Photoallergic contact dermatitis from benzydamine presenting mainly as lip dermatitis

BACKGROUND: Benzydamine, a non-steroidal anti-inflammatory drug (NSAID) in use for more than four decades, has been reported to cause photosensitivity. OBJECTIVES: To study the results of photopatch testing to benzydamine and the clinical features of the dermatitis during a 3-year period (2006-2008). PATIENTS AND METHODS: During this period, 74 patients with photodermatoses were photopatch tested with an extended baseline series of allergens including benzydamine and in suspicious cases, with drugs that contain it. Test sites were irradiated on D2 with 5 J/cm(2) and readings were performed on D2 and D4. RESULTS: Ten patients (six females/four males), aged 21-84 years (mean 64.9) had a positive photopatch test to benzydamine [1-5% petrolatum (pet.) from Bial-Aristegui] and to drugs that contain it (Tantum verde oral solution and Momen gel). Nine patients had lower lip cheilitis and one lichenified eczema on photo-exposed sites. CONCLUSION: Photosensitivity from both topical and systemic benzydamine has been occasionally described, mainly in southern Spain. Despite its widespread use and its known photosensitizing capacity, photoallergic contact dermatitis from benzydamine is probably underdiagnosed as the clinical presentation of mainly the lip and chin is not typical of photoallergic contact dermatitis and benzydamine is not part of most photoallergen series

Prevalence of subclinical ketosis and relationships with postpartum diseases in European dairy cows

Subclinical ketosis (SCK) is defined as concentrations of β-hydroxybutyrate (BHBA) ≥ 1.2 to 1.4 mmol/L and it is considered a gateway condition for other metabolic and infectious disorders such as metritis, mastitis, clinical ketosis, and displaced abomasum. Reported prevalence rates range from 6.9 to 43% in the first 2 mo of lactation. However, there is a dearth of information on prevalence rates considering the diversity of European dairy farms. The objectives of this study were to (1) determine prevalence of SCK, (2) identify thresholds of BHBA, and (3) study their relationships with postpartum metritis, clinical ketosis, displaced abomasum, lameness, and mastitis in European dairy farms. From May to October 2011, a convenience sample of 528 dairy herds from Croatia, Germany, Hungary, Italy, Poland, Portugal, Serbia, Slovenia, Spain, and Turkey was studied. β-Hydroxybutyrate levels were measured in 5,884 cows with a handheld meter within 2 to 15 d in milk (DIM). On average, 11 cows were enrolled per farm and relevant information (e.g., DIM, postpartum diseases, herd size) was recorded. Using receiver operator characteristic curve analyses, blood BHBA thresholds were determined for the occurrence of metritis, mastitis, clinical ketosis, displaced abomasum, and lameness. Multivariate binary logistic regression models were built for each disease, considering cow as the experimental unit and herd as a random effect. Overall prevalence of SCK (i.e., blood BHBA ≥ 1.2 mmol/L) within 10 countries was 21.8%, ranging from 11.2 to 36.6%. Cows with SCK had 1.5, 9.5, and 5.0 times greater odds of developing metritis, clinical ketosis, and displaced abomasum, respectively. Multivariate binary logistic regression models demonstrated that cows with blood BHBA levels of ≥ 1.4, ≥ 1.1 and ≥ 1.7 mmol/L during 2 to 15 DIM had 1.7, 10.5, and 6.9 times greater odds of developing metritis, clinical ketosis, and displaced abomasum, respectively, compared with cows with lower BHBA blood levels. Interestingly, a postpartum blood BHBA threshold ≥ 1.1 mmol/L increased the odds for lameness in dairy cows 1.8 (95% confidence interval: 1.3 to 2.5) times. Overall, prevalence of SCK was high between 2 to 15 DIM and SCK increased the odds of metritis, clinical ketosis, lameness, and displaced abomasum in European dairy herds

Research into the quality standard of homes delivered through change of use permitted development rights

The report provides the findings of independent research into the quality standard of homes delivered through certain national permitted development rights for the change of use. The research considers the quality of homes delivered in 11 case study areas in England in respect of size, amenity, location and design, drawing out the differences between homes delivered through permitted development compared with planning applications

Can ePROMs improve the understanding and management of lung cancer patients’ Quality of Life? A Scoping review (Preprint)

Background: Electronic patient-reported outcome measures (ePROMs) are essential for clinical practice and research. The growth of electronic health technologies has provided unprecedented opportunities to collect information systematically through ePROMs. They are widely used in scientific research, but we need more evidence if they will also be used, with their implementation, in daily clinical practice. For example, patients with lung cancer have an advanced stage of the disease when diagnosed. This entails tremendous suffering due to high mortality and losses in the different dimensions of the human being. In this case, monitoring symptoms and other outcomes expressly represent great utility in improving a patient's quality of life. Objective: ePROMs provided unprecedented opportunities to collect information systematically. The authors aim to prove that ePROMs are more helpful in managing patient symptoms, lung cancer, and overall survival than their alternatives, such as non-electronic PROMs. Methods: This scoping review considered articles published between 2017 and 2022 identified through searches in PubMed, Scopus, Cochrane, CINAHL, and PsycINFO. We found 5,097 articles; after eliminating duplicates, we reduced them to 3,315, and after reading the abstract, we were left with 56; finally, after applying the exclusion criteria, we reviewed 12. Arksey and O'Malley's five-step framework was used to refine the initial search results with the following research questions: 1) Do ePROMs help physician-patient communication? 2) To what extent do they improve decision-making? 3) Are institutions and their digitization policies barriers or enablers for this process? 4) What else is needed for routine implementation?. Results: Twelve articles were included in this review. The answers to our questions were: 1) ePROMs are an integrative and facilitative communication tool, highlighting their importance in the relationship between palliative care and medical oncology. 2) ePROMs help assess patient symptoms and functionality more accurately and facilitate clinical decision-making. In addition, it allows more precise predictions of overall patient survival and the adverse effects of their treatments. 3) The main institutional obstacles are the initial investment, which can be costly, and the data protection policy. However, as enablers, we have better funding through the development of telemedicine, support from institutional leaders to overcome resistance to change, and transparent policies to ensure the safe and secure use of ePROMs. 4) More than evidence for its routine application, its implementation must overcome physicians' inertia and safeguard the confidentiality of the data obtained. Conclusions: Routine collection of remote ePROMs is an effective and valuable strategy for providing real-time clinical feedback. In addition, it provides satisfaction to patients and professionals. Optimizing ePROMs in lung cancer patients leads to a more accurate view of health outcomes and ensures quality patient follow-up. It also allows us to stratify patients based on their morbidity, creating specific follow-ups for their needs. However, data privacy and security are concerns when using ePROMs to ensure compliance with local entities. At least four barriers were identified: cost, complex programming within health systems, security, and socio-health literacy.info:eu-repo/semantics/publishedVersio

