非淋菌性尿道炎衣原体及支原检测和药敏试验

为了解非淋菌性尿道炎(NGU)的病原体情况及支原体对抗菌药物的敏感性为临床治疗提供依据，采用免疫层析法试剂盒检测衣原体(Ct)，支原体培养计数药敏试剂盒进行解脲支原体(Uu)和人型支原体(Mh)的培养和药敏试验。结果．236例NGU患者病原体的感染率分别是Uu43．2％，Ct18．6％．Mh10．2％．Uu Ct6．4％．Uu Mh5．1％．Mh Ct3．4％，Uu Mh Ct1．7％。对支原体敏感性较高的药物有交沙霉素、阿奇霉素，米诺环素、司帕沙星、多西环素，敏感率分别是96．4％、95.2％、92．1％、90．3％、89．7%。环丙沙星和壮观霉素耐药性较高，耐药率分别是44．8％、18．7％?Uu和Ct是NGU感染的主要病原体，环丙沙星和壮观霉素不能作为本地区治疗NGU的常规用药，而交沙霉素可作为首选药物。     

泌尿生殖道支原体检测及药敏试验分析

为了解支原体在泌尿生殖道中的感染及耐药情况。我们对769例疑似NGU患者进行支原体培养、鉴定、药敏一体化试剂盒进行检测。结果支原体培养阳性178例，阳性率23．1％，其中解脲支原体(Uu)阳性143例(80．3％)；人型支原体(Mh)阳性9例(5．1％)；Uu和Mh混合感染26例(14．6％)。Uu对10种药物作药敏试验，敏感性最高者为米诺环素(93．7％)，耐药率最高者为四环素(32．2％)。米诺环素是本地区治疗泌尿生殖道支原体感染的首选药物?     

泌尿生殖道感染支原体培养及其药敏结果分析

支原体感染被认为是非淋菌性尿道炎（non—gonococcalurethritis，NGU）的重要病因之一，其主要的病原体是解脲脲原体（Uu）和人型支原体（Mh）。由于抗生素的广泛应用，耐药菌株日益增多。为了解姜堰地区支愿体的感染及其耐药情况，对我院2007年1月～2008年2月对629例疑为NGU患者的支原体培养及药敏试验结果进行总结，现将结果报道如下。     

性病门诊366例女性下生殖道STD病原体分析

目的：了解性病门诊女性下生殖道STD病原体感染情况。方法：利用淋球菌（NG）培养，支原体（Uu,Mh)培养，沙眼衣原体（CT）培养，白色念珠菌（以下简称白念）培养，阴道毛滴虫（以下简称滴虫）镜检等方法，于1996年4-2000上4月对366例性病门诊女性下生殖道STD病原检查。结果：366例女性下生殖道感染STD病原体303例，感染率为82．79％，其中Uu感染率为65．57％，Mh为27．87％，CT为19．67％，白念为21．31％，滴虫为4．10％，NG为1．64％。结论：性病门诊女性下生殖道感染，STD病原有多种，以Uu最为多见，其次是Mh，再次为CT及白念，NG感染率较低，STD病原体混合感染较严重。     

性病门诊就诊者支原体感染状况及耐药分析

目的：了解我院性病门诊解脲支原体（Uu）、人型支原体（Mh）的感染状况和耐药情况,指导临床合理选用抗菌药物.方法：对性病门诊2011年至2013年疑似非淋菌尿道炎（NGU）患者的实验室报告进行回顾性调查,对检验数据进行统计分析.结果：3年中,5526例患者中,Uu感染1979例（35.81％）,Mh感染382例（6.91％）,混合感染214例（3.87％）.解脲支原体药敏趋势显示,交沙霉素、米诺环素、多西环素、克拉霉素有较高的抑菌能力,环丙沙星耐药明显.人型支原体药敏显示,交沙霉素、米诺霉素、多西霉素依然有效,大环内酯类和喹诺酮类出现较强的耐药.结论：我院性病门诊患者支原体属感染率高,可选用抗菌药品种少,要引起医院的重视,应在药敏结果指导下合理选药,减缓耐药菌株的产生.     

1186例非淋菌性泌尿生殖系感染患者支原体检测及药敏分析

了解非淋菌性泌尿生殖系感染患者的支原体感染情况及耐药性。通过对1186例就诊患者的支原体检测，支原体感染的阳性率为51．6％，单纯Uu、Mh感染及混合感染者分别为36．2％，3．0％和12．4％；Uu和Mh的阳性率分别为48．7％和15．3％。米诺环素、交沙霉素和阿奇霉素可作为支原体所致泌尿生殖系感染的首选药物。     

泌尿生殖道支原体检测及耐药性分析

近年来，解脲支原体（Uu）和人型支原体（Mh）作为非淋菌性尿道炎（NGU）的主要病原体，其感染率呈不断上升趋势。随着各种广谱抗生素的滥用，其耐药菌株日益增多，给临床治疗带来很大困难。为了解台州市Uu和Mh在泌尿生殖道感染中的状况以及对不同药物的体外敏感性，我们对1351例可疑支原体感染者进行了支原体培养及药物敏感试验，现将结果报道如下。     

北海地区泌尿生殖道支原体对抗菌药物的耐药性

通过检测734例患者支原体的感染情况，发现解脲脲原体（Uu)感染显著高于人型支原体（Mh)感染，支原体培养阳性的患者中，女性显著高于男性。在对抗菌药物的耐药上，2种支原体大致相似，但也存在着差异。Uu、Mh耐药率在20％以下的抗菌药物有多西环素、左旋氧氟沙星、氧氟沙星、交沙霉素；Uu、Mh耐药率较高的抗菌药有四环素、乙酰螺旋霉素、红霉素；Uu对阿奇霉素、罗红霉素、米诺环素耐药率低，但Mh对阿奇霉素、罗红霉素耐药率较高。四环素的耐药性变迁，说明密切注意泌尿生殖道支原体的耐药性发展是十分重要的。     

