Cell motility-a cellular behavior of paramount relevance in embryonic development, immunological response, metastasis, or angiogenesis-demands a mechanical deformation of the cell membrane and influences the surface motion of molecules and their biochemical interactions. In this work, we develop a fully coupled multi-physics model able to capture and predict the protein flow on endothelial advecting plasma membranes. The model has been validated against co-designed in vitro experiments. The complete picture of the receptor dynamics has been understood, and limiting factors have been identified together with the laws that regulate receptor polarization. This computational approach might be insightful in the prediction of endothelial cell behavior in different tumoral environments, circumventing the time-consuming and expensive empirical characterization of each tumor.
Neoplasms , Humans , Cell Membrane/metabolism , Physics , Endothelial Cells/physiology , Biophysics
BACKGROUND: Laparoscopic surgery is associated with shorter hospital stay and less post-operative morbidity. Cost, expertise and availability of equipment, however remain limitations to the range of surgeries available in low resource settings. OBJECTIVES: To determine the indications, the patient characteristics and the surgical outcomes of laparoscopic gynaecological surgeries in a Nigerian private tertiary level hospital. METHODS: This retrospective observational study included all gynaecologic laparoscopy procedures done between August 2016 and July 2021, at the Babcock University Teaching Hospital (BUTH). Data were extracted from the hospital records with the use of a proforma designed for this purpose and were analyzed using the SPSS version 21.0. RESULTS: Laparoscopy accounted for 13.5% of gynaecological surgeries. They were majorly in nulliparous women (67.6%) of reproductive age (mean 33.9±10.2 years and median of 32 years). The commonest indication was secondary infertility (27.3%) and operative procedures were more commonly done (59.0%). The mean duration of surgery was 94.8±52.4 min and conversion to laparotomy rate was 8.6%. Operative procedures lasted longer (113.9±58.1 min) and accounted for most conversions, 10/12 (83.3%). Intraoperative complication rate was 2.2% and they were mostly (66.7%) entry related. The mean duration of hospitalization was 2.2± 1.6 days. CONCLUSION: The prevalence and indications for laparoscopic surgeries were similar to findings from other parts of Nigeria. Operative procedures were however more commonly done. In spite of the sustained increase in procedure rates, a steady decline in the duration of surgery, conversion and complication rates occurred. Private hospitals may have potential for uninterrupted progression of laparoscopic gynaecocologic surgeries in Nigeria.
CONTEXTE: La chirurgie laparoscopique est associée à un séjour hospitalier et moins de morbidité postopératoire. Coût, expertise et la disponibilité de l'équipement restent cependant des limites à la gamme de chirurgies disponibles dans des contextes à faibles ressources. OBJECTIFS: Pour déterminer les indications, le patient et résultats chirurgicaux de la chirurgies gynécologiques par laparascopie dans un hôpital privé nigérian de niveau tertiaire. MÉTHODES: Cette étude observationnelle rétrospective comprenait les procédures de laparoscopie gynécologique effectuées entre août 2016 et juillet 2021, au Babcock University Teaching Hospital (BUTH). Les données ont été extraites des dossiers de l'hôpital à l'aide d'un proforma conçu à cet effet et a été analysé à l'aide de version 21.0 du SPSS. RÉSULTATS: La laparoscopie représentait 13.5 % des gynécologues Chirurgies. Ils étaient principalement chez les femmes nullipares (67.6%) âge de reproduction (moyenne 33.9±10.2 ans et médiane de 32 ans). L'indication la plus courante était l'infertilité secondaire (27.3%) etles procédures opératoires étaient plus couramment effectuées (59.0 %). La durée moyenne de la chirurgie était de 94.8±52.4 min et la conversion en laparotomie était de 8.6 %. Les procédures opératoires ont duré plus longtemps (113.9±58.1 min) et représentait la plupart des conversions, 10/12 (83.3 %). Le taux de complicationsintra opérative était de 2.2 % et ils étaient principalement (66.7 %) apparenté. La durée moyenne de l'hospitalisation était de 2.2 ± 1.6 jour. CONCLUSION: La prévalence et les indications pour les chirurgies par laparoscopie étaient similaires aux résultats d'autres régions du Nigéria. Les procédures opératoires étaient cependant plus courantes. Malgré tout de l'augmentation soutenue des taux d'intervention, une baisse constante de la durée de la chirurgie, la conversion et les taux de complications sont survenus. Les hôpitaux privés peuvent avoir un potentiel de progression interrompue des chirurgies gynécologiques laparoscopiques au Nigeria. Mots-clés: Audit, endoscopie, laparoscopie, hôpital privé.
