bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cotrimoxazole prescribing by dispensing and non‐dispensing doctors: do they differ in rationality?
Authors: Trap Birna , Hansen Ebba H. 
Published: March 2003

Summarybackground  Dispensing doctors (DDs) have been found to prescribe significantly more drugs, more injections and more antibiotics per patient than non‐dispensing doctors (NDDs). However, the rationality of prescription in relation to diagnoses and symptoms has not been studied.objectives  To identify and assess differences in the rationality of cotrimoxazole prescription by DDs and NDDs evaluated by drug choice and dosage in relation to diagnoses and symptoms.methods  Cohort study of 28 private sector DDs and 25 NDDs in Zimbabwe, using retrospective data from 688 patient records. Drug choice and dose in relation to the recorded diagnoses and symptom(s) were assessed. A new method was developed and tested to measure rationality in a specific and realistic way. A ‘correctness‐score list’ was developed based on a panel of four evaluators assessing the rationality of cotrimoxazole prescription in relation to diagnoses and symptoms. This list was then used as a reference for the assessment.results  The two groups of prescribers did not differ significantly with respect to rationality of drug choice. Both DDs and NDDs prescribed cotrimoxazole to patients for diagnoses and symptoms for which cotrimoxazole could not be justified (41.4%vs. 43.5%). DDs compared with NDDs used subcurative doses more often (26.4% of the encounters compared with 11.7%; P = 0.035) and correct doses less frequent (58.0% compared with 72.6%; P = 0.047).conclusion  The prescription of cotrimoxazole by both DDs and NDDs was widely irrational. They prescribed cotrimoxazole too frequently, and DDs used subcurative doses to a wider extent. By this prescribing practice, both groups, but especially the DDs, contribute to increasing health hazards, cost and risk of developing bacterial resistance. The method for assessing rationality of drug prescribing was found feasible, and it is recommended that it be further tested and developed.
Comparison of three monoclonal and three polyclonal antibodies in the immunohistochemical diagnosis of canine autoimmune skin diseases
Authors: Pérez José , Arce Cristina , Moreno Angela , Mozos Elena , Rodríguez Francisco , Llanes Diego 
Published: March 2003

Abstract The aim of this study was to evaluate the utility of three monoclonal antibodies (mAbs), and two anticanine IgG and one anticanine IgM polyclonal antibodies (pAbs) for the immunohistochemical diagnosis of canine autoimmune skin diseases. Skin biopsies from 11 cases of pemphigus (7 foliaceus, 3 vulgaris and 1 erythematosus), 12 cases of discoid lupus erythematosus (DLE) and 12 cases of chronic hyperplasic dermatitis were used. The CA4E7 mAb (IgG1 + IgG2) showed similar sensitivity, but higher specificity and lower background than the two anti‐IgG pAbs for the immunohistochemical diagnosis of pemphigus and DLE. The CA4F1 mAb (IgG2) and CA3H1 mAb (IgG2) showed moderate and low interepithelial reactivity, respectively, in autoimmune skin diseases, but strong staining of the cytoplasm of plasma cells of the inflammatory infiltrates. These results suggest that the CA4E7 mAb may be valuable in the immunohistochemical diagnosis of such disorders.
Nevus depigmentosus and inflammatory linear epidermal nevus – an unusual combination with a note on histology
Authors: Ogunbiyi Adebola O. , Ogunbiyi J. Olufemi 
Published: March 2003

