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Objective@#To evaluate the clinical effect of clear aligners in the anterior region in non-extraction cases by establishing a three-dimensional model of crown-root fusion to guide clinical application.@*Methods@#Eleven patients visiting the orthodontic department of Xuzhou Stomatological Hospital from December 2020 to December 2021 were collected, and the orthodontic plan was designed using Maestro 3D Dental Studio scheduling software to obtain the expected three-dimensional model of the patient's orthodontic treatment result. CBCT, intraoral scan, and 3D reconstruction software were used to create a postoperative model of the patient. The crown and root data were aligned in Geomagic Studio 2014, and differences in torque and axial inclination between the actual model after treatment and the predicted model of the anterior teeth before treatment were compared in 3-matic.@*Results@#The actual torque angles of the anterior teeth were all smaller than the predicted angles before treatment, with the highest realization rate of 77.55% for lateral incisors and the lowest of 60.70% for central incisors; the actual axial inclination angles of the anterior teeth were also smaller than the predicted angles before treatment, with the highest realization rate of 81.49% for central incisors and the lowest of 74.95% for cuspids. @*Conclusion@# A digital model of crown-root integration based on a combination of 3D reconstruction and intraoral scanning techniques is advantageous in assessing the efficacy of clear aligners. In non-extraction cases with clear aligner, the efficiency of movement is higher for small areas of the anterior region.
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The present study was aimed to investigate the role of GluN2B-BDNF pathway in the cerebrospinal fluid-contacting nucleus (CSF-CN) in neuropathic pain. Intra-lateral ventricle injection of cholera toxin subunit B conjugated with horseradish peroxidase (CBHRP) was used to label the CSF-CN. Double-labeled immunofluorescent staining and Western blot were used to observe the expression of GluN2B and BDNF in the CSF-CN. Chronic constriction injury of sciatic nerve (CCI) rat model was used to duplicate the neuropathic pain. Pain behavior was scored to determine the analgesic effects of GluN2B antagonist Ro 25-6981 and BDNF neutralizing antibody on CCI rats. GluN2B and BDNF were expressed in the CSF-CN and their expression was up-regulated in CCI rats. Intra-lateral ventricle injection of GluN2B antagonist Ro 25-6981 or BDNF neutralizing antibody notably alleviated thermal hyperalgesia and mechanical allodynia in CCI rats. Moreover, the increased expression of BDNF protein in CCI rats was reversed by intra-lateral ventricle injection of Ro 25-6981. These results suggest that GluN2B and BDNF are expressed in the CSF-CN and alteration of GluN2B-BDNF pathway in the CSF-CN is involved in the modulation of the peripheral neuropathic pain.
Subject(s)
Animals , Rats , Brain-Derived Neurotrophic Factor , Hyperalgesia , Neuralgia , Rats, Sprague-Dawley , Sciatic NerveABSTRACT
Background@#Topical corticosteroids are the mainstay of treatment for patients with atopic dermatitis. However, adverse effects associated with long-term steroid use often limit its use. This interventional study compared the efficacy of a proprietary moisturiser containing licochalcone A, omega-6 fatty acids, and ceramide 3 against 1% hydrocortisone cream in treating patients with mild-to-moderate atopic dermatitis.@*Methods@#Patients with mild-to-moderate atopic dermatitis affecting either the cubital fossa or popliteal fossa symmetrically were given twice-daily applications of the moisturiser and hydrocortisone on opposite sides of the body and monitored for a total of three weeks in a non-randomised half body, doubleblind study. Hydrocortisone was switched to aqueous cream after two weeks, whereas the application of the moisturiser continued until study completion. The assessment of SCORing Atopic Dermatitis (SCORAD) index and Dermatology Life Quality index was performed at baseline and every subsequent follow-up visit to measure patients’ response to treatment. @*Results@#The licochalcone A (LA) moisturiser and 1% hydrocortisone (HC) cream both demonstrated significant reduction in sign and symptom scores after only 1 week of treatment (percentage of reduction in sign and symptom scores: 52.8% [LA] vs 58.5% [HC]). Further reduction in mean sign and symptom scores for both treatments was observed at week 2 (61.3% [LA] vs 56.8% [HC]) and also at week 3 when HC was switched to aqueous cream (70.5% [LA] vs 63.5% [HC→aqueous cream]) (p<0.001 vs baseline within the same treatment arm at weeks 1, 2 and 3). When comparing the mean difference in SCORAD index for both individual as well as total skin signs and symptoms between LA and HC (i.e. inter-arm comparison), there was no significant difference between the two treatments for all the assessed parameters. Patients reported improvements in itching, sleeplessness, and overall quality of life over the course of treatment.@*Conclusion@#The licochalcone A moisturiser can be considered as an effective steroid-sparing alternative to topical corticosteroids in managing mild-to-moderate atopic dermatitis.
