Addictive Behaviors

Substance craving changes in university students receiving heart rate variability biofeedback: A longitudinal multilevel modeling approach Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Nour Alayan, David Eddie, Lucille Eller, Marsha E. Bates, Dennis P. Carmody Abstract Background Previously published findings from a study of university students living in substance use disorder (SUD) recovery housing showed an eight-session heart rate variability biofeedback (HRVB) intervention significantly reduced craving. That study, however, uncovered pronounced inter-participant variability in craving change patterns through the course of HRVB that warranted further exploration. The purpose of the current investigation was to examine how within- and between-person factors may have differentially influenced craving changes. Methods A longitudinal multilevel modeling approach was used with time at level-1 nested within persons at level-2. Multilevel models of change were estimated to model craving trajectories and predictor relationships over time as a function of age, sex, length of abstinence, daily HRVB practice, anxiety, depression, and stress. Results A quadratic pattern of craving reductions was found, indicating that craving reductions accelerated over time for some participants. Daily HRVB practice of >12 min and older age significantly enhanced craving reductions over time. Increases in depressive symptoms attenuated the effects of HRVB on craving. The other predictors were not significantly associated with craving in this study. The true R2 for the final model indicated that 20.5% of the variance in craving was explained by older age, daily HRVB >12 min, and within-person changes in depression. Conclusions HRVB shows promise as an accessible, scalable, and cost-effective complementary anti-craving intervention. Healthcare providers may help persons recovering from SUD to better manage substance craving by the routine and strategic use of HRVB practice.

The relationship of loot box purchases to problem video gaming and problem gambling Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Wen Li, Devin Mills, Lia Nower Abstract Loot boxes are virtual items in many video games that let players "gamble" on an item of chance. Loot boxes bring an element of gambling into video games, which might prime video game users to engage in online gambling activities. However, few studies have focused on this emerging issue. The present study investigated the relationships between loot box purchases and both problem video gaming and problem gambling severity. Cross-sectional, self-report data were collected from 618 adult video gamers (M = 27 years of age, SD = 8.9, 63.7% male) via an online survey. Nearly half of the sample (44.2%) spent money on loot box purchases in the past year. Loot box purchasers played video games and gambled online more frequently, reported more extended gaming and online gambling sessions, and endorsed higher levels of problem video gaming and problem gambling severity as well as greater mental distress relative to those who did not buy loot boxes. Results from a series of path analyses revealed that loot box purchasing was directly related to problem video gaming and problem gambling severity as well as indirectly through increased video gaming/online gambling engagement, which in turn is related to elevated psychological distress. The present findings provide insight into the role of loot box purchasing in the transition from recreational engagement in video gaming and online gambling to problem video gaming and/or problem gambling.

History of regular nonmedical sedative and/or alcohol use differentiates substance-use patterns and consequences among chronic heroin users Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Tabitha E.H. Moses, Mark K. Greenwald Abstract Background Concurrent use of sedating substances (e.g. alcohol or benzodiazepines) with opioids is associated with increased negative consequences of opioid use; however, few studies have attempted to differentiate effects of using sedating substances on heroin-use outcomes. This study examines differences between heroin users who use alcohol or misuse sedatives regularly and those who do not. Methods Substance-use data were collected from 367 non-treatment seeking, chronic heroin-using, 18-to-55 year-old participants. We created 4 groups based on self-reported lifetime history of regular (at least weekly) substance use: heroin only (n = 95), heroin and sedatives (n = 21), heroin and alcohol (n = 151), and heroin, sedative, and alcohol (n = 100). Chi-square analyses and ANOVAs with Bonferroni post hoc tests were used to explore differences between these groups. Results Heroin users who denied lifetime alcohol or nonmedical sedative use regularly endorsed fewer consequences associated with any substance they had used. Total adverse consequences of heroin use (e.g. health problems) were significantly higher among those who misused sedatives regularly, irrespective of alcohol use history (F(3,361) = 10.21; p < .001). Regular alcohol use did not independently impact heroin consequences but was associated with increased use of other substances. Conclusions Although polysubstance use is normative among heroin users, the risks depend on the substances used. Regular sedative use is associated with increased heroin consequences whereas regular alcohol use is not. This study refines the investigation of polysubstance use and highlights subgroup differences depending on types of substances used regularly. This knowledge is critical for understanding substance-use motivations and creating avenues for harm reduction.

The fuzzy future: Time horizon, memory failures, and emotional distress in gambling disorder Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Giovanna Nigro, Francesca D'Olimpio, Maria Ciccarelli, Marina Cosenza Abstract This study aimed to first investigate the interplay among self-rated ability in both retrospective and prospective memory, time perspective, and negative affectivity to gambling severity. Two hundred and three habitual players took part in the study. Participants were administered the South Oaks Gambling Screen (SOGS), the Consideration of Future Consequences scale (CFC-14), the Prospective and Retrospective Memory Questionnaire (PRMQ), as well as the Depression, Anxiety and Stress Scales-21 (DASS-21). Overall, data indicated that the higher the involvement in gambling, the higher the depression levels and the shorter the time horizon. The results of linear regression analysis showed that, along with gender, years of education, depression, and inattention to the future consequences of actual behavior, the negative self-perception of prospective memory functioning represents a significant predictor of gambling severity. Finally, to clarify if depression was on the path from prospective memory to gambling severity or if prospective memory was the mediator of the impact of depression on gambling severity, data were submitted to path analysis. Results indicated that depression has a direct effect on gambling severity and mediates the association between prospective memory and gambling involvement. The relation between gambling severity and prospective memory scores suggests that impairment in prospective memory plays a key role in adult problematic gambling.

Fatigue severity and electronic cigarette beliefs and use behavior Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Michael J. Zvolensky, Kara Manning, Lorra Garey, Nubia A. Mayorga, Natalia Peraza Abstract Electronic cigarette (e-cigarette) use has risen dramatically in the United States. Clinically significant fatigue may represent one previously unexplored individual difference factor related to e-cigarette use patterns and e-cigarette specific cognitive processes. Fatigue reflects the experience of being tired, lacking energy, and feeling exhausted. Although fatigue is a normal bodily response, severe or chronic fatigue is maladaptive. Thus, the current study sought to evaluate clinically significant fatigue and its relation to perceived barriers for quitting e-cigarettes, perceived risks and perceived benefits of e-cigarette use, and e-cigarette dependence among 625 adult e-cigarette smokers (51.8% female, Mage = 34.91 years, SD = 10.29). Results indicated that severe fatigue was significantly related to greater perceived barriers to quitting (p < .001), perceived risks (p < .001) and perceived benefits (p < .001) of e-cigarette use, and greater e-cigarette dependence (p < .001); effects that were evident after adjusting for a range of other factors (e.g., combustible cigarette use, pain severity). These novel empirical results highlight the severity of fatigue as a potentially important construct in efforts to better understand beliefs related to e-cigarette use and e-cigarette dependence.

Psychosocial correlates in treatment seeking gamblers: Differences in early age onset gamblers vs later age onset gamblers Publication date: October 2019 Source: Addictive Behaviors, Volume 97 Author(s): Steve Sharman, Raegan Murphy, John Turner, Amanda Roberts Abstract Background Age of onset is an important factor in the development and trajectory of psychiatric disorders; however, little is known regarding the age of onset in relation to disordered gambling in treatment seeking samples in the UK. Utilising a large residential treatment seeking gambler cohort, the current study examined the relationship between age of gambling onset and a range of variables thought to be associated with disordered gambling. Method Data were collected from 768 gamblers attending residential treatment for disordered gambling. Individuals were grouped per the age they started gambling as either a child (≤12), adolescent (13–15), or young adult/adult (≤16). Data were analysed using linear, backward stepwise, and multinomial logistic regressions to identify significant relationships between age of onset and variables of theoretical significance. Results Results indicate the younger age of gambling onset was associated with increased gambling severity. Those who began gambling at an earlier age were more likely to have abused drugs or solvents, committed an unreported crime, been verbally aggressive and experienced violent outbursts. They are less likely to report a positive childhood family environment and are more likely to have had a parent with gambling and/or alcohol problems. Discussion Gamblers who began gambling at an earlier age experience negative life events and exhibit some antisocial behaviors more than later onset gamblers, indicating that when addressing gambling behavior, it is important to consider the developmental trajectory of the disorder, rather than merely addressing current gambling behavior. However, the direction of the relationship between gambling and significant variables is in some instance unclear, indicating a need for further research to define causality.

Cue-induced craving and symptoms of online-buying-shopping disorder interfere with performance on the Iowa Gambling Task modified with online-shopping cues Publication date: September 2019 Source: Addictive Behaviors, Volume 96 Author(s): Patrick Trotzke, Katrin Starcke, Astrid Müller, Matthias Brand Abstract Background and aims Subjects with buying-shopping disorder (BSD) continue to buy offline as well as online despite negative consequences. Previous studies indicate that subjects with BSD show cue-reactivity and craving when exposed to shopping cues and have problems in long-term advantageous decision-making. The current study aimed at investigating the effect of online-shopping cues on decision-making, and whether addiction-relevant concepts such as cue-reactivity/craving and the symptom severity of BSD are related to decision-making. Methods A non-clinical sample of 57 participants played a version of the modified Iowa Gambling Task (IGT), with online-shopping-related pictures shown either on the advantageous decks or on the disadvantageous decks (with control pictures on the opposing ones). Symptom severity of online-BSD and the craving to buy were assessed using questionnaires. In addition, the online-shopping pictures were rated concerning arousal, valence, and urge to buy. Results The participants who played the IGT with the online-shopping pictures displayed on the disadvantageous decks performed significantly poorer than the other group with online-shopping pictures on the advantageous decks. The between-group differences were moderated by craving reactions and the symptom severity of online-BSD: When online-shopping pictures were displayed on the disadvantageous decks, this only interfered with IGT performance in participants who had high craving reactions towards shopping cues and/or high symptom severity of online-BSD. Conclusion Results indicate that exposure to online-shopping cues interferes with advantageous decision-making, especially in individuals with craving reactions and high symptoms of online-BSD. Results contribute to the question of why some people continue to buy despite negative consequences.

Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers Publication date: September 2019 Source: Addictive Behaviors, Volume 96 Author(s): Michael J. Zvolensky, Justin M. Shepherd, Jafar Bakhshaie, Lorra Garey, Andres G. Viana, Natalia Peraza Abstract Latinx smokers in the United States (U.S.) represent an understudied health disparities group in terms of tobacco use. Despite scientific interest to elucidate individual difference risk factors for smoking, there is limited understanding of how emotional dysregulation relates to smoking outcomes among Spanish-speaking Latinx smokers. The purpose of the present investigation was therefore to explore emotion dysregulation in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Results indicated that emotion dysregulation was significantly related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Notably, the effects accounted for 7% to 15% of variance and were evident after adjusting for gender, income, education, number of medical conditions, depression symptoms, non-alcohol drug use, and alcohol consumption. The findings provide novel evidence that emotion dysregulation may represent an important individual difference factor for better understanding smoking-related outcomes among Latinx smokers and supports the need for greater attention to this affective vulnerability during smoking cessation treatment.

The epidemiology of prescription fentanyl misuse in the United States Publication date: September 2019 Source: Addictive Behaviors, Volume 96 Author(s): Ty S. Schepis, Vita V. McCabe, Carol J. Boyd, Sean Esteban McCabe Abstract Background US opioid overdose deaths continue to climb, with a 12.0% increase from 2016 to 2017. Fentanyl, a synthetic opioid, has been a major contributor to opioid-related overdose deaths. While fentanyl-related overdose is driven by illicit fentanyl, little is known about individuals who misuse prescription fentanyl, which is also linked to elevated overdose and mortality risk. This work aimed to fill that gap through analyses of prescription fentanyl misuse correlates. Methods Data were from the 2015–16 National Survey on Drug Use and Health (N = 114,043), a nationally representative survey of the non-institutionalized US population. Respondents were (all past-year): those misusing prescription fentanyl (PF); those misusing other (non-fentanyl) prescription opioids (NFPO); and population controls. Respondent groups were compared using multinomial regression on sociodemographics, physical health, mental health and substance use. The PF and NFPO misuse groups were compared on opioid misuse characteristics, using logistic regression. Results An estimated 4.4% misused NFPO, and 0.1% misused PF (past-year). Past-year heroin use was more common in those who misused PF (44.3%) than those who misused other NFPO (4.4%; relative risk ratio [RRR] = 7.1, 95%CI = 3.7–13.9) or population controls (0.1%, RRR = 35.1, 95%CI = 17.3–71.1). Non-alcohol substance use disorder (SUD) was similarly elevated in those who misused PF (78.7%) versus the other NFPO group (27.5%, RRR = 3.8, 95%CI = 1.8–8.2) or population controls (1.6%, RRR = 20.6, 95%CI = 9.4–45.5). Conclusions Respondents who misused prescription fentanyl were both more drug-involved generally and opioid-involved specifically; and likely need a combination of significant interventions and monitoring for their polysubstance use.

Overlapping epidemics of alcohol and illicit drug use among HCV-infected persons who inject drugs Publication date: September 2019 Source: Addictive Behaviors, Volume 96 Author(s): Risha Irvin, Geetanjali Chander, Oluwaseun Falade-Nwulia, Jacquie Astemborski, Laura Starbird, Gregory D. Kirk, Mark S. Sulkowski, David L. Thomas, Shruti H. Mehta Abstract Background Alcohol use in people who inject drugs (PWID) with hepatitis C virus (HCV) infection accelerates liver disease progression. This paper describes the prevalence and associated correlates of alcohol use among HCV antibody positive PWID. Methods In a large cohort of HCV antibody positive PWID (N = 1623) followed from 2005 to 2013, we characterized alcohol use using the AUDIT-C. We used multivariable logistic regression with generalized estimated equations to examine socio-demographic, clinical, and substance use correlates of alcohol use. Results At their initial visit, 41% reported no, 21% reported moderate, and 38% reported heavy alcohol use. The odds of moderate and heavy alcohol use increased with greater intensity of substance use represented by a composite summary variable which ranged from 0 to 3 substances (street-acquired prescription drugs, non-injection cocaine/heroin, and injection drugs) used. Compared to those who used no drugs, those who used 3 substances had 3.71 odds (95% CI: 3.07–4.48) of moderate alcohol use and 3.65 odds (95% CI: 3.20–4.16) of heavy alcohol use. Conclusions The prevalence of moderate/heavy alcohol use is high among HCV antibody positive PWID and occurs frequently in combination with other drug use. This may contribute to progressive liver fibrosis thus limiting the gains achieved from HCV cure. Public health interventions need to address the overlapping epidemics of HCV, alcohol use, and other substance use in this population.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Dermatologie , Vénéréologie

Lymphome cérébral primitif après immunothérapie d'un mélanome métastatique Publication date: Available online 20 May 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): M. Castel, C. Cotten, A. Deschamps-Huvier, M.-H. Commin, F. Marguet, F. Jardin, A.-B. Duval-Modeste, P. Joly Résumé Introduction Les anticorps anti-PD-1 et anti-CTLA-4 sont des inhibiteurs de checkpoints du système immunitaire utilisés dans le traitement du mélanome. Les anti-PD-1 ont été récemment validés comme traitement du lymphome de Hodgkin. Le lymphome cérébral primitif est une forme rare de lymphome non hodgkinien pour lequel il existe peu de traitements efficaces. Des études ont montré l'efficacité des anticorps anti-PD-1 dans des lymphomes non hodgkiniens, dont le lymphome cérébral primitif. Observation Un patient de 59 ans présentait un mélanome métastatique traité depuis plusieurs mois par immunothérapie (anti-CTLA-4, puis anti-PD-1). Après 28 cures, le pembrolizumab était arrêté devant une rémission complète du mélanome. Une hémiparésie gauche survenait deux mois après l'arrêt de l'immunothérapie, révélant un lymphome cérébral primitif évolutif. Une chimiothérapie par méthotrexate à hautes doses était débutée, sans efficacité. Malgré une seconde ligne de traitement par chimiothérapie R-ICE (rituximab-ifosfamide, carboplatine et étoposide), le patient décédait des suites de son lymphome cérébral. Discussion Plusieurs hypothèses peuvent être avancées quant à un lien éventuel entre l'immunothérapie et la survenue du lymphome cérébral. Nous pouvons évoquer le contrôle d'un lymphome méconnu par l'immunothérapie, suivi d'un échappement et d'une progression rapide à l'arrêt du traitement, mais l'hypothèse d'un lymphome induit par l'immunothérapie n'est pas exclue. Enfin, l'immunothérapie peut n'avoir joué aucun rôle, l'association entre lymphome et mélanome étant bien connue. Conclusion Malgré l'impossibilité de conclure sur l'imputabilité de l'immunothérapie dans la survenue du lymphome cérébral primitif, ce cas soulève de nombreuses questions sur le possible rôle de l'immunothérapie dans la survenue de cancers secondaires, dont des lymphomes. Summary Background Anti-PD-1 and anti-CTLA-4 monoclonal antibodies are used in melanoma, while anti-PD-1 are also used in Hodgkin's lymphoma. Primary central nervous system lymphoma is a rare form of non-Hodgkin's lymphoma with few effective treatments. However, several recent studies have reported multiple cases of non-Hodgkin's lymphoma and primary central nervous system lymphoma treated by anti-PD-1 antibodies with favourable responses. Patients and methods This study focuses on the case of a 59-year-old man with metastatic melanoma treated by immunotherapy (anti-CTLA-4 followed by anti-PD-1). He underwent 28 courses of therapy with pembrolizumab. Treatment was stopped after clinical and radiological remission. The patient presented left hemiparesis and a primary central nervous system lymphoma was diagnosed two months after discontinuation of immunotherapy. He started urgent high-dose methotrexate chemotherapy but without significant results. Despite second-line chemotherapy with R-ICE (rituximab-ifosfamide, carboplatin and etoposide), the patient died. Discussion Several hypotheses may be advanced regarding a possible relationship between immunotherapy and the occurrence of this primary central nervous system lymphoma. The lymphoma may have been pre-existing and controlled by immunotherapy, but progressing rapidly after treatment, or it may have been induced by the immunotherapy. However, immunotherapy may have played no role; the relationship between melanoma and lymphoma is well known. Conclusion While immunotherapy cannot be unequivocally incriminated in primary central nervous system lymphoma, this case raises many questions about the imputability of immunotherapy in the occurrence of secondary cancers, including lymphomas.

Exploration photodermatologique en France. Enquête de la Société Française de Photodermatologie Publication date: Available online 15 May 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A. Moreau, M. Avenel-Audran, H. Adamski, F. Aubin, J.-C. Beani, C. Bedane, A. Bonnevalle, C. Boulitrop, J.-L. Bourrain, L. Boursault, H. Dutartre, M. Jeanmougin, F. Leonard, L. Machet, M.-C. Marguery, B. Rouchouse, J.-L. Schmutz, Groupe de la Société française de photodermatologie

Skin lightening and its motives: A historical overview Publication date: Available online 12 May 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A. Petit