An 18‐year‐old woman was seen in the clinic with complaints of a bizarre hypopigmentation of her skin which her mother said had been present from birth and had been asymptomatic, constant, and permanent. She also complained of a rough eruption which had developed at one year of age and had progressed slightly in size over the years. It was first noticed in the left axilla, groin, parasternal area and posteriorly on the neck and was restricted to the left side of the body. It became inflamed and pruritic, was asymptomatic at times, but never cleared although the patient felt some of the lesion had sloughed off. There were no associated systemic symptoms, no history of seizures, and her psychomotor development was normal.On examination, the main findings were mucocutaneous; she had hypopigmented bands, whorls, and streaks following Blaschko’s lines, the lesions affected the front and the back of her trunk bilaterally, with the arms and thighs also involved. Her face was spared ( Fig. 1a,b). There was no evidence of atrophy or scarring in the hypopigmented lesions.Hypopigmented whorls, bands, and streaks on both front (a) and back (b) of patient. Note also the one‐sided distribution of the ILVEN (affecting the neck, left parasternal area, and dorsal surface of the hand)imageThe patient also had linear verrucous lesions in left armpit, left hand (dorsal surface), left groin, left parasternal region ( Fig. 2) and posteriorly on the neck (
Fig. 1b). The lesions in some areas were fragile and there was evidence of shedding in some places, leaving hypopigmented lesions; no vesicles were seen. Her hair, nails, and teeth were normal, as were the musculo‐skeletal, ocular, and central nervous system.Verrucous lesions of ILVEN affecting the left armpit and groinimageA diagnosis of nevus depigmentosus with inflammatory linear epidermal nevus to rule out incontinentia pigmenti was made. Skin biopsies were taken from the whorled, hypopigmented, and verrucous patches.The biopsy result of the hypopigmented patch showed an essentially normal looking epidermis and dermis; there was no melanin incontinence. The verrucous patch showed hyperkeratosis, psoriasiform hyperplasia of the epidermis with regular alternation of parakeratotic areas with hypergranulosis and orthokeratosis with a reduction in the granular layer.
Sweet's syndrome without granulocytosis
Authors: Probert, MD Christine , Ehmann, MD W. , Al‐Mondhiry, MD Hamid , Helm, MD J. 
Published: March 2003

Background Sweet's syndrome (SS), acute febrile neutrophilic dermatosis, has been linked to hematologic malignancies and presents with characteristic edematous dermal plaques. Peripheral blood neutrophilia is frequently seen in association with SS and is one of the diagnostic criteria. Objective To report the clinical, laboratory, and hematologic data of four patients with myeloid leukemia who developed SS after chemotherapy. Three of these patients were neutropenic. Methods A retrospective study of four patients with SS and hematologic malignancies was undertaken. Three patients had de novo acute myelogenous leukemia and one was in the acute blast crisis of chronic myelogenous leukemia. ResultsSweet's syndrome was not originally suspected in these patients because of the low peripheral white blood cell counts caused by chemotherapy. All of the patients presented with fevers, arthralgias, and an eruption. They had been treated with antibiotics because of a presumed infection. Once the correct diagnosis was made and oral prednisolone was started, a rapid response followed. ConclusionsSweet's syndrome should be considered in the differential diagnosis when acute myeloid leukemic patients develop skin lesions and unexplained fevers regardless of the peripheral blood counts.
Capillaropathy and capillaroneogenesis in the pathogenesis of rosacea
Authors: Neumann MD Emil , Frithz MD Anders 
Published: March 2003

BackgroundDilatation of vascular vessels in rosacea has generally been attributed to yielding to deranged connective tissue. In contrast, in a previous study a degrading effect of insufficient vascular vessels in connective tissue has been demonstrated in connection with diabetic microangiopathy. In yet another paper, it was demonstrated that the fusing of damaged capillaries, which had lost part of their adjacent walls due to functional inadequacy, led to the formation of dilated vessels. These pathogenetic patterns are the main subjects of this study of rosacea. Methods Punch biopsies from rosacea lesions were examined by light microscopy and immunochemistry in order to identify structural changes leading to the formation of telangiectasias. Results Deranged connective tissue is secondary to damaged capillaries. The primary damage may be evoked mostly by environmental influences, mainly the sun. Conclusions Infections, infestations, and granulomatous formations are not primary in the development of rosacea.
Drug eruptions in Bangkok: a 1‐year study at Ramathibodi Hospital
Authors: Puavilai Siripen , Choonhakarn Charoen 
Published: March 2003

