Squamoid eccrine ductal carcinoma of the scalp

An 85‐year‐old man presented with an ulcerated pruritic nodule on the scalp. Histology of a deep curette specimen showed the typical features of a squamoid eccrine ductal carcinoma: superficial squamous differentiation and deep ductal structures.     

Fungal eosinophilic pustular folliculitis

A young woman presented with a persistent unilateral erosive and pustular plaque of the forearm. Repeated biopsy was required to make the diagnosis of a fungal cause for her eosinophilic pustular folliculitis.     

SUBCUTANEOUS FAT NECROSIS OF THE NEWBORN COMPLICATED BY HYPERCALCAEMIA AND THROMBOCYTOPENIA

Subcutaneous fat necrosis of the newborn is an uncommon but distinctive condition which appears in the first six weeks of life, associated with variable degrees of hypercalcaemia and which resolves spontaneously over months. We report a case of subcutaneous fat necrosis of the newborn following perinatal distress and complicated by thrombocytopenia and hypercalcaemia.     

Strategies to recruit and retain college smokers in cessation trials

Techniques to recruit and retain college fraternity and sorority members who reported past 30‐day smoking into a cessation trial are described. Recruitment efforts included relationship‐building, raffles, and screening survey administration during existing meetings. Surveys were administered to 76% (n = 3,276) of members in 30 chapters, 79% of eligible members agreed to participate, and 76% of those completed assessments and were enrolled in the trial (n = 452). The retention rate was 73%. Retention efforts included cash incentives, flexible scheduling, multiple reminders, chapter incentives, and use of chapter members as study personnel. Retention was not related to demographic, behavioral, or group characteristics. The strategies of partnership, convenience, and flexibility appear effective and may prove useful to investigators recruiting similar samples. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:144–155, 2010     

Improvements in cognitive function and quantitative sleep electroencephalogram in obstructive sleep apnea after six months of continuous positive airway pressure treatment

Study ObjectivesUntreated obstructive sleep apnea (OSA) is associated with cognitive deficits and altered brain electrophysiology. We evaluated the effect of continuous positive airway pressure (CPAP) treatment on quantitative sleep electroencephalogram (EEG) measures and cognitive function.MethodsWe studied 167 patients with OSA (age 50 ± 13, AHI 35.0 ± 26.8) before and after 6 months of CPAP. Cognitive tests assessed working memory, sustained attention, visuospatial scanning, and executive function. All participants underwent overnight polysomnography at baseline and after CPAP. Power spectral analysis was performed on EEG data (C3-M2) in a sub-set of 90 participants. Relative delta EEG power and sigma power in NREM and EEG slowing in REM were calculated. Spindle densities (events/min) in N2 were also derived using automated spindle event detection. All outcomes were analysed as change from baseline.ResultsCognitive function across all cognitive domains improved after six months of CPAP. In our sub-set, increased relative delta power (p < .0001) and reduced sigma power (p = .001) during NREM were observed after the 6-month treatment period. Overall, fast and slow sleep spindle densities during N2 were increased after treatment.ConclusionsCognitive performance was improved and sleep EEG features were enhanced when assessing the effects of CPAP. These findings suggest the reversibility of cognitive deficits and altered brain electrophysiology observed in untreated OSA following six months of treatment.     

A PERIOD3 variable number tandem repeat polymorphism modulates melatonin treatment response in delayed sleep-wake phase disorder

