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94 Skin symptoms among workers in the Norwegian salmon processing industry
ObjectiveSalmon processing workers have various occupational dermal exposures including wet work (frequent contact with water, hand wash and prolonged use of gloves), contact with fish products, disinfectants, and detergents. However, knowledge regarding whether work within this industry may cause skin symptoms is limited. In this study, we aimed to investigate the prevalence of skin symptoms among workers in the salmon processing industry.Material and MethodsA total of 738 workers (664 processing workers and 74 office workers) from nine Norwegian salmon processing plants were included in a cross-sectional study. All completed a questionnaire comprising questions regarding work tasks and skin symptoms on hands during the past 12 months. Chi-squared tests or Fisher’s exact tests were used to identify significant difference in skin symptoms between the groups.ResultsProcessing workers had a higher prevalence of skin symptoms compared to office workers. We found a significant difference in prevalence of skin symptoms between processing workers and office workers for ‘redness’ (15% vs. 5%, p=0.03), ‘dry skin with scaling/flaking’ (21% vs. 8%, p=0.01), ‘tiny water blisters (vesicles)’ (7% vs. 0%, p=0.01), ‘burning, pricking, or stinging’ (8% vs. 1%, p=0.03) and ‘aching or pain’ (12% vs. 0%, p<0.001).We observed a non-significant elevated prevalence of skin symptoms among processing workers compared to office workers for: ‘fissures or cracks’ (19% vs. 10%), ‘weeping or crusts’ (5% vs. 1%), ‘papules’ (4% vs. 0%), ‘rapidly appearing itchy wheals/welts (urticaria)’ (7% vs. 1%), ‘itching’ (16% vs. 10%), and ‘tenderness’ (8% vs. 4%).ConclusionsSalmon processing workers had higher prevalence of skin symptoms on hands compared to office workers in the same industry. The study contributes to increased knowledge on skin symptoms among workers in the salmon processing industry.FundingThis project received funding from The Research Council of Norway (project code 302902) with additional funding from Helse Nord health trust (grant HNF 1345-17) and grants from Helse Vest health trust, and Haukeland University Hospital.AcknowledgementsWe thank the participants for giving consent to participate in the study and the salmon processing plants for their facilitation and support.
Journal Article
Can somebody please scratch my back?
\"Elephant has a massive itch that no one can scratch, so Elephant is forced to help himself--or so he thinks\"-- Provided by publisher.
Book
A Routine over the Counter Phenylephrine Causing Rarer Drug Eruption as Adverse Drug Reaction-A Case Report
Introduction: Adverse drug responses are unpleasant side effects of commonly used or recently begun medications, and they are most often in the skin. Cutaneous drug responses (CDR) are widespread and often manifest as moderate, self-limiting lesions, however, certain severe versions can be fatal [1-2]. Multiple medications with similar chemical structures can create some types of lesions. Lips, legs, hands, cheeks, genitalia, and oral mucosa are common sites for lesions that generate a burning sensation. Bullae can form as a result of a fixed medication eruption (EDE). Intranasal injection of phenylephrine resulted in fast systemic absorption, which is linked with a clinically modest elevation in blood pressure [3]. Case Presentation: Here we discuss a case of a 19-year-old female patient who reported to our hospital with blebs on the skin throughout her legs and torso. The drug eruption or adverse drug response was linked with itching, had a slow beginning, and progressed. Her medical history indicated that she had been taking phenylephrine 10 mg orally twice a day. On the sixth day, she experienced an adverse medication response caused by the medicine phenylephrine. Phenylephrine was stopped immediately and the other medications, such as levocetirizine, montelukast, and nasal spray, were continued. The patient was told not to use phenylephrine, either alone or in combination with FDCs. There are no other complaints. As a result, the patient was diagnosed with phenylephrine-induced eruption. Conclusion: We present this case to highlight the importance of inspiring a pharmacovigilance mindset among all clinicians providing care as an alert routine drug, phenylephrine-induced drug eruption.
Journal Article
Itch! : everything you didn't want to know about what makes you scratch
\"Everybody gets itchy, and every kid will love this title that scratches the itch to know more and about the history, anatomy, botany, biology behind it\"--Amazon.com.
Book
A central neural circuit for itch sensation
Although itch sensation is an important protective mechanism for animals, chronic itch remains a challenging clinical problem. Itch processing has been studied extensively at the spinal level. However, how itch information is transmitted to the brain and what central circuits underlie the itch-induced scratching behavior remain largely unknown. We found that the spinoparabrachial pathway was activated during itch processing and that optogenetic suppression of this pathway impaired itch-induced scratching behaviors. Itch-mediating spinal neurons, which express the gastrin-releasing peptide receptor, are disynaptically connected to the parabrachial nucleus via glutamatergic spinal projection neurons. Blockade of synaptic output of glutamatergic neurons in the parabrachial nucleus suppressed pruritogen-induced scratching behavior. Thus, our studies reveal a central neural circuit that is critical for itch signal processing.
Journal Article
Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis (faSScinate): a phase 2, randomised, controlled trial
Systemic sclerosis is a rare disabling autoimmune disease with few treatment options. The efficacy and safety of tocilizumab, an interleukin 6 receptor-α inhibitor, was assessed in the faSScinate phase 2 trial in patients with systemic sclerosis.
