutaneous cyst prompted us to make a diagnosis of Pachyonychia Congenita type II.
Indian Journal of Dermatology 2017 62(6):553-556
Pachyonychia Congenita (PC) refers to a group of autosomal dominant disorders with variable clinical presentations. While nail dystrophy and plantar keratoderma are the most consistent features in all the variants, a myriad of other manifestations has been observed. This report highlights a case of young female presenting with multiple asymptomatic cutaneous cysts associated with plantar kearatoderma and nail dystrophy. Similar nail changes were evident in her son also. Such clinical presentation, in corroboration with histopathological evaluation of the cutaneous cyst prompted us to make a diagnosis of Pachyonychia Congenita type II.
Facial acanthosis nigricans: A morphological marker of metabolic syndrome
Saumya Panda, Anupam Das, Koushik Lahiri, Manas Chatterjee, Tanmay Padhi, Sanjay Rathi, Sandipan Dhar, Nilendu Sarma
Indian Journal of Dermatology 2017 62(6):483-489
Introduction: Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published. Aims and Objectives: The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist–hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN. Methods: A multicentric case–control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA). Results: Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN. Conclusion: Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome.
Indian Journal of Dermatology 2017 62(6):483-489
Introduction: Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published. Aims and Objectives: The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist–hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN. Methods: A multicentric case–control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA). Results: Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN. Conclusion: Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome.
Mycobacterium leprae or Tuberculosis: A diagnostic dilemma
Pugazhenthan Thangaraju, Sajitha Venkatesan, Elavarasan Sivashanmugam, MK Showkath Ali
Indian Journal of Dermatology 2017 62(6):563-563
Indian Journal of Dermatology 2017 62(6):563-563
Occult hepatitis B virus infections (often with human herpesvirus 7 co-infection) detected in Pityriasis rosea patients: A pilot study
Abhishek De, Subrata Roy, Soumi Sukla, Asad Ansari, Subhajit Biswas
Indian Journal of Dermatology 2017 62(6):490-497
Background: The etiopathogenesis of Pityriasis rosea (PR), a papulo-squamous skin disease, remains elusive and hypothesized to be caused primarily by human herpesvirus (HHV) 6 or 7 or immune dysfunction. Aims: The recent increasing incidences of hepatitis B virus (HBV) infections, including asymptomatic occult HBV infections (OBIs), in a densely populated city in India, prompted us to investigate whether PR patients (from varied socioeconomic and immune status) harbor the underlying HBV infections. These cases were also investigated for HHV 6 and 7 infections. Materials and Methods: DNA from ethylenediaminetetraacetic acid blood samples from PR-diagnosed individuals (n = 13; mostly young adults) and healthy controls (n = 11) were subjected to virus gene-specific polymerase chain reactions (PCRs) for HBV and HHV 6 and 7. PCR products of expected length, when observed, were sequenced (bidirectional) using overlapping primers. Sequences were identified by NCBI BLAST and analyzed by multiple sequence alignment and phylogenetic studies. The blood samples were tested for HBsAg by EIA. Results: In 5/13 PR samples, only HBV DNA (4/5 being HBsAg negative) was detected, providing first-time evidence that PR may be manifested in asymptomatic HBV carriers. 6/13 cases were HHV 7 (not HHV 6) DNA positive, providing confirmatory molecular genetic evidence for the first time of PR association with HHV 7 from India. Surprisingly, 5/6 HHV 7-positive PR cases were also HBV positive. Overall, 10/13 PR samples showed evidence of HBV infection. 8/13 were OBI, harboring at least one OBI-signature S protein mutation. All healthy controls were HBsAg EIA and PCR negative. Conclusions: 77% of PR patients presented the evidence of underlying HBV infection (genotype D2), suggestive of horizontal HBV transmission. This warrants for mass HBV vaccination. PR patients should be tested for underlying virus infections for appropriate therapy and management.
Indian Journal of Dermatology 2017 62(6):490-497
Background: The etiopathogenesis of Pityriasis rosea (PR), a papulo-squamous skin disease, remains elusive and hypothesized to be caused primarily by human herpesvirus (HHV) 6 or 7 or immune dysfunction. Aims: The recent increasing incidences of hepatitis B virus (HBV) infections, including asymptomatic occult HBV infections (OBIs), in a densely populated city in India, prompted us to investigate whether PR patients (from varied socioeconomic and immune status) harbor the underlying HBV infections. These cases were also investigated for HHV 6 and 7 infections. Materials and Methods: DNA from ethylenediaminetetraacetic acid blood samples from PR-diagnosed individuals (n = 13; mostly young adults) and healthy controls (n = 11) were subjected to virus gene-specific polymerase chain reactions (PCRs) for HBV and HHV 6 and 7. PCR products of expected length, when observed, were sequenced (bidirectional) using overlapping primers. Sequences were identified by NCBI BLAST and analyzed by multiple sequence alignment and phylogenetic studies. The blood samples were tested for HBsAg by EIA. Results: In 5/13 PR samples, only HBV DNA (4/5 being HBsAg negative) was detected, providing first-time evidence that PR may be manifested in asymptomatic HBV carriers. 6/13 cases were HHV 7 (not HHV 6) DNA positive, providing confirmatory molecular genetic evidence for the first time of PR association with HHV 7 from India. Surprisingly, 5/6 HHV 7-positive PR cases were also HBV positive. Overall, 10/13 PR samples showed evidence of HBV infection. 8/13 were OBI, harboring at least one OBI-signature S protein mutation. All healthy controls were HBsAg EIA and PCR negative. Conclusions: 77% of PR patients presented the evidence of underlying HBV infection (genotype D2), suggestive of horizontal HBV transmission. This warrants for mass HBV vaccination. PR patients should be tested for underlying virus infections for appropriate therapy and management.
Red eccrine chromhidrosis with review of literature
Ashok Kumar Jaiswal, Shilpashree P Ravikiran, Prasoon Kumar Roy
Indian Journal of Dermatology 2017 62(6):567-567
A 22-year-old male presented with reddish discoloration of the vest following perspiration for 6 months. He was a habituated consumer of cranberry juice. The peak absorption on spectrophotometric analysis of the extracted sweat coincided approximately with the peak absorption of diluted distillate of the juice. A diagnosis of eccrine chromhidrosis, probably due to the coloring agents in the juice, was considered. This rare case report emphasizes the possible side effect of the various coloring agents used as food additives.
Indian Journal of Dermatology 2017 62(6):567-567
A 22-year-old male presented with reddish discoloration of the vest following perspiration for 6 months. He was a habituated consumer of cranberry juice. The peak absorption on spectrophotometric analysis of the extracted sweat coincided approximately with the peak absorption of diluted distillate of the juice. A diagnosis of eccrine chromhidrosis, probably due to the coloring agents in the juice, was considered. This rare case report emphasizes the possible side effect of the various coloring agents used as food additives.
Clinico-epidemiological study of congenital ichthyosis in a tertiary care center of Eastern India
Arghyaprasun Ghosh, Rahul Ahar, Gobinda Chatterjee, Neha Sharma, Shruti Alhad Jadhav
Indian Journal of Dermatology 2017 62(6):498-503
Background: Congenital ichthyoses comprises various specific genetic diseases and can range from mild to very severe presentation. Furthermore, these may be associated with various syndromes. There is scanty data regarding the demographic profile and clinical features of patients with congenital ichthyosis in India. Aims and Objectives: The aim is to evaluate the epidemiology and clinical characteristics of various types of congenital ichthyoses. Materials and Methods: The study was conducted for 1 year from April 2013 to March 2014. Patients were evaluated for epidemiological profile and clinical features. Results: During the study of 1 year, 106 patients of congenital ichthyoses were identified. The most common of the various ichthyoses was ichthyosis vulgaris, followed by lamellar ichthyosis, X-linked recessive ichthyosis. One case of Netherton syndrome and one of ichthyosis hystrix were also identified. Conclusion: Various types of congenital ichthyoses present with different clinical features which range from mild to severe. These present with significant psychological stress to both patients and their families. Furthermore, all these diseases have significant implications of transmission to their offspring.
Indian Journal of Dermatology 2017 62(6):498-503
Background: Congenital ichthyoses comprises various specific genetic diseases and can range from mild to very severe presentation. Furthermore, these may be associated with various syndromes. There is scanty data regarding the demographic profile and clinical features of patients with congenital ichthyosis in India. Aims and Objectives: The aim is to evaluate the epidemiology and clinical characteristics of various types of congenital ichthyoses. Materials and Methods: The study was conducted for 1 year from April 2013 to March 2014. Patients were evaluated for epidemiological profile and clinical features. Results: During the study of 1 year, 106 patients of congenital ichthyoses were identified. The most common of the various ichthyoses was ichthyosis vulgaris, followed by lamellar ichthyosis, X-linked recessive ichthyosis. One case of Netherton syndrome and one of ichthyosis hystrix were also identified. Conclusion: Various types of congenital ichthyoses present with different clinical features which range from mild to severe. These present with significant psychological stress to both patients and their families. Furthermore, all these diseases have significant implications of transmission to their offspring.
Relapsed primary cutaneous diffuse large B-cell lymphoma, leg type
Shaohua Wu, Wei Gui, Liping Su, Yanfeng Xi
Indian Journal of Dermatology 2017 62(6):568-568
Indian Journal of Dermatology 2017 62(6):568-568
Clinical, histopathological characteristics and immunohistochemical findings in lichen planus pigmentosus
Ramesh M Bhat, Teena Ramesh Mathanda, CS Jayaprakash, Sukumar Dandakeri
Indian Journal of Dermatology 2017 62(6):504-509
Background: Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East. Aims: Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna. Materials and Methods: Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4+, CD8+ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed. Results: The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration <4 months had a more intense inflammatory infiltrate on histology. CD4+ and CD8+ cells showed very good Pearsons correlation on statistical analysis. CD45 was seen in association with CD8+, and staining for CD68 to assess the macrophage density showed a close correlation with CD45RO. Limitations: Small sample size. Conclusion: LPP represents a misguided lesional immune response pattern. The intense inflammatory infiltrate seen in the early lesions necessitates prompt treatment to arrest progression which may prevent the chronic pigmentary phase of the disease.
