Search

Background The morbidity and mortality associated with pemphigus and its treatments have not been fully described. Previous studies have found conflicting results about certain comorbidities and were limited by small sample sizes. Objectives To determine the morbidity and mortality from pemphigus and its treatments in the U.S.A. Methods We examined a cross-sectional cohort of 87 039 711 hospitalized patients in the U.S.A. to determine the inpatient comorbidities and mortality of pemphigus. Results In multivariate survey logistic regression models adjusting for age, sex and race/ethnicity, pemphigus and its treatments were associated with 39 of 122 comorbidities examined. The disorders most strongly associated with pemphigus were Cushing syndrome [adjusted odds ratio ( OR) 17·23, 95% confidence interval ( CI) 2·41-122·90], adrenal insufficiency (4·08, 1·71-9·73), myasthenia gravis (6·92, 2·55-18·79), mucositis (17·19, 7·73-38·22), herpes infection (7·98, 3·62-17·62), fungal infections (4·03, 3·60-4·52), insomnia (18·02, 2·46-131·88) and hidradenitis (5·34, 1·33-21·43). Among malignancies, only leukaemia ( OR 1·56, 95% CI 1·08-2·24) and non-Hodgkin lymphoma (1·52, 1·15-2·03) were associated with pemphigus, but not any solid organ malignancies. Patients with a secondary diagnosis of pemphigus had higher inpatient mortality (3·20%, 95% CI 2·71-3·69) than those with a primary (1·60%, 1·29-1·91) or no (1·78%, 1·78-1·78) diagnosis of pemphigus ( P < 0·001). Conclusions Pemphigus is associated with increased inpatient mortality, likely through its association with numerous comorbid health conditions. Patients with pemphigus require improved access to dermatological care and increased screening for the myriad of comorbidities. [ABSTRACT FROM AUTHOR]

The article discusses research that establishes the validity of the International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) diagnostic codes to screen autoimmune blistering disease (AIBD). Topics covered include the diagnostic codes' high predictive value for the confirmed diagnosis of their respective diseases, the reliability of a single ICD-9-CM code for pemphigus and pemphigoid, and ICD miscoding in electronic medical records.

Introduction. Depression occupies a substantial part of medical visit attendance. However, medical practitioners have very little time so that a brief, quick and reliable procedure to evaluate the intensity of symptoms and their changes could be useful. Our objective has been to analyze the reliability of a self-applied Visual Analogue Scale (VAS) to measure symptom intensity in depressed patients within this context. Material and Methods. One hundred depressed outpatients (ICD-10) stated their clinical situation on a VAS. The psychiatrist evaluated them using a Global Clinical Impression (GGI) and Hamilton Depression Rating Scale (HDRS-17). Results and conclusions. The patient's VAS showed high correlation with the HDRS-17 and with the GCI used by the psychiatrist (r = 0.63 and r=0.58; p=0.000). This suggests that the use of a VAS in Primary Care could be useful and reliable for these purposes within the medical contexts of those having little time availability. [ABSTRACT FROM AUTHOR]

Introducción. La obsesividad y la impulsividad como rasgos de la personalidad han sido objeto de pocos estudios sobre la población general. Los autores plantean como objetivo estudiar si tales rasgos son constructos coexistentes, como abogan algunos autores o los polos opuestos de un continuum como afirman otros. Material y Métodos. Se estudian las respuestas a un cuestionario sobre rasgos obsesivos de la personalidad (MIRAP) y otro referido a la impulsividad como rasgo (ECIRyC) de 418 sujetos extraídos al azar de la población general. Se aplican técnicas de análisis estadístico multivariantes (Análisis Factorial, Análisis de Correspondencias, Análisis de Regresión lineal) para establecer el tipo de relación que tienen los dos rasgos estudiados. Resultados. Las puntuaciones totales del MIRAP y la ECIRyC correlacionan de un modo estadísticamente significativo (r=0,39; p<0,01). El Análisis de Correspondencias de esas puntuaciones totales distribuidas en deciles y dos Análisis de Regresión lineal muestran, también, una relación directa entre ambos rasgos que es estadísticamente significativa. La obsesividad y la impulsividad no correlacionan con el principal factor del rasgo opuesto. Todos los factores de ambos rasgos se agrupan factorialmente entre sí de forma positiva, excepto el factor impulsivo "precipitación" que lo hace negativamente con el factor obsesivo "orden". Conclusiones. Nuestros resultados señalan que la obsesividad y la impulsividad, como rasgos de la personalidad, son constructos convergentes y no polos opuestos de un continuum. Pero, simultáneamente, uno de los factores de cada rasgo ("precipitación" y "orden"), entre cinco, sí se comportan como polos opuestos de un continuum, dentro del marco conceptual, más amplio, de los rasgos a los que pertenecen. [ABSTRACT FROM AUTHOR]

