Phototherapy for atopic dermatitis: A survey of European practice.

BACKGROUND: Phototherapy is used to treat atopic dermatitis (AD). Evidence for its efficacy, impact on quality of life, cost-effectiveness and short- and long-term safety with real-life usage is weak. OBJECTIVES: We established a taskforce to examine how phototherapy is currently being used as a treatment for AD across the United Kingdom and Europe to inform our understanding and guide future research into management of patients with AD using UV-based phototherapies. METHODS: An anonymous electronic multiple-response survey exploring phototherapy prescribing practices and experience of phototherapy modalities was developed by the study authors and sent to members of phototherapy networks from the United Kingdom and Europe. Responses were received between February and July 2021. RESULTS: About 144 respondents from 27 European countries completed the survey. NBUVB was the most widely used [n = 138 (96%)]. Home-based NBUVB was available in 8/27 countries (25/144 respondents, 17%). Oral psoralen-UVA (PUVA) was more widely available than bath PUVA (n = 106, 74% vs. n = 60, 42%) and used mainly in adult patients. 49/144 (34%) of respondents had access to UVA1. Phototherapy would be considered instead of systemic treatment in 96% of adults and 82% of children for NBUVB, versus 40% of adults and 3% of children for PUVA. Starting doses, standard dosing increments, length of treatment courses, lifetime limits for treatments and thresholds for performing annual skin assessments varied between responders. CONCLUSIONS: NBUVB was the most widely used phototherapy for AD in adult and paediatric patients, while PUVA and UVA1 were less used. Prescribing practices varied considerably, highlighting the lack of consensus practice in many different aspects of phototherapy for the treatment of AD in children and adults. This indicates that further studies are required to determine optimal phototherapeutic regimens for AD and informs our understanding of parameters that should be included in future high-quality randomized controlled trials (RCT) of phototherapy.

FiO2 prediction formula during low flow oxygen therapy in an adult model: a bench study.

During low-flow oxygen therapy, the true value of inspired oxygen fraction (FiO2) is generally unknown. Knowledge of delivered FiO2 values may be useful as well as to adjust oxygen therapy, as well as to predict patient deterioration. This study proposes a New FiO2 Prediction Formula (NFiO2) for low-flow oxygenation and compares its predictive value to precedent formulas. In a bench study, the O2 Flow rate was delivered through a T-piece connected to a dual-compartment artificial lung controlled by a mechanical ventilator. To test the NFiO2 formula, a set of ventilatory parameters were tested: Tidal Volume was set from 400 to 600 ml, Respiratory Rate (RR) was set from 18 to 30 CPM, Ti/Ttot was set at 0.33 and 0.25, and O2 flow rates from 3 to 10 L/min. A data acquisition system measured all parameters. To quantify the accuracy of the NFiO2 compared to other FiO2 prediction formulas, Bland and Altman agreement analyses were performed. To make use of the Duprez Formula 2018 in clinical practice, we simplified the formula to estimate the FiO2 during oxygenation at low flow. This NFiO2 formula makes use of only O2 Flow Rate and RR. Bias and limits of agreement between predicted FiO2 and benchtop FiO2 highlighted consistent differences between different FiO2 prediction formulas. The NFiO2 and the Duprez Formula 2018 seemed to be the most accurate formulas, followed by the Vincent Formula, and lastly the Shapiro Formula. A New FiO2 Prediction Formula was developed using clinical readily available variables (RR and O2 Flow rate) which showed good accuracy in predicting FiO2 during oxygenation at low flow.

High-flow nasal cannula therapy, factors affecting effective inspired oxygen fraction: an experimental adult bench model.