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Context: The safety and efficacy of irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) are well established. However, whether adjuvant chemoradiotherapy after IRE increases, the survival rate remains unknown. Therefore, this study evaluated the effect of chemoradiotherapy combined with IRE in patients with LAPC. Subjects and Methods: We retrospectively analyzed 42 patients with LAPC between July 2015 and December 2016 at PLA General Hospital treated with IRE or IRE combined with radiation and/or chemotherapy. These patients were divided into the IRE group and the combined-therapy group. All patients underwent computed tomography (CT), magnetic resonance imaging, and positron-emission tomography-CT and no signs of metastases were found. The prognosis of these patients was observed. Results: The times after operation and after diagnosis in the combined-therapy group (304.20 ± 118.54) and (334.40 ± 114.07) days, respectively, were better those than in the IRE group (214.36 ± 95.68) and (244.68 ± 110.61) days, respectively. Moreover, patients in the combined-therapy group had a significantly better survival rate than the IRE group (80 vs. 45.45%, P < 0.05). Conclusions: IRE combined with radiotherapy or chemotherapy was superior to IRE alone for the treatment of LAPC, as it prolonged the survival time and improved the survival rate, making it worthy of wide dissemination and clinical application
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The pathological grading diagnosis of pancreatic neuroendocrine neoplasms is the basis of clinical treatment and prognosis.The general principle guiding the classification of NEN has been evoluted several times.From the size of tumor,to the proliferation index as a key factor,and subsequently proposed distuishing between well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas.Firstly,neuroendocrine tumors and neuroendocrine carcinomas were classified according to their morphology.Then,according to mitotic image and Ki67 proliferation index,the former was classified into G1,G2 and G3 grades.
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BACKGROUND:Polylactic acid and its copolymers have been widely used in biomedical fields because of their good biocompatibility and biodegradability, which have become a hotspot in the research of biomaterials. OBJECTIVE:To review the biocompatibility of fully degradable polylactic acid and its copolymers. METHODS:A computer-based online retrieval of PubMed and CNKI was performed to search relevant papers published from 2006 to 2016, with the key words of "polylactide, polylactic acid, copolymer, biodegradability, biocompatibility, animal" in English and Chinese, respectively. RESULTS AND CONCLUSION:Polylactic acid and its copolymers as polyester compounds are approved by the US Food and Drug Administration for use in the biomedical field because of their good biocompatibility mainly as drug delivery carriers and temporary implants. Moreover, their side effects in clinical application have attracted attentions. Polylactide copolymers can cause some adverse reactions when used in drug delivery systems, orthopedic and skin care, and other clinical medical fields. These copolymers are deemed to have no impact on the central nervous system, eyes, cardiovessels and other tissues and organs. They also have no virtually genotoxic and carcinogenic effects. Currently, the polylactide copolymer implant mainly results in local reactions in the surrounding tissues, and no systemic reactions have been found.
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Introduction: Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN overlap in University Malaya Medical Centre (UMMC). Methods: All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji et al.2 Results: A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs (n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3). Conclusion: This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug is important and high index of suspicion of SJS and TEN is needed if patients were on the above medications.