Abstract Background As new drugs are introduced onto the market, it is important to determine those that can cause cutaneous reactions and with what frequency. In addition, drugs that have been used for a long period of time may cause new types of eruption that have not been observed previously. The purpose of this study was to evaluate the types of drug eruption and the causative agents in a hospital‐based population for a period of 1 year. Methods All in‐ and outpatients consulting for drug eruptions at the Dermatology Clinic, Ramathibodi Hospital from June 1995 to May 1996 were included in the study. The history and physical examination were performed by one of the authors. In suspected cases, a skin biopsy was carried out to confirm the diagnosis. Rechallenge tests with suspected drugs were performed with informed consent. Results One hundred and thirty‐two patients were enrolled in the study. The most common types of drug eruption were maculopapular eruption, fixed drug eruption, and urticaria. Antimicrobial agents were found to be the most common causative drugs, followed by antipyretic/anti‐inflammatory agents and drugs acting on the central nervous system. Conclusions Although the most common type of drug eruption and the most common causative agents were not different from those found in previous studies, the new generation of antibiotics and antifungal agents were found to be a frequent cause of drug eruptions. New types of drug eruption, such as generalized exanthematous pustulosis and acral erythema, were observed in this study.
Bubble hair – a possible explanation for its distribution
Authors: Krasnoff MD Jennifer , Glusac MD Earl , Bolognia MD Jean L. 
Published: March 2003

A 23‐year‐old white woman presented with a circumscribed area of shortened hairs along the anterior hairline. Approximately 1 month previously, the involved hairs had broken abruptly following shampooing. She used a hot air blow dryer for hair styling, but did not use electric rollers or a curling iron. Nor did she bleach, dye, or permanently wave her hair. The patient’s hair styling technique involved wrapping hairs of the frontal hairline over a round brush whilst blow drying. There was no personal or family history of alopecia or scalp infections.On physical examination, an oval‐shaped area of shortened hairs (5–6 cm in length) was noted along the anterior hairline (Fig. 1). The area of involvement measured 5×4 cm and was to the left of the midline. The texture of the affected hairs was coarser than that of the unaffected hairs, and these broken hairs were somewhat crinkled in appearance. There was no erythema, scale, or discrete areas of alopecia on the scalp. By light microscopy, the broken hairs demonstrated multiple bubbles within the hair shafts (Fig. 2). Some of the bubbles led to the distension of the hair shaft. There was no evidence of trichorrhexis nodosa.
The “gauntlet” of pellagra
Authors: Isaac Shaun 
Published: March 2003

A 48‐year‐old alcoholic Filipino man presented to the outpatient department with a 2‐year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health.Dermatologic examination revealed a browny‐red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry (Fig. 1). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion.“Gauntlet” of pellagra, showing browny‐red discoloration with sharply demarcated erythematous borderimageA clinical diagnosis of pellagra was made based on the morphology, and treatment with nicotinamide 500 mg daily was instituted. The eruption quickly improved and resolved in 2 weeks (Fig. 2).Two weeks after treatment, showing rapid clearance of the lesionsimage
Early repeeling – a matter of time
Authors: Wolf Ronni 
Published: March 2003

AbstractBackground Repeeling after a short interval in medium‐depth or deep peeling is considered by most experts as hazardous, and is generally contraindicated. Most experts recommend an interval of 6 months or more before repeating the same level of peel. The results are presented of four patients who underwent repeeling after a short interval.Methods and results All four patients were dissatisfied with their first peel (medium‐depth peel performed with trichoroacetic acid (TCA) 35%). Repeelings were performed using two methods: TCA 30–35% (Cases 1–3) and unoccluded Baker phenol peel (Case 4). On three occasions (Cases 1–3), the patients underwent three peelings at short intervals. All four cases gave excellent objective results.Conclusions The risk of a second peel shortly after the first is not as high as indicated in the literature, and should not be automatically ruled out. In a selected group of patients who, for various reasons, be persuaded to wait, repeeling after a short interval (2–3 weeks) may solve certain problems and may even make the difference between an unhappy patient and a satisfied one. In performing repeeling after a short interval, one should take into consideration that the skin, particularly the keratin layer, is thinner, so that the degree of penetration of the second peel solution and the peel depth will be greater. It is possible that the scarring reported after repeeling is a result of the disregard of this important factor and, consequently, the use of too high a concentration of peel solution in the second peel procedure.
Kasabach–Merritt syndrome in two successive pregnancies
Authors: Singh Girija , Rajendran Chakrapani 
Published: March 2003