Infections humaines à poxvirus Publication date: Available online 9 May 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): G. Bohelay, T.-A. Duong Résumé Les infections à poxvirus (PXV) sont fréquemment responsables de manifestations cutanées. En France, certaines poxviroses sont fréquentes et bénignes (molluscum contagiosum), alors que d'autres sont exceptionnelles mais potentiellement graves (cowpoxvirus [CPXV]). Si seuls le virus de la variole et le molluscum contagiosum virus sont à réservoir humain et à transmission interhumaine, la plupart des infections à poxvirus sont des zoonoses avec un réservoir animal distinct. Seule une partie des poxvirus est responsable d'infections humaines, mais l'augmentation du nombre des nouveaux animaux de compagnie, parfois exotiques, et la rapidité des voyages internationaux exposent au risque de transmission de PXV zoonotiques à de nouveaux vecteurs et leur diffusion, à de nouvelles régions du monde. En France, le molluscum contagiosum, l'orf et le nodule du trayeur sont responsables de multiples consultations et sont bien connus des dermatologues. Toutefois d'autres parapoxvirus de présentations proches de l'orf ne doivent pas être méconnus ; ainsi le CPXV ou le monkeypox virus sont considérés comme des virus potentiellement émergents avec un fort risque d'épidémie et de diffusion du fait de l'exacerbation des transports internationaux et de la perte de la protection vaccinale antivariolique. Enfin, malgré une éradication déclarée, la variole fait l'objet d'une surveillance du fait d'un risque potentiel de réintroduction accidentelle ou volontaire par le bioterrorisme. Summary Poxvirus (PXV) infections are a common cause of cutaneous signs. In France, certain forms of poxvirus are frequent and benign (molluscum contagiosum), while others are rare but potentially serious (cowpox virus [CPXV]). Whereas only smallpox and molluscum contagiosum viruses have a human reservoir and are transmitted between humans, most poxvirus infections are zoonoses having only animal reservoirs. Only a small number of poxviruses are responsible for infection in humans, but the increasing number of new pets, some of which are exotic, coupled with the rapid rise in international travel are creating a greater risk of transmission of zoonotic PXV to new vectors and of spread of these diseases to new regions throughout the world. In France, molluscum contagiosum, orf and milkers' nodule give rise to numerous consultations and are well known to dermatologists. However, dermatologists must also be able to identify other parapoxviruses of similar presentation to orf; thus, CPXV and monkeypox are considered potentially emergent viruses with a high risk of epidemic and spread due to increasing international transport and the loss of the maximum protection against smallpox. Finally, despite its declared eradication, smallpox is currently being monitored because of the potential risk of reintroduction, whether accidentally or deliberately through bioterrorism.

Scores de sévérité dans le psoriasis de l'enfant : revue systématique de la littérature Publication date: Available online 4 May 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): J. Lavaud, E. Mahé Résumé Introduction Le psoriasis touche 0,5 à 1 % des enfants en Europe. Il impacte de manière importante la qualité de vie. Depuis quelques années, des traitements systémiques ont été autorisés chez les enfants atteints de psoriasis modéré à sévère. L'évaluation de la sévérité de la maladie est donc importante pour la prise en charge de ces enfants. Il n'existe cependant pas d'uniformisation des scores de sévérité, ni de consensus national ou international concernant leur utilisation dans le psoriasis de l'enfant. L'objectif de ce travail était d'étudier l'utilisation des scores de sévérité clinique et de qualité de vie (critères et seuil définissant la sévérité) chez les enfants atteints de psoriasis. Méthode Une revue systématique de la littérature a été conduite à partir des bases de données PubMed et Embase. Des recherches complémentaires ont été réalisées à partir des références bibliographiques des articles sélectionnés. Les mots-clés suivants ont été utilisés : « psoriasis », avec « pediatric », « childhood », « infant », « Child » ou « adolescent », et « Severity of Illness Index », « sickness impact profile », « quality of life », « index », « measure » ou « score ». Une première sélection a été effectuée à partir du titre et du résumé des articles. Résultats Après évaluation de 1712 articles sur Medline et 233 sur Embase, 78 ont finalement été retenus. Le « Psoriasis Area and Severity Index » (PASI : 74,4 %) était le score le plus fréquemment utilisé, suivi par la « Surface Cutanée Atteinte » (SCA : 48,7 %) et le « Physician's Global Assessment » (PGA : 29,5 %). Le recours à des thérapies systémiques ou l'échec des traitements locaux ont également été utilisés comme critère de sévérité. Plus de la moitié des études ne spécifiaient pas le seuil de la sévérité. Nous avons aussi observé une grande hétérogénéité des seuils de définition de la sévérité du psoriasis. Les scores utilisés étaient souvent les mêmes quels que soient le type de psoriasis et l'âge des patients. Concernant la qualité de vie, la majorité des études utilisaient le « Children's Dermatology Life Quality Index » (CDLQI : 23,1 %) et le DLQI (5,1 %). Des scores de qualité de vie non spécifiques du psoriasis ont également été utilisés comme le « Pediatric Quality of Life Inventory » (Peds-QL : 6,4 %) et le Skindex (2,6 %). Il n'y avait pas non plus de définition du seuil de sévérité pour ces scores. Discussion Les scores de sévérité sont utilisés pour la plupart par analogie avec l'adulte, sans validation dans la population pédiatrique. Ils ne tiennent pas compte des spécificités pédiatriques : évolution de la SCA en fonction de l'âge, aspects cliniques du psoriasis, types cliniques. Les limites de la sévérité sont très mal définies chez l'enfant, qu'il s'agisse de la clinique ou de la qualité de vie. Cela rend difficile la comparaison entre les différents travaux et pose problème pour la prescription des traitements systémiques. Cette étude montre la nécessité de valider les scores de gravité et de qualité de vie, et de définir les seuils adaptés aux enfants. Summary Background Psoriasis affects 0.5 to 1 % of children in Europe. It has a significant impact on quality of life. Recently, systemic treatments have been licensed for children with moderate-to-severe psoriasis. While scores to assess the severity of the disease are thus important for the management of these children, there is no standardization or consensus concerning their use in childhood psoriasis. The aim of this study was to examine the use of clinical severity scores and quality of life in children with psoriasis. Patients and methods A systematic literature review was conducted on PubMed and Embase. Further research was carried out using the bibliographic references in selected articles. The following keywords were used: "psoriasis" with "pediatric", "childhood", "infant", "child" or "adolescent", and "Severity of Illness Index", "sickness impact profile", "quality of life", "index", "measure" or "score". A first selection was made from the titles and abstracts of the selected articles. Results After evaluating 1712 articles on Medline and 233 on Embase, 78 were finally selected. The Psoriasis Area Severity Index (PASI: 74.4 %) was the most frequently found score followed by the Body Surface Area (BSA: 48.7 %) and the Physician's Global Assessment (PGA: 29.5 %). Recourse to systemic therapies and failure of topical treatments were also used as severity criteria. Over half the studies did not define a severity threshold. We also observed extensive heterogeneity in the definition of psoriasis severity. The same scores were often used regardless of psoriasis type or patient age. Regarding quality of life, most studies used the Children's Dermatology Life Quality Index (CDLQI: 23.1 %) and DLQI (5.1 %). Non-specific quality-of-life scores for psoriasis were also used, such as the Pediatric Quality of Life Inventory (Peds-QL: 6.4 %) and Skindex (2.6 %). Here again, no severity threshold was defined for these scores. Discussion Severity scores are chiefly used by analogy with adults but without validation in the pediatric population. They do not consider pediatric specificities such as progression of BSA according to age, clinical aspect, clinical types, etc. Severity thresholds are rarely defined in children, whether in terms of clinical score or quality of life. This can constitute a limitation in terms of both prescription of systemic treatments and comparison between different studies. Our study demonstrates the need to validate severity and quality-of-life scores and to define child-specific thresholds.

Etanercept reduces anxiety and depression in psoriasis patients, and sustained depression correlates with reduced therapeutic response to etanercept Publication date: Available online 30 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A. Yang, X. Xin, W. Yang, M. Li, W. Yang, L. Li, X. Liu Summary Background The purpose of this study was to explore the correlation of anxiety and depression with therapeutic response to etanercept in psoriasis patients. Patients and methods One hundred and thirty-three patients with moderate-to-severe plaque psoriasis undergoing etanercept treatment were consecutively enrolled in this prospective cohort study, with all patients receiving etanercept treatment for 6 months. Psoriasis Area and Severity Index (PASI) score was evaluated at baseline (M0) and at month 1 (M1), M3 and M6 after treatment, and PASI 75/90 responses were calculated. The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score and the HADS-Depression (HADS-D) score were used to evaluate patients' anxiety and depression at M0, M1, M3 and M6. Sustained anxiety/depression were defined as HADS-A/D score ≥ 8 points both at M0 and M1. Results Female gender and higher PASI score were associated with high risk of anxiety, while female gender, higher PASI score and longer disease duration were correlated with increased depression risk. After 6 months of etanercept treatment, 65.4% and 36.1% patients achieved PASI 75 and PASI 90 responses respectively, and both HADS-A and HADS-D scores were decreased. Most importantly, no correlation of baseline anxiety and depression with PASI 75 or PASI 90 response after 6 months of treatment was noted, while sustained depression, though not sustained anxiety, was observed to be correlated with decreased PASI 75 and PASI 90 responses. Conclusions Etanercept reduces anxiety and depression in psoriasis patients, and sustained depression correlates with reduced therapeutic response to etanercept. Résumé Introduction Le but de ce travail était d'étudier la relation entre la réponse à l'étanercept et les niveaux d'anxiété et de dépression des patients atteints de psoriasis. Patients et méthodes Ont été inclus dans cette étude prospective 133 patients consécutifs atteints de psoriasis en plaques modéré à sévère ; tous ont reçu un traitement par étanercept d'une durée de six mois. Le score Psoriasis Area and Severity Index (PASI) était mesuré à l'inclusion (M0) et après 1,3 et 6 mois de traitement ; les réponses PASI 75 et PASI 90 (améliorations de respectivement 75% et 90% du score) ont été calculées. Les scores Hospital Anxiety and Depression Scale-Anxiety (HADS-A) pour l'anxiété et HADS-D pour la dépression ont été évalués à M0, M1, M3 et M6. Une anxiété ou une dépression persistantes étaient définies par des scores HADS-A ou D ≥ 8 points à la fois à M0 et M1. Résultats Le sexe féminin et un score PASI plus élevé étaient associés à une plus grande anxiété ; les mêmes facteurs plus la durée d'évolution de la maladie étaient associés à un score de dépression plus élevé. Après 6 mois d'étanercept, le PASI 75 et le PASI 90 étaient atteints par respectivement 65,4% et 36,1 % des patients, tandis que les scores HADS-A et HADS-D diminuaient tous les deux. Le point le plus important est qu'il n'est apparu aucune corrélation les niveaux d'anxiété et de dépression à M0 et les réponses PASI 75 ou PASI 90 à M6 ; en revanche, la dépression persistante, mais non l'anxiété persistante, était associée à une moins bonne réponse au traitement en termes de PASI 75 et de PASI 90. Conclusions L'étanercept réduit les niveaux d'anxiété et de dépression des patients atteints de psoriasis. Une dépression persistante est associée à une moins bonne réponse au traitement.

