St. Jude Children's Research Hospital investigators and collaborators have shown how to predict if a child who is infected with respiratory syncytial virus (RSV) while being treated for cancer or another catastrophic disease is at high risk for developing severe infection. The finding will help clinicians improve guidelines for managing these infected children.
RSV is a common cause of pneumonia among infants, children and adults during winter, frequently causing fever, runny nose and coughs. It can be much more severe in patients who are undergoing cancer treatments and whose immune systems are suppressed. In these patients, the virus can move into the deep lung, causing pneumonia and other respiratory problems that can be fatal. However, it is difficult to predict which infected patient is likely to develop a serious lower respiratory tract illness and which one will continue to simply have a mild runny nose and cough.
The St. Jude team and collaborators found that if these children are under 2 years old and have very low levels of immune system cells in their blood called lymphocytes, they are at high risk for the RSV infection to become serious by moving into the lung. Such infections are especially dangerous because they can be fatal in some immunocompromised children, and there is no standard effective treatment for these infections, the researchers said. A report on the retrospective findings appears in the February issue of the journal "Pediatrics."
The new information is important because it helps identify children who are most at risk for severe disease using easily available clinical information," said Aditya Gaur, M.D., assistant member of the St. Jude Department of Infectious Diseases and the paper's senior author. "This narrows down the patient population who needs to be considered for antiviral therapy, which is costly and often inconvenient to receive from a child's perspective. For example, one treatment for RSV infection is to have the child breathe an aerosolized form of the antiviral drug ribavirin for 12 to 18 hours, which is tough for the child and the parent."
The findings of this study require confirmation in prospective studies, Gaur said. Results of the study also help define which children should receive medications that can help prevent RSV infection.
Another significant finding was that--unlike some previous reports in immunocompromised adults with RSV--neutropenia is not a risk factor for lower respiratory track infection, Gaur said. Neutropenia is an abnormally low level of neutrophils, immune system cells that engulf and digest germs.
"This finding is important because with cancer patients, clinicians are used to identifying those at risk for bacterial and fungal infections based on a patient having neutropenia," Gaur said. This study shows that for RSV, which is a viral infection, lymphopenia and not neutropenia is what identifies children at risk.
Previous studies have shown that lower respiratory track infection, is more common in children whose immune system is suppressed, who are receiving chemotherapy or who have received a hematopoietic stem cell transplant (HSCT). However, while some studies report that lower respiratory track infection, due to RSV is fatal in 50 to 100 percent of infected adults, there is little information about this type of infection in immunocompromised children. "We decided to analyze the course of RSV infection in children being treated for cancer to identify factors that could help us predict which ones were at highest risk for severe disease or death due to a lower respiratory tract infection with this virus," Gaur said. HSCT is the transplantation of special cells from the blood or bone marrow that can give rise to all the blood cells of the body (red and white cells and platelets).
The St. Jude team studied clinical and laboratory information from the records of 58 patients who had tested positive for RSV infection. Among these children, 23 (40 percent) had acute lymphoblastic leukemia, 11 (19 percent) had solid tumors and 24 patients (41 percent) had acute myeloid leukemia (AML), severe combined immunodeficiency syndrome (SCIDS), or had undergone bone marrow transplantation. RSV disease in these infected children was classified as upper respiratory track infection only or lower respiratory tract infection; and children with both upper and lower respiratory track infections, were defined as having lower respiratory track infection.
Overall, 16 (28 percent) of these children developed lower respiratory track infection, due to RSV. The frequency of this type of infection was highest (42 percent) in patients who had undergone HSCT or who had AML or SCIDS. Five patients (31 percent) with LRTI died, an overall mortality rate of 8.6 percent. All deaths occurred in lower respiratory track infection patients who were severely immunocompromised from their cancer, from chemotherapy or from the HSCT.
Sex Life Still Alive For Physically Challenged
Sexuality does not end when a person experiences the effects of a spinal cord injury. Issues of meeting potential partners, building self confidences and enhancing sexual function are an essential part of adjusting to life after an injury. Many physical and emotional changes take place during the rehabilitation process and the matter of being able to perform sexually usually becomes an issue of importance. The truth is that as time passes, those with spinal cord injury find a greater appreciation for sexuality and many will move on to find greater emotional closeness with their partner.
