Summary
Patients with atopic dermatitis (AD) have skin barrier impairment in both lesional and nonlesional skin. They are typically exposed daily to emollients and intermittently to topical ...anti‐inflammatory medicaments, thereby increasing the risk of developing contact allergy and systemic exposure to chemical ingredients found in these topical preparations. We systematically searched for studies that investigated skin absorption of various penetrants, including medicaments, in patients with AD, but also in animals with experimentally‐induced dermatitis. We identified 40 articles: 11 human studies examining model penetrants, 26 human studies examining AD drugs, and three animal studies. We conclude that patients with AD have almost twofold increased skin absorption compared with healthy controls. There is a need for well‐designed epidemiological and dermatopharmacokinetic studies that examine to what extent AD causes patients to be systemically exposed to chemicals compared with nonatopic dermatitis.
What's already known about this topic?
Patients with atopic dermatitis (AD) have skin barrier abnormality in both lesional and nonlesional skin.
Patients with AD are frequently exposed to chemicals through anti‐inflammatory medicaments and emollients.
What does this study add?
Skin absorption is increased about twofold in patients with AD compared with controls, indicating patients are at higher risk of systemic exposure to chemicals from topical products.
Linked Comment: Jacob. Br J Dermatol 2017; 177:11–12
Summary
Background
Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results.
Objectives
To carry ...out a systematic review and meta‐analysis that examines the association with cardiovascular disease and type 2 diabetes in adults with AD.
Methods
We compared the risk of CVD and diabetes for adult patients with and without AD by searching the PubMed, Embase and Web of Science databases. Data extraction was carried out by two independent reviewers. We found a total of 2855 citations, of which 53 were considered relevant based on title and . Overall, 16 publications were included in the qualitative analysis, of which 13 were also included in a quantitative meta‐analysis of crude data.
Results
No association was observed between AD and unspecified but suspected type 2 diabetes pooled odds ratio (OR) 1·11; 95% confidence interval (CI) 0·87–1·42, hypertension (pooled OR 1·16; 95% CI 0·98–1·37), stroke (pooled OR 1·15; 95% CI 0·95–1·39) or myocardial infarction (pooled OR 1·14; 95% CI 0·83–1·56), but a positive association was observed with angina pectoris (OR 1·73; 95% CI 1·27–2·37). Meta‐analysis of adjusted data gave similar results.
Conclusions
While adults with AD in some populations have an increased prevalence of cardiovascular risk factors, such as obesity and smoking, it is unlikely that AD represents an independent and clinically relevant risk factor for cardiometabolic disease.
What's already known about this topic?
Atopic dermatitis has been associated with atopic, psychiatric and autoimmune comorbidities.
Recent studies investigating a possible association with cardiovascular comorbidities and type 2 diabetes have produced conflicting results.
What does this study add?
Based on a systematic review and meta‐analysis, atopic dermatitis is unlikely to represent an independent risk factor for cardiometabolic disease.
Observed differences in risk estimates between North American and European studies may be explained by variations in cardiovascular risk factors such as body weight.
Linked Comment: Drucker and Flohr. Br J Dermatol 2018; 178:1235–1236.
Plain language summary available online
Abstract Objective To estimate sensitivity and specificity of CT and MRI examinations in patients with fractures of the proximal femur. To determine the interobserver agreement of the modalities ...among a senior consulting radiologist, a resident in radiology and a resident in orthopaedics surgery. Materials and methods 67 patients (27 males, 40 females, mean age 80.5) seen in the emergency room with hip pain after fall, inability to stand and a primary X-ray without fracture were evaluated with both CT and MRI. The images were analysed by a senior consulting musculoskeletal radiologist, a resident in radiology and a resident in orthopaedic surgery. Sensitivity and specificity were estimated with MRI as the golden standard. Kappa value was used to assess level of agreement in both MRI and CT finding. Results 15 fractures of the proximal femur were found (7 intertrochanteric-, 3 femoral neck and 5 fractures of the greater trochanter). Two fractures were not identified by CT and four changed fracture location. Among those, three patients underwent surgery. Sensitivity of CT was 0.87; 95% CI 0.60; 0.98. Kappa for interobserver agreement for CT were 0.46; 95% CI 0.23; 0.76 and 0.67; 95% CI 0.42; 0.90. For MRI 0.67; 95% CI 0.43; 0.91 and 0.69; 95% CI 0.45; 0.92. Conclusion MRI was observed to have a higher diagnostic accuracy than CT in detecting occult fractures of the hip. Interobserver analysis showed high kappa values corresponding substantial agreement in both CT and MRI.
