The global prevalence of primary psychodermatologic disorders: a systematic review.

The management of primary psychodermatologic disorders (PPDs) (i.e. psychiatric disorders with dermatologic presentation) is challenging. The scarceness of reported prevalence hinders the development of coordinated interventions to improve healthcare delivery. This review aimed to explore the global prevalence of PPDs. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 4632 identified publications, 59 were included. Five PPDs were investigated from the included studies: delusional parasitosis (n = 9), skin picking disorder (n = 26), trichotillomania (n = 26), tanning dependence (n = 5) and repetitive nail biting (n = 6). Delusional parasitosis was rare in the general population (prevalence ranging from 0.0002% to 0.03%), with higher rates in psychiatric settings (outpatient = 0.5%; inpatient = 0.1%). Other pathologic or subclinical forms of PPDs had a minimum prevalence of 0.3% (median = 7.0%; mean = 17.0%). The distribution of the prevalence rates was highly skewed, with large differences based on the study setting (e.g. dermatologic settings, psychiatric settings, and general population). The most common condition was pathologic skin picking (prevalence, 1.2%-11.2%) in the general population. Its rates were higher in the psychiatric settings (obsessive-compulsive disorder, 38.5%; Tourette syndrome, 13.0%; body dysmorphic disorder, 26.8%-64.7%). The prevalence of trichotillomania in the general population ranged from 0.6% to 2.9%, while that of pathologic tanning and nail biting could not be ascertained as the studies were mainly in students (range; 12.0%-39.3% and 3.0%-10.1%, respectively). In conclusion, PPDs are common, especially in the dermatologic and psychiatric settings. Further population-based studies are needed to determine more accurate prevalence rates.

The impact of demographic factors on quality of life in women after breast cancer surgery.

BACKGROUND: Health is the main focus of studies on quality of life. Cancer can lead to changes in quality of life in postmastectomy women. AIMS: The aim of this study was to examine the relation among sociodemographic factors and to assess the quality of life of women with breast cancer a year from their surgery. MATERIALS AND METHODS: This single-center cross-sectional study included 104 participants (50 participants with mastectomy and 54 participants with quadrantectomy) aged from 37 to 72 years. The 36-Item Short Form Survey (SF-36) was used to assess physical, psychological, and social functioning of participants, as well as their sociodemographic factors and the clinical variables of the treatment. RESULTS: Participants with quadrantectomy aged up to 50 years had a significantly higher score when assessed in social functioning and mental/emotional health. Older participants expressed no significant differences in quality of life. Participants with quadrantectomy in all age groups had a higher score in social functioning, mental/emotional health, energy, and vitality than participants with mastectomy. CONCLUSION: A year from the surgery and cancer treatment, the quality of life of postquadrantectomy women was better compared to postmastectomy women.

Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures.

Interventional radiology and cardiology are widespread employed techniques for diagnosis and treatment of several pathologies because they avoid the majority of the side-effects associated with surgical treatments, but are known to increase the radiation exposure to patient and operators. In recent years many studies treated the exposure of the operators performing cardiological procedures. The aim of this work is to study the exposure condition of the medical staff in some selected interventional radiology procedures. The Monte Carlo simulations have been employed with anthropomorphic mathematical phantoms reproducing the irradiation scenario of the medical staff with two operators and the patient. A personal dosemeter, put on apron, was modelled for comparison with measurements performed in hospitals, done with electronic dosemeters, in a reduced number of interventional radiology practices. Within the limits associated to the use of numerical anthropomorphic models to mimic a complex interventional procedure, the personal dose equivalent, H p (10), was evaluated and normalised to the simulated Kerma-Area Product, KAP, value, indeed the effective dose has been calculated. The H p (10)/KAPvalue of the first operator is about 10 µSv/Gy.cm2, when ceiling shielding is not used. This value is calculated on the trunk and it varies of +/-30% moving the dosemeter to the waist or to the neck. The effective dose, normalised to the KAP value, varies between 0.03 and 0.4 µSv/Gy.cm2. Considering all the unavoidable approximation of this kind of investigations, the comparisons with hospital measurement and literature data showed a good agreement allowing to use of the present results for dosimetric characterisation of interventional radiology procedures.

Mining for pairs: shared clinic visit dates identify steady HIV-positive partnerships.

