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Sample records for alopecia clinical narratives

  1. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part II

    OpenAIRE

    Werner, Betina; Mulinari-Brenner, Fabiane

    2012-01-01

    Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (femalepattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alop...

  2. Three Cases of Alopecia Following Clinical Islet Transplantation

    Science.gov (United States)

    Zuk, Dalyce M; Koh, Angela; Imes, Sharleen; Shapiro, AM James; Senior, Peter A

    2010-01-01

    Successful clinical islet allotransplantation requires control of both allo- and auto-immunity by using immunosuppressant drugs which have a number of side effects. The development of the autoimmune condition alopecia areata following successful islet transplantation is therefore unexpected. Three cases of alopecia affecting female islet transplant recipients are described. In all cases, alopecia developed approximately 7 years after initial transplant. All had received daclizumab, sirolimus and tacrolimus with their initial transplants, but all were receiving a combination of tacrolimus and mycophenolate mofetil at the time alopecia developed. Two subjects had received thymoglobulin for a subsequent islet infusion and prior to the onset of alopecia. The progression of alopecia has been halted or reversed in all cases. Tacrolimus has been continued in 2 cases (one as monotherapy) while cyclosporine was used in place of tacrolimus in the third case. These three cases represent a crude incidence of alopecia in islet transplant candidates (pre-transplant) of alopecia might be expected in a proportion of individuals with type 1 diabetes, the risk may be increased after islet transplantation, and may be associated with the use of anti-TNF drugs, lymphodepleting antibodies or higher dose tacrolimus. PMID:21199356

  3. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part I

    OpenAIRE

    Werner, Betina; Mulinari-Brenner, Fabiane

    2012-01-01

    Diffuse androgenetic alopecia (female pattern hair loss), telogen effluvium, and diffuse alopecia areata may have similar clinical manifestations. Subtle details on physical examination and dermoscopy of the scalp may help to identify those disorders. The authors present a practical discussion on how to approach the patient with diffuse alopecia, considering clinical history, physical examination, and dermoscopic findings. If the diagnosis remains unclear after a careful analysis of the clini...

  4. Alopecia areata and autoimmunity: A clinical study

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    Thomas Emy

    2008-01-01

    Full Text Available Alopecia areata (AA frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1% in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.

  5. Clinical features of primary cicatricial alopecia in Chinese patients

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    Shiling Qi

    2014-01-01

    Full Text Available Background: There have been few reports on primary cicatricial alopecias (PCR especially from Asia (PCA. Aims: To study the clinical, pathological and dermoscopic characteristics of PCA among Chinese patients. Methods: A retrospective analysis of the clinical data of 59 patients with PCA was conducted and the dermoscopic, pathological, treatment and prognosis characteristics analyzed. Fisher′s Chi-square exact test, Kruskal-Wallis and Spearman rank correlation test were performed. Results: The ratio of neutrophilic to lymphocytic cicatricial alopecias was about 1.3:1 in this group. The most frequent disorder was folliculitis decalvans. Follicular openings were absent on dermoscopy in all cases except alopecia mucinosa. Patulous follicular openings were characterisitc of alopecia mucinosa. After treatment, an increase in short vellus hairs was the earliest feature, while telangiectasia, epidermal scale, follicular hyperkeratosis, pustules and hair diameter diversity gradually decreased or even disappeared. Improvement in the areas of hair loss after treatment was seen more often in discoid lupus erythematosus, folliculitis decalvans and dissecting cellulitis than in patients with classic pseudopelade of Brocq. Nine patients (13.6% relapsed after cessation of therapy. Female patients needed longer treatment times. Long duration, large areas of hair loss and shorter treatment courses were the major factors in relapses. Conclusions: Dermatoscopy provides a rapid, practical and useful aid for the diagnosis of PCA and also to assess disease activity. Patulous follicular openings are a specific dermoscopic sign of alopecia mucinosa. Lichen planopilaris is less common in China than in the West.

  6. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part II Desafio clínico e histológico no diagnóstico diferencial de alopecia difusa: alopecia androgenética, eflúvio telógeno e alopecia areata - parte II

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    Betina Werner

    2012-12-01

    Full Text Available Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (femalepattern hair loss and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alopecia.A alopecia difusa tem como principais causas eflúvio telógeno, alopecia androgenética difusa (alopecia androgenética de padrão feminino e alopecia areata difusa. Em muitas ocasiões o diagnóstico diferencial entre as três entidades é difícil. Na segunda parte deste artigo se discute em mais detalhes as características clínicas, dermatoscópicas e histológicas do eflúvio telógeno crônico e da alopecia areata difusa. Uma maneira prática e objetiva de abordagem diagnóstica da alopecia difusa é apresentada através de um fluxograma.

  7. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part I Desafio clínico e histológico no diagnóstico diferencial de alopecia difusa: alopecia androgenética, eflúvio telógeno e alopecia areata - parte I

    OpenAIRE

    Betina Werner; Fabiane Mulinari-Brenner

    2012-01-01

    Diffuse androgenetic alopecia (female pattern hair loss), telogen effluvium, and diffuse alopecia areata may have similar clinical manifestations. Subtle details on physical examination and dermoscopy of the scalp may help to identify those disorders. The authors present a practical discussion on how to approach the patient with diffuse alopecia, considering clinical history, physical examination, and dermoscopic findings. If the diagnosis remains unclear after a careful analysis of the clini...

  8. Clinical characteristics of doxorubicin-associated alopecia in 28 dogs.

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    Falk, Elizabeth F; Lam, Andrea T H; Barber, Lisa G; Ferrer, Lluis

    2017-04-01

    Chemotherapy-induced alopecia (CIA) is common in humans, but there are limited reports describing the clinical features of CIA in dogs. To describe the epidemiological and clinical characteristics of doxorubicin-associated alopecia (DAA) in canine patients at a teaching hospital from 2012 to 2014. Signalment, diagnosis, treatment protocols and clinical examination findings were recorded in 150 dogs treated with doxorubicin from 2012 to 2014. Medical records were searched retrospectively for the keywords "alopecia" and "hypotrichosis." Dogs were excluded if the causal link of hair loss was unclear. Doxorubicin-associated alopecia was reported in 28 of 150 dogs (19%). Two parameters were statistically associated with the development of DAA: coat-type and cumulative doxorubicin dose. Dogs with curly or wire-haired coat-type were significantly more likely to develop DAA than dogs with straight-haired coat-type [χ 2 (1, N = 147) = 30, P < 0.0001]. After adjusting for sex, weight and doxorubicin dose, the odds of dogs with curly or wire-haired coat-type developing DAA were 22 times higher than those with straight-haired coat-type (P < 0.0001). Dogs that developed DAA received a significantly higher median cumulative doxorubicin dose (103.0 versus 84.5 mg/m 2 ; P = 0.0039) than those that did not develop DAA. Dogs treated with doxorubicin may be at risk for developing DAA. This risk increases as the cumulative dose of doxorubicin increases, and with a curly or wire-haired coat-type. © 2016 ESVD and ACVD.

  9. Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia, telogen effluvium and alopecia areata - part I Desafio clínico e histológico no diagnóstico diferencial de alopecia difusa: alopecia androgenética, eflúvio telógeno e alopecia areata - parte I

    Directory of Open Access Journals (Sweden)

    Betina Werner

    2012-10-01

    Full Text Available Diffuse androgenetic alopecia (female pattern hair loss, telogen effluvium, and diffuse alopecia areata may have similar clinical manifestations. Subtle details on physical examination and dermoscopy of the scalp may help to identify those disorders. The authors present a practical discussion on how to approach the patient with diffuse alopecia, considering clinical history, physical examination, and dermoscopic findings. If the diagnosis remains unclear after a careful analysis of the clinical signs, a scalp biopsy may help to distinguish between the three diseases. In this first part of our study, an objective review of female androgenetic alopecia is presented and the most important histological changes are discussed.Alopecia androgenética difusa (alopecia de padrão feminino, eflúvio telógeno e alopecia areata difusa podem ter apresentações clínicas similares. Detalhes sutis no exame físico e na dermatoscopia do couro cabeludo podem ser úteis no diagnóstico diferencial e interferir na conduta e resultados terapêuticos. Os autores apresentam uma discussão prática de como abordar a paciente com alopecia difusa considerando dados da história clínica, exame físico e dermatoscópico. Quando a dúvida persistir após uma análise cuidadosa dos aspectos clínicos, uma biópsia de couro cabeludo pode permitir a distinção entre as três doenças. Nesta primeira parte, a alopecia androgenética de padrão feminino é abordada em maior detalhe e se faz uma revisão objetiva das principais alterações microscópicas observadas.

  10. Clinical and histological study of permanent alopecia after bone marrow transplantation.

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    Basilio, Flávia Machado Alves; Brenner, Fabiane Mulinari; Werner, Betina; Rastelli, Graziela Junges Crescente

    2015-01-01

    Permanent alopecia after bone marrow transplantation is rare, but more and more cases have been described, typically involving high doses of chemotherapeutic agents used in the conditioning regimen for the transplant. Busulfan, classically described in cases of irreversible alopecia, remains associated in recent cases. The pathogenesis involved in hair loss is not clear and there are few studies available. In addition to chemotherapeutic agents, another factor that has been implicated as a cause is chronic graft-versus-host disease. However, there are no histopathological criteria for defining this diagnosis yet. the study aims to evaluate clinical and histological aspects in cases of permanent alopecia after bone marrow transplantation, identifying features of permanent alopecia induced by myeloablative chemotherapy and alopecia as a manifestation of chronic graft-versus-host disease. data were collected from medical records of 7 patients, with description of the clinical features and review of slides and paraffin blocks of biopsies. Two distinct histological patterns were found: one similar to androgenetic alopecia, non-scarring pattern, and other similar to lichen planopilaris, scarring alopecia. The first pattern corroborates the literature cases of permanent alopecia induced by chemotherapeutic agents, and the second is compatible with manifestation of chronic graft-versus-host disease on scalp, that has never been described yet. The results contribute to the elucidation of the factors involved in these cases, including the development of therapeutic methods.

  11. Clinical and histological study of permanent alopecia after bone marrow transplantation*

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    Basilio, Flávia Machado Alves; Brenner, Fabiane Mulinari; Werner, Betina; Rastelli, Graziela Junges Crescente

    2015-01-01

    BACKGROUND Permanent alopecia after bone marrow transplantation is rare, but more and more cases have been described, typically involving high doses of chemotherapeutic agents used in the conditioning regimen for the transplant. Busulfan, classically described in cases of irreversible alopecia, remains associated in recent cases. The pathogenesis involved in hair loss is not clear and there are few studies available. In addition to chemotherapeutic agents, another factor that has been implicated as a cause is chronic graft-versus-host disease. However, there are no histopathological criteria for defining this diagnosis yet. OBJECTIVE the study aims to evaluate clinical and histological aspects in cases of permanent alopecia after bone marrow transplantation, identifying features of permanent alopecia induced by myeloablative chemotherapy and alopecia as a manifestation of chronic graft-versus-host disease. METHODS data were collected from medical records of 7 patients, with description of the clinical features and review of slides and paraffin blocks of biopsies. RESULTS Two distinct histological patterns were found: one similar to androgenetic alopecia, non-scarring pattern, and other similar to lichen planopilaris, scarring alopecia. CONCLUSION The first pattern corroborates the literature cases of permanent alopecia induced by chemotherapeutic agents, and the second is compatible with manifestation of chronic graft-versus-host disease on scalp, that has never been described yet. The results contribute to the elucidation of the factors involved in these cases, including the development of therapeutic methods PMID:26734861

  12. Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata.

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    Pinto, Ana Cecília Versiani Duarte; Andrade, Tatiana Cristina Pedro Cordeiro de; Brito, Fernanda Freitas de; Silva, Gardênia Viana da; Cavalcante, Maria Lopes Lamenha Lins; Martelli, Antonio Carlos Ceribelli

    2017-01-01

    Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm.

  13. Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata*

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    Pinto, Ana Cecília Versiani Duarte; de Andrade, Tatiana Cristina Pedro Cordeiro; de Brito, Fernanda Freitas; da Silva, Gardênia Viana; Cavalcante, Maria Lopes Lamenha Lins; Martelli, Antonio Carlos Ceribelli

    2017-01-01

    Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm. PMID:28225970

  14. Emerging treatments in alopecia.

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    Falto-Aizpurua, Leyre; Choudhary, Sonal; Tosti, Antonella

    2014-12-01

    Alopecia is a common concern encountered in the medical practice. Treatment approach varies according to the type and severity of alopecia. However, available treatment options have limited efficacy and several adverse effects. Presently, there are different treatment options being studied to overcome these limitations. Additionally, cellular pathways involved in the pathophysiology of alopecia are further being clarified to potentially target pathogenic molecules. We searched the literature for recently published articles discussing new treatment options as well as mechanisms involved in alopecia. We discuss the use of stem cells, growth factors, cellular pathways and robotic hair transplant, among other emerging therapies used for alopecia. Future looks very promising and new effective treatments such as janus kinase inhibitors could possibly be available for alopecia areata. The stem-cell technology is advancing and companies involved in hair follicle neogenesis are starting clinical trials on patients with androgenetic alopecia.

  15. Clinical profile and impact on quality of life: Seven years experience with patients of alopecia areata

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    Nawaf Al-Mutairi

    2011-01-01

    Full Text Available Background: Alopecia areata (AA is the most common cause of localized, non-scarring alopecia. Stress and other psychological factors have been implicated in the causation of the disease, and it is also found to alter the course of the disease process. Unfortunately no one has studied the impact of AA on the quality of life, which includes the social life of the patients. Aim: To study the clinical profile and impact of alopecia areata on the quality of life, including the social life of adult patients with severe forms of the disease. Methods: The present study determined the clinical pattern of AA and its impact on the quality of life (QOL in all the patients with severe forms of alopecia areata attending the Dermatology Outpatient Department. Results: The male : female ratio was 1.86 : 1. Most (58.03% of the patients were between 21 and 40 years of age. Almost 40% of the patients had associated systemic disease or other dermatological disorders. A family history of AA was found in 593 (20.02% of the patients. Nail changes were observed in 297 (10% of the patients. There were significant differences between the mean Dermatology Life Quality Index (DLQI score in cases with severe forms of AA and controls ( p0 < 0.001. Conclusions: Severe forms of alopecia areata had a major impact on the psychosocial well-being of the patients. These individuals had to be treated early, and they required more than just prescription drugs. Educational and psychological support in addition to medical therapy for AA could improve their long-term physical outcomes.

  16. Alopecia areata in children

    International Nuclear Information System (INIS)

    Ahmed, I.; Nasreen, S.; Bhatti, R.

    2007-01-01

    To determine the clinical presentations of alopecia areata in children as well as the frequency of associated disorders. Children of either gender suffering from alopecia areata, upto 15 years of age, who fulfilled the selection criteria were included in the study. Only freshly registered cases were studied. Severity of the disease was graded as mild, moderate and severe disease, and other clinical patterns including alopecia totalis, alopecia universalis and ophiasis. Hematological and biochemical profile was evaluated. Chi-square test was applied for statistical analysis in order to determine p-value using the percentages of variables. One hundred and fourteen patients comprising 54 males (47%) and 60 females (53%), aged 4 upto 15 years, the mean age being 9.1 years, were enrolled. Family history of alopecia areata was positive in 11 patients (10%). Fifty nine patients (51%) were of age 6-10 years, 39 patients (35%), aged 11-15 years, and 16 (14%) were of age below 5 years. Mild alopecia areata (41%, p<0.05) was the most common presentation followed by moderate disease (31%, p<0.05), severe alopecia (17%, p <0.05), alopecia totalis (7%, p <0.05), alopecia universalis (2.7%, p=0.05) and ophiasis (1.7%, p=0.05). Nail changes were found in 40 patients (35%, p<0.05). Definite evidence of atopy was obtained in 23 patients (20%, p<0.05). The autoimmune disorders associated with alopecia areata included: hypothyroidism (4.3%), vitiligo (3.5%), psoriasis (1.8%), systemic lupus erythematosus (SLE 0.9%), hypoparathyroidism (0.9%) and diabetes mellitus (0.9%). The spectrum of childhood alopecia areata ranges from mild, moderate and severe alopecia, ultimately to alopecia totalis, alopecia universalis and ophiasis. Nail changes as well as atopy and autoimmune disorders are the associated disorders. (author)

  17. Cicatricial Alopecia

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    ... Conditions Kids Pages Breadcrumb Home Health Topics Cicatricial Alopecia Basics In-Depth Download Download EPUB Download PDF What is it? Points To Remember About Cicatricial Alopecia Hair lost from cicatricial alopecia does not grow ...

  18. Evaluation of clinical significance of dermoscopy in alopecia areata

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    Akhila Sai Guttikonda

    2016-01-01

    Full Text Available Background: Alopecia areata (AA is a common, chronic inflammatory disease characterized by nonscarring hair loss on the scalp or any hair-bearing area of the body. Recently, dermoscopy, a noninvasive diagnostic procedure, has been employed for the diagnosis of AA. Aim: To evaluate various dermoscopic patterns in AA and correlate these patterns with the disease activity and severity. Materials and Methods: Dermoscopy was performed on AA patients using DL1 dermoscope (magnification ×10 was used. The dermoscopic patterns recorded were analyzed to identify any correlation with the disease activity and severity. Results: A total of fifty patients of AA were recruited in the study. Female outnumbered males with the ratio being 1.173:1. Mean age of the patients was 25.06 years. Mean duration of disease was 14 months. The most common site involved was scalp (80% and type noted was patchy (84%. Various dermoscopic patterns noted were yellow dots (YD (88%, short vellus hair (66%, black dots (BD (58%, broken hairs (BHs (56%, tapering hair (TH (26%, Coudability hairs (14%, pigtail hair (14%, and Pohl-Pinkus constrictions (2%. Statistically significant correlation was observed between BD, BHs, THs, and disease activity. No significant correlation was found between severity and any of the dermoscopic features. Conclusion: The most common dermoscopic pattern in our study was YD. Presence of BDs, BHs, and THs indicate active disease. Dermoscopic patterns were not affected by severity of the disease.

  19. Annotating temporal information in clinical narratives.

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    Sun, Weiyi; Rumshisky, Anna; Uzuner, Ozlem

    2013-12-01

    Temporal information in clinical narratives plays an important role in patients' diagnosis, treatment and prognosis. In order to represent narrative information accurately, medical natural language processing (MLP) systems need to correctly identify and interpret temporal information. To promote research in this area, the Informatics for Integrating Biology and the Bedside (i2b2) project developed a temporally annotated corpus of clinical narratives. This corpus contains 310 de-identified discharge summaries, with annotations of clinical events, temporal expressions and temporal relations. This paper describes the process followed for the development of this corpus and discusses annotation guideline development, annotation methodology, and corpus quality. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Alopecia as the Presenting Symptom of Syphilis.

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    Ornelas, Jennifer; Agbai, Oma N; Kiuru, Maija; Sivamani, Raja K

    2015-07-15

    Alopecia can be one of the many symptoms of secondary syphilis and the clinical presentations include essential syphilitic alopecia or symptomatic syphilitic alopecia. In this report, we present a case of a patient with essential syphilitic alopecia whose sole presenting symptom of syphilis was alopecia. Despite an initial negative rapid plasma reagin (RPR) test, he was ultimately found to have syphilis on scalp biopsy. His alopecia improved following treatment with benzathine penicillin. This presentation serves as a reminder to clinicians to be cognizant of alopecia as a presenting sign of syphilis. A review of the specificity and sensitivity of the typical tests used for the diagnosis is presented.

  1. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.

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    Goren, Andy; Shapiro, Jerry; Roberts, Janet; McCoy, John; Desai, Nisha; Zarrab, Zoulikha; Pietrzak, Aldona; Lotti, Torello

    2015-01-01

    Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia (AGA) is typically observed after 3-6 months. Approximately 40% of patients will regrow hair. Given the prolonged treatment time required to elicit a response, a diagnostic test for ruling out nonresponders would have significant clinical utility. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. The aim of this study was to assess the clinical utility and validity of minoxidil response testing. In this communication, the present authors conducted an analysis of completed and ongoing studies of minoxidil response testing. The analysis confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA. © 2014 Wiley Periodicals, Inc.

  2. [Aetiology of childhood alopecia].

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    Cortés G, Andrea; Mardones V, Felipe; Zemelman D, Viviana

    2015-01-01

    Childhood alopecia is a relative rare event in general paediatric dermatology practice. Hair loss in children may have multiple causes, and there are different types of alopecia according to age groups. The aim of the study was to describe the clinical and epidemiological profile of alopecia in children from two Chilean paediatric hospitals. Descriptive analysis of clinical records of patients from the Dermatology Department of Roberto del Rio and Luis Calvo Mackenna Hospitals between January 2007 and June 2010. Patients with clinical diagnosis of alopecia were included. A total of 345 clinical records were analysed, with 179 males (51.9%). The median age was 72 months. Overall, the most common diagnoses were: alopecia areata (AA), (36.8%), tinea capitis (TC), (21%), nevus sebaceous (13.2%), and tellogen effluvium (8.7%). According to age groups, in newborns, the most common causes were aplasia cutis and nevus sebaceous. In toddlers, pre-school and school children, the principal causes were nevus sebaceous, AA and TC. Trichotillomania was also significant in school children. In adolescents, nevus sebaceous, AA and tellogen effluvium were the most frequent diagnoses. AA was statistically associated with autoimmune disease, thyroid disease, nail disorder, psychiatric disease, and Down's syndrome. The most common aetiological agent in TC was M. canis (86.6%). Trichotillomania was also statistically associated to psychiatric disorders. In this study, the main causes of alopecia in children were acquired and non-scarring alopecia. In our results, the type of alopecia varies according to age group. Some types of childhood alopecia showed a close correlation to psychiatric disorders. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Narrative medicine in clinical genetics practice.

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    Nowaczyk, Małgorzata J M

    2012-08-01

    Over the last 30 years medicine has undergone a significant paradigm shift. Due to the tremendous advances of modern medicine more and more people are living longer with their illnesses. These people have stories to tell, and they want these stories to be heard: They are reclaiming their voices. As clinical geneticists we need to hear what these voices are telling us, especially so in our area of clinical care where cures are rare, and disease states can be permanent. Narrative medicine is an important new skill set that hones abilities to do just that.This article highlights how integral narrative medicine is to clinical genetics practice, how geneticists already employ many of its tools and how they practice it diligently every day. I will show how geneticists can further improve their abilities to hear and honor patients' stories by writing and sharing stories with patients and with each other as doctors, counselors, and nurses, social workers and chaplains. The review presents the skills of close reading and how they improve patient care and illustrates how geneticists can, by using reflective writing, reshape their emotions in order to understand them, to let them go, and to make room for more. It presents the major types of illness narratives whose recognition allows us to hear and understand patients' stories. When used, the tools of narrative medicine can result in better patient care. Copyright © 2012 Wiley Periodicals, Inc.

  4. Randomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese men.

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    Tsuboi, Ryoji; Arano, Osamu; Nishikawa, Tooru; Yamada, Hidekazu; Katsuoka, Kensei

    2009-08-01

    Minoxidil is efficacious in inducing hair growth in patients with androgenetic alopecia by inducing hair follicles to undergo transition from the early to late anagen phase. Although the efficacy of 1% topical minoxidil has been confirmed in Japan, no controlled study of 5% topical minoxidil has been conducted using male Japanese subjects. The objective of this trial was to verify the superiority in clinical efficacy of 5% topical minoxidil to 1% topical minoxidil in a double-blind controlled study with male, Japanese androgenetic alopecia patients as the subjects. The trial included 300 Japanese male patients aged 20 years or older with androgenetic alopecia who were administered either 5% topical minoxidil (n = 150) or 1% topical minoxidil (n = 150) for 24 weeks. The mean change from the baseline in non-vellus hair/cm(2), the primary efficacy variable, was 26.4 (n = 142) in the 5% topical minoxidil group and 21.2 (n = 144) in the 1% topical minoxidil group at 16 weeks, the main time point for the evaluation. The difference between the groups was significant (P = 0.020). The incidence of adverse events was 8.7% (13/150) in the 5% group and 5.3% (8/150) in the 1% group, with no significant difference between the groups (chi(2)-test: P = 0.258). Our findings confirmed the superiority of 5% topical minoxidil to 1% topical minoxidil in treating Japanese men with androgenetic alopecia.

  5. Metabolic syndrome in androgenic alopecia.

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    Gopinath, Hima; Upadya, Gatha M

    2016-01-01

    Androgenic alopecia has been associated with an increased risk of coronary heart disease in various studies. The relationship between androgenic alopecia and metabolic syndrome, a known risk factor for atherosclerotic cardiovascular disease, is still poorly understood. To study the association between metabolic syndrome and early-onset androgenic alopecia. A hospital-based analytical cross-sectional study was done on men in the age group of 18-55 years. Eighty five clinically diagnosed cases with early-onset (alopecia of Norwood grade III or above, and 85 controls without androgenic alopecia were included. Data collected included anthropometric measurements, arterial blood pressure and history of chronic diseases. Fasting blood and lipid profile were determined. Metabolic syndrome was diagnosed as per the new International Diabetes Federation criteria. Chi-square and Student's t-test were used for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 17.00. Metabolic syndrome was seen in 19 (22.4%) patients with androgenic alopecia and 8 (9.4%) controls (P = 0.021). Abdominal obesity, hypertension and lowered high-density lipoprotein were significantly higher in patients with androgenic alopecia versus their respective controls. The limitations of our study include small sample size in subgroups and the lack of evidence of a temporal relationship between metabolic syndrome and androgenic alopecia. A higher prevalence of metabolic syndrome is seen in men with early-onset androgenic alopecia. Early screening for metabolic syndrome and its components is beneficial in patients with early-onset androgenic alopecia.

  6. Treatments options for alopecia.

    Science.gov (United States)

    Iorizzo, Matilde; Tosti, Antonella

    2015-01-01

    Hair disorders have a very high social and psychological impact. Treatment is often frustrating and time-consuming both for the patients and the clinicians and requires special skills and expertise. This paper aims to provide an overview of available treatments for the most common forms of alopecia in adults (androgenetic alopecia [AGA], alopecia areata and cicatricial alopecias) after reviewing the literature in PubMed, Google Scholar and ClinicalTrial.gov. Before starting treatment, it is very important to confirm diagnosis and discuss patient's expectations. Treatment of hair disorders requires time and first results are usually visible a few months after beginning of therapy. Treatment of most hair disorders is mostly not evidenced-based as randomized controlled trials are available only for AGA.

  7. Alopecia areata

    Science.gov (United States)

    ... the immune system mistakenly attacks and destroys healthy body tissue. Some people with this condition have a family history of alopecia . Alopecia areata is seen in men, women, and children. In a few people, hair loss may occur after a major life event ...

  8. Clinical characteristics and HLA alleles of a family with simultaneously occurring alopecia areata.

    Science.gov (United States)

    Emre, Selma; Metin, Ahmet; Caykoylu, Ali; Akoglu, Gulsen; Ceylan, Gülay G; Oztekin, Aynure; Col, Esra S

    2016-06-01

    Alopecia areata (AA) is a T-cell-mediated autoimmune disease resulting in partial or total noncicatricial hair loss. HLA class II antigens are the most important markers that constitute genetic predisposition to AA. Various life events and intense psychological stress may play an important role in triggering AA attacks. We report an unusual case series of 4 family members who had simultaneously occurring active AA lesions. Our aim was to evaluate the clinical and psychiatric features of 4 cases of active AA lesions occurring simultaneously in a family and determine HLA alleles. The clinical and psychological features of all patients were examined. HLA antigen DNA typing was performed by polymerase chain reaction with sequence-specific primers. All patients had typical AA lesions over the scalp and/or beard area. Psychological examinations revealed obsessive-compulsive personality disorder in the proband's parents as well as anxiety and lack of self-confidence in both the proband and his sister. HLA antigen types were not commonly shared with family members. These findings suggest that AA presenting concurrently in members of the same family was not associated with genetic predisposition. Shared psychological disorders and stressful life events might be the major key points in the concurrent presentation of these familial AA cases and development of resistance against treatments.

  9. Two different trichoscopic patterns of mid-frontal scalp in patients with frontal fibrosing alopecia and clinical features of androgenetic alopecia

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    Adriana Rakowska

    2017-03-01

    Full Text Available Introduction . Frontal fibrosing alopecia is a primary lymphocytic cicatricial alopecia with progressive frontotemporal hairline recession. In some cases, hair loss in the mid-frontal scalp, similar to female pattern hair loss, may be observed. Objective. Assessment of the trichoscopic pattern of mid-frontal scalp hair loss in patients diagnosed with frontal fibrosing alopecia. Material and methods. The retrospective analysis included 31 women diagnosed with frontal fibrosing alopecia and hair loss in the mid-frontal scalp and 36 women diagnosed with female pattern hair loss. Results . In patients with frontal fibrosing alopecia two different trichoscopic patterns in the mid-frontal scalp were identified. In 68% of patients (21/31 we observed a diffuse fibrotic pattern. It was characterized by irregular arrangement of follicular units with small areas with loss of follicular units, an increased percentage of follicular units with one hair and a decreased percentage of follicular units with three hairs, normal hair shaft thickness and presence of mild perifollicular scaling. The androgenetic alopecia pattern was present in 32% of patients (10/31. It was characterized by hair shaft thickness diversity (20% or more, a percentage of vellus hairs higher than 10%, presence of yellow dots, an increased percentage of follicular units with one hair and a decreased percentage of follicular units with three hairs. Conclusions. In patients with frontal fibrosing alopecia and coexisting mid-frontal scalp hair loss, we identified two different patterns of this area in trichoscopy: the diffuse fibrotic pattern (more common and the androgenetic alopecia pattern. This observation may have therapeutic and prognostic implications.

  10. Alopecia areata: Update on management

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    Julie S Kranseler

    2017-01-01

    Full Text Available Alopecia areata (AA is a common autoimmune nonscarring alopecia. AA presents heterogeneously and is influenced by both environmental and genetic factors. Diagnosis is clinical after ruling out other local or systemic causes of alopecia. Standard first-line therapy is typically topical steroids, but the response can be frustrating. Novel treatment options have shown great promise in the management of the refractory disease. We review initial data on topical and systemic Janus kinase inhibitors (tofacitinib, ruxolitinib, and baricitinib, topical bimatoprost, simvastatin/ezetimibe, and excimer laser therapy among others within the context of a general approach to AA management.

  11. Histologic features of alopecias: part II: scarring alopecias.

    Science.gov (United States)

    Bernárdez, C; Molina-Ruiz, A M; Requena, L

    2015-05-01

    The diagnosis of disorders of the hair and scalp can generally be made on clinical grounds, but clinical signs are not always diagnostic and in some cases more invasive techniques, such as a biopsy, may be necessary. This 2-part article is a detailed review of the histologic features of the main types of alopecia based on the traditional classification of these disorders into 2 major groups: scarring and nonscarring alopecias. Scarring alopecias are disorders in which the hair follicle is replaced by fibrous scar tissue, a process that leads to permanent hair loss. In nonscarring alopecias, the follicles are preserved and hair growth can resume when the cause of the problem is eliminated. In the second part of this review, we describe the histologic features of the main forms of scarring alopecia. Since a close clinical-pathological correlation is essential for making a correct histopathologic diagnosis of alopecia, we also include a brief description of the clinical features of the principal forms of this disorder. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  12. What Is Alopecia Areata?

    Science.gov (United States)

    ... Kids Pages Breadcrumb Home Health Topics English Español Alopecia Areata Basics In-Depth Download Download EPUB Download PDF What is it? Points To Remember About Alopecia Areata Alopecia areata causes hair to fall out. ...

  13. Suffering from Alopecia Areata

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    mitra Safa

    2008-02-01

    Full Text Available Safa M1, Jebraili2, Momen-nasab M3 1. Assistant Professor, Department of Psychiatry, School of Medicine, Lorestan University of Medical Sciences 2. Assistant Professor, Department of Dermatology, Faculty of Medicine, Lorestan University of Medical Sciences 3. Instructor, Department of Nursing, Lorestan University of Medical Sciences Abstract Background: Some of the skin diseases cause severe stress in patients and relieving these stresses greatly helps to treat the underlying disease. Alopecia areata is one of the common causes of alopecia which is an autoimmune disease. Other factors like genetics and psychological factors have important roles in the beginning or exacerbation of the disease. This study aimed to determine the frequency of depression and anxiety disorders in patient suffering from alopecia areata. Materials and methods: In this descriptive study, 80 patients with alopecia areata who had referred to dermatologic clinic of Shohaday-e Ashayer hospital in Khorramabad from 1382 to 1383(Hj. were evaluated. After filling the questionnaires, the patients were referred to the Psychiatric Clinic and the cases were diagnosed by interviews using SCL-90 test and DSM-IV-IIIR scale. The analysis of data was done by the SPSS software. Results: 80 patients were selected as the subjects of the study. including 52 men (65% and 28 women (35%. 43 patients (53.8% were less than 25 years old and 54 (67.5% were unmarried. 56 patients (70% had a family history of alopecia areata and 45 (56.25% had no history of drug intake. In most of the patients (63.8% the site of the first lesion was the scalp. Out of 80 patients, 64 (80% had anxiety and 60 (75% had depression. 27 (33.3% had major depressive disorders. These findings were statistically significant. Major depressive disorders were more in women. No correlation was found between education, marital status, family history, and the history of drug intake, and the site of first lesion. Conclusion: The

  14. Narratives of neoliberalism: 'clinical labour' in context.

    Science.gov (United States)

    Parry, Bronwyn

    2015-06-01

    Cross-border reproductive care has been thrust under the international spotlight by a series of recent scandals. These have prompted calls to develop more robust means of assessing the exploitative potential of such practices and the need for overarching and normative forms of national and international regulation. Allied theorisations of the emergence of forms of clinical labour have cast the outsourcing of reproductive services such as gamete donation and gestational surrogacy as artefacts of a wider neoliberalisation of service provision. These accounts share with many other narratives of neoliberalism a number of key assertions that relate to the presumed organisation of labour relations within this paradigm. This article critically engages with four assumptions implicit in these accounts: that clinical labourers constitute a largely homogeneous underclass of workers; that reproductive labour has been contractualised in ways that disembed it from wider social and communal relations; that contractualisation can provide protection for clinical labour lessening the need for formal regulatory oversight; and that the transnationalisation of reproductive service labour is largely unidirectional and characterised by a dynamic of provision in which 'the rest' services 'the West'. Drawing on the first findings of a large-scale ethnographic research project into assisted reproduction in India I provide evidence to refute these assertions. In so doing the article demonstrates that while the outsourcing and contractualisation of reproductive labour may be embedded in a wider neoliberal paradigm these practices cannot be understood nor their impacts be fully assessed in isolation from their social and cultural contexts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Nail Involvement in Alopecia Areata: A Questionnaire-based Survey on Clinical Signs, Impact on Quality of Life and Review of the Literature

    NARCIS (Netherlands)

    Roest, Y.B.M.; Middendorp, H.T. van; Evers, A.W.M.; Kerkhof, P.C.M. van de; Pasch, M.C.

    2018-01-01

    Alopecia areata (AA) is an immune-mediated disease causing temporary or permanent hair loss. Up to 46% of patients with AA also have nail involvement. The aim of this study was to determine the presence, types, and clinical implications of nail changes in patients with AA. This questionnaire-based

  16. Design of an extensive information representation scheme for clinical narratives.

    Science.gov (United States)

    Deléger, Louise; Campillos, Leonardo; Ligozat, Anne-Laure; Névéol, Aurélie

    2017-09-11

    Knowledge representation frameworks are essential to the understanding of complex biomedical processes, and to the analysis of biomedical texts that describe them. Combined with natural language processing (NLP), they have the potential to contribute to retrospective studies by unlocking important phenotyping information contained in the narrative content of electronic health records (EHRs). This work aims to develop an extensive information representation scheme for clinical information contained in EHR narratives, and to support secondary use of EHR narrative data to answer clinical questions. We review recent work that proposed information representation schemes and applied them to the analysis of clinical narratives. We then propose a unifying scheme that supports the extraction of information to address a large variety of clinical questions. We devised a new information representation scheme for clinical narratives that comprises 13 entities, 11 attributes and 37 relations. The associated annotation guidelines can be used to consistently apply the scheme to clinical narratives and are https://cabernet.limsi.fr/annotation_guide_for_the_merlot_french_clinical_corpus-Sept2016.pdf . The information scheme includes many elements of the major schemes described in the clinical natural language processing literature, as well as a uniquely detailed set of relations.

  17. Alopecia frontal fibrosante: relato de seis casos Frontal fibrosing alopecia: report of six cases

    Directory of Open Access Journals (Sweden)

    Fabiane Mulinari-Brenner

    2007-10-01

    Full Text Available Alopecia frontal fibrosante é forma progressiva de alopecia cicatricial. Os casos iniciais foram relatados a partir 1994, na Austrália, em pacientes do sexo feminino pós-menopausa. Desde então inúmeros casos foram descritos na literatura sugerindo que ela é mais prevalente do que inicialmente se supunha. Seu curso progressivo se assemelha ao da alopecia androgenética; histologicamente, entretanto, o infiltrado liquenóide é evidente. O artigo relata seis casos brasileiros e discute a alopecia frontal fibrosante dentro do grupo das alopecias cicatriciais, como variante do líquen plano pilar.Frontal fibrosing alopecia is a progressive cicatricial alopecia. The first cases were described in Australia in postmenopausal women, in 1994. Since then, numerous cases were reported, suggesting that frontal fibrosing alopecia is more prevalent than initially thought. Its progressive course in postmenopausal women, clinically resembles androgenetic alopecia; however, histologically, lichenoid infiltrate is evident. This article report six brazilian cases of frontal fibrosing alopecia and discusses them in the context of cicatricial alopecias, as a variant of lichen planopilaris.

  18. Central centrifugal cicatricial alopecia amalgamated with alopecia areata: immunologic findings

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    Ana Maria Abreu Velez

    2014-07-01

    Full Text Available Introduction: Both scarring and non-scarring alopecias exist; however, rare cases demonstrate features of both classes. Case Report: We describe an interesting alopecia case with amalgamated clinical, histologic and immunopathologic features of scarring and non-scarring alopecia. Specifically, the case displays combined features of alopecia areata (AA and of central centrifugal cicatricial alopecia (CCCA. A 36 year old female presented with symmetric, round, patchy hair loss on her scalp. Methods: Biopsies for hematoxylin and eosin (H&E examination, as well as for special stains, direct immunofluorescence (DIF and immunohistochemistry (IHC were performed. Results: The H&E biopsy revealed focally diminished hair follicular units, and sebaceous gland damage. Perifollicular concentric fibrosis was confirmed by Verhoeff elastin special staining. Antibodies to micelles were noted. Positive IHC staining for CD4, CD8, CD45 and multiple proteases and protease inhibitors was noted around selected follicular unit remnants. Conclusion: We present a rare alopecia, combining histologic features of CCCA with additional, selected immunologic features of AA.

  19. Traction alopecia: the root of the problem

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    Billero V

    2018-04-01

    Full Text Available Victoria Billero, Mariya MitevaDepartment of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USAAbstract: Traction alopecia (TA affects one-third of women of African descent who wear various forms of traumatic hairstyling for a prolonged period of time. The risk of TA is increased by the extent of pulling and duration of traction, as well as the use of chemical relaxation. The frequent use of tight buns or ponytails, the attachment of weaves or hair extensions, and tight braids (such as cornrows and dreadlocks are believed to be the highest risk hairstyles. TA can also occur in the setting of religious and occupational traumatic hairstyling. In its later stages, the disease may progress into an irreversible scarring alopecia if traumatic hairstyling continues without appropriate intervention. The most common clinical presentation includes marginal alopecia and non-marginal patchy alopecia. A clue to the clinical diagnosis is the preservation of the fringe sign as opposed to its loss in frontal fibrosing alopecia (FFA. Dermoscopy can be helpful in the diagnosis and can detect the ongoing traction by the presence of hair casts. Histopathology can distinguish TA from alopecia areata, FFA, and patchy central centrifugal cicatricial alopecia. Currently, there is no cure. Therefore, it is imperative that clinicians educate high-risk populations about TA and those practices that may convey the risk of hair loss. Keywords: hair loss, alopecia, dermoscopy, trichoscopy, traction alopecia, African-American 

  20. Male androgenetic alopecia

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    Zekayi Kutlubay

    2014-06-01

    Full Text Available Androgenetic alopecia (AGA is a form of hair loss due to the effects of androgens, in genetically susceptible individuals. This disease is seen very commonly in every population and causes increased amount of stress for the patients. The disease is known from very early ages and is first medically described by Hamilton. The pathogenesis of the disease can be based on age, genetic factors, and androgens. Clinically alopecia is observed on the temporal and vertex areas, during postpubertal period. Vellus like hairs are pathognomonic for the disease. The decrease in anagen/telogen ratio is detected in histopathological examination. The treatment consists of topical mioxidil, oral finasteride and commonly used surgical methods.

  1. Dermoscopic findings in cicatricial alopecia

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    Seher Arı

    2013-12-01

    Full Text Available Background: Dermoscopy is an important tool for the diagnosis of pigmented skin lesions. Newly, this method has also been used in the diagnosis and follow-up hair and scalp disorders. Objective: The objective of this study was to investigate dermoscopic findings in a sample of patients with clinical and histopathological compatible with cicatricial alopecia. Methods: Twenty nine patients with cicatricial alopecia diagnosed by clinical and histological findings were examined by dermoscopy.. Results: Dermoscopic features evaluated included folliculitis decalvans (n=8, pseudopelade of Brocq (n=7, lichen planopilaris (n=6, discoid lupus erythematosus (n=2, dissecting cellulitis (n=1, and secondary cicatricial alopecia (n=5. Visualization of structures previously examined with naked eye were seen in great detail with dermoscopy. The loss of follicular orifices was seen in all patients with cicatricial alopecia. Perifollicular scaling, arborizing red lines, honeycomb pigment pattern, white dots and tufted hairs were the other most obvious findings. Conclusion: Use of dermoscopy in the clinical evaluation of cicatrical alopecia improves diagnostic capability beyond simple clinic inspection, but larger studies correlating dermoscopic findings with histopathology exams are needed to improve understanding of this method.

  2. The effectiveness of the hair-restorer "Dabao" in males with alopecia androgenetica. A clinical experiment.

    Science.gov (United States)

    Kessels, A G; Cardynaals, R L; Borger, R L; Go, M J; Lambers, J C; Knottnerus, J A; Knipschild, P G

    1991-01-01

    In a randomized, double-blind trial the effectiveness of 6 months' use of a Chinese herb extract (Dabao) as a hair-restorer was studied on 396 males with alopecia androgenetica. The effect was evaluated by nonvellus hair counts, participants' opinions and a panel's judgement of a photo-report. Twenty-three participants withdrew prematurely from the study. In both the Dabao and placebo groups an increase in the amount of hair was observed; 133 and 109 hairs on a 5 cm2 marked area, a difference of 24 hairs (p = 0.03, one-sided). Participants as well as the panel reached a similar conclusion. Regarding cosmetic effect, 42% of the participants in the Dabao group and 37% in the placebo group reported positive results. The average panel score for the cosmetic result on a scale of -10 to +10 was 0.46 in the Dabao and 0.21 in the placebo group, a difference of 0.24 (p = 0.04, one-sided). It appears from our study that, although the cosmetic effect over 6 months is modest, Dabao does have a certain effect on the growth of nonvellus hair.

  3. Traction alopecia: the root of the problem.

    Science.gov (United States)

    Billero, Victoria; Miteva, Mariya

    2018-01-01

    Traction alopecia (TA) affects one-third of women of African descent who wear various forms of traumatic hairstyling for a prolonged period of time. The risk of TA is increased by the extent of pulling and duration of traction, as well as the use of chemical relaxation. The frequent use of tight buns or ponytails, the attachment of weaves or hair extensions, and tight braids (such as cornrows and dreadlocks) are believed to be the highest risk hairstyles. TA can also occur in the setting of religious and occupational traumatic hairstyling. In its later stages, the disease may progress into an irreversible scarring alopecia if traumatic hairstyling continues without appropriate intervention. The most common clinical presentation includes marginal alopecia and non-marginal patchy alopecia. A clue to the clinical diagnosis is the preservation of the fringe sign as opposed to its loss in frontal fibrosing alopecia (FFA). Dermoscopy can be helpful in the diagnosis and can detect the ongoing traction by the presence of hair casts. Histopathology can distinguish TA from alopecia areata, FFA, and patchy central centrifugal cicatricial alopecia. Currently, there is no cure. Therefore, it is imperative that clinicians educate high-risk populations about TA and those practices that may convey the risk of hair loss.

  4. [Drug treatment of alopecia].

    Science.gov (United States)

    Wolff, H

    2015-10-01

    Alopecia is the term used to describe hairless areas of the scalp. They can follow a specific pattern, be diffuse or circumscript. Androgenetic alopecia (AGA) follows a pattern: in men thinning of temples and vertex up to total baldness; in women thinning of the midline or parietal area. Lack of iron or cytostatic drugs cause diffuse alopecia, while in autoimmune diseases such as alopecia areata or lichen planus bizarre shapes of hairless areas are observed. For therapy, the following medications are used: topical minoxidil solution for AGA of men and women; systemic finasteride 1 mg for men with AGA; topical diphencyprone immunotherapy for alopecia areata; systemic antimycotic agents for tinea capitis; antibiotics such as clindamycin and rifampicin for folliculitis decalvans; systemic corticosteroids and isotretinoin for folliculitis et perifolliculitis capitis abscedens et suffodiens; topical corticosteroids for lichen planus and Kossard's frontal fibrosing alopecia.

  5. Topical Melatonin for Treatment of Androgenetic Alopecia

    OpenAIRE

    Fischer, Tobias W; Tr?eb, Ralph M; H?nggi, Gabriella; Innocenti, Marcello; Elsner, Peter

    2012-01-01

    Background: In the search for alternative agents to oral finasteride and topical minoxidil for the treatment of androgenetic alopecia (AGA), melatonin, a potent antioxidant and growth modulator, was identified as a promising candidate based on in vitro and in vivo studies. Materials and Methods: One pharmacodynamic study on topical application of melatonin and four clinical pre-post studies were performed in patients with androgenetic alopecia or general hair loss and evaluated by standardise...

  6. Tick Bite Alopecia: A Report and Review.

    Science.gov (United States)

    Lynch, Michael C; Milchak, Marissa A; Parnes, Herbert; Ioffreda, Michael D

    2016-11-01

    Tick bites can cause a number of local inflammatory reactions, which are often difficult to differentiate from those induced by other arthropod bites or stings. These include erythematous nodular or pustular lesions, erosive plaques, annular lesions of erythema chronicum migrans, and both scarring and nonscarring inflammatory alopecia. We report a case of nonscarring alopecia in a 21-year-old male who reported a recent history of tick bite to the scalp. The biopsy demonstrated a dense pseudolymphomatous inflammatory infiltrate with numerous eosinophils associated with hair follicle miniaturization and an elevated catagen-telogen count. Signs of external rubbing, including lichen simplex chronicus and the "hamburger sign", were also visualized and are indicative of the associated pruritus. To the authors' knowledge, this is the fifth report of nonscarring tick bite alopecia in the literature and the first in an adult patient. This text will review the classic clinical presentation, histologic findings, and proposed mechanism of tick bite alopecia.

