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Falconnier-Williams OC, Taeschner W, Hille A, Falconnier AD, Haefeli WE. Untapped options to reduce waste from blister packaging for tablets and capsules. Eur J Clin Pharmacol 2024; 80:151-161. [PMID: 37978998 PMCID: PMC10781798 DOI: 10.1007/s00228-023-03594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE In Europe, most medicines are taken orally and primarily packaged as single solid oral dosage forms (SODF) in blister chambers (alveoli) arranged on blister cards. Blister cards are constructed as multilayer laminates of aluminum (Al) foils and/or various plastic polymers bonded together, forming the alveoli, which are separated by more or less large gaps. We calculated the amount of packaging material (and thus waste) generated annually for the packaging of the most commonly prescribed SODF in Germany and estimated how much waste could be saved by rearranging the alveoli. METHODS For this purpose, we analysed the SODF of the 50 most frequently prescribed medicines that were packaged in alveoli (N = 45; 13 of aluminum-aluminum blisters, 32 of mixed materials), measured and weighed their packaging material and content, calculated the annual amount of waste produced from them, and estimated how much waste could be saved if the alveoli were optimally positioned on the blister cards. In addition, we examined the variability of the blister packaging of eight groups of commonly prescribed generics of the same strength. RESULTS Detailed analysis of the blister cards revealed that most of the material (69%) was used for the space between blisters and that aluminum-aluminum alveoli were more than four times larger than the packaged SODF. The (conservatively) estimated annual amount of composite waste generated for the primary packaging of these SODF was 3868 t (and extrapolated to the entire German pharmaceutical market 8533 t), of which an optimized arrangement of the blister chambers, i.e., a 2-mm sealing area around each alveolus and the arrangement of the SODF in 2 rows, would save approximately 37%. CONCLUSION Considering that other ecological strategies are not yet mature, the optimal arrangement of blister chambers would be a captivatingly simple and, above all, immediately implementable strategy to avoid large amounts of avoidable waste.
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Affiliation(s)
- Olivia C Falconnier-Williams
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Andreas Hille
- Drossapharm AG, Pharmaceuticals, Birsweg 1, 4144, Arlesheim, Switzerland
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Chávez Dávila YN, Pinos León VH, Tello Astudillo S, Loza Erazo GM, Granizo Rubio JD. Extranodal NK/T-Cell Lymphoma, Nasal Type, Extranasal and Ulcerative Blister Variant, Case Report. Ann Dermatol 2023; 35:S304-S309. [PMID: 38061727 PMCID: PMC10727907 DOI: 10.5021/ad.21.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/23/2022] [Accepted: 01/12/2023] [Indexed: 12/20/2023] Open
Abstract
The extranodal natural killer (NK) T-cell lymphoma of nasal type is a form of lymphoma that falls within the WHO/EORTC 2018 classification of cutaneous T-cell lymphomas. It is characterized for being aggressive, infrequent, and destroying midline facial structures; however, it can also be in primary or secondary form at extranasal sites, such as the skin or the gastrointestinal tract, among others. We report the case of an 18-year-old patient with an extranodal NK/T-cell lymphoma located in an extranasal site. The clinical presentation is characterized for being multifocal and with erythematous-violaceous plaques that progress to hemorrhagic blisters and necrotic ulcers. Although this type of lymphoma has been reported previously by others, the presence of blisters is an atypical finding, which we believe has been described only in one case in the medical literature.
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He J, Shen J, Guo W. An unusual case of linear IgA disease affecting only the oral gingiva: a case report. BMC Oral Health 2023; 23:541. [PMID: 37543641 PMCID: PMC10403837 DOI: 10.1186/s12903-023-03250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/21/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND We present a case report on desquamative gingivitis diagnosed as linear IgA disease (LAD), which is a rare autoimmune bullous disease exclusively affecting the oral gingiva. The oral mucosa can be impacted by various autoimmune bullous diseases, and our report focuses on this particular manifestation of LAD. CASE PRESENTATION This patient presented with atypical symptoms, as frequent blister formation on the gingiva was the primary clinical manifestation. A combination of systemic and local treatment was administered to the patient. Following the treatment, there was a significant improvement observed in both the erythema and the bullous lesions on the gingiva. CONCLUSIONS A more suitable local treatment strategy should be formulated for patients presenting with oral topical lesions, which clinicians can employ effectively.
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Affiliation(s)
- Jianing He
- Department of VIP Service Center, Stomatological Hospital, Southern Medical University, 366# Southern Jiangnan Road, Guangzhou, 510280, Guangdong, China
| | - Jun Shen
- Department of VIP Service Center, Stomatological Hospital, Southern Medical University, 366# Southern Jiangnan Road, Guangzhou, 510280, Guangdong, China.
| | - Wei Guo
- Department of Oral Pathology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, China
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Zúnica-García S, Moya-Cuenca C, Gracia-Sánchez A, García-Cremades S, Chicharro-Luna E. Influence of blistering lesions on foot functionality in hikers. J Tissue Viability 2023; 32:395-400. [PMID: 37258334 DOI: 10.1016/j.jtv.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters. MATERIAL AND METHODS This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language. RESULTS Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007). CONCLUSION The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.
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Affiliation(s)
- Sara Zúnica-García
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Coral Moya-Cuenca
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Alba Gracia-Sánchez
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | | | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
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Teimouri M, Lalehzar SS. Evaluation of the therapeutic effect of dressing containing Silver (Ag coat) in the process of healing skin blisters caused by limb fractures: a clinical trial study. BMC Surg 2023; 23:101. [PMID: 37118690 PMCID: PMC10148518 DOI: 10.1186/s12893-023-02012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The main activity of the skin is to create a protective barrier against damage. Loss of the skin due to injury or disease and failure to regenerate the affected area may result in disability, infection, or even death. We conducted a clinical trial to evaluate the therapeutic effect of dressing containing silver in process of healing skin blisters caused by limb fractures. METHOD This is a pioneering randomized trial that compares the effectiveness of two dressings containing silver (Ag coat) and Gaz Vaseline among patients with skin blisters due to bone fractures who were randomly selected from patients referred to the Kashani Medical Training Center. There were two treatment groups containing 16 patients treated with Ag coat and 15 patients treated with Gaz Vaseline. Pictures were taken of blisters on days 0, 7, and 14 to evaluate the healing process. The amount of pain, duration of the visit (measured by minutes), and general condition of the wound were checked. The amount of pain, duration of visit (measured by minutes) and general condition of the wound was checked. All continuous and categorical data are presented as mean ± standard deviation (SD) and frequency (percentage), respectively. Paired sample T-test and repeated measure analysis of variance (ANOVA), Chi-squared test was used. All pictures were analyzed by Mosaic soft ward. RESULT During this study, there was no significant difference between the mean of age and BMI and frequency of gender in the two study groups (P > 0.05). There was a significant difference in mean between the duration of the visit, number of dressings, and net cost of dressing [Formula: see text]. In the macroscopic study and analysis for evaluation and comparing wound area with the Mosaic soft ward, there was significant relation in time (p1 = 0.00). There is no significant difference between the groups (p2 = 0.84). There was a significant difference between time and group (p3 = 0.00). On day 14 the wound area between groups had a significant difference (p4 = 0.00) (Table 3). In the VAS score there was a significant difference in time, and group (p1,2 = 0.00), there was no significant relation between time and group (p3 = 0.62). On all days the wound area between groups had a significant difference (p4 = 0.00). CONCLUSION In conclusion, Ag coat dressing, not only has a significant effect on wound healing but also, decreases pain, shorter visit time, and its more cost-effective.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Sadat Lalehzar
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Bizikova P, Olivry T, Linder K, Rybnicek J. Spontaneous autoimmune subepidermal blistering diseases in animals: a comprehensive review. BMC Vet Res 2023; 19:55. [PMID: 36849885 PMCID: PMC9969658 DOI: 10.1186/s12917-023-03597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
Autoimmune subepidermal blistering diseases (AISBDs) are rare skin disorders of animals that were first identified in dogs but several AISBDs are now recognised in other companion animal species. Most AISBDs in animals are homologues of the human diseases and are thought to share similar pathomechanisms of epidermal and/or mucosal blister formation caused by autoantibodies targeting structural proteins of the basement membrane zone (BMZ). Disruption of their structural function by the autoantibodies and/or recruited inflammation leads to BMZ fragility, which presents clinically as vesicles, bullae and, later, deep erosions and ulcers. Canine AISBDs are the best characterised, particularly the more common variants such as mucous membrane pemphigoid (48%), epidermolysis bullosa acquisita (EBA) (26%), and bullous pemphigoid (10%). Exceedingly rare AISBDs in the dog are junctional EBA, mixed AISBD, type-1 bullous systemic lupus erythematosus, linear IgA dermatosis, and pemphigus gestationis. The diagnosis of a specific AISBD is made by combining the clinical features (breed, age, lesion distribution) with histological evidence of subepithelial clefting, but not all AISBDs can be differentiated in this manner and specialised immunological testing is required. This latter, unfortunately, is not readily available and, therefore, the specific AISBD diagnosis often remains unconfirmed. While this limits further understanding of these diseases, it does not prevent clinicians from treating their patients, as the treatment approaches are similar for the different AISBDs in dogs. This review primarily focuses on canine AISBDs, the species for which these diseases have been best characterised, and shorter descriptions of variants in other species are also provided.