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The present study aimed to improve the processing of data acquired from laser speckle contrast imaging (LSCI) to provide a standardization method to explore changes in regional cerebral blood flow (rCBF) and to determine the correlations among rCBF, cerebral ischemic lesion volume and microvascular density over time in a focal ischemic region. C57BL/6J mice were subjected to focal photothrombotic (PT) ischemia. rCBF was measured using LSCI at different time points before and after PT ischemia through an intact skull. Standardized rCBF (SrCBF), defined as the ratio of rCBF measured in the ipsilateral region of interest (ROI) to that in the corresponding contralateral region, was calculated to evaluate potential changes. In addition, the volume of the ischemic lesion and the microvascular density were determined using Nissl staining and immunofluorescence, respectively. The relationships among the ischemic lesion volume, microvascular density and SrCBF were analyzed over time. The results showed that the cortical rCBF measured using LSCI following PT ischemia in the C57BL/6J mice gradually increased. Changes in the cerebral ischemic lesion volume were negatively correlated with SrCBF in the ischemic region. Changes in the microvascular density were similar to those observed in SrCBF. Our findings indicate that LSCI is a practical technique for observing changes in murine cortical rCBF without skull opening and for analyzing the relationships among the ischemic lesion volume, microvascular density and SrCBF following focal cerebral ischemia. Preliminary results also suggest that the use of LSCI to observe the formation of collateral circulation is feasible.
Subject(s)
Animals , Male , Mice , Brain Ischemia , Diagnostic Imaging , Cerebrovascular Circulation , Diagnostic Imaging , Methods , Intracranial Thrombosis , Diagnostic Imaging , Laser-Doppler Flowmetry , Methods , Light , Mice, Inbred C57BLABSTRACT
Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular diseases. Aldosterone was reported to be increased in patients with OSA and correlated with OSA severity. Many studies investigated the effect of continuous positive airway pressure (CPAP) therapy on plasma aldosterone concentrations (PAC) in OSA patients. The results, however, were inconsistent. In the present study, we aimed to evaluate the effects of CPAP therapy on PAC by performing a meta-analysis. Literature search was carried out in electronic databases including PubMed/Medline, Cochrane Library, Embase and Web of Science. Eligible full-text articles were identified, and important data were extracted. Pooled analysis was performed using the STATA12.0 and RevMan 5.2. Standardized mean difference (SMD) was calculated to estimate the treatment effects. A total of eight studies involving 219 patients were included for our final analysis. PAC was found unchanged after CPAP treatment in OSA patients (SMD=-0.36, 95% CI:-0.91 to 0.18, Z=1.32, P=0.19). Meanwhile, CPAP therapy showed no impact on PAC (SMD=-0.21, 95% CI:-0.85 to 0.42, Z=0.66, P=0.51) in a separate meta-analysis including 3 randomized controlled trials. In conclusion, the evidence for the use of CPAP therapy to decrease PAC in OSA patients is low, and further studies are still warranted.
Subject(s)
Humans , Aldosterone , Blood , Continuous Positive Airway Pressure , Randomized Controlled Trials as Topic , Sleep Apnea, Obstructive , Blood , TherapeuticsABSTRACT
The present study aimed to improve the processing of data acquired from laser speckle contrast imaging (LSCI) to provide a standardization method to explore changes in regional cerebral blood flow (rCBF) and to determine the correlations among rCBF, cerebral ischemic lesion volume and microvascular density over time in a focal ischemic region. C57BL/6J mice were subjected to focal photothrombotic (PT) ischemia. rCBF was measured using LSCI at different time points before and after PT ischemia through an intact skull. Standardized rCBF (SrCBF), defined as the ratio of rCBF measured in the ipsilateral region of interest (ROI) to that in the corresponding contralateral region, was calculated to evaluate potential changes. In addition, the volume of the ischemic lesion and the microvascular density were determined using Nissl staining and immunofluorescence, respectively. The relationships among the ischemic lesion volume, microvascular density and SrCBF were analyzed over time. The results showed that the cortical rCBF measured using LSCI following PT ischemia in the C57BL/6J mice gradually increased. Changes in the cerebral ischemic lesion volume were negatively correlated with SrCBF in the ischemic region. Changes in the microvascular density were similar to those observed in SrCBF. Our findings indicate that LSCI is a practical technique for observing changes in murine cortical rCBF without skull opening and for analyzing the relationships among the ischemic lesion volume, microvascular density and SrCBF following focal cerebral ischemia. Preliminary results also suggest that the use of LSCI to observe the formation of collateral circulation is feasible.