  7. A study of peripheral T-Lymphocytes in alopecia areata

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    Sharma R

    1995-01-01

    Full Text Available Estimation of peripheral T-lymphocytes (active and total was carried out in 100 cases of alopecia areata as per method described by Boyam (1977 and West et al (1978. Clinically patients were divided in two groups, alopecia areata circumscribed (group I and severe alopecia areata (group II. Thirty healthy subjects served as controls. Decrease in percentage of both active and total E-RFC was observed in 70% cases. The decrease was more significant in group II.

  8. Trichoscopy of alopecia areata: An update.

    Science.gov (United States)

    Waśkiel, Anna; Rakowska, Adriana; Sikora, Mariusz; Olszewska, Małgorzata; Rudnicka, Lidia

    2018-03-22

    The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6-100% patients), short vellus hairs (34-100%), black dots (0-84%), broken hairs (0-71%) and exclamation mark hairs (12-71%). Tapered hairs (5-81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11-96%), pigtail (circle) hairs (4-61%) and Pohl-Pinkus constrictions (2-10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature. © 2018 Japanese Dermatological Association.

  9. Alopecia in four kittens caused by abnormal maternal licking behaviour.

    Science.gov (United States)

    Fanton, N; Michelazzi, M; Cornegliani, L

    2015-11-01

    Abnormal maternal behaviour has been reported in cats, but is generally not included among the causes of alopecia in kittens. A litter of four kittens, 2 months old, was referred for evaluation of facial alopecia of differing severity. The 2-year-old queen was unaffected. Dermatological examination of the kittens did not find any infectious cause. Trichograms showed broken hair shafts with longitudinal splitting. Congenital alopecia was unlikely based on the clinical presentation. A behavioural consultation revealed abnormal grooming behaviour by the mother, who chewed and removed the hair from the kittens. The kittens were separated from the queen and alopecia resolved within a few weeks. To the authors' knowledge, this is the first report of alopecia caused by abnormal maternal licking behaviour. Abnormal maternal behaviour should be considered in cases of alopecia affecting a litter of kittens, when infectious and congenital causes have been ruled out. © 2015 Australian Veterinary Association.

  10. Extraction of events and temporal expressions from clinical narratives.

    Science.gov (United States)

    Jindal, Prateek; Roth, Dan

    2013-12-01

    This paper addresses an important task of event and timex extraction from clinical narratives in context of the i2b2 2012 challenge. State-of-the-art approaches for event extraction use a multi-class classifier for finding the event types. However, such approaches consider each event in isolation. In this paper, we present a sentence-level inference strategy which enforces consistency constraints on attributes of those events which appear close to one another. Our approach is general and can be used for other tasks as well. We also design novel features like clinical descriptors (from medical ontologies) which encode a lot of useful information about the concepts. For timex extraction, we adapt a state-of-the-art system, HeidelTime, for use in clinical narratives and also develop several rules which complement HeidelTime. We also give a robust algorithm for date extraction. For the event extraction task, we achieved an overall F1 score of 0.71 for determining span of the events along with their attributes. For the timex extraction task, we achieved an F1 score of 0.79 for determining span of the temporal expressions. We present detailed error analysis of our system and also point out some factors which can help to improve its accuracy. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Narratives of social justice: learning in innovative clinical settings.

    Science.gov (United States)

    Reimer Kirkham, Sheryl; Van Hofwegen, Lynn; Hoe Harwood, Catherine

    2005-01-01

    The nursing profession has renewed its commitment to social and political mandates, resulting in increasing attention to issues pertaining to diversity, vulnerable populations, social determinants of health, advocacy and activism, and social justice in nursing curricula. Narratives from a qualitative study examining undergraduate nursing student learning in five innovative clinical settings (corrections, international, parish, rural, and aboriginal) resonate with these curricular emphases. Data were derived from focus groups and interviews with 65 undergraduate nursing students, clinical instructors, and RN mentors. Findings of this study reveal how students in innovative clinical placements bear witness to poverty, inequities, and marginalization (critical awareness), often resulting in dissonance and soul-searching (critical engagement), and a renewed commitment to social transformation (social change). These findings suggest the potential for transformative learning in these settings.

  12. Androgenetic alopecia: stress of discovery.

    Science.gov (United States)

    Passchier, Jan; Erdman, Jeroen; Hammiche, Fatima; Erdman, Ruud A M

    2006-02-01

    The psychological problems of men in the initial stages of alopecia androgenetica (hereditary male hair loss) have seldom been studied. We evaluated two groups of 80 men with alopecia androgenetica in Stages II to IV, indicating the amount of hair loss (overall N=160; for Group I: M=48 yr., SD=18.2; for Group II: M=50 yr., SD=18.0) who visited a dermatology clinic for benign dermatological complaints but not for hair loss, by questionnaires and interview, retrospectively. As predicted, hair problems were reported to be significantly greater overall at the moment of discovery of hair loss than later. About half of the men reported feeling annoyed to very annoyed about the discovery of hair loss. For those patients, provision of information by internet might facilitate a visit to the dermatologist.

  13. Nail Involvement in Alopecia Areata: A Questionnaire-based Survey on Clinical Signs, Impact on Quality of Life and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Yvonne B.M. Roest

    2017-10-01

    Full Text Available Alopecia areata (AA is an immune-mediated disease causing temporary or permanent hair loss. Up to 46% of patients with AA also have nail involvement. The aim of this study was to determine the presence, types, and clinical implications of nail changes in patients with AA. This questionnaire-based survey evaluated 256 patients with AA. General demographic variables, specific nail changes, nail-related quality of life (QoL, and treatment history and need were evaluated. Prevalence of nail involvement in AA was 64.1%. The specific nail signs reported most frequently were pitting (29.7%, p = 0.008 and trachyonychia (18.0%. Red spots on the lunula were less frequent (5.1%, but very specific for severe AA. Nail-related QoL was only minimally affected by nail changes. In conclusion, nail involvement is common in patients with AA and presents mostly with pitting and trachyonychia. The presence of these nail changes reflects the severity of the disease, with red spots on the lunula as a predictor for severe alopecia

  14. Color dilution alopecia in a blue Doberman pinscher crossbreed

    OpenAIRE

    Perego, Roberta; Proverbio, Daniela; Roccabianca, Paola; Spada, Eva

    2009-01-01

    A 6-year-old male, blue Doberman pinscher crossbreed was presented with coat abnormalities; in particular, flank alopecia and pruritus. Based on medical the history, clinical evidence, and histopathological examination, color dilution alopecia was diagnosed. The dog was with oral melatonin treated for 3 months without success.

  15. Color dilution alopecia in a blue Doberman pinscher crossbreed.

    Science.gov (United States)

    Perego, Roberta; Proverbio, Daniela; Roccabianca, Paola; Spada, Eva

    2009-05-01

    A 6-year-old male, blue Doberman pinscher crossbreed was presented with coat abnormalities; in particular, flank alopecia and pruritus. Based on medical the history, clinical evidence, and histopathological examination, color dilution alopecia was diagnosed. The dog was with oral melatonin treated for 3 months without success.

  16. Improving Layman Readability of Clinical Narratives with Unsupervised Synonym Replacement.

    Science.gov (United States)

    Moen, Hans; Peltonen, Laura-Maria; Koivumäki, Mikko; Suhonen, Henry; Salakoski, Tapio; Ginter, Filip; Salanterä, Sanna

    2018-01-01

    We report on the development and evaluation of a prototype tool aimed to assist laymen/patients in understanding the content of clinical narratives. The tool relies largely on unsupervised machine learning applied to two large corpora of unlabeled text - a clinical corpus and a general domain corpus. A joint semantic word-space model is created for the purpose of extracting easier to understand alternatives for words considered difficult to understand by laymen. Two domain experts evaluate the tool and inter-rater agreement is calculated. When having the tool suggest ten alternatives to each difficult word, it suggests acceptable lay words for 55.51% of them. This and future manual evaluation will serve to further improve performance, where also supervised machine learning will be used.

  17. Living with Alopecia Areata

    Science.gov (United States)

    ... Common Emotions with Alopecia Areata These include feeling Loneliness, withdrawal and isolation A sense of loss and grief Sadness or depression Confusion Denial Stress Anger Hopelessness Embarrassment Fear Guilt ...

  18. Anaphoric relations in the clinical narrative: corpus creation.

    Science.gov (United States)

    Savova, Guergana K; Chapman, Wendy W; Zheng, Jiaping; Crowley, Rebecca S

    2011-01-01

    The long-term goal of this work is the automated discovery of anaphoric relations from the clinical narrative. The creation of a gold standard set from a cross-institutional corpus of clinical notes and high-level characteristics of that gold standard are described. A standard methodology for annotation guideline development, gold standard annotations, and inter-annotator agreement (IAA) was used. The gold standard annotations resulted in 7214 markables, 5992 pairs, and 1304 chains. Each report averaged 40 anaphoric markables, 33 pairs, and seven chains. The overall IAA is high on the Mayo dataset (0.6607), and moderate on the University of Pittsburgh Medical Center (UPMC) dataset (0.4072). The IAA between each annotator and the gold standard is high (Mayo: 0.7669, 0.7697, and 0.9021; UPMC: 0.6753 and 0.7138). These results imply a quality corpus feasible for system development. They also suggest the complementary nature of the annotations performed by the experts and the importance of an annotator team with diverse knowledge backgrounds. Only one of the annotators had the linguistic background necessary for annotation of the linguistic attributes. The overall generalizability of the guidelines will be further strengthened by annotations of data from additional sites. This will increase the overall corpus size and the representation of each relation type. The first step toward the development of an anaphoric relation resolver as part of a comprehensive natural language processing system geared specifically for the clinical narrative in the electronic medical record is described. The deidentified annotated corpus will be available to researchers.

  19. DEVELOPMENT OF ALOPECIA DURING TREATMENT WITH A TUMOR NECROSIS FACTOR-ALPHA INHIBITOR IN A FEMALE PATIENT WITH PSORIATIC ARTHRITS: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    R. G. Mukhina

    2016-01-01

    Full Text Available Objective: to describe a case of the total development of alopecia in a female patient with psoriatic arthritis during treatment with a tumor necrosis factor-αlpha (TNF-α inhibitor. Materials and methods. Patient I., aged 36 years has been followed up at the Kazan’ Center of Rheumatic Diseases and Osteoporosis since 1998. At approximately the same time, the patient noted the appearance of skin eruptions behind the ears, on the skin of the scalp. She was examined by a dermatologist who diagnosed psoriasis. In 2005, she was admitted to Kazan’ Rheumatology Center, City Clinical Hospital Seven, for the development of obvious synovitis of the knee joint and for the inefficiency of therapy with nonsteroidal anti-inflammatory drugs and diagnosed with psoriatic arthritis. During the prescribed therapy with methotrexate 10 mg/week, evident menstrual irregularities were observed in the patient who stopped using the drug herself. The second pregnancy occurred in 2008. Articular syndrome progression and eruptive psoriasis were recorded in the lactation period. After lactation cessation in 2009, she was hospitalized again. Her examination revealed high laboratory activity (erythrocyte sedimentation rate, as high as 40 mm/hr; magnetic resonance imaging of the knee joints showed the signs of bilateral synovitis; lumbar spine radiography exhibited grade II sacroiliitis. Leflunomide 20 mg/day was recommended as a basic drug. In 2012, the patient used leflunomide, her condition worsened; joint pain progressed; new joints were involved into the process, and cutaneous manifestations were aggravated. To verify a diagnosis and to choose therapy, the patient was referred to a consultation at the Moscow Research Institute of Rheumatology. Results. In connection with the high activity of the disease and with no response to the performed therapy, it was recommended to initiate therapy with biologics, such as infliximab, the drug of choice. Seven infliximab

  20. Understanding Autoimmunity of Vitiligo and Alopecia Areata

    Science.gov (United States)

    Rork, Jillian F.; Rashighi, Mehdi; Harris, John E.

    2016-01-01

    Purpose of review Vitiligo and alopecia areata are common, disfiguring skin diseases. Treatment options are limited and include non-targeted approaches such as corticosteroids, topical calcineurin inhibitors, narrow band UVB phototherapy, and other immune-modifying agents. The purpose of this article is to review shared, novel mechanisms between vitiligo and alopecia areata, as well as discuss how they inform the development of future targeted treatments. Recent findings Vitiligo and alopecia areata are both autoimmune diseases, and striking similarities in pathogenesis have been identified at the level of both the innate and adaptive immune system. Increased reactive oxygen species and high cellular stress level have been suggested as the initiating trigger of the innate immune system in both diseases, and genome-wide association studies have implicated risk alleles that influence both innate and adaptive immunity. Most importantly, mechanistic studies in mouse models of vitiligo and alopecia areata have specifically implicated an IFN-γ-driven immune response, including IFN-γ, IFN-γ-induced chemokines, and cytotoxic CD8+ T cells as the main drivers of disease pathogenesis. These recent discoveries may reveal an effective strategy to develop new treatments, and several proof-of-concept clinical studies support this hypothesis. Summary The identification of IFN-γ-driven immune signaling pathways has enabled discoveries of potential new treatments for vitiligo and alopecia areata, and supports initiation of larger clinical trials. PMID:27191524

  1. Characteristics of leadership that influence clinical learning: a narrative review.

    Science.gov (United States)

    Walker, Rachel; Cooke, Marie; Henderson, Amanda; Creedy, Debra K

    2011-11-01

    Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Alopecia universalis in a dog with testicular neoplasia.

    Science.gov (United States)

    Outerbridge, Catherine A; White, Stephen D; Affolter, Verena K

    2016-12-01

    To describe a case of testicular neoplasia and alopecia universalis in a dog, and successful treatment of the latter with ciclosporin. Twelve-year-old intact male wirehaired fox terrier. Castration, skin biopsy for histopathology, lymphocyte immunophenotyping and clonality analysis of the canine T-cell receptor gamma locus (TCRγ) rearrangement. The dog presented with symmetrical generalized alopecia. Testicular enlargement was noted which on castration was determined to be caused by bilateral interstitial cell tumours, Sertoli cell tumours and a unilateral seminoma. During the four months after castration the alopecia became more severe and widespread. Histopathology of the skin showed moderate, multifocal, mural folliculitis, peribulbar mucinosis and lymphocytic bulbitis, and targeting of anagen hair follicles. Immunophenotyping of the infiltrate showed a population of well-differentiated, small CD3-positive T lymphocytes, some expressing CD4 and others CD8. Molecular analysis revealed a polyclonal lymphocytic infiltrate, substantiating the diagnosis of alopecia areata rather than lymphoma. Treatment with ciclosporin (4.6 mg/kg) and ketoconazole (4.6 mg/kg) resulted in complete hair regrowth. Ciclosporin treatment, in combination with ketoconazole, can be effective for treatment of alopecia universalis in the dog. Alopecia universalis may present with clinically noninflammatory, symmetrical, generalized alopecia, mimicking an endocrine alopecia, and skin biopsies are needed to confirm the diagnosis. © 2016 ESVD and ACVD.

  3. Scalp hyperkeratosis and alopecia in children of color.

    Science.gov (United States)

    Coley, Marcelyn K; Bhanusali, Dhaval G; Silverberg, Jonathan I; Alexis, Andrew F; Silverberg, Nanette B

    2011-05-01

    Scalp hyperkeratosis and/or alopecia are common pediatric dermatologic findings. In Caucasian children, scalp hyperkeratosis of childhood is most often associated with atopic and seborrheic dermatides. Recent data is lacking on the clinical meaning of scalp hyperkeratosis and alopecia in children of color. To determine diagnosis associated with scalp hyperkeratosis and/or alopecia in a predominately Black and Hispanic pediatric patient population. A retrospective chart review was conducted for all children (0-17 years of age) seen at our institution who had a scalp fungal culture for the evaluation of scalp hyperkeratosis and/or alopecia from January 2007 to September 2009. Fungal culture was performed using cotton swab technique, plating onto Sabouraud's and Mycosel media. Demographic features, fungal culture results, clinical symptoms, physical findings and final diagnosis were reviewed. 164 children were identified who were eligible for inclusion in the study, 75 of whom were Black and 56 Hispanic/Latino. Scalp hyperkeratosis was noted in 106 patients and alopecia was noted in 71 subjects. Tinea capitis was the final diagnosis in 50 out of 80 children who had hyperkeratosis without alopecia (60%), 16 of 43 children with alopecia alone (37.2%) and 23 of 28 children with both hyperkeratosis and alopecia (82.1%, P=0.0007). The odds ratio of tinea capitis in the presence of hyperkeratosis with alopecia was 7.49 with a 95 percent confidence limit of 2.19-25.70. Scalp hyperkeratosis, especially when accompanied by alopecia, is usually associated with tinea capitis in Black and Hispanic children. Fungal culture and empirical anti-fungal therapy are warranted in children of color with scalp hyperkeratosis.

  4. Alopecia Following Bicoronal Incisions.

    Science.gov (United States)

    Kadakia, Sameep; Badhey, Arvind; Ashai, Sara; Lee, Thomas S; Ducic, Yadranko

    2017-05-01

    Multiple techniques may be used to perform bicoronal incisions, and alopecia is a known postoperative complication of this procedure. To date, no large studies exist comparing alopecia outcomes among bicoronal incision techniques with and without the use of Raney clips. To determine (1) whether postoperative alopecia is more common when bicoronal incisions are performed with monopolar cautery, Colorado microdissection tip cautery, or traditional cold steel and (2) whether this outcome is affected by the use of Raney clips. This retrospective study of postoperative alopecia included 505 patients undergoing bicoronal incisions in a single head and neck surgery practice from 1997 to 2015 with a minimum follow-up of 1 year. Patients with preexisting baldness as well as patients not following up for the minimum period were excluded. All data analysis took place between 1997 and 2015. Maximum alopecia width was measured in the postoperative period and compared among the technique groups both with and without Raney clip use. Raney clip duration as a product of surgery length was also compared. A total of 505 patients (301 male, 204 female) ranging in age from 3 to 97 years were included in the study (median age, 53.9 years). Of these, 236 underwent bicoronal incisions to approach the skull base, 78 to treat chronic frontal sinusitis unresponsive to endoscopic management or frontal sinus mucocele, 143 for trauma, and 48 for craniofacial surgery. For 173 patients, the cold steel technique was used for both skin and subcutaneous incision, 102 of whom needed Raney clips. For 161 patients, cold steel technique was used for skin incisions and monopolar cautery for subcutaneous incision; 81 of these patients required Raney clips. For 171 patients, Colorado tip microdissection cautery was used for both skin and subcutaneous incision, with Raney clips used in 66 of these patients. Incisions made with cold steel for both skin and subcutaneous tissue, regardless of Raney clip use

  5. Struggle and failure on clinical placement: a critical narrative review.

    Science.gov (United States)

    Davenport, Rachel; Hewat, Sally; Ferguson, Alison; McAllister, Sue; Lincoln, Michelle

    2018-03-01

    Clinical placements are crucial to the development of skills and competencies in speech-language pathology (SLP) education and, more generally, a requirement of all health professional training programmes. Literature from medical education provides a context for understanding how the environment can be vital to all students' learning. Given the increasing costs of education and demands on health services, students who struggle or fail on clinical placement place an additional burden on educators. Therefore, if more is known or understood about these students and their experience in relation to the clinical learning environment, appropriate strategies and support can be provided to reduce the burden. However, this literature does not specifically explore marginal or failing students and their experience. To review existing research that has explored failing and struggling health professional students undertaking clinical placements and, in particular, SLP students. A critical narrative review was undertaken. Three electronic databases, ProQuest, CINAHL and OVID (Medline 1948-), were searched for papers exploring marginal and failing students in clinical placement contexts across all health professions, published between 1988 and 2017. Data were extracted and examined to determine the breadth of the existing research, and publications were critically appraised and major research themes identified. Sixty-nine papers were included in the review. The majority came from medicine and nursing in the United States and United Kingdom, with other allied health disciplines less well represented. The review identified key themes with the majority of papers focused on identification of at risk students and support and remediation. The review also highlighted the absence of literature relating to the student voice and in the allied health professions. This review highlighted the limited research related to failing/struggling student learning in clinical contexts, and only a

  6. Alopecia cicatricial da sarcoidose

    Directory of Open Access Journals (Sweden)

    Teixeira Giane Pereira Giro

    2003-01-01

    Full Text Available Os autores apresentam um caso de alopecia cicatricial associada a lesões papulosas na face e no tronco, com quatro anos de evolução. O diagnóstico de sarcoidose foi confirmado pelo exame histopatológico. Durante o seguimento, a paciente desenvolveu lesões pulmonares. A alopecia cicatricial é complicação rara da sarcoidose e se confunde, clinicamente, com outras dermatoses, entre elas o lúpus eritematoso discóide e o líquen plano pilar.

  7. Narratives of neoliberalism: ‘clinical labour’ in context

    Science.gov (United States)

    Parry, Bronwyn

    2015-01-01

    Cross-border reproductive care has been thrust under the international spotlight by a series of recent scandals. These have prompted calls to develop more robust means of assessing the exploitative potential of such practices and the need for overarching and normative forms of national and international regulation. Allied theorisations of the emergence of forms of clinical labour have cast the outsourcing of reproductive services such as gamete donation and gestational surrogacy as artefacts of a wider neoliberalisation of service provision. These accounts share with many other narratives of neoliberalism a number of key assertions that relate to the presumed organisation of labour relations within this paradigm. This article critically engages with four assumptions implicit in these accounts: that clinical labourers constitute a largely homogeneous underclass of workers; that reproductive labour has been contractualised in ways that disembed it from wider social and communal relations; that contractualisation can provide protection for clinical labour lessening the need for formal regulatory oversight; and that the transnationalisation of reproductive service labour is largely unidirectional and characterised by a dynamic of provision in which ‘the rest’ services ‘the West’. Drawing on the first findings of a large-scale ethnographic research project into assisted reproduction in India I provide evidence to refute these assertions. In so doing the article demonstrates that while the outsourcing and contractualisation of reproductive labour may be embedded in a wider neoliberal paradigm these practices cannot be understood nor their impacts be fully assessed in isolation from their social and cultural contexts. PMID:26052118

  8. Theory and practice of clinical ethics support services: narrative and hermeneutical perspectives

    NARCIS (Netherlands)

    Porz, R.; Landeweer, E.G.M.; Widdershoven, G.A.M.

    2011-01-01

    In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative

  9. Tool-supported Interactive Correction and Semantic Annotation of Narrative Clinical Reports.

    Science.gov (United States)

    Zvára, Karel; Tomečková, Marie; Peleška, Jan; Svátek, Vojtěch; Zvárová, Jana

    2017-05-18

    Our main objective is to design a method of, and supporting software for, interactive correction and semantic annotation of narrative clinical reports, which would allow for their easier and less erroneous processing outside their original context: first, by physicians unfamiliar with the original language (and possibly also the source specialty), and second, by tools requiring structured information, such as decision-support systems. Our additional goal is to gain insights into the process of narrative report creation, including the errors and ambiguities arising therein, and also into the process of report annotation by clinical terms. Finally, we also aim to provide a dataset of ground-truth transformations (specific for Czech as the source language), set up by expert physicians, which can be reused in the future for subsequent analytical studies and for training automated transformation procedures. A three-phase preprocessing method has been developed to support secondary use of narrative clinical reports in electronic health record. Narrative clinical reports are narrative texts of healthcare documentation often stored in electronic health records. In the first phase a narrative clinical report is tokenized. In the second phase the tokenized clinical report is normalized. The normalized clinical report is easily readable for health professionals with the knowledge of the language used in the narrative clinical report. In the third phase the normalized clinical report is enriched with extracted structured information. The final result of the third phase is a semi-structured normalized clinical report where the extracted clinical terms are matched to codebook terms. Software tools for interactive correction, expansion and semantic annotation of narrative clinical reports has been developed and the three-phase preprocessing method validated in the cardiology area. The three-phase preprocessing method was validated on 49 anonymous Czech narrative clinical reports

  10. Automatic prediction of coronary artery disease from clinical narratives.

    Science.gov (United States)

    Buchan, Kevin; Filannino, Michele; Uzuner, Özlem

    2017-08-01

    Coronary Artery Disease (CAD) is not only the most common form of heart disease, but also the leading cause of death in both men and women (Coronary Artery Disease: MedlinePlus, 2015). We present a system that is able to automatically predict whether patients develop coronary artery disease based on their narrative medical histories, i.e., clinical free text. Although the free text in medical records has been used in several studies for identifying risk factors of coronary artery disease, to the best of our knowledge our work marks the first attempt at automatically predicting development of CAD. We tackle this task on a small corpus of diabetic patients. The size of this corpus makes it important to limit the number of features in order to avoid overfitting. We propose an ontology-guided approach to feature extraction, and compare it with two classic feature selection techniques. Our system achieves state-of-the-art performance of 77.4% F1 score. Copyright © 2017. Published by Elsevier Inc.

  11. Topical melatonin for treatment of androgenetic alopecia.

    Science.gov (United States)

    Fischer, Tobias W; Trüeb, Ralph M; Hänggi, Gabriella; Innocenti, Marcello; Elsner, Peter

    2012-10-01

    In the search for alternative agents to oral finasteride and topical minoxidil for the treatment of androgenetic alopecia (AGA), melatonin, a potent antioxidant and growth modulator, was identified as a promising candidate based on in vitro and in vivo studies. One pharmacodynamic study on topical application of melatonin and four clinical pre-post studies were performed in patients with androgenetic alopecia or general hair loss and evaluated by standardised questionnaires, TrichoScan, 60-second hair count test and hair pull test. FIVE CLINICAL STUDIES SHOWED POSITIVE EFFECTS OF A TOPICAL MELATONIN SOLUTION IN THE TREATMENT OF AGA IN MEN AND WOMEN WHILE SHOWING GOOD TOLERABILITY: (1) Pharmacodynamics under once-daily topical application in the evening showed no significant influence on endogenous serum melatonin levels. (2) An observational study involving 30 men and women showed a significant reduction in the degree of severity of alopecia after 30 and 90 days (P melatonin solution can be considered as a treatment option in androgenetic alopecia.

  12. Female pattern alopecia: current perspectives

    Directory of Open Access Journals (Sweden)

    Levy LL

    2013-08-01

    Full Text Available Lauren L Levy, Jason J Emer Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA Abstract: Hair loss is a commonly encountered problem in clinical practice, with men presenting with a distinctive pattern involving hairline recession and vertex balding (Norwood-Hamilton classification and women exhibiting diffuse hair thinning over the crown (increased part width and sparing of the frontal hairline (Ludwig classification. Female pattern hair loss has a strikingly overwhelming psychological effect; thus, successful treatments are necessary. Difficulty lies in successful treatment interventions, as only two medications – minoxidil and finasteride – are approved for the treatment of androgenetic alopecia, and these medications offer mediocre results, lack of a permanent cure, and potential complications. Hair transplantation is the only current successful permanent option, and it requires surgical procedures. Several other medical options, such as antiandrogens (eg, spironolactone, oral contraceptives, cyproterone, flutamide, dutasteride, prostaglandin analogs (eg, bimatoprost, latanoprost, and ketoconazole are reported to be beneficial. Laser and light therapies have also become popular despite the lack of a profound benefit. Management of expectations is crucial, and the aim of therapy, given the current therapeutic options, is to slow or stop disease progression with contentment despite patient expectations of permanent hair regrowth. This article reviews current perspectives on therapeutic options for female pattern hair loss. Keywords: androgenetic alopecia, female pattern hair loss, minoxidil, finasteride, antiandrogens, spironolactone

  13. Central centrifugal cicatricial alopecia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Herskovitz I

    2016-08-01

    Full Text Available Ingrid Herskovitz, Mariya Miteva Department of Dermatology and Cutaneous Surgery, University of Miami L Miller School of Medicine, Miami, FL, USA Abstract: Central centrifugal cicatricial alopecia (CCCA is the most common scarring alopecia among African American women. Data about epidemiology, etiology, genetic inheritance, and management are scarce and come from individual reports or small series. CCCA has been associated with hot combing and traumatic hair styling for years; however, studies fail to confirm it as the sole etiologic factor. It has been shown in a small series that CCCA can be inherited in an autosomal dominant fashion, with a partial penetrance and a strong modifying effect of hairstyling and sex. CCCA presents clinically as a central area of progressive irreversible hair loss that expands to the periphery. A patchy form has also been described. Dermoscopy is helpful to identify the optimal site for the biopsy, which establishes the diagnosis. Well-designed randomized controlled trials are needed to discover the optimal management. At this point, patients are advised to avoid traction and chemical treatments; topical and intralesional steroids, calcineurin inhibitors, and minoxidil can be helpful in halting the progression. Keywords: hair loss, alopecia, dermatoscopy, dermoscopy, trichoscopy, black scalp, African American, scarring alopecia

  14. Psychosocial aspects of androgenetic alopecia

    NARCIS (Netherlands)

    A. van der Donk (Jos)

    1992-01-01

    textabstractThe main objective of the studies described in this thesis is to study the psychosocial problems of men and women with androgenetic alopecia who applied for treatment. In chapter 2, the psychological characteristics of 59 men with androgenetic alopecia from a sample of the general

  15. Relapsing Polychondritis Following Alopecia Areata

    Directory of Open Access Journals (Sweden)

    John C. Starr

    2010-01-01

    Full Text Available A case of alopecia areata followed by relapsing polychondritis is presented. Similar cases from the literature are reviewed and speculation about the relationship of these diseases is offered. Although the occurrence of these diseases together could be coincidental, an association seems immunologically plausible. Thus, relapsing polychondritis might be an unusual systemic manifestation of alopecia areata.

  16. Histopathologic diagnosis of multifactorial alopecia.

    Science.gov (United States)

    Wohltmann, Wendi E; Sperling, Leonard

    2016-06-01

    Establishing a definitive diagnosis for any form of alopecia can be challenging. Adding to the diagnostic complexity is the fact that many patients have more than one form of alopecia contributing to their hair loss. We conducted a review of 1360 consecutive scalp biopsy specimens submitted for the evaluation of scalp hair loss over a 16-month period, demonstrating that 12.5% of cases had a combination of diagnoses (multifactorial alopecia) accounting for their hair loss. An approach to the histopathologic diagnosis of multifactorial alopecia, particularly multiple forms of alopecia found in a single biopsy, is here presented. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  17. Psychogenic Alopecia in Rhesus Macaques Presenting as Focally Extensive Alopecia of the Distal Limb

    Science.gov (United States)

    Kramer, Joshua A; Mansfield, Keith G; Simmons, Joe H; Bernstein, Joseph A

    2011-01-01

    Focally extensive alopecia affecting the distal limbs is a common clinical finding in rhesus macaque (Macaca mulatta) colonies and is both a regulatory and colony-health concern. We performed diagnostic examinations including physical exams, bloodwork, skin scrapes, surface cytology, and surface bacterial–fungal cultures on 17 rhesus macaques with this presentation of alopecia. Skin biopsies from alopecic skin obtained from each macaque were compared with those of normal skin from the same animal. Immunohistochemistry and metachromatic staining for inflammatory cells were performed to compare alopecic and normal skin. In addition, we compared these biopsies with those previously obtained from macaques with generalized alopecia and dermal inflammatory infiltrates consistent with cutaneous hypersensitivity disorders and with those from animals with normal haircoats. Bacterial and fungal cultures, skin scrapes, surface cytology, and bloodwork were unremarkable. Affected skin showed only mild histologic alteration, with rare evidence of trichomalacia and follicular loss. Numbers of mast cells and CD3+ lymphocytes did not differ between alopecic and normally haired skin from the same animal. The number of mast cells in alopecic skin from animals in the current cohort was significantly lower than that in skin of animals previously diagnosed with a cutaneous hypersensitivity disorder. Numbers of both mast cells and CD3+ lymphocytes in alopecic skin from the current cohort were similar to those from biopsies of animals with normal haircoats. Together, the clinical findings and pathology are consistent with a psychogenic origin for this pattern of alopecia in rhesus macaques. PMID:21819697

  18. Alopecia areata: medical treatments

    Directory of Open Access Journals (Sweden)

    Zonunsanga

    2015-01-01

    Full Text Available Alopecia areata (AA is a non-scarring, autoimmune, inflammatory, relapsing hair loss affecting the scalp and/or body. In acute-phase AA, CD4+ and CD8+ T cells infiltrated in the juxta-follicular area. In chronic-phase AACD8+ T cells dominated the infiltrate around hair bulbs which contributes to the prolonged state of hair loss. Treatments include mainly corticosteroids, topical irritants, minoxidil, cytotoxic drugs and biologicals. This review highlights mainly the pathomechanism and pathology, classifications and associated diseases with regard to their importance for current and future treatment.

  19. Bitemporal hair loss related to traction alopecia.

    Science.gov (United States)

    Muñoz Moreno-Arrones, Oscar; Vañó-Galván, Sergio

    2016-09-15

    We present a 24-year-old woman that had received a diagnosis of alopecia areata in the past and was treated with topical 19 corticosteroids with little improvement. Instead, the patient exhibited bitemporal alopecia of one year of evolution related to 20 traction alopecia. Traction alopecia is characterized by localized hair loss related to persistent excessive traction. Although it is 21 initially a reversible condition, if this excessive traction is not removed permanent alopecia may develop.

  20. Role for the Epidermal Growth Factor Receptor in Chemotherapy-Induced Alopecia

    Science.gov (United States)

    Bichsel, Kyle J.; Gogia, Navdeep; Malouff, Timothy; Pena, Zachary; Forney, Eric; Hammiller, Brianna; Watson, Patrice; Hansen, Laura A.

    2013-01-01

    Treatment of cancer patients with chemotherapeutics like cyclophosphamide often causes alopecia as a result of premature and aberrant catagen. Because the epidermal growth factor receptor (EGFR) signals anagen hair follicles to enter catagen, we hypothesized that EGFR signaling may be involved in cyclophosphamide-induced alopecia. To test this hypothesis, skin-targeted Egfr mutant mice were generated by crossing floxed Egfr and Keratin 14 promoter-driven Cre recombinase mice. Cyclophosphamide treatment of control mice resulted in alopecia while Egfr mutant skin was resistant to cyclophosphamide-induced alopecia. Egfr mutant skin entered catagen normally, as indicated by dermal papilla condensation and decreased follicular proliferation, but did not progress to telogen as did Egfr wild type follicles. Egfr mutant follicles responded with less proliferation, apoptosis, and fewer p53-positive cells after cyclophosphamide. Treatment of control mice with the EGFR inhibitors erlotinib or gefitinib similarly suppressed alopecia and catagen progression by cyclophosphamide. Secondary analysis of clinical trials utilizing EGFR-targeted therapies and alopecia-inducing chemotherapy also revealed evidence for involvement of EGFR in chemotherapy-induced alopecia. Taken together, our results demonstrated the involvement of EGFR signaling in chemotherapy-induced alopecia, which will help in the design of novel therapeutic regimens to minimize chemotherapy-induced alopecia. PMID:23894460

  1. Clinical empathy and narrative competence: the relevance of reading talmudic legends as literary fiction.

    Science.gov (United States)

    Davidson, John H

    2015-04-01

    The "curative potential" in almost any clinical setting depends on a caregiver establishing and maintaining an empathic connection with patients so as to achieve "narrative competence" in discerning and acting in accord with their preferences and best interests. The "narrative medicine" model of shared "close reading of literature and reflective writing" among clinicians as a means of fostering a capacity for clinical empathy has gained validation with recent empirical studies demonstrating the enhancement of theory of mind (ToM), broadly conceived as empathy, in readers of literary fiction. Talmudic legends, like that of Rabbi Judah's death, are under-appreciated, relevant sources of literary fiction for these efforts. The limitations of narrative medicine are readily counterbalanced by simultaneously practiced attention to traditional bioethical principles, including-especially-beneficence, non-maleficence, and autonomy.

  2. Non-invasive diagnostics of scarring alopecias by the method of trichoscopy

    Directory of Open Access Journals (Sweden)

    I. N. Kondrachine

    2014-01-01

    Full Text Available Literary and own data on trichoskopy opportunities are presented with differential-diagnostic tools of non-cicatricial alopecia. Clinical data are discussed, the importance of a trichoskopy is established at diagnosis of patients with alopecia of different etiology.

  3. MedTime: a temporal information extraction system for clinical narratives.

    Science.gov (United States)

    Lin, Yu-Kai; Chen, Hsinchun; Brown, Randall A

    2013-12-01

    Temporal information extraction from clinical narratives is of critical importance to many clinical applications. We participated in the EVENT/TIMEX3 track of the 2012 i2b2 clinical temporal relations challenge, and presented our temporal information extraction system, MedTime. MedTime comprises a cascade of rule-based and machine-learning pattern recognition procedures. It achieved a micro-averaged f-measure of 0.88 in both the recognitions of clinical events and temporal expressions. We proposed and evaluated three time normalization strategies to normalize relative time expressions in clinical texts. The accuracy was 0.68 in normalizing temporal expressions of dates, times, durations, and frequencies. This study demonstrates and evaluates the integration of rule-based and machine-learning-based approaches for high performance temporal information extraction from clinical narratives. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Alopecia neoplastica: An uncommon presentation of metastatic breast carcinoma

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    Felipe Ladeira de Oliveira

    2016-12-01

    Full Text Available Cutaneous metastasis may correspond to the initial clinical presentation of hidden internal malignancies. In patients presenting said neoplasia, clinical manifestations of breast cancer reaches 23.9%. Considering that neoplastic alopecia appears as an unusual pattern of the said metastasis, this report describes a case of such uncommon neoplastic alopecia which presents itself as a cutaneous metastasis of rapid progression in a patient with prior breast cancer history. We present a 47-year-old female patient reporting lesions at the scalp, and who was asymptomatic with a 1-year evolution. The patient reported prior breast cancer history and presence of lung metastasis, and was undergoing chemotherapy at the time of consultation. A dermatological evaluation showed only a nodular lesion with erythematous surface and a diameter measuring about 4 cm, firm in consistency, and immovable. She was routed to the Department of Dermatological Surgery, and the results from histopathology were consistent with a diagnosis of metastatic breast adenocarcinoma. Neoplastic alopecia appears as an unusual form of cutaneous metastasis which is predominantly described in association with breast cancer. The lesion’s clinical features play a crucial role at the differential diagnosis, as the presence of erythema could distinguish neoplastic alopecia from alopecia areata. The existence of cutaneous metastasis leads to unfavorable outcomes. As a conclusion, cutaneous evaluation of patients is essential for treating visceral metastases, since the forms of cutaneous metastasis are diverse and can also affect the scalp.

  5. Side Effects: Hair Loss (Alopecia)

    Science.gov (United States)

    Hair loss, also called alopecia, is a side effect of cancer treatments, such as chemotherapy and radiation therapy. Learn how to cope with and manage hair loss. Listen to tips from others who have experienced hair loss.

  6. Relevance of trichoscopy in the differential diagnosis of alopecia: A cross-sectional study from North India.

    Science.gov (United States)

    Chiramel, Minu Jose; Sharma, Vinod Kumar; Khandpur, Sujay; Sreenivas, Vishnubhatla

    2016-01-01

    Trichoscopy is an office tool used in the diagnosis of alopecia but its utility has not been assessed. To compare the trichoscopic characteristics of different types of alopecia, identify features of diagnostic value, and to determine the utility of trichoscopy in the diagnosis of alopecia. A descriptive cross-sectional study was performed in patients with alopecia. After clinical assessment and relevant investigations, trichoscopy was performed using a non-polarized trichoscope (×10). The utility of trichoscopy in difficult cases of alopecia was assessed statistically. One hundred and twenty patients of alopecia (90 non-cicatricial, 30 cicatricial) were recruited. The diagnosis was made on the basis of a detailed history and clinical examination, and confirmed by biopsy and relevant investigations in difficult cases. Yellow dots (63.3%) were the most common trichoscopic feature followed by thin hair (40.8%). Among the 21 difficult cases of alopecia, trichoscopy was diagnostic in 19 (90.5%). Statistically significant features on intergroup comparison included black dots (Fischer's exact test, Palopecia areata; diameter diversity more than 20% (P alopecia; broken hair of different lengths (P alopecia was a limiting factor. Trichoscopy is useful in the differential diagnosis of alopecia. Among the various trichoscopic findings, those of diagnostic value were identified.

  7. Plica neuropathica causing traction alopecia

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    K Pavithran

    1990-01-01

    Full Text Available A middle aged woman developed matting of the hairs of the scalp following use of a home made shampoo that contained leaves of Hibiscus rosasiensis. The entangled and matted hair mass in the occipital region pulled hairs of the vertex region of the scalp, resulting in a patch of traction alopecia. Release of tension on the hairs by cutting them with scissors prevented further extension of alopecia.

  8. Androgenetic alopecia: An update

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    Feroze Kaliyadan

    2013-01-01

    Full Text Available Androgenetic alopecia (AGA is one of the commonest reasons for dermatological consultation. Over the last few years our understanding of the pathophysiology of AGA has improved and this has paved way for better diagnostic and therapeutic options. Recent research has dwelled on the role of stem cells in the pathophysiology of AGA and has also identified newer genetic basis for the condition. Dermoscopy/trichoscopy has emerged as a useful diagnostic tool for AGA. While the major treatment options continue to be topical minoxidil, systemic Finasteride and hair transplantations, newer modalities are under investigation. Specific diagnostic and treatment recommendations have also been developed on evidence based principles. This article reviews the recent concepts in relation to AGA. With regards to the pathophysiology we have tried to stress on recent knowledge of the molecular and genetic basis of AGA. We have emphasized on an evidence based approach for treatment and diagnosis.

  9. Alopecia areata: Treatment options

    Directory of Open Access Journals (Sweden)

    E. Kasumagić-Halilović

    2006-02-01

    Full Text Available Alopecia areata (AA is a common cause of reversible hair loss afflictingapproximately1-2%ofthegeneralpopulation. It commonly present as round patches of hair loss which can be the firstmanifestationofamoreseverealopecia totalis or universalis. The cause of AA is unknown although most evidence supports the hypothesis that AA is an immunologically mediated disease. Treatment of AA may be divided into four different categories of widely accepted therapeutic modalities: immune inhibitors (steroid or psoralen and UVA light- PUVA, topicalsensitizers (squaric acid dibutylester and diphenylcyclopropenone, non-specificirritants(anthralinandthevasodilatator minoxidil. Improved future treatments may be immunosuppressive or immunomodulatory or they may otherwise protect hair follicles from the injurious effects of inflammation.Theaimofthisarticleistoreviewavailable data on current and potential agents for the treatment of AA.

  10. Study of the efficacy of carboxytherapy in alopecia.

    Science.gov (United States)

    Doghaim, Noha Nabil; El-Tatawy, Rania Ahmed; Neinaa, Yomna Mazid El-Hamd; Abd El-Samd, Marwa Mohsen

    2018-02-20

    Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3 months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results. © 2018 Wiley Periodicals, Inc.

  11. Psoriatic Alopecia in a Patient with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Wimolsiri Iamsumang

    2017-03-01

    Full Text Available Psoriasis is a chronic, recurrent, and relatively common inflammatory dermatologic condition, which demonstrates various clinical manifestations including hair loss. It was once believed that alopecia was not a presentation of scalp psoriasis, but it is now widely accepted that psoriatic alopecia exists. Although the majority of patients get hair regrowth, it can potentially lead to permanent hair loss. Herein, we report a case of 26-year-old female patient with systemic lupus erythematosus who presented with scalp hair loss and nonpruritic scaly plaques on the scalp. Her clinical presentation, dermoscopic, and histopathologic findings were consistent with psoriatic alopecia. Additionally, we also described a novel scalp dermoscopic pattern of “patchy dotted vessels” which we detected in the lesion of scalp psoriasis.

  12. EFECTIVITY MINOXIDIL AS A TREATMENT OF ALOPECIA AREATA

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    Wayan Evie Frida Yustin

    2014-01-01

    Full Text Available Alopecia areata is hair loss with patchy formation, the most common cause of alopecia nonscarring. Occurred in 1,7 % of Americans aged 50 years. Canoccurs in both sexes, all races and any age. Genetic and immunological factorsplay an important role as a cause of Alopecia areata. The clinical features alopecia areata are round or oval lesions, total baldness, smoothness on the scalpor other parts of the body that has hair. Minoxidil is one of the effective therapyfor Alopecia areata. Known for more than 30 years of minoxidil to stimulate hairgrowth. Minoxidil works on hair follicles, opening the potassium channels, andhave vascular effects that can increase blood flow to hair. Histological studiesshowed that minoxidil therapy may increase the proportion hair follicles in anagenphase and decrease hair follicles at telogen phase. Minoxidil through sulphatmetabolites can open potassium channels, the opening potassium channels canincrease the hair follicles growth. The study of the effects minoxidil on humanepidermal keratinocytes and hair follicles with different culture conditions andmarkers proliferation, found that minoxidil with micro molar concentration canstimulate proliferation both type of cells and all culture condition, whereasminoxidil with milimolar concentration will inhibit cell growth. In addition,several studies have also reported an association minoxidil to vascular effect andstimulating VEGF can promote the increase hair follicle

  13. Semantator: annotating clinical narratives with semantic web ontologies.

    Science.gov (United States)

    Song, Dezhao; Chute, Christopher G; Tao, Cui

    2012-01-01

    To facilitate clinical research, clinical data needs to be stored in a machine processable and understandable way. Manual annotating clinical data is time consuming. Automatic approaches (e.g., Natural Language Processing systems) have been adopted to convert such data into structured formats; however, the quality of such automatically extracted data may not always be satisfying. In this paper, we propose Semantator, a semi-automatic tool for document annotation with Semantic Web ontologies. With a loaded free text document and an ontology, Semantator supports the creation/deletion of ontology instances for any document fragment, linking/disconnecting instances with the properties in the ontology, and also enables automatic annotation by connecting to the NCBO annotator and cTAKES. By representing annotations in Semantic Web standards, Semantator supports reasoning based upon the underlying semantics of the owl:disjointWith and owl:equivalentClass predicates. We present discussions based on user experiences of using Semantator.

  14. Narrative thematic analysis of baccalaureate nursing students' reflections: critical thinking in the clinical education context.

    Science.gov (United States)

    Naber, Jessica L; Hall, Joanne; Schadler, Craig Matthew

    2014-09-01

    This study sought to identify characteristics of clinically situated critical thinking in nursing students' reflections, originally part of a study guided by Richard Paul's model of critical thinking. Nurses are expected to apply critical thinking in all practice situations to improve health outcomes, including patient safety and satisfaction. In a previous study, Paul's model of critical thinking was used to develop questions for reflective writing assignments. Within that study, 30 nursing students completed six open-ended narratives of nurse-patient clinical encounters during an 8-week period. Improvements were seen in critical thinking scores after the intervention. This article reports the qualitative analysis of the content of six open-ended narratives. Six overarching themes were identified and combined into a tentative conceptual model. Faculty's understanding of the characteristics of critical thinking in the context of clinical education will help them to teach and evaluate students' progress and competencies for future practice.