OBJECTIVES: Here we examined the hypothesis that some stable HIV-infected partnerships can be found in cohort studies, as the patients frequently attend the clinic visits together. METHODS: Using mathematical approximations and shuffling to derive the probabilities of sharing a given number of visits by chance, we identified and validated couples that may represent either transmission pairs or serosorting couples in a stable relationship. RESULTS: We analysed 434 432 visits for 16 139 Swiss HIV Cohort Study patients from 1990 to 2014. For 89 pairs, the number of shared visits exceeded the number expected. Of these, 33 transmission pairs were confirmed on the basis of three criteria: an extensive phylogenetic tree, a self-reported steady HIV-positive partnership, and risk group affiliation. Notably, 12 of the validated transmission pairs (36%; 12 of 33) were of a mixed ethnicity with a large median age gap [17.5 years; interquartile range (IQR) 11.8-22 years] and these patients harboured HIV-1 of predominantly non-B subtypes, suggesting imported infections. CONCLUSIONS: In the context of the surge in research interest in HIV transmission pairs, this simple method widens the horizons of research on within-pair quasi-species exchange, transmitted drug resistance and viral recombination at the biological level and targeted prevention at the public health level.

Effect of final irrigation procedures on fracture resistance of root filled teeth: an ex vivo study.

AIM: To evaluate the effect of chlorhexidine (CHX) on fracture resistance of roots treated with different concentrations of ethylenediaminetetraacetic acid (EDTA). METHODOLOGY: One hundred and twenty intact single-rooted premolar teeth were sectioned below the cementum-enamel junction to standardize the length of the teeth to 12 mm. The canals of one hundred specimens were instrumented with ProTaper Universal rotary instruments up to size F4 and were randomly divided into five groups (n = 20) according to the final irrigating solutions: Group 1: distilled water (DW); Group 2: 5% EDTA and 2.5% NaOCl; Group 3: 17% EDTA and 2.5% NaOCl; Group 4: 5% EDTA, 2.5% NaOCl, DW and 2% CHX; Group 5: 17% EDTA and 2.5% NaOCl, DW and 2% CHX. Root canals were filled with gutta-percha and epoxy resin-based root canal sealer using a single-cone technique. Twenty teeth served as negative controls and were not instrumented nor root filled (Group 6). All specimens were embedded in self-curing acrylic resin and loaded vertically at 0.5 mm min-1 until fracture occurred. The data were evaluated statistically using one-way anova test followed by Holm-Sidak's multiple comparison test (P < 0.05). RESULTS: Group 1 (only DW) had the lowest vertical fracture strength, followed by Group 3 (17% EDTA and 2.5% NaOCl; P < 0.05). Group 6 (negative control group) had the highest fracture resistance. Final irrigation with CHX following irrigation with 17% EDTA or 5% EDTA and 2.5% NaOCl (groups 4 and 5) significantly increased the fracture resistance of roots (P < 0.05). However, the difference between Group 4 and Group 5 was not significant (P > 0.05). CONCLUSIONS: Intracanal CHX rinse of EDTA/NaOCl-treated root dentine enhanced the fracture resistance of roots filled with AH Plus.

Recurrent multiple cardiac myxomas.

BACKGROUND: The recurrence of cardiac myxoma after a surgical excision is a rare condition. The mechanism responsible for the recurrence remains unclear. Multifocal growth of a benign myxoma or malignant transformation, inadequate resection, intraoperative implantation or embolization, familial disposition, and the abnormal DNA ploidy pattern play an important role in development of recurrent myxoma. CASE: We report the case of a 24-year-old female with recurrent multiple cardiac myxomas. She had an abortus 2 months ago. The patient had undergone a resection of left atrial and right ventricular myxoma with extension to the right pulmonary artery 8 years ago. The preoperative echocardiographic examinations revealed recurrent left atrial and right and left ventricular myxomas. The patient underwent a redo-surgery and, in addition to a large myxoma in the right ventricle with involvement of the tricuspid valve and anterior papillary muscle, three myxomas including both myxomas originating at the top and the base of the posterior papillary muscle, respectively, the other myxoma between both papillary muscles in the posterior wall of the left ventricle, and 2 more small myxomas including 1 in the interatrial septum and the other on atrial surface of anterior mitral annulus were found in the left ventricle and atrium. The myxomas were successfully excised through a transmitral approach with a combined bi-atrial incision. The tricuspid valve and mitral valve were repaired with annuloplasty. She had an uneventful postoperative course and no residual myxoma was found by echocardiography. CONCLUSION: We think that a long-term follow-up by echocardiography in all patients after the resection of myxoma is advised for an early detection of any recurrence (Fig. 5, Ref. 9).

Diamond burs versus curettes in root planing: a randomized clinical trial.