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Affiliation(s)
- Petra Bizikova
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Thierry Olivry
- grid.40803.3f0000 0001 2173 6074Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - Keith Linder
- grid.40803.3f0000 0001 2173 6074Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Jan Rybnicek
- Veterinary Dermatology and Dermatopathology Service, Padochov 175, 66491 Ivancice, Czech Republic
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Koh XQ, Tan KB, Schmidt E, Zillikens D, Chandran NS. Case Report of a Novel Association between Anti-p200 Pemphigoid and Acquired Haemophilia A. Ann Dermatol 2023; 35:61-65. [PMID: 36750460 PMCID: PMC9905869 DOI: 10.5021/ad.20.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 01/31/2023] Open
Abstract
Anti-p200 pemphigoid is an uncommon subepidermal autoimmune bullous disease that, unlike many other autoimmune bullous diseases, has not previously been associated with hematological diseases. The diagnosis of anti-p200 pemphigoid in a patient with congruent clinical features requires the demonstration of subepidermal blistering, with linear deposition of immunoglobulin (Ig) G and/or C3 at the dermoepidermal junction on direct immunofluorescence, and a floor-binding pattern on indirect immunofluorescence. In addition, the detection of antibodies against p200 antigen via immunoblotting is ideal but not readily accessible in many facilities, leading to a potential under-recognition and under-diagnosis of this condition. In this case report, we describe a 53-year-old gentleman with recently diagnosed acquired hemophilia A who developed a concurrent vesiculobullous eruption and was evaluated to have anti-p200 pemphigoid. Both of his conditions were controlled with immunosuppression via prednisolone and cyclophosphamide. While we acknowledge the contemporaneous occurrence of both diseases in this patient may be a mere coincidence, it is important to recognize the possibility of this association given the potential clinical significance. Whether the activity of one disease parallels the other will require further evaluation.
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Affiliation(s)
- Xuan Qi Koh
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - Kong Bing Tan
- Department of Pathology, National University Hospital, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Enno Schmidt
- Department of Dermatology and Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Hübner S, Sarhan M, Schauer F. Use of Complementary and Alternative Medicine in Patients with Autoimmune Bullous Dermatoses: A Cohort Study Analysis of a Rare Disease Group. Complement Med Res 2023; 30:221-229. [PMID: 36646063 DOI: 10.1159/000529142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Autoimmune bullous diseases (AIBD) are a heterogeneous group of rare autoantibody-mediated blistering dermatoses of the skin and/or mucous membranes. Their incidence is around 20 new cases per million inhabitants per year in Germany. Patients with chronic, oncological, or rare diseases often urge for a holistic therapeutic approach that includes complementary and alternative medicine (CAM). So far, only few contradictory reports on CAM in pemphigoid or pemphigus disease exist. The purpose of this study was to determine the frequency, motives, and satisfaction with the use of alternative treatments in patients with AIBD and to provide a basis for further investigation. METHODS We used a structured online questionnaire, consisting of 20 questions to survey patients with AIBD and their relatives. The German pemphigus and pemphigoid self-help groups were responsible for distributing anonymized questionnaires. In total, we recovered 97 questionnaires, 63 of which met full inclusion criteria (24 males and 39 females). RESULTS Of the included participants, more than half had a currently active disease. Of all patients, 58.7% stated that they had used CAM at least once. Women were more likely to use CAM, whereas age and education showed no association to CAM use. The main motives for using CAM were "doing something for oneself" and "opportunity to contribute to treatment" (38.1% each). The internet (23.8%) was the most common source of information, and vitamins were the most frequently used therapy (49.2%). CONCLUSION Our results provide new insights into the demand for CAM within this rare disease patient group. Physicians should be aware of these methods to meet patient needs but also be able to identify potential barriers such as risks and interactions.
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Affiliation(s)
- Stefanie Hübner
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Maysa Sarhan
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center - University Freiburg, Faculty of Medicine, Freiburg, Germany
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Fallahi M, Jamee M, Enayat J, Abdollahimajd F, Mesdaghi M, Khoddami M, Segarra-Roca A, Frohne A, Dmytrus J, Keramatipour M, Mansouri M, Eslamian G, Fallah S, Boztug K, Chavoshzadeh Z. Novel PGM3 mutation in two siblings with combined immunodeficiency and childhood bullous pemphigoid: a case report and review of the literature. Allergy Asthma Clin Immunol 2022; 18:111. [PMID: 36566211 PMCID: PMC9789581 DOI: 10.1186/s13223-022-00749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Bullous pemphigoid is the most common autoimmune subepidermal blistering disorder with a low incidence in childhood. Combined immunodeficiencies (CIDs) are a group of monogenic inborn errors of immunity (IEIs) characterized by T- and B-cell dysfunction leading to recurrent infections, lymphoproliferation, predisposition to malignancy, and autoimmunity. Here, we report two Afghan siblings with a diagnosis of CID and extremely rare manifestation of diffuse bullous pemphigoid skin lesions. CASE PRESENTATION The older sibling (patient 1) was a 32-month-old male with facial dysmorphism, protracted diarrhea, failure to thrive, recurrent oral candidiasis, recurrent otitis media with tympanic membrane perforation, who had been previously diagnosed with CID. While he was under treatment with intravenous immunoglobulin (IVIg), he developed extensive blistering lesions, which were diagnosed as childhood bullous pemphigoid. Methylprednisolone and azathioprine were added to the regimen, which resulted in a remarkable improvement of the skin lesions and also the feeding condition. However,2 weeks later, he was re-admitted to the intensive care unit (ICU) and eventually died due to fulminant sepsis. Later, his 12-month-old sister (patient 2) with similar facial dysmorphism and a history of developmental delay, food allergy, recurrent oral candidiasis, and respiratory tract infections also developed blistering skin lesions. She was under treatment for occasional eczematous lesions, and had been receiving IVIg for 3 months due to low levels of immunoglobulins. Further immunologic workup showed an underlying CID and thus treatment with IVIg continued, gradually improving her clinical condition. The genetic study of both siblings revealed a novel homozygous mutation in exon 7 of the PGM3 gene, c.845 T > C (p.Val282Ala). CONCLUSIONS Dermatologic disorders may be the presenting sign in patients with CID and mutated PGM3. This case report further extends the spectrum of skin manifestations that could be observed in PGM3 deficiency and emphasizes the importance of considering CIDs during the assessment of skin disorders, particularly if they are extensive, recurrent, refractory to treatment, and/or associated with other signs of IEIs.
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Affiliation(s)
- Mazdak Fallahi
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Mahnaz Jamee
- grid.411600.2Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Javad Enayat
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Fahimeh Abdollahimajd
- grid.411600.2Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Clinical Research Development Unit of Shohada-E Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Mesdaghi
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Maliheh Khoddami
- grid.411600.2Pediatric Pathology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anna Segarra-Roca
- grid.511293.d0000 0004 6104 8403Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria ,grid.416346.2St. Anna Children’s Cancer Research Institute (CCRI), Vienna, Austria
| | - Alexandra Frohne
- grid.511293.d0000 0004 6104 8403Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria ,grid.416346.2St. Anna Children’s Cancer Research Institute (CCRI), Vienna, Austria
| | - Jasmin Dmytrus
- grid.511293.d0000 0004 6104 8403Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria ,grid.416346.2St. Anna Children’s Cancer Research Institute (CCRI), Vienna, Austria
| | - Mohammad Keramatipour
- grid.411705.60000 0001 0166 0922Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mansouri
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Golnaz Eslamian
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Shahrzad Fallah
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
| | - Kaan Boztug
- grid.511293.d0000 0004 6104 8403Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria ,grid.411705.60000 0001 0166 0922Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,grid.418729.10000 0004 0392 6802CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria ,grid.22937.3d0000 0000 9259 8492St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Zahra Chavoshzadeh
- grid.411600.2Immunology and Allergy Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 15514-15468 Iran
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Chen YC, Tsai YC. Dry dechlorination of solid-derived fuels obtained from food waste and polyvinyl chloride. Sci Total Environ 2022; 841:156745. [PMID: 35716746 DOI: 10.1016/j.scitotenv.2022.156745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/04/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
Solid-recovered fuels (SRFs) with low chlorine (Cl) contents are urgently needed, particularly considering the limited availability of energy resources globally. Two main sources of chlorinated pollution in municipal solid wastes, namely food waste and polyvinyl chloride (PVC), were used as raw materials for SRF production. These materials were dechlorinated using alkaline adsorbents (calcium hydroxide (Ca(OH)2) and sodium bicarbonate (NaHCO3)), yielding five sample SRFs. The SRFs had low heating values (LHVs) of 14.10-15.12 MJ/kg. The alkaline adsorbents were introduced during dry dechlorination, which increased the LHVs by 8.4 MJ/g. Approximately 50 % of the total Cl content was transformed into the liquid and gaseous phases after incineration of the SRF. The PVC content was increased to increase the amount of gaseous Cl produced. Conversely, the yields of liquid and solid Cl increased when the FW content was increased. Among alkaline adsorbents, Ca(OH)2 exhibited better adsorption performance than NaHCO3. Upon mixing ~15 wt% of Ca(OH)2 with the SRFs, the highest Cl removal efficiency (77 %) in the gaseous phase was achieved. Over 90 % of the total Cl content was converted into solid-phase calcium chloride and sodium chloride by the alkaline adsorbents. The total cost of the SRF was US$85.48/t, of which labor and electricity costs accounted for 50 % and 25 %, respectively.