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Background & Objective: Symptomatic sarcocystosis has been said to be rare until recent years, when there were reports of outbreaks of febrile myositis for travellers returning from the Malaysian island resorts. In 2012, an outbreak of Sarcocystis nesbitti infection involving 92 college students and staff occurred after returning from Pangkor Island, Malaysia. A few months after recovering from the febrile illness, some patients complained of hair loss. This study aimed to determine the prevalence, clinical features and outcome of this disorder. Methods: All patients who became sick in the outbreak were asked whether they had the hair loss. For those who had, they were interviewed with standard questionnaires, examined and investigated. Patients were followed-up via an online survey 2 years later. Results: Out of 89 patients who were ill, 19 patients (21.4%) complained of alopecia. The mean peak onset was 4 months after the initial illness. Eleven patients (57.9%) reported the hair fall of more than 100 per day. The other symptoms were itch 10 (52.6%), scaling 10 (52.6%), erythema 4 (21.1%), none had scarring. Eleven patients (57.8%) had positive antinuclear factor with high titre (speckled or nucleolar pattern). Two years after the event, 10 had complete or near complete spontaneous recovery, 1 had partial response and 1 had no improvement. Conclusions: A delayed transient diffuse alopecia is seen in close to half of patients with Sarcocystis nesbittiinfection. This high frequency of positive ANF suggested an immune-mediated mechanism.
Subject(s)
SarcocystosisABSTRACT
<p><b>INTRODUCTION</b>Singapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake.</p><p><b>MATERIALS AND METHODS</b>Females ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening.</p><p><b>RESULTS</b>There were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%).</p><p><b>CONCLUSION</b>Our results show the current influences on Singapore women's screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Breast Neoplasms , Diagnosis , Diagnostic Imaging , Breast Self-Examination , Early Detection of Cancer , Health Knowledge, Attitudes, Practice , Mammography , Patient Acceptance of Health Care , Singapore , Surveys and QuestionnairesABSTRACT
Induced pluripotent stem cells (iPSCs) can be propagated indefinitely, while maintaining the capacity to differentiate into all cell types in the body except for the extra-embryonic tissues. This iPSC technology not only represents a new way to use individual-specific stem cells for regenerative medicine but also constitutes a novel method to obtain large numbers of disease-specific cells for biomedical research. However, the low efficiency of reprogramming and genomic integration of oncogenes and viral vectors limit the potential application of iPSCs. Chemical-induced reprogramming offers a novel approach to generating iPSCs. In this study, a new combination of small-molecule compounds (SMs) (sodium butyrate, A-83-01, CHIR99021, Y-27632) under conditions of transient folate deprivation was used to generate iPSC. It was found that transient folate deprivation combined with SMs was sufficient to permit reprogramming from mouse embryonic fibroblasts (MEFs) in the presence of transcription factors, Oct4 and Klf4, within 25 days, replacing Sox2 and c-Myc, and accelerated the generation of mouse iPSCs. The resulting cell lines resembled mouse embryonic stem (ES) cells with respect to proliferation rate, morphology, pluripotency-associated markers and gene expressions. Deprivation of folic acid, combined with treating MEFs with SMs, can improve the inducing efficiency of iPSCs and reduce their carcinogenicity and the use of exogenous reprogramming factors.
