Orthopedic complications of linear morphea: Implications for early interdisciplinary care

Abstract

Linear morphea of the limb primarily affects children, and extracutaneous manifestations are common. Orthopedic surgeons are often essential in the care of patients with linear morphea, yet there are few reports outlining specific orthopedic complications in this population. We sought to improve the understanding of orthopedic complications in linear morphea of the limb. Between 1999 and 2014, 51 children were evaluated for linear morphea of an extremity. Twenty-six (51%) had documented orthopedic manifestations. Outcome measures included limb length discrepancy, angular malalignment, limb atrophy, and orthopedic surgical intervention. Joint contractures were most common, affecting 88% of patients, followed by limb atrophy, angular deformity, and limb length discrepancy; 14% required surgical intervention. Despite the use of systemic immunosuppressive therapy in many patients, approximately half of patients with linear morphea of an extremity have orthopedic disease. Early orthopedist involvement is crucial to improve limb alignment and preserve function.

Die Umsetzung der EU-Hochwasserrichtlinie (RL 2007/60/EG) in Österreich

Zusammenfassung

Hochwasser haben das Potenzial, zu Todesfällen, zur Umsiedlung von Personen und zu Umweltschäden zu führen, die wirtschaftliche Entwicklung ernsthaft zu gefährden und wirtschaftliche Tätigkeiten in der Gemeinschaft zu behindern. Die Richtlinie 2007/60/EG des Europäischen Parlaments und des Rates vom 23. Oktober 2007 über die Bewertung und das Management von Hochwasserrisiken hat zum Ziel einen Rahmen für die Bewertung und das Management von Hochwasserrisiken zur Verringerung der hochwasserbedingten nachteiligen Folgen auf die menschliche Gesundheit, die Umwelt, das Kulturerbe und wirtschaftliche Tätigkeiten in der Gemeinschaft zu schaffen. Im Rahmen des Beitrags wird dargestellt, wie die einzelnen Arbeitsschritte der Richtlinie auf Basis bundesweit einheitlicher Methoden in Österreich umgesetzt und international koordiniert wurden.

Trends and predictors of syphilis prevalence in the general population: Global pooled analyses of 1103 prevalence measures including 136 million syphilis tests

Abstract

Background

This study assessed levels, trends, and associations of observed syphilis prevalence in the general adult population using global pooled analyses.

Methods

A standardized database of syphilis prevalence was compiled by pooling systematically-gathered data. Random-effects meta-analyses and meta-regressions were conducted using data from 1990–2016 to estimate pooled measures and assess predictors and trends. Countries were classified by World Health Organization regions. Sensitivity analyses were conducted.

Results

The database included 1103 prevalence measures from 136 million syphilis tests across 154 countries (85% from antenatal care women). Global pooled mean prevalence (weighted by region population size) was 1.11% (95% confidence interval [CI]: 0.99–1.22). Prevalence predictors were region, diagnostic assay, sample size, and calendar year interacting with region. Compared to the African Region, the adjusted odds ratio (AOR) was 0.42 (95% CI: 0.33–0.54) for the Americas, 0.13 (95% CI: 0.09–0.19) for Eastern Mediterranean, 0.05 (95% CI: 0.03–0.07) for European, 0.21 (95% CI: 0.16–0.28) for South-East Asia, and 0.41 (95% CI: 0.32–0.53) for Western Pacific. TPHA-only or RPR-only tests, compared to dual RPR/TPHA diagnosis, produced higher prevalence (AOR>1.26), as did smaller sample-size studies (<500 persons) (AOR>2.16). Prevalence declined in all regions; the annual AORs ranged from 0.84 (95% CI: 0.79–0.90) in Eastern Mediterranean to 0.97 (95% CI: 0.97–1.01) in Western Pacific. The pooled mean male-to-female prevalence ratio was 1.00 (95% CI: 0.89–1.13). Sensitivity analyses confirmed robustness of results.

Conclusion

Syphilis prevalence has declined globally over the past three decades. Large differences in prevalence persist among regions, with the African Region consistently the most affected.

Risk of Subsequent Sepsis within 90 Days of a Previous Hospital Stay by Type of Antibiotic Exposure

Abstract

Background

We examined the risk of sepsis within 90 days after discharge from a previous hospital stay by type of antibiotic received during the previous stay.

Methods

We retrospectively identified a cohort of hospitalized patients from the Truven Health MarketScan Hospital Drug Database. We examined the association between the use of certain antibiotics, determined a priori, during the initial hospital stay and risk of post-discharge sepsis controlling for potential confounding factors in a multivariable logistic regression model. Our primary exposure was receipt of antibiotics more strongly associated with clinically important microbiome disruption. Our primary outcome was a hospital stay within 90 days of the index stay that included an ICD-9-CM discharge diagnosis of severe sepsis (995.92) or septic shock (785.52).

