The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis.

BACKGROUND: Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0·2% to 1·8%. U.K. guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological comorbidity in people with vitiligo has not been described. OBJECTIVES: To establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used. METHODS: We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsycINFO to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were used to estimate the overall pooled prevalence. RESULTS: We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n = 25) or anxiety (n = 13). The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on 13 other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0·29 [95% confidence interval (CI) 0·21-0·38] and 0·33 (95% CI 0·18-0·49), respectively. Prevalence was lower for clinically diagnosed depression (0·21, 95% CI 0·15-0·28) and anxiety (0·15, 95% CI 0·06-0·24). When nonspecific tools were used the prevalence remained similar for depression (0·27, 95% CI 0·08-0·46) but increased for anxiety (0·46, 95% CI 0·39-0·52). High heterogeneity was observed. CONCLUSIONS: A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting the need for validation of psychological outcome screening tools in the field of dermatology.

Potential toxicity of chlorpheniramine plus chloroquine for the treatment of childhood malaria.

OBJECTIVES: To compare the adverse effects of two regimens of chlorpheniramine plus chloroquine (CP+CQ) in children who live in a country where chloroquine resistant malaria is endemic. METHODS: 99 children with acute uncomplicated malaria were randomised into two treatment groups. Group I received high dose chlorpheniramine (6 mg +12 mg/day for 7 days in children = 5 years; 8 mg + 18 mg/day for 7 days in those >5 years) plus chloroquine 10 mg/kg daily for 3 days. Group II received a 50% higher dose of chlorpheniramine plus chloroquine 10 mg/kg daily for 3 days. Outcome measures were vital signs, clinical response and parasite clearance on days 0-7 and day 14. RESULTS: Parasite clearance, fever clearance and cure rate were comparable for the two groups. Drowsiness occurred in 66.7% of high dose and 86.3% of higher dose CP+CQ subjects (p = 0.05). Compared to children treated with high dose, those treated with higher dose CP+CQ had significantly lower respiratory rates on day 2 (p = 0.001), day 6 (p = 0.015), and on day 14 (p = 0.003). CONCLUSION: The higher rates of drowsiness and lower respiratory rates in children treated with higher dose CP+CQ calls for caution in the clinical application of the higher dose combination. The higher dose has no additional benefit and may in fact be dangerous.

Effect of mastoid oscillation on the outcome of the canalith repositioning procedure.

OBJECTIVE: The canalith repositioning procedure (CRP), as described by Epley, is a well-established method of treatment for benign paroxysmal positional vertigo (BPPV). Debate exists as to whether simultaneous application of a mastoid oscillator confers any added benefit. The aim of this study was to examine this question. STUDY DESIGN: Prospective randomized study. METHOD: Eighty-four subjects with unilateral posterior canal BPPV were randomized into two groups. The oscillator group was treated by CRP with mastoid oscillation and the nonoscillator group was treated by CRP alone. Positive outcome was regarded as complete resolution of symptoms and a negative Dix-Hallpike's test after a 4 to 6 week follow-up period. RESULTS: Five patients were lost to follow-up. Twenty-eight (72%) patients from the oscillator group and 26 (65%) patients from the nonoscillator group had a positive outcome. This difference was not significant (chi = 0.17, P =.68) CONCLUSION: For the treatment of posterior canal BPPV, concurrent mastoid oscillation with CRP does not significantly alter the short-term outcome.

Health effects of asbestos and nonasbestos fibers.

Exposures to asbestos and synthetic fibers remain areas of great concern in the field of occupational lung disease. Despite extensive study, the health effects associated with fibers remains an area of substantial controversy. In particular, effects of fibers at relatively low doses, particularly for mesothelioma, remain a matter of evolving opinion, especially when integrated with the divergence of opinion on relative pathogenicity of different fiber types. Mechanistic studies continue to provide a window into pathogenesis and some hope for understanding dose-response relationships at the lower levels seen in contemporary Western workplaces and the general environment. Changes in clinical assessment based on use of new chest imaging techniques beyond the traditional plain film are also an area of evolution and begin to challenge B-reading as the definitive tool for noninvasive assessment of disease. Public health concerns have to a great extent been transported to the developing world where there is a strong trend toward increased use of asbestos, although it has been virtually eliminated from commerce in most developed countries. For nonasbestos fibers, the major unsettled issues are their relative potencies as carcinogens for the human lung and mesothelium and the need to sort out the relation between physical and chemical properties of these fibers and their pathogenicity. The recent discovery of "flock worker's lung" due to synthetic fibers once again alerts us to emerging diseases associated with new technologies.

Identification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air.

BACKGROUND AND OBJECTIVES: The major determinant of successful epidural anesthesia is the localization of the epidural space. The manual loss of resistance technique is widely used by anesthesiologists in identifying the epidural space. Should air or saline be used in detecting the point of loss of resistance? No consensus exists as to which technique is superior, and individual providers currently use the technique with which they are most comfortable. The incidence of adverse effects associated with the use of epidural air is unknown and may be underreported as the effects may be unrecognized or considered trivial. The authors comprehensively review the complications of epidural air from published reports. METHODS: Using the appropriate key words, the authors searched the Medline (National Library of Congress) scientific data bank from 1966 to 1995, for case reports of epidural complications. RESULTS: There are few prospective, controlled, double-blinded studies comparing the relative merits of using air versus saline for the loss of resistance technique of epidural placement. There are, however, numerous case reports. Complications associated with the use of air for the loss of resistance technique included pneumocephalus, spinal cord and nerve root compression, retroperitoneal air, subcutaneous emphysema, and venous air embolism. Additionally, inadequate analgesia and paresthesia have been associated with the loss of resistance technique using air. Transient and permanent neurologic sequelae have been attributed to some of the complications. The simultaneous administration of nitrous oxide and positive. Pressure ventilation has also been reported to expand localized collections of air, resulting in heightened symptoms. CONCLUSIONS: The potential complications associated with the use of air for identifying the epidural space with the loss of resistance technique may outweigh the benefits. The use of saline to identify the epidural space may help to reduce the incidence of these complications.

Foreign body in the throat migrating through the common carotid artery.

We present a 55-year-old lady who swallowed a 3 cm pointed metal foreign body whilst eating a sardine salad. The foreign body migrated from the hypopharynx through the parapharyngeal space and traversed the common carotid artery over a period of 12 days. The foreign body was removed by exploration of the neck.

Preoperative spinal bupivacaine does not reduce postoperative morphine requirement in women undergoing total abdominal hysterectomy.

BACKGROUND AND OBJECTIVES: This study was undertaken to determine whether preoperative spinal anesthesia with local anesthetics would exert a pre-emptive effect on postoperative analgesia by reducing neural afferent stimulation. METHODS: The authors studied 38 healthy women undergoing total abdominal hysterectomy. Patients were randomly allocated to two groups: group A received a spinal block (T3-S5) prior to induction of anesthesia and surgery, while in group B the block was performed after surgery prior to extubation of the trachea. Patient-controlled analgesia morphine was administered to both groups during the first 24 postoperative hours. RESULTS: Pain and sedation scores at 6, 12, and 24 hours were similar in the two groups. Cumulative morphine consumption at 6 and 24 hours after surgery was similar in both groups; however at 12 hours more morphine was needed in group A (P < .02). CONCLUSIONS: The authors were unable to demonstrate that spinal block with bupivacaine before surgery, as opposed to after surgery, decreased the requirement of morphine in the postoperative period.