Indian Journal of Dermatology 2017 62(6):504-509
Background: Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East. Aims: Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna. Materials and Methods: Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4+, CD8+ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed. Results: The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration <4 months had a more intense inflammatory infiltrate on histology. CD4+ and CD8+ cells showed very good Pearsons correlation on statistical analysis. CD45 was seen in association with CD8+, and staining for CD68 to assess the macrophage density showed a close correlation with CD45RO. Limitations: Small sample size. Conclusion: LPP represents a misguided lesional immune response pattern. The intense inflammatory infiltrate seen in the early lesions necessitates prompt treatment to arrest progression which may prevent the chronic pigmentary phase of the disease.
“i hair”: A prognostic marker in alopecia areata & trichotillomania
Subrata Malakar, Purva Ranjit Mehta
Indian Journal of Dermatology 2017 62(6):550-552
Trichoscopy as an investigative tool is revolutionizing the diagnosis of hair disorders. The use of a trichoscope has unveiled a plethora of signs which not only helps in decoding the underlying tricoscopic condition but also acts as prognostic markers. Herein, we present a new trichoscopic sign, "i hair" in alopecia areata and trichotillomania. "i hair" are short hairs with an accentuated distal end. There may be a thin hypopigmented shaft just beneath the darker distal end, thus making them resemble the alphabet "i."
Indian Journal of Dermatology 2017 62(6):550-552
Trichoscopy as an investigative tool is revolutionizing the diagnosis of hair disorders. The use of a trichoscope has unveiled a plethora of signs which not only helps in decoding the underlying tricoscopic condition but also acts as prognostic markers. Herein, we present a new trichoscopic sign, "i hair" in alopecia areata and trichotillomania. "i hair" are short hairs with an accentuated distal end. There may be a thin hypopigmented shaft just beneath the darker distal end, thus making them resemble the alphabet "i."
Cutaneous adverse drug reactions in a tertiary care teaching hospital in India: An intensive monitoring study
Sejal Thakkar, Tejas K Patel, Roshni Vahora, Prakash Bhabhor, Raksha Patel
Indian Journal of Dermatology 2017 62(6):510-517
Background: The epidemiological data based on intensive monitoring studies are limited for the cutaneous adverse drug reactions (CADRs) in terms of incidence. Most of earlier Indian studies focused only on types and causative drugs of CADRs. Aim: The aim of this study is to analyze the CADRs with reference to the incidence, its subgroup analysis, causative drugs, and other clinical characteristics in Indian population. Methodology: Intensive monitoring study was carried out over a period of 3 years in the dermatology outpatient and inpatient department. CADRs due to only systematically administered drugs were considered. The WHO definition for CADR, the WHO causality definitions, modified Schumock and Thornton's criteria for preventability, and International Conference on Harmonisation E2A guidelines for seriousness were considered. Incidence was expressed in percentage and its 95% confidence interval. The incidence was analyzed on basis of characteristics of study population and CADRs. Results: A total of 171 CADRs were observed from 37,623 patients. The CADR incidence was 0.45% (95% CI: 0.39–0.53). The incidence did not significantly differ in different age groups and gender. Commonly observed CADRs were maculopapular rash (23.98%), urticaria (21.64%), and fixed drug eruptions (FDEs) (18.13%). Antimicrobials (35.18%) and nonsteroidal anti-inflammatory drugs (NSAIDs) were suspected in all common CADRs. Anti-infective and NSAIDs were most commonly suspected drugs in overall CADRs, maculopapular rash, urticaria, FDEs, and erythema multiforme. The exact nature of drugs remained inaccessible in one-fourth cases due to use of the over-the-counter self-medications. The incidence of preventable and serious and fatal CADRs was 0.08% (95% CI: 0.05–0.11), 0.04% (95% CI: 0.02–0.06), and 0.003% (95% CI: 0.000–0.001), respectively. Conclusion: Ethnic characteristics should be considered while interpreting incidence from the international studies. The demographic characteristics of study population do not affect the incidence of CADRs. Indian patients should be sensitized about hazards of self-medications.
Indian Journal of Dermatology 2017 62(6):510-517
Background: The epidemiological data based on intensive monitoring studies are limited for the cutaneous adverse drug reactions (CADRs) in terms of incidence. Most of earlier Indian studies focused only on types and causative drugs of CADRs. Aim: The aim of this study is to analyze the CADRs with reference to the incidence, its subgroup analysis, causative drugs, and other clinical characteristics in Indian population. Methodology: Intensive monitoring study was carried out over a period of 3 years in the dermatology outpatient and inpatient department. CADRs due to only systematically administered drugs were considered. The WHO definition for CADR, the WHO causality definitions, modified Schumock and Thornton's criteria for preventability, and International Conference on Harmonisation E2A guidelines for seriousness were considered. Incidence was expressed in percentage and its 95% confidence interval. The incidence was analyzed on basis of characteristics of study population and CADRs. Results: A total of 171 CADRs were observed from 37,623 patients. The CADR incidence was 0.45% (95% CI: 0.39–0.53). The incidence did not significantly differ in different age groups and gender. Commonly observed CADRs were maculopapular rash (23.98%), urticaria (21.64%), and fixed drug eruptions (FDEs) (18.13%). Antimicrobials (35.18%) and nonsteroidal anti-inflammatory drugs (NSAIDs) were suspected in all common CADRs. Anti-infective and NSAIDs were most commonly suspected drugs in overall CADRs, maculopapular rash, urticaria, FDEs, and erythema multiforme. The exact nature of drugs remained inaccessible in one-fourth cases due to use of the over-the-counter self-medications. The incidence of preventable and serious and fatal CADRs was 0.08% (95% CI: 0.05–0.11), 0.04% (95% CI: 0.02–0.06), and 0.003% (95% CI: 0.000–0.001), respectively. Conclusion: Ethnic characteristics should be considered while interpreting incidence from the international studies. The demographic characteristics of study population do not affect the incidence of CADRs. Indian patients should be sensitized about hazards of self-medications.
Rational for drug dosimetry and duration of terbinafine in the context of recalcitrant dermatophytosis: Is 500 mg better than 250 mg OD or BD?
Kabir Sardana, Aastha Gupta
Indian Journal of Dermatology 2017 62(6):557-559
Indian Journal of Dermatology 2017 62(6):557-559
Inpatient mortality resulting from dermatological disorders at a tertiary care center in Eastern India: A record-based observational study
Satyendranath Chowdhury, Indrashis Podder, Abanti Saha, Debabrata Bandyopadhyay
Indian Journal of Dermatology 2017 62(6):518-521
Background: Contrary to popular perception, several dermatological conditions may be associated with lethal outcome in the absence of timely intervention or due to complications. Aims: The aim was to estimate the number of deaths and analyze their causes due to skin disorders at a tertiary level inpatient dermatology ward. Materials and Methods: We conducted a retrospective, record-based observational study involving 538 patients spanning over 4 years (2013–2016) at our dermatology indoor setup. Results: There were 45 deaths (male:female = 1.5:1), accounting for 8.4% or total admissions, occurring mostly in patients in their 7th decade. Vesiculobullous disorders were the most frequent cause of mortality (57.8%), followed by drug reactions accounting for 17.8% of cases. In the former group pemphigus vulgaris accounted for most deaths (31.1%) followed by bullous pemphigoid (17.8%) and pemphigus foliaceus (8.9%), whereas toxic epidermal necrolysis was the most frequent cause of death from drug reactions (8.9%). Almost half of all deaths (48.9%) occurred due to septicemia followed by cardiopulmonary complications (40%). Most of the cases presented to us at an advanced state of the disease previously being treated inappropriately. Conclusion: Prompt diagnosis and treatment of such dermatological conditions are mandated, preferably in an intensive care set-up, to reduce mortality rates. Advanced age, the area of skin involvement, mucosal involvement, and septicemia were adverse prognostic factors in these patients.
Indian Journal of Dermatology 2017 62(6):518-521
Background: Contrary to popular perception, several dermatological conditions may be associated with lethal outcome in the absence of timely intervention or due to complications. Aims: The aim was to estimate the number of deaths and analyze their causes due to skin disorders at a tertiary level inpatient dermatology ward. Materials and Methods: We conducted a retrospective, record-based observational study involving 538 patients spanning over 4 years (2013–2016) at our dermatology indoor setup. Results: There were 45 deaths (male:female = 1.5:1), accounting for 8.4% or total admissions, occurring mostly in patients in their 7th decade. Vesiculobullous disorders were the most frequent cause of mortality (57.8%), followed by drug reactions accounting for 17.8% of cases. In the former group pemphigus vulgaris accounted for most deaths (31.1%) followed by bullous pemphigoid (17.8%) and pemphigus foliaceus (8.9%), whereas toxic epidermal necrolysis was the most frequent cause of death from drug reactions (8.9%). Almost half of all deaths (48.9%) occurred due to septicemia followed by cardiopulmonary complications (40%). Most of the cases presented to us at an advanced state of the disease previously being treated inappropriately. Conclusion: Prompt diagnosis and treatment of such dermatological conditions are mandated, preferably in an intensive care set-up, to reduce mortality rates. Advanced age, the area of skin involvement, mucosal involvement, and septicemia were adverse prognostic factors in these patients.
Clinical and genetic characteristics of xeroderma pigmentosum in Nepal
Summary
Background
Little is known about xeroderma pigmentosum (XP) in Himalayan countries.
Objective
To describe clinical characteristics of XP in Nepal and investigate its genetic bases.
Methods
This study was carried out on all consecutive patients referred for XP to a Nepalese tertiary referral centre in 2014-2015. Clinical data were collected using a standardized questionnaire. DNA was extracted from salivary samples and next generation sequencing (NGS) was conducted using a panel covering all 8 known XP genes (classical XP (XPA to XPG) and XP variant) and a skin cancer modifier gene, the melanocortin 1 receptor gene (MC1R).