  15. System architecture for temporal information extraction, representation and reasoning in clinical narrative reports.

    Science.gov (United States)

    Zhou, Li; Friedman, Carol; Parsons, Simon; Hripcsak, George

    2005-01-01

    Exploring temporal information in narrative Electronic Medical Records (EMRs) is essential and challenging. We propose an architecture for an integrated approach to process temporal information in clinical narrative reports. The goal is to initiate and build a foundation that supports applications which assist healthcare practice and research by including the ability to determine the time of clinical events (e.g., past vs. present). Key components include: (1) an annotation schema for temporal expressions and the development of an associated tagger; (2) a natural language processing (NLP) system for encoding and extracting medical events and associating them with formalized temporal data; (3) a post-processor, with a knowledge-based subsystem to help discover implicit information, that resolves temporal expressions and deals with issues such as granularity and vagueness; and (4) a reasoning mechanism which models clinical reports as Simple Temporal Problems (STPs).

  16. Managing Chemotherapy Side Effects: Hair Loss (Alopecia)

    Science.gov (United States)

    ... C ancer I nstitute Managing Chemotherapy Side Effects Hair Loss (Alopecia) “Losing my hair was hard at first. Then ... and anywhere on your body may fall out. Hair loss is called alopecia. When will my hair start ...

  17. Oxidative stress in androgenetic alopecia.

    Science.gov (United States)

    Prie, B E; Iosif, L; Tivig, I; Stoian, I; Giurcaneanu, C

    2016-01-01

    Rationale: Androgenetic alopecia is not considered a life threatening disease but can have serious impacts on the patient's psychosocial life. Genetic, hormonal, and environmental factors are considered responsible for the presence of androgenetic alopecia. Recent literature reports have proved the presence of inflammation and also of oxidative stress at the level of dermal papilla cells of patients with androgenetic alopecia Objective: We have considered of interest to measure the oxidative stress parameters in the blood of patients with androgenetic alopecia Methods and results: 27 patients with androgenetic alopecia and 25 age-matched controls were enrolled in the study. Trolox Equivalent Antioxidant Capacity (TEAC), malondialdehyde (MDA) and total thiols levels were measured on plasma samples. Superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) activities, and also non protein thiols levels together with TEAC activity were determined on erythrocytes samples No statistically significant changes were observed for TEAC erythrocytes, non-protein thiols, GPx and CAT activities. Significantly decreased (palopecia. For plasma samples decreased TEAC activity (palopecia are indicators of oxidative stress presence in these patients. Significantly decreased SOD activity but no change in catalase, glutathione peroxidase, non protein thiols level and total antioxidant activity in erythrocytes are elements which suggest the presence of a compensatory mechanism for SOD dysfunction in red blood cells of patients with androgenetic alopecia. AAG = androgenetic alopecia, MDA = malondialdehyde, SOD = superoxide dismutase, CAT = catalase, GPx = glutathione peroxidase, GSH = glutathione, GST = glutathione transferase, SH = thiols, TEAC = trolox equivalent antioxidant capacity, ABTS = 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid), CDNB = 1-chloro-2,4-dinitrobenzene.

  18. Alopecia secondary to anti-tumor necrosis factor-alpha therapy*

    Science.gov (United States)

    Ribeiro, Lara Beatriz Prata; Rego, Juliana Carlos Gonçalves; Estrada, Bruna Duque; Bastos, Paula Raso; Piñeiro Maceira, Juan Manuel; Sodré, Celso Tavares

    2015-01-01

    Biologic drugs represent a substantial progress in the treatment of chronic inflammatory immunologic diseases. However, its crescent use has revealed seldom reported or unknown adverse reactions, mainly associated with anti-tumor necrosis factor (anti-TNF). Psoriasiform cutaneous reactions and few cases of alopecia can occur in some patients while taking these drugs. Two cases of alopecia were reported after anti-TNF therapy. Both also developed psoriasiform lesions on the body. This is the second report about a new entity described as 'anti-TNF therapy-related alopecia', which combines clinical and histopathological features of both alopecia areata and psoriatic alopecia. The recognition of these effects by specialists is essential for the proper management and guidance of these patients. PMID:25830994

  19. Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia

    Science.gov (United States)

    Urysiak-Czubatka, Izabela; Broniarczyk-Dyła, Grażyna

    2014-01-01

    Introduction Androgenetic alopecia (AGA) is the most common form of hair loss. Clinically observed hair loss is due to the continuous miniaturization of affected hair follicles. Genetic factors and androgenic factors especially dihydrotestosterone (DHT), which is a testosterone tissue metabolite, play major roles in the pathogenesis of AGA. However, expert opinions about the usefulness of DHT in the diagnosis of this type of alopecia are divided. Aim To evaluate the usefulness of DHT level in patients with androgenetic alopecia compared with the control group. Material and methods The study comprised 49 subjects: 19 women and 9 men with androgenetic alopecia. The control group consisted of 17 healthy women and 4 men without hair loss. Results Increased serum concentrations of DHT were observed in patients with androgenetic alopecia (17 women, 5 men), but also in the control group. The differences in mean values of DHT were not significant according to the types of alopecia and the control group. Increased serum concentrations of DHT were not correlated with the advance of alopecia. Conclusions Dihydrotestosterone is the most influential androgen and seems to play a very important role in the pathogenesis of androgenetic alopecia. Based on the results of our study and others, the most important factors would appear to be the genetically-determined sensitivity of the follicles to DHT and their different reactions to androgen concentration. PMID:25254005

  20. Doing It Collaboratively! Addressing the Dilemmas of Designing Quantitative Effect Studies on Narrative Family Therapy in a Local Clinical Context

    DEFF Research Database (Denmark)

    Ejbye-Ernst, Ditte; Jørring, Nina Tejs

    2017-01-01

    in a local clinical context. The article offers a detailed case description of implementing psychometric effect measurements on narrative family therapy and of creating a shared collaborative stance for researchers using quantitative effect measurements and clinicians using narrative therapy. Our findings...

  1. Alopecia Areata Associated with Localized Vitiligo

    Directory of Open Access Journals (Sweden)

    Shankarling D. Kuchabal

    2010-03-01

    Full Text Available Alopecia areata is a common cause of noncicatricial alopecia that occurs in a patchy, confluent or diffuse pattern. It may occur as a single, self-limiting episode or may recur at varying intervals over many years. The association of alopecia areata with localized vitiligo has not been reported. The association of alopecia areata with localized vitiligo in the same patient is documented here; it is the first of its kind.

  2. Alopecia areata in children : treatment with diphencyprone

    NARCIS (Netherlands)

    Schuttelaar, M L; Hamstra, J J; Plinck, E P; Peereboom-Wynia, J D; Vuzevski, V D; Mulder, P G; Oranje, A P

    1996-01-01

    We assessed the efficacy of diphencyprone (DPCP) treatment in a total of 26 children with alopecia areata (AA). Sixteen children had alopecia areata totalis (AAT) and 10 had alopecia areata localis (AAL). DPCP is an absolute contact sensitizer. Twenty-five children could be sensitized with a 2% DPCP

  3. PHARMACOTHERAPY ALOPECIA ANDROGENETIC IN MEN

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    Riezky Januar Pramitha

    2013-03-01

    Full Text Available Androgenetic alopecia is hair thinning due to the stimulation of hair follicles to androgens. Incidence in men is higher than in women, it is because men have a degree higher 5? reductase. This condition can cause both physical and psychological effects to the patient. Physical effects due to baldness cause hair loss as a function of protection against heat, cold and trauma. While psychologically can affect self-esteem and self-perception of the patient. Androgenetic alopecia in men influenced by the androgen dihydrotestosterone and genetic predisposition, although the physiology remains unclear. Modality in the management of androgenetic alopecia in males patients including pharmacotherapy, hair transplants and cosmetic approach. According to the Food and Drug Administration (FDA, there are two main drugs are safe and effective in the long term given to men with androgenetic alopecia are minoxidil and finasteride. Although the mechanism of action and route of administration are different, but both drugs have similar effectiveness in stopping the progression of androgenetic alopecia in men.

  4. A Second Opinion: A Case Narrative on Clinical Ethics Mediation.

    Science.gov (United States)

    Weinstein, Michael S

    2015-01-01

    Contrasting traditional and common forms of ethics consultation with bioethics mediation, I describe the case of a "second opinion" consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, led to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led to creative solutions in which all stakeholders could reach consensus on a plan of care. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  5. Clinical considerations in restorative dentistry - A narrative review

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    Ashwini Tumkur Shivakumar

    2015-01-01

    Full Text Available The relationship between periodontal health and the restoration of teeth is intimate and inseparable. Human teeth are designed in such a way that the individual tooth contributes significantly to their own support as well as collectively the teeth in the arch. Decay on the proximal surfaces occurs mainly due to the faulty interrelationship between the contact area, marginal ridge, the embrasures and the gingiva. An adequate understanding of the relationship between periodontal tissues and restorative dentistry is paramount to ensure an adequate form, function, aesthetics and comfort of the dentition. For long-term survival of restoration, both functionally and esthetically, certain biological considerations are very critical to preserve the health of the periodontium and thus must be given due importance in clinical practice. While most clinicians are aware of this important relationship, uncertainly remains regarding specific concept such as biologic width and its maintainces.

  6. Detection of sentence boundaries and abbreviations in clinical narratives.

    Science.gov (United States)

    Kreuzthaler, Markus; Schulz, Stefan

    2015-01-01

    In Western languages the period character is highly ambiguous, due to its double role as sentence delimiter and abbreviation marker. This is particularly relevant in clinical free-texts characterized by numerous anomalies in spelling, punctuation, vocabulary and with a high frequency of short forms. The problem is addressed by two binary classifiers for abbreviation and sentence detection. A support vector machine exploiting a linear kernel is trained on different combinations of feature sets for each classification task. Feature relevance ranking is applied to investigate which features are important for the particular task. The methods are applied to German language texts from a medical record system, authored by specialized physicians. Two collections of 3,024 text snippets were annotated regarding the role of period characters for training and testing. Cohen's kappa resulted in 0.98. For abbreviation and sentence boundary detection we can report an unweighted micro-averaged F-measure using a 10-fold cross validation of 0.97 for the training set. For test set based evaluation we obtained an unweighted micro-averaged F-measure of 0.95 for abbreviation detection and 0.94 for sentence delineation. Language-dependent resources and rules were found to have less impact on abbreviation detection than on sentence delineation. Sentence detection is an important task, which should be performed at the beginning of a text processing pipeline. For the text genre under scrutiny we showed that support vector machines exploiting a linear kernel produce state of the art results for sentence boundary detection. The results are comparable with other sentence boundary detection methods applied to English clinical texts. We identified abbreviation detection as a supportive task for sentence delineation.

  7. Patients' Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry.

    Science.gov (United States)

    Lindsay, Gail M; Mior, Silvano A; Côté, Pierre; Carroll, Linda J; Shearer, Heather M

    2016-01-01

    The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries. Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs. Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language ("injured persons") being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised. A narrative inquiry of 11 patients' experiences with traffic collision and their recommendations for clinical

  8. Application of the Diagnostic Evaluation for Alopecia in Traditional Veterinary Species to Laboratory Rhesus Macaques (Macaca mulatta)

    Science.gov (United States)

    Luchins, Kerith R; Baker, Kate C; Gilbert, Margaret H; Blanchard, James L; Liu, David Xianhong; Myers, Leann; Bohm, Rudolf P

    2011-01-01

    Alopecia in nonhuman primates in the biomedical research setting is often attributed to compromised psychologic wellbeing. Behavioral causes, mainly hair plucking, have become the unconfirmed and exclusive default diagnosis, and the possibility that alopecia may be secondary to a primary medical or dermatologic disease is often overlooked. Although nonbehavioral causes of alopecia in nonhuman primates are described in the literature, few prospective hypothesis-based studies have investigated medical and behavioral etiologies concurrently. We therefore undertook such a study with the aim of designing a clinical diagnostic guide for approaching cases of nonhuman primate alopecia. Because most cases of alopecia in nonhuman primates in the literature and at our facility are not associated with a definitive diagnosis, the hypothesis we tested was that the well-established diagnostic evaluation for alopecia used for traditional veterinary species is not applicable to nonhuman primates. Discounting differences in histopathology and behavioral assessment, the current study revealed few clinically relevant significant differences between nonhuman primates with and without alopecia. As a result, our hypothesis was confirmed, and we conclude that the standard dermatologic diagnostic plan typically described for alopecia diagnosis in traditional veterinary species and used as the basis for assessment of alopecia in nonhuman primates should be reassessed. PMID:22330789

  9. Is there a relationship between androgenic alopecia and benign prostatic hyperplasia?

    Science.gov (United States)

    Dastgheib, Ladan; Shirazi, Mehdi; Moezzi, Iman; Dehghan, Saber; Sadati, Maryam-Sadat

    2015-01-01

    Androgenic alopecia as a physiologic process and benign prostatic hyperplasia (BPH) as a pathologic process in the older population are androgen-dependent processes influenced by 5-alpha reductase enzyme which converts testosterone to dihydrotestosterone. This cross sectional study was done to evaluate the relationship between androgenic alopecia and BPH. 150 men older than 50 years old, who presented to the free prostate screening clinic, were included. They were asked about urinary symptoms. PSA level, prostate volume with sonography and alopecia grading using Hamilton-Norwood classification (grade I to VII) were evaluated. Analysis was done by SPSS statistical method. 59.6% of men had mild alopecia (grade I, II, III), 34.1% had moderate alopecia (grade IV, V) and 6.3% had severe alopecia (grade VI, VII).The mean PSA level was 1.37 ± 1.48 ng/ml. The minimum PSA level was 0.1 ng/ml, and the maximum level was 6.8 ng/ml. The mean prostate volume was 37.85 ± 21.85cc. The minimum prostate size was 10 ml, and the maximum volume was 173 ml. The mean international prostate symptom score (IPSS) was 7.6 ± 6.11 with the minimum score 0 and the maximum score 27. However, no relationship between these parameters and androgenic alopecia was detected. This study showed that there is no relationship between androgenic alopecia, PSA level, IPSS, and prostate volume. Occurrence of alopecia in younger age and a positive family history correlated with a higher grade of alopecia.

  10. Prediction of venous thromboembolism using semantic and sentiment analyses of clinical narratives.

    Science.gov (United States)

    Sabra, Susan; Mahmood Malik, Khalid; Alobaidi, Mazen

    2018-03-01

    Venous thromboembolism (VTE) is the third most common cardiovascular disorder. It affects people of both genders at ages as young as 20 years. The increased number of VTE cases with a high fatality rate of 25% at first occurrence makes preventive measures essential. Clinical narratives are a rich source of knowledge and should be included in the diagnosis and treatment processes, as they may contain critical information on risk factors. It is very important to make such narrative blocks of information usable for searching, health analytics, and decision-making. This paper proposes a Semantic Extraction and Sentiment Assessment of Risk Factors (SESARF) framework. Unlike traditional machine-learning approaches, SESARF, which consists of two main algorithms, namely, ExtractRiskFactor and FindSeverity, prepares a feature vector as the input to a support vector machine (SVM) classifier to make a diagnosis. SESARF matches and maps the concepts of VTE risk factors and finds adjectives and adverbs that reflect their levels of severity. SESARF uses a semantic- and sentiment-based approach to analyze clinical narratives of electronic health records (EHR) and then predict a diagnosis of VTE. We use a dataset of 150 clinical narratives, 80% of which are used to train our prediction classifier support vector machine, with the remaining 20% used for testing. Semantic extraction and sentiment analysis results yielded precisions of 81% and 70%, respectively. Using a support vector machine, prediction of patients with VTE yielded precision and recall values of 54.5% and 85.7%, respectively. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Alopecia in patients treated with molecularly targeted anticancer therapies.

    Science.gov (United States)

    Belum, V R; Marulanda, K; Ensslin, C; Gorcey, L; Parikh, T; Wu, S; Busam, K J; Gerber, P A; Lacouture, M E

    2015-12-01

    The introduction of molecularly targeted anticancer therapies presents new challenges, among which dermatologic adverse events are noteworthy. Alopecia in particular is frequently reported, but the true incidence is not known. We sought to ascertain the incidence and risk of developing alopecia during treatment with approved inhibitors of oncogenic pathways and molecules [anaplastic lymphoma kinase, breakpoint cluster region-abelson, B-rapidly accelerated fibrosarcoma, Bruton's tyrosine kinase, cytotoxic T-lymphocyte antigen-4, epidermal growth factor receptor, human epidermal growth factor receptor-2, Janus kinase, MAPK/ERK (extracellular signal-regulated kinase) Kinase, mammalian target of rapamycin, smoothened, vascular endothelial growth factor, vascular endothelial growth factor receptor, platelet derived growth factor receptor; proteasomes; CD20, CD30, CD52]. Electronic database (PubMed, Web of Science) and ASCO meeting abstract searches were conducted to identify clinical trials reporting alopecia. Meta-analysis was conducted utilizing fixed- or random-effects models. The calculated overall incidence of all-grade alopecia was 14.7% [95% confidence interval (CI) 12.6% to 17.2%]-lowest with bortezomib, 2.2% (95% CI 0.4% to 10.9%), and highest with vismodegib, 56.9% (95% CI 50.5% to 63.1%). There was an increased risk of all-grade alopecia [relative risk (RR), 7.9 (95% CI 6.2-10.09, P ≤ 0.01)] compared with placebo, but when compared with chemotherapy, the risk was lower [RR, 0.32 (95% CI 0.2-0.55, P ≤ 0.01)]. Targeted therapies are associated with an increased risk of alopecia. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  12. [Psoriatic alopecia manifestation, course and therapy in 34 patients].

    Science.gov (United States)

    Runne, U; Kroneisen, P

    1989-04-15

    We report on a long-term clinical study on 34 patients (aged 6 to 88) suffering from psoriasis vulgaris capillitii with ensuing loss of hair and alopecia. Most patients showed heavy hyperkeratosis. The loss of hair was either massive (sometimes in tufts) or moderate; its course was acute in 53%, chronically recurrent in 15%, and chronically progressive in 32% of the cases. The psoriatic alopecia was circumscribed in 80% (from the size of a coin up to that of a palm of a hand; thinned out or bare) and diffuse in 20% of the patients. Alopecia was only observed in psoriatic lesions, but not necessarily in every plaque. Thus, psoriasis of the entire scalp did either result in circumscribed or in diffuse alopecia. The trichogram taken from regions next to alopecic areas revealed a telogen rate between 25 and 86%, according to the respective progression of the disease. The light microscope showed the typical features of psoriasis associated with distinct follicular hyper-(para-)keratosis; in some of the histologic sections, we saw a well-defined perifollicular adnexophilic infiltration of lymphocytes and histiocytes, which could cause alterations of the follicular epithelium and sometimes even destroy it altogether. In due course, these alterations resulted in granulomatous foreign-body reaction with scar formation. After topical anti-psoriatic treatment, we noticed regrowth of hair in more than 70% of the patients, whereas 25% developed scarring alopecia. - What we call psoriatic alopecia is the symptomatic loss of hair in psoriatic lesions of the scalp. In most of the cases, it can easily be identified on account of the underlying psoriasis.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Achados dermatoscópicos na alopecia androgenética feminina

    OpenAIRE

    Ramos, Lya Duarte; Santili, Maria Cândida Nahás; Bezerra, Fabiane Castilho; Ruiz, Maria De Fátima Maklouf Amorim [UNIFESP; Petri, Valeria [UNIFESP; Patriarca, Marisa Teresinha [UNIFESP

    2012-01-01

    BACKGROUND: Androgenetic alopecia is the most common form of hair loss. It is a clinical entity of relevant interest and presents a significant psychosocial impact as it undermines self-esteem and quality of life in female patients due to the importance of the hair for people's facial balance. OBJECTIVE: The purpose of the present study is to evaluate dermoscopic signs in women clinically diagnosed with androgenetic alopecia. METHOD: Observational study with 34 women between 17 and 68 years o...

  14. Alopecia With Endocrine Therapies in Patients With Cancer

    Science.gov (United States)

    Saggar, Vishal; Wu, Shenhong; Dickler, Maura N.

    2013-01-01

    Background. Whereas the frequency of alopecia to cytotoxic chemotherapies has been well described, the incidence of alopecia during endocrine therapies (i.e., anti-estrogens, aromatase inhibitors) has not been investigated. Endocrine agents are widely used in the treatment and prevention of many solid tumors, principally those of the breast and prostate. Adherence to these therapies is suboptimal, in part because of toxicities. We performed a systematic analysis of the literature to ascertain the incidence and risk for alopecia in patients receiving endocrine therapies. Methods. An independent search of citations was conducted using the PubMed database for all literature as of February 2013. Phase II–III studies using the terms “tamoxifen,” “toremifene,” “raloxifene,” “anastrozole,” “letrozole,” “exemestane,” “fulvestrant,” “leuprolide,” “flutamide,” “bicalutamide,” “nilutamide,” “fluoxymesterone,” “estradiol,” “octreotide,” “megestrol,” “medroxyprogesterone acetate,” “enzalutamide,” and “abiraterone” were searched. Results. Data from 19,430 patients in 35 clinical trials were available for analysis. Of these, 13,415 patients had received endocrine treatments and 6,015 patients served as controls. The incidence of all-grade alopecia ranged from 0% to 25%, with an overall incidence of 4.4% (95% confidence interval: 3.3%–5.9%). The highest incidence of all-grade alopecia was observed in patients treated with tamoxifen in a phase II trial (25.4%); similarly, the overall incidence of grade 2 alopecia by meta-analysis was highest with tamoxifen (6.4%). The overall relative risk of alopecia in comparison with placebo was 12.88 (p Alopecia is a common yet underreported adverse event of endocrine-based cancer therapies. Their long-term use heightens the importance of this condition on patients' quality of life. These findings are critical for pretherapy counseling, the identification of risk

  15. Postoperative (pressure) alopecia following sacrocolpopexy.

    Science.gov (United States)

    Bagaria, Madhu; Luck, Ali Maria

    2015-06-01

    Postoperative alopecia is a rare occurrence seen after a variety of surgical procedures performed under general anesthesia. The speculated cause is pressure-induced ischemia due to prolonged head immobilization. This case describes a patient who developed this complication after undergoing sacrocolpopexy. A 57-year-old postmenopausal Caucasian female was consented to undergo a robotic-assisted sacrocolpopexy, perineoplasty, and midurethral sling with possible conversion to an open procedure. The indication was symptomatic proximal and distal rectocele with foreshortened vagina. It was converted to laparotomy due to difficult presacral dissection. Her total operative time was 540 with 240 min in the Trendelenburg position. No intraoperative hypotension or excessive blood loss was noted. She started complaining of scalp pain in the postoperative recovery area. She developed soreness, crusting, and later alopecia in the same area. It was noted at her 3-week office visit. Referral was made for dermatology and anesthesiology evaluation. There was spontaneous full recovery by the 5th month. Postoperative alopecia is a rare condition mimicking alopecia areata but it is preceded by inciting events. There is some evidence to suggest that it is a preventable condition by frequent head repositioning during surgery. This case report is intended to increase the surgeon's awareness about this rare complication as its occurrence can be distressing for the patient.

  16. Theory and practice of clinical ethics support services: narrative and hermeneutical perspectives.

    Science.gov (United States)

    Porz, Rouven; Landeweer, Elleke; Widdershoven, Guy

    2011-09-01

    In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative ethics' and 'philosophical hermeneutics' provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like 'story', 'responsibility', or 'vulnerability' to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa. © 2011 Blackwell Publishing Ltd.

  17. A study of immunoglobulins and complements (C3 &C4 in alopecia areata

    Directory of Open Access Journals (Sweden)

    Sharma R

    1995-01-01

    Full Text Available Estimation of serum Immunoglobulins (IgG, IgM and IgA and complements (C3 and C4 was carried out in 100 cases of alopecia areata as per method described by Mancini (1965.[1] Clinically patients were divided in two groups, alopecia areata circumscribed (group I and severe alopecia areata (group II. Significant decrease in levels of one or more Immunoglobulins were observed in most of the patients. However, Serum complements (C3 and C4 were within range of normal control values

  18. Alopecia: Kids are not just little people.

    Science.gov (United States)

    Goldberg, Lynne J; Castelo-Soccio, Leslie A

    2015-01-01

    Alopecia is a disorder that affects all patients, young and old. Many diagnoses, particularly the scarring alopecias, are more common in adults; however, others, such as tinea capitis, are more common in children, and some, such as alopecia areata, often affect both age groups. The approach to, and evaluation of, an alopecia patient is thus highly dependent on his or her age. In adults with diffuse, non-scarring hair loss, a part-width examination can help detect pattern hair loss, the most common cause of diffuse loss in this age group. In children this is much less likely, and a careful evaluation for tinea capitis is in order. The same holds true for patchy alopecia in children, as well as scarring alopecia-tinea needs to always be considered. In adults, patchy alopecia is often due to alopecia areata and sometimes to one of the primary scarring alopecias. A laboratory evaluation, and especially a biopsy, would be a more appropriate undertaking for an adult than a child, and an adult would be more likely to tolerate certain therapeutic regimens such as intralesional injections. In a conversational manner, the authors discuss their individual approaches to the alopecia patient, highlighting the differences in diagnosis, workup, and management that depend on whether the affected individual is an adult or a child. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Pattern Alopecia during Hormonal Anticancer Therapy in Patients with Breast Cancer.

    Science.gov (United States)

    Park, Jin; Kim, Ju-Ik; Yun, Seok-Kweon; Kim, Han-Uk; Ihm, Chull-Wan

    2014-12-01

    We report five cases of pattern alopecia in female patients who are undergoing hormonal anticancer therapy for the prevention of recurrence of breast cancer after surgery. Three patients demonstrated male pattern alopecia with receding frontal hairlines, and two patients demonstrated female pattern alopecia without receding hairlines. The detailed clinical history showed that the pattern alopecia of the patients developed after the full recovery of global hair loss of the entire scalp due to previous cytotoxic chemotherapy. All of the adjuvant hormonal anticancer drugs that were used in the patients are antiestrogenic agents, either aromatase inhibitors or selective estrogen receptor modulators. Considering androgen effect on the hair follicles of the fronto-parietal scalp, the androgen-estrogen imbalance caused by the drugs was thought to be the reason for the onset of pattern alopecia in the patients. In general, alopecia that develops during cytotoxic chemotherapy is well known to both physicians and patients; however, the diagnosis of pattern alopecia during hormonal anticancer therapy in breast cancer patients seems to be overlooked.

  20. FAMILIAL ALOPECIA ARETA, ATOPY AND THYROIDITIS HASHIMOTO

    Directory of Open Access Journals (Sweden)

    Ani Tsvetanova

    2004-10-01

    Full Text Available We present a case of morbid association of two organ-specific autoimmune diseases (Alopecia areata-AA and Thyreoiditis Hashimoto-TH in two white sisters - 23 and 26 years old. There is no family history of AA or any autoimmune disorders. The onset of AA, in the both sisters was in early childhood (3 and 7 years of age. The clinical and laboratory examinations showed engagement of the scalp with round or oval large patches of alopecia, without involvement of the body hairs and nails. There were also alterations of thyroid gland function, positive TMA (Thyroid Microsomal Antibodies and Rö-data of Pituitary adenoma as well as episodes of allergic rhinitis (in one of the sisters, and bronchial asthma (in the other. According to Ikeda’s classification, they have an "Atopic type" AA. We suppose that the observed case is not an occasional coincidence of AA and TH. HLA Aw32B18 determination could be support our suggesting about the familial pattern of these autoimmune diseases.

  1. The Role of Clinical Records in Narrative Medicine: A Discourse of Message.

    Science.gov (United States)

    Murphy, John W; Choi, Jung Min; Cadeiras, Martin

    This article is designed to unite theory and practice. The focus of attention is the impact of narrative medicine on clinical records. Specifically important is that records are created through dialogue, whereby patients are able to grow the record through their ability to offer critiques and alternative explanations. Merely allowing patients to peruse their records, through advances in technology, is not sufficient to facilitate this aim. Various theoretical and practical considerations are discussed that may facilitate patient involvement and the creation of more accurate and relevant patient records.

  2. Women entering clinical psychology: Q-sort narratives of career attraction of female clinical psychology trainees in the UK.

    Science.gov (United States)

    Baker, Martyn; Nash, Jen

    2013-01-01

    The great majority of the UK clinical psychology workforce are women, and this fact prompted an examination of the various ways clinical psychology might be seen as attractive to women--a neglected research topic. Female clinical psychology trainees from a variety of training programmes Q-sorted statements of potential job attractors. The process of analysis is outlined before most of the article is devoted to explicating the five narratives of attraction generated: making a difference, waiting for what I want, idealising challenge, identifying with distress and acknowledging power and privilege. Two super-ordinate 'stories' spanning the narratives are suggested--an over-riding attraction to the profession and a rebuttal of the suggestion that this attraction may be based on any overtly gendered grounds. In the absence of previous empirical data of women's attraction to clinical psychology, the small but significant contribution to understanding the profession made by the analysis is acknowledged--as is the need for further research to confirm and develop the findings. Copyright © 2011 John Wiley & Sons, Ltd.

  3. Hair Mesotherapy in Treatment of Alopecia

    Directory of Open Access Journals (Sweden)

    Selcuk Ozdogan

    2011-01-01

    mesotherapy in any form. Material and Methods: In this study, we evaluate the clinical changes of mesotherapy formulation on 15 men and 8 women patients, which consists of minoxidil, biotin, dexpantenol, herbal complex and procain and which is applied for androgenetic alopecia in our clinic every week. Results: In the analysis done before and after the mesotherapy, when the hair quantity, hair thickness, scalp state and hair loss are compared, the difference between them was statistically meaningful (p<0,05. There was no side effect during and after the application. Conclusion: In the hair mesotherapy, there is lack of mixture and application scheme whose effectiveness has been proved scientifically. We approve this study to be published that it supports the few  issues.

  4. Stuck in the past: negative bias, explanatory style, temporal order, and evaluative perspectives in life narratives of clinically depressed individuals.

    Science.gov (United States)

    Habermas, Tilmann; Ott, Lisa-M; Schubert, Merve; Schneider, Beatrix; Pate, Anna

    2008-01-01

    This study attempted to replicate negative bias and depressive explanatory style in depression using life narratives. The two central aspects of narrative, temporal succession and evaluation, were also explored. These aspects were tested for the first time using entire life narratives of 17 depressed inpatients and non-depressed controls matched for sex and educational level. Negative bias and depressive explanatory style were replicated as typical for the depressed group. Life narratives of depressed patients also deviated more from a linear temporal order and compared less frequently the past with the present. Contrary to expectations, the depressed did not differ in the overall frequency of evaluations. However, they used more past than present evaluations and more experience-near evaluations than cognitive evaluations, suggesting that they are more immersed in past experiences. It is concluded that negative bias and depressive explanatory style can be found also in a naturalistic narrative measure, and that depression affects the two major aspects of narrative. It is argued that life narratives, as measures close to everyday clinical practice and as the most encompassing form of self-representation, should complement more experimental procedures in the study of cognitive and communicative processes in psychopathology. 2007 Wiley-Liss, Inc.

  5. Faecal incontinence: a narrative review of clinic-based management for the general gynaecologist.

    Science.gov (United States)

    Williams, Kathryn S; Shalom, Dara F; Winkler, Harvey A

    2018-01-01

    The objective of this article is to provide an informative and narrative review for the general Gynaecologist regarding the pathophysiology and conservative treatments available for faecal incontinence (FI). A PubMed search was performed by library staff and an author using the keywords: anal incontinence, faecal incontinence, accidental bowel leakage, outpatient clinic management of faecal incontinence and defecatory dysfunction. As the social limitations of FI can be devastating and long-term patient satisfaction rates after anal sphincteroplasty remain reportedly-low, the role of clinic-based management of FI has continued to grow. The purpose of this article is to provide the Obstetrician and Gynaecologist with a basic template for screening, evaluation and management of faecal incontinence in the clinical setting.

  6. [Lymphocyte subpopulations in alopecia areata].

    Science.gov (United States)

    Calandria, L; Paciel, J; Bruno, J; Martini, M; Vignale, R; Civila, E

    1986-01-01

    Subsets of peripheral blood lymphocytes were studied in 19 patients with alopecia areata. The results shows: a decreased Tm/Tg ratio, decreased number of OKT4+ cells, increased OKT8+ cells, decreased OKT4+/OKT8+ cell ratio. Total lymphocytes, T cells, Tm cells, Tg cells, T DR+ cells and B lymphocytes were normal. The results are similar to those founded in autoimmune diseases and suggest the existence of an immunopathogenic mechanism in these disease.

  7. Chronic Diffuse Alopecia In Female

    Directory of Open Access Journals (Sweden)

    Roy Aloke K

    1997-01-01

    Full Text Available Fifty female patients, in the age range 3.5 to 45 yrs, suffering from chronic diffuse alopecia were studied for the probable causes. In 26% of cases, iron deficiency anaemia was found to be the major aetiological factor and 20% cases showed hupothyroidism. The cause could not be traced in 40% of cases. In majority of cases, multiple factors might be implicated.

  8. Dictionary construction and identification of possible adverse drug events in Danish clinical narrative text.

    Science.gov (United States)

    Eriksson, Robert; Jensen, Peter Bjødstrup; Frankild, Sune; Jensen, Lars Juhl; Brunak, Søren

    2013-01-01

    Drugs have tremendous potential to cure and relieve disease, but the risk of unintended effects is always present. Healthcare providers increasingly record data in electronic patient records (EPRs), in which we aim to identify possible adverse events (AEs) and, specifically, possible adverse drug events (ADEs). Based on the undesirable effects section from the summary of product characteristics (SPC) of 7446 drugs, we have built a Danish ADE dictionary. Starting from this dictionary we have developed a pipeline for identifying possible ADEs in unstructured clinical narrative text. We use a named entity recognition (NER) tagger to identify dictionary matches in the text and post-coordination rules to construct ADE compound terms. Finally, we apply post-processing rules and filters to handle, for example, negations and sentences about subjects other than the patient. Moreover, this method allows synonyms to be identified and anatomical location descriptions can be merged to allow appropriate grouping of effects in the same location. The method identified 1 970 731 (35 477 unique) possible ADEs in a large corpus of 6011 psychiatric hospital patient records. Validation was performed through manual inspection of possible ADEs, resulting in precision of 89% and recall of 75%. The presented dictionary-building method could be used to construct other ADE dictionaries. The complication of compound words in Germanic languages was addressed. Additionally, the synonym and anatomical location collapse improve the method. The developed dictionary and method can be used to identify possible ADEs in Danish clinical narratives.

  9. Diffuse scarring alopecia in a female pattern hair loss distribution.

    Science.gov (United States)

    Fergie, Bonnie; Khaira, Gurpreet; Howard, Vicki; de Zwaan, Sally

    2018-02-01

    We describe three cases of hair loss in a female pattern hair loss (FPHL) distribution with histologic features of lichen planopilaris (LPP). All patients had a history of diffuse, gradual hair loss in a Christmas tree pattern that clinically presented as FPHL on gross and dermoscopic examination. Notably, there were no characteristic clinical signs of LPP and no histologic features of FPHL. These cases are most consistent with cicatricial pattern hair loss (CPHL). This relatively new entity is similar to fibrosing alopecia in a pattern distribution (FAPD) in that they are both scarring alopecias confined to a FPHL distribution, but CPHL lacks the clinical signs of perifollicular erythema and perifollicular keratosis seen in FAPD. These three cases may present an early, subtle form of CPHL and will be of interest to clinicians and histopathologists alike. © 2017 The Australasian College of Dermatologists.

  10. The Relationship between Androgenic Alopecia and Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Ghasem Rahmatpour Rokni

    2016-07-01

    Full Text Available Prostate cancer (PC and Androgenic Alopecia (AGA i are both common diseases in elder men. It seems that androgen plays a crucial role in the growth and development of prostate cancer. Therefore, the current study intended to investigate the relationship between androgenic alopecia and prostate cancer. The present study is a case-control study conducted on 75 patients with prostate cancer (case group referring to Imam Khomeini Hospital in Sari, Iran. The case group was compared with the control group (75 healthy individuals. The intended questionnaire of the study included information such as the age, sex, duration of disease, stage of disease, level of PSA, time diagnosis and time of interview for all the participants. The results of interview and clinical examination along with the patient’s information all were filled in the questionnaire and were statistically analyzed by SPSS after data collection. The mean age of PC group and healthy group was respectively 69.08 ± 8.97 and 68 .45 ± 10.16 years. The average level of PSA was 10.86 ± 11.7 and 2.66 ± 2.7 ng/ml in PC and healthy group in turn. The average duration of cancer was 12.63 ± 9.19 months in PC group. Furthermore, about 6.7% of cancer patients were in stage I, 48% were stage II, 29.3% were in stage III and 16% were in stage IV of prostate cancer. Besides, the number of cancer patients who had both frontal and vertex alopecia (baldness altogether exceeded healthy individuals (P=0.002. According to the results of the present study, there was a significant relationship between prostate cancer and androgenic alopecia which might have been caused by the effect of androgens on both diseases. Consequently, androgenic alopecia can be considered as one of the risk factors associated with prostate cancer.

  11. The use of systematic reviews in clinical trials and narrative reviews in dermatology: is the best evidence being used?

    Science.gov (United States)

    Conde-Taboada, A; Aranegui, B; García-Doval, I; Dávila-Seijo, P; González-Castro, U

    2014-04-01

    Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas, and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas, very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

  12. Mining peripheral arterial disease cases from narrative clinical notes using natural language processing.

    Science.gov (United States)

    Afzal, Naveed; Sohn, Sunghwan; Abram, Sara; Scott, Christopher G; Chaudhry, Rajeev; Liu, Hongfang; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

    2017-06-01

    Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard. We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets. We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  13. The usefulness of dermoscopy in canine pattern alopecia: a descriptive study.

    Science.gov (United States)

    Zanna, Giordana; Roccabianca, Paola; Zini, Eric; Legnani, Sara; Scarampella, Fabia; Arrighi, Silvana; Tosti, Antonella

    2017-02-01

    Dermoscopic studies evaluating noninflammatory, nonpruritic progressive alopecia attributable to pattern alopecia are currently unavailable. To evaluate the dermoscopic features observed in healthy skin of short coated dogs and compare these findings with those observed in dogs affected by pattern alopecia diagnosed by clinical and dermatopathological examination. Thirty male and female, healthy, breed matched, young adult, short coated dogs (controls) and 30 male and female, young adult, short coated dogs affected by pattern alopecia. Dermoscopy was performed with a Fotofinder II videodermoscope equipped with software that allowed the measurement of structures visualized in magnified images (20×-40×-70×). Skin biopsy samples were obtained from the thorax and evaluated dermoscopically for dermoscopic-histological correlation in affected dogs. Dermoscopic findings in canine pattern alopecia were hair shaft thinning, circle hairs and follicular keratin plugs; in the affected sun exposed areas there was a honeycomb-like pattern of pigmentation. Arborizing red lines reflecting vascularization were classified as a nonspecific finding because they were also common in healthy dogs. Dermoscopic features correlated with histology for selected hair follicle abnormalities. Although canine pattern alopecia is a visually striking disease, this study supports the value of dermoscopy for clinical examination and also opens promising perspectives for the identification of diagnostic dermoscopic patterns that may be useful for other skin disorders. © 2016 ESVD and ACVD.

  14. Effect of minoxidil topical foam on frontotemporal and vertex androgenetic alopecia in men: a 104-week open-label clinical trial.

    Science.gov (United States)

    Kanti, V; Hillmann, K; Kottner, J; Stroux, A; Canfield, D; Blume-Peytavi, U

    2016-07-01

    Topical minoxidil formulations have been shown to be effective in treating androgenetic alopecia (AGA) for 12 months. Efficacy and safety in both frontotemporal and vertex regions over longer application periods have not been studied so far. To evaluate the effect of 5% minoxidil topical foam (5% MTF) in the frontotemporal and vertex areas in patients with moderate AGA over 104 weeks. An 80-week, open-label extension phase was performed, following a 24-week randomized, double-blind, placebo-controlled study in men with AGA grade IIIvertex to VI. Group 1 (n = 22) received ongoing 5% MTF for 104 weeks, Group 2 (n = 23) received placebo topical foam (plaTF) until week 24, followed by 5% MTF until week 104 during the extension phase. Frontotemporal and vertex target area non-vellus hair counts (f-TAHC, v-TAHC) and cumulative hair width (f-TAHW, v-TAHW) were assessed at baseline and at weeks 24, 52, 76 and 104. In Group 1, f-TAHW and f-TAHC showed a statistically significant increase from baseline to week 52 and week 76, respectively, returning to values comparable to baseline at week 104. No significant differences were found between baseline and week 104 in v-TAHC in Group 1 as well as f-TAHC, v-TAHC, f-TAHW and v-TAHW values in Group 2. 5% MTF is effective in stabilizing hair density, hair width and scalp coverage in both frontotemporal and vertex areas over an application period of 104 weeks, while showing a good safety and tolerability profile with a low rate of irritant contact dermatitis. © 2015 European Academy of Dermatology and Venereology.

  15. Selective immunological evaluation in alopecia areata

    Directory of Open Access Journals (Sweden)

    singla A

    1991-01-01

    Full Text Available Fifty patients of alopecia areata were studied to find out their T cell count and serum immunoglobulin levels as compared to normal individuals. It was found that T cell forming E Rossettes were significantly decreased and there was also significant depression of serum IgG in patients of alopecia areata.

  16. Dermatoglyphics in Ichthyosis and Alopecia Areata

    Directory of Open Access Journals (Sweden)

    K C Verma

    1981-01-01

    Full Text Available A total of 80 cases comprising of 40 controls and twenty each of ichthyosis and alopecia areata were studied for dermatoglyphic patterns and ridge count. Statistically significant increased incidence of whorl pattern was observed in female cases of autosomal dominant and sex linked ichthyosis. Significant change in the distribution of patterns was found in female cases of alopecia areata. -

  17. Retrospective evaluation of childhood alopecia areata cases

    Directory of Open Access Journals (Sweden)

    Munise Daye

    2013-09-01

    Full Text Available Background and design: Approximately 20% of alopecia areata (AA cases are children. There is limited information about childhood AA.We aimed to examine demographic features,treatments and diseases prognosis of child cases of AA that were followed in our clinic. Material and methods: Datas of 110 AA patients who are 16 and under 16 years old were examined retrospectively.The age,gender,disease onset age,duration of disease,types of AA and onset area,nail involvement, accompanying systemic and dermatological diseases,laboratory tests,treatments and the prognosis were evaluated in their follow-up time.Results: Female cases were 46,4%, male cases were 53,6%.The mean age was 10,35 years.The age of disease onset was 8,65 years.Primary onset areas of AA cases were scalp in 83,6%, eyebrows in 5,4%, body hair in 5,4%, eyelashes in 2,7%, eyebrows and eyelashes in 2,7%.Types of disease were AA in 73,4% cases,alopecia totalis in 19% cases, alopecia universalis in 5,4% cases,ophiaisis in 1,8% cases.Nail involvement was established in 36,3% cases. Nevus flammeus was established in 2,7% cases.Mean disease duration was 17,02 months.Accompaying dermatosis were vitiligo in 2,7% cases,atopic dermatitis in 6,3% cases. The accompaying systemic diseases were autoimmune thyroiditis in 1,8% cases and Down's Syndrome in 2,7% cases.Thyroid autoantibodies were high in 0,9% cases.We have treated 24,5% of cases with topical corticosteroid lotion, 30,9% of cases with anthralin, 0,9%of cases with 2% minoxidil lotion, 0,9% of cases with calcipotriol lotion, 1,8% of cases with topical calcineurin inhibitors, 10% of cases with intralesional corticosteroids.We have treated 15,4% of cases with systemic corticosteroids and PUVA therapy who were resistant to topical treatment.We have treated 14,5% of cases with different combinations of topical treatments.Remission was observed in 34,5% of cases.The mean remission duration was 12.2 months.Relapse was observed at a average of two

  18. Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support.

    Science.gov (United States)

    Miller, Kristen; Mosby, Danielle; Capan, Muge; Kowalski, Rebecca; Ratwani, Raj; Noaiseh, Yaman; Kraft, Rachel; Schwartz, Sanford; Weintraub, William S; Arnold, Ryan

    2018-05-01

    Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.

  19. Patchy alopecia areata sparing gray hairs: a case series.

    Science.gov (United States)

    Jia, Wei-Xue; Mao, Qiu-Xia; Xiao, Xue-Min; Li, Zhi-Liang; Yu, Rui-Xing; Li, Cheng-Rang

    2014-05-01

    Alopecia areata is an unpredictable, non-scarring hair loss condition. Patchy alopecia areata sparing gray hairs is rare. Here we present 4 cases with patchy non-scarring hair loss, which attacked pigmented hairs only and spared gray hairs. It should be differentiated from vitiligo, colocalization of vitiligo and alopecia areata, and depigmented hair regrowth after alopecia areata.

  20. Patchy alopecia areata sparing gray hairs: a case series

    OpenAIRE

    Jia, Wei-Xue; Mao, Qiu-Xia; Xiao, Xue-Min; Li, Zhi-Liang; Yu, Rui-Xing; Li, Cheng-Rang

    2014-01-01

    Alopecia areata is an unpredictable, non-scarring hair loss condition. Patchy alopecia areata sparing gray hairs is rare. Here we present 4 cases with patchy non-scarring hair loss, which attacked pigmented hairs only and spared gray hairs. It should be differentiated from vitiligo, colocalization of vitiligo and alopecia areata, and depigmented hair regrowth after alopecia areata.

  1. Dictionary construction and identification of possible adverse drug events in Danish clinical narrative text

    DEFF Research Database (Denmark)

    Eriksson, Robert; Jensen, Peter Bjødstrup; Pletscher-Frankild, Sune

    2013-01-01

    Objective Drugs have tremendous potential to cure and relieve disease, but the risk of unintended effects is always present. Healthcare providers increasingly record data in electronic patient records (EPRs), in which we aim to identify possible adverse events (AEs) and, specifically, possible...... adverse drug events (ADEs).Materials and methods Based on the undesirable effects section from the summary of product characteristics (SPC) of 7446 drugs, we have built a Danish ADE dictionary. Starting from this dictionary we have developed a pipeline for identifying possible ADEs in unstructured...... clinical narrative text. We use a named entity recognition (NER) tagger to identify dictionary matches in the text and post-coordination rules to construct ADE compound terms. Finally, we apply post-processing rules and filters to handle, for example, negations and sentences about subjects other than...

  2. [Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording].

    Science.gov (United States)

    Chao, Yu-Mei Y; Chiang, Hsien-Hsien

    2017-02-01

    Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. To explore the essence of CNPR in the contexts of clinical teaching and learning. Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by re-locating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.

