This case series describes the results of intralesional rituximab treatment in men with granuloma faciale.
Τετάρτη 5 Σεπτεμβρίου 2018
Necrotic Plaque on the Distal Nose With Diffuse Crateriform Nodules
A man in his 30s presented with a progressively necrotic plaque on the nose, scattered nodules on the extremities, and erythematous papules on the arms and legs. What is your diagnosis?
Complementary and Alternative Medicine Therapies for Psoriasis
This systematic review summarizes the evidence on the efficacy of the most studied complementary and alternative medicine therapies for treatment of plaque psoriasis and discusses those treatments with the most robust available evidence.
Predictions, Surprises, and the Future of the Dermatology Workforce
With the debut of managed care in the 1980s, experts in the physician workforce portended an impending surplus of specialist physicians, including dermatologists. Despite these dire predictions, a dermatology workforce shortage was identified in the late 1990s, with an associated geographical imbalance. Since then, the overall shortage has only modestly abated, so it would not be surprising to find that an urban-rural workforce maldistribution has persisted. Indeed, in this issue of JAMA Dermatology, Feng and colleagues present physician data from 1995 to 2013 demonstrating that the maldistribution of dermatologists may well have worsened. They show an overall increase in density of dermatologists but a widening gap between metropolitan vs nonmetropolitan and rural communities. Additionally, the ratio of younger compared with older dermatologists (using a cutoff of age 55 years, the approximate mean physician age in the United States) increased in urban settings and simultaneously decreased in rural settings, a distribution that may cause this gap to grow.
Comparison of Dermatologist Density Between Urban and Rural Counties in the United States
This study analyzes county-level data from nationwide US data to compare dermatologist density between urban and rural areas.
Laser Treatment Performed Decades After Napalm Burns
This case report describes the use of laser treatment beginning in 2015 to treat napalm burns sustained by the famous Vietnamese "Napalm Girl" in 1972.
Detection of Glycemia and Osmolarity Changes Using Eye Examinations
Metabolic Syndrome and Related Disorders, Ahead of Print.
Efficacy of breast reconstruction with fat grafting: A systematic review and meta-analysis
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mikkel Herly, Mathias Ørholt, Andreas Larsen, Christian B. Pipper, Rikke Bredgaard, Christina S. Gramkow, Adam J. Katz, Krzysztof T. Drzewiecki, Peter V. Vester-Glowinski
Summary
Background
Breast reconstruction with fat grafting is a new alternative to prosthetic implants and flaps for women with breast cancer. In this study, we investigate the efficacy of fat grafting for breast reconstruction in a meta-analysis.
Methods
The study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. Studies were included if the patients underwent complete breast reconstruction with fat grafting as the only treatment modality. The number of fat grafting treatments needed to complete a breast reconstruction was modeled in a meta-analysis for five treatment categories: modified radical mastectomy, skin-sparing mastectomy and breast-conserving surgery; the two mastectomy groups were subdivided into non-irradiated and irradiated.
Results
Twenty-one studies were included in the meta-analysis. The studies comprised 1011 breast reconstructions from 834 patients. The estimated numbers of treatments to complete a reconstruction were 2.84-4.66 in the mastectomy groups and 1.72 in the breast-conserving surgery group. The number of fat grafting sessions needed to complete a breast reconstruction was significantly higher for the irradiated patients than for the non-irradiated patients (p < 0.05). There was no significant difference in the number of fat grafting sessions needed to complete a breast reconstruction after a modified radical mastectomy versus a skin-sparing mastectomy.
Conclusions
This study provides an evidence-based foundation for several practical issues related to breast reconstruction with fat grafting. The analysis showed that radiotherapy is the most important factor associated with the number of treatment sessions needed to complete a breast reconstruction and with the rate of complications.
Comparison of piezosurgery, percutaneous and endonasal continuous osteotomy techniques on a caprine skull model
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Sevgi Kurt Yazar, Merdan Serin, Ibrahim Taskin Rakici, Selami Serhat Sirvan, Fatih Irmak, Memet Yazar
Abstract
Background
Osteotomy is a crucial step in rhinoplasty which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and endonasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques.
Materials and Methods
This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals which consist of endonasal continuous, external perforating and piezosurgery groups. All the groups were evaluated for the bone gaps, comminuted fractures as well as nasal mucosa damage.
Results
There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group compared with the other groups. The time required for the osteotomy was shorter in the endonasal group, similar in external and piezo group.
Conclusion
New techniques are constantly being developed to achieve better results in rhinoplasty. As a natural consequence to technological developments new devices are being introduced to rhinoplasty practice. Piezo is one of such devices. We have found that piezo osteotomy has resulted in lower amounts nasal mucosal damage and comminuted fractures. We believe that piezo can be safely be used in rhinoplasty practice until newer and more reliable technologies are being developed.
A SIMPLE METHOD FOR LYMPHEDEMA SELF-MEASUREMENT USING THE ZOZOSUIT BODYSUIT
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Chihena H. Banda, Ryohei Ishiura, Minami Fujita, Kohei Mitsui, Mitsunaga Narushima
Cartilage sparing surgery for melanoma of the external ear
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Conrad Harrison, Cian Wade, Matthew Potter, Oliver Cassell
Summary
Background
The excision of melanoma of the external ear poses a challenge to surgeons, who must achieve adequate oncological control while minimising impact on form and function. Cartilage preserving surgery is an attractive option as it leaves behind a scaffold for immediate reconstruction with a variety of techniques including full thickness skin grafts (FTSGs) and local flaps. This manuscript will review the literature comparing cartilage sparing surgery with composite excision of skin and cartilage for the treatment of auricular melanoma. We report the results of a 17-year experience of using both techniques, together with sentinel node biopsy at our centre.
Methods
A structured review of MEDLINE and EMBASE was conducted evaluating all studies reporting local recurrence or survival rates for melanoma of the external ear treated with cartilage preserving surgery. A retrospective review of all patients undergoing wide local excision (WLE) and sentinel lymph node biopsy (SLNB) for auricular melanoma at our centre between 2000-2017 was performed.
Results
Of 40 patients identified, 29 underwent cartilage preserving surgery with no local recurrences or evidence of perichondral involvement. There was one local recurrence out of 11 patients who had had cartilage excised. There were no significant differences in recurrence rates or melanoma-specific survival when comparing cartilage preserving and cartilage sacrificing surgery. Our results are supported by the literature review which suggests cartilage sparing surgery is gaining acceptance as safe practice.
sOPTIMISING EXPOSURE OF THE CORONOID PROCESS DURING LENGTHENING TEMPORALIS MYOPLASTY FOR FACIAL REANIMATION
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hodgins N, Ahmed OA, Ragbir M, Bashir MA
Shear wave elastography in the diagnosis of the ulnar tunnel syndrome.
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ł Paluch, BH Noszczyk, J Walecki, K Osiak, M Kiciński, P Pietruski
Summary
An interesting alternative to traditional diagnostic techniques of the upper extremity nerve entrapments might be provided by an ultrasound elastography that started to gain attention in recent research. The aim of this preliminary study was to verify if quantitative analysis of ulnar nerve stiffness with shear-wave elastography can be used to diagnose the ulnar tunnel syndrome, an ulnar nerve neuropathy at the Guyon's canal. The study included 46 patients (39 women) and 39 healthy controls (34 women). All diagnoses in patients and controls were confirmed with nerve conduction studies. Measurements of nerve stiffness were taken at three levels: in Guyon's canal (G) and at distal (DF) and mid-forearm (MF). Additionally, ulnar nerve cross-sectional area at the canal's level was determined by means of ultrasonography. Patients with the ulnar tunnel syndrome presented with significantly greater nerve stiffness than the controls (mean, 99.41 kPa vs. 49.08 kPa, P <0.001). No significant intergroup differences were found in the nerve elasticity at DF and MF (P <0.836 and P < 0.881, respectively). Ulnar nerve stiffness value of 80 kPa, and G:DF and G:MF ratios equal to 1.5 provided 100% sensitivity, specificity, positive and negative predictive value in the detection of the syndrome. Mean nerve cross-sectional area in the Guyon's canal was significantly greater in patients than in the controls (4.63 mm2, range, 2-7 mm2 vs. 3.23 mm2, range, 2-5 mm2, P <0.001). In conclusion, we believe that shear-wave elastography has a potential to become a useful adjunct diagnostic test for the ulnar tunnel syndrome.
Utilization of Installation Wound Vacuum Device for Breast Implant Salvage: Approach and Results
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Risal Djohan, Isis Scomaco, Eliana Duraes, Rebecca Knackstedt
Readability and quality of breast reduction on-line resources
Publication date: Available online 4 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): AM Kennedy, C Davidson, E Cronin, R Caulfield
Summary
Many patients are now using the Internet as a resource for health-related information. It is recommended that the readability of patient education materials should be equal to or less than an 11-13-year-old reading level.
The aim of this study was to evaluate the readability and quality of websites related to breast reduction.
The largest internet search engine was queried for 'breast reduction'. 112 articles from the ten most popular websites were downloaded for analysis. Results from the private cosmetic industry were excluded. Articles were assessed for readability using 10 validated readability tools and for quality using the DISCERN instrument.
The mean reading level of all websites was that of of a 16-17 year-old. The BAAPS, BAPRAS and NHS websites all exceeded the recommended reading level (all greater than a 14-year old reading level).
The highest quality website was NHS Choices with a DISCERN score of 75. The American Board of Cosmetic Surgery website received the lowest quality score of 36.
There was a statistically significant strong negative correlation between the DISCERN score and reading age, implying that higher quality websites are more likely to achieve the recommended 11-13-year old reading level.
Online patient resources about breast reduction are uniformly above the recommended target readability level and are likely too difficult for many patients to understand. The results of this study could enable surgeons to recommend sources of information for patients considering breast reduction as well as helping patients to evaluate the quality of medical information available on the Internet.
Magnetic biochar-based manganese oxide composite for enhanced fluoroquinolone antibiotic removal from water
Abstract
Magnetic biochar-based manganese oxide composite (MMB) and raw biochar (BC) were synthesized via pyrolysis at a temperature of 500 °C under anoxic conditions of potato stems and leaves, characterized, and successfully used for the removal of norfloxacin (NOR), ciprofloxacin (CIP), and enrofloxacin (ENR) as representative compounds of fluoroquinolone antibiotics (FQs). Characterization results suggested that Fe3O4 and MnOx are the dominant crystals in MMB. MMB possessed large surface area and pore volume than BC. Batch adsorption experiments showed that the maximum adsorption abilities of MMB for norfloxacin (NOR), ciprofloxacin (CIP), and enrofloxacin (ENR) were 6.94, 8.37, and 7.19 mg g−1. In comparison to BC, the adsorption abilities of MMB increased 1.2, 1.5, and 1.6 times for NOR, CIP, and ENR, respectively. The pseudo-second-order kinetic model and the Langmuir model correlated satisfactorily to the experimental data. Thermodynamic studies revealed that the adsorption processes were spontaneous and endothermic. The adsorption capacity of MMB decreased with increasing solution pH (between 3.0 and 10.0) and increasing ionic strength (0.001–0.1). The MMB with high FQ removal efficiency, easy separation, and desirable regeneration ability may have promising environmental applications for the removal of fluoroquinolone antibiotics from water environment.
