Intermittent ketoconazole therapy of chronic mucocutaneous candidiasis in childhood.

We report the clinical and laboratory findings in two children with chronic mucocutaneous candidiasis (CMC) treated successfully with intermittent long-term ketoconazole therapy. Both had chronic infection of the nails, skin and mucous membranes with positive cultures for candida. Both were resistant to multiple local and systemic antifungal agents. After institution of ketoconazole therapy there was a dramatic improvement with clearing of the oral (one week), skin (two months) and nail lesions (5 months). After 8 months the drug was stopped and clinical remission persisted for 10 and 7 months respectively. Relapse of oral candidiasis was treated with a short course of ketoconazole (4-16 weeks) leading to complete healing of the lesions. Clinical improvement was not related to an amelioration in lymphocyte transformation. There was no change in the progressive deterioration of the lymphocyte responses to candida antigen which was probably due to persisting candida cell wall components (e.g. mannan).

Review: Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates.

A. Costanza, K. Weber, S. Gandy, C. Bouras, P. R. Hof, P. Giannakopoulos and A. Canuto (2011) Neuropathology and Applied Neurobiology37, 570-584 Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates Professional boxers and other contact sport athletes are exposed to repetitive brain trauma that may affect motor functions, cognitive performance, emotional regulation and social awareness. The term of chronic traumatic encephalopathy (CTE) was recently introduced to regroup a wide spectrum of symptoms such as cerebellar, pyramidal and extrapyramidal syndromes, impairments in orientation, memory, language, attention, information processing and frontal executive functions, as well as personality changes and behavioural and psychiatric symptoms. Magnetic resonance imaging usually reveals hippocampal and vermis atrophy, a cavum septum pellucidum, signs of diffuse axonal injury, pituitary gland atrophy, dilated perivascular spaces and periventricular white matter disease. Given the partial overlapping of the clinical expression, epidemiology and pathogenesis of CTE and Alzheimer's disease (AD), as well as the close association between traumatic brain injuries (TBIs) and neurofibrillary tangle formation, a mixed pathology promoted by pathogenetic cascades resulting in either CTE or AD has been postulated. Molecular studies suggested that TBIs increase the neurotoxicity of the TAR DNA-binding protein 43 (TDP-43) that is a key pathological marker of ubiquitin-positive forms of frontotemporal dementia (FTLD-TDP) associated or not with motor neurone disease/amyotrophic lateral sclerosis (ALS). Similar patterns of immunoreactivity for TDP-43 in CTE, FTLD-TDP and ALS as well as epidemiological correlations support the presence of common pathogenetic mechanisms. The present review provides a critical update of the evolution of the concept of CTE with reference to its neuropathological definition together with an in-depth discussion of the differential diagnosis between this entity, AD and frontotemporal dementia.

Critical single proximal left arterial descending coronary artery stenosis to mimic chronic myocardial ischemia: a new model induced by minimal invasive technology.

BACKGROUND/AIMS: The present report examines a new pig model for progressive induction of high-grade stenosis, for the study of chronic myocardial ischemia and the dynamics of collateral vessel growth. METHODS: Thirty-nine Landrace pigs were instrumented with a novel experimental stent (GVD stent) in the left anterior descending coronary artery. Eight animals underwent transthoracic echocardiography at rest and under low-dose dobutamine. Seven animals were examined by nuclear PET and SPECT analysis. Epi-, mid- and endocardial fibrosis and the numbers of arterial vessels were examined by histology. RESULTS: Functional analysis showed a significant decrease in global left ventricular ejection fraction (24.5 +/- 1.6%) 3 weeks after implantation. There was a trend to increased left ventricular ejection fraction after low-dose dobutamine stress (36.0 +/- 6.6%) and a significant improvement of the impaired regional anterior wall motion. PET and SPECT imaging documented chronic hibernation. Myocardial fibrosis increased significantly in the ischemic area with a gradient from epi- to endocardial. The number of arterial vessels in the ischemic area increased and coronary angiography showed abundant collateral vessels of Rentrop class 1. CONCLUSION: The presented experimental model mimics the clinical situation of chronic myocardial ischemia secondary to 1-vessel coronary disease.

Chronic Disease Connections, January 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, February 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, March 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, April 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, May 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, June 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, July 2014

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

The vitamin D receptor gene bAt (CCA) haplotype impairs the response to pegylated-interferon/ribavirin-based therapy in chronic hepatitis C patients.