  3. Using domain knowledge and domain-inspired discourse model for coreference resolution for clinical narratives.

    Science.gov (United States)

    Jindal, Prateek; Roth, Dan

    2013-01-01

    This paper presents a coreference resolution system for clinical narratives. Coreference resolution aims at clustering all mentions in a single document to coherent entities. A knowledge-intensive approach for coreference resolution is employed. The domain knowledge used includes several domain-specific lists, a knowledge intensive mention parsing, and task informed discourse model. Mention parsing allows us to abstract over the surface form of the mention and represent each mention using a higher-level representation, which we call the mention's semantic representation (SR). SR reduces the mention to a standard form and hence provides better support for comparing and matching. Existing coreference resolution systems tend to ignore discourse aspects and rely heavily on lexical and structural cues in the text. The authors break from this tradition and present a discourse model for "person" type mentions in clinical narratives, which greatly simplifies the coreference resolution. This system was evaluated on four different datasets which were made available in the 2011 i2b2/VA coreference challenge. The unweighted average of F1 scores (over B-cubed, MUC and CEAF) varied from 84.2% to 88.1%. These experiments show that domain knowledge is effective for different mention types for all the datasets. Error analysis shows that most of the recall errors made by the system can be handled by further addition of domain knowledge. The precision errors, on the other hand, are more subtle and indicate the need to understand the relations in which mentions participate for building a robust coreference system. This paper presents an approach that makes an extensive use of domain knowledge to significantly improve coreference resolution. The authors state that their system and the knowledge sources developed will be made publicly available.

  4. Use of dermoscopy in the diagnosis of temporal triangular alopecia.

    Science.gov (United States)

    Campos, Jullyene Gomes de; Oliveira, Cláudia Marina Puga Barbosa; Romero, Sandra Adolfina Reyes; Klein, Ana Paula; Akel, Patricia Bandeira de Melo; Pinto, Giselle Martins

    2015-01-01

    Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.

  5. Molecular signatures define alopecia areata subtypes and transcriptional biomarkers

    Directory of Open Access Journals (Sweden)

    Ali Jabbari

    2016-05-01

    Full Text Available Alopecia areata (AA is an autoimmune disease typified by nonscarring hair loss with a variable clinical course. In this study, we conducted whole genome gene expression analysis of 96 human scalp skin biopsy specimens from AA or normal control subjects. Based on gene expression profiling, samples formed distinct clusters based on the presence or absence of disease as well as disease phenotype (patchy disease compared with alopecia totalis or universalis. Differential gene expression analysis allowed us to robustly demonstrate graded immune activity in samples of increasing phenotypic severity and generate a quantitative gene expression scoring system that classified samples based on interferon and cytotoxic T lymphocyte immune signatures critical for disease pathogenesis.

  6. Document clustering of clinical narratives: a systematic study of clinical sublanguages.

    Science.gov (United States)

    Patterson, Olga; Hurdle, John F

    2011-01-01

    It is widely believed that different clinical domains use their own sublanguage in clinical notes, complicating natural language processing, but this has never been demonstrated on a broad selection of note types. Starting from formal sublanguage theory, we constructed a feature space based on vocabulary and semantic types used in 17 different clinical domains by three author types (physicians, nurses, and social workers) in both the in- and outpatient settings. We supplied the resulting vectors to CLUTO, a robust clustering tool suitable for this high-dimensional space. Our results confirm that note types with a broad clinical scope, e.g, History & Physicals and Discharge Summaries, cluster together, while note types with a narrow clinical scope form surprisingly pure, disjoint sublanguages. A reasonable conclusion from this study is that any tool relying on term statistics or semantics trained on one clinical note type may not work well on any other.

  7. Development and validation of the Frontal Fibrosing Alopecia Severity Score.

    Science.gov (United States)

    Saceda-Corralo, David; Moreno-Arrones, Óscar Muñoz; Fonda-Pascual, Pablo; Pindado-Ortega, Cristina; Buendía-Castaño, Diego; Alegre-Sánchez, Adrián; Segurado-Miravalles, Gonzalo; Rodrigues-Barata, Ana Rita; Jaén-Olasolo, Pedro; Vaño-Galván, Sergio

    2018-03-01

    Frontal fibrosing alopecia (FFA) is a scarring alopecia characterized by recession of the frontotemporal hairline and loss of the eyebrows. To design and validate a scoring system to assess the severity of FFA. The Frontal Fibrosing Alopecia Severity Score (FFASS) was developed; criterion validity was assessed by the Investigator's Global Assessment, and construct validity was evaluated by the convergence of other measures of severity (the Patient's Global Assessment], the rest of the clinical features, the Lichen Planopilaris Activity Index, and quality of life measures (Dermatology Life Quality Index and Hospital Anxiety Depression Scale). Intraobserver and interobserver reliability were determined. In total, 103 female patients were included. The FFASS showed significant correlation to the Patient's Global Assessment, occipital involvement, and the Lichen Planopilaris Activity Index. Intraobserver reliability was completed for 31 subjects and showed good correlation (intraclass correlation coefficient, 0.86; 95% confidence interval, 0.7-0.95; P < .001). Interobserver reliability showed excellent correlation (intraclass correlation coefficient, 0.97; 95% confidence interval, 0.95-0.99; P < .001). The study was performed at a single institution, and only female patients were assessed. The FFASS is a statistically validated scale and a reliable measure of FFA severity, and it can be used in clinical practice and future research studies as an assessment tool. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Identifying influenza-like illness presentation from unstructured general practice clinical narrative using a text classifier rule-based expert system versus a clinical expert.

    Science.gov (United States)

    MacRae, Jayden; Love, Tom; Baker, Michael G; Dowell, Anthony; Carnachan, Matthew; Stubbe, Maria; McBain, Lynn

    2015-10-06

    We designed and validated a rule-based expert system to identify influenza like illness (ILI) from routinely recorded general practice clinical narrative to aid a larger retrospective research study into the impact of the 2009 influenza pandemic in New Zealand. Rules were assessed using pattern matching heuristics on routine clinical narrative. The system was trained using data from 623 clinical encounters and validated using a clinical expert as a gold standard against a mutually exclusive set of 901 records. We calculated a 98.2 % specificity and 90.2 % sensitivity across an ILI incidence of 12.4 % measured against clinical expert classification. Peak problem list identification of ILI by clinical coding in any month was 9.2 % of all detected ILI presentations. Our system addressed an unusual problem domain for clinical narrative classification; using notational, unstructured, clinician entered information in a community care setting. It performed well compared with other approaches and domains. It has potential applications in real-time surveillance of disease, and in assisted problem list coding for clinicians. Our system identified ILI presentation with sufficient accuracy for use at a population level in the wider research study. The peak coding of 9.2 % illustrated the need for automated coding of unstructured narrative in our study.

  9. Comparing deep learning and concept extraction based methods for patient phenotyping from clinical narratives.

    Science.gov (United States)

    Gehrmann, Sebastian; Dernoncourt, Franck; Li, Yeran; Carlson, Eric T; Wu, Joy T; Welt, Jonathan; Foote, John; Moseley, Edward T; Grant, David W; Tyler, Patrick D; Celi, Leo A

    2018-01-01

    In secondary analysis of electronic health records, a crucial task consists in correctly identifying the patient cohort under investigation. In many cases, the most valuable and relevant information for an accurate classification of medical conditions exist only in clinical narratives. Therefore, it is necessary to use natural language processing (NLP) techniques to extract and evaluate these narratives. The most commonly used approach to this problem relies on extracting a number of clinician-defined medical concepts from text and using machine learning techniques to identify whether a particular patient has a certain condition. However, recent advances in deep learning and NLP enable models to learn a rich representation of (medical) language. Convolutional neural networks (CNN) for text classification can augment the existing techniques by leveraging the representation of language to learn which phrases in a text are relevant for a given medical condition. In this work, we compare concept extraction based methods with CNNs and other commonly used models in NLP in ten phenotyping tasks using 1,610 discharge summaries from the MIMIC-III database. We show that CNNs outperform concept extraction based methods in almost all of the tasks, with an improvement in F1-score of up to 26 and up to 7 percentage points in area under the ROC curve (AUC). We additionally assess the interpretability of both approaches by presenting and evaluating methods that calculate and extract the most salient phrases for a prediction. The results indicate that CNNs are a valid alternative to existing approaches in patient phenotyping and cohort identification, and should be further investigated. Moreover, the deep learning approach presented in this paper can be used to assist clinicians during chart review or support the extraction of billing codes from text by identifying and highlighting relevant phrases for various medical conditions.

  10. Comparing deep learning and concept extraction based methods for patient phenotyping from clinical narratives.

    Directory of Open Access Journals (Sweden)

    Sebastian Gehrmann

    Full Text Available In secondary analysis of electronic health records, a crucial task consists in correctly identifying the patient cohort under investigation. In many cases, the most valuable and relevant information for an accurate classification of medical conditions exist only in clinical narratives. Therefore, it is necessary to use natural language processing (NLP techniques to extract and evaluate these narratives. The most commonly used approach to this problem relies on extracting a number of clinician-defined medical concepts from text and using machine learning techniques to identify whether a particular patient has a certain condition. However, recent advances in deep learning and NLP enable models to learn a rich representation of (medical language. Convolutional neural networks (CNN for text classification can augment the existing techniques by leveraging the representation of language to learn which phrases in a text are relevant for a given medical condition. In this work, we compare concept extraction based methods with CNNs and other commonly used models in NLP in ten phenotyping tasks using 1,610 discharge summaries from the MIMIC-III database. We show that CNNs outperform concept extraction based methods in almost all of the tasks, with an improvement in F1-score of up to 26 and up to 7 percentage points in area under the ROC curve (AUC. We additionally assess the interpretability of both approaches by presenting and evaluating methods that calculate and extract the most salient phrases for a prediction. The results indicate that CNNs are a valid alternative to existing approaches in patient phenotyping and cohort identification, and should be further investigated. Moreover, the deep learning approach presented in this paper can be used to assist clinicians during chart review or support the extraction of billing codes from text by identifying and highlighting relevant phrases for various medical conditions.

  11. Comparing deep learning and concept extraction based methods for patient phenotyping from clinical narratives

    Science.gov (United States)

    Dernoncourt, Franck; Li, Yeran; Carlson, Eric T.; Wu, Joy T.; Welt, Jonathan; Foote, John; Moseley, Edward T.; Grant, David W.; Tyler, Patrick D.; Celi, Leo A.

    2018-01-01

    In secondary analysis of electronic health records, a crucial task consists in correctly identifying the patient cohort under investigation. In many cases, the most valuable and relevant information for an accurate classification of medical conditions exist only in clinical narratives. Therefore, it is necessary to use natural language processing (NLP) techniques to extract and evaluate these narratives. The most commonly used approach to this problem relies on extracting a number of clinician-defined medical concepts from text and using machine learning techniques to identify whether a particular patient has a certain condition. However, recent advances in deep learning and NLP enable models to learn a rich representation of (medical) language. Convolutional neural networks (CNN) for text classification can augment the existing techniques by leveraging the representation of language to learn which phrases in a text are relevant for a given medical condition. In this work, we compare concept extraction based methods with CNNs and other commonly used models in NLP in ten phenotyping tasks using 1,610 discharge summaries from the MIMIC-III database. We show that CNNs outperform concept extraction based methods in almost all of the tasks, with an improvement in F1-score of up to 26 and up to 7 percentage points in area under the ROC curve (AUC). We additionally assess the interpretability of both approaches by presenting and evaluating methods that calculate and extract the most salient phrases for a prediction. The results indicate that CNNs are a valid alternative to existing approaches in patient phenotyping and cohort identification, and should be further investigated. Moreover, the deep learning approach presented in this paper can be used to assist clinicians during chart review or support the extraction of billing codes from text by identifying and highlighting relevant phrases for various medical conditions. PMID:29447188

  12. Clinical impact of wordless picture storybooks on bilingual narrative language production: A comparison of the 'Frog' stories.

    Science.gov (United States)

    Heilmann, John J; Rojas, Raúl; Iglesias, Aquiles; Miller, Jon F

    2016-05-01

    Language sampling, recognized as a gold standard for expressive language assessment, is often elicited using wordless picture storybooks. A series of wordless storybooks, commonly referred to as 'Frog' stories, have been frequently used in language-based research with children from around the globe. To examine the impact that differences in stories have on narrative output by comparing narrative productions across a series of five storybooks produced by 831 bilingual (Spanish-English) children in kindergarten through third grade. Each participant produced oral narratives using one of the five Frog storybooks in both English and Spanish. The narratives were recorded, transcribed and coded for a variety of measures of language production. Negligible differences were observed in language measures when comparing groups of children who told different stories, with the exception of lexical diversity. The implications of using different storybooks to elicit narrative language samples from children are discussed from the perspectives of research and clinical practice. © 2015 Royal College of Speech and Language Therapists.

  13. Concept-value pair extraction from semi-structured clinical narrative: a case study using echocardiogram reports.

    Science.gov (United States)

    Chung, Jeanhee; Murphy, Shawn

    2005-01-01

    The task of gathering detailed patient information from narrative text presents a significant barrier to clinical research. A prototype information extraction system was developed to identify concepts and their associated values from narrative echocardiogram reports. The system uses a Unified Medical Language System compatible architecture and takes advantage of canonical language use patterns to identify sentence templates with which concepts and their related values can be identified. The data extracted from this system will be used to enrich an existing database used by clinical researchers in a large university healthcare system to identify potential research candidates fulfilling clinical inclusion criteria. The system was developed and evaluated using ten clinical concepts. Concept-value pairs extracted by the system were compared with findings extracted manually by the author. The system was able to recall 78% [95%CI, 76-80%] of the relevant findings, with a precision of 99% [95%CI, 98-99%].

  14. How can placebo effects best be applied in clinical practice? A narrative review

    Directory of Open Access Journals (Sweden)

    Bystad M

    2015-01-01

    Full Text Available Martin Bystad,1,2 Camilla Bystad,3 Rolf Wynn1,3 1Division of Addictions and Specialized Psychiatric Services, University Hospital of North Norway, 2Institute of Psychology, 3Institute of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway Abstract: Placebo effects are documented in a number of clinical and experimental studies. It is possible to benefit from placebo effects in clinical practice by using them as effects additive to those of documented and effective treatments. The purpose of this paper is to discuss how doctors and other health workers may benefit from placebo effects within an ethical framework. A narrative review of the literature relating to placebo effects in clinical practice was performed. We searched PubMed and selected textbooks on placebo effects for articles and book chapters relating to placebo effects in clinical practice. By drawing on placebo effects, doctors may access patients’ self-healing potentials. In practice, doctors may best benefit from placebo effects by influencing the patient’s expectations through communication. An important principle is to give the patient information stating that a particular treatment is effective, as long as this is based on realistic optimism. A patient-centered style involving elements such as developing trust and respect, exploring the patient’s values, speaking positively about treatments, and providing reassurance and encouragement might aid in activating placebo effects. The total effect of a documented treatment will partly depend on how well the placebo effects have been activated. Thus, placebo effects can be understood as a form of supplemental treatment. Keywords: placebo effects, doctor-patient communication, expectations, biopsychosocial model

  15. Annotating risk factors for heart disease in clinical narratives for diabetic patients.

    Science.gov (United States)

    Stubbs, Amber; Uzuner, Özlem

    2015-12-01

    The 2014 i2b2/UTHealth natural language processing shared task featured a track focused on identifying risk factors for heart disease (specifically, Cardiac Artery Disease) in clinical narratives. For this track, we used a "light" annotation paradigm to annotate a set of 1304 longitudinal medical records describing 296 patients for risk factors and the times they were present. We designed the annotation task for this track with the goal of balancing annotation load and time with quality, so as to generate a gold standard corpus that can benefit a clinically-relevant task. We applied light annotation procedures and determined the gold standard using majority voting. On average, the agreement of annotators with the gold standard was above 0.95, indicating high reliability. The resulting document-level annotations generated for each record in each longitudinal EMR in this corpus provide information that can support studies of progression of heart disease risk factors in the included patients over time. These annotations were used in the Risk Factor track of the 2014 i2b2/UTHealth shared task. Participating systems achieved a mean micro-averaged F1 measure of 0.815 and a maximum F1 measure of 0.928 for identifying these risk factors in patient records. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Charcot-Marie-Tooth 1A: A narrative review with clinical and anatomical perspectives.

    Science.gov (United States)

    McGrath, M C

    2016-07-01

    Charcot-Marie-Tooth 1A (CMT1A) is regarded as the most common hereditary peripheral neurodegenerative disorder. This narrative review highlights perspectives around the historically well-established and characteristic anatomical manifestations of CMT1A seen in the feet, legs and hands, in addition to a clinical diagnosis that may be confirmed by electrophysiology, genetic or molecular markers together with the presence of a typical family history. A less well-known perspective is the potential for systemic manifestations and wider complication. The condition is characterised by a progressive clinical picture with unmistakable anatomical and neurological features that have been described since the late 19th century. There remains no cure although supportive, rehabilitative, and surgical regimes may provide helpful management or amelioration of symptoms. Most recently, the emergence of a pleotherapeutic approach suggests distinct promise. Future research focused on a detailed elucidation of the underlying molecular mechanisms underpinning myelin and axonal function may eventually hold the key to successful treatment of CMT1A. Genetic modification would potentially present a cure. Clin. Anat. 29:547-554, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  17. Experimental and early investigational drugs for androgenetic alopecia.

    Science.gov (United States)

    Guo, Hongwei; Gao, Wendi Victor; Endo, Hiromi; McElwee, Kevin John

    2017-08-01

    Treatments for androgenetic alopecia constitute a multi-billion-dollar industry, however, currently available therapeutic options have variable efficacy. Consequently, in recent years small biotechnology companies and academic research laboratories have begun to investigate new or improved treatment methods. Research and development approaches include improved formulations and modes of application for current drugs, new drug development, development of cell-based treatments, and medical devices for modulation of hair growth. Areas covered: Here we review the essential pathways of androgenetic alopecia pathogenesis and collate the current and emerging therapeutic strategies using journal publications databases and clinical trials databases to gather information about active research on new treatments. Expert opinion: We propose that topically applied medications, or intra-dermal injected or implanted materials, are preferable treatment modalities, minimizing side effect risks as compared to systemically applied treatments. Evidence in support of new treatments is limited. However, we suggest therapeutics which reverse the androgen-driven inhibition of hair follicle signaling pathways, such as prostaglandin analogs and antagonists, platelet-rich plasma (PRP), promotion of skin angiogenesis and perfusion, introduction of progenitor cells for hair regeneration, and more effective ways of transplanting hair, are the likely near future direction of androgenetic alopecia treatment development.

  18. Narrative abilities of monolingual and bilingual children with and without language impairment: implications for clinical practice

    NARCIS (Netherlands)

    Boerma, T.D.; Leseman, P.P.M.; Timmermeister, M.; Wijnen, F.N.K.; Blom, W.B.T.

    2016-01-01

    Background Understanding and expressing a narrative's macro-structure is relatively independent of experience in a specific language. A narrative task is therefore assumed to be a less biased method of language assessment for bilingual children than many other norm-referenced tests and may thus be

  19. Narrative Abilities of Monolingual and Bilingual Children with and without Language Impairment: Implications for Clinical Practice

    Science.gov (United States)

    Boerma, Tessel; Leseman, Paul; Timmermeister, Mona; Wijnen, Frank; Blom, Elma

    2016-01-01

    Background: Understanding and expressing a narrative's macro-structure is relatively independent of experience in a specific language. A narrative task is therefore assumed to be a less biased method of language assessment for bilingual children than many other norm-referenced tests and may thus be particularly valuable to identify language…

  20. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation.

    Science.gov (United States)

    El Taieb, Moustafa A; Ibrahim, Hassan; Nada, Essam A; Seif Al-Din, Mai

    2017-01-01

    Alopecia areata is a common cause of nonscarring alopecia that occurs in a patchy, confluent, or diffuse pattern. Dermoscopy is a noninvasive technique for the clinical diagnosis of many skin diseases. Topical minoxidil solution 5% and platelet rich plasma are important modalities used in treatment of alopecia areata. We aimed to evaluate the efficacy of PRP versus topical minoxidil 5% in the treatment of AA by clinical evaluation and trichoscopic examination. Ninety patients were allocated into three groups; the first was treated with topical minoxidil 5% solution, the second with platelets rich plasma injections, and the third with placebo. Diagnosis and follow up were done by serial digital camera photography of lesions and dermoscopic scan before and every 1 month after treatment for 3 months. Patients treated with minoxidil 5% and platelets rich plasma both have significant hair growth than placebo (p minoxidil and control (p minoxidil 5% as evaluated by clinical and trichoscopic examination. © 2016 Wiley Periodicals, Inc.

  1. Dermoscopic findings in female androgenetic alopecia Achados dermatoscópicos na alopecia androgenética feminina

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    Lya Duarte Ramos

    2012-10-01

    Full Text Available BACKGROUND: Androgenetic alopecia is the most common form of hair loss. It is a clinical entity of relevant interest and presents a significant psychosocial impact as it undermines self-esteem and quality of life in female patients due to the importance of the hair for people's facial balance. OBJECTIVE: The purpose of the present study is to evaluate dermoscopic signs in women clinically diagnosed with androgenetic alopecia. METHOD: Observational study with 34 women between 17 and 68 years old who were diagnosed with androgenetic alopecia. All of them underwent photographic sessions with a 10x magnification dermoscope and a digital camera zoom set to 20x magnification and 40x magnification on the scalp frontal midline. RESULTS: All patients showed miniaturization. A peripilar brown halo was found in 22 patients, honeycomb-like scalp pigmentation was found in 14 and yellow dots in only 1 patient. Recent studies show dermoscopy as the new tool for diagnosis assistance and treatment follow up in scalp disorders. Our study used an ordinary dermoscope and we evaluated several findings reported in the literature with significant clarity and easiness. CONCLUSION: The dermoscope, which is used by dermatologists on a daily basis, is an excellent tool to assist in early diagnosis and assessment of therapeutic response in androgenetic alopecia.FUNDAMENTOS: Alopecia androgenética é forma mais comum de queda de cabelo. Constitui entidade clínica de interesse relevante e acarreta grande impacto psicossocial por comprometer a auto-estima e a qualidade de vida das pacientes. OBJETIVO: Procurar os sinais dermatoscópicos comuns em mulheres com diagnóstico clínico de alopecia androgenética, visando diagnóstico precoce e melhor resposta terapêutica. MÉTODOS: Estudo observacional em 34 mulheres com idades entre 17 e 68 anos, com diagnóstico clínico de alopecia androgenética. Todas pacientes foram avaliadas e submetidas a registros fotográficos com o

  2. Ehlers-Danlos syndrome with diffuse alopecia

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    Tolat S

    1993-01-01

    Full Text Available A case of Ehlers-Danlos syndrome in a 20 year old male involving cutaneous and skeletal systems is reported. Generalised alopecia involving scalp was an unusual and interesting feature in this case.

  3. Systematic reviews versus narrative reviews in clinical anatomy: Methodological approaches in the era of evidence-based anatomy.

    Science.gov (United States)

    Henry, Brandon Michael; Skinningsrud, Bendik; Vikse, Jens; Pękala, Przemysław A; Walocha, Jerzy A; Loukas, Marious; Tubbs, R Shane; Tomaszewski, Krzysztof A

    2018-04-01

    Two main types of review articles with distinct characteristics and goals are commonly found in the scientific literature: systematic reviews and narrative (also called expert or traditional) reviews. Narrative reviews are publications that describe and discuss the state of science on a specific topic or theme from a theoretical and contextual point of view with little explicit structure for gathering and presenting evidence. Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence-based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy. The goal of this perspective article is to address the key differences between narrative and systematic reviews in the context of clinical anatomy, to provide guidance on which type of review is most appropriate for a specific issue, and to summarize how the two types of reviews can work in unison to enhance the quality of anatomical research and its delivery to clinicians and anatomists alike. Clin. Anat. 31:364-367, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  4. Concentric Polycyclic Regrowth Pattern in Alopecia Areata.

    Science.gov (United States)

    Delorenze, Lilian Mathias; Gavazzoni-Dias, Maria Fernanada Reis; Teixeira, Marcelo S; Aide, Marcia Kalil

    2016-01-01

    Alopecia areata (AA) is a common form of autoimmune nonscarring hair loss of scalp and/or body. Atypical hair regrowth in AA is considered a rare phenomenon. It includes atypical pattern of hair growth (sudden graying, perinevoid alopecia, Renbok phenomenon, castling phenomenon, and concentric or targetoid regrowth) and atypical dark color hair regrowth. We report a case of AA that resulted in a concentric targetoid hair regrowth and discuss the possible related theories regarding the significance of this phenomenon.

  5. Central centrifugal cicatricial alopecia: challenges and solutions

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    Herskovitz, Ingrid; Miteva, Mariya

    2016-01-01

    Ingrid Herskovitz, Mariya Miteva Department of Dermatology and Cutaneous Surgery, University of Miami L Miller School of Medicine, Miami, FL, USA Abstract: Central centrifugal cicatricial alopecia (CCCA) is the most common scarring alopecia among African American women. Data about epidemiology, etiology, genetic inheritance, and management are scarce and come from individual reports or small series. CCCA has been associated with hot combing and traumatic hair styling for years; howev...

  6. The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review.

    Science.gov (United States)

    Dodek, Peter; Cahill, Naomi E; Heyland, Daren K

    2010-01-01

    The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" and encompasses leadership, communication, teamwork, conflict resolution, and other domains. This narrative review highlights the results of recent quantitative and qualitative studies, including studies on adherence to nutrition guidelines in the critical care setting, which demonstrate that elements of organizational culture, such as leadership support, interprofessional collaboration, and shared beliefs about the utility of guidelines, influence adherence to guideline recommendations. Outside nutrition therapy, there is emerging evidence that strategies focusing on organizational change (eg, revision of professional roles, interdisciplinary teams, integrated care delivery, computer systems, and continuous quality improvement) can favorably influence professional performance and patient outcomes. Consequently, future interventions aimed at implementing nutrition guidelines should aim to measure and take into account organizational culture, in addition to considering the characteristics of the patient, provider, and guideline. Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy.

  7. Clinical Features and Management of Cartilage-Hair Hypoplasia: A Narrative Review

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    Kobra Shiasi Arani

    2015-01-01

    Full Text Available Context: Cartilage-hair hypoplasia is a rare hereditary cause of short stature. The aim of this study was to familiarize physicians with this rare but important disease. Evidence Acquisition: This article is a narrative review of the scientific literature to inform about clinical features and management of Cartilage-hair hypoplasia. A systematic search identified 127 papers include original and review articles and case reports. Results: Cartilage-Hair Hypoplasia characterized by short-limb dwarfism associated with metaphyseal chondrodysplasia. The inheritance is autosomal recessive. Other findings include hair hypoplasia, anemia, immunodeficiency, propensity to infections, gastrointestinal disorders (Hirschsprung disease, anal stenosis, esophageal atresia and malabsorption, defective spermatogenesis, increased risk of malignancies and higher rate of mortality. Immunodeficiency in cartilage-hair hypoplasia may be an isolated B-cell or isolated T-cell immunodeficiency or combined B and T-cell immunodeficiency; however, severe combined immunodeficiency is rare. There is no known treatment for hair hypoplasia. Growth hormone was used with conflicting results for short stature in children with Cartilage-hair hypoplasia. Skeletal problems must be managed with physiotherapy and appropriate orthopedic interventions. Hirschsprung disease, anal stenosis and esophageal atresia should be surgically corrected. Patients with severe hypoplastic anemia require repeated transfusions. Bone marrow transplantation may be required for patients with severe combined immunodeficiency or severe persistent hypoplastic anemia. Treatment with G-CSF is useful for neutropenia. Patients should be monitored closely for developing malignancy such as skin neoplasms, lymphomas and leukemias. Conclusions: Cartilage-hair hypoplasia is an important hereditary disease with different medical aspects. The high rate of consanguineous marriages in Iran necessitates considering CHH in any

  8. EFECTIVITY MINOXIDIL AS A TREATMENT OF ALOPECIA AREATA

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    Wayan Evie Frida Yustin

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Alopecia areata is hair loss with patchy formation, the most common cause of alopecia nonscarring. Occurred in 1,7 % of Americans aged 50 years. Can occurs in both sexes, all races and any age. Genetic and immunological factors play an important role as a cause of Alopecia areata. The clinical features alopecia areata are round or oval lesions, total baldness, smoothness on the scalp or other parts of the body that has hair. Minoxidil is one of the effective therapy for Alopecia areata. Known for more than 30 years of minoxidil to stimulate hair growth. Minoxidil works on hair follicles, opening the potassium channels, and have vascular effects that can increase blood flow to hair. Histological studies showed that minoxidil therapy may increase the proportion hair follicles in anagen phase and decrease hair follicles at telogen phase. Minoxidil through sulphat metabolites can open potassium channels, the opening potassium channels can increase the hair follicles growth. The study of the effects minoxidil on human epidermal keratinocytes and hair follicles with different culture conditions and markers proliferation, found that minoxidil with micro molar concentration can stimulate proliferation both type of cells and all culture condition, whereas minoxidil with milimolar concentration will inhibit cell growth. In addition, several studies have also reported an association minoxidil to vascular effect and stimulating VEGF can promote the increase hair follicle /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso

  9. Numerical versus narrative: A comparison between methods to measure medical student performance during clinical clerkships.

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    Bartels, Josef; Mooney, Christopher John; Stone, Robert Thompson

    2017-11-01

    Medical school evaluations typically rely on both language-based narrative descriptions and psychometrically converted numeric scores to convey performance to the grading committee. We evaluated inter-rater reliability and correlation of numeric versus narrative evaluations for students on their Neurology Clerkship. 50 Neurology Clerkship in-training evaluation reports completed by their residents and faculty members at the University of Rochester School of Medicine were dissected into narrative and numeric components. 5 Clerkship grading committee members retrospectively gave new narrative scores (NNS) while blinded to original numeric scores (ONS). We calculated intra-class correlation coefficients (ICC) and their associated confidence intervals for the ONS and the NNS. In addition, we calculated the correlation between ONS and NNS. The ICC was greater for the NNS (ICC = .88 (95% CI = .70-.94)) than the ONS (ICC = .62 (95% CI = .40-.77)) Pearson correlation coefficient showed that the ONS and NNS were highly correlated (r = .81). Narrative evaluations converted by a small group of experienced graders are at least as reliable as numeric scoring by individual evaluators. We could allow evaluators to focus their efforts on creating richer narrative of greater value to trainees.

  10. INTRALESIONAL PLATELET RICH PLASMA vs INTRALESIONAL TRIAMCINOLONE IN THE TREATMENT OF ALOPECIA AREATA: A COMPARATIVE STUDY

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    Shumez H, Prasad PVS, Kaviarasan PK, Deepika R

    2015-01-01

    Full Text Available Background: Alopecia areata (AA is a chronic non-scarring alopecia that involves the scalp and/or body, and is characterized by patchy areas of hair loss without any signs of clinical inflammation. Various therapies have been proposed for their treatment.But none have been shown to alter the course of the disease. Platelet Rich Plasma (PRP is a volume of autologous plasma that has a high platelet concentration. Growth factors released from platelets may act on stem cells in the bulge area of the follicles, stimulating the development of new follicles and promoting neovascularization. Aim: To evaluate and compare the efficacy of intralesional injection of autologous platelet rich plasma with intralesional injection of triamcinolone acetonide (10mg/ml in the treatment of alopecia areata. Methodology: 74 patients with alopecia areata were allocated into 2 groups and treated with triamcinolone and PRP injections. Treatment outcome was measured by taking into account extent and density of regrowth of hair and was expressed as a percentage of overall growth. Results: Forty eight patients were treated with triamcinolone injections and 26 patients were treated with PRP injections. Patients treated with PRP had an earlier response at the end of 6weeks than patients treated with triamcinolone. However, this difference was statistically insignificant. The overall improvement at the end of 9 weeks was 100% for all patients in both groups. Conclusion: PRP is a safe, simple, biocompatible and effective procedure for the treatment of alopecia areata with efficacy comparable with triamcinolone.

  11. Comparing the demographic factors of patient with limited and diffuse type of alopecia areata

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    Mina Daliri

    2010-09-01

    Full Text Available Background: Alopecia areata is a chronic inflammatory disease that involves the hair follicle. Clinically, patients with alopecia areata may have patchy or confluent hair loss on the scalp or body so we conduct a study to compare the demographic aspects of patient with limited and diffuse type of alopecia areata.Materials and Method: We conducted a descriptive-analyzing study in which 306 patient were chosen. The patients were divided into two groups of diffuse and limited Alopecia. Demographic factors including age, gender, disease onset were compared in two groups. Results: Out of 306 patients, 58.8 % were male and 41.2 % were female. 247 patients (80.7% suffered from limited type and 59 patients (19.2% suffered from diffuse type. The mean age of the onset of involvement in limited group was 21.9±12 yr and 15.8±12 yr in diffuse group. The mean duration of involvement in limited group was 18.7 months and 71 months in diffuse group. Conclusion: Diffuse type alopecia areata starts at lower age and has longer duration. Our study results were similar to the others. Like other studies, thyroid disorders and atopic dermatitis are positively correlative to the severity of disease

  12. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years` experience at St John`s Institute of Dermatology

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    Taylor, C.R.; Hawk, J.L.M. [St Thomas` Hospital, London (United Kingdom). St John`s Institute of Dermatology

    1995-12-01

    Our 10-year experience with PUVA treatment for alopecia areata, partialis, totalis and universalis was retrospectively reviewed using charts and follow-up questionnaires for 70 patients at St John`s Institute of Dermatology. In all cases, several previous therapies were judged to be unsatisfactory prior to starting PUVA, and many cases were already deemed clinically refractory prior to referral for PUVA. If cases of vellus hair growth are excluded, and those who lost their PUVA-induced regrowth rapidly on follow-up, the effective success rate was at best 6.3% for alopecia areata partialis, 12.5% for alopecia areata totalis and 13.3% for alopecia areata universalis. We affirm that PUVA is generally not an effective treatment for alopecia areata. (Author).

  13. Male Androgenetic Alopecia : Response To Finasteride

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    Thakkar Suruchi

    2004-01-01

    Full Text Available Androgenetic alopecia (AGA is one of the most common causes of hair loss in genetically predisposed men and women. We studied the therapeutic efficacy and safety of oral finasteride in male patients with AGA. A total of 40 male AGA patients, 18-35 years of age, wad enrolled in the study for a period of 9 months. Oral finasteride, 1mg/day, was started and the drug efficacy was assessed on the basis of pre- and post-treatment clinical photographs, trichogram, hair pull test and self assessment of hair re-growth by the investigators. Routine hematological and bio-chemical investigations and a questionnaire related to sexual disturbances were carried out to assess the safety profile of the drug at each follow-up visit every three months. Improvement in hair growth was observed by comparing the paired pre- and post-treatment global photographs (p<0.05, decreased hair shedding by the patients’ self assessment (p<0.05, hair pull test evaluation (p<0.001 and increase in anagen-telogen hair ratio (p<0.001 with the trichogram, as early as 3 months of finasteride therapy with maximum benefit in the mid-area followed by vertex and frontal areas. No significant side effect related to the drug was observed. It is concluded that oral finasteride is a relatively safe, well tolerated and efficacious drug for AGA in Males.

  14. Retrospective Evaluation of Alopecia Areata Patients

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    Müzeyyen Gönül

    2011-06-01

    Full Text Available Objective: We aimed to evaluate the clinical, demographic and laboratory features of alopecia areata (AA patients who attended our policlinic in the last year.Material and Methods: The study was performed retrospectively and age, gender, family history of patients, onset age, duration and localization area of AA, number of recurrences, associated findings and laboratory findings were obtained from records. Results: The study included 132 patients. Median duration of disease was 4 months. 15.9% of the patients had a family history, 20.5% had another autoimmune disorder, 18% had nail findings, 18.5% atopy history. 6.5% of patients had nuchal nevus flammeus. Multifocal involvement was significantly higher in males. Positive correlation was detected between duration and severity of disease. The duration of disease was statistically related with increased thyroid autoantibodies. Nuchal nevus flammeus was related with total/universal AA. Low levels of iron, ferritin and hemoglobin were detected in approximately 10% of the patients. Conclusion: Our study is one of the studies investigating the largest parameters in AA patients. Our results indicate that there is a male dominance in AA and multifocal involvement is common in men. While early onset of disease, association with atopy and autoimmune disorder does not affect prognosis, antithyroid antibody positivity and association with nevus flammeus might be indicators of poorer prognosis.

  15. The case of ichthyosis follicularis, alopecia and photophobia syndrome with retinal detachment

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    Bengü Nisa Akay

    2014-06-01

    Full Text Available Ichtiyosis follicularis, alopecia and photophobia (IFAP syndrome is a rare congenital ectodermal syndrome with X-linked inheritance. It occurs as a result of missense mutation in chromosome Xp22.11-Xp22.13 locus of MBTPS2 gene. It usually affects men and family history is always negative. Ichtiyosis follicularis and alopecia starts with birth. Photophobia and eye symptoms begin in early infancy or childhood. Other manifestations of the syndrome include short stature, mental retardation and seizures. There are no spesific histopathological findings specific for ichtyosis follicularis. A 29 years old male patient was admitted to outpatient clinic. Dermatological examination revealed keratosis pilaris localized to scalp, extremities and anterolateral of the body. Patient had xerosis, diffuse alopecia and prominent folicular appereance. Eye examination revealed cataracts and vision loss. These findings led us to IFAP syndrome diagnosis. The patient is presented for the rarity of the syndrome in the literature.

  16. Topical Minoxidil For the Treatment of Alopecia Areata

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    Vinod K Sharma

    1986-01-01

    Full Text Available One percent minoxidil solution was used topically for the treatment of 10 patients having alopecia areata (4 each having alopecia universalis and totalis and 2 patients with extensive alopecia areata . Significant hair growth did not occur even′ after 3 months of therapy.

  17. The practical application of narrative medicine at Mayo Clinic: imagining the scaffold of a worthy house.

    Science.gov (United States)

    Rian, Johanna; Hammer, Rachel

    2013-12-01

    American health care institutions increasingly recognize narrative medicine as a means to developing quality patient care. More commonly applied in health care professional development settings, narrative medicine is less overtly employed with patient populations. In this article, we describe the application of various narrative practices in the patient care and medical education programs of a major health care center in Minnesota. We discuss the impact of these programs on their participants in relation to the evidence based in current scholarship. Further, we examine narrative externalization of illness in Katherine Butler Hathaway's disability memoir "The Little Locksmith," a text which implicates the work of metaphor-making as a transformative step in healing. While several reports demonstrate that patients can find creative writing during times of illness to be therapeutic, there are many for whom the practice is problematic or unattractive, obstacles to practice implementation that the authors discuss. However, based on the experience of our institution, for health care institutions seeking to build a legacy of leadership in empathic patient care, narrative--employed in mentoring physicians in training and in establishing strong, dialogic relationships with patients and colleagues--should serve as a central strategy, or scaffold.

  18. Traction alopecia: A neglected entity in 2017

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    Christiana Oyinlola Akingbola

    2017-01-01

    Full Text Available Traction alopecia was first described in 1904 but is still a cause of scarring hair loss in young women worldwide. It is unique in being initially a reversible then an irreversible (scarring form of alopecia. Linked to tightly-pulled hairstyles, it is seen across all races. The pattern of hair loss depends on the style creating it but most commonly affects the frontotemporal hairline. There are some new examination findings associated with traction alopecia, which are traction folliculitis, the fringe sign and hair casts (pseudonits on dermatoscopy. These may prove key in prompting early specialist referral. The mainstay of current treatment is cessation of the contributing hairstyles. Camouflage, anti-inflammatory or growth-stimulating topical preparations are second line treatments. In later stages of severe traction alopecia hair transplantation may be the only effective treatment. The evidence basis for medical intervention with topical agents is anecdotal at best. Furthermore, additional research is required to clarify the pathogenesis of this biphasic alopecia. Until then, prompt diagnosis and identification of causative hairstyles are focus of current dermatological practice.

  19. Ichthyosis follicularis with alopecia and photophobia syndrome (IFAP): A Case Report.

    Science.gov (United States)

    Ferrari, Bruno; Morita, Lucila; Choate, Keith; Hu, Rong-Hua

    2017-02-15

    IFAP syndrome is a rare autosomal recessive X-linked disease characterized by the triad of alopecia universalis, severe photophobia, and follicular ichthyosis. It is caused by loss of function of the gene MBTPS2. Its severity varies and there are only a few reports in the literature. We present a patient with characteristic clinical features and a mutation not previously reported.

  20. Low-level laser therapy for the treatment of androgenic alopecia: a review.

    Science.gov (United States)

    Darwin, Evan; Heyes, Alexandra; Hirt, Penelope A; Wikramanayake, Tongyu Cao; Jimenez, Joaquin J

    2018-02-01

    There are many new low-level laser technologies that have been released commercially that claim to support hair regrowth. In this paper, we will examine the clinical trials to determine whether the body of evidence supports the use of low-level laser therapy (LLLT) to treat androgenic alopecia (AGA). A literature search was conducted through Pubmed, Embase, and Clinicaltrials.gov for clinical trials using LLLT to treat AGA. Thirteen clinical trials were assessed. Review articles were not included. Ten of 11 trials demonstrated significant improvement of androgenic alopecia in comparison to baseline or controls when treated with LLLT. In the remaining study, improvement in hair counts and hair diameter was recorded, but did not reach statistical significance. Two trials did not include statistical analysis, but showed marked improvement by hair count or by photographic evidence. Two trials showed efficacy for LLLT in combination with topical minoxidil. One trial showed efficacy when accompanying finasteride treatment. LLLT appears to be a safe, alternative treatment for patients with androgenic alopecia. Clinical trials have indicated efficacy for androgenic alopecia in both men and women. It may be used independently or as an adjuvant of minoxidil or finasteride. More research needs to be undertaken to determine the optimal power and wavelength to use in LLLT as well as LLLT's mechanism of action.

  1. Pistas dermatoscópicas para diferenciar a tricotilomania da alopecia areata em placa Dermoscopic clues to distinguish trichotillomania from patchy alopecia areata

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    Leonardo Spagnol Abraham

    2010-10-01

    Full Text Available INTRODUÇÃO: Tricotilomania e alopecia areata em placa possuem características clínicas e dermatoscópicas semelhantes. OBSERVAÇÕES: O exame dermatoscópico da tricotilomania revela densidade capilar diminuída, cabelos fraturados em diferentes tamanhos, enovelados e vellus, tricoptilose, pontos amarelos com ou sem pontos pretos e ausência de cabelos em "ponto de exclamação". CONCLUSÃO: No contexto de alopecia em placa e cabelos fraturados, a ausência de "pontos de exclamação" sugere o diagnóstico de tricotilomania. Por outro lado, o achado de pontos amarelos sem pontos pretos não afasta o mesmo.BACKGROUND: Trichotillomania and patchy alopecia areata have similar clinical and dermoscopic features. OBSERVATIONS: In trichotillomania, dermoscopy shows decreased hair density, short vellus hair, broken hairs with different shaft lengths, coiled hairs, short vellus hair, trichoptilosis, sparse yellow dots, which may or may not contain black dots and no exclamation mark hairs. CONCLUSIONS: In the case of patchy alopecia and broken hairs, the absence of exclamation mark hairs suggests a diagnosis of trichotillomania. On the other hand, the finding of yellow dots without black dots does not exclude it.

  2. Comparison of androgenic alopecia distribution among type 2 diabetes and healthy women in Isfahan city: a brief report

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    Fariba Jafari

    2014-09-01

    Methods: This is a case-control study. Case and control groups were selected from type II diabetes and healthy women respectively that were refered to clinics of Alzahra, Noor and Amin Hospitals in Isfahan City, Iran in 2011. Participants were selected based on random sampling. Sample size was estimated 141 subjects in each group. Participants were visited by doctor and severity of androgenic alopecia was determined based on Ludwish criteria. Data were analyzed with SPSS software and 2 test. P<0.05 was considered as significant. Results: Mean age and body mass index were 58.96±12.8 year and 25.6±4.15 kg/m2 respectively in whole population. Findings not show any significant association between type II diabetes and androgenic alopecia (P<0.05. Comparison of distribution of alopecia severity according to Ludwish criteria separately showed similar result. In addition to, there was not any significant relationship between diabetes and alopecia after adjusting with body mass index as confounding factor (P<0.05. Conclusion: In the present study, there was not any significant relationship between type II diabetes and androgenic alopecia among diabetes and healthy women. However, more researches need to investigate this relationship in both gender and assess insulin resistant indices as homeostasis model assessment-estimated insulin resistance and androgenic alopecia.

  3. The appearance of pili annulati following alopecia areata.

    Science.gov (United States)

    Cruz, Antonio P; Liang, Christine A; Gray, Jennifer P; Robinson-Bostom, Leslie; McDonald, Charles J

    2012-03-01

    Pili annulati is a rare autosomal-dominant hair shaft abnormality. It is characterized by alternating light and dark bands along the shaft due to air-filled cavities within the cortex of the hair shaft. Alopecia areata has been previously described as a common association with pili annulati, with improvement in alopecia areata coinciding with resolution of pili annulati. We report the case of a patient with a history of alopecia areata and alopecia universalis who developed the characteristic banded hair of pili annulati upon resolution of her alopecia areata. We provide direct microscopic examination of postregrowth hairs compared to normal and cross-polarized light microscopy.

  4. Frictional alopecia of the distal legs: case series and review.

    Science.gov (United States)

    Zhao, Johnny; Cohen, Philip R

    2016-08-15

    BackgroundAcquired alopecia of the lower legs may occur secondary to friction due to socks, footwear, or both on the lower extremities. There is scant literature that reports on this phenomenon.Methods and MaterialsWe describe 5 patients who presented with alopecia of their lower legs induced by socks, footwear, or both. We reviewed PubMed for the following terms: ankle alopecia, friction alopecia, frictional alopecia, lower extremity alopecia, non-scarring leg alopecia, and sock alopecia. We also reviewed papers containing these terms and their references.ResultsAcquired frictional alopecia of the lower extremities is often an asymptomatic condition found incidentally on physical examination. The condition can persist for many years despite removal of the source of friction.ConclusionThe incidence of acquired frictional alopecia of the lower extremities may be greater than reflected in previously published reports. It is a non-scarring subtype of alopecia that was noted as an incidental finding during the patient's dermatology appointment.

  5. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.

    Science.gov (United States)

    Bolduc, Chantal; Sperling, Leonard C; Shapiro, Jerry

    2016-12-01

    Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. TNF-inhibitor associated psoriatic alopecia: Diagnostic utility of sebaceous lobule atrophy.

    Science.gov (United States)

    Afanasiev, Olga K; Zhang, Cathryn Z; Ruhoy, Steven M

    2017-06-01

    The increasingly successful and widespread use of Tumor Necrosis Factor inhibitors (TNFi) to treat autoimmune and inflammatory conditions has also been accompanied by adverse reactions, both systemic and cutaneous. Psoriasiform cutaneous rashes are well described. Recently, TNF inhibitor associated psoriatic alopecia (TiAPA) is being more frequently reported. The purpose of this study is to describe the features of TiAPA, including marked atrophy of sebaceous lobules as a histologic clue to diagnosis, helping to distinguish it from other types of alopecia. Clinical and histopathological features of 3 patients who developed scalp alopecia while on TNFi treatment were examined. Clinical follow up was conducted after discontinuation of TNFi. A review of the previous literature on the subject was also conducted. Atrophy of sebaceous lobules is a potentially reversible, characteristic and conspicuous feature of TiAPA that can be distinguished from idiopathic psoriatic alopecia by clinical history of drug exposure and sometimes by histologic presence of a mixed inflammatory response including plasma cells and eosinophils. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Epidemiology and burden of alopecia areata: a systematic review

    Directory of Open Access Journals (Sweden)

    Villasante Fricke AC

    2015-07-01

    Full Text Available Alexandra C Villasante Fricke, Mariya MitevaDepartment of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USABackground: Alopecia areata (AA is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure.Objective: The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA.Methods and selection criteria: A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA’s incidence, prevalence, distribution, disability-adjusted life years (DALYs, quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data.Results: The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions.Conclusion: AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.Keywords: hair loss, hair, prevalence, incidence, burden of disease

  8. Narrative teorier

    DEFF Research Database (Denmark)

    Bank, Mads

    2014-01-01

    kapitlet omhandler Narrative psykologiske teorier i et personlighedspsykologisk og socio-kulturelt perspektiv.......kapitlet omhandler Narrative psykologiske teorier i et personlighedspsykologisk og socio-kulturelt perspektiv....

