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This cohort study assess rates of acne relapse and isotretinoin retrial and identifies associated factors in patients after completing an isotretinoin course.
Presentato studio alla Festa del Bio-MontagnaMadre
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Prime linee guida da Iss e 20 società scientifiche
Autore/Fonte: Università di Padova
Objectives
To identify what changes in the prescribing of isotretinoin have occurred since funded prescriber access was widened in 2009 from ‘dermatologist only’ prescribing to include ‘general practitioners (GPs) and nurse practitioners working within their scope of practice’.
Design
Evaluation of isotretinoin dispensing data from 2008 to 2023 using the national annual prescribing data obtained from the New Zealand Pharmaceutical National Collection database.
Setting
All New Zealand citizens prescribed and dispensed funded isotretinoin for acne from 2008 to 2023 were included.
Main outcome measures
The prescribing data were analysed to identify the total number of prescriptions per year by prescribing clinician type, patient ethnicity and deprivation levels.
Results
In 2008, nearly 100% (26897) of dispensed prescriptions were written by a dermatologist, while in 2023, 79% (39432) were written by primary care clinicians. Annual isotretinoin prescriptions increased by 87%, from 26 897 (2008) to 50613 (2023). Prescriptions for Māori increased from 1750 in 2008 to 4374 in 2023, with similar increases for other ethnic minorities.
Conclusion
Expanding the prescriber cohort has resulted in a substantial increase in prescriptions, with primary care now issuing the majority of isotretinoin prescriptions. These data demonstrate that the GP workforce can absorb and manage the additional acne workload from the increasing population. Enhanced access for patients suggests an unmet need. An absolute number of prescriptions have risen faster for Māori and Asian patients than for Europeans. Pacific people were generally lower than Europeans. This suggests the longstanding ethnic disparity in access to isotretinoin is partially reduced.
Many countries have restrictions on patient access to isotretinoin, similar to New Zealand in 2008. This is the first study demonstrating that, given appropriate postgraduate education and support, the isotretinoin risk–benefit profile may be enhanced to safely deliver high-quality, timely, equitable patient access to isotretinoin in primary care.
Esperti al lavoro per uno stile alimentare personalizzato
Autore/Fonte: University of Virginia
This qualitative study examines whether patient-reported outcomes measures for acne incorporate LGBTQ+-inclusive language.
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Circulation, Volume 150, Issue Suppl_1, Page A4145478-A4145478, November 12, 2024. Introduction:Pericarditis is an inflammation of the pericardium, a thin sac-like membrane surrounding the heart, which can progress to life threatening cardiac tamponade. It can be caused by infections (viral, bacterial, fungal, or parasitic), autoimmune conditions, injuries, or underlying medical conditions. Common symptoms include chest pain, fever, shortness of breath, and fatigue. In the case presented, the patient suffered from a severe form of pericarditis caused by a rare infectious etiology, leading to the development of cardiac tamponade.Case Summary:A 29-year-old female with type II diabetes and hypothyroidism presented with a week of shortness of breath, chest pain, lightheadedness, and loss of consciousness. Workup showed WBC (20.6), CRP (283), and ESR (85). Echocardiogram revealed a large pericardial effusion with right ventricular collapse, indicating cardiac tamponade. She underwent pericardiocentesis, draining 400 ml of exudative fluid. Unfortunately, the effusion rapidly re-accumulated, requiring a pericardial window procedure with drainage of fibrinous, loculated fluid over 2 days, improving her symptoms. She was discharged on colchicine and NSAIDs, however she returned 5 days later with recurrent symptoms and fever. The culture of the previous fluid showed Cutibacterium acne. Histopathology of pericardial biopsy revealed fibrinoid pericarditis. She was treated with ceftriaxone, and transitioned to doxycycline for 14 days, along with 14 days of ibuprofen and 3 months of colchicine. At 3-month follow-up, she was asymptomatic with no effusion recurrence.Conclusion::As bacterial pericarditis cases rise, the initial work-up should include investigating bacterial etiology. This raises the question of antibiotic coverage for patients presenting with pericardial effusion until bacterial etiology is excluded and also advocate for elective pericardiocentesis in bacterial effusions without tamponade physiology.
Ricerca esamina correlazioni tra alimentazioni e patologia
