Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data

Abstract

Background

Routinely collected electronic health data (RCD) obtained for administrative and clinical purposes are increasingly used to study atopic dermatitis (AD). Methods for identifying AD patients in RCD differ, and it is unknown how this might affect study results.

Objectives

We sought to evaluate how AD patients have been identified in studies using RCD, to determine whether these methods were validated, and to estimate how the method for identifying AD patients affected variability in prevalence estimates.

Methods

We systematically searched PubMed, EMBASE, and Web of Science for studies utilizing RCD that reported on AD as a primary outcome. Studies of localized AD and other types of dermatitis were excluded. The protocol for this review was registered in PROSPERO (CRD42016037968).

Results

59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code, and prescription data were used to identify AD patients. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0.18%-38.33% (median 4.91%) and up to 3-fold variation in prevalence was introduced by differences in the method for identifying AD patients.

Conclusions

This systematic review highlights the need for clear reporting of methods for identifying AD patients in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.

This article is protected by copyright. All rights reserved.

Dermatology Training Across the Globe

Abstract

Dermatology residency program rankings often stem from assessments by practicing physicians or evaluations of scholarly achievements such as grants and publicatons.^1-3 Such rankings, however, are continuously changing, and fail to account for the specific missions of dermatology training programs.² Additionally, a global comparison of dermatology training requirements and a worldwide understanding of the ideal dermatology curriculum remains missing from the literature. Therefore, this study aims to compare and contrast accreditation requirements for dermatology training programs across the world. As a secondary objective, it attempts to identify the different missions of dermatology training programs around the world to create a global vision of what constitutes an ideal dermatology training program.

This article is protected by copyright. All rights reserved.

Computerized planimetry to assess clinical responsiveness in a phase II randomized trial of topical R333 for discoid lupus erythematosus

Abstract

Background

R333 is a topical janus kinase and spleen tyrosine kinase inhibitor being evaluated for discoid lupus erythematosus (DLE) treatment. There is no validated measure to assess area of active DLE lesions.

Objectives

To evaluate R333 efficacy and assess a technique to measure responsiveness.

Methods

54 DLE patients were randomized in a double blind design to R333 or placebo. The primary endpoint was the proportion of patients achieving ≥50% decrease in erythema and scale based on lesional CLASI for all treated lesions at week 4. Two-dimensional area measurements for each lesion were recorded at baseline and week 1-6. 88 photographs (44 pre- and 44 post-treatment) were obtained from the trial and change in size of active areas was analyzed by computerized planimetry and physician assessed area change.

Results

36 patients were randomized to R333 and 18 patients were randomized to placebo. The primary endpoint was not achieved. There was a strong association between lesion activity and physician global assessment, a measure of activity of all treated lesions (p<10^-6). Photos of 42 patients assessed by computerized planimetry demonstrated excellent inter-rater and intra-rater reliability. Area change by computerized planimetry showed a strong correlation with physician assessed area change (Spearman r=0.72). Area change by two-dimensional measurements showed a weak correlation with physician assessed area change (Spearman r=0.29)

Conclusion

Four weeks of R333 treatment did not result in significant improvement in lesion activity. Lesion activity and area change using computerized planimetry are better determinants of responsiveness as compared to area change using two-dimensional measurements.

This article is protected by copyright. All rights reserved.

Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause

Efficacy and safety of fezakinumab (an anti-IL-22 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by conventional treatments - A randomized, double-blind, phase 2a trial

IL-22 promotes epidermal hyperplasia and inhibits skin barrier function.

Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE)

Interleukin (IL)-13 plays a key role in type 2 inflammation and is an emerging pathogenic mediator in atopic dermatitis.

Acrodermatitis acidaemica

Summary

Methylmalonic acidaemia (MMA) is an inborn error of amino acid metabolism that may be associated with cutaneous manifestations mimicking other diagnoses, including staphylococcal scalded skin syndrome (SSSS), psoriasis and acrodermatitis enteropathica. Whether this is due to the underlying metabolic disorder itself or occurs as a consequence of dietary restriction has yet to be elucidated. Skin biopsies typically show histological features shared by a number of other metabolic disorders and nutritional deficiency-associated diseases. Some presentations, especially SSSS-like eruptions, may be associated with acute metabolic decompensation. An underlying metabolic disorder, such as MMA, should be considered in a diagnosed adult or undiagnosed child presenting with skin eruptions that resemble those listed above, so that specialist management may be initiated early.

