Pedal dermatophyte infection in psoriasis.

Background Dermatophyte infections have been considered rare in psoriasis. However, there are data indicating that tinea unguium is as common or even more common in psoriasis compared with healthy controls. Tinea unguium is generally a secondary event to tinea pedis infection. Objectives To study the prevalence of tinea pedis and tinea unguium in psoriasis compared with a control group. Methods Consecutive psoriasis outpatients aged 18-64 years attending a department of dermatology were examined. Samples for direct microscopy and culture were taken from the interdigital spaces, soles and toenails. Consecutive patients without signs of psoriasis or atopic dermatitis seeking examination of moles constituted the control group. Results In total, 239 patients with psoriasis and 245 control patients were studied. The prevalence of tinea pedis was 8·8%[95% confidence interval (CI) ± 3·6%] in the psoriasis group and 7·8% (95% CI ± 3·4%) in the control group. The corresponding figures for prevalence of tinea unguium were 4·6% (95% CI ± 2·7%) and 2·4% (95% CI ± 1·9%), respectively. The differences found in the psoriasis vs. the control groups were not statistically significant. Conclusions This study does not support the hypothesis that the prevalence of tinea pedis and tinea unguium in patients with psoriasis differs from that in a normal population

Treatment of Facial Seborrheic Dermatitis with Pimecrolimus Cream 1%: An Open-Label Clinical Study in Korean Patients

Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis

Bioavailability, Antipsoriatic Efficacy and Tolerability of a New Light Cream with Mometasone Furoate 0.1%

Mometasone furoate, a potent glucocorticoid (class III) with a favorable benefit/risk ratio, has emerged as a standard medication for the treatment of inflammatory skin disorders. The purpose of the investigation presented here was to determine the noninferiority of a topical mometasone formulation, a light cream (O/W 60/40 emulsion) with mometasone furoate 0.1% (water content of 33%) versus marketed comparators. Using the vasoconstrictor assay, a strong blanching effect of the new cream (called Mometasone cream) comparable to that of a mometasone comparator, a fatty cream with mometasone furoate 0.1%, could be demonstrated. Thus, the topical bioavailability of the active ingredient mometasone furoate (0.1%) was regarded to be similar for Mometasone cream and the mometasone comparator. Using the psoriasis plaque test, a strong antipsoriatic effect comparable to that of the mometasone comparator was found for Mometasone cream after 12 days of occlusive treatment. A nearly identical reduction in the mean infiltrate thickness and similar mean AUC values were noted with both formulations confirmed by clinical assessment data. The noninferiority of Mometasone cream to its active comparator with re-spect to the AUC of change to baseline in infiltrate thickness was demonstrated. Both medications were well tolerated. Overall, Mometasone cream and the mometasone comparator showed similar efficacy and tolerability. Mometasone cream, in addition to its high potency and good tolerability, provides the properties of a light cream, which might make this new medication particularly suitable for application on acutely inflamed and sensitive skin. Copyright (C) 2012 S. Karger AG, Base

Skin flora: Differences Between People Affected by Albinism and Those with Normally Pigmented Skin in Northern Tanzania - Cross Sectional Study.

Skin flora varies from one site of the body to another. Individual's health, age and gender determine the type and the density of skin flora. A 1  cm² of the skin on the sternum was rubbed with sterile cotton swab socked in 0.9% normal saline and plated on blood agar. This was cultured at 35 °C. The bacteria were identified by culturing on MacConkey agar, coagulase test, catalase test and gram staining. Swabs were obtained from 66 individuals affected by albinism and 31 individuals with normal skin pigmentation. Those with normal skin were either relatives or staying with the individuals affected by albinism who were recruited for the study. The mean age of the 97 recruited individuals was 30.6 (SD ± 14.9) years. The mean of the colony forming units was 1580.5 per cm2. Those affected by albinism had a significantly higher mean colony forming units (1680  CFU per cm²) as compared with 453.5  CFU per cm² in those with normally pigmented skin (p = 0.023). The skin type and the severity of sun- damaged skin was significantly associated with a higher number of colony forming units (p = 0.038). Individuals affected by albinism have a higher number of colony forming units which is associated with sun- damaged skin

A survey among dermatologists: diagnostics of superficial fungal infections - what is used and what is needed to initiate therapy and assess efficacy?