Gynecologic Surgical Procedures , Laparoscopy , Adult , Female , Hospitals, Private , Hospitals, Teaching , Humans , Laparoscopy/methods , Nigeria/epidemiology , Young Adult
Obesity and metabolic disorders are important public health problems. In this review, the role of vasculature network and VEGF in the adipose tissue maintenance and supplementation is discussed. Angiogenesis is a key process implicated in regulation of tissues homeostasis. Dysregulation of new blood vessels formation may be crucial and contribute to the onset of several pathological conditions, including metabolic syndrome-associated disorders. Adipose tissue homeostasis is fine regulated by vascular network. Vessels support adipose structure. Vasculature modulates the balance between positive and negative regulator factors. In white adipose tissue, vascular endothelial growth factor (VEGF) controls the metabolic activities of adipocytes promoting the trans-differentiation from white to beige phenotype. Trans-differentiation results in an increase of energy consumption. VEGF exerts an opposite effect on brown adipose tissue, where VEGF increases oxygen supply and improves energy expenditure inducing the whitening of adipocytes.
Metabolic Diseases/etiology , Vascular Endothelial Growth Factor A/physiology , Adipocytes/physiology , Adipose Tissue, Beige/physiology , Adipose Tissue, White/physiology , Animals , Cell Differentiation/genetics , Energy Metabolism/genetics , Humans , Metabolic Diseases/genetics , Metabolic Diseases/metabolism , Metabolic Diseases/pathology , Obesity/genetics , Obesity/metabolism , Phenotype
The Long-Term Evolution (LTE) system represents the evolution of the Universal Mobile Telecommunication System technology. This technology introduces two duplex modes: Frequency Division Duplex and Time Division Duplex (TDD). Despite having experienced a limited expansion in the European countries since the debut of the LTE technology, a renewed commercial interest for LTE TDD technology has recently been shown. Therefore, the development of extrapolation procedures optimised for TDD systems becomes crucial, especially for the regulatory authorities. This article presents an extrapolation method aimed to assess the exposure to LTE TDD sources, based on the detection of the Cell-Specific Reference Signal power level. The method introduces a ßTDD parameter intended to quantify the fraction of the LTE TDD frame duration reserved for downlink transmission. The method has been validated by experimental measurements performed on signals generated by both a vector signal generator and a test Base Transceiver Station installed at Linkem S.p.A facility in Rome.
Electromagnetic Fields , Environmental Exposure/analysis , Radiation Monitoring/methods , Radio Waves , Telecommunications/instrumentation , Wireless Technology/instrumentation , Europe , Italy , Models, Statistical
Syndecan-1 is a heparan sulfate proteoglycan (HSPG) commonly upregulated in AIDS-related B lymphoid malignancies. Tat is the main HIV-1 transactivating factor that has a major role in the pathogenesis of AIDS-related lymphomas (ARL) by engaging heparan sulfate proteoglycans (HSPGs), chemokine receptors and integrins at the lymphoid cell (LC) surface. Here B-lymphoid Namalwa cell clones that do not express or overexpress syndecan-1 (EV-Ncs and SYN-Ncs, respectively) were compared for their responsiveness with Tat: in the absence of syndecan-1, Tat induces a limited EV-Nc migration via C-X-C motif chemokine receptor 4 (CXCR4), G-proteins and Rac. Syndecan-1 overexpression increases SYN-Nc responsiveness to Tat and makes this response independent from CXCR4 and G-protein and dependent instead on pp60src phosphorylation. Tat-induced SYN-Nc migration and pp60src phosphorylation require the engagement of αvß3 integrin and consequent pp125FAK phosphorylation. This complex set of Tat-driven activations is orchestrated by the direct interaction of syndecan-1 with pp60src and its simultaneous coupling with αvß3. The Tat/syndecan-1/αvß3 interplay is retained in vivo and is shared also by other syndecan-1+ B-LCs, including BJAB cells, whose responsiveness to Tat is inhibited by syndecan-1 knockdown. In conclusion, overexpression of syndecan-1 confers to B-LCs an increased capacity to migrate in response to Tat, owing to a switch from a CXCR4/G-protein/Rac to a syndecan-1/αvß3/pp60src/pp125FAK signal transduction pathway that depends on the formation of a complex in which syndecan-1 interacts with Tat via its HS-chains, with αvß3 via its core protein ectodomain and with pp60src via its intracellular tail. These findings have implications in ARL progression and may help in identifying new therapeutical targets for the treatment of AIDS-associated neoplasia.
