Melatonin and sleep disorders in patients with severe atopic dermatitis.

INTRODUCTION: Many atopic dermatitis (AD) patients suffer from insomnia. Out of numerous factors associated with sleep disorders, melatonin seems to play a significant role. AIM: To assess the relation between melatonin concentration and sleep disorders in adult patients with severe and very severe AD. MATERIAL AND METHODS: The study included 36 adult patients with severe and very severe AD and 20 healthy Caucasian volunteers. The severity of skin lesions was assessed by the EASI scale. Skin itch was evaluated by a visual-analogue scale (VAS), and sleep disorders were assessed by the Polish version of the Athens Insomnia Scale (AIS). Serum melatonin concentration of patients and controls was determined by ELISA. RESULTS: Melatonin concentration in patients with very severe AD was significantly (p < 0.001) lower than in patients with severe AD, however, melatonin concentration in the group of AD patients did not differ significantly (p = 0.33) from that observed in the control group. There was a significant negative correlation between the concentration of melatonin in the study group and the severity of itching (R = -0.54, p < 0.001). The intensity of sleep disorders was significantly higher (p < 0.001) in patients with a very severe form of AD compared to patients with severe AD. Moreover, there was a significant negative correlation between melatonin concentration and sleep disorders (R = -0.67, p < 0.001). CONCLUSIONS: Our results clearly showed that sleep disturbances are more expressed in very severe AD patients compared to subjects suffering from severe disease. We also suggest that melatonin serum concentration could play a role in the pathogenesis of sleep disturbances in AD patients.

Does Sex in Managerial Positions Really Matter? Differences in Work-Related Feelings and Behaviors.

PURPOSE: The aim of the current study was to test hypotheses regarding differences in work-related feelings (ie, dejection, anxiety, anger, and happiness) and behaviors (aggressive, avoidance-passive, and proactive) between males and females, managers and non-managers, and male and female managers. METHODS: This survey-based study included a total of 3019 respondents, consisting of 502 managers and 2517 employees working in non-managerial positions. Data were collected using two questionnaires developed by the authors: the scale of work-related affective feelings (WORAF) and the scale of work-related behaviors (WORAB). RESULTS: The results revealed significant differences between managers and non-managers, with managers being happier in their jobs and exhibiting more proactive behaviors. However, there were no differences in work-related feelings or work-related behaviors between males and females in the total sample of respondents or in the group of employees holding managerial positions. CONCLUSION: In terms of work-related feelings and behaviors, there are no sex differences among working people. However, some differences between managers and non-managers were observed.

Pruritus Characteristics in Severe Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is classified as a most common inflammatory skin disease. The condition is characterized by recurrent eczematous lesions and intense pruritus or itch, a hallmark of AD. The aim of this study was to identify the provoking factors of itch in severe AD adult patients. There were 34 adult patients suffering from AD of the median age of 40 years enrolled into the study and a control group that consisted of 20 healthy subjects. The severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) index, pruritus intensity was assessed on a visual analog scale (VAS), and itch aggravating factors were assessed with a questionnaire. Specific IgE (sIgE) antibodies and interleukin IL-33 were measured in venous blood. We found that all the patients with severe AD had intensive itch (VAS: 9-10 points) during the whole day and 30 (88.2%) patients had it during nighttime. The most significant factors aggravating itch were the following: dry skin (27 patients; 79.4%), exposure to dust mite (22 patients; 64.7%,), and emotional distress (17 patients; 50%). Moreover, there was a positive correlation between the intensity of itch and the level of sIgE antibodies to dust mite (p < 0.001). The content of IL-33 was significantly higher in AD patients with severe skin lesions. This exploratory study shows that skin dryness, dust exposure, and distress play an essential role in the exacerbation of AD in the adult population.

A Cross-Sectional Study of the Relationships between Work-Related Affective Feelings Expressed by Workers in Turkey.