Introduction. The authors develop a new rating scale for to measure its sensibility to the change of the intensity of the depressive symptoms under the effects of antidepressants drugs, and for to analyze the predictive validity of its total score. Designate it: The Axial Diagnostic and Sensitive-to-Change for Depression Index (ADSCDI). For this, use only seven nuclear items for the depression diagnosis (mood, interest, impulse/drive, pleasure, energy, daily job and different quality) without vegetative symptoms or anxious. Methodology. The authors interview to 111 psychiatric outpatients attended consecutively in a Mental Health Center. Sixty were fulfilling the criteria for depressive episode of the ICD-10 and fifty and one were forming part of the group of control: psychiatric outpatients not depressed. They use for this a protocol of collection of data that contains the ADSCDI, where the patients indicate how are found on a Visual Analogical Scale in the one which quantify their answers in each item, the Hamilton Rating Scale for Depression of 17 articles (HRSD- 17) and an Global Clinical Impression scale (GCI). Each depressed patient receipt the antidepressant treatment that better were adjusted to his clinical profile according to the psychiatrist that was trying to him. The depressed patients were evaluated a second time after thirty days of treatment. Results. All the items of the ADSCDI perceive a change statistically significant in the intensity of the depressive symptoms (p=0.00). The total score of the ADSCDI, also, at same level of statistical significance that the total scores of the HRSD-17 and of the GCI (p=0.000). The ADSCDI interrelates high and significatively with the HRSD-17 as with the GCI (r=0.77 and r=0.73 respectively; p=0.00). Equally makes it with the average of the "proportion of improvement" that evaluates, with the one evaluated by the HRSD-17 and the GCI (r=0.74 and r=0.68 respectively; p=0.000). A cut-off of 39 offers the best predictive values for the ADSCDI respect to the clinical and the ICD-10 criteria for depression. With a sensibility of 0.97, a specificity of 0.76 (of 0.88 with psychiatric patients free of symptoms), a total probability of guessing right of 93% and a kappa reliability of 0.74. The results improve when the ADSCDI is used as external criterion. For this new operative diagnostic criteria (ADCD), a cut-off of 40 offers a sensibility of 1.00, a specificity of 0.96 a probability of guessing right of 99% and a kappa reliability of 0.96. Conclusions. The ADSCDI offers sufficient concurrent validity with the HRSD-17 and the GCI. It can be considered a sensitive instrument to the change, with the advantage of containing, only, items that have shown be frequent, discriminant and predictives. The ADSCDI also is a good instrument to establish diagnostic of depression in the system ADCD/ADSCDI or in the ICD-10 one. [ABSTRACT FROM AUTHOR]

Introduction. The authors have developed a new axial diagnostic criterion for depression (ADCD) made up of seven items: mood, motivation/interest, impulse/drive, liking/pleasure, daily job, energy and different quality. They have aimed to examine its predictive validity and reliability, psychometric properties and constructive validity. There are few studies that have examined the psychometric properties of other diagnostic criteria for depression currently in use. Material and methods. A total of 111 psychiatric outpatients who attended an out-patient clinic consecutively were interviewed. Sixty met the ICD-10 criteria for depressive episode and 51 formed a part of the control group: non-depressed psychiatric outpatients. For the interview, the authors used a brief self-administered questionnaire (IDASD) in which the patients indicated how they felt. Each item had a Visual Analogue Scale so that the subjects could quantify their answers. Results. Four or more items are needed for the ADCD to correctly diagnose depression. At least two of these should belong to a group of three items that were extracted using a discriminant function (mood, energy and different quality). The ADCD constructed in this way has a 0.93 sensitivity and 0.82 specificity, with a kappa reliability of 0.76 and a proportion of total cases correctly classified ranging from 88% to 93%. Specificity reaches up to 0.92 when the control group is formed exclusively by symptom-free psychiatric outpatients. A factor analysis reveals that the ADCD is a one-dimensional model that has good construct validity (0.69). It also has good alpha reliability (α = 0.92), elevated consistency of the two halves of the test (R = 0.91) and a high test-retest correlation (r = 0.67). The ADCD diagnostic agreement between two psychiatrists who use the IDASD as a data source is very high (κ: 1.00). Conclusions. The ADCD/IDASD system offers a valid and reliable procedure to diagnose depression. It also has an excellent internal architecture, good construct validity and internal consistency. These data are much more than what can be said about other more used diagnostic criteria, which lack this information. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the prevalence of contrast-induced nephropathy (CIN) in intensive care unit (ICU) patients who are undergoing computerized tomography. A review of electronic laboratory database and manual chart of patients in ICU in Newcastle, New South Wales was conducted. The study found that 16 out of 139 patients developed CIN, while over 70 percent showed two or more risk factors. Study authors concluded that CIN cannot be predicted using risk factors.