Results
Seventeen patients (median age: 15 years; range: 1-32) were included. Twelve had skin cancers (including a total of 8 squamous cell carcinomas, 60 basal cell carcinomas, ocular carcinomas requiring an orbital exenteration in 3 patients, but no melanoma). Fifteen patients carried the same homozygous nonsense XPC mutation c.1243C>T, p.R415X. A homozygous nonsense XPA mutation (p.W235X) was found in the only patient with a history of early severe sunburn reaction and associated neurologic symptoms. Associated genetic alterations included heterozygous missense variants in XPD/ERCC2 gene and the presence of MC1R variant R163Q in 5 and 9 patients, respectively.
Conclusion
Although not previously reported, XP seems frequent in Nepal. Patients often presented with a very severe phenotype after a long history of excessive sun exposure without knowledge of the disease. 15/17 had the same p.R415X XPC mutation, which seems very specific of XP in Nepal, suggesting a founder effect. NGS analyses frequently revealed associated genetic alterations which could play a modifier role in the clinical expression of the disease.
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Non-melanoma Hutchinson's sign: A reappraisal of this important, remarkable melanoma simulant
Abstract
Background
More than 20 years ago our reappraisal of the Hutchinson Sign (HS) gave birth to the concept of the Pseudo-Hutchinson sign.
Objectives
We have found it interesting to emphasize some important histologic points and to expand the list of the numerous HS simulants.
Methods
We have examined the cutaneous samples taken from the pigmented skin of patients in association with nail matrix biopsy. We have also extended the long list of non-melanoma HS.
Results
Histologically HS may present only as an epidermal pigmentation, depending on the area sampled. Occasionally, there may be a sparse junctional melanocytic proliferation which does not demonstrate cytologic atypia due to an underlying melanocytic nevus of the nail matrix. However, early HS can show a melanoma in situ, with a HS at the proximal nail fold (PNF) and confluent atypical melanocytes in the nail matrix. Finally, involvement of the proximal nail fold, nail matrix and nail bed containing atypical melanocytes in irregular array may be seen.
Conclusion
The mere presence of periungual pigmentation is neither clinically nor histologically pathognomonic of subungual melanoma and justifies the usefulness of this work stressing the non-melanoma HS.
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In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5-fluorouracil
Abstract
Background
Histological examination is the gold standard for actinic keratosis diagnosis; however, it is not always a feasible approach. Reflectance confocal microscopy (RCM) is a non-invasive technique that may be an alternative for monitoring actinic keratoses treatment response. Topical 5-fluorouracil is indicated for actinic keratosis multiple lesions and for field cancerization treatment.
Objectives
To assess the RCM accuracy, sensibility and specificity for actinic keratosis, considering as a gold-standard the histopathological examination; as well as to evaluate the efficacy of 5% 5-fluorouracil treatment.
Methods
This is a prospective study in actinic keratosis patients between August, 2014 and November, 2015. RCM analyses were performed in one randomly selected actinic keratosis lesion of the upper limbs by two independent observers before and after 5% 5-fluorouracil treatment. At the end of treatment and with clinical bleaching of treated lesions, histological examination was performed by two pathologists.
Results
A total of 50 lesions were enrolled, and 40 lesions presented complete clinical bleaching after treatment and were included in the final analysis. Accuracy, sensibility and specificity means among observers were 83.8%, 84.6% and 83.3%, respectively. After 5-fluorouracil treatment, actinic keratosis was diagnosed in 45.0% (observer 1) and 32.5% (observer 2) of subjects according to RCM and in 32.5% of subjects according to histological examination. Considering RCM observers diagnosis, the concordance was substantial (k 0,637, p<0,001). 5-fluorouracil led to a reduction in 55.0%-67.5% of actinic keratoses according to RCM analysis.
Conclusion
This study allows to validate of RCM as a non-invasive method capable of monitoring actinic keratosis therapeutic response to 5-fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5-fluorouracil may be a satisfactory option for therapeutic control of this condition.
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Novel device-based acne treatments: comparison of a 1,450-nm diode laser and micro-needling radiofrequency on mild to moderate acne vulgaris and seborrhea in Korean patients through a 20-week prospective, randomized, split-face study
Abstract
Background
While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1,450-nm diode laser (DL) and fractional micro-needling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodeling effects.
Objective
To compare the clinical course for acne treatment between DL and FMR.
Methods
Twenty five Korean patients with mild to moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated.
Results
Both DL and FMR demonstrated steady improvement of acne and seborrhea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow up. Patients' subjective assessments for seborrhea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety proflie, no significant difference was observed between two regimens, while mild post inflammatory hyperpigmentation was observed only in DL side.
Conclusion
Both DL and FMR demonstrated efficacies for acne and seborrhea, with reasonable safety proflie. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.
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Educational and Practice Gaps in the Management of Volar Melanocytic Lesions
Abstract
Background
The benign and malignant patterns of acral melanocytic nevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A 3-step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population.
Objectives
Our study aimed to review the current management strategy of acral melanocytic lesions and to investigate the utility of the 3-step algorithm in a predominately Caucasian cohort.
Methods
A retrospective search of the pathology and image databases at Mayo Clinic was performed between the years 2006 – 2016. Only cases located on a volar surface with dermoscopic images were included. Two dermatologists reviewed all dermoscopic images and assigned a global dermoscopic pattern. Clinical and follow-up data was gathered by chart review. All lesions with known diameter and pathological diagnosis were used for the 3-step algorithm.
Results
Regular fibrillar and ridge patterns were more likely to be biopsied (p=0.01). The majority of AMN (58.1%) and AM (60%) biopsied were due to physician-deemed concerning dermoscopic patterns. 39.2% of these cases were parallel furrow, lattice-like, or regular fibrillar. When patients were asked to follow-up within a 3-6-month period, only 16.7% of the patients returned within that interval. The 3-step algorithm would have correctly identified 4/5 AM for biopsy, missing a 6mm, multi-component, invasive melanoma.
Conclusion
We found one major educational gap in the recognition of low risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low-risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow up and the potential insensitivity of the 3-step algorithm to small multi-component acral melanocytic lesions.
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Cutaneous granuloma caused by Rhizopus oryzae with a novel mutation in the CYBB gene in a monozygotic male twin
Abstract
A 2-year-old Chinese boy presented to our institution with a large lump in the sacrococcygeal region for two months, along with fever for five days. The initial lesion presented as a red papule accompanied by itching, and then progressed to 10 cm in diameter (Fig. 1a). Five days previously, the patient had developed a fever.
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Response to – Bullous pemphigoid inguinalis?
Abstract
We appreciate the constructive comments by author Abdelmaksoud in response to our report of bullous pemphigoid (BP) presenting in association with metastatic penile squamous cell carcinoma (SCC). Though our patient had few blisters on the back, upper limbs and oral cavity, the chief brunt of the disease was on the inguinal area. Cases of localized BP, arising after radiotherapy for breast carcinoma have been reported. Our patient developed BP before receiving radiotherapy.
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Bullous Pemphigoid Inguinalis?
Abstract
I read with great interest a case report by Bishnoi et al. published recently in the journal of European Academy of Dermatology and Venereology. The authors presented a case of a 43-year old man who had history of penile SCC, presented with bullous pemphigoid (BP) lesions. Interestingly, the BP lesion was limited to the inguinal region, suprapubic area and inner aspect of the right thigh, that was predominantly on top of the bilateral metastatic inguinal lymphadenopathy(LN).
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Electrochemotherapy of unresectable cutaneous tumors with reduced dosages of intravenous bleomycin: analysis of 57 patients from the InspECT (International network for sharing practices of ElectroChemoTherapy) registry
Abstract
Background
Electrochemotherapy (ECT) is currently used to treat unresectable superficial tumors of different histotypes through the combination of cytotoxic chemotherapy and local application of electric pulses. In 2006, a collaborative project defined the ESOPE (European Standard Operating Procedures of Electrochemotherapy) guidelines to standardize the procedure. The International Network for Sharing Practices of Electrochemotherapy (InspECT) aims to to refine the ESOPE and improve clinical practice. Limiting patient exposure to systemic chemotherapy would be advisable in order to ameliorate ECT safety profile.
Objective
The aim of this study was to evaluate the efficacy and toxicity of ECT with reduced chemotherapy dosages.
Methods
In a retrospective analysis of a prospectively maintained database (InspECT registry), we evaluated the outcome of patients who received ECT with reduced dosages of bleomycin (7.500, 10.000, or 13.500 IU/m2, instead of the standard dose of 15.000 IU/m2). Tumor response in melanoma patients was compared with melanoma patients of the InspECT registry who received the standard dose of bleomycin.
Results
We identified 57 patients with 147 tumors (melanoma, 38.6%; squamous cell carcinoma, 22.8%; basal cell carcinoma, 17.5%; breast cancer 7%, Kaposi sarcoma 7%, other histotypes, 7.1%. Per-tumor complete response (CR) rate at 60 days was 70.1% (partial, 16.3%); per-patient CR was 57.9% (partial, 21.1%). Local pain was the most frequently reported side effect (n=22 patients [39%], mostly mild; 2 patients experienced flu-like symptoms, 1 patient nausea. We observed the same CR rate (55%) in melanoma patients treated by reduced or conventional bleomycin dosages (p=1.00).
Conclusions
ECT performed with reduced bleomycin dosages could be as effective as with currently recommended dose. Patients with impaired renal function or candidate to multiple ECT cycles could benefit from a reduced dose protocol. Our findings need prospective confirmation before being adopted in clinical practice.
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Does obesity cause a distinct phenotype of hidradenitis suppurativa?
Abstract
I have read the article by Theut Riis et al proposing BMI based clinical subtypes of hidradenitis suppurativa (HS) patients with interest. In addition to giving valuable clinical information, the article is important in the discussion of the pathophysiology of such HS subgroups, with focus on the obese subtype. The papers main difference from earlier clinical proposals of subtyping is the focus on the body mass index (BMI) as a functional factor in the disease evolution.