The effect of cellulose production waste and municipal sewage sludge on biomass and heavy metal uptake by a plant mixture
Abstract
Environmental management of cellulose production waste and municipal sewage sludge appears to be substantiated due to various physicochemical properties of these wastes. The aim of the conducted research was to determine the effect of cellulose production waste and sewage sludge on yielding and heavy metal uptake by a plant mixture. The research was conducted under field experiment conditions, determining the fertilizer value of these wastes in the environmental aspect. The research was carried out in the years 2013–2016. Species composition of the plant mixture was adjusted to habitat conditions. It was established that, as compared with the cellulose production waste, the municipal sewage sludge used in the experiment had a higher content of macroelements. The content of heavy metals in the studied waste did not exceed the limits that condition their use in agriculture and reclamation. Applying only the cellulose production waste did not significantly decrease the yield of the plants. Municipal sewage sludge showed the highest yield-forming effect. Mixing the above-mentioned wastes and their application to soil had a significant effect on the increase in the plant mixture yield. The waste applied to soil also increased the content of Cr, Cd, Pb, Cu, and Zn in the plant mix. The level of heavy metal content in the plant mix did not exclude this biomass from being used for fodder or reclamation purposes. The cellulose production waste and municipal sewage sludge increased the heavy metal uptake by the plant mixture. The plant biomass extracted heavy metals from the sewage sludge more intensively than from the cellulose production waste. Among the analyzed heavy metals, the highest phytoremediation was recorded for Ni (30%), followed by Cd (20%), Cr (15%), Pb (10%), and the lowest for Cu (9%) and Zn (8%). Application of the cellulose production waste and sewage sludge to soil also increased the content of the studied heavy metals in soil. However, it did not cause deterioration of soil quality standards. Heterogeneity in the chemical composition of the wastes confirms that each batch intended to be used for environmental management should be subjected to chemical control.
Physiological characterization of common bean ( Phaseolus vulgaris L.) under abiotic stresses for breeding purposes
Abstract
In the Brazilian wet and dry seasons, common beans (Phaseolus vulgaris L.) are grown under rainfed conditions with unexpected episodes of drought and high temperatures. The objective of this study was to evaluate the physiological mechanisms associated with drought adaptation traits in landraces and line/cultivars of beans from the Andean and Mesoamerican gene pools. Twenty-five genotypes, contrasting in terms of drought tolerance, were evaluated in a phenotyping platform under irrigated and rainfed conditions. Agronomic and physiological parameters such as grain yield, shoot structures, gas exchange, water potential, and osmotic adjustment were evaluated. The stress intensity was estimated to be 0.57, and the grain yield reduction ranged from 22 to 89%. Seven accessions, representative of the Andean and Mesoamerican germplasm (CF 200012, CF 240056, CF 250002, CF 900004, CNF 4497, CNF 7382, and SEA 5), presented superior performance in grain yield with and without stresses. The physiological responses under abiotic stresses were highly variable among the genotypes, and two Mesoamerican accessions (CF 200012 and SEA 5) showed more favorable adaptive responses. As the main secondary physiological traits, gas exchange and osmotic adjustment should be evaluated together with the grain yield to increase the selection efficiency of abiotic stresses-tolerant common bean lines.
Highly efficient treatment of real benzene dye intermediate wastewater by simple limestone and lime neutralization-coagulation with improved Fenton oxidation
Abstract
Multistage Fenton oxidation is a favored method for the treatment of benzene dye intermediate (BDI) wastewater, but the pH adjustments required after each stage of the Fenton process with a simple way is still a challenge. Limestone pretreatment and lime neutralization-coagulation were used to solve the problem in multistage Fenton process. First, we determined the optimal conditions of Fenton oxidation using the Box-Behnken response surface method. Limestone pretreatment before the multistage Fenton process allowed for simultaneous pH adjustment and 14.15% COD removal. Most notably, the lime cream neutralization-coagulation process effectively adjusted the pH after each stage of the Fenton process. The optimum CaO particle size, lime mass fraction, mixing time, and stirring speed were determined by orthogonal tests. COD removal (89.23%) was obtained when lime cream neutralization-coagulation was applied to the three-staged Fenton process, while only 58.57% COD removal was obtained by the unadjusted single-staged Fenton process. The COD and wastewater color were reduced from 10,600 mg/L and 12,200 multiples to 495 mg/L and 20 multiples, respectively, using the adjusted process. This improved method provides a promising cost-effective way to efficiently treat real BDI wastewater.
Effect of distillery spentwash fertigation on crop growth, yield, and accumulation of potentially toxic elements in rice
Abstract
The safe disposal of industrial effluents always remained a challenging process because of their high level of nutrients, toxic elements, and salts. A pot experiment was conducted to investigate the effects of various concentrations (5%, 10%, 15%, and 20%) of sugar industry effluent spentwash (SW) fertigated with tab water (TW), on soil properties, crop growth, physiological parameters, yield components, and accumulation of potentially toxic elements (PTEs) in rice (Oryza sativa L.) grains and straw. The results showed that soil physico-chemical properties were modified with rise in SW concentration. Application of 5% SW significantly enhanced the plant growth, and yield components. Photosynthesis rate, transpiration rate, and stomatal conductance were significantly higher under 5% SW concentration in comparison with control. However, SW concentrations of > 5% showed inhibitory effects for all growth, physiological, and yield components. Accumulation of PTEs showed increasing trend with rise in SW concentration. However, under 5% SW concentration, all the PTEs in rice grain and straw were within the permissible limits (PLs) recommended by FAO/WHO and no health hazards were detected by health risk assessment. Based on the study results, 5% SW fertigation with TW can be applied as fertilizer for enhancing the growth and productivity of rice.
Graphical abstract
Effects of Reslizumab on Asthma Outcomes in a Subgroup of Eosinophilic Asthma Patients with Self-Reported Chronic Rhinosinusitis with Nasal Polyps
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Steven F. Weinstein, Rohit K. Katial, Philip Bardin, Stephanie Korn, Mirna McDonald, Margaret Garin, Eric D. Bateman, Flavia C.L. Hoyte, Matthew Germinaro
ABSTRACT
BACKGROUND
An estimated 7% of patients with asthma have chronic rhinosinusitis with nasal polyps (CRSwNP) and over 80% have at least some radiographic evidence of sinonasal inflammation. Aspirin sensitivity is strongly associated with elevated blood eosinophil levels and increased asthma severity. Intravenous (IV) reslizumab has been shown to improve asthma control in patients with nasal polyps.
OBJECTIVE
These post-hoc analyses of pooled data from two BREATH phase 3 clinical trials, studies 1 and 2 (NCT01287039 and NCT01285323), examined asthma-related outcomes in patients with comorbid, self-reported CRSwNP with and without aspirin sensitivity.
METHODS
Patients aged 12–75 years with elevated blood eosinophils (≥400 cells/μL) and inadequately controlled asthma were randomized to receive placebo or reslizumab (3 mg/kg IV) every 4 weeks for 52 weeks. Patients continued their background asthma maintenance therapy during the study. Information regarding the presence of CRSwNP was obtained through patient-reported medical history.
RESULTS
Add-on reslizumab treatment reduced the frequency of clinical asthma exacerbations (CAE) by 83% vs placebo among patients with CRSwNP. Among patients with and without aspirin sensitivity, reductions of 79% and 84%, respectively, were observed. Patients with CRSwNP (with and without aspirin sensitivity) treated with reslizumab add-on therapy also had significant improvements in lung function, as measured by FEV1, compared with placebo. Among patients with CRSwNP, reslizumab was also associated with improvements in patient-reported asthma control and asthma quality of life.
CONCLUSION
Patients with eosinophilic asthma and self-reported CRSwNP, with and without aspirin sensitivity, are highly responsive to treatment with reslizumab for asthma-related outcomes. These findings suggest that prospective investigation of reslizumab in this patient population is warranted.
Staphylococcus aureus nasal colonization and asthma in adults: systematic review and meta-analysis
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Young-Chan Kim, Ha-Kyeong Won, Ji Won Lee, Kyoung-Hee Sohn, Min-Hye Kim, Tae-Bum Kim, Yoon-Seok Chang, Byung-Jae Lee, Sang-Heon Cho, Claus Bachert, Woo-Jung Song
Abstract
Background
Staphylococcus aureus (SA) is a frequent colonizer in human and it is known to be associated with chronic allergic diseases including asthma. Recent individual studies suggested that nasal SA colonization may be positively associated with asthma.
Objective
To examine relationships between nasal SA colonization and asthma prevalence and activity in adults.
Methods
Electronic databases were searched for studies published until June 2018. Studies that reported nasal SA colonization prevalence and asthma outcome (prevalence and disease activity) in general adult populations or chronic rhinosinusitis (CRS) patients were included. Random effects meta-analyses were performed to calculate pooled odds ratio (OR) of the relationships. Subgroup analysis was conducted for the presence of nasal polyps within CRS populations.
Results
A total of 21 cross-sectional studies were identified, and the data from 16 studies using culture methods for SA detection were meta-analyzed (5 general population-based studies and 11 CRS patient studies). In studies of general populations, nasal SA colonization had significant relationships with asthma prevalence (OR 1.19; 95% confidence interval 1.06-1.34; I2 = 1%). In CRS patient studies, positive associations were also found but had a considerable heterogeneity (OR 1.87; 95% CI 1.18-2.97; I2 = 72%). However, the results were comparable between CRS with and without nasal polyps.
Conclusions
This study demonstrated modest but significant relationships between nasal SA colonization and asthma, supporting potential roles of SA in adult asthma patients. Further longitudinal cohort and intervention studies are warranted to identify host determinants and to clarify causality of the relationships.
Patient versus allergy specialist interpretation of a negative workup for suspected iodinated contrast media allergy
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rik Schrijvers, Christine Breynaert, Jean-Luc Bourrain, Pascal Demoly, Anca Mirela Chiriac
Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival and impaired clearance
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jocelyn R. Grunwell, Susan T. Stephenson, Rabindra Tirouvanziam, Lou Ann S. Brown, Milton R. Brown, Anne M. Fitzpatrick
Background
Airway neutrophils are abundant in some children with severe asthma, but their functions are poorly understood.