  9. Acute Alopecia: Evidence to Thallium Poisoning

    OpenAIRE

    Senthilkumaran, Subramanian; Balamurugan, Namasivayam; Jena, Narendra Nath; Menezes, Ritesh G; Thirumalaikolundusubramanian, Ponniah

    2017-01-01

    Thallium is a toxic heavy metal often involved in criminal poisonings and occasionally in accidental poisoning. Here, we report a case of acute, nonintentional thallium poisoning due to thallium-contaminated alternative medicine for its rarity and to create awareness about the combination of rapid, diffuse alopecia with neurologic and gastrointestinal symptoms among practitioners, professionals, public, and policymakers.

  10. Acute Alopecia: Evidence to Thallium Poisoning.

    Science.gov (United States)

    Senthilkumaran, Subramanian; Balamurugan, Namasivayam; Jena, Narendra Nath; Menezes, Ritesh G; Thirumalaikolundusubramanian, Ponniah

    2017-01-01

    Thallium is a toxic heavy metal often involved in criminal poisonings and occasionally in accidental poisoning. Here, we report a case of acute, nonintentional thallium poisoning due to thallium-contaminated alternative medicine for its rarity and to create awareness about the combination of rapid, diffuse alopecia with neurologic and gastrointestinal symptoms among practitioners, professionals, public, and policymakers.

  11. Narrative and psychiatry.

    Science.gov (United States)

    Lewis, Bradley

    2011-11-01

    The study of narrative has become increasingly important in the humanities and social sciences and there is a growing use of narrative in the clinical domains of medicine and psychotherapy. Narrative psychiatry is also on the rise and promises to help psychiatry be responsive to increasing critical concerns from inside and outside the field. The field of narrative is vast and cuts across a variety of disciplines. Contemporary scholars in narrative medicine build on 30 years of work in medical humanities and bioethics to rigorously understand human variables in medicine and to improve physician empathy. Narrative psychotherapists have developed a new model of psychotherapy and a meta-narrative theory of diverse mental health interventions. Psychiatrists have picked up these insights and are finding them invaluable for navigating contemporary issues in psychiatry. Narrative theory has become important in the humanities, social sciences, medicine, and psychotherapy for understanding human meaning making. Increasingly, the tools of narrative are proving valuable for psychiatry as well. Narrative psychiatry does not negate or supersede other knowledge and research in psychiatry, but it can help psychiatry understand how people use psychiatric knowledge, among other cultural resources, for making sense of psychic difficulties and psychic differences.

  12. Complex narratives

    NARCIS (Netherlands)

    Simons, J.

    2008-01-01

    This paper brings together narratology, game theory, and complexity theory to untangle the intricate nature of complex narratives in contemporary cinema. It interrogates the different terms - forking-path narratives, mind-game films, modular narratives, multiple-draft films, database narratives,

  13. Evaluation of the relationship between androgenetic alopecia and demodex infestation

    Directory of Open Access Journals (Sweden)

    Zari Javidi

    2008-01-01

    Full Text Available Introduction: Androgenetic alopecia (AGA is one of the most common dermatologic disorders with a multifactorial etiology. Inflammatory activators such as Demodex infestation may play a role in the pathogenesis of some cases of androgenetic alopecia that do not respond to common treatments such as minoxidil and finasteride. The goal of this study is to evaluate the relationship between Demodex infestation and AGA. Materials and Methods: In this case-control study, 41 patients with AGA referred to the Dermatology Clinic of Imam Reza Hospital and 33 healthy individuals were evaluated as control. All of them were between 20 and 40 years old men. In order to identify Demodex infestation they were referred to the Parasitology laboratory. Results: Demodex was detected in 19.5% of patients and 15.2% of controls; therefore, there was no significant relationship between them statistically ( P = 0.0787. Most of patients (85.4% had greasy hair. The most common pattern of baldness was II degree in Hamilton scale. Conclusion: There is no relation between AGA and Demodex.

  14. A simple alopecia scoring system for use in colony management of laboratory-housed primates.

    Science.gov (United States)

    Bellanca, Rita U; Lee, Grace H; Vogel, Keith; Ahrens, Joel; Kroeker, Rose; Thom, Jinhee P; Worlein, Julie M

    2014-06-01

    Alopecia in captive primates continues to receive attention from animal care personnel and regulatory agencies. However, a method that enables personnel to reliably score alopecia over time and under various conditions has proven difficult to achieve. The scoring system developed by the behavioral and veterinary staffs at the Washington National Primate Research Center (WaNPRC) uses the rule of 9s to estimate the percentage of the body affected with alopecia (severity) and how the alopecia presents itself (pattern). Training and scoring can conveniently be managed using photographic images, cage-side observations, and/or physical examinations. Personnel with varying degrees of experience were quickly trained with reliability scores ranging from 0.82 to 0.96 for severity and 0.82 to 0.89 for pattern using Cohen's κ. This system allows for reliable and consistent scoring across species, sex, age, housing condition, seasons, clinical or behavioral treatments, and level of personnel experience. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Platelet-rich plasma in androgenic alopecia: Myth or an effective tool

    Directory of Open Access Journals (Sweden)

    Swapna S Khatu

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP has become a newer method for the treatment of various types of alopecia. In this prospective study, safety, efficacy and feasibility of PRP injections in treating androgenic alopecia were assessed. Eleven patients suffering from hair loss due to androgenic alopecia and not responding to 6 months treatment with minoxidil and finasteride were included in this study. The hair pull test was performed before every treatment session. A total volume of 2-3 cc PRP was injected in the scalp by using an insulin syringe. The treatment was repeated every two weeks, for a total of four times. The outcome was assessed after 3 months by clinical examination, macroscopic photos, hair pull test and patient′s overall satisfaction. Results: A significant reduction in hair loss was observed between first and fourth injection. Hair count increased from average number of 71 hair follicular units to 93 hair follicular units. Therefore, average mean gain is 22.09 follicular units per cm 2. After the fourth session, the pull test was negative in 9 patients. Conclusion: PRP injection is a simple, cost effective and feasible treatment option for androgenic alopecia, with high overall patient satisfaction.

  16. Narrative writing competence and internal state terms of young adults clinically diagnosed with childhood attention deficit hyperactivity disorder.

    Science.gov (United States)

    Miranda, Ana; Baixauli, Inmaculada; Colomer, Carla

    2013-06-01

    The first objective of this study was to compare the written expression competence of young adults with attention deficit hyperactivity disorder (ADHD) with that of young adults without ADHD on three types of measures: indicators of the story's microstructure with regard to productivity and morphosyntax; indicators of the macrostructure (story grammar); and expressions of the mental states of the story's characters (internal state language). The second objective consisted of determining the relationships among the different narrative writing measures and the ADHD behavior ratings of inattention and hyperactivity obtained using the family observer report. The sample was composed of 54 participants, aged from 18 to 24, divided equally into a group with a childhood clinical diagnosis of combined subtype ADHD and a control group without ADHD. Written composition was assessed using a narrative task based on a sequence of images. As expected, the young adults with ADHD obtained significantly worse results than the control group on the majority of the parameters of the story's microstructure and macrostructure. Likewise, they included a significantly lower number of terms about the characters' mental states. A correlation was also observed between measures of narrative competence and core symptoms of ADHD, as well as between the use of words with an emotional content and estimations related to core symptoms of ADHD. The findings of this study point out that expressive writing should be assessed in individuals with ADHD as part of screening and comprehensive evaluation. More research is needed to design and implement effective interventions in this area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Det narrative og narrative undervisningsformer

    DEFF Research Database (Denmark)

    2010-01-01

    I denne power point gennem grundtrækkene i den narrative vending og der kommes med eksempler på narrative undervisningsformer.......I denne power point gennem grundtrækkene i den narrative vending og der kommes med eksempler på narrative undervisningsformer....

  18. Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United States.

    Science.gov (United States)

    Hanson, Janice L; Rosenberg, Adam A; Lane, J Lindsey

    2013-01-01

    In medical education, evaluation of clinical performance is based almost universally on rating scales for defined aspects of performance and scores on examinations and checklists. Unfortunately, scores and grades do not capture progress and competence among learners in the complex tasks and roles required to practice medicine. While the literature suggests serious problems with the validity and reliability of ratings of clinical performance based on numerical scores, the critical issue is not that judgments about what is observed vary from rater to rater but that these judgments are lost when translated into numbers on a scale. As the Next Accreditation System of the Accreditation Council on Graduate Medical Education (ACGME) takes effect, medical educators have an opportunity to create new processes of evaluation to document and facilitate progress of medical learners in the required areas of competence. Proposal and initial experience: Narrative descriptions of learner performance in the clinical environment, gathered using a framework for observation that builds a shared understanding of competence among the faculty, promise to provide meaningful qualitative data closely linked to the work of physicians. With descriptions grouped in categories and matched to milestones, core faculty can place each learner along the milestones' continua of progress. This provides the foundation for meaningful feedback to facilitate the progress of each learner as well as documentation of progress toward competence. This narrative evaluation system addresses educational needs as well as the goals of the Next Accreditation System for explicitly documented progress. Educators at other levels of education and in other professions experience similar needs for authentic assessment and, with meaningful frameworks that describe roles and tasks, may also find useful a system built on descriptions of learner performance in actual work settings. We must place medical learning and assessment

  19. Childhood alopecia areata: A study of 89 patients

    Directory of Open Access Journals (Sweden)

    Sibel Doğan

    2014-09-01

    Full Text Available Background and Design: Alopecia areata (AA is a frequent type of acquired hair loss with a sudden onset. The aim of this study was to investigate the epidemiological and clinical features of AA and diseases associated with AA in the Turkish pediatric population. Materials and Methods: We retrospectively evaluated the medical data of patients under 16 years of age who were admitted to the pediatric dermatology outpatient clinic at Hacettepe University Hospital between 2006 and 2011 with a diagnosis of AA, alopecia totalis (AT and alopecia universalis (AU. Results: A total of 89 patients (34 females and 55 males, were included in this study. The mean age of the subjects was 9.8±3.4 years (range: 18 months-16 years. 9% (n=8 patients had other autoimmune diseases: Hashimoto's thyroiditis in 5, vitiligo in 1, juvenile rheumatoid arthiritis (JRA in 1 and morphea in 1 patient. AA was located on the scalp in 86.5% (n=77 of the patients, 7.9% (n=7 of the patients had AA on the scalp together with eyelashes, eyebrows and the body. AT was noted in 1, AU was noted in 4 patients. Severity of hair loss was <25% in 94.3% (n=84 of the patients according to the involved area. Hashimoto's thyroiditis was diagnosed in 5 patients; these patients had normal thyroid function tests (TFT. TFT abnormalities were detected in 27% (n=24 of the patients. 24.7% (n=22 of these patients were diagnosed with clinically insignificant thyroid disorder, 2 patients had compansated hypothyroidism (n=2. Eight patients (9% patients were found to be positive for anti-thyroid peroxidase antibody (Anti-TPO ab. Antithyroglobulin antibody (Anti-TG Ab elevation was noted in 3.3% (n=3 and antinuclear antibody (ANA positivity was noted in 9% (n=8. Nail changes were detected in 12.3% (n=11 of the patients as leukonychia (n=2, longitudinal striation (n=2, trachyonychia (n=1, onychoschizia (n=1 and pitting (n=1. Conclusion: Childhood AA usually causes limited hair loss. TFT anomalies can

  20. Alopecia in three macaque species housed in a laboratory environment

    Science.gov (United States)

    Kroeker, R.; Bellanca, R. U.; Lee, G. H.; Thom, J. P.; Worlein, J. M.

    2014-01-01

    Alopecia is a persistent problem in captive macaque populations and despite recent interest, no factors have been identified that can unequivocally explain the presence of alopecia in a majority of cases. Seasonal, demographic and environmental factors have been identified as affecting alopecia presentation in rhesus macaques, the most widely studied macaque species. However, few studies have investigated alopecia rates in other macaque species. We report alopecia scores over a period of 12 months for three macaque species (Macaca nemestrina, M. mulatta, and M. fascicularis) housed at three indoor facilities within the Washington National Primate Research Center (WaNPRC) in Seattle. Clear species differences emerged with cynomolgus (M. fascicularis) showing the lowest alopecia rates and pigtails (M. nemestrina) the highest rates. Further analysis of pigtail and rhesus (M. mulatta) macaques revealed that sex effects were apparent for rhesus but not pigtails. Age and seasonal effects were evident for both species. In contrast to previous reports, we found that older animals (over 10 years of age) had improved alopecia scores in comparison to younger adults. This is the first report on alopecia rates in pigtail macaques and the first comparison of alopecia scores in pigtail, cynomolgus, and rhesus macaques housed under similar conditions. PMID:24243351

  1. Diphenylcyclopropenone-Induced Vitiligo in a Patient with Alopecia Universalis

    Directory of Open Access Journals (Sweden)

    Hassan Riad

    2013-08-01

    Full Text Available Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune comorbidities. Many studies show colocalization of these diseases at the same anatomical site. Here, we have a case where both disorders were reported to present in the same patient. Diphenylcyclopropenone (diphencyprone, DCP is used in the treatment of alopecia areata and may induce vitiligo in some patients. We report on one case of vitiligo that was induced by DCP during therapy for alopecia universalis. Alopecia areata and vitiligo share many susceptibility genes. Follicular melanocyte destruction may represent the link between the two diseases.

  2. Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

    Directory of Open Access Journals (Sweden)

    Vipawee Ounsakul

    2016-01-01

    Full Text Available Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia.

  3. Narrative ethics for narrative care.

    Science.gov (United States)

    Baldwin, Clive

    2015-08-01

    Narrative permeates health care--from patients' stories taken as medical histories to the development of health policy. The narrative approach to health care has involved the move from narratives in health care as objects of study to the lens through which health care is studied and, more recently, to narrative as a form of care. In this paper, I argue that narrative care requires a move in the field of ethics--from a position where narratives are used to inform ethical decision making to one in which narrative is the form and process of ethical decision making. In other words, I argue for a narrative ethics for narrative care. The argument is relatively straightforward. If, as I argue, humans are narrative beings who make sense of themselves, others, and the world in and through narrative, we need to see our actions as both narratively based and narratively contextual and thus understanding the nature, form, and content of the narratives of which we are a part, and the process of narrativity, provides an intersubjective basis for ethical action. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Cytokines and Other Mediators in Alopecia Areata

    Directory of Open Access Journals (Sweden)

    Stamatis Gregoriou

    2010-01-01

    Full Text Available Alopecia areata, a disease of the hair follicles with multifactorial etiology and a strong component of autoimmune origin, has been extensively studied as far as the role of several cytokines is concerned. So far, IFN-, interleukins, TNF-, are cytokines that are well known to play a major role in the pathogenesis of the disease, while several studies have shown that many more pathways exist. Among them, MIG, IP-10, BAFF, HLA antigens, MIG, as well as stress hormones are implicated in disease onset and activity. Within the scope of this paper, the authors attempt to shed light upon the complexity of alopecia areata underlying mechanisms and indicate pathways that may suggest future treatments.

  5. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients.

    Science.gov (United States)

    Fonia, Athina; Cota, Carlo; Setterfield, Jane F; Goldberg, Lynne J; Fenton, David A; Stefanato, Catherine M

    2017-05-01

    Anagen effluvium with reversible scalp alopecia is a known side effect of chemotherapy. However, there are an increasing number of reports in the literature documenting permanent alopecia in patients treated with taxanes. We sought to describe the clinicopathologic features in breast cancer patients who underwent treatment with taxanes and adjuvant hormonal chemotherapy. We reviewed the clinical and histopathologic information of a cohort of 10 patients treated with taxanes and adjuvant hormonal chemotherapy. We have observed 3 types of clinical patterns of alopecia (types A, B, and C), and have validated the histopathologic features showing alopecia areata-like and female pattern hair loss. The study was based on a small sample size and retrospective retrieval of clinical information and histopathologic review of posttreatment slides. We hypothesize a clinicopathologic model of hair follicle cycle disruption in response to the chemoinflammatory and hormonal insults to the hair follicles resulting in permanent alopecia. Clinicopathologic correlation is paramount to the understanding of the morphobiologic pathways in chemotherapy-induced alopecia caused by taxanes and adjuvant hormonal treatment. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. Evidence for supplemental treatments in androgenetic alopecia.

    Science.gov (United States)

    Famenini, Shannon; Goh, Carolyn

    2014-07-01

    Currently, topical minoxidil and finasteride are the only treatments that have been FDA approved for the treatment of female pattern hair loss and androgenetic alopecia. Given the incomplete efficacy and sife effect profile of these medications, some patients utilize alternative treatments to help improve this condition. In this review, we illustrate the scientific evidence underlying the efficacy of these alternative approaches, including biotin, caffeine, melatonin, a marine extract, and zinc.

  7. Genetic Underpinnings of Alopecia Areata

    Medline Plus

    Full Text Available ... Menu Close Health Topics Grants & Funding Labs @ NIAMS Clinical Trials News Room About NIAMS Asian Language Publications Portal ... Menu Close Health Topics Grants & Funding Labs @ NIAMS Clinical Trials News Room About NIAMS Asian Language Publications Portal ...

  8. STUDY OF THERAPEUTIC COMPARISON OF TACROLIMUS 0.1% AND MINOXIDIL 2% IN ALOPECIA AREATA

    Directory of Open Access Journals (Sweden)

    Kallappa C. Herkal

    2013-07-01

    Full Text Available Introduction: Alopecia areata is a unique, idiopathic disease in which there is patchy hair loss. The variable and uncertain natural history of alopecia areata is accounting for the multiplicity of uncritical claims for a large variety of therapeutic procedures. Aim: to find the therapeutic comparison between tacrolimus 0.1% ointment and minoxidil 2% solution. Material and Methods: Patients attending skin out patient department in Navodaya medical college hospital and research centre, Raichur were screened and the consenting consecutive cases of Aopecia Areata (AA from December 2010 to November 2011 were chosen for study. There were 75 patients in the study. It is a randomized, single blind, intension to treat study. The eligible patients for the study were randomly allocated into two groups-Group A and Group B (38 in Group A and 37 in Group B. Patients in Group A were treated with 2% Minoxidi solution to be applied twice daily over the alopecia patch, where as Patients in Group B were treated with Tacrolimus 0.1% ointment applied twice daily. Patients were followed up at 2, 4, 6, 8, 10 and 12 weeks. Alopecia Grading Score (AGS was calculated at baseline and 12 weeks. Regrowth Score (RGS was calculated at 12 weeks. Results: Total 69 patients completed the study (35 in Group A and 34 in Group B. In our study RGS ≥ 3 was observed in 65.71% of patients treated with Tinoxidil 2% solution and 44.12% of patients treated with Tacrolimus 0.1% ointment. Conclusion: In our study Minoxidil 2% solution had better stimulatory effect on hair growth compared to Tacrolimus 0.1% ointment in the treatment of mild to moderate patchy alopecia areata. The combination treatment may yield a better clinical response than either of the agents used singly.

  9. Heart rate variability measurement and clinical depression in acute coronary syndrome patients: narrative review of recent literature

    Science.gov (United States)

    Harris, Patricia RE; Sommargren, Claire E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

    2014-01-01

    Aim We aimed to explore links between heart rate variability (HRV) and clinical depression in patients with acute coronary syndrome (ACS), through a review of recent clinical research literature. Background Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results Nine clinical studies met the inclusion criteria. The studies’ results indicate that there may be a relationship between abnormal HRV and clinical depression when assessed early after an ACS event, offering the possibility that these risk factors play a modest role in patient outcomes. Conclusion While a definitive conclusion about the relevance of HRV and clinical depression measurement in ACS patients would be premature, the literature suggests that these measures may provide additional information in risk assessment. Potential avenues for further research are proposed. PMID:25071372

  10. Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases

    Science.gov (United States)

    Li, Qingfeng

    2016-01-01

    Alopecia is a dermatological condition with limited therapeutic options. Only two drugs, finasteride and minoxidil, are approved by FDA for alopecia treatment. However, little is known about the differences in adverse effects between these two drugs. We examined the clinical reports submitted to the FDA Adverse Event Reporting System (FAERS) from 2004 to 2014. For both female and males, finasteride was found to be more associated with reproductive toxicity as compared to minoxidil. Among male alopecia cases, finasteride was significantly more concurrent with several forms of sexual dysfunction. Among female alopecia cases, finasteride was significantly more concurrent with harm to fetus and disorder of uterus. In addition, drug-gene network analysis indicated that finasteride could profoundly disturb pathways related to sex hormone signaling and oocyte maturation. These findings could provide clues for subsequent toxicological research. Taken together, this analysis suggested that finasteride could be more liable to various reproductive adverse effects. Some of these adverse effects have yet to be warned in FDA-approved drug label. This information can help improve the treatment regimen of alopecia and post-marketing regulation of drug products. PMID:27738338

  11. A review of monochromatic light devices for the treatment of alopecia areata.

    Science.gov (United States)

    Darwin, Evan; Arora, Harleen; Hirt, Penelope A; Wikramanayake, Tongyu Cao; Jimenez, Joaquin J

    2018-02-01

    There are many laser technologies that are being tested that claim to support hair regrowth for patients with alopecia areata (AA). In this paper, we will determine whether the body of evidence supports the use of devices using monochromatic light sources to treat AA. Articles were gathered from PubMed, Embase, and the Cochrane database using these keywords: lasers, excimer laser, low-level laser therapy (LLLT), low-level light therapy, alopecia, alopecia areata, and hair loss with a category modifier of English. Ten clinical trials and seven case reports/abstracts were assessed. Eight clinical trials and two case reports demonstrated hair regrowth with the 308-nm excimer laser/light in men, women, and children. One case report demonstrated hair regrowth with the ALBA 355® laser. One clinical trial and two case reports demonstrated hair regrowth with LLLT. While two case reports demonstrated hair regrowth with fractional laser therapy, one clinical trial showed no improvement. The 308-nm excimer laser is a safe and effective treatment for men, women, and children with refractory AA of the scalp and beard. Larger, double-blinded clinical trials should be conducted to compare excimer laser therapy to standard treatments. More data is needed to determine the efficacy of LLLT and fractional laser therapy in the treatment of AA.

  12. The pattern of name tokens in narrative clinical text and a comparison of five systems for redacting them.

    Science.gov (United States)

    Kayaalp, Mehmet; Browne, Allen C; Callaghan, Fiona M; Dodd, Zeyno A; Divita, Guy; Ozturk, Selcuk; McDonald, Clement J

    2014-01-01

    To understand the factors that influence success in scrubbing personal names from narrative text. We developed a scrubber, the NLM Name Scrubber (NLM-NS), to redact personal names from narrative clinical reports, hand tagged words in a set of gold standard narrative reports as personal names or not, and measured the scrubbing success of NLM-NS and that of four other scrubbing/name recognition tools (MIST, MITdeid, LingPipe, and ANNIE/GATE) against the gold standard reports. We ran three comparisons which used increasingly larger name lists. The test reports contained more than 1 million words, of which 2388 were patient and 20,160 were provider name tokens. NLM-NS failed to scrub only 2 of the 2388 instances of patient name tokens. Its sensitivity was 0.999 on both patient and provider name tokens and missed fewer instances of patient name tokens in all comparisons with other scrubbers. MIST produced the best all token specificity and F-measure for name instances in our most relevant study (study 2), with values of 0.997 and 0.938, respectively. In that same comparison, NLM-NS was second best, with values of 0.986 and 0.748, respectively, and MITdeid was a close third, with values of 0.985 and 0.796 respectively. With the addition of the Clinical Center name list to their native name lists, Ling Pipe, MITdeid, MIST, and ANNIE/GATE all improved substantially. MITdeid and Ling Pipe gained the most--reaching patient name sensitivity of 0.995 (F-measure=0.705) and 0.989 (F-measure=0.386), respectively. The privacy risk due to two name tokens missed by NLM-NS was statistically negligible, since neither individual could be distinguished among more than 150,000 people listed in the US Social Security Registry. The nature and size of name lists have substantial influences on scrubbing success. The use of very large name lists with frequency statistics accounts for much of NLM-NS scrubbing success.

  13. Psychologic characteristics of men with alopecia androgenetica and their modification.

    Science.gov (United States)

    van der Donk, J; Passchier, J; Dutree-Meulenberg, R O; Stolz, E; Verhage, F

    1991-01-01

    Psychologic characteristics were studied in a sample of 168 men with alopecia androgenetica who participated in a clinical trial on the efficacy of minoxidil gel. In general, no evidence of psychologic malfunctioning was found. Instead, a slightly more adequate psychologic state was indicated. However, specific problems associated with hair loss were reported by a substantial number of men. Responders with cosmetic improvement in the group over 35 years of age improved more regarding general psychologic maladjustment, inadequacy, and self-evaluation than those who did not respond. A reverse trend was, however, found in the group younger than 35 years of age, where the nonresponders improved more. An explanation for these findings is derived from the theory of cognitive dissonance.

  14. Complex Narratives

    NARCIS (Netherlands)

    Simons, J.; Buckland, W.

    2014-01-01

    In the opening chapter, "Complex Narratives," Jan Simons brings together narratology, game theory, and complexity theory to untangle the intricate nature of complex narratives in contemporary cinema. He presents an overview of the different concepts - forking path narratives, mind-game films,

  15. Religious narrative

    DEFF Research Database (Denmark)

    Geertz, Armin W.

    2013-01-01

    Denne artikel er en introduktion til et temanummer i religionslærernes tidsskrift i USA. Den er et udtræk af mit kapitel "Religious Narrative, Cognition and Culture: Approaches and Definitions" udgivet i Religious Narrative, Cognition and Culture: Image and Word in the mind of Narrative, redigeret...

  16. Narrating psychological distress

    DEFF Research Database (Denmark)

    Zinken, Jörg; Blakemore, Caroline; Zinken, Katarzyna

    2011-01-01

    Psychological research has emphasized the importance of narrative for a person's sense of self. Building a coherent narrative of past events is one objective of psychotherapy. However, in guided self-help therapy the patient has to develop this narrative autonomously. Identifying patients......' narrative skills in relation to psychological distress could provide useful information about their suitability for self-help. The aim of this study was to explore whether the syntactic integration of clauses into narrative in texts written by prospective psychotherapy patients was related to mild...... to moderate psychological distress. Cross-clausal syntax of texts by 97 people who had contacted a primary care mental health service was analyzed. Severity of symptoms associated with mental health difficulties was assessed by a standardized scale (Clinical Outcomes in Routine Evaluation outcome measure...

  17. Accentuate the Negative: Grammatical Errors during Narrative Production as a Clinical Marker of Central Nervous System Abnormality in School-Aged Children with Fetal Alcohol Spectrum Disorders

    Science.gov (United States)

    Thorne, John C.

    2017-01-01

    Purpose: The purpose of this study was to examine (a) whether increased grammatical error rates during a standardized narrative task are a more clinically useful marker of central nervous system abnormality in Fetal Alcohol Spectrum Disorders (FASD) than common measures of productivity or grammatical complexity and (b) whether combining the rate…

  18. Bimatoprost for the treatment of eyelash, eyebrow and scalp alopecia.

    Science.gov (United States)

    Barrón-Hernández, Yevher Lorena; Tosti, Antonella

    2017-04-01

    Alopecia is a common condition observed among people of all ages. It is a disorder that can involve only the scalp as observed in androgenetic alopecia or scalp and body as in alopecia areata or patients under chemotherapy treatment. There are several treatment options with different safety and efficacy outcomes. Bimatoprost, a synthetic prostamide F2α analog originally approved for the treatment of ocular hypertension and open-angle glaucoma, is now FDA approved as a 0.03%, solution to be applied once daily to increase eyelashes growth. Areas covered: In this review, the authors evaluate the role of bimatoprost in idiopathic hypotrichosis of the eyelashes, in hypotrichosis of the eyelashes associated to chemotherapy, in alopecia areata of the eyelashes and eyebrows and in androgenetic alopecia. In addition, pharmacokinetics, pharmacodynamics, safety and tolerability of bimatoprost are discussed. Expert opinion: Bimatoprost will likely be the third FDA approved weapon in the fight against hair loss. Prostaglandin analogs are the only possible treatment for hypotrichosis and alopecia of the eyelashes regardless of its etiology. Eyebrow hypotrichosis due to alopecia areata or frontal fibrosis alopecia can also possibly benefit of these medications.

  19. Genetic Underpinnings of Alopecia Areata

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  1. Genetic Underpinnings of Alopecia Areata

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  9. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review

    Science.gov (United States)

    Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul

    2015-01-01

    Hypertension, a common cardiovascular disease (CVD) risk factor, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured in the clinic versus outside of the clinic setting. Over the past several decades, evidence has accumulated on two approaches for measuring out-of-clinic blood pressure: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Blood pressure measures on ABPM and HBPM each have a stronger association with CVD outcomes than clinic blood pressure. Controversy exists whether ABPM or HBPM is superior for estimating CVD risk, and under what circumstances these methods should be used in clinical practice for assessing out-of-clinic blood pressure. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measures that can be ascertained, and the evidence that supports the use of each approach to measure out-of-clinic blood pressure. This review also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research. PMID:26457954

  10. A Randomized Trial Testing the Impact of Narrative Vignettes vs. Guideline Summaries on Provider Response to a Professional Organization Clinical Policy for Safe Opioid Prescribing

    Science.gov (United States)

    Meisel, Zachary F.; Metlay, Joshua P.; Sinnenberg, Lauren; Kilaru, Austin S.; Grossestreuer, Anne; Barg, Frances K.; Shofer, Frances S.; Rhodes, Karin V.; Perrone, Jeanmarie

    2016-01-01

    Background Clinical guidelines are known to be underused by practitioners. In response to the challenges of treating pain amidst a prescription opioid epidemic, the American College of Emergency Physicians published an evidence-based clinical policy for opioid prescribing in 2012. Evidence-based narratives, an effective method of communicating health information in a variety of settings, offer a novel strategy for disseminating guidelines to physicians and engaging providers with clinical evidence. Objectives To compare whether narrative vignettes embedded in the American College of Emergency Physician (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared to traditional summary text. Methods A prospective randomized controlled study, entitled Stories to Promote Information using Narrative (SPIN) trial, was performed. Derived from qualitative interviews with 61 ACEP physicians, 4 narrative vignettes were selected and refined, using a consensus panel of clinical and implementation experts. All ACEP members were then block randomized by state of residence to receive alternative versions of a daily emailed newsletter for a total of 24 days during a 9 week period. Narrative newsletters contained a selection of vignettes that referenced opioid prescription dilemmas. Control newsletters contained a selection of descriptive text about the clinical policy using similar length and appearance to the narrative vignettes. Embedded in the newsletters were web links to the complete vignette or traditional summary text, as well as additional links to the full ACEP clinical policy and a website providing assistance with prescription drug monitoring program enrollment. The newsletters were otherwise identical. Outcomes measured were the percentage of subjects who visited any of the web pages that contained additional guideline related information and the odds of any unique physician

  11. Automatic acquisition of sublanguage semantic schema: towards the word sense disambiguation of clinical narratives.

    Science.gov (United States)

    Patterson, Olga; Igo, Sean; Hurdle, John F

    2010-11-13

    Natural language processing of clinical notes is challenging due to a high degree of semantic ambiguity. Previous research has uncovered ways to improve disambiguation accuracy using manually created rules of semantic sentence structure. However, applying a natural language processing system in a new clinical domain using this method is very labor intensive. This paper presents an automatic method of developing such disambiguation rules for a wide range of clinical domains. Our rules are based on the co-occurrence patterns of semantic types of terms unambiguously mapped to UMLS concepts by MetaMap. These patterns are combined into a sublanguage semantic schema that can be used by an existing natural language processing system such as MetaMap. The differences of co-occurrence patterns across clinical notes of different domains are presented here as evidence of clinical sublanguages.

  12. Genetic Underpinnings of Alopecia Areata

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  14. Utility of dermoscopy in alopecia areata

    Directory of Open Access Journals (Sweden)

    Mandar Mane

    2011-01-01

    Full Text Available Background: Alopecia areata (AA shows several well-defined dermoscopic features which may help in confirming diagnosis in AA. Aims: We carried out a study to examine the dermoscopic features of AA and develop a protocol for diagnosis of AA by dermoscopy. Materials and Methods: Dermoscopy was performed in 66 patients with AA. Hanse HVS-500NP dermoscope (magnification of ×32 and ×140 was used. Results: The mean age of the patients (46 males and 20 females was 26.85 years. The mean age of onset was 25.15 years. The mean duration of alopecia was 10.3 months. Most common AA in our study was patchy type (57/66, 87.7%. Single patch was seen in 24 patients and multiple patches in 33 patients. Diffuse AA was seen in five patients. Ophiasis and alopecia universalis were seen in two patients each. Nail changes were fine pitting (4, ridging (2, thinning of nail plate (2. Twenty nail dystrophy, distal onycholysis, striate leukonychia and coarse pitting were seen in one patient each. Intralesional triamcinolone acetonide was the most common therapy offered. Others were oral betamethasone minipulse therapy, dexamethasone pulse, minoxidil, anthralin and corticosteroids. The most common dermoscopic finding was yellow dots seen in 54 patients (81.8%, followed by black dots (44 patients, 66.6%, broken hairs (36 patients, 55.4%, short vellus hair (27 patients, 40.9% and tapering hairs (8 patients, 12.1%. Conclusions: The most common dermoscopic finding of AA in our study was yellow dots, followed by black dots, broken hairs, short vellus hair and tapering hairs. Dermoscopic findings were not affected by the type of AA or the severity of the disease.

  15. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia

    Directory of Open Access Journals (Sweden)

    Hajheydari Zohreh

    2009-01-01

    Full Text Available Background: Finasteride, a type P-selective 5a-reductase inhibitor, as a causative agent of decreasing dihydroxy testestrone (DHT level, is effective in the treatment of male androgenic alopecia. Aim: We compared the local and oral finasteride in the treatment of androgenic alopecia. Method: This is a double blind, randomized clinical trial study of 45 male patients, who were referred with alopecia to the private clinics and departments in Boo-Ali Sina Hospital, in Sari. Patients with male androgenic alopecia were selected according to the history and physical examinations. The patients were randomly divided into two: topical finasteride (A and oral finasteride (B groups. Topical finasteride group (A received a topical gel of 1% finasteride and placebo tablets, while the oral finasteride group (B received finasteride tablets (1 mg and gel base (without drug as placebo for 6 months. The patients were followed by clinical observation and recording of side effects prior to the treatment and at the end of first week, and then by a monthly follow-up. The size of bald area, total hair count, and terminal hair were studied. Data were analyzed by descriptive and Chi-square statistical test. Results: The mean duration of hair loss was 18.8±23.10 months. Each month the terminal hair, size of bald area and hair count between the two groups were compared. There were no significant differences between the two groups as a viewpoint of hair thickness, hair counts and the size of bald area. Serial measurements indicated a significant increase in hair counts and terminal hair counts between the two groups. Conclusions: The results of this study showed that the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.

  16. What about narrative dentistry?

    Science.gov (United States)

    Vergnes, Jean-Noel; Apelian, Nareg; Bedos, Christophe

    2015-06-01

    Narrative medicine strives toward a humanized form of medicine in which empathy and the ability to listen are developed with the same emphasis as scientific rigor. We hypothesize that the adoption of narrative medicine in dentistry would be an excellent method to cultivate the philosophy behind the emerging clinical concept of patient-centered dentistry. Reading literary works, reflective writing, and creative writing would sensitize practitioners to the daily lives of people, human uniqueness, and alterity. Narrative dentistry could lead to more empathic and self-aware practices, and improve dental professionals' observational abilities by making them more perceptive and more attentive to image, metaphor, and meaning. The introduction of narrative dentistry would enrich the clinical clerkship of dentists by bringing the often-missing humanities to the dental professional, academic, and scientific environment. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  17. The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review.

    Science.gov (United States)

    Daum, Corinna; Hubschmid, Monica; Aybek, Selma

    2014-02-01

    Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and identifying 'positive' signs suggestive of a functional disorder. These positive signs are well known to all trained neurologists but their validity is still not established. The aim of this study is to provide current evidence regarding their sensitivity and specificity. We conducted a systematic search on motor, sensory and gait functional signs in Embase, Medline, PsycINfo from 1965 to June 2012. Studies in English, German or French reporting objective data on more than 10 participants in a controlled design were included in a systematic review. Other relevant signs are discussed in a narrative review. Eleven controlled studies (out of 147 eligible articles) describing 14 signs (7 motor, 5 sensory, 2 gait) reported low sensitivity of 8-100% but high specificity of 92-100%. Studies were evidence class III, only two had a blinded design and none reported on inter-rater reliability of the signs. Clinical signs for functional neurological symptoms are numerous but only 14 have been validated; overall they have low sensitivity but high specificity and their use should thus be recommended, especially with the introduction of the new DSM-V criteria.

  18. Music for the dying: a personal account of the new field of music-thanatology--history, theories, and clinical narratives.

    Science.gov (United States)

    Schroeder-Sheker, T

    1994-03-01

    Music-thanatology is a palliative medical modality employing prescriptive music to tend the complex physical and spiritual needs of the dying. "Infirmary music" was an intimate expression of French monastic medicine in 11th-century Cluny and anticipated the holism of both the hospice and palliative medical movements by almost 800 years. Although no longer an expression of any institutional religious identity, music-thanatology is nevertheless concerned with the possibility of a blessed death and the gift that conscious dying can bring to the fullness of life. Music-thanatology interns seek to integrate and model these contemplative and clinical values in daily practice: 18 interns deliver prescriptive music in bedside vigils serving the dying in home, hospital, and hospice settings with great effectiveness in oncology, respiratory illnesses, the slow degenerative diseases, and AIDS. This article is submitted to nurses to serve as an introduction to the field of music-thanatology, providing readers with a brief history, meaningful clinical narratives, some of the musical theories involved, research concerns (archival and medical), and milestones to be addressed for the future implementation of music-thanatology in hospitals and hospices and communities across the nation.

  19. Heart rate variability measurement and clinical depression in acute coronary syndrome patients: narrative review of recent literature

    Directory of Open Access Journals (Sweden)

    Harris PR

    2014-07-01

    Full Text Available Patricia RE Harris,1 Claire E Sommargren,2 Phyllis K Stein,3 Gordon L Fung,4,5 Barbara J Drew6,7 1ECG Monitoring Research Lab, 2Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA; 3Heart Rate Variability Laboratory, School of Medicine, Washington University, St Louis, MO, USA; 4Asian Heart & Vascular Center at Mount Zion, Division of Cardiology, University of California, 5Cardiology Consultation Service, Cardiac Noninvasive Laboratory, and The Enhanced External Counterpulsation Unit, Department of Medicine, University of California, San Francisco Medical Center, 6Division of Cardiology, 7Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA Aim: We aimed to explore links between heart rate variability (HRV and clinical depression in patients with acute coronary syndrome (ACS, through a review of recent clinical research literature. Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results: Nine clinical studies met the inclusion criteria. The

  20. Current and future treatments of alopecia areata and trichotillomania in children.

    Science.gov (United States)

    Iorizzo, Matilde; Oranje, Arnold P

    2016-09-01

    Treatment options for hair disorders are generally very limited. These options are even more limited in children due to the lack of trials and clinical research. Moreover, physicians are sometimes scared to treat children with drugs without safety data, especially because most hair disorders are benign. The objective of this paper is to review current and future treatments for alopecia areata and trichotillomania, two disorders that are sometimes encountered in differential diagnosis or even occur together and probably affect the mental condition of the patient involved more than others. Hair disorders are very stressful in paediatric population. Both physicians and families are often unsatisfied leading to non-compliance. New drugs with less side- effects are needed to increase the percentage of cure. It is also crucial to refine genetic studies on alopecia areata in order to identify new potential drugs worth studying. Moreover, studies on trichotillomania should not be evaluated only by psychiatrics, but also by dermatologists.

  1. Incidental Syringomas of the Scalp in a Patient with Scarring Alopecia

    Directory of Open Access Journals (Sweden)

    Kristyn Deen

    2015-07-01

    Full Text Available Syringomas are benign adnexal neoplasms of eccrine lineage, which occur most commonly in the periorbital region in middle-aged females. These cutaneous lesions rarely occur on the scalp, are typically asymptomatic and are predominantly of cosmetic significance. Involvement of the scalp may be indistinguishable from that of scarring alopecia. We present an unusual case of clinically inapparent syringomas occurring on the scalp of a 56-year-old female with alopecia who was subsequently diagnosed with lichen planopilaris after repeated scalp biopsy. In patients with unexplained hair loss, or in cases that are refractive to treatment, clinicians should perform scalp biopsy to exclude the diagnosis of rare neoplastic lesions like syringomas and to diagnose associated conditions.

  2. Active surveillance for prostate cancer: a narrative review of clinical guidelines.

    Science.gov (United States)

    Bruinsma, Sophie M; Bangma, Chris H; Carroll, Peter R; Leapman, Michael S; Rannikko, Antti; Petrides, Neophytos; Weerakoon, Mahesha; Bokhorst, Leonard P; Roobol, Monique J

    2016-03-01

    In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.

  3. A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men.

    Science.gov (United States)

    Hillmann, Kathrin; Garcia Bartels, Natalie; Kottner, Jan; Stroux, Andrea; Canfield, Douglas; Blume-Peytavi, Ulrike

    2015-01-01

    5% minoxidil formulations twice daily are effective in treating vertex male androgenetic alopecia (AGA); however, efficacy and safety data in frontotemporal regions are lacking. To assess the efficacy of 5% minoxidil topical foam (5% MTF) in the frontotemporal region of male AGA patients after 24 weeks of treatment compared to placebo treatment and to the vertex region. Seventy males with moderate AGA applied 5% MTF or placebo foam (plaTF) twice daily for 24 weeks in frontotemporal and vertex regions. Target area non-vellus hair count (TAHC) was the primary end point. Frontotemporal and vertex TAHC and target area cumulative non-vellus hair width (TAHW) showed similar responses to 5% MTF with significant increases up to week 16 compared to baseline (p < 0.001). After 24 weeks of treatment, frontotemporal TAHW increased significantly in the 5% MTF group compared to the plaTF group (p = 0.017), while TAHC showed a similar non-significant increase from baseline in both regions. At 24 weeks, 5% MTF users rated a significant improvement in scalp coverage for the frontotemporal (p = 0.016) and vertex areas (p = 0.027). 5% MTF twice a day promotes hair density and width in both frontotemporal and vertex regions in men with moderate stages of AGA. © 2015 S. Karger AG, Basel.

  4. Cohesive Referencing Errors During Narrative Production as Clinical Evidence of Central Nervous System Abnormality in School-Aged Children With Fetal Alcohol Spectrum Disorders.

    Science.gov (United States)

    Thorne, John C; Coggins, Truman E

    2016-11-01

    Previous evidence suggests that cohesive referencing errors made during narratives may be a behavior that is revealing of underlying central nervous system abnormality in children with fetal alcohol spectrum disorders (FASD). The current research extends this evidence. Retrospective analysis of narrative and clinical data from 152 children (ages 6 to 14), 72 of whom had confirmed FASD, was used. Narrative analysis was conducted blind to diagnostic status, age, or gender. Group performance was compared. The associations between measures of cohesive referencing and clinically gathered indices of the degree of central nervous system abnormality were examined. Results show clear associations between elevated rates of cohesive referencing errors and central nervous system abnormality. Elevated error rates were more common in children with FASD than those without, and prevalence increased predictably across groups with more severe central nervous system abnormality. Risk is particularly elevated for those with microcephaly or a diagnosis of fetal alcohol syndrome. Cohesive referencing errors during narrative are a viable behavioral marker of the kinds of central nervous system abnormality associated with prenatal alcohol exposure, having significant potential to become a valuable diagnostic and research tool.

  5. Narrative approaches

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2012-01-01

    Narrative coaching is representative of the new wave – or third generation – of coaching practice . The theory and practice of narrative coaching takes into account the social and cultural conditions of late modern society, and must be seen as intertwined with them. Some initial conceptualizations...... of narrative coaching were developed by David Drake (2006, 2007, 2008, 2009) in the USA and Australia, by Ho Law in the UK (Law, 2007a + b; Law & Stelter, 2009) and by Reinhard Stelter (2007, 2009, 2012, in preparation; Stelter & Law, 2010) in Denmark. In the following chapter the aim is to present coaching...... as a narrative-collaborative practice, an approach that is based on phenomenology, social constructionism and narrative theory. Seeing narrative coaching as a collaborative practice also leads to reflecting on the relationship between coach and coachee(s) in a new way, where both parts contribute to the dialogue...

  6. A alopecia androgenética na consulta de tricologia do Hospital Geral de Santo António (cidade do Porto, Portugal entre 2004 e 2006: estudo descritivo com componente analítico Androgenetic alopecia in trichology consultation at the Hospital Geral de Santo António (Oporto - Portugal, 2004-2006: a descriptive study with an analytic component

    Directory of Open Access Journals (Sweden)

    Inês Lobo

    2008-06-01

    Full Text Available FUNDAMENTOS: A alopecia androgenética é a causa mais comum de perda progressiva de cabelo. Geralmente ocorre em doentes com predisposição hereditária para esse tipo de alopecia e com androgénios circulantes. OBJETIVO: Avaliar aspectos epidemiológicos e clínicos de pacientes com alopecia androgenética pertencentes ao sexo feminino. MÉTODOS: Realizou-se estudo clínico transversal e descritivo em grupo de mulheres com alopecia androgenética observadas na consulta de tricologia entre 2004 e 2006. Os dados foram analisados com base na estatística descritiva e no teste do qui-quadrado. RESULTADOS: Foram estudadas 200 mulheres com diagnóstico clínico de alopecia androgenética. Em 68% das pacientes foi detectada história familiar e, na maioria das mulheres, a alopecia era frontobiparietal. De acordo com os dados analíticos estudados, 17% delas tiveram níveis baixos de zinco e 9% de albumina e ferritina. Em 20% foi detectada alteração no estudo hormonal. CONCLUSÃO: A alteração analítica mais detectada nas mulheres estudadas com alopecia androgenética foi a alteração hormonal.BACKGROUND: Androgenetic alopecia is the most frequent cause of progressive hair loss. It usually affects individuals with genetic predisposition and sufficient circulating androgens. OBJECTIVE: To assess the clinical and epidemiology aspects of androgenetic alopecia in females. METHODS: A cross-sectional and descriptive study was performed. The sample comprised a group of women with androgenetic alopecia seen in trichology consultation from 2004 to 2006. The results were analyzed using descriptive statistics and the chi-square test. RESULTS: A total of 200 women with clinical diagnosis of androgenetic alopecia were studied. Family history was detected in 68% of patients, and the most common site was frontoparietal hairline. The laboratory tests showed that 17% of females had low zinc and 9% low albumin and ferritin levels. Twenty percent of patients

  7. Microwave ablation of renal tumors: A narrative review of technical considerations and clinical results.

    Science.gov (United States)

    Cornelis, F H; Marcelin, C; Bernhard, J-C

    2017-04-01

    The purpose of this review was to identify the specific technical considerations to adequately perform microwave ablations (MWA) of renal tumors and analyze the currently available clinical results. Using Medline, a systematic review was performed including articles published between January 2000 and September 2016. English language original articles, reviews and editorials were selected based on their clinical relevance. MWA has several theoretical advantages over radiofrequency ablation in consistently providing higher intratumoral temperatures. MWA is less dependent of electrical conductivities of tissues and the delivered energy is less limited by desiccation of heated tissues. While there are insufficient data, especially because of a lack of studies with mid- to long-term follow-up, to determine the oncologic effectiveness of MWA, this technique appears safe and effective for the ablation of T1 renal tumors. There is evidence for using mid-level settings based on experimental and clinical data. Power set at 50-65W for 5-15min appears adequate in kidney but close clinical and imaging follow-up have to be performed. Renal MWA offers theoretical advantages by comparison with other available techniques to treat renal tumors. However, MWA suffers of less cumulative data compared to radiofrequency ablation or cryoablation. Moreover, microwaves still require further studies to identify the optimal tumor characteristics and device settings leading to predictable ablation. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  8. The use of D-dimer in specific clinical conditions: a narrative review

    NARCIS (Netherlands)

    Bruinstroop, E.; van de Ree, M. A.; Huisman, M. V.