Results

Among 516 hospitals, we randomly selected a single stay for eligible patients. Of those, 0.17% developed severe sepsis/septic shock within 90 days after discharge. The risk of sepsis associated with exposure to our high risk antibiotics was 65% higher compared to those without antibiotic exposure.

Conclusions

Our study identified an increased risk of sepsis within 90 days of discharge among patients with exposure to high risk or increased quantities of antibiotics during hospitalization. Given a significant proportion of inpatient antimicrobial use may be unnecessary, this study builds on previous evidence suggesting that increased stewardship efforts in hospitals may not only prevent antimicrobial resistance, CDI and other adverse effects, but also reduce unwanted outcomes potentially related to disruption of the microbiota, including sepsis.

Risks of infection and mortality among patients colonized with KPC-producing Klebsiella pneumoniae : validation of scores and proposal for management.

Abstract

Background

The management and indication of empirical treatment in Klebsiella pneumoniae-carbapenemase producing K. pneumoniae (KPC-Kp) colonized patients should be improved.

Methods

A prospective cohort of 94 patients colonized by KPC-Kp was followed for 90 days to validate: (i) the Giannella risk score (GRS) to predict the development of any type of KPC-Kp infection and (ii) the INCREMENT-CPE score (ICS) to predict 30-day mortality in patients with infection. Both scores were combined in order to recommend appropriate empirical treatment. The predictive ability of the scores was measured by calculating the area under the receiver operating characteristic (AUROC) curve.

Results

The GRS showed an AUROC curve for infection due to KPC-Kp of 0.92 (CI 95%: 0.87–0.98). The optimal cutoff point was fixed at < 7 and ≥ 7 (92.9% sensitivity, 84.8% specificity); infection developed in 6.3% patients in the 0–6 GRS group and in 84.8% patient in the ≥ 7 GRS group. According to the ICS, the severity of the infection was also significantly higher in the ≥ 7 GRS group. The ICS showed an AUROC of 0.78 (95% CI: 0.65–0.91) for 30-day all-cause mortality among patients with infection. A CART analysis confirmed the GRS cutoff point at 7, and selected ≥ 12 points to predict a KPC-Kp infection with a high ICS.

Conclusion

Our results validate the GRS and ICS for indicating empirical therapy in KPC-Kp- colonized patients

Bedaquiline resistance: Its emergence, mechanism and prevention

Abstract

Bedaquiline, a new anti-tuberculosis drug, has already been used in more than 50 countries. The emergence of bedaquiline resistance is alarming, as it may result in the rapid loss of this new drug. This paper aims to review currently identified mechanisms of resistance, the emergence of bedaquiline resistance, and discuss strategies to delay the resistance acquisition. In vitro and clinical studies as well as reports from the compassionate use have identified the threat of bedaquiline resistance and cross-resistance with clofazimine, emphasizing the crucial need for the systematic surveillance of resistance. Currently known mechanisms of resistance include mutations within the atpE, Rv0678 and pepQ genes. The development of standardized drug susceptibility testing (DST) for bedaquiline is urgently needed.Understanding any target and non-target based mechanisms is essential to minimize the resistance development and treatment failure, help to develop appropriate DST for bedaquiline and genetic based resistance screening.

Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, second edition

Edited by MulveyMA, KlumppDJ, StapletonAE.Washington, D.C.: ASM Press, 2017. XX pp. $150.00 (hardcover) ISBN: 9781555817398

Economic evaluations of mass drug administration: The importance of economies of scale and scope

Abstract

It is recognised that changing the current approaches for the control of the neglected tropical diseases will be needed to reach the World Health Organization's (WHO) 2020 goals. Consequently, it is important that economic evaluations of the alternative approaches are conducted. A vital component of such evaluations is the issue of how the intervention's costs should be incorporated. We discuss this issue – focusing on mass drug administration. We argue that the common approach of assuming an intervention's cost per treatment is constant, regardless of the number of individuals treated, is a misleading way to consider the delivery costs of mass drug administration due to the occurrence of economies/diseconomies of scale and scope. Greater care and consideration are required when the costs are incorporated into such analyses. Without this, these economic evaluations could potentially lead to incorrect policy recommendations.

Current Epidemiology and Trends in Meningococcal Disease—United States, 1996-2015

Abstract

Background

In 2005, meningococcal conjugate vaccine (MenACWY) was recommended for routine use among adolescents aged 11–18 years. This report describes the epidemiologic features of meningococcal disease and trends in meningococcal disease incidence following MenACWY introduction in the United States.