Dermite de rappel induite par le vémurafénib Publication date: Available online 10 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): A. Greliak, A. Le Guern, M. Bataille, D. Lebas, T. Wiart, P. Modiano Résumé Introduction La dermite de rappel est une réaction inflammatoire survenant sur un site précédemment irradié et provoquée par l'administration d'un traitement. Dans de rares cas, il s'agit d'un traitement par inhibiteurs de BRAF ou de MEK. Cas clinique Nous rapportons le cas inhabituel d'une dermite de rappel survenue trois mois après l'introduction de l'association vémurafénib/cobimétinib. Discussion La dermite de rappel est une réaction cutanée qui doit être connue et qui peut exceptionnellement, comme dans notre observation, survenir tardivement après la fin de la radiothérapie. Summary Introduction Radiation recall dermatitis is an uncommon inflammatory reaction of the skin appearing after several days to several years at the site of previous irradiation; it is precipitated by the use of triggering drugs, although rarely by BRAF or MEK inhibitors. Patients and methods We report an unusual case of recall dermatitis induced 3 months after initiation of vemurafenib and cobimetinib therapy. Discussion Radiation recall dermatitis is a cutaneous reaction that must be known and which in rare cases such as ours may occur a long time after the end of radiotherapy.

Psoriasis de l'enfant vu en milieu libéral : les aspects cliniques et épidémiologiques diffèrent des données habituellement publiées Publication date: Available online 4 April 2019 Source: Annales de Dermatologie et de Vénéréologie Author(s): E. Mahé, F. Maccari, M. Ruer-Mulard, N. Bodak, H. Barthelemy, C. Nicolas, E. Pépin, M. Pillette-Delarue, C. Buzenet, P.-L. Delaire, M. Nadaud, F. Bouscarat, D. Drouot-Lhoumeau, C. Lepelley-Dupont, A. Acher, A. Beauchet, F. Corgibet, Fédération française de formation continue et d'évaluation en dermatologie-vénéréologie et le GEM Resopso Résumé Introduction Le psoriasis touche 0,2 à 0,7 % des enfants et est associé à l'obésité. Les études publiées ont été réalisées en milieu hospitalier. L'étude PsoLib a évalué le psoriasis de l'enfant consultant dans des cabinets privés en évaluant les aspects épidémiologiques et cliniques, ainsi que les comorbidités. Méthodes Il s'agissait d'une étude multicentrique, transversale et non interventionnelle d'enfants (0 à 18 ans) atteints de psoriasis, réalisée par 41 dermatologues travaillant dans des cabinets privés. Les aspects cliniques et thérapeutiques et les comorbidités ont été évalués de manière systématique. Nous avons comparé les données à l'étude χ-Psocar réalisée avec la même méthodologie dans des hôpitaux français. Résultats Au total, 207 enfants (filles : 60,4 % ; âge moyen : 10,5 ± 4,2 ans) ont été inclus. Le psoriasis du cuir chevelu (40,6 %) était le type clinique le plus fréquent, tandis que le type en plaques généralisées ne représentait que 26 % des cas. L'atteinte des ongles ou de la langue et le rhumatisme psoriasique étaient rarement observés. Moins de 1 % des enfants souffraient d'hypertension, de diabète de type 1 ou de dyslipidémie, mais 16,4 % étaient en surpoids et 7,0 % étaient obèses. La gravité (PGA maximum ≥ 4) était associée au surpoids (p = 0,01). Conclusion Le psoriasis du cuir chevelu est le type clinique de psoriasis le plus fréquent chez l'enfant. Les comorbidités et la localisation extracutanée sont rares. Même dans les cabinets privés, la gravité de la maladie est associée au surpoids. Summary Background Psoriasis affects 0.2–0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. Patients and methods This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. Results In all, 207 children (girls: 60.4 %; mean age: 10.5 ± 4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG ≥ 4 at peak) was associated with excess weight (P = 0.01). Conclusion Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.

Réponse des auteurs à la correspondance à propos de l'article : « Maladie de Paget sur sein surnuméraire » Publication date: April 2019 Source: Annales de Dermatologie et de Vénéréologie, Volume 146, Issue 4 Author(s): M.-H. Jegou, E. Lorier-Roy, Groupe Dermatolist, I. Roche

Correspondance à propos de l'article : « Maladie de Paget sur sein surnuméraire » Publication date: April 2019 Source: Annales de Dermatologie et de Vénéréologie, Volume 146, Issue 4 Author(s): C. Perrin

