Panniculitis in childhood and adolescence

Background: The purpose of the present paper was to describe the clinical manifestations and treatment of patients with panniculitis. Methods: From January 1983 to December 2002, 4294 patients were treated for pediatric rheumatological diseases at Pediatric Rheumatology Unit, University of São Paulo, Brazil. Of these, 35 children and adolescents (0.8%) presented with panniculitis: erythema nodosum (EN) or Weber–Christian disease (WCD). Clinical characteristics, laboratory exams, biopsy of the lesion, treatment and clinical course were studied. Results: Of the 35 patients, 29 presented with EN and six with WCD, one of these with cytophagic histiocytic panniculitis. Mean age at symptom onset was 85 months (6–204 months) and the mean duration of follow up was 55 months (1–144 months). All the patients presented with inflammatory subcutaneous nodules. The patients with WCD presented with systemic manifestations and cutaneous atrophy. The principal etiologies of EN were streptococcal infection (42%), undetermined (13.5%), pulmonary tuberculosis (10%), and acute rheumatic fever (10%). Biopsy of the nodules indicated septal panniculitis in 14 patients with EN and lobular panniculitis without vasculitis in the patients with WCD, one of which had cytophagic histiocytic panniculitis. There was recurrence in 11 patients (38%) with EN and in all those with WCD. Non‐steroidal anti‐inflammatory drugs were used in 15 patients with EN and corticosteroids and/or immunosuppressive drugs in the six patients with WCD. Three patients died. Conclusions: EN is the most frequent panniculitis, with a benign course and is mainly associated with infections. WCD is a severe disease, with systemic involvement, that proceeds with cutaneous atrophy and requires the use of corticosteroids and or immunosuppressive drugs.     

Health worker remuneration in WHO Member States

Objective

To present the available data on the money spent by Member States of the World Health Organization (WHO) on remunerating health workers in the public and private sectors.

Methods

Data on government and total expenditure on health worker remuneration were obtained through a review of official documents in WHO’s Global Health Expenditure Database and directly from country officials and country official web sites. Such data are presented in this paper, by World Bank country income groups, in millions of national currency units per calendar year for salaried and non-salaried health workers. They are presented as a share of gross domestic product (GDP), total health expenditure and general government health expenditure. The average yearly change in remuneration (i.e. compound annual growth rate) between 2000 and 2012 as a function of these parameters was also assessed.

Findings

On average, payments to health workers of all types accounted for more than one third of total health expenditure across countries. Such payments have grown faster than countries’ GDPs but less rapidly than total health expenditure and general government health expenditure. Remuneration of health workers, on the other hand, has grown faster than that of other types of workers.

Conclusion

As they seek to attain universal health coverage (UHC), countries will need to devote an increasing proportion of their GDPs to health and health worker remuneration. However, the fraction of total health expenditure devoted to paying health workers seems to be declining, partly because the pursuit of UHC calls for strengthening the health system as a whole.     

三种抗癫痫药对癫痫患者脑电图的背景影响比较研究

目的 :观察比较苯妥因钠 (PHT)、丙戊酸钠 (SVP)和卡马西平 (CBZ)三种抗癫痫药物在治疗癫痫过程中对脑电图(EEG)的背景影响。方法 :对 76例临床确诊为癫痫、EEG检查有痫样波放电的病人按照用药分成 PHT组 2 6例 ,SVP组 2 7例 ,CBZ组 2 3例 ,动态观察各组在服药期间痫样波放电的频度和 EEG背景的变化。结果 :SVP组对 EEG痫样波放电的抑制率明显优于 PHT和 CBZ,对 EEG背景活动影响最明显的是 CBZ,服用 CBZ两周后α波即开始变慢 ,三周后慢波明显增多 ,这种变化与临床疗效不呈一致。结论 :三种药物对 EEG背景活动影响的程度顺序是 CBZ>PHT>SVP,开始时间是服药后 2周 ,而对痫样波放电的抑制率是 SVP>PHT>CBZ     

优化处方工艺改善环扁桃酯胶囊装量差异及崩解时限

目的：改善环扁桃酯胶囊的装量差异及崩解时限。方法：以装量差异和崩解时限为考察指标。对环扁桃酯胶囊的处方工艺进行优化。结果：通过处方工艺优化，选用Avicel PH302作稀释剂，Ac-Di-Sol作崩解剂，可改善环扁桃酯胶囊的装量差异及崩解时限。结论：AvicelPH302具有极佳的流动性，在胶囊充填过程中，可以大大改善粉体的流动性，减小胶囊的装量差异。Ac-Di-Sol作为崩解剂的效果优于国产CMS-Na。明显缩短胶囊的崩解时间。     

Fatty infiltration of the liver: evaluation by proton spectroscopic imaging

The reliability of proton spectroscopic imaging in evaluating fatty infiltration of the liver was investigated in 35 subjects (12 healthy volunteers and 23 patients with fatty livers). With this modified spin-echo technique, fatty liver could be separated from normal liver both visually and quantitatively. On the opposed image, normal liver had an intermediate signal intensity, greater than that of muscle, whereas fatty liver had a lower signal intensity, equal to or less than that of muscle. In normal livers, the lipid signal fraction was less than 10%, while in fatty livers it was greater than 10% and usually exceeded 20%. With this technique, nonuniform fatty infiltration of the liver can be differentiated from hepatic metastases, and the technique may prove useful in the differentiation of some hepatic disorders.