Cercarial Dermatitis

Cercarial dermatitis or “swimmers’ itch” is a maculopapular skin eruption associated with the penetration of the skin by cercaria of certain species of nonhuman schistosomes. It is globally distributed and affects those who work or play in fresh and salt water.

The etiology and epidemiology of the disease are similar to that of human schistosomiasis (bilharziasis). The trematode parasite passes through a life cycle that involves both warm-blooded and molluscan hosts.

The clinical manifestations of “swimmers’ itch” are principally associated with an intensely pruritic dermatitis that lasts five to ten days and becomes more severe with subsequent exposure. Prevention is directed toward control of the molluscan hosts and their supporting environment. Treatment is symptomatic.     

Lifetime exposure to self-reported occupational noise and prevalent rheumatoid arthritis in the National Health and Nutrition Examination Survey (2011–2012)

Multiple risk factors for rheumatoid arthritis (RA) have been studied, but there is a dearth of research on occupational noise, which is highly prevalent in the United States (U.S.). This study aimed to determine whether occupational noise exposure was associated with an elevated risk of prevalent RA in the U.S. general population. Data from the 2011 to 2012 cross-sectional, population-based National Health and Nutrition Examination Survey were used for secondary analysis. Self-reported lifetime exposure to very loud noise was linked to self-reported doctor-diagnosed RA in a sample of 4192 participants. Weighted logistic regression was used to obtain nationally representative prevalence odds ratios (OR). The main and fully adjusted models yielded OR = 3.98 (95% CI: 1.74, 9.11) and OR = 2.84 (95% CI: 1.23, 6.57) for participants exposed for ≥ 15 years compared to never exposed participants. Excluding those diagnosed with RA more than five years before the interview, the effect dropped to OR = 3.67 (95% CI: 1.06, 12.75) in the main model, and was no longer significant in the fully adjusted model (OR = 2.68, 95% CI: 0.80, 8.96). The only significant effect modifier was race/ethnicity, with higher risk in Non-Hispanic whites. To conclude, long-term occupational noise exposure might be a modifiable risk factor for RA, but currently, the evidence base is very thin and tenuous.     

Frontal sinus obliteration after trauma: analysis of bone regeneration for two selected methods

We present a prospective randomized experimental study comparing bone regeneration obtained in 60 post-traumatic frontal sinuses obliterated with either calvarial bone dust (n = 30, group I) or calvarial bone and demineralized bone matrix (DBM; n = 30, group II). Radiological follow-up included high-resolution computed tomography with quantitative micro-density analysis in Hounsfield units (HU), together with a volumetric evaluation of the ossification at 6 and 24 months after surgical treatment. Epidemiological information and potential drawbacks were analysed. Bone volume and density data (HU) for the regenerated areas were subjected to statistical analysis at 6 and 24 months for both groups. Results were compared with reference values obtained from frontal and temporal bone in every patient. Complications developed for 10% of operated sinuses. The resulting bone formation (HU) in group I patients was significantly better than that obtained in group II. Ossification progressed in a statistically significant manner in both groups when compared at 6 and 24 months postoperatively. The use of DBM as a biomaterial associated with calvarial bone dust for sinus obliteration shows long-term safe results, similar to autogenous bone, but with a lower final bone density.     

Inhalable Dust Measurements as a First Approach to Assessing Occupational Exposure in the Pharmaceutical Industry

Occupational exposure to active ingredients in the pharmaceutical industry has been the subject of very few published studies. Nevertheless, operations involving active powdered drugs or dusty operations potentially lead to operator exposure. The aim of this study was to collect occupational exposure data in the pharmaceutical industry for production processes involving powdered active ingredients. While the possibility of assessing drug exposure from dust level is examined, this article focuses on inhalable dust exposure, without taking chemical risk into account. A total of 377 atmospheric (ambient and personal) samples were collected in nine drug production sites (pharmaceutical companies and contract manufacturing organizations) and the dust levels were assessed. For each sample, relevant contextual information was collected. A wide range of results was observed, both site- and operation-dependent. Exposure to inhalable dust levels varied from 0.01 mg/m³to 135 mg/m³. Though restricted to dust exposure, the study highlighted some potentially critical situations or operations, in particular manual tasks (loading, unloading, mechanical actions) performed in open systems. Simple preventive measures such as ventilation, containment, and minimization of manual handling should reduce dust emissions and workers’ exposure to inhalable dust.     

Sublingual immunotherapy efficacy in patients with atopic dermatitis and house dust mites sensitivity: a prospective pilot study

ABSTRACT

Background: Specific subcutaneous immunotherapy (SCIT) with house dust mite (HDM) preparation has recently been shown to improve eczema in patients with atopic dermatitis (AD). So far, there is less data regarding efficacy and safety of specific sublingual immunotherapy (SLIT) in patients with AD.

Study aim: To evaluate in an open non-controlled, non-randomized pilot trial the effect of SLIT with HDM allergen extracts preparation (SLITone, ALK Abellò Italy) on SCORAD in adult patients with mild–moderate AD.

Patients and methods: 86 Subjects (53 females and 33 males) between 3 and 60 years of age with AD and IgE-proved (Class > 2) HDM sensitization were enrolled after their informed consent in the trial. Exclusion criteria were severe asthma and treatment with systemic or high potent topical corticosteroids or immunosuppressant agents. Patients were treated with SLIT (Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts: SLITone, ALK-Abellò) for at least 12 months. SCORAD was evaluated at baseline and after 12 months of treatment.

Results: Baseline SCORAD value, mean ± SD, was 43.3 ± 13.7 (range 15–84). After 1 year of SLIT, mean ± SD, SCORAD value was reduced to 23.7 ± 13.3 (range: 0–65) (p = 0.0001; unpaired t-test vs. baseline). This was a 46% reduction in SCORAD in comparison with baseline value. A significant improvement, defined as a SCORAD reduction of > 30%, was observed in 51 out of 86 patients (59%). In 5 patients (5.8%) SCORAD values did not change at the end of the observation period. In 30 patients (35%) the SCORAD reduction after SIT was ≤ 30% in comparison with baseline. Total and specific IgE serum levels were significantly (p = 0.001) reduced after SLIT. No severe adverse events were observed during the trial.

Conclusion: In this open non-controlled trial SLIT with HDM extracts in patients with mild to moderate AD was effective in reducing the SCORAD after 1 year of SLIT treatment. In addition the treatment was very well tolerated. Treatment with SLIT, furthermore, has allowed a gradual and relevant reduction of concomitant therapies with topical corticosteroids or immunosuppressants. Present results require further controlled trials in order to confirm the potential clinical benefit of SLIT in this clinical setting.