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PCDD/PCDF formation in the chlor-alkali process—laboratory study and comparison with patterns from contaminated sites
Abstract
Studies on the formation of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) during the electrolysis of sodium chloride solution (brine) using graphite or titanium electrodes were carried out at a laboratory scale. High concentrations of PCDFs but no PCDDs were formed in tests using graphite electrodes. With titanium electrodes, PCDFs were only formed when tar pitch was added and mainly originated from the dibenzofuran present in the tar. For the first time, a detailed assessment of the formation of mono- to octachlorinated PCDD/PCDF from tar pitch was investigated. The assessment included of the chlorination steps proved that PCDFs were formed by successive lateral chlorinated from dibenzofuran to MonoCDFs, DiCDFs, and TriCDFs to form the typical known "chlorine pattern" of TetraCDF to OctaCDF with a dominance of 1,2,7,8- and 2,3,7,8-TetraCDFs, 1,2,3,7,8-PentaCDF, and 1,2,3,4,7,8-HexaCDF as marker congeners. The final homologue distributions depended on reaction time and reaction temperature. In addition, electrolysis with non-chlorinated dibenzo-p-dioxins, dibenzofuran, and biphenyl was carried out. As a result, PCDDs, PCDFs, and PCB were formed at comparable yields. Congener patterns in soil samples from a PCDD/F-contaminated site where chlor-alkali electrolysis had been operated for decades in Japan had identical isomer distribution demonstrating the source and contamination potential and risk of these processes. Therefore, sites where in the past 120 years chlor-alkali electrolysis has been operated or where residues from chlor-alkali production or other chlorine using industries have been disposed should be assessed for their pollution level and exposure relevance. The assessment of total organohalogen content revealed that PCDF is only a small fraction of organohalogens in the contaminated soils. For an appropriate risk assessment, also other chlorinated aromatic compounds such as PCBs or PCNs need to be considered.
Dysregulatory effects of retinoic acid isomers in late zebrafish embryos
Abstract
All-trans retinoic acid (atRA) and 9-cis retinoic acid (9cRA) are two natural derivatives of vitamin A that contribute to the normal vertebrate development by affecting gene expression through the retinoic acid signalling pathway. We show transcriptomic effects of the ectopic addition of atRA or 9cRA to zebrafish embryos at the posthatching embryonic stage. Exposure for 24 or 72 h to sublethal concentrations of both isomers resulted in characteristic transcriptome changes, in which many proliferation and development-related genes became underexpressed, whereas genes related to retinoid metabolism and some metabolic functions became overrepresented. While short and long exposures elicit essentially the same set of genes, atRA specifically induced expression of a specific subset of proteases, likely acting at the extracellular level, and of elements of the response to xenobiotics. These results reflect the well-known antiproliferative activity of retinoids, and they suggest a dysregulation of the developmental process at final stages of embryogenesis. They also indicate a potential role of endopeptidases as markers of developmental alterations, as well as their possible control by the retinoic signalling pathway. We propose to monitor mRNA levels of cyp16a, cyp16b, and cyp16c in zebrafish embryos as a bioassay for retinoid disruption.
Enhanced phosphorus removal using acid-treated magnesium slag particles
Abstract
Magnesium-enriched magnesium slag particles (MSPs) can be used as an adsorption substrate as well as the magnesium source for struvite precipitation. In this study, an HCl treatment was used to enhance MSPs for phosphorus removal. After soaking in 1 mol/L HCl, an 11.27% decrease in median diameter (D50) and a 6.73% increase in specific surface area were observed when compared with the original MSPs. The improvement of the MSP surface properties resulted in 188.96 mg/kg increase in the PO43− adsorption capacity. Irrespective of HCl treatment, the phosphorus adsorption process followed the Dubinin–Radushkevich (D–R) model much more accurately than the Langmuir and Freundlich equations with correlation coefficients higher than 0.94. The adsorption free energy obtained through the D–R model revealed a 9.75% decrease after HCl treatment. Sequential fraction extraction results indicated that 96% of the Mg2+ released from the HCl-treated MSPs came from acid-soluble magnesium (exchangeable and carbonate-bound). Mg2+ obtained from HCl-treated solutions provided a reliable magnesium source for struvite precipitation. The PO43− removal rate can reach 53.63% with the optimal pH value of 10.0 and molar ratio of NH4+ to PO43− of 1:1. Struvite precipitation and adsorption can simultaneously occur in HCl-treated MSP solution. It contributed 63.19% to the overall PO43− removal and is a major contributor compared with adsorption. Thus, HCl treatment greatly enhanced the potential of MSPs for phosphorus removal due to an improved adsorption capacity and is a reliable Mg2+ source for struvite precipitation.
Volatile organic compounds and nitric oxide as responses of a Brazilian tropical species to ozone: the emission profile of young and mature leaves
Abstract
The emission profile of volatile organic compounds (VOCs) and nitric oxide (NO) in young and mature leaves of Croton floribundus was assessed in plants exposed to filtered air (FA) and ozone-enriched filtered air (FA+O3). After the period of exposure, leaves were enclosed in polyethylene terephthalate bags and VOCs were collected in young and mature leaves. Both young and mature leaves constitutively emitted the same VOC, but the concentrations were higher in young leaves. O3 exposure induced the emission of sesquiterpenes (mainly β-caryophyllene) known as antioxidant compounds that may scavenge O3. Young leaves were the highest emitters of sesquiterpenes. O3 induced a rapid accumulation of NO in different tissues and leaf developmental stages; this accumulation was marked in palisade and spongy parenchyma cells in young and mature leaves, respectively. O3 altered the levels of the signaling compound methyl salicylate (MeSA). Moreover, our data showed that NO together with VOC emissions, such as geranyl acetate, α-cadiene, trans-farnesol, cis-β-farnesene, and MeSA, participate of plant defense mechanisms against the oxidative damage caused by O3.
The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis
Abstract
Atopic dermatitis (AD) and hand eczema (HE) are common chronic and relapsing inflammatory skin conditions that often co-occur. While several studies have addressed their relationship, the exact association estimate is unknown. We systematically reviewed published literature on the association between AD and HE in PubMed, Embase, and Web of Science using the following search terms; (atopic dermatitis OR atopic eczema) AND (hand dermatitis OR hand eczema). Meta-analyses were then performed to examine the association between AD and the point-, one-year- and lifetime prevalence of HE, respectively. We identified 35 relevant studies, of which 26 were included in the meta-analyses. AD was associated with an increased prevalence of HE with regards to point- (odds ratio (OR) 2.35; 95% CI: 1.47-3.76), one-year- (OR 4.29; 95% CI: 3.13-5.88), and lifetime prevalence (OR 4.06; 95% CI: 2.72-6.06). Furthermore, positive associations between AD and occupational HE were identified when assessing the one-year- 4.31 (95% CI: 2.08-8.91) and lifetime prevalence (OR 2.81; 95% CI: 2.08-3.79). Similar positive associations were found in the general population studies, i.e. OR 4.19 (95% CI: 3.46-5.08) and OR 5.69 (95% CI: 4.41-7.36). Important study limitations include the wide use of questionnaire studies, and lack of prospective studies as well as poor clinical phenotype descriptions. In conclusion, our systematic review and meta-analysis showed that patients with AD had a strongly increased prevalence of HE. Clinicians should continue to guide patients with AD away from occupations with high risk of HE.
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Ex-vivo flush of the limb allograft reduces inflammatory burden prior to transplantation
Passenger leukocytes and inflammatory debris transferred from the donor limb to the recipient can induce allorecognition, which activates the host immune response. This is the first study to evaluate whether the transfer of this inflammatory burden can be reduced via post-preservation flush prior to revascularisation, and whether this is influenced by ischaemia.
Estimating the cost of skin cancer detection by dermatology providers in a large healthcare system
Data on the cost and efficiency of skin cancer detection through total body skin examination (TBSE) are scarce.
Differentiating Merkel cell carcinoma of lymph nodes without a detectable primary skin tumor from other metastatic neuroendocrine carcinomas: the ELECTHIP criteria
-Merkel cell carcinoma may initially present in lymph nodes without an evident primary skin tumor.-When this occurs the tumor may be misdiagnosed as lymph node metastasis from other neuroendocrine carcinomas. -The ELECTHIP criteria assists in differentiating between these diagnoses and may help classify patients with neuroendocrine lymph node metastasis.
Dermoscopy of different stages of lymphomatoid papulosis
Abstract
A 47-year-old man presented with a 3-year history of asymptomatic, erythematous papules and nodules located on his trunk, buttocks and limbs (Fig.1). Lesions were at different stages of clinical development: some were crusted or ulcerated, other necrotic or cicatricial. The patient's medical history was not relevant.
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BRAF internal deletions and resistance to BRAF/MEK inhibitor therapy
Abstract
BRAF and MEK inhibitors have improved clinical outcomes in advanced, BRAFV600- mutated melanomas. Acquired resistance occurs in most patients, with numerous and diverse drivers. We obtained pre-treatment and progression biopsies from a patient who progressed on dabrafenib and trametinib. In addition to a preserved BRAFV600E mutation, an internal deletion (rearrangement) of BRAF was observed in the progression sample. This deletion involved exons 2-8, which includes the Ras-binding domain, and is analogous to previously documented BRAF fusions and splice variants known to reactivate RAS-RAF-MEK-ERK signaling. In a large cohort of melanomas, 10 additional internal deletions were identified (0.4% of all melanomas; 9 of which had concurrent BRAF mutations), as well as sporadically in other tumor types. Thus, we describe a novel mechanism of resistance to BRAF and MEK inhibition.
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Value of in vitro acoustic radiation force impulse application on uterine adenomyosis
Abstract
Purpose
Adenomyosis is the presence of endometrial glandular and stromal tissue in the myometrium. This phenomenon can be the cause of excessive bleeding and menstrual pain in premenopausal women. Diagnosis of adenomyosis may present difficulty with conventional methods such as ultrasound and magnetic resonance imaging. Frequently, diagnosis is accomplished retrospectively based on the hysterectomy specimen.
Materials and methods
This is a prospective case control study done in vitro on 90 patients' hysterectomy specimens. Acoustic radiation force impulse (ARFI) and color elastography were used to determine the elasticity of hysterectomy specimens of patients undergoing indicated surgeries. Based on histopathological examinations, two groups were formed: a study group (n = 28—with adenomyosis) and a control group (n = 62—without adenomyosis).
Results
Elasticity measurements of tissue with adenomyosis were observed to be significantly higher than measurements of normal myometrial tissue (p < 0.01). Uterine fibroids were found to have higher values on ARFI study compared to normal myometrial tissues (p < 0.01).