Introduction. The authors validate a 20 item scale designed to measure anankastic (obsessive) personality traits: the Mini-Inventory of Anankastic Personality Traits, 2nd version (MIAPT-2) Material and methods. The answers of a sample of 418 subject of both genders obtained from the general population were used to analyze construct validity (factorial analysis), its alpha reliability and its internal consistency through the item/total correlations and the two halves test. An additional sample of 22 medical students was used to analyze the concurrent validity of the scale (external criterion: the Maudsley Obsessional-Compulsive Inventory) and the temporary reliability with the test-retest method. After this, the total scores of the instrument and the factorial scores were standardized and distributed into percentiles. Results. The scale shows good concurrent validity (r = 0.67; p < 0.000) and construct validity (56 % of the total of the variance explained by the factorial analysis) as well as a good internal consistency through the item/total correlations (all p = 0.000) and two halves test (r = 0.71; p < 0.000; with the Spearman-Brown correction R = 0.83). The alpha reliability of the scale (α = 0.84), and the test-retest (r = 0.69; p < 0.000) are high. Conclusions. The validated MIAPT-2 shows good validity and reliability to evaluate anankastic personality traits. The authors include an appendix with the scale and the standardization of its total and factorial scores distributed into percentiles to be used in clinical and general population samples. [ABSTRACT FROM AUTHOR]

HLA class I antigens arc thought lo be integral membrane proteins. However, soluble forms of these molecules have been detected. Our laboratory has recently shown that the predominant form of these soluble proteins present in human scrum, spleen tissue and culture supernatant of activated lymphocytes exhibits molecular weight and structure similar to classical HLA class I antigens, but lacks HLA A or B polymorphic determinants. In the present study, the secretion of such soluble proteins by lymphocytes has been further explored. Phytohaemagglutinin-stimulated normal lymphocytes secrete considerable quantities of soluble HLA (sHLA) class I proteins. This secretion seems to be a general property of lymphocytes, since activation of T as well as B cells by appropriate mitogens equally induce sHLA I secretion. Lymphocytes require RNA and protein synthesis, but not DNA synthesis, for the secretion to occur. Kinetic studies reveal that maximal sHLA 1 secretion precedes the peak of DNA synthesis by 24 h, In vitro stimulation with antigens or alloantigens also provokes sHLA I secretion. Moreover, this phenomenon has also been detected for in vivo-activated lymphocytes, as enhanced spontaneous sHLA I secretion was observed in cultures of low-density blastic B and T cells, and of blood lymphocytes obtained from normal subjects who had received a booster immunization 5 days earlier, Interferon-gamma (IPN-γ) increases the expression of membrane-bound class I antigens but does not induce any sHLA I secretion, suggesting that both molecules are under different regulatory mechanisms. Our results indicate that human lymphocytes, upon stimulation, actively secrete considerable amounts of a soluble form of these biologically relevant proteins. [ABSTRACT FROM AUTHOR]

Summary: Background: Little is known about the impact of ultraviolet exposure, climate factors and pollutants on pemphigus. Aim: To determine whether these factors are associated with pemphigus exacerbation resulting in hospitalization. Methods: The analysis used data from the 2002–2012 National Inpatient Sample in the USA, including 68 476 920 children and adults, and measurements of relative humidity (%), ultraviolet (UV) index, outdoor air temperature and particulate matter of ≤ 2.5 or ≤ 10 μm (PM2.5 and PM10). Results: Higher rates of admission primarily for pemphigus occurred during the summer and autumn months (June–November), with the highest admission rates in July and October (both 19.7 per million). There was significant statewide variation of the prevalence of hospitalization for pemphigus, with apparent hotspots located in the southwest and northeast states. Hospitalization for a primary diagnosis of pemphigus vs. other diagnosis was associated with significantly lower humidity [mean (95% confidence interval): 64.8% (63.2–66.4%) vs. 66.4% (65.6–67.3%); analysis of variance, P < 0.01) and higher temperature [58.7 (57.1–60.2) vs. 56.3 (55.8–56.7)°F, P = 0.001], UV index [6.0 (5.7–6.2) vs. 5.7 (5.6–5.7), P = 0.02], PM2.5 [12.9 (12.0–13.7) vs. 11.8 (11.5–12.0) mg/m3, P < 0.001] and PM10 [26.2 (24.5–27.9) vs. 23.1 (22.6–23.6) mg/m3, P < 0.001]. All associations remained significant in multilevel regression models that controlled for age, sex and race/ethnicity, except for ultraviolet index, which was associated with pemphigus hospitalization only for Hispanic patients [odds ratio (95% CI) for quartile 4: 2.07 (1.02–4.21)]. Conclusion: Increasing temperature, UV exposure and small particle air pollution are associated with increased hospitalization for pemphigus. Patients with pemphigus may benefit from avoidance of these potential environmental triggers. [ABSTRACT FROM AUTHOR]

