Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study.

BACKGROUND: Severity-associated factors in atopic dermatitis (AD) have focussed on early onset, concomitant atopic diseases, markers of Th2-shifted inflammation and filaggrin mutations. OBJECTIVES: To investigate factors associated with severe AD in Finnish patients. METHODS: We conducted a single-centre, cross-sectional observational study with 502 AD patients aged 4.79 to 79.90 years (mean 32.08 years). Disease severity was assessed with the Rajka-Langeland severity score and EASI and associated clinical signs were evaluated. Data regarding onset, relatives, atopic and other comorbidities was gathered retrospectively. We investigated total serum IgE-levels, a panel of filaggrin null mutations and functional variants of genes associated with skin barrier defects. RESULTS: Factors more frequent in severe AD included early onset (P = 0.004, 95%CI 0.000-0.024), male sex (P = 0.002, 95%CI 0.000-0.11), history of smoking (P = 0.012, 95%CI 0.000-0.024), concomitant asthma (P = 0.001, 95%CI 0.000-0.011), palmar hyperlinearity (P = 0.013, 95%CI 0.014-0.059), hand dermatitis (P = 0.020, 95%CI 0.000-0.029) and history of contact allergy (P = 0.042, 95%CI 0.037-0.096). Body mass indices (P < 0.000, 95%CI 0.000-0.011) and total serum IgE-levels (P < 0.000, 95%CI 0.000-0.011) were higher in severe AD. No differences were observed for allergic rhinitis, allergic conjunctivitis, food allergy, peanut allergy, prick positivity, keratosis pilaris, history of herpes simplex infections, filaggrin null mutations and other gene variants. CONCLUSIONS: Severity determinants in Finnish patients seem to be early-onset, male sex, smoking, overweight, concomitant asthma, palmar hyperlinearity, hand dermatitis and high IgE-levels. A sub-typing of patients in relation to confirmed severity determinants may be useful for course prediction, prognosis and targeted AD management.

OCCUPATIONAL HAZARDS AS A RISK FACTOR OF ONSET AND UNFAVORABLE OUTCOME OF ISCHEMIC HEART DISEASE.

Objective -to identify the role of occupational hazards (OH) as a risk factor of onset and unfavorable outcome of coronary artery disease (CAD). Retrospective study included analysis of 307 case reports of CAD patients, including 59 patients with long term history of OH exposure. Prospective study included observation of 244 STEMI patients during their in-patient treatment, including 113 patients with prior exposure to OH. OH were demonstrated to contribute to the risk of CAD, and to be directly involved in atherosclerotic coronary artery (CA) injury, its role being equal to that of the classical risk factors, such as arterial hypertension (AH), dyslipidemia, and diabetes mellitus (DM). As shown by regression analysis, AH, DM, and dyslipidemia primarily promote atherogenesis in second and third order CA, while technogenic xenobiotics - mostly in first and second order CA, including the left CA truncus. History of OH directly affects the degree of stenosis, along with such important factors as LDL cholesterol, HDL cholesterol, triglycerides, and AH. According to Caplan-Meyer curves, OH exposure affects the hospital course of STEMI due to the adverse impact of technogenic xenobiotics leading, which contributes to the main mechanisms of CAD progression. In these patients the activity of systemic inflammation is higher, endothelial dysfunction, and autonomic disbalance and heterogeneity of myocardial repolarization are more profound. More pronounced remodeling of left ventricle, which is apparently due to the pre-existing abnormalities of cardiomyocytes caused by the long term effect of technogenic xenobiotics, significantly impairs the functional condition of myocardium, and accordingly the patient's prognosis. Our data suggest occupational hazards as a risk factor for onset and progression of CAD. Further studies involving this patient category are necessary.

Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America.

BACKGROUND: In high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America. METHODS: This was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates. FINDINGS: The highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p<0.001; and AMI: 678 vs. 586 per month, p<0.001). Monthly average temperatures were moderately lower during winter than other seasons and they were not associated with hospitalizations for HF and AMI. INTERPRETATION: The winter season was associated with a greater number of hospitalizations for both HF and AMI. This increase was not associated with seasonal oscillations in temperature, which were modest. Our study suggests that the prevention of cardiovascular disease decompensation should be emphasized during winter even in low to middle-income countries with tropical and subtropical climates.

[Risk factors of coronary disease].

Archival materials (medical histories, results of coronary angiography) of 307 patients with coronary artery disease (mean age 57.12 ± 10.04 years) were analyzed. Professional activity of 59 patients was associated with prolonged exposure to industrial hazard (xenobiotics). It was shown that proximal and middle parts of the major epicardial coronary arteries were most susceptible to atherosclerosis. In these segments complete chronic occlusion most often occurred. In one of five patients with coronary artery disease changes in the coronary arteries were not visualized by angiography. Percentage of unaffected coronary arteries was significantly higher in patients who were not in contact with technogenic xenobiotics. The degree of stenosis depended primarily on the effects of harmful occupational exposures, triglyceride, HDLP and LDLP cholesterol levels and hypertension. The number of damages to coronary blood vessels was determined mainly by the age of the patients and the presence of diabetes. The results show the importance of harmful work conditions as a risk factor for atherosclerotic changes in the coronary vessels.

[Cryosurgery of hepatic tumors]. / Kriokhirurgiia opukholei pecheni.