We did this double-blind, placebo-controlled study at 35 hospitals in Canada, France, Germany, the UK, and the USA. We enrolled adults with progressive systemic sclerosis of 5 or fewer years' duration from first non-Raynaud's sign or symptom. Patients were randomly assigned (1:1) to weekly subcutaneous tocilizumab 162 mg or placebo. The primary endpoint was the difference in mean change from baseline in modified Rodnan skin score at 24 weeks. This study is registered with ClinicalTrials.gov, number NCT01532869.
We enrolled 87 patients: 43 assigned to tocilizumab and 44 assigned to placebo. The least squares mean change in modified Rodnan skin score at 24 weeks was −3·92 in the tocilizumab group and −1·22 in the placebo group (difference −2·70, 95% CI −5·85 to 0·45; p=0·0915). The least squares mean change at 48 weeks was −6·33 in the tocilizumab group and −2·77 in the placebo group (treatment difference −3·55, 95% CI −7·23 to 0·12; p=0·0579). In one of several exploratory analyses, fewer patients in the tocilizumab group than in the placebo group had a decline in percent predicted forced vital capacity at 48 weeks (p=0·0373). However, we detected no significant difference in disability, fatigue, itching, or patient or clinician global disease severity. 42 (98%) of 43 patients in the tocilizumab group versus 40 (91%) of 44 in the placebo group had adverse events. 14 (33%) versus 15 (34%) had serious adverse events. Serious infections were more common in the tocilizumab group (seven [16%] of 43 patients) than in the placebo group (two [5%] of 44). One patient died in relation to tocilizumab treatment.
Tocilizumab was not associated with a significant reduction in skin thickening. However, the difference was greater in the tocilizumab group than in the placebo group and we found some evidence of less decline in forced vital capacity. The efficacy and safety of tocilizumab should be investigated in a phase 3 trial before definitive conclusions can be made about its risks and benefits.
F Hoffmann-La Roche, Genentech.
Journal Article
Histopathological study of epidermal& dermal changes in lesional&perilesional biopsies of psoriasis cases at a tertiary center- An Original Research
Background: Psoriasisis a chronic disease of the skin of unknown etiology that is characterised bychronic relapsing nature and variable clinical features. Since histopathological study gives the exact diagnosis of psoriasis & can differentiate it from other histological mimics, present study was aimed to study histopathological features of epidermal and dermal changes in lesionaland perilesional biopsies of psoriasis cases at a tertiary center.Materials and Methods:Present study was single-center, prospective, observational study, conducted in patients with clinical features of psoriasis, not received treatment for the past, skin biopsies were taken from both lesional& perilesional areas of psoriatic patients, H & E staining was done. Results:Among 52 cases, majority of patients were from the age group 31-40 years (40.3 %), and maleto female patient ratio was 2.7:1.Clinically, common features were macules/papules/plaques (100 %), moderate-severe itching (80.7%), nail involvement (61.5 %), nail pitting (40.3%), subungual hyperkeratosis (17.3%), nail discolouration (3.84%), Koebner phenomenon (23%), Auspitz sign (75%). Among 8 cases of early lesions, common features observed were parakeratosis (100%) mild to moderate acanthosis (100%), dilated capillaries and perivascular cellular infiltrate (100%), thinning of supra papillary plate (50%), Munro micro abscess (50%), spongiosis (37.5%).
Journal Article
Efficacy and Safety of Tofacitinib in Patients With Refractory Prurigo Nodularis: A 16‐Week, Single‐Center, Prospective, Observational Pilot Study
Background: The current management for prurigo nodularis (PN) is challenging. Tofacitinib may emerge as a promising treatment for PN. Aim: This study aimed to assess the efficacy and safety of tofacitinib in treating refractory PN. Design and methods: A 16‐week prospective observational pilot study was conducted in patients with moderate‐to‐severe refractory PN. The enrolled patients received oral tofacitinib. The primary endpoints included improvement in pruritus and quality of life, as measured by investigator’s global assessment (IGA), prurigo activity score (PAS), visual analog scale (VAS), numeric rating scale (NRS), verbal rating scale (VRS), Dermatology Life Quality Index (DLQI), and Itchy Specific Quality of Life (Itchy QoL) at week 12. Secondary endpoints were the proportion of patients with a ≥ 4‐point reduction in Worst Itch‐Numeric Rating Scale (WI‐NRS) from baseline at week 12 and week 16. Safety assessments were conducted through week 16. Besides, historical controls, mixed‐effects model (MMRM), and post‐hoc analyses were performed to evaluate the efficacy of tofacitinib. Results: Twenty‐four PN patients included demonstrated clinical improvement in terms of skin lesions, pruritus, and quality of life. IGA, PAS items, VAS, NRS, VRS, DLQI, and Itchy QoL significantly improved from the baseline to 12 weeks of tofacitinib treatment ( p < 0.05 for all). However, the response to tofacitinib became less pronounced at week 16, with reduced improvement in skin lesions, itch, and quality of life compared to that at week 12. The percentage of patients experiencing a ≥ 4‐point WI‐NRS reduction decreased from 75% at week 12% to 66.67% at week 16. The results of historical controls, MMRM model, and post hoc analyses supported the clinical efficacy of tofacitinib in PN, with baseline NRS 24h,worst appearing to be a potentially clinical feature impacting treatment efficacy. No severe adverse events were reported up until the end of the study period. Conclusions: Tofacitinib demonstrates effectiveness in reducing itch and skin infiltration in patients with moderate‐to‐severe PN, whereas its long‐term efficacy requires further observation. Trial Registration: ClinicalTrials.gov identifier: NCT06201715
Journal Article