Methods

Incidence rates and case-fatality ratios by age group and serogroup during 2006–2015 were calculated using data from the National Notifiable Diseases Surveillance System (NNDSS); changes in incidence during this time were evaluated. Additionally, 20-year trends (1996–2015) in age- and race-standardized incidence were examined using data from Active Bacterial Core surveillance (ABCs).

Results

During the years 2006–2015, 7,924 cases of meningococcal disease were reported to NNDSS, resulting in an average annual incidence of 0.26 cases per 100,000 population; 14.9% of cases were fatal. Among cases with serogroup information, 2,290 (35.8%) were serogroup B, 1,827 (28.5%) were serogroup Y, 1,457 (22.8%) were serogroup C, 436 (6.8%) were serogroup W, and 392 (6.1%) were other serogroups. The incidence of serogroups A, C, W, and Y combined declined 76% among persons aged 11–20 years from 2006–2010 to 2011–2015 (p<.0001). From 1996-2015, the incidence of meningococcal disease declined among all age groups and predominant serogroups.

Conclusions

Declines in meningococcal disease incidence in the United States have been observed among all age groups and predominant serogroups (B, C, and Y). Reductions in the incidence of meningococcal disease due to serogroups A, C, W, and Y among adolescents suggest an impact of the MenACWY vaccine program in this age group.

The Importance of HIV Research for Transgender and Gender Non-Binary Individuals.

Abstract

Transgender and gender non-binary (trans/GNB) individuals are disproportionally affected by HIV, yet they are not adequately represented in HIV research and often underserved in clinical care. By building on community strengths and addressing structural, psychological and biological challenges, we can improve the engagement of trans/GNB people in research and ultimately improve prevention, testing and care for this population. Here, we review the current state of the science related to HIV for trans/GNB people, and we discuss next steps to expand research that aims to improve the lives and well-being of trans/GNB persons.

Poly-L-lactic acid for the Improvement of photodamage and rhytids of the décolletage

Summary

Background

Poly-L-lactic acid (PLLA) is a biostimulatory filler approved for use in HIV lipoatrophy as well as cosmetic improvement in facial folds and wrinkles in immunocompetent patients. Similar to the face and hands, the décolletage is commonly subject to photodamage and the resulting appearance of rhytids and crepiness, which could benefit from PLLA treatment.

Objectives

The objective of the study was to assess the safety and efficacy of injected PLLA for the improvement in rhytids and crepiness of the décolletage.

Methods

In this open-label, prospective, interventional study, 25 healthy female volunteers aged 40-to-70 years with moderate-to-severe crepiness and wrinkling of the décolletage were injected with 1 vial of PLLA at each of three treatments. The Fabi-Bolton 5-point chest wrinkling scale was used by both investigators and subjects to assign pretreatment and post-treatment follow-up scores at 1 month, 3 months, and 6 months. Adverse events were reported at each visit.

Results

All post-treatment mean scores had statistically significant improvement compared to the pretreatment baseline means as rated by both investigators and subjects. At 1 month following the last treatment, compared to baseline, investigators rated 83% of subjects had improved by at least one point on the scale. Subjects rated 74% of subjects improved by at least one point. At 6 months, 90% of subjects, as rated by the investigators, and 57% of subjects, as rated by the subjects, had improvement from baseline.

Conclusion

PLLA is safe and effective for improvement in the rhytids and skin quality of the photodamaged décolletage.

Open access: Is there a predator at the door?

Deposition of absolute and relative airborne metals on eggshells: a field study

Abstract

A biomonitoring field study was conducted to test the deposition of airborne metals on chicken eggshell. The goal was to correlate PM2.5 particle concentration in air, absolute (metals in air) and relative (metals in PM2.5 particles) metals, and metal accumulation on eggshell. The PM2.5 sample was collected for 8 h at different air pollution sites as well as an unpolluted site with glass fiber filters via a fine particulate sampler (with and without addition of eggshell). The PM2.5 particle concentration was high at a cement factory site and low at a sugar factory site. The highest absolute total mass of metal (total mass of all metals in air) was found in the traffic site, and the highest relative total mass of metal (total mass of all metals in PM2.5 particles) was found at the tannery factory. The accumulation of Zn and Pb in eggshell was high at the tannery and sugar factory sites, and Fe was high in the other areas. Three common metals including Cd, As, and Pb were found with significant positive correlation between absolute and relative metals with the metals accumulated in eggshell. The results concluded that the eggshells might be useful tools for monitoring the airborne metals.

