Introduction
Up to 25% of children and 5.6% of adults in the USA have atopic dermatitis (AD), with substantial impacts on quality of life. Effective control can be challenging despite therapy ...efforts. The emergence of information and communication technologies (ICT) in AD management prompted this study to assess its impact on self-management. We conducted a meta-analysis to assess outcomes from peer-reviewed clinical trials evaluating the effectiveness of teledermatology, mobile health (mHealth) apps, and electronic devices for managing AD.
Methods
We searched PubMed, Web of Science, Scopus, and Embase for articles written in English and published until May 2023.
Results
Twelve trials with 2424 participants were selected from 811 studies. A meta-analysis of 1038 individuals reported a mean difference (MD) of −1.57 95% confidence interval (CI): −2.24, −0.91 for the Patient Oriented Eczema Measure (POEM). A meta-analysis of 495 individuals reported a Dermatology Life Quality Index (DLQI) MD of −0.59 95% CI: −0.95, −0.23. Despite heterogeneity (
I
2
= 47% and
I
2
= 74%), the impact was significant (
P
≤ 0.001). SCORing Atopic Dermatitis (SCORAD) showed an insignificant MD of −0.12 (
P
= 0.91).
Conclusion
mHealth applications and telemonitoring show significant improvement in patients’ quality of life (DLQI) and self-management (POEM) but no significant impact on AD severity (SCORAD).
Little is known about the association of urticarial vasculitis (UV) with thyroid autoimmunity. The latter has been mostly described in the setting of patients with chronic spontaneous urticaria ...(CSU). In this letter to the editor, we compare UV and CSU through retrospective analyses, which reveal that 41.7% patients with UV presented antithyroperoxidase (anti-TPO) and/or antithyroglobulin antibody (ATA) above the reference range, while only 4% patients with CSU had these antibodies elevated. There is a moderately strong association assessed by the Phi coefficient (φ = 0.420, p = 0.004). Further research is needed to appropriately address the relationship between UV and thyroid autoimmunity and explore any potential underlying pathophysiological process between both diseases.
Purpose of Review
Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017–February 2018.
...Recent Findings
Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6–8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse.
Summary
Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).
Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA ...and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL).
We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables.
The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL.
Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.
Rationale Chronic spontaneous urticaria (csU) affects 0.5-1 % of the global population at any given time and has a considerable burden on patients, healthcare systems and society.
The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America.
A Cross-sectional survey ...was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey.
Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist.
The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF.
Background Chronic urticaria (CU) is defined as the spontaneous appearance of wheals, with or without angioedema, persisting for ≥6 weeks. Chronic Spontaneous Urticaria (CSU) is a type of CU which ...affects 0.5–1 % of the global population, but it represents a high burden to patients. In recent years, omalizumab is available as treatment of disease. Our aim is to extend previous findings, analyzing effects of omalizumab on symptoms in Latin American patients with CSU.
Methods Retrospective analysis of patients treated with omalizumab in Cuenca-Ecuador. 150 mg omalizumab was administered every 4 weeks, and its effects were measured by Urticaria Activity Score (UAS) at baseline and each month in follow up. Complete response was defined as a UAS of 0 or 1, and partial response was classified as a UAS of 2 or more. Also, demographic and clinical variables were collected. Descriptive analyses were employed. Response rates were summarized as counts and percentages after 3 and 5 months. Related Samples Wilcoxon signed rank tests were used to compare UAS at baseline and after 3 months. P values <0.05 indicated statistical significance.
Results 26 subjects were enrolled, almost half were female individuals (57.7 %), with mean age 47.8 years (range, 18–81 years). Mean duration of CU after diagnosis was 23.3 months (range, 2–180 months). Mean UAS at baseline was 5.7 points (range, 4–6 points). Nine patients (34.6 %) completed 3 months of treatment (33 % reported a complete response), with a mean difference in UAS of 3.33 (p = 0.01). Four patients completed 5 months of treatment (75.0 % showed a complete response). All patients previously treated with first-generation antihistamines plus corticosteroids showed no responses at neither 3 nor 5 months of treatment.
Conclusion Omalizumab is an effective treatment for patients with CU. It is necessary to conduct some future investigations where we can establish if 150 mg could be an option in developing countries.
Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This ...study aimed to identify specific items reflecting the main characteristics of CU that should be included in a comprehensive medical history for patients with CU. We also aimed to clarify possible eliciting factors for CU to support accurate diagnosis of the disease.
A panel of postgraduate dermatologists conducted a literature search for relevant studies on CU using Medline, the Cochrane database, and PubMed.
We identified82 articles from which we drew a collection of items to inform development of an easy-to-use checklist and collection of items that should be included in a correct medical history. The final version of the checklist included42 items across two areas: essential clues for anamnesis and diagnosis of CU; and typical symptoms/parameters or characteristics according to subtype, etiology, and laboratory findings. Items included time of disease onset; duration, shape, size, color, and distribution of wheals; associated angioedema; atopy; and triggering factors.
Our guide provides an easy-to-use tool to support clinicians to focus, orient themselves, and save time in medical consultations for CU, allowing better diagnosis and management of this disease.
We aimed to assess recent Latin American medical school graduates' knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians.
...Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates' data with data collected in 2010-2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly.
Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%;
< 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception-recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1.03-2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP.
OSA-focused educational interventions during medical school should help to improve recent medical graduates' abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students' exposure to sleep education.
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