Conclusion
The findings lead to the conclusion that adenomyosis tissue is significantly softer than the normal myometrium. ARFI was found to be beneficial in differentiating myometrial tissue with adenomyosis from normal myometrial tissue. It was found to be feasible and beneficial to implement ARFI in daily gynecology practice for diagnosis of adenomyosis.
Clinical and photobiological response in eight patients with solar urticaria under treatment with omalizumab, and review of the literature
Abstract
Background
Solar urticaria (SU) is a rare photodermatosis. Treatment is challenging and outcomes are often disappointing. Omalizumab is an anti-IgE, currently approved for treatment of chronic spontaneous urticaria. We sought to evaluate therapy with omalizumab in refractory SU and describe predictive factors for response.
Materials/methods
Patients with refractory SU under treatment with omalizumab were included in this study. Clinical outcome was evaluated using the Urticaria Activity score 7 (UAS7), Dermatology Life Quality Index (DLQI) and Pruritus Visual Analogue scale (VAS). Complete clinical response (CCR) was defined as having an UAS7=0, DLQI<6 and VAS=0. Phototesting was performed and compared to baseline.
We performed a PUBMED search to identify reported cases of SU in adults treated with omalizumab, analyzing their characteristics in order to predict response to omalizumab
Results
Eight patients were included. Median age was 45.5 years (range, 23-64). Light spectrum most commonly implicated was UV-A. Clinical outcomes: 89% (7/8) achieved CCR with omalizumab. Phototesting was normal in 42.8% (3/7) of them.
In our review we identified 38 patients (including the current case series), 68.4% showed favourable outcomes with omalizumab. Median time since onset of SU was lower in responders.
Conclusions
Omalizumab can be an effective treatment in refractory SU
Fast trace determination of nine odorant and estrogenic chloro- and bromo-phenolic compounds in real water samples through automated solid-phase extraction coupled with liquid chromatography tandem mass spectrometry
Abstract
A fast and reliable method was developed for simultaneous trace determination of nine odorous and estrogenic chloro- and bromo-phenolic compounds (CPs and BPs) in water samples using solid-phase extraction (SPE) coupled with liquid chromatography tandem mass spectrometry (LC-MS/MS). For sample preparation, the extraction efficiencies of two widely applied cartridges Oasis HLB and Sep-Pak C18 were compared, and the Oasis HLB cartridge showed much better extraction performance; pH of water sample also plays important role on extraction, and pH = 2–3 was found to be most appropriate. For separation of the target compounds, small addition of ammonium hydroxide can obviously improve the detection sensitivity, and the optimized addition concentration was determined as 0.2%. The developed efficient method was validated and showed excellent linearity (R 2 > 0.995), low limit of detection (LOD, 1.9–6.2 ng/L), and good recovery efficiencies of 57–95% in surface and tap water with low relative standard deviation (RSD, 1.3–17.4%). The developed method was finally applied to one tap and one surface water samples and most of these nine targets were detected, but all of them were below their odor thresholds, and their estrogen equivalent (EEQ) were also very low.
A procedure to evaluate the factors determining the elemental composition of PM 2.5 . Case study: the Veneto region (northeastern Italy)
Abstract
The Po Valley is one of the most important hot spots in Europe for air pollution. Morphological features and anthropogenic pressures lead to frequent breaching of air quality standards and to high-pollution episodes in an ~46 × 103-km2-wide alluvial lowland. Therefore, it is increasingly important to study the air quality in a wide geographical scale to better implement possible and successful mitigation measures. The Veneto region lies in the eastern part of the Po Valley and the elemental composition of PM has been mainly studied in the Venice area, whereas scarce data are available for the remaining territory of the region. In this study, the elemental composition of PM2.5 was investigated over 1 year (2012–2013) at six major cities of the Veneto region. Samples were analyzed for 16 elements (Ca, Al, Fe, S, K, Mg, Ti, Mn, Zn, Ba, As, Ni, Pb, Sb, V, and Cu), and results were processed to investigate spatial and seasonal variations, the influence of meteorological factors, and the most probable sources by using a procedure based on (i) elemental ratios (Cu/Sb, Cu/Zn, Cu/Pb, Mn/V, V/Ni, and Zn/Pb), (ii) cluster analysis on wind data, and (iii) conditional probability function (CPF). The percentage of elements in PM2.5 ranged between 11 and 20%, and Ca and S were the most abundant elements in the region. Typical seasonal variations and similar trends were exhibited by each element, especially in the lowland. Some elements such as Zn, K, Mn, Pb, and Sb were found at high concentrations during the cold period. However, no similar dispersion processes were observed throughout the region, and their concentrations were mostly depending on individual local sources. In the alpine and foothill parts of the region, lower concentrations were recorded with respect to the Po Valley cities, which resulted enriched of most of the elements considered in this study. The cluster analysis on wind data and the CPF of the ratio-related sources demonstrated that a widespread pollution condition exists in the region, apart from the coastal area. However, specific directions (e.g., a link with high-traffic roads, industrial areas, and airports) resulted the most probable explanation for each ratio-related source. In addition, the Veneto region hosts one of the most important Mediterranean ports for the cruise sector (Venice harbor), and its impact was previously demonstrated in the historical city center. In this study, the impact of Venice shipping emissions was estimated to be 3.5% of PM2.5 in some particular days.
Evaluation of sources and fate of nitrates in the western Po plain groundwater (Italy) using nitrogen and boron isotopes
Abstract
Diffuse nitrate pollution in groundwater is currently considered one of the major causes of water quality degradation. Determining the sources of nitrate contamination is an important first step for a better management of water quality. Thus, the isotopic composition of nitrate (δ15NNO3 and δ18ONO3) and boron (δ11B) were used to evaluate nitrate contamination sources and to identify geochemical processes occurring in the shallow and deep aquifers of the Turin-Cuneo plain (NW Italy). The study area is essentially an agricultural zone, where use of synthetic nitrogenous fertilizers and organic manure is a common practice and the connection to sewer services is locally lacking. Also livestock farming are highly developed. A groundwater sampling campaign was performed on 34 wells in the shallow aquifer and 8 wells in the deep aquifers, to analyze nitrate, chloride, boron, δ15NNO3, δ18ONO3 and δ11B. Isotope data of nitrate indicate that nitrate contamination in the Turin-Cuneo plain originates from mixtures of synthetic and organic sources, slightly affected by denitrification, and manure or septic tank effluents. Moreover, boron isotopes were used to discriminate further among the main anthropogenic sources of pollution. The analyses results confirm that both animal manure and domestic sewage, especially under the city of Turin, can contribute to the nitrate contamination. The isotope analysis was also used for the evaluation of denitrification and nitrification processes: contrary to expectations, a significant denitrification phenomenon was assessed only in the shallow unconfined aquifer, especially in the Poirino Plateau, the most contaminated sector of the study area.
Study on diesel vertical migration characteristics and mechanism in water-bearing sand stratum using an automated resistivity monitoring system
Abstract
Oil spills frequently occur on both land and sea. Petroleum in mobile phase will cause serious pollution in the sediment and can form a secondary pollution source. Therefore, it is very important to study the migration of petroleum in sediments ideally in a rapid and simplified approach. The release of diesel was simulated using fine beach sand to construct a model aquifer, and dynamic monitoring was carried out using an automated monitoring system including a resistivity probe originally developed by our research group. The mobile phase migration fronts were determined accurately using wavelet analysis method combined with resistivity curve method. Then, a relationship between resistivity and the joint oil–water content was established. The main conclusions were as follows. The seepage velocity of the diesel with high mobility at the initial stage of infiltration was faster, followed by a period when gravity seepage was dominant, and finally a redistribution period at the later stage, which was mainly an oil–water displacement process. The resistivity trends for diesel infiltration in different water-saturated soil layers varied with depth. The resistivity in the vadose zone fluctuated significantly, increasing initially and later decreasing. The resistivity change in the capillary zone was relatively small and constant in the initial stage; then, it increased and subsequently decreased. The resistivity in the saturated zone was basically unchanged with depth, and the value became slightly larger than the background value over time. Overall, for a large volume of mobile phase diesel leakage, the arrival migration fronts can be detected by wavelet analysis combined with resistivity curves. The thickness of the oil slick in the capillary zone can be estimated by resistivity changes. The relationships between resistivity and both the moisture content and oil–water joint saturation are in agreement with the linear models. The research results provide basic data and a new data processing method for monitoring of contaminated sites following major oil spills using the resistivity method.
Building Healthy Start Grantees’ Capacity to Achieve Collective Impact: Lessons from the Field
Abstract
Purpose While Healthy Start has emphasized the need for multi-sectorial community engagement and collaboration since its inception, in 2014 Healthy Start adopted Collective Impact (CI) as a framework for reducing infant mortality. This paper describes the development of a peer-focused capacity-building strategy that introduced key elements of CI and preliminary findings of Healthy Start grantees' progress with using CI as an approach to collaboration. Description The Collective Impact Peer Learning Networks (CI-PLNs) consisted of eight 90-min virtual monthly meetings and one face-to-face session that reviewed CI pre-conditions and conditions. Evaluation sources included: a facilitated group discussion at the final CI-PLN exploring grantee CI and CAN accomplishments (n = 57); routine evaluations (n = 144 pre, 46 interim, and 40 post PLN) examining changes in knowledge and practices regarding CI; and post CI-PLN implementation, three in-depth interviews with grantees who volunteered to discuss their experience with CI and participation in the CI-PLN. Assessment CI-PLN participants reported increased knowledge and confidence in the application of CI. Several participants reported that the CI-PLN created a space for engaging in peer sharing challenges, successes, and best practices. Participants also reported a desire to continue implementing CI and furthering their learning. Conclusion The CI-PLNs met the initial goal of increasing Healthy Start grantees' understanding of CI and determining the initial focus of their efforts. By year five, the EPIC Center anticipates Healthy Start CANs will have a sustainable infrastructure in place that supports the established common agenda, shared measures, and ongoing and meaningful inclusion of community members.