Objective
We hypothesized that the inflammatory airway environment of children with neutrophil-predominant severe asthma promotes neutrophil survival and disrupts neutrophil-associated innate immune defenses.
Methods
Sixty seven children with severe asthma refractory to high-dose inhaled corticosteroid (ICS) treatment undergoing bronchoscopy with bronchoalveolar lavage (BAL) for clinical indications were stratified into neutrophil "high" versus "low" groups based on BAL differential counts. Neutrophil activation markers, functional assays and phenotyping studies were performed as well as airway macrophage functional assays. Results were compared to those from children with moderate asthma treated with ICS.
Results
Children with neutrophil-predominant severe asthma had increased markers of neutrophil activation/degranulation and a greater magnitude of airway pro-inflammatory cytokine and chemokine release. Primary neutrophils exposed to BAL of these children exhibited greater phagocytic capability and greater neutrophil extracellular trap formation, but a more impaired respiratory burst. Despite greater abundance of airway TGF-β1, the neutrophils were not more apoptotic. Instead, neutrophils had a highly pro-inflammatory phenotype associated with a number of surface markers that regulate neutrophil activation, recruitment/migration and granule release. Airway macrophages from children with neutrophil-predominant severe asthma were also more pro-inflammatory with impaired phagocytosis and increased apoptosis.
Conclusions
Children with neutrophil-predominant severe asthma have pro-inflammatory neutrophils with enhanced survival. Airway macrophages are also pro-inflammatory and dysfunctional and may contribute to global innate immune impairment. Therapies that target neutrophils and related inflammation may be warranted in this subset of children.
Bronchial Thermoplasty: A Decade of Experience: State of The Art
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Laren D. Tan, Ken Y. Yoneda, Samuel Louie, D.Kyle Hogarth, Mario Castro
Abstract:
Bronchial thermoplasty (BT) delivers targeted radiofrequency energy to bronchial airway walls and results in the partial ablation of the airway smooth muscle that is responsible for bronchoconstriction. It is approved for the treatment of severe persistent asthma. Multiple, large clinical trials including a recent "real-world" study demonstrate significant improvements in asthma-related quality of life, reduction in asthma exacerbations, emergency department visits and hospitalizations after BT that is sustained out to 5 years. In this article, we review the state of the art of BT treatment in severe persistent asthma and share a decade of BT research and clinical experience. We share our personal experience and introduce the three "I"s (identification, implementation and intense follow up) that we believe promote successful patient outcomes and help build a successful BT program.
Fatal asthma: an audit of 30 million patient-years of health plan membership from 2007 to 2015
Publication date: Available online 5 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Eric Macy, Janis F. Yao, Wansu Chen
Abstract
Background
Without accurate data on deaths directly caused by asthma, prevention will be difficult.
Objective
Determine how often asthma could be confirmed as a proximal cause of death in a large well-defined population with active health plan membership and no acute barriers to medical care.
Methods
All deaths occurring in active Kaiser Permanente Southern California health plan members between 2007 and 2015 were identified. Asthma-coded deaths were manually audited for cause. Healthcare and asthma medication use in the 6 months prior to death were determined.
Results
There were 248 [0.80 per 100,000 patient-years] un-audited asthma-coded deaths. There were only 63 (26.5%) [0.20 per 100,000 patient-years] asthma-confirmed deaths. Individuals with asthma-confirmed deaths were younger, less likely to have ever smoked, and had fewer emergency visits in the 6 months prior to death compared to those with asthma excluded. Individuals with asthma-confirmed deaths used preventative inhalers at very low rates. We unexpectedly found that ever inclusion in the 2016 National Committee for Quality Assurance health effectiveness data and information set (HEDIS) for persistent asthma was associated with a higher risk of all cause early death. Individuals with asthma-confirmed deaths were also unlikely to be in the HEDIS asthma dataset in the year they died, thus not targeted for outreach.
Conclusions
Audit-confirmed fatal asthma is more likely to occur in younger, non-smoking, individuals, using very low rates of preventive inhalers. This will be a very difficult group to prospectively identify and manage effectively. Further research into the reasons for early death after HEDIS asthma dataset inclusion is warranted.
Profile of the skin microbiota in a healthy Chinese population
The Journal of Dermatology, EarlyView.
Photochemical oxidation of di- n -butyl phthalate in atmospheric hydrometeors by hydroxyl radicals from nitrous acid
Abstract
The photochemical oxidation of di-n-butyl phthalate (DBP) by •OH radicals from nitrous acid (HONO) in atmospheric hydrometeors was explored by two techniques, steady-state irradiation, and laser flash photolysis (LFP). The effects of atmospheric liquid parameters on DBP transformation were systematically evaluated, showing that DBP does not react with HONO directly and •OH-initiated reactions are crucial steps for consumption and transformation of DBP. Two reaction channels are operative: •OH addition and hydrogen atom abstraction. The overall rate constant for the reaction of DBP with •OH is 5.7 × 109 M−1 s−1, and its specific rate constant for addition is 3.7 × 109 M−1 s−1 determined by using laser flash photolysis technique. Comparing the individual reaction rate constant for aromatic ring addition with the total rate constant, the majority of the •OH radicals (about 65%) attack the aromatic ring. The major transformation products were identified by GC-MS, and the trends of their yields derived from both ring addition and H-abstraction with time are discussed. These results provide important insights into the photochemical transformation of DBP in atmospheric hydrometeors and contribute to atmospheric aerosol chemistry.
Levels and sources of organic compounds in fine ambient aerosols over National Capital Region of India
Abstract
The study presents the spatial and temporal variation of fine ambient aerosols (PM2.5) over National Capital Region (NCR), India, during January to June 2016. The investigation includes three sampling sites, one in Delhi and two in the adjoining states of Delhi (Uttar Pradesh and Haryana), across NCR, India. The average PM2.5 concentration was highest for Delhi (128.5 ± 51.5 μg m−3) and lowest for Mahendragarh, Haryana (74.5 ± 28.7 μg m−3), during the study period. Seasonal variation was similar for all the sites with highest concentration during winter and lowest in summer. PM2.5 samples were analysed for organic compounds using gas chromatograph (GC). The concentration of three organic compound classes, n-alkanes (C11–C35), polycyclic aromatic hydrocarbons (PAHs), and phthalates, present in PM2.5 samples has been reported. Diagnostic ratios for n-alkanes demonstrated that biogenic emissions were dominant over Mahendragarh while major contributions were observed from petrogenic emissions over Delhi and Modinagar, Uttar Pradesh. Molecular diagnostic ratios were calculated to distinguish between different sources of PAHs, which revealed that the fossil fuel combustion (diesel and gasoline emissions), traffic emissions, and biomass burning are the major source contributors. Health risk associated with human exposure of phthalates and PAHs was also assessed as daily intake (DI, ng kg−1 day−1) and lung cancer risk, respectively. Backward trajectory analysis explained the local, regional, and long-range transport routes of PM2.5 for all sites. Principal component analysis (PCA) results summarized that the vehicular emissions, biomass burning, and plastic burning were the major sources of the PAHs and phthalates over the sampling sites.
Earthworms as plug flow reactors: a first-order kinetic study on the gut of the vermicomposting earthworm Eudrilus eugeniae
Abstract
Earthworms are commonly referred as environmental engineers and their guts are often compared with chemical reactors. However, modeling experiments to substantiate it are lacking. The aim of this study was to use established reactor models, particularly PFR, on the gut of the vermicomposting earthworm Eudrilus eugeniae to understand more on its digestion. To achieve the objective, a mathematical model based on first-order kinetics was framed and used to determine the pattern of digestion rates of nutrient indicators, namely total carbon (%), total nitrogen (%), C/N ratio, 13C (‰), and 15N (‰) at five intersections (pre-intestine, foregut, midgut A, midgut B, and hindgut) along the gut of E. eugeniae. The experimental results revealed that the concentrations of TC, TN, 13C, and 15N decreased during gut transit, whereas C/N ratio increased. The first-order model demonstrated that all the nutrients exhibit a linear pattern of digestion during gut transit, which supports the PFR model. On this basis, the present study concludes that the gut of E. eugeniae functions as PFR.
Diagnostics of Pleiotropy in Mendelian Randomization Studies: Global and Individual Tests for Direct Effects
Abstract
Diagnosing pleiotropy is critical for assessing the validity of Mendelian randomization (MR) analyses. The popular MR-Egger method evaluates whether there is evidence of bias-generating pleiotropy among a set of candidate genetic instrumental variables. In this article, we propose GLIDE, GLobal and Individual tests for Direct Effects, a statistical method to systematically evaluate pleiotropy among the set of genetic variants, e.g., single nucleotide polymorphisms (SNPs), used for MR. As a global test, simulation experiments suggest that GLIDE is nearly uniformly more powerful than the MR-Egger method. As a sensitivity analysis, GLIDE is capable of detecting outliers in individual variant-level pleiotropy, in order to obtain a refined set of genetic instrumental variables. We used GLIDE to analyze both body-mass index and height for risk of colorectal cancer in the Genetics and Epidemiology of Colorectal Cancer Consortium. Among the body mass index associated SNPs and the height associated SNPs, several individual variants showed evidence of pleiotropy. Removal of these potentially pleiotropic SNPs resulted in attenuation of respective estimates of the causal effects. In summary, the proposed GLIDE method is useful for sensitivity analyses and improves the validity of MR.Promise and Pitfalls of the Sibling Comparison Design in Studies of Optimal Birth Spacing
Abstract
Numerous observational studies have shown that infants born after short interpregnancy intervals (the interval between birth and subsequent conception) are more likely to experience adverse perinatal outcomes than infants born following longer intervals. Yet, it remains controversial whether the link between short interpregnancy interval and adverse outcomes is causal, or confounded by factors such as low socio-economic position, inadequate access to healthcare, and unintended pregnancy. Sibling comparison studies, which use a woman as her own control by comparing exposure and outcome status of her different pregnancies (i.e., comparing sibling offspring), have gained popularity as a strategy to reduce confounding by these difficult-to-measure factors that are nevertheless relatively stable within women. A variant of the design, used by Regan et al. in this issue (Am J Epidemiol 2018;XX:XXX-XXX), is a maternally-matched design based on a single interpregnancy interval per woman. Using real and simulated data, we highlight underappreciated shortcomings of these designs that may limit the validity of study findings. In particular, we illustrate how the single-interval variant appears to derive estimates from comparisons between different mothers, not within mothers. Future studies of optimal birth spacing using sibling comparison designs should examine in detail the potential consequences of these methodological limitations.Detecting individual and global horizontal pleiotropy in Mendelian randomization: a job for the humble heterogeneity statistic?
