Risk of depression among patients with acne in the U.K.: a population-based cohort study

Onset of action of the fixed combination intranasal azelastine-fluticasone propionate in an allergen exposure chamber

Publication date: Available online 7 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jean Bousquet, Eli Meltzer, Peter Couroux, Arkady Koltun, Ferdinand Kopietz, Ullrich Munzel, Hans Christian Kuhl, Duc Tung Nguyen, Anne Marie Salapatek, David Price
BackgroundA fixed-dose combination of intranasal azelastine hydrochloride–fluticasone propionate (MP-AzeFlu) is the most effective treatment of allergic rhinitis (AR), but its onset of action requires further investigation.ObjectivesThis study compared onset of action of MP-AzeFlu with the free combination of oral loratadine and intranasal fluticasone propionate (LORA/INFP).MethodsIn this single-center randomized, placebo-controlled, double-blind, double-dummy, three-period crossover trial, AR symptoms were induced in asymptomatic patients by ragweed pollen challenge in an allergen environmental exposure chamber. Patients received single-dose MP-AzeFlu, LORA/INFP, or placebo and were monitored for 4 hours. The primary outcome was onset of action measured by total nasal symptom score (TNSS). Secondary measures were total ocular symptom score (TOSS), total score of the seven nasal and ocular symptoms (T7SS), and the global visual analogue scale (VAS).ResultsThe full analysis set included 82 patients; 78 completed all treatments. TNSS was significantly reduced versus placebo from 5 minutes for MP-AzeFlu and 150 minutes for LORA/INFP onward (both P<0.05) until the end of assessment (0 to 4 hours). MP-AzeFlu reduced TNSS to a greater extent at each time point from 5 to 90 minutes (P<0.05) and over the entire assessment interval (P≤0.005) versus LORA/INFP or placebo. No statistically significant difference between LORA/INFP and placebo was observed over the assessment interval (P=0.182). MP-AzeFlu onset of action assessed by TOSS, T7SS, and VAS was 10 minutes, 2 hours earlier than with LORA/INFP.ConclusionMP-AzeFlu had a more rapid onset of action (5 minutes) and was more effective than LORA/INFP.Registration of the trialClinicalTrials.gov Identifier: NCT03004131; Key words: allergic rhinitis, azelastine, environmental exposure chamber, fluticasone propionate, loratadine, onset of action

Smell loss is associated with severe and uncontrolled disease in children and adolescents with persistent allergic rhinitis

Publication date: Available online 6 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Franklin Mariño-Sanchez, Meritxell Valls-Mateus, Oliver Haag, Isam Alobid, Jean Bousquet, Joaquim Mullol

A favorable response to omalizumab in a patient with cheilitis granulomatosa

Publication date: Available online 6 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Eustachio Nettis, Elisabetta Di Leo, Maria Bisaccia, Carolina Marasco, Caterina Foti, Angelo Vacca

Increased Dose and Duration of Statin Use is Associated with Decreased Asthma-Related Emergency Department Visits and Hospitalizations

Publication date: Available online 6 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jiu-Yao Wang, Tsung-Chieh Yao, Yu-Ting Tsai, Ann Chen Wu, Hui-Ju Tsai
BackgroundStatins have pleiotropic anti-inflammatory and immunomodulatory effects, yet the effect of statin use on asthma-related emergency department (ED) visits and hospitalizations has remained unclear, especially in Asian populations.ObjectiveWe sought to examine the effect of statin therapy on asthma-related ED visits and/or hospitalizations.MethodsA cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2013. A total of 117,595 adult patients with asthma were included. The outcomes were defined as asthma-related ED visits and/or hospitalizations. Multiple Cox proportional hazards models were applied to determine the effect of statin use on asthma-related ED visits and/or hospitalizations.ResultsThere were 3,417 asthma-related ED visits and/or hospitalizations among 117,595 subjects with asthma. Statin users were significantly less likely to experience asthma-related ED visits and/or hospitalizations (adjusted hazard ratio: 0.81; 95% confidence interval: 0.74-0.89) compared with nonstatin users. The risks of asthma-related ED visits and/or hospitalizations were decreased among those with a higher cumulative defined daily dose (DDD), greater average DDD, and longer cumulative-day users than the counterparts.ConclusionsOur study suggests that statin use is associated with the decreased risk of asthma-related ED visits and/or hospitalizations in patients with asthma. A dose-response effect of statin use is also observed in this study. Therefore, future randomized clinical trials would be warranted to further evaluate the association.