BACKGROUND: Superficial fungal infections are common. It is important to confirm the clinical diagnosis by mycological laboratory methods before initiating systemic antifungal treatment, especially as antifungal sensitivity and in vitro susceptibility may differ between different genera and species. For many years, the gold standard for diagnosis of superficial fungal infections has been direct fungal detection in the clinical specimen (microscopy) supplemented by culturing. Lately, newer molecular based methods for fungal identification have been developed. OBJECTIVE: This study was initiated to focus on the current usage of mycological diagnostics for superficial fungal infections by dermatologists. It was designed to investigate whether it was necessary to differentiate between initial diagnostic tests and those used at treatment follow-up in specific superficial fungal infections. METHODS: An online questionnaire was distributed among members of the EADV mycology Task Force and other dermatologists with a special interest in mycology and nail disease. RESULTS: The survey was distributed to 62 dermatologists of whom 38 (61%) completed the whole survey, 7 (11%) partially completed and 17 (27%) did not respond. Nearly, all respondents (82-100%) said that ideally they would use the result of direct microscopy (or histology) combined with a genus/species directed treatment of onychomycosis, dermatophytosis, Candida- and Malassezia-related infections. The majority of the dermatologists used a combination of clinical assessment and direct microscopy for treatment assessment and the viability of the fungus was considered more important at this visit than when initiating the treatment. Molecular based methods were not available for all responders. CONCLUSION: The available diagnostic methods are heterogeneous and their usage differs between different practices as well as between countries. The survey confirmed that dermatologists find it important to make a mycological diagnosis, particularly prior to starting oral antifungal treatment in order to confirm the diagnose and target the therapy according to genus and species

A comparative study of the effects of topical application of Aloe vera, thyroid hormone and silver sulfadiazine on skin wounds in Wistar rats

Many research studies report the healing effects of Aloe Vera, thyroid hormone cream and silver sulfadiazine. However, the effects of these therapeutic agents are not well understood and have not been compared in one study. This study aimed at investigating the effects of topical application of an Aloe vera gel, a thyroid hormone cream and a silver sulfadiazine cream on the healing of skin wounds surgically induced in Wistar rats for determining the treatment of choice. In a randomized controlled trial, twelve male rats, aged 120 days and with a mean weight of 250 to 300 g, were divided randomly into 5 groups based on drug treatments: Aloe vera gel (AV), thyroid hormone cream (TC), silver sulfadiazine 1% (S), vehicle (V) and control. To evaluate the efficacy of each treatment technique, a biomechanical approach was used to assess tensile stress after 14 days of treatment. Tensile stress was significantly improved in the Aloe vera gel group as compared with the other four groups (P≤0.05). While the other treatment options resulted in better healing than the control group, this difference was not significant. We conclude that Aloe vera topical application accelerated the healing process more than thyroid hormone, silver sulfadiazine and vehicle in surgically induced incisions in rats

A Simplified Water Accounting Procedure to Assess Climate Change Impact on Water Resources for Agriculture across Different European River Basins

