The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria.

BACKGROUND: Despite the existence of numerous dermatology-specific quality-of-life questionnaires, there exists a need for a well-validated instrument to evaluate and monitor patients with chronic urticaria. OBJECTIVE: To develop and validate a novel chronic urticaria-specific questionnaire, the Urticaria Severity Score (USS). METHODS: The USS was developed with 12 questions and 7 response options per question included in the final questionnaire. The USS was pilot tested on 28 patients with symptomatic chronic urticaria, and a modified version was tested in 80 patients. In this latter group, the USS was compared with the previously validated Dermatology Life Quality Index (DLQI). Patients completed both questionnaires at baseline and at follow-up (median, 2 weeks). Spearman rank correlation tests were used to compare the USS with the DLQI. At a subsequent visit, 9 additional patients completed the USS to evaluate test-retest reliability. RESULTS: There was a positive correlation between the USS and DLQI at baseline (r = 0.64) and follow-up (r = 0.69). The test-retest reliability correlation for the USS was adequate (r = 0.96) (P = .001). The USS was more sensitive in detecting symptom improvement than the DLQI. The mean (SD) "raw score" change from baseline to follow-up for the USS was 9.95 (12.80), whereas the mean (SD) change from baseline to follow-up for the DLQI was 2.25 (4.87). CONCLUSIONS: The USS is a valid and reliable instrument for monitoring urticaria severity. The USS is more sensitive than the DLQI for quantifying urticaria severity and may be moreapplicable in the evaluation of urticaria-specific treatment efficacy.

A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population.

BACKGROUND: Asthma education and action plans (AP) have been recognized as important components in the optimal management of asthma. Studies have differed on the importance of a peak flow-based self-management plans in reducing health care costs and use due to asthma exacerbation. OBJECTIVE: To analyze the cost-effectiveness of peak flow-based action plans in reducing costs associated with ER visits and hospitalizations due to acute asthma exacerbation in a population of high-risk and high-cost patients, defined as patients with moderate to severe asthma with a history of recent urgent treatment in the ER or hospitalization due to asthma. METHODS: A literature review of randomized clinical trials comparing peak flow-based (PFB) action plans, symptom-based (SB) action plans, and usual care/no action plan (NAP) was performed. Probability values regarding the effectiveness of each alternative (as measured by increase/decrease in ER visits and hospitalizations over a 6-month period) were derived. Incremental cost-effectiveness and cost-benefit ratios were calculated for each alternative. Sensitivity analyses were performed. RESULTS: For high-risk and high-cost asthma patients, our analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based self-management plan. The peak flow-based self-management program had an incremental cost-effectiveness (C/E) ratio of $ 60.57 per ER visit averted compared to usual care/NAP and a C/E ratio of $31.46 compared to the SB-AP. The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an incremental C/E ratio of $300 per hospitalization prevented, compared with usual care and a C/E ratio of $311, compared to a SB-AP. Analysis yielded a cost-benefit ratio of 13.79 for the PFB-AP compared to NAP; the SB-AP had a cost-benefit ratio of 11.53 compared to NAP. CONCLUSION: Cost-effectiveness and cost-benefit analyses reveal that for high-cost patients, a peak flow-based asthma education and self-management plan program is the most cost-effective alternative in reducing costs associated with ER visits and hospitalizations due to asthma exacerbation. Further refinements to this cost-effectiveness analysis including measuring changes in drug use and costs and patients' productivity losses need to be pursued and may demonstrate additional cost-savings due to peak flow-based asthma education plans.

Effect of prior hepatitis B infection on serum IgE levels in patients with human immunodeficiency virus infection.

BACKGROUND: Advanced HIV infection is associated with increased serum IgE levels, which in turn have been associated with a poor prognosis. Our preliminary data revealed that serum IgE levels were significantly elevated in HIV seropositive injection drug users compared with HIV seropositive non-injection drug users. Since viral hepatitis is common among injection drug users and is itself associated with elevated serum IgE levels, we studied whether there was an association between increased serum IgE levels and positive hepatitis serology in HIV-seropositive patients. METHODS: A retrospective cross-sectional analysis was performed. The medical records of ambulatory HIV-infected patients in an ongoing study were reviewed. Forty-five patients had hepatitis A, B, and C serology performed. The associations between serum IgE levels and hepatitis A, B and C antibodies, CD4 and CD8 lymphocyte percentages, injection drug use, and sex were analyzed by univariate and multiple regression analyses. RESULTS: On univariate analyses, hepatitis B antibody was significantly associated with increased serum IgE levels in HIV-infected subjects (P = .013), especially in those with AIDS (P = .015). Multiple regression analyses controlling for CD4 lymphocyte percentages, sex, and drug use, confirmed that hepatitis B antibody status remained significantly associated with increased serum IgE levels (P = .05). There was no association of serum IgE levels with hepatitis A or C serology. CONCLUSION: Prior hepatitis B infection is significantly associated with increased serum IgE levels in advanced HIV infection. The clinical implications of this finding deserve further study.