Análise Retrospetiva Sobre a Utilização em Contexto Real do Ranibizumab em Doentes com Degenerescência Macular da Idade Exsudativa em Portugal

INTRODUCTION: Anti-vascular endothelial growth factor therapy has revolutionized the treatment of wet age-related macular degeneration; however, it is important to monitor actual use of ranibizumab and related treatment outcomes in routine practice. MATERIAL AND METHODS: This was a retrospective, observational study to monitor the 2-year outcomes following ranibizumab treatment for wet age-related macular degeneration in Portugal. Patients treated between January 2009 and December 2009 were retrospectively evaluated. All decisions were made by the treating physician in accordance with their usual routine clinical practice. The primary assessment was mean change in visual acuity score using Early Treatment Diabetic Retinopathy Study or Snellen equivalent. RESULTS: A total of 128 patients with wet age-related macular degeneration were analyzed (mean age 79.4 years; mean visual acuity score 54.2 letters). Mean change in visual acuity score from baseline was -1.6 letters (n = 82) at year one and -5.1 letters (n = 72) at year two. The mean number of ranibizumab injections was 3.8 (year one) and 1.6 (year two). On average, patients attended 8.6 and 5.0 visits and optical coherence tomography was used in 75.0% of patients in year one and in 56.3% of patients in year two, respectively. DISCUSSION: Despite a relatively high number of visits, including monitoring visits and use of optical coherence tomography - guided therapy, few injections were administered and visual acuity was not improved. CONCLUSION: These findings indicate that as-needed treatment resulted in under-dosing in a real-life setting in Portugal. Such limitations may also be related to increasing numbers of patients, resulting in clinic saturation.info:eu-repo/semantics/publishedVersio

Thoracic high resolution computed tomography (HRCT) in asthma

INTRODUCTION: High-resolution computed tomography (HRCT) is a widespread medical imaging method for the study of thoracic diseases. In asthma it is very useful particularly when it is difficult to achieve an effective control of disease, and in severe deterioration. AIM: It was intended to evaluate the imaging changes by HRCT in asthmatic patients and to assess the expression according to the symptoms and duration of disease. MATERIAL AND METHODS: Thirty three patients from the Outpatient Department, with asthma classified in the different clinical severity stages according to GINA, were randomly included. They were submitted to HRCT (Somaton Plus-4, Siemens). The lesions were classified in reversible (mucoid impaction, acinar pattern centrilobular nodules and lobar collapse) and irreversible (bronchiectasis, bronchial wall-thickening, sequellar line shadows and emphysema). RESULTS: The 33 asthmatic patients (20 female) had an average age of 44.76 +/- 16.98 years and a mean disease evolution time of 23.39 +/-14.83 years. 30% had mild persistent asthma, 43% moderate persistent asthma and 27% severe persistent asthma. All the patients were under inhaled corticotherapy. Only 6 patients had normal HRCT 4 with mild persistent asthma (4 to 25 years of duration of disease) and 2 with moderate persistent (10 to 48 years of duration of disease). 81.81% of the patients had changes in HRCT, being the irreversible lesions the most frequent. The most important irreversible lesions were observed in severe asthma patients with longer duration of disease. All the patients with reversible lesions had also irreversible changes. Most of the bronchiectasis were centrally located and were found in severe asthma patients. Irreversible changes were identified in 3 patients with mild asthma and a maximum of 6 years of duration of disease. DISCUSSION: HRCT findings were related with asthma severity and long lasting disease but there are some asthmatics that also present early abnormalities, even in milder forms. All the groups of asthmatic patients presented all types of imaging changes, including the irreversible ones. In asthma these changes can be the result of individual patterns of response to frequent exacerbations, leading to a persistent chronic inflammatory process that will determine airway remodelling, even in early stages of disease and/or mild asthma

Top-Down Particle Fabrication: Control of Size and Shape for Diagnostic Imaging and Drug Delivery

This review discusses rational design of particles for use as therapeutic vectors and diagnostic imaging agent carriers. The emerging importance of both particle size and shape is considered, and the adaptation and modification of soft lithography methods to produce nanoparticles is highlighted. To this end, studies utilizing particles made via a process called Particle Replication In Non-wetting Templates (PRINT™) are discussed. In addition, insights gained into therapeutic cargo and imaging agent delivery from related types of polymer-based carriers are considered