Search

BACKGROUND Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

Background/purpose Tricyclic antidepressants (TCAs) are still widely used and are available to purchase without prescription in some countries. Awareness of adverse cutaneous drug reactions is essential. Method We reported a case of photo-distributed hyperpigmentation due to imipramine and carried out a systematic search of the related articles using the search terms "tricyclic antidepressants" or "tricyclic antidepressive agents", and "hyperpigmentation" or "photosensitivity disorder". Fifty non-duplicate citations were identified of which 28 articles which were independently assessed in full. The review was registered in PROSPERO, CRD42018107338. Results The remaining 25 articles met our inclusion criteria. Photo-distributed hyperpigmentation tricyclic antidepressant-induced photosensitivity reactions (TIPs) was the most common presentation. In 21 cases, this presented as an asymptomatic discolouration of exposed sites. Imipramine (81%), amitriptyline (9.5%), desipramine hydrochloride (4.8%) and mirtazapine (4.8%) were reported to be the culprit drugs. Nineteen were female with a mean age at presentation of 55 years. Mean duration from commencing the culprit drug until the development of discolouration was 10.4 years. Mean daily dose was 222.7 mg for imipramine. Histology was characteristic with golden-brown or brownish granules deposited in dermis. Staining for Masson-Fontana and MEL-5 was positive in all cases. Phototesting had not been done in cases prior to ours (negative 3 months after discontinuation of imipramine). Three further reports of suspected TIP presented with non-specific and eczematous eruption. The two presentations were reported along with systemic problems (thrombocytopenia and hepatic injury). Conclusions This systematic review highlights the characteristic features of exposed site hyperpigmentation of TCA-induced photosensitivity occurring after prolonged drug exposure in many cases.

Acute dermatological emergencies cover a wide range of severe skin eruptions. Several of these rashes are potentially life-threatening and carry significant morbidity and mortality. Dermatological emergencies occur across all spectrums of age, race and gender. Rapid diagnosis is vital to instigating appropriate treatment and reversing the underlying precipitant. High-quality multidisciplinary management with specialist nurses, general physicians and dermatologists is essential to ensure patients can be kept systemically stable while appropriate treatments are instigated. In this article we aim to cover some of the most significant emergency dermatological presentations and their management.

Wolff-Parkinson-White (WPW) syndrome is a commonly undiagnosed cardiac rhythm anomaly in a previously healthy patient who may precipitate malignant arrhythmia under surgical stress. We report successful management of a reconstruction surgery patient who developed cardiac arrest under general anesthesia due to undiagnosed WPW syndrome and a malignant arrhythmia during subsequent emergency surgery. A male patient with no previous history of the co-existing disease, age 23 years old underwent 14 hours of leg reconstruction with a posterior back flap. At the end of the surgery, the patient developed malignant arrhythmia that worsens to pulseless ventricular tachycardia. High-quality resuscitation was conducted and resulted in the return of spontaneous circulation. The patient had to undergo emergency surgery the next day, and another episode of intraoperative malignant arrhythmia was treated with propafenone and diltiazem. The patient underwent ablation postoperatively and, on the 14th day, was discharged without any residual complications. In conclusion, WPW may appear asymptomatic in a healthy young patient. Good anesthesia management and monitoring, knowledge of selective antiarrhythmic drugs and high-quality resuscitation skills can provide an optimal outcome in an unpredicted intraoperative crisis. Laporan Kasus: Manajemen Pasien Sindrom Wolff-Parkinson-White (WPW) yang Menjalani Tindakan Pembedahan Sindrom Wolff-Parkinson-White (WPW) adalah kelainan irama jantung yang sering tidak terdiagnosis pada pasien usia muda dan sering tanpa gejala. Stres akibat pembedahan dapat memicu aritmia maligna pada kelainan ini. Kami melaporkan keberhasilan manajemen pada pasien bedah plastik rekonstruksi dalam anestesi umum yang mengalami henti jantung karena sindrom WPW yang tidak terdiagnosis sebelumnya dan terjadi aritmia maligna serupa pada operasi darurat berikutnya. Seorang laki-laki berusia 23 tahun tanpa riwayat penyakit penyerta sebelumnya, menjalani rekonstruksi kaki dengan flap posterior selama 14 jam. Pada akhir pembedahan, pasien mengalami aritimia maligna dan berkembang menjadi ventricular takikardia tanpa nadi. Tindakan resusitasi jantung paru berkualitas tinggi dilakukan dan sirkulasi spontan kembali muncul. Pasien harus menjalani operasi darurat keesokan harinya dan mengalami episode aritmia maligna ulangan intraoperatif yang telah berhasil diidentifikasi pada pemeriksaan pascaoperasi pertama sebagai sindrom Wolff-Parkinson-White. Aritmia maligna tersebut diatasi dengan pemberian propafenon dan diltiazem. Pasien menjalani tindakan ablasi pascaoperasi dan pulang pada hari keempat belas perawatan tanpa gejala sisa. Simpulan, sindrom WPW mungkin tampak asimtomatik pada pasien muda yang sehat. Manajemen anestesi yang baik, pengetahuan mengenai profil berbagai obat antiaritmia serta pelaksanaan tindakan resusitasi berkualitas tinggi dapat memberikan hasil keluaran yang optimal bila terjadi krisis intraoperatif yang tidak diperkirakan sebelumnya.

