Tanning and Cutaneous Malignancy

BACKGROUND Exposure to ultraviolet radiation (UVR) results in a darkening of the skin known as tanning. Recently, it has been shown that tanning is a response to UVR-induced DNA damage and represents the skin's efforts to protect itself against further injury. Despite the link between UVR and cutaneous malignancy, people continue to pursue tanning from natural and artificial sources. This trend is reflected in the exponential rise in skin cancer incidence.
OBJECTIVE The objective of this study was to review our current understanding of the factors controlling the tanning response and the relationship to cutaneous carcinogenesis, as well as the impact that the multibillion dollar tanning industry has had on the practice of dermatology.
MATERIALS AND METHODS Extensive literature review was conducted in subjects related to tanning and the relationship to cutaneous malignancy.
RESULTS Our knowledge of tanning and its effects on the skin has increased tremendously. It is clear that tanning contributes to the development of skin cancer. Despite this information, the incidence of skin cancer continues to increase exponentially.
CONCLUSIONS Skin cancer poses a major public health concern and tanning remains the most modifiable risk factor in its etiology. Social, economic, and legislative issues have become tightly intertwined with the complex nature of human behavior in the continued pursuit of an activity that clearly has detrimental effects on one's health.     

Health-related quality of life and productivity impact in haemophilia patients with inhibitors

Summary.  To measure health-related quality of life (HRQL), its determinants, and its association with patient and caregiver productivity among a sample of haemophilia patients with inhibitors in the United States (US). Data on demographical and clinical characteristics, treatment patterns, HRQL (SF-12v2), and productivity outcomes were reported for 53 patients. Mean SF-12v2 domain and mental (MCS) and physical (PCS) component summary scores were assessed and compared with US norms. Regression analyses explored the association of patient and treatment factors with HRQL and productivity. Patients' mean age was 20.7 years (SD = 18.8), 88.5% were type A, and 39.6% received on-demand therapy as their only mode of treatment. Mean PCS was significantly lower than the US norm (PCS, 39.9, P  < 0.01) and mean MCS showed no significant difference (MCS, 49.9, P  = ns). On-demand treatment ( B  = −0.336, P <  0.05) and number of haemorrhages ( B  = −0.366, P <  0.05) were negatively associated with PCS; and PCS was associated with patients' missed work or school days [incidence rate ratio (IRR) = 0.93, P <  0.001] and perceived impact on daily activities (OR = 0.72, P <  0.05). Younger age (IRR = 0.91, P <  0.01), lower PCS (IRR = 0.94, P <  0.01), more haemorrhages (IRR = 1.05, P < 0.05), and surgery (IRR = 2.74, P  < 0.05) were associated with fewer patients' productive days. Physical functioning among inhibitor patients in the US is compromised and is negatively associated with their daily activities and productivity. These data suggest a positive association of prophylactic and immunotolerance therapy with HRQL, specifically physical impairment.     

Fetal corticotrophin-releasing hormone mRNA, but not phosphatidylserine-exposing microparticles, in maternal plasma are associated with factor VII activity in pre-eclampsia

Summary.  Background:  Pre-eclampsia is associated with increased placental debris circulating in maternal plasma. Objectives:  This study related placental debris to maternal markers of coagulation and endothelial activation in pre-eclampsia. Patients/methods:  Circulating fetal corticotrophin-releasing hormone (CRH) mRNA and phosphatidylserine (PS)-exposing microparticles were assayed in third trimester plasma from women with pre-eclampsia ( n  = 32) and controls ( n  = 32) matched for age, body mass index, parity, and gestational age at sampling. Markers of maternal hemostasis and endothelial function were assessed. Results:  Fetal CRH mRNA levels were higher in pre-eclampsia [mean 0.75 (SD 2.77) CRH/glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA ratio] than in control pregnancies [0.20 (0.74), P  = 0.014]. PS-exposing microparticle levels were not different between the groups. Women with pre-eclampsia had higher levels of tissue factor pathway inhibitor (TFPI), prothrombin F ₁₊₂ fragment ( F ₁₊₂), factor XIIa, soluble vascular cell adhesion molecule 1, von Willebrand factor and plasminogen activator inhibitor 1 than controls. Fetal CRH mRNA correlated with TFPI in pre-eclampsia and control groups ( r  = 0.38, P  = 0.031, and r  = 0.37, P  = 0.039, respectively). Fetal CRH mRNA correlated with FVII activity ( r  = 0.43, P  = 0.017) and PS-exposing microparticles correlated inversely with F ₁₊₂ ( r  = −0.64, P  < 0.001) in pre-eclampsia. Conclusions:  Placental debris, assessed by fetal CRH mRNA levels in maternal blood, is related to coagulation potential, i.e. FVII activity, but not to markers of coagulation or endothelial activation in pre-eclampsia.     