BACKGROUND: This study compares diamond burs and curettes by clinical, microbiological, biochemical and scanning electron microscopic parameters and treatment time data in the non-surgical periodontal treatment of patients with chronic periodontitis. METHODS: Two quadrants of each of the 12 patients received root planing with diamond burs, whereas the other two quadrants were treated with curettes. Clinical periodontal measurements were recorded at baseline and then 1, 3 and 6 months after completion of non-surgical periodontal treatment. Subgingival plaque and gingival crevicular fluid samples were obtained at baseline and 1-month control. Twenty-one hopeless teeth received root planing with diamond burs or curettes or no treatment and then extracted for microscopic evaluations. RESULTS: Clinical periodontal parameters improved similarly with both treatment modalities. Microbiological analyses revealed similar findings for the bacterial load (16S gene copy numbers) and ratio of each bacterium to the total bacterial count at baseline and 1-month control. Cytokine levels in the gingival crevicular fluid samples exhibited differences between the two treatments. Scanning electron microscopic analyses indicated that diamond burs were better in terms of calculus removal and loss of tooth substance indices but roughness index values were better for curettes. CONCLUSIONS: Diamond burs provide findings comparable with curettes in root planing.

Acute aortic insufficiency after blunt chest trauma: a case report.

Traumatic aortic valve regurgitation is a rare complication of non penetrating blunt chest trauma which usually requires surgical management. We describe a case of a 21 year old man with blunt chest trauma who was diagnosed with aortic valve regurgitation due to rupture of the right coronary cusp one month after falling from a high place. Rupture of aortic valve cusp was treated successfully with aortic valve replacement.

Atrial fibrillation after off-pump coronary artery surgery: a prospective, matched study.

The effect of cardiopulmonary bypass and myocardial ischaemia on the occurrence of atrial fibrillation (AF) after coronary artery bypass graft (CABG) was studied in 136 patients undergoing off-pump CABG who were matched for age and number of distal anastomoses with 136 patients undergoing on-pump CABG. Possible risk factors for post-operative new-onset AF were recorded. AF occurred in 64 (24%) of the 267 patients for whom data could be analysed. AF occurred in 29 patients (22%) in the off-pump group versus 35 (26%) in the on-pump group, but this difference was not statistically significant. On univariate analysis, age and length of hospital stay were significant risk factors for the occurrence of AF. In a multivariate analysis that included operative technique, age was found to be the only significant risk factor. In conclusion, the occurrence of AF after CABG does not depend on the type of operation.

3-Alkylpyridinium compounds as potential non-toxic antifouling agents.

To date, around thirty bioactive 3-alkylpyridinium compounds, either in monomeric or oligomeric forms, have been identified in marine sponges belonging to the order Haplosclerida In this work, we have reviewed their biological activities, which include mainly cytotoxicity, ichthyotoxicity, inhibition of bacterial growth, and enzyme inhibition. Most of these activities increase with the increasing degree of oligomerization of the corresponding 3-alkylpyridinium compound. It was shown recently that 3-alkylpyridines also exhibit promising antifouling activities. Linear 3-octylpyridinium polymers (Poly-APS), isolated from the Mediterranean sponge Reniera sarai, showed a non-toxic reversible mechanism of settlement inhibition of Balanus amphitrite cypris larvae with an EC50 of 0.27 microg/mL. At the same time, their toxicity towards the organisms used in the toxicity bioassays (B. amphitrite nauplii, microalga Tetraselmis suecica and larvae of Mytilus galloprovincialis) was almost negligible in comparison to commercially available and currently used booster biocides based on copper and zinc complexes with pyrithione. Poly-APS and some other natural 3-alkylpyridines were also found to be very effective in preventing microbial biofilm formation. Preliminary tests have confirmed that some monomeric and oligomeric synthetic analogues of poly-APS also exert antifouling activity, which makes these compounds promising candidates as new environmentally-friendly ingredients in the new generation of antifouling coatings.

[Nitrous-oxide sedation indispensable in the dental care of anxious people and the mentally impaired]. / Lachgassedatie onmisbaar bij de tandheelkundige behandeling van gehandicapten en angstigen.

The long-term occupational exposure to high concentrations of nitrous oxide in health-care workers in a Dutch hospital, with probable adverse effects on their offspring, has triggered a discussion about the benefits and risks of nitrous oxide. In Dutch dentistry, nitrous-oxide sedation is a valuable and indispensable aid in the treatment of patients with challenging behaviour, such as those with mental impairment or in extremely-anxious adults and children. Nitrousoxide sedation can be used without risk to the dental team, provided that measures are taken for sufficient scavenging and room ventilation. A possible ban on nitrous oxide would be a major setback for specialty-care dentistry in the Netherlands.

