Progressive muscle relaxation therapy to relieve dental anxiety: a randomized controlled trial

Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4‐wk (−3.82 vs. −0.89) and 3‐month (−4.22 vs. −0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time‐points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.

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Enhancing Value of MRI: A Call for Action

As national healthcare spending has spiraled out of control, payment reform that moves from volume to value‐based payment has been introduced as a practical solution. Under alternative value‐based payment models, physicians and clinical teams must deliver the best care possible at a lower cost. Medical imaging has changed the way we diagnose disease, evaluate severity, assess treatment effects, and provide biological insights for the pathophysiology of many diseases. Over the past 50 years, imaging techniques have become increasingly advanced—from X‐ray to computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and multi‐modal imaging. Advanced imaging such as MRI has given clinicians remarkable insights into medical conditions and saved innumerable lives. Under the value proposition, however, we must ask if each imaging study changes treatment decisions, improves patient outcomes, and is cost‐effective. Imaging research has been focused on developing new technologies and clinical applications to assess diagnostic accuracy. What is needed is the higher‐level technology assessment. In this article we review why we need to demonstrate the value of MRI, how we define value, what strategies can enhance MR value through partnership with various stakeholders, and how imaging scientists can contribute to healthcare delivery in the future.

Level of Evidence: 5

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2018.

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Characterization of clinical human prostate cancer lesions using 3.0‐T sodium MRI registered to Gleason‐graded whole‐mount histopathology

Background

Overtreatment of prostate cancer (PCa) is a healthcare issue. Development of noninvasive imaging tools for improved characterization of prostate lesions might reduce overtreatment.

Purpose

To measure the distribution of tissue sodium concentration (TSC), proton T₂‐weighted signal, and apparent diffusion coefficient (ADC) values in human PCa and to test the presence of a correlation between regional differences in imaging metrics and the Gleason grade of lesions determined from histopathology.

Study Type

Cross‐sectional.

Subjects

Ten men with biopsy‐proven PCa.

Sequences/Field Strength

Sodium, proton T₂‐weighted, and diffusion‐weighted MRI data were acquired using Broad‐Band 3D‐Fast‐Gradient‐Recalled, 3D Cube (Isotropic 3D‐Fast‐Turbo‐Spin‐Echo acquisition) and 2D Spin‐Echo sequences, respectively, with a 3.0T MR scanner.

Assessment

All imaging data were coregistered to Gleason‐graded postprostatectomy histology, as the standard for prostate cancer lesion characterization. Regional TSC and T₂ data were assessed using percent changes from healthy tissue of the same patient (denoted ΔTSC, ΔT₂).

Statistics

Differences in ΔTSC, ADC, and ΔT₂ as a function of Gleason score were analyzed for each imaging contrast using a one‐way analysis of variance or a nonparametric t‐test. Correlations between imaging data measures and Gleason score were assessed using a Spearman's ranked correlation.

Results

Evaluation of the correlation of ΔTSC, ADC, and ΔT₂ datasets with Gleason scoring revealed that only the correlation between ΔTSC and Gleason score was statistically significant (r _s = 0.791, p < 0.01), whereas the correlations of ADC and ΔT₂ with Gleason score were not (r _s = –0.306, p = 0.079 and r _s  = –0.069, p = 0.699, respectively). In addition, all individual patients showed monotonically increasing ΔTSC with Gleason score.

Data Conclusion

The results of this preliminary study suggest that changes in TSC, assessed by sodium MRI, has utility as a noninvasive imaging assay to accurately characterize PCa lesions. Sodium MRI may provide useful complementary information on mpMRI, which may assist the decision‐making of men choosing either active surveillance or treatment.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Generalized bullous fixed drug eruption due to ibuprofen

Ibuprofen can cause a wide variety of cutaneous reactions with a relatively high frequency, but establishing the causal relationship is usually difficult [1]. We report a case of a skin drug reaction due to ibuprofen, confirmed by positive patch test results.

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Sensitization to fragrances in Spain: A 5‐year multicentre study (2011‐2015)

Background

Fragrance chemicals constitute the second most frequent cause of contact allergy in Spain. There are no data available concerning the individual fragrances that are most frequently involved.

Objectives

To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series.

Materials and methods

We performed a 5‐year retrospective study of fragrance marker‐positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers.

Results

Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I‐positive patients and the 419 FM II‐positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations.

Conclusions

We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances.

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Immediate hypersensitivity to p‐phenylenediamine

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Methylchloroisothiazolinone and/or methylisothiazolinone in cosmetic products—A market survey

Background

There was a global 'epidemic' of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics.

Objective

To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive.

Methods

The presence of MCI and/or MI in leave‐on and rinse‐off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed.