The current and evolving role of FDG–PET/CT in personalized iodine-131 therapy of differentiated thyroid cancer
Abstract
Purpose
Several approaches have been recommended for the selection of patients with differentiated thyroid cancer amenable for postoperative radioiodine remnant ablation or repeated radioiodine treatment, though with inadequate results. 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography is gaining consideration for predicting disease-free or survival of differentiated thyroid carcinoma patients, in particular in the peri-or post-surgery setting and for the detection of recurrence in patients with elevated or rising thyroglobulin without evidence of disease on neck ultrasound or iodine scintigraphy. This paper aims to review the role of FDG–PET/CT in tailoring iodine-131 empiric therapy for radioiodine remnant ablation and the detection of recurrence in patients with elevated thyroglobulin and negative iodine-123 scan.
Methods
A literature search up to May 2017 of MEDLINE® and SCOPUS® with the Mesh terms: "PET/CT", "iodine-131 therapy", "differentiated thyroid cancer" and "prognosis" was performed. Thereafter, papers dealing with radioiodine remnant ablation and empiric therapy were selected.
Results
Ninety papers were retrieved from the initial search and 19 considered for the review. The percentage of positive FDG–PET/CT performed at radioiodine remnant ablation or shortly after ranged from 17 to 69%, with highest values in high- and intermediate-to-high risk patients. The response rate to radioiodine remnant ablation and survival were consistently higher in negative FDG–PET/CT patients. Besides, FDG–PET/CT imaging was found to be a very accurate diagnostic tool for the detection of recurrence in patients with elevated thyroglobulin and negative iodine-123 scan, discriminating patients needing further empirical iodine-131 therapy from those who could benefit from alternative approaches.
Conclusions
Although a meta-analysis was not possible due to the heterogeneity and the small population samples of the studies retrieved, the results of the present review support the use of FDG–PET/CT in tailoring iodine-131 therapy when used close to radioiodine remnant ablation and in patients amenable to iodine-131 empiric therapy.
Matching-Adjusted Indirect Comparison of Efficacy in Patients with Moderate-to-Severe Plaque Psoriasis Treated with Ixekizumab Versus Secukinumab
Abstract
Background
Head-to-head randomised studies comparing ixekizumab and secukinumab in the treatment of psoriasis are not available.
Objective
Assess efficacy and quality of life with ixekizumab vs. secukinumab treatment using matching-adjusted indirect comparisons.
Methods
Psoriasis Area and Severity Index (PASI) improvement of at least 75%, 90% and 100% and Dermatology Life Quality Index (DLQI) 0/1 response rates for approved doses of ixekizumab (160 mg at Week 0, then 80 mg every two weeks for the first 12 weeks) and secukinumab (300 mg at Weeks 0, 1, 2, 3 and 4, then 300 mg every 4 weeks) treatment were compared using data from active (etanercept and ustekinumab) and placebo-controlled studies. Comparisons were made using the Bucher (BU) and two modified versions of the Signorovitch method (SG total and SG separate). Subsequently, results based on active treatment common comparators were combined using generic inverse-variance meta-analysis.
Results
In meta-analysis of studies with active comparators, PASI 90 response rates were 12.7% (95% CI: 5.5%-19.8%; p=0.0005), 10.0% (2.1%-18.0%; p=0.01) and 11.2% (3.2%-19.1%; p=0.006) higher and PASI 100 response rates 11.7% (5.9%-17.5%; p<0.001), 12.7% (6.0%-19.4%; p<0.001) and 13.1% (6.3%-19.9%; p<0.001) higher for ixekizumab compared to secukinumab using BU, SG total and SG separate methods. PASI 75 results were comparable when SG methods were used and in favor of ixekizumab using BU method. Week 12 DLQI 0/1 response rates did not differ significantly.
Conclusion
Ixekizumab had higher PASI 90 and PASI 100 responses at Week 12 compared to secukinumab using adjusted indirect comparisons.
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Adjuvant therapy in renal cell carcinoma: does higher risk for recurrence improve the chance for success?
Abstract
The success of targeted therapies, including inhibitors of the vascular endothelial growth factor pathway or the mammalian target of rapamycin, in the treatment of metastatic renal cell carcinoma (RCC) led to interest in testing their efficacy in the adjuvant setting. Results from the first trials are now available with other studies due to report imminently. This review provides an overview of adjuvant targeted therapy in RCC, including interpretation of currently available conflicting data and future direction of research.We discuss the key differences between the completed targeted therapy adjuvant trials, and highlight the importance of accurately identifying patients who are likely to benefit from adjuvant treatment. We also consider reasons why blinded independent radiology review and treatment dose may prove critical for adjuvant treatment success. The implications of using disease-free survival as a surrogate endpoint for overall survival from the patient perspective and measurement of health benefit have recently been brought into focus and are discussed. Finally, we discuss how the ongoing adjuvant trials with targeted therapies and checkpoint inhibitors may improve our understanding and ability to prevent tumor recurrence after nephrectomy in the future.Treatment For The Large Aggressive Benign Lesions Of The Jaws
Abstract
Objectives
Our aim was to evaluate the clinical outcome of the conservative management of the significantly large benign aggressive lesions of the jaws.
Subjects and Methods
Twenty-two patients were reviewed regarding the demographic, radiographic, and operative findings. Patients were treated by decompression followed by curettage or only with curettage.
Results
No bone grafts were used. Mean follow-up time was 56.2 months. The mandible was more affected than the maxilla. Two of the ameloblastoma, two of the keratocystic odontogenic tumours, and one odontogenic myxoma were recurred.
Conclusions
Despite the low number of the patients, it is concluded that the conservative management is predictable for the management of the benign aggressive lesions in order to reduce morbidity instead of directly performing radical surgery. The life during follow-up is mandatory in the situation of performing conservative surgery for the management of large aggressive lesions with high recurrence rate.
Heavy-metal speciation redistribution in solid phase and potential environmental risk assessment during the conversion of MSW incineration fly ash into molten slag
Abstract
The alkalinity (AKash), BCR sequential extraction method, and principle component analysis (PCA) were adopted to investigate the heavy-metal partitioning and their speciation redistribution in solid phase in ash-melting process. The results indicated that the conversion of Zn-OXI (oxidisable fraction) into Zn-RES (residual fraction) and the decomposition of Cu-OXI fraction were prevailing in solid-phase reaction. Moreover, the alkalinity reduction from AKash = 2.0 to AKash = 1.2 had positive implications for the concentration reduction of As-RED (reducible fraction), Zn-RED, and Pb-RES fractions in slags. The modified synthesis toxicity index (STIM) calculation model was introduced to investigate the potential ecological risk (PEI) of heavy metals in the recycling and utilization of molten slag. Based on STIM calculation model, PEI of heavy metal in hazardous materials was classified into five ranks, such as serious pollution (STIM > 462), heavy pollution (330 < STIM < 462), moderate pollution (132 < STIM < 330), mild pollution (0 < STIM < 132), and no pollution (STIM = 0). The molten slags produced from fly ash can be directly reused as building materials like freestone and ceramics due to the mild PEI.
Bodycontouring beim Mann
Zusammenfassung
Verfahren der Körperformung werden bei Männern immer häufiger eingesetzt. Die Jahresstatistiken der International Society of Aesthetic Plastic Surgery (ISAPS) belegen diese Entwicklung. Etwa 20 % der Patienten, die sich weltweit einer Körperformung unterziehen, sind Männer. Für gute Behandlungsergebnisse und im Sinne der Sicherheit ist es wichtig, die Besonderheiten der männlichen Anatomie zu kennen und sie bei der Operationsplanung sowie bei der Festlegung der Inzisionslinien zu berücksichtigen. Im vorliegenden Beitrag werden die geschlechtsspezifischen Unterschiede herausgestellt, insbesondere in Bezug auf die Abdominoplastik.
The role of dermoscopy in the diagnosis of distal lateral subungual onychomycosis
Abstract
Recently dermoscopic patterns, that can be useful in the diagnosis of distal and lateral subungual onychomycosis, were identified. In this study, we aimed to determine the frequency of the defined patterns so far and additionally to identify other patterns that were observed and to investigate the place of these patterns in the diagnosis of Distal Lateral Subungual Onychomycosis (DLSO) in the dermoscopic examination of the patients with pre-diagnosis of DLSO. Patients admitted dermatology outpatient clinic of Haydarpasa Numune Training and Research Hospital with the complaint of nail disturbance suspicious for DLSO (97 patients) between the August 2015 and February 2016. Clinical and dermoscopic photographs of the cases with a pre-diagnosis of DLSO were taken and their nails were cut for pathological examination and culture. In hematoxylin and eosin, and periodic acid schiff examination, hyphe and/or spore were observed in 134 (65.4%) and fungal growth was detected in 99 (48.3%) of the nail samples. As a result of logistic regression model analysis, the p values of the 'ruin appearance', 'homogeneous leukonychia', 'punctate leukonychia', and 'black discoloration' patterns preserved their statistical significance (p = 0.015, p = 0.009, p = 0.026, p = 0.040, respectively). We believe that in nail disorders clinically resembling DLSO patients, the presence of dermoscopic patterns of ruin appearance, homogenous leuconychia, punctate leuconychia, and black discoloration strongly supports the clinical diagnosis of DLSO.