Abstract
Mendelian randomization (MR) is gaining in recognition and popularity as a method for strengthening causal inference in epidemiology by utilizing genetic variants as instrumental variables. Concurrently with the explosion in empirical MR studies there has been the steady production of new approaches for MR-analysis. The recently proposed Global and Individual tests of Direct Effects (GLIDE) approach fits into a family of methods that aim to detect horizontal pleiotropy - at the individual SNP level and at the global level - and to adjust the analysis by removing outlying SNPs. The purpose of this commentary is to explain how existing methods can (and indeed are) being used to detect pleiotropy at the individual and global level, although not explicitly using this terminology. By doing so, we will show that the true comparator for GLIDE is not MR-Egger regression (as the authors of the GLIDE approach claim), but rather the humble heterogeneity statistic.A Population-based Matched Sibling Analysis Estimating the Association between First Interpregnancy Interval and Birth Outcomes
Abstract
The association between a single interpregnancy interval (IPI) on birth outcomes has not yet been explored using matched methods. We modelled the odds of preterm birth, small-for-gestational age and low birthweight in a second, liveborn infant in a cohort of 192,041 sibling pairs born in Western Australia between 1980 and 2010. The association between IPI and birth outcomes was estimated from the interaction between birth order and IPI (with 18–23 months as the reference category), using conditional logistic regression. Matched analysis showed the odds of preterm birth were higher for siblings born following an IPI <6 month (adjusted Interaction Odds Ratio [IOR]: 1.22; 95% CI: 1.06, 1.38) compared with 18–23 month IPI. There were no significant differences for IPI <6 months for other outcomes (small-for-gestational age or low birthweight). This is the first study to use matched analyses to investigate the association between a single IPI on birth outcomes. IPI <6 months were associated with increased odds of preterm birth in secondborn infants, although the association is likely smaller than previously estimated by unmatched studies.Estimating the Short-term Effects of the Earned Income Tax Credit on Child Health
Abstract
The earned income tax credit (EITC) is the largest U.S. poverty alleviation program, yet few studies examine its effects on the health of recipients' children. We employed quasi-experimental techniques to test the hypothesis that EITC refund receipt is associated with short-term improvements in child health. The data set included children surveyed in the Third National Health and Nutrition Examination Survey (N=7,444). We employed a difference-in-differences approach, exploiting the seasonal nature of EITC refund receipt. We compared children of EITC-eligible families interviewed immediately after refund receipt (February-April) with those interviewed during other months (May-January), differencing out seasonal variation among non-EITC-eligible families. We examined outcomes that were likely to be affected immediately after refund receipt, including general health, nutrition, metabolic and inflammatory biomarkers, and test scores. There were improvements in physician-reported overall health after refund receipt, but no changes in infection, serum metabolic or inflammatory markers, or test scores, and contradictory findings for food insufficiency. In summary, EITC refunds are not strongly associated with most short-term health outcomes among recipients' children, although numerous previous studies have demonstrated impacts on longer-term outcomes. This highlights the importance of examining the effects of public policies on beneficiaries and their children using varying study designs.Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts by Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data from a Systematic Review
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both 'exposure' (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority to heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian re-analysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.Diet Quality Indices and Risk of Type 2 Diabetes: The Singapore Chinese Health Study
Abstract
We aimed to test whether predefined dietary patterns inversely relating to risk of type 2 diabetes (T2D) in Western populations were similarly associated with lower T2D risk in an Asian population. We included 45,411 middle aged and older participants of the Singapore Chinese Health Study free of diabetes, cancer or cardiovascular disease at baseline (1993–1998). Participants were followed up for T2D diagnosis through 2010. Dietary information was collected using a validated food frequency questionnaire. Dietary pattern scores were calculated for the alternate Mediterranean diet, alternative Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension diet, an overall plant-based diet index, and a healthful plant-based diet index. During a median 11.2 years of follow-up, 5,207 incident cases of T2D occurred. After the adjustment for multiple potential confounders, the 5 dietary pattern scores were significantly associated with 16% (for alternate Mediterranean diet) to 29% (for Dietary Approaches to Stop Hypertension diet) lower risk of T2D when comparing the highest with the lowest score quintiles (all P for trend <0.001). These associations did not vary substantially by baseline age, sex, body mass index or hypertension status, but were limited to non-smokers (P for interaction <0.001 for alternate Mediterranean diet and 0.03 for alternative Healthy Eating Index-2010). Adherence to a high-quality diet, as reflected by several predefined diet quality indices derived in Western populations, was significantly associated with lower risk of T2D in an Asian population.Associations of Long-Term Exposure to Ultrafine Particles and Nitrogen Dioxide with Increased Incidence of Congestive Heart Failure and Acute Myocardial Infarction
Abstract
Although long-term exposure to traffic-related air pollutants such as nitrogen dioxide (NO2) has been linked to cardiovascular mortality, little is known about the association of ultrafine particles (UFPs) with incidence of major cardiovascular events. We conducted a population-based cohort study to assess the associations of chronic exposure to UFPs and NO2 with incident congestive heart failure (CHF) and acute myocardial infarction. Our study population comprised all long-term Canadian residents aged 30-100 years who lived in Toronto, Canada, 1996-2012. We estimated annual concentrations of UFPs and NO2 using land-use regression models and assigned these estimates to participants' postal-code addresses in each year during the follow-up period. We estimated hazard ratios (HRs) for UFPs and NO2 using random-effects Cox proportional hazards models. We controlled for smoking and obesity using an indirect adjustment method. Our cohorts comprised ~1.1 million individuals at baseline. In single-pollutant models, each interquartile increase in UFPs exposure was associated with increased incidence for CHF (HRiqr: 1.03; 95%CI: 1.02, 1.05) and acute myocardial infarction (HRiqr: 1.05; 95%CI: 1.02, 1.07), respectively. Adjustment for fine particles and NO2 did not materially change these estimated associations. Exposure to NO2 was also independently associated with higher CHF incidence (HRiqr: 1.04; 95%CI: 1.03, 1.06).MGMT promoter methylation status testing to guide therapy for glioblastoma: refining the approach based on emerging evidence and current challenges
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor, with a universally poor prognosis. The emergence of molecular biomarkers has had a significant impact on histological typing and diagnosis, as well as predicting patient survival and response to treatment. The methylation status of the O6-methylguanine-DNA methyl-transferase (MGMT) gene promoter is one such molecular biomarker. Despite the strong evidence supporting the role of MGMT methylation status in prognostication, its routine implementation in clinical practice has been challenging. The methods and optimal cutoff definitions for MGMT status determination remain controversial. Variation in detection methods between laboratories presents a major challenge for consensus. Moreover, consideration of other clinical and genetic/epigenetic factors must also be incorporated into treatment decision making. In this review, we distill the available evidence to summarize our position on the optimal use of available assays, and propose strategies for resolving cases with equivocal methylation status and a framework for incorporating this important assay into research and clinical practice.A systematic review of financial implications of air pollution on health in Asia
Abstract
Economic losses due to health-related implications of air pollution were huge and incurred significant burdens towards healthcare providers. The objective of this study is to systematically review published literature on the financial implications of air pollution on health in Asia. Four databases: PubMed, Scopus, NHS Economic Evaluation Database (NHS EED), and Web of Science (WoS) were used to identify all the relevant articles. It was limited to all articles that had been published in the respected databases from January 2007 until March 2017. Twenty-four articles were included in this review. Five of the 24 studies (20.8%) reported financial implications of air pollution-related disease through value of statistical life (VOSL) which ranged from USD180 million to USD2.2 billion, six (25%) studies used cost of illness (COI) to evaluate air pollution-related morbidity and found that the cost ranged from USD5.4 million to USD9.1 billion. Another six studies (25%) used a combination of VOSL and COI for both mortality and morbidity valuation and found that the financial implications ranging from USD253 million to USD2.9 billion. Thirteen (54.2%) studies reported healthcare cost associated with both hospital admission and outpatient visit, five (20.1%) on hospital admission only, and one (4.2%) on outpatient visit only. Economic impacts of air pollution can be huge with significant deterioration of health among the Asians.
Application of magnesium peroxide (MgO 2 ) nanoparticles for toluene remediation from groundwater: batch and column studies
Abstract
In the present study, magnesium peroxide (MgO2) nanoparticles were synthesized by electro-deposition process and characterized by X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM). The batch experiments were conducted to evaluate the MgO2 half-life (600 mg/L) in groundwater under various temperatures (4, 15, and 30 °C) and initial pH (3, 7, and 12). The effect of Fe2+ ions (enhanced oxidation) on the toluene remediation by MgO2 was also investigated. Nanoparticles were injected to sand-packed continuous-flow columns, and toluene removal (50 ppm) was studied within 50 days at 15 °C. The results indicated that the half-life of MgO2 at pH 3 and 12 were 5 and 15 days, respectively, in comparison to 10 days at the initial pH 7 and 15 °C. The nanoparticles showed 20 and 7.5 days half-life at 4 and 30 °C temperatures, respectively. Injection of Fe2+ ions indicated an impressive effect on toluene removal by MgO2, and the contaminant was completely removed after 5 and 10 days, in the batch and column experiments, respectively. Confocal laser scanning microscope (CLSM) analysis indicated that the attached biofilm had a significant role in the decontamination of groundwater. Comparison of bioremediation and enhanced oxidation resulted in a considerable insight into the application of magnesium peroxide in groundwater remediation.
Graphical abstract
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Transparency in Algorithmic and Human Decision-Making: Is There a Double Standard?
Abstract
We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little worse or better and argue that at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett's theory of the "intentional stance" and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool.
How much does community-based targeting of the ultra-poor in the health sector cost? Novel evidence from Burkina Faso
Targeting efforts aimed at increasing access to care for the poorest by reducing to a minimum or completely eliminating payments at point of use are increasingly being adopted across low and middle income coun...
