Patient preference and satisfaction should be considered when prescribing inhaler devices, since these attributes may influence treatment concordance, facilitate correct handling and improve clinical outcomes. The aim of this study was to investigate pressurised metered dose inhaler (pMDI) characteristics important to asthma patients, and to compare a new long-acting β2-agonist/inhaled corticosteroid (LABA/ICS) pMDI with other pMDIs with respect to these characteristics. This was an open-label, cross-sectional, quantitative UK survey of asthma patients prescribed a new LABA/ICS pMDI or other pMDI. Eligible patients completed a survey using computer-assisted web interviewing. The survey was divided into 4 sections: (i) baseline information (ii) most important pMDI attributes, (iii) pMDI satisfaction and (iv) impact on asthma control. Items ii-iv were rated using a Likert scale – attributes: 1 (not important), 10 (very important); satisfaction: 1 (not satisfied), 10 (very satisfied); asthma control: 1 (don’t agree), 10 (fully agree)). Results are expressed as % of respondents rating a 9 or 10 on these Likert scales. 81 people with (63% female; mean age: 36.9 (12.3) yrs) completed the survey. Compared to other pMDIs, users found the new LABA/ICS pMDI superior for ease of use (76% vs 58%), mouthpiece size (80% vs 53%), sensitive dose counter (68% vs 50%), and good quality-to-price ratio (55% vs 27%). More users reported that they were very satisfied with the new LABA/ICS pMDI (59%) vs other pMDI users (45%), and perceived that it provided greater asthma control (68% vs 50%). The proportion of patients very satisfied with their device increased from 27% to 59% when switched to the new LABA/ICS pMDI. By contrast, user satisfaction rating remained the same when switching from, and to, other pMDIs (approx. 45%). The new LABA/ICS pMDI was assessed positively and better than other pMDIs for almost all of the characteristics most relevant to users.
BACKGROUND: In the world, cases of onychomycosis have increased, reaching 50% of all nail diseases. Although onychomycosis is a studied disease, the etiology of this disease in elderly patients has been poorly understood. OBJECTIVES: The purpose of this study was to identify etiological agents responsible for onychomycosis in elderly patients and possible predisposing factors. METHODS: n this study, 42 patients were diagnosed based on the clinical characteristics presented by the hosts, to the visualization in the sample of hyphae or yeasts in the direct microscopic examination and in the isolation of the causative agent via the culture in mycosel medium. RESULTS AND CONCLUSION: In this study, 42 patients were diagnosed with signs and symptoms compatible with fungal infection. Direct examination using 15% KOH revealed that 86% of the population studied had an onychomycosis while the culture showed that 52% of these were related to non-dermatophyte molds, 24% to yeasts and 24% to dermatophytes; Trichophyton rubrum (14.71%) was the most frequent etiologic agent. Hypertension was the most frequent clinical characteristic related to mycosis, followed by diabetes and HIV.
Importance: Skin cancer rates continue to escalate in the United States, yet little is known about changes in climatologic contributors to this epidemic. Objectives: To assess whether there has been a change in solar radiation over time. Methods: This manuscript analyzes extant climatologic data on measured solar radiation from the North America Land Data Assimilation System Daily Sunlight available from the Centers for Disease Control and Prevention. Data for the Continental United States was analyzed from 1979 to 2011. In addition to descriptive statistics, to test the hypothesis that sunlight energy is changing, a series of regressions was performed on data on National, Regional, and Divisional levels. Also, the relationship between total sunlight energy and ultraviolet B radiation was explored. Results: The average daily sunlight was 16,432MJ/m2 across the Continental United States. Over the 32 year study period, the Continental United States experienced a 2.4% increase in average daily radiation, which translates to a 0.076% per year increase. Although all 9 United States Census Bureau Geographic Divisions saw an increase in their average daily radiation over the study period, for two of these Divisions, Pacific and West North Central, the change was not significant. The Geographic Division with the greatest numeric increase in daily sunlight energy, New England, experienced a 6% increase, translating to a 0.19% increase per year. Daily sunlight energy was an excellent predictor for UVB energy (p=.0001, R2=.97) Conclusions: Solar radiation demonstrates increases over time, which may have profound implications for a continuously increasing risk of nonmelanoma skin cancer.