Several novel biologics are available or in development for moderate‐to‐severe plaque psoriasis. These drugs may differ in time until Psoriasis Area and Severity Index (PASI) response is obtained. In ...this systematic review, we examined the time to onset of action for interleukin (IL)‐17 and IL‐23 agents in the treatment of psoriasis. The primary objective was the weighted mean time needed for 25% and 50% of patients with psoriasis to achieve PASI90. The medical databases PubMed, Web of Science and EMBASE were searched using the following terms: psoriasis AND (ixekizumab OR secukinumab OR brodalumab OR risankizumab OR guselkumab OR tildrakizumab). A total of 27 studies were included for data extraction and qualitative synthesis, and 26 of these were quantitatively analysed. The shortest time to 25% and 50% of patients to achieved PASI90 were seen with brodalumab 210 mg every 2 weeks (Q2W; 3.5 weeks and 6.2 weeks, respectively) followed by ixekizumab 80 mg Q2W (4.1 and 7.4 weeks, respectively) and ixekizumab 80 mg Q4W (4.6 and 8.1 weeks, respectively) dosages. In conclusion, clinical trials yielded shorter time to onset of action in studies assessing approved dosing ranges of IL‐17 inhibitors compared with studies assessing IL‐23 inhibitors.
While several maternal exposures have been associated with an increased risk of atopic dermatitis (AD) in offspring, the effect of alcohol use during pregnancy on the risk of AD in offspring is ...unclear. Furthermore, it is unclear whether adults with AD have an increased alcohol use, although other poor health behaviours have been associated with AD including smoking and physical inactivity as well as psychiatric disease. In this systematic review and meta‐analysis, the association between alcohol use and AD was investigated in two ways: 1) whether alcohol use (drinkers versus abstainers) during pregnancy is associated with AD in offspring and 2) whether AD is associated with increased alcohol use. The medical databases PubMed, EMBASE and Web of Science were searched, and data extraction was carried out by two independent reviewers. Eighteen studies were included in the qualitative analysis (comparing alcohol drinkers to abstainers), and 12 studies were included in the quantitative analysis. There was a positive association between alcohol use during pregnancy and development of AD in offspring (pooled odds ratio OR 1.16; 95% confidence interval CI 1.09–1.24). However, there was no consistent association between AD in adults and adolescents and alcohol use (pooled OR 1.06; 95% CI 0.92–1.23). There is a need for future well‐designed prospective studies to firmly establish the association between alcohol use and AD.
What is philosophy? How should we do it? Why should we bother to? These are the kinds of questions addressed by metaphilosophy – the philosophical study of the nature of philosophy itself. Students ...of philosophy today are faced with a confusing and daunting array of philosophical methods, approaches and styles and also deep divisions such as the notorious rift between analytic and Continental philosophy. This book takes readers through a full range of approaches – analytic versus Continental, scientistic versus humanistic, 'pure' versus applied – enabling them to locate and understand these different ways of doing philosophy. Clearly and accessibly written, it will stimulate reflection on philosophical practice and will be invaluable for students of philosophy and other philosophically inclined readers.
To investigate 1-year postoperative effect of preoperative resistance training (RT) in patients undergoing total hip arthroplasty (THA) on patient-reported outcomes on activity and function and ...objective outcomes on muscle strength and physical performance.
A 3–12 months follow-up of a randomized controlled trial. Patients scheduled for THA were randomized into: RT-group, twice a week for 10 weeks prior to THA, or ‘care-as-usual’ (CG). Primary endpoint of this sequel analysis is HOOS-ADL at 12 months follow-up. Secondary outcome measures are; other HOOS subscales, knee- and hip muscle strength plus function (gait, ascending/descending stairs, and sit-to-stand) at three and/or 12 months.
NCT01164111.
Eighty patients (70% women, 70.4 ± 7.6 years, BMI of 27.8 ± 4.6) were randomized to RT (n = 40) or CG (n = 40); data from 85% were available at 12 months. No superior effects were observed at 12 months for HOOS ADL (between-group change score 95%CI) (2.6 -4.2; 9.8, P = 0.44) or remaining subscales. However, ascending (1.3 s 0.3; 2.3, P = 0.01)) and descending stairs (1.6 s 0.3; 2.9, P = 0.01) demonstrated additional effects. At 3 months clinically relevant change-scores in favour of RT was observed on HOOS-Sport/Rec (10.5 points 1.4; 19.6, P = 0.023), together with higher knee strength of the affected side (14.6 Nm 6.3; 22.9, P < 0.001), and selected outcomes of physical function.
At 12 months after surgery, there was no additional effect of preoperative RT compared with THA alone, but rehabilitation was accelerated at 3 months.
Summary Objective To investigate the efficacy and feasibility of progressive explosive-type resistance training (RT) in patients with osteoarthritis (OA) of the hip scheduled for total hip ...arthroplasty (THA). Method Randomized controlled trial (1:1) in patients diagnosed with hip OA and scheduled for THA. The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8–12 repetition maximum). The control group (CG) received ‘care as usual’. Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported as adherence, exercise related pain and adverse effects. Post-surgical follow up will be reported separately. ClinicalTrials.gov registration: NCT01164111. Results Eighty patients (age 70.4 ± 7.6 years, BMI 27.8 ± 4.6, 52 females (65%) were included. Adherence was high (93%) with acceptable exercise related pain (VAS score ≤ 5) reported in 83% of sessions and no adverse events. Changes in HOOS ‘function’ was 10.0 points 95%CI 4.7; 15.3 higher in IG compared to CG ( P < 0.001). For all the remaining HOOS subscales IG scored significantly better ( P < 0.03) and had higher leg extension muscle power ( P < 0.0001) compared to CG. Conclusion Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power.
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