Hyperhidrosis: Evolving concepts and a comprehensive review

Hyperhidrosis (primary or secondary) describes a disorder of excessive sweating. It has a significant negative impact on quality of life and affects nearly 1% of the population living in the United Kingdom (UK). Axillary involvement is the most common affecting 80% of cases.A common link to these disorders is an extreme non-thermoregulatory sympathetic stimulus of exocrine sweat glands, mostly due to emotional stimuli. Non-surgical treatment involves topical medication, iontophoresis and systemic anti-cholinergics. More recently the use of intradermal botulinum toxin has gained popularity.Surgical treatment reserved for severe cases, not responding to conservative management involves local excision, curettage and thoracoscopic sympathectomy. Evolving concepts for treatment, risks and benefits are discussed in the paper herein.     

新疆宫颈癌高发区维吾尔族人群人乳头瘤病毒亚型的研究

目的 分析人乳头瘤病毒(HPV)各亚型在新疆宫颈癌高发区维吾尔族人群中的分布.方法 通过凯普导流杂交HPV DNA检测法,对新疆墨玉县喀尔赛乡维吾尔族男性尿道分泌物及女性宫颈分泌物(各400例)进行21种HPV亚型的检测.结果 (1)女性HPV感染总阳性率为14.25%,HPV亚型按其出现的频率依次为HPV16、58、39、18、33、52、43、66、CP8304、6、11,其中HPV16在HPV阳性者中比例最高(66.67%).(2)男性HPV总阳性率为8.00%,其中HPV16在HPV阳性者中比例最高(44.44%);HPV亚型按其出现的频率依次为HPV16、43、33、39、6(39和6型并列)、53.(3)夫妻间配对后发现男、女性HPV感染类型不同;女性HPV感染者的配偶中大部分HPV阴性;而男性HPV阳性者的配偶中也大部分HPV阴性.夫妻HPV感染吻合率为7.02%,而男性HPV感染与女性吻合率为9.38%.结论 HPV在新疆维吾尔族人群中的阳性率均较低,但HPV阳性者中高危型HPV尤其是HPV16的构成比高,HPV16是新疆地区维吾尔族人群中流行的主要病毒类型.

Abstract：

Objective To study the distribution of human papilloma virus(HPV)subtypes in Uyghur people from the high risk region of cervical cancer in Xinjiang. Methods 21 subtypes of HPV from 400 cases of men's swabs of penile and 400 cases of women's cervix swabs were detected, using flow-through hybridization and gene chip technology. Results(1)The positive rate of HPV among the 400 women cases was 14.25% ,with HPV16 the most common type. In women whose HPV was positive, the positive rate of HPV16 was 66.67%. The ranking of frequencies on the HPV subtypes in women were: HPV 16, 58,39, 18,33,52,43,66, CP8304, HPV6 and 11.(2)Among the 400 male cases, the positive rate of HPV was 8.00%, with HPV16 the most common type. In men whose HPV was positive, the rate of HPV16 was 44.44%. The ranking of HPV subtypes in men were HPV16, 43, 33, 39, 6(HPV39 and 6 are equivalent)and 53.(3)Both wives and husbands were infected by different subtypes of HPV, the positive rate was relatively low among men whose wife's HPV were positive. However, the HPV positive rate was relatively low among women whose husband's HPV were positive. The concordance infection rate of women and men were 7.02% and the concordance infection rate of men and women were 9.38%. Conclusion The HPV positive rates were relatively low in both men and women living in the region with high risk of cervical cancer in Xinjiang. However, the positive rate of high risk types HPV and HPVI6 in both men and women were relatively high. Uyghur men seemed to have played a certain role related to the carcinogenensis of cervical cancer. HPV16 was the main type in both men and women in Xinjiang.     