2 247例非淋菌性尿道炎病原体检测及支原体药物敏感分析

非淋菌性尿道炎（nongonococcal urethritis，NGU）是常见的性传播疾病之一，近年来发病率明显增加，已成为最常见的性传播疾病之一。为了解无锡地区NGU的病原体流行及其耐药情况，我科于2003年1月-2005年12月对2247例疑为NGU的患者进行沙眼衣原体（C．trachomatis，Ct）检测以及解脲支原体（U．urealyticum，Uu）和人型支原体（M．hominis，Mh）培养,并对支原体进行药敏试验，为临床抗生素的选择提供参考依据,现将结果报告如下。[第一段]     

有泌尿生殖道症状者支原体感染及药物敏感性的研究

对260例未经治疗患者进行支原体培养及药敏试验，以聚类分析法处理数据。支原体总分离率43．8％，Uu、Mh感染及混合感染分别为28％、3．46％、12．3％。耐药最多的是壮观霉素，敏感性最好的药物是多西环素。支原体感染以Uu为主，Mh感染逐渐增多，治疗药物首选多西环素和米诺环素。     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.     

Anästhesieverfahren in der Dermatologie

Zusammenfassung Die Verfahren der Lokalanästhesie sind integraler Bestandteil der operativen Dermatologie. Sie gewährleisten eine effiziente und sichere Analgesie in umschriebenen Haut- und Weichteilregionen und ermöglichen, einen sonst schmerzhaften diagnostischen oder therapeutischen Eingriff bei erhaltenem Bewusstsein zu tolerieren. Einzelne Methoden der Applikation sind "konkurrenzlos", wie die topische Applikation von EMLA^® oder die Kryoanästhesie, andere bieten alternative Optionen zur Allgemeinanästhesie. Die Tumeszenzlokalanästhesie wurde—jenseits der kosmetischen Liposuktion—zu einer effizienten Anästhesieform für größere Operationen bei Tumoren der Haut, plastische Rekonstruktionen und in der Phlebochirurgie weiterentwickelt. Die Wahl des Verfahrens im Einzelfall wird vom Alter, der Kooperationsfähigkeit und der Komorbidität des Patienten bestimmt. Für Infiltrationsanästhesien werden heute vorwiegend Lokalanästhetika vom Amidtyp eingesetzt. Fundierte Kenntnisse über die Anatomie der sensiblen Nerven sind Voraussetzung für erfolgreiche operationsfeldnahe periphere Blockaden. Wenn die Wirkungsweise der Lokalanästhetika, ihre toxischen Effekte und potenzielle Arzneimittelinteraktionen bei ihrem Metabolismus in der Praxis beachtet werden, dann ist das Risiko von Komplikationen relativ gering. Es sollte dennoch nicht unterschätzt, und adäquate Notfallmaßnahmen im Operationsteam sollten regelmäßig trainiert werden.     

Leprosy in a University Hospital in Southern Brazil

BACKGROUND

Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient''s quality of life and leading to loss of working years.

OBJECTIVES

To evaluate the epidemiological profile of patients followed at a University Hospital.

MATERIALS AND METHODS

This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.

RESULTS

The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.

CONCLUSIONS

This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.     

Therapie der Akne mit Antiandrogenen – Eine evidenzbasierte Übersicht

Background: Increased sebaceous gland activity with seborrhea is one of the major pathogenetic factors in acne. Antiandrogen treatment targets the androgen‐metabolizing follicular keratinocytes and the sebaceous gland leading to sebostasis, with a reduction of the sebum secretion rate of 12.5 – 65 %. Antiandrogens can be classified based on their mechanism of action as androgen receptor blockers, inhibitors of circulating androgens by affecting ovarian function (oral contraceptives), inhibitors of circulating androgens by affecting the pituitary (gonadotropin‐releasing hormone agonists and dopamine agonists in hyperprolactinemia), inhibitors of adrenal function, and inhibitors of peripheral androgen metabolism (5α‐reductase inhibitors, inhibitors of other enzymes). Methods: All original and review publications on antiandrogen treatment of acne as monotherapy or in combination included in the MedLine system were extracted by using the terms “acne”, “seborrhea”, “polycystic ovary syndrome”, “hyperandrog*”, and “treatment” and classified according to their level of evidence. Results: The combinations of cyproterone acetate (2 mg)/ethinyl estradiol (35 µg), drospirenone (3 mg)/ethinyl estradiol (30 µg), and desogestrel (25 µg)/ethinyl estradiol (40 µg) for 1 week followed by desogestrel (125 µg)/ethinyl estradiol (30 µg) for 2 weeks showed the strongest anti‐acne activity. Gestagens or estrogens as monotherapy, spironolactone, flutamide, gonadotropin‐releasing hormone agonists, and inhibitors of peripheral androgen metabolism cannot be endorsed based on current knowledge. Low dose prednisolone is only effective in late‐onset congenital adrenal hyperplasia and dopamine agonists only in hyperprolactinemia. Treatment with antiandrogens should only be considered if none of the contraindications exist. Conclusion: Antiandrogen treatment should be limited to female patients with additional signs of peripheral hyperandrogenism or hyperandrogenemia. In addition, women with late‐onset or recalcitrant acne who also desire contraception can be treated with antiandrogens as can those being treated with systemic isotretinoin. Antiandrogen treatment is not appropriate primary monotherapy for noninflammatory and mild inflammatory acne.