Oxygenation through High Flow Delivery Systems (HFO) is described as capable of delivering accurate FiO2. Meanwhile, peak inspiratory flow [Formula: see text] ) of patients with acute hypoxemic respiratory failure can reach up to 120 L/min, largely exceeding HFO flow. Currently, very few data on the reliability of HFO devices at these high [Formula: see text] are available. We sought to evaluate factors affecting oxygenation while using HFO systems at high [Formula: see text] in a bench study. Spontaneous breathing was generated with a mechanical test lung connected to a mechanical ventilator Servo-i®, set to volume control mode. Gas flow from a HFO device was delivered to the test lung. The influence on effective inspired oxygen fraction of three parameters (FiO2 0.6, 0.8, and 1, [Formula: see text] from 28 to 98.1 L/min, and HFO Gas Flows from 40 to 60 L/min) were analyzed and are reported. The present bench study demonstrates that during HFO treatment, measured FiO2 in the lung does not equal set FiO2 on the device. The substance of this variation (ΔFiO2) is tightly correlated to [Formula: see text] (Pearson's coefficient of 0.94, p-value < 0.001). Additionally, set FiO2 and Flow at HFO device appear to significatively affect ΔFiO2 as well (p-values < 0.001, adjusted to [Formula: see text] ). The result of multivariate linear regression indicates predictors ([Formula: see text] , Flow and set FiO2) to explain 92% of the variance of delta FiO2 through K-Fold Cross Validation. Moreover, adjunction of a dead space in the breathing circuit significantly decreased ΔFiO2 (p < 0.01). The present bench study did expose a weakness of HFO devices in reliability of delivering accurate FIO2 at high [Formula: see text] as well as, to a lesser extent, at [Formula: see text] below equivalent set HFO Flows. Moreover, set HFO flow and set FIO2 did influence the variability of effective inspired oxygen fraction. The adjunction of a dead space in the experimental set-up significantly amended this variability and should thus be further studied in order to improve success rate of HFO therapy.

The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017.

BACKGROUND: The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide. OBJECTIVES: Here we present the burden estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017. METHODS: Data on the burden of AD were obtained from the GBD Study. RESULTS: Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability-adjusted life-years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 [95% uncertainty interval (UI) 65·4-201] and remained similar in 2017 at 123 (95% UI 66·8-205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178-547), the UK (284, 95% UI 155-478) and Iceland (277, 95% UI 149-465), whereas Uzbekistan (85·1, 95% UI 45·2-144), Armenia (85·1, 95% UI 45·8-143) and Tajikistan (85·1, 95% UI 46·1-143) ranked lowest. CONCLUSIONS: The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle-aged and older populations. We also found a moderate positive correlation between a country's gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age-related variations in disease burden.

Effects of miR-27a, miR-196a2 and miR-146a polymorphisms on the risk of breast cancer.

Background microRNAs (miRNAs) are potentially involved in many physiopathological processes, including regulation of cell growth, differentiation, apoptosis and cancer. Single nucleotide polymorphisms of the genes encoding miRNAs can alter their expression and may influence cancer risks. This case-control study explored the relationship between three microRNA polymorphisms (miR-27a, miR-196a2 and miR -146a) and breast cancer (BC). Methods A total of 353 breast cancer cases and 353 controls were genotyped for miR-27a (rs895819), miR-196a2 (rs11614913) and miR -146a (rs2910164). The miR-27a and miR-146a variants were discriminated using a PCR-restriction fragment length polymorphism method, while miR-196a2 were analysed by tetra-primers amplification refractory mutation system PCR. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to estimate associations. Results The CC homozygous genotype of miR-146a (rs2910164) was seen in 45(12.7%) patients with breast cancer and 18(5.1%) controls (OR 4.09 [95%CI 2.19-7.67] p < 0.001). The minor allele G of miR-27a was associated with a decreased risk of breast cancer (OR 0.24 [95% CI 0.14-0.42] p < 0.001). The miR-196a2 (rs11614913) was not related to breast cancer (p > 0.05). Conclusion Our data indicate that miR-146a (rs2910164) and miR-27a (rs895819) variants contribute to breast cancer. Further studies in larger populations including other genetic and environmental factors are required to achieve a definitive conclusion.

The treatment of vulval lichen sclerosus in prepubertal girls: a critically appraised topic.

Lichen sclerosus is one of the dermatoses that specifically affects the anogenital skin. It has peaks of incidence in prepubertal girls and postmenopausal women. The objective of this critical appraisal was to review systematically the evidence for efficacy and safety of different treatments. There are no randomized controlled studies of treatment in prepubertal girls and most studies are small case series or case reports. There is little focus on quality of life.

Solution of the nonlinear mixed Volterra-Fredholm integral equations by hybrid of block-pulse functions and Bernoulli polynomials.