This research aims to find out if computer self-efficacy, learning motivation, and accounting knowledge affect the computer anxiety of accounting students in using accounting software. The method used in this research is quantitative with data collection techniques using questionnaires and done through google form media. That will be distributed to students of Muhammdiyah University Sidoarjo. Data feasibility test using validity test and reliability test, while for testing this hypothesis using data analysis tool in the form of multiple linear regression and T test. The results of this study revealed that computer self-efficacy, learning motivation, and accounting knowledge influenced the computer anxiety of accounting students in using accounting software. Keywords - Computer Anxiety, Computer Self-efficacy, Learning Motivation, Accounting knowledge Abstrak. Penelitian kali ini memiliki tujuan untuk mengetahui apakah computer self-efficacy, motivasi belajar, dan pengetahuan akuntansi berpengaruh terhadap computer anxiety mahasiswa akuntansi dalam menggunakan software akuntansi. Metode yang digunakan dalam penelitian ini adalah kuantitatif dengan teknik pengumpulan data menggunakan kuesioner dan dilakukan melalui media google form. Yang akan dibagikan kepada Mahasiswa Universitas Muhammdiyah Sidoarjo. Uji kelayakan data menggunakan uji validitas dan uji reliabilitas, sedangkan untuk pengujian hipotesis ini menggunakan alat analisis data yang berupa regresi linier berganda dan uji T. Pada penelitian ini menggunakan pengujian hipotesis dengan bantuan aplikasi software SPSS (Statistical Product and Service Solution). Hasil dari penelitian ini mengungkapkan bahwa computer self-efficacy, motivasi belajar, dan pengetahuan akuntansi berpengaruh terhadap computer anxiety mahasiswa akuntansi dalam menggunakan software akuntansi. Kata kunci - Computer Anxiety, Computer Self-efficacy, Motivasi Belajar, Pengetahuan Akuntansi

This study aims to determine the positive and negative impacts of the application of online credit distribution based on the android mobile application as an effort to accelerate credit disbursement in the Tunaiku application. To obtain the data needed in the study, the researcher tries to obtain related data such as primary data, which is sure that the data obtained by a researcher is directly from the object. In this study, the primary data source came from the results of interviews with the Tunaiku application and the second party who was the debtor of the Tunaiku application. And secondary data, namely data obtained by a researcher indirectly from the object. In this study, the secondary data sources came from literature studies conducted by researchers. And the type of research used in this research is descriptive research with a qualitative approach. And the results of this study are the researchers found a positive impact arising from the application of online credit provision based on the Android mobile application as an effort to accelerate credit disbursement on the Tunaiku application, namely: saving time and energy, not requiring collateral for goods or other valuable documents, can be a solution for debtors who need instant funds and fast disbursement of funds, loan funds can be used for various needs, flexible ceiling amounts and tenors. And the negative impact of the application of online credit application based on the android mobile application as an effort to accelerate credit disbursement on the Tunaiku application, namely: creating a culture of debt, high interest on debt, fishing for the system to dig holes and cover holes, misuse of personal data, family or closest relatives will be disturbed.

Background/Purpose: To examine the efficacy, tolerability and safety of phototherapy in children, in whom there is currently a paucity of data. Materials and Methods: Retrospective review of children under 18 years who received narrowband UVB (NB-UVB), broadband UVB (BB-UVB) phototherapy or psoralen with UVA (PUVA) photochemotherapy between 2003 and 2017 at a tertiary Paediatric dermatology centre in Southampton, UK. Results: 100 children aged 6-17 years were included. The majority of children had psoriasis (74), atopic dermatitis (10) or vitiligo (8), with others having rarer dermatoses. Grade 2 erythema or above occurred in 46% of all included children and 42% (36/86) of those receiving NB-UVB; however, grade 3 and 4 reactions were infrequent and only 3 children stopped treatment due to burning. NB-UVB was particularly effective in those with psoriasis; 55/65 (85%) significantly improved, and 72% had not relapsed after 2 years. However, its effectiveness in atopic dermatitis was less convincing; in a small group of children, 6/10 (60%) significantly improved, but 66% relapsed within 3 months. Conclusions: Our analysis demonstrates that NB-UVB is effective in children with psoriasis and vitiligo, with potential to achieve extended periods of remission in psoriasis. Its usefulness in atopic dermatitis is less clear. The long-term safety of NB-UVB in children is still unknown, but it appears to be a well-tolerated treatment and should be considered in children for a variety of inflammatory dermatoses before progressing to immunosuppressive therapies.