Often times those with spinal cord injuries focus on simple pleasures to please one another, by caressing their partners erogenous zone, holding hands, hugging and kissing. Many couples still enjoy sexual intercourse. Yet, this act can be a challenge, especially in certain positions. Most couples will tell you that they are always interested in ways to add more fun and variety to their love life and there are items available to enhance sexual performance but few deal with the issues of boosting sexual motion. One such product that does address enhanced sexual movement is the IntimateRider from HealthPostures.
IntimateRider can make sexual activity easy and comfortable again. It offers a method of support where balance, strength and coordination may be poor, while also assisting by means of a natural gliding motion to enhance sexual relations. IntimateRider also offers a number of options with positioning in order to deal with loss of lower body muscle control. Couples now can focus on being gentle, caring and romantic again as they move forward in their relationship.
Matthew, C6-7 quadriplegic says, "Life after my injury has been a challenge but I am fortunate enough to have found a wonderful relationship with an understanding and caring woman who is also my best friend. We are open in our communication about sex and when we heard about the IntimateRider it did not take us long to figure out this is something that would change our sex life for the better. We are able to please each other now in ways that were just not physically possible before."
A number of other physical conditions can get in the way of sexual performance due to limited movement or fear of pain from uncomfortable positioning. Multiple sclerosis, cerebral palsy, stroke, arthritis and chronic back pain are among the most common conditions that may hinder a more enjoyable sex life. Research also finds that senior citizens still enjoy the act of love making but find that time has taken away the sexual Olympics of their youth. People with these conditions have a strong need to find something to accommodate sexual positioning and also provide natural movement that may be difficult to achieve.
Everything from the softness of the fabric to the fluid gliding motion of the IntimateRider has been given a great deal of consideration to assure the most comfortable and enjoyable sexual experience possible. Adjustable legs, back support height, optional transfer set and selection of colorful slip-covers provide a means to a rewarding sex life and improved relationship.
So rejoice! The sex lives of the physically challenged are still alive and well and in fact have just gotten better. Each individual has their own way of finding what works best for them in their personal relationship. Advancements with products like the IntimateRider enhance an already gratifying love life and will give couples a way to enjoy the best sex possible.
Hand Washing Puts Health Care Workers At Increased Risk For Irritant Contact Dermatitis
Dermatitis
For the millions of health care workers in the United States, repeated hand washing may not seem like an occupational hazard at first glance. In fact, good hand hygiene is essential in health care workers to stop the spread of potentially serious infections, such as staphylococcus and clostridium. However, new research examining the risk factors for irritant contact dermatitis -- a common skin condition marked by scaling, redness, itching and burning due to a chemical substance on the skin -- among health care workers finds that those who washed their hands more than 10 times per day were more likely to develop the condition than those who washed their hands less frequently.
Speaking today at the 66th Annual Meeting of the American Academy of Dermatology, dermatologist Susan T. Nedorost, MD, FAAD, associate professor of dermatology at University Hospitals Case Medical Center in Cleveland, Ohio, presented findings that demonstrated a positive link between frequent hand washing and irritant contact dermatitis, or hand dermatitis, among health care workers.
"We demonstrated that some people are predisposed to skin reactions to irritant detergents, and those who do 'wet' work in low humidity conditions where frequent hand washing is an essential part of the job are very susceptible to hand dermatitis," said Dr. Nedorost. "Our findings confirm that health care workers who wash their hands repeatedly are at an increased risk of developing hand dermatitis, which can take months to heal. This knowledge can help workers at risk for the condition to practice good hand care and follow preventative tips to decrease their risk factors on the job." Conducted in collaboration with the National Institute of Occupational Safety and Health (NIOSH), the study included a total of 100 health care workers in Cleveland, Ohio, who washed their hands at least eight times daily. Study participants were asked to complete a questionnaire to identify frequency of hand washing, use of alcohol-based cleansers, history of specific medical conditions (including asthma, eczema, and psoriasis, among others), and family history of dermatitis or eczema.