A new numerical method for solving the nonlinear mixed Volterra-Fredholm integral equations is presented. This method is based upon hybrid functions approximation. The properties of hybrid functions consisting of block-pulse functions and Bernoulli polynomials are presented. The operational matrices of integration and product are given. These matrices are then utilized to reduce the nonlinear mixed Volterra-Fredholm integral equations to the solution of algebraic equations. Illustrative examples are included to demonstrate the validity and applicability of the technique.

Knowledge, attitude and practice of pharmacists and health-care workers regarding oral contraceptives correct usage, side-effects and contraindications.

Despite the success of the Iranian family planning programme, the number of unwanted pregnancies remains high. To investigate whether health workers in Tabriz are providing correct information and counselling about OCP use, the current study was planned to examine the level of knowledge, attitude and practice of OCP providers. A sample of 150 health-care workers in health houses and 150 community/hospital pharmacists answered a questionnaire about knowledge of correct use of OCP, side-effects, contraindications, danger signs/symptoms and non-contraceptive benefits, and whether they counselled patients about these subjects. Knowledge of pharmacists and health workers was not as high as expected and in many topics they were counselling patients even when they had incorrect knowledge and in other areas they were not providing information to patients despite having the correct knowledge. Better continuing education for OCP providers and especially for pharmacists seems necessary.

Beliefs and practices of Iranian pregnant mothers regarding vitamins and minerals.

The objective of this descriptive study was to examine the vitamin and mineral supplements safety beliefs and practices of Iranian pregnant women. Data were collected from 400 randomly chosen women. More than 50% of the participants believed that taking vitamins and minerals during pregnancy was safe; 87% reported taking iron during pregnancy, of which 71.7 % reported their doctor as the main recommender; 21.8% reported first trimester as the most beneficial time for iron supplementation, 13.0% second trimester and 3.0% third trimester. Although an appropriate intake of vitamins and minerals can assure health in pregnancy, excess can be harmful. Educational programmes for women of childbearing age are necessary.

Patients' report of statins use and side-effects in a sample of hospitalized cardiac patients in the Islamic Republic of Iran.

We aim to study the prevalence of the side-effects of statins among Iranians patients admitted to a cardiac-specialized hospital and had taken statins prior to hospitalization. Data was collected between September 2007 and March 2008 and 200 patients were enrolled. A questionnaire was completed using the patients' records and by interviewing the patients. The mean age of the participants was 61.5 (SD 12.3) years and 63% were males. The most commonly used statins was atrovastatin (99% of the patients). In all, 63.5% of the participants reported experiencing side-effects due to statins. The reported side-effects were respiratory (18.5%), headache (16.5%), rash (0.5%) and allergic reactions (5%); 9.5% reported (4%) and gastrointestinal effect muscle-related side-effects such as myalgia. Although, the clinical benefits outweigh the small risk of liver failure and myopathy, clinicians should be aware of the side-effects of statins.

Patients' report of statins use and side-effects in a sample of hospitalized cardiac patients in the Islamic Republic of Iran

We aimed to study the prevalence of the side-effects of statins among Iranians patients admitted to a cardiac-specialized hospital and had taken statins prior to hospitalization. Data was collected between September 2007 and March 2008 and 200 patients were enrolled. A questionnaire was completed using the patients' records and by interviewing the patients. The mean age of the participants was 61.5 [SD 12.3] years and 63% were males. The most commonly used statins was atrovastatin [99% of the patients]. In all, 63.5% of the participants reported experiencing side-effects due to statins. The reported side-effects were respiratory [4%)] and gastrointestinal effect [18.5%], headache [16.5%], rash [0.5%] and allergic reactions [5%]; 9.5% reported muscle-related side-effects such as myalgia. Although, the clinical benefits outweigh the small risk of liver failure and myopathy, clinicians should be aware of the side-effects of statins

Beliefs and practices of Iranian pregnant mothers regarding vitamins and minerals

The objective of this descriptive study was to examine the vitamin and mineral supplements safety beliefs and practices of Iranian pregnant women. Data were collected from 400 randomly chosen women. More than 50% of the participants believed that taking vitamins and minerals during pregnancy was safe; 87% reported taking iron during pregnancy; of which 71.7% reported their doctor as the main recommender; 21.8% reported first trimester as the most beneficial time for iron supplementation, 13.0% second trimester and 3.0% third trimester. Although an appropriate intake of vitamins and minerals can assure health in pregnancy, excess can be harmful. Educational programmes for women of childbearing age are necessary

Impact of anti-cancer drugs and other determinants on serum protein binding of morphine 6-glucuronide.

