Patient and practitioner satisfaction with tele-dermatology including Australia’s indigenous population: A systematic review of the literature

AbstractBackgroundAustralia’s health disparity, combined with evolving technologies, has evoked increasing interest and funding in health services that could address inequities. One such emerging service is tele-medicine.ObjectiveThe purpose of this report is to discuss and evaluate the current literature regarding patient and practitioner satisfaction with tele-medicine, and more specifically tele-dermatology.MethodsWe searched for literature relevant to tele-dermatology use among Australia’s indigenous population. We synthesized the literature in our report and identified elements of tele-dermatology not yet researched.ResultsMost significantly, all available research is currently based on descriptive studies and there is no validated tool to assess the efficacy of tele-dermatology.LimitationsNo published research currently exists on the use of tele-dermatology among Australia’s indigenous population.ConclusionA review of the literature shows that tele-dermatology is considered a valuable service, particularly to patients living in rural areas who might not otherwise have access to specialist care

A case report of the use of rituximab and the Epidermolysis Bullosa Disease Activity Scoring Index (EBDASI) in a patient with epidermolysis bullosa acquisita with extensive esophageal involvement

A 49-year-old man with recalcitrant mechanobullous epidermolysis bullosa acquisita (EBA) with significant esophageal involvement was treated with rituximab. EBA is a chronic autoimmune subepidermal bullous disease. It is characterized by skin fragility and scarring caused by circulating and tissue bound antibodies to type VII collagen. EBA is often unresponsive or poorly responsive to conventional immunosuppressive therapies such as corticosteroids, methotrexate, and cyclosporine. The burden of long-term use of immunosuppressants also limits their use in the treatment of chronic autoimmune diseases such as EBA. Since a validated and objective way of measuring disease activity in patients with EBA has not been described, we used the Epidermolysis Bullosa Disease Activity Scoring Index (EBDASI), for hereditary EB, as a surrogate to measure disease severity and activity in our patient with EBA. After three courses of rituximab over three years, our patient has achieved near complete clinical remission from disease activity. The patient’s response suggests that treatment with rituximab may be a valuable treatment regimen for severe mechanobullous EBA, which is demonstrated by paralleled declines in objective disease activity scores, the EBDASI. This is in line with recently observed beneficial effects of rituximab in the management of EBA.</p

Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology

Background: Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives: To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods: A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure.1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients.2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions: Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety

Incorporation of a Dietary Omega 3 Fatty Acid Impairs Murine Macrophage Responses to Mycobacterium tuberculosis

by creating an immunosuppressive environment. We hypothesized that incorporation of n-3 PUFA suppresses activation of macrophage antimycobacterial responses and favors bacterial growth, in part, by modulating the IFNγ-mediated signaling pathway.. The fatty acid composition of macrophage membranes was modified significantly by DHA treatment. DHA-treated macrophages were less effective in controlling intracellular mycobacteria and showed impaired oxidative metabolism and reduced phagolysosome maturation. Incorporation of DHA resulted in defective macrophage activation, as characterized by reduced production of pro-inflammatory cytokines (TNFα, IL-6 and MCP-1), and lower expression of co-stimulatory molecules (CD40 and CD86). DHA treatment impaired STAT1 phosphorylation and colocalization of the IFNγ receptor with lipid rafts, without affecting surface expression of IFNγ receptor. in response to activation by IFNγ, by modulation of IFNγ receptor signaling and function, suggesting that n-3 PUFA-enriched diets may have a detrimental effect on host immunity to tuberculosis

Validating the BIOCHIP, a mosaic- based immunofluorescence test to diagnose autoimmune bullous diseases – bullous pemphigoid, pemphigus vulgaris and pemphigus foliaceous.

Background: The BIOCHIP (Dermatology Mosaic 7, EUROIMMUN, Lubeck, Germany) is a novel multiplex indirect immunofluorescence (llF) technique that has been proposed for the use of the serological diagnosis of bullous pemphigoid (BP) and pemphigus diseases. The BIOCHIP method combines the screening of autoantibodies and target antigen specific substrates in asingle miniature incubation field.Objective: To validate the accuracy and measure the inter-rater reliability (lRR) of the BIOCHIP in the diagnosis of BP, pemphigus foliaceous (PF) and pemphigus vulgaris (PV).Methods: Sera from patients with BP (n=38), PF (n=8), PV (n=23), diseased control volunteers (n=64) and healthy control volunteers (n=39) were collected. The multiplex BIOCHIP was performed on all serum samples and the sensitivity and specificity was calculated. Direct immunofluorescence (DlF) for BP, PV and PF patients was performed. Additional conventional llF was performed on patients with BP and ELISA was performed on patients with pemphigus. Cohen's Kappa values were calculated to measure the level of correlation between the results of the BIOCHIP compared with the results of the gold standard methods - DIF/IIF/ELISA.1872 digital images of each individual substrate were taken from 312 BIOCHIP slides. These were rated by ten experts from around the world with experience in the use of the BIOCHIP. Each rater rated all 1872 digital images. Raters would select options from a drop down list alongside each image. lnter-rater agreement was tested using Fleiss Kappa statistical test.Results: The BIOCHIP mosaic showed a sensitivity of 86.8% and specificity of 85.0% for BP180 or BP230 being positive in BP. A sensitivity of 75.0%and specificity of 97.7%for Dsg1 in PF and sensitivity of 60.9% and specificity of 73.6% for Dsg3 in PV. The IIR varied between fair [monkey oesophagus (MO) (k=0.257), MO pattern (k=0.357), Dsg1 (k=0.390) and BP230 (k=0.281)] and moderate [Salt-split-skin (SSS) (k=0.816), SSS location (k=0.505), Dsg3 (k=0.423) and BP180 (k=0.568)].Conclusion: The BIOCHIP has demonstrated high validity in the diagnosis of BP and pemphigus diseases however it falls short of producing reliable results between users. lt should be used with caution as the sole method of diagnosis in BP, PV and PF