Background Bullous pemphigoid (BP) is associated with significant disability and comorbid health disorders that may lead to or result from hospitalization. However, little is known about the inpatient burden and comorbidities of BP. Objectives To obtain data on the inpatient burden and comorbidities of BP in the U.S.A. Methods We analysed data from the 2002 to 2012 National Inpatient Sample, including a representative 20% sample of all hospitalizations in the U.S.A. (72 108 077 adults). Results The prevalence of hospitalization for BP increased from 25·84 to 32·60 cases per million inpatients from 2002 to 2012. In multivariate logistic regression models with stepwise selection, increasing age, nonwhite ethnicity, higher median household income, being insured with Medicare or Medicaid, and increasing number of chronic conditions were all associated with hospitalization for BP ( P < 0·05 for all). The top three primary discharge diagnoses for patients with a secondary diagnosis of BP were septicaemia (prevalence 5·51%, 95% confidence interval 5·03-5·99), pneumonia (4·60%, 4·19-5·01) and urinary tract infection (3·52%, 3·15-3·89). Patients with BP also had numerous autoimmune, infectious, cardiovascular and other comorbidities. Interestingly, BP was associated with multiple neuropsychiatric disorders, including demyelinating disorders, dementias (presenile, senile, vascular and other), paralysis, neuropathy (diabetic, other polyneuropathy), Parkinson disease, epilepsy, psychoses and depression. The mean annual age- and sex-adjusted in-hospital mortality rate was significantly higher in patients with a secondary diagnosis of BP compared with no BP (2·9%, range 2·8-3·9% vs. 2·1%, range 1·9-2·2%). Significant predictors of mortality in patients with BP included increasing age, nonwhite ethnicity and insurance with Medicaid or other payment status ( P < 0·05 for all). Conclusions Hospitalization for BP increased significantly between 2002 and 2012. Moreover, there were significant ethnic and healthcare disparities with respect to hospitalization and inpatient mortality from BP. [ABSTRACT FROM AUTHOR]

Incidence of cutaneous adverse events after exposure to tenofovir-emtricitabine in HIV-uninfected vs HIV-infected patients: pharmacovigilance within a large Midwestern U.S. patient population from the Research on Adverse Drug events And Reports program Tenofovir disoproxil fumarate (TDF) combined with emtricitabine (FTC) for HIV pre-exposure prophylaxis (PrEP; FDA approval 07/2012) has been shown to dramatically decrease HIV acquisition rates in high-risk populations.[[1]] TDF-FTC is also used as part of multidrug combination antiretroviral (cART) regimens for treatment of HIV(+) patients (FDA approval 08/2004). In the medical record database, 4237 patients were determined to have been exposed to TDF-FTC (Table), of which 1212 (28.6%) were HIV(-) with a prophylaxis indication versus 3025 (71.4%) who were HIV(+) with a treatment indication. [Extracted from the article]

Provides information on a study that presented data on methoxamine/albuterol and fluticasone responsiveness of airway blood flow in healthy subjects, alterations in baseline airway blood flow and its responsiveness to the agents in asthma, and the physiological interactions between methoxamine and fluticasone. Methodology of the study; Results and discussion of the study.

The article presents a case study of a 48-year-old man who was presented with a thickened, overcurved nail plate of the right third finger with an irregular black discolouration wherein the nail became progressively darker in colour over a period of 15 months. Information about the result of the physical examination as well as pigmented onychomatricoma, which is associated with subungual melanoma, is presented.

A response from the authors of the article "Validation of Database Search Strategies for the Epidemiological Study of Pemphigus and Pemphigoid" that was published in the 2015 issue is presented.

Presents a letter to the editor about stem cell transplantation in refractory pemphigus foliaceus.

