Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity.

BACKGROUND: Chronic urticaria (CU), one of the most common skin disorders, is characterized by spontaneous recurrent bouts of weals and pruritus and associated with severely impaired quality of life (QoL). OBJECTIVES: To determine what aspects of life quality are affected and to characterize the factors that impact on QoL in CU patients. SUBJECTS AND METHODS: This interdisciplinary interview/questionnaire-based study included 100 patients admitted to a University Hospital Dermatology Department for the identification of underlying causes of CU; 96 healthy subjects matched for age and sex were used as controls. QoL was assessed using Skindex-29, a validated instrument to measure the effects of skin disease on overall QoL (composite score) and three defined QoL aspects (emotions, symptoms, functioning). RESULTS: CU patients exhibited markedly reduced overall QoL compared with healthy control subjects. CU had distinct effects on the three QoL aspects assessed (functioning = emotions > symptoms). The age or sex of patients, the absence or presence of angio-oedemas, and the duration or cause of CU did not significantly influence QoL impairment. Interestingly, psychiatric comorbidity (depression, anxiety, somatoform disorders) was associated with a more pronounced reduction of QoL compared with CU patients without a psychiatric diagnosis and the severity of psychiatric disease was found to correlate with QoL impairment. CONCLUSIONS: Our data confirm that overall QoL is markedly reduced in CU patients. Social functioning and emotions were found to be the areas of QoL most affected in CU patients. Psychiatric comorbidity significantly increased QoL impairment, whereas QoL in CU patients was not significantly affected by age or sex, the absence or presence of angio-oedema, or the course or cause of CU.

Role of the outer membrane for quinolone resistance in enterobacteria.

Quinolone-resistant clones were selected from clinical Escherichia coli, Citrobacter freundii and Serratia marcescens isolates in a frequency ranging from 10(-8) to 10(-6). The outer membrane proteins of quinolone-resistant E. coli clones remained unaltered, as was the case for 10 of 11 C. freundii and 4 of 11 S. marcescens clones ('nal B' type). There was no strong relation between alterations of outer membrane proteins and cross-resistance with chemically unrelated compounds such as tetracycline or chloramphenicol; however, tetracycline resistance was observed in some C. freundii clones with unaltered outer membrane proteins ('mar A'). Most of the quinolone-resistant S. marcescens clones can be considered 'nor B' or 'nor C' mutants due to their cross-resistance with other compounds, their altered outer membrane proteins and changes of lipopolysaccharide. In a few cases, subinhibitory quinolone concentrations caused alterations of outer membrane proteins in S. marcescens during mid log phase without development of resistance.

[Comparative antibacterial activity of fleroxacin: selection frequencies and outer membrane proteins of resistant mutants]. / Antibakterielle Aktivität von Fleroxacin im Vergleich: Selektionsfrequenzen und äussere Membranproteine resistenter Mutanten.

The antibacterial activity of fleroxacin was evaluated in 427 gram-positive and gram-negative strains, all isolated recently from clinical specimens and compared to that of ofloxacin, ciprofloxacin and co-trimoxazole. The activity of fleroxacin resembled to that of ofloxacin; its excellent activity against Haemophilus influenzae on the one hand and its lack of activity against beta-hemolytic streptococci on the other hand have to be mentioned. Selection frequencies for resistant clones were evaluated for clinical E. coli and Serratia marcescens isolates and the quinolones. With respect to clinical E. coli and Serratia marcescens isolates selection frequencies ranged from 10(-7) to 10(-9) in the presence of 2-fold or 8-fold the MIC. The outer membrane proteins of E. coli and Serratia marcescens wild-type strains were compared with those of their quinolone-resistant mutants. No discrepancies could be observed in E. coli, whereas some of the resistant Serratia marcescens mutants exhibited an increased expression of 31 kdal protein linked with a decrease of a 37 kdal major outer membrane protein. As these alterations could not be observed in each of the resistant mutants, it cannot be decided at present whether such alterations may provide an explanation for the resistance observed.