A 20‐year‐old Indian Hindu woman, a primigravida at 8 months of pregnancy, presented with symptoms of progressively worsening dyspnea and anasarca of 1 month duration. Physical examination showed signs of severe congestive cardiac failure. She had multiple hemangiomas, 5 cm in size, located over the right temporal region, right side of the chin, right side of the nose, left upper part of the abdominal wall, and anterior aspect of the left leg ( Fig. 1). These hemangiomas had been present since birth and had enlarged considerably during pregnancy. The clinical diagnosis was pregnancy—34 weeks—with multiple hemangiomas and congestive cardiac failure.HemangiomasimageLaboratory investigations revealed hemoglobin (Hb) 11 g/dL, total leucocyte count 7000/mm3, differential count P 60 L 40, random blood sugar 110 mg/dL, blood urea (BU) 34 mg/dL, creatinine 0.9 mg/dL, and serum electrolytes: Na, 130 mEq/L; K, 4 mEq/L; Cl, 110 mEq/L. Electrocardiogram (ECG) was normal. Chest X‐ray showed cardiomegaly with congestion. Echocardiogram (ECHO) showed enlarged right atrium and right ventricle.The patient was refractory to antifailure therapy and went into labor at the end of 35 weeks of pregnancy and delivered a 1.3 kg male baby. The patient developed post partum hemorrhage and was treated with blood transfusion. During labor, the patient developed purpuric eruption and epistaxis. At that time, the bleeding time was more than15 min and the platelet count was 46,000. At this juncture, a diagnosis of Kasabach–Merritt syndrome was considered. Skin biopsy revealed hemangiomatous changes. After delivery, the patient’s edema and dyspnea decreased considerably and the eruption disappeared. The hemangiomas regressed in size. A platelet count performed 3 days after delivery was 120,000/mm3. The bleeding time was 7 min, and a chest X‐ray showed the reduction of heart size to normal. ECHO repeated 1 week after delivery showed normal‐sized chambers. Follow‐up as an outpatient showed the patient returning to normalcy. She had a similar presentation during her second pregnancy, 1 year later.
Captopril‐triggered linear IgA bullous dermatosis
Authors: Friedman Ilyse S. , Rudikoff Donald , Phelps Robert G. , Sapadin Allen N. 
Published: March 2003

A 57‐year‐old African–American woman with a history of long‐standing asthma, hypertension, and congestive heart failure was referred for an intensely pruritic, blistering eruption of 2 months duration. The blistering began 2 weeks after the initiation of captopril for essential hypertension. It was localized predominantly on the thighs and legs, but had recently spread to the upper extremities. Previously, the patient had been treated with albuterol and furosemide. She had been admitted to the hospital with a diagnosis of acute varicella, which was ruled out by a negative Tzanck preparation. Clarithromycin was prescribed upon discharge.Physical examination revealed multiple healed and crusted erosions ranging in size from 1 to 7 cm on the anteromedial aspect of the thighs and legs (Fig. 1). Discrete and confluent tense vesicles, some forming arciform or rosette‐like patterns, were noted (Fig. 2). Multiple hypopigmented macules and patches were seen. On the flexural aspect of the forearms, there were multiple small erosions, some of which appeared excoriated. There were no urticarial lesions, and the oral mucosa and scalp were spared.Multiple healed and crusted erosions on the anteromedial aspect of the left thigh. Hypopigmented macules and patches are also evidentimageConfluent tense vesicles in an arciform arrangementimageA biopsy specimen of lesional skin from the left thigh revealed epidermal detachment at the dermal–epidermal junction with prominent festooning of dermal papillae. A dense, perivascular lymphohistiocytic infiltrate was present in the underlying dermis (Fig. 3). Well‐defined neutrophilic papillary microabscesses were not identified, nor were eosinophils. Direct immunofluorescence (DIF) staining revealed linear deposition of immunoglobulin A (IgA) at the dermal–epidermal junction (Fig. 4). Indirect immunofluorescence studies of the serum were negative for circulating pemphigus and pemphigoid antibodies. On the basis of these findings, a diagnosis of linear IgA bullous dermatosis was made.(a) Subepidermal blister with prominent festooning of dermal papillae. (b) Dense, perivascular lymphohistiocytic infiltrate in underlying dermisimageDeposition of IgA in a linear pattern at the dermal–epidermal junctionimageDespite discontinuation of captopril, the patient continued to develop new blisters. Treatment with dapsone was initiated at a dose of 25 mg t.i.d. Because of continued blister formation, the dose was increased to 50 mg t.i.d. and prednisone was added to the regimen. The latter was tapered over a period of 3 months. For the past year, dapsone has been administered at a dosage of 100 mg b.i.d., and the patient has experienced only occasional blister formation.
Acneiform eruptions after facial beauty treatment
Authors: Khanna Neena , Gupta Siddhartha Datta 
Published: March 2003

