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2.
Pediatr Emerg Care ; 33(12): e164-e166, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29095386

RESUMO

Cat-scratch disease-associated vertebral osteomyelitis and epidural involvement are rare and may manifest with nonspecific chronic symptoms in children, such as fever or torticollis. We present only the fourth case in the literature describing epidural involvement in an immunocompetent boy presenting with fever, torticollis, and indiscriminate left upper back tenderness. Bartonella henselae serologies are important to consider because such atypical complications often are responsive to conservative management with antibiotics.


Assuntos
Doença da Arranhadura de Gato/diagnóstico , Celulite (Flegmão)/complicações , Osteomielite/complicações , Antibacterianos/uso terapêutico , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/tratamento farmacológico , Celulite (Flegmão)/tratamento farmacológico , Pré-Escolar , Diagnóstico Diferencial , Espaço Epidural/patologia , Febre/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteomielite/tratamento farmacológico , Coluna Vertebral/patologia , Torcicolo/etiologia
3.
Psychol Serv ; 13(2): 133-9, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27148947

RESUMO

Although the burden of mental health disorders among youth involved with the juvenile justice system is high, few communities have effectively integrated mental health resources with law enforcement (Myers & Farrell, 2008). The city of Cambridge, Massachusetts has developed the Safety Net Collaborative, which is a multiagency integrated model of preventive services for at-risk youth involving mental health providers, police officers, schools, and the department of youth and families. There are 6,000 youth in the city's public schools under the local police jurisdiction. Youth are referred to this program by schools, courts, and parents. There are approximately 30 active cases each year. Initial outcome measures were tracked, including number of arrests, diversions, and mental health referrals. Rate of decline in arrests was compared pre and post implementation. Community arrests have decreased by more than 50% since implementing this model. Contracting with mental health services has led to an average 94 outpatient mental health provider referral per year. The results show positive trends in arrest rates after implementation of this collaborative model of preventive services. These findings support greater research and utilization of integrated, preventive service models for at-risk youth. (PsycINFO Database Record


Assuntos
Serviços de Saúde do Adolescente/estatística & dados numéricos , Colaboração Intersetorial , Delinquência Juvenil/prevenção & controle , Delinquência Juvenil/estatística & dados numéricos , Aplicação da Lei , Governo Local , Serviços de Saúde Mental/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Humanos , Massachusetts
5.
Arch Dermatol ; 147(11): 1313-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22106118

RESUMO

BACKGROUND: Dermatitis herpetiformis is an autoimmune disease typically characterized by pruritic vesicles located on the extensor surfaces. Classic disease consists of neutrophils in the dermal papillae. Additional histopathologic findings include fibrin deposition and edema within the dermal papillae. Subepidermal vesicles also may be present. Direct immunofluorescence demonstrates granular IgA in the dermal papillae. OBSERVATIONS: A 58-year-old man with tender and pruritic erythematous macules and papules ranging from 2 to 6 mm in diameter had bilateral knee, elbow, forearm, scalp, and neck involvement. Petechiae also were present on the hands, thigh, knee, and ankle. A biopsy specimen initially demonstrated leukocytoclastic vasculitis. The results of workup for systemic vasculitis were negative. Subsequent biopsy specimens and direct immunofluorescence showed histologic evidence of dermatitis herpetiformis and leukocytoclastic vasculitis in the setting of an elevated serum IgA antitissue transglutaminase level. Marked improvement of the lesions was observed with a reduction of gluten in the patient's diet. CONCLUSIONS: Physicians should consider the possibility of dermatitis herpetiformis in patients with petechiae and leukocytoclastic vasculitis because leukocytoclastic vasculitis may be a prominent feature of dermatitis herpetiformis.


Assuntos
Dermatite Herpetiforme/diagnóstico , Imunoglobulina A/imunologia , Vasculite Leucocitoclástica Cutânea/diagnóstico , Biópsia , Dermatite Herpetiforme/dietoterapia , Dermatite Herpetiforme/imunologia , Dieta Livre de Glúten , Técnica Direta de Fluorescência para Anticorpo , Humanos , Masculino , Pessoa de Meia-Idade , Transglutaminases/imunologia , Vasculite Leucocitoclástica Cutânea/etiologia , Vasculite Leucocitoclástica Cutânea/imunologia
6.
Maturitas ; 69(3): 249-56, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21612880