Seasonal variation and source apportionment of PM 2.5 -bound trace elements at a coastal area in southwestern Taiwan

Abstract

The aim of this study is to investigate the seasonal variations and source apportionment on atmospheric fine particulate matter (PM_2.5) mass and associated trace element concentrations at a coastal area, in Chiayi County of southwestern Taiwan. Particle measurements were conducted in 2015. Twenty-three trace elements in PM_2.5 were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Multiple approaches of the enrichment factor (EF) analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM_2.5-bound trace elements. Daily mean concentration of PM_2.5 in cold season (25.41 μg m⁻³) was higher than that in hot season (13.10 μg m⁻³). The trace elements contributed 11.02 and 10.74% in total PM_2.5 mass concentrations in cold season and hot season, respectively. The results of EF analysis confirmed that Sb, Mo, and Cd were the top three anthropogenic trace elements in the PM_2.5; furthermore, carcinogenic elements (Cr, Ni, and As) and other trace elements (Na, K, V, Cu, Zn, Sr, Sn, Ba, and Pb) were attributable to anthropogenic emissions in both cold and hot seasons; however, highly enriched Li and Mn were observed only in cold season. The PMF model identified four main sources: iron and steel industry, soil and road dust, coal combustion, and traffic-related emission. Each of these sources has an annual mean contribution of 8.2, 27.5, 11.2, and 53.1%, respectively, to PM_2.5. The relative dominance of each identified source varies with changing seasons. The highest contributions occurred in cold season for iron and steel industry (66.2%), in hot season for traffic-related emission (58.4%), soil and road dust (22.0%), and coal combustion (2.8%). These findings revealed that the PM_2.5 mass concentration, PM_2.5-bound trace element concentrations, and their contributions were various by seasons.

Is there an association of ABO blood groups and Rhesus factor with alopecia areata?

Summary

Background/Objectives

Alopecia areata (AA) is an autoimmune disease characterized by noncicatricial hair loss localized on hair, beard, mustache, eyebrow, eyelash, and sometimes on the body. Although etiopathogenesis is not fully understood, many studies show remarkable associations between various diseases and ABO blood groups. However, there is no study with AA and blood groups.

Methods

Healthy people and patients with AA were included in this study. A total of 155 patients with AA and 299 healthy controls were included in the study.

Results

ABO blood group distribution in patients with AA and distribution of healthy donors were similar. However, Rhesus factor positivity in the AA group was significantly higher than in healthy donors. The relationship between stress and AA was high as known. But, ABO blood group and Rhesus factor were not in a significant connection with stress.

Conclusion

We conclude that there was no association between ABO blood group and AA, but the observed distribution of Rhesus blood group differed slightly but significantly from that of the healthy population. The result of the study shows a small but statistically significant difference in the Rh blood group between patients with AA and the healthy population blood groups. This result is important because it suggests that genetic factors may influence the development of AA. The role of blood groups in the development of AA remains to be determined. We believe that the studies which will be carried out in other centers with wider series will be more valuable to support this hypothesis.

The Impact of Reported Beta-Lactam Allergy in Hospitalized Patients with Hematologic Malignancies Requiring Antibiotics

Abstract

Background

Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.

Objective

To define the impact of reported BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients requiring systemic antibiotics.

Methods

Retrospective cohort study of adult inpatients with hematologic malignancy admitted at two tertiary care hospitals 2010-2015. The primary outcome was hospital length of stay (LOS) after first antibiotic. Secondary outcomes included re-admission, mortality, complications, total hospital charges, and antibiotic usage.