Focal Adhesion Kinase 1/genetics , Integrin alphaVbeta3/genetics , Lymphocytes/metabolism , Neoplasms/genetics , Syndecan-1/genetics , Cell Adhesion/genetics , Gene Expression Regulation, Neoplastic , HIV-1/genetics , Humans , Lymphocytes/pathology , Multiprotein Complexes/genetics , Neoplasms/pathology , Phosphorylation , Proto-Oncogene Proteins pp60(c-src)/genetics , Receptors, CXCR4/genetics , Signal Transduction/genetics , tat Gene Products, Human Immunodeficiency Virus/administration & dosage , tat Gene Products, Human Immunodeficiency Virus/metabolism
BACKGROUND: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. However, treatment of hypertrophic or resistant PWSs is a major therapeutic challenge. The long-pulsed Alexandrite laser could be a safe and effective treatment for resistant PWSs, due to an increase depth of penetration of 50-75% over PDL. OBJECTIVE: The aim of this study was to assess the efficacy and safety of a long-pulsed Alexandrite laser in patients with hypertrophic, dark and/or resistant PWSs. Pink pale resistant PWS were excluded from the study. METHODS: Twenty-one patients (age 20-75 years), phototypes I-IV on the Fitzpatrick scale, with PDL dark resistant PWSs were treated with long-pulsed Alexandrite laser. We excluded high phototypes and PDL pink resistant PWSs. All patients were treated with 3 laser sessions at settings of 3-ms pulse duration, 10-mm spot, 35-55J/cm2, with cooling (Dynamic Cooling Device 50 ms with delay 30 ms). Laser sessions were repeated approximately every 2 months. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before and after laser treatment (scale from 0 to 4). Adverse events were registered. Patient satisfaction was also assessed (scale from 0 to 10). RESULTS: Mean global improvement was rated as 2.28. Long-lasting side effects included minimal scarring after blistering in 1 patient. Mean patient satisfaction was 8.5. CONCLUSIONS: Our study concludes that long-pulsed Alexandrite laser was effective for treatment of resistant PWSs, although the therapeutical window is narrow with this treatment
ANTECEDENTES: Las manchas en vino de oporto (MVO) son normalmente tratadas con láser de colorante pulsado. Sin embargo, el tratamiento de MVO hipertróficas o resistentes continúa siendo un importante reto terapéutico. El láser de Alejandrita de pulso largo podría ser un método seguro y eficaz para el tratamiento de estas lesiones, debido a que la profundidad que alcanza puede superar entre un 50-75% al láser de colorante pulsado. OBJETIVO: El objetivo de este estudio fue evaluar la eficacia y la seguridad del láser de Alejandrita de pulso largo en pacientes con MVO hipertróficas y/o resistentes. Los pacientes con MVO resistentes de color rosa pálido fueron excluidos del estudio. MÉTODOS: Veintiún pacientes (Edades entre 20-75 años), fototipos I-IV en la escala Fitzpatrick, con MVO oscuras, resistentes al tratamiento con láser de colorante pulsado fueron tratados con láser de Alejandrita de pulso largo. Se excluyeron los fototipos altos y las MVO de color rosado pálido. Todos los pacientes fueron tratados con 3 sesiones de láser con los siguientes parámetros: duración de pulso de 3 ms, spot de 10 mm de diámetro, fluencias comprendidas entre 35 y 55 J/cm2, con refrigeración (Dynamic Coolong Device). El intervalo de tiempo entre sesiones fue de 2 meses aproximadamente. Tres dermatólogos evaluaron la efectividad del tratamiento a través de las fotografías de los pacientes antes y después del tratamiento con láser (escala de 0 a 4). Se registraron los eventos adversos acontecidos. La satisfacción del paciente también se evaluó (escala de 0 a 10). RESULTADOS: La mejoría global media fue de 2,28. Los efectos adversos duraderos fueron lesiones cicatriciales mínimas en un paciente. La satisfacción media de los pacientes fue de 8,5. CONCLUSIONES: Nuestro estudio concluye que el láser de Alejandrita de pulso largo puede ser eficaz en el tratamiento de MVO resistentes, aunque la ventana terapéutica es estrecha con este tratamiento
Humans , Male , Female , Adult , Middle Aged , Aged , Hair Diseases/radiotherapy , Hair Diseases , Port-Wine Stain/therapy , Skin Abnormalities/therapy , Laser Therapy/instrumentation , Laser Therapy/methods , Laser Therapy , Lasers, Solid-State/therapeutic use , Skin/anatomy & histology , Skin/pathology , Skin/radiation effects , Treatment Outcome , Evaluation of the Efficacy-Effectiveness of Interventions , Prospective Studies