Analysis of a family containing three members with common variable immunodeficiency.

BACKGROUND: Common variable immunodeficiency (CVID), a diverse immunodeficiency syndrome characterized by low immune globulin levels and recurrent infections, has been observed in families with the HLA A1 B8 DR3 haplotype. METHODS: We report a two-generation family with three members affected by CVID. Immunoglobulin levels, antibody titers, lymphocyte marker analyses, T cell proliferation assays, and HLA typing were performed on the affected family members. RESULTS: Studies of the affected patients revealed low levels of immunoglobulin G and A; normal tetanus, rubella and rubeola antibody titers; low B cell numbers; normal T cell numbers; normal CD4/CD8 ratios and normal lymphocyte proliferation studies. HLA typing did not reveal the HLA A1 B8 DR3 haplotype previously associated with familial CVID. CONCLUSION: We report a family with a unique presentation of CVID involving possible genetic inheritance other than the HLA A1 B8 DR3 haplotype and possessing lymphocyte characteristics distinct from those usually seen in sporadic CVID.

Nevo comedonico zoniforme / Nevus comedonicus zoniform

Presentamos una paciente de 20 anos de edad portadora desde el nacimiento de un extenso nevo comedonico en la cara posterior del miembro inferior derecho. Se efectua una revision de las caracteristicas clinicas, etiologia, evolucion, asociaciones y posibilidades terapeuticas de esta patologia. Debido a la extencion de la lesion y a su baja frecuencia consideramos de interes la presentacion de este caso clinico, realizando un aporte mas a la bibliografia nacional

Nevo comedonico zoniforme / Nevus comedonicus zoniform

Presentamos una paciente de 20 anos de edad portadora desde el nacimiento de un extenso nevo comedonico en la cara posterior del miembro inferior derecho. Se efectua una revision de las caracteristicas clinicas, etiologia, evolucion, asociaciones y posibilidades terapeuticas de esta patologia. Debido a la extencion de la lesion y a su baja frecuencia consideramos de interes la presentacion de este caso clinico, realizando un aporte mas a la bibliografia nacional(AU)

Treatment of resistant oral aphthous ulcers in children with acquired immunodeficiency syndrome.

Four children with acquired immunodeficiency syndrome and aphthous oral ulcers with severe odynophagia were treated with a short oral course of prednisone. The lesions resolved completely with no adverse effects. We recommend considering a short course of prednisone for relief of symptoms in these patients.

Living arrangements and the flow of support between generations in the Philippines.

This article is based on 18 focus group discussions (FDGs) conducted among elderly and adult children in varying urban/rural and class contexts. According to most participants, the majority of Filipino elderly prefer co-residence. Co-residence involves various types, each of which is defined according to the resources, needs, and life stage of the family. Although co-residence benefit the elderly and younger family members, it also entails some costs. Mechanisns supporting and weakening co-residence are also discussed in the article. Social change seems to have both positive and negative implications for living arrangements. Further research is needed to specify which conditions lead to which direction and nature of change.

Living arrangements in four Asian countries: a comparative perspective.

The findings of the 4 preceding country studies are examined here from a comparative perspective identifying some of the similarities and differences that underlie living arrangements of the elderly. More specifically, we compare the normative basis underlying living arrangements, mechanisms that help perpetuate co-residence, strains inherent to co-residence, preferences for co-residents, alternative forms of living arrangements, and views of social changes in relation to living arrangements. Overall, the focus group data on which the studies are based highlight the importance of culture in influencing the living arrangements of elderly people in Asia. The results suggest that at least for the next generation, co-residential living by elderly with children will continue to be a viable option, although the extent to which it persists is likely to vary among the 4 countries studied.

[Tamoxifen as the primary treatment for breast cancer in elderly patients]. / Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada.

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57% had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43% had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67% there was a clinical objective response (RC: 14%, RP: 53%), and 33% had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81% are still alive, and 14% died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.

Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada. / [Tamoxifen as the primary treatment for breast cancer in elderly patients]

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57

had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43

had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67

there was a clinical objective response (RC: 14

, RP: 53

), and 33

had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81

are still alive, and 14

died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.