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Affiliation(s)
- Ying-Chu Chen
- Department of Civil Engineering, National Taipei University of Technology, Taipei City 106, Taiwan.
| | - Yi-Chen Tsai
- Master of Science, Institute of Environmental Engineering and Management, National Taipei University of Technology, Taipei City 106, Taiwan
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11
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Satici MO, İslam MM, Aksel G, Eroglu SE. Trauma-related oral lesions; Angina bullosa haemorrhagica: a rare case presentation. Malawi Med J 2022; 34:204-205. [PMID: 36406096 PMCID: PMC9641610 DOI: 10.4314/mmj.v34i3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Angina bullosa haemorrhgica is a relatively uncommon condition characterized by blood-filled subepithelial lesions in the oral mucosa that is idiopathic and not caused by a systemic disease or a hemostatic abnormality. Middle-aged and elderly patients are usually affected and lesions heal spontaneously without scarring. A rapidly expanding hemorrhagic blister in the oropharynx can induce upper airway obstruction, so recognizing the lesion as soon as possible is essential. Because of its rarity, we wanted to highlight a 42-year-old male patient who presented with hemorrhagic bullae associated with insignificant local trauma in the oral mucosa and to emphasize that Angina bullosa haemorrhagica is a rare but recognizable lesion that clinicians should be aware of.
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Zarei B, Tavanaee Sani A, Elyasi S. Skin ulcers as a complication of short-term use of phenazopyridine in an old man: A case report. J Infect Chemother 2022:S1341-321X(22)00231-8. [PMID: 35963601 DOI: 10.1016/j.jiac.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Phenazopyridine is an azo dye, which exerts local anesthetic or analgesic action on urinary tract mucosa through an unknown mechanism. Besides its common complications including orange discoloration of the urine and gastrointestinal problems, it may have rare side effects like hemolytic anaemia, methemoglobinemia, renal failure, and skin changes. We reported a paraplegic man with skin ulcers on scretom and right foot after about 3 days of phenazopyridine use CASE REPORT: A 62-year-old man presented with flesh shaped deep ulcers in lower parts of the body. He declared that at first a bluish discoloration was developed in the lower extremities and scrotum skin after use of eight phenazopyridine tablets (200 mg) and then these lesions turned to blisters and ulcers and they were prurient. The patient underwent sonography and CT-angiography; however, no pathologic findings were found. He just received losartan for many years as past drug history. According to the history, a delayed drug hypersensitivity reaction was suspected and the patient wounds healed after using special type of dressings and antibiotic therapy regarding positive wound cultures. CONCLUSION Phenazopyridine severe skin changes are hardly reported. We described a case who experienced severe skin reactions and ulcers following phenazopyridine use not related to other complications including renal dysfunction, methemoglobinemia, and hemolytic anemia.
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Namazi P, Fatemi MJ, Pahlevanpour P, Abbastabar H, Naderi Gharahgheshlagh S. Comparative Effects of Recove® and Nitrofurazone 0.2% on the Treatment of First and Second-Degree Burns: a Double-Blind Randomized Clinical Trial. World J Plast Surg 2022; 11:55-62. [PMID: 36694677 DOI: 10.52547/wjps.11.3.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background Burns are among the major health challenges of all societies and more than any other trauma incur physical, mental, social, and economic burdens on the patient and society. This study was conducted to assess whether Recove® burn ointment is capable of alleviating the pain, preventing the formation of new blisters and controlling the microbial contamination of the wound. Methods We, therefore, compared its efficacy to nitrofurazone 0.2% cream. This randomized clinical trial was conducted on individuals who had two burn injuries in their body at the same time in the Motahari Burn Hospital, Tehran Province, from June to October 2016. Sampling was carried out with a non-random method using available samples. The intervention in experimental and control groups was Recove® and nitrofurazone, respectively. The effect of interventions on pain relief, the formation of new blisters and prevention of infection at the burn wound were evaluated. In our double-blind study, blindness was applied to the patients and the person evaluating the outcomes. Results Both Recove® and nitrofurazone interventions significantly alleviated pain (P < 0.01), but Recove ®showed more effectiveness (P=0.01). Similarly, in terms of new blister formation, the experimental group receiving Recove® showed less new blister formation over 24 hours after treatment compared to nitrofurazone group (P=0.03) and with respect to antimicrobial activity, there was no significant difference between Recove® and nitrofurazone (P=0.12). Conclusion Recove® was effective on pain reduction, prevention of new blisters formation as well as infection. Therefore, it seems that Recove® could be considered as a new and efficient treatment for burn.
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Bassani F, Rodrigues C, Marques P, Freire F. Ecodesign approach for pharmaceutical packaging based on Life Cycle Assessment. Sci Total Environ 2022; 816:151565. [PMID: 34762947 DOI: 10.1016/j.scitotenv.2021.151565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Packaging ecodesign can contribute to improve the environmental performance of pharmaceutical products. The main goal of this article is to present an ecodesign approach based on Life Cycle Assessment (LCA) for pharmaceutical packaging, assessing opportunities to improve the packaging environmental performance, and providing ecodesign recommendations to the pharmaceutical sector. The proposed ecodesign approach consists of five phases. I) The most representative packaging of medicines in the market (blister, bottle, and sachet), with different sizes, materials and weights, were investigated. II) Three ecodesign strategies were selected to analyze with LCA: i) weight and/or volume reduction, ii) alternative types of packaging, and iii) transportation with less environmental impact. III-IV) A cradle-to-gate life cycle model has been implemented, including transport to pharmacies. Alternative transportation modes (truck, train, airplane, and ship) and different packaging production locations have been considered. Thirteen environmental categories have been analyzed. V) Ecodesign recommendations for improving the environmental performance of pharmaceutical packaging are presented in two stages: i) specific recommendations based on LCA, illustrated in sheets with examples of ecodesign, quantifying the environmental impact reduction of an ecodesign solution compared to the original; and ii) generic recommendations for different packaging life cycle phases. Ecodesign recommendations highlight the use of smaller-size packaging, avoiding superfluous elements and empty spaces, which reduces material and production costs, and transportation impacts; the selection of modes of transportation with less environmental impact, considering the packaging production location; and the use of electric vehicles for pharmacy distribution. This ecodesign approach based on LCA allows quantifying environmental impacts robustly to support the incorporation of environmental information from the design, material selection, and packaging production to distribution till the final consumer. This article emphasizes the importance of developing specific packaging ecodesign based on LCA to improve environmental performance and provide more informed recommendations to stakeholders.
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Affiliation(s)
- Fabiana Bassani
- University of Coimbra, ADAI, Department of Mechanical Engineering, Coimbra, Portugal; Federal Institute of Education, Science and Technology of Pará - IFPA, Conceição do Araguaia, Brazil
| | - Carla Rodrigues
- University of Coimbra, ADAI, Department of Mechanical Engineering, Coimbra, Portugal.
| | - Pedro Marques
- University of Coimbra, ADAI, Department of Mechanical Engineering, Coimbra, Portugal
| | - Fausto Freire
- University of Coimbra, ADAI, Department of Mechanical Engineering, Coimbra, Portugal
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Byamugisha J, Adero N, Kiwanuka TS, Nalwadda CK, Ntuyo P, Namagembe I, Nabunya E, Nakirijja E, Mwadime-Ngolo R, Mukasa DC, Ononge S. The effect of blister packaging Iron and Folate on adherence to medication and hemoglobin levels among pregnant women at National Referral Hospital antenatal clinics in a low to middle income country: a Randomised Controlled Trial (The IFAd Trial). BMC Pregnancy Childbirth 2022; 22:179. [PMID: 35241006 PMCID: PMC8895867 DOI: 10.1186/s12884-022-04507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Anemia in pregnancy is an important global public health problem. It is estimated that 38% of pregnant women worldwide are anemic. In Africa, literature from observational studies show 20% of maternal deaths are attributed to anemia. In Uganda, 50% of pregnant women have iron deficiency anaemia. The proportion of pregnant women receiving Iron-Folic acid (IFA) supplementation has improved. However, the number of IFA pills consumed is still low. We carried out a randomized controlled trial to determine the effect of dispensing blister and loose packaged IFA pills on adherence measured by count on next return visit and hemoglobin levels among pregnant women at two National Referral Hospitals in Kampala, Uganda. Methods This trial was conducted between April and October 2016. Nine hundred fifty pregnant women at ≤28 weeks were randomized to either the blister (intervention arm) or loose (control arm) packaged IFA. The participants completed the baseline measurements and received 30 pills of IFA at enrolment to swallow one pill per day. We assessed adherence by pill count and measured hemoglobin at four and 8 weeks. The results were presented using both intention-to-treat and per-protocol analysis. Results There were 474 participants in the control and 478 in the intervention arms. Adherence to IFA intake was similar in the two groups at 4th week (40.6 and 39.0%, p = 0.624) and 8th week (51.9 and 46.8%, p = 0.119). The mean hemoglobin level at 4 weeks was higher in the blister than in the loose packaging arms (11.9 + 1.1 g/dl and 11.8 + 1.3 g/dl, respectively; p = 0.02), however, similar at week 8 (12.1 + 1.2 and 12.0 + 1.3, respectively; p = 0.23). However, over the 8-week period blister packaging arm had a higher change in hemoglobin level compared to loose package (blister package 0.6 ± 1.0; loose packaging 0.2 ± 1.1; difference: 0.4 g/dL (95% CI: 0.24–0.51 g/dL); p = 0.001. There were no serious adverse events. Conclusions Our results showed no effect of blister packaging on IFA adherence among pregnant women. However, our findings showed that blister packaged group had a higher hemoglobin increase compared to loose iron group. Trial registration No. PACTR201707002436264 (20 /07/ 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04507-3.