Declining HCV incidence in Dutch HIV positive men who have sex with men after unrestricted access to HCV therapy
Abstract
Background
Direct acting antivirals (DAA) cure 95% of patients infected with hepatitis C (HCV). Modeling studies predict that universal HCV treatment will lead to a decrease in the incidence of new infections but real-life data are lacking. The incidence of HCV among Dutch HIV-positive men who have sex with men (MSM) has been high for >10 years. In 2015 DAA became available to all Dutch HCV patients and resulted in a rapid treatment uptake in HIV-positive MSM. We assessed whether this uptake was followed by a decrease in the incidence of HCV infections. Methods
Two prospective acute HCV treatment studies enrolled patients in 17 Dutch HIV centers, having 76% of the total HIV-positive MSM population in care in the Netherlands. Patients were recruited in 2014 and 2016, the year preceding and following unrestricted DAA availability. We compared the HCV incidence in both years. Results
The acute HCV incidence decreased from 93 infections during 8290 person years of follow up in 2014 (11.2/1000 PYFU, 95% CI 9.1-13.7) to 49 during 8961 PYFU in 2016 (5.5/1000, 95% CI 4.1–7.2). The incidence rate ratio of 2016 compared with 2014 was 0.49 (95% C.I. 0.35-0.69). Simultaneously, a significant increase in the percentage positive syphilis (+2.2%) and gonorrhea (+2.8%) tests in HIV-positive MSM was observed at sexual health clinics across the Netherlands and contradicts a decrease in risk behavior as an alternative explanation. Conclusions
Unrestricted DAA availability in the Netherlands was followed by a 51% decrease in acute HCV infections among HIV-positive MSM.High treatment uptake in HIV/HCV-coinfected patients after unrestricted access to direct-acting antivirals in the Netherlands
Abstract
Background
The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide HCV treatment uptake among HIV/HCV-coinfected patients. Methods
Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA, did not spontaneously clear and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, only data of the most recent treatment episode were included. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved SVR. Results
Of 23,574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men (MSM), 15% people who (formerly) inject drugs and 15% another HIV transmission route) fulfilled the inclusion criteria. Eighty-seven percent (1284/1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124/1471) were cured and in 6% (92/1471) DAA treatment results were pending. Among MSM 83% (844/1022) were cured and in 6% (66/1022) DAA treatment results were pending. Overall 187 patients had never initiated treatment, 14 patients failed DAAs and 54 patients failed a pegylated-interferon-alpha based regimen. Conclusion
Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands are cured (76%) or awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.Photocatalytic decomposition of N 2 O over g-C 3 N 4 /WO 3 photocatalysts
Abstract
Although the nitrous oxide belongs among three of the most contributing greenhouse gases to global warming, it is quite neglected by photocatalytic society. The g-C3N4 and WO3 composites were therefore tested for the photocatalytic decomposition of N2O for the first time. The pure photocatalysts were prepared by simple calcination of precursors, and the composites were prepared by mixing of suspension of pure components in water followed by calcination. The structural (X-ray diffraction, X-ray photoelectron spectroscopy, high-resolution transmission electron microscopy), textural (N2 physisorption), and optical properties (diffuse reflectance spectroscopy, photoluminescence spectroscopy, photoelectrochemical measurements) of all composites were correlated with photocatalytic activity. The experimental results and results from characterization techniques confirmed creation of Z-scheme in the WO3/g-C3N4 composites, which was confirmed by hydroxyl radicals' trapping measurements. The photocatalytic decomposition of N2O was carried out in the presence of UVA light (peak intensity at 365 nm) and the 1:2 WO3/g-C3N4 composite was the most active one, but the photocatalytic activity was just negligibly higher than that of pure WO3. This is caused by relatively weak interaction between WO3 and g-C3N4 which was revealed from XPS.
Are shocks to renewable energy consumption permanent or temporary? Evidence from 54 developing and developed countries
Abstract
The renewable energy sources are considered as the important factor to decrease the level of carbon emissions and to promote the global green economy. Understanding the dynamics of renewable energy consumption, this paper analyzes whether there is a unit root in renewable energy consumption in 54 countries over the period 1971–2016. To this end, the unit root test of Narayan–Popp with two endogenous (unknown) breaks is implemented. The paper finds that renewable energy consumption series are stationary around a level and the time trend in 45 of 54 countries. In other words, renewable energy consumption follows a unit root process only in nine countries: Brazil, China, Colombia, India, Israel, Japan, the Netherlands, Spain, and Turkey. The evidence implies that renewable energy demand policies, which aimed to decrease the carbon emissions, will only have permanent effects in those nine countries.
Germline SUFU mutation carriers and medulloblastoma: clinical characteristics, cancer risk and prognosis.
Abstract
Background
Germline SUFU mutations predispose to SHH medulloblastoma. Germline SUFU mutations have been reported in nevoid basal cell carcinoma syndrome (NBCCS), but little is known about the cancer risk and clinical spectrum. Patients and methods
We performed a retrospective review of all patients with medulloblastoma and a germline SUFU mutation in France. Results
Twenty-two patients from 17 families were identified with a medulloblastoma and a germline SUFU mutation (median age at diagnosis: 16.5 months). Macrocrania was present in 20 patients, but only 5 met the diagnostic criteria for NBCCS. Despite treatment with surgery and chemotherapy, to avoid radiotherapy in all patients except one, the outcome was worse than expected for SHH medulloblastoma, due to the high incidence of local relapses (8/22 patients) and second malignancies (n=6 in 4/22 patients). The 5-year progression-free survival and overall survival rates were 42% and 66%. Mutations were inherited in 79% of patients, and 34 additional SUFU mutation carriers were identified within 14 families. Medulloblastoma penetrance was incomplete, but higher than in PTCH1 mutation carriers. Besides medulloblastoma, 19 other tumors were recorded among the 56 SUFU mutation carriers, including basal cell carcinoma (BCC) in two patients and meningioma in three patients. Conclusion
Germline SUFU mutations strongly predispose to medulloblastoma in the first years of life, with worse prognosis than usually observed for SHH medulloblastoma. The clinical spectrum differs between SUFU and PTCH1 mutation carriers and BCC incidence is much lower in SUFU mutation carriers. The optimal treatment of SUFU mutation-associated medulloblastoma has not been defined.Variability, Flexibility and Constraint: Towards the Evolutionary Roots of Teaching
Abstract
This article considers the evolutionary roots of education in the hominin lineage drawing on the variability selection hypothesis. The variability selection hypothesis emphasizes adaptation to a variable environment and flexible behavior. However, the archaeological record indicates that there are some structuring factors including learned technical skill and knowledge, trends in the progressive development of technology, and the contextual influence on the adaptive advantage conferred by learning versus trial and error. Thus, the flexibility of hominin behavior includes both the ability to develop novel responses to changing conditions and to structure behavior within constraints. It is argued that negotiating between the capacity for flexibility and for behavior based on learned structures is fundamental to the practice of education.
Les intertrigos interorteils impliquant Fusarium spp. à Dakar (Sénégal)
Publication date: Available online 11 November 2017
Source:Journal de Mycologie Médicale
Author(s): K. Diongue, M.A. Diallo, M. Ndiaye, M.C. Seck, A.S. Badiane, D. Ndiaye
IntroductionL'intertrigo interorteils (IIO) d'origine mycosique est une pathologie fréquente essentiellement due à des dermatophytes et à des levures. Fusarium sp. est rarement incriminé dans la genèse d'intertrigo. À Dakar, une étude récemment réalisée en 2016 sur l'IIO fongique avait montré que les Fusarium étaient plus impliqués dans l'étiologie des IIO que les dermatophytes, venant juste après les levures dominées par les Candida. Suite à cela, nous avons voulu attirer l'attention sur l'incidence croissante des IIO impliquant Fusarium spp. à Dakar (Sénégal) et analyser les particularités épidémiologiques et mycologiques de ces IIO à Fusarium spp.Patients et méthodesUne étude rétrospective incluant tous les patients reçus au laboratoire pour suspicion d'IIO entre le 1er janvier 2014 et le 30 juin 2017 a été menée. Le diagnostic était basé sur l'examen myologique, comprenant l'examen direct et la culture. L'analyse mycologique a été considérée comme positive lorsque l'examen direct et la culture étaient positifs après au moins une répétition.RésultatsVingt-neuf cas d'IIO à Fusarium représentant 44,6 % de tous les IIO de la période d'étude ont été diagnostiqués chez 15 hommes et 14 femmes. L'âge moyen des patients était de 48,4 ans. Les IIO ont été diagnostiqués chez des patients immunocompétents sauf chez deux diabétiques. La durée moyenne des lésions était de 6,83 ans. Les espèces impliquées appartenaient majoritairement au complexe d'espèce Fusarium solani avec 19 cas.ConclusionL'IIO à Fusarium chez un sujet sain nécessite une surveillance régulière car toute diminution ultérieure des défenses immunitaires pourrait entraîner une dissémination hématogène mortelle.IntroductionFungal interdigital tinea pedis (ITP) is a common pathology mainly due to dermatophytes and yeasts. Fusarium sp. is rarely incriminated in the genesis of intertrigo. In Dakar, a recent study conducted in 2016 on fungal ITP showed that Fusarium were more involved in the etiology of ITP than dermatophytes, coming just after yeasts dominated by Candida. Following this, we wanted to draw attention to the increasing incidence of ITP resulting from Fusarium spp., in Dakar, Senegal, and to analyze the epidemiological and mycological particularities of these ITP due to Fusarium spp.Patients and methodsA retrospective study including all patients received at the laboratory for suspicion of ITP between January 1st, 2014 and June 30th, 2017 was conducted. Diagnosis was based on mycological examination, including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat.ResultsTwenty-nine cases of Fusarium ITP accounting for 44.6% of all ITP in the study period were diagnosed in 15 men and 14 women. The mean age of the patients was 48.4 years. Fusarium ITP were diagnosed in immunocompetent patients except in two diabetics. The mean duration of the lesions was 6.83 years. The most frequent species isolated belonged to the Fusarium solani complex with 19 cases.ConclusionFusarium ITP in a healthy subject requires regular monitoring because any subsequent decrease in immune defenses could lead to fatal hematogenous spread.