Understanding employees' feelings at work plays a significant role in developing practical and effective organizational and human resource management policies and practices. Furthermore, work-related emotions may have a considerable effect on workers' health and wellbeing and affect work effectiveness and work performance. The objectives of the current study were to investigate the relationships among four work-related (WOR) affective feelings (WORAF) and to validate the WORAF questionnaire in a Turkish sample. A survey was performed including four constructs: (1) WOR feelings of happiness, (2) WOR feelings of anxiety, (3) WOR feelings of anger, and (4) WOR feelings of dejection. A total of 322 workers from various companies in Turkey completed a paper-based survey. A research model was developed, and its main components were estimated with partial least squares structural equation modeling (PLS-SEM). The results revealed that dejection and anger at work play a critical role in experienced anxiety in occupational settings. Similarly, dejection, anger, and anxiety at work play a crucial role in perceived happiness at work.

Adipokines as Biomarkers of Atopic Dermatitis in Adults.

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic skin inflammation and does not have a well-understood pathogenesis. In this study, we addressed the contribution of adipokines to AD eczema based on the assessment of blood levels of adiponectin, resistin, leptin, lipocalin-2, and vaspin in adult non-obese patients suffering from chronic extrinsic childhood-onset AD. We investigated 49 AD patients with a median age of 37 years. The control group consisted of 30 age-matched healthy subjects. Adipokines were assessed in the serum by ELISA assays and the severity of AD with the SCORing Atopic Dermatitis (SCORAD) index. We found that adiponectin and resistin decreased and leptin appreciably increased in AD patients when compared to those in healthy subjects. Further, the levels of adiponectin and resistin were inversely related to the intensity of eczema. In conclusion, apart from the formerly investigated role of leptin in AD, this study points to adiponectin and resistin as the potential candidate adipokine biomarkers involved in shaping eczema intensity and severity, which may help predict disease exacerbations and enable the development of effective targeted therapeutic interventions.

Can the blood tryptase be an indicator of the severity of atopic dermatitis?

Atopic dermatitis (AD - atopic eczema) is a chronic inflammatory dermatosis resulting from complex genetic, epigenetic and environmental interactions with an overlapping defect in the epidermal barrier.AD is one of the most common inflammatory dermatoses in children and adults. AIM: The aim of the study was to assess the relationship between serum basal tryptase (sBT) and total IgE (tIgE) level in blood serum and the severity of lesions (SCORAD; SCORing atopic dermatitis). MATERIALS AND METHODS: The study was performed in the group of adult patients (57 people, F/M: 30/27; average age: 37.5 years) and in the control group (10 people, K/M: 6/4; average age: 44 years). Diagnosis of atopic dermatitis was established by a dermatologist-allergist specialist based on the criteria of Hanifin and Rajka. The severity of lesions was determined on the SCORAD scale (SCORing atopic dermatitis). RESULTS: The distribution of tryptase concentration did not differ statistically significantly between patients with various disease severity and the control group also the severity of skin lesions was significantly higher (p<0.001) in patients whose tIgE level exceeded 3500 IU / ml. Conclusion. sBT did not prove to be a useful biomarker in assessing. CONCLUSIONS: sBT did not prove to be a useful biomarker in assessing severity of AD. The present study demonstrated that in the patients with atopic dermatitis the concentration of total IgE was correlated with severity of the disease symptoms.

Is the presence of a fur animal an exacerbating factor of atopic dermatitis in adults?

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. To date, no clear relationship between the severity of AD and the exposure to dog and guinea pig-derived allergens has been established. AIM: The aim of the study was to assess the association between the specific serum immunoglobulin E levels (against dog and guinea pig) and the grade of skin symptoms measured with the SCORAD and VAS scales in the population of adult patients suffering from atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 47 patients suffering from atopic dermatitis since infancy (30 women and 17 men). Concentration of IgE was measured by the fluoroenzymatic immunoassay. The Mann-Whitney's test was used to compare the distribution of specific IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD and VAS scales, and the measured specific IgE concentrations for investigated fur animals was found. CONCLUSIONS: The study demonstrated that in the patients with atopic dermatitis the concentration of specific IgE was correlated with severity of the disease symptoms, including itch. This enables forecasting the course of the disease and selecting a group of patients who should immediately reduce their contact with allergen.

