Navigating through the healthcare system with atopic dermatitis: Analysing patient journeys in Germany.

BACKGROUND: Atopic dermatitis (AD), which can significantly impact quality of life, is a complex, heterogeneous skin disease affecting all ages and therefore can lead to very different patient journeys. Understanding the patient journey within the healthcare system is essential for improving care outcomes. OBJECTIVES: To explore the patient journey of individuals with AD in Germany, with a specific focus on the utilization of Internet resources throughout this process. METHODS: A cross-sectional study using a self-administered questionnaire was conducted from June 2021 to February 2022. Participants were recruited from dermatology private practices, a university hospital and online platforms. RESULTS: The study included 276 participants (62.3% female; mean age: 46.3 ± 18.4 years; mean disease duration: 26.9 ± 17.5 years; mean DLQ Index: 10.0 ± 5.6). Around 191 participants were currently receiving medical treatment, with 9.1% receiving biologic therapy. Most of the people initially contacted a GP (42.4%) and were diagnosed by a dermatologist first (57.6%). Around 47.1% were currently in treatment by a dermatologist, seeking dermatological care on average 4.5 times a year. Almost all individuals (86.2%) have already consulted more than one physician during their patient journey. Overall, participants consulted a median of five physicians, while those with severe AD consulted a median of six physicians. Initial symptoms to diagnosis and between consulting two different physicians both had a median duration of 6 months. Dissatisfaction with treatment outcomes emerged as a common reason for changing physicians. Approximately 76.4% of participants used the Internet for disease-related information, primarily relying on Google. Overall, 63% found the information quality unsatisfactory. CONCLUSION: The study underlines the widespread utilization of medical treatment and the proactive healthcare-seeking behaviour during a long patient journey. Dissatisfaction with treatment outcomes, alternative medicine and the quality of the Internet sources emphasize the potential for improving the comprehensive disease management to improve care outcomes.

[Reversible hearing loss in acute salicylate intoxication]. / Reversible Hörminderung bei akuter Salizylatintoxikation.

Acetylic acid, such as aspirin, is one of the most commonly used medication in Western societies. Aspirin overdosage causes ototoxic side effects in some patients, such as bilateral mild to moderate sensorineural hearing loss and tinnitus. Recent literature describes, that salicylates act as competitive inhibitors of Cl- anions at the anion-binding site of prestin, the motor protein of the outer hair cell. This molecular mechanism correlates well with the clinical audiological mainstays of aspirin-induced hearing loss, dose dependency, cochlear site of hearing loss and reversibility. We report about a young man with an acute moderate aspirin intoxication resulting in asymmetric hearing loss of 50 dB HL and tinnitus for five days. Otoacoustic emissions were absent on the first day of intoxication but could be measured again on the fifth day after the intoxication. As the ototoxic side effects resolve with in two or three days, no specific treatment is necessary for ototoxicity. Medical treatment of acute or chronic aspirin intoxications aims to decrease further drug absorption by gastrointestinal decontamination and to accelerate elimination by alkaline diuresis. Only in severe intoxications hemodialysis may be considered to treat neurologic, pulmonal, renal or cardial complications.

Cellular mechanisms of rejection.

Studies by molecular biologists, protein chemists and cell biologists are rapidly providing new tools and information for those interested in the cellular mechanisms of graft rejection. Despite these contributions, a clear picture of the mechanisms involved in rejection has not yet evolved. However, whole new areas for research have developed, providing opportunities for new insights as well as therapeutic interventions.

[Cardiac involvement in urticaria]. / Kardiale Mitbeteiligung bei Urtikaria.

Cardiac involvement in patients with urticaria is rare, but repeatedly assured in publications. Subjective complaints concern chest pain, which extends to the left shoulder and the left arm. Transient electrocardiographic changes can be observed more frequently and they often persist longer than the ches pain. In these patients the most frequent electrocardiographic changes consist in flattening or inversion of the T-wave and depression of the ST-distance. Such a patient is described who additionally showed monotopic extrasystoles.

Changes in the concentrations of branched chain amino acids in the blood in response to alterations in the composition of a hypocaloric diet.

This report describes an investigation of the effect of an alteration in the amount of protein, carbohydrate and fat in hypocaloric diets on the concentration ratios of valine/(isoleucine + leucine) in the morning fasting blood in healthy men: in some cases the effect of a higher caloric diet was also analysed. During the nutrition periods, each over 10 days, the concentrations of branched chain amino acids and alanine, blood levels of insulin, glucose and free fatty acids and the nitrogen balance were estimated daily. With hypocaloric diets, as well as with hypercaloric diets, supplementation of food protein from 0.6 or 0.8 up to 2.0 g protein per kg body weight (isocalorically) induced a rise of the molar ratios of valine/(isoleucine + leucine) in blood from 0.98 to 1.25 (4600 kJ/d) or 1.06 to 1.45 (14600 kJ/d) respectively. A correlation of molar ratios of valine/(isoleucine + leucine) in the blood and the nitrogen balance could not be established. However, it is suggested that ratios above a limiting value exclude the possibility of a distinct negative nitrogen balance during 7 or 10 days of observation.

[Relationship between nitrogen balance and amino acids, free fatty acids, glucose and insulin in human blood under various metabolic conditions (author's transl)]. / Beziehungen zwischen Stickstoff-Bilanz und Aminosäuren, freien Fettsäuren, Glucose und Insulin im Blut in verschiedenen Stoffwechselsituationen des menschlichen Organismus

Nutrition experiments with various levels of calorie and protein intake were carried out on five healthy young men. Three series of experiments with two persons each were undertaken for periods up to 14 days. The first part of each experiment, with 1100 to 1500 kcal/day, was immediately followed by the second part, with 3500 to 2300 kcal/day. The concentrations of insulin, free fatty acids, glucose and amino acids were determined in the morning, fasted blood. The nitrogen balance was also determined. When insufficient carbohydrate intake is coupled with normal and high protein content of the food, there is interindividually an initial drop in the insulin concentration. Regardless of the absolute insulin concentration, this drop causes an increase in the free fatty acids and the branched-chain amino acids, together with a decrease in the concentrations of alanine and glycine (threonine) in the blood and a negative nitrogen balance. The high concentrations of branched-chain amino acids and the low threonine concentrations might be involved as feedback regulators in the further regulation of the gluconeogenic metabolism. When carbohydrate calories are added to the diet, a simultaneous decrease in the free fatty acids and branched-chain amino acids and increase in the blood concentrations of insulin, alanine, glycine and threonine within 24 to 48 h are only observed with 3500 kcal/day and 0.8 to 1.4 g protein per kg body weight. A positive nitrogen balance, however, is only observed with 1.4 g protein per kg body weight, regardless of the relative changes in the insulin level, while the increase in alanine and decrease in branched-chain amino acids (valine) are greatest at 0.8 g protein per kg body weight and day. In spite of the high glucose level, the falling insulin level provokes counter-regulatory processes in which the low concentrations of branched-chain amino acids and the high threonine (alanine) concentrations may play a role.