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1.
Clin Exp Allergy ; 47(5): 684-692, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28160338

RESUMEN

BACKGROUND: Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. OBJECTIVE: To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. METHODS: This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q2 oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. RESULTS: Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2 , respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q2 oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). CONCLUSIONS AND CLINICAL RELEVANCE: This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.


Asunto(s)
Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Urticaria/tratamiento farmacológico , Adolescente , Adulto , Anciano , Enfermedad Crónica , Femenino , Alemania/epidemiología , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Urticaria/epidemiología , Urticaria/patología
3.
Clin Microbiol Infect ; 12(8): 718-28, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16842566

RESUMEN

Recent years have witnessed the emergence of novel methicillin-resistant Staphylococcus aureus (MRSA) strains that produce the potent toxin Panton-Valentine leukocidin (PVL). PVL-positive strains can cause complicated skin infections or necrotising pneumonia with high mortality, and these strains have the potential for epidemic spread in the community. In 2004-2005, two case clusters and two isolated cases were observed in eastern Saxony and southern Brandenburg. These were the first known infections with PVL-positive community-acquired MRSA (caMRSA) in this part of Germany. The isolates belonged to agr type III, spa type 44 or spa type 131, and showed a SmaI macrorestriction pattern that corresponded to caMRSA of clonal group ST80. The isolates were susceptible to levofloxacin, macrolides, clindamycin, gentamicin and vancomycin. Most isolates showed resistance to tetracycline and fusidic acid because of the presence of the tetK and far1 genes. A novel plasmid (designated pUB102) harbouring far1, tetK and blaZ was characterised and partially sequenced. Microarray analysis revealed that the caMRSA isolates harboured genes encoding several bi-component toxins (lukF/S-PVL, lukD/E, lukS/F plus hlgA, and another putative leukocidin homologue). Neither tst1 nor genes for enterotoxins A-Y were detected, but the isolates harboured several staphylococcal enterotoxin-like toxin genes (set genes), as well as genes encoding an epidermal cell differentiation inhibitor (edinB) and exfoliative toxin D (etD). Comparative analysis of other isolates from Australia, Germany, Switzerland and the UK showed that these isolates were representative of a widespread clone of caMRSA.


Asunto(s)
Toxinas Bacterianas/análisis , Infecciones Comunitarias Adquiridas/microbiología , Exotoxinas/análisis , Resistencia a la Meticilina , Análisis de Secuencia por Matrices de Oligonucleótidos , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genética , Adulto , Anciano , Femenino , Ácido Fusídico/farmacología , Humanos , Leucocidinas , Masculino , Persona de Mediana Edad , Plásmidos , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos
4.
Hautarzt ; 55(3): 296-300, 2004 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-15029438

RESUMEN

A 63 year old man developed non-healing ulcerations after en-bloc resection of multiple cylindromas of the scalp. After excision and granulation-stimulating local therapy, the wound was covered with mesh grafts from the thighs. He developed widespread tension blisters with superficial ulcerations in the occipital region which did not heal despite adequate topical therapy. We then treated him successfully with EpiDex, a tissue engineered fully differentiated epidermal equivalent derived from keratinocytes of the outer root sheath of plucked anagen hair follicles. We introduce this treatment modality as a non-invasive effective option in treating non-healing ulcers.


Asunto(s)
Carcinoma Adenoide Quístico/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Complicaciones Posoperatorias/cirugía , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Trasplante de Piel , Úlcera Cutánea/cirugía , Ingeniería de Tejidos , Carcinoma Adenoide Quístico/genética , Carcinoma Adenoide Quístico/patología , Epitelio/patología , Epitelio/fisiopatología , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patología , Regeneración/fisiología , Reoperación , Cuero Cabelludo/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Enfermedades Cutáneas Vesiculoampollosas/cirugía , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Úlcera Cutánea/patología , Cicatrización de Heridas/fisiología
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