[EN] European agriculture and water policies require accurate information on climate change impacts on available water resources. Water accounting, that is a standardized documentation of data on water resources, is a useful tool to provide this information. Pan-European data on climate impacts do not recognize local anthropogenic interventions in the water cycle. Most European river basins have a specific toolset that is understood and used by local experts and stakeholders. However, these local tools are not versatile. Thus, there is a need for a common approach that can be understood by multi-fold users to quantify impact indicators based on local data and that can be used to synthesize information at the European level. Then, policies can be designed with the confidence that underlying data are backed-up by local context and expert knowledge. This work presents a simplified water accounting framework that allows for a standardized examination of climate impacts on water resource availability and use across multiple basins. The framework is applied to five different river basins across Europe. Several indicators are extracted that explicitly describe green water fluxes versus blue water fluxes and impacts on agriculture. The examples show that a simplified water accounting framework can be used to synthesize basin-level information on climate change impacts which can support policymaking on climate adaptation, water resources and agriculture.This research was funded by Horizon 2020 IMPREX project, grant number 641811Hunink, J.; Simons, G.; Suárez-Almiñana, S.; Solera Solera, A.; Andreu Álvarez, J.; Giuliani, M.; Zamberletti, P.... (2019). A Simplified Water Accounting Procedure to Assess Climate Change Impact on Water Resources for Agriculture across Different European River Basins. 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Climatic Change, 135(2), 341-355. doi:10.1007/s10584-015-1570-4Samaniego, L., Thober, S., Kumar, R., Wanders, N., Rakovec, O., Pan, M., … Marx, A. (2018). Anthropogenic warming exacerbates European soil moisture droughts. Nature Climate Change, 8(5), 421-426. doi:10.1038/s41558-018-0138-5Panagopoulos, Y., Stefanidis, K., Faneca Sanchez, M., Sperna Weiland, F., Van Beek, R., Venohr, M., … Birk, S. (2019). Pan-European Calculation of Hydrologic Stress Metrics in Rivers: A First Assessment with Potential Connections to Ecological Status. Water, 11(4), 703. doi:10.3390/w11040703Macknick, J., Newmark, R., Heath, G., & Hallett, K. C. (2012). Operational water consumption and withdrawal factors for electricity generating technologies: a review of existing literature. Environmental Research Letters, 7(4), 045802. doi:10.1088/1748-9326/7/4/045802Koutroulis, A. G., Papadimitriou, L. V., Grillakis, M. G., Tsanis, I. K., Wyser, K., & Betts, R. A. (2018). Freshwater vulnerability under high end climate change. A pan-European assessment. Science of The Total Environment, 613-614, 271-286. doi:10.1016/j.scitotenv.2017.09.074Lobanova, A., Liersch, S., Nunes, J. P., Didovets, I., Stagl, J., Huang, S., … Krysanova, V. (2018). Hydrological impacts of moderate and high-end climate change across European river basins. Journal of Hydrology: Regional Studies, 18, 15-30. doi:10.1016/j.ejrh.2018.05.003Beck, H. E., Vergopolan, N., Pan, M., Levizzani, V., van Dijk, A. I. J. M., Weedon, G. P., … Wood, E. F. (2017). Global-scale evaluation of 22 precipitation datasets using gauge observations and hydrological modeling. Hydrology and Earth System Sciences, 21(12), 6201-6217. doi:10.5194/hess-21-6201-2017Naz, B. S., Kurtz, W., Montzka, C., Sharples, W., Goergen, K., Keune, J., … Kollet, S. (2019). Improving soil moisture and runoff simulations at 3 km over Europe using land surface data assimilation. Hydrology and Earth System Sciences, 23(1), 277-301. doi:10.5194/hess-23-277-2019Haro, D., Solera, A., Paredes, J., & Andreu, J. (2014). Methodology for Drought Risk Assessment in Within-year Regulated Reservoir Systems. Application to the Orbigo River System (Spain). Water Resources Management, 28(11), 3801-3814. doi:10.1007/s11269-014-0710-3Zaniolo, M., Giuliani, M., Castelletti, A. F., & Pulido-Velazquez, M. (2018). Automatic design of basin-specific drought indexes for highly regulated water systems. Hydrology and Earth System Sciences, 22(4), 2409-2424. doi:10.5194/hess-22-2409-2018Koutroulis, A. G., Tsanis, I. K., Daliakopoulos, I. N., & Jacob, D. (2013). Impact of climate change on water resources status: A case study for Crete Island, Greece. Journal of Hydrology, 479, 146-158. doi:10.1016/j.jhydrol.2012.11.055Vargas-Amelin, E., & Pindado, P. (2014). The challenge of climate change in Spain: Water resources, agriculture and land. Journal of Hydrology, 518, 243-249. doi:10.1016/j.jhydrol.2013.11.035Giuliani, M., Li, Y., Castelletti, A., & Gandolfi, C. (2016). A coupled human-natural systems analysis of irrigated agriculture under changing climate. Water Resources Research, 52(9), 6928-6947. doi:10.1002/2016wr019363Giuliani, M., & Castelletti, A. (2016). Is robustness really robust? How different definitions of robustness impact decision-making under climate change. Climatic Change, 135(3-4), 409-424. doi:10.1007/s10584-015-1586-9Grindlay, A. L., Zamorano, M., Rodríguez, M. I., Molero, E., & Urrea, M. A. (2011). Implementation of the European Water Framework Directive: Integration of hydrological and regional planning at the Segura River Basin, southeast Spain. Land Use Policy, 28(1), 242-256. doi:10.1016/j.landusepol.2010.06.005Quevauviller, P., Barceló, D., Beniston, M., Djordjevic, S., Harding, R. J., Iglesias, A., … Werner, M. (2012). Integration of research advances in modelling and monitoring in support of WFD river basin management planning in the context of climate change. Science of The Total Environment, 440, 167-177. doi:10.1016/j.scitotenv.2012.07.055Edens, B., & Graveland, C. (2014). Experimental