BACKGROUND: Chronic hepatitis C infection is a major cause of end-stage liver disease. Therapy outcome is influenced by 25-OH vitamin D deficiency. To further address this observation, our study investigates the impact of the vitamin D receptor (NR1I1) haplotype and combined effects of plasma vitamin D levels in a well-described cohort of hepatitis C patients. METHODS: A total of 155 chronic hepatitis C patients were recruited from the Swiss Hepatitis C Cohort Study for NR1I1 genotyping and plasma 25-OH vitamin D level measurement. NR1I1 genotype data and combined effects of plasma 25-OH vitamin D level were analysed regarding therapy response (sustained virological response). RESULTS: A strong association was observed between therapy non-response and the NR1I1 CCA (bAt) haplotype consisting of rs1544410 (BsmI) C, rs7975232 (ApaI) C and rs731236 (TaqI) A alleles. Of the HCV patients carrying the CCA haplotype, 50.3% were non-responders (odds ratio [OR] 1.69, 95% CI 1.07, 2.67; P=0.028). A similar association was observed for the combinational CCCCAA genotype (OR 2.94, 95% CI 1.36, 6.37; P=0.007). The combinational CCCCAA genotype was confirmed as an independent risk factor for non-response in multivariate analysis (OR 2.50, 95% CI 1.07, 5.87; P=0.034). Analysing combined effects, a significant impact of low 25-OH vitamin D levels on sustained virological response were only seen in patients with the unfavourable NR1I1 CCA (bAt) haplotype (OR for non-SVR 3.55; 95% CI 1.005, 12.57; P=0.049). CONCLUSIONS: NR1I1 vitamin D receptor polymorphisms influence response to pegylated-interferon/ribavirin-based therapy in chronic hepatitis C and exert an additive genetic predisposition to previously described low 25-OH vitamin D serum levels.

Totally implantable robot to treat chronic atrial fibrillation

Chronic atrial fibrillation affects millions of people worldwide. Its surgical treatment often fails to restore the transport function of the atrium. This study first introduces the concept of an atrial assist device (AAD) to restore the pump function of the atrium. The AAD is developed to be totally implantable in the human body with a transcutaneous energy transfer system to recharge the implanted battery. The ADD consists of a motorless pump based on artificial muscle technology, positioned on the external surface of the atrium to compress it and restore its muscular activity. A bench model reproduces the function of a fibrillating atrium to assess the circulatory support that this pump can provide. Atripump (Nanopowers SA, Switzerland) is a dome-shaped silicone-coated nitinol actuator 5 mm high, sutured on the external surface of the atrium. A pacemaker-like control unit drives the actuator that compresses the atrium, providing the mechanical support to the blood circulation. Electrical characteristics: the system is composed of one actuator that needs a minimal tension of 15 V and has a maximum current of 1.5 A with a 50% duty cycle. The implantable rechargeable battery is made of a cell having the following specifications: nominal tension of a cell: 4.1 V, tension after 90% of discharge: 3.5 V, nominal capacity of a cell: 163 mA h. The bench model consists of an open circuit made of latex bladder 60 mm in diameter filled with water. The bladder is connected to a vertically positioned tube that is filled to different levels, reproducing changes in cardiac preload. The Atripump is placed on the outer surface of the bladder. Pressure, volume and temperature changes were recorded. The contraction rate was 1 Hz with a power supply of 12 V, 400 mA for 200 ms. Preload ranged from 15 to 21 cm H(2)O. Maximal silicone membrane temperature was 55 degrees C and maximal temperature of the liquid environment was 35 degrees C. The pump produced a maximal work of 16 x 10(-3) J. Maximal volume pumped was 492 ml min(-1). This artificial muscle pump is compact, follows the Starling law and reproduces the hemodynamic performances of a normal atrium. It could represent a new tool to restore the atrial kick in persistent atrial fibrillation.

Eczéma chronique des mains: traitements conventionnels et nouveautés [Chronic hand eczema, conventional and new treatments].

Chronic hand eczema is a frequent cause of consultation. In Europe and Switzerland, it's one of the main reasons for patients to interrupt their profession. The etiology is pluri-factorial. Atopic patients are more likely predisposed. Pruritus, associated to pain and bleeding, is intense. Psychosocial consequences are huge, making this illness to an important public health problem. Topical treatment and UV-light are the main therapeutical strategy but the results are often disappointing. Recently, alitretinoine (9-cis retinoic acid) became the treatment of second choice with good response, allowing patients to preserve a good quality of life and their job.

Chronic Diseases A Critical Issue for Iowa, June 1, 2005

The prevalence of chronic disease is shaping the health care future of Iowa and its citizens. This paper profiles chronic disease in Iowa, examines responsible yet limited initiatives to mitigate chronic disease progression and provides a series of recommended key actions to address this quiet yet dramatic public health issue.