Summary Psoriasis is an immune-mediated chronic inflammatory disorder which manifests as dermatologic lesions, and psoriatic arthritis (PsA) in about 30% of cases. Psoriasis is associated with ...multiple comorbidities including metabolic syndrome, hypertension, diabetes, cardiovascular events, obesity and psychiatric disorders, which can all affect the course of sleep disorders. A systematic review of the literature on the relationship between psoriasis, PsA, and formal sleep disorders identified 33 studies. There is an increased prevalence of obstructive sleep apnea (OSA) with 36%–81.8% prevalence in psoriasis versus 2%–4% in the general population. There was also an increase in the prevalence of restless legs syndrome of 15.1%–18% in psoriasis versus 5%–10% in European and North American samples. The wide variety of insomnia criteria used in studies resulted in an insomnia prevalence of 5.9%–44.8% in psoriasis, which is insufficient to show an elevated prevalence when the general population has a 10% prevalence of chronic insomnia and 30–35% prevalence of transient insomnia. There is evidence that symptoms of insomnia in psoriasis are directly mediated by pruritus and pain. Treatments that decrease the cutaneous symptoms in psoriasis were successful in mitigating insomnia, but did not show improvements in OSA where the relationship with psoriasis is multifactorial.
Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in ...highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations.
A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups.
The search retrieved 47 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insufficient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD.
OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.
Therapies for the treatment of onychomycosis Gupta, Aditya K., MD, PhD, FRCP(C); Paquet, Maryse, PhD; Simpson, Fiona C., BSc
Clinics in dermatology,
09/2013, Letnik:
31, Številka:
5
Journal Article
Recenzirano
Abstract Onychomycosis treatments include nail avulsion and debridement by chemical or surgical procedures, topical and oral antifungals, and device-based therapies. The advantages, disadvantages, ...and limitations of the different types of treatments—including the most commonly prescribed topical (ciclopirox) and oral (terbinafine, itraconazole, and fluconazole) treatments for onychomycosis caused by dermatophytes, non-dermatophyte molds, and yeasts—are reviewed. Safety and efficacy data for the healthy adult population and for special populations such as children and diabetic patients have confirmed the importance of proper mycological diagnosis before the initiation of therapy as well as the evaluation of the risks and benefits of the different treatments.
We report an allelic series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal dominant primary lymphedema associated with a predisposition to acute myeloid leukemia. GATA2 is a ...transcription factor that plays an essential role in gene regulation during vascular development and hematopoietic differentiation. Our findings indicate that haploinsufficiency of GATA2 underlies primary lymphedema and predisposes to acute myeloid leukemia in this syndrome.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Summary Patients with obstructive sleep apnea (OSA) frequently present with symptoms of depression and anxiety. The objective of this study is to determine if treatment with positive airway pressure ...(PAP) improves symptoms of depression and anxiety. A systematic review was conducted to identify clinical trials of PAP that contained a validated measure of depression severity. Meta-analysis was conducted for depression, anxiety, excessive daytime sleepiness (EDS), quality of life (QoL) and respiratory variables. The systematic review included 33 reports. Pre-post-test analysis of PAP showed a moderate effect size (Hedge's g, 95% CI) for depression 0.524 0.401–0.647, but a low effect size compared to oral placebo (0.355 0.187–0.524) and no effect when compared to dental appliances (0.107 −0.72–0.287) and sham PAP (−0.049 −0.292–0.194). Anxiety, EDS, and QoL showed similar improvement in pre-post-test analysis, but a lack of superiority to dental appliances and sham PAP. PAP was superior to all comparators for respiratory variables. PAP has a moderate clinical effect on symptoms of depression and anxiety in OSA, but it is not superior to dental appliances or sham PAP. The improvement in subjective symptoms, such as depression and anxiety, may be mediated by patient expectations and contact with healthcare providers.