Results

Before the implementation date, most leave‐on products contained MCI/MI. After the regulations came into force, the only leave‐on cosmetic subcategories that complied with the law were facial skin‐care, sunscreen and make‐up products. MCI/MI and MI alone were found on the labels of both leave‐on and rinse‐off products, the presence of each varying between product subcategories.

Conclusions

Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.

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Mice with epidermal filaggrin deficiency show increased immune reactivity to nickel

Background

Nickel allergy and dermatitis have been associated with filaggrin gene mutations in epidemiological studies, but the mechanisms mediating these associations are unknown.

Objectives

To investigate whether filaggrin‐deficient flaky tail (ft/ft) mice show increased immune reactivity to nickel and elucidate the mechanisms mediating this.

Methods

The immune responses to nickel, 2,4‐dinitrofluorobenzene (DNFB), cinnamal and p‐phenylenediamine were assessed in ft/ft and wild‐type (WT) mice. The amounts of nickel in the skin of ft/ft and WT mice were determined 20 hours after nickel exposure. The effect of blocking either the interleukin (IL)‐17A pathway or the IL‐1 pathway on the response to nickel in ft/ft mice was evaluated.

Results

Increased responsiveness to nickel, DNFB and cinnamal was observed in ft/ft mice as compared with controls. A reduced amount of nickel was found in the skin of ft/ft mice as compared with WT mice, suggesting increased nickel absorption by the skin of ft/ft mice. Blocking either the IL‐17A pathway or the IL‐1 pathway reduced nickel responsiveness in ft/ft mice.

Conclusions

These findings suggest that the increased nickel responsiveness associated with epidermal filaggrin deficiency is mediated by a combination of increased nickel penetration and the steady‐state inflammation found in the skin of filaggrin‐deficient mice.

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Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project

Background

Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor.

Objective

To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs.

Methods

A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self‐reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG).

Results

Self‐reported cream use at follow‐up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29‐3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80‐6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW.

Conclusion

The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.

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Dermatitis caused by Olanedine (olanexidine gluconate) and povidone iodine

Olanedine (Ohtsuka Pharmaceutical Factory, Tokushima, Japan) is a biguanide antiseptic for external use released in 2015 [1]. The active ingredient is olanexidine gluconate, which has been shown to demonstrate a significant bactericidal effect against various gram‐positive and ‐negative bacteria and also against MRSA, VRE, Pseudomonas aeruginosa [2,3] and Cepacia resistant to other antiseptics [4]. It has been reported that use of Olanedine as a skin disinfectant is associated with almost no systemic side effects [5].

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Generalized bullous fixed drug eruption due to ibuprofen

Ibuprofen can cause a wide variety of cutaneous reactions with a relatively high frequency, but establishing the causal relationship is usually difficult [1]. We report a case of a skin drug reaction due to ibuprofen, confirmed by positive patch test results.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RWKGU5

Sensitization to fragrances in Spain: A 5‐year multicentre study (2011‐2015)

Background

Fragrance chemicals constitute the second most frequent cause of contact allergy in Spain. There are no data available concerning the individual fragrances that are most frequently involved.

Objectives

To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series.

Materials and methods

We performed a 5‐year retrospective study of fragrance marker‐positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers.

Results

Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I‐positive patients and the 419 FM II‐positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations.

Conclusions

We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances.

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Methylchloroisothiazolinone and methylisothiazolinone contact allergy: A retrospective cohort study from a tertiary dermatology clinic in Turkey

Isothiazolinones, methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI), are widely used preservatives in cosmetic, industrial and household products owing to their strong biocidal effects.¹ Following an epidemic of contact allergy to MCI/MI (Kathon CG) and subsequent regulatory measures on the use of MCI/MI, the use of MI as a monopreservative has increased.

This article is protected by copyright. All rights reserved.

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Immediate hypersensitivity to p‐phenylenediamine

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DH22Bh

Methylchloroisothiazolinone and/or methylisothiazolinone in cosmetic products—A market survey

Background

There was a global 'epidemic' of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics.

Objective

To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive.

Methods

The presence of MCI and/or MI in leave‐on and rinse‐off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed.

Results

Before the implementation date, most leave‐on products contained MCI/MI. After the regulations came into force, the only leave‐on cosmetic subcategories that complied with the law were facial skin‐care, sunscreen and make‐up products. MCI/MI and MI alone were found on the labels of both leave‐on and rinse‐off products, the presence of each varying between product subcategories.

Conclusions

Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RXC7s7

Mice with epidermal filaggrin deficiency show increased immune reactivity to nickel

Background

Nickel allergy and dermatitis have been associated with filaggrin gene mutations in epidemiological studies, but the mechanisms mediating these associations are unknown.