Results

In our cohort (n=4671), 38.3% had leukemia, 4.9% had Hodgkin's lymphoma, 36.1% had non-Hodgkin's lymphoma and 20.7% had multiple myeloma. Among subjects, 35.1% reported antibiotic allergy, 14.1% (n=660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Subjects with BLOA had longer median LOS compared to NBLA (11.3 vs. 7.6 days, p<0.001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes compared to NBLA in terms of mortality rate at 30-days (7.6% vs. 15.8%, p=0.017) and 180-days (15.8% compared to 12.2%, p=0.013), 30-day re-admission rate (19.2% vs. 15.1%, p=0.008), Clostridium difficile rate (17.7% vs. 11.6%, p<0.001), total hospital charges ($223046 vs. $173256, p<0.001), antibiotic classes used (median 3 vs. 2 classes/patient, p<0.001), and antibiotic duration (median 9.0 vs. 6.0 days, p<0.001).

Conclusion

In hospitalized patients with hematologic malignancy requiring antibiotics, patients with reported BL allergy have worse clinical outcomes and higher healthcare cost than those without BL allergy label.

A nosocomial foodborne outbreak of a VIM carbapenemase-expressing Citrobacter freundii

Abstract

Background

A foodborne outbreak of VIM carbapenemase-expressing Citrobacter freundii (CPC) occurred between February and June 2016 at a major university hospital in Germany.

Methods

An explosive increase of CPC isolated from rectal swabs of patients during weekly routine screening led to the declaration of an outbreak. A hospital-wide prevalence screening was initiated as well as screening of all patients on admission and before transfer to another ward, and canteen staff, patient rooms, medical and kitchen inventory and food. Swabs were streaked out on selective plates. All CPC isolates were analysed by mass spectrometry and selected isolates by whole-genome sequencing.

Results

In total, 76 mostly unrelated cases in different wards were identified. The CPC was isolated from retained samples of prepared vegetable salads and puddings and from a mixing machine used to prepare them only after an overnight culture. The immediate ban on serving potential source food resulted in a sharp decline and finally disappearance of novel cases. Repeated testing of pre-sliced vegetables showed a high degree of contamination with C. freundii without a carbapenemase, indicating a possible source.

Conclusions

This report demonstrates that an explosive increase in carbapenemase-expressing Enterobacteriaceae contamination may be caused by a food-borne source, and suggests that pre-sliced vegetables have to be taken into account as a putative pathogen repository. It also underlines the importance of appropriate cooling, transport, re-heating and distribution of meals and indicates that probing of non-organic surfaces is limited by low sensitivity, which may be increased by additional overnight cultivation in appropriate media.

Combating Global Antibiotic Resistance: Emerging One Health Concerns in Lower- and Middle-Income Countries

Abstract

Antibiotic misuse in lower- and middle-income countries (LMICs) contributes to the development of antibiotic resistance that can disseminate globally. Strategies specific to LMICs that seek to reduce antibiotic misuse by humans, but simultaneously improve antibiotic access, have been proposed. However, most approaches to date have not considered the growing impact of animal and environmental reservoirs of antibiotic resistance, which threaten to exacerbate the antibiotic resistance crisis in LMICs. In particular, current strategies do not prioritize the impacts of increased antibiotic use for terrestrial food-animal and aquaculture production, inadequate food safety, and widespread environmental pollution. Here, we propose new approaches that address emerging, One Health challenges.

Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with Demodex and increased IL-17 levels? Reply from authors

Abstract

In studies in atopic dermatitis (AD), dupilumab has been associated with higher rates of conjunctivitis compared with placebo. Consistent with previous studies, in LIBERTY AD CAFÉ (NCT02755649), all cases but one were mild or moderate, most (62–89%) were recovered/resolved or recovering/resolving by end of treatment, and no patients permanently discontinued study treatment because of conjunctivitis.¹ No patients reported atopic keratoconjunctivitis in this study.

This article is protected by copyright. All rights reserved.

Mass balance of arsenic fluxes in rivers impacted by gold mining activities in Paracatu (Minas Gerais State, Brazil)