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Otology & Neurotology

The Impact of Canalplasty on Outcomes of Medial Graft Tympanoplasty Objective: Both medial and lateral graft techniques are commonly employed in tympanoplasty with acceptable closure rates. Canalplasty is routinely performed to obtain adequate exposure in the lateral graft technique; this usually entails removal of the anterior canal wall skin with subsequent replacement as a free graft. While formal canalplasty can also be performed in conjunction with medial graft technique to improve exposure, it is not commonly described. The current study seeks to examine the impact of canalplasty on outcomes of medial graft tympanoplasty. Methods: A retrospective chart review was performed for patients undergoing tympanoplasty for chronic otitis media with the senior author. Audiometric data were recorded both preoperatively and postoperatively. Primary outcome measure was perforation closure with audiometric outcomes examined as secondary outcome measures. Results: One hundred seventy tympanoplasties without ossiculoplasty were included in our study. The overall rate of perforation closure postoperatively was 77%. Cartilage use portended a higher closure rate (100%) when compared with nonuse (75%) (p = 0.04). The success rates with lateral grafts (94%) and medial grafts with canalplasty (92%) were considerably higher than obtained with medial grafts without canalplasty (69%) (p = 0.005 and 0.02, respectively). In cases with anterior perforations greater than 25% of the tympanic membrane, our results demonstrated a significant advantage in performing canalplasty (p = 0.04). Conclusions: Data from the current study suggest that canalplasty offers benefit regarding closure rate in medial graft tympanoplasty. Use of cartilage also portended a higher rate of perforation closure. Canalplasty should be considered when using medial graft techniques if exposure is limited due to bony canal anatomy. Address correspondence and reprint requests to Paul R. Lambert, M.D., Department of Otolaryngology, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425; E-mail: lambertp@musc.edu The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Easy Stapes Subluxation in 22q11.2 Deletion Syndrome: A Clinical Capsule and Literature Review Objectives: This report describes iatrogenic stapes subluxation in a 22q11 deletion syndrome patient and reviews the human and murine literature for evidence that these patients have stapes malformations. We aim to alert otologic surgeons regarding the possibility of stapes footplate abnormalities in 22q11 deletion patients. Patient: An adult woman with known 22q11 deletion syndrome. Additionally, the literature review focused on other patients with 22q11 deletion syndrome as well as mouse models of this disorder. Interventions: A combination of diagnostic and therapeutic interventions were conducted consisting of middle ear exploration, removal of ossicular chain adhesions, and ultimately ossicular reconstruction. Results: The stapes footplate was poorly attached to the oval window in our patient. During removal of ossicular adhesions, the entire stapes subluxed requiring placement of a stapes prosthesis. The postoperative audiogram was similar to the preoperative audiogram. Literature review identified one other case of stapes subluxation in a patient with 22q11 deletion syndrome, and mouse models suggest that the stapes footplate has an abnormal connection to the oval window in those affected by 22q11 deletion syndrome. Conclusions: Patients with 22q11 deletion syndrome have chronic middle ear pathology, and if middle ear exploration is undertaken, the surgeon should be aware that the stapes may have a weak attachment to the oval window. This could put the stapes at risk of injury and contribute to conductive hearing loss. Address correspondence and reprint requests to Arnaldo L. Rivera, M.D., Department of Otolaryngology, One Hospital Drive, Columbia, MO 65212; E-mail: riveraal@health.missouri.edu This report has been submitted for presentation at the American Otological Society's Annual Meeting portion of the Combined Otolaryngology Spring Meetings, May 3–5, 2019. This case report received institutional review board approval by the University of Missouri IRB. No funding sources were utilized for this study. A.R., C.K. and J.C. has no competing interests to disclose. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Comprehensive Analysis of Factors Leading to Poor Performance in Prelingual Cochlear Implant Recipients Objective: To comprehensively analyze the prognostic factors responsible for affecting outcomes following cochlear implantation in prelinguals. Study Design: Retrospective cohort study from June 2004 to November 2015. Setting: Tertiary care center. Patients: Patients who had undergone cochlear implantation during June 2004 to November 2015 for prelingual sensorineural hearing loss with a minimum follow-up of 2 years. Intervention: Patients were evaluated for the presence of 20 risk factors possibly influencing postimplantation outcomes using a questionnaire. Main Outcome Measures: Assessment for speech and auditory function was done at the last follow-up with speech intelligibility ratings (SIR) and categories of auditory performance (CAP) scores, respectively. Results: One hundred fifty-one patients were included in this study. On univariate analysis for CAP, age at implantation, noncompliance to pre and postimplantation auditory and speech habilitation, poor parental motivation, socioeconomic status and literacy were found to be associated with lower scores (p < 0.05). Whereas, for SIR, additionally, attention deficit hyperactivity disorder and inner ear malformation were statistically significant negative predictors on univariate analysis. Finally, factors responsible for low CAP scores on multivariate analysis were poor parental literacy, poor socioeconomic status, irregular pre/postimplantation rehabilitation, and attention deficit hyperactivity disorder. While for SIR, additionally age at implantation was also a significant negative predictor. Increasing IQ and duration of implant use were associated with higher CAP (univariate) and SIR scores (univariate and multivariate) (p < 0.05). Conclusion: We were able to demonstrate negative impact of higher age at implantation, minimal cognitive disorder, adverse parental/socioeconomic profile, and poor compliance to pre/postimplantation auditory verbal habilitation on auditory and speech outcomes. Address correspondence and reprint requests to Kapil Sikka, M.S., Associate Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Teaching Block, 4th Floor, All India Institute of Medical Sciences, Ansari Nagar, East, New Delhi 110029, India; E-mail: Kapil_sikka@yahoo.com The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Evaluating the Long-Term Hearing Outcomes of Cochlear Implant Users With Single-Sided Deafness Objectives: To investigate the long-term outcomes of cochlear implantation in individuals with single-sided deafness (SSD) in terms of speech perception, subjective hearing performance, and sound localization. Methods: Thirty-four subjects with SSD were recruited across two large cochlear implant (CI) centers (Antwerp, Belgium and Perth, Australia). The long-term hearing outcomes (between 4 and 10 years of CI use) were evaluated using speech in noise tests, a subjective hearing performance questionnaire (Speech, Spatial and Qualities Questionnaire [SSQ12]), and sound localization tests. Results: Statistically significant improvements were observed in speech perception in noise and sound localization results postoperatively with the use of a CI in comparison to preoperative measurements. Subjective hearing abilities also significantly improved after long-term CI use. Conclusion: Access to binaural hearing is important for subjects with SSD. CI users with SSD experience long-term benefits in speech understanding, sound localization, and quality of life. Address correspondence and reprint requests to Dayse Távora-Vieira, Otolaryngology, Head & Neck Surgery, Medical School, University of Western Australia, Perth, 102 - 118 Murdoch Drive, Murdoch WA 6150, Australia; Fiona Stanley Hospital, Perth, Australia; E-mail: dayse.tavora@gmail.com The authors report no conflicts of interest Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Application of Kaizen Principles to a Large Cochlear Implant Practice: A Continuous Quality Improvement Initiative at Mayo Clinic Objective: To remove barriers and improve access for patients seeking cochlear implantation. Study Design: Prospective quality improvement study at a large tertiary academic care center. Methods: A Kaizen quality improvement model was applied over the course of a year. Four weeklong meetings were used to identify areas for improvement and remediation. Data were collected at baseline, 90-days, and 1-year postcompletion of the project. Outcome measures included lead times, defined as the wait time between first contact with the clinic and the first appointment, and the wait time between surgery and activation, and cycle times defined as the total test time needed to determine cochlear implant candidacy, and total time needed to complete initial activation. The total inventory kept as clinic stock was also calculated Results: Kaizen team members collected data for each outcome measure. After the Kaizen principles were applied, the following outcomes were observed: median lead times between first contact with the clinic to candidacy testing, candidacy testing to surgery, and surgery to activation of the implant remained stable from baseline to 1-year follow-up. Median cycle time for candidacy testing decreased from 7.3 hours at baseline to 3.0 hours at 1-year follow-up. Cycle times for initial activation of the device did not change over time. The total inventory of clinic stock was reduced by 31%. Conclusions: Though outcomes for lead and cycle times varied, implementation of Kaizen principles was found to be an effective method for completing this quality improvement project at a large cochlear implant program overall. Level of Evidence: 3a Address correspondence and reprint requests to Douglas P. Sladen, Ph.D., Department of Communication Sciences and Disorders, Western Washington University, 516 High Street, Bellingham, WA 98225; E-mail: douglas.sladen@wwu.edu This project was funded through a grant provided by MED EL GMBH. M.L.C. is a consultant for Advanced Bionics Corp., Cochlear Corp., and MED-EL GmbH. M.D.D. is a consultant for MED-EL GmbH. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Quality of Life in Jugular Paraganglioma Following Radiosurgery Objective: The treatment paradigm for jugular paraganglioma (JP) has changed considerably over time with the wider adoption of stereotactic radiosurgery (SRS). To the best of the authors' knowledge, there are no published studies that use validated patient-reported outcome measures to ascertain quality of life (QoL) outcomes following SRS for JP when used in single or combined modality treatment regimens. Study Design: Cross-sectional survey. Setting: Tertiary referral center. Patients: Adult patients with JP treated with primary SRS or SRS following primary surgery between 1990 and 2017. Interventions(S): Surgery and/or Gamma Knife SRS. Main Outcome Measures: Global and treatment-related QoL and differences in QoL based on treatment approach. Results: Sixty-nine surveys were distributed and a total of 26 completed surveys were received (38% response rate). Among respondents, the median age at SRS was 53 years and 16 of the 26 patients (62%) were female. Median follow-up was 97 months. Nineteen patients (73%) were treated with primary SRS or staged SRS following intentional subtotal resection (STR; hereafter referred to as "staged SRS"), while the remainder (n = 7, 27%) were treated with SRS for recurrent JP. Median physical and mental health QoL PROMIS-10 T-scores regardless of treatment strategy were 39.8 and 38.8, respectively, while median SF36 physical and mental component subscores were similar to national averages and non-tumor controls. When comparing general physical and mental health QoL scores, there was no significant difference between patients treated with primary or staged SRS and those treated with SRS for recurrent JP. However, age-adjusted swallowing function among patients treated with primary or staged SRS was better than in those patients treated with SRS for recurrent JP (p = 0.05). Conclusions: Patients treated with primary or staged SRS for JP tend to exhibit better swallowing outcomes than those treated with SRS for recurrent JP. However, the majority of overall and disease-specific quality of life measures were not different between groups. Based on the low incidence of new cranial neuropathy following SRS, it is likely that initial surgical morbidity is the primary contributor to this outcome. Disease-specific overall quality of life measures, akin to those already used for other benign skull base tumors, are necessary to better gauge physical and mental health outcomes following treatment for JP. Though limited by small sample size, this represents the first study to gauge QoL outcomes following treatment for JP. Address correspondence and reprint requests to Matthew L. Carlson, M.D., Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905; E-mail: carlson.matthew@mayo.edu Internal departmental funding was used without commercial sponsorship or support. Mayo Clinic IRB Approval 16-002291. Presented at the 2018 American Academy of Otolaryngology – Head and Neck Surgery Meeting, October 7–10, Atlanta, GA. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo Tends to Reoccur Objective: We analyzed the clinical characteristics of quite a large cohort of patients with bilateral posterior canal benign paroxysmal positional vertigo (bil-BPPV) with respect to the rate and types of recurrence. Study Design: Retrospective case review. Setting: Outpatient dizziness clinic. Patients: About 2,050 patients diagnosed with BPPV during the years 2003 to 2018 were reviewed. Results: Sixty (2.9%) were diagnosed with bil-BPPV. Fifty three (88%) were idiopathic and seven (12%) posttraumatic. Multiple BPPV episodes were encountered in 28 (47%) patients. Patients with bil-BPPV and multiple BPPV episodes were comparable with patients with a single attack of bil-BPPV except for older age and longer follow up. The most frequent type of recurrence following a bil-BPPV episode was posterior canal canalolithiasis (37.5%) and bil-BPPV (31.3%). Combined (posterior and horizontal) BPPV was encountered in 12.5% while horizontal canal involvement was found in only 7% of recurrences. Conclusions: The prevalence of bil-BPPV amongst all BPPV patients was lower than previously reported possibly due to stricter selection criteria. Older age and longer follow up of patients with multiple BPPV episodes than those with a single episode of bil-BPPV is in accordance with the theory of degenerative otoconia loosening. In contrast to the general consensus regarding random recurrences of BPPV side and subtypes, bil-BPPV recurred more frequently than expected. This might be the consequence of individual vulnerability to head movements, increased bone metabolism or an underlying vestibular pathology. Address correspondence and reprint requests to Lea Pollak, M.D., Kibutz Galuyot 4, Nes Ziona 74012, Israel; E-mail: lea.pollak@gmail.com The authors declare no funding sources or acknowledgments. The authors have no conflicts of interest to disclose. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Serum Bilirubin Level as a Potential Marker for the Hearing Outcome in Severe-Profound Bilateral Sudden Deafness Objective: To investigate the association of serum bilirubin level with hearing outcomes in bilateral sudden sensorineural hearing loss (BSSHL) patients. Participants: One hundred thirteen in-patient BSSHL patients were consecutively enrolled between July 2008 and December 2015 in a tertiary center. Main Outcome Measures: Multivariable linear regression, generalized estimating equations (GEE), and stratified analyses were applied to examine the association between serum bilirubin level and hearing outcome measures such as final hearing threshold and absolute and relative hearing gains in BSSHL. Results: After full adjustment for potential confounders, total bilirubin levels (TBIL) were observed to be positively and independently associated with hearing outcomes as measured by final hearing (β [95% confidence interval {CI}]: −1.5 [−2.7, −0.2] dB HL per 1 μmol/L increase in TBIL) and absolute and relative hearing gains (β [95% CI]: 1.4 [0.2, 2.7] dB and 1.6 [0.2, 3.1] dB, respectively) in the severe to profound hearing loss subpopulation. Conclusions: Higher TBIL levels, within the normal or mildly elevated ranges, were independently and significantly associated with better hearing outcome in BSSHL patients with severe to profound hearing loss. Given bilirubin elevation treatments exist, our finding suggests a novel pharmacological strategy for this specific subpopulation. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Address correspondence and reprint requests to Qiu-Ju Wang, M.D., Ph.D., Department of Otolaryngology–Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, 100853, Beijing, China; E-mail: wqcr301@vip.sina.com Source of Funding: The work was supported by the National Natural Science Foundation of China (No.81530032 and No.81500794), the National Key Basic Research Program of China (No.2014CB943001), the China Postdoctoral Science Foundation (No. 2017M613326) and the New Researcher Foundation of the PLA General Hospital (No. 14KMZ04). The authors have no conflicts of interest to disclose. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Incus Necrosis and Blood Supply: A Micro-CT and Synchrotron Imaging Study Background: Incus necrosis is a common complication following stapes surgery and is associated with impaired microcirculation. The objective of this study was to investigate the vascular anatomy of the human incus by using light microscopy, micro-computed tomography (micro-CT), and synchrotron phase-contrast imaging (SR-PCI) for a novel three-dimensional (3D) analysis of the middle ear, mucosal folds, major vascular pathways, and intraosseous vascular bone channels. Methods: One-hundred-and-fifty temporal bones from the Uppsala collection were analyzed under light microscopy. Twenty temporal bones underwent high-resolution micro-CT scanning, and an additional seven specimens underwent SR-PCI at the Canadian Lightsource in Saskatoon, Canada. One of these specimens was from an individual who had undergone stapes surgery. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping for bone transparency, cropping, and soft tissue analyses. Results: Micro-CT and SR-PCI with 3D rendering revealed the extensive vascular plexus within the un-decalcified incus bone communicating with the exterior surface. The relationship between the vessels, lenticular process, and incudostapedial joint were clearly observed. SR-PCI allowed for histologic-level detail while preserving the specimen and its 3D relationships. Conclusion: SR-PCI with 3D reconstructions confirmed the main vascular supply to the lenticular process along the intraosseous lenticular vessels. This is the first synchrotron analysis of a patient having undergone stapes surgery, and it suggests that incus necrosis associated with stapes surgery may be caused by a disruption of the lenticular blood flow induced by the prosthesis loop, and not by strangulation of mucosal vessels as has been previously described. Address correspondence and reprint requests to Helge Rask-Andersen, M.D., Ph.D., Department of Surgical Sciences, Head and Neck Surgery, Section of Otolaryngology, and Departments of Otolaryngology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden; E-mail: helge.rask-andersen@surgsci.uu.se H.M.L., H.R.-A., and S.A. are co-senior authors. Funding: This study was supported by ALF grants from Uppsala University Hospital, Uppsala University and by the Foundation of "Tysta Skolan," the Swedish Deafness Foundation (Hörselskadades Riksförbund – HRF), the Ingrid Löwenström Foundation. Part of the research described in this article was performed at the BioMedical Imaging and Therapy (BMIT) facility at the Canadian Light Source, which is funded by the Canada Foundation for Innovation, the Natural Sciences and Engineering Research Council of Canada, the National Research Council Canada, the Canadian Institutes of Health Research, the Government of Saskatchewan, the Western Economic Diversification Canada, and the University of Saskatchewan. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