The role of lysine, histidine and carboxyl residues in biological activity of equinatoxin II, a pore forming polypeptide from the sea anemone Actinia equina L.

Equinatoxin II, a pore forming polypeptide from the sea anemone Actinia equina L. was subjected to chemical modifications with group specific reagents. Lysine residues were modified with pyridoxal-5'-phosphate, histidine residues with diethyl pyrocarbonate and carboxyl groups with the use of a water soluble carbodiimide. Modification of charged residues had no significant influence on the toxin interaction with serum lipoproteins. Lysine 5'-phosphopyridoxylated and histidine carbethoxylated derivatives of the toxin retained lethal and hemolytic activities, but the pH profile of hemolytic activity of 5'-phospho-pyridoxylequinatoxin II was markedly altered. Modification of the toxin carboxyl groups impaired both hemolytic and lethal activities, the latter, however, to the greater extent.

The role of tryptophan in structural and functional properties of equinatoxin II.

A pore-forming, cytolytic and lethal polypeptide, equinatoxin II, from the sea anemone Actinia equina, was subjected to oxidation with N-bromosuccinimide to study the role of five present tryptophan residues in structure-function relationships. In the folded toxin molecule, 1-2 tryptophan residues were readily susceptible to oxidation with N-bromosuccinimide, whereas modification of a single residue resulted in complete impairment of the toxin lethal and hemolytic activities as well as the ability of an oxidized toxin to precipitate with serum lipoproteins. CD and fluorescence spectra indicated a slight alteration of a toxin secondary structure following N-bromosuccinimide treatment. Incubation with sphingomyelin of the toxin prior to oxidation did not prevent subsequent modification with N-bromosuccinimide and loss of its activities, indicating that the modified tryptophan residue is not directly involved in toxin binding and insertion into lipid membranes. It was concluded that the modified tryptophan residue is essential for the structure of equinatoxin II.

Inhibition of acetylcholinesterase by an alkylpyridinium polymer from the marine sponge, Reniera sarai.

Large polymeric 3-alkylpyridinium salts have been isolated from the marine sponge Reniera sarai. They are composed of N-butyl(3-butylpyridinium) repeating subunits, polymerized head-to-tail, and exist as a mixture of two main polymers with molecular weights without counterion of about 5520 and 18900. The monomer analogue of the inhibitor, N-butyl-3-butylpyridinium iodide has been synthesized. This molecule shows mixed reversible inhibition of acetylcholinesterase. The polymers also act as acetylcholinesterase inhibitors and show an unusual inhibition pattern. We tentatively describe it as quick initial reversible binding, followed by slow binding or irreversible inhibition of the enzyme. This kinetics suggests that there are several affinity binding sites on the acetylcholinesterase molecule where the polymer can bind. The first binding favors binding to other sites which leads to an apparently irreversibly linked enzyme-inhibitor complex.

Primary and secondary structure of a pore-forming toxin from the sea anemone, Actinia equina L., and its association with lipid vesicles.

The complete amino acid sequence of equinatoxin II, a potent pore-forming toxin with hemolytic, cytotoxic and cardiotoxic activity from the venom of the sea anemone, Actinia equina L., is reported. In addition, circular dicroism was used to estimate the secondary structure of this toxin either in the water-soluble or in the membrane-anchored form. Equinatoxin II when in water was found to contain about 29-33% of alpha-helical structure, 53-58% of beta-strand+beta-turn and 10-16% of random structure. Upon association with phospholipids, in particular with sphingomyelin, a rearrangement of the secondary structure occurs resulting in an increase of the alpha-helix content. An amphiphilic alpha-helical segment is predicted at the N-terminus, which shares structural homology with membrane active peptides like melittin and viral fusion peptides. In analogy to the behaviour of these peptides we propose that at least part of the alpha-helix content increase of equinatoxin II is due to the insertion of its N-terminus into the lipid bilayer. As in the case of melittin, association of 3-4 equinatoxin molecules is necessary to induce membrane permeabilisation.

Chemical modification of equinatoxin II, a lethal and cytolytic toxin from the sea anemone Actinia equina L.