Abstract

Arsenic (As) is a dangerous and carcinogenic element and drinking water is its main pathway of human exposure. Gold mines are widely recognized as important sources of As pollution. This work proposes the assessment of As distribution along watersheds surrounding "Morro do Ouro" gold mine (Paracatu, southeastern Brazil). A balance approach between filtered As fluxes (As < 0.45 μm) and suspended particulate material (AsSPM) in different river segments was applied. Ultrafiltration procedure was used to categorize As into the following classes: particulate > 0.1 μm, colloidal < 0.1 μm to > 10 kDa, dissolved < 10 kDa to > 1 kDa, and truly dissolved < 1 kDa. By applying this approach, arsenic contributions from mining facilities were quantified in order to identify critical fluvial segments and support decision makers in actions of remediation. The mass balance indicated the occurrence of a decreasing gradient from upstream to downstream: (i) of the As concentrations higher than the limit established by Brazilian law (10 μg L⁻¹); (ii) of the ratio between specific fluxes (g As km⁻² day⁻¹) and those determined using an uncontaminated watershed (a proxy for estimating the anthropic contribution), from 103 to 101; (iii) of the specific fluxes As < 0.45 μm and AsSPM from 102 to 100; and (iv) of the negative balance output minus input for each river segment that suggests As accumulation in sediments along the rivers in both urban and rural areas, mainly due to SPM sedimentation and sorption by Fe oxyhydroxides. Ultrafiltration shattering showed concentrations of decreasing As with particle size; the SPM load (> 0.1 μm) was almost one order higher to dissolved load (< 1 kDa).

Silicone Migration after Buttock Augmentation

Summary: We present the case of a 30-year-old woman who presented with enlarged inguinal lymph nodes and sacral hyperpigmentation 4 months after gluteal augmentation with silicone implants. Inguinal lymph node biopsy revealed granulomatous lymphadenitis due to foreign material. Upon right buttock implant revision, a 1.5-cm-thick capsule was noted with the absence of peri-implant inflammatory fluid and no macroscopic implant defects. Analysis of the implant by the manufacturer revealed a microscopic silicone leak. The patient's recovery was uneventful, and her symptoms resolved shortly after her reoperation.

Predictors of Success Following Muller’s Muscle-Conjunctival Resection

Purpose: This study aims to describe Muller's muscle-conjunctival resection surgery in terms of outcomes and potential factors that may predict final positions. Methods: This cross-sectional cohort study included patients undergoing Muller's muscle-conjunctival resection surgery for involutional ptosis over a 15-year period. Success was defined in 2 ways: 1) final marginal reflex distance 1 (MRD1) ≥2.5 mm (MRD1 success) and 2) final difference in MRD1 ≤1 mm between eyelids (symmetry success). Percentages of patients achieving both outcomes were calculated. Predictors of outcome were assessed using bivariate analysis and multivariate models. Results: The final sample included 315 eyes in 192 patients. The mean age (standard deviation) was 67.9 (11.9) years, and 60.0% were female. MRD1 ≥2.5 mm was achieved in 65.7% of the sample. Symmetry within 1 mm was achieved in 82.9% of the sample. Significant (p

A Novel Technique for Measuring Eyelid Force

Purpose: We present a novel technique to directly measure the eyelid upward force generation. This technique can be used during routine clinical examination using an inexpensive, portable force gauge. Methods: This prospective case series was conducted January to June 2015 in an ophthalmology clinic affiliated with a tertiary care medical center. A convenience sample of 42 patients (40–90 years of age) without known eyelid pathology participated. The eyelid upward net force generated was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Comparison of the eyelid-brow upward force generated with eyelid upward net force generated allowed us to assess the contribution of levator and frontalis muscles to the force generated during upgaze. Data were evaluated with relation to gender and age. Results: Upper eyelid force generated was 53.3 g OD and 53.9 g OS; the generated force during frontalis muscle fixation was 38.4 g OD and 41.1 g OS. The levator and frontalis muscles showed a 3:1 ratio respectively in their contribution to the force generated during upgaze. Although no statistically significant differences were seen between eyes, gender, or within age groups, younger patients showed increased generating force which is attributed to the levator muscle. Interclass correlation coefficient showed virtually no correlation between clinical eyelid assessments and direct muscle force measurement. Reliability for repeated direct force measurements by the same physician was strong, with interclass correlation coefficient 0.951 to 0.969. No adverse events occurred. Conclusions: We describe a simple, reliable, inexpensive, new method for assessing upper eyelid upward force generation. Because the levator muscle serves as the primary contributor to eyelid elevation, this directly measurable eyelid assessment may help to increase understanding of its functional contribution and assessment when assessing eyelid pathologies. Accepted for publication July 11, 2017. Presented at Annual Conference of Ocular Microsurgery, January 8-10, 2015 in Eilat, Israel. The authors have no financial or conflicts of interest to disclose. Shay Ofir, Avner Belkin, and Arie Y. Nemet contributed to conception, design, analysis, writing, and literature search; Shay Ofir contributed to data collection, materials and patient recruitment; Arie Y. Nemet contributed to critical revision and final approval; and Shay Ofir had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Address correspondence and reprint requests to Shay Ofir, MD, Department of Ophthalmology, Meir Medical Center, 59 Tshernichovsky St., Kfar Saba 44281, Israel. E-mail: shayofirl@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Medial Buttressing in Orbital Blowout Fractures