Depression and Serum Content of Serotonin in Adult Patients with Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic skin disease with the etiology not yet conclusively established. Recent reports demonstrate the role of serotonin (5-hydroxytryptamine; 5-HT) in the pathogenesis of AD. The aim of this study was to investigate the relationship between the serum content of serotonin and depression in adult patients suffering from severe AD. There were 31 patients of the median age of 41 years enrolled into the study, who suffered from AD since childhood, and a control group that consisted of 14 healthy subjects. AD was diagnosed on the basis of Hanifin and Rajka criteria. The severity of skin lesions was assessed with the SCORing Atopic Dermatitis (SCORAD) index and that of depression with the Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire. We found that all of the patients with severe AD characterized by SCORAD >50 had depression. Depression was classified as mild and moderate according to the MADRS score. Serotonin content was significantly lower in the patients with severe AD (MADRS >12), and there was an adverse relation between the serotonin content and the score of depression, the features not noticed in the control group. We conclude that severe AD, as expressed by the intensification of skin lesions, associates with depression and with the lowering of serum serotonin content. The findings point attention to the cognitive and affective problems in AD patients which could worsen the course of the skin disease.

The scale of Work-Related Affective Feelings (WORAF).

Interest in the field of emotions in the workplace continues to grow. However, a narrow range of measurements exists for the examination of affective states in organizational settings, all of which were developed based on the discrete-emotions approach. The main objective of the current study was to develop and validate a new instrument to assess four work-related (WR) affective feelings (WORAF): WR feelings of happiness, WR feelings of anxiety, WR feelings of anger, and WR feelings of dejection. Three independent samples of Polish employees in different occupations were included in the study (n = 297, n = 3019, n = 284). The results provide significant evidence for the validity of the proposed WORAF scale, although further investigations are needed.

Cat Allergy as a Source Intensification of Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is characterized by exacerbations and remissions of eczematous skin, underlain by impaired skin barrier and aberrant Th2-type and Th-22 cytokine production. A number of allergens, in particular contact with fur animals, may aggravate the disease. This study seeks to define the influence of having a regular contact with a pet cat at home on the severity of symptoms and signs of AD. We addressed the issue using the SCORing Atopic Dermatitis (SCORAD) and visual analog (VAS) scores to assess the intensity of pruritus and by measuring the blood content of specific IgE and IL-4, IL-13, and IL-22 cytokines. The study group consisted of 47 adult patients suffering from AD since childhood, 18 of whom declared having regular contact with a cat and the remaining 29 who denied it. There also was a control group consisted of 16 healthy volunteers with no AD signs. The SCORAD and VAS scores were significantly higher in patients in contact with a cat than in those without it (median SCORAD 61.0 vs. 50.4 and VAS 9.0 vs. 4.0 points, respectively). The sIgE of a majority of patients (94.4%) in contact with a cat was in Class V-VI, compared with just a few patients (3.4%) with no such contact, having sIgE in the same classes (p < 0.001). Significant correlations were revealed between SCORAD and VAS scores and the class level of serum sIgE value. In addition, IL-22 was a single elevated cytokine, only in the patients in contact with a cat, and it correlated with pruritus severity. The results of the study underline the need to beware of the cat fur allergen, and they stress forethought and caution in acquiring and keeping a pet cat by patients suffering from AD.

The level of total immunoglobulin E as an indicator of disease grade in adults with severe atopic dermatitis.