Immune modulation in a patient with Morquio syndrome treated with enzyme replacement therapy

Publication date: Available online 6 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Angela Sun, Walaa Alshuaibi, Daniel Petroni, Suzanne Skoda-Smith, Michael J. Goldberg, Susan Hale

Efficacy and safety of five-day challenge for the evaluation of non-severe amoxicillin allergy in children

Publication date: Available online 7 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Roxane Labrosse, Louis Paradis, Jonathan Lacombe, Kathryn Samaan, François Graham, Jean Paradis, Philipps Bégin, Anne Des Roches
BackgroundPenicillin allergy is the most frequent drug allergy, among which aminopenicillins are reputed for causing delayed rashes in children, particularly in the context of viral infections. Despite a negative allergy evaluation, a significant proportion of individuals continue to avoid penicillin antibiotics for fear of an allergic reaction.ObjectivesThis study sought to evaluate the safety and efficacy of a five-day challenge to amoxicillin and the proportion of subsequent use of amoxicillin.MethodsPediatric patients with a history of a reaction to amoxicillin were prospectively recruited in the study. All patients were challenged, and those with negative immediate challenges underwent an ambulatory five-day challenge of amoxicillin to rule out nonimmediate reactions. Patients were called 2 years after their initial allergy evaluation to assess subsequent amoxicillin use and tolerance.ResultsOne hundred thirty children with a history of amoxicillin allergy underwent a graded drug provocation test (DPT) to amoxicillin. Three patients had a positive immediate challenge, three had a positive nonimmediate challenge, and two were equivocal. Of the 122 patients with a negative challenge, 114 (93.4%) were reached 2 years after their initial allergy evaluation: 75 had used antibiotics since, of which only 1 (1.3%) had refused to reuse amoxicillin because of fear of an allergic reaction. Finally, five-day DPT resulted in a 24.1% decrease in future penicillin avoidance compared to classical single-dose graded DPT performed over one day in a historical cohort (p<0.0001).ConclusionFive-day challenge is a safe and effective way to rule out nonimmediate amoxicillin allergy, and it ensures a better compliance with future penicillin use.

Comparative safety and efficacy of topical mometasone furoate with other topical corticosteroids

Abstract

Derivatives of hydrocortisone, such as mometasone furoate, a (2′) furoate-17 ester with chlorine substitutions at positions 9 and 21, have been designed to improve efficacy and reduce the incidence of adverse effects. An extensive literature search of MEDLINE, Embase and other databases was conducted to review the safety and efficacy of various formulations of topical mometasone furoate. Mometasone furoate exhibits high potency with greater anti-inflammatory activity and a longer duration of action than betamethasone. In clinical trials, mometasone furoate shows comparable or significantly better efficacy, depending on the comparator, in all indications studied in both adults and children. It is well tolerated with only transient, mild to moderate local adverse effects. It is characterised by low systemic availability due to its high lipophilicity, low percutaneous absorption and rapid hepatic biotransformation, and consequently has no significant effect on the hypothalamic-pituitary-adrenal axis. The molecular biotransformation of mometasone furoate in the skin results in a lower affinity with dermal cells than epidermal cells, which contributes to its low atrophogenicity. Sensitisation to mometasone furoate is low. Overall, mometasone furoate is a highly efficacious potent corticosteroid with a low risk of both local and systemic adverse effects.

Infant case of tinea faciei caused by Microsporum canis

Necrobiosis lipoidica with mucin deposition in a patient with autoimmune thyroiditis

Decrease in eosinophils infiltrating into the skin of patients with dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid

Abstract

Bullous pemphigoid (BP) is an acquired autoimmune blistering disease in which autoantibodies against epitopes in the basement membrane zone of the skin such as BP180 or BP230 are produced. Dipeptidyl peptidase (DPP)-4 inhibitors have become commonly used to treat diabetes. As DPP-4 inhibitors are more commonly prescribed for diabetes, BP related to DPP-4 inhibitors has been reported and has attracted attention. Therefore, we retrospectively investigated patients who were diagnosed with BP in order to examine characteristics of DPP-4 inhibitor-related BP (nine patients; median age, 85 years) in comparison with non-DPP-4 inhibitor-related BP (21; median age, 85 years). There was no significant difference in Bullous Pemphigoid Disease Area Index between DPP-4 inhibitor-related BP patients and non-DPP-4 inhibitor-related BP patients, except for erosions/blisters score in mucosa. Laboratory tests revealed no significant differences between DPP-4 inhibitor-related BP patients and non-DPP-4 inhibitor-related BP patients in total white blood cell count, eosinophil count, neutrophil count and the titer of anti-BP180 antibody. The number of eosinophils infiltrating into the skin was significantly lower in patients with DPP4 inhibitor-related BP than in patients with non-DPP4 inhibitor-related BP. Our results showed that DPP-4 inhibitor-related BP has some distinct pathological characteristics from BP not associated with DPP-4 inhibitor.