Cryptococcose neuroméningée chez des patients infectés par le VIH au Centre Hospitalier Régional d’Agadir (région Souss-Massa, Maroc)
Publication date: Available online 11 November 2017
Source:Journal de Mycologie Médicale
Author(s): S. Chadli, M. Aghrouch, N. Taqarort, M. Malmoussi, Z. Ouagari, F. Moustaoui, M. Bourouache, S. Oulkheir
IntroductionLa cryptococcose neuroméningée (CNM) est une infection opportuniste sévère et mortelle. La létalité est fréquente en absence de traitement, en particulier en existence d'une co-infection par le VIH.ObjectifsDéterminer la prévalence, les aspects épidémiologiques, cliniques, biologiques et thérapeutiques ainsi que le devenir de la CNM chez des patients infectés par le VIH.Patients et méthodesIl s'agit d'une étude rétrospective portant sur 40 cas de cryptococcose neuroméningée diagnostiquées chez des patients infectés par le VIH. Les données sont collectées durant 7 ans (du janvier 2010 à décembre 2016) dans les registres du laboratoire de parasitologie et du service des maladies infectieuses du centre hospitalier régional d'Agadir.RésultatsUne réduction de la prévalence de la CNM chez les patients infectés par le VIH a été notée de 2010 à 2016 (3,66 % à 0,83 %). La prévalence globale de la CNM est de 1,53 %. L'âge moyen des patients était de 37±10 ans, avec 90 % âgés de moins de 45 ans. La symptomatologie clinique principale était les céphalées (75 %). Les principales anomalies cytochimiques du LCR étaient une hyperprotéinorachie (60 %), une hypoglycorachie (63 %) et une lymphocytose (50 %). Le taux moyen des CD4 était de 47/mm3. Les patients ont été initialement traités par l'amphotéricine B, avec relais par le fluconazole. La létalité globale était de 35 %.ConclusionLa CNM est une infection opportuniste grave chez les patients infectés par le VIH, et le taux de létalité demeure inacceptable. La lutte contre la CNM chez les patients à VIH+ impose un diagnostic précoce, un accroissement de l'accès aux antirétroviraux et une instauration rapide d'un traitement adapté et une prescription d'antifongiques systémiques efficaces.IntroductionNeuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is frequent in the absence of treatment, especially in the presence of HIV co-infection.ObjectiveTo determine the prevalence, epidemiological, clinical, biological and therapeutic aspects as well as the evolution of NMC for patients infected with HIV.Patients and methodsThis is a retrospective study of 40 cases of neuromeningeal cryptococcosis diagnosed in HIV-infected patients. Data are collected for 7 years (from January 2010 to December 2016) in the registers of the parasitology laboratory and the infectious diseases department at the regional hospital center in Agadir.ResultsA reduction in the prevalence of neuromeningeal cryptococcosis in HIV-infected patients was noted from 2010 to 2016 (3.66% to 0.83%). The overall prevalence of NMC was 1.53%. The mean age was 37±10 years old, with 90% of patients aged less than 45 years. The main clinical symptomatology was headache (75%). The main cytochemical abnormalities of cerebrospinal fluid analysis were hyperproteinorachy (60%), hypoglycorachy (63%) and lymphocytosis (50%). The mean CD4 cell count was 47/mm3. Patients were initially treated with amphotericin B, relayed with fluconazole. The overall lethality was 35%.ConclusionNeuromeningeal cryptococcosis is a serious opportunistic infection in patients HIV-infected, and the lethality rate remains unacceptable. Fighting NMC in HIV+ patients requires early diagnosis, increased access to antiretrovirals, rapid introduction of appropriate treatment and the prescription of effective systemic antifungals.
Saccharomyces cerevisiae fungemia after probiotic treatment in an intensive care unit patient
Publication date: Available online 11 November 2017
Source:Journal de Mycologie Médicale
Author(s): İ. Kara, F. Yıldırım, Ö. Özgen, S. Erganiş, M. Aydoğdu, M. Dizbay, G. Gürsel, A. Kalkanci
Saccharomyces cerevisiae is a common colonizer of the human gastrointestinal system as a benign organism. Enteral supplementation of this yeast as a probiotic product is effective in the treatment of antibiotic associated diarrhae. In rare occasions it can cause invasive infections. We present two fungemia cases in an intensive care unit following probiotic treatment containing S. boulardii. We are warning the safety of probiotic treatment in critically ill patients.
Rhinocerebral mucormycosis caused by Rhizopus arrhizus var. tonkinensis
Publication date: Available online 7 November 2017
Source:Journal de Mycologie Médicale
Author(s): Y. Cheng, Y. Gao, X.Y. Liu, G.Y. Wang, G.Q. Zhang, S.Q. Gao
Mucormycosis is a rare life-threatening opportunistic infection caused by fungi of the order Mucorales. We report a case of rhinocerebral mucormycosis caused by Rhizopus arrhizus var. tonkinensis, the first formally reported case in the literature. Early diagnosis, reversal of predisposing factors, surgical debridement and prompt administration of antifungal therapy are critical for good outcome.
Caractéristiques cliniques et myologiques des onychomycoses à Candida à l’Institut Pasteur de Côte d’Ivoire
Publication date: Available online 7 November 2017
Source:Journal de Mycologie Médicale
Author(s): K.E. Angora, A. Ira-Bonouman, A.H. Vanga-Bosson, A. Konaté, F.K. Kassi, K. Tuo, K. Sylla-Thanon, P.C. Kiki-Barro, S. Miezan, A.V. Bedia-Tanoh, V. Djohan, W. Yavo, E.H. Menan, A.T. Offianan
ObjectifCe travail vise à étudier les caractéristiques cliniques et mycologiques des onychomycoses à Candida à l'unité de mycologie l'Institut de Pasteur de Côte d'Ivoire.Patients et méthodesC'est une étude rétrospective réalisée au laboratoire de mycologie de l'Institut Pasteur de Côte d'Ivoire. Elle a porté sur les dossiers de patients adressés au laboratoire entre 1990 et 2016 pour diagnostic mycologique d'onychomycoses pour lesquels les données sociodémographiques, les résultats de l'examen direct et de la culture ont été enregistrés.RésultatsAu total, 1898 dossiers de patients ont été retenus. L'âge moyen des patients était de 31,69 ans (écart-type=15,11) avec un sex-ratio de 0,87. La prévalence des onychomycoses à Candida chez les patients reçus était de 61,7 %. Les ongles des doigts (67,7 %) étaient significativement plus atteints par cette affection, suivi de ceux des orteils (25,3 %). Quatre-vingt-dix cas d'atteintes doubles des ongles des mains et orteils ont été retrouvés. Candida albicans était l'espèce la plus fréquente représentant 79,1 % des levures isolées. Parmi les espèces non albicans, C. parapsilosis et C. tropicalis ont été isolés au niveau des ongles des orteils avec des fréquences de 11,2 et 9,6 %.ConclusionLes onychomycoses à Candida sont relativement fréquentes à Abidjan et dominées sur le plan étiologique par C. albicans. La confirmation mycologique de l'étiologie fongique d'une onychopathie et une bonne hygiène des ongles permettront une meilleure prise en charge.ObjectiveThis study aims to study the clinical and mycological characteristics of onychomycosis due to Candida in mycology unit of Institut Pasteur of Côte d'Ivoire.Patients and methodsThis is a retrospective study which was carried out on patients from 1990 to 2016 for mycological diagnosis of onychomycosis and which socio-demographic characteristics, direct examination and culture results were recorded.ResultsIn this study, 1898 patient files were selected. The average age of the patients was 31.69 years (standard deviation=15.11) with a sex ratio of 0.87. The frequency of Candida onychomycosis from patients received was 61.7%. Finger nails (67.7%) were more affected by this condition, followed by those of the toes (25.3%). Ninety cases of double localization of the nails of the hands and toes have been found. Candida albicans was the most frequent species accounting for 79.1% of isolated yeasts. Among the non-albicans, C. parapsilosis and C. tropicalis were isolated at the level of the toenails with frequencies rate of 11.2 and 9.6%.ConclusionOnychomycosis due to Candida are relatively common in Abidjan and are dominated by C. albicans. The mycological confirmation of the fungal etiology in onychopathy and a good hygiene of the nails will allow a better management.
Quelles mesures pour maîtriser le risque infectieux chez les patients immunodéprimés ? Recommandations formalisées d’experts
Publication date: Available online 11 November 2017
Source:Journal de Mycologie Médicale
Author(s): J.-R. Zahar, S. Jolivet, H. Adam, C. Dananché, J. Lizon, S. Alfandari, H. Boulestreau, N. Baghdadi, J.-O. Bay, A.-M. Bénéteau, M.-E. Bougnoux, M.-P. Brenier-Pinchart, J.-H. Dalle, S. Fournier, J.-G. Fuzibet, C. Kauffmann-Lacroix, I. Le Guinche, D. Lepelletier, N. Loukili, A. Lory, M. Morvan, R. Oumedaly, P. Ribaud, P. Rohrlich, P. Vanhems, S. Aho, D. Vanjak, J.-P. Gangneux
L'intensification des traitements immunosuppresseurs et la généralisation de leur utilisation aux patients atteints de cancer solide et/ou de maladies inflammatoires nécessitent de revisiter nos pratiques de prévention du risque infectieux en milieu de soin. Cette révision est justifiée aussi par les modifications de nos pratiques avec une intensification des prises en charge en structures de soins de suites réhabilitation et en ambulatoire. Une revue de la littérature menée par un groupe de travail multidisciplinaire réuni début 2014 a souhaité répondre aux 4 questions suivantes : (i) Quelle définition des patients immunodéprimés à risque infectieux élevé, intermédiaire et faible, (ii) Quel traitement d'air recommander pour les patients immunodéprimés à risque d'infections ? (iii) Quelles précautions complémentaires recommander pour les patients immunodéprimés à risque d'infections ? (iv) Quelle maîtrise globale de l'environnement recommander pour les patients immunodéprimés à risque d'infections ? À partir des données de la littérature et en utilisant la méthode GRADE, nous proposons 15 recommandations qui permettront de réduire le risque infectieux dans ces populations exposées.The increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations.
Challenges in culture-negative cases of Madurella mycetomatis: A case report re-accentuating PCR as an essential diagnostic tool
Publication date: Available online 6 November 2017
Source:Journal de Mycologie Médicale
Author(s): S. K, S. Das, D. Pandhi, G. Rai, M.A. Ansari, C. Gupta, S. Haque, S.A. Dar
Identification of dematiaceous fungi responsible for black-grain mycetoma has remained cumbersome and time consuming for years leading to delayed diagnosis and thereby increased agony to patients. Moreover, difficult morphology of some of these fungi demanding enough expertise for species identification in addition to culture-negativity has often led to misdiagnosis and hence inapt treatment to the patients. We report the identification of Madurella mycetomatis from culture-negative black granules discharged from foot nodular lesions of a 27 years old male using PCR followed by sequencing of the internal transcribed spacer region. The patient's lesions were successfully treated using a combination of itraconazole (200mg) and terbinafine (250mg), confirming our diagnosis. Our case study proves the clinical value of PCR as the best, rapid and accurate diagnostic method for the identification of Madurella mycetomatis and related fungi, particularly in culture-negative cases.
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