Second-degree burn induced by high-concentration topical capsaicin with mobility sequelae: A case report

High-concentration topical capsaicin is used as a second-line treatment for neuropathic pain. Transient, mild burning sensation and erythema are expected adverse drug reactions. Here, we report the first case of second degree burn after the application of a high-concentration topical capsaicin patch with secondary mobility sequelae. Nine months after the application, neuropathic pain still remained and the patient described mobility difficulties in daily activities, preventing her from returning to work. This report aims to raise the question of the benefit/risk ratio of high concentration topical capsaicin.     

Bedeutung der chronischen Endometritis bei rezidivierendem Implantationsversagen und wiederholten Fehlgeburten

Gynäkologische Endokrinologie - Aufgrund der häufig nicht zu identifizierenden Ursachen stellen rezidivierendes Implantationsversagen und wiederholte Fehlgeburten sowohl für die...     

Risk factors for instability after reverse shoulder arthroplasty

BackgroundInstability after primary reverse total shoulder arthroplasty (rTSA) is a rare but serious complication, potentially resulting in revision surgery. The causes of instability after rTSA are multifactorial and sometimes unknown. The goal of this study is to analyze an international database of one-platform shoulder prosthesis and conduct a logistic multivariate regression analysis to identify the factors associated with instability after primary rTSA and quantify the 2-year minimum clinical outcomes of patients with and without instability.MethodsA total of 5631 primary rTSA patients were analyzed from the international database of single rTSA prosthesis to quantify clinical outcomes at 2-year minimum follow-up for patients with and without instability. rTSA patients were divided into 2 cohorts based on if they were stable or unstable, and a subanalysis was conducted for patients who were unstable early (<6 months) and also unstable late (>6 months). For both stable and unstable rTSA patients, univariate and multivariate analyses were performed to quantify the patient, implant, and operative risk factors associated with instability after rTSA.ResultsFifty-five of the 5631 primary rTSA shoulders were reported to be unstable, with an overall instability rate of 0.98%. Female patients had an instability rate of 0.60% (21/3496), which was significantly lower (P < .0001) than the 1.63% instability rate for male patients (34/2085). Patients with subscapularis repair had an instability rate of 0.45% (10/2222), which was significantly lower (P = .0052) than the 1.17% instability rate of patients without a subscapularis repair (37/3161). Multivariate analysis identified numerous risk factors for instability, including younger age at the time of surgery, the use of cemented humeral fixation, larger glenosphere diameters, expanded/lateralized center of rotation glenospheres, and not repairing the subscapularis.DiscussionOur study demonstrated that patients with instability had significantly worse clinical outcomes, more pain, and worse function and range of motion as compared to rTSA patients who were stable. The univariate and multivariate analyses identified numerous patient, implant, and operative risk factors associated with instability. A patient with 1 or more of these identified parameters has an increased risk for instability, and that recognition is useful for patient counseling and consideration of repair of the subscapularis, when possible.     

Treatment of hepatitis C virus infection

Acute and chronic hepatitis C virus （HCV） infection remains a serious health problem worldwide, however, there has been advancement in the treatment of HCV infection due to standard treatment using pegylated interferon and ribavirin. The literature indicates that therapy for HCV is becoming more individualized. In addition to considering genotype and viral RNA levels before treatment, achievement of an early virologic response （EVR） and a rapid virologic response （RVR） is now possible during therapy. Moreover, problem patients, such as non-responders, relapsers, HIV or HBV coinfected patients, patients with liver cirrhosis, and preor post-liver transplantation patients are an increasing fraction of the patients requiring treatment. This article reviews the literature regarding standard treatments and problem patients with acute and chronic HCV infection. It also includes discussion on contraindications and side effects of treatment with interferon and ribavirin, as well as new drug development.     

Reliability of malaria microscopy in epidemiological studies: results of quality control

To assess the interrater reproducibility of malaria microscopy in epidemiological studies, 711 thick blood films from population-based surveys were randomly selected and reread by 4 experienced microscopists. Sample estimates of the prevalence of P. falciparum infection, geometric mean parasite density and the proportion of samples above various parasite density cut-off levels were almost identical in the routine and quality control readings. Differences were, however, encountered in the sample estimates for gametocyte ratio, proportion of mixed infection and average density index. In all three cases the quality control result was significantly higher than the routine evaluation. On the level of the individual slide there was good interrater agreement for the presence of P. falciparum infections (Kappa index kappa = 0.79) which was even better when parasite densities between 4 and 100/microl were excluded (kappa = 0.94). With respect to the assessment of parasite density, a high level of disagreement was found. While the mean difference between the two readings was not different from 0, the second reading was between 0.12 and 10 times that of the first. However, the level of disagreement significantly fell with increasing parasite densities. Thus malaria microscopy is very reliable for the estimation of parasite ratios and geometric mean parasite densities within and between studies as long as the same methodology is used, but tends to underestimate the gametocyte ratio and proportion of mixed infections. Care must be taken, however, when individual parasite density is related to other explanatory variables, due to the high degree of variability in the parasite enumeration.