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Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Nancy Adero
- JSI Research & Training Institute Inc., Boston, USA
| | - Tusuubira S Kiwanuka
- Baylor College of Medicine COE, Kampala, Uganda.,Mengo Hospital, Kampala, Uganda
| | - Christine K Nalwadda
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Ntuyo
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Imelda Namagembe
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Evelyn Nabunya
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Emily Nakirijja
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | | | | | - Sam Ononge
- Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda
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Sinha S, Kumar A, Jameel J, Qureshi OA, Majeed A, Kumar S. The Current Consensus on the Management of Post-traumatic Blisters Among Orthopaedic Surgeons. Indian J Orthop 2022; 56:1011-1017. [PMID: 35669027 PMCID: PMC9123097 DOI: 10.1007/s43465-022-00612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/13/2022] [Indexed: 02/04/2023]
Abstract
Introduction Post-traumatic blister is often encountered in high-energy injuries and following major limb surgeries. Currently, there is very limited evidence concerning blister management resulting in a lack of comprehensive guidelines for their management. The current survey-based study aims to appraise the current consensus in post-traumatic management among the practising orthopaedic surgeons and compare the same with the evidence in the literature. Materials and Methods We conducted an online questionnaire-based survey of orthopaedic surgeons concerning post-traumatic blister management practices. The questionnaire mainly focused on antibiotic prophylaxis, local invasive procedures, antiseptics dressings and additional treatment options regarding blister management. Results A high prevalence (~ 78%) of systemic antibiotics administration was noticed for post-traumatic blister management. Similarly, large section of respondents (66.4%) advocated for either de-roofing or aspiration of blisters. Approximately 42% of respondents preferred sending blister fluid for cultures. More than half of the respondents used some form of local dressing to cover the blister bed to provide a healing environment. Additional opinions mostly included anti-inflammatory and swelling reducing measures. Few respondents also advocated for oral steroids for inflammation control. Conclusion The limited evidence available in literature could be the potential contributing factor for varying clinical practices for post-traumatic blister management. The general measures to reduce soft-tissue oedema have been supported by the literature. However, the use of systemic antibiotics and steroids has not been supported by the literature and should be avoided unless indicated due to other reasons. Further evidence is required to strengthen the recommendations for post-traumatic blister management.
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Affiliation(s)
- Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
| | - Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
| | - Owais Ahmed Qureshi
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
| | - Abdul Majeed
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Hamdard Nagar, New Delhi, 110062 India
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Ziegler B, Ofner S, Lischent J, Perndorfer J, Diem A, Laimer M, Prodinger C, Treff F. [Anesthesiological aspects in patients with epidermolysis bullosa]. Anaesthesist 2022; 71:467-474. [PMID: 35175387 DOI: 10.1007/s00101-022-01096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
Epidermolysis bullosa causes blistering due to altered structural proteins of the dermoepidermal junction, resulting in scarring and strictures of the skin and mucous membranes. Affected individuals typically require frequent surgical interventions due to burdensome symptoms and complications of the disease. The anesthesiological management of these patients is inherently challenging. This review article summarizes the relevant features of this patient cohort and provides practical recommendations for care.
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Affiliation(s)
- B Ziegler
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
| | - S Ofner
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - J Lischent
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - J Perndorfer
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - A Diem
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.,EB Haus Austria, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - M Laimer
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich.,EB Haus Austria, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - C Prodinger
- Univ. Klinik f. Dermatologie und Allergologie, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
| | - F Treff
- Univ.Klinik f. Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, LKH Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Österreich
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Abstract
Background: Clinical diagnosis of vesiculobullous disorders (VBD) is not always straightforward. It is a challenge for a dermatologist to make the right diagnosis noninvasively in a short time. Objective: To evaluate dermoscopic patterns associated with vesiculobullous disorders. Methods: A total of 230 patients, irrespective of age and gender, with a history and clinical presentation suggestive of VBD (including primarily infectious, inflammatory, genetic, antibody-mediated, mechanical, environmental, metabolic, and drug-related) were recruited into the study. Patients with secondarily infected lesions were excluded. Dermoscopic examination along with Tzanck smear/skin biopsy smear test was performed on the most representative lesions. Data were compiled and statistically analyzed using SPSS version 21.0. Results: Lesions with erythematous (vascular) and yellowish (serum) translucent background with regular margins were seen in most of the VBD studied. Chickenpox (CP) and herpes zoster (HZ) lesions evolved with the progress of their clinical stages. Follicular and eccrine openings were commonly seen, but the pigmentation around them was specific to pemphigus vulgaris. A distorted pigment network was noted in bullous pemphigoid. White rosettes (keratin blockage) were characteristic of epidermolysis bullosa, Wickham striae (orthokeratosis) of lichen planus, and crumpled fabric appearance (flaccidity) of Hailey-Hailey disease. Globules/dots (microvesicles) of different colors were also seen in various VBD. Blue/black color usually corresponded to retained melanin. Conclusion: Some dermoscopic patterns are observed consistently with certain diseases, and these can be used for their diagnosis, complementary to histopathological examination.
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Affiliation(s)
- Namita D Narkhede
- Department of Dermato-Venereo-Leprology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Balakrishna Nikham
- Department of Dermato-Venereo-Leprology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Varsha Jamale
- Department of Dermato-Venereo-Leprology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Asma Hussain
- Department of Dermato-Venereo-Leprology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Mohan Kale
- Department of Dermato-Venereo-Leprology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Park HS, Oh A, Keum CW, Lee J, Lee JK, Son BR, Shin KS, Hahn YS. A novel likely pathogenic PLCG2 variant in a patient with a recurrent skin blistering disease and B-cell lymphopenia. Eur J Med Genet 2021; 65:104387. [PMID: 34768012 DOI: 10.1016/j.ejmg.2021.104387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/15/2021] [Accepted: 11/07/2021] [Indexed: 11/03/2022]
Abstract
Pathogenic variants of PLCG2 encoding phospholipase C gamma 2 (PLCγ2) were first reported in 2012 and their clinical manifestations vary widely. PLCG2-associated antibody deficiency and immune dysregulation (PLAID) and autoinflammation and PLCγ2-associated antibody deficiency and immune dysregulation (APLAID) are representative examples of PLCG2 pathogenic variants. In this report, we describe a 17-year-old male with recurrent blistering skin lesions, B-cell lymphopenia, and asthma. Distinct from the patients in previous reports, this patient had the heterozygous de novo c.2119T > C missense variant (NM_002661.4) resulting in a serine to proline amino acid substitution (p.Ser707Pro). The variant located to the PLCγ2 C-terminal Src homology 2 (cSH2) domain, which is a critical site for the restriction of intrinsic enzyme activity. This variant could be classified as "likely pathogenic" according to American College of Medical Genetics and Genomics guidelines. Laboratory results showed a reduction in circulating B cells without a decrease of serum IgG and IgA. Our findings expand the variety of clinical phenotypes for PLCG2 missense variants.
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Affiliation(s)
- Hee Sue Park
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Laboratory Medicine, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Arum Oh
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Chang Won Keum
- Rare Genetic Disease Research Center, 3billion Inc, Seoul, Republic of Korea
| | - Jisu Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Bo Ra Son
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Laboratory Medicine, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Laboratory Medicine, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Youn-Soo Hahn
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.
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Khan NR, Elarjani T, Cajigas I, Chen S, Morcos JJ. Microsurgical Clip Trapping of Dorsal Internal Carotid Artery Blister Ruptured Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E244-E245. [PMID: 34097734 DOI: 10.1093/ons/opab196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/04/2021] [Indexed: 11/15/2022] Open
Abstract
Dorsal internal carotid artery (ICA) blister aneurysms are an uncommon aneurysm variant constituting 0.3% to 1% of intracranial aneurysms and can be due to ulceration, atherosclerosis, or dissection.1-3 Despite its rarity, it carries a high risk of rupture with an estimation of 0.9% to 6.5% among intracranial aneurysms.1,2 Blister aneurysms are small in size, have no distinguishable neck, and have a friable wall that can easily rupture if manipulated, hence the difficulty in its treatment utilizing both microsurgical and endovascular techniques.1,2,4-6 Endovascular coiling of these lesions may not be adequate due to the broad-based size; stenting requires the use of antiplatelet medications, which could lead to rebleeding; flow diversion takes longer to exert its treatment effect.1,4 Conversely, microsurgical management carries a higher intraoperative rupture rate.2 Microsurgical options include clipping, clip reconstruction, trapping with bypass, and wrapping.4,7 We present a case of a 38-yr-old man who presented with a ruptured right dorsal ICA blister aneurysm treated with microsurgical trapping with intraoperative flow measurements. We demonstrate how the use of quantitative intraoperative flow measurements allows confident sacrifice of the supraclinoid ICA. We also demonstrate in contrast another case example of utilizing a clip-graft repair. The patient remained unchanged with an intact neurological exam, and postoperative imaging showed no aneurysm remnant and patent anterior choroidal artery. We review the literature and management of dorsal ICA aneurysms.8-15 We also review the technical nuances and different endovascular and microsurgical treatments that can be used for this condition. The patient gave informed consent for the procedure and verbal consent to the publication.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ian Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie Chen
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques J Morcos
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Guo J, Gao Z, Wang L, Feng C, Hou Z, Zhang Y. The blister occurring in severe tibial plateau fractures (Schatzker V-VI) decreases the risk of acute compartment syndrome. Int Orthop 2021; 45:743-9. [PMID: 33420553 DOI: 10.1007/s00264-020-04925-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Severe tibial plateau fractures may result in acute compartment syndrome (ACS) of the leg, which is always considered to be an orthopaedic emergency. Blistering is not an uncommon sign and may be related to decreased compartment pressure. No experiments on the risk of ACS based on the presence of blisters after tibial plateau fractures have been conducted, and controversies about the high rate of ACS in patients with tibial plateau fractures still exist. QUESTIONS/PURPOSES This research retrospectively followed the bicondylar tibial plateau fractures treated with locking plates and verified if the risk of ACS was decreased after a blister was observed. METHODS A total of 100 patients with closed tibial fractures (63 men and 37 women) were included and divided into with blister (group A, 40) and without blister groups (group B, 60). The creatine kinase (CK), BUN, and chloride levels were recorded on the first day after hospitalization. The hospitalization costs and injury to operation time were collected in the two groups. The Lysholm knee score and a visual analogue scale (VAS) for pain were used to assess the rehabilitation after follow-up. Clinical and serological results of ACS in the two groups were compared. RESULTS There was significant delay in the time from injury to operation (11.0 ± 3.5 VS 7.6 ± 7.2, Z = - 3.771, P < 0.001) in the with blister (group A) and without blister groups (group B). The levels of chloride and BUN were significantly lower in the with blister group than in the without blister group (102.7 ± 3.0 VS 104.7 ± 2.57 mg/dL, Z = - 3.33, P = 0.001) (10.3 ± 2.5 VS 10.3 ± 2.8 mg/dL, Z = - 2.366, P = 0.018). There were no significant differences in the CK levels in the with blister and without blister groups (285.8 ± 202.6 VS 408.4 ± 633.6 U/L, Z = - 1.379, P = 0.168), but a trend of decreasing to normal was obvious in patients with blisters. There were no significant differences in the Lysholm knee score (40 VS 60, 80 ± 4.9 VS 79.8 ± 3.0, Z = - 0.872, P = 0.383), or the VAS (40 VS 60, 1.6 ± 0.7 VS 2.2 ± 1.3, Z = - 1.568, P = 0.117) for pain compared with patients without blisters. CONCLUSION In conclusion, the presence of blisters in patients with severe tibial plateau fractures decreases the pressure in the compartment. There was a significant improvement in serological results after blisters appeared, which may be related to the reason for the decreased pressure decreased, and conservative management is recommended for these patients.