RESUMO

Ageing of human skin may result from both the passage of time (intrinsic ageing) and from cumulative exposure to external influences (extrinsic ageing) such as ultraviolet radiation (UVR) which promote wrinkle formation and loss of tissue elasticity. Whilst both ageing processes are associated with phenotypic changes in cutaneous cells, the major functional manifestations of ageing occur as a consequence of structural and compositional remodeling of normally long-lived dermal extracellular matrix proteins. This review briefly considers the effects of ageing on dermal collagens and proteoglycans before focusing on the mechanisms, functional consequences and treatment of elastic fibre remodeling in ageing skin. The early stages of photoageing are characterised by the differential degradation of elastic fibre proteins and whilst the activity of extracellular matrix proteases is increased in photoexposed skin, the substrate specificity of these enzymes is low. We have recently shown however, that isolated fibrillin microfibrils are susceptible to direct degradation by physiologically attainable doses of UV-B radiation and that elastic fibre proteins as a group are highly enriched in UV-absorbing amino acid residues. Functionally, elastic fibre remodeling events may adversely impact on: the mechanical properties of tissues, the recruitment and activation of immune cells, the expression of matrix metalloproteinases and cytokine signaling (by perturbing fibrillin microfibril sequestration of TGFß). Finally, newly developed topical interventions appear to be capable of regenerating elements of the elastic fibre system in ageing skin, whilst systemic treatments may potentially prevent the pathological tissue remodeling events which occur in response to elastic fibre degradation.


Assuntos
Envelhecimento/metabolismo , Colágeno/metabolismo , Tecido Elástico/metabolismo , Proteoglicanas/metabolismo , Pele/metabolismo , Raios Ultravioleta/efeitos adversos , Envelhecimento/efeitos da radiação , Proteínas da Matriz Extracelular/metabolismo , Humanos , Microfibrilas/metabolismo , Pele/efeitos da radiação
7.
Psychiatr Serv ; 62(4): 344-6, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21459982

RESUMO

This column reports results from a qualitative study of employees' knowledge of and access to mental health benefits after implementation of New York State's parity law in 2007. Fifty-four employed individuals with insurance coverage were interviewed by telephone (32 adults with mental illness and 22 parents of children with mental illness). Contrary to findings of previous studies, most had been informed of their coverage limits before the parity law but were unaware of their extended parity benefits. They cited their lack of knowledge and inadequate communication from their health plan as barriers to accessing benefits. They also reported barriers to accessing high-quality services. The findings indicate an urgent need for benefits education and monitoring of health plan communications on a federal level.


Assuntos
Comportamento do Consumidor , Acessibilidade aos Serviços de Saúde , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde , Serviços de Saúde Mental , Humanos , Entrevistas como Assunto , Estudos Longitudinais , New York
8.
J Clin Psychol Med Settings ; 17(3): 258-71, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20803165

RESUMO

This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were randomly assigned to receive either usual care or a behavioral prescription to read the self-help book, Feeling Good (Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins). The treatment groups did not differ in terms of overall outcome variables. Patients in both treatment groups reported statistically significant decreases in depression symptoms, decreases in dysfunctional attitudes, and increases in quality of life. Although not statistically significant, the mean net medical expenses in the behavioral prescription group were substantially less. This study provided empirical evidence that a behavioral prescription for Feeling Good may be as effective as standard care, which commonly involves an antidepressant prescription.


Assuntos
Biblioterapia/métodos , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Atenção Primária à Saúde/métodos , Análise de Variância , Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Qualidade de Vida/psicologia , Resultado do Tratamento
9.
J Am Acad Dermatol ; 58(6): 1021-4, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18485984

RESUMO

Blue nail dyschromia may represent melanocytic, vascular, or other etiologies. A case of a subungual blue nodule is presented, with a pseudo-clubbed nail. On histopathologic examination, there was a combined subungual blue nevus, with features of a common blue nevus and a pigmented epithelioid melanocytoma. This unusual presentation is reviewed, with a discussion of blue nail dyschromia and subungual blue nevi.


Assuntos
Doenças da Unha/genética , Nevo Azul/genética , Neoplasias Cutâneas/genética , Adulto , Feminino , Humanos , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Fenótipo , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
10.
J Am Acad Dermatol ; 58(4): 636-41, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18342709

RESUMO

Primary cutaneous adenoid cystic carcinoma is a rare, slow-growing malignancy first described by Boggio in 1975. This tumor characteristically consists of basophilic cells with a distinct adenoid or cribriform pattern in the mid to deep reticular dermis. Modified myoepithelial cells with prominent basement membrane material often surround true lumina. Definitive diagnosis relies on the characteristic histologic features and the exclusion of metastatic disease. We describe two patients who presented with painful papules of the scalp and were successfully treated with wide local excision.


