Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening immunologic reactions. Prior studies using electronic health records, registries or reporting databases are often limited in sample size or lack clinical details. We reviewed diverse detailed case reports published over four decades. Methods: Stevens-Johnson syndrome and toxic epidermal necrolysis-related case reports were identified from the MEDLINE database between 1980 and 2020. Each report was classified by severity (i.e., SJS, TEN, or SJS-TEN overlap) after being considered a "probable" or "definite" SJS/TEN case. The demographics, preconditions, culprit agents, clinical course, and mortality of the cases were analyzed across the disease severity. Results: Among 1,059 "probable" or "definite" cases, there were 381 (36.0%) SJS, 602 (56.8%) TEN, and 76 (7.2%) SJS-TEN overlap cases, with a mortality rate of 6.3%, 24.4%, and 21.1%, respectively. Over one-third of cases had immunocompromised conditions preceding onset, including cancer (n = 194,18.3%), autoimmune diseases (n = 97, 9.2%), and human immunodeficiency virus (HIV) (n = 52, 4.9%). During the acute phase of the reaction, 843 (79.5%) cases reported mucous membrane involvement and 210 (19.8%) involved visceral organs. Most cases were drug-induced (n = 957, 90.3%). A total of 379 drug culprits were reported; the most frequently reported drug were antibiotics (n = 285, 26.9%), followed by anticonvulsants (n = 196, 18.5%), analgesics/anesthetics (n = 126, 11.9%), and antineoplastics (n = 120, 11.3%). 127 (12.0%) cases reported non-drug culprits, including infections (n = 68, 6.4%), of which 44 were associated with a mycoplasma pneumoniae infection and radiotherapy (n = 27, 2.5%). Conclusion: An expansive list of potential causative agents were identified from a large set of literature-reported SJS/TEN cases, which warrant future investigation to understand risk factors and clinical manifestations of SJS/TEN in different populations.

The Use of Electronic Health Records to Study Drug-Induced Hypersensitivity Reactions from 2000 to 2021: A Systematic Review.

Electronic health records (EHRs) have revolutionized the field of drug hypersensitivity reaction (DHR) research. In this systematic review, we assessed 140 articles from 2000-2021, classifying them under six themes: observational studies (n=61), clinical documentation (n=27), case management (n=22), clinical decision support (CDS) (n=18), case identification (n=9), and genetic studies (n=3). EHRs provide convenient access to millions of medical records, facilitating epidemiological studies of DHRs. Though the goal of CDS is to promote safe drug prescribing, allergy alerts must be designed and used in a way that supports this effort. Ultimately, accurate allergy documentation is essential for DHR prevention.

User satisfaction with a smartphone-compatible, artificial intelligence-based cutaneous pigmented lesion evaluator.

INTRODUCTION: Melanoma is the most aggressive type of skin cancer, and it may arise from a cutaneous pigmented lesion. As artificial intelligence (AI)-based teledermatology services hold promise in redefining the melanoma screening paradigm, a study that evaluates user satisfaction with a smartphone-compatible, AI-based cutaneous pigmented lesion evaluator is lacking. METHODS: Data was collected between April and May 2019 in Taiwan. To assess user satisfaction with MoleMe, an AI-based cutaneous pigmented lesion evaluator on a smartphone, users were asked to complete a questionnaire designed to evaluate four aspects, including interaction, impact on daily life, usability, and overall performance, after completing a MoleMe evaluation session. For each question, users could rank their satisfaction level from 1 to 5, with five showing strongly satisfied and one showing strongly unsatisfied. The Kruskal-Wallis and Wilcoxon rank-sum tests were used to compare user satisfaction among different age groups, genders, and risk predictions received. RESULT: A total of 1231 questionnaires were collected for analysis. Over 90% of the participants were satisfied (score = 4 or 5) and over 75% of the participants were strongly satisfied (score 5) with MoleMe, in terms of usability, interaction, and impact on daily life. The user satisfaction did not show a significant difference between genders, age groups, and risk predictions received. (all P > 0.05) CONCLUSION: With high user satisfaction regardless of age group, gender, and risk prediction received, AI-based teledermatology services on a smartphone such as MoleMe may potentially achieve widespread usage and be beneficial to both patients and physicians.

Temporal increases in 25-hydroxyvitamin D in midlife women: Longitudinal results from the Study of Women's Health Across the Nation.

OBJECTIVE: 25-hydroxyvitamin D (25(OH)D) is critical for bone mineralization and may prevent fractures. Understanding vitamin D deficiency trends in midlife women is particularly important given their concurrent menopausal changes that increase risk for fracture. We aimed to evaluate changes in mean 25(OH)D over time and their determinants in a racially, ethnically and socioeconomically diverse cohort of midlife women. DESIGN: A multi-centre prospective cohort study. PATIENTS: 1585 women ages 42-52 years at baseline. MEASUREMENTS: We measured serum 25(OH)D at 2 time points (1998-2000 and 2009-2011). Between-visit change was assessed in the whole cohort and in socioeconomic and demographic subgroups. Among those with vitamin D deficiency (25(OH)D <30 nmol/L) at baseline, we evaluated determinants of persistent deficiency at follow-up. RESULTS: Mean 25(OH)D increased from 53.8 to 70.0 nmol/L (P < 0.001), and the prevalence of deficiency decreased from 20.4% to 9.7% (P < 0.001). While baseline 25(OH)D differed among subgroups, the changes in 25(OH)D were similar among groups. The proportion of women reporting dietary supplement use increased from 40.8% to 67.1% (P < 0.001), and the increase in 25(OH)D was significantly higher in supplement users. Among women with vitamin D deficiency at baseline, White women and supplement users were less likely to remain deficient at follow-up. CONCLUSIONS: Among midlife women, temporal increases in 25(OH)D concentrations are driven largely by increases in supplement use. The proportion of women with 25(OH)D <30 nmol/L and thus at high risk for skeletal consequences remains substantial. Targeted screening for vitamin D deficiency in populations at risk for fragility fracture may be advisable.

Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca.

Contaminated food is responsible for a significant amount of illnesses. In Morocco, it has become a worrying concern. Numerous awareness campaigns are conducted to warn the population against the risks of such scourge in ways that will prevent foodborne illness. Lawful commissions are in charge of examining and ensuring food safety in production and catering establishments, in addition to the assessment of food poisoning risks. The aim of this study is to evaluate the hygienic quality of food handling, preparation, and storage in catering establishments within Hay Hassani prefecture in Casablanca. During the period 2006-2012 a total of 1765 food samples were taken and examined for microbiological quality tests. As analyzed, 562 per 1765 samples are declared unhealthy for consumption. We note that some products were highly contaminated as compared to other products (p <0.001), specifically vegetable dishes, and meat dishes. In Hay Hassani district food is generally prepared and sold under unhygienic conditions, adequate corrective measures have been announced to improve hygienic practices.