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Carrascosa J, Morillas V, Bielsa I, Munera-Campos M. Cutaneous Manifestations in the Context of SARS-CoV-2 Infection (COVID-19). Actas Dermosifiliogr (Engl Ed) 2020; 111:734-742. [PMID: 32882184 PMCID: PMC7458046 DOI: 10.1016/j.ad.2020.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/28/2020] [Accepted: 08/22/2020] [Indexed: 01/22/2023] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus2 (SARS-CoV-2), has had enormous health, economic, and social consequences. The clinical spectrum of cutaneous manifestations observed in patients with COVID-19 is both heterogeneous and complex. To date, reports have identified 5main categories: acral lesions, vesicular rashes, urticarial rashes, maculopapular rashes, and livedoid and necrotic lesions. However, these will probably be modified as new information comes to light. Cutaneous manifestations associated with COVID-19 probably reflect the activation of pathogenic pathways by the virus or a response to inflammatory processes, vascular or systemic complications, or even treatments. Familiarity with the cutaneous manifestations of COVID-19 may enable early diagnosis or help guide prognosis.
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Carrascosa JM, Morillas V, Bielsa I, Munera-Campos M. Cutaneous Manifestations in the Context of SARS-CoV-2 Infection (COVID-19). Actas Dermosifiliogr 2020. [PMID: 34012157 PMCID: PMC7560260 DOI: 10.1016/j.adengl.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had enormous health, economic, and social consequences. The clinical spectrum of cutaneous manifestations observed in patients with COVID-19 is both heterogeneous and complex. To date, reports have identified 5 main categories: acral lesions, vesicular rashes, urticarial rashes, maculopapular rashes, and livedoid and necrotic lesions. However, these will probably be modified as new information comes to light. Cutaneous manifestations associated with COVID-19 probably reflect the activation of pathogenic pathways by the virus or a response to inflammatory processes, vascular or systemic complications, or even treatments. Familiarity with the cutaneous manifestations of COVID-19 may enable early diagnosis or help guide prognosis.
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Affiliation(s)
- J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - V Morillas
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - I Bielsa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - M Munera-Campos
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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Keshavarzi A, Mohammadi AA, Ayaz M, Javanmardi F, Hoghoughi MA, Shirazi Yeganeh B, Emami A, Mackie M, Akrami R, Iranpak S. Cutaneous Vesicular of COVID-19 in Two Burn Patients. World J Plast Surg 2020; 9:331-338. [PMID: 33330012 PMCID: PMC7734937 DOI: 10.29252/wjps.9.3.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
Despite the whole world's effort for controlling an ongoing global outbreak caused by new corona virus; it is still a major public health issue. Any hospitalized patient or outpatient in burn departments should be considered as a potential infectious source of COVID-19, which may cause an overwhelming of disease. However, there are no previous experiences about COVID-19 in burn patients all over the world, and here we reported two burn cases at Amir-al-Momenin Burn Hospital Affiliated to Shiraz University of Medical Sciences, Shiraz, Iran with skin manifestations, which were detected as a rarely COVID-19 symptom. A 13-year-old girl [total body surface area (TBSA): 18%] and a 37-year-old woman (TBSA: 30%) who had burn injuries by gas explosion and car accident, respectively were enrolled. After admission, some vesicular injuries were visible in burn area. To confirm, skin biopsy specimens were either sent for histopathology examination or for real time polymerase chain reaction (PCR) as follow: Herpes Simplex Virus (HSV), chicken pox, and potassium hydroxide (KOH) for fungal infections. All test results were negative. Although they had no symptoms of COVID-19, two swabs from nasopharyngeal and oropharyngeal samplings were taken, the result was negative either. Specimens were obtained from vesicular lesions for qRT-PCR assay of COVID-19. According to the molecular results for vesicular samples, all the results were positive for COVID-19. Unlike all other COVID-19 patients who have respiratory symptoms, SARS-COV-2 appeared by cutaneous vesicular and blisters in two burn cases.
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Affiliation(s)
- Abdolkhalegh Keshavarzi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Plastic and Reconstructive Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ayaz
- Division of Burn and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Javanmardi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Hoghoughi
- Department of Plastic and Reconstructive Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amir Emami
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Microbiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mandana Mackie
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahimeh Akrami
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sorayya Iranpak
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Lee S, Rastogi S, Hsu DY, Nardone B, Silverberg JI. Association of bullous pemphigoid and comorbid health conditions: a case-control study. Arch Dermatol Res 2020; 313:327-332. [PMID: 32647978 DOI: 10.1007/s00403-020-02100-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bullous pemphigoid is an autoimmune skin disease characterized by the formation of blisters between the epidermis and dermis. Comorbidities of pemphigoid have not been well-described. Identification of comorbidities associated with pemphigoid is important to decrease morbidity and mortality. OBJECTIVE To identify the comorbid health conditions of bullous pemphigoid. METHODS This was a case-control study of 91 cases of pemphigoid verified by clinical and laboratory diagnosis and 546 age- and sex-matched controls with complete follow-up at a large metropolitan quaternary care medical center. RESULTS The average age of bullous pemphigoid patients was 76 years and 53% of patients were female. Forty-eight (53%) of the BP patients had a history of inpatient hospitalization, of which 22 (24.2%) were hospitalized for either previously undiagnosed BP or an exacerbation of BP. Bullous pemphigoid was significantly associated with hypertension [adjusted odds ratio (95% confidence interval)]: [2.03 (1.24-3.32)], diabetes mellitus [2.59 (1.60-4.19)], chronic kidney disease [2.29 (1.19-4.40)], end-stage renal disease [3.82 (1.48-9.85)], basal cell carcinoma of the skin [6.00 (1.94-18.6)], and obstructive sleep apnea [5.23 (2.45-11.19)]. 78% of BP patients used at least one systemic immunosuppressant. There was no significant association between treatments for pemphigoid and any of the comorbidities. CONCLUSIONS Bullous pemphigoid patients need screening for comorbid health conditions even though treatment options do not seem to be associated with these comorbidities.
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Affiliation(s)
- Sherry Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Supriya Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Derek Y Hsu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Suite 1600, 676 N Saint Clair Street, Chicago, IL, 60611, USA. .,Department of Dermatology, George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
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26
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Mellerio JE, El Hachem M, Bellon N, Zambruno G, Buckova H, Autrata R, Salavastru C, Caldaro T, Greco C, Has C, Bodemer C. Emergency management in epidermolysis bullosa: consensus clinical recommendations from the European reference network for rare skin diseases. Orphanet J Rare Dis 2020; 15:142. [PMID: 32505191 DOI: 10.1186/s13023-020-01403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Epidermolysis bullosa (EB) comprises a group of genetic disorders with the hallmark of fragility of the skin and mucosal surfaces. The severity of different types of EB varies markedly as does the occurrence of extra-cutaneous involvement and complications. A number of emergency situations may occur in the context of EB including obstruction to oral intake from oral or esophageal blisters or scarring, acute airway obstruction, acute urinary retention, sepsis and corneal erosions. Whilst general management principles apply in each of these settings, specific considerations are essential in managing EB to avoid undue trauma or damage to delicate tissues. These recommendations have been developed from a literature review and consensus from experts of the European Network for Rare Skin Disorders (ERN-Skin) to aid decision-making and optimize clinical care by non-EB expert health professionals encountering emergency situations in babies, children and adults with EB.
