Familial Coexisting and Colocalized Psoriasis and Vitiligo Responding to Alefacept

2009 ◽  
Vol 13 (3) ◽  
pp. 172-175 ◽  
Author(s):  
Nawaf Al-Mutairi ◽  
Azari Al-Doukhi
Keyword(s):  
Chronic Inflammatory Disease ◽  
Hair Follicles ◽  
Expected Improvement ◽  
Off Label ◽  
Immune Mediated ◽  
Interfollicular Epidermis ◽  
Emotional Aspects ◽  
Laboratory Investigations

Background: Psoriasis is an immune-mediated, chronic, inflammatory disease that significantly impairs both physical and emotional aspects of an individual's quality of life. Vitiligo leads to depigmentation of skin, in which some or all melanocytes in the interfollicular epidermis and occasionally those in the hair follicles are selectively destroyed. The coexistence of the two disorders is rarely seen. Objective: To report two cases of the rare coexistence of psoriasis and vitiligo in a family. Methods: After providing informed written consent, both patients were given alefacept 15 mg/kg weekly injections for 12 weeks. The patients were monitored both clinically and with all relevant laboratory investigations. These patients were then followed up once a month for 2 years. Results: Treatment with alefacept led to complete clearance of vitiligo along with the expected improvement in psoriasis. In the 2-year follow-up, vitiligo did not recur, although psoriasis relapsed and was appropriately treated. Conclusion: Use of alefacept in vitiligo may turn out to be a possible novel off-label treatment option in vitiligo. But the results need to be reproduced in larger studies

Combination of Prednisolone and Azathioprine for Steroid-Responsive Meningitis-Arteritis Treatment in Dogs

2020 ◽  
Vol 57 (1) ◽  
pp. 1-7
Author(s):  
Lucile Giraud ◽  
Maud Girod ◽  
Laurent Cauzinille
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Primary Treatment ◽  
Immunosuppressive Drug ◽  
Duration Of Treatment ◽  
Glucocorticoid Treatment ◽  
Immune Mediated

ABSTRACT Treatment with high corticosteroid dosages for steroid-responsive meningitis-arteritis (SRMA) is correlated with severe adverse effects and worse quality of life. In order to improve immunosuppression and decrease dosage and duration of glucocorticoid treatment, a second immunosuppressive drug is commonly used in most of the immune-mediated diseases. The objective of this retrospective study was to evaluate the efficacy, tolerability, and occurrence of relapse for the combination of prednisolone and azathioprine. All dogs received azathioprine 2 mg/kg q 24 hr for 1 mo and then 2 mg/kg every other day for 2 mo; prednisolone was started at an immunosuppressive dosage and tapered off gradually during a mean of 3 mo. Twenty-six dogs met inclusion criteria. Twenty-one dogs (81%) were in clinical remission with no relapse observed within the 2 yr follow-up period. Treatment was well tolerated in all dogs and side effects were most of the time mild and self-limiting. The relapse rate (19%) was lower than most published rates. A prednisolone and azathioprine combination appeared to be effective for primary treatment of dogs with SRMA and allows a quicker tapering in prednisolone dosage, a decrease in long-term side effects of steroids, a shorter duration of treatment, and a low relapse rate.

scholarly journals Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision

2019 ◽  
Vol 27 (3) ◽  
pp. 204-210 ◽  
Author(s):  
Selami Serhat Sirvan ◽  
Isil Akgun Demir ◽  
Fatih Irmak ◽  
Kamuran Zeynep Sevim ◽  
Daghan Dagdelen ◽  
...  
Keyword(s):  
Hidradenitis Suppurativa ◽  
Perforator Flap ◽  
Wound Dehiscence ◽  
Chronic Inflammatory Disease ◽  
Hair Follicles ◽  
Perforator Flaps ◽  
Axillary Region ◽  
Critical Location ◽  
The Mean