Environmental exposure of anthropogenic micropollutants in the Prut River at the Romanian-Moldavian border: a snapshot in the lower Danube river basin
Abstract
The Prut River, the second longest tributary of the Danube river, was investigated for a wide range of anthropogenic organic pollutants to fill the data gap on environmental contamination in eastern European surface waters. In this study, the occurrence of a wide range of organic pollutants was measured along the transboundary Prut River, between Sculeni and Branza in 2010–2012. Using two different analytical methods, gas chromatography coupled to mass spectrometry and liquid chromatography coupled to high-resolution mass spectrometry, over 300 compounds were screened for and 88 compounds were determined in the Prut River. In general, the chemicals occurred at low levels. At the last sampling site upstream of the confluence with the Danube river at Branza, the highest average concentrations (≥ 100 ng L−1) were determined for the artificial sweetener acesulfame, the pharmaceuticals metformin, 4-acetamidoantipyrene, and 4,4,5,8-tetramethylchroman-2-ol, the antioxidants 2,4-di-tert-butylphenol, 3-tert-butyl-4-hydroxyanisol, and 3,5-di-tert-butyl-4-hydroxy-toluene, the personal care products HHCB (galaxolide), 4-phenyl-benzophenone, and octyl dimethyl-p-aminobenzoic acid, the industrial chemical diphenylsulfone, and the sterol cholesterol. Low concentrations of agricultural pesticides occurred in the catchment. At Branza, the total accumulated load of all measured compounds was calculated to be almost 19 kg day−1. In comparison to the Rhine River, the loads in the Prut, determined with same LC-HRMS method for the same set of analytes, were two orders of magnitude lower. Discharge of wastewater without proper treatment from the city of Iasi in the Jijia catchment (Romania) as well as from the city of Cahul (Moldova) revealed a distinct increase in concentrations and loads in the Prut at Frasinesti and Branza. Thus, an implementation of wastewater treatment capacities in the Prut River basin would considerably reduce the loads of micropollutants from urban point sources.
Depersonalization Disorder, Affective Processing and Predictive Coding
Abstract
A flood of new multidisciplinary work on the causes of depersonalization disorder (DPD) provides a new way to think about the feeling that experiences "belong" to the self. In this paper I argue that this feeling, baptized "mineness"(Billon 2013, 2018a, b) or "subjective presence" (Seth, Trends in Cognitive Sciences 17(11): 565–573, 2013) emerges from a multilevel interaction between emotional, affective and cognitive processing. The "self" to which experience is attributed is a predictive model made by the mind to explain the modulation of affect as the organism progresses through the world. When the world no longer produces predicted affect, the organism needs to explain or explain this unpredicted absence of feeling away. It is important to this account that cognition and perception are otherwise intact. Consequently the mind's representation of the world and its emotionally salient properties are unchanged, leading the mind to predict a characteristic affective response. When that prediction is not fulfilled the organisms feels as if she is no longer present in experience. This is reported at the as feeling of depersonalization.
Radiostrontium transport in plants and phytoremediation
Abstract
Radiostrontium is a common product of nuclear fission and was emitted into the environment in the course of nuclear weapon tests as well as from nuclear reactor accidents. The release of 90Sr and 89Sr into the environment can pose health threats due to their characteristics such as high specific activities and easy access in human body due to its chemical analogy to calcium. Radiostrontium enters the human food chain by the consumption of plants grown on sites comprising fission-derived radionuclides. For humans, Sr is not an essential element, but, due to solubility in water and homology with calcium, once interred in the body, it gets deposited in bones and in teeth. This concern has drawn the attention of researchers throughout the globe to develop sustainable treatment processes to remediate soil and water resources. Nowadays, phytoremediation has become a promising approach for the remediation of large extents of toxic heavy metals. Some of the plants have been reported to accumulate Sr inside their biomass but detailed mechanisms at genetic level are still to be uncovered. However, there is inadequate information offered to assess the possibility of this remediation approach. This review highlights phytoremediation approach for Sr and explains in detail the uptake mechanism inside plants.
Silver Doped TiO2 Coated Cotton Fabric as an Effective Photocatalytic System for Dye Decolorization in UV and Visible Light
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Application of Photoacoustic Methods and Confocal Microscopy for Monitoring of Therapeutic Response in Plaque Psoriasis
Psoriasis is prone to relapses and requires long-term therapy that may induce a range of adverse effects; therefore, an efficient and early detection of relapses is desirable. In this study, photoacoustic imaging and confocal laser scanning microscopic (CLSM) methods were investigated for their suitability in psoriasis follow-up examinations. Using a high-resolution photoacoustic system, the vascular structures of 11 psoriatic patients and 6 healthy volunteers were investigated. No differences were detected with respect to the average vessel diameter and vasculature per unit volume in the tissue of healthy volunteers and non-lesional and lesional skin areas of psoriatic patients. By means of CLSM, the diameters of the dermal papillae of 6 volunteers and 6 psoriatic patients were determined. The diameters of the dermal papillae of the healthy volunteers (0.074 ± 0.006 mm) revealed no significant difference when compared to non-lesional skin areas of psoriatic patients (0.079 ± 0.005 mm). The results obtained for the lesions in psoriatic patients showed a significant difference (Wilcoxon test, p = 0.028) between the diameters of the dermal papillae of the lesional skin areas (0.114 ± 0.012 mm) and the non-lesional skin areas (0.079 ± 0.005 mm). Thus, CLSM can be applied for monitoring psoriasis follow-up examinations.
Skin Pharmacol Physiol 2018;31:308–315
Heavy metal leaching and plant uptake in mudflat soils amended with sewage sludge
Abstract
The leaching and uptake of Cd, Cu, Pb, and Zn by maize (Zea mays L.) in mudflat saline-alkali soils amended by sewage sludge was examined using a greenhouse leaching column experiment. Application of sewage sludge caused decreased pH, increased DOC, and increased Cd, Cu, Pb, and Zn concentrations in leachates. The similar temporal dynamics of DOC and the metal concentrations in leachates suggested complexation of the metals with DOC. There was downward movement of metals as evidenced by the metal enrichment in the bottom layer (20–40-cm depth) of leaching columns (p < 0.05). The enrichment of metals was contributed by the acid-soluble/exchangeable fraction (EX), reducible fraction (RG), oxidizable fraction (OXI), and residual fraction (RES), indicating redistribution of leached metals from the top 20-cm layer. The sewage sludge application also enhanced plant uptake of metals. However, even under the greatest sludge application rate (150 g kg−1), very small proportions, averagely 0.65% and 0.35%, of the applied metals were leached and taken up by maize, respectively, over the experimental period. Long-term field-scale research is warranted for further investigation of the effects of sewage sludge amendment on heavy metal fractionation and distribution in mudflat soil-plant-water system.
Τρίτη 4 Σεπτεμβρίου 2018
The clinical, biochemical, and ultrasonographic characteristics of patients with hidradenitis suppurativa in Northern Peninsular Malaysia: a multicenter study
International Journal of Dermatology, EarlyView.
Lues maligna in an immunocompetent female
Swetalina Pradhan, Chandra S Sirka, Maitreyee Panda, Manas Baisakh
Indian Dermatology Online Journal 2018 9(5):344-346
Indian Dermatology Online Journal 2018 9(5):344-346
“Hair building” fibers through the dermoscope
Feroze Kaliyadan, Kaberi Feroze
Indian Dermatology Online Journal 2018 9(5):362-363
Indian Dermatology Online Journal 2018 9(5):362-363
A study of cutaneous adverse drug reactions in a tertiary care center in Punjab
Niharika Jha, Emy Alexander, Bimal Kanish, Dinesh K Badyal
Indian Dermatology Online Journal 2018 9(5):299-303
Context: Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aims: To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. Patients and Methods: This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. Statistical Analysis: Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. Results: A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens–Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. Conclusion: The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.
Indian Dermatology Online Journal 2018 9(5):299-303
Context: Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aims: To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. Patients and Methods: This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. Statistical Analysis: Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. Results: A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens–Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. Conclusion: The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.
Giant shagreen patch in tuberous sclerosis complex
V Kuntoji, PV Bhagwat, C Kudligi
Indian Dermatology Online Journal 2018 9(5):353-355
Indian Dermatology Online Journal 2018 9(5):353-355
Prevalence of metabolic syndrome in patients with lichen planus: A cross-sectional study from a tertiary care center
Hashim Hashba, Joy Bifi, Anoop Thyvalappil, Rajiv Sridharan, Ajayakumar Sreenivasan, Pretty Mathew
Indian Dermatology Online Journal 2018 9(5):304-308
Background: There have been reports of association between lichen planus (LP) and metabolic syndrome and its various parameters. Aims and Objectives: To determine the prevalence of metabolic syndrome in patients with LP and to determine the association between the morphologic types of LP and metabolic syndrome. Materials and Methods: In this cross-sectional study conducted over a period of 1 year, 70 clinically diagnosed patients with LP were included and evaluated for metabolic syndrome based on the modified National Cholesterol Education Program: Adult Treatment Panel III guidelines. Data were analyzed using Statistical Package for the Social Sciences version 17 software, and inferential statistical tools such as t-test for continuous data and Chi-square test for categorical data were used. Results: A 35.7% prevalence of metabolic syndrome was found in patients with LP. The average duration of LP was found to be higher in patients with metabolic syndrome. There was a higher prevalence of central obesity, increased fasting blood sugar, and low high-density lipoprotein-cholesterolin patients with LP. Conclusion: Metabolic syndrome was seen in 25 patients (35.7%) with LP. It is important to advise our patients to adopt healthy lifestyle choices to help prevent comorbidities and improve the general health of population. As this study was a cross-sectional study, the directionality of the association between LP and metabolic syndrome could not be assessed. Lack of controls and a small sample size are other limitations of our study.
Indian Dermatology Online Journal 2018 9(5):304-308
Background: There have been reports of association between lichen planus (LP) and metabolic syndrome and its various parameters. Aims and Objectives: To determine the prevalence of metabolic syndrome in patients with LP and to determine the association between the morphologic types of LP and metabolic syndrome. Materials and Methods: In this cross-sectional study conducted over a period of 1 year, 70 clinically diagnosed patients with LP were included and evaluated for metabolic syndrome based on the modified National Cholesterol Education Program: Adult Treatment Panel III guidelines. Data were analyzed using Statistical Package for the Social Sciences version 17 software, and inferential statistical tools such as t-test for continuous data and Chi-square test for categorical data were used. Results: A 35.7% prevalence of metabolic syndrome was found in patients with LP. The average duration of LP was found to be higher in patients with metabolic syndrome. There was a higher prevalence of central obesity, increased fasting blood sugar, and low high-density lipoprotein-cholesterolin patients with LP. Conclusion: Metabolic syndrome was seen in 25 patients (35.7%) with LP. It is important to advise our patients to adopt healthy lifestyle choices to help prevent comorbidities and improve the general health of population. As this study was a cross-sectional study, the directionality of the association between LP and metabolic syndrome could not be assessed. Lack of controls and a small sample size are other limitations of our study.