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Chicharro-Luna E, Martínez-Nova A, Ortega-Ávila AB, Requena-Martínez A, Gijón-Noguerón G. Prevalence and risk factors associated with the formation of dermal lesions on the foot during hiking. J Tissue Viability 2020; 29:218-23. [PMID: 32371147 DOI: 10.1016/j.jtv.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/02/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study is to assess the prevalence of blisters on the foot during hiking and the factors associated with this condition. MATERIAL AND METHODS A cross-sectional observational comparative study was conducted of 315 patients treated at two hostels, located on the Way of Saint James, in northern Spain. The study participants were interviewed and clinically examined to obtain sociodemographic and clinical variables. The variables recorded concerned the type of terrain covered (asphalt or dirt trails), the weight carried (backpack), the footwear used (weight, type, impermeability), the type of socks worn and the hydration of the skin obtained. The inclusion criteria were at least 18 years and to walk at least 20 km in the last five days. RESULTS 74% (n = 233) of the hikers presented a bullous lesion on the foot after completing several stages of hiking. The most frequent locations were the first or second metatarsal head and the fifth toe. Logistic regression showed that risk factors for the appearance of blistering were the number of kilometres walked on asphalt (p = .001 [95% CI (1.019-1.064)]) and having wet socks at the end of the day (p = . 006 [95% CI (1.286-4.479)]). The protective factors identified were walking on a dirt, grass or gravel surface (p < .001 [95% CI (0.982- 0.995)]) and using customised plantar orthoses (p = .001 [95% CI (0.085) - 0.512)]). CONCLUSIONS The type of terrain is a determining factor in the appearance of blisters. Walking on a dirt trail reduces the risk. Using custom made insoles and controlling humidity are other factors that should be considered as preventive measures.
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Lalor LE, Chiu YE. Rare Vesiculopustular Eruptions of the Neonatal Period. Clin Perinatol 2020; 47:53-75. [PMID: 32000929 DOI: 10.1016/j.clp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
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Affiliation(s)
- Leah E Lalor
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Yvonne E Chiu
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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29
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Aljehani Y, Almutairi M, Alreshaid F, El-Bawab H. Lung carcinoma within a lung bulla wall: literature review and case report. Asian Cardiovasc Thorac Ann 2019; 28:39-44. [PMID: 31840525 DOI: 10.1177/0218492319896514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary emphysema is a common pulmonary disease encountered in daily medical practice. Its management follows specific guidelines but lacks standardized screening for the development of lung cancer. The precancerous theory of emphysematous bulla/cyst is not well described in the literature, with only a few reports of malignancy within an emphysematous bulla wall. We report the case of a 46-year-old man with productive cough and hemoptysis. A chest radiograph showed multiple irregular radiolucencies in both lung apices. Computed tomography revealed bilateral emphysema with a left apical emphysematous bulla that showed a thickened wall and accumulation of fluid within the bullous cavity. Due to life-threatening hemoptysis, a left upper lobectomy and mediastinal lymph node sampling were performed. The pathology report showed pleomorphic carcinoma within the emphysematous cystic wall. Postoperative computed tomography of the abdomen and pelvis showed focal thickening in the left adrenal gland, and adrenal metastatic carcinoma was confirmed. Brain magnetic resonance imaging also showed metastasis. The patient was started on chemotherapy. He died 2 years postoperatively. Twenty-three cases have been reported from 1989 to 2016, but there was no case of metastatic disease within the wall of an emphysematous bulla. Lung emphysema is not routinely screened for cancer development because it is not cost-effective and does not seem to improve patient outcome, but should this practice be reviewed?
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Affiliation(s)
- Yasser Aljehani
- Thoracic Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq Almutairi
- Thoracic Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farouk Alreshaid
- Thoracic Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem El-Bawab
- Thoracic Surgery Division, Department of Surgery, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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30
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Bhuin T, Roy JK. Developmental expression, co-localization and genetic interaction of exocyst component Sec15 with Rab11 during Drosophila development. Exp Cell Res 2019; 381:94-104. [PMID: 31071318 DOI: 10.1016/j.yexcr.2019.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
Sec15, a component of an evolutionarily conserved octomeric exocyst complex, has been identified as an interactor of GTP-bound Rab11 in mammals and Drosophila which shows its role in secretion in yeast and intracellular vesicle transport. Here, we report the expression patterns of Drosophila Sec15 (DSec15) transcript and Sec15 protein during Drosophila development. At early embryonic stages, a profound level of maternally loaded DSec15 transcript and protein is found. At cellular blastoderm cells (stage 5 embryos); the expression is seen in pole cells, apical membrane and sub-apical region. The transcript is predominantly accumulated in mesoderm, tracheal pits, gut, LE cells, trachea, and ventral nerve cord as development proceeds. While, a robust expression of Sec15 is seen in amnioserosa (AS), lateral epidermis (LAE), developing trachea, gut, ventral nerve cord and epithelial cells. During larval development, the transcript is also found in all imaginal discs with a distinguished accumulation in the morphogenetic furrow of eye disc, gut, proventriculus and gastric ceacae, garland cells/nephrocytes, malpighian tubules, ovary and testis. Further, we show that Sec15 co-localizes with Rab11 during Drosophila embryonic and larval development. Finally, using a genetic approach, we demonstrate that Sec15 interacts with Rab11 in producing blister during Drosophila wing development.
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Affiliation(s)
- Tanmay Bhuin
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, 221 005, India; Department of Zoology, The University of Burdwan, Golapbag, Burdwan, 713104, India.
| | - Jagat K Roy
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, 221 005, India
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Abstract
Anti-p200 pemphigoid is a rare autoimmune blistering disease. It belongs to the group of pemphigoid diseases and was first described in 1996. The diagnostic gold standard is the combination of (1) linear deposits of immunoreactants at the dermal epidermal junction by direct immunofluorescence microscopy of a perilesional skin biopsy, (2) detection of circulating autoantibodies binding to the dermal side (blister floor) of human salt split skin by indirect immunofluorescence microscopy, and reactivity with a 200 kDa protein (p200) in extract of human dermis by immunoblotting. In 2009, laminin γ1 was described as an additional target antigen in 90% of anti-p200 pemphigoid patients. Since ex vivo and in vivo studies have shown no direct pathogenic relevance for laminin γ1 antibodies and the preadsorption of patient sera against laminin γ1 does not reduce their reactivity with p200, the molecular identity of p200 still remains to be elucidated. The clinical phenotype of the disease is heterogeneous; in most cases, however, it resembles bullous pemphigoid. Anti-p200 patients are younger and skin lesions more often appear on palms of the hands and soles of the feet than in bullous pemphigoid. Therapy consists of topical and systemic corticosteroids. In addition, the use of daspone and immunosuppressants has been reported.
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32
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Padrão EMH, Teixeira LF, Maruta CW, Aoki V, Felipe da Silva AS, Kim EIM, Smelli LA. Bullous systemic lupus erythematosus - a case report. Autops Case Rep 2019; 9:e2018069. [PMID: 30863736 PMCID: PMC6394362 DOI: 10.4322/acr.2018.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 12/31/2022] Open
Abstract
Skin involvement in systemic lupus erythematosus (SLE) occurs in more than 75% of patients with this condition. Vesicles and blisters in lupus erythematosus (LE) may be present in SLE secondary to interface vacuolar changes in the epidermis, in discoid LE also secondary to vacuolar epidermal changes, and in bullous LE secondary to antibodies anti-collagen VII deposits with neutrophilic aggregates. In addition, blisters can occur due to the association of SLE with other autoimmune blistering diseases (e.g. bullous pemphigoid). BSLE is a rare blistering disease that mainly occurs in females (30–40 years old), and less frequently in children and adolescents. The most common presentation is rapid and widespread development of tense vesicles and bullae over erythematous macules or plaques. Preferential sites are: superior trunk, proximal superior limbs, and face (lips) with symmetrical distribution. Mucosal involvement is common on perioral, pharyngeal, laryngeal, and genital areas. The involvement of sun-exposed areas is not mandatory. The lesions usually progress with no scarring, but hypo or hyperchromia may be present. We report an 18-year-old female patient with blistering lesions at admission, who was diagnosed with BSLE. She was initially treated with systemic prednisone and hydroxychloroquine. Her condition evolved with relapsing lesions, which required the introduction of Dapsone. The authors emphasize the relevance of recognizing BSLE—a rare presentation of SLE—which may evolve with marked clinical presentation.
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Affiliation(s)
| | - Lucas Faria Teixeira
- Universidade de São Paulo, Medical School, Department of Internal Medicine. São Paulo, SP, Brazil
| | - Celina Wakisaka Maruta
- Universidade de São Paulo, Medical School, Department of Dermatology. São Paulo, SP, Brazil
| | - Valéria Aoki
- Universidade de São Paulo, Medical School, Department of Dermatology. São Paulo, SP, Brazil
| | - Aloisio Souza Felipe da Silva
- Universidade de São Paulo, University Hospital Pathology. São Paulo, SP, Brazil.,Universidade de São Paulo, Department of Pathology. São Paulo, SP, Brazil
| | - Elizabeth In Myung Kim
- Universidade de São Paulo, Hospital Universitário, Department of Internal Medcine. São Paulo, SP, Brazil
| | - Luciana Avena Smelli
- Universidade de São Paulo, Hospital Universitário, Department of Internal Medcine. São Paulo, SP, Brazil
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Abstract
Isolation and culture of keratinocytes from patients with different types of epidermolysis bullosa are sometimes challenging, because of the inherent adhesion defects of these cells. We routinely employ a well-established protocol for in vitro culture of these cells from small skin samples remaining after diagnostic procedures are performed. Keratinocytes and fibroblast can be used for downstream expression and functional studies or for construction of in vitro organotypic cocultures. These cells maintain main common characteristics of spreading, adhesion, migration, and survival, which depend on the underlying molecular defect.
