A randomized clinical trial of topical dexamethasone vs. cyclosporine treatment for oral lichen planus

Oral lichen planus (OLP) is a common, frequently symptomatic, immune-mediated disease. Various treatments have been used for symptomatic OLP, including corticosteroids and immunosuppressants administered topically or systemically. The aim of this study was to compare the effectiveness of topical dexamethasone vs. topical cyclosporine in treatment of symptomatic OLP. Thirty-two patients with biopsy-proven symptomatic OLP were randomly assigned to two therapeutic groups: dexamethasone 2mg/5ml or cyclosporine 100mg/ml, both administered topically in a swish and spit method three times a day for 4 weeks. The patients were followed up for a total of 6 months. Assessed parameters included clinical scoring (according to Thongprasom?s scale, 0-5), pain (VAS scale, 0-10), dysphagia and speech difficulties (none, mild or severe). Possible side effects, including fungal overgrowth, were also recorded. At the end of the 4-week treatment period, both dexamethasone and cyclosporine showed a statistically significant improvement in clinical scoring (p<0.025 and p=0.034, respectively), which was better with dexamethasone (p=0.001). In addition, both dexamethasone and cyclosporine induced statistical significant improvement in pain and dysphagia (and speech difficulties for dexamethasone), without significant differences between the two groups. Regarding side effects, patients in the dexamethasone group developed candidiasis more frequently compared to cyclosporine (p=0.031). At the end of the 6-month follow-up period, the difference in response between the two groups was not statistically significant. Interestingly, a trend for further improvement compared with the end of the 4-week treatment period was noticed only for patients treated with cyclosporine. Despite the small number of enrolled patients, topical cyclosporine treatment induces a significant clinical improvement in symptomatic OLP patients, which, compared to topical dexamethasone, appears to be less pronounced during initial administration, but capable to induce further improvement after discontinuation with a satisfactory long-term remission in the absence of significant side effects. This study may contribute to a better understanding of the differences in effectiveness of OLP topical treatments and guide future larger scale clinical trials

Canalicular adenoma with unicystic morphology. A rare entity

Canalicular adenoma (CA) is a benign salivary gland tumor (SGT) almost exclusively affecting the minor salivary glands, predominantly of the upper lip, and exhibiting characteristic histopathologic features. As observed in several other SGTs, a commonly

Frequent COL4 mutations in familial microhematuria accompanied by later-onset Alport nephropathy due to focal segmental glomerulosclerosis

Familial microscopic hematuria (FMH) is associated with a genetically heterogeneous group of conditions including the collagen-IV nephropathies, the heritable C3/CFHR5 nephropathy and the glomerulopathy with fibronectin deposits. The clinical course varies widely, ranging from isolated benign familial hematuria to end-stage renal disease (ESRD) later in life. We investigated 24 families using Next Generation Sequencing (NGS) for five genes: COL4A3, COL4A4, COL4A5, CFHR5 and FN1. In 17 families (71%), we found 15 pathogenic mutations in COL4A3/A4/A5, nine of them novel. In five families patients inherited classical AS with hemizygous X-linked COL4A5 mutations. Even more patients developed later-onset Alport-related nephropathy having inherited heterozygous COL4A3/A4 mutations that cause thin basement membranes. Amongst 62 heterozygous or hemizygous patients, eight (13%) reached ESRD, while 25% of patients with heterozygous COL4A3/A4 mutations, aged >50-yrs, reached ESRD. In conclusion, COL4A mutations comprise a frequent cause of FMH. Heterozygous COL4A3/A4 mutations predispose to renal function impairment, supporting that thin basement membrane nephropathy is not always benign. The molecular diagnosis is essential for differentiating the X-linked from the autosomal recessive and dominant inheritance. Finally, NGS technology is established as the gold standard for the diagnosis of FMH and associated collagen-IV glomerulopathies, frequently averting the need for invasive renal biopsies

End-stage kidney disease due to haemolytic uraemic syndrome - outcomes in 241 consecutive ANZDATA Registry cases

Extent: 11p.Background: The aim of this study was to investigate the characteristics and outcomes of patients receiving renal replacement therapy for end-stage kidney disease (ESKD) secondary to haemolytic uraemic syndrome (HUS). Methods: The study included all patients with ESKD who commenced renal replacement therapy in Australia and New Zealand between 15/5/1963 and 31/12/2010, using data from the ANZDATA Registry. HUS ESKD patients were compared with matched controls with an alternative primary renal disease using propensity scores based on age, gender and treatment era. Results: Of the 58422 patients included in the study, 241 (0.4%) had ESKD secondary to HUS. HUS ESKD was independently associated with younger age, female gender and European race. Compared with matched controls, HUS ESKD was not associated with mortality on renal replacement therapy (adjusted hazard ratio [HR] 1.14, 95% CI 0.87-1.50, p = 0.34) or dialysis (HR 1.34, 95% CI 0.93-1.93, p = 0.12), but did independently predict recovery of renal function (HR 54.01, 95% CI 1.45-11.1, p = 0.008). 130 (54%) HUS patients received 166 renal allografts. Overall renal allograft survival rates were significantly lower for patients with HUS ESKD at 1 year (73% vs 91%), 5 years (62% vs 85%) and 10 years (49% vs 73%). HUS ESKD was an independent predictor of renal allograft failure (HR 2.59, 95% CI 1.70-3.95, p < 0.001). Sixteen (12%) HUS patients experienced failure of 22 renal allografts due to recurrent HUS. HUS ESKD was not independently associated with the risk of death following renal transplantation (HR 0.92, 95% CI 0.35-2.44, p = 0.87). Conclusions: HUS is an uncommon cause of ESKD, which is associated with comparable patient survival on dialysis, an increased probability of renal function recovery, comparable patient survival post-renal transplant and a heightened risk of renal transplant graft failure compared with matched ESKD controls.Wen Tang, Janaki Mohandas, Stephen P McDonald, Carmel M Hawley, Sunil V Badve, Neil Boudville, Fiona G Brown, Philip A Clayton, Kathryn J Wiggins, Kym M Bannister, Scott B Campbell and David W Johnso

