Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature

Skin serves as the first protective line and barrier of the body. Like many other organs, skin can be affected by several disorders in response to external factors such as pathogens, ultraviolet light, and pollution, as well as endogenous alterations related to aging and/or oxidative stress disturbance. Researchers have reported new insights into how skin cells are altered in response to caloric restriction diets in mammals. One of the most well-known caloric restriction diets is the Ramadan intermittent fasting, which is a radical change in the diet plan of practitioners for the period of one lunar month. Ramadan fasting represents the fourth of the five pillars of the Islamic creed. Even though infirm individuals are waived to take part in this religious duty, patients with various health problems, including those with different skin disorders, might choose to share this event with peers and family members. No standardized protocols or guidelines exist, however, to advise their physicians on the proper management of their patients' condition during fasting. With an increasing Muslim population living in Western countries, this topic has started to draw substantial attention, not only of Middle-Eastern physicians, but also of clinicians in the West. For this purpose, we carried out a comprehensive overview on the topic. Our main findings are that: (1) there is a strong need for evidence-based suggestions and guidance. Literature on the impact of the Ramadan fasting, as well as of other kinds of fasting, on skin diseases is scarce and of poor quality, as well as the information available from the Internet; (2) patients willing to fast should be advised about the importance of taking proper treatments or consider alternative options including administration of trans-dermal/topical drugs, as they are permitted during daylight hours. Further, non-compliance has important, clinical and economic implications for an effective patient management

Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review

Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Non-invasive monitoring of microbial induced oil degradation in beach sediment under high conductivity conditions using the spectral induced polarization method

Massive oil spills, such as the Deepwater Horizon oil spill in April 2010, have prompted increased research and attention on the techniques available to monitor oil spills, including degradation processes, and have highlighted the limitations of existing monitoring methods. Previous research has shown the spectral induced polarization method (SIP) to be sensitive to the biogeochemical changes that occur as a result of microbial oil degradation; however, there is no research on the applicability of the SIP method under high conductivity conditions typical of coastal environments. The purpose of this study is to monitor natural attenuation of microbial oil degradation in brackish coastal sediment. Natural attenuation is of primary importance since in many instances, such as for remote and inaccessible areas, it is the only option available for remediation. This research is based on the hypothesis that biogeochemical changes due to microbially-induced processes can generate detectable SIP signals, even under high conductivity environments. Five different treatments of heavy oil contaminated sediment were run for 143 days. Results indicated that geophysical signals were more pronounced in the columns with conductivities close to the actual field conditions from where the sediments were collected. Gas Chromatography/Mass Spectrometry analysis showed decreased peaks in the chromatograms of active columns compared to control columns, as well as the appearance of metabolites, indicating degradation of the substrate (contaminant oil). The results show that SIP is sensitive to the biogeochemical changes occurring as a result of microbial oil degradation even under high conductivity conditions, indicating that it could be a useful tool to non-invasively monitor natural attenuation within brackish environments.M.S.Includes bibliographical referencesby Christine M. Kima