Atopic dermatitis is one of the most common inflammatory dermatoses in children and adults. The disorder is associated with significant worsening of quality of life. Due to the frequently suggested pathogenetic relationship with atopic dermatitis, immunoglobulin E seems to be an adequate indicator of the disease. AIM: The aim of the study was to assess the association between the total serum immunoglobulin E levels and the grade of skin lesions measured with the SCORAD and oSCORAD scales in the population of adult patients suffering from severe atopic dermatitis. MATERIALS AND METHODS: The study was performed in the group of 31 patients suffering from atopic dermatitis since early childhood (17 women and 14 men) in 2017. Total IgE was measured by the fluoroenzymatic immunoassay. The Spearman's rank correlation coefficient was used to determine the power of the relationship between the concentration of total IgE and atopic dermatitis severity. The Kruskal-Wallis and Mann- Whitney's tests were used to compare the distribution of IgE concentration and the distribution of atopic dermatitis grade. RESULTS: The statistically significant correlation between SCORAD/ oSCORAD and the measured IgE levels was found in the patients with the IgE level above 3500 IU/ml (19 subjects). CONCLUSIONS: The present study demonstrated that in the patients with severe extrinsic atopic dermatitis, the concentration of total IgE was correlated with the severity of the disease. This suggests an opportunity of employing IgE as an atopic dermatitis biomarker.

Caudal regression syndrome associated with the white matter lesions and chromosome 18p11.2 deletion.

Caudal regression syndrome (CRS) is a rare combination of congenital abnormalities characterized by caudal vertebral agenesis/dysgenesis that is usually associated with congenital anomalies of spinal cord, gastrointestinal and genitourinary organs. Although the exact teratogenic mechanism is not known, same environmental, e.g., hyperglycemia and genetic factors appears to play a crucial role in this fetopathy. Herein, we report an unusual case of CRS associated with unspecific white matter lesions and 18p-syndrome manifested by congenital ptosis, hypothyroidism, facial dysmorphy and chromosome 18p11.2 deletion.

[Physical and other methods therapy of the spasticity in children]. / Neurorehabilitacja i inne sposoby leczenia spastycznosci u dzieci.

BACKGROUND: Spasticity is a very bothering symptom, which aggravates disability and prevents in many cases a successful treatment. THE AIM: The aim of this paper was to remind different methods of treatment of spasticity, with a special attention to neurorehabilitation. RESULTS: In the research the complex pathogenesis of spasticity was referred, as well as factors influenced its aggravation and associated symptoms. Methods of evaluation of degree of spasticity were also recalled. The advantage and disadvantage of neurorehabilitation were also discussed. NDT-Bobath method as well as other kinesiotherapy methods were described with the necessity to make individualised program. The methods of rehabilitation which help in the reduction of muscle tone were refered, as well as the importance of botulin toxin, in the context of lack of efficacy of drugs in the reduction of spasticity, which cannot in fact help to reach better results of rehabilitation. The effectiveness of spasticity therapy with baclofen pump and other surgical methods were also mentioned. CONCLUSIONS: The decision to treat spasticity must be justified and depended on its intensity. It is necessary to develop new methods to obtain the durable effect of therapy of spasticity.

[Videoelectroencephalography in children with paroxysmal events]. / Wideoelektroencefalografia w stanach napadowych u dzieci.

The paper presents the crucial role of video EEG, modern diagnostic method, which allowed synchronized recording of clinical status and EEG pattern of the patient. This method gives the possibility to compare these two parameters in term of paroxysmal events. Video EEG allows to diagnosed clinical events associated with bioelectrical discharges (epilepsy), recording of bioelectrical events without clinical seizures, diagnosing clinical attacks without bioelectrical discharges (pseudoseizures) and nonepileptic events (without epileptic character in video and EEG). This method is very useful especially in children and adolescents because of huge polymorphism of clinical signs, more common ambiguous diagnosis in this age and due to heterogeneity of bioelectrical brain function in children. Video EEG monitoring gives the possibility for clinical and electro-physiological interpretation of paroxysmal events and plays a crucial rule in localizing of epileptogenic focus, classification of the seizure, epilepsy type or syndrome. The role of suggestion and placebo is important in diagnosing psychogenic pseudoseizures. The duration of video EEG recording is differentiated and much more shorter in diagnosing the type of the event. Prolonged monitoring is needed in children with drag resistant epilepsy and in pre-operation evaluation.