    2009-01-01

    The use of D-dimer in combination with a clinical decision rule has been widely investigated in pulmonary embolism and deep venous thrombosis. Although it has been shown to be safe in excluding venous thromboembolism, the clinician is often faced with specific situations in which the use of D-dimer

  9. Study of diffuse alopecia in females

    Directory of Open Access Journals (Sweden)

    Jain V

    2000-01-01

    Full Text Available One hundred female patients, in the age range of 14-60 years suffering from diffuse hair loss were studied for pattern of aiopecia and probable causes. Pattern of hair loss was of telogen effluvium in 92% patients, androgenetic alopecia in 7% and anagen defluvium in 1%. The probable causes of diffuse alopecia were found to be psychological stress in 30%, fever in 33%, abortion and delivery in 21%, trauma and surgical operation in 13%, and hypothyroidism in 10%. In 57% patients more than two fac-tors, while in 6% no probable cause could be found on the basis of history. Routine laboratory investiga-tions revealed Hb level less than 12gm% in 96% patients, hypochromic picture on PBF examination in 57% patients, GIT parasites in 13% patients on stool examination, T 3 value less than 70 p gm/dl in 7% and TSH more than 7IU in 8 % cases. Mircoscopic examination of hairs in all the cases showed (telogen club root except in one case which showed broken and tapered root end (anagen.

  10. Unnatural Narratives

    Directory of Open Access Journals (Sweden)

    Roy Alfaro Vargas

    2017-02-01

    Full Text Available A critique is developed for unnatural narratives, which respond to a new narratological schema understood in anti-mimetic terms. The main characteristics of these narratives are described in relation to concepts such as reader, time or narration, regarding the development of experimental literatures and within the context of a politics of the impossible that aims to set up (post postmoden alternate ontologies through the representation of possible worlds that evade social reality and whose sociological role is social control. In addition, the internal contradictions of these unnatural narratives are emphasized.

  11. Topical minoxidil. A preliminary review of its pharmacodynamic properties and therapeutic efficacy in alopecia areata and alopecia androgenetica.

    Science.gov (United States)

    Clissold, S P; Heel, R C

    1987-02-01

    When minoxidil is administered orally for periods in excess of 1 month, hypertrichosis occurs as a side effect in a majority of patients. Consequently, topical minoxidil has been developed to try to improve hair growth in patients with alopecia areata and alopecia androgenetica. Preliminary studies have shown that topical minoxidil promotes cosmetically acceptable hair regrowth in a variable proportion of patients with alopecia areata. Data from a large multicentre trial indicate that cosmetically worthwhile results are achieved in about one-third of subjects with alopecia androgenetica after 1 year of treatment. A much higher proportion (about 80%) of patients with alopecia androgenetica exhibited some non-vellus hair regrowth after 1 year, and whether more of these patients would develop a cosmetically acceptable result with a longer treatment period is an important area of future investigation. Initial indications suggest that less severe disease is a predictor of likely response. Thus, topical minoxidil would seem to be a useful treatment modality for patients with alopecia androgenetica--a disease for which no other safe and effective drug therapy exists. Results from treating patients with alopecia areata with topical minoxidil, although encouraging, have been more variable and require further evaluation. Even though a number of questions remain to be answered about topical minoxidil (as would be expected at this stage in its development), it would seem to be the first available drug with the potential to promote substantial hair regrowth in these divergent diseases.

  12. Barriers to hospital-based clinical adoption of point-of-care testing (POCT): A systematic narrative review.

    Science.gov (United States)

    Quinn, Alistair D; Dixon, Dorian; Meenan, Brian J

    2016-01-01

    Recent advances in areas such as biomarker discovery and microfluidic device fabrication have allowed clinical testing to be moved ever closer to the site of patient care. The development of a range of point-of-care testing (POCT) devices that seek to provide the clinician with diagnostic test results more rapidly offer the opportunity to enhance the quality of care for the individual patient and the population at large. However, there are indications that, notwithstanding advances in the technologies that underpin the utility of POCT, their clinical uptake and utilization is less than might be expected. Moreover, the nature and relative importance of the barriers identified as being impediments to their more widespread adoption are not well understood. This article reports the findings from a systematic narrative review of published literature sources over the period 2000 to January 2014 to identify and categorize the various barriers to adoption of POCT devices within the clinical environment. Data from a total of six electronic bibliographic databases were accessed and these searches were supplemented by scrutinizing the reference lists within the key articles identified. A set of 49 key articles were assessed in detail and from these four specific categories of barrier to adoption of POCT were identified. Identification and categorization of these barriers, along with an assessment of their significance to clinical practice, is seen as necessary for developing real solutions to ensure appropriate and effective POCT uptake. The most prevalent categories were those associated with the economics of adoption and quality assurance and regulatory issues, each which were reflected in 65% of the literature articles reviewed. Device performance and data management issues were cited in 51% of the publications. Staff and operational issues were found within 35% of articles. The most significant barriers identified concerned higher cost per test of POCT in comparison to

  13. Delirium clinical motor subtypes: a narrative review of the literature and insights from neurobiology.

    Science.gov (United States)

    FitzGerald, James M

    2018-04-01

    Clinical motor subtypes have been long recognised in delirium and, despite a growing body of research, a lack of clarity exists regarding the importance of these motor subtypes. The aims of this review are to (1) examine how the concept of motor subtypes has evolved, (2) explore their relationship to the clinical context, (3) discuss the relationship between the phenomenology of delirium and motor activity, (4) discuss the application of neurobiology to the theory of delirium motor subtypes, and (5) identify methodological issues and provide solutions for further studies. The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified peer-reviewed research assessing delirium motor subtypes published between 1990 and 2016. Sixty-one studies met the inclusion criteria. The majority of studies (n = 50) were found to use validated psychometric tools, while the remainder (n = 11) used clinical criteria. The majority of studies (n = 45) were conducted in the medical setting, while the remainder were in the ICU/post-operative setting (n = 17). Although host sensitivities (e.g. frailty) and exogenous factors (e.g. medication exposure) may determine the type of motor disturbance, it remains unclear to what extent motor subtypes are influenced by other features of delirium. The use of more specialised tools (e.g. delirium motor subtyping scale), may enable researchers to develop an approach to delirium that has a greater nosological consistency. Future studies investigating delirium motor subtypes may benefit from enhanced theoretical considerations of the dysfunctional neural substrate of the delirious state.

  14. Three clinical experiences with SNP array results consistent with parental incest: a narrative with lessons learned.

    Science.gov (United States)

    Helm, Benjamin M; Langley, Katherine; Spangler, Brooke; Vergano, Samantha

    2014-08-01

    Single nucleotide polymorphism microarrays have the ability to reveal parental consanguinity which may or may not be known to healthcare providers. Consanguinity can have significant implications for the health of patients and for individual and family psychosocial well-being. These results often present ethical and legal dilemmas that can have important ramifications. Unexpected consanguinity can be confounding to healthcare professionals who may be unprepared to handle these results or to communicate them to families or other appropriate representatives. There are few published accounts of experiences with consanguinity and SNP arrays. In this paper we discuss three cases where molecular evidence of parental incest was identified by SNP microarray. We hope to further highlight consanguinity as a potential incidental finding, how the cases were handled by the clinical team, and what resources were found to be most helpful. This paper aims to contribute further to professional discourse on incidental findings with genomic technology and how they were addressed clinically. These experiences may provide some guidance on how others can prepare for these findings and help improve practice. As genetic and genomic testing is utilized more by non-genetics providers, we also hope to inform about the importance of engaging with geneticists and genetic counselors when addressing these findings.

  15. Project Narrative

    Energy Technology Data Exchange (ETDEWEB)

    Driscoll, Mary C. [St. Bonaventure University, St Bonaventure, NY(United States)

    2012-07-12

    The Project Narrative describes how the funds from the DOE grant were used to purchase equipment for the biology, chemistry, physics and mathematics departments. The Narrative also describes how the equipment is being used. There is also a list of the positive outcomes as a result of having the equipment that was purchased with the DOE grant.

  16. STELLA Narratives.

    Science.gov (United States)

    Reese, Alison

    2001-01-01

    Presents a selection of 21 brief (about two pages) narratives by primary and secondary teachers on STELLA (Standards for Teachers of English Language and Literacy in Australia) panels in Victoria and Queensland. Notes that each narrative describes a moment of "good" English/literacy teaching. (RS)

  17. Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia.

    Science.gov (United States)

    Belum, Viswanath Reddy; de Barros Silva, Giselle; Laloni, Mariana Tosello; Ciccolini, Kathryn; Goldfarb, Shari B; Norton, Larry; Sklarin, Nancy T; Lacouture, Mario E

    2016-06-01

    The use of scalp cooling for the prevention of chemotherapy-induced alopecia (CIA) is increasing. Cold caps are placed onto the hair-bearing areas of the scalp for varying time periods before, during, and after cytotoxic chemotherapy. Although not yet reported, improper application procedures could result in adverse events (AEs). At present, there are no evidence-based scalp cooling protocols, and there is no regulatory oversight of their use. To report the occurrence of cold thermal injury (frostbite) on the scalp, following the use of cold caps for the prevention of CIA. We identified four patients who developed cold thermal injuries on the scalp following the application of cold caps. Medical records were analyzed to retrieve the demographic and clinical characteristics. The cold thermal injuries in our patients were grade 1/2 in severity and improved with topical interventions and interruption of cold cap use, although grade 1 persistent alopecia ensued in 3 patients. The true incidence of such injuries in this setting, however, remains unknown. Cold thermal injuries are likely infrequent and preventable AEs that may result from improper device application procedures during cold cap use. Although these untoward events are usually mild to moderate in severity, the potential occurrence of long-term sequelae (e.g., permanent alopecia and scarring) or the need to discontinue cold cap use, are not known. Prospective studies are needed to further elucidate the risk and standardize healthcare delivery methods, and to improve patient/supportive/healthcare provider education.

  18. Higher concentrations of dithranol appear to induce hair growth even in severe alopecia areata.

    Science.gov (United States)

    Ngwanya, M R; Gray, N A; Gumedze, F; Ndyenga, A; Khumalo, N P

    2017-07-01

    Alopecia areata (AA) is the commonest autoimmune cause of non-scarring alopecia. Topical treatments including corticosteroids and irritants maybe beneficial. Studies report variable hair regrowth with dithranol (anthralin) but all used low concentrations (0.1-1.25%) and inconsistent measurements of AA severity. We report retrospective data (2005-2014) of 102 patients who had failed ultra-potent topical steroids and were referred to a specialist hair clinic for treatment with dithranol up to 3%. The severity of alopecia areata tool was used and participants graded as mild (25 to 75%), and severe (>75%) hair loss. Compared with baseline any and at-least 50% hair regrowth [72%, 68%, 50% and 61.5%, 48.4%, 37.5%, in mild, moderate and severe AA respectively] occurred in all groups (median treatment duration 12 months). Twenty-nine patients (28.4%) were discharged with complete regrowth; with no difference in proportions in severity groups (33.3%, 29%, and 21.9%) but in the period to discharge [7.9, 6.3, and 29.4 months (p-values <.05)] for mild, moderate, and severe AA. Treatment trials of 12 months with dithranol at higher concentrations may be an option in patients who failed potent topical or intra-lesional steroids) regardless of AA severity. Randomized trials (of less staining formulations) of dithranol are warranted. © 2017 Wiley Periodicals, Inc.

  19. Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

    International Nuclear Information System (INIS)

    Mahadevan, Anand; Sampson, Carrie; LaRosa, Salvatore; Floyd, Scott R.; Wong, Eric T.; Uhlmann, Erik J.; Sengupta, Soma; Kasper, Ekkehard M.

    2015-01-01

    Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. All six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V 24 (9 cc vs. 44 cc, p < 0.0000) and V 30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia

  20. Comparison of thyroid function tests in alopecia totalis and universalis with control group

    Directory of Open Access Journals (Sweden)

    Hassan Seirafi

    2013-07-01

    Full Text Available Background: Alopecia areata (AA is a common cause of noncicatricial alopecia that occurs as a patchy, confluent or diffuse pattern. Exact etiologic factor of AA not yet recognized. Among many hypothesis, relationship between AA and autoimmune disease, especially thyroid disorders, was more interesting. The objective of this study was to determine the prevalence of thyroid test disorders in the patients with alopecia totalis and universalis in comparison with normal population.Methods: We analyzed medical records of 100 patients, including 44 male and 56 female in Tehran Razi Hospital from 1388 to 1389. The mean age was 24.1 years. Patients having totalis and universalis form of AA considered as case group while 100 normal person (42 male and 58 female with mean age of 26.1 who had not any form of AA considered as control group. Both groups had not any sign of thyroid disease at clinical examination according to their available medical records. Collected data were analyzed statistically in SPSS software 17th version. Results: In the majority of patients (54% the disease was manifested in the first two decades of life. History of atopia was seen in 9.8% of patient. Presence of the similar disease in first-degree family members was seen in 14.3% of patients. Abnormal T3, T4 and TSH were significantly higher in case group. Abnormal T3 uptake was higher in case group but not statistically significant. Conclusion: Paraclinical thyroid disorders were significantly higher in the alopecia areata patients than in normal population. There was no significant association between the age, sex and duration of disease and presence thyroid dysfunction.

  1. Narrative udvidelser

    DEFF Research Database (Denmark)

    Skøtt, Bo

    2015-01-01

    Dette pilotstudies ambition er at undersøge, hvordan og hvorfor narrative elementer lejlighedsvist aktiveres af aktører i deres kontakt med bibliotekarer i folkebiblioteker. Ved hjælp af en kulturanalytisk tilgang studeres forskellige aktørers narrative udvidelser af referenceinterviewet. Teoretisk....... Pilotstudiet bekræfter de 2 indledende antagelser: 1) at nogle aktører anvender narrative udvidelser, fordi de vælger at betone den mellemmenneskelige relation mellem aktør og bibliotekar, som om det var enhver anden social relation og derved ignorerer andre, mere repræsentative dele af bibliotekarernes...... funktioner. Og 2) at nogle aktører anvender narrative udvidelser i bestræbelserne på at legitimere egne sociale positioner og identitetsdannelse gennem kritisk refleksion over bibliotekarernes og folkebibliotekets institutionelle position og magt. Gennem den narrative udvidelse formår disse aktører...

  2. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review.

    Science.gov (United States)

    McGregor, Alyson J; Beauchamp, Gillian A; Wira, Charles R; Perman, Sarah M; Safdar, Basmah

    2017-10-01

    The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.

  3. Transient Efficacy of Tofacitinib in Alopecia Areata Universalis

    Directory of Open Access Journals (Sweden)

    Florian Anzengruber

    2016-04-01

    Full Text Available Alopecia areata is a common autoimmune disorder that targets hair follicles. Swarms of lymphocytes surround the basis of the follicles, inducing loss of pigmented terminal hair and subsequently inhibit further hair growth. Depending on the extent of involvement, alopecia areata can be associated with a dramatic reduction of quality of life. Currently, no targeted treatment option is available, and topical immune therapies or immunosuppressive drugs are typically used with mixed success. Recently, several cases of alopecia areata responding to Janus kinase inhibitors were published. Here, we report on a businessman with alopecia areata universalis who was treated with tofacitinib. We observed initial signs of hair regrowth in the same timeframe as previously reported, but efficacy quickly waned again, leading to renewed effluvium. Thus, even though tofacitinib and ruxolitinib are a promising new treatment option, we have yet to learn more about their potential role in each particular patient's individual treatment strategy.

  4. VIEWPOINT – Vitiligo and alopecia areata: Apples and oranges?

    Science.gov (United States)

    Harris, John E.

    2013-01-01

    Vitiligo and alopecia areata are common autoimmune diseases of the skin. Vitiligo is caused by the destruction of melanocytes and results in the appearance of white patches on any part of the body, while alopecia areata is characterized by patchy hair loss primarily on the scalp, but may also involve other areas as well. At first glance, the two diseases appear to be quite different, targeting different cell types and managed using different treatment approaches. However, the immune cell populations and cytokines that drive each disease are similar, they are closely associated within patients and their family members, and vitiligo and alopecia areata have common genetic risk factors, suggesting that they share a similar pathogenesis. Like apples and oranges, vitiligo and alopecia areata have some obvious differences, but similarities abound. Recognizing both similarities and differences will promote research into the pathogenesis of each disease, as well as the development of new treatments. PMID:24131336

  5. TINEA CAPITIS– SIGNIFICANCE OF TIMELY TREATMENT TO PREVENT SCARRING ALOPECIA

    Directory of Open Access Journals (Sweden)

    Sandrina Carvalho

    2016-09-01

    Conclusion: The treatment of tinea capitis is simple and effective. Timely identification and treatment are essential to prevent the formation of a cicatricial alopecia, often disturbing for the patient.

  6. Topical minoxidil in the treatment of alopecia areata.

    Science.gov (United States)

    Fenton, D A; Wilkinson, J D

    1983-01-01

    A modified double blind crossover study was performed to assess the effect of 1% topical minoxidil as compared with placebo in 30 patients with alopecia areata and alopecia totalis. The active preparation produced a highly significant incidence of hair regrowth. A cosmetically acceptable response was noted in 16 patients. No side effects were seen. The study confirmed that topical minoxidil will induce new hair growth in alopecia areata but that it is less likely to do so in more severe and extensive disease. Furthermore, patients with alopecia universalis and totalis may not respond at all. Nevertheless, as compared with other drugs minoxidil applied topically is relatively non-toxic, is easy to use, and has no systemic or local side effects. Images p1016-a PMID:6412929

  7. Review of quality of life studies in women with alopecia

    Directory of Open Access Journals (Sweden)

    D.S. Davis, MD, MS

    2018-03-01

    Full Text Available Alopecia is a dermatologic condition that affects the pilosebaceous unit in both men and women. In addition to a thorough medical history and physical examination, a host of diagnostic tools may be warranted to differentiate nonscarring and scarring alopecias. Female pattern hair loss represents the most common form of hair loss experienced by up to 40% of women by a certain age. Although alopecia is a benign disorder, even the most negligible amount of hair loss can be devastating to a patient’s self-esteem, self-image, and overall quality of life. We present this comprehensive review of quality of life studies in women with alopecia to describe the multitude of feelings and emotions associated with the disorder and remind dermatologists of the psychological impact it can have on women.

  8. Acquired alopecia, mental retardation, short stature, microcephaly, and optic atrophy

    NARCIS (Netherlands)

    Hennekam, R. C.; Renckens-Wennen, E. G.

    1990-01-01

    We report on a female patient who had acquired total alopecia, short stature, microcephaly, optic atrophy, severe myopia, and mental retardation. A survey of published reports failed to show an identical patient, despite various similar cases

  9. FDA drug safety communications: a narrative review and clinical considerations for older adults.

    Science.gov (United States)

    Marcum, Zachary A; Vande Griend, Joseph P; Linnebur, Sunny A

    2012-08-01

    The US Food and Drug Administration (FDA) has new regulatory authorities intended to enhance drug safety monitoring in the postmarketing period. This has resulted in an increase in communication from the FDA in recent years about the safety profile of certain drugs. It is important to stay abreast of the current literature on drug risks to effectively communicate these risks to patients, other health care providers, and the general public. To summarize 4 new FDA drug safety communications by describing the evidence supporting the risks and the clinical implications for older adults. The FDA Web site was reviewed for new drug safety communications from May 2011 to April 2012 that would be relevant to older adults. Approved labeling for each drug or class was obtained from the manufacturer, and PubMed was searched for primary literature that supported the drug safety concern. FDA drug safety communications for 4 drugs were chosen because of the potential clinical importance in older adults. A warning for citalopram was made because of potential problems with QT prolongation in patients taking less than 40 mg per day. The evidence suggests minor changes in QT interval. Given the flat dose-response curve in treating depression with citalopram, the new 20-mg/d maximum dose in older adults is sensible. Another warning was made for proton pump inhibitors (PPIs) and an increased risk of Clostridium difficile infection. A dose-response relationship was found for this drug risk. With C. difficile infections on the rise in older adults, along with other safety risks of PPI therapy, PPIs should only be used in older adults indicated for therapy for the shortest duration possible. In addition, a warning about dabigatran was made. There is strong evidence from a large clinical trial, as well as case reports, of increased bleeding risk in older adults taking dabigatran, especially in older adults with decreased renal function. This medication should be used with caution in older

  10. Human Permanent Ectoparasites; Recent Advances on Biology and Clinical Significance of Demodex Mites: Narrative Review Article

    Directory of Open Access Journals (Sweden)

    Dorota LITWIN

    2017-02-01

    Full Text Available Background: Demodex is a genus of mites living predominantly in mammalian pilosebaceous units. They are commonly detected in the skin of face, with increasing numbers in inflammatory lesions. Causation between Demodex mites and inflammatory diseases, such as rosacea, blepharitis, perioral and seborrhoeic dermatitis or chalazion, is controversially discussed. Clinical observations indicate a primary form of human Demodex infection. The aim of this review was to highlight the biological aspects of Demodex infestation and point out directions for the future research.Methods: We conducted a broad review based on the electronic database sources such as MEDLINE, PubMed and Scopus with regard to the characteristics of the Demodex species, methods of examination and worldwide epidemiology, molecular studies and its role in the complex human ecosystem.Results: Demodex mites are organisms with a worldwide importance as they act in indicating several dermatoses, under certain conditions. However, correlations between Demodex and other parasites or microorganisms occupying one host, as well as interactions between these arachnids and its symbiotic bacteria should be considered. There are few methods of human mites' examination depending on purpose of the study. Nevertheless, paying attention must be needed as polymorphism of Demodex species has been reported.Conclusion: Overall, the present review will focus on different aspects of Demodex mites’ biology and significance of these arachnids in human’s health.

  11. Environmental Enrichment Reduces the Likelihood of Alopecia in Adult C57BL/6J Mice

    Science.gov (United States)

    Bechard, Allison; Meagher, Rebecca; Mason, Georgia

    2011-01-01

    Barbering (incessant grooming) is an abnormal behavior causing alopecia and commonly affects various strains of laboratory mice, including C57BL/6J. Barbering-induced alopecia is a potential symptom of brain impairment and can indicate a stressful environment. We compared alopecia prevalence and severity in mice housed in enriched or standard cages. Providing an enriched environment delayed the onset and reduced the prevalence and overall severity of alopecia in C57BL/6J mice. Husbandry methods that reduce adult alopecia are likely to promote the wellbeing of the animals. We suggest that environmental enrichment is a simple and economic way to reduce alopecia in mouse colonies. PMID:21439209

  12. High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease

    Science.gov (United States)

    Čeović, Romana; Desnica, Lana; Pulanić, Dražen; Serventi Seiwerth, Ranka; Ilić, Ivana; Grce, Magdalena; Mravak Stipetić, Marinka; Klepac Pulanić, Tajana; Bilić, Ervina; Bilić, Ernest; Milošević, Milan; Vrhovac, Radovan; Nemet, Damir; Pavletic, Steven Z

    2016-01-01

    Aim To determine the frequency and the characteristics of cutaneous manifestations, especially vitiligo and alopecia areata, in patients with chronic graft-vs-host disease (cGVHD). Methods 50 patients with cGVHD were prospectively enrolled in the observational study protocol and evaluated by an experienced dermatologist. The evaluation was focused on the clinical spectrum of skin and adnexal involvement, and the cutaneous GVHD score was determined according to National Institutes of Health (NIH) Consensus criteria. The presence of vitiligo, alopecia, xerosis, nail changes, and dyspigmentation was also assessed. Results Out of 50 cGVHD patients, 28 (56%) had skin involvement, and 27 of them (96%) had hypo and/or hyperpigmentations. 11 patients (39%) had a mild cutaneous NIH cGVHD score, 22% moderate, and 39% severe. 15 (30%) patients had nail changes and 10 (20%) had vitiligo or alopecia areata. Univariate analysis showed that patients with vitiligo/alopecia areata received more lines of prior systemic immunosuppressive therapy (P = 0.043), had lower Karnofsky performance status (P = 0.028), and had a higher B-cell number (P = 0.005), platelet count (P = 0.022), and total protein (P = 0.024). Vitiligo and alopecia areata were associated with higher NIH skin score (P = 0.001), higher intensity of immunosuppressive treatment (P = 0.020), and total body irradiation conditioning (P = 0.040). Multivariate regression model showed that patients with higher NIH skin scoring were 3.67 times more likely to have alopecia and/or vitiligo (odds ratio 3.67; 95% confidence interval 1.26-10.73), controlled for all other factors in the model (age at study entry, number of B-cells, platelet count, and global NIH score). Conclusion These data indicate that vitiligo and alopecia areata occur more frequently in cGVHD than previously reported. PMID:27374824

  13. Narrative interviewing.

    Science.gov (United States)

    Anderson, Claire; Kirkpatrick, Susan

    2016-06-01

    Introduction Narrative interviews place the people being interviewed at the heart of a research study. They are a means of collecting people's own stories about their experiences of health and illness. Narrative interviews can help researchers to better understand people's experiences and behaviours. Narratives may come closer to representing the context and integrity of people's lives than more quantitative means of research. Methodology Researchers using narrative interview techniques do not set out with a fixed agenda, rather they tend to let the interviewee control the direction, content and pace of the interview. The paper describes the interview process and the suggested approach to analysis of narrative interviews, We draw on the example from a study that used series of narrative interviews about people's experiences of taking antidepressants. Limitations Some people may find it particularly challenging to tell their story to a researcher in this way rather than be asked a series of questions like in a television or radio interview. Narrative research like all qualitative research does not set out to be generalisable and may only involve a small set of interviews.

  14. Chemotherapy-induced irreversible alopecia in early breast cancer patients.

    Science.gov (United States)

    Kim, Gun Min; Kim, Sanghwa; Park, Hyung Seok; Kim, Jee Ye; Nam, Sanggen; Park, Seho; Kim, Seung Il; Kim, DoYoung; Sohn, Joohyuk

    2017-06-01

    The purpose of this work is to determine the prevalence of chemotherapy-induced irreversible alopecia (CIIA), which is defined as an alopecia that exists at least 6 months after completion of chemotherapy and factors affecting CIIA in early breast cancer patients. We performed a cross-sectional study. We retrospectively identified breast cancer patients who had received AC (Adriamycin, Cyclophosphamide) or AC-T (AC followed by Taxane) as neoadjuvant or adjuvant chemotherapy. We conducted questionnaire survey regarding alopecia and measured hair density using phototrichogram. From February 2015 to May 2015, among 265 patients who responded properly to the questionnaire, the women who answered they had severe alopecia (alopecia > 50% of scalp) were 19 patients (7.2%). AC-only and AC-T treated patients reported severe alopecia in 2.7% and 10.5%, respectively, which were significantly different (p < 0.001). Mean hair density was 75 hair/cm 2 (range 42-112) and 75.2/cm 2 (range 48.3-102) on occipital area and vertex area, respectively. Hair loss was the most frequent in parietal area (42.6%). Half of total patients (46%) and 73% of CIIA patients regarded that their hair became thinner after chemotherapy CONCLUSIONS: We found that significant proportion of early breast cancer patients were suffering from severe CIIA, especially when they had been treated with AC followed by taxane regimen.

  15. Sarcoidosis presenting as non-scarring non-scalp alopecia.

    Science.gov (United States)

    Dan, Luke; Relic, John

    2016-08-01

    In this article we describe a 39-year-old man who presented with non-scarring non-scalp alopecia of his limbs as the initial presentation of sarcoidosis. Alopecia is a rare cutaneous manifestation of sarcoidosis. A literature review has found only one other example of sarcoidosis presenting as non-scarring non-scalp alopecia in an area other than the scalp in a patient who was otherwise asymptomatic. Several reported cases have described scarring alopecia of the scalp, which is the area of skin most commonly affected by sarcoidosis. There has been one documented case of sarcoidosis manifesting as total body non-scarring alopecia in a patient who had systemic symptoms of sarcoidosis. Other cases have presented rare cutaneous manifestations of sarcoidosis but in all these cases several other organ systems have been involved, and the patient has had systemic symptoms on presentation or the cutaneous presentation did not include non-scalp non-scarring alopecia. © 2015 The Australasian College of Dermatologists.

  16. Hair morphology in androgenetic alopecia: sonographic and electron microscopic studies.

    Science.gov (United States)

    Wortsman, Ximena; Guerrero, Robinson; Wortsman, Jacobo

    2014-07-01

    To assess hair morphology in androgenetic alopecia on sonography and electron microscopy. A prospective study was performed in 33 patients with androgenetic alopecia and 10 unaffected control participants. In vivo sonography of the hair follicles of the scalp and in vitro sonography and electron microscopy of the hair shafts were performed according to a standardized protocol that included analysis of the right frontal and occipital regions. The upper frequency limit of the ultrasound probes ranged between 15 and 18 MHz. Scalp hair follicles and hair shafts were recognizable on sonography in all cases. Hair follicles in alopecia cases had significantly lower depths (P alopecia also had a different distribution of their laminar pattern on in vitro sonography, with a greater presence of mixed (trilaminar and bilaminar) and solely bilaminar tracts in comparison with the controls (mostly trilaminar). On electron microscopy, the alopecia hair tracts showed irregularities and commonly a "melted candle" appearance of the cuticle. Sonography and electron microscopy uncover distinct abnormalities in the morphology of hair in androgenetic alopecia, which may potentially support the diagnosis and management of this common condition. © 2014 by the American Institute of Ultrasound in Medicine.

  17. Alopecia Areata of the Beard: A Review of the Literature.

    Science.gov (United States)

    Cervantes, Jessica; Fertig, Raymond M; Maddy, Austin; Tosti, Antonella

    2017-12-01

    Alopecia areata (AA) is a T-cell mediated autoimmune disorder in which inflammatory cells attack the hair follicle, resulting in round, well-circumscribed patches of noncicatricial hair loss in normal appearing skin. AA affecting the beard area is well known and is referred to as AA of the beard (BAA) or AA barbae when involvement is limited exclusively to the beard. BAA has been documented in a select number of studies. We review the literature and discuss the clinical features, epidemiology, diagnosis, and treatment of BAA. Clinical presentation of BAA can vary and manifest as single small areas of hair loss, multiple small or large simultaneous focuses, or total hair loss. Most patients are middle-aged males with focal patches of round or oval hair loss, mostly localized along the jawline. Patches are characteristically well circumscribed and smooth with white hair present at the periphery. Dermoscopic features of BAA include yellow dots, broken hair, and short vellus hairs. BAA may be associated with other autoimmune disorders, including atopic dermatitis, vitiligo, and psoriasis. Many treatment modalities are available for BAA, and selection of a therapy depends on several factors, including disease activity, extent of area affected, duration of disease, and age of the patient. Topical corticosteroids are most commonly used as initial treatment, followed by intralesional steroids. Other therapeutic modalities are discussed.

  18. Narrative Absence

    DEFF Research Database (Denmark)

    Kaur, Ravinder

    2008-01-01

    examples of successful refugee resettlement and national self-assertion. Within the master narrative of Partition migration history, however, the experiences of forced movement and resettlement suffered by the ‘Untouchables' are obscured. Popular accounts of violence, forced movement and suffering...... are largely built around the narratives produced by upper caste and upper middle-class migrants and exclude the experiences of Untouchable migrants. This narrative absence becomes a gauge of both the discursive and physical exclusion of ‘Untouchable' refugees from the legitimate community of Partition...... migrants. Such a meta-version of Partition history constitutes the realm of the normal outside which ‘Untouchable' narratives exist as an aberration in the theme of modern citizen-making in post-colonial India. In this article, I examine these ‘aberrations' to provide an alternate reading that helps us...

  19. Bakhtin, nursing narratives, and dialogical consciousness.

    Science.gov (United States)

    Bowers, R; Moore, K N

    1997-03-01

    Dialogical interaction is fundamental to considerations of nursing narrative, discourse, and communication. The story the patient tells is listened to, interpreted, and responded to through appropriate nursing care. Although nurses have long recognized narrative as central to humanistic nursing practice, the theoretical considerations of dialogue have received less attention with respect to nursing knowledge development. Mikhail Bakhtin, a key philosopher of narrative in the 20th century, put forward a dialogical narrative approach that is directly related to nursing concepts of narrative, interaction, and personhood and suggestive of a postmodern clinical epistemology. This article relates Bakhtin's dialogical narrative approach to nursing practice.

  20. Narrative konstruktioner

    DEFF Research Database (Denmark)

    Kristiansen, Claus Krogholm

    The dissertation deals with narrative as a cognitive structure - as a way of handling experience in the modern world. The question is: What is man when he is not created in god's image. Some recent scandinavian novels are analysed as examples.......The dissertation deals with narrative as a cognitive structure - as a way of handling experience in the modern world. The question is: What is man when he is not created in god's image. Some recent scandinavian novels are analysed as examples....

  1. Prevalence of anti-gliadin antibody in patients with alopecia areata: a case-control study

    Directory of Open Access Journals (Sweden)

    Hallaji Z

    2011-03-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Alopecia areata, a non-cicatricial form of hair loss, is believed to be an immunologic response that targets hair follicles. Genetic background is important in the pathogenesis of this disorder, although some evidence point to the role of melanocytic antigens. There are some reports on the relationship between alopecia areata and celiac disease. The aim of the present study was to identify antigliadin antibodies in patients with alopecia areata. "n"nMethods: Fifty patients, aged 2.5-50 years, with alopecia areata presenting to the dermatology clinic of Razi Educational Hospital in Tehran, Iran, and fifty healthy individuals, aged 5-48 were matched and enrolled in the study. After signing an informed consent form, blood samples (10 ml clotted blood were obtained from the participants and sent to referral laboratory for the presence of antigliadin IgA and IgG antibodies. Concentrations of antibodies were measured by ELISA through a full automatic ELISA reader. The data were analyzed statistically."n"nResults: The study included 29(58% male and 21(42% female patients with a mean age of 24.6 years. The control group included 29(58% male and 21(42% female individuals with a mean age

  2. A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia.

    Science.gov (United States)

    Montgomery, Kerry; White, Caroline; Thompson, Andrew

    2017-05-04

    This study aimed to examine levels of social anxiety, anxiety and depression reported by people with alopecia as a result of a dermatological condition and associations with wig use. The study also sought to report on experiences of wearing wigs in social situations and the relationship with social confidence. A cross-sectional survey was sent by email to the Alopecia UK charity mailing list and advertised on social media. Inclusion criteria were a diagnosis of alopecia, aged 13 or above and sufficient English to complete the survey. Exclusion criteria included experiencing hair loss as a result of chemotherapy treatment or psychological disorder. Participants (n=338) were predominantly female (97.3%), Caucasian (93.5%) and aged between 35 and 54 years (49.4%) with a diagnosis of alopecia areata (82.6%). The Social Phobia Inventory measured symptoms of social anxiety, and the Hospital Anxiety and Depression Scale was used to measure symptoms of anxiety and depression. Survey questions were designed to measure the use of wigs. Open-ended questions enabled participants to comment on their experiences of wearing wigs. Clinically significant levels of social anxiety (47.5%), anxiety (35.5%) and depression (29%) were reported. Participants who reported worries about not wearing a wig reported significantly higher levels of depression: t(103)=3.40, p≤0.001; anxiety: t(109)=4.80, p≤0.001; and social anxiety: t(294)=3.89, p≤0.001. Wearing wigs was reported as increasing social confidence; however, the concealment it afforded was also reported as both reducing fear of negative evaluation and maintaining anxiety. Overall, 46% of participants reported that wearing a wig had a positive impact on their everyday life with negative experiences related to fears of the wig being noticed. Psychological interventions alongside wig provision would be beneficial for people living with alopecia. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  3. Evaluating Platelet-Rich Therapy for Facial Aesthetics and Alopecia: A Critical Review of the Literature.

    Science.gov (United States)

    Motosk O, Catherine C; Khouri, Kimberly S; Poudrier, Grace; Sinno, Sammy; Hazen, Alexes

    2018-05-01

    Despite the growing popularity of platelet-rich plasma, existing evidence supporting its efficacy remains controversial due to the lack of large-scale studies and standardized protocols for preparation and application. This article reviews its use in facial rejuvenation, fat grafting, acne scarring, and androgenic alopecia. Emphasis is placed on comparing methods of platelet-rich plasma preparation and application across studies. A systematic review was performed for articles published between 2006 and 2015. All clinical studies and case reports that addressed platelet-rich plasma alone and/or in combination with fat grafting for facial rejuvenation, acne scarring, or androgenic alopecia were included. Of the 22 articles included in the analysis, seven studies used platelet-rich plasma alone for facial rejuvenation, seven in combination with fat grafting, two for treatment of acne scarring, and six for treatment of androgenic alopecia. Individual study procedures, means of evaluation, and significant results are summarized. Although the majority of studies in this review report positive results, significant variation exists in preparation protocols and in the number and frequency of clinical treatments. The majority of studies report positive results for all indications evaluated in this review, but the procedure is limited by the lack of a standardized method for preparation and application of platelet-rich plasma. The extent to which significant variability in platelet-rich plasma preparation and/or application methods may affect clinical outcomes is not completely clear. In the interim, we present a consolidation of platelet-rich plasma treatment techniques and outcomes currently in use to help guide physicians in their clinical practice.

  4. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.

    Science.gov (United States)

    Keasberry, Justin; Scott, Ian A; Sullivan, Clair; Staib, Andrew; Ashby, Richard

    2017-12-01

    Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes. Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool. Outcome measures were benefits and harms relating to electronic medical records (EMRs), computerised physician order entry (CPOE), electronic prescribing (ePrescribing) and computerised decision support systems (CDSS). Results are presented as a narrative overview given marked study heterogeneity. Results Nineteen systematic reviews and two reviews of systematic reviews were included from 1197 abstracts, nine rated as high quality. For EMR functions, there was moderate-quality evidence of reduced hospitalisations and length of stay and low-quality evidence of improved organisational efficiency, greater accuracy of information and reduced documentation and process turnaround times. For CPOE functions, there was moderate-quality evidence of reductions in turnaround times and resource utilisation. For ePrescribing, there was moderate-quality evidence of substantially fewer medications errors and adverse drug events, greater guideline adherence, improved disease control and decreased dispensing turnaround times. For CDSS, there was moderate-quality evidence of increased use of preventive care and drug interaction reminders and alerts, increased use of diagnostic aids, more appropriate test ordering with fewer tests per patient, greater guideline adherence, improved processes of care and less disease morbidity. There was conflicting evidence regarding effects on in-patient mortality and overall costs. Reported harms were

  5. Case study: fibrosing alopecia in a pattern distribution localized on alopecia androgenetica areas and unaffected scalp.

    Science.gov (United States)

    Amato, Lauretta; Chiarini, Caterina; Berti, Samantha; Bruscino, Paolo; Fabbri, Paolo

    2004-01-01

    A 54-year-old man with a 24-year history of androgenetic alopecia was referred to the Department of Dermatological Sciences with follicular inflammatory lesions leading to scleroatrophy in the vertex region (Figure 1) of 1-year duration. These lesions appeared a year ago. There was no previous history of this condition. On examination, the patient showed confluent infiltrative follicular lesions on the frontoparietal and occipital scalp (Figure 2). Some lesions evolved into erosions that developed in ivory white scleroatrophy within weeks. These lesions were localized both in and outside of are as affected by alopecia androgenetica and were associated with mild pruritus. Histopathologic examination, performed on an early lesion of the vertex, documented a mild thinning of follicular epithelium associated with an intense lymphohistiocytic perifollicular infiltrate. The damage of the basal cell layer was limited to the follicle, while epidermis was intact. In particular, follicular keratinocytes under the isthmus showed a very intense degeneration exactly where the infiltrate was the most prominent. The damage of the hair sheath was under the isthmus and involved the lower portions of the follicles (including the hair bulbs). The inflammatory infiltrate was exclusively represented by perifollicular lymphohistiocytes. Finally, a connective fibrotic shell with numerous fibroblasts formed a sheath around the atrophic follicle (Figure 3). Results of laboratory investigations (including complete blood cell counts, basal thyroid-stimulating hormone, C-reactive protein, serum ferritin levels, B and C hepatitis markers, antinuclear antibodies, and cultural examinations) were negative.We diagnosed the patient with fibrosing alopecia in a pattern distribution.

  6. Alopecia and nail changes associated with voriconazole therapy.

    Science.gov (United States)

    Malani, Anurag N; Kerr, Lisa; Obear, Janet; Singal, Bonita; Kauffman, Carol A

    2014-08-01

    Voriconazole was 1 of 2 antifungal agents recommended for treatment of fungal infections associated with injection of contaminated methylprednisolone. Alopecia and nail changes are not commonly reported side effects of voriconazole. Having noted increasing hair loss among our patients treated with voriconazole, we sought to determine the prevalence and characteristics of alopecia associated with this agent. Patients who received voriconazole for at least 1 month for probable or confirmed fungal infection were eligible to complete a survey regarding alopecia and nail changes. For those patients who reported alopecia, additional questions about reversal of hair loss were asked after voriconazole had been stopped for at least 3 months. A total of 152 of 175 eligible patients (87%) completed the survey. One hundred twenty-five (82%) reported alopecia. Hair loss on the scalp was noted in 120 (96%), arms and legs in 52 (42%), and eyebrows and eyelashes in 47 each (38%). Nineteen patients (15%) reported wearing a wig or hat because of extensive hair loss. Alopecia developed a mean (standard deviation) of 75 (54) days after initiation of voriconazole. Of 114 patients who were off voriconazole for at least 3 months, hair loss had stopped in 94 (82%) and regrowth had begun in 79 (69%), including those who were changed to either itraconazole or posaconazole. Nail changes or loss occurred in 106 (70%) patients. Alopecia and nail changes were common adverse effects associated with voriconazole therapy during the multistate fungal outbreak. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. Increased Pathological Worry Levels in Patients with Alopecia Areata

    Directory of Open Access Journals (Sweden)

    Basak Sahin

    2017-01-01

    Full Text Available Aim: Alopecia Areata (AA is a type of hair loss that has been considered to have associations with various psychiatric disorders. In this study, we aimed to compare pathological worry levels between patients with AA and healthy controls (HC. Material and Method: Sixty-three patients with AA and 90 HCs were included in the present study after applying inclusion and exclusion criteria. The socio-demographic characteristics, some clinical characteristics, and the scores from the Penn State Worry Questionnaire (PSWQ were compared between groups. Results: The demographic characteristics were found to be similar between groups except for gender. The family history of AA was significantly higher in the AA group. The mean score of PSWQ in the AA group was 44.02 ± 11.59, compared to 39.71 ± 7.77 in the HC group. The mean score of PSWQ was significantly higher in the AA group (t=-3.27, p= 0.001.Discussion: The present study is the first to compare pathological worry between patients with AA and HCs. We suggest that pathological worry should be more thoroughly investigated in patients with AA to improve their quality of life. Also, this can be an effective approach to targeting the patients who may develop anxiety disorder.

  8. Efficacy of fractional lasers in treating alopecia: a literature review.

    Science.gov (United States)

    Perper, Marina; Aldahan, Adam S; Fayne, Rachel A; Emerson, Christopher P; Nouri, Keyvan

    2017-11-01

    Hair loss stemming from different types of alopecia, such as androgenic alopecia and alopecia areata, negatively affects over half the population and, in many circumstances, causes serious psychosocial distress. Current treatment options for alopecia, such as minoxidil, anthralin, and intralesional corticosteroids, vary efficacy and side effect profiles. It is known that low-level laser/light therapies (LLLT), or photobiomodulations, such as the US FDA-cleared HairMax Lasercomb®, He-Ne laser, and excimer laser, are relatively affordable, user-friendly, safe, and effective forms of treatment for hair loss. While less is known about the effectiveness of fractional lasers for combating hair loss, research suggests that by creating microscopic thermal injury zones, fractional lasers may cause an increase in hair growth from a wound healing process, making them potential therapeutic options for alopecia. A literature review was performed to evaluate the effectiveness of fractional lasers on hair regrowth. The specific fractional laser therapies include the 1550-nm nonablative fractional erbium-glass laser, the ablative fractional 2940-nm erbium:YAG laser, and the ablative fractional CO 2 fractional laser. Additional randomized controlled trials are necessary to further evaluate the effectiveness of the lasers, as well as to establish appropriate parameters and treatment intervals.

  9. Androgenic alopecia; the risk–benefit ratio of Finasteride

    Directory of Open Access Journals (Sweden)

    David L. Rowland

    2018-04-01

    Full Text Available Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset, several concerns appeared over time regarding the frequency and magnitude of finasteride adverse effects, which in some cases seem to be even irreversible. This paper presents administration of finasteride in androgenic alopecia from two distinct perspectives. On one hand, androgenic alopecia is a condition that affects especially the self-image and esteem, aspects that are subjective, namely changeable and thus relative. On the other hand, this condition presents a multifactorial etiology, androgens being only in part involved. In addition, androgens have their own physiological roles within the body, so that any androgenic suppression should be carefully advised. Yet, adverse effects induced by Finasteride are only in part documented and treatable. Finally, alternative therapeutic approaches (like topical finasteride become available, so that the oral administration of Finasteride for androgenic alopecia should be in our opinion reevaluated. As a conclusion, a very detailed and informed discussion should take place with such patients accepting to start a therapy with finasteride for androgenic alopecia.

