Longitudinal course and phenotypes of health-related quality of life in adults with atopic dermatitis.

BACKGROUND: The real-world course of health-related quality of life (HRQoL) in atopic dermatitis (AD) is not well established. AIM: To examine predictors, longitudinal course and phenotypes of HRQoL in adult patients with AD. METHODS: This was a prospective dermatology-practice based study of 955 patients with AD (age 18-97 years). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. HRQoL was assessed using the 10-item short-form Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (PGH). AD severity and impact was assessed by patient-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Eczema Area and Severity Index (EASI), Objective SCORing Atopic Dermatitis (O-SCORAD), Investigator's Global Assessment (IGA), Numerical Rating Scale (NRS) average and worst itch, PROMIS sleep-related impairment (SRI), and nine-item Patient Health Questionnaire (PHQ)-9. Repeated-measures regression models were constructed to examine itch over time. RESULTS: In multivariable linear regression models controlling for age, race/ethnicity, history of asthma, hay fever and food allergy, baseline PGH-physical (PGH-P4) T scores were inversely associated with patient-reported global AD severity, POEM, EASI, objective SCORAD, IGA, NRS average and worst itch, PROMIS SRI and PHQ-9, with stepwise decreases of physical health with worsening severity. PGH-mental health (PGH-M4) T scores were associated with all aforementioned severity measures aside from POEM. In multivariable repeated measures linear regression models, decreased PGH-P4 and PGH-M4 T scores and mapped five-dimension EuroQoL over time were associated with self-reported global AD severity, NRS worst and mean itch, POEM, PROMIS sleep disturbance and SRI, EASI, objective SCORAD, IGA and PHQ-9. Latent class analysis identified six classes of HRQoL, which were associated with measures of AD severity, nonwhite race, Hispanic ethnicity and having only public health insurance, but not age or sex. CONCLUSION: Patients with AD have a heterogeneous longitudinal course and distinct patterns of HRQoL. Many patients had fluctuating HRQoL over time. Most patients with moderate to severe disease at baseline had persistent HRQoL impairment over time.

Behçet's disease complicated by pylephlebitis and hepatic abscesses.

A 22 year old man presented with fever, abdominal pain, weight loss and diarrhea. Past medical history revealed recurrent aseptic meningitis, uveitis, and erythema nodosum. Further inquiry unveiled a prominent history of oral aphthous ulcers; all features of Behçet's disease. Imaging revealed mesenteric arteritis and pylephlebitis, septic thrombophlebitis of the portal vein, a previously unrecognized complication of Behçet's disease, with multiple intrahepatic abscesses. Portal venography demonstrated an extensively diseased, expanded, and obstructed portal venous system. Blood cultures and portal vein aspirate yielded polymicrobial flora. Percutaneous intraportal thrombolytic therapy and mechanical thrombectomy were attempted to restore flow to the portal venous system. This distinctly rare manifestation of Behçet's Disease, pylephlebitis, may result from ischemic injury and structural compromise of the bowel mucosa, resulting from underlying vasculitis.

Recommendations to eliminate subjective olfactory methods from compendial identification tests.

Substitution of IR and UV absorption spectroscopy and use of the various test papers listed in the compendia provide satisfactory means of identifying drug and other substances that presently require subjective odor identification.

Ambiguities in IR and X-ray characterization of amphotericin B.

Two distinct IR spectra of amphotericin B have been reported. These differences can be obtained from the same sample by surprisingly small changes in the method of sample preparation. Type I spectra (hand-ground samples) are characterized by a sharp C = O stretching band at 1692 cm-1, and Type II spectra (vibrator-ground samples) are characterized by a broad C = O stretching band near 1710 cm-1. X-ray powder diffraction demonstrates that vibrator grinding promotes a transition from a crystalline to an amorphous phase. The two phases are not bioequivalent. Differential thermal analysis reveals a transition near 157 degrees and samples heated to 158 degrees give only Type II IR spectra. However, a marked color change accompanies such heating (i.e., structural changes affecting the chromophore have been thermally induced), while X-ray spectra show an increase of only about 30% in amorphous content. Furthermore, hand-ground samples heated to 120 degrees still display only Type I IR spectra. Thus, the vibrator-induced transition is not solely a static thermal effect. Many observed spectral lines can be assigned to specific functional groups.

Omental infarction as a delayed complication of abdominal surgery.

Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.

A daughter of a depressed mother: a case report.

Stern notes that infants attempt to enliven their depressed mothers. The reconstructed childhood of a patient who was the daughter of a depressed mother is discussed. The treatment of this 31-year-old single woman whose talk was rapid, whose comments were studded with high-powered names, and whose checks bounced is described. The intensity of this patient's attempts to connect with the therapist illustrated her need to enliven the therapist. This adult charmer is reminiscent of the infants that Stern observed in interaction with their depressed mothers.

Infrared spectrophotometric analysis of medicinal gases for trace impurities.

The feasibility of examining medical gases for trace impurities, using an infrared spectrophotometer in conjunction with a 10 m gas cell, was investigated. Many of the impurities for which the USP includes limits were detected and measured at concentrations at or below those permitted by the USP; these include sulfur dioxide, carbon dioxide, carbon monoxide, and water. However, others (hydrogen sulfide, nitric oxide, and nitrogen dioxide) were not detected at these levels by this technique. Methane was found at low levels in some samples.

Infrared identification of maleic acid in pharmaceutical maleate salts.

Difficulties are encountered in the USP melting point identification test for maleic acid extracted from chlorpheniramine maleate. A general procedure is described for the isolation and infrared identification of the maleic acid moiety of pharmaceutical salts from drug substances or dosage forms. This procedure permits the concurrent infrared identification of the amine moiety.

The analysis of pharmaceuticals by combined gas chromatography-mass spectrometry. I. The analysis of a medicated aerosol spray.

A medicated aerosol product was qualitatively analyzed by combined gas chromatography-mass spectrometry. The data were processed by a minicomputer. Ten of the 11 peaks in the gas chromatogram were identified with the assistance of the National Institutes of Health/Division of Computer Research and Technology/Chemical Information System mass spectral search system. The unidentified peak is probably a member of the terpene class. The aerosol propellants were also partially analyzed by infrared spectrophotometry.

Controle de qualidade do cloroformio e do tetracloreto de carbono por cromatografia gasosa e espectrofotometria no infravermelho. / Quality control of chloroform and carbon tetrachloride by gas chromatography and infrared spectrophotometry

Propoe-se metodo de analise por cromatografia gasosa e teste de identificacao por espectrofotometria no infravermelho para o controle de qualidade do cloroformio e do tetracloreto de carbono.Como padrao interno para a analise cromatografia quantitativa dos solventes empregou-se o cloreto de qualidade do cloroformio e do tetracloreto de carbono. Como padrao interno para a analise cromatografia quantitativa dos solventes empregou-se o cloreto de metileno. Na analise espectrofotometrica no infravermelho utilizou-se cela de gas para injecao dos vapores dos solventes estudados. Os procedimentos descritos sao exatos e precisos