Prevalence and association of dermatological manifestations with fanconi anemia: A retrospective study
Pallavi Shukla, Seema Korgaonkar, Lily Kerketta, Babu R Vundinti
Indian Dermatology Online Journal 2018 9(5):341-342
Indian Dermatology Online Journal 2018 9(5):341-342
Impact of palmoplantar dermatoses on quality of life
Rochit Singhal, Nilofar G Diwan, Pragya A Nair
Indian Dermatology Online Journal 2018 9(5):309-313
Background: Palmoplantar dermatoses are commonly found in dermatological practice. Quality of life (QOL) is severely impaired if these areas are affected. Early and appropriate management of palmoplantar dermatoses help in improving patient's QOL. Aim: To assess the impact of palmoplantar dermatoses on QOL. Materials and Methods: Patients with palmoplantar dermatoses with or without other body part involvement were enrolled in the study. QOL was assessed by Dermatology Life Quality Index (DLQI) questionnaire for >16 years of age and by Children's Dermatology Life Quality Index (CDLQI) questionnaire for 5–16 years of age. Results: Two hundred and two patients participated, of which 108 (53.46%) were males and 94 (46.53%) were females. The commonest age group affected was 17–40 years (42.57%). Housewives 61 (30.2%) and laborers 53 (26.2%) were most common occupational group affected. The mean DLQI and CDLQI scores were 7.68 and 7.46, respectively. Fifty-seven (28.21%) patients had palmoplantar psoriasis (PPP), 35 (17.32%) had palmoplantar keratoderma (PPK), and 26 (12.87%) had hand eczema (HE) with mean DLQI scores 8.60, 8.53, 8.60, and CDLQI scores 8.40, 8.28, and 8.26, respectively. In both DLQI and CDLQI, questions on symptoms and feelings scored maximum. Gender, age, occupation, duration, progress, and type of dermatosis did not show statistically significant association with DLQI. However, chronic recalcitrant dermatoses such as PPP, PPK, and HE showed significant impairment in QOL in relation to occupation and duration of disease. Limitation: Severity of various palmoplantar dermatoses was not graded and therefore relation between severity of various dermatoses and QOL was not established. Conclusion: Majority of patients with palmoplantar dermatoses especially those having chronic course had significant impairment in their QOL.
Indian Dermatology Online Journal 2018 9(5):309-313
Background: Palmoplantar dermatoses are commonly found in dermatological practice. Quality of life (QOL) is severely impaired if these areas are affected. Early and appropriate management of palmoplantar dermatoses help in improving patient's QOL. Aim: To assess the impact of palmoplantar dermatoses on QOL. Materials and Methods: Patients with palmoplantar dermatoses with or without other body part involvement were enrolled in the study. QOL was assessed by Dermatology Life Quality Index (DLQI) questionnaire for >16 years of age and by Children's Dermatology Life Quality Index (CDLQI) questionnaire for 5–16 years of age. Results: Two hundred and two patients participated, of which 108 (53.46%) were males and 94 (46.53%) were females. The commonest age group affected was 17–40 years (42.57%). Housewives 61 (30.2%) and laborers 53 (26.2%) were most common occupational group affected. The mean DLQI and CDLQI scores were 7.68 and 7.46, respectively. Fifty-seven (28.21%) patients had palmoplantar psoriasis (PPP), 35 (17.32%) had palmoplantar keratoderma (PPK), and 26 (12.87%) had hand eczema (HE) with mean DLQI scores 8.60, 8.53, 8.60, and CDLQI scores 8.40, 8.28, and 8.26, respectively. In both DLQI and CDLQI, questions on symptoms and feelings scored maximum. Gender, age, occupation, duration, progress, and type of dermatosis did not show statistically significant association with DLQI. However, chronic recalcitrant dermatoses such as PPP, PPK, and HE showed significant impairment in QOL in relation to occupation and duration of disease. Limitation: Severity of various palmoplantar dermatoses was not graded and therefore relation between severity of various dermatoses and QOL was not established. Conclusion: Majority of patients with palmoplantar dermatoses especially those having chronic course had significant impairment in their QOL.
A rare case of neurofibromatosis type i with coexistent wilson disease
Tulika Rai, Vijay Kumar, Najuma Subba
Indian Dermatology Online Journal 2018 9(5):348-350
Indian Dermatology Online Journal 2018 9(5):348-350
Coexistence of fungal infections in psoriatic nails and their correlation with severity of nail psoriasis
Suteeraporn Chaowattanapanit, Penvadee Pattanaprichakul, Charussri Leeyaphan, Onjuta Chaiwanon, Panitta Sitthinamsuwan, Waritch Kobwanthanakun, Suchanan Hanamornroongruang, Sumanas Bunyaratavej
Indian Dermatology Online Journal 2018 9(5):314-317
Background: Nail involvement in psoriasis is often complicated by concomitant fungal infections. The aim of this study was to investigate the prevalence of fungal infections in nail psoriasis and correlate it with the severity of nail psoriasis. Materials and Methods: This retrospective study included patients with nail psoriasis aged ≥18 years with at least one fingernail and one toenail involvement who were treated at Siriraj Hospital from September 2012 to January 2014. Severity of nail psoriasis was assesed by Nail Psoriasis Area Severity Index (NAPSI) score. The nail clippings from the the least and most severely involved psoriatic fingernails and toenails were cultured to determine the presence of coexisting fungal infections and isolate the fungal species. Results: Sixty-two patients (33 males, 29 females) fulfilling the inclusion criteria were included in the study. The mean age at the time of presentation was 51.3 years mention SD. The most common nail change consistent with psoriasis was onycholysis, followed by subungual hyperkeratosis. The most commonly isolated fungi in the most severely affected fingernails were Candida spp. (41.9%) manifesting as paronychia in 5 patients (19.2%). The most commonly isolated fungi in the most severely affected toenails were nondermatophytes (NDMs) other than candida (32.3%). Dermatophytes were not detected from any of the psoriatic nails. The fungal species isolated from the most severely affected fingernails were significantly different than the isolated fungal species in the most severely affected toenails (P = 0.026). Fungal organisms were identified in 32.3% of the most severely affected fingernails and in 27.4% of the most severely affected toenails. The overall rate of isolation of fungus was significantly significantly higher in severely affected nails than in the least affected nails (P < 0.005). Conclusion: A high rate of concomitant fungal infections, especially yeasts and NDMs, was found in psoriatic nail patients. The rate of isolation of fungal species was higher in severely involved psoriatic nails than mildly involved ones. The spectrum of fungal species isolated from the the severely involved toenails and fingernails were also different from each other. These organisms may be true pathogens that cause onychomycosis or their presence may reflect colonization, contamination, or concurrent infection.
Indian Dermatology Online Journal 2018 9(5):314-317
Background: Nail involvement in psoriasis is often complicated by concomitant fungal infections. The aim of this study was to investigate the prevalence of fungal infections in nail psoriasis and correlate it with the severity of nail psoriasis. Materials and Methods: This retrospective study included patients with nail psoriasis aged ≥18 years with at least one fingernail and one toenail involvement who were treated at Siriraj Hospital from September 2012 to January 2014. Severity of nail psoriasis was assesed by Nail Psoriasis Area Severity Index (NAPSI) score. The nail clippings from the the least and most severely involved psoriatic fingernails and toenails were cultured to determine the presence of coexisting fungal infections and isolate the fungal species. Results: Sixty-two patients (33 males, 29 females) fulfilling the inclusion criteria were included in the study. The mean age at the time of presentation was 51.3 years mention SD. The most common nail change consistent with psoriasis was onycholysis, followed by subungual hyperkeratosis. The most commonly isolated fungi in the most severely affected fingernails were Candida spp. (41.9%) manifesting as paronychia in 5 patients (19.2%). The most commonly isolated fungi in the most severely affected toenails were nondermatophytes (NDMs) other than candida (32.3%). Dermatophytes were not detected from any of the psoriatic nails. The fungal species isolated from the most severely affected fingernails were significantly different than the isolated fungal species in the most severely affected toenails (P = 0.026). Fungal organisms were identified in 32.3% of the most severely affected fingernails and in 27.4% of the most severely affected toenails. The overall rate of isolation of fungus was significantly significantly higher in severely affected nails than in the least affected nails (P < 0.005). Conclusion: A high rate of concomitant fungal infections, especially yeasts and NDMs, was found in psoriatic nail patients. The rate of isolation of fungal species was higher in severely involved psoriatic nails than mildly involved ones. The spectrum of fungal species isolated from the the severely involved toenails and fingernails were also different from each other. These organisms may be true pathogens that cause onychomycosis or their presence may reflect colonization, contamination, or concurrent infection.
Cutaneous larva migrans in an infant
Farzana Ansari, Lalit K Gupta, Ashok K Khare, Manisha Balai, Asit Mittal, Sharad Mehta
Indian Dermatology Online Journal 2018 9(5):359-359
Indian Dermatology Online Journal 2018 9(5):359-359
The prevalence of psychiatric comorbidity in patients with prurigo nodularis
Lovee Dhawan, Shubh M Singh, A Avasthi, M Sendhil Kumaran, Tarun Narang
Indian Dermatology Online Journal 2018 9(5):318-321
Background: Prurigo nodularis (PN) is a chronic, recalcitrant itchy dermatosis. It is supposed to be associated with psychological factors, but research in this area is scarce. Objectives: To study the prevalence and determinants of psychiatric morbidity, and the phenomenology of itch in PN. Materials and Methods: This study was carried out in the outpatient service of the Department of Dermatology. Purposive sampling was used to recruit 50 patients each with PN, chronic urticaria (CU), and vitiligo (V). A one-time cross-sectional assessment was carried out on the participants. Psychiatric morbidity was assessed using Mini-International Neuropsychiatric Interview and Patient Health Questionnaire-9. Results: The three groups were comparable on socio-demographic parameters. The prevalence of any psychiatric disorder (current or lifetime) was 48%, 42%, and 58% in the PN, CU, and V groups, respectively (P = 0.27). Limitations: The limitations of this study include the small sample size and the purposive, non-blind nature of assessments. Conclusion: Our study suggests that there is significant psychiatric morbidity in PN which is comparable to that seen in CU and V.
Indian Dermatology Online Journal 2018 9(5):318-321
Background: Prurigo nodularis (PN) is a chronic, recalcitrant itchy dermatosis. It is supposed to be associated with psychological factors, but research in this area is scarce. Objectives: To study the prevalence and determinants of psychiatric morbidity, and the phenomenology of itch in PN. Materials and Methods: This study was carried out in the outpatient service of the Department of Dermatology. Purposive sampling was used to recruit 50 patients each with PN, chronic urticaria (CU), and vitiligo (V). A one-time cross-sectional assessment was carried out on the participants. Psychiatric morbidity was assessed using Mini-International Neuropsychiatric Interview and Patient Health Questionnaire-9. Results: The three groups were comparable on socio-demographic parameters. The prevalence of any psychiatric disorder (current or lifetime) was 48%, 42%, and 58% in the PN, CU, and V groups, respectively (P = 0.27). Limitations: The limitations of this study include the small sample size and the purposive, non-blind nature of assessments. Conclusion: Our study suggests that there is significant psychiatric morbidity in PN which is comparable to that seen in CU and V.
