Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa.

BACKGROUND: Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative. OBJECTIVES: To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence. METHODS: We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence-associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 75 patients [median age 31.4 years (range 16-71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one-stage surgical closure [OR 3.2 (95% CI 1.4-7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment. CONCLUSIONS: Hidradenitis suppurativa recurrence in our study was 35% and associated with one-stage surgical closures, but two-thirds of patients were satisfied with surgical treatment and would recommend surgery.

Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center.

INTRODUCTION: There is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon. MATERIALS AND METHODS: This was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed. RESULTS: A total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**). CONCLUSION: The mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient.

Systemic involvement of acute generalized exanthematous pustulosis: a retrospective study on 58 patients.

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by rash with sterile pustules, high fever and elevated circulating neutrophil counts. OBJECTIVES: To investigate the frequency and clinical features of AGEP systemic involvement. METHODS: This retrospective study included all patients hospitalized in our department between 2000 and 2010 with a discharge diagnosis of AGEP. Patients had to fulfil the following criteria: (i) a specific EuroSCAR score > 4 and (ii) biological and radiological work-up available. RESULTS: Among the 58 patients enrolled, 10 had at least one systemic involvement: hepatic function test results were abnormal for seven; six had renal insufficiency; two developed acute respiratory distress, with one patient's bronchoalveolar lavage fluid containing many neutrophils but no microorganisms; one was agranulocytotic. Mean peripheral neutrophil counts and mean C-reactive protein levels were elevated significantly in patients with systemic involvement. Amoxicillin rechallenge and hospitalization duration were associated with systemic involvement. AGEP systemic involvement was observed in 17% of cases studied, including liver, kidney, bone-marrow and lung involvement. Outcomes were favourable after drug withdrawal, and symptomatic and topical steroid treatments. CONCLUSIONS: The neutrophil count-systemic involvement association may suggest a role for neutrophils in AGEP systemic involvement. Physicians should be aware of the possibility of systemic involvement in AGEP and should actively look for signs of extracutaneous reactions.

Interpretation by clinicians of probability expressions in cytology reports and effect on clinical decision-making.

BACKGROUND: Cytology often is used to obtain a diagnosis, such as that of malignant neoplasia. When a diagnosis is uncertain, pathologists often express probability using qualitative terms, such as "probable," that have imprecise meanings. HYPOTHESIS: Terms expressing probability are interpreted variably by veterinary practitioners and affect decisions regarding treatment and euthanasia. ANIMALS: None. METHODS: An online survey of members of the Veterinary Information Network was conducted. Veterinarians were asked to assign percentage probabilities to 18 modifiers of a diagnosis of lymphoma. They also were asked to select their most likely clinical action based on a diagnosis of lymphoma qualified one of 4 modifiers. Results were analyzed using descriptive and nonparametric methods. Percentage probabilities were analyzed by ANOVA after variance stabilization. RESULTS: For 871 valid surveys, probabilities assigned to the 18 modifiers overlapped substantially, with medians (interquartile range) of 50% (50-70%) for "possible," 66% (66-85%) for "probable," and 70% (70-90%) for "consistent with." More (P < .001) veterinarians (50.4%) chose to initiate treatment with a diagnosis of "consistent with lymphoma" as compared with "probable" (14.6%) or "possible" (1.6%) lymphoma. For clients considering euthanasia if the diagnosis was cancer, more (P < .001) veterinarians recommended euthanasia with a diagnosis of "consistent with lymphoma" (62.5%) as compared with "probable" (35.3%), or "possible" (2.0%) lymphoma. CONCLUSIONS AND CLINICAL IMPORTANCE: Probability expressions are interpreted variably yet have a major impact on clinical decision-making, including the decision to recommend euthanasia. Standardized terminology could improve decision-making and enhance clinical outcome.

Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study.