From Mid 16th Century French Court to End 18th Century Danish Court: The Fatal Power of the Mammillary Process Objectives/Hypothesis: Two Royal events marked the history of the mastoid process between the 16th and 18th centuries. The first was the death of François II, King of France, following a complication of a chronic running left ear at the age of 16 years, and the second the death of Justus von Berger, Court physician of Christian VII, King of Denmark, after a trepanation of the mastoid process to heal his right-sided deafness at the age of 68 years. The aim of this study is to analyze these two events again with only original references and to replace them in their historical context. Method: Historical review of original literature dealing with the subject. Results/Conclusion: These two Royal events marked the history of the mastoid process, but they were unlikely to have been avoided during their specific era. Medical knowledge was insufficient to avoid these fatal outcomes. Because of their societal impact, they were known of and largely discussed, notably in the medical world, leading to the eventual modification of medical practice during that time. François II's death had no medical impact but von Berger's death practically stopped, for more than a half century, the development of mastoid surgery. Address correspondence and reprint requests to Albert Mudry, M.D., Ph.D., School of Medicine, Stanford University, Stanford, CA 94305-5739; E-mail: amudry@stanford.edu The author discloses no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Medical Sciences

Stress, coping, and immunologic relevance: An empirical literature review Chandra Sekhar Tripathy, Sarvodaya Tripathy, Bandna Gupta, Sujita Kumar Kar Journal of Medical Sciences 2019 39(3):107-113 Stress is an inevitable phenomenon in life. Stress plays a pivotal role in regulating the body's physiology. Stress also improves the survival skills of an individual. However, when stress becomes unmanageable, it starts affecting the individual adversely. The adverse effects of the stress alter the normal physiology and the mental well-being of the individual. People attempt to cope with their stressor using various coping strategies. Adapting coping strategies may help in successful handling of stress. Maladaptive coping strategies, on the other hand, though control stress, are often transient and may result in the impairment of mental health. Evidences suggest that stress significantly affects the immune system of the body. The effect of stress on the immune system may depend on the nature and severity of the stressor. Ineffective regulation of stress results in immune dysregulation. Effective coping strategies for handling stress might be useful to correct the immune dysregulation.

Descriptive study of snakebite patients in Northern Taiwan: 2009 to 2016 Cheng-Hsuan Ho, Yan-Chiao Mao, Yi-Da Tsai, Chin-Sheng Lin, Shing-Hwa Liu, Liao-Chun Chiang, Yuan Hung, Shih-Hung Tsai Journal of Medical Sciences 2019 39(3):114-120 Background: Taiwan is located in a subtropical area where there are approximately 50 kinds of land snakes and six principal kinds of venous snakes. Snakebite envenomation is not an uncommon issue in Taiwan. We design a study to obtain an understanding of the characteristics of snakebites and snakebite patients in a medical center in northern Taiwan. Materials and Methods: This was a retrospective medical records study of an 8-year period. We used the key word “snake” to search the emergency department (ED) diagnosis of all patients and then used antivenom management codes to select patients for inclusion. The species of snake involved, time and site of the bite, geographic data of the patients and patient outcomes were recorded. Results: In total, there were 125 snakebite patients (male 70%, female 30%). The snakes involved were Protobothrops mucrosquamatus (50%), followed by Trimeresurus stejnegeri (7%). The feet and ankles were the most frequently bitten areas (42.4%). The peak months were July and October. The average ED stasis time was 2 hours and 45 minutes, and 65.6% of snakebite patients received antivenom. In patients bitten by P. mucrosquamatus, there was a high surgical rate, 23.8% higher than those reported in other studies. No mortalities or side effects of antivenom were reported in these patients. Conclusion: We propose a clinical flow chart for physicians who are treating patients bitten by P. mucrosquamatus. Snakebites, especially those inflicted by P. mucrosquamatus, induce severe soft tissue swelling, which can mimic compartment syndrome. Antivenom for P. mucrosquamatus is the first and only choice of treatment. The amount of antivenom needs to match the clinical symptoms. Patients bitten by P. mucrosquamatus may need longer observation times than patients bitten by other species of snakes, in addition to toxicologist consultations, sonographic examinations, and measurement of the objective compartment pressure before surgery.

Lower incidence of prolonged extubation in propofol-based total intravenous anesthesia compared with desflurane anesthesia in laparoscopic cholecystectomy: A retrospective study Hou-Chuan Lai, Nan-Kai Hung, Bo-Feng Lin, Jia-Lin Chen, Yi-Hsuan Huang, Zhi-Fu Wu Journal of Medical Sciences 2019 39(3):121-126 Background: Reducing anesthesia-controlled time (ACT) such as extubation time may improve operating room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for laparoscopic cholecystectomy (LC) under general anesthesia (GA) is not available in the literature. Methods: This retrospective study uses our hospital database to analyze the ACT of elective LC after either DES anesthesia or TIVA via target-controlled infusion (TCI) with propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, postanesthetic care unit (PACU) stay time, and percentage of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 622 patients undergoing LC, with 286 patients receiving TIVA and 336 patients receiving DES anesthesia. The extubation time was faster (7.8 ± 0.4 vs. 10.9 ± 0.4 min; P < 0.001) and the exit from OR after extubation was faster (6.8 ± 0.5 vs. 9.3 ± 0.5 min, P < 0.001) in the TIVA group than that in the DES group. Besides, the incidence of prolonged extubation was lower (4.5% vs. 10.1%, P = 0.014) in the TIVA group than that in the DES group. The prolonged extubation was associated with age, sex, anesthetic technique, and anesthesia time. Conclusions: In our hospital, propofol-based TIVA by TCI provided faster extubation time, faster exit from OR after extubation, and lower prolonged extubation rate compared with DES anesthesia in LC. Besides, older age, female, DES anesthesia, and lengthy anesthesia time were factors affecting prolonged extubation.

Shoulder pain and risk of developing hypertension and cardiovascular disease: A nationwide population-based cohort study in Taiwan Kuen-Tze Lin, Shiue-Wei Lai, Sheng-Der Hsu, Chao-Yueh Fan, Hong-Jaan Wang, Pi-Kai Chang, Wei-Hsiu Liu, Yen-Lin Chen, I-Chuan Yen, Shih-Yu Lee Journal of Medical Sciences 2019 39(3):127-134 Background: Shoulder pain is a common complaint across the population. It is associated with co-morbidities such as depression, diabetes mellitus, musculoskeletal disorders or cancer. However, there has been no study on the association of shoulder symptoms with future development of diseases. This nationwide population-based study aimed to investigate and clarify this association. Materials and Methods: A total of 76,304 patients with shoulder symptoms during 2000 and 2013 were selected from the National Health Insurance Research Database in Taiwan. Clinical endpoints such as hypertension (HTN) and cardiovascular disease (CVD) were evaluated by hazard ratio (HR) with 95% confidence interval (CI) after adjusting any confounding factors in Cox regression analysis. Results: Among the registered subjects, 16,570 (21.72%) and 8,453 (11.08%) patients developed HTN and CVD, respectively. After adjusting gender, age, household income, catastrophic illness, season, urbanization level and level of care, patients with shoulder symptoms aged ≥65 years had the highest risk of HTN (adjusted HR = 5.806, 95% CI = 5.464-6.169, P < 0.001), and CVD (adjusted HR = 4.371, 95% CI = 4.047-4.721, P < 0.001), with reference to younger age group of 22-44. The association of older age persisted in other cardiovascular problems (P < 0.001). Conclusions: Shoulder symptoms were associated with HTN and CVD. Future studies are required to elucidate the clinicopathogenesis.

Predict fluid responsiveness by stroke volume variation in patients undergoing protective one-lung ventilation in pressure-controlled ventilation mode Wei-Hung Chan, Tsai-Wang Huang, Chiao-Pei Cheng, Go-Shine Huang, Yung-Chi Hsu, Yi-Hsuan Huang, Zhi-Fu Wu Journal of Medical Sciences 2019 39(3):135-139 Objective: The aim of this study is to use stroke volume variation (SVV) as an indicator to predict fluid responsiveness in patients undergoing protective one-lung ventilation (OLV) in pressure-controlled ventilation mode. Design and Setting: A prospective clinical study in an operating room in a medical center. Patients: Fourteen patients receiving video-assisted thoracic surgery while undergoing OLV in pressure-controlled ventilation mode. Methods: After starting OLV in pressure-controlled ventilation mode, all patients were administered 6 ml/kg 6% hydroxyethyl starch for 20 min. Vigileo-FloTrac system was used to record hemodynamic variables before and after volume loading. The ability of SVV to predict fluid responsiveness was tested by calculating the area under the receiver operating characteristic (ROC) curve for an increase in stroke volume index of ≥10% after volume loading, and the optimal threshold value of SVV was calculated. Results: The area under the ROC curve for SVV to discriminate between responders and nonresponders was 0.89 (95% confidence interval, 0.700–1; P = 0.03). The optimal threshold value of SVV was 8.5% (sensitivity 88.89%; specificity 75%). Conclusions: SVV may be suitable for predicting fluid responsiveness in patients undergoing protective OLV in pressure-controlled ventilation mode.