[Epilepsy with polymorphic seizures in hospitalized children]. / Padaczka z napadami polimorficznymi u dzieci hospitalizowanych.

OBJECTIVES: Epilepsy with polymorphic seizures is characterised by occurrence alternately two or more types of attacks. It represents a heterogenic group, taking into consideration etiology, course, management and prognosis, especially in the developmental age. THE AIM: The aim of this research was to establish a importance of epilepsy with polymorphic seizures in hospitalized with epilepsy children; the characteristics of type of epilepsy and epileptic syndrome, type of seizures, medication and results of pharmacological therapy were studied as well. MATERIALS AND METHODS: 58 children with epilepsy with polymorphic seizures were included, out of 1225 children hospitalized with epilepsy between the years 1998 and 2004. The group consisted of 30 girls and 28 boys aged 2 weeks to 15. As diagnostic tools, neuroimaging using MRI and CT were performed. Other such as EEG and videoEEG, and also 10 types of examinations were done as well. RESULTS: Children with epilepsy and polymorfic seizures represented 4.8% of the group hospitalized with epilepsy. The majority of them were infants and children in the pre-school age. The most frequent causes of this type of epilepsy were early encephalopathies, and ceroidolipofuscinosis. Among 13 types of seizures, the most common in analysed cases were myoclonic jerks and tonic-clonic seizures. The most frequently used drugs were valproate and vigabatrin, rendering seizure-free 43% of children. Only in 1/3 of children the intellectual development was normal. CONCLUSION: The high frequency and heterogenity of epilepsy with polymorphic seizures confirms the opinion that this type of epilepsy constitute a significant issue in the epileptology of the developmental age. In most of the children epilepsy was associated with intellectual impairment, while final etiology of epilepsy in half of the children was not established. Therapy of epilepsy with polymorphic seizures was complicated and seizures were fully controlled in less than one half of the children.

[Non traumatic spinal syndromes in children]. / Nieurazowe zespoly rdzeniowe u dzieci.

BACKGROUND: Spinal cord syndromes are caused by trauma in most cases, but the non traumatic spinal syndromes are needed to be urgently diagnosed and treated. THE AIM OF THE STUDY: It was to assess the prevalence of non traumatic spinal syndromes among hospitalized children with diseases of the nervous system and diagnostic analysis, therapy and its course. MATERIAL AND METHODS: The group of 16 children age 0,5-18 years hospitalized in the years between 1996-2005 in the Department of Child Neurology in Krakow. The diagnosis was based on neurological assessment, imaging, cerebrospinal fluid examination and other data. Pharmacology, surgery and physiotherapy were performed as a treatment. The modified Rankin scale was used to assess the motor function after the spinal disorder. RESULTS: The non traumatic spinal syndromes were identified in 0.3% of hospitalized children. In 5 cases they were caused by infection etiology, in other 3 cases the congenital spinal cord malformations were diagnosed. Three children had spinal tumors, in a single case the haematoma, vertebral dislocation, the vertebral fracture with bulging of the annulus fibrosus of the intervertebral disc, isolated bulging and MRI hiperintensive lesion of unknown etiology were seen. Two patients, which were most motor impaired past away, the intramedular tumor caused the middle motor dysfunction, the others spinal syndromes elicted minor disability. CONCLUSION: The most common etiology of the non traumatic spinal syndromes, rare in hospitalized children, were inflammation, congenital spinal malformation and neoplastic tumors. Three fourths of the children had mild and other more severe handicaps due to non traumatic spinal syndromes.

[Psychological evaluation in children with a cavum of the septum pellucidum]. / Wyniki oceny psychologicznej dzieci z torbiela przegrody przezroczystej.