Randomized investigator-blinded comparative study of moisturizer containing 4-t-butylcyclohexanol and licochalcone A versus 0.02% triamcinolone acetonide cream in facial dermatitis

Summary

Background

Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects.

Objective

To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis.

Methods

This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4.

Results

Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity.

Conclusion

The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.

Numerical simulation of the intra-annual evolution of beryllium-7 ( 7 Ве) in the surface layer of the Black Sea

Abstract

A numerical model simulating the distribution of ⁷Ве in the Black Sea was developed and applied to study the spatial and temporal variations in the content of ⁷Be in the surface waters. Variations in the distribution of ⁷Ве were analyzed for the period from January to December of 2012. The average seasonal content of ⁷Ве in the surface layer ranges from 2.2 to 6.2 Bq m⁻³. The maximum concentration is typical for the eastern part of the sea in winter to spring, and the minimum concentration is typical for the central and western parts of the sea in summer. The seasonally averaged activity of ⁷Ве on suspended matter ranges from 440 to 1560 Bq kg⁻¹. The highest values are observed in the sea in winter to spring, and the lowest values are typically observed in the central and western parts of the sea in summer. It was revealed that the adsorption of ⁷Ве on suspended matter is most significant for the evolution of the content of this radionuclide in shelf waters.

Identification of functional groups of Opuntia ficus-indica involved in coagulation process after its active part extraction

Abstract

Opuntia ficus-indica that belongs to the Cactaceae family and is a member of Opuntia kind has received increasing research interest for wastewater treatment by flocculation. The objectives of this study were (i) to provide more information regarding the active constituents of Opuntia spp. and (ii) to improve the extracting and using conditions of the flocculant molecules for water treatment. A classic approach by jar test experiments was used with raw and extracted material by solubilization and precipitation. The surface properties of solid material were characterized by FTIR, SEM, zeta potential measurement, and surface titration. The splitting based on the solubility of the material with pH and the titration of functional groups completed the method. The optimal pH value for a coagulation–flocculation process using cactus solid material (CSM) was 10.0 and a processing rate of 35 mg L⁻¹. The alkaline pH of flocculation suggests an adsorption mechanism with bridging effect between particles by water-soluble extracted molecules. To validate this mechanism, an extraction water was carried out at pH = 10 (optimum of flocculation) and the solution was acidified (pH = 7) to allow precipitation of so considered active flocculant molecules. The strong flocculant property of this extract was verified, and titration of this solution showed at least one specific pKa of 9.0 ± 0.6. This pKa corresponds to phenol groups, which could be assigned to lignin and tannin.

Microwave-assisted extraction and dyeing of chemical and bio-mordanted cotton fabric using harmal seeds as a source of natural dye

Abstract

The revival of cultural heritage in a form of natural colorants for textile dyeing is gaining popularity due to their soothing nature and bright shades. The present study was conducted to explore the coloring potential of harmala (Peganum harmala) seeds and to improve color strength of dye using microwave radiations followed by a mordanting process. The results showed that harmala plant seeds could be an excellent source of natural dyes for cotton dyeing if the irradiated acidified methanolic extract (RE, 4 min) is used to dye un-irradiated fabric (NRC) at 85 °C for 45 min using a dye bath of pH 9.0 having salt concentration of 7 g/100 mL. Alum (1%) as pre-mordants and iron (7%) as post-mordants have improved the color strength in chemical mordanting more than other mordants employed. The bio-mordants employed reveal that 10% of acacia as pre-bio-mordants and 7% of acacia as post-bio-mordants are effective amounts to obtain high color strength. Suggested ISO standards for colorfastness illustrate that bio-mordanting has given more excellent rating as compared to chemical mordants. It is concluded that harmala seeds have a great potential to act as a source of natural colorant for cotton dyeing under the influence of microwave radiation.