Objectives

To investigate whether filaggrin‐deficient flaky tail (ft/ft) mice show increased immune reactivity to nickel and elucidate the mechanisms mediating this.

Methods

The immune responses to nickel, 2,4‐dinitrofluorobenzene (DNFB), cinnamal and p‐phenylenediamine were assessed in ft/ft and wild‐type (WT) mice. The amounts of nickel in the skin of ft/ft and WT mice were determined 20 hours after nickel exposure. The effect of blocking either the interleukin (IL)‐17A pathway or the IL‐1 pathway on the response to nickel in ft/ft mice was evaluated.

Results

Increased responsiveness to nickel, DNFB and cinnamal was observed in ft/ft mice as compared with controls. A reduced amount of nickel was found in the skin of ft/ft mice as compared with WT mice, suggesting increased nickel absorption by the skin of ft/ft mice. Blocking either the IL‐17A pathway or the IL‐1 pathway reduced nickel responsiveness in ft/ft mice.

Conclusions

These findings suggest that the increased nickel responsiveness associated with epidermal filaggrin deficiency is mediated by a combination of increased nickel penetration and the steady‐state inflammation found in the skin of filaggrin‐deficient mice.

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Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project

Background

Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor.

Objective

To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs.

Methods

A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self‐reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG).

Results

Self‐reported cream use at follow‐up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29‐3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80‐6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW.

Conclusion

The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.

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Small-molecule inhibitor of OGG1 suppresses proinflammatory gene expression and inflammation

The onset of inflammation is associated with reactive oxygen species and oxidative damage to macromolecules like 7,8-dihydro-8-oxoguanine (8-oxoG) in DNA. Because 8-oxoguanine DNA glycosylase 1 (OGG1) binds 8-oxoG and because Ogg1-deficient mice are resistant to acute and systemic inflammation, we hypothesized that OGG1 inhibition may represent a strategy for the prevention and treatment of inflammation. We developed TH5487, a selective active-site inhibitor of OGG1, which hampers OGG1 binding to and repair of 8-oxoG and which is well tolerated by mice. TH5487 prevents tumor necrosis factor–α–induced OGG1-DNA interactions at guanine-rich promoters of proinflammatory genes. This, in turn, decreases DNA occupancy of nuclear factor B and proinflammatory gene expression, resu...

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A target to suppress inflammation

(Source: ScienceNOW)

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Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study

Abstract

Background

Global chronic urticaria (CU) disease experience and management is not well documented. This study descriptively compares these aspects among CU patients residing in Europe (EU) and Central and South America (C/SA).

Methods

AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is a global prospective, non-interventional study of CU in the real-world setting. Patients were ≥ 18 years with a diagnosis of H1-antihistamine-refractory CU for > 2 months. Differences between the EU and C/SA regions in demographic and clinical characteristics, quality of life (QoL), work and activity impairment, pharmacological treatment, and healthcare resource use were examined.

Results

In total, 4224 patients were included in the analysis (C/SA 492; EU 3732). Rates of untreated patients were greater in the C/SA region (45.1% vs. 31.9%; P < 0.005) and escalation to third-line therapy was rare in both regions. Differences in disease experience emerged, with C/SA patients more commonly experiencing angioedema (C/SA 50.8% vs. EU 46.1%; P = 0.03) or comorbid chronic inducible urticaria (C/SA 30% vs. EU 22%; P < 0.001). Correspondingly, rates of uncontrolled urticaria were higher among C/SA patients (82.8% vs. 77.5%; P = 0.017) and patients in the C/SA region showed significantly greater work and activity impairment (absenteeism: 10.4 ± 19.7 vs. 6.7 ± 19.0, P = 0.004; presenteeism: 30.3 ± 31.9 vs. 24.4 ± 25.8, P = 0.001; work productivity loss: 33.9 ± 33.9 vs. 26.5 ± 27.5, P < 0.001; activity impairment: 37.7 ± 34.7 vs. 32.7 ± 30.1, P = 0.001). However, QoL impairment was greater in the EU region (Dermatology Life Quality Index: C/SA 6.5 ± 5.9 vs. EU 8.3 ± 7.0; P < 0.001). There was a significant difference in use of healthcare resources, including emergency services (39.6% vs. 29.3%; P < 0.001), hospitalization (7.7% vs 21.9%; P < 0.001) general practitioners (31.7% vs 57.3%; P < 0.001), and additional allergists or dermatologists (50.6% vs. 47.3%, P < 0.001), among patients in the C/SA and EU region, respectively. In both regions, patients with a primary diagnosis of CU with angioedema had significantly greater impairment in work and non-work activities and healthcare resource utilization compared to those without angioedema.

Conclusions

This study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity.

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