Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer.

BACKGROUND: Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS: We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS: Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B = 0.12, P = 0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B = 0.07, P = 0.138). Intervention patients had lower readmission risk (hazard ratio = 0.68, P = 0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B = 0.16, P = 0.862). CONCLUSIONS: This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.

Effects of laser etching on shear bond strengths of brackets bonded to fluorosed enamel.

AIM: To evaluate the effects of laser etching on the shear bond strengths (SBS) and failure modes of brackets bonded to fluorosed enamel. MATERIALS AND METHODS: This in vitro study included 34 fluorosed and 34 nonfluorosed teeth. Teeth were divided into four subgroups according to the etching procedure: Group (A) normal enamel etched with 37% phosphoric acid for 15 s, Group (B) nonfluorosed enamel etched with erbium:yttrium aluminum garnet (Er: YAG) laser for 15 s, Group (C) fluorosed enamel etched with 37% phosphoric acid for 30 s, Group (D) fluorosed enamel etched with Er: YAG laser for 30 s. After bonding of the premolar metal brackets, specimens were subjected to the thermal cycles. After SBS test, modified adhesive remnant index (ARI) by using stereomicroscope and failure modes with a scanning electron microscope (SEM) was determined. After bonding, one specimen from each group was examined under SEM to identify enamel-resin interfaces. ANOVA and Tukey post-hoc tests were used to compare the SBS values. The Kruskal-Wallis and Chi-square tests were used to analyze the distribution of ARI scores and failure modes of groups. RESULTS: The highest mean SBS value (17.56 ± 1.05 MPa) was found in Group A, while the lowest (12.25 ± 0.96 MPa) in Group D. Significant differences were found in the SBS test and failure modes among all groups. The differences between ARI scores of the groups were not significant. CONCLUSION: According to our findings, laser etching reduced the SBS of brackets bonded to fluorosed teeth, but provided clinically acceptable SBS values.