  10. Randomized trial of aromatherapy. Successful treatment for alopecia areata.

    Science.gov (United States)

    Hay, I C; Jamieson, M; Ormerod, A D

    1998-11-01

    To investigate the efficacy of aromatherapy in the treatment of patients with alopecia areata. A randomized, double-blind, controlled trial of 7 months' duration, with follow-up at 3 and 7 months. Dermatology outpatient department. Eighty-six patients diagnosed as having alopecia areata. Eighty-six patients were randomized into 2 groups. The active group massaged essential oils (thyme, rosemary, lavender, and cedarwood) in a mixture of carrier oils (jojoba and grapeseed) into their scalp daily. The control group used only carrier oils for their massage, also daily. Treatment success was evaluated on sequential photographs by 2 dermatologists (I.C.H. and A.D.O.) independently. Similarly, the degree of improvement was measured by 2 methods: a 6-point scale and computerized analysis of traced areas of alopecia. Nineteen (44%) of 43 patients in the active group showed improvement compared with 6 (15%) of 41 patients in the control group (P = .008). An alopecia scale was applied by blinded observers on sequential photographs and was shown to be reproducible with good interobserver agreement (kappa = 0.84). The degree of improvement on photographic assessment was significant (P = .05). Demographic analysis showed that the 2 groups were well matched for prognostic factors. The results show aromatherapy to be a safe and effective treatment for alopecia areata. Treatment with these essential oils was significantly more effective than treatment with the carrier oil alone (P = .008 for the primary outcome measure). We also successfully applied an evidence-based method to an alternative therapy.

  11. The Role of Vitamin D in Non-Scarring Alopecia

    Directory of Open Access Journals (Sweden)

    Agnieszka Gerkowicz

    2017-12-01

    Full Text Available Non-scarring hair loss is a common problem that affects both male and female patients. Since any disturbances in the hair follicle cycle may lead to hair shedding, or alopecia, it is not surprising that the possible role of vitamin D in alopecia was investigated in many studies. Vitamin D has been shown to have many important functions. A growing body of evidence shows that vitamin D and its receptor are responsible for maintaining not only calcium homeostasis but also skin homeostasis. Moreover, vitamin D could also regulate cutaneous innate and adaptive immunity. This paper presents a review of current literature considering the role of vitamin D in alopecia areata, telogen effluvium, and female pattern hair loss. The majority of studies revealed decreased serum 25-hydroxyvitamin D levels in patients with different types of non-scarring alopecia, which could suggest its potential role in the pathogenesis of hair loss. According to the authors, vitamin D supplementation could be a therapeutic option for patients with alopecia areata, female pattern hair loss, or telogen effluvium. However, further studies on a larger group of patients are required.

  12. Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome.

    Science.gov (United States)

    Mégarbané, Hala; Mégarbané, André

    2011-05-21

    The IFAP syndrome is a rare X-linked genetic disorder reported in nearly 40 patients. It is characterized by the triad of Ichthyosis Follicularis, Alopecia, and Photophobia from birth. Other features such as short stature, intellectual disability, and seizures may develop in the first few years of life. Skin histopathology is non-specific and consists of dilated hair follicles with keratin plugs extending above the surface of the skin, decreased or absent sebaceous glands, and decreased desmosomes in number and size. The disorder results from mutations in the MBTPS2 gene that impairs cholesterol homeostasis and the ability to cope with endoplasmic reticulum stress. Follicular hyperkeratosis can be treated using topical keratolytics, emollients and urea preparations. A moderate response to acitretin therapy has been noted in some patients. Intensive lubrication of the ocular surface is essential. Life expectancy in patients with IFAP syndrome can vary from death in the neonatal period to normal surviving. Cardiopulmonary complications remain the major cause of death.

  13. Assessment of tissue levels of dickkopf-1 in androgenetic alopecia and alopecia areata.

    Science.gov (United States)

    Fawzi, Marwa M T; Mahmoud, Sara B; Shaker, Olfat G; Saleh, Marwah A

    2016-03-01

    Androgenetic alopecia (AGA) is the commonest form of hair loss in men. Alopecia areata (AA) is an organ-specific autoimmune disease. Studies revealed that Dickkopf 1 (DKK-1), a powerful suppressor of the Wnt/β-catenin signaling pathway, induced anagen-to-catagen transition in mice. Moreover, in vitro studies suggested that DKK-1 played a role in dihydrotestosterone (DHT)-induced balding. To evaluate the tissue levels of DKK-1 in patients with AGA and AA, to assess its possible role as a pathogenetic mechanism in both disorders. This study included 24 patients with AGA, 31 patients with AA, and 33 healthy controls. Scalp biopsies were taken from all participants for the detection of tissue DKK-1 levels. Tissue DKK-1 levels were significantly higher in patients with AGA than in controls (P = 0.000) as well as in patients with AA than in controls (P = 0.001). In addition, they were significantly higher in patients with AGA than in patients with AA (P = 0.000). DKK-1 was higher in male than in female patients with AGA. DKK-1 was negatively correlated with disease duration in AGA. In conclusion, this study suggests an important role for DKK-1 in the pathogenesis of AGA and AA through documenting higher tissue DKK-1 levels in patients with both hair disorders compared to controls and suggests that DKK-1 may be a promising therapeutic target for these hair diseases. © 2015 Wiley Periodicals, Inc.

  14. Assessment of vitamin D receptors in alopecia areata and androgenetic alopecia.

    Science.gov (United States)

    Fawzi, Marwa M T; Mahmoud, Sara Bahaa; Ahmed, Shereen Fathi; Shaker, Olfat Gamil

    2016-12-01

    Alopecia areata (AA) is a frequent autoimmune disease, the pathogenesis of which is still unknown. Androgenetic alopecia (AGA) is a noncicatricial type of patterned hair loss. Expression of vitamin D receptors (VDRs) on keratinocytes is essential for maintenance of normal hair cycle, especially anagen initiation. To assess VDRs in the skin and blood of AA and AGA patients, in order to evaluate their possible role in these hair diseases. This study recruited 20 patients with AA, 20 patients with AGA, and 20 healthy controls. Blood samples and lesional scalp biopsies were taken from all participants for detection of VDR levels. Serum and tissue VDR levels were lower in AA as well as AGA patients when compared to controls (P = 0.000). Serum and tissue VDR were positively correlated in each group. Tissue VDR was significantly lower in female patients with AA than males (P = 0.046) although serum and tissue VDR levels were significantly higher in female AGA patients than males (P = 0.004). This study suggests an important role for VDR in the pathogenesis of AA and AGA through documenting lower serum and tissue VDR levels in AA and AGA patients in comparison with controls. © 2016 Wiley Periodicals, Inc.

  15. Narrative absorption

    DEFF Research Database (Denmark)

    Narrative Absorption brings together research from the social sciences and Humanities to solve a number of mysteries: Most of us will have had those moments, of being totally absorbed in a book, a movie, or computer game. Typically we do not have any idea about how we ended up in such a state. Nor...... do we fully realize how we might have changed as we return for the fictional worlds we have visited. The feeling of being absorbed is one of the most illusive and transient feelings, but also one that motivates audiences to spend considerable amounts of time in narrative worlds, and one...... that is central to our understanding of the effects of narratives on beliefs and behavior. Key specialists inform the reader of this book about the nature of the peculiar state of consciousness during episodes of absorption, the perception of absorption in history, the role of absorption in meaningful experiences...

  16. Thyroid disorders associated with alopecia areata in Egyptian patients

    Directory of Open Access Journals (Sweden)

    Ola A Bakry

    2014-01-01

    Full Text Available Context: Alopecia areata (AA is a common form of localized, non-scarring hair loss. The etiopathogenesis of the disease is still unclear, but the role of autoimmunity is strongly suggested. AA is commonly associated with various autoimmune disorders; the most frequent among them is autoimmune thyroid disorders. Aim: To determine whether AA is associated with thyroid autoimmunity or thyroid function abnormalities in Egyptian patients. Materials and Methods: Fifty subjects with AA (37 males and 13 females without clinical evidence of thyroid disorders were selected from Dermatology Outpatient Clinic, Menoufiya University Hospital, Menoufiya Governorate, Egypt, during the period from June 2009 to February 2010. They were divided into 3 groups according to severity of AA. Fifty age and sex-matched healthy volunteers (35 males and 15 females were selected as a control group. Every case and control were subjected to history taking, complete general and dermatological examination. Venous blood samples were taken from cases and controls after taking their consents for measurement of thyroid stimulating hormone (TSH, free T3, freeT4 and detection of Anti-thyroglobulin Antibody (Tg-Ab and Anti-thyroid Peroxidase Antibody (TPO-Ab. Results: Subclinical hypothyroidism was detected in 16% of cases. There were statistically significant differences between cases and controls regarding levels of TSH, free T3 and free T4. There were significant differences between cases and controls regarding the presence of Tg-Ab and TPO-Ab. Conclusions: Every patient with AA should be screened for thyroid functions and presence of thyroid autoantibodies even in absence of clinical manifestations suggestive of thyroid affection.

  17. Narrative coaching

    DEFF Research Database (Denmark)

    Drake, David; Stelter, Reinhard

    2014-01-01

    From the introduction: While a narrative frame is relatively new in the fi elds of psychotherapy and coaching, stories have been an essential constituent of cultures and communities since the dawn of time and are fundamental to the way we make sense and meaning. We use stories to structure our...... keep individually and collectively telling ourselves that reinforce them. As such, they are at the core of what it means to be human – as refl ected in our biology, ontology, epistemology and cosmology – and a natural medium for use in coaching. Narrative coaches are, therefore, keenly interested...

  18. Narrative coaching

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2010-01-01

    is presented to give a concrete example of this narrative, community psychological oriented intervention, a process which helps people to develop a sense of personal or cultural identity and an understanding of their doing as being in correspondence with their values and intentions. The overarching focus...... of narrative coaching as presented in this chapter is on shaping modified, uplifting and/or alternative stories about experiences and activities athletes or exercisers are able to share in their concrete community of practice. These joint actions might be a way to build up local cultures in different sport...

  19. Alopecia Areata Treated with Phenolisation and Intravenous Dexamethasone Pulses

    Science.gov (United States)

    Kar, Sumit; Singh, Neha

    2013-01-01

    Phenol is an aromatic hydrocarbon derived from coal tar or manufactured from monochlorobenzene. Alopecia areata is a common non scarring autoimmune condition characterised by patchy loss of hair without atrophy. Various treatment modalities have been proposed and used for the treatment of alopecia areata, which is indeed a difficult condition to treat. Variable results have been documented using intralesional corticosteroid injections, topical minoxidil, topical anthralin ointment, topical contact sensitizers like diphencyprone, dinitrochlorobenzene or squaric acid dibutyl ester, and oral mini pulse with betamethasone. The use of 88% phenol for the treatment of alopecia areata has been documented in literature, but it has failed to secure a place in the priority list. Herein we have reported a case of a young girl who was treated with short-time aggressive therapy using 88% phenol and dexamethasone pulse therapy and who responded well to the treatment with no recurrence in the last 6 months of follow-up. PMID:23960401

  20. Alopecia areata - pattern in industrial city of Baroda

    Directory of Open Access Journals (Sweden)

    Jain S

    2003-03-01

    Full Text Available Department of Dermatology, Venereology and Leprology, S.S.G. Hospital, Baroda. The profile of Alopecia areata (AA was studied in 150 subjects in industrial city of Baroda, alopecia areata is the problem of young males as 52.1 %patients are in 2-39 years age group and male to female ratio being 1.7: 1. Most of alopecia areata presents within 6 month of onset. The problem of AA is of cosmetic significance. AA pattern is the commonest and only few have combined AA and ophiasis. The common site is scalp (parietal, occipital, frontal followed by beard and moustache. Associated atopic state is not common hence indicating good prognosis. Nail involvement though not common but is in form of pitting.

  1. Frontal Fibrosing Alopecia and Concomitant Lichen Planus Pigmentosus: A Case Series of Seven African American Women.

    Science.gov (United States)

    Uwakwe, Laura N; Cardwell, Leah A; Dothard, Emily H; Baroudi, Bernice I; McMichael, Amy J

    2018-04-01

    The association of frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPPigm) is rare. Prior reports suggest that FFA and LPPigm are on the same spectrum of disease, and a diagnosis of LPPigm may predict the future development of FFA. We aim to further characterize the association between FFA and LPPigm by reviewing the clinical cases of seven African American women. Seven patients with FFA were diagnosed clinically by recession of frontotemporal hairline and confirmed by histopathologic examination showing lymphocyte-mediated cicatricial alopecia. LPPigm was diagnosed by clinical evaluation alone based on the characteristic morphology, color, and distribution of the lesions. It is difficult to distinguish whether halted progression of FFA was due to the success of the treatment regimen or spontaneous stabilization of disease over time. Our case series supports the theory that FFA and LPPigm likely exist on the same spectrum of disease. Our observations demonstrate a likely positive correlation between FFA and LPPigm. J Drugs Dermatol. 2018;17(4):397-400..

  2. A case of lenflunomide-induced alopecia areata

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    Gürol Açıkgöz

    2015-03-01

    Full Text Available Leflunomide is an immunomodulatory drug widely used in the treatment of inflammatory arthritis especially in rheumatoid arthritis and psoriatic arthritis. The common side effects of leflunomide are hepatopathy, hypertension, various gastrointestinal complaints and transient hair loss, which were mild and reversible. Although leflunomide is associated with transient hair loss, leflunomide induced alopecia areata was reported previously only in one case. In this case report, we present a 38-year-old male patient who suffered from alopecia areata after leflunomide therapy.

  3. HLA-DP antigens in patients with alopecia areata

    DEFF Research Database (Denmark)

    Ødum, Niels; Morling, N; Georgsen, J

    1990-01-01

    The distribution of HLA-DP antigens were studied in 41 patients with alopecia areata (AA) and 188 ethnically matched controls. An increase of DR4 and possibly DR5 in 24 of these patients has previously been reported. HLA-DP typing for DPw1 through w6 and the local specificity, CDP HEI, was perfor......The distribution of HLA-DP antigens were studied in 41 patients with alopecia areata (AA) and 188 ethnically matched controls. An increase of DR4 and possibly DR5 in 24 of these patients has previously been reported. HLA-DP typing for DPw1 through w6 and the local specificity, CDP HEI...

  4. Comparison of the Therapeutic Effect of 2% Topical Minoxidil with Rosemary Solution in the Treatment of Alopecia Areata on the Scalp

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    R Yaghmaei

    2014-09-01

    Full Text Available Background & aim: Alopecia Areata is a chronic inflammatory disease which affects the hair roots. Different drugs and methods are used to treat this disease, nevertheless there is still no cure. The aim of this study was to compare the therapeutic effect of topical Minoxidil 2% solution in the treatment of alopecia areata on the scalp with rosemary solution. Methods: The present clinical-trial study was conducted on 78 patients with Alopecia Areata. Block randomization was designed in two groups of four Minoxidil 2% (n=39 and Rosemary (n=39. During the initial evaluation, patients were assessed in terms of location, number and extent of lesions by a dermatologist, and then the data were recorded. Patients in the intervention group were administered rosemary, as well as those in the control group were given Minoxidil 2%. The patients were instructed to apply the medication to the lesion twice a day. The lesion was re-evaluated two months later. Data were analyzed using SPSS version 18 as well as T-test and Chi-square test and descriptive statistics. Results: There were no significant differences in terms of mean age, mean duration of disease, and alopecia conflict in the patients of two groups (p>0.05. There was no significant difference in cure rates between the two groups (05/0 p>0.05. Conclusions: The findings of this study revealed that both Rosemary and Minoxidil had the same effects on alopecia areata. Due to the fact that the treatment of alopecia areata by rosemary plant is effective and affordable, it can be recommended.

  5. Comparison of the Therapeutic Effect of 2% Topical Minoxidil with Rosemary Solution in the Treatment of Alopecia Areata on the Scalp

    Directory of Open Access Journals (Sweden)

    R Yaghmaei

    2014-12-01

    Full Text Available Background & aim: Alopecia Areata is a chronic inflammatory disease which affects the hair roots. Different drugs and methods are used to treat this disease, nevertheless there is still no cure. The aim of this study was to compare the therapeutic effect of topical Minoxidil 2% solution in the treatment of alopecia areata on the scalp with rosemary solution. Methods: The present clinical-trial study was conducted on 78 patients with Alopecia Areata. Block randomization was designed in two groups of four Minoxidil 2% (n=39 and Rosemary (n=39. During the initial evaluation, patients were assessed in terms of location, number and extent of lesions by a dermatologist, and then the data were recorded. Patients in the intervention group were administered rosemary, as well as those in the control group were given Minoxidil 2%. The patients were instructed to apply the medication to the lesion twice a day. The lesion was re-evaluated two months later. Data were analyzed using SPSS version 18 as well as T-test and Chi-square test and descriptive statistics. Results: There were no significant differences in terms of mean age, mean duration of disease, and alopecia conflict in the patients of two groups (p>0.05. There was no significant difference in cure rates between the two groups (05/0 p>0.05. Conclusions: The findings of this study revealed that both Rosemary and Minoxidil had the same effects on alopecia areata. Due to the fact that the treatment of alopecia areata by rosemary plant is effective and affordable, it can be recommended.

  6. A mouse model of clonal CD8+ T lymphocyte-mediated alopecia areata progressing to alopecia universalis

    Science.gov (United States)

    Alli, Rajshekhar; Nguyen, Phuong; Boyd, Kelli; Sundberg, John P.; Geiger, Terrence L.

    2011-01-01

    Alopecia areata is among the most prevalent autoimmune diseases, yet compared with other autoimmune conditions is not well studied. This in part results from limitations in the C3H/HeJ mouse and DEBR rat model systems most commonly used to study the disease, which display a low frequency and late onset. We describe a novel high incidence model for spontaneous alopecia areata. The 1MOG244 T cell expresses dual TCRA chains, one of which, when combined with the single TCRB present, promotes the development of CD8+ T cells with specificity for hair follicles. Retroviral transgenic mice expressing this TCR develop spontaneous alopecia areata at nearly 100% incidence. Disease initially follows a reticular pattern, with regionally cyclic episodes of hair loss and regrowth, and ultimately progresses to alopecia universalis. Alopecia development is associated with CD8+ T cell activation, migration into the intrafollicular region, and hair follicle destruction. The disease may be adoptively transferred with T lymphocytes, and is class I and not class II MHC-dependent. Pathologic T cells primarily express IFNG and IL17 early in disease, with dramatic increases in cytokine production and recruitment of IL4 and IL10 production with disease progression. Inhibition of individual cytokines did not significantly alter disease incidence, potentially indicating redundancy in cytokine responses. These results therefore characterize a new high incidence model for alopecia areata in C57BL/6J mice, the first to apply a monoclonal TCR, and indicate that class I MHC-restricted CD8+ T lymphocytes can independently mediate the pathologic response. PMID:22116824

  7. A new strategy to prevent chemotherapy and radiotherapy-induced alopecia using topically applied vasoconstrictor

    Science.gov (United States)

    Soref, Cheryl M.; Fahl, William E.

    2015-01-01

    In a new strategy, we sought to determine whether topically applied vasoconstrictor, with its accompanying transient skin hypoxia and exclusion of systemic drug, would prevent or suppress radiotherapy or chemotherapy-induced alopecia. Topical vasoconstrictor was applied to 1-cm2 skin patches on the backs of 10-day-old rats and minutes later they received either 7.1 gray (Gy) whole-body radiation or systemic N-nitroso-N-methylurea (MNU) or Cytoxan. The degree of alopecia was scored 10 days later by visual assessment (% coat retention) and hair follicle histologic analysis. Topical application of epinephrine or norepinephrine in an alcohol:water delivery vehicle induced clear skin blanch, and in a dose-dependent manner, topical epinephrine or norepinephrine (20–1,000 mM) applied before 7.1 Gy irradiation conferred 95% of coat retention in the treated skin patches versus 0% coat retention in vehicle controls, or in skin outside the treated patches. By histology, small numbers of dystrophic hair follicles were observed in hairless skin versus the normal density of anagen follicles in the immediately adjacent, drug-protected skin patches at day 20; protected coats were retained into adulthood. Topical epinephrine or norepinephrine before systemic MNU (30 ug/gm body weight) conferred up to 95% of coat retention in treated skin patches versus 0% coat retention elsewhere. Epinephrine-conferred % coat retention dropped to 16% in rats that received systemic Cytoxan, a drug whose plasma half-life is at least 8- to 10-fold longer than MNU. A general strategy is discussed for the use of topical epinephrine or norepinephrine in the clinic to provide an inexpensive and convenient strategy to prevent cancer therapy-induced alopecia. PMID:24811525

  8. The Most Frequent Herbs Proposed by Iranian Traditional Medicine for Alopecia Areata.

    Science.gov (United States)

    Rezghi, Maedeh; Fahimi, Shirin; Zakerin, Sara

    2016-05-01

    Alopecia areata (AA) is a common immune-mediated hair loss disorder. AA has a reported incidence of 0.1-0.2% with a lifetime risk of 1.7%. Histologically, AA is characterized by the accumulation of mononuclear cells around the bulb of the affected hair follicles. Corticosteroids are the most popular drugs for the treatment of this disease. Despite its high prevalence, currently available treatments are mostly unsatisfactory and inefficient for the more chronic and severe types of the AA. Alopecia areata is a well-known disorder in Iranian traditional medicine (ITM). "Da oth-tha , lab" was the term used by ITM scholars to indicate AA. Traditional Iranian physicians believed that the presence of morbid matter in the scalps is the main cause of the disease, which blocks nutrients and causes hair roots to deteriorate. Herbal medicines in the form of topical preparations were applied by ITM scholars for the treatment of AA. This study was performed to determine the most frequent useful herbs for AA as mentioned in ITM. Seven ITM references such as Canon of Medicine (Avicenna), Alhavi (Razes) Tuhfat ul-Momineen (Mo , men tonekaboni), Makhzan-ul-Adwiah (Aghili), Ikhtiyarat Badi,i (Ansari), Al-abnia An-Haghyegh el-advia (Heravi) and al-jāmi li-mufradāt al-adwiyawa al-aghdhiya (Ibn al-Baitar) were studied for anti-AA medicines. Subsequent to our study, the herbal medicines were listed and scored based on the frequency of their prescriptibility. Moreover, we took the effort to provide the best scientific name for each plant. This study showed that Allium cepa L., Artemisia abrotonon L., Allium sativum L., and Asphodelus ramosus L. were the most frequent herbs mentioned in ITM references for the recovery of AA. These herbs can be introduced as new herbal medicines for clinical research in the field of alopecia areata treatment.

  9. TREATMENT SUCCESS IN THREE ANDEAN BEARS (TREMARCTOS ORNATUS) WITH ALOPECIA SYNDROME USING OCLACITINIB MALEATE (APOQUEL®).

    Science.gov (United States)

    Drake, Gabby J; Nuttall, Tim; López, Javier; Magnone, William; Leclerc, Antoine; Potier, Romain; Lécu, Alexis; Guézénec, Maëlle; Kolter, Lydia; Nicolau, Amélie; Lemberger, Karin; Pin, Didier; Cosgrove, Sallie B

    2017-09-01

    Andean bear (Tremarctos ornatus) alopecia syndrome (ABAS) commonly affects captive bears, particularly sexually mature females. ABAS is characterized by bilaterally symmetrical predominantly flank alopecia with or without profound pruritus and secondary bacterial and Malassezia infections. There is no effective treatment and severely affected bears have been euthanized. This paper describes the successful management of ABAS in three female Andean bears. Skin biopsies and cytology revealed a mixed dermal inflammatory infiltrate, alopecia, hyperkeratosis, and Malassezia dermatitis. Allergen specific serology was positive for environmental allergens in one case. Hematology, serum biochemistry, and thyroid and adrenal function were normal in all cases. There was no consistent response to novel diet trials, antifungals, antihistamines, allergen specific immunotherapy, or topical antimicrobials. There was a partial response to ciclosporin (Atopica® cat, Novartis Animal Health; 5 mg/kg po, sid) in one case and oral glucocorticoids in all cases (dexamethasone sodium phosphate, [Colvasone 0.2%, Norbrook], 0.15 mg/kg po, sid or prednisolone [Deltacortene, Bruno Farmaceutici, and Megasolone 20, Coophavet], 0.3-1.2 mg/kg po, sid), but treatment was withdrawn following adverse effects. Treatment with oclacitinib maleate (Apoquel®, Zoetis; 0.46-0.5 mg/kg po, bid) resulted in rapid and complete resolution of the pruritus with subsequent improvement in demeanor and fur regrowth. After 5 mo, the bears were almost fully furred and off all other medication. Treatment was tapered to the lowest dose that prevented relapse of the pruritus (0.23-0.4 mg/kg po, sid). No adverse effects have been noted. ABAS is usually an intractable condition, and, to our knowledge, oclacitinib is the first treatment shown to result in sustained clinical improvement. Further studies on the etiology of ABAS, and on efficacy and long-term safety of oclacitinib are needed.

  10. Automated systems for the de-identification of longitudinal clinical narratives: Overview of 2014 i2b2/UTHealth shared task Track 1.

    Science.gov (United States)

    Stubbs, Amber; Kotfila, Christopher; Uzuner, Özlem

    2015-12-01

    The 2014 i2b2/UTHealth Natural Language Processing (NLP) shared task featured four tracks. The first of these was the de-identification track focused on identifying protected health information (PHI) in longitudinal clinical narratives. The longitudinal nature of clinical narratives calls particular attention to details of information that, while benign on their own in separate records, can lead to identification of patients in combination in longitudinal records. Accordingly, the 2014 de-identification track addressed a broader set of entities and PHI than covered by the Health Insurance Portability and Accountability Act - the focus of the de-identification shared task that was organized in 2006. Ten teams tackled the 2014 de-identification task and submitted 22 system outputs for evaluation. Each team was evaluated on their best performing system output. Three of the 10 systems achieved F1 scores over .90, and seven of the top 10 scored over .75. The most successful systems combined conditional random fields and hand-written rules. Our findings indicate that automated systems can be very effective for this task, but that de-identification is not yet a solved problem. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. TNF inhibitor induced alopecia: an unusual form of psoriasiform alopecia that breaks the Renbök mold.

    Science.gov (United States)

    Craddock, Lauren N; Cooley, David M; Endo, Justin O; Longley, B Jack; Caldera, Freddy

    2017-03-15

    TNF-α-inhibitors are known to induce skin adverseeffects including psoriasis and alopecia areata. Here, wedescribe a unique pattern of hair loss that has psoriaticand alopecia areata-like features. Diagnosis requiresclinical-pathologic correlation and is supportedby increased catagen/telogen hairs, psoriasiformepidermal hyperplasia, perifollicular lymphocyticinfiltrate, and the presence of eosinophils and plasmacells. Although there are no treatment consensusguidelines, management options include stoppingtherapy, switching to a different TNF-α inhibitor orustekinumab (in severe cases), or continuing TNF-αinhibitor therapy with addition of topical, intralesional,or systemic immunosuppressants.

  12. Therapeutic Effects of Topical Minoxidil or Rosemary and the Combination of Both on the treatment of Alopecia areata

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Lohrasb

    2015-02-01

    Full Text Available Background & Objectives: Considering the prevalence of Alopecia areata, , failure of treatment, and the unknown pathogenesis of this illness, a comparative study was performed by using topical Minoxidil 2% and topical rosemary solution alone and in combination to treatment this disease. Materials & Methods: This study is a clinical trial performed on 200 patients with Alopecia areata referring to Hamzeh clinic of Fasa during the years 2012 and 2013. They were divided into four groups by random permutation, each group contained 50 patients. Group one received the combination of topical Minoxidil 2% and topical rosemary, group two received only topical Minoxidil 2% solution, group three received only topical rosemary solution and the fourth group, the case-control group, did not receive any medication and were just advised to rub the site of the disease for the same period of time. The patients were under observation for one year. Results: The Results of this investigation showed that the best remissions after treatments were as follow (respectively: combination of topical Minoxidil 2% and topical rosemary (27 patient=54 %, Minoxidil 2% solution (23 patients =46%, rosemary solution (21 patients =42%, and case- control group (9 patients =18%. These results showed that despite better response to the combination of rosemary and Minoxidil solutions in comparison to the two other treated groups, the changes were minimal and statistically insignificant (P-value =0.0411. Conclusion: Using the combination of both rosemary and Minoxidil is more effective than the individual one on treatment of Alopecia areata.

  13. Frontal fibrosing alopecia among men: A clinicopathologic study of 7 cases.

    Science.gov (United States)

    Tolkachjov, Stanislav N; Chaudhry, Hafsa M; Camilleri, Michael J; Torgerson, Rochelle R

    2017-10-01

    Frontal fibrosing alopecia (FFA) is a lichen planopilaris-variant scarring alopecia that has rarely been described in men. To characterize the clinicopathologic findings of FFA in men by studying a series of 7 male patients. We conducted a retrospective review of all cases of male patients with FFA at the Mayo Clinic from 1992 to 2016. Seven male patients with FFA were identified. The frontal scalp (in 6 of 7 patients), sideburns (in 4 of 7), and temporal scalp (in 4 of 7) were most frequently involved. Three patients had involvement of the eyebrows. One patient had hair loss of the upper cutaneous lip. All patients had biopsy evidence of lichen planopilaris. None of the patients had associated autoimmune or thyroid disease. Two patients had hypogonadism upon testosterone studies. Limitations include small sample size and varied follow-up. Although most often reported among postmenopausal women, FFA also occurs among men. The clinical and histopathologic characteristics of FFA in men parallel those described in women with FFA. Unique areas of involvement in men include sideburns and facial hair. Concomitant mucocutaneous lichen planus, autoimmune disease, and thyroid disease are infrequent among men with FFA. Distribution of hair loss and associated hormonal abnormalities aid in the recognition of FFA in men. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Reformed Narration

    DEFF Research Database (Denmark)

    Roesen, Tine

    2008-01-01

    thought. Furthermore, it is argued that a central role in the structuring of this mental text is played by an overwhelming amount of brackets. The article suggests a categorisation of the different types of parenthetic remarks in the novel according to their function in the textual, would-be narrative......The article analyses Vladimir Makanin's novel Andegraund ili Geroj našego vremeni (1998), focusing on its author-hero relation and narrative characteristics. The hero, Petrovič to whom the author leaves the stage, neither writes nor tells his story, rather, his words reach the reader as if directly...... from his mind, and the text appears as a kind of structured stream-of-consciousness. A comparison of Makanin's hero to that of Dostoevskij reveals that while the latter, according to Michail Bachtin, aimed to present his hero as pure voice, Makanin apparently aims to present his Petrovič as pure...

  15. Interwoven Narratives

    DEFF Research Database (Denmark)

    Frølunde, Lisbeth

    2016-01-01

    This paper focuses on how difference unfolds in a creative writing workshop (Wordquake in Prison) held at a Danish prison (2016) with focus on the texts produced by young prisoners, reflexive narrative interviews and a book reception held at a Danish prison for youth. This paper concerns methodol...... are the methodological challenges of evaluation, relational ethics, and difference in collaborative research. (This is an updated abstract, the online version available on the ICA conference website is an older version)...

  16. Narrative reviews

    Directory of Open Access Journals (Sweden)

    Jong-Myon Bae

    2014-09-01

    Full Text Available Although qualitative researches (QR are invaluable in understanding complex healthcare situations, the quantitative systematic reviews could not treat them. To improve quality of healthcare services, results of QR should be considered in healthcare decision-making processes. Several methods and theories for synthesizing evidences of QR have been developed. In order to activate the narrative reviews and mixed methods reviews in Korean healthcare academies, I arranged the related nomenclatures and suggested some issues to conduct them.

  17. DNA polymorphism of HLA class II genes in alopecia areata

    DEFF Research Database (Denmark)

    Morling, N; Frentz, G; Fugger, L

    1992-01-01

    We investigated the DNA restriction polymorphism (RFLP) of the Major Histocompatibility Complex (MHC) class II genes: HLA-DQA, -DQB, -DPA, and -DPB in 20 Danish patients with alopecia areata (AA) and in healthy Danes. The frequency in AA of the DQB1*0301 and DQw7 associated DQB Bgl/II 4.2 kb...

  18. DNA polymorphism of HLA class II genes in alopecia areata

    DEFF Research Database (Denmark)

    Morling, N; Frentz, G; Fugger, L

    1992-01-01

    We investigated the DNA restriction polymorphism (RFLP) of the Major Histocompatibility Complex (MHC) class II genes: HLA-DQA, -DQB, -DPA, and -DPB in 20 Danish patients with alopecia areata (AA) and in healthy Danes. The frequency in AA of the DQB1*0301 and DQw7 associated DQB Bgl/II 4.2 kb frag...

  19. HLA-DP antigens in patients with alopecia areata

    DEFF Research Database (Denmark)

    Ødum, Niels; Morling, N; Georgsen, J

    1990-01-01

    The distribution of HLA-DP antigens were studied in 41 patients with alopecia areata (AA) and 188 ethnically matched controls. An increase of DR4 and possibly DR5 in 24 of these patients has previously been reported. HLA-DP typing for DPw1 through w6 and the local specificity, CDP HEI, was perfor...

  20. Intravenous Dexamethasone Pulse Therapy For Extensive Alopecia Areata

    Directory of Open Access Journals (Sweden)

    Thappa Devinder Mohan

    1999-01-01

    Full Text Available Patient with extensive alopecia areata (>30% scalp involvement were given 32mg of dexamethasone in 200 ml of 5% dextrose intravenously on three consecutive days (total 96mg every four weeks. Response was quantified as 1 to 25%, 25% to 50%, 50 to 75% and 75 to 100% of terminal hair growth by mapping and serial photographs. They were examined monthly for side effects of steroids. Six patients (5 male and 1 female with a mean age of 32 years were recruited. They had alopecia areata for a period ranging from 3 months to 2.5 years. All the six cases did not show further worsening of alopecia after 3 pulses. However, two of them showed less than 25% hair growth after 4 pulses and did not turn up for follow up. In 2 cases, 25 to 50% growth was observed an 50 to 75% growth was seen in 2 patients (one of them with ophiasic pattern after 6 pulses. The results were cosmetically acceptable for three of them. No adverse effect to steroids was encountered and the patients are still under follow up. The preliminary results show that dexamethasone pulse therapy is safe and effective for extensive alopecia areata.

  1. An evaluation of PUVA-therapy for alopecia areata

    NARCIS (Netherlands)

    van der Schaar, W. W.; Sillevis Smith, J. H.

    1984-01-01

    30 patients with alopecia areata were treated with 8-methoxypsoralen orally combined with whole body UVA exposure. 9 patients showed more than 60% regrowth of hair, 8 of them had recurrences of hair loss within a mean time of 7.7 months. No selecting criteria could be found prophesying good results

  2. Diphenylcyclopropenone in patients with alopecia areata. A critically appraised topic

    NARCIS (Netherlands)

    Kuin, R. A.; Spuls, P. I.; Limpens, J.; van Zuuren, E. J.

    2015-01-01

    To assess the efficacy and safety of topical diphenylcyclopropenone (DPCP) in patients with alopecia areata. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. The quality of evidence was rated with Grading of Recommendations

  3. Perception of Hair Transplant for Androgenetic Alopecia.

    Science.gov (United States)

    Bater, Kristin L; Ishii, Masaru; Joseph, Andrew; Su, Peiyi; Nellis, Jason; Ishii, Lisa E

    2016-12-01

    Hair transplant is among the most common cosmetic services sought by men, with more than 11 000 procedures performed in 2014. Despite its growing popularity, the effect of hair transplant on societal perceptions of youth, attractiveness, or facets of workplace and social success is unknown. To determine whether hair transplant improves observer ratings of age, attractiveness, successfulness, and approachability in men treated for androgenetic alopecia and to quantify the effect of hair transplant on each of these domains. A randomized controlled experiment was conducted from November 10 to December 6, 2015, using web-based surveys featuring photographs of men before and after hair transplant. One hundred twenty-two participants recruited through various social media platforms successfully completed the survey. Observers were shown 2 side-by-side images of each man and asked to compare the image on the left with the one on the right. Of 13 pairs of images displayed, 7 men had undergone a hair transplant procedure and 6 had served as controls. Observers evaluated each photograph using various metrics, including age, attractiveness, successfulness, and approachability. A multivariate analysis of variance was performed to understand the effect of hair transplant on observer perceptions. Planned posthypothesis testing was used to identify which variables changed significantly as a result of the transplant. Observer ratings of age (in number of years younger) and attractiveness, successfulness, and approachability (on a scale of 0 to 100; scores higher than 50 indicate a positive change). Of the 122 participants in the survey, 58 were men (47.5%); mean (range) age was 27.1 (18-52) years. The initial multivariate analysis of variance revealed a statistically significant multivariate effect for transplant (Wilks λ = 0.9646; P hair transplant on observers' perceptions of age (mean [SD] number of years younger, 3.6 [2.9] years; P hair transplant. Participants also

  4. A non-invasive study of alopecia in Japanese macaques Macaca fuscata

    Directory of Open Access Journals (Sweden)

    Peng ZHANG

    2011-02-01

    Full Text Available This article provides information on the phenomenon of alopecia in Japanese macaques, Macaca fuscata, in various environments and proposes a 3-step scoring system for a quantitative assessment of hair loss. Results suggest that alopecia is commonly observed in Japanese macaques, with 20.5% of individuals showing head alopecia and 4.7% showing back alopecia across eight study groups. Alopecia was more commonly observed in adult females (30.8% individuals showing head alopecia and 15.3% showing back alopecia than in other age-sex classes. Seasonal variation of back alopecia was noted, in particular, individuals with patchy back hair were more frequently observed in winter than in summer. Seasonal variation was not observed in head hair. The distribution of alopecia was also different among study groups. The wild population generally had better hair condition than provisioned populations and captive populations. The present study used a non-invasive alopecia scoring system which can be a useful, rapid and non-invasive tool to monitor animal health and well-being at a population level [Current Zoology 57 (1: 26–35, 2011].

  5. Quality of life assessment in patients with alopecia areata and androgenetic alopecia in the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Zhang M

    2017-01-01

    Full Text Available Min Zhang,1 Nan Zhang2 1Department of Dermatology, 2Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People’s Republic of China Introduction: In medical terms, alopecia is considered a relatively mild dermatological condition that nevertheless is a serious condition, but it causes major depression in many sufferers. Alopecia areata (AA and androgenetic alopecia (AGA are the main types of hair loss. This study assessed the quality of life (QoL of Chinese patients with AA and AGA using the Dermatology Life Quality Index (DLQI questionnaire.Methods: A total of 178 AA and AGA patients were enrolled in this study, and DLQI was used to evaluate the QoL of the patients. The DLQI used 10 items regarding symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment as dimensions of life. Each was scored on a 0–3 scale. The total DLQI score equaled 0–30; higher scores showed greater impact on QoL.Results: The DLQI scores of the 178 patients ranged from 0 to 28, with a mean score of 6.3. Higher DLQI scores were reported by younger patients (P<0.05 and by those who had hair loss for a duration of >12 months (P<0.05. The DLQI score of AA patients was significantly higher than that of AGA patients (P<0.05. QoL was not affected by gender, marital status, educational level, past history of alopecia, family history of alopecia, or severity of alopecia.Conclusion: AA and AGA moderately affected the QoL of the patients. A higher DLQI score was significantly associated with younger age, hair loss for a duration of >12 months, and AA. Both AA and AGA moderately affected the QoL of the patients not only in physiological aspects but also in their emotional and social aspects. The bio-psycho-social aspects of disease need to be addressed in patients with AA and AGA, even though these conditions are not life-threatening. Keywords: alopecia, quality of life, People’s Republic of

  6. Understanding the Person through Narrative

    Directory of Open Access Journals (Sweden)

    Joanne M. Hall

    2011-01-01

    Full Text Available Mental health nurses need to know their clients at depth, and to comprehend their social contexts in order to provide holistic care. Knowing persons through their stories, narratives they tell, provides contextual detail and person-revealing characteristics that make them individuals. Narratives are an everyday means of communicating experience, and there is a place for storytelling in nearly all cultures. Thus narrative is a culturally congruent way to ascertain and understand experiences. This means the nurse should ask questions such as “How did that come about?” versus why questions. A narrative approach stands in contrast to a yes/no algorithmic process in conversing with clients. Eliciting stories illustrates the social context of events, and implicitly provides answers to questions of feeling and meaning. Here we include background on narrative, insights from narrative research, and clinical wisdom in explaining how narratively understanding the person can improve mental health nursing services. Implications for theory, practice, and research are discussed.

  7. Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain.

    Science.gov (United States)

    Vañó-Galván, S; Fernández-Crehuet, P; Grimalt, R; Garcia-Hernandez, M J; Rodrigues-Barata, R; Arias-Santiago, S; Molina-Ruiz, A; Garcia-Lora, E; Dominguez-Cruz, J; Brugues, A; Ferrando, J; Serrano-Falcón, C; Serrano, S; Paoli, J; Camacho, F

    2017-03-01

    Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge. To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU. This retrospective multicenter study included patients diagnosed with AAT/AAU with a minimum follow-up of 12 months. Response was assessed based on the regrowth of scalp hair. In all, 132 patients (92 women and 40 men) - 80 (61%) diagnosed with AAU and 52 (39%) diagnosed with AAT - were included. The median time between the presentation of alopecia areata (AA) and the development of extensive AA was 1 year and it was less than 4 years in 121 patients (91%). There was an initial response to treatment in 64% of patients, although only 14% presented a persistent response. Adverse side effects from the medications used were detected in 33% of patients. The prognostic factors associated with poor response were the presence of AAU and a positive family history of AA. Treatment of AAT and AAU is challenging. Although an initial regrowth may be achieved, the duration of response is usually short. There were no significant differences on the effectiveness or duration of response between the various systemic therapies. © 2016 European Academy of Dermatology and Venereology.

  8. Trilostane Treatment of Canine Alopecia X in an American Pit Bull Terrier

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    J. Kolevská

    2007-01-01

    Full Text Available This paper describes the case of a one-year-old female American Pit Bull Terrier, presented with the history of progressive baldness. The initial clinical signs were demonstrated by symmetric, primarily non-pruritic alopecia that began in the perineal, genital, and ventral abdominal regions and propagated cranially to the thorax and to the neck. Based on physical and dermatological examination, laboratory findings, and results of skin biopsy, a hormone-responsive dermatosis was diagnosed. Once hypothyroidism and hyperadrenocorticism were ruled out, with the help of hormonal tests, the diagnosis was specified as alopecia X. The first treatment option recommended for the patient and subsequently completed was ovariohysterectomy. After three months, the owner reported improvement; the dog was almost covered with hair. The patient was presented again six months later, showing almost the same dermatological symptoms, which, however, were of a more striking character than before ovariohysterectomy. Again a series of hormonal tests was carried out. Considering the elevated basal and post-adrenocorticothropin stimulation progesterone concentrations, the final aetiology of the disease was determined as an adrenal sex hormone imbalance. Therefore trilostan therapy was initiated. The trilostan dosage of 8 mg/kg/day was divided and given 2 times daily. This treatment led to complete hair regrowth in the dog within four months. No adverse effects associated with trilostane were recognized.

  9. Psychiatric morbidity and quality of life in skin diseases: A comparison of alopecia areata and psoriasis

    Directory of Open Access Journals (Sweden)

    Sagar B Karia

    2015-01-01

    Full Text Available Background: Alopecia areata (AA and psoriasis are associated with various psychiatric comorbidities. Both greatly affect the quality of life (QOL of patients and psychiatric comorbidities can further worsen it. Thus there is need to recognise psychiatric comorbidities and treat them in these patients. Aims: To determine the psychiatric morbidity and the QOL in these patients to study the factors affecting them. Methodology: 50 patients each of psoriasis and AA were included. 50 people accompanying these patients served as control group. They were diagnosed for psychiatric disorders by clinical interview. Scales used were severity of alopecia tool for AA, psoriasis area and severity index for psoriasis, WHO-QOL scale, Hamilton Rating Scale for anxiety and depression. Results: 22% and 38% patients in AA and psoriasis group respectively suffered from psychiatric disorder, depression was present in 18% and 24% of patients and 4% and 12% had anxiety disorders in respective groups. The control group had only 6% of psychiatric comorbidities. QOL scores had negative correlation with Hamilton-A, Hamilton-D and severity of psoriasis scores and they were statistically significant but not with severity of AA. Conclusion: Thus AA and psoriasis patients had more prevalence of psychiatric comorbidities and it had bearing on their QOL.

  10. The Frequency of Autoimmune Thyroid Disease in Alopecia Areata and Vitiligo Patients

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    Gulcan Saylam Kurtipek

    2015-01-01

    Full Text Available Aim. Many studies demonstrated that alopecia areata (AA and vitiligo are commonly associated with autoimmune thyroid diseases. We aimed to investigate the frequency of thyroid dysfunctions and autoimmunity related with vitiligo and AA. Material and Methods. 200 patients, 92 AA and 108 vitiligo diagnosed, were surveyed retrospectively. The control population was in reference range and from Konya, central Anatolian region of Turkey. Thyroid function tests (free T3, free T4, and TSH and serum thyroid autoantibody (anti-TG, anti-TPO levels were evaluated in all patients. Results. In vitiligo patients, 9 (8.3% had elevated anti-TG levels and 16 (14.8% had elevated anti-TPO, and in 17 patients (15.7% TSH levels were elevated and 3 (2.8% patients had elevated fT4 levels and 5 (4.6% had elevated fT3 levels. Within AA patients, 2 (2.2% had anti-TG elevation and 13 (14.1% had anti-TPO elevation, in 7 patients (7.6% TSH were elevated, and in 1 patient (1.1% fT4 were elevated and 5 (5.4% patients had elevated fT3 levels. Conclusion. In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at lower rates than the previous studies. According to results of this study there is no need for detailed examination in alopecia areata and vitiligo patients without clinical history.

  11. Epidemiological survey of dermatophytosis in meat rabbits with alopecia in Portugal

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    Fernando Moreira

    2012-04-01

    Full Text Available An epidemiological dermatophytosis survey was carried out in farmed rabbits with alopecia in Northern and Central Portugal.  Between August and October 2008, samples from suspected clinical cases of alopecia in meat rabbits on industrial farms were collected and cultured by conventional methods.  Effects on the prevalence of several variables, such as breed, age, month of sample collection, configuration of the lesions and presence of concomitant infections in the rabbitries were evaluated using a logistic regression model.  The overall prevalence of dermatophytes species was 82.7% (95% CI: 80.1-85.3%. Two dermatophytes species were isolated: Trichophyton mentagrophytes (91.9% and Microsporum canis (8.1%.  Five variables were associated with dermatophyte isolation in univariate analysis.  The multivariate logistic regression model identified configuration of lesions (OR=3.15; 95% CI: 1.39-7.15% and the presence of concomitant infections on the farms (OR=2.71; 95% CI: 1.03-7.12% as risk factors.  Considering the paucity of epidemiological reports in this country, these results could make a useful contribution towards the diagnosis and prevention of rabbit dermatophytosis.

  12. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial.