THE AIM OF THE STUDY: Was to determine the influence of the persistent cavum of the septum pellucidum (CSP) on the children intellectual development in different age groups. THE MATERIAL AND METHODS: There were 53 children with CSP examined (3.4% of the hospitalised children), 28 girls and 25 boys aged 2 months-14 years. Among them 30 was with normal intellectual development, 14 children with IQ under the average and 9 with mental retardation. The control group consists of 30 children without CSP and with normal intellectual development. The children were divided into three groups: aged under 2 years, between 2 and 6 years and between 7 and 14 years. Using Psyche Cattell, Terman-Merrill and D. Wechsler (WISC-R) scales performed the general intellectual assessment. The evaluation of the cognitive, motor abilities and lateralization of the motor and visual functions in children was done using tests: Bender-Koppitz, Benton, R. Zazzo, M. Stambak, H. Spionek and Lingual Abilities Test. The anamnesis was obtained from parents. The statistic analyses was performed with chi-square and Fisher tests. RESULTS: The percentage of children with IQ under average and with mental retardation in the group <2 years was 60%, in 2-6 years 47% and in the group 7-14 years was 35%. The study show significantly lower score in the Code test of the D. Wechsler scale in children with CSP and normal intellectual development. Older children presented also significantly lower scores in manual abilities. A lot of intellectual functions were deleted in the majority of the children with CSP and the IQ under the average or with mental retardation. CONCLUSION: The CSP in children is connected to the deficits of the intellectual functions and that why the psychological assessment should be early performed in children with CSP.

[Nervous system involvement in children suffering from disorders associated with vasculitis]. / Zajecie ukladu nerwowego u dzieci z chorobami przebiegajacymi z zapaleniem naczyn.

The article presented the material of 12 children with vasculitis disorders and involvement of the nervous system, 8 of CNS and 4 of the peripheral nervous system. The most frequent form of these disorders was ischaemic stroke. Authors discussed issues specific for developmental diagnostic, etiopathogenetic and therapeutic topics.

[Bioelectric activity of the brain in children and adolescents with pseudoepileptic seizures]. / Czynnosc bioelektryczna mózgu u dzieci i mlodziezy z napadami rzekomopadaczkowymi.

THE AIM OF THE STUDY: Pseudo-epileptic seizures are a very crucial clinical problem in the developmental age and are coexisting with epileptic seizures in children. There is no answer to the question if the appearance of pseudoepileptic seizures in this age is connected to bioelectric brain function disorders. In adults with pseudoepileptic seizures the temporal area disorders are detected. MATERIAL: The video EEG was performed in 36 girls and 4 boys aged 8 to 18 years (average 13 years). The most frequent types of pseudo seizure were syncope (30%), fainting (15%), abdominal pain (10%) and visual disturbances (10%). In 7.5% clonic and tonic-clonic seizures and in 2.5 % paroxysmal sense disorders were seen. Confusion of place and time and paroxysmal behavioral disorders in 5%. In 3 cases hyperventilation was observed. In 15/40 with pseudoseizures epilepsy was coexisting. METHODS: In all children 1 hour interictal videoEEG monitoring was performed. The pattern was done during waking state and all children was activated. In 15, the procedure were repeated after sleep deprivation in physiological sleep. We analysed the basic activity, reactivity, symmetry and synchrony in the EEG patterns, presence of the epileptic-like grapho-elements and paroxysmal discharges. In sleep patterns the bioelectrical features, stages, epileptic-like and paroxysmal graphoelements are assessed. RESULTS: In 40% children with pseudoepileptic seizures, abnormalities of the interictal EEG were seen. Sleep deprivation provoked the abnormalities in another 4/15 children. In this pattern 27.5% children had localized paroxysmal discharges, and 22.5% generalized. In most of the cases the EEG was sensitive to stimulation. CONCLUSION: Pseudoepileptic seizures appear mostly in girls. One half of these cases had basic EEG pattern and paroxysmal bioelectric abnormalities, however 12/20 of them had epileptic seizures as well.