Patch tests to determine how easily the skin was irritated by detergents also were conducted on the study participants. Low concentrations of three common detergents were patch tested to predict which patients were at risk for hand dermatitis.
Data from the questionnaires and patch tests that were analyzed from 60 subjects who completed the study to date found that 63 percent of participants developed hand dermatitis. Specifically, 22 percent of participants who washed their hands more than 10 times per day developed hand dermatitis compared to only 13 percent of those who washed their hands less than 10 times daily. The researchers determined that neither the use of an alcohol-based cleanser nor the use of gloves significantly influenced the development of hand dermatitis, and the other variables assessed in the questionnaire did not significantly alter susceptibility to hand dermatitis.
Some study participants had reactions to even low concentrations of detergent when patch tested, indicating that they were at increased risk for hand dermatitis likely due to genetic factors. In addition, in analyzing the patch testing data, Dr. Nedorost determined that the most important factor in predicting those at risk for hand dermatitis was a reaction to the detergent sodium lauryl sulfate (SLS). Specifically, the large percentage of participants who reacted positively to SLS and developed hand dermatitis far outweighed the number of participants who did not react positively to SLS, but subsequently developed hand dermatitis.
A secondary goal of this study was to investigate possible associations of genetic variations in genes susceptible to hand dermatitis. The genetic analysis is not yet complete, but an example of a candidate gene that may play a role in hand dermatitis is filaggrin.
"Recently, genetic variants in the gene encoding filaggrin -- a protein that binds to cells in the outermost layer of skin known as the epidermis -- have been shown to be strong predisposing factors for atopic eczema, in which impaired skin barrier function plays a key role," explained Dr. Nedorost. "Variations in the filaggrin gene may cause a disturbance of the top layer of the skin, which serves as a barrier against environmental exposures -- such as frequent wetting and drying of the skin. Once the top layer of the skin cracks due to frequent wet/dry cycles, especially in conditions of low humidity where drying occurs rapidly, it results in inflammation. This is how irritant hand dermatitis begins."
Since environmental factors such as humidity and the need for good hand hygiene at work are beyond health care workers' control, prevention is the key to warding off hand dermatitis. Dr. Nedorost recommended the following tips for health care workers to help prevent hand dermatitis:
-- Cotton gloves should be worn under rubber or vinyl gloves for wet work to prevent perspiration from dampening the skin. The cotton gloves should be changed frequently if wet work is prolonged.
-- When appropriate, alcohol-based hand cleansers should be substituted for hand washing. These cleansers are well tolerated, but may cause temporary stinging when in contact with skin cracks.
-- A cream or ointment-based emollient should be applied immediately after water exposure before the skin is completely dry. The goal is to prevent rapid drying and cracking, so applying the emollient after the skin is dry is not nearly as beneficial.
Although patients often receive prescriptions for topical corticosteroids to treat symptoms of hand dermatitis, Dr. Nedorost cautions that evidence suggests that chronic use of topical steroids may reduce the skin's ability to tolerate irritants, thins the skin, and increases bruising and tearing.
"Topical steroids should never be used long term as a substitute for emollients," added Dr. Nedorost. "Patients should consult a dermatologist for the proper treatment of hand dermatitis, particularly those who suspect their work environment may be the culprit."
Top Tips To Help Keep Lips In Tip-Top Shape
While winter's harsh, windy weather is often to blame for dry, cracked lips, sometimes the cause of lip irritation is harder to pinpoint. In fact, several types of foods, cosmetic products, medications or even bad habits have been linked to dry lips. The key is determining the source of the irritation and modifying your daily regimen to eliminate the problem.
Sexuality does not end when a person experiences the effects of a spinal cord injury. Issues of meeting potential partners, building self confidences and enhancing sexual function are an essential part of adjusting to life after an injury. Many physical and emotional changes take place during the rehabilitation process and the matter of being able to perform sexually usually becomes an issue of importance. The truth is that as time passes, those with spinal cord injury find a greater appreciation for sexuality and many will move on to find greater emotional closeness with their partner.