valuation of Dutch water resources according to SNA and SEEA. Water Resources and Economics, 7, 66-81. doi:10.1016/j.wre.2014.10.003Pedro-Monzonís, M., Jiménez-Fernández, P., Solera, A., & Jiménez-Gavilán, P. (2016). The use of AQUATOOL DSS applied to the System of Environmental-Economic Accounting for Water (SEEAW). Journal of Hydrology, 533, 1-14. doi:10.1016/j.jhydrol.2015.11.034Gouveia, C. M., Trigo, R. M., Beguería, S., & Vicente-Serrano, S. M. (2017). Drought impacts on vegetation activity in the Mediterranean region: An assessment using remote sensing data and multi-scale drought indicators. Global and Planetary Change, 151, 15-27. doi:10.1016/j.gloplacha.2016.06.011Borrego-Marín, M., Gutiérrez-Martín, C., & Berbel, J. (2016). Water Productivity under Drought Conditions Estimated Using SEEA-Water. Water, 8(4), 138. doi:10.3390/w8040138Vardon, M., Lenzen, M., Peevor, S., & Creaser, M. (2007). Water accounting in Australia. Ecological Economics, 61(4), 650-659. doi:10.1016/j.ecolecon.2006.07.033Pedro-Monzonís, M., del Longo, M., Solera, A., Pecora, S., & Andreu, J. (2016). Water Accounting in the Po River Basin Applied to Climate Change Scenarios. Procedia Engineering, 162, 246-253. doi:10.1016/j.proeng.2016.11.051Momblanch, A., Andreu, J., Paredes-Arquiola, J., Solera, A., & Pedro-Monzonís, M. (2014). Adapting water accounting for integrated water resource management. The Júcar Water Resource System (Spain). Journal of Hydrology, 519, 3369-3385. doi:10.1016/j.jhydrol.2014.10.002Karimi, P., Bastiaanssen, W. G. M., & Molden, D. (2012). Water Accounting Plus (WA+) – a water accounting procedure for complex river basins based on satellite measurements. doi:10.5194/hessd-9-12879-2012Karimi, P., Bastiaanssen, W. G. M., Molden, D., & Cheema, M. J. M. (2013). Basin-wide water accounting based on remote sensing data: an application for the Indus Basin. Hydrology and Earth System Sciences, 17(7), 2473-2486. doi:10.5194/hess-17-2473-2013Orth, R., & Destouni, G. (2018). Drought reduces blue-water fluxes more strongly than green-water fluxes in Europe. Nature Communications, 9(1). doi:10.1038/s41467-018-06013-7Van den Hurk, B., Hirschi, M., Schär, C., Lenderink, G., van Meijgaard, E., van Ulden, A., … Jones, R. (2005). Soil Control on Runoff Response to Climate Change in Regional Climate Model Simulations. Journal of Climate, 18(17), 3536-3551. doi:10.1175/jcli3471.1Bergström, S., Carlsson, B., Gardelin, M., Lindström, G., Pettersson, A., & Rummukainen, M. (2001). Climate change impacts on runoff in Sweden-assessments by global climate models, dynamical downscaling and hydrological modelling. Climate Research, 16, 101-112. doi:10.3354/cr016101Arnell, N. W. (1999). The effect of climate change on hydrological regimes in Europe: a continental perspective. Global Environmental Change, 9(1), 5-23. doi:10.1016/s0959-3780(98)00015-6Teuling, A. J., Van Loon, A. F., Seneviratne, S. I., Lehner, I., Aubinet, M., Heinesch, B., … Spank, U. (2013). Evapotranspiration amplifies European summer drought. Geophysical Research Letters, 40(10), 2071-2075. doi:10.1002/grl.50495Destouni, G., & Prieto, C. (2018). Robust Assessment of Uncertain Freshwater Changes: The Case of Greece with Large Irrigation—and Climate-Driven Runoff Decrease. Water, 10(11), 1645. doi:10.3390/w10111645Suárez-Almiñana, S., Pedro-Monzonís, M., Paredes-Arquiola, J., Andreu, J., & Solera, A. (2017). Linking Pan-European data to the local scale for decision making for global change and water scarcity within water resources planning and management. Science of The Total Environment, 603-604, 126-139. doi:10.1016/j.scitotenv.2017.05.259Huang, Z., Hejazi, M., Tang, Q., Vernon, C. R., Liu, Y., Chen, M., & Calvin, K. (2019). Global agricultural green and blue water consumption under future climate and land use changes. Journal of Hydrology, 574, 242-256. doi:10.1016/j.jhydrol.2019.04.046Kahil, M. T., Connor, J. D., & Albiac, J. (2015). Efficient water management policies for irrigation adaptation to climate change in Southern Europe. Ecological Economics, 120, 226-233. doi:10.1016/j.ecolecon.2015.11.004Velasco-Muñoz, J., Aznar-Sánchez, J., Belmonte-Ureña, L., & López-Serrano, M. (2018). Advances in Water Use Efficiency in Agriculture: A Bibliometric Analysis. Water, 10(4), 377. doi:10.3390/w10040377Berbel, J., & Mateos, L. (2014). Does investment in irrigation technology necessarily generate rebound effects? A simulation analysis based on an agro-economic model. Agricultural Systems, 128, 25-34. doi:10.1016/j.agsy.2014.04.002Pedro-Monzonís, M., Ferrer, J., Solera, A., Estrela, T., & Paredes-Arquiola, J. (2014). Water Accounts and Water Stress Indexes in the European Context of Water Planning: The Jucar River Basin. Procedia Engineering, 89, 1470-1477. doi:10.1016/j.proeng.2014.11.431Vanham, D., Hoekstra, A. Y., Wada, Y., Bouraoui, F., de Roo, A., Mekonnen, M. M., … Bidoglio, G. (2018). Physical water scarcity metrics for monitoring progress towards SDG target 6.4: An evaluation of indicator 6.4.2 «Level of water stress». Science of The Total Environment, 613-614, 218-232. doi:10.1016/j.scitotenv.2017.09.056Liu, J., Yang, H., Gosling, S. N., Kummu, M., Flörke, M., Pfister, S., … Oki, T. (2017). Water scarcity assessments in the past, present, and future. 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Journal of Water Reuse and Desalination, 8(2), 153-168. doi:10.2166/wrd.2018.043García-Rubio, M. A., & Guardiola, J. (2012). Desalination in Spain: A Growing Alternative for Water Supply. International Journal of Water Resources Development, 28(1), 171-186. doi:10.1080/07900627.2012.642245Andreu, J., Capilla, J., & Sanchís, E. (1996). AQUATOOL, a generalized decision-support system for water-resources planning and operational management. Journal of Hydrology, 177(3-4), 269-291. doi:10.1016/0022-1694(95)02963-