Nurses&apos; attitudes toward truthful communication with patients with cancer: A Greek study

The purpose of this study was to examine Greek nurses&apos; attitudes toward truth-telling practices when working with cancer patients and their psychological status regarding the difficulties they face in their day-to- day communication with these patients. A self-administered questionnaire composed of 19 questions, including both multi-item scales and single-item measures, was designed for the study. For this study, 200 nurses were asked to participate, of whom 148 (74%) completed and returned the questionnaire. The questionnaire is self-administered, formulated after a thorough review of the relevant literature. The pretesting was carried out using the alpha model of reliability and the Cochran Chi Square test (Q-test), which was 545.46 (P &lt; .0001) and showed a Cronbach alpha coefficient of 0.7148. A large percentage of the respondents (75.7%) believe that only some patients with cancer should be told the truth of their diagnosis and prognosis, although a larger percentage (89.1%) believe that the truth should be told to the relatives. Most of the respondents (66.2%) reported that is difficult to engage in open communication with the patients, because their academic education did not sufficiently train them in communication skills. Although 83.78% of the nurse respondents do not reveal that the disease is incurable, 86 (58.1%) believe that only the patient&apos;s physician should reveal the truth. These results indicate that although many Greek nurses believe that the patients should be informed and know their condition, lack of training in communication skills is a major obstacle to achieving this. Finally, this self-assessment questionnaire may provide acceptable and valid assessment of Greek nurses&apos; perceptions and attitudes on truth telling

Powerless and Reversible Color Humidity Sensor

One dimensional (1D) Photonic crystals (PC) are the simplest form of PC consisting of alternative layers of materials having different refractive indices. This periodic structure has very interesting optical properties allowing manipulation and control of light reflectance wavelength. Polymers have already been used as optical components in several devices and recently became candidate materials for the fabrication of PC. In the present work, a polymeric multilayer stack consisting of alternating hydrophobic and hydrophilic layers is fabricated and its response in controlled concentrations of humidity is evaluated towards the development of an optical humidity sensor. (C) 2011 Published by Elsevier Ltd

A randomized clinical trial of topical dexamethasone vs. cyclosporine treatment for oral lichen planus

BACKGROUND: Oral lichen planus (OLP) is a common, frequently symptomatic, immune-mediated disease. Various treatments have been used for symptomatic OLP, including corticosteroids and immunosuppressants administered topically or systemically. The aim of this study was to compare the effectiveness of topical dexamethasone vs. topical cyclosporine in treatment of symptomatic OLP. MATERIAL AND METHODS: Thirty-two patients with biopsy-proven symptomatic OLP were randomly assigned to two therapeutic groups: dexamethasone 2mg/5ml or cyclosporine 100mg/ml, both administered topically in a swish and spit method three times a day for 4 weeks. The patients were followed up for a total of 6 months. Assessed parameters included clinical scoring (according to Thongprasom&apos;s scale, 0-5), pain (VAS scale, 0-10), dysphagia and speech difficulties (none, mild or severe). Possible side effects, including fungal overgrowth, were also recorded. RESULTS: At the end of the 4-week treatment period, both dexamethasone and cyclosporine showed a statistically significant improvement in clinical scoring (p&lt;0.025 and p=0.034, respectively), which was better with dexamethasone (p=0.001). In addition, both dexamethasone and cyclosporine induced statistical significant improvement in pain and dysphagia (and speech difficulties for dexamethasone), without significant differences between the two groups. Regarding side effects, patients in the dexamethasone group developed candidiasis more frequently compared to cyclosporine (p=0.031). At the end of the 6-month follow-up period, the difference in response between the two groups was not statistically significant. Interestingly, a trend for further improvement compared with the end of the 4-week treatment period was noticed only for patients treated with cyclosporine. CONCLUSIONS: Despite the small number of enrolled patients, topical cyclosporine treatment induces a significant clinical improvement in symptomatic OLP patients, which, compared to topical dexamethasone, appears to be less pronounced during initial administration, but capable to induce further improvement after discontinuation with a satisfactory long-term remission in the absence of significant side effects. This study may contribute to a better understanding of the differences in effectiveness of OLP topical treatments and guide future larger scale clinical trials

Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report

Squamous cell carcinoma (SCC) developing in lesions of discoid lupus erythematosus (DLE) is rare, most frequently arising on sun-exposed skin and very rarely affecting the lips. A review of the English language literature revealed only 21 published cases of labial SCC in patients with DLE. Here, an unusual case of a patient with DLE who developed 3 primary SCCs of the oral and perioral region is presented. A 40-year-old female with a 24-year history of DLE with peri- and intraoral involvement initially developed SCC of the vermillion border of the right lower lip; the lesion was surgically removed and did not recur within 6 months. In spite of strong recommendation for regular follow-up, the patient failed to keep her appointments but returned 7 years later. No signs of recurrence of the original lower lip cancer were noticed, but a new SCC of the left lateral border of the tongue with cervical lymph node metastasis was diagnosed; despite aggressive combined treatment, locoregional recurrence and distant metastatic disease developed within a few months; in addition, a new primary SCC of the vermillion border of the left lower lip developed. This rare case and a thorough review of the pertinent literature underscore the possibility of development of even multiple intraoral and perioral SCCs in the context of longstanding DLE, which necessitates close long term follow-up for early diagnosis and management. © 2017 Elsevier Inc