Often times those with spinal cord injuries focus on simple pleasures to please one another, by caressing their partners erogenous zone, holding hands, hugging and kissing. Many couples still enjoy sexual intercourse. Yet, this act can be a challenge, especially in certain positions. Most couples will tell you that they are always interested in ways to add more fun and variety to their love life and there are items available to enhance sexual performance but few deal with the issues of boosting sexual motion. One such product that does address enhanced sexual movement is the IntimateRider from HealthPostures.
IntimateRider can make sexual activity easy and comfortable again. It offers a method of support where balance, strength and coordination may be poor, while also assisting by means of a natural gliding motion to enhance sexual relations. IntimateRider also offers a number of options with positioning in order to deal with loss of lower body muscle control. Couples now can focus on being gentle, caring and romantic again as they move forward in their relationship.
Matthew, C6-7 quadriplegic says, "Life after my injury has been a challenge but I am fortunate enough to have found a wonderful relationship with an understanding and caring woman who is also my best friend. We are open in our communication about sex and when we heard about the IntimateRider it did not take us long to figure out this is something that would change our sex life for the better. We are able to please each other now in ways that were just not physically possible before."
A number of other physical conditions can get in the way of sexual performance due to limited movement or fear of pain from uncomfortable positioning. Multiple sclerosis, cerebral palsy, stroke, arthritis and chronic back pain are among the most common conditions that may hinder a more enjoyable sex life. Research also finds that senior citizens still enjoy the act of love making but find that time has taken away the sexual Olympics of their youth. People with these conditions have a strong need to find something to accommodate sexual positioning and also provide natural movement that may be difficult to achieve.
Everything from the softness of the fabric to the fluid gliding motion of the IntimateRider has been given a great deal of consideration to assure the most comfortable and enjoyable sexual experience possible. Adjustable legs, back support height, optional transfer set and selection of colorful slip-covers provide a means to a rewarding sex life and improved relationship.
So rejoice! The sex lives of the physically challenged are still alive and well and in fact have just gotten better. Each individual has their own way of finding what works best for them in their personal relationship. Advancements with products like the IntimateRider enhance an already gratifying love life and will give couples a way to enjoy the best sex possible.
Hand Washing Puts Health Care Workers At Increased Risk For Irritant Contact Dermatitis
Dermatitis
For the millions of health care workers in the United States, repeated hand washing may not seem like an occupational hazard at first glance. In fact, good hand hygiene is essential in health care workers to stop the spread of potentially serious infections, such as staphylococcus and clostridium. However, new research examining the risk factors for irritant contact dermatitis -- a common skin condition marked by scaling, redness, itching and burning due to a chemical substance on the skin -- among health care workers finds that those who washed their hands more than 10 times per day were more likely to develop the condition than those who washed their hands less frequently.
Speaking today at the 66th Annual Meeting of the American Academy of Dermatology, dermatologist Susan T. Nedorost, MD, FAAD, associate professor of dermatology at University Hospitals Case Medical Center in Cleveland, Ohio, presented findings that demonstrated a positive link between frequent hand washing and irritant contact dermatitis, or hand dermatitis, among health care workers.
"We demonstrated that some people are predisposed to skin reactions to irritant detergents, and those who do 'wet' work in low humidity conditions where frequent hand washing is an essential part of the job are very susceptible to hand dermatitis," said Dr. Nedorost. "Our findings confirm that health care workers who wash their hands repeatedly are at an increased risk of developing hand dermatitis, which can take months to heal. This knowledge can help workers at risk for the condition to practice good hand care and follow preventative tips to decrease their risk factors on the job." Conducted in collaboration with the National Institute of Occupational Safety and Health (NIOSH), the study included a total of 100 health care workers in Cleveland, Ohio, who washed their hands at least eight times daily. Study participants were asked to complete a questionnaire to identify frequency of hand washing, use of alcohol-based cleansers, history of specific medical conditions (including asthma, eczema, and psoriasis, among others), and family history of dermatitis or eczema.
Patch tests to determine how easily the skin was irritated by detergents also were conducted on the study participants. Low concentrations of three common detergents were patch tested to predict which patients were at risk for hand dermatitis.