Levels and distribution of cobalt and nickel in the aquatic macrophytes found in Skadar Lake, Montenegro

Abstract

Macrophytes react to changes in the quality of the environment in which they live (water/sediment), and they are good bioindicators of surface water conditions. In the present study, the content of the metals cobalt (Co) and nickel (Ni) was determined in the sediment, the water, and different organs of macrophytes from six localities around Lake Skadar, across four different seasons of year. The aquatic macrophytes that have been used as bioindicator species in this study are Phragmites australis (an emerged species), Ceratophyllum demersum (a submerged species), and Lemna minor (a floating species). The aim of this study was to determine the distribution of metals in macrophyte tissues and also to discover the degree of bioaccumulation of the investigated metals, depending both on the location and on the season. The content of Co and Ni in the examined parts of the macrophytes was in the range of 0.04–8.78 and 0.30–28.5 ppm, respectively. The greatest content of the investigated metal in the organs of P. australis and C. demersum was recorded at the beginning of and during the growing season. Greater concentrations of metals in the tissue of L. minor were observed at the end of the growing season.

Using laboratory-generated biosolids to evaluate the microbial ecotoxicity of triclosan in a simulated land application scenario

Abstract

Land application accounts for approximately 50% of wastewater solids disposal in the USA. Yet, little is known regarding the ecological impacts of many non-regulated chemicals found in biosolids. In most previous studies aimed at assessing ecological impacts, a model biosolid is generated by spiking high concentrations of the target chemical into a soil or biosolid. This approach does not account for the interaction of the chemical of interest with the solids throughout the biosolids production process (a.k.a., aging) which may impact the bioavailability and, thus, ultimate toxicity of the chemical. In the present study, using a lab-scale wastewater and digestion treatment system, we generated biosolids which contained aged triclosan and compared ecological impacts to that of spiked biosolids. Ecotoxicity was assessed based on functional and community structure changes to soil denitrifiers, microorganisms critical to nitrogen cycling. A decrease in denitrifier abundance and diversity was observed in the aged biosolids at concentrations of 17.9 ± 1.93 μg/kg while decreases in activity were observed at 26.9 ± 4.6 μg/kg. In the spiked biosolids treatment, lower denitrifier abundance, diversity, and activity were observed at triclosan (TCS) concentrations of 68.6 ± 26.9 μg/kg. This difference suggests a need to better understand TCS bioavailability dynamics.

Complications After Vulvar and Perineal Reconstruction With a Lotus Petal Flap

Background Lotus petal flaps are often used to reconstruct defects in the vulvoperineal area. Wound complications occur more often after surgery in the vulvoperineal area than in other areas of the body. Postoperative complications have a great impact on patients' well-being, length of hospital stay, care needed, and return to participation in daily life. Therefore, it is important to determine which patients are more prone to develop complications. Methods All lotus petal flap reconstructions in our center between January 2004 and August 2014 were retrospectively reviewed. Complications were categorized by the Clavien-Dindo classification. Results Ninety-three patients with 137 flaps were reviewed. The complication rates did not differ significantly between the reconstruction areas. In 30.1% of subjects, no complications were reported. A total of 51.7% of the subjects experienced Clavien-Dindo grade I or II complications, which required no or minor intervention. In 18.3% of subjects, intervention was required under general anesthesia (Clavien-Dindo grade IIIb complications), usually for debridement (64.7%). Donor site morbidity occurred in 14.0% of the subjects. The age group younger than 60 years showed a significantly higher rate of complications compared with the group older than 60 years (P = 0.015; odds ratio, 0.235; 95% confidence interval, 0.073–0.754). Conclusions This is the largest study to date on the complications of the lotus petal flap reconstruction. Complication rates did not differ between vulvar, perineal, and vulvoperineal reconstruction. Young patients seem to have a higher risk of developing complications.

Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution

No abstract available

Insurance Appeals for Pediatric Reconstructive Surgery: A Micro Cost Analysis and How-to Guide

Background When insurance coverage for pediatric reconstructive procedures is denied, a stressful and time-consuming appeals process ensues. This article discusses the results of a micro cost analysis performed to better understand the time and monetary burden that the insurance process places on our clinic and families. We also advise plastic surgeons on how to appeal insurance denials for necessary reconstructive procedures. Methods Our micro cost analysis focused on patients with congenital breast anomalies who were denied insurance coverage during the preservice insurance authorization process. We surveyed staff and family members to determine the steps involved in the insurance process and how long each person spent on each step. We combined this with average compensation data to calculate cost. Results For the 5 patients included in our analysis, the insurance process took an average of 7.4 hours of institutional time and cost $521.43 per patient. All patients were denied coverage during prior authorization and required a peer-to-peer, and all denials occurred because surgery was deemed cosmetic or not medically necessary. Conclusions This analysis estimated the time and monetary cost of the insurance process in our department. Access to care was limited by prior authorization and the opinion of medical directors that these procedures are unnecessary or cosmetic. We encourage plastic surgeons to continue to perform patient-centered outcomes research in their practice to build on literature that proves the functional and psychosocial benefits of reconstructive procedures.