RENIN, ANGIOTENSIN, CORTICOSTEROIDS, AND ELECTROLYTE BALANCE IN ADDISON'S DISEASE

Two patients with previously untreated Addison's disease werestudied. Both showed defective adrenal responsiveness to infusionsof corticotrophin and angiotensin, and both had abnormally lowplasma sodium and high plasma renin concentrations. Plasma potassiumwas elevated in one and normal in the other. Steroid replacement therapy was accompanied by an increase inNa_E, correction of plasma electrolyte concentrations, and areduction of plasma renin concentration to normal. K_E was virtuallyunchanged in the first weeks of treatment in either patient. In Case 1 treatment caused a movement of water and sodium fromICF to ECF, and probably of potassium from ECF to ICF. ECF volumeincreased more than TBW. Angiotensin infusion caused abdominal pain in this man, suggestingthat the elevated plasma renin may contribute to the characteristicabdominal pain of Addison's disease. In Case 2 treatment restored the normal nyothemeral rhythm ofurine flow, and caused a slight initial loss of TBW and weight.     

Helicobacter pylori eradication: efficacy and side effect profile of a combination of omeprazole, amoxycillin and metronidazole compared with four alternative regimens

We evaluated eradication of Helicobacter pylori infection in263 patients by a new 14-day regimen of omeprazole 40 mg mane(a gastric secretory inhibitor) plus two antibiotics: amoxycillin500 mg three-times daily (tds) plus metronidazole 400 mg tds.The comparative groups included updated results of our previouswork with a 14-day course of either standard triple therapy(STT, colloidal bismuth subcitrate 120 mg four times daily (qds)plus tetracycline 500 mg qds and metronidazole 400 mg tds),omeprazole 40 mg once daily plus amoxycillin 500 mg tds (OA),or two modified triple therapy: either Borody's (BTT) of allthree components (colloidal bismuth subcitrate 120 mg, tetracycline500 mg, metronidazole 200 mg) qds instead of tds, or Logan's(ITT) seven-day therapeutic regimen of colloidal bismuth subcitrate120 mg qds, amoxycillin 500 mg qds and, for the last three days,metronidazole 400 mg five times daily. Omeprazole/amoxycillin/metronidazole (OAM) therapy was bettertolerated than STT (course completion 98.1% vs. 81.4%, p <0.001). H. pylori was eradicated by OAM therapy in 53/55 (96.4%)patients with metronidazole-sensitive organisms and in 54/72(75.0%) with metronidazole-resistant isolates (p < 0.01).The respective corresponding rates for STT and OA therapy were20/22 (90.9%) and 14/29 (48.3%), (metronidazole-sensitive organisms)and 7/21 (33.3%) and 15/31 (48.4%) (infections resistant tometronidazole). BTT and LTT were also better tolerated than STT. The eradicationrate for BTT was 23/26 (88.5%) but that for LTT, the best toleratedof the five treatment regimens, was only 19/28 (67.9%) whenpretreat-ment isolates were metronidazole-sensitive. OAM therapywas better tolerated than either STT or BTT. With metronidazole-sensitiveorganisms, all three regimens eradicated about 90% of the organisms,although in our hands LTT was significantly less effective (67.9%).In patients infected with metronidazole-resistant organisms,OAM therapy was significantly (p < 0.01) more effective thanSTT (95% Cl 19.2–64.2). These results support our current practice of prescribing OAMfor patients with duodenal ulcer infected with H. pylori, reservingBTT for patients allergic to penicillin.