Data from the questionnaires and patch tests that were analyzed from 60 subjects who completed the study to date found that 63 percent of participants developed hand dermatitis. Specifically, 22 percent of participants who washed their hands more than 10 times per day developed hand dermatitis compared to only 13 percent of those who washed their hands less than 10 times daily. The researchers determined that neither the use of an alcohol-based cleanser nor the use of gloves significantly influenced the development of hand dermatitis, and the other variables assessed in the questionnaire did not significantly alter susceptibility to hand dermatitis.
Some study participants had reactions to even low concentrations of detergent when patch tested, indicating that they were at increased risk for hand dermatitis likely due to genetic factors. In addition, in analyzing the patch testing data, Dr. Nedorost determined that the most important factor in predicting those at risk for hand dermatitis was a reaction to the detergent sodium lauryl sulfate (SLS). Specifically, the large percentage of participants who reacted positively to SLS and developed hand dermatitis far outweighed the number of participants who did not react positively to SLS, but subsequently developed hand dermatitis.
A secondary goal of this study was to investigate possible associations of genetic variations in genes susceptible to hand dermatitis. The genetic analysis is not yet complete, but an example of a candidate gene that may play a role in hand dermatitis is filaggrin.
"Recently, genetic variants in the gene encoding filaggrin -- a protein that binds to cells in the outermost layer of skin known as the epidermis -- have been shown to be strong predisposing factors for atopic eczema, in which impaired skin barrier function plays a key role," explained Dr. Nedorost. "Variations in the filaggrin gene may cause a disturbance of the top layer of the skin, which serves as a barrier against environmental exposures -- such as frequent wetting and drying of the skin. Once the top layer of the skin cracks due to frequent wet/dry cycles, especially in conditions of low humidity where drying occurs rapidly, it results in inflammation. This is how irritant hand dermatitis begins."
Since environmental factors such as humidity and the need for good hand hygiene at work are beyond health care workers' control, prevention is the key to warding off hand dermatitis. Dr. Nedorost recommended the following tips for health care workers to help prevent hand dermatitis:
-- Cotton gloves should be worn under rubber or vinyl gloves for wet work to prevent perspiration from dampening the skin. The cotton gloves should be changed frequently if wet work is prolonged.
-- When appropriate, alcohol-based hand cleansers should be substituted for hand washing. These cleansers are well tolerated, but may cause temporary stinging when in contact with skin cracks.
-- A cream or ointment-based emollient should be applied immediately after water exposure before the skin is completely dry. The goal is to prevent rapid drying and cracking, so applying the emollient after the skin is dry is not nearly as beneficial.
Although patients often receive prescriptions for topical corticosteroids to treat symptoms of hand dermatitis, Dr. Nedorost cautions that evidence suggests that chronic use of topical steroids may reduce the skin's ability to tolerate irritants, thins the skin, and increases bruising and tearing.
"Topical steroids should never be used long term as a substitute for emollients," added Dr. Nedorost. "Patients should consult a dermatologist for the proper treatment of hand dermatitis, particularly those who suspect their work environment may be the culprit."
Top Tips To Help Keep Lips In Tip-Top Shape
While winter's harsh, windy weather is often to blame for dry, cracked lips, sometimes the cause of lip irritation is harder to pinpoint. In fact, several types of foods, cosmetic products, medications or even bad habits have been linked to dry lips. The key is determining the source of the irritation and modifying your daily regimen to eliminate the problem.
Speaking today at the 66th Annual Meeting of the American Academy of Dermatology, dermatologist Margaret E. Parsons, MD, FAAD, assistant clinical professor of dermatology at the University of California at Davis, discussed the most common causes of lip irritation, available treatments and preventative measures to keep lips healthy.
"When I treat a patient for dry lips, the first thing I try to determine is what this patient might be doing or not doing that could be contributing to the problem," said Dr. Parsons. "In some cases, it might be a new lipstick that contains an ingredient irritating to the skin or an anti-aging facial product that inadvertently comes in contact with the lips that could be the culprit. Or, someone might be working outdoors or participating in sports and not protecting their lips from wind and sun damage with a lip balm, especially one with sunscreen. Once we determine the cause, there are some simple, tried-and-true treatments that work well for most patients."