Ischemic Heart Disease in Chronic Hepatitis B: A Danish Nationwide Cohort Study

OBJECTIVE: Data on the risk of ischemic heart disease (IHD) in patients with chronic hepatitis B virus (CHB) are conflicting. Our objective was to address the rate of IHD in patients with CHB compared with individuals without CHB (control-persons) from the general population. STUDY DESIGN AND SETTING: We conducted a cohort study of prospectively obtained data from Danish nationwide registries. We produced cumulative incidence curves and calculated the unadjusted incidence rate ratio (IRR) of IHD in persons with and without CHB. The adjusted association between having CHB and developing IHD was examined using a cause-specific Cox regression model. RESULTS: In total, 6472 persons with CHB and 62,251 age- and sex-matched individuals from the general population were followed for 48,840 and 567,456 person-years, respectively, during which 103 (1,59%) with CHB and 1058 (1,70%) control-persons developed IHD. The crude IRR was 1.13 (95% CI: 0.91–1.39). CHB did not have a statistically significant effect on the rate of IHD after adjusting for several confounding factors (adjusted hazard ratio: 0.96, 95% CI: 0.76–1.21). CONCLUSION: In this nationwide cohort study, we did not find any difference between rate of IHD in persons with CHB in comparison with the general population

Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.

OBJECTIVE: The aim of this study was to explore the potential of ambulance call-out data in understanding violence to inform about prevention activity. METHOD: This cross-sectional (2013-2015) study examined the nature, extent and characteristics of violence-related ambulance call-outs (n=15 687) across North West England and relationships with temporal, celebratory and sporting events. RESULTS: The majority of call-outs were for men, with a mean age of 33 years. Most call-outs were to deprived (64.4%) and urban (65.4%) areas and occurred at night (18:00-5:59; 75.2%). Three-quarters (77.3%) were recorded as assault/sexual assault and 22.7% stab/gunshot/penetrating trauma. Significant differences in call-out characteristics were identified between the two violence types. Generalised linear modelling found that call-outs significantly increased on weekends, New Year's Eve and weekday bank holiday eves (except for stab/gunshot/penetrating trauma). No significant associations between all violence call-outs, the two violence categories and sporting or celebration events were identified. Two-thirds (66.1%) of the call-outs were transferred to another health service for further assessment and/or treatment. The odds of being transferred were significantly higher among men (adjusted OR (AOR) 1.5, 95%CI 1.4 to 1.6), those aged 13-24 years (AOR 1.2, 95%CI 1.0 to 1.4), call-outs for stab/gunshot/penetrating trauma (AOR 1.4, 95%CI 1.3 to 1.5) and call-outs on Fridays/Saturdays (AOR 1.1, 95%CI 1.0 to 1.2) and lower for call-outs on New Year's Eve (AOR 0.6, 95%CI 0.4 to 0.9). CONCLUSION: Ambulance call-out data can provide a wealth of information to understand violence and subsequently inform about violence prevention and response activity. Ambulance services and staff could play a key role in preventing violence through sharing data and identifying and supporting victims