Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

IntroductionPrimary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.ObjectiveTo evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.MethodThis was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.ResultsThirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88–95%, I²=47.5%), the symptom control rate was 96% (95% CI = 93–99%, I²=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.ConclusionThis review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.

Key message

• Pure axillary hyperhidrosis has great potential to compromise quality of life.
• Surgery should be indicated only when clinical treatment fails.
• Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.

     

Effect of Coffee and Cocoa-Based Confectionery Containing Coffee on Markers of DNA Damage and Lipid Peroxidation Products: Results from a Human Intervention Study

The effect of coffee and cocoa on oxidative damage to macromolecules has been investigated in several studies, often with controversial results. This study aimed to investigate the effect of one-month consumption of different doses of coffee or cocoa-based products containing coffee on markers of DNA damage and lipid peroxidation in young healthy volunteers. Twenty-one volunteers were randomly assigned into a three-arm, crossover, randomized trial. Subjects were assigned to consume one of the three following treatments: one cup of espresso coffee/day (1C), three cups of espresso coffee/day (3C), and one cup of espresso coffee plus two cocoa-based products containing coffee (PC) twice per day for 1 month. At the end of each treatment, blood samples were collected for the analysis of endogenous and H₂O₂-induced DNA damage and DNA oxidation catabolites, while urines were used for the analysis of oxylipins. On the whole, four DNA catabolites (cyclic guanosine monophosphate (cGMP), 8-OH-2′-deoxy-guanosine, 8-OH-guanine, and 8-NO2-cGMP) were detected in plasma samples following the one-month intervention. No significant modulation of DNA and lipid damage markers was documented among groups, apart from an effect of time for DNA strand breaks and some markers of lipid peroxidation. In conclusion, the consumption of coffee and cocoa-based confectionery containing coffee was apparently not able to affect oxidative stress markers. More studies are encouraged to better explain the findings obtained and to understand the impact of different dosages of these products on specific target groups.     

Carbapenemase-producing Enterobacteriaceae during 2011-12 in the Bolzano area (Northern Italy): increasing diversity in a low-endemicity setting

The recent (2011–2012) distribution of carbapenemase determinants in Enterobacteriaceae was studied in the Bolzano area (Northern Italy). Low proportions of carbapenemase producers were found for Escherichia coli (0.2%), Citrobacter freundii (1.1%), Klebsiella pneumoniae (1.3%), Klebsiella oxytoca (1.6%) and Enterobacter spp (1.8%). Although VIM-1 remained the most common carbapenemase, the emergence of K. pneumoniae producing KPC-3 and of E. coli producing OXA-48 was observed. Of concern is the spread of the hyperepidemic strains E. coli ST131 producing VIM-1 and K. pneumoniae ST258 producing KPC-3. Low essential and category agreements between the reference broth microdilution and commercial methods were observed for carbapenems.     

Triage of children with headache at the ED: a guideline implementation study

We present a multicenter validation of a modified Manchester Triage System (MTS) flowchart for pediatric patients who present with headache to the emergency department.     

Diversity of auxin-producing bacteria associated to Pseudomonas savastanoi -induced olive knots

Forty three strains were isolated from knots induced by Pseudomonas savastanoi in different olive cultivars. All the selected bacteria were shown to produce variable amounts of the plant growth hormone indole-3-acetic acid (IAA). Amplification of the intergenic transcribed spacers (ITS) between 16S and 23S rDNA genes, allowed the clustering of the isolates into seven distinct groups. All isolates from ITS group 1 were positive to the Pseudomonas savastanoi pv. savastanoi specific iaa L gene as shown by PCR. Partial sequencing of 16S rDNA gene confirmed the identity of these isolates to Pseudomonas savastanoi strains and allowed to tentatively assign the other isolates from the remaining ITS groups to Pantoea oleae/agglomerans, Burkholderia cepacia, Pseudomonas putida, Stenotrophomonas maltophilia and Hafnia alvei. Identification of endophytic knot-derived isolates revealed association of various saprophytic and putative human pathogenic bacteria with P. savastanoi pv. savastanoi in knot environment of olive infected trees.     

Quality of Web-based information on cocaine addiction

OBJECTIVE: To evaluate the quality of web-based information on cocaine use and addiction and to investigate potential content quality indicators. METHODS: Three keywords: cocaine, cocaine addiction and cocaine dependence were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. RESULTS: Of the 120 websites identified, 61 were included. Most were commercial sites. The results of the study indicate low scores on each of the measures including content quality. A global score (the sum of accountability, interactivity, content quality and aesthetic criteria) appeared as a good content quality indicator. CONCLUSIONS: While cocaine education websites for patients are widespread, their global quality is poor. There is a need for better evidence-based information about cocaine use and addiction on the web. PRACTICE IMPLICATIONS: The poor and variable quality of web-based information and its possible impact on physician-patient relationship argue for a serious provider for patient talk about the health information found on Internet. Internet sites could improve their content using the global score as a quality indicator.