Job satisfaction, depression severity and quality of life ratings of perioperative nurses in robotic-assisted and laparoscopic surgery.

The rapid introduction of technological developments into healthcare systems adds another layer of complexity to the already demanding jobs of nurses, particularly for those working in perioperative care. In the present study, our primary aim is job satisfaction, whereas the secondary outcomes are psychological well-being and quality of life (QoL) ratings of perioperative nurses who take part in robotic-assisted and pure laparoscopic surgery. A total of 101 perioperative nurses in six different centers were included in the study. Fifty-one of the nurses were working in robotic-assisted laparoscopic surgery and 50 of them were working in pure laparoscopic surgery. All participants responded to Minnesota Job Satisfaction Questionnaire (MJSQ), Beck Depression Inventory (BDI) and SF-36 QoL Measurement Survey. The two groups did not differ in their total MJSQ, BDI and SF-36 QoL scores (pMJSQ:0.066, pBDI:0.329, pSF-36-QoL:0.136). In addition, there were no differences between the two groups in their intrinsic job satisfaction and extrinsic job satisfaction sub-scores (pintrinsic: 0.473, pextrinsic:0.121). Overall, 18.9% of the nurses reported having moderate to extreme depressive symptoms and most of them (87.1%) had low to moderate levels of job satisfaction. Finally, QoL ratings was generally at moderate levels. Perioperative nurses who work in robotic-assisted laparoscopic surgery do not differ from those working in pure laparoscopic surgery in terms of their job satisfaction, psychological well-being, and QoL ratings. In addition, across groups' psychological well-being, job satisfaction, and QoL ratings were not particularly high, suggesting that more attention needs to be paid to improving the work conditions of perioperative nurses.

Intrahepatic cholestasis occurring with prurigo of pregnancy.

A 23-year-old woman presented to our polyclinic complaining of itching, generalized dermatitis, and jaundice. She was in her 31st gestational week and had developed pruritus and the dermatitis since the first month of pregnancy; her jaundice started about a month before presentation. Her history included similar complaints in a previous pregnancy, which resulted in premature birth of a baby with a permanent brain defect. One of her sisters had had jaundice and itching in her 27th gestational week and delivered a healthy baby; a second sister had experienced itching and dermatitis in her second trimester and delivered a healthy baby. Physical examination of the patient showed that her eyes were jaundiced (Figure 1); skin examination revealed generalized erythematous excoriated papules, symmetrically distributed all over her body (Figure 2 Figure 3). Laboratory analyses revealed the following results: leukocyte count, 14.30/mm(3) (3.8-10.3/mm(3)); erythrocyte sedimentation rate, 25 mm/h (<20 mm/h); aspartate aminotransferase, 44 U/L (5-40 U/L); alanine aminotransferase, 63 U/L (5-40 U/L); lactate dehydrogenase, 1158 U/L (220-450 U/L); total bilirubin, 6.88 mg/dL (<1.10 mg/dL); and direct bilirubin, 3.27 mg/dL (<0.35 mg/dL). Urinalysis results were positive for bilirubin and urobilinogen. Positive serologic findings included rubella immunoglobulin G, 93 AU/mL (<15) and cytomegalovirus, 188 AU/mL (<10); negative findings included herpes simplex virus type 2 and hepatitis. Histopathologic examination of material collected from the left breast via punch biopsy showed parakeratosis, acanthosis, and perivascular lymphocyte infiltration in dermal vessels. Treatment with 2 g/d cholestyramine and a topical corticosteroid was effective in the patient, who was diagnosed with intrahepatic cholestasis of pregnancy and prurigo of pregnancy based on the clinical, histopathologic, and laboratory findings. To the authors' knowledge, this is the first such reported case in the literature.

Atopic dermatitis and Valpha24+ natural killer T cells.

OBJECTIVE: Atopic dermatitis is a chronic inflammatory skin disease associated with cutaneous hyperreactivity to environmental triggers and is often the first step in the atopic march that results in asthma and allergic rhinitis. Helper T cells and their cytokines, in addition to IgE and eosinophils, play a major role in the pathogenesis of atopic dermatitis. Natural killer T (NKT) cells may play a role in atopic dermatitis status. METHODS: The authors examined the percentage of Valpha24+CD161+ NKT cells and CD3+CD16+ CD56+ NKT cells in peripheral blood from 23 patients with atopic dermatitis aged 8 to 35 years (mean, 21.77+/-2.88 years) and 30 healthy controls aged 18 to 32 years (mean, 24.32+/-2.44 years) by using flow cytometric analysis. The mean percentages of Valpha24+CD161+ NKT cell subtypes in the atopic dermatitis group and the healthy group were 0.29%+/-0.02% and 0.42%+/-0.05%, respectively (P<.001). RESULTS: Percentages of Valpha24+CD161+ NKT cell subtypes are significantly lower in patients with atopic dermatitis than healthy individuals. On the other hand, the CD3+CD16+CD56+ NKT cell subtype does not differ between the groups. CONCLUSIONS: The reduction of Valpha24+CD161+ NKT cells subtypes may be involved in the immunopathogenesis of atopic dermatitis.