The role of arginine and tyrosine in cytolytic properties of equinatoxin II, isolated from the sea anemone Actinia equina L., was studied by means of chemical modifications. The toxin was modified with 2,3 butanedione and tetranitromethane, respectively. The extent of modification and physico-chemical properties of the modified proteins were checked with amino acid analysis, isoelectric focusing and circular dichroic spectra. Extensive treatment of the toxin with 2,3 butanedione modified seven arginines and also two tyrosines, with resulting loss of hemolytic activity. Modification of two out of nine arginine residues resulted in a 25% loss of hemolytic activity, whereas nitration of three out of ten tyrosines decreased hemolytic activity by 95%. The nitrated toxin had at least a 30-fold higher i.v. LD50 than the native toxin. None of the modifications significantly affected the secondary structure of the toxin as revealed by the CD spectra. It is concluded that tyrosine residues are involved in both lethal and cytolytic activity, while the role of arginine residues is not evident because of the non-specific alteration of tyrosine residues with 2,3 butanedione.

Inhibition of acetylcholinesterase by a pseudozoanthoxanthin-like compound isolated from the zoanthid Parazoanthus axinellae (O. Schmidt).

An ethanolic extract from a zoanthid crust coral Parazoanthus axinellae was lethal to mice and crabs and exhibited anticholinesterase activity. The isolation of several AChE inhibitors with the aid of RP-HPLC is described. The most abundant of the inhibitors present in the P. axinellae extract was identified as pseudozoanthoxanthin or an almost identical compound which belongs to the chemically well-characterized series of tetrazacyclopentazulene natural pigments from the genera Parazoanthus, Epizoanthus, Zoanthus and Palythoa. The inhibitor has a mol. wt of 242 and acts as a competitive inhibitor with a Ki of 4 microM. The inhibitor exhibited a strong blue fluorescence. In vivo action of crude extract and the isolated inhibitor showed a typical picture of systemic acetylcholinesterase inhibition. Atropinization of experimental animals prior to injection of the inhibitor almost entirely neutralized its activity.

Anticholinesterase activity of the fluorescent zoanthid pigment, parazoanthoxanthin A.

A synthetic linear tetrazacyclopent(f)azulene compound, parazoanthoxanthin A (m.w. 214.2), strongly fluorescent pigment occurring in zoanthids, was characterized and assayed for anticholinesterase activity. The pigment, emitting fluorescence at lambda(em) 420 nm, was found to be a pure competitive inhibitor of cholinesterases. At pH 8.0, a Ki value of 19 and 26 microM was determined with insect recombinant, and electric eel acetylcholinesterase. Horse serum butyrylcholinesterase was less sensitive with a Ki of 70 microM.

The prevalence of familial Mediterranean fever in the Turkish province of Denizli: a field study with a zero patient design.

OBJECTIVE: This study had two aims: (1) to investigate the prevalence of familial Mediterranean fever (FMF) and Behçet's disease (BD) in school students in Denizli, a province in western Turkey; and (2) to determine whether the previously suggested "zero patient design" was reliable for use in a prevalence survey. METHODS: The field survey was performed in two stages. In the first stage 7,389 students (3,847 females and 3,542 males) were asked to fill out a questionnaire in the classroom. In the questionnaire, filtering questions for FMF (the presence of recurrent attacks of fever accompanying abdominal pain, joint pain/swelling, and/or chest pain) and BD (presence of aphthous stomatatis) were asked. The second stage consisted of two parts. In the first, 3225 questionnaires were completed by 1778 female and 1447 male students calculated according to the zero patient design, who were selected randomly from among 7389 students for evaluation. Students with any suspicion of FMF and Behçet's disease were called to the hospital for detailed investigation. In the second step the remaining students were evaluated. RESULTS: Out of 3225 children questioned in the first step, 156 claimed recurrent abdominal pain and/or chest pain, and/or joint pain/swelling with accompanying fever, which might suggest the presence of FMF However, this diagnosis was excluded after further clinical evaluation. In the second step 152 students were called for detailed investigation: 2 patients, one 10 years and the other 12 years old, were diagnosed as having FMF. None were diagnosed to have Behçet's disease. CONCLUSION: The prevalence of FMF in Turkey in general is about 0.093%. The prevalence rate found in this survey was lower (0.027%) which may be due to the historic background of the region. This is the first study that has shown that the "zero patient design" can be used in an epidemiological survey.

Congenital aortic insufficiency due to aortic cusp stretching: 'kite anomaly'.

Aortic insufficiency may be either acquired or congenital. A 46-year-old male had a congenital pathology which resulted in aortic insufficiency due to the presence of a fibrous band that stretched from the non-coronary cusp to the aortic wall. The patient underwent successful aortic valve replacement. At surgery, the fibrous band was stretching the non-coronary cusp so that it prevented coaptation of the aortic valve. The situation was termed by us as the 'kite anomaly'.