Abstract Background Female patients in the post‐adolescent age group presented with predominantly deep‐seated nodules and a few comedones situated mainly on the cheeks. As most of these subjects related the onset of their symptoms to antecedent facial beauty treatment, we decided to study the clinical and histologic profile of these patients. Methods Thirty seven subjects (36 women and one man) were questioned in detail about their acneiform eruptions. The patients were examined and a biopsy of typical lesions was taken in eight patients. Results On direct questioning, all patients related the onset of their lesions to facial beauty treatment taken 3–8 weeks previously. The predominant types of lesion were deep‐seated nodules, although a few closed comedones were present in some cases. Most lesions took a long time to heal and, on healing, left behind hyperpigmentation. The cheeks were universally involved in all patients, and the chin and forehead were involved in 14. The histopathologic study revealed a predominantly peri‐appendageal dermal infiltrate consisting of lymphocytes and histiocytes admixed with polymorphs. A granulomatous infiltrate was seen in one‐third of the biopsies. Conclusions This eruption is unlike the earlier eruption described as acne cosmetica in being inflammatory, indolent, and often occurring after the first cream massage itself.
Erythema multiforme following the exacerbation of hepatitis B virus infection
Authors: Tabata Nobuko , Kato Taizo , Noguchi Kenji , Ueno Yoshiyuki , Tagami Hachiro 
Published: March 2003

Japan A 56‐year‐old Japanese woman suffered from chronic persistent hepatitis, which was HBeAg and hepatitis B virus (HBV) DNA positive. In October 1996, her hepatitis deteriorated and was associated with an increase in the HBeAg titer and HBV DNA concentration. The HBeAg titer and HBV DNA concentration were followed on a monthly basis as shown in Table 1. The serum aspartate transaminase (AST), alanine transaminase (ALT), and total bilirubin reached peaks of 1427 IU/L, 1363 IU/L (8–35), and 2.2 mg/dL (0.2–1.2), respectively. Five weeks later, the patient developed symmetric, well‐demarcated, dark, annular, erythematous lesions on the lower and upper extremities and face. The trunk and mucosal surfaces were spared (Fig. 1). We made the clinical diagnosis of erythema multiforme (EM). The eruption cleared spontaneously within 2 weeks. She had no history of a previous eruption, recurrent throat infections, herpes simplex, or drug exposure.

Serologic data showing the exacerbation of hepatitis B virus infection

–10 weeks

*

–5 weeks
–2 weeks

HBV DNA (pg/mL)
32
1100
43

HBeAg (cut‐off index)
0.6
41.8
0.05

HBeAb (inhibition, %)
99.9
36.9
99.9

Weeks before the appearance of skin eruptions.

Symmetric, well‐demarcated, dark, annular, erythematous lesions on the lower extremitiesimage