Introduction:Hidradenitis suppurativa (HS) is a chronic inflammatory disease arising from the hair follicles in apocrine gland-rich areas. It is also one of the most common indications for axillary surgery. Reconstruction of the axillary region after such surgery must be performed meticulously due to its critical location and crucial content. In this report, we present our experience of reconstruction of axillary defects with posterior arm perforator flaps (PAPF) following radical excisions.Methods:A total of 14 patients (9 male, 5 female) aged between 16 and 49 years who had presented with HS in the axillary region and, after surgery, underwent reconstruction with either island or skin bridge posterior arm flap between January 2015 and October 2016 were included in the study and evaluated retrospectively. All of the defects were reconstructed with PAPF following wide excision.Results:Five of the flaps (over 4 patients) were designed as flaps with skin bridges, while the remaining 12 flaps in 11 patients were raised as island flaps. The flaps had areas ranging from 20 to 84 cm2(mean 39.5 cm2), depending on the size of the defect after excision. The mean follow-up time after the operation was 6 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis during the postoperative period; no other complications were observed.Conclusion:Posterior arm perforator flaps can provide sufficient amounts of soft tissue to cover axillary defects and should be considered as the flap of choice in axillary reconstruction.

scholarly journals Migraine Headache as a Presenting Feature of Multiple Sclerosis: A Case Report

2021 ◽  
Vol 8 (4) ◽  
pp. 208-211
Author(s):  
Mohammad Mahdi Rabiei ◽  
Zahra Cheraghi ◽  
Mahtab Ramezani ◽  
Hossein Pakdaman
Keyword(s):  
Multiple Sclerosis ◽  
Chronic Inflammatory Disease ◽  
Comorbid Condition ◽  
Initial Symptom ◽  
Newly Diagnosed ◽  
Neurological Exam ◽  
The Central Nervous System ◽  
Inflammatory Drugs

Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system. Symptoms of MS vary widely because of different grades of sensory, motor, and cognitive dysfunctions. Although headache as the initial symptom of MS is rare, it is a common comorbidity that affects most patients. However, it is unclear that the headache manifestation in newly diagnosed people with MS should be considered as an MS attack or merely a comorbid condition. We report the case of a 31-year-old woman with newly diagnosed MS who presented with exacerbation of headache episodes without any abnormal neurological exam findings. The headaches did not respond to nonsteroidal anti-inflammatory drugs and triptans. After administration of methylprednisolone, the headaches were significantly improved, and during 3 months of follow-up receiving glatiramer acetate, no episode of headache has occurred. This case demonstrates the possible relationship between migraine and MS in newly diagnosed patients. New-onset headaches, a change in the pattern of previous episodes, and inadequate clinical drug response to headache treatment should all be taken seriously and warrant further investigation. Thereby, early diagnosis and proper treatment for patients with MS could improve their quality of life.

scholarly journals Sacubitril/valsartan in the treatment of systemic right ventricular failure

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318074
Author(s):  
Tjitske E Zandstra ◽  
Marieke Nederend ◽  
Monique R M Jongbloed ◽  
Philippine Kiès ◽  
Hubert W Vliegen ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Walking Distance ◽  
Angiotensin Ii Receptor ◽  
Systemic Right Ventricle ◽  
Atrial Switch ◽  
Receptor Blockers ◽  
Β Blocker ◽  
Laboratory Investigations

ObjectivePharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients.MethodsData on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment.ResultsSix-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively).ConclusionsWe describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.

Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic

2020 ◽  
Vol 129 (7) ◽  
pp. 699-706 ◽  
Author(s):  
Kevin L. Li ◽  
Christina H. Fang ◽  
Denisa Ferastraoaru ◽  
Nadeem A. Akbar ◽  
Elina Jerschow ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Care ◽  
Chronic Inflammatory Disease ◽  
Allergy Clinic ◽  
Time Period ◽  
Immune Mediated ◽  
High Satisfaction ◽  
Multidisciplinary Clinic ◽  
Sinonasal Mucosa

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. Methods: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. Results: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation ( P ≤ .02) and time to follow up appointment ( P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. Conclusion: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

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