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Biomedical subjects

M Rademaker

Publications and source records attributed to M Rademaker.

At least 19 recordsLinked to original sources
PubMed2003

Beneficial effects of fumarate therapy in psoriasis vulgaris patients coincide with downregulation of type 1 cytokines.

BACKGROUND: Fumarates have been shown to be effective in psoriasis vulgaris. OBJECTIVES: To find out whether successful therapy is associated with modulation of cytokines. METHODS: We determined interferon (IFN)-gamma, interleukin (IL)-4 and IL-10 secretion capacities of peripheral blood mononuclear cells (PBMC) after phytohaemagglutinin stimulation, and IL-12p70 and IL-10 secretion capacities of PBMC after endotoxin stimulation in psoriasis vulgaris patients during treatment with fumarates. In a cohort study, 12 patients (five men, median age 50 years; seven women, median age 46 years) with psoriasis vulgaris were followed during 24 months of fumarate treatment. In addition, we followed 14 healthy controls (six men, median age 31 years; eight women, median age 29 years) without skin diseases during 12 months to investigate possible changes in the cytokine secretion capacity of PBMC as a result of seasonal changes. Disease activity in patients was determined by Psoriasis Area and Severity Index (PASI) score. Blood was collected for measurement by enzyme-linked immunosorbent assay of cytokine levels after stimulation of PBMC. RESULTS: Within 6 months of fumarate treatment, the mean +/- SD PASI score had decreased to 22 +/- 9% of its initial value. These beneficial effects coincided with lymphocytopenia and a significant (P < 0.05) downregulation of IFN-gamma expression by circulating blood cells, followed by a significant downregulation of IL-4 expression. Notably, production of the cytokine synthesis inhibitor IL-10 by PBMC was unchanged. CONCLUSIONS: The beneficial effects of fumarates may be attributed to their downregulatory action on type 1 cytokines.

Cohort Studies↗
PubMed2001

Inhibition of hBD-3, but not hBD-1 and hBD-2, mRNA expression by corticosteroids.

Intensive use of corticosteroids may be accompanied by increased susceptibility to infections; hence, we investigated the effects of dexamethasone on the expression of antimicrobial peptides, termed human beta-defensins (hBD), by cultured bronchial epithelial cells and mononuclear phagocytes. The results revealed that dexamethasone inhibited the (stimulated) expression of mRNA for hBD-3, but not hBD-1 and hBD-2 by these epithelial cells. Dexamethasone did not affect the (stimulated) mRNA expression of hBD-1 and hBD-2 by mononuclear phagocytes, whereas these cells did not express hBD-3 mRNA.

Adrenal Cortex Hormones↗
PubMed2001

Tinea due to Trichophyton violaceum and Trichophyton soudanense in Hamilton, New Zealand.

Between 1994 and 2000, 63 isolates of Trichophyton violaceum and five isolates of Trichophyton soudanense were recorded in both private and public laboratories in Hamilton, New Zealand. A retrospective analysis of medical records of these patients was performed. From these 68 isolates, 58 were recovered from scalp specimens and 10 were recovered from other body sites. There were 51 patients with tinea capitis and nine patients in the tinea corporis group. Six patients had more than one isolate reported at different laboratories. As expected, the vast majority of scalp infections (46/51 patients) were children, with an overall median age of 6 years (range 8 months to 66 years). All patients in the tinea capitis group, except one, were refugee immigrants from East Africa. Of nine patients in the tinea corporis group, six were refugees from the same area. For tinea capitis, 31 patients received systemic antifungal therapy for at least 4 weeks, with either terbinafine (21 patients), griseofulvin (four patients) or itraconazole (six patients). Five patients received topical antifungal creams or shampoo as monotherapy only. The remainder (15 patients) received either no therapy or no record was available. The emergence of these two pathogens as causes of tinea capitis in Hamilton closely correlates with the increasing number of refugees from endemic areas. There is a high rate of person-to-person transmission with these anthropophilic organisms in children as well as adults in the family. Transmission of infection to the local population has been observed, but there is no evidence to date to suggest that these organisms have become endemic in the local population.

Adolescent↗
PubMed2001

A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand.

A randomized controlled trial was carried out to measure the societal costs of realtime teledermatology compared with those of conventional hospital care in New Zealand. Two rural health centres were linked to a specialist hospital via ISDN at 128 kbit/s. Over 10 months, 203 patients were referred for a specialist dermatological consultation and 26 were followed up, giving a total of 229 consultations. Fifty-four per cent were randomized to the teledermatology consultation and 46% to the conventional hospital consultation. A cost-minimization analysis was used to calculate the total costs of both types of dermatological consultation. The total cost of the 123 teledermatology consultations was NZ$34,346 and the total cost of the 106 conventional hospital consultations was NZ$30,081. The average societal cost of the teledermatology consultation was therefore NZ$279.23 compared with NZ$283.79 for the conventional hospital consultation. The marginal cost of seeing an additional patient was NZ$135 via teledermatology and NZ$284 via conventional hospital appointment. From a societal viewpoint, and assuming an equal outcome, teledermatology was a more cost-efficient use of resources than conventional hospital care.