Subject(s)
Animals , Mice , Amides , Pharmacology , Butyric Acid , Pharmacology , Cell Differentiation , Cell Line , Cell Proliferation , Extraembryonic Membranes , Cell Biology , Folic Acid , Pharmacology , Induced Pluripotent Stem Cells , Cell Biology , Kruppel-Like Transcription Factors , Metabolism , Octamer Transcription Factor-3 , Metabolism , Proto-Oncogene Proteins c-myc , Metabolism , Pyrazoles , Pharmacology , Pyridines , Pharmacology , Pyrimidines , Pharmacology , SOXB1 Transcription Factors , Metabolism , Thiocarbamates , Pharmacology , ThiosemicarbazonesABSTRACT
Induced pluripotent stem cells (iPSCs) can be propagated indefinitely, while maintaining the capacity to differentiate into all cell types in the body except for the extra-embryonic tissues. This iPSC technology not only represents a new way to use individual-specific stem cells for regenerative medicine but also constitutes a novel method to obtain large numbers of disease-specific cells for biomedical research. However, the low efficiency of reprogramming and genomic integration of oncogenes and viral vectors limit the potential application of iPSCs. Chemical-induced reprogramming offers a novel approach to generating iPSCs. In this study, a new combination of small-molecule compounds (SMs) (sodium butyrate, A-83-01, CHIR99021, Y-27632) under conditions of transient folate deprivation was used to generate iPSC. It was found that transient folate deprivation combined with SMs was sufficient to permit reprogramming from mouse embryonic fibroblasts (MEFs) in the presence of transcription factors, Oct4 and Klf4, within 25 days, replacing Sox2 and c-Myc, and accelerated the generation of mouse iPSCs. The resulting cell lines resembled mouse embryonic stem (ES) cells with respect to proliferation rate, morphology, pluripotency-associated markers and gene expressions. Deprivation of folic acid, combined with treating MEFs with SMs, can improve the inducing efficiency of iPSCs and reduce their carcinogenicity and the use of exogenous reprogramming factors.
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Various stem cells, including neural stem cells (NSCs), have been extensively studied in stroke models, but how to increase neuronal differentiation rate of NSCs remains unresolved, particularly in a damaged environment. The purpose of this study was to investigate the effects of cerebral microvascular endothelial cells (CMECs) on the neurogenesis of NSCs with or without oxygen-glucose deprivation (OGD). The NSCs acquired from primary culture were immunostained to prove cell purity. Survival and proliferation of NSCs were determined after the co-culture with CMECs for 7 days. After removing the CMECs, NSCs were randomly divided into two groups as follows: OGD and non-OGD groups. Both groups were maintained in differentiation culture for 4 days to evaluate the differentiation rate. Mouse embryo fibroblast (MEF) cells co-cultured with NSCs served as control group. NSCs co-cultured with CMECs had an increase in size (on the 7th day: 89.80±26.12 μm vs. 73.08±15.01 μm, P<0.001) (n=12) and number [on the 7th day: 6.33±5.61/high power objective (HP) vs. 2.23±1.61/HP, P<0.001] (n=12) as compared with those co-cultured with MEF cells. After further differentiation culture for 4 days, NSCs co-cultured with CMECs had an increase in neuronal differentiation rate in OGD and non-OGD groups, but not in the control group (15.16% and 16.07% vs. 8.81%; both P<0.001) (n=6). This study provided evidence that OGD could not alter the effects of CMECs in promoting the neuronal differentiation potential of NSCs. These findings may have important implications for the development of new cell therapies for cerebral vascular diseases.
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Various stem cells, including neural stem cells (NSCs), have been extensively studied in stroke models, but how to increase neuronal differentiation rate of NSCs remains unresolved, particularly in a damaged environment. The purpose of this study was to investigate the effects of cerebral microvascular endothelial cells (CMECs) on the neurogenesis of NSCs with or without oxygen-glucose deprivation (OGD). The NSCs acquired from primary culture were immunostained to prove cell purity. Survival and proliferation of NSCs were determined after the co-culture with CMECs for 7 days. After removing the CMECs, NSCs were randomly divided into two groups as follows: OGD and non-OGD groups. Both groups were maintained in differentiation culture for 4 days to evaluate the differentiation rate. Mouse embryo fibroblast (MEF) cells co-cultured with NSCs served as control group. NSCs co-cultured with CMECs had an increase in size (on the 7th day: 89.80±26.12 μm vs. 73.08±15.01 μm, P<0.001) (n=12) and number [on the 7th day: 6.33±5.61/high power objective (HP) vs. 2.23±1.61/HP, P<0.001] (n=12) as compared with those co-cultured with MEF cells. After further differentiation culture for 4 days, NSCs co-cultured with CMECs had an increase in neuronal differentiation rate in OGD and non-OGD groups, but not in the control group (15.16% and 16.07% vs. 8.81%; both P<0.001) (n=6). This study provided evidence that OGD could not alter the effects of CMECs in promoting the neuronal differentiation potential of NSCs. These findings may have important implications for the development of new cell therapies for cerebral vascular diseases.