Systemic drug-induced chronic paronychia and periungual pyogenic granuloma
Uwe Wollina
Indian Dermatology Online Journal 2018 9(5):293-298
Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma – a benign vascular tumor of the capillaries – can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.
Indian Dermatology Online Journal 2018 9(5):293-298
Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma – a benign vascular tumor of the capillaries – can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.
Innovative use of felt-tip pen applicator for uniform spread of linkage fluid during dermatoscopy
Deepak Jakhar, Chander Grover
Indian Dermatology Online Journal 2018 9(5):322-323
Indian Dermatology Online Journal 2018 9(5):322-323
Dermoscopic features of cutaneous collagenous vasculopathy: A report of rare disorder
Daksha Vasava, Hita Mehta
Indian Dermatology Online Journal 2018 9(5):342-344
Indian Dermatology Online Journal 2018 9(5):342-344
Caruncular oncocytoma: Report of two cases with review of literature
Suvradeep Mitra, Khushboo Lath, Ramanuj Samanta, Uma N Saikia
Indian Dermatology Online Journal 2018 9(5):324-327
Caruncular lesions are uncommon and could be related to hair follicles, sebaceous glands, sweat glands, and accessory lacrimal gland harbored in caruncle. As the lesions of caruncle are diverse, the clinical diagnosis is difficult. Majority of the caruncular lesions are benign although rare malignant lesions have also been reported. Caruncular oncocytoma (CO) is a rare ocular neoplasm with an incidence of <3%, as per the Western literature. However, only two cases of ocular oncocytoma are reported in the Indian literature. Here, we report two more cases of CO from India with their histochemical and ultrastructural characteristics.
Indian Dermatology Online Journal 2018 9(5):324-327
Caruncular lesions are uncommon and could be related to hair follicles, sebaceous glands, sweat glands, and accessory lacrimal gland harbored in caruncle. As the lesions of caruncle are diverse, the clinical diagnosis is difficult. Majority of the caruncular lesions are benign although rare malignant lesions have also been reported. Caruncular oncocytoma (CO) is a rare ocular neoplasm with an incidence of <3%, as per the Western literature. However, only two cases of ocular oncocytoma are reported in the Indian literature. Here, we report two more cases of CO from India with their histochemical and ultrastructural characteristics.
Tubular apocrine adenoma on vulva: An unusual location
Sarina Jain, Kausar Valiulla, Atul M Dongre, Balasaheb V Malkar
Indian Dermatology Online Journal 2018 9(5):346-348
Indian Dermatology Online Journal 2018 9(5):346-348
Methotrexate cutaneous toxicity following a single dose of 10 mg in a case of chronic plaque psoriasis: A possible idiosyncratic reaction
Aastha Gupta, Kabir Sardana, Minakshi Bhardwaj, Ajeet Singh
Indian Dermatology Online Journal 2018 9(5):328-330
Low-dose methotrexate is a well-tolerated and inexpensive systemic immunosuppressive agent used commonly in dermatology. However, several adverse events such as pancytopenia, pneumonitis, mucositis, and cutaneous ulcerations may develop during acute toxicity with dose-dependent or idiosyncratic mechanisms. Risk factors for methotrexate toxicity include advanced age, hypoalbuminemia, renal dysfunction, and concomitant drugs increasing the level of methotrexate in the body. We present a case of methotrexate toxicity presenting with classical features along with mucocutaneous side-effects, such as ulceration of psoriatic plaques and acral erythema, following a single dose of methotrexate.
Indian Dermatology Online Journal 2018 9(5):328-330
Low-dose methotrexate is a well-tolerated and inexpensive systemic immunosuppressive agent used commonly in dermatology. However, several adverse events such as pancytopenia, pneumonitis, mucositis, and cutaneous ulcerations may develop during acute toxicity with dose-dependent or idiosyncratic mechanisms. Risk factors for methotrexate toxicity include advanced age, hypoalbuminemia, renal dysfunction, and concomitant drugs increasing the level of methotrexate in the body. We present a case of methotrexate toxicity presenting with classical features along with mucocutaneous side-effects, such as ulceration of psoriatic plaques and acral erythema, following a single dose of methotrexate.
Unilateral facial telangiectasia macularis eruptiva perstansmimicking as rosacea
Preema Sinha, Anwita Sinha, Deep K Raman, Aradhana Sood
Indian Dermatology Online Journal 2018 9(5):351-353
Indian Dermatology Online Journal 2018 9(5):351-353
The mTOR-inhibitor Sirolimus decreases the cyclosporine-induced expression of the oncogene ATF3 in human keratinocytes
Cutaneous Squamous cell carcinoma (cSCC) is after basal cell carcinoma the second most common non-melanoma skin cancer and accounts for 20% of all cutaneous malignancies [1]. Particularly effected are organ transplant recipients (OTRs) with a 65 to 250 higher risk than the general population due to their immunosuppression as major risk factor [2]. Moreover, cSCC in OTRs are often quite aggressive with high recurrence rates, metastasis and death [3]. The most widely used agents to prevent graft rejection in solid OTRs are calcineurin-inhibitors in combination with mycophenolate mofetil (MMF) and corticosteroids as the standard triple therapy especially after renal transplantation.
Sweaty feet in adolescents—Early use of botulinum type A toxin in juvenile plantar hyperhidrosis
Pediatric Dermatology, EarlyView.
Melanotic neuroectodermal tumor of infancy: A rare pediatric head and neck lesion
Pediatric Dermatology, EarlyView.
Long-term follow-up of a community sample of adolescents with frequent headaches
Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome ...
Congenital Syphilis—Still a Shadow on the Land
The US Surgeon General, Thomas Parran, chose an ominous phrase—Shadow on the Land—as the title of his best-selling book about syphilis, published in 1937. It was not without reason. At the time, according to Parran, nearly 700 000 Americans were being treated for syphilis, constituting only a fraction of the approximately 1.7 million that he estimated needed treatment. At least 500 000 new infections occurred in the United States each year, Parran stated, including 60 000 cases of congenital syphilis. Cardiovascular syphilis claimed 40 000 lives each year. The arsenic-containing compound salvarsan, supplemented with mercury or bismuth, was the most effective treatment. Syphilis, Parran wrote, was "the most urgent public health problem in this country today."(p52)
Plankton community assessment in anthropogenic-impacted oligotrophic coastal regions
Abstract
Microbial planktonic communities are critical components of marine biogeochemical pathways. Despite this, there is still limited knowledge on the dynamics of this group in warm and oligotrophic waters. We used high-throughput sequencing to characterise the bacterial (16S rRNA) and eukaryotic (18S rRNA) microbial plankton communities in two regions under the influence of anthropogenic impacts (a port and sewage outflow) and a coastal region with no direct anthropogenic disturbances in the central Red Sea. Overall, bacterial and eukaryotic components responded in a similar way to the environmental conditions. Community composition and structure were more sensitive than alpha diversity measures to environmental impacts. With the exception of eukaryotes, for which the number of OTU differed significantly between sampling periods in all the regions, environmental changes associated with anthropogenic pressures seem to be better reflected by variations in the relative dominance of microbial groups. For example, elevated proportional abundances of nitrifying and sewage-/faecal-related bacteria at the impacted sites were observed compared with the coastal region. The recently developed microgAMBI also appeared to correlate well with the level of anthropogenic impact the regions experienced, showing the potential to be applied in oligotrophic waters.
Nitrate leaching from open-field and greenhouse vegetable systems in China: a meta-analysis
Abstract
The potential for nitrate leaching in Chinese vegetable systems is substantial because of high inputs of nitrogen (N) fertilizer and water. To quantify the nitrate leaching and identify the key controlling factors in Chinese vegetable systems, we conducted a meta-analysis that included 221 data sets from 18 field studies. The results revealed that nitrate leaching over the entire crop growing season in Chinese vegetable systems was very high and averaged 79.1 kg N ha−1 and primarily resulted from extremely high N fertilizer inputs (in average 423 kg N ha−1). Nitrate leaching was, on the average, 63.9% greater in the greenhouse systems (98.0 kg N ha−1) than in open-field systems (59.8 kg N ha−1). The leaching factor, defined as the proportion of the quantity of N applied to soils that was lost due to nitrate leaching, averaged 14.6% overall and was significantly lower in greenhouse systems (10.9%) than in open-field systems (18.4%). This difference appears to be due to lower of the total water inputs (irrigation + precipitation) in greenhouse systems. Nitrate leaching increased with water input, the number of growing days, and the N rate. The nitrate leaching response to increasing N rate was linear. The leaching factor significantly increased with water input but was not affected by the N rate or the number of growing days. Compared with application of synthetic fertilizer alone, the application of manure alone or manure plus synthetic fertilizer significantly reduced both the nitrate leaching and the leaching factor in open-field and greenhouse systems. These results suggest that nitrate leaching in Chinese vegetable systems can be reduced by optimizing rates of N and water supply to synchronize crop needs. Application of mixed synthetic N fertilizer and manure is more effective in reducing nitrate leaching, compared to synthetic N only.
Influence of earthworms on the nitrogen transfer of sewage sludge in the vermifilter process
Abstract
A 6-year laboratory study was conducted to explore the performance of the vermifilter (VF) on reducing sewage sludge. Sewage sludge was found to be reduced significantly in the VF and exhibited a better performance of sludge reduction as compared with the conventional biofilter (BF), which could be traced through the nitrogen-rich organic matter. The nitrogen stable isotope technology was applied to study the matter flow of sewage sludge in the VF process and the influence of earthworms Eisenia fetida on sewage sludge reduction. Results showed that (1) the protein material could be consumed more than the polysaccharide and lipid materials, respectively, in the VF; (2) the presence of earthworms could enhance the consumption capacity of the VF on the protein-rich material of the sewage sludge; (3) earthworms played a leading role on the nitrogen lifting of the sewage sludge, leading to the performance difference of the effluent sludge or biofilm sludge between the VF and BF; (4) in the VF, nitrogen-isotope accumulation in either biofilms or earthworms happened more significantly in the lower layer than in the upper one, while nitrogen transfer of sewage sludge happened more significantly in the upper layer than in the lower one; (5) earthworms improved the feeding environment of organisms (microorganisms in biofilms, moth fly larvae, Limacidaes, and Lymnaeidaes); (6) biofilms, Limacidaes, and moth fly larvae performed better than leeches, Lymnaeidaes, and moth fly adults at nitrogen transfer of sewage sludge.