OBJECTIVE: To introduce practices for improving complementary feeding and evaluate their adoption and association with improved dietary intakes. DESIGN: A quasiexperimental pilot study comparing dietary intakes from complementary foods among three intervention communities and one control community before and after the intervention, and adoption of new complementary feeding practices among intervention communities following the intervention. SETTING: Rural subsistence communities in southern Malawi, Central Africa. SUBJECTS: Mothers and their children aged 6 to 23 months receiving complementary foods. INTERVENTIONS: A participatory, nutrition education intervention based on four locally adapted lessons for complementary feeding practices designed to increase: (i) total complementary food intake; (ii) energy and nutrient density of the complementary diet, and; (iii) iron and zinc bioavailability of the complementary diet. RESULTS: Adoption rates for the four practices ranged from 25% for preparation of enriched porridges, to 10% for preparing soaked, pounded maize. The amount of complementary foods (g/day) and intakes of energy, animal protein, niacin, riboflavin, calcium, iron, and zinc, but not vitamin A, were significantly greater (P<0.05) in the intervention compared to control group, as were the energy, iron, and riboflavin density, and the estimated amount of bioavailable iron and zinc. CONCLUSIONS: Several intervention practices were well accepted and adopted and were associated with improved adequacy of energy and nutrient intakes from the complementary diet. Such improvements were attributed mainly to greater total intakes and, to a lesser extent, enhanced dietary quality of the complementary foods.

Identifying populations at risk of zinc deficiency: the use of supplementation trials.

Zinc supplementation trials assessing the response of growth and immunity have assisted in identifying populations at risk of zinc deficiency and the factors that contribute. A recent trial in Ethiopia demonstrated a high risk of zinc deficiency among young children, particularly among those who were stunted.

A method for the determination of type I iodothyronine deiodinase activity in liver and kidney using 125I-labelled reverse triiodothyronine as a substrate.

OBJECTIVES: A detailed method for the determination of iodothyronine deiodinase type 1 (DI-1) activity is described. The objective of the present method development was to consolidate the effective procedures of previous methods and produce an efficient assay that can be easily reproduced. DESIGN AND METHODS: This method uses a 5',-125I labelled rT3 as substrate and ion-exchange chromatography to separate released ionic iodine. Released 125I- collected in the eluate is counted, and the results used to calculate DI-1 activity. RESULTS: Results were found to be linear for tissue homogenates containing 3-11 mg protein.mL-1. Day-to-day coefficient of variation of liver homogenate was determined to be 13%. CONCLUSIONS: This method was found to be reliable, reproducible, and sample sizes as small as 10 microL could be readily assayed. The use of centrifuge filter units to contain the ion-exchange medium decreased handling of the material, and potential sources of error.

Complementary feeding practices and dietary intakes from complementary foods amongst weanlings in rural Malawi.

OBJECTIVE: The objectives of this study were to estimate the quantity and nutritive quality of the complementary diet in rural Malawi, and to identify feeding practices, nutrients and dietary modifiers of iron and zinc bioavailability that may limit the quality of the diet. DESIGN: This cross-sectional study design included an anthropometric survey, a feeding practices questionnaire, and an interactive, 24 h recall dietary data survey. SETTING: Four rural villages in Balaka district, southern Malawi. SUBJECTS: Mothers resident in the study communities with breastfed children aged up to 24 months were eligible. RESULTS: Stunting was prevalent among these weanlings. Maize was the predominant food source, with limited contribution of animal foods. Deficits in dietary energy and several nutrients were found when compared to estimated needs. When expressed per kg body weight, energy intakes appeared adequate. The bioavailability of zinc was low due to a high phytate:zinc molar ratio. Iron bioavailability was also low due to low intake of absorption enhancers such as meat/fish/poultry protein and ascorbic acid. Dietary quality was poorest for 6 to 8-month-old infants. CONCLUSIONS: Iron, zinc and calcium were the most limiting nutrients to the quality of the diet, partly exacerbated by the poor bioavailability of iron and zinc. Increased total intake and bioavailability of iron and zinc would improve the complementary diets. SPONSORSHIP: This study was funded by the Thrasher Research Fund, Salt Lake City, Utah, USA.

Assessment of home-based processing methods to reduce the phytate content and phytate/zinc molar ratio of white maize (Zea mays).

Various methods of processing maize suitable for household use in rural Malawi, Central Africa, were investigated for their ability to reduce its phytate content and phytate/zinc molar ratio. These methods included fermentation, germination, and soaking. Penta- and hexainositol phosphates were measured by HPLC, and zinc was measured by atomic absorption spectrophotometry. Natural lactic fermentation of maize flour slurries resulted in 88% phytate retention compared to unprocessed, unrefined maize flour porridges, whereas lower phytate retention was observed when a starter culture (61%) or germinated flour (71%) was also used. Fermentation of cooked maize flour porridges with germinated flour added resulted in 54-85% retention of phytate compared to controls. Soaking maize flour or pounded maize and decanting excess water resulted in 43 and 49% retention of phytate, respectively. The latter soaking procedures were simple and effective and were suitable for household use in rural Malawian communities.