Impacto económico de la dermatitis atópica en adultos: estudio de base poblacional (estudio IDEA)

Publication date: Available online 8 November 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Sicras-Mainar, R. Navarro-Artieda, J.M. Carrascosa Carrillo
ObjetivoDeterminar el uso de los recursos y los costes de la dermatitis atópica (DA) en adultos según su gravedad y las comorbilidades asociadas en situación de práctica clínica habitual.Pacientes y métodosSe efectuó un diseño observacional retrospectivo realizado a partir de la revisión de registros de pacientes ≥18años que demandaron asistencia durante 2013-2014 en un área geográfica de Cataluña con una población de 215.634 personas. Se constituyeron 3 grupos de gravedad en función del tratamiento prescrito. Las variables evaluadas fueron el conjunto de comorbilidades, la medicación concomitante/específica; y los costes sanitarios directos/indirectos. El análisis estadístico se elaboró mediante modelos de regresión múltiple, p<0,05.ResultadosSe reclutaron 6.186 sujetos con diagnóstico de DA (edad-media: 47,1años; mujeres, 61,6%). En función de la gravedad de la DA se consideraron 3 grupos; el 55,7% leve (n=3.445), el 38,2% moderada (n=2.361) y el 6,1% grave (n=380). La DA grave se asoció a la probabilidad de presentar comorbilidades (β=0,192); específicamente: asma (β=0,138), depresión (β=0,099), eventos cardiovasculares (β=0,087), obesidad (β=0,085) y hábito tabáquico (β=0,025), p<0,001. El coste ascendió a 9,3 millones de euros (costes sanitarios: 75,5%; pérdidas de productividad: 24,5%), con un promedio/unitario de 1.504euros/año. Los promedios/unitarios corregidos (ANCOVA) fueron mayores en la DA grave en comparación con la moderada y la leve (3.397 vs. 2.111 y 885 euros, respectivamente; p<0,001).ConclusionesLa DA grave se asocia a una elevada utilización de recursos sanitarios y costes para el Sistema Nacional de Salud proporcional a la gravedad de la dermatosis. La comorbilidad general y el asma fueron los factores con mayor impacto asociado al coste sanitario.ObjectiveTo determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice.Patients and methodsWe performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05.ResultsWe included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (β=0.192), namely, asthma (β=0.138), depression (β=0.099), cardiovascular events (β=0.087), obesity (β=0.085), and smoking (β=0.025); P<.001. Costs reached €9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of €1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (€3,397 vs. €2,111 vs. €885; P<.001), respectively.ConclusionsSevere atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.

Graphical abstract

Correction to: Apocynin and dimethyl sulfoxide synergistically protect against ischemia-reperfusion injury in a rat hind limb ischemia-reperfusion model

Abstract

Dr. Ozer Sehirli's affiliation needs to be updated as he was transferred from Marmara University Faculty of Pharmacy to Near East University Faculty of Dentistry two years ago. The updated information is provided in the affiliation section below.

Brain amyloid PET interpretation approaches: from visual assessment in the clinic to quantitative pharmacokinetic modeling

Abstract

Purpose

Cerebral β-amyloid burden can be measured by positron emission tomography (PET) tracers, including ¹¹C-Pittsburgh Compound B (¹¹C-PiB) and three fluorinated tracers that have been approved by regulatory agencies. This review focuses on the current clinical use of amyloid PET and the added utility of quantifying β-amyloid deposition.

Methods

Using systematic review methods, a PubMed search identified studies on the added value of standardized uptake value ratio (SUVR) to visual reads. PubMed search was also performed to identify studies that illustrate important factors that cause variability in SUVR results, as well as key papers in the initial development of ¹¹C-PiB.

Results

Among studies comparing visual interpretation and SUVR, there is high concordance between visual reads and SUVR for diagnosis classification, with evidence that SUVR decreases inter-reader variability in visual interpretation and improves accuracy. The variability among results of studies utilizing SUVR is likely multifactorial, including choice of reference regions, choice of target regions, and methods for determining SUVR thresholds. The initial ¹¹C-PiB studies illustrate the importance of rigorous pharmacokinetic modeling and stepwise simpler quantitative methods when translating radiotracers.

Conclusion

There is increasing evidence of the added value of SUVR in the clinic, in particular in borderline cases or for detection of subtle changes. SUVR provides a reasonably accurate measurement of amyloid plaque deposition compared to pharmacokinetic modeling methods.