Subject(s)
Animals , Mice , Animals, Newborn , Brain , Cell Differentiation , Physiology , Cell Proliferation , Cells, Cultured , Coculture Techniques , Methods , Endothelial Cells , Cell Biology , Metabolism , Glucose , Metabolism , Mice, Inbred C57BL , Microvessels , Cell Biology , Metabolism , Neural Stem Cells , Cell Biology , Metabolism , Oxygen , MetabolismABSTRACT
Linezolid is active against drug-resistant gram-positive bacteria. However, the efficacy and safety of linezolid in the treatment of the elderly have not been well characterized. The purpose of this study was to evaluate the efficacy of linezolid in the treatment of the elderly with gram-positive bacterial infection and to investigate the risk factors associated with the development of thrombocytopenia in these patients. This was a retrospective analysis of 50 elderly patients who were treated with intravenous linezolid for gram-positive bacterial infection. Clinical data and bacteriological responses were assessed. Risk factors associated with thrombocytopenia in elderly patients were analyzed. The overall clinical cure rate of linezolid was 74%, and the bacteriological eradication rate was 69%. Thrombocytopenia occurred in 24 patients, and thrombocytopenia was associated with both the duration of treatment [P = 0.005] and the baseline platelet count [P = 0.042]. Based on a logistic regression analysis, the baseline platelet count < 200_10[9]/L [OR = 0.244; 95% CI = 0.068- 0.874; P = 0.030] was identified as the only significant risk factor for linezolid-associated thrombocytopenia in elderly patients. The mean platelet count decreased significantly from the 7[th] day of treatment, and decreased to the lowest value 1-2 days after the end of therapy. Linezolid is effective and safe for the elderly with gram-positive bacterial infections. Adverse effects such as thrombocytopenia are of greater concern. Platelet counts should be monitored in patients who are treated with linezolid and that measures should be taken in advance to avoid hemorrhagic tendencies
Subject(s)
Humans , Female , Male , Risk Factors , Aged , Retrospective Studies , Gram-Positive Bacteria/drug effects , ThrombocytopeniaABSTRACT
No abstract available.
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Syphilis is an ancient sex u a l ly transmitted infection, described since centuries ago, caused by the bacterium Treponema pallidum. Syphilis or luetic disease is known as the great imitator as it can have myriads of clinical presentations, often making it a diagnostic challenge to clinicians. We report a patient with secondary syphilis, wh o presented with scaly plaques on his trunk and face, sparing the palms and soles.
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Background: Individuals with AD have an increased susceptibility to colonization with Staphylococcus aureus (S. aureus), contributing to the exacerbation of the disease. Sodium hypochlorite (bleach) has both in vitro and in vivo antimicrobial activity against S.aureus. Objectives: To evaluate the efficacy and safety of diluted sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in our Malaysian population. Methods: This was a prospective randomized, investigator-blinded, placebo-controlled study. Patients were randomly assigned through computer generated simple randomized numbers to treatment (bleach baths) or placebo (distilled water baths). Patients were instructed to soak in the baths neck down for 10 minutes, twice a week for 2 months. The efficacy outcome measures were the Eczema Area and Severity Index (EASI) score, percentage body surface area involved, quantitative S. aureus counts and patient’s assessment of overall response (including itch scores). Safety outcomes were also assessed. Results: A total of 36 patients completed the study. EASI scores and body surface area showed significant improvement between treatment and placebo groups at 2 months (p=0.02, p=0.02). At baseline, 88% of patients yielded S. aureus from lesional skin. Although most cultures in the treatment group continued to yield S. aureus, there was a reduction in the density over time, although not statistically significant. Five patients reported burning/stinging and dry skin in the treatment arm which did not differ significantly compared to placebo. Conclusion: Diluted sodium hypochlorite baths as an adjunctive treatment decreased the clinical severity of patients with moderate to severe atopic dermatitis and may reduce S. aureus density. This treatment was well tolerated with minimal adverse effects.