Computerised tomography (CT) with contrast is frequently used in intensive care. Contrast-induced nephropathy (CIN) is an important complication largely studied in stable cardiology patients and can lead to acute renal failure. The aim of this study was to determine the incidence of CIN in an intensive care unit (ICU) setting and describe the prevalence of associated risk factors. We performed a retrospective analysis by review of electronic laboratory database and manual chart review of all patients in two tertiary intensive care units in Newcastle, New South Wales who underwent CT with intravenous contrast during their ICU stay in 2006. CIN was defined as an absolute increment in serum creatinine of 44.2 micromol/l or a relative increment of 25% from baseline at 48 to 72 hours following intravenous contrast. Patients' demographic, biochemical and contrast media data, physiological parameters, fluid and drug administrations and previously described as well as ICU specific risk factors were analysed. We compared CIN positive and CIN negative patients to identify risk factors associated with CIN. In total, 2043 patients were admitted to ICU during 2006 and 509 CT studies were performed. One hundred and forty-one of these included administration of intravenous contrast and 139 charts were reviewed. Sixteen out of 139 patients developed CIN (11.5%). More than 70% of patients had two or more risk factors. Age was the only risk factor found to be significantly associated with the development of CIN in a multivariate analysis (P value 0.04, OR 1.041, 95% confidence interval 1.002 to 1.081). Mortality was higher in CIN positive patients (31 vs 13%, P value 0.068). ICU and hospital length of stay was not significantly different in CIN positive and negative patients and persisting renal impairment was not found in CIN positive survivors. Based on this study, we cannot predict who will develop CIN in ICU using the described risk factors. Further prospective studies are needed to evaluate the incidence and outcomes of CIN in an ICU setting. [ABSTRACT FROM AUTHOR]

Pseudo-ainhum is an auto-amputation of the digits. Although extremely rare, it is a traumatic and painful experience that can be alleviated with early recognition and intervention. The scientific literature is filled with reports of this interesting but unfortunate phenomenon. To date, a firm causative aetiology has not yet been established. Although reports on this phenomenon have attempted to further our understanding of pseudo-ainhum, a clear understanding has been complicated by the interchangeable use of terms describing this auto-amputation. In this review, we discuss the current understanding, diagnostic criteria, and management of pseudo-ainhum. Furthermore, the nomenclature of pseudo-ainhum is clarified. Ideally, this will allow for more efficient exploration of pseudo-ainhum, its causes, and therapeutic approaches. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the possible association between the protein tyrosine phosphatase non-receptor 22 ( PTPN22) gene 1858C→T ( rs2476601, encoding R620W) polymorphism and inflammatory bowel disease (IBD). Our study population consisted of 1113 IBD [544 ulcerative colitis (UC) and 569 Crohn's disease (CD)] patients and 812 healthy subjects. All the individuals were of Spanish white origin. Genotyping of the PTPN22 gene 1858C→T polymorphism was performed by real time polymerase chain reaction technology, using TaqMan 5′-allelic discrimination assay. The frequency of the PTPN22 1858T allele in healthy subjects was 6.2% compared with 6.7% in the UC patients and 5.1% in Crohn's patients. No statistically significant differences were observed when the PTPN22 1858C→T allele and genotype distribution among CD patients, UC patients and healthy controls were compared. These results indicate that the PTPN22 1858C→T polymorphism does not appear to play a major role in IBD predisposition in our population. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSE) from multiple sclerosis (MS) patients contains B cells capable of spontaneous IgG secretion in vitro. This study analyses the function and regulation of these cells, CSF cells obtained from nine MS patients actively produced IgG during 2-3 days in culture, and the activity decreased when CSE ceils were cultured in serum-free medium. CSE cells from four controls did not secrete detectable IgG in vitro. Further experiments revealed that IL-6 played a role on MS CSE IgG-secreting cells, as can be deduced from the following findings: (i) the addition of exogenous IL-6. but not of other cytokines. to serum-free cultures restored missing CSE cell IgG secretion; (ii) the inclusion of anti-IL-6, but not of control. blocking MoAb reduced IgG secretion by CSE cells in fetal calf scrum (ECS)-containing cultures; and (iii) CSE cells were capable of active lL-6 production in the presence of ECS. These results suggest that endogenous IL-6 production by MS CSE cells seems to be responsible for inducing CSE IgG-secreting B Cells to reach terminal differentiation. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the hidradenitis suppurativa (HS) inflammatory disease, discussing its association at the time of diagnosis of inflammatory bowel disease (IBD) in U.S. patient population. Topics discussed include the search of electronic medical records in the study, the use of logistic regression analysis to determine concurrent diagnosis, and the possible biological link between the two diseases.