ВПЛИВ КОМПЛЕКСНОГО ЛІКУВАННЯ НА ПОКАЗНИКИ ВУГЛЕВОДНОГО ОБМІНУ У ХВОРИХ НА ГЕНЕРАЛІЗОВАНИЙ ПАРОДОНТИТ ОСІБ МОЛОДОГО ВІКУ

Abstract. The dynamics of the inflammatory process in the periodontium, its generalization and chronization are determined not only by the composition of the microflora, but also by the state of the protective reactions of the organism (the pro-atherogenic spectrum of lipids and the violation of the carbohydrate metabolism) and  reactivity of the immune system in response to the pathogenic factor.Purpose of the study. The study of changes in the parameters of carbohydrate metabolism in the oral fluid of young patients with generalized periodontitis (GP), before and during different terms after the complex treatment, has determined the relevance of the direction we selected.Material and methods. Somatically healthy persons aged 18-25 years were examined and treated: 30 patients with chronic generalized periodontitis – group І, 32 patients – with exacerbation of chronic generalized periodontitis – group II and 30 persons with a healthy parodontium. Indicators of carbohydrate metabolism were determined in the oral liquid: content of glucose, pyruvate (pyruvic acid) and lactate (lactic acid) and lactate dehydrogenase (LDG) activity before, immediately and after 6 and 12 months after the treatment. A significant increase of all studied by us carbohydrate metabolism parameters (p<0.001) has been found, which confirms its imbalance. In order to regulate the revealed violations, initial periodontal therapy was prescribed; oral dishes with the solution of St. John’s wort, gum applications and instillation of the gel developed by us on the basis of medicinal herbs (extract of Echinacea purpureum, tincture of Eleutherococcus and St. John’s wort) and sorbent, and inside – the herbal syrup “Immuno-tone”.Results. Conclusions. The regulation of the parameters of carbohydrate metabolism in the oral liquid of patients of groups I and II with the achievement of these standards, especially after 6 and 12 months after the treatment, showed the effectiveness of the developed by us therapeutic complex and allowed us to recommend it for the widespread introduction into practice.Резюме. Динамика воспалительного процесса в пародонте, его генерализация и хронизация определяются не столько составом микрофлоры, как состоянием защитных реакций организма (проатерогенный спектр липидов и нарушение углеродного обмена) и реактивностью иммунной системы в ответ на патогенный фактор. Поскольку метаболизм углеродов больных генерализованным пародонтитом (ГП), особенно молодых людей, малоисследован, избранное нами направление актуальное.Цель работы. Изучение изменений показателей углеродного обмена в ротовой жидкости лиц молодого возраста, больных ГП, до и в разные сроки после комплексного лечения.Материал и методы. Обследованы и пролечены  соматически здоровые лица, возрастом 18-25 лет: 30 больных с хроническим генерализованным пародонтитом – І группа, 32 – с обострением хронического генерализованного пародонтита – ІІ группа и 30 лиц со здоровым пародонтом. В ротовой жидкости определяли показатели углеродного обмена: содержание глюкозы, пирувата (пировиноградной кислоты), лактата (молочной кислоты) и активность лактатдегидрогеназы (ЛДГ) до, сразу, через 6 и 12 месяцев после лечения.Определено достоверное повышение всех изученных нами показателей углеродного обмена (р<0,001), что свидетельствует о его дисбалансе. Для регуляции установленных нарушений назначали инициальную пародонтальную терапию, ротовые ванночки с раствором зверобоя, апликации на десна и инстиляции разработанного нами геля на основании лечебных трав и сорбента, внутрь – растительный сироп „Имуно-тон”.Результаты и выводы. Регуляция показателей углеродного обмена в ротовой жидкости больных І и ІІ групп с достижением данных нормы, особенно через 6 и 12 месяцев после лечения, свидетельствуют о действенности разработанного нами терапевтического комплекса и разрешает предлагать его для широкого внедрения в практику.Резюме. Динаміка запального процесу в пародонті, його генералізація та хронізація визначаються не стільки складом мікрофлори, як станом захисних реакцій організму (проатерогенний спектр ліпідів і порушення вуглеводного обміну) та реактивністю імунної системи у відповідь на патогенний чинник. Оскільки метаболізм вуглеводів у хворих на генералізований пародонтит (ГП), особливо в молодих людей, досліджувався мало, обраний нами напрямок є  актуальним.Мета роботи. Вивчення змін показників вуглеводного обміну в ротовій рідині осіб молодого віку, хворих на ГП, до і в різні терміни після комплексного лікування.Матеріал і методи. Обстежено і проліковано соматично здорові особи, віком 18-25 років: 30 хворих на хронічний генералізований пародонтит – І група, 32 – на загострення хронічного генералізованого пародонтиту – ІІ група та 30 осіб зі здоровим пародонтом. У ротовій рідині визначали показники вуглеводного обміну: вміст глюкози, пірувату (піровиноградної кислоти) і лактату (молочної кислоти) та активність лактатдегідрогенази (ЛДГ) до, одразу, через 6 і 12 місяців після лікування.Результати. Встановлено достовірне підвищення усіх вивчених нами показників вуглеводного обміну (р<0,001), що засвідчує його дисбаланс. Для регуляції виявлених порушень призначали ініціальну пародонтальну терапію, ротові ванночки із розчину звіробою, аплікації на ясна й інстиляції розробленого нами гелю на основі лікарських трав (екстракту ехінацеї пурпурової, настоянки елеуторокока і звіробою) та сорбента, всередину – рослинний сироп „Імуно-тон”.Висновок. Урегулювання показників вуглеводного обміну в ротовій рідині хворих І і ІІ груп із досягненням даних норми, особливо через 6 і 12 місяців після лікування, засвідчило дієвість розробленого нами терапевтичного комплексу, що дозволяє рекомендувати його для широкого впровадження у практику