Cost Savings↗
PubMed2001

Teledermatology in the Waikato region of New Zealand.

Teledermatology consultations over a video-link began at Health Waikato in 1995. Clinical trials involving about 500 patients have demonstrated the diagnostic accuracy and economic gains of these teleconsultations, and patient satisfaction with them. Yet, six years on, out-of-date equipment remains under-used. There has been no expansion of the network and no additional clinical teleconsultation services. Possible reasons include the excessive capital cost of videoconferencing equipment, clinician overwork, inconvenience, lack of reimbursement, administrative and governmental inertia, and little demand from patients and their doctors. To widen our referral base without the inconvenience of videoconferencing, we decided to offer a secure browser-based dermatology tele-advice service to referring general practitioners who owned digital cameras. With the increase in online health information and electronic communication, we assumed it would be popular. But, despite up to six-month waits for patients to be seen in the dermatology outpatient clinic, few patients have been referred to the service. Explanations have included time constraints, unavailability of a camera, no Internet access at the time of consultation and lack of reimbursement. Can we look forward to a future in which all doctors have high-speed access to the Internet at their desktop through their practice management systems? Who will pay? Will they continue to prefer conventional referral?

Dermatology↗
PubMed2001

Intravenous immunoglobulin therapy for the treatment of severe atopic dermatitis.

Intravenous immunoglobulin (IVIg) is standard therapy for primary immunodeficiencies, Kawasaki Disease and idiopathic thrombocytopenic purpura. More recently, the use of high dose IVIg (2 g/kg in divided doses) has widened to include a number of inflammatory diseases, including atopic eczema. The mechanism of IVIg's anti-inflammatory action has yet to be fully understood. Proposed mechanisms include modulation of IgE responses and a reduction in inflammatory cytokines with a reduction in T-cell proliferation. Antibacterial and antitoxin effects may also play a role.

Antibody Formation↗
PubMed2001

Do women have more adverse drug reactions?

Up to 5% of all hospital admissions are the result of adverse drug reactions (ADRs). Identifying those factors which may predispose to ADRs is essential for risk management. Amongst the known risk factors for adverse reactions are increasing age, polypharmacy, liver and renal disease as well as being female. Female patients have a 1.5- to 1.7-fold greater risk of developing an ADR, including adverse skin reactions, compared with male patients. The reasons for this increased risk are not entirely clear but include gender-related differences in pharmacokinetic, immunological and hormonal factors as well as differences in the use of medications by women compared with men. Women generally have a lower lean body mass, a reduced hepatic clearance, have differences in activity of cytochrome P450 (CYP) enzymes (40% increase in CYP3A4, varied decrease in CYP2D6, CYP2C19 and CYP1A2), and metabolize drugs at different rates compared with men. Other important factors include conjugation, absorption, protein binding and renal elimination, which may all have some gender-based differences. However, how these differences result in an increased risk of ADRs is not clear. There are pharmacodynamic differences between men and women, seen particularly with cardiac and psychotropic medications. There is no doubt that chlorpromazine, fluspirilene and various antipsychotics appear more effective in women than men for the same dosage and plasma concentration. Similarly, women are at increased risk of QT prolongation with certain anti-arrhythmic drugs compared with men even at equivalent serum concentrations. The mechanisms are unknown. Increasingly the evidence is that idiosyncratic drug reactions, particularly cutaneous reactions, appear to have an immunological etiology. It is possible that gender difference in T cell activation and proliferation account for this as well as the increased prevalence of skin diseases such as systemic lupus erythematosus and photosensitivity. Whatever the mechanism(s), it is important to be aware that gender is a significant factor in ADRs.

Adult↗
PubMed2000

Allergy to lichen acids in a fragrance.

A 48-year-old clerical officer with a recurrent facial eruption had positive patch test reactions to nickel, fragrance mix and lichen acid mix. On testing to individual ingredients of fragrance mix and lichen acid mix, she had 2+ reactions to oak moss, which is thought to be the main allergen in fragrance mix, and to usnic acid, which is one of a number of lichen acids comprising oak moss. Avoidance of fragrance use resulted in clearing of the eruption but, subsequently, an acute vesicular flare on her face and hands occurred after exposure to lichen on garden shrubs.

Allergens↗
PubMed2000

Occupational epoxy resin allergic contact dermatitis.

Sixteen cases of occupational contact dermatitis to epoxy resins were seen over a 5-year period. All were men. Six cases worked in the construction industry, two worked as painters, two as engineers, two as car windscreen repairers, and one each worked in a timber yard, a car yard, on a farm and as a cane-furniture salesman. Most presented with rashes on their faces (56%), hands (50%) or arms (37%). Two patients were allergic to the reactive diluent phenyl glycidyl ether, and one was allergic to the epoxy hardener isophorone diamine. The rest were allergic to the epoxy resin itself. Outcome in this series was poor because most continued to be exposed to epoxy resins in their workplace environment.