Molecular variability and genetic structure of White spot syndrome virus strains from northwest Mexico based on the analysis of genomes
Abstract
White spot syndrome virus (WSSV) has a ∼300 kb double-stranded DNA genome. It originated in China, spread rapidly through shrimp farms in Asia, and subsequently to America. This study determined complete genome sequences for nine historic WSSV strains isolated from Pacific white shrimp (Litopenaeus vannamei) captured in farm ponds in northwest Mexico (Sinaloa and Nayarit). Genomic DNA was captured by an amplification method using overlapping long-range PCR and sequencing by Ion Torrent-PGM. Complete genome sequences were assembled (length range 255–290 kb) and comparative genome analysis with WSSV strains revealed substantial deletions (3 and 10 kb in two regions) in seven strains, with two strains differing from the rest. Phylogenetic analysis identified that the WSSV strains from the northern area of the state of Sinaloa clustered with strains from China (LC1, LC10, DVI) and Korea (ACF2, ACF4), while those from the southern region of the state of Nayarit (AC1 and JP) differed from both of those and from strains found in Taiwan and Thailand. Our data offer insights into the diversity of the WSSV genome in one country and their divergent origin, suggest that it entered Mexico via multiple routes and that specific genome regions can accommodate substantial deletions without compromising viability.Tracing sediment sources in a mountainous forest catchment under road construction in northern Iran: comparison of Bayesian and frequentist approaches
Abstract
Development and land use change lead to accelerated soil erosion as a serious environmental problem in river catchments in Iran. Reliable information about the sources of sediment in catchments is therefore necessary to design effective control strategies. This study used a composite sediment source tracing procedure to determine the importance of forest road cuttings as a sediment source in a mountainous catchment located in northern Iran. A fallout radionuclide (137Cs) and 12 geochemical tracers (Ca, Cu, Fe, K, Mg, Mn, Na, Ni, OC, Pb, Sr and TN) were used to determine the relative contributions of three sediment source types (hillslopes, road cuttings and channel banks) to both suspended and bed sediment samples. Two mixing models based on different mathematical concepts were used to apportion the sediment sources: the mixture sampling importance resampling Bayesian model which incorporates the mass-balance matrix and a distribution model using normal and summed probability of normal distributions. The results of both mixing models indicated that sub-soil erosion from road cuttings and channel banks dominated the sources of river bed and suspended sediment samples, respectively. These results therefore highlight that conservation that works in the study area to remedy the sediment problem should initially focus on stabilisation and rehabilitation of road cuttings and channel banks. This successful application of a composite (radionuclide and geochemical) tracing technique for discriminating source end members characterised by different erosion processes underscores the importance of sub-soil erosion in this case study.
Behandlung des nichtkleinzelligen Lungenkarzinoms
Zusammenfassung
Die stadienabhängige Behandlung des nichtkleinzelligen Lungenkarzinoms unterliegt Veränderungen. In den frühen Stadien ist die Resektion, gefolgt von einer adjuvanten Chemotherapie bei Lymphknotenbefall oder großem Tumor, der Standard. Das Stadium III ist eine Domäne der Chemoradiotherapie, in Zukunft gefolgt von einer Konsolidierungstherapie mit einem Checkpointinhibitor. Unter gewissen Umständen hat in diesem Stadium auch die Resektion einen Stellenwert. Die größten Veränderungen sind bei metastasierter Erkrankung zu erwarten. Neue Medikamente und Kombinationen gegen Tumoren mit Treibermutationen sowie die Kombinationen von Chemo- und Immuntherapie werden die Behandlung grundlegend verändern.
Preventive treatment with dizocilpine attenuates oedema in a carrageenan model of inflammation: the interaction of glutamatergic and nitrergic signaling
Abstract
Dizocilpine is a highly selective and potent non-competitive antagonist of the N-methyl-d-aspartate (NMDA) glutamate receptor. It is well known that dizocilpine has different neuroprotective effects in animal models of pain, epilepsy and oedema during trauma. The search for alternative antiinflammatory drugs is ongoing. We investigated the anti-oedematous effects of dizocilpine and the probable mechanism of action in a rat model that mimics local and persistent inflammation without tissue injury or damage. Male Wistar rats were injected with 100 μL of 0.5% carrageenan to the plantar surface of the hind paw. Anti-oedematous activity was assessed in the carrageenan-induced paw inflammatory oedema test with a plethysmometer. To assess possible mechanisms of dizocilpine action, we examined the effects of the selective inhibitor of neuronal [N-ω-propyl-l-arginine hydrochloride (L-NPA)] and inducible [S-methylisothiourea (SMT)] nitric oxide synthase (NOS). Dizocilpine after systemic (0.0005, 0.005 and 0.02 mg/kg, subcutaneous (s.c.)), but not after local peripheral administration, reduced the paw inflammatory oedema. The effect is not dose dependent, and the highest decrease by about 47% at the time of maximally developed oedema was achieved with 0.005 mg/kg. Intraperitoneally (i.p.) administered L-NPA (0.5, 1 and 2 mg/kg) or SMT (0.005, 0.01 and 0.015 mg/kg) before dizocilpine abolished or reduced the anti-oedematous effect of dizocilpine by about 70–85%. An acute single dose of dizocilpine administered before inducing oedema systemically reduced the development of inflammatory oedema. The mechanism of the anti-oedematous effect includes, at least partially, an increase in nitric oxide (NO) production.
Ranking skin‐sensitizing hair dye molecules according to their potency by the use of human cells
Contact Dermatitis, EarlyView.
Dietary soyasaponin attenuates 2,4‐dinitrofluorobenzene‐induced contact hypersensitivity via gut microbiota in mice
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
Immunohistochemistry of p16 in nevi of pregnancy and nevoid melanomas
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
Influence of Relative Humidity on Electrodermal Levels and Responses
Background/Aim: Electrodermal activity (EDA) is a widely used measure in psychophysiological research, and its use in wearable devices has grown in recent times. It is recommended to have proper conditions for EDA measurement, and skin hydration is one factor that has a significant influence. It is, however, not known to what extent the ambient humidity influences the recording. This study explored the influence of relative humidity (RH) on EDA levels, and also the responses using a new technique for simultaneous recording of all measures of EDA: skin conductance (SC), skin susceptance (SS), and skin potential (SP) at the same skin site. Methods: A total of 10 healthy subjects were exposed to environments of low and high RH while EDA measures were recorded, including cognitive, visual and breathing stimuli for evoking electrodermal responses of different origin. EDA levels and responses were compared between the two humidity levels for all stimuli and all EDA measures. Results: It was found that EDA levels, in particular for SC and SS, were significantly increased during high humidity exposure, but that the change in EDA responses (SC, SS, and SP) was not statistically significant (p #x3e; 0.05, paired t test). Conclusion: This suggests that ambient humidity influences the recording of EDA levels and is important to consider when these parameters are used, but is not important in the recording or analysis of EDA responses.
Skin Pharmacol Physiol 2018;31:298–307
Skin Pharmacol Physiol 2018;31:298–307
Successful treatment with diclofenac sodium 1% gel of a case of suspected Darier disease
Clinical and Experimental Dermatology, EarlyView.
Determinants of pollution and the role of the military sector: evidence from a maximum likelihood approach with two structural breaks in the USA
Abstract
We investigate the role of military expenditure on emission in USA during the period 1960–2015. To achieve the objectives of this study, two measures of military expenditure are utilised, while several timeseries models are constructed with the gross domestic product (GDP) per capita, population, energy consumption per capita, non-renewable energy consumption per capita, renewable energy consumption per capita, urbanisation, trade openness and financial development serving as additional determinants of air pollution. We also use ecological indicator as an alternative measure of pollution. Moreover, different timeseries methods are utilised including a likelihood-based approach with two structural breaks. The output of this research concluded that all the variables are cointegrated. It is found that military expenditure has mixed impact on CO2 emissions. Real GDP per capita, energy consumption per capita, non-renewable energy consumption per capita, population and urbanisation increase CO2 emissions per capita in the long-run, while renewable energy consumption, financial development and trade openness reduce it. There is also evidence for the mixed role of military expenditure, when ecological footprint is utilised as the environmental degradation index. From the output of this research, few policy recommendations are offered for the examined country.
Adsorption of cadmium, nickel and lead ions: equilibrium, kinetic and selectivity studies on modified clinoptilolites from the USA and RSA
Abstract
The performance of modified clinoptilolites (zeolites) from two different sources (South Africa and the USA) for the adsorption of Ni2+, Cd2+ and Pb2+ from synthetic industrial effluent contaminated with metal concentration levels at 50, 150 and 500 ppm was evaluated. The selectivity of the clinoptilolite for the adsorption of Ni2+, Cd2+ and Pb2+ was investigated with mixed feed solutions containing all three ions in equal concentrations and single-component concentrations containing only one of the ions. The homoionic forms of the clinoptilolite were made of Na+, K+ and Ca2+. Batch experiments were then conducted to measure the uptake of metals by the zeolites. The zeolites were characterised using SEM, XRD and BET. The South African clinoptilolite showed a higher surface area and pore volume (17.52m2/g and 0.047cm3/g respectively) than the USA zeolite (12.26m2/g and 0.028cm3/g respectively) for the Na+ homoionic form. According to the equilibrium studies, the selectivity sequence was found to be Pb2+ > Cd2+ > Ni2+, with good fits being obtained using Langmuir and Freundlich adsorption isotherms for low metal concentrations. Examples of equilibrium adsorption capacities for RSA and USA clinoptilolite modified with Na+ for Pb were 26.94 mg/g and 27.06 mg/g when RSA-Na+ and USA-Na+ were used respectively. The adsorption was found to depend on the homoionic form of the zeolite and to a lesser extent the source of the zeolite. The selectivity of a particular zeolite for a particular heavy metal can be altered by the homoionic form of the zeolite. Overall, the adsorption capacity of the USA clinoptilolite was higher than the adsorption capacity of the SA clinoptilolite, revealing the potential of clinoptilolite in metal-polluted industrial effluent treatment.
Expression of hormone receptors, adipophilin, and GCDFP‐15 in mucinous carcinoma of the skin
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
Δευτέρα 3 Σεπτεμβρίου 2018
The Sjögren's syndrome‐associated autoantigen Ro52/TRIM21 modulates follicular B cell homeostasis and immunoglobulin production
Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.
Melanoma and mastocytosis: is really only a coincidence?
Clinical and Experimental Dermatology, EarlyView.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