We have identified KIF11 mutations in individuals with syndromic autosomal-dominant microcephaly associated with lymphedema and/or chorioretinopathy. Initial whole-exome sequencing revealed ...heterozygous KIF11 mutations in three individuals with a combination of microcephaly and lymphedema from a microcephaly-lymphedema-chorioretinal-dysplasia cohort. Subsequent Sanger sequencing of KIF11 in a further 15 unrelated microcephalic probands with lymphedema and/or chorioretinopathy identified additional heterozygous mutations in 12 of them. KIF11 encodes EG5, a homotetramer kinesin motor. The variety of mutations we have found (two nonsense, two splice site, four missense, and six indels causing frameshifts) are all predicted to have an impact on protein function. EG5 has previously been shown to play a role in spindle assembly and function, and these findings highlight the critical role of proteins necessary for spindle formation in CNS development. Moreover, identification of KIF11 mutations in patients with chorioretinopathy and lymphedema suggests that EG5 is involved in the development and maintenance of retinal and lymphatic structures.
New therapeutic options for onychomycosis Gupta, Aditya K; Simpson, Fiona C
Expert opinion on pharmacotherapy,
2012-June, 6/1/2012, 2012-Jun, 2012-06-00, 20120601, Letnik:
13, Številka:
8
Journal Article
Recenzirano
Introduction:
Onychomycosis is a fungal infection of the nail apparatus that affects 10 - 30% of the global population. Current therapeutic options for onychomycosis have a low to moderate efficacy ...and result in a 20 - 25% rate of relapse and reinfection. New therapeutic options are needed to broaden the spectrum of treatment options and improve the efficacy of treatment.
Areas covered:
This review discusses the emerging pharmacotherapeutics; including topical reformulations of terbinafine, new azole molecules for systemic and topical administration, topical benzoxaboroles and topical polymer barriers. The paper also discusses device-based options, which may be designed to activate a drug or to improve drug delivery, such as photodynamic therapy and iontophoresis; laser device systems have also begun to receive regulatory approval for onychomycosis.
Expert opinion:
Device-based therapeutic options for onychomycosis are expanding more rapidly than pharmacotherapy. Systemic azoles are the only class of pharmacotherapy that has shown a comparable efficacy to systemic terbinafine; however terbinafine remains the gold standard. The most notable new topical drugs are tavaborole, efinaconazole and luliconazole, which belong to the benzoxaborole and azole classes of drugs. Photodynamic therapy, iontophoresis and laser therapy have shown positive initial results, but randomized controlled trials are necessary to determine the long-term success of these devices.
Abstract The diagnosis of onychomycosis may require the use of mycological diagnostic testing to supplement the clinical presentation. In order to verify that onychomycosis is present, the viability, ...penetrance, and species of the fungal infection should be determined. The most common diagnostic tests are mycological culture, direct microscopic examination, histopathologic study, and polymerase chain reaction (PCR)-based tests. Each of these tests has individual strengths in satisfying the three criteria, with a minimum of two positive diagnostic tests being the gold standard for confirming all three diagnostic criteria.
Investigational drugs for onychomycosis Gupta, Aditya K; Simpson, Fiona C
Expert opinion on investigational drugs,
2014-January, 1/1/2014, 2014-Jan, 2014-01-00, 20140101, Letnik:
23, Številka:
1
Journal Article
Recenzirano
Introduction:
Onychomycosis is the fungal infection of the nail plate by dermatophytes, yeasts and nondermatophyte molds. The treatment of onychomycosis poses many challenges due to low initial cure ...rates and a high rate of relapse and recurrence. Oral therapy is limited by adverse events and drug-drug interactions, whereas topical therapy has limited penetrance through the nail plate.
Areas covered:
New and reformulated drugs are in development for the treatment of onychomycosis. Experimental molecules include both oral and topical azole molecules, topical reformulations of terbinafine, the benzoxaboroles tavaborole and AN2718, the aganocide NVC-422 and the photosensitizer Sylsens B. These drugs are in varying stages of development so results from in vitro studies to Phase III clinical trials are discussed to present a complete picture of the current development pipeline for onychomycosis.
Expert opinion:
The development of new molecules from familiar and novel classes for both oral and topical administration is encouraging. It is clear that there is currently more emphasis on the development of topical drugs than orals, due to their lower potential for adverse events and drug-drug interactions. The emergence of novel molecular targets is encouraging for the possibility of combination therapy and any future drug-resistant strains of fungi.
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