BACKGROUND: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. However, treatment of hypertrophic or resistant PWSs is a major therapeutic challenge. The long-pulsed Alexandrite laser could be a safe and effective treatment for resistant PWSs, due to an increase depth of penetration of 50-75% over PDL. OBJECTIVE: The aim of this study was to assess the efficacy and safety of a long-pulsed Alexandrite laser in patients with hypertrophic, dark and/or resistant PWSs. Pink pale resistant PWS were excluded from the study. METHODS: Twenty-one patients (age 20-75 years), phototypes I-IV on the Fitzpatrick scale, with PDL dark resistant PWSs were treated with long-pulsed Alexandrite laser. We excluded high phototypes and PDL pink resistant PWSs. All patients were treated with 3 laser sessions at settings of 3-ms pulse duration, 10-mm spot, 35-55J/cm(2), with cooling (Dynamic Cooling Device 50ms with delay 30ms). Laser sessions were repeated approximately every 2 months. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before and after laser treatment (scale from 0 to 4). Adverse events were registered. Patient satisfaction was also assessed (scale from 0 to 10). RESULTS: Mean global improvement was rated as 2.28. Long-lasting side effects included minimal scarring after blistering in 1 patient. Mean patient satisfaction was 8.5. CONCLUSIONS: Our study concludes that long-pulsed Alexandrite laser was effective for treatment of resistant PWSs, although the therapeutical window is narrow with this treatment.
Lasers, Solid-State/therapeutic use , Port-Wine Stain/pathology , Port-Wine Stain/surgery , Adult , Aged , Female , Humans , Hypertrophy , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Treatment Outcome , Young Adult
BACKGROUND: Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES: To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS: Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS: Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS: IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS
ANTECEDENTES: Entre las distintas estrategias para intentar mejorar la eficacia en el tratamiento de las malformaciones capilares tipo mancha en vino de Oporto (MC tipo MVO) están las fuentes de luz pulsada intensa. Existen hasta la fecha pocos estudios clínicos que avalen su utilidad en el tratamiento de las MC. Además, no disponemos de estudios histológicos que objetiven los efectos de la luz pulsada en la coagulación de estos vasos anómalos. OBJETIVOS: Evaluar los efectos histológicos de la luz pulsada en las MC tipo MVO. Intentamos comparar el daño epidérmico, dérmico y de la pared de los vasos después del tratamiento con distintos parámetros de IPL. MATERIAL Y MÉTODOS: Fueron realizadas 55 biopsias postratamiento en las MC de 15 pacientes. Las muestras fueron teñidas con cloruro de nitroblue tetrazolium. RESULTADOS: Quince pacientes (edad media: 39 años) fueron inscritos en este estudio. En esta serie los pacientes con mayor daño epidérmico fueron aquellos con un fototipo más alto (>IV). Las malformaciones de color rosa pálido eran especialmente resistentes al tratamiento, incluso con altas fluencias, duraciones de pulso corto y pulsos repetidos. Los pulsos de una mayor duración fueron especialmente eficaces en malformaciones capilares violáceas. CONCLUSIONES: Los equipos de IPL ofrecen una gran cantidad de opciones de tratamiento en las MC, sin embargo necesitamos conocer mejor sus efectos para realizar abordajes más eficaces y seguros. En este estudio hemos podido observar los efectos histológicos de los distintos pulsos sobre las MC tipo MVO
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Hair Diseases/diagnosis , Hair Diseases/prevention & control , Hair Diseases/therapy , Intense Pulsed Light Therapy/adverse effects , Intense Pulsed Light Therapy , Intense Pulsed Light Therapy/instrumentation , Nitroblue Tetrazolium/pharmacology , Nitroblue Tetrazolium/therapeutic use , Solar Radiation/adverse effects , Chromophore-Assisted Light Inactivation/instrumentation , Chromophore-Assisted Light Inactivation/methods , Chromophore-Assisted Light Inactivation
BACKGROUND: Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES: To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS: Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS: Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS: IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS.