Acute Type B aortic dissection with right hemothorax Jui-Tsung Chang, Yi-Chang Lin Journal of Medical Sciences 2019 39(3):140-142 Normal descending aorta is in the left thorax. Thus, ruptured type B aortic dissection more commonly presents with left hemothorax. However, there is a case of type B dissection complicated with right hemothorax.

Polypoid basal cell carcinoma on the right groin: A case report and review of literature Shou-En Wu, Yi-Hsien Chen, Hong-Wei Gao, Chien-Ping Chiang Journal of Medical Sciences 2019 39(3):143-145 Basal cell carcinoma (BCC) is the most common type of skin cancer. Polypoid BCC is very rare and distinguishes from other types of BCC by being female predominant, locating on nonsun-exposed areas, prevailing in dark-skinned races, and having large average size, but considered nonaggressive. We report a case of BCC presenting as an inconspicuous polyp. A 40-year-old female sustained a slowly growing mass at the left groin for many years. Physical examination revealed a polypoid mass over the right groin without specific symptoms. Surgical removal with simple polypectomy was performed, whereas the pathological features revealed BCC with polyp feature. There has been no recurrence after the surgery. This case highlights the importance of remaining clinically alert to differentiate a benign-looking polyp.

A patient presenting with isolated psychotic depression due to the ischemic stroke of centrum semiovale Halil Onder, Emre Misir Journal of Medical Sciences 2019 39(3):146-149 Post-stroke depression (PSD) is the most common neuropsychiatric complication of stroke, such that it can occur in one-third of stroke survivors. It has been tried to be explained by the disruption in the neural circuits involved in the mood regulation in the setting of some additional clinical risk factors. However, there is no consensus in this regard. Herein, we present a 58-year-old male patient presenting with isolated psychotic depression which was finally found to be associated with acute ischemic stroke of bilateral centrum semiovale. This report constitutes an extremely rare illustration of acute onset organic psychotic depression which was clearly demonstrated to be associated with ischemic stroke. Through the presentation of this patient and limited literature, we propose some discussions regarding the pathophysiology of PSD. We also remark the need for future reports of neuroimaging methods to clarify the unknown neural correlates in these manifestations.

Acute hemothorax secondary to chest tube-related diaphragmatic injury in a patient with traumatic liver laceration Wei-Cheng Tseng, Wei-Cheng Tseng, Ting-Yi Sun, Ti-Hei Wu, Shing-Hwa Huang, Zhi-Fu Wu Journal of Medical Sciences 2019 39(3):150-153 Despite its many benefits, there are several potentially significant complications inherent to chest tube insertion (CTI), a commonly used invasive procedure to evacuate air or fluid from the pleural space. The average rate of complications following CTI ranges from 5% to 10%, whereas insertion-related complications are rare. Here, we present the case of a 45-year-old female suffering from a motor vehicle accident who developed Grade IV liver laceration complicated with intra-abdominal hemorrhage and right-sided fractures from the fourth to the ninth rib. Misplacement of the preventive CTI for potential hemopneumothorax during the first attempt was observed by computed tomography and simultaneously led to diaphragmatic penetration. Subsequently, massive bloody pleural effusion from the abdominal cavity through the defect in the right hemidiaphragm was noted through a newly inserted chest tube when the patient coughed due to endotracheal suctioning. This case illustrates the significance of identification of patients at high risk for complications related to CTI and the utility of ultrasound guidance during CTI.

Unintentional pediatric trauma in the emergency department Beuy Joob, Viroj Wiwanitkit Journal of Medical Sciences 2019 39(3):154-154

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Integrative Nephrology and Andrology

Acute kidney injury: A definition with a rich past and an evolution Dimitrios C Karathanasis, C Androula Karaolia Journal of Integrative Nephrology and Andrology 2018 5(4):121-125 The term acute kidney injury (AKI) appeared in the society of nephrology in 2004 mirroring a key station of the constant development of the whole entity of acute renal failure. The long route from “acute Bright's disease” in the 19th century to modern “acute kidney stress” reflects the continuous effort of the society of nephrology to set the appropriate criteria and finally to formulate a precise and consensus definition in nomenclature of kidney injury. The most important definitions were the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease in 2004, Acute Kidney Injury Network (AKIN) in 2007, and Kidney Disease Improving Global Outcomes (KDIGO) in 2012 which had been proposed by the committees of Acute Dialysis Quality Initiative, AKIN, and KDIGO, respectively. Common basis of the above definitions was the clinical-laboratory criteria of urine output and serum creatinine while the target of every newer attempt was to increase the sensitivity of AKI and to offer a globally unified perception in terms of diagnosis and prevention. Since the emersion of KDIGO definition, the interest in defining AKI has been focused on the stage that precedes renal damage by the detection of clinically reliable biomarkers. Subsequently, the concept of acute injury is being lately realized as an attack in correspondence with heart attack or even more as an acute stress which can only be witnessed by the appropriate biomarkers. Recent research is focusing on the discovery of the ideal biomarker which must meet the requirements of high specificity, low cost, and ease of application.

To study the prevalence of thyroid disorders in chronic renal disease patients Upendra Nath Gupta, Apoorva Jain, Prashant Prakash, Prabhat Agrawal, Ravi Kumar, Maaz Farooqui Journal of Integrative Nephrology and Andrology 2018 5(4):126-129 Background and Objectives: The high prevalence of thyroid dysfunction in chronic kidney disease (CKD) patients reveals significant association between CKD progression and thyroid dysfunction. The aim was to study the thyroid dysfunction in patients of CKD for the prevalence of subclinical hypothyroidism (SCH) and clinical hypothyroidism and study the correlation between thyroid dysfunction and severity of renal diseases. In view of the variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases. Materials and Methods: A total of 100 patients with CKD on conservative management fulfilling the criteria for CKD who were admitted at the Department of Medicine, SNMC, Agra, Uttar Pradesh, India, during the period of July 2016–June 2017, were selected in this study. Descriptive analysis of the collected data was done and association of various parameters with the presence or absence of SCH or overt hypothyroidism was studied using Chi-square test and correlated. Results: Results showed that out of the 100 patients with CKD, 53 patients had thyroid dysfunction which accounted for 53%. The prevalence of SCH and clinical hypothyroidism was 33% and 20%, respectively. The number of patients with hypothyroidism progressively increased with increased severity of renal failure. Conclusions: We observed a high prevalence of thyroid dysfunction in our CKD patients and revealed significant association between CKD progression and thyroid dysfunction.

Clinical profile of acute kidney injury in a tertiary care center in the Tropical Region Utkarsh Rajesh Patel, Amit S Pasari, Manish Ramesh Balwani, Amol Bhawane, Priyanka R Tolani, Shaurya Acharya Journal of Integrative Nephrology and Andrology 2018 5(4):130-133 Objective: The objectives of the study were to study etiology, manifestations, and outcome of acute kidney disease in the tropical region in a tertiary care center. Materials and Methods: In the present prospective study, patients with acute kidney disease admitted to JNMC, Wardha, India, between January 2017 and December 2017 were studied with a detailed history, general physical examination, and systemic examination. Data were collected and analyzed. Statistical analysis was performed using descriptive and inferential statistics using the Chi-square test and Student's unpaired t-test and software used in the analysis was SPSS 22.0 version and Graph Pad Prism 6.0 version. Results: This study showed male-to-female ratio of 1.8:1. Maximum incidence was seen in patients aged >60 years. As per the Kuppuswamy's scale, most of the patients belonged to lower-middle and upper lower class. The study showed various etiological factors associated with acute kidney injuries (AKIs) such as renal causes (most common), heart failure, respiratory failure, cirrhosis, malaria, snake bite, acute gastroenteritis, poisoning, drug nephrotoxicity, and sepsis. Common symptoms were oliguria followed by pedal edema and dyspnea. The most common comorbid illness was hypertension followed by diabetes mellitus which may have made them prone to AKI. About 81.42% of patients survived and 18.58% expired. Of 70, 56 patients were managed conservatively, whereas 14 underwent hemodialysis. Mean duration of hospitalization was 11.01 ± 8.60 days. Conclusion: Intrinsic renal causes followed by heart failure were the common causes of AKI as against infective causes a few years earlier. This shows the changing trend of AKI causes in a developing nation. Average duration of hospitalization was 11 days in the study.

Study of some electrocardiographic and echocardiographic data in toddelers and children with primary glomerulonephropathy Mohamed Abdelaziz El-Gamasy, Walid El-Shehabi Journal of Integrative Nephrology and Andrology 2018 5(4):134-139 Background and Objective: Primary glomerulonephropathy mainly acute poststreptococcal glomerulonephritis (APSGN) is the most common cause of hypertensive heart failure in the pediatric age as APSGN may involve various systems including cardiovascular system. There are few research publications on electrocardiographic (ECG) and echocardiographic (two-dimensional [2D]-echo) data in childrenwith primary glomerulonephropathy. The aim is to study some ECG and 2D-echo data in Egyptian pediatric patients with ANS). Subjects and Methods: Sixty children with ANS were included and subjected to clinical, laboratory, ECG for corrected QT (QTc) interval and 2D echocardiographic study on admission and repeated at 6 and 12 weeks using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) to measure left ventricular ejection fraction (LVEF), left atrium to aorta ratio and E/A ratio. Results: Prolonged QTc interval was reported in 22 patients (37%), of whom 18 had hypertension. Fourteen of the 60 children had LVEF <60%. The same children also had left atrium/aorta ratio >2 and E/A ratio more than two. LVEF became within normal values by 1½ month (6 weeks) in 12 patients, two become normal by three months of follow-up. Four (28.6%) from 14 children with low LVEF had normal arterial blood pressure. All the 14 children had completely recovered on follow-up period of 3 months. Conclusion: Changes in ECG and echo data which were reported in the acute phase of ANS appear to be temporary (transient) as they became within normal values in almost all children by 12 weeks period of follow-up. Although elevated blood pressure was the most common etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration.