Mother Nature
Dr. Parsons noted that not only can winter's outdoor elements contribute to dry, cracked lips, but the conditions indoors during this season can play a role in irritating the lips. Heat used to warm the indoor temperature dries out the air and lowers the humidity level, which can lead to dry skin and lips. At the other end of the weather spectrum, the intense summer sun can lead to sunburned or sun-irritated lips.
"When working outdoors or engaging in sports, men and women should apply a lip balm with an SPF of 15 or higher year-round to protect their lips from sun damage," said Dr. Parsons. "By wearing lipstick -- particularly the products in recent years with sunscreen -- women have protected their lips better than men, which could explain why men have significantly more skin cancers on their lips than women."
Cosmetics
In some cases, products that you put on your lips -- lipsticks, lip balms or the newer lip plumpers, which are applied topically to make lips appear fuller -- can cause dry or irritated lips.
"Lip plumpers often contain chemicals used to intentionally irritate the lips and make them appear fuller, such as capsaicin (derived from chili peppers), mint, or menthol, among others," explained Dr. Parsons. "For some, this irritation is mild, causing a slight swelling and fuller appearance. For others, this irritation is significant and causes painful swelling and redness."
Dr. Parsons added that the ingredient phenol used in some of the traditional lip balms and other lip products can irritate and actually contribute to further drying out the lips. Even though phenol is used in low concentrations in lip products, it is the same chemical used in deep-penetrating facial peels that removes the top layer of skin.
Foods
Spicy foods, the acid found in citrus foods and even the cut edge of a mango peel (which contains the chemical toxicodendron found in poison ivy) can burn the lips and lead to dryness and irritation. In addition, people with nut allergies could react to lip products that contain nut-based products, such as shea butter.
Medications
Although many people might not suspect their medications to be the root of their lip problems, Dr. Parsons explained that patients who cannot attribute their dry or irritated lips to other common factors should take a close look at their medicine cabinet. For example, some oral acne medications, such as isotretinoin, can cause considerable lip dryness even though they do not come into direct contact with the lips. Products applied topically, such as acne medications containing benzoyl peroxide or retinoids and anti-aging products such as alpha-hydroxy acids or retinoids, could cause considerable lip dryness when they come into contact with the lip area. Vitamin E and aloe vera gel also can be irritating to many people with sensitive skin.
Similarly, patients with eczema or other skin conditions that make the skin more sensitive could be more susceptible to allergic reactions from lip products. Dr. Parsons advised patients with any underlying skin conditions or who regularly use medications to check with their dermatologist to determine if these are contributing factors to their lip problems.
"Lip-Smacking"
Another cause of dry, chapped lips that is common in younger children is what dermatologists refer to as "lip-smacking." This habit, which can be hard to break the more the lips become irritated, can be formed when children are nervous about something, such as starting school. In particularly bothersome cases, a mild prescription product may be needed to accelerate the healing process.
Tips and Treatments
In most cases, applying petroleum jelly or a lip product containing petrolatum or mineral oil will soothe and heal irritated lips. Dr. Parsons also recommends the following tips to prevent lip irritations and to keep lips healthy and moisturized:
-- Opt for lip products, such as lipsticks or lip moisturizers, which contain sunscreen whenever possible to protect lips from harmful sun exposure.
-- Be smart about what you put on your lips. Avoid lip plumpers or other products that intentionally irritate lips to make them appear fuller, as the chemicals they contain can be irritating to some people.
-- Apply a petrolatum-based product at bedtime, which Dr. Parsons refers to as the perfect time for patients to "grease up" their lips.
-- Choose a simple product with few additives to minimize possible irritation.
-- See a dermatologist if lips are not getting better with simple at-home treatments or if new symptoms develop.
"Caring for your lips shouldn't be an after-thought," added Dr. Parsons. "By incorporating good lip care into your overall skin care regimen, you can maintain healthy lips, avoid some of the common sources of irritation and protect your lip area from possible skin cancers."
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