Serum Sickness-Like Reaction in an Adolescent Taking Minocycline for Acne.

We report a case of serum sickness-like reaction (SSLR) in a 14-year-old male taking minocycline for acne. The patient presented with urticarial rash, arthralgia/arthritis, and tender lymphadenopathy. Symptoms resolved with discontinuation of minocycline and treatment with prednisone, cetirizine, and ibuprofen. SSLR is a rare complication of minocycline treatment that may go unrecognized and underreported.

Axillary Granular Parakeratosis.

We describe a case of an 85-year-old Caucasian female who presented to the dermatology clinic with pruritic, scaly hyperpigmented papules and plaques with surrounding erythema in the left axilla. Based on the history and physical examination, there was concern for possible varicella zoster infection, and the patient was started on valacyclovir 1000 mg three times daily for seven days. A shave biopsy was taken from the left axilla to confirm a diagnosis. Microscopic examination revealed compact hyperparakeratosis with keratohyalin granules throughout the parakeratotic stratum corneum as well as admixed eosinophils within the stratum corneum. The epidermis was acanthotic with irregular hyperplasia of the rete ridges. These microscopic findings supported a diagnosis of axillary granular parakeratosis, a benign skin condition caused by a defect in epidermal differentiation. Granular parakeratosis is seemingly rare but is felt to be an underreported condition. It is important for clinicians to be aware of the disease in order to correctly identify the lesions and reassure patients of its benign nature and provide appropriate treatment recommendations.

Implementation and enforcement of tobacco bans in two prisons in North Carolina: a qualitative inquiry.

Despite the national trend that 90% of prisons have smoke-free indoors policies, compliance and enforcement remain barriers to policy success. Key informant interviews about policy compliance and enforcement were conducted with 10 staff and inmates at two North Carolina prison facilities, one with a complete ban (indoors and outdoors) and one with a partial ban (indoors only). Communication of the tobacco bans was consistent and well understood in both facilities. Barriers to compliance and enforcement, especially in the complete ban facility, included policy ''buy in,'' the emerging black market for cigarettes, staff support, and access to nicotine replacement therapy. Despite these barriers, most informants reported that implementation and enforcement of complete bans is possible with adequate communication about the policy and access to cessation therapy.

Effect of salmeterol on mucociliary and cough clearance in chronic bronchitis.

The effect of long acting beta(2)-adrenergic bronchodilators on impaired mucociliary clearance in chronic bronchitis is unknown. Using a radiolabeled aerosol (technetium-99m-labeled sulfur colloid) and gamma camera analysis, we measured the acute effect of salmeterol vs. placebo on mucociliary and cough clearance in mild-moderate chronic bronchitics (n = 14) over a 2h period. During the 1-1(1/2) h period of observation patients performed 60 controlled coughs on each study day. Average whole lung clearance through 1 and 2h after administration of salmeterol (42 microg) or placebo via metered dose inhaler (double-blinded, crossover design study) showed no significant difference between treatments. Similarly, for the specific period when cough was added to mucociliary clearance, there was no difference on whole lung clearance between treatments. However, when clearance from the peripheral region of the lung was assessed over the entire 2h period of observation, salmeterol provided a 30% enhancement of airway clearance compared to placebo, average peripheral 2h clearance (%) = 22 +/- 9 vs. 17 +/- 10 for salmeterol vs. placebo (P = 0.05 by paired analysis). Thus, in addition to its bronchodilating effects, salmeterol acutely enhances peripheral airway clearance of secretions in mild-moderate chronic bronchitis.

Assessing the need to update prevention guidelines: a comparison of two methods.

BACKGROUND: An important concern for developers of clinical practice guidelines is how best to determine when guidelines require updating to ensure they remain current and evidence based. Because of the high costs associated with updating guidelines, recent attention has focused on approaches that can reliably assess the extent of updating required. Recently, Shekelle and colleagues proposed a model of limited literature searches with modest expert involvement as a way to reduce the cost and time requirements for assessing whether a guideline needs updating. METHODS: The main objective of this study was to compare the Shekelle et al. assessment model (review approach) and a conventional process using typical systematic review methods (traditional approach) in terms of comprehensiveness and effort. We modeled the review approach on that by Shekelle and colleagues but refined it iteratively over three phases to achieve greater efficiency. Using both methods independently, we assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services from the US Preventive Services Task Force. Main outcomes included completeness of study identification, importance of missed studies and the effort involved. RESULTS: Although the review approach identified fewer eligible studies than the traditional approach, none of the studies missed was rated as important by task force members acting as liaisons to the project with respect to whether the topic required an update. On average, the review approach produced substantially fewer citations to review than the traditional approach. The effort involved and potential time saving depended largely on the scope of the topic. CONCLUSIONS: The revised review approach provides an efficient and acceptable method for judging whether a guideline requires updating.