Oral lichenoid drug reaction with autoantibodies in peripheral blood: Case report

AbstractA 51-year-old man complained of oral roughness and pain. At the age of 49 years, he was admitted for 8 months for bipolar emotional disorder. Oral administration of lithium carbonate was started. Extensive, hemorrhagic, erythema-mixed white lace-like patches were noted on the lip, buccal mucosae, and lingual margins. On biopsy, all lesions were consistent with oral lichen planus. A drug lymphocyte stimulation test showed a positive reaction to lithium carbonate. Blood examination revealed marked increases in the peripheral blood levels of antinuclear antibodies. To relieve the symptoms, the systemic administration of prednisolone was performed while continuing the lithium carbonate

Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research

BACKGROUND: There is a need for a clinically relevant and feasible outcome measure to facilitate clinical studies in perioperative care medicine. This large-scale retrospective cohort study proposed a novel composite outcome measure comprising invasive respiratory or vasopressor support (IRVS) and death. We described the prevalence of IRVS in patients undergoing major abdominal surgery and assessed the validity of combining IRVS and death to form a composite outcome measure. METHODS: We retrospectively collected perioperative data for 2776 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or esophageal resection) at Kyoto University Hospital. We defined IRVS as requirement for mechanical ventilation for ≥24 hours postoperatively, postoperative reintubation, or postoperative vasopressor administration. We evaluated the prevalence of IRVS within 30 postoperative days and examined the association between IRVS and subsequent clinical outcomes. The primary outcome of interest was long-term survival. Multivariable Cox proportional regression analysis was performed to adjust for the baseline patient and operative characteristics. The secondary outcomes were length of hospital stay and hospital mortality. RESULTS: In total, 85 patients (3.1%) received IRVS within 30 postoperative days, 15 of whom died by day 30. Patients with IRVS had a lower long-term survival rate (1- and 3-year survival probabilities, 66.1% and 48.5% vs 95.2% and 84.0%, respectively; P < .001, log-rank test) compared to those without IRVS. IRVS was significantly associated with lower long-term survival after adjustment for the baseline patient and operative characteristics (adjusted hazard ratio, 2.72; 95% confidence interval, 1.97–3.77; P < .001). IRVS was associated with a longer hospital stay (median [interquartile range], 65 [39–326] vs 15 [12–24] days; adjusted P < .001) and a higher hospital mortality (24.7% vs 0.5%; adjusted P < .001). Moreover, IRVS was adversely associated with subsequent clinical outcomes including lower long-term survival (adjusted hazard ratio, 1.78; 95% confidence interval, 1.21–2.63; P = .004) when the analyses were restricted to 30-day survivors. CONCLUSIONS: Patients with IRVS can experience ongoing risk of serious morbidity and less long-term survival even if alive at postoperative day 30. Our findings support the validity of using IRVS and/or death as a composite outcome measure for clinical studies in perioperative care medicine

Década de la Energía Sostenible para Todos

Naciones Unidas, tras la proclamación de 2012 como "Año Internacional de la Energía Sostenible para todos", refuerza ahora su ambicioso pero fundamentado proyecto de revolución energética, instituyendo una Década (2014-2024) destinada a la puesta en marcha de las medidas necesarias para que la totalidad de los seres humanos pueda disponer de recursos energéticos renovables y no contaminantes. Se pretende así contribuir a erradicar la pobreza y a atajar el destructivo desarreglo climático que ya estamos empezando a sufrir