Capillaries/pathology , Dermis/pathology , Epidermis/pathology , Phototherapy/adverse effects , Port-Wine Stain/therapy , Adult , Hemangioma, Capillary/etiology , Humans , Laser Therapy , Treatment Outcome
No disponible
Humans , Male , Infant , Hemangioma/complications , Vascular Malformations/complications , Capillaries/abnormalities
No disponible
Humans , Male , Female , Chromoblastomycosis/complications , Chromoblastomycosis/diagnosis , Chromoblastomycosis/therapy , Blastomycosis/complications , Blastomycosis/epidemiology , Blastomycosis/prevention & control , Chromoblastomycosis/physiopathology , Chromoblastomycosis , Blastomycosis/physiopathology , Blastomycosis/therapy , Blastomycosis
An 11-month-old girl presented with an erythematous nodule on the chest, which had been growing for 8 months. The tumor was composed of uniform polygonal and spindle-shaped cells, forming nodules and fascicles. The diagnosis of neurothekeoma was based upon the histology and immunohistochemistry.
Neurothekeoma/diagnosis , Skin Neoplasms/diagnosis , Antibodies, Monoclonal , Antibodies, Neoplasm , Antigens, Neoplasm/analysis , Erythema/etiology , Female , Humans , Infant , Neurothekeoma/chemistry , Neurothekeoma/pathology , Skin Neoplasms/chemistry , Skin Neoplasms/pathology , Thorax
The facial flat wart is not only a contagious viral disease, but also a cause of a distressing cosmetic problem. Although there are many therapeutic options, including salicylic acid, imiquimod, cryotherapy, retinoids, intralesional immunotherapy, and topical 5-aminolevulinic acid photodynamic therapy among others, no monotherapy has been proved to achieve complete remission in every case. Treatment with pulsed dye laser (PDL) seems to be a promising therapeutic option. To assess the efficacy and safety of PDL in a series of patients with viral flat warts on the face, in this prospective study, 32 patients were treated with PDL at 595-nm wavelength, a laser energy density of 9 or 14 J/cm(2) with a spot size of 7 or 5 mm, respectively, with air cooling and a pulse duration of 0.5 millisecond. A complete response was noted in 14 patients (44%), and an excellent response was observed in 18 patients (56%) with 1-year follow-up, with only four recurrences. No significant side effects were reported except intense transitory purpuric response. We consider that PDL is a good option of treatment for flat warts on the face due to its good clinical results, fast response, and low incidence of side effects.