The work presents an experience with cryosurgical treatment of malignant and benign tumors of the liver in 110 patients. The cryosurgery was performed using an original apparatus. The methods of resection of the liver using cryosurgical instruments are described which reduce the intraoperative blood loss and facilitate visualization of the vascular-tubular structures along the resection line. The use of low temperatures allows optimization and extension of indications for operative interventions. Cryodestruction of the residual portion of the liver tissue after resection can be taken as a subsidiary means for prevention of dissemination of tumor cells.

An efficient approach for screening minimal PKS genes from Streptomyces.

Degenerated oligonucleotide primers were designed to amplify fragments of ketosynthase genes from polyketide antibiotics producing Streptomyces spp. and bacterial strains enriched from soil samples. Cell lysates were used as templates in amplification, so time-consuming DNA purification was avoided. A phylogenetic tree constructed from the amino acid sequences of the amplified fragments shows a distribution of spore pigments and antibiotics in separate classes. In addition, several different subgroups form within the antibiotics group. Anthracyclines were divided into separate branches according to the starter unit used in biosynthesis.

Mast cells in psoriatic skin are strongly positive for interferon-gamma.

The increased number and early activation of cutaneous mast cells is a typical feature of psoriatic inflammation. Interferon-gamma (IFN-gamma) is believed to be one of the important mediators in the cytokine cascade of psoriasis. Human mast cells have been previously reported to release various cytokines upon stimulation including interleukin (IL) -4, IL-5, IL-6, IL-8, IL-13 and tumour necrosis factor-alpha. Here we report that human mast cells synthesize also IFN-gamma at mRNA and protein level and that the number of IFN-gamma producing mast cells is significantly increased in the psoriatic skin. IFN-gamma immunoreactivity in mast cells was demonstrated by staining non-lesional and lesional skin sections from 21 patients with psoriasis. Ten patients with atopic dermatitis (AD) and five healthy persons served as control groups. The percentage (mean +/- SD) of IFN-gamma + mast cells in lesional compared with non-lesional psoriatic skin was 67 +/- 18% vs. 44 +/- 17% (P < 0.0001, paired t-test), respectively, but only 9 +/- 6% vs. 10 +/- 7% in corresponding skin samples of AD. In the skin of healthy controls, only 12 +/- 12% of the mast cells were IFN-gamma +. Using immunoelectron microscopy, we confirmed the ultrastructural localization of IFN-gamma within the granules of mast cells in psoriatic skin. In addition, stimulation of a human mast cell line HMC-1 with phorbol myristate acetate (PMA) (100 nmol/L) for periods of 2-24 h induced expression of IFN-gamma mRNA, which peaked at 24 h. When HMC-1 cells were stimulated with PMA (100 nmol/L) for periods of 0-3 days, the cells released IFN-gamma protein, peaking on day 1. These results provide further evidence for the important role of mast cells in the pathogenesis of psoriasis.

[The nursing care of a dying patient on the health center ward--the relatives' point of view]. / Kuolevan potilaan hoitaminen terveyskeskuksen vuodeosastolla--omaisten näkökulma.

The purposes of the study were to find out relatives' opinions about the care of dying patients as well as to find out how relatives assess the nursing care which was given to their nearest on the hospital wards. In order to collect the data for the study, the family members of patients (N = 628) who had died not more than one year before in the hospital, were interviewed. The interviewing was done by sending a questionnaire to every other relative (N = 314), 210 of which (62%) answered the questions. The answers to the structured questions were analyzed with the SAS-software and open-ended questions by the content analysis method. The relatives found that the hospital ward was quite a suitable environment for the nursing care of a dying patient. They found visiting hours flexible but they wished that they had the possibility to rest or stay over night in the hospital. The health care professionals responsible for the care of dying patients were considered to succeed in the field of the patient's rest and hygiene, but they took less well care of patient's physical exercise and dental hygiene. The relatives were satisfied with the pain relief the patient got. According to the relatives, examinations, medication, nursing interventions or the "futile" care given did not cause additional suffering. Although the nurses did not response to patients' spiritual well-being or needs of affections, they were able to make the patients happy with their kindness, presence and with good basic care. The relatives were best informed about patients' every day well-being, medication as well as practical matters concerning the time after the death of the patient. If the patient was transferred to another hospital for the terminal care, the relatives found, however, that they didn't get enough information of the situation. The health care professionals did not console the relatives for their grief and they had not been encouraged to participate in the care of their family members.

[The role of determining the level of middle molecules in patients in the diagnosis and treatment of suppurative-inflammatory complications after operations on the liver and pancreas]. / Rol' opredeleniia urovnia molekul srednei massy u bol'nykh v diagnostike i lechenii gnoino-vospalitel'nykh oslozhnenii posle operatsii na pecheni i podzheludochnoi zheleze.

Investigations of the level of medium-mass molecules were performed in blood plasma of 52 patients in dynamics after different operations on the liver and pancreas. Significant elevation of the level of medium-mass molecules was noted in patients with pyo-inflammatory complications. The inverse relationship between the level of medium-mass molecules and the prognostic coefficient value (the ratio of the general plasma protein to the general protein of wound discharge) was revealed. The indicators of the prognostic coefficient value decreased when the level of the medium-size molecules elevated against the background of purulent complications. These data allowed to estimate the severity of purulent complications and degree of intoxication which helped to determine the correct method of treatment of patients and to timely detect pyo-inflammatory complications.