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Affiliation(s)
- Yinghong He
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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34
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Klimi E. A Probable Case of Mucosal Fixed Drug Eruption Following Treatment with Silodosin. Sultan Qaboos Univ Med J 2018; 18:e402-e404. [PMID: 30607288 DOI: 10.18295/squmj.2018.18.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/11/2018] [Accepted: 06/27/2018] [Indexed: 11/16/2022] Open
Abstract
A fixed drug eruption consists of erythematous patches that appear on the skin and/or mucous membranes following administration of a drug which, once healed, leaves residual hyperpigmentation. We report a 76-year-old male who presented to the Thriasio General Hospital, Athens, Greece, in 2016 with erythema, oedema and blistering of the lower lip and glans penis following the administration of silodosin for benign prostatic hyperplasia. The eruption regressed two weeks after silodosin was discontinued.
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Affiliation(s)
- Eleni Klimi
- Department of Dermatology, Thriasio General Hospital, Athens, Greece
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35
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Chang YC, Gordon MK, Gerecke DR. Expression of Laminin 332 in Vesicant Skin Injury and Wound Repair. Clin Dermatol (Wilmington) 2018; 2:115. [PMID: 30058002 PMCID: PMC6063082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sulfur Mustard (SM) is a potent vesicant or blistering agent. It is a highly reactive bi-functional alkylating agent that cross links proteins, DNA, and other cellular components. Laminin 332 is a heterotrimer glycoprotein and a crucial skin component that attaches the epidermal basal keratinocytes to the dermis. SM wounds histologically appear similar to Epidermolysis Bullosa (EB), human genetic blistering diseases that involve genetic changes in laminin 332. The specific mechanism of action of SM exposure is unknown, but there are several key similarities between vesicant induced cutaneous injury and the Junctional form of EB (JEB) cutaneous injury: 1) Initial alkylation causes blistering similar to JEB; 2) Initial injury is followed by protease activation and prolonged inflammation similar to the chronic inflammation observed in EB; 3) The blister plane is at the level of the lamina lucida in the Basement Membrane Zone (BMZ) for both JEB and SM-induced injury. This suggests that injury induced by vesicants is not unique and probably involves malformation of laminin 332. Understanding the role of laminin 332 in SM induced blisters may provide perspectives for future molecular therapeutic countermeasures against SM exposure.
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Affiliation(s)
| | | | - Donald R Gerecke
- Correspondence: Donald R Gerecke, Department of Pharmacology and, Toxicology, Rutgers University, Ernest Mario School of Pharmacy, 170 Frelinghuysen Road, Piscataway, NJ 08854, Tel: 848-445-0123;
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36
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Abstract
Localized bullous pemphigoid is a seldom subtype of bullous pemphigoid. We report the case of a 63-year-old man who developed tense bullae on an erythematous area on the left calf after two episodes of erysipelas. Using histological and direct immunofluorescence studies localized bullous pemphigoid provoked by erysipelas was diagnosed. The patient was successfully treated with topical steroids. Clinicians should be aware of this differential diagnosis to avoid unnecessary antibiotic treatments.
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Affiliation(s)
- F B Löffel
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Gudrunstr. 56, 44791, Bochum, Deutschland.
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37
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Au S, Yousif A, Anandan S. Orange and Sunlight: A Recipe for Blisters. World J Plast Surg 2017; 6:260-262. [PMID: 28713725 PMCID: PMC5506369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Stephanie Au
- Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, UK
| | - Ali Yousif
- Department of Plastic Surgery, Wexham Park Hospital, Slough, UK
| | - Suresh Anandan
- Department of Plastic Surgery, Wexham Park Hospital, Slough, UK
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38
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Ramelli V, Lava SAG, Simonetti GD, Bianchetti MG, Ramelli GP, Milani GP. Blistering eruptions in childhood Henoch-Schönlein syndrome: systematic review of the literature. Eur J Pediatr 2017; 176:487-492. [PMID: 28161822 DOI: 10.1007/s00431-017-2858-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/02/2016] [Accepted: 01/16/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED The occurrence of blistering eruptions in childhood Henoch-Schönlein syndrome has been so far addressed exclusively in individual case reports. To describe epidemiology, clinical presentation, and therapeutic options in Henoch-Schönlein patients ≤18 years of age with blistering eruptions, we completed a systematic literature search. For the final analysis, we retained 39 reports. Ten children with blisters were found in 7 (1.5%) case series containing a total of 666 unselected pediatric Henoch-Schönlein cases. We also found 41 individually documented cases of Henoch-Schönlein syndrome with blistering eruptions. Blistering eruptions and purpura were distributed very similarly, blisters developed concomitantly with palpable purpura or with a latency of ≤14 days, and 80% of the cases remitted within 4 weeks with a similar course in children managed expectantly and in those managed with steroids. CONCLUSION Blistering eruptions are rare in Henoch-Schönlein syndrome. They can be a source of diagnostic dilemma but do not have any prognostic value since they almost always spontaneously subside within 4 weeks. What is known: • Textbooks and reviews marginally refer to the occurrence of blistering eruptions in children with Henoch-Schönlein syndrome. What is new • Blistering eruptions occur in <2% of cases. • Blisters and purpura are distributed similarly, blisters develop concomitantly with purpura or with a latency of ≤14 days. • Almost all cases remit within 4 weeks with a similar course in children managed expectantly and in those managed with systemic steroids.
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Affiliation(s)
- Vera Ramelli
- Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- University Children's Hospital Bern and University of Bern, Bern, Switzerland.,Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland.,University Children's Hospital Bern and University of Bern, Bern, Switzerland
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland. .,Università della Svizzera Italiana, Lugano, Switzerland.
| | - Gian Paolo Ramelli
- Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland
| | - Gregorio P Milani
- Pediatric unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Niem T, Schmidt A, Wöstmann B. Bonding resin thixotropy and viscosity influence on dentine bond strength. J Dent 2016; 51:21-8. [PMID: 27234437 DOI: 10.1016/j.jdent.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/04/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the influence of bonding resin thixotropy and viscosity on dentine tubule penetration, blister formation and consequently on dentine bond strength as a function of air-blowing pressure (air-bp) intensity. METHODS Two HEMA-free, acetone-based, one-bottle self-etch adhesives with similar composition except disparate silica filler contents and different bonding resin viscosities were investigated. The high-filler-containing adhesive (G-Bond) featured a lower viscous bonding resin with inherent thixotropic resin (TR) properties compared to the low-filler-containing adhesive (iBond) exhibiting a higher viscous bonding resin with non-thixotropic resin (NTR) properties. Shear bond strength tests for each adhesive with low (1.5bar; 0.15MPa; n=16) and high (3.0bar; 0.30MPa; n=16) air-bp application were performed after specimen storage in distilled water (24h; 37.0±1.0°C). Results were analysed using a Student's t-test to identify statistically significant differences (p<0.05). Fracture surfaces of TR adhesive specimens were morphologically characterised by SEM. RESULTS Statistically significant bond strength differences were obtained for the thixotropic resin adhesive (high-pressure: 24.6MPa, low-pressure: 9.6MPa). While high air-bp specimens provided SEM images revealing resin-plugged dentine tubules, resin tags and only marginally blister structures, low air-bp left copious droplets and open dentine tubules. In contrast, the non-thixotropic resin adhesive showed no significant bond strength differences (high-pressure: 9.3MPa, low-pressure: 7.6MPa). CONCLUSIONS A pressure-dependent distinct influence of bonding resin thixotropy and viscosity on dentine bond strength has been demonstrated. Stronger adhesion with high air-bp application is explained by improved resin fluidity and facilitated resin penetration into dentine tubules. CLINICAL SIGNIFICANCE Filler particles used in adhesive systems may induce thixotropic effects in bonding resin layers, accounting for improved free-flowing resin properties. In combination with high air-bp this effect allows an easy plugging of dentine tubules and elimination of blister structures, both resulting in superior dentine bond strength.
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Affiliation(s)
- Thomas Niem
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
| | - Alexander Schmidt
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
| | - Bernd Wöstmann
- Department of Prosthodontics, Justus-Liebig University, Schlangenzahl 14, D-35392 Giessen, Germany.
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Lim HJ, Lim CH. A rare case of unilateral severe bullous emphysema in a 32-year-old female. Asian Cardiovasc Thorac Ann 2016; 24:597-600. [PMID: 27206777 DOI: 10.1177/0218492316651217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital bullous emphysema is defined as large bullae involving at least one-third of a hemithorax. We describe the case of a 32-year-old female who presented with increasing shortness of breath. Radiological investigations revealed severe emphysema with hyperexpansion of the right lung and a mediastinal shift to the left. A lung perfusion scan showed reduced perfusion in the right lung. The patient underwent a right pneumonectomy with a diagnosis of congenital bullous emphysema. She was doing well 6 years later.
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Affiliation(s)
- Hui Jun Lim
- Department of Cardiothoracic Surgery, National Heart Centre, Singapore
| | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Centre, Singapore
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Abstract
Epidermolysis bullosa (EB) comprises a collection of clinically diverse inherited blistering diseases that affect the skin and, in some subtypes, mucous membranes and other organs. Currently classified into four main subtypes (EB simplex, junctional EB, dystrophic EB, and Kindler syndrome, mainly based on the level of skin cleavage), the spectrum of EB extends to more than 30 clinical subtypes with pathogenic mutations in at least 18 distinct genes. This review focuses on three recent additions to variants of EB: all are autosomal recessive, and result from mutations in either DST-e (coding for epidermal dystonin, also known as the 230 kDa bullous pemphigoid antigen, BP230), EXPH5 (coding for exophilin-5, also known as Slac2-b), or ITGA3 (coding for the integrin alpha-3 subunit). Each of these new forms of EB is reviewed with respect to the initial gene discovery, clinical features, the current mutation database, and skin pathology. Awareness of these recently described forms of EB is helpful in the clinical evaluation of patients with EB and in defining genotype-phenotype correlation for inherited blistering skin diseases.