    Science.gov (United States)

    Fischer, T W; Burmeister, G; Schmidt, H W; Elsner, P

    2004-02-01

    In addition to the well-known hormonal influences of testosterone and dihydrotestosterone on the hair cycle, melatonin has been reported to have a beneficial effect on hair growth in animals. The effect of melatonin on hair growth in humans has not been investigated so far. To examine whether topically applied melatonin influences anagen and telogen hair rate in women with androgenetic or diffuse hair loss. A double-blind, randomized, placebo-controlled study was conducted in 40 women suffering from diffuse alopecia or androgenetic alopecia. A 0.1% melatonin or a placebo solution was applied on the scalp once daily for 6 months and trichograms were performed to assess anagen and telogen hair rate. To monitor effects of treatment on physiological melatonin levels, blood samples were taken over the whole study period. Melatonin led to a significantly increased anagen hair rate in occipital hair in women with androgenetic hair loss compared with placebo (n=12; P=0.012). For frontal hair, melatonin gave a significant increase in the group with diffuse alopecia (n=28; P=0.046). The occipital hair samples of patients with diffuse alopecia and the frontal hair counts of those with androgenetic alopecia also showed an increase of anagen hair, but differences were not significant. Plasma melatonin levels increased under treatment with melatonin, but did not exceed the physiological night peak. To the authors' knowledge, this pilot study is the first to show that topically applied melatonin might influence hair growth in humans in vivo. The mode of action is not known, but the effect might result from an induction of anagen phase.

  13. Cosmopolitan Narratives

    DEFF Research Database (Denmark)

    Bondebjerg, Ib

    ? Belonging to a nation, a culture is of course still a very central thing. We still experience the world from where we are, we view others through a lens of imaginary (Anderson 1983) and real belonging somewhere. The distant ’other’ can still for many be rather distant, and certainly more distant than those...... close others in our everyday life. But the media play an increasingly strong and important role in developing a cosmopolitan imaginary through narratives that bring us closer to the various distant, global others. Through migration those earlier distant others are also more and more mixed in our daily...

  14. [Efficacy and tolerability of 5% minoxidil solution (Carexidil®) in male and female androgenetic alopecia: a 6-month open multicentric study].

    Science.gov (United States)

    Piraccini, B; Starace, M; Alessandrini, A; Guarrera, M; Fiorucci, M C; Lorenzi, S

    2011-12-01

    The aim of the study was to evaluate efficacy and safety of 5% Carexidil solution®, applied twice a day on the scalp, on male and female androgenetic alopecia. The 6 month-study was performed in three Italian dermatological centers. Evaluation of efficacy was performed with subjective and objective methods, including operator and patient assessments, global photography and videodermoscopy. Global photography revealed that after 6 months of treatment with 5% Carexidil solution®, androgenetic alopecia was improved in all 32 females and 16 males. Alopecia stopped to progress in 6 males. Scalp videodermoscopy confirmed the results. Some patients complained of increased hair greasiness, others complained of mild scalp itching. Two female patients developed contact sensitization to minoxidil, confirmed by patch test, 2 a mild malar-temporal hypertrichosis. All patients were satisfied by treatment and continued it after the end of the study. Our study confirms the data of the literature and the evidence coming from years of clinical experience, that twice a day topical application of 5% minoxidil solution, Carexidil ®, is effective in the treatment of male and female androgenetic alopecia, with evident efficacy already after 6 months.

  15. Pili Annulati Coincident with Alopecia Areata, Autoimmune Thyroid Disease, and Primary IgA Deficiency: Case Report and Considerations on the Literature

    Directory of Open Access Journals (Sweden)

    E. Castelli

    2012-11-01

    Full Text Available Pili annulati is a rare autosomal dominant hair disorder clinically characterized by a pattern of alternating bright and dark bands of the hair, the bright bands appearing dark if observed by transmitted light. This pattern is due to the periodic occurrence of air-filled cavities along the hair cortex which scatter and reflect the light while precluding its transmission. A susceptibility region, including a possibly responsible Frizzled gene, has been mapped to the telomeric region of chromosome 12q, although a specific mutation has not been identified. The condition has sometimes been observed in concurrence with alopecia areata, and in this paper we report a case in whom the concomitant severe alopecia areata was associated with autoimmune thyroid disease and primary IgA deficiency – a quadruple complex which, to our knowledge, has never been previously described. The occurrence of multiple immune disorders in the same patient affected by pili annulati could represent a key to understanding the high prevalence of alopecia areata in this condition. Specifically, in individuals predisposed to autoimmune disease, the molecular alterations that cause the anatomical changes of pili annulati could prompt the immune response against the hair root that underlies alopecia areata.

  16. Frontal fibrosing alopecia and lichen planus pigmentosus: diagnosis and therapeutic challenge.

    Science.gov (United States)

    Mulinari-Brenner, Fabiane Andrade; Guilherme, Marina Riedi; Peretti, Murilo Calvo; Werner, Betina

    2017-01-01

    Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.

  17. Alopecia universalis, renal stones, and hyperuricemia: A familial or an unfamiliar association

    Directory of Open Access Journals (Sweden)

    Kalachand Jana

    2014-01-01

    Full Text Available Alopecia Universalis is an autoimmune disorder which sometimes may be associated with other autoimmune diseases like vitiligo, atopic dermatitis and endocrine disorders like hypothyroidism. In less than 2% of cases it may be associated with nephrotic syndrome although the underlying etiology has not been reported. We report here one similar case that had alopecia universalis beginning at the age of 17 years and simultaneously developed hyperuricemia. His son also developed alopecia universalis and renal stones at an early age of 10 years. The case represents one of the rare forms of alopecia namely alopecia universalis in two generations of the same family. Apart from this the case highlights the presence of renal stones probably due to hyperuricemia in both the generations which invokes a need to investigate any association of hyperuricemia with alopecia universalis.

  18. Application of language processing techniques to capture the use of nursing clinical terms from narrative statements: report of a pilot study.

    Science.gov (United States)

    Frisch, Noreen; Frisch, Larry

    2011-01-01

    The authors piloted the use of the "General Architecture for Text Engineering" (GATE) program in an analysis of writings from the nursing literature to determine if this standard language processing technique could be used to capture the use of complex nursing terms. This work was undertaken as an initial step in evaluating if widely-available natural language processing methods could be applied to narrative nursing notes in a way that a nursing diagnosis could be identified and extracted from a narrative text. For purposes of the pilot study, the complex nursing term "powerlessness", which is identified as a NANDA-I nursing diagnosis, was selected as the test case. A PubMed search was performed on the term "powerlessness" limited to articles in the nursing literature that contained abstracts, resulting in 232 articles published between 1981 to 2010 meeting the criteria. Three-sentence extracts from each abstract were analyzed by applying GATE to identify noun and adjective roots occurring in close proximity to the index word, and then identifying if these proximal words reflected the standardized defining characteristics, adjectives and qualifiers of the diagnostic term. The analysis resulted identification 2,174 unique terms. While a few terms coincided with the NANDA-I defining characteristics of "powerlessness", most of the established defining characteristics were not reflected in the use of the term. Machine language processing techniques are promising in identifying meanings and contextual use of words related to nursing concepts, but the use of such words in published papers does not represent definitions found in standard nursing nomenclature. Nursing writers use terms that are also understood outside the disciplinary domain, making standardization and coding particularly challenging. Future research in Nursing should apply the techniques described to clinical reports and to evaluate the match between clinical usage and standardized meanings.

  19. Neonatal Alopecia Due to Birth Trauma: Case Report and Trichoscopic Findings.

    Science.gov (United States)

    Liberati, Giulia; Starace, Michela; Patrizi, Annalisa; Piraccini, Bianca Maria

    2016-07-01

    A 4-day-old boy was referred for evaluation of an oval patch of occipital alopecia associated with caput succedaneum and ipsilateral eyelid ecchymoses. Based on the history of a prolonged, difficult labor with vacuum-assisted delivery, the diagnosis of neonatal alopecia associated with birth trauma was made. Trichoscopy showed purple dots corresponding to blood extravasation and follicular ostia. We also review the trichoscopic differential diagnosis of focal neonatal alopecia. © 2016 Wiley Periodicals, Inc.

  20. Psychosocial reaction patterns to alopecia in female patients with gynecological cancer undergoing chemotherapy.

    Science.gov (United States)

    Ishida, Kazuko; Ishida, Junko; Kiyoko, Kanda

    2015-01-01

    This study aims to clarify the psychosocial reactions of female patients with gynecological cancer undergoing chemotherapy and in the process of suffering from alopecia and to examine their nursing support. The target group comprised female patients who had received two or more cycles of chemotherapy, were suffering from alopecia, and were aged 30-65. Data were collected from semi-structured interviews, conducted from the time the patients were informed by their doctors that they might experience alopecia due to chemotherapy to the time they actually experienced alopecia and until they were able to accept the change. Inductive qualitative analysis was employed to close in on the subjective experiences of the cancer patients. The results showed the existence of six phases in the psychosocial reactions in the process of alopecia: phase one was the reaction after the doctor's explanation; phase two was the reaction when the hair starts to fall out; phase three was the reaction when the hair starts to intensely fall out; phase four was the reaction when the hair has completely fallen out; phase five was the reaction to behavior for coping with alopecia; and phase six was the reaction to change in interpersonal human relationships. The results also made it clear that there are five types of reaction patterns as follows: 1) treatment priority interpersonal relationship maintenance type; 2) alopecia agitated interpersonal relationship maintenance type; 3) alopecia agitated interpersonal relationship reduction type; 4) alopecia denial interpersonal relationship reduction type; and 5) alopecia denial treatment interruption type. It is important to find out which of the five types the patients belong to early during treatment and provide support so that nursing intervention that suits each individual can be practiced. The purpose of this study is to make clear the process in which patients receiving chemotherapy come to accept alopecia and to examine evidence-based nursing

  1. Linear non scarring alopecia of the scalp: A rare manifestation of lupus panniculitis

    Directory of Open Access Journals (Sweden)

    Sandhyarani Kshetrimayum

    2016-01-01

    Full Text Available Alopecia in a linear pattern is very rare with only a few cases reported in the medical literature. We report a case of linear non scarring alopecia involving the scalp in a 17-year-old boy with a histological diagnosis of lupus panniculitis. We report this case because of its rarity and also the inclusion of this entity as one of the rare differential of non scarring alopecia.

  2. DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms.

    Science.gov (United States)

    Gaspar, Neide Kalil

    2016-01-01

    The transforming growth factor-beta 1 (TGFβ1) promotes fibrosis, differentiating epithelial cells and quiescent fibroblasts into myofibroblasts and increasing expression of extracellular matrix. Recent investigations have shown that PPAR (peroxisome proliferator-activated receptor*) is a negative regulator of fibrotic events induced by TGFβ1. Dehydroepiandrosterone (DHEA) is an immunomodulatory hormone essential for PPAR functions, and is reduced in some processes characterized by fibrosis. Although scarring alopecia characteristically develops in the female biological period in which occurs decreased production of DHEA, there are no data in the literature relating its reduction to fibrogenic process of this condition. This article aims to review the fibrogenic activity of TGFβ1, its control by PPAR and its relation with DHEA in the frontal fibrosing alopecia.

  3. FINASTERIDE AS A TREATMENT FOR MALE ANDROGENETIC ALOPECIA

    Directory of Open Access Journals (Sweden)

    Ni Komang Tristiana Dewi

    2013-04-01

    Full Text Available Androgenetic alopecia (AGA is a type of alopecia non sikatrik that most often occur, especially in men. AGA is hereditary baldness and form distinctive patterns. Causes related to AGA estimated serum androgen levels, especially 5-?-dehydrotestosterone (DHT, which can lead to miniaturization of the hair follicle. Finasteride is one of drugs that proven effective in treating hair loss caused by AGA. Finasteride is a 4-azasteroid components that are competitive and specific inhibitor of the enzyme 5-?-reductase type II, an enzyme that converts testosteron into intracellular DHT. By inhibiting the enzyme 5-?-reductase type II, conversion of testosteron to DHT inhibited, thereby causing a significant decrease in serum and tissue DHT concentrations. The use of finasteride 1 mg per day proven to effectively treat AGA in men.  

  4. Temporal triangular alopecia and a review of 52 past cases.

    Science.gov (United States)

    Yamazaki, Masashi; Irisawa, Ryokichi; Tsuboi, Ryoji

    2010-04-01

    Temporal triangular alopecia (TTA) is a circumscribed, non-cicatricial form of alopecia confined to the frontotemporal region. The patient, a 15-year-old boy, was noticed at birth to have an alopecial area, sized 1.5 cm x 2.5 cm, in the right temporal region. Microscopic examination revealed miniaturized hair follicles accompanied by differentiated sebaceous glands. We have provided a synopsis of the past 52 cases. Of the 53 cases of TTA including our case, more than half (55.8%) were detected in childhood between the ages of 2 and 9 years, while 36.5% were detected at birth and only 3.8% (only two cases) in adulthood. There were three familial cases. Several congenital diseases were associated with the condition, for example, phakomatosis pigmentovascularis, Down syndrome and Dandy-Walker malformation. This information suggests that TTA can be recognized as a hamartomatous mosaic disease.

  5. Early-onset androgenetic alopecia and endocrine disruptors

    Directory of Open Access Journals (Sweden)

    M. Guarrera

    2011-01-01

    Full Text Available Androgenetic alopecia (AGA is the most common acquired non scarring alopecia in humans caused by androgen hormones in the setting of a genetic predisposition. Usually AGA starts after puberty, but recently it has been observed also in adolescents. Their mean age was 13 years with a slight prevalence in males. The premature AGA may be caused by environmental, alimentary (meat and milk or cosmetics overexposure to sexual hormones or to endocrine disrupters (EDs. EDs are "exogenous substances that interfere with the synthesis, secretion, transport, binding, action, or elimination of natural hormones in the body causing adverse effects to human health" and they are able bind to the steroid hormone receptors. Early onset AGA may be linked to the well known phenomenon of early puberty caused in some cases by hormones contained in food or by environmental chemicals. Therefore it is likely that the EDs may play a role also in the pathogenesis of early-onset AGA.

  6. Effect of minoxidil on hair transplantation in alopecia androgenetica

    Directory of Open Access Journals (Sweden)

    Singh Gurinderjit

    1998-01-01

    Full Text Available Forty patients suffering from androgenetic alopecia were given 3 to 4 sittings of hair transplantation at an interval of 4 to 6 weeks each. Only patients of type III, type III(vertex and type IV baldness were operated. Twenty patients, six of type III, six of type III(vertex and eight of type IV baldness were advised to use minoxidil 2% locally at the recipient area in the dose of 1 ml applied twice daily. Twenty patients of similar types of baldness were advised to just shampoo their hair daily without using topical minoxidil. Percentage of response was compared between the two groups. Minoxidil did not play any role in the percentage of hair survival before and after transplantation in androgenetic alopecia. However in 60percent grafts of patients who had used topical minoxidil, there was no initial postoperative hair shedding.

  7. Effect of minoxidil on hair transplantation in alopecia androgenetica.

    Science.gov (United States)

    Singh, G

    1998-01-01

    Forty patients suffering from androgenetic alopecia were given 3 to 4 sittings of hair transplantation at an interval of 4 to 6 weeks each. Only patients of type III, type III(vertex) and type IV baldness were operated. Twenty patients, six of type III, six of type III(vertex) and eight of type IV baldness were advised to use minoxidil 2% locally at the recipient area in the dose of 1 ml applied twice daily. Twenty patients of similar types of baldness were advised to just shampoo their hair daily without using topical minoxidil. Percentage of response was compared between the two groups. Minoxidil did not play any role in the percentage of hair survival before and after transplantation in androgenetic alopecia. However in 60percent grafts of patients who had used topical minoxidil, there was no initial postoperative hair shedding.

  8. Ichthyosis follicularis with alopecia and photophobia (IFAP syndrome

    Directory of Open Access Journals (Sweden)

    Rai Vandana

    2006-01-01

    Full Text Available A 12-year-old boy born of a nonconsanguineous marriage presented with dry rough skin and photophobia since birth. His growth and developmental milestones were normal and there was no history of any neurological problem, hearing deficit or scarring around the hair follicles. Cutaneous examination revealed diffuse thinning of scalp hair with loss of eyebrows and eyelashes and a sandpapery texture of the skin all over the body, suggestive of ichthyosis follicularis with alopecia and photophobia syndrome.

  9. Nail changes in alopecia areata: Incidence and pattern

    Directory of Open Access Journals (Sweden)

    Gandhi V

    2003-03-01

    Full Text Available One hundred consecutive patients with alopecia areata were examined for presence of nail abnormalities. Nail changes were seen in 44/100 (44% of patients with most frequent occurrence in multifocal variety (30/44=68%. The commonest abnormality observed was superficial pits seen in 28(64% patients. Presence and severity of nail changes may indicate a more severe and recalcitrant disease.

  10. Architectural Narratives

    DEFF Research Database (Denmark)

    Kiib, Hans

    2010-01-01

    a functional framework for these concepts, but tries increasingly to endow the main idea of the cultural project with a spatially aesthetic expression - a shift towards “experience architecture.” A great number of these projects typically recycle and reinterpret narratives related to historical buildings......In this essay, I focus on the combination of programs and the architecture of cultural projects that have emerged within the last few years. These projects are characterized as “hybrid cultural projects,” because they intend to combine experience with entertainment, play, and learning. This essay...... identifies new rationales related to this development, and it argues that “cultural planning” has increasingly shifted its focus from a cultural institutional approach to a more market-oriented strategy that integrates art and business. The role of architecture has changed, too. It not only provides...

  11. Drug discovery for alopecia: gone today, hair tomorrow.

    Science.gov (United States)

    Santos, Zenildo; Avci, Pinar; Hamblin, Michael R

    2015-03-01

    Hair loss or alopecia affects the majority of the population at some time in their life, and increasingly, sufferers are demanding treatment. Three main types of alopecia (androgenic [AGA], areata [AA] and chemotherapy-induced [CIA]) are very different, and have their own laboratory models and separate drug-discovery efforts. In this article, the authors review the biology of hair, hair follicle (HF) cycling, stem cells and signaling pathways. AGA, due to dihydrotesterone, is treated by 5-α reductase inhibitors, androgen receptor blockers and ATP-sensitive potassium channel-openers. AA, which involves attack by CD8(+)NK group 2D-positive (NKG2D(+)) T cells, is treated with immunosuppressives, biologics and JAK inhibitors. Meanwhile, CIA is treated by apoptosis inhibitors, cytokines and topical immunotherapy. The desire to treat alopecia with an easy topical preparation is expected to grow with time, particularly with an increasing aging population. The discovery of epidermal stem cells in the HF has given new life to the search for a cure for baldness. Drug discovery efforts are being increasingly centered on these stem cells, boosting the hair cycle and reversing miniaturization of HF. Better understanding of the molecular mechanisms underlying the immune attack in AA will yield new drugs. New discoveries in HF neogenesis and low-level light therapy will undoubtedly have a role to play.

  12. Ichthyosiform mycosis fungoides with alopecia and atypical membranous nephropathy

    Directory of Open Access Journals (Sweden)

    Qiang Zhou

    2011-01-01

    Full Text Available We describe here a rare case of variant of mycosis fungoides (MF: ichthyosiform MF with alopecia and atypical membranous nephropathy. The diagnosis was made based on the following findings: generalized ichthyosis-like eruption, alopecia, enlarged superficial lymph nodes, proteinuria, and hematuria, the histological features of the skin biopsy from both ichthyotic and alopecic lesions with immunohistochemical staining, and the renal biopsy examination with immunofluorescence. The histological examination of ichthyotic and alopecic lesions displayed a predominant infiltration of atypical lymphocytes in the upper dermis with the characteristics of epidermotropism and folliculotropism. Immunohistochemical studies demonstrated that most infiltrated atypical lymphocytes were CD3, CD4, and CD45RO positive, whereas negative for CD5, CD7, CD20, CD30, and CD56. A renal biopsy examination revealed atypical membranous nephropathy with deposition of immunoglobulin G (IgG, IgM, IgA, C1q, and C3. In this case atypical membranous nephropathy was involved, which is very uncommon and has never been presented in the literature to date. Although ichthyosiform MF usually features a relatively favorable course, diffuse alopecia and the renal involvement in this case might indicate aggressive disease and poor prognosis.

  13. Feature engineering combined with machine learning and rule-based methods for structured information extraction from narrative clinical discharge summaries.

    Science.gov (United States)

    Xu, Yan; Hong, Kai; Tsujii, Junichi; Chang, Eric I-Chao

    2012-01-01

    A system that translates narrative text in the medical domain into structured representation is in great demand. The system performs three sub-tasks: concept extraction, assertion classification, and relation identification. The overall system consists of five steps: (1) pre-processing sentences, (2) marking noun phrases (NPs) and adjective phrases (APs), (3) extracting concepts that use a dosage-unit dictionary to dynamically switch two models based on Conditional Random Fields (CRF), (4) classifying assertions based on voting of five classifiers, and (5) identifying relations using normalized sentences with a set of effective discriminating features. Macro-averaged and micro-averaged precision, recall and F-measure were used to evaluate results. The performance is competitive with the state-of-the-art systems with micro-averaged F-measure of 0.8489 for concept extraction, 0.9392 for assertion classification and 0.7326 for relation identification. The system exploits an array of common features and achieves state-of-the-art performance. Prudent feature engineering sets the foundation of our systems. In concept extraction, we demonstrated that switching models, one of which is especially designed for telegraphic sentences, improved extraction of the treatment concept significantly. In assertion classification, a set of features derived from a rule-based classifier were proven to be effective for the classes such as conditional and possible. These classes would suffer from data scarcity in conventional machine-learning methods. In relation identification, we use two-staged architecture, the second of which applies pairwise classifiers to possible candidate classes. This architecture significantly improves performance.

  14. Relationship between irreversible alopecia and exposure to cyclophosphamide, thiotepa and carboplatin (CTC) in high-dose chemotherapy

    NARCIS (Netherlands)

    de Jonge, M. E.; Mathôt, R. A. A.; Dalesio, O.; Huitema, A. D. R.; Rodenhuis, S.; Beijnen, J. H.

    2002-01-01

    Reversible alopecia is a commonly observed, important and distressing complication of chemotherapy. Permanent alopecia, however, is rare after standard-dose therapy, but has occasionally been observed after high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin (CTC). We evaluated

  15. Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.

    Science.gov (United States)

    Sasmaz, Sezai; Arican, Ozer

    2005-01-01

    Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

  16. Nye narrative gleder?

    DEFF Research Database (Denmark)

    Bondebjerg, Ib

    2008-01-01

    Anmeldelse af Anne Mangen: New Narrative Pleasures? A Cognitive-Phenomenological Study of the Experience of Reading Digital Narrative Fictions.......Anmeldelse af Anne Mangen: New Narrative Pleasures? A Cognitive-Phenomenological Study of the Experience of Reading Digital Narrative Fictions....

  17. Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia.

    Science.gov (United States)

    Gunawan, Stefanus; Broeke, Chloe Ten; Ven, Peter van de; Arnoldussen, Marijn; Kaspers, Gertjan; Mostert, Saskia

    2016-01-01

    This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital. Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires. The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021). Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate children's return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.

  18. From P0 to P6 medicine, a model of highly participatory, narrative, interactive, and “augmented” medicine: some considerations on Salvatore Iaconesi’s clinical story

    Directory of Open Access Journals (Sweden)

    Bragazzi NL

    2013-04-01

    Full Text Available Nicola Luigi Bragazzi School of Public Health, Department of Health Sciences (DISSAL, Genoa, Italy Abstract: Salvatore Iaconesi was recently diagnosed with a brain tumor. He decided to share his clinical records not only with doctors but with everybody who wishes to find him a cure. “Because cure is not unique,” he emphasizes “there are cures for the body and cures for the soul, and everyone, from a painter to a musician, can find me a cure. Please, feel free to take my clinical history for example and let it become a game, a video, a music, a picture, whatever you like.” The emblematic hallmark of the changing times, Salvatore Iaconesi’s case is an example of how many profound revolutions and steps medicine has undertaken during the past few centuries. Stemming from a form of remote medical paternalism and arriving at the concept of a therapeutic alliance, medicine nowadays faces challenges and opportunities at a level before unforeseeable and unimaginable. The new concept of P6 medicine (personalized, predictive, preventive, participatory, psychocognitive, and public is discussed, together with its profound implications. Keywords: cancer, narrative medicine, paternalistic medicine, P4 medicine, P5 medicine

  19. Successful treatment of multiplex alopecia areata using transactional analysis: a case report.

    Science.gov (United States)

    Yamakita, Takashi; Shimizu, Yoshinori; Arima, Masaru; Ashihara, Mutsumi; Matsunaga, Kayoko

    2014-09-01

    The patient was a 13-year-old female. Six years previously, she developed alopecia areata when her parents divorced. One year after that, the bald area drastically expanded when her mother remarried. She was treated at her local hospital; however, no improvement was observed. She then visited our hospital for examination. A bald patch was covering >80% of her head. Self Grow-Up Egogram indicated the basic interpersonal relationship stance of 'I am not OK, You are OK'. We therefore implemented a transactional analysis approach to increase the patient's score on the Free Child subscale. New hair growth was observed after 6 months and the bald patch disappeared after 2 years. Our results suggest that this method could also be easily applied in a clinical setting by dermatologists.

  20. A Narrative Interpretive Perspective

    OpenAIRE

    Adorisio, Anna Linda Musacchio

    2015-01-01

    In this paper I will discuss the possibility offered by the “linguistic turn” for narrative research in the realm of financial communication. I will propose three categories by which a narrative interpretive approach can be applied to financial communication: narrative-as-artifacts, narrative-as-practice and narrative-as-method. Such a constitutive communication approach challenges a mechanistic and functionalist view of communication as a tool to represent social realities in ...

  1. Narrative Finality

    Directory of Open Access Journals (Sweden)

    Armine Kotin Mortimer

    1981-01-01

    Full Text Available The cloturai device of narration as salvation represents the lack of finality in three novels. In De Beauvoir's Tous les hommes sont mortels an immortal character turns his story to account, but the novel makes a mockery of the historical sense by which men define themselves. In the closing pages of Butor's La Modification , the hero plans to write a book to save himself. Through the thrice-considered portrayal of the Paris-Rome relationship, the ending shows the reader how to bring about closure, but this collective critique written by readers will always be a future book. Simon's La Bataille de Pharsale , the most radical attempt to destroy finality, is an infinite text. No new text can be written. This extreme of perversion guarantees bliss (jouissance . If the ending of De Beauvoir's novel transfers the burden of non-final world onto a new victim, Butor's non-finality lies in the deferral to a future writing, while Simon's writer is stuck in a writing loop, in which writing has become its own end and hence can have no end. The deconstructive and tragic form of contemporary novels proclaims the loss of belief in a finality inherent in the written text, to the profit of writing itself.

  2. The emotional impact of loss narratives: event severity and narrative perspectives.

    Science.gov (United States)

    Habermas, Tilmann; Diel, Verena

    2010-06-01

    Out of the complex influences of event, narrative and listener characteristics on narrative emotions, this paper focuses on event severity, narrative perspectives, mood, and dispositions for emotion regulation and empathy. Event severity and perspective representation were systematically varied in sad autobiographical narratives to study their influence on quantity and quality of readers' emotional response. Each of three stories were manipulated to contain elaborated perspectives, only the past protagonists' perspective (dramatic narration), and very little perspectives at all (impersonal narration). We predicted that event severity influences the quantity of emotional response, while degree of perspective representation influences plausibility and whether emotional responses are sympathetic or interactional, that is, directed against the narrator. Hypotheses were confirmed except for plausibility, and perspective representation had an effect only on anger against and dislike of the narrator. In a second study, impersonal narration evoked anger at and negative evaluations of the narrator which were related to blaming the narrator for showing too little emotional involvement. The generalizability of findings across emotions and implications for sharing of emotions in everyday and clinical settings are discussed.

  3. Early-Onset Alopecia and Amyotrophic Lateral Sclerosis: A Cohort Study

    Science.gov (United States)

    Fondell, Elinor; Fitzgerald, Kathryn C.; Falcone, Guido J.; O'Reilly, Éilis J.; Ascherio, Alberto

    2013-01-01

    A recent meta-analysis of 7 genome-wide association studies on early balding (alopecia) revealed single nucleotide polymorphism variants in the region of the amyotrophic lateral sclerosis (ALS) gene TAR DNA-binding protein 43 (TARDBP/TDP-43). We therefore explored the association of early-onset alopecia and ALS in the Health Professionals Follow-up Study, a large cohort of 51,529 US men. In 1992, the participants (then aged 46–81 years) were asked to report their hair line pattern at age 45 years. During the follow-up period (1992–2008), 42 men were diagnosed with ALS. Of those, 13 had reported no alopecia, 18 had reported moderate alopecia, and 11 had reported extensive alopecia at age 45 years. Those who reported extensive alopecia had an almost 3-fold increased risk of ALS compared with those who reported no alopecia (relative risk = 2.74, 95% confidence interval: 1.23, 6.13). Furthermore, we observed a linear trend of increased risk of ALS with increasing level of balding at age 45 years (Ptrend = 0.02). In conclusion, men with early-onset alopecia seem to have a higher risk of ALS. The mechanisms underlying this association deserve further investigation. PMID:23942216

  4. Quality of life and psychosocial impact of scarring and non-scarring alopecia in women.

    Science.gov (United States)

    Katoulis, Alexandros C; Christodoulou, Christos; Liakou, Aikaterini I; Kouris, Anargyros; Korkoliakou, Panagiota; Kaloudi, Eythymia; Kanelleas, Antonios; Papageorgiou, Charalabos; Rigopoulos, Dimitrios

    2015-02-01

    Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact. To assess the impact of alopecia on quality of life and certain psychological domains and to compare it between scarring and non-scarring alopecia in Greek adult women. Forty-four women, aged 18-70 years, with scarring (n = 19) or non-scarring alopecia (n = 25) were recruited. All patients were evaluated by Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-esteem Scale (RSES) and UCLA Loneliness Scale (UCLA-LS). Women with scarring alopecia had higher scores in DLQI, HADS and UCLA- LS and lower scores in RSES, compared to women with non-scarring alopecia. A statistically significant difference between the two groups was documented for DLQI (p = 0.0067), HADS (p = 0.0008), and HADS-Anxiety (HADS-A) (p alopecia compared with non-scarring alopecia, probably depicting the poorer prognosis of the former. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  5. Genetics Home Reference: T-cell immunodeficiency, congenital alopecia, and nail dystrophy

    Science.gov (United States)

    ... alopecia, and nail dystrophy is a type of severe combined immunodeficiency (SCID), which is a group of disorders characterized ... Diseases Educational Resources (7 links) Boston Children's Hospital: Severe Combined Immunodeficiency Disease InfoSearch: T-cell immunodeficiency, congenital alopecia and ...

  6. Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study.

    Science.gov (United States)

    Ewertsson, Mona; Bagga-Gupta, Sangeeta; Allvin, Renée; Blomberg, Karin

    2017-01-01

    Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice. An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews ( n  = 7) that were conducted during nursing students' ( n  = 17) clinical practice at an emergency department at a university hospital in Sweden. The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches". Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for

  7. Dose-dependent valproate-induced alopecia in patients with mental disorders.

    Science.gov (United States)

    Tomita, Takashi; Goto, Hidekazu; Yoshida, Tadashi; Tanaka, Katsuya; Sumiya, Kenji; Kohda, Yukinao

    2015-01-01

    Drug-induced hair loss may occur as a side effect in patients treated with valproate. However, few studies have reported a relationship between the blood levels of valproate and the occurrence of hair loss. We report three cases of alopecia that occurred in patients who received sodium valproate for mental disorders. In all three cases, alopecia appeared after long-term valproate exposure with a plasma concentration of 100 µg/ml approximately. However, the alopecia resolved in all cases after dose reduction or treatment discontinuation. Therefore, alopecia may develop in patients with chronic exposure to high plasma concentrations of valproate. Based on these findings, we believe that patients with high plasma concentrations of valproate should be closely monitored for the occurrence of side effects, particularly alopecia.

  8. Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits.

    Science.gov (United States)

    Ferneini, Elie M; Beauvais, Daniel; Castiglione, Concetta; Ferneini, Moniek V

    2017-04-01

    The purpose of this study was to provide an overview of platelet-rich plasma (PRP) injected into the scalp for the management of androgenic alopecia. A literature review was performed to evaluate the benefits of PRP in androgenic alopecia. Hair restoration has been increasing. PRP's main components of platelet-derived growth factor, transforming growth factor, and vascular endothelial growth factor have the potential to stimulate hard and soft tissue wound healing. In general, PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality. Currently, different PRP preparations are being used with no standard technique. This review found beneficial effects of PRP on androgenic alopecia. However, more rigorous study designs, including larger samples, quantitative measurements of effect, and longer follow-up periods, are needed to solidify the utility of PRP for treating patients with androgenic alopecia. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Women from refugee backgrounds and their experiences of attending a specialist antenatal clinic. Narratives from an Australian setting.

    Science.gov (United States)

    Stapleton, Helen; Murphy, Rebecca; Correa-Velez, Ignacio; Steel, Michelle; Kildea, Sue

    2013-12-01

    In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  10. Association between androgenetic alopecia and hyperlipidemia: a comparative study

    Directory of Open Access Journals (Sweden)

    Ramin Taheri

    2013-12-01

    Full Text Available Background: Androgenetic alopecia (AGA is the most common type of progressive balding that appears with early loss of hair, chiefly from the vertex. There has been significant relationship between AGA with coronary artery disease and related risk factors, such as hypertension in some studies. The aim of this study is to investigate the association between androgenetic alopecia with hyperlipidemia.Methods: This cross-sectional study was performed on 112 patients with vertex type AGA (in male grade 3 or higher Hamilton- Norwood scale, and in female grade 2 or higher Ludwig scale (study group and 115 persons age and sex matched, with normal hair status (Normal group. None of participants had diabetes mellitus, hypothyroidism, liver disease, kidney disease and none of them had history of smoking and using drugs with effect on serum lipids. They were 20-35 years old and their body mass index were 20-30. Blood samples were obtained following 12 hours fasting status and serum levels of triglyceride (TG, cholesterol, high-density lipoprotein (HDL and low-density lipoprotein (LDL were determined using standard laboratory methods. Total cholesterol greater than 240 or TG greater than 200 or LDL greater than 160 or HDL less than 40 in men or HDL less than 50 in women were considered hyperlipidemia.Results: In androgenetic alopecia group 46.4% and 47% of normal group were female. Mean (±SE of total cholesterol (172.4±3.1, 148.8±3.1, P 0.05.Conclusion: The findings showed that there is no relationship between AGA and hyperlipidemia. Regarding to high levels of total cholesterol, LDL and triglyceride in AGA patients, it seems that, AGA increases risk of coronary heart disease. To determine a definite association between AGA and hyperlipidemia more studies are recommended.

  11. THE ROLE OF FOLLICULAR UNIT GRAFTING IN TREATMENT ALOPECIA

    Directory of Open Access Journals (Sweden)

    Duhita Ayuningtyas

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Alopecia is usually treatable and self-limited, but it may be permanent. Careful diagnosis of the type of hair loss will aid in selecting effective treatment. Many drugs used to treat alopecia, but in many people not satisfied with the result. One of the treatment currently used to treat alopecia is hair transplantation with follicular unit grafting (FUG. The advantages of hair transplantation is to create a natural appearance, one that mimics natural hair growth both in terms of numbers and pattern /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  12. Mindfulness, Mysticism, and Narrative Medicine.

    Science.gov (United States)

    Lewis, Bradley

    2016-12-01

    Mindfulness based interventions (MBIs) are rapidly emerging in health care settings for their role in reducing stress and improving physical and mental health. In such settings, the religious roots and affiliations of MBIs are downplayed, and the possibilities for developing spiritual, even mystical, states of consciousness are minimized. This article helps rebalance this trend by using the tools of medical humanities and narrative medicine to explore MBI as a bridge between medical and spiritual approaches to health related suffering. My narrative medicine method draws insights from the arts and humanities that are rarely used in standard clinical research but are increasingly common among medical humanities and narrative medicine scholars. The specific path I take will be to work through historical, linguistic, and philosophic dimensions of mindfulness and mysticism as relevant to illness, suffering, death, and dying. I close with two case examples in which mindfulness is used as an intentionally spiritual practice for health concerns.

  13. Linear alopecia areata versus trichotillomania: The game of time

    Directory of Open Access Journals (Sweden)

    Samipa Samir Mukherjee

    2018-01-01

    Full Text Available Linear variant of alopecia areata (AA is a rare entity posing as a diagnostic challenge owing to the ability to mimic multiple conditions ranging from trichotillomania, dermatitis artefacta to linear lupus erythematosus profundus. Awareness regarding this entity optimized with dermoscopy and histopathology examination is essential for an effective diagnosis and treatment. Herein, we describe a case of a 7-year-old female with linear AA simulating trichotillomania which we believe is the first reported case in pediatric age group in India.

  14. Emotions, narratives, and ethical mindfulness.

    Science.gov (United States)

    Guillemin, Marilys; Gillam, Lynn

    2015-06-01

    Clinical care is laden with emotions, from the perspectives of both clinicians and patients. It is important that emotions are addressed in health professions curricula to ensure that clinicians are humane healers as well as technical experts. Emotions have a valuable and generative role in health professional ethics education.The authors have previously described a narrative ethics pedagogy, the aim of which is to develop ethical mindfulness. Ethical mindfulness is a state of being that acknowledges everyday ethics and ethically important moments as significant in clinical care, with the aim of enabling ethical clinical practice. Using a sample narrative, the authors extend this concept to examine five features of ethical mindfulness as they relate to emotions: (1) being sensitized to emotions in everyday practice, (2) acknowledging and understanding the ways in which emotions are significant in practice, (3) being able to articulate the emotions at play during ethically important moments, (4) being reflexive and acknowledging both the generative aspects and the limitations of emotions, and (5) being courageous.The process of writing and engaging with narratives can lead to ethical mindfulness, including the capacity to understand and work with emotions. Strategies for productively incorporating emotions in narrative ethics teaching are described. This can be a challenging domain within medical education for both educators and health care students and thus needs to be addressed sensitively and responsibly. The potential benefit of educating health professionals in a way which addresses emotionality in an ethical framework makes the challenges worthwhile.

  15. Human resources for health: A narrative review of adequacy and distribution of clinical and nonclinical human resources in hospitals of Iran.

    Science.gov (United States)

    Nobakht, Samin; Shirdel, Arash; Molavi-Taleghani, Yasamin; Doustmohammadi, Mohammad M; Sheikhbardsiri, Hojjat

    2018-03-15

    Human resource supply is considered as one of the most vital factors in achieving organizational goals, and human resources are the most valuable factor in the production and delivery of services. Labor shortages and surpluses could downgrade the quality of services offered to patients. Considering the seriousness of this issue, this study aimed to investigate the status of human resources in Iran hospitals. The narrative review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The key terms "Human Resource," "Human Resource Management," "Staff," "Workforce," "Hospital," "emergency," "staff nursing," "medical," "clinical personnel," "administration," "physician personnel," "non clinical personnel," "hospital personnel," "human development," and "Iran" were used in combination with Boolean operators OR and AND. The Institute for Scientific Information's Web of Science, PubMed, Scopus, ScienceDirect, Ovid, ProQuest, Wiley, Google Scholar, and the Persian database were searched. The research findings revealed that Iran's hospitals have no uniform distribution of human resources. In spite of the concentration of labor forces in some positions (eg, laboratory, radiology, operating room, anesthesia, and midwifery), other positions occupied by physicians and nurses are experiencing serious shortages of human resources, affecting the quality of the provided services. With respect to the study findings, planning to compensate for staff shortages and achieving personnel standard levels as well as providing the grounds for training the heads of wards for proper human resource management and planning would lead to an increase in the efficiency and effectiveness of hospital activities. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Narrative and embodiment

    DEFF Research Database (Denmark)

    Køster, Allan

    2016-01-01

    Recent work on the relation between narrative and selfhood has emphasized embodiment as an indispensable foundation for selfhood. This has occasioned an interesting debate on the relation between embodiment and narrative. In this paper, I attempt to mediate the range of conflicting intuitions...... within the debate by proposing a scalar approach to narrative and an accompanying concept of a split-self (Waldenfels, 2000). Drawing on theoretical developments from contemporary narratology, I argue that we need to move away from a binary understanding of narrative as something an entity (the self......) strictly is or is not; rather, we need to see narrative as an attribute admitting of degrees. I suggest that the relation between narrative and embodiment should be seen along these lines, proposing three levels of the narrativity of embodied experiencing: 1) the unnarratable, 2) the narratable and 3...

  17. Narrative Dietary Counseling

    DEFF Research Database (Denmark)

    Søndergaard Jakobsen, Nina; Kaufmann, Lisbeth; Hennesser, Yvonne

    2017-01-01

    show that the use of whiteboards and narrative learning strategies, such as exploration, externalization, evaluating questions, and unique outcomes, were experienced by the dietitians to provide advantages over the existing practice, which used motivational interviewing alone. Specifically, narrative...

  18. Alopecia in Outdoor Group- and Corral-Housed Baboons (Papio hamadryas spp.).

    Science.gov (United States)

    Lutz, Corrine K; Sharp, R Mark

    2015-07-01

    Alopecia has been reported to occur in several species of captive NHP. Much of this research has focused on macaque monkeys; whether other primate species such as baboons are affected similarly is unknown. Because alopecia can be a focus of inspectors and a possible marker of wellbeing, the purpose of the current study was to survey the occurrence of alopecia in 2 baboon populations and to identify potential risk factors. Subjects were 262 group-housed and 279 corral-housed baboons. Alopecia was assessed cage-side (group-housed) and on sedated animals (corral-housed). Although alopecia was mild in both populations, there were significant effects of season and sex. Alopecia was greater in the winter (group-housed) and the fall (corral-housed) and in female baboons. In addition, the group-housed baboons showed a significant negative effect of age and a lesser effect of group size on alopecia. These results demonstrate that variables other than those associated with animal management practices can affect hair loss in baboons.

  19. Evaluation of permanent alopecia in pediatric medulloblastoma patients treated with proton radiation

    International Nuclear Information System (INIS)

    Min, Chul Hee; Paganetti, Harald; Winey, Brian A; Adams, Judith; MacDonald, Shannon M; Tarbell, Nancy J; Yock, Torunn I

    2014-01-01

    To precisely calculate skin dose and thus to evaluate the relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with proton beams. The dosimetry and alopecia outcomes of 12 children with medulloblastoma (ages 4-15 years) comprise the study cohort. Permanent alopecia was assessed and graded after completion of the entire therapy. Skin threshold doses of permanent alopecia were calculated based on the skin dose from the craniospinal irradiation (CSI) plan using the concept of generalized equivalent uniform dose (gEUD) and accounting for chemotherapy intensity. Monte Carlo simulations were employed to accurately assess uncertainties due to beam range prediction and secondary particles. Increasing the dose of the CSI field or the dose given by the boost field to the posterior fossa increased total skin dose delivered in that region. It was found that permanent alopecia could be correlated with CSI dose with a threshold of about 21 Gy (relative biological effectiveness, RBE) with high dose chemotherapy and 30 Gy (RBE) with conventional chemotherapy. Our results based on 12 patients provide a relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with protons. The alopecia risk as assessed with gEUD could be predicted based on the treatment plan information

  20. [Current approach in the diagnosis and therapy of alopecia in gynecology].

    Science.gov (United States)

    Klobusch, J; Mössler, K; Rabe, T; Runnebaum, B

    1990-12-01

    With an increasing frequency patients complaining problems with their hair show up in gynecologic office practices. We observe cases with alopecia androgenetica; both alopecia climacterica and postpartualis, being subgroups of alopecia androgenetica. From symptomatic as well as from pathogenetic point of view two other forms can be subdivided, to be named alopecia diffusa and alopecia areata. At the Department of Obstetrics and Gynecology of the University of Heidelberg an outpatients consulting programme for women with androgenetic symptoms was established some years before. The diagnostic procedures for a possible classification of the alopecia was intensified. The search for underlying internal diseases and/or endocrinopathies will be the first step towards a pathogenetically correct diagnosis, and if there is no plausible explanation reached by that, the investigation will be extended for heavy metal tracing or for the detection of other ecological damaging influences. A local treatment with thymus gland preparations (Thymu-Skin) was examined by following the conditions of a protocol. After treatment with the preparation (Thymu-Skin) 73% of all cases show improvement of the alopecia. The formula seems to be an effective alternative to the hormonal therapy. It is easy to administer and has no side-effects or contraindications. It proved also to be advisable for prophylactic use in combination with chemotherapy.

  1. A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males

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    Sehdev Singh

    2017-01-01

    Full Text Available Introduction: Androgenetic alopecia is a common form of alopecia with multifactorial etiology. Finasteride and minoxidil are approved by the FDA for the treatment of androgenetic alopecia. Balding scalp is believed to have relative microvascular insufficiency. Blood vessels in the scalp travel through the intramuscular plane. Intramuscular injection of botulinum toxin relaxes muscles and thereby increases blood flow in balding scalp. We conducted a pilot study to evaluate the efficacy of botulinum toxin in androgenetic alopecia management. Material and Methods: The study was conducted in a tertiary care center. A total of 10 male patients with androgenetic alopecia meeting inclusion criteria of the study were included. In the scalp, 30 sites were injected with 5 U of botulinum toxin in each site. Preprocedure photograph taken and evaluation was done, which was repeated after 24 weeks. Efficacy was assessed by photography and self-assessment scoring was done by patients. Results: Of 10 patients, 8 had good to excellent response on photographic assessment. At the end of 24 weeks, 1 patient showed poor and 1 showed fair response to treatment. As per self-assessment, 7of 10 patients showed good to excellent response. Two patients had fair response and 1 patient showed poor response to treatment. Conclusion: Botulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study. Studies with larger sample size and randomized controlled trials are required to establish the role of botulinum toxin in the management of androgenetic alopecia.

  2. Narrative, Preaching, and Formation

    Science.gov (United States)

    Finney, Mark David

    2017-01-01

    This dissertation focuses on the place of narrative in the transformational encounter that can take place between hearers of sermons and God. Chapter 1 surveys the history and development of contemporary scholarship related to narrative preaching. It argues that most homileticians consider narrative either as a way of structuring sermons, or as a…

  3. Beyond the Investment Narrative

    Science.gov (United States)

    Moss, Peter

    2013-01-01

    The current policy interest in early childhood education and care is driven by an investment narrative, a story of quality and high returns emerging from a dominant neoliberal political economy. This short note expresses deep reservations about this narrative, and hints at another narrative that foregrounds democracy, experimentation and…

  4. Performing Narrative Medicine

    Science.gov (United States)

    Langellier, Kristin M.

    2009-01-01

    In this article, the author weaves narrative medicine and performance together to consider what might it mean to call narrative medicine a performance. To name narrative medicine as performance is to recognize the texts and bodies, the stories and selves, that participate in its practice--patients' and physicians' embodied stories as well as the…

  5. Functional realism: a defense of narrative medicine.

    Science.gov (United States)

    Vannatta, Seth; Vannatta, Jerry

    2013-02-01

    In this paper we (1) define and describe the practice of narrative medicine, (2) reveal the need for narrative medicine by exposing the presuppositions that give rise to its discounting, including a reductive empiricism and a strict dichotomy between scientific fact and narrative value, (3) show evidence of the effects of education in narrative competence in the medical clinic, and (4) present Peircean realism as the proper conceptual model for our argument that the medical school curriculum committees should give space to the employment of the scientific and literary knowledge in medical practice. On account of our argument, we contend that the medical community should tend to latitude and openness with regard to the tools we