Novel management of granuloma formation secondary to dermal filler: A multi-modality approach.

BACKGROUND: Dermal fillers for soft tissue augmentation have become increasingly popular among patients of all ages and ethnicities. With more widespread use, there has been an increased incidence of adverse reactions, one of which is the granulomatous foreign body reaction (GFBR). MATERIALS & METHODS: We present a three patient case series in which GFBR secondary to dermal filler was successfully treated with a multi-leveled approach. The first modality involves intralesional injection of a mixture containing 1 cc of 5-fluorouracil (5-FU), 0.5 cc of dexamethasone sodium phosphate, and 0.1 cc of triamcinolone 10. The lesion is injected intradermally in small aliquots, similar to scar treatment. The patient then takes colchicine 1.2 mg loading dose on day 1, then 0.6 mg twice per day for 4 days concurrently with naproxen 500 mg orally once daily for 5-7 days. This process may be repeated in 6 weeks if the lesions have not resolved and PDL laser may be employed for residual post-inflammatory erythema. RESULTS: All three patients presented in this case series had significant aesthetic improvement in their dermal filler-derived foreign body granulomatous reactions. CONCLUSION: GFBR provides both a medical and aesthetic issue for these patients including mental distress, pain, and dysfunction, therefore having an effective treatment for GFBR will affect medical management of these patients, improving patient outcomes and satisfaction. Our proposed regimen for GFBR has been shown to be highly efficacious and safe for these patients, providing a significant improvement in both function and cosmesis of the area.

Peer Review Processes for Quality Improvement in Health Care Settings and Their Implications for Health Care Professionals: A Meta-Ethnography.

INTRODUCTION: Peer review processes are used to improve professional practice in health care, although no synthesis of existing studies has yet been undertaken. These processes are included in the UK professional revalidation processes for medical practitioners and nurses and midwives but not for allied health professionals. The purpose of this review was to identify, appraise, and synthesize the available qualitative evidence regarding health care professionals' experiences and views about peer review processes and to explore the implications for health care professionals in the United Kingdom. METHODS: Qualitative review using meta-ethnography, reported according to Meta-ethnography Reporting Guidance guidance. Search strategy was developed using MeSH headings. The following data sources were searched: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Ovid full text (between May 2007 and May 2019) (one reviewer with librarian support) plus manual searching. Screening, data extraction, and evaluation were undertaken independently by two reviewers. Studies were independently appraised for quality by two reviewers to identify concepts which were compared and developed into a conceptual model by the team. RESULTS: Thirteen studies (937 participants) were included. Findings explored peer review processes and three key components, namely, purpose, process, and peers. Participants' perceptions of peer review processes were categorized by four main concepts: value/benefits, reflection/shared learning, anxiety about the process, and how to improve "buy-in." DISCUSSION: Evidence supports the introduction and use of peer review processes as a quality improvement tool. Further research exploring whether/how to incorporate peer review processes into the process of assessing continuing fitness to practice for allied health professionals seems appropriate. The time and resources required to implement peer review processes are considered barriers to implementation.

Lupus Erythematosus Lichen Planus Overlap Syndrome Mimicking Squamous Cell Carcinoma.

Lupus erythematosus lichen planus (LE-LP) overlap syndrome remains an uncommon diagnostic entity, combining both the histologic and clinical features of lupus erythematosus and lichen planus. A rare and challenging diagnosis, clinicopathologic correlation is essential for accurate and timely identification. Histologically, superficial evaluation of lupus erythematosus lichen planus overlap syndrome can mimic squamous cell carcinoma due to the presence of squamatized keratinocytes with concomitant irregular acanthosis. Here, we present a case of LE-LP overlap syndrome in a patient with long standing systemic lupus erythematosus initially misdiagnosed as squamous cell carcinoma.

Effect of formulation variables on oral grittiness and preferences of multiparticulate formulations in adult volunteers.

Multiparticulate formulations are composed of multiple solid dosage units which can be administered directly to the mouth or sprinkled on food. Oral grittiness (i.e. rough mouthfeel) may arise from the presence of particles in the mouth, limiting palatability. In this work, multiparticulate formulations were prepared by dispersion of spherical granules into orange flavoured vehicles thickened with hypromellose (HPMC) at different viscosities in order to assess oral perception of grittiness by a panel of thirty adults through direct scaling on a 100mm visual analogue scale. The effect of formulation factors such as particle size (90, 127, 263µm), amount of particles per 10ml (0.25, 0.50, 1.00g) and viscosity of the vehicle (0.08, 0.43, 2.80Pas) were investigated. Grittiness was increasingly perceived with increasing amount and size of particles. Increasing viscosity of the administration media had a masking effect on the perception of particles. Less gritty samples were generally regarded as 'more pleasant' by the participants of the study. However, samples dispersed in thickened vehicles seemed to be less preferred despite being less gritty; which could be ascribed to an unpleasant mouthfeel of the vehicle. In the design of multiparticulate formulations acceptable for a targeted patient group all these formulation factors will need to be considered and optimised.

Specific aspects of gastro-intestinal transit in children for drug delivery design.

This mini-review discusses relevant aspects of gastro-intestinal transit in different ages of paediatric patients with an attempt to highlight factors which should be considered in oral dosage form design, in particular multi-particulate dosage forms. This emphasis is due to multi-particulates possessing many of the benefits of liquid oral formulations (such as ease of swallowing and dose adaptability) without many of their drawbacks (such as stability issues and lack of enteric or modified release functionalities). It is commonly stated that children are not merely small adults with regards to medicines. However, there has been very little research regarding how different dosage forms transit through the gastro-intestinal tract in children compared to adults, due to both ethical and practical hurdles. Due to this lack of studies on dosage form transit in children, information which was available on the transit of food, milk and liquids (often dependent upon the age of the patient) has been used to look at how various aspects of transit vary with age and, where possible, when they reach adult values and how these may affect the fate of dosage forms in vivo: swallowability, oesophageal transit, gastric emptying and pH, intestinal and colonic transit are discussed.