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Affiliation(s)
- John A McGrath
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, UK
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Tan J, He W, Luo G, Wu J. Involvement of impaired desmosome-related proteins in hypertrophic scar intraepidermal blister formation. Burns 2015; 41:1517-23. [PMID: 25922301 DOI: 10.1016/j.burns.2015.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 02/28/2015] [Accepted: 03/27/2015] [Indexed: 01/07/2023]
Abstract
Hypertrophic scar is one of the unique fibrotic diseases in human. Intraepidermal blister is a common clinical symptom following the hypertrophic scar formation. However, little is known about the reason of blister creation. In this study, we selected three patients with hypertrophic scar as manifested by raised, erythematous, pruritic, blister and thickened appearance undergoing scar resection. The first scar sample was 6 months after burn from the neck of a 3 years old male patient with 10 score by Vancouver Scar Scale (VSS). The second scar sample was 12 months after burn from the dorsal foot of a 16 years old female patient with 13 score by VSS. The third one was 9 months after burn from the elbow of a 34 years old male patients with 13 score by VSS. In order to understand the molecular mechanism of blister formation, we screened the different protein expression between hypertrophic scar and normal skin tissue by means of isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology and high throughput 2D LC-MS/MS. There were 48 proteins found to be downregulated in hypertrophic scar. Among the downregulated ones, plakophilin1 (PKP1), plakophilin3 (PKP3) and desmoplakin (DSP) were the desmosome-related proteins which were validated by immunohistochemistry and western blotting assay. Transmission electron microscopy further showed the considerably reduced size and intensity of hemidesmosome and desmosome in hypertrophic scar tissue, compared to control normal skin. Our data indicted for the first time that downregulation of DSP, PKP1 and PKP3 in hypertrophic scar might be responsible for intraepidermal blister formation.
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Affiliation(s)
- Jianglin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Weifeng He
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jun Wu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Ogawa M, Sakurai K, Kawaguchi T, Naiki-Ito A, Nakagawa M, Okita K, Matsukawa N, Shibamoto Y. Internal carotid artery blister-like aneurysm caused by Aspergillus - case report. Pol J Radiol 2015; 80:159-63. [PMID: 25848441 PMCID: PMC4376144 DOI: 10.12659/pjr.893050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022] Open
Abstract
Background Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection. Case Report An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion. Conclusions The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection.
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Affiliation(s)
- Masaki Ogawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keita Sakurai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takatsune Kawaguchi
- Department of Radiology, Toyota-kai Medical Corporation Kariya Toyota General Hospital, Nagoya, Japan
| | - Aya Naiki-Ito
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenji Okita
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyuki Matsukawa
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Lien SY, Yang CH, Wu KC, Kung CY. Investigation on the passivated Si/Al2O3 interface fabricated by non-vacuum spatial atomic layer deposition system. Nanoscale Res Lett 2015; 10:93. [PMID: 25852389 PMCID: PMC4385260 DOI: 10.1186/s11671-015-0803-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/05/2015] [Indexed: 05/31/2023]
Abstract
Currently, aluminum oxide stacked with silicon nitride (Al2O3/SiNx:H) is a promising rear passivation material for high-efficiency P-type passivated emitter and rear cell (PERC). It has been indicated that atomic layer deposition system (ALD) is much more suitable to prepare high-quality Al2O3 films than plasma-enhanced chemical vapor deposition system and other process techniques. In this study, an ultrafast, non-vacuum spatial ALD with the deposition rate of around 10 nm/min, developed by our group, is hired to deposit Al2O3 films. Upon post-annealing for the Al2O3 films, the unwanted delamination, regarded as blisters, was found by an optical microscope. This may lead to a worse contact within the Si/Al2O3 interface, deteriorating the passivation quality. Thin stoichiometric silicon dioxide films prepared on the Si surface prior to Al2O3 fabrication effectively reduce a considerable amount of blisters. The residual blisters can be further out-gassed when the Al2O3 films are thinned to 8 nm and annealed above 650°C. Eventually, the entire PERC with the improved triple-layer SiO2/Al2O3/SiNx:H stacked passivation film has an obvious gain in open-circuit voltage (V oc) and short-circuit current (J sc) because of the increased minority carrier lifetime and internal rear-side reflectance, respectively. The electrical performance of the optimized PERC with the V oc of 0.647 V, J sc of 38.2 mA/cm(2), fill factor of 0.776, and the efficiency of 19.18% can be achieved.
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Affiliation(s)
- Shui-Yang Lien
- />Department of Materials Science and Engineering, DaYeh University, No. 168, Xuefu Road, Changhua, 515 Taiwan
| | - Chih-Hsiang Yang
- />Department of Electrical Engineering, National Chung Hsing University, 250 State Road, Taichung, 402 Taiwan
| | - Kuei-Ching Wu
- />Crystalline Silicon R & D Section, Mosel Vitelic Inc, No. 1, Creation Road 1, Hsinchu, 300 Taiwan
| | - Chung-Yuan Kung
- />Department of Electrical Engineering, National Chung Hsing University, 250 State Road, Taichung, 402 Taiwan
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Abstract
Endovascular management of intracranial aneurysms has advanced significantly over the last couple decades and continues to evolve, including aneurysms within the subgroup of supraclinoid internal carotid artery (ophthalmic, superior hypophyseal, posterior communicating, anterior choroidal, dorsal wall/blister, and carotid terminus).
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Alberdi-Navarro J, Gainza-Cirauqui ML, Prieto-Elías M, Aguirre-Urizar JM. Angina bullosa hemorrhagica an enigmatic oral disease. World J Stomatol 2015; 4:1-7. [DOI: 10.5321/wjs.v4.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/01/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5th decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculo-bullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic.
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Kervarrec T, Binois R, Bléchet C, Estève É. [Hypocomplementaemic urticarial vasculitis with bullous lesions and pericardial involvement]. Ann Dermatol Venereol 2015; 142:557-62. [PMID: 25613197 DOI: 10.1016/j.annder.2014.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 08/07/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare disease involving urticarial cutaneous vasculitis, hypocomplementaemia and systemic manifestations. Pericardial involvement occurs in very rare cases. We report a case of HUVS associated with specific pericarditis and bullous lesions. PATIENTS AND METHODS A 63-year-old woman consulted for chronic urticaria that had appeared ten months earlier. Her skin lesions were associated with weight loss of 10 kg, deterioration of respiratory function and abdominal pain. Leukocytoclastic vasculitis was seen in the skin biopsy sample. Hypocomplementaemia and anti C1q antibodies were present and a diagnosis of HUVS was made. During hospitalisation, extensive compressive pericardial effusion was identified, and histological examination of the biopsy revealed specific pericardial lymphocytic vasculitis. During follow-up, four episodes of infectious pneumonitis were noted. Bullous skin lesions were also observed. DISCUSSION HUVS is a disease caused by an antibody against C1q complement responsible for urticarial lesions and vasculitis antibodies. To our knowledge, there have been only five reports in the literature of pericardial injury associated with HUVS. In our case, histological examination of the pericardium demonstrated lymphocytic vasculitis.
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Widgerow AD, King K, Tocco-Tussardi I, Banyard DA, Chiang R, Awad A, Afzel H, Bhatnager S, Melkumyan S, Wirth G, Evans GRD. The burn wound exudate-an under-utilized resource. Burns 2014; 41:11-7. [PMID: 24986597 DOI: 10.1016/j.burns.2014.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/11/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. METHOD A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant articles were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. RESULTS Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies has the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. CONCLUSION Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
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Affiliation(s)
- Alan D Widgerow
- Director Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
| | - Kassandra King
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ilaria Tocco-Tussardi
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Derek A Banyard
- Research Fellow Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ryan Chiang
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Antony Awad
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Hassan Afzel
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Shweta Bhatnager
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Satenik Melkumyan
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Garrett Wirth
- Plastic Surgery Dept, University of California, Irvine, United States
| | - Gregory R D Evans
- Plastic Surgery Dept, University of California, Irvine, United States
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Choi SC, Min YG, Lee IS, Yoon GH, Kang BR, Jung YS, Cho JP, Kim GW. Injuries associated with the 580 km university student grand voluntary road march: focus on foot injuries. J Korean Med Sci 2013; 28:1814-21. [PMID: 24339714 PMCID: PMC3857380 DOI: 10.3346/jkms.2013.28.12.1814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022] Open
Abstract
College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 ± 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.
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Affiliation(s)
- Sang-cheon Choi
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - In-Soo Lee
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Gi-Ho Yoon
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Bo-Ra Kang
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Yoon-Seok Jung
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Joon-Pil Cho
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
| | - Gi-Woon Kim
- Department of Emergency Medicine, Ajou University School of Medicine and Ajou University Hospital, Suwon, Korea
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50
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Park JH, Kim J, Lee JK, Kim SJ, Lee AR, Moon HJ, Kim DK. A case of bilateral giant bullae in young adult. Tuberc Respir Dis (Seoul) 2013; 75:222-4. [PMID: 24348672 PMCID: PMC3861380 DOI: 10.4046/trd.2013.75.5.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022] Open
Abstract
Giant bullae are large bullae occupying at least one-third of the hemithorax and surgical bullectomy is the treatment of choice. We report a case with symptomatic giant bullae which were resected successfully. A 35-year-old man presented with bilateral giant bullae that occupied almost the entire left hemithorax and a third of the right hemithorax. He was a current smoker with a 30 pack-year history and he presented with dyspnea on exertion. An elective surgical bullectomy was performed with video-assisted thoracoscopic surgery. The patient recovered without any adverse events and stayed well for 1 month after surgery.
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Affiliation(s)
- Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ae-Ra Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. ; Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jong Moon
- Department of Thoracic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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