Laser Therapy/methods , Lasers, Dye/therapeutic use , Warts/surgery , Adolescent , Adult , Child , Face , Female , Humans , Male , Middle Aged , Prospective Studies
Introducción y objetivos: La mayoría de hospitales españoles no dispone de dermatólogo de guardia. El objetivo del estudio fue conocer el perfil de paciente que acude a Urgencias por un proceso dermatológico y de manera secundaria analizar la capacidad resolutiva del dermatólogo de guardia. Material y métodos: Estudio prospectivo que incluyó pacientes con afección dermatológica atendidos en Urgencias de un hospital con residente de Dermatología de guardia durante un periodo de 2 meses. Se recogió sexo, edad, diagnóstico, días de evolución, justificación o no de la consulta urgente, procedencia, destino tras la asistencia y motivo principal de la consulta. Para analizar la capacidad resolutiva del dermatólogo de guardia se valoró el porcentaje de altas directas, las pruebas complementarias realizadas y el porcentaje de revisitas. Resultados: Se atendieron 861 pacientes 58% mujeres y 42% varones (14,4 pacientes al día). Se realizaron 131 diagnósticos distintos, siendo los más frecuentes celulitis infecciosa, urticaria aguda y herpes zóster. Solo la mitad del total de consultas tenían un motivo urgente justificado (el 95% de los pacientes menores de 30 años acudió sin motivo urgente justificado, frente al 6% de pacientes mayores de 65 años, p<0,005). El dermatólogo de guardia dio el alta directa al 58% de los pacientes y se registró un porcentaje de revisitas <1%. En 4 de cada 5 urgencias atendidas no se requirió ninguna prueba complementaria. Conclusiones: El perfil de paciente con enfermedad urgente dermatológica es variable. En la mitad de las consultas no se encontró un motivo justificado de urgencia, especialmente en pacientes jóvenes. El dermatólogo de guardia presentó una alta capacidad resolutiva (AU)
Introduction and objectives: Most Spanish hospitals do not have an on-call dermatologist. The primary objective of our study was to determine the profile of patients visiting our hospitals emergency department for dermatologic conditions; our secondary objective was to analyze the case-resolving capacity of the on-call dermatologist. Material and methods: Prospective study that included patients with dermatologic conditions treated in the emergency department of a hospital with an on-call dermatology resident during a 2-month period. We collected data on sex, age, diagnosis, days since onset, whether or not the emergency visit was justified, referral (self-referral or other), continued care, and the main reason for the visit. To analyze the case-resolving capacity of the on-call dermatologist we assessed the percentage of direct discharges, the diagnostic tests performed, and the percentage of revisits. Results: The on-call dermatologist attended 861 patients (14.4 patients per day), of whom 58% were women and 42% men. In total, 131 different diagnoses were made; the most common were infectious cellulitis, acute urticaria, and herpes zoster. Only half of the visits were justifiable as emergencies (95% of patients < 30 years of age had conditions that did not justify emergency care, compared to 6% of patients > 65 years, P <0 .005). The on-call dermatologist discharged 58% of the patients directly and the revisit rate was 1%. In 4 of 5 emergency visits no diagnostic tests were required. Conclusions: The profile of patients seeking emergency dermatologic care is variable. Half of the emergency visits were not justified, and unjustified visits were especially common in younger patients. The case-resolving capacity of the on-call dermatologist was high (AU)
Humans , Male , Female , Emergency Medicine/methods , Emergency Medicine/trends , Dermatology/education , Skin Diseases/complications , Cellulite/complications , Communicable Diseases/complications , Communicable Diseases/diagnosis , Prospective Studies , Dermatitis/complications , Dermatitis/diagnosis , Eczema/complications , Eczema/diagnosis , Angioedema/complications , Urticaria/complications
BACKGROUND AND PURPOSE: To identify adverse events (AEs) significantly associated with perampanel treatment in double-blind clinical studies (RCTs). Serious AEs, study withdrawals due to AEs and dose-effect responses of individual AEs were also investigated. METHODS: All placebo controlled, double-blind RCTs investigating therapeutic effects of oral perampanel were searched. AEs were assessed for their association with perampanel after exclusion of synonyms, rare AEs and non-assessable AEs. Risk difference (RD) was used to evaluate the association of any AE (99% confidence intervals) and withdrawals or serious AEs (95% confidence intervals) with perampanel. RESULTS: Nine RCTs (five in pharmacoresistant epilepsy and four in Parkinson's disease) were included in our study. Almost 4000 patients had been recruited, 2627 of whom were randomized to perampanel and treated with drug doses of 0.5 mg/day (n = 68), 1 mg/day (n = 65), 2 mg/day (n = 753), 4 mg/day (n = 1017), 8 mg/day (n = 431) or 12 mg/day (n = 293). Serious AEs were not significantly associated with perampanel treatment. The experimental drug was significantly associated with an increased risk of AE-related study withdrawals at 4 mg/day [RD (95% confidence interval) 0.03 (0.00, 0.06)] and 12 mg/day [RD (95% confidence interval) 0.13 (0.07, 0.18)]. Of 15 identified AEs, five (dizziness, ataxia, somnolence, irritability and weight increase) were found to be significantly associated with perampanel and one (seizure worsening) was significantly associated with placebo. CONCLUSIONS: Vestibulocerebellar AEs (dizziness, ataxia), sedative effects (somnolence), irritability and weight increase were significantly associated with perampanel treatment.
Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Pyridones/adverse effects , Pyridones/therapeutic use , Anticonvulsants/administration & dosage , Confidence Intervals , Dose-Response Relationship, Drug , Double-Blind Method , Drug Resistance , Epilepsies, Partial/drug therapy , Epilepsy/drug therapy , Humans , Nitriles , Parkinson Disease/drug therapy , Pyridones/administration & dosage , Randomized Controlled Trials as Topic , Risk Assessment , Seizures/drug therapy
INTRODUCTION AND OBJECTIVES: Most Spanish hospitals do not have an on-call dermatologist. The primary objective of our study was to determine the profile of patients visiting our hospital's emergency department for dermatologic conditions; our secondary objective was to analyze the case-resolving capacity of the on-call dermatologist. MATERIAL AND METHODS: Prospective study that included patients with dermatologic conditions treated in the emergency department of a hospital with an on-call dermatology resident during a 2-month period. We collected data on sex, age, diagnosis, days since onset, whether or not the emergency visit was justified, referral (self-referral or other), continued care, and the main reason for the visit. To analyze the case-resolving capacity of the on-call dermatologist we assessed the percentage of direct discharges, the diagnostic tests performed, and the percentage of revisits. RESULTS: The on-call dermatologist attended 861 patients (14.4 patients per day), of whom 58% were women and 42% men. In total, 131 different diagnoses were made; the most common were infectious cellulitis, acute urticaria, and herpes zoster. Only half of the visits were justifiable as emergencies (95% of patients <30 years of age had conditions that did not justify emergency care, compared to 6% of patients >65 years, P<.005). The on-call dermatologist discharged 58% of the patients directly and the revisit rate was 1%. In 4 of 5 emergency visits no diagnostic tests were required. CONCLUSIONS: The profile of patients seeking emergency dermatologic care is variable. Half of the emergency visits were not justified, and unjustified visits were especially common in younger patients. The case-resolving capacity of the on-call dermatologist was high.
Dermatology , Medical Staff, Hospital/statistics & numerical data , Skin Diseases/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Emergencies , Female , Hospitals, Teaching , Humans , Infant , Male , Middle Aged , Prospective Studies , Tertiary Healthcare , Workforce , Young Adult
Perampanel is a new chemical entity recently approved in the United States (US) and European Union (EU) as adjunctive treatment of partial-onset seizures with and without secondary generalization in patients with epilepsy aged 12 years and older. Pharmacological studies suggest that perampanel acts with a new mechanism of action via non-competitive antagonism of the ionotropic α-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) receptor of glutamate, the main mediator of excitatory neurotransmission in the central nervous system. Perampanel is completely absorbed after oral administration. The drug is 95% bound to plasma proteins and is extensively metabolized by oxidation followed by glucuronidation. Perampanel has an elimination half-life of approximately 52-129h, allowing once daily dosing, with peak plasma levels observed 0.25-2h post-dose. Randomized placebo-controlled trials of adjunctive treatment have demonstrated that once-daily perampanel doses of 4-12mg/day significantly reduced partial-onset seizure frequency in patients with pharmacoresistant epilepsy along with a favorable tolerability profile. In perampanel pivotal trials, the most frequently reported treatment emergent adverse events (>10%) included dizziness, somnolence, fatigue and headache. Perampanel therapeutic response was maintained in patients included in the long term open-label extension studies for up to 4 years. Based on these data, perampanel offers a valuable option in the add-on treatment of partial-onset and secondarily generalized seizures.
Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Pyridones/therapeutic use , Administration, Oral , Animals , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Anticonvulsants/pharmacokinetics , Clinical Trials as Topic , Drug Evaluation, Preclinical , Drug Interactions , Drug Therapy, Combination , Humans , Molecular Structure , Nitriles , Pyridones/administration & dosage , Pyridones/adverse effects , Pyridones/pharmacokinetics , Treatment Outcome