Tamoxifeno como tratamiento primario del cáncer de mama en pacientes de edad avanzada. / [Tamoxifen as the primary treatment for breast cancer in elderly patients]

A total of 21 elderly patients with breast carcinoma without evidence of systemic dissemination received tamoxifen (20 mg daily) as primary treatment. Of these 57

had a potentially operable tumor (stages I:2, IIa:6, IIb:2, IIIa:2) with a high operative risk that contraindicated the surgery and 43

had a locally advanced tumor unfit for primary radiotherapy, chemotherapy, or surgery. The mean age was 81.3 +/- 5.7 years (range 70-91). Diagnosis was made by fine-needle aspiration cytology in 16 patients and by incision biopsy in 5 of them. The median follow-up was 11.5 months (range 3-54). In 67

there was a clinical objective response (RC: 14

, RP: 53

), and 33

had disease stabilization. There was no evidence of systemic dissemination during the follow-up. Two patients who had achieved a partial response with a duration of 11 and 54 months, respectively, had a loco regional progress. One of them responded to a second hormonal treatment. Of the patients, 81

are still alive, and 14

died of other causes. One patient was lost during the follow-up. These preliminary results show a high loco regional response to tamoxifen. A higher number of patients and a longer time of follow-up are needed to establish the habitual use of tamoxifen as primary treatment of breast carcinoma in elderly patients.

The predictive value and the management of cycles with low initial estradiol levels.

This study was undertaken to examine the predictive value of low estradiol (E2) after 5 days of human menopausal gonadotropin (hMG) stimulation response to therapy in that cycle. We further examined whether the outcome of such cycles can be improved by increasing the hMG dose. When 18 cycles in which day 8 E2 was less than or equal to 50 pg/mL were compared with 48 cycles with corresponding E2 levels of 51 to 150 pg/mL, the former showed a significantly worse response to subsequent hMG therapy. To determine the effect of an increase in hMG dose we studied 48 cycles with day 8 E2 of 51 to 150 pg/mL. In 32 cycles hMG dose was increased from three to a mean of five ampules a day, after 5 days of therapy. In 16 cycles it was kept constant at three ampules per day. Although a tendency towards lower fertilization rate was observed in the higher hMG groups, no significant differences were observed in the results between the two groups. We thus conclude that very low E2 levels after 5 days of gonadotropin therapy are predictive of low response in that cycle, and that in cycles with day 8 E2 of 51 to 150 pg/mL, increasing the dosage of hMG on day 8 and beyond does not alter the course of the cycle.

Effects of different proportions of carbohydrates, polysaccharides/monosaccharides, and different fibers on the metabolic control in diabetic rats.

Recent findings have suggested that diets with a high level of carbohydrates may impair the metabolic control of diabetes mellitus in humans. Moreover, other investigations have indicated that if the simple sugar content is increased in order to attain a proportion of polysaccharides/monosaccharides equal to 1, then neither the blood glucose nor the lipidic response show any change. We have studied the effect of increasing carbohydrates in the diet (59% v 82%), while maintaining cereal fiber levels constant (30%) and replacing cereal fiber in high carbohydrate diets by guar gum (30%) and lentil-derived leguminous fiber (30%) on the metabolic control of streptozotocin-induced diabetic rats. A study with different diets was performed for 3 weeks. An increase of carbohydrates in the diet produces an increase in the HbA1 concentration (1.9% v 3.9%, P less than 0.01) and in serum triglyceride levels (98.75 +/- 22.09 mg/dL v 144.50 +/- 3.52 mg/dL, P less than 0.05). Total cholesterol and HDL-cholesterol levels remained unchanged. The increase does not occur if the cereal fiber is replaced by lentil-derived leguminous fiber. In a second experiment, we substituted 50% of the complex carbohydrates in diets with 80% carbohydrates by glucose. Blood glucose, triglycerides, and HbA1 levels rose significantly in the four groups of rats that received diets containing 50% carbohydrates in glucose form. In addition, a test meal was carried out on day 19, consisting of 2.5 g of food/kg of wt. The maximum increase in blood glucose and the area below the glucose curve response was also significantly higher in the four groups of rats who received glucose in their diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Tratamiento primario del carcinoma de mama, factores pronosticos. / Primary treatment of breast carcinoma. Prognostic factors

155 pacientes con un seguimiento minimo de 3 anos fueron evaluados. La demora en la consulta no influyo en la incidencia de ganglios metastasicos. El 73.5% de las parecurrencia o metastasis a los 3 y 5 anos T3, T4). El 56% presento metastasis en los ganglios axilares. El tamano tumoral influyo en la incidencia de metastasis axilares excepto cuando se comparo T1 con T2 (PO. 06). Cuando se correlaciono tamano tumoral (T) con el estado de ganglios y recurrencia o metastasis a los 3 y5 anos no se observo diferencia significativa.Los pacientes con ganglios positivos tuvieron peor pronostico que las con ganglios negativos a los 3 y 5 anos (P 0.01). El estado menopausico no influyo en la sobrevida libre de enfermedad. El 87% de las pacientes con recurrencia a los 5 anos presentaron enfermedad diseminada. Los resultados terapeuticos a los 5 anos son similares a los publicados por otros autores en U.S.A.y Europa