We examined whether a polymorphism of the PERIOD3 gene (PER3; rs57875989) modulated the sleep-promoting effects of melatonin in Delayed Sleep-Wake Phase Disorder (DSWPD). One hundred and four individuals (53 males; 29.4 ±10.0 years) with DSWPD and a delayed dim light melatonin onset (DLMO) collected buccal swabs for genotyping (PER3^4/4 n = 43; PER3 5 allele [heterozygous and homozygous] n = 60). Participants were randomised to placebo or 0.5 mg melatonin taken 1 hour before desired bedtime (or ~1.45 hours before DLMO), with sleep attempted at desired bedtime (4 weeks; 5-7 nights/week). We assessed sleep (diary and actigraphy), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS: Sleep Disturbance, Sleep-Related Impairment), Sheehan Disability Scale (SDS) and Patient- and Clinician-Global Improvement (PGI-C, CGI-C). Melatonin treatment response on actigraphic sleep onset time did not differ between genotypes. For PER3^4/4 carriers, self-reported sleep onset time was advanced by a larger amount and sleep onset latency (SOL) was shorter in melatonin-treated patients compared to those receiving placebo (P = .008), while actigraphic sleep efficiency in the first third of the sleep episode (SE T1) did not differ. For PER3 5 carriers, actigraphic SOL and SE T1 showed a larger improvement with melatonin (P < .001). Melatonin improved ISI (P = .005), PROMIS sleep disturbance (P < .001) and sleep-related impairment (P = .017), SDS (P = .019), PGI-C (P = .028) and CGI-C (P = .016) in PER3^4/4 individuals only. Melatonin did not advance circadian phase. Overall, PER3^4/4 DSWPD patients have a greater response to melatonin treatment. PER3 genotyping may therefore improve DSWPD patient outcomes.     

Acrokeratoelastoidosis

An Indian woman presented with crateriform and pearly papules along the lines of transgredience of the hands and feet. Her father and an older sister are similarly affected. Histology showed hyperkeratosis and elastorrhexis. The differential diagnosis of acrokeratoelastoidosis includes focal acral hyperkeratosis. The current classification of marginal papular acrokeratodermas is discussed.     

Mapping the illness trajectories of insomnia: a biographical disruption?

The insomnia illness experience can be conceptualised as a form of biographical disruption. Using a critical interpretive phenomenological lens 51 in‐depth semi‐structured interviews were conducted with patients from specialist sleep and psychology clinics (n = 22) and the general community (n = 29). Patients’ narratives revealed key phases of their illness trajectories as they recognise, rethink and respond to insomnia. Their biographical events served as reference points for both patient groups to make sense of their illness experiences as they transitioned from a perceived state of sleeplessness to clinical insomnia. The innate biological process of sleep at night and the sleep‐dependent daytime psychosocial function exerted a negative bi‐directional effect, creating a continuous circuit of disruption. Coping mechanisms were inspired by the participants’ immediate social environment and centred on sociocultural motifs of relaxation and alertness to break the ‘circuit’. Access to specialist clinic services appeared to be contingent on the richness of resources in one's social network and surrounding environment rather than the clinical severity of the disease alone. Treatment that can simultaneously target the night time and daytime consequences of insomnia resonates closely with participants’ depiction of insomnia as both a physiological and a psychosocial phenomenon.     

Predictors of primary medical care consultation for sleep disorders

ObjectivesTo describe the prevalence and risk factors for primary care consultations for insomnia and/or snoring/sleep apnea.MethodsRetrospective cross-sectional, population-based postal survey of 10,000 people randomly selected from the New South Wales electoral roll; 3300 responded (35.6%). Direct contact with a random subset from the non-responders (n = 100) was also undertaken with a response rate of 49%.ResultsThe population weighted prevalence for having insomnia was 33.0%, with 11.1% visiting a doctor. The weighted prevalence for reporting a visit to the doctor for snoring/sleep apnea was 6.2%, while 2.9% reported having visited a doctor for both disorders. The percentages of males and females consulting their doctor for either sleep disorder were similar. Independent risk factors for insomnia visits were: being older, daytime sleepiness, short sleep durations, and reduced enthusiasm. Self-medication for insomnia symptoms was common. Independent risk factors for snoring/sleep apnea visits were: being older, daytime sleepiness, short sleep durations, and reduced enthusiasm.ConclusionsThe risk factors for seeking medical help for self-suspected insomnia or snoring/sleep apnea were similar. The reported excess proportion of men being diagnosed in sleep apnea clinics appears to be related to a differential referral by clinicians. We recommend that clinicians discuss both insomnia and snoring/sleep apnea because these disorders are commonly found in patients presented with either condition.