Urticaria in association with etiocholanolone fever

A 17-year-old girl is reported with a history of recurrent febrile episodes during her menstrual bleeding accompanied by a generalised exanthem. Increased plasma levels of unbound etiocholanolone were noticed during the febrile attacks. Both the fever and the skin eruption could be suppressed by oral contraceptives.     

Female executives are particularly prone to the sleep-disturbing effect of isolated high-strain jobs: a cross-sectional study in German-speaking executives

This study assessed the main, curvilinear, interactive and gender-dependent effects of job demands, job control and social support in the prediction of sleep quality. Participants were 348 male and 76 female executives and managers from Germany, Austria and Switzerland. A multiple regression controlling for age, occupational hierarchy and various health behaviors was computed. On the level of the main effects of the Job–Demand–Control–Support (JDCS) model, the results indicate a sleep-promoting effect of social support. A significant three-way interaction of job demands, job control and social support was observed. This interaction confirms the buffering effect of high job control and high social support on high job demands. Further, this three-way interaction of the JDCS dimensions is moderated by gender as indicated by a significant four-way interaction. The directions of the significant interactions suggest that female executives are especially prone to react with impaired sleep quality when exposed to isolated high-strain jobs. The study seems to imply that the JDCS model is a suitable framework for the prediction of sleep quality among executives and managers. The results suggest that the JDCS model might contribute to a better understanding of the higher prevalence of poor sleep amongst female executives. Further, the results imply that high job control and high social support might help executives to maintain good sleep quality despite experiencing high job demands.     

A Prospective Randomized Cross-Over Comparison of Mono- and Biphasic Defibrillation Using Nonthoracotomy Lead Configurations in Humans

Biphasic Defibrillation with Nonthoracotomy Leads. Introduction: For current implantable defibrillators, the nonthoracotomy approach to implantation fails in a substantial number of patients. In a prospective randomized cross-over study the defibrillation efficacy of a standard monophasic and a new biphasic waveform was compared for different lead configurations.
Methods and Results: Intraoperatively, in 79 patients receiving nonthoracotomy defibrillation leads, the defibrillation threshold was determined in the initial lead configuration for the mono-and biphasic waveform. In each patient, both waveforms were used alternately with declining energies (20, 15,10, 5 J) until failure of defibrillation occurred. Three different initial lead configurations were tested in different, consecutive, nonrandomized patients using a bipolar endocardial defibrillation lead alone (A; n = 36) or in combination with a subcutaneous defibrillation patch (B; n = 24) or array (C; n = 19) lead. The lowest successful defibrillation energy with the biphasic waveform was less than, equal to, or higher than with the monophasic waveform in 64%, 28%, and 8% of patients, respectively, and on average significantly lower with the biphasic waveform for all three lead configurations (A: 11.3 ± 4.4 J vs 14.5 ± 4.5.); B: 9.7 ± 4.7 J vs 15.1 ± 4.5 J; C: 7.9 ± 4.5 J vs 12.4 ± 4.9 J). Defibrillation efficacy at 20 J was significantly improved by the biphasic waveform (91% vs 76%).
Conclusion: In combination with nonthoracotomy defibrillation leads, the biphasic waveform of a new implantable cardioverter defibrillator showed superior defibrillation efficacy in comparison to the standard monophasic waveform. Defibrillation thresholds were improved for lead systems with and without a subcutaneous patch or array lead.