Background: Syncope is one of the most common reasons for emergency department visits. The most common causes of syncope include vasovagal, orthostatic, neurogenic and cardiogenic. In some cases, history and physical examination can point towards a specific cause. While in most cases, history and physical alone are insufficient to indicate an obvious etiology. Patients with cardiogenic syncope have an increased rate of all-cause mortality as well as mortality associated with cardiovascular events. The risk of missing these serious conditions often results in low-risk patients being admitted for further workup and undergoing extensive investigation including a transthoracic echocardiogram (TTE). However, the utility of such testing including TTE in patients with a negative initial evaluation with history, physical exam and ECG is uncertain. The aim of this study was to assess the utility of TTE in the evaluation of patients admitted with syncope with an initial negative evaluation Methods: It is a retrospective study. Data was collected from all the patients admitted to the hospital for the workup of syncope from January to October 2019. Baseline characteristics including age, sex and ethnicity were collected for each patient. Data was also collected in regard to their significant cardiac past medical and family history. History of present illness and physical examination at the time of admission was noted. Patients were divided into two groups based on if the medical evaluation indicated a cardiogenic etiology. Cardiac testing data including EKG and TTE were included in the analysis. Abnormal EKG was defined by the presence of bradycardia, arrhythmia, QT prolongation, bundle branch blocks, heart blocks and left ventricular hypertrophy. Positive TTE findings were defined as low ejection fraction, significant left ventricular outflow tract obstruction, significant valvular abnormalities, wall motion abnormality and presence of pericardial effusion. Collected data were analyzed using Chi-square test and multiple linear regression. Results: The mean age of the study group was 72 years with 45% of males. Out of the total of 93 patients included in the study, 57(61%) patients had a TTE done. Out of this only 10(17%) patients had positive TTE. Only 2 patients with positive TTE had a negative EKG. In these two patients, the history was, however suspicious for cardiogenic syncope. A significant association of positive TTE findings with abnormal EKG (p-value: 0.003) was found. The odds of having a positive TTE finding when the EKG was negative was only 6%. These results remained significant with multiple linear regression analyses. Conclusions: TTE is being overutilized in the evaluation of patients presenting with syncope to rule out cardiac etiology. A thorough history and complete physical examination along with the basic cardiac testing including EKG can help reduce the overutilization

Television is one of the most widely used electronic mass media in Indonesia. This is because it is easy and inexpensive to be able to watch television broadcasts. Accompanied by the rapid development of the television industry from day to day, causing each television station to compete to present various kinds of shows. Twitter as a micro blog-based social media, is also used by the television industry for publication media, besides that it is also a mouthpiece for criticism and public advice on the programs being aired. Indonesian society with a large number is directly proportional to the number of tweets about television topics in Indonesia. This can be a difficult problem if the assessment data in the form of tweets from the community is still processed manually to produce information regarding the evaluation of television shows. To that end, the authors propose to analyze the data of tweets using an application with a naive Bayes algorithm to be able to produce information on public sentiment assessment regarding television shows. This application is designed using the Python language and PHP. The accuracy value obtained in this study is 91.67%.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are characterized by widespread skin and mucosal blistering and necrosis. The triggers and long-term sequelae in children may differ from those reported for adults. Bronchiolitis obliterans (BO) is an uncommon complication, with only 15 previously reported cases, but can lead to significant long-term morbidity, requiring lung transplantation in some cases. We report three children with nondrug-related SJS (n = 1) and TEN (n = 2) who developed BO. Two were treated with intravenous immunoglobulin therapy (2-2.4 g/kg) and all three survived. We highlight salient learning points from our cases and potential pitfalls in diagnosis of BO, including delayed onset, and we also review the literature.

ContextThe GH-2000 team proposed a method based on IGF1 and type III pro-collagen (P-III-P) to detect exogenously administered GH. As previous studies involved predominantly white European athletes, it is important to assess whether the response of these markers to recombinant human GH (rhGH) differs with ethnicity.ObjectiveTo examine the response of serum IGF1 and P-III-P and GH-2000 score to rhGH in non-Caucasian amateur athletes.DesignDouble-blind placebo-controlled rhGH administration study.SettingWellcome Trust Clinical Research Facility, Southampton General Hospital.SubjectsThe study included 31 male and 14 female amateur athletes of different ethnicities.InterventionThe subjects were assigned to treatment with placebo or 0.1 IU/kg per day (low dose) or 0.2 IU/kg per day (high dose) rhGH for 28 days. Blood was collected weekly during treatment and on days 35, 42 and 84 during the washout period. Serum IGF1 and P-III-P were measured, and GH-2000 score was calculated.ResultsIGF1, P-III-P and GH-2000 score rose in response to both low- and high-dose GH in both men and women. When compared with the Caucasian volunteers of the previous GH-2000 study, mean baseline and placebo-treated P-III-P and GH-2000 score were lower in GH-2004 men and women. Post-GH, however, peak IGF1 or P-III-P did not differ between studies but the peak GH-2000 score was lower in GH-2004 men. There was no difference between studies in the maximal change in IGF1, P-III-P and GH-2000 score in response to GH in either gender.ConclusionsThese data do not support a significant ethnic effect on the peak or maximal response to rhGH.

A 46 year old man developed a well defined area of erythema and blistering on his right upper arm …