Purpose: To study whether ethmoidectomy predisposes the orbit to medial wall fracture with lesser trauma. Methods: An interventional cadaver study of 5 heads (10 orbits); the left or right orbit was randomized to undergo endoscopic complete ethmoidectomy with the fellow orbit as control. Fractures were induced with direct globe trauma, and heads underwent CT scanning. Energy to induce fracture, peak orbital pressure at time of fracture, fracture pattern, and volume of herniated tissue were measured and analyzed. Results: Fractures were induced in both orbits of all cadavers. Experimental orbits after ethmoidectomy sustained orbital fracture at less energy required (2.14 ± 0.66 vs. 3.10 ± 0.19 J, mean difference: −0.96 ± 0.33 J, p

Seminoma Metastatic to the Orbit

Purpose: Seminomas are solid tumors in young men, but which rarely metastasize to the orbit. The authors review the known literature on seminoma metastatic to the orbit, and describe an additional case in a 33-year-old man. Methods: A literature search was performed on the MEDLINE database using keywords "seminoma," "testicular germ-cell tumors," "testicular cancer," "testicular neoplasm," "orbital metastasis," and "germ-cell neoplasms." Results: Malignant neoplasms of the testis account for only 1% of cancers in men. None-the-less, testicular germ cell seminoma is the most common solid tumor found in young men between the ages of 15 and 39. Only seven previous cases have been mentioned in the literature. The pathogenesis remains unclear although genetic, environmental, and maternal factors may play a role. The number of cases is too few to determine the best treatment options, but surgical excision and adjunctive orbital radiotherapy appear to be most appropriate. Conclusions: Although metastases to the orbit are rare, seminoma should be considered in the differential diagnosis of all young men with proptosis. Accepted for publication October 9, 2017. The authors have no financial or conflicts of interest to disclose. Dr. Carol Shields served as guest editor for this submission. Address correspondence and reprint requests to Jonathan J. Dutton, M.D., Ph.D., Department of Ophthalmology, University of North Carolina, Chapel Hill, NC 27599. E-mail: jonathan_dutton@med.unc.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Gelatin-Based Hemostatic Agents: Histopathologic Differences

Purpose: To delineate the histopathologic appearance of gelatin-based hemostatic agents, Surgiflo, Gelfoam, and Floseal, which are used by ophthalmic plastic surgeons, and which may incidentally be found as foreign materials in histopathologic tissue samples. Methods: Histopathologic analysis was performed with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome, and elastin staining on tissue samples in which gelatin-based agents were found. To better characterize these materials, similar analyses were performed on in vitro samples of commonly used gelatin-based hemostatic agents. Results: Surgiflo and Gelfoam are composed of small stellate pieces of gelatin with a smooth, homogeneous quality. In tissues, they are faintly positive with periodic acid-Schiff staining, amphophilic with Masson trichrome staining, and ink-black with elastin staining. Floseal has a distinctly different morphology of large rectangular sheets, yet almost identical in vitro staining properties. Discussion: While the morphology of the gelatin-based hemostatic agents is consistent under various conditions, the staining properties of these materials differ based on whether they have been in contact with human tissue. Conclusions: Gelatin-derived hemostatic agents are best identified based on their morphologic characteristics. Elastin staining highlights these materials prominently within tissue samples and may be helpful in distinguishing them from other foreign materials. Accepted for publication November 16, 2017. Natalie Wolkow received a Heed Ophthalmic Fellowship. The remaining authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Frederick A. Jakobiec, M.D., D.Sc., Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Suite 328, Boston, MA 02114. E-mail: Fred_Jakobiec@meei.harvard.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.