BACKGROUND AND THE PURPOSE OF THE STUDY: The aim of the present study was to examine factors that may influence the protein binding of morphine 6-glucuronide (M6G), the most active metabolite of morphine. METHODS: An enzyme-linked immunoabsorbent assay technique was used to measure the M6G concentration in serum of 18 healthy adults, 18 neonatal and 7 children with cancer. Total and free M6G concentrations were measured following equilibrium dialysis for 3 hrs and at physiological pH at 37°C. The influence of vincristine, methotrexate, 6-mercaptopurine, morphine, human albumin, alpha-1-acid glycoprotein, palmitic acid, oleic acid and pH on M6G protein binding was examined. RESULTS: M6G was 66.87±0.73 percent free in human serum at physiological pH and temperature. The percentage free (unbound) was increased significantly by vincristine (4.33%) and methotrexate (9.68%), but 6- mercaptopurine and morphine had no significant effect on it. Free percentages of M6G was reduced by decreasing serum albumin concentration but was unaffected by the presence of alpa-1-acid glycoprotein (AAG) or changes in serum pH. Similar results were obtained in human serum albumin (HAS) solutions. Addition of palmitic acid and oleic acid reduced protein binding significantly by 6.3% and 7.4%, respectively. MAJOR CONCLUSION: Although M6G in this study was not highly bounded, but because of its high analgesic potency, any change in its free concentration due to concurrent medication or disease caused significant changes in its effects. This dearth of evidence has been implicated in the reluctance of professionals to be cautious in prescribing them to children, particularly in the neonatal period.

Evidence of active transport involvement in morphine transport via MDCKII and MDCK-PGP cell lines.

Several transporters appear to be important in transporting various drugs. Many patients, who receive morphine as analgesic medication, also receive other medications with potency of changing morphine transport by affecting P-glycoprotein (P-GP) and oatp2 transport system. This could influence morphine pharmacokinetics and pharmacodynamics. The aim of present study was to elucidate the transport mechanisms involved in transporting morphine via MDCKII and MDCK-PGP cells. Morphine permeability was examined in the presence of various compounds with ability in inhibiting different transport systems including: digoxin, probenecid and d- glucose. The effect of morphine concentration changes on its transport was also examined. Morphine concentration was measured using HPLC with electrochemical detector. Morphine permeability via a MDCK II cells was greater than sucrose permeability, and reduced when a P-GP expressed cell line was used. Its permeability was increased significantly in the presence of a strong P-GP inhibitor. Morphine permeability decreased significantly in the presence of digoxin but not in the presence of d-glucose or probenecid. These results showed that morphine was a P-GP substrate, and digoxin related transporters such as oatp2 were involved in its transport. Morphine was not substrate for glucose or probenecid-sensitive transporters.

Rapid and sensitive quantitation of morphine using HPLC with electrochemical detection.

BACKGROUND: Morphine is one of the most widely used opioid analgesics for controlling pain in cancer and post-operative patients. OBJECTIVE: This study aimed at finding a sensitive method for measuring morphine. METHOD: A one-step solid phase extraction was developed for extracting morphine from various samples, and morphine concentration was measured using a high-performance liquid chromatographic system with electrochemical detection. The sensitivity of the assay was 1.53 ng/mL with a recovery of 93.4% +/- 0.01. The mean intra-assay and inter-assay test for three concentrations was 10.54 and 7.47, respectively. The assay showed no cross-reaction with a wide range of compounds. CONCLUSION: This method for morphine in small biological samples is easy, sensitive and reproducible with low cross-reactivity.

Extensive emphysematous pyelonephritis.

We report an unusually severe case of emphysematous pyelonephritis with very extensive kidney necrosis that led to unilateral nephrectomy. We discuss the diagnosis and treatment options in this very rare complication of pyelonephritis almost exclusively encoutered in diabetic patients.