Adolescent↗
PubMed2000

Contact dermatitis to Asparagus officinalis.

A 53-year-old farm worker presented with a 3-year history of an occupational allergic contact dermatitis to asparagus. The dermatitis cleared quickly with courses of systemic corticosteroids but relapsed within days of further exposure to asparagus. The genera Asparagus is made up of some 300 species. It belongs to the family Liliaceae which includes tulips, onions and garlic. Asparagus contains asparagin, coniferin and the glucoside vanillin. The allergen may be a plant growth inhibitor, 1,2,3-Trithiane-5-carboxylic acid, which is present in young shoots.

Agricultural Workers' Diseases↗
PubMed2000

Patient cost-benefits of realtime teledermatology--a comparison of data from Northern Ireland and New Zealand.

As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology (24%) as after a hospital appointment (26%) and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.

Computer Systems↗
PubMed1999

Multicentric reticulohistiocytosis in a child.

A case of multicentric reticulohistiocytosis in an 8-year-old girl, which is a diagnosis rarely seen in children, is presented. Multicentric reticulohistiocytosis is a disorder of unknown aetiology, predominantly affecting the joints, skin and mucosa. Joint symptoms, but not cutaneous lesions, have improved with treatment with methotrexate.

Arthritis, Juvenile↗
PubMed1998

Griseofulvin and terbinafine in the treatment of tinea capitis in children.

AIM: To compare the effectiveness of griseofulvin and terbinafine in the treatment of tinea capitis in children. METHOD: Twenty four consecutive patients with culture proven tinea capitis were treated randomly with griseofulvin (10 mg/kg/day for 8 weeks) or terbinafine (62.5-250 mg/day for 4 weeks). Outcome was determined by absence of clinical signs, hair regrowth or negative mycology. RESULTS: Twenty four patients (16 male, 8 female) were treated. Age ranged between 2 and 15 years (mean 4.8). Seven patients presented with kerion, the remainder with a scaling and patchy alopecia pattern of tinea capitis. The responsible organisms were Microsporum canis (17 cases) and Trichophyton verrucosum (7 cases). Fourteen children were treated with griseofulvin and 10 with terbinafine. By three months follow up, 19 patients had cleared completely with good new hair regrowth. Three children had no active disease but only minimal new hair growth. One child (griseofulvin group) had no hair regrowth but was culture negative. She had sustained significant dermal and subcutaneous skin damage requiring plastic surgery. The other (terbinafine group) had ongoing active kerion. CONCLUSION: Both griseofulvin and terbinafine are equally effective in the treatment of tinea capitis.

Adolescent↗
PubMed1998

Pellagra in a woman using alternative remedies.

A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.

Adult↗
PubMed1998

A continuum of neutrophilic disease occurring in a patient with ulcerative colitis.

A case of Sweet's syndrome (acute febrile neutrophilic dermatosis) occurring concurrently with bullous pyoderma gangrenosum is reported to emphasize the close relationship between these two disorders. Atypical pyoderma gangrenosum and Sweet's syndrome have been described as occurring simultaneously in haematological dyscrasias but not, to our knowledge, in ulcerative colitis. It has been proposed that pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum and subcorneal pustular dermatosis may represent manifestations along a continuum of neutrophilic dermatoses.

Biopsy, Needle↗
PubMed1998

Occupational contact dermatitis among New Zealand farmers.

Forty-six farmers were patch tested to determine whether their dermatitis was secondary to an occupational allergen. Twenty-eight had a positive patch test of which 23 were thought relevant (definite or probable). In 20 of these cases, the allergen(s) was considered to be work related (define or probable). The common allergens were pesticides (N-(1,1,2,2-tetrachloroethylthio) -4-cyclohexene-1,2-dicarboximide (captafol), ethylenebis (dithiocarbamato) manganese (maneb) and copper sulfate), rubber compounds (N-isopropyl-N-phenyl-4-phenylenediamine (IPPD) and 4-phenylene diamine base) and sunscreen chemicals.

Adolescent↗
PubMed1997

Nosocomial Trichophyton tonsurans in a long stay ward.

AIMS: To document a nosocomial outbreak of Trichophyton tonsurans infection in a long stay ward. METHOD: Retrospective review of mycology cultures taken from patients and staff during 1993-5 and clinical examination of both patients and staff. RESULTS: Thirty-three mycology samples from 13 patients and staff, cultured T tonsurans during the period 1993-5. Twenty-two patients and staff were examined; 4 had mycology confirmed T tonsurans (2 scalp, 2 fingernail). Treatment with terbinafine 250 mg/day for 2 months resulted in clinical clearance (only 1 positive culture in 16 months follow-up). SUMMARY: T tonsurans is emerging as an important pathogen which may cause nosocomial infections.

Adult↗