Assuntos
Carcinoma Adenoide Cístico/ultraestrutura , Neoplasias de Cabeça e Pescoço/ultraestrutura , Couro Cabeludo , Neoplasias Cutâneas/ultraestrutura , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoide Cístico/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Neoplasias Cutâneas/cirurgia
11.
J Am Acad Dermatol ; 58(1): 149-50, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18158925

RESUMO

Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy is an idiopathic fibrosing disorder recently described in patients with renal disease. The typical histology in nephrogenic systemic fibrosis consists of haphazardly arranged dermal collagen bundles with clefting, collagenous change which extends into the subcutaneous septa, mucin deposition, fibroblast proliferation, and increased elastic fibers with minimal inflammation. We present a 65-year-old female with classic clinical features whose biopsy demonstrated unique histologic features of septal pannicilitis with lymphocytic aggregates and Miescher's radial granulomas mimicking erythema nodosum.


Assuntos
Eritema Nodoso/patologia , Falência Renal Crônica/complicações , Paniculite/etiologia , Paniculite/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Idoso , Feminino , Fibrose , Granuloma/etiologia , Granuloma/patologia , Humanos , Linfócitos/patologia
12.
Drug Metab Dispos ; 30(7): 771-7, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12065435

RESUMO

The pharmacokinetics and oral bioavailability of (R)-N-[4-[2-[[2-hydroxy-2-(pyridin-3-yl)ethyl]amino]ethyl]phenyl]-4-[4-[4-(trifluoromethylphenyl]thiazol-2-yl]benzenesulfonamide (1), a 3-pyridyl thiazole benzenesulfonamide beta3-adrenergic receptor agonist, were investigated in rats, dogs, and monkeys. Systemic clearance was higher in rats (approximately 30 ml/min/kg) than in dogs and monkeys (both approximately 10 ml/min/kg), and oral bioavailability was 17, 27, and 4%, respectively. Since systemic clearance was 25 to 40% of hepatic blood flow in these species, hepatic extraction was expected to be low, and it was likely that oral bioavailability was limited either by absorption or a large first-pass effect in the gut. The absorption and excretion of 3H-labeled 1 were investigated in rats, and only 28% of the administered radioactivity was orally absorbed. Subsequently, the hepatic extraction of 1 was evaluated in rats (30%) and monkeys (47%). The low oral bioavailability in rats could be explained completely by poor oral absorption and hepatic first-pass metabolism; in monkeys, oral absorption was either less than in rats or first-pass extraction in the gut was greater. In an attempt to increase oral exposure, the pharmacokinetics and oral bioavailability of two potential prodrugs of 1, an N-ethyl [(R)-N-[4-[2-[ethyl[2-hydroxy-2-(3-pyridinyl)ethyl]amino]ethyl]phenyl]-4-[4-[4-(trifluoromethyl)phenyl]thiazol-2-yl]benzenesulfonamide; 2] and a morpholine derivative [(R)-N-[4-[2-[2-(3-pyridinyl)morpholin-4-yl]ethyl]phenyl]-4-[4-[4-(trifluoromethyl)- phenyl]thiazol-2-yl]benzenesulfonamide; 3], were evaluated in monkeys. Conversion to 1 was low (<3%) with both derivatives, and neither entity was an effective prodrug, but the oral bioavailability of 3 (56%) compared with 1 (4%) was significantly improved. The hypothesis that the increased oral bioavailability of 3 was due to a reduction in hydrogen bonding sites in the molecule led to the design of (R)-N-[4-[2-[[2-hydroxy-2-(pyridin-2-yl)ethyl]amino]ethyl]phenyl]-4-[4-(4-trifluoromethylphenyl)thiazol-2-yl]benzenesulfonamide (4), a 2-pyridyl beta3-adrenergic receptor agonist with improved oral bioavailability in rats and monkeys.


Assuntos
Agonistas de Receptores Adrenérgicos beta 3 , Agonistas Adrenérgicos beta/farmacocinética , Sulfonamidas/farmacocinética , Tiazóis/farmacocinética , Administração Oral , Agonistas Adrenérgicos beta/química , Agonistas Adrenérgicos beta/metabolismo , Animais , Disponibilidade Biológica , Cães , Avaliação Pré-Clínica de Medicamentos , Macaca mulatta , Masculino , Ratos , Ratos Sprague-Dawley , Receptores Adrenérgicos beta 3/fisiologia , Sulfonamidas/química , Sulfonamidas/metabolismo , Tiazóis/química , Tiazóis/metabolismo , Benzenossulfonamidas
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