Clinical presentation of cutaneous manifestations in complex regional pain syndrome (type 1).

OBJECTIVE: Complex regional pain syndrome type I (CRPS I) is a primary polymorphic condition of persistent pain and swelling that frequently occurs secondary to trauma associated with vasomotor disorders. The aim of this study was to evaluate the cutaneous findings in patients with CRPS I. METHODS: Eighteen patients with CRPS I were included in the study. Written informed consent was obtained from all participants. RESULTS: Of the 18 patients with CRPS I, 9 (50%) had hyperhidrosis, while hypohidrosis was present in 2 patients (11.1%). Eight patients (44.4%) had hypertrichosis, and 1 patient (5.6%) had hypotrichosis. Five of the patients (27.8%) had nail changes. CONCLUSIONS: These cutaneous changes are not rare in CRPS I and generate difficulties for the patient; therefore, they should be prevented during the early stages of CRPS I with use of an effective treatment.

Topical 0.05% clobetasol propionate versus 1% pimecrolimus ointment in vitiligo.

Vitiligo is a common skin condition resulting from loss of normal melanin pigments in the skin which produces white patches. Topical corticosteroids are indicated for the treatment of limited areas of vitiligo. Pimecrolimus, which inhibits calcineurin, has recently been shown to be effective for the treatment of vitiligo. We performed a prospective study to evaluate the efficacy of the 0.05% clobetasol propionate and 1% pimecrolimus in the treatment of vitiligo. Ten patients with virtually bilateral symmetrical lesions of vitiligo were included. 0.05% clobetasol propionate was applied twice daily over the lesion on right side of the body, and topical 1% pimecrolimus was applied twice daily over the lesion on left side of the body. It was determined that both treatment modalities resulted in a comparable rate of repigmentation. Response to treatment was varied according to the anatomical location of the lesions where better results were seen on the trunk and extremities. Results from this pilot study indicate that topical 1% pimecrolimus is as effective as clobetasol propionate in restoring skin disfiguring due to vitiligo. For a better conclusive statement further studies involving larger groups of patients should be performed.

Pimecrolimus 1% cream, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel in the treatment of seborrhoeic dermatitis: a randomized clinical study.

BACKGROUND: Seborrhoeic dermatitis is a common, chronic, papulosquamous dermatosis. Treatment of seborrhoeic dermatitis includes topical treatments such as corticosteroids, antifungals, metronidazole and pimecrolimus. OBJECTIVE: This study aimed to compare and contrast the efficacy and tolerability of pimecrolimus cream 1%, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel topical treatments in the treatment of facial seborrhoeic dermatitis. METHODS: The study included a total of 64 (32 males and 32 females) consecutive patients with facial seborrhoeic dermatitis. Patients were randomized into three equal groups. One group applied pimecrolimus 1% cream, another group applied methylprednisolone aceponate 0.1% cream, and the third group applied metronidazole 0.75% gel to their facial lesions twice daily for 8 weeks. Assessment of the disease severity was performed at baseline and at weeks 2, 4, and 8. Clinical measures assessed were erythema, scaling and pruritus, which were evaluated using a four-point scale (0-3). RESULTS: Of the 64 patients, 17 (80%) in the metronidazole group, 21 (100%) in the pimecrolimus group and 22 (100%) in the methylprednisolone aceponate group completed the study. Four patients in the metronidazole group left the study. All of the therapeutic agents were found to be effective; however, the efficacy of pimecrolimus was higher than those of metronidazole and methylprednisolone (p < 0.05). When side effects associated with pimecrolimus and metronidazole were compared, the latter was found to be associated with more side effects (p < 0.05). CONCLUSIONS: We suggest pimecrolimus to be a therapeutic option for seborrhoeic dermatitis cases that show an unfavourable response to methylprednisolone aceponate.