Paroxysmal nocturnal hemoglobinuria manifesting as hemolytic anemia with acute kidney injury Amol Bhawane, Manish Ramesh Balwani, Amit S Pasari, Priyanka R Tolani Journal of Integrative Nephrology and Andrology 2018 5(4):140-142 Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder characterized by low-grade, chronic hemolytic anemia accompanied by either thrombocytopenia or leukopenia with usually benign kidney involvement secondary to chronic tubular deposition of hemosiderin. Acute kidney injury (AKI) may be seen during hemolytic crisis. We report the case of a 45-year-old man with PNH who developed reversible AKI requiring temporary hemodialysis support following herpes zoster infection.

Serum magnesium concentration a need for revision especially in renal failure Majid Malaki Journal of Integrative Nephrology and Andrology 2018 5(4):143-144

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Clinical Trials: Nervous System Diseases

Influence of bladder management on long-term quality of life in patients with neurogenic lower urinary tract dysfunction Jürgen Pannek, Jörg Krebs, Jens Wöllner Asia Pacific Journal of Clinical Trials: Nervous System Diseases 2019 4(2):29-32 Background and objective: Patients with spinal cord injury suffer from neurogenic lower urinary tract dysfunction (NLUTD). NLUTD is associated with a considerable morbidity and mortality, but also affects the quality of life (QoL). We aimed to evaluate the longitudinal course of QoL in persons with NLUTD in relation to their bladder management. Subjects and methods: In a prospective self-controlled case series study. Patients with chronic NLUTD managing their bladder either by intermittent catheterization (n = 21), reflex voiding (n = 8), anterior root stimulation (n = 7), straining (n = 7) or suprapubic catheter (n = 4) were asked to fill in the Qualiveen® questionnaire at two time points with a time span of at least 1 year. Eleven patients were tetraplegic, and 36 persons suffered from paraplegia. The study was approved by the Ethics Committee of the Ethikkommission Nordwestund Zentralschweiz (approval No. PB_2016-02657) on September 24, 2007. Results: In total 47 patients returned both questionnaires and their data were therefore evaluated. The mean age at the first evaluation was 52 ± 12.8 years. The mean duration of NLUTD was 20.4 ± 12.3 years. A mean 2.4 ± 0.5 years had elapsed from the first to the second evaluation. None of the Qualiveen questionnaire domains showed a significant change between the two evaluation time points. The lesion level had a significant (P ≤ 0.023) effect on the domains constraints and QoL index. Conclusion: QoL in patients with chronic NLUTD seems to remain stable in long-term follow-up. Trial registration: ClinicalTrials.gov (NCT02179073) on July 1, 2014.

Efficacy of entacapone and pramipexole in treating non-motor symptoms of Parkinson's disease: a prospective randomized controlled trial Zheng Bei, Guo-Qiang Wen, Yi Chen, Ning Bei Asia Pacific Journal of Clinical Trials: Nervous System Diseases 2019 4(2):33-39 Background and objective: Individuals with Parkinson’s disease exhibit a variety of non-motor symptoms that can negatively impact quality of life. Although both entacapone and pramipexole can be used to treat Parkinson’s disease via modulation of dopamine metabolism, the ways in which these treatments differ in terms of their effects on the non-motor symptoms of Parkinson’s disease are unknown. Participants and methods: This prospective, randomized, controlled trial will be conducted in the Geriatric Hospital of Hainan, Haikou, China. A total of 388 patients with idiopathic Parkinson’s disease will be randomly assigned to receive entacapone (n = 194) or pramipexole (n = 194). This study was approved by the Ethics Committee of the Geriatric Hospital of Hainan, China on August 30, 2013 (approval number: S2013-038-01) on August 30, 2013. Written informed consent regarding the study protocol and surgical procedure will be obtained from all participants. Results: The primary outcome measure will be the rate of improvement of non-motor symptoms 3 weeks after treatment. Secondary outcome measures will be soluble interleukin-2 receptor and homocysteine levels in serum, which reflect inflammation, and adverse events before and 3 weeks after treatment. Our self-controlled pilot study involving 100 patients showed that incidences of autonomic neurological symptoms such as postural hypotension, urinary urgency, urinary frequency, sexual dysfunction, dry mouth, and salivation, psychiatric symptoms such as cognitive dysfunction, hallucination, depression, and anxiety, and sensory abnormalities such as spasm, pain, and restless leg syndrome were remarkably reduced. Meanwhile, levels of serum soluble interleukin-2 receptor and homocysteine had noticeably decreased after treatment with entacapone and pramipexole. Conclusion: This trial will confirm the efficacy of entacapone and pramipexole in the treatment of non-motor symptoms of Parkinson’s disease. We hope that our findings will provide direction for future clinical treatment of non-motor symptoms of Parkinson’s disease, leading to improved patient quality of life. Trial registration: This study was registered with the Chinese Clinical Trial Registry on April 15, 2019 (registration number: ChiCTR1900022534). Protocol version is 1.0.

Effect of transcranial direct current stimulation on the level of consciousness in patients with traumatic coma: study protocol for a self-controlled trial Nilpadma Sarkar, Subhasish Chatterjee, Ajay Gehlot Asia Pacific Journal of Clinical Trials: Nervous System Diseases 2019 4(2):40-43 Background and objectives: Traumatic brain injury patients suffer from coma, which leads to changes in behavior and consciousness. There is a paucity of available treatments which can improve the level of consciousness. Transcranial direct current stimulation (tDCS) is one of the non-invasive techniques to stimulate the motor cortex and improve the level of consciousness. The purpose of the study will be to assess the effect of tDCS on consciousness in patients with traumatic coma. Subjects and methods: The single-subject ABA design single-center study will be conducted in the Neuro-Surgery ICU, Maharishi Markandeshwar Hospital, India. Comatose patients associate with traumatic brain injury will be recruited. After baseline assessment all patients will get treatment with tDCS for 20 minutes twice a day for consecutive 5 days. Follow-up assessment will be taken on every first day of the consecutive 1st, 3rd and 5th weeks post-treatment. Ethical approval has been obtained from the Institutional Ethical Committee (IEC) of Maharishi Markandeshwar (Deemed to be University) (IEC/MMDU/2018/1183) on June 6, 2018. Outcome measures: JFK Coma Recovery Scale-Revised (CRS-R). Discussion: The study will investigate the possible effect of tDCS in improving level of consciousness in patients with traumatic brain injury. Trial registration: The study was registered with ctri.nic.in (CTRI/2019/01/017186) on January 22, 2019. It is the official website for registration of clinical trials in India regulated by Indian Council of Medical Research.

Efficacy and safety of traditional Chinese medicine combined with western medicine for early-phase treatment of acute ischemic stroke based on the primary syndrome elements: protocol for a randomized controlled trial Fu-Sheng Liu, Xiao-Lei Fang, Zhi-Rui Cheng, Jin Liu, Zhi Liu, Chen-Chen Sun, Lei Sun, Hui Jin Asia Pacific Journal of Clinical Trials: Nervous System Diseases 2019 4(2):44-50 Background and objective: Acute ischemic stroke is a major cause of disability among adults. Although traditional Chinese medicine and western medicine have been widely used for the treatment of acute ischemic stroke, their efficacy when used in combination for the treatment of acute ischemic stroke during the early phase is poorly understood. According to traditional Chinese medicine theory, the primary syndrome elements of acute ischemic stroke during the early stage include three pathogens, “wind,” “fire,” and “phlegm,” and treatments that target these primary syndrome elements contribute to recovery from the condition. We have designed a randomized controlled trial to investigate the efficacy and safety of traditional Chinese medicine combined with western medicine in the treatment of acute ischemic stroke during the early phase based on the primary syndrome elements. Subjects and methods: This prospective, single-center, assessor-blinded, randomized controlled trial will enroll 120 eligible patients with acute ischemic stroke who will receive treatment in the Department of Emergency, Dongfang Hospital of Beijing University of Chinese Medicine, China. Participants will be randomly assigned to a combined treatment group or a control group. Both groups will undergo treatment with conventional western medicine, and patients in the combined treatment group will also receive traditional Chinese medicine (i.e., oral stroke initial state decoction, intravenous Gastrodin injection, and Tanreqing injection; Xingnaojing injection will be added for patients who are unconscious). Immediately after admission, patients will undergo 3-day treatment for early-phase ischemic stroke and subsequently undergo a 2-week follow up. This study was approved by Hospital Ethics Committee, Dongfang Hospital, Beijing University of Traditional Medicine, China (approval No. JDF-IRB-2016033602) on November 2, 2016. Written informed consent will be obtained from conscious patients or the legal guardians of unconscious patients. Outcome measures: The primary outcome measures of this study are the National Institute of Health Stroke Scale score and traditional Chinese medicine stroke scale score on days 1, 3, 7, and 14 after treatment. Secondary outcome measures include National Institute of Health Stroke Scale score, Barthel index, Modified Rankin scale score, Glasgow coma scale score on days 1, 3, 7, and 14 after treatment, serum matrix metalloproteinase-9 and vascular endothelial growth factor levels on days 1 and 3 after treatment. Safety outcomes on days 1 and 3 after treatment and adverse events on days 3, 7, and 14 after treatment are also evaluated. Discussion: The results of this study will provide evidence to support the rationale for using traditional Chinese medicine combined with western medicine for the treatment of acute ischemic stroke during the early phase, and may indicate the underlying mechanism in this treatment strategy. Trial registration: This study was registered with the Chinese Clinical Trial Registration (registration number: ChiCTR-INR-16010075) on December 4, 2016. Study protocol refers to 1.0. Patient recruitment began in December 2016 and will be ended in November 2019.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com