Juvenile dermatomyositis

Juvenile dermatomyositis (JDM) is an important subtype of dermatomyositis characterized by inflammation of muscle, skin and gastrointestinal tract. A 14-year-old girl, with a history of fever, joint pain, easy fatigability and a rash since the age of 3 years is described. Physical examination, laboratory evaluation, electromyography (EMG) and muscle biopsy were suggestive of a chronic inflammatory process involving the muscles, most likely dermatomyositis. The report highlights the importance of a muscle biopsy as the gold standard for diagnosing dermatomyositis.     

Resistance patterns of diversified phylogroups of Escherichia coli associated with mothers having history of preterm births in Pakistan

Objective: Urinary tract infections (UTIs) are caused by extraintestinal pathogenic Escherichia coli (ExPEC), and are one of the key predictors of preterm births. In the light of this fact, present study was conducted to determine the predominant Escherichia coli (E. coli) phylotypes and their associated antibiotic susceptibility patterns, isolated from pregnant mothers with the history of preterm births.

Methods: Forty seven E. coli strains were isolated out of a total of 80 urine samples of pregnant women. The isolates were phylotyped and further screened for the presence of Clonal group A. Moreover, Antimicrobial susceptibility testing and screening for Extended Spectrum Beta Lactamase (ESBL) producing strains were also performed.

Results: Among the 47 isolates, phylogroup B2 was found to be highly prevalent (45%), followed by group D (23%), B1 (10.64%), A (6.38%), E (6.38%), cryptic clade I (4.25%) and F (2.13%). Two isolates belonged to CgA and 41 (87.23%) isolates were found to be multidrug-resistant. Out of nine antibiotics tested in the study, the isolates displayed high resistance to Ampicillin (82.6%), Sulphamethoxazole (65.22%), Nalidixic acid (60.87%), Sulphamethoxazole-Trimethoprim, Doxycycline and Erythromycin (56.52% each). In total, 8 (17.02%) of the isolates were found to be ESBL positive.

Conclusions: The prevalence of infections caused by virulent and highly drug resistant E. coli isolates constitute a risk of developing preterm birth complications in pregnant women and requires the selection of appropriate antibiotics for the treatment of infections caused during pregnancy.     

High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall

We report three cases of massive chest wall plasmacytoma, each greater than 10 cm in diameter, without evidence of overt myeloma, whom we treated with a combination of VAD chemotherapy consolidated by high-dose melphalan and autologous peripheral blood stem cell transplantation and radical radiotherapy. All three patients completed all components of their therapy without experiencing any major side effects and one patient has had a durable remission. The other two patients have had disease progression but at sites other than the original tumour.     

Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction

Purpose  

To determine the accuracy of 64-slice multidetector computed tomography scans in detecting the point of transition of small bowel obstruction by using surgical findings as the gold standard.     

Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

Objectives:

The primary purpose of this study was to determine whether occurrences of within- and between-session changes were significantly associated with functional outcomes, pain, and self-report of recovery in patients at discharge who were treated with manual therapy for mechanical neck pain. A secondary purpose was to determine the extent of change needed for the within- and between-session change in association to function.

Methods:

This secondary data analysis examined 56 patients who demonstrated a positive response to manual therapy during the initial assessment within a randomized controlled trial (RCT) that examined manual therapy techniques and a home exercise program (HEP). Within- and between-session findings were defined as ‘changes in pain report during the initial session (within)’ and ‘changes in pain from baseline to 48-hours post initial assessment (between)’. Outcomes were analyzed for associations with the global rating of change (GRoC), self-report activity scale (SRAS), and a 50% reduction of the neck disability index (NDI) by discharge at 96 hours.

Results:

Findings indicate that within-session pain changes of 36·7% are strongly associated with a 50% change in NDI at 96 hours. Between-session changes in pain were associated with 50% change in NDI and a ≧3-point change in GRoC at 96 hours.

Conclusion:

Both within- and between-session measures may be useful to predict success levels at 96 hours for NDI; however, between-session changes are more useful to predict success in GRoC. Measures used during clinical examination may help guide clinicians in identification of candidates best suited for the treatment.