Background: In individuals of Chinese descent, skin cancers are less common but are associated with greater morbidity and mortality compared to those in persons of other ethnic groups. However, skin cancer awareness and behaviors in this population are not well described. Objective: To begin to understand skin cancer and sun protection knowledge, attitudes and behaviors in the Chinese speakers of San Francisco. Methods: We conducted a cross-sectional survey analysis in the waiting rooms of outpatient primary care and dermatology clinics in San Francisco in 2013. Chinese-speaking participants responded to questions about demographics, skin cancer risk and history, knowledge, attitudes and behaviors related to skin cancer and sun protection. Results: The sample included 58 Chinese speakers. Almost half of the Chinese speakers had poor understanding about skin cancer risk factors. Nonetheless, they were unlikely to have suffered sunburn in the past and to believe that suntans are attractive. The Chinese speakers were also unlikely to have seen a dermatologist or received skin screening. Conclusions: Our results highlight an opportunity to improve skin health for Chinese speakers through targeted interventions.
Background: Lactic acidosis occurs in asthma exacerbations at times and is felt to be secondary to B2-agonist use most of the time. It is also possible that subjects with decreased lactate clearance due to organ dysfunction are more susceptible to B2agonist-induced lactic acidosis. Objective: Profile acute asthma exacerbation patients with normal liver and hepatic function and lactic acidosis associated with B2-agonists use. Study Design: Retrospective case series. Methods: Subjects were selected for the series if they were being admitted for an asthma exacerbation from the ED, had an elevated lactate >4 mmol/L, and had no evidence of hepatic or renal dysfunction. The hospital course of these patients is described. Results: Ten asthmatics (7 female), average age 54.7 + 10.7 were admitted with lactates ranging from 4.5 to 8.7 mmoles/L after receiving initial albuterol treatments of at least 2 to 6 and usual care in the ED. After treatment for acute asthma, all ten asthmatics improved and were discharged home over several days to a just over one week. Conclusion: Asthmatics with B2-agonist-induced lactic acidosis can have normal hepatic and renal function and still develop the acidosis. This speaks against reduced lactate clearance as a contributing factor in B2-agonist-induced lactic acidosis in asthma.
Ibuprofen is in a category of non-steroidal anti-inflammatory drugs that has nearly complete cross-reactivity with aspirin in terms of ability to provoke symptoms in patients with aspirin exacerbated respiratory disease(AERD)(1,2). While the most widely used desensitization protocols utilize aspirin, these protocols typically involve serial increments of oral aspirin administration over several hours(1,2). Aspirin absorption itself can vary even with the use of rapid release aspirin, with time to peak blood levels ranging from 18 minutes to 2 hours(3). This absorption time could potentially eliminated if intravenous administration were used, and thus could potentially enable a more rapid desensitzation procedure in AERD patients. The contrasting clinical courses of 2 patients desensitized with intravenous ibuprofen are described and the outcomes are discussed in terms of implications for managing AERD patients.
Human seminal plasma protein hypersensitivity (SPH) is characterized as an immunologic reaction against glycoprotein antigens in seminal plasma. It can present with post-coital systemic and local symptoms which can be treated with local subcutaneous injections or intravaginal graded challenges (IVGC’s). Our goal was to gain a better understanding of SPH and report on the patients who presented with SPH to our clinics. Data were collected on current age, types and onset of symptoms, number of partners with whom symptoms occurred, allergy history and skin testing results. Fifteen patients were evaluated and diagnosed with SPH at our facilities. The majority experienced onset of symptoms in their twenties. Six of fifteen patients (40%) had symptoms with their first exposure to vaginal intercourse. Nine of fifteen patients (60%) experienced local symptoms only and the remaining six patients (40%) had both local and systemic symptoms. Five out of thirteen patients (38.5%) who were skin prick tested had a positive result to fresh semen. Five out of seven patients (71.4%) who underwent IVGC were successful in achieving desensitization.
Pyoderma gangrenosum is an idiopathic and chronic condition characterised by rapid progression of a purple plaque into an expanding ulcer. It is a diagnosis of exclusion, hence appropriate diagnosis and early treatment helps to prevent complications in patients who have other causes of severe cutaneous ulceration. We present a case of cutaneous tuberculosis in a 30 year old patient which was misdiagnosed as pyoderma gangrenosum , that resulted in delay in instituting appropriate treatment.
Trichoepithelioma (TE) represent benign hamartomas of the pilosebaceous apparatus that may occur as a non-hereditary solitary form or as multiple lesions that is dominantly inherited. Multiple TE may represent a syndrome in which tumors develop from undifferentiated germinative cells of the pilosebaceous –apocrine unit.1 We report a case of multiple trichepithelioma in a 35 year lady. INTRODUCTION Occurrence of multiple trichoepithelioma appears to be uncommon. They commonly appear in childhood and puberty, and are described more commonly in females. It can run in families and the gene for multiple TE has been mapped to a locus on 9p21 . 2 CASE REPORT A 35-year-old woman presented for advice because of multiple facial tumors, which had been present since many years. She was deeply concerned about them for cosmetic reasons. Physical examination showed numerous small pearly white papules involving the nasal root, the medial part of the eyebrows, and the nasolabial folds. Figure 1 Face of patient Histopathological examination of the lesion showed nests of bland appearing basaloid cells in the dermis with peripheral palisading, forming horn cysts. No mitotic figures were seen among tumor cells. Few of the nests showed follicular differentiation and an attempt to form abortive papillae. Figure 2 Histology 100x A Rare Case Of Familial Multiple Trichoepithelioma 2 of 3 Figure 3 Histology 200x
Angiocardiography hospitalizations (n=1,971,571) in New York State were examined for adverse drug effects between 1996 and 2010 focusing particularly on radiocontrast material (RCM) related hypersensitivity manifestations. Using the E code E947.8 (adverse drug effect from radiocontrast) and coding for other anaphylaxis (ICD9 995.0), allergic urticarial (ICD9 708.0), angioedema (ICD9 995.1), laryngospasm (ICD9 478.6) or laryngeal edema (ICD9 478.75) , an overall immediate hypersensitivity rate of 16.04x10-5 was found. Logistic regression modeling found that these immediate hypersensitivity manifestations were most strongly predicted by coding for E947.8 (odds ratio 501: 95%CI 433-580) followed by adverse coding to anti-infective, analgesic/anti-rheumatic, anti hypertension or cardiovascular drugs(odds ratio of any of these 84.91: 95% CI 69-104). There was an overall increase in the proportion of hospitalizations coding for these immediate hypersensitivity manifestations over the study period(binomial regression for time effect p<0.0001). Multivariate modeling showed not only a year effect but also a significant predictor effect from younger age, longer length of stay and female gender. Although a history of allergy to food, insect, latex, RCM or other substances were also multivariate predictors, asthma was not. Over a period of time when non-ionic RCM has predominated, the inpatient rate of RCM associated immediate hypersensitivity reactions associated with cardiac angiography has continued to exceed the combined rate of other common drug associated immediate hypersensitivity reactions, overall by more than 2 fold.
We are reporting a clinical presentation for a case that resamples CD30 positive lymphoproliferative disorder. The clinical challenge, the deferential diagnosis and review of literature have been discussed.
Background: Fish oil supplementation has been shown to attenuate hyperpnea- and exercise-induced bronchoconstriction. In vitro studies suggest that the omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA), rather than eicosapentaenoic acid, may be the potent component of fish oil. Objective: Therefore, the main aim of this study was to determine whether DHA supplementation can attenuate hyperpneainduced bronchoconstriction (HIB) and airway inflammation in adults with asthma compared to placebo. Methods: Nine subjects (aged 18-30 years) with asthma and HIB participated in a randomized, double-blind, placebo-controlled crossover trial where they received either 4.0 g of DHA or placebo capsules for 3 weeks. Following a 2-week washout phase, subjects then received the opposite supplement for 3 weeks. Subjects were tested in a laboratory following an initial 2-week run-in phase and after each supplementation phase. Each time, bronchoprovocation was elicited with eucapnic voluntary hyperventilation (EVH), a surrogate for an exercise challenge. Prior to and following the EVH challenge, pulmonary function, exhaled breath condensate (EBC) pH, and EBC concentrations of 8-isoprostane and the DHA metabolites 17Shydroxydocosahexaenoic acid and protectin D1 were measured. This study was registered at clinicaltrials.gov (study # NCT01200446). Results: Nine subjects completed the crossover design protocol without any adverse effects. There were no significant changes (p > 0.05) in any variables measured (i.e., percent change in forced expiratory volume-1-sec, EBC pH, 8-isoprostane, protectin D1 and 17S-hydroxydocosahexaenoic acid) among the pre-supplementation, placebo, and DHA tests. The effect size (�…2) for the maximum percent change in FEV1 was 0.08. Conclusion: The data indicate that supplementation with 4.0 g of DHA for 3 weeks does not attenuate HIB or airway inflammation in asthmatic subjects compared to baseline or placebo. Variations in study design, including time course, dose,
A case of herpes zoster in the distribution of left supraorbital branch of ophthalmic division of the trigeminal nerve, in a 9-month-old infant is reported for its rare occurrence in this age group.
Histoplasmosis is a systemic fungal disease. Oral histoplasmosis usually occurs in association with the chronic disseminated form of the disease and isolated oral presentation is rare. A case of isolated histoplasmosis involving the tongue in a HIVnegative patient is being reported.
During the Iraq-Iran war (1980-1988) many Iranian soldiers had been exposed to mustard gas. We had opportunity to observe the late-onset skin manifestations of these patients. In a prospective study we examined the skin of 2921 patients, were referred to Shiraz Chemical Warfare Victims’ Clinic One hundred and seventy-two (5.88%) out of 2921 patients had late-onset skin involvement. Forty-eight (27.9%) of 172 patients had mild mustard dermatosis, 44.8% (77/172) and 27.3% (47/172) had moderate and severe skin involvement, respectively. Cherry angiomas were seen in 62 out of 172 (36%) patients. Twenty-nine out of 62 (46.78%) patients with cherry angiomas had mild mustard dermatosis, 35.48% (22/62) and 17.74% (11/62) had moderate and severe mustard dermatosis, respectively. There were statistically significant correlation between the severity of mustard dermatosis and the incidence of eruptive cherry angiomas (P = 0.00015). The higher of the severity correlates with the less number of cherry angiomas.
Aims: We aimed to sort out clinical types, localizations and frequencies of only hand dermatoses (HD), only foot dermatoses (FD) and both hand and foot dermatoses (HFD) and to evaluate the relationship with sociodemographic parameters. Methods and Material: Dermatological examination of 450 outpatients was done and the relationship between the frequencies of diseases, localizations of the lesions and sociodemographic features was assessed statistically. Results: The frequencies of dermatoses were 34% for tinea pedis, 29% for eczema, 9% for warts, 5% for corns, 3% for psoriasis and 21% for the others in the participiants. Tinea pedis was the most frequent dermatose of men while eczema of women. HD except warts were the most frequent in housewives while warts in students. The most frequent HFD were psoriasis, eczema and tinea.Statistical analysis used: Chi square test, one way ANOVA test and tukey’s test were used for statistical assessments Results: The frequencies of dermatoses were 34% for tinea pedis, 29% for eczema, 9% for warts, 5% for corns, 3% for psoriasis and 21% for the others in the participants. Tinea pedis was the most frequent dermatose of men while eczema of women. HD except warts were the most frequent in housewives while warts in students. The most frequent HFD were psoriasis, eczema and tinea.Conclusions: We believe that elucidating the frequencies, clinical localizations and demographic features of these dermatoses will be helpful both for diagnosing and decreasing the incidence of these diseases in general population which seem to be a common health problem.
Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides characterized by the presence of folliculotropic infiltrates, often with sparing of the epidermis, and preferential involvement of the head and neck. We report a case with classical FMF lesions but also with a deep ulcer, which is an unusual presentation. Abbreviations: MFMycosis Fungoides,