The interface interaction behavior between E. coli and two kinds of fibrous minerals

Abstract

In the present, studies of interaction between human normal flora and fibrous mineral are still lacking. Batch experiments were performed to deal with the interaction of Escherichia coli and two fibrous minerals (brucite and palygorskite), and the interface and liquid phase characteristics in the short-term interaction processes were discussed. The bacterial concentrations, the remnant glucose (GLU), pyruvic acid, and the activity of β-galactosidase and six elements were measured, and the results show that the promoting effect of brucite on the growth of E. coli was more significant than that of palygorskite. FTIR and XRD analysis results also confirmed E. coli has obviously dissolved on brucite and damage effect on palygorskite silicon structure. SEM results show that the interfacial contact degree between E. coli cells and brucite fibers was higher than that of palygorskite. These may be due to the zeta potential difference between E. coli and palygorskite was 14.57–22.37 mV, while it of brucite was 44.04–64.24 mV. The elements dissolving of two fibrous minerals not only increased regularly to liquid EC but also had a good buffer effect to the decrease of liquid pH. Studies of short-term interaction between E. coli and brucite and palygorskite can help to understand the effect of fibrous minerals on microeubiosis of human normal flora and the contribution of microbial behaviors on the fibrous minerals weathering in the natural environment.

Photolytic degradation of ciprofloxacin in solid and aqueous environments: kinetics, phototransformation pathways, and byproducts

Abstract

Many lipophilic pharmaceuticals may be sorbed in solid phases, leading to different photochemical behaviors. This study investigated the photochemistry of ciprofloxacin in a solid-phase system and compared it to that in a water-phase system. Kaolinite was used as the model solid matrix. The photolysis of ciprofloxacin in kaolinite fits pseudo-first-order kinetics for thicknesses less than 199 μm, and the rate constants k _p decreased from 0.0154 to 0.0016 min⁻¹ as the thickness of the layer increased. Unlike the aqueous phase, two-step degradation processes were observed for all kaolinite layer thicknesses (14–199 μm), and the pseudo-first-order constant at the surface of the kaolinite layer was smaller than that in the water phase. Comparatively, a similar photolysis rate constant of ciprofloxacin in a kaolinite suspension was also observed, and it was an order of magnitude smaller than that of the direct photodegradation (0.035 min⁻¹) in water. The results indicate that ciprofloxacin is likely more stable when it is adsorbed on kaolinite and that the half-lives of ciprofloxacin in kaolinite and a kaolinite suspension are 2–25 times longer than that in deionized water (20 min) under simulated sunlight. Direct photolysis is proposed to be the main photodegradation mechanism for ciprofloxacin in kaolinite, and the cleavage of a piperazine ring is the main degradation pathway. However, the interaction between ciprofloxacin and kaolinite reduces the direct photolysis and leads to a higher light stability. In association with the reduction in photolysis, the yields of norfloxacin and defluorinated byproduct decreased significantly. Consequently, the interaction increases the persistence of ciprofloxacin and thus the ecological risk to the environment.

Liquid chromatography-mass spectrometry method for evaluating the dissipation dynamics of cyromazine and its metabolite in Agaricus bisporus and dietary risk assessment

Abstract

Providing guidance on the reasonable use of pesticide in agricultural production is of particular importance for ensuring food safety. In the present study, a field trial was performed to study the dissipation and accumulative pattern of cyromazine (CA) and its metabolite in Agaricus bisporus (A. bisporus) cultivation. An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was first developed and validated for the determination of CA and melamine (MEL) in the casing soil and fruiting body. During the cultivation period, the dissipation rates of CA in the casing soil were between 51.57 and 63.48% at three dose groups. The fruiting body presented higher accumulation ability for MEL compared with CA. The terminal residues of MEL never exceeded the maximum residue limits (MRLs) in food. In addition, the intake health risk from the CA and MEL residues in the fruiting body were negligible to humans. This study will help to provide valuable guidance on the application strategies of CA in A. bisporus cultivation.

BRAF Mutation Status Concordance Between Primary Cutaneous Melanomas and Corresponding Metastases: A Review of the Latest Evidence

Publication date: Available online 8 November 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): E. Godoy-Gijón, M. Yuste-Chaves, Á. Santos-Briz
The identification of B-Raf proto-oncongene (BRAF) mutation and the emergence of targeted therapy marked a turning point in the treatment of melanoma. The study of mutation status concordance between primary tumors and metastases in this cancer has major treatment implications as it facilitates the selection of candidates for targeted therapy. This review analyzes the evidence on the level of mutation status concordance between primary tumors and different types of metastases in cutaneous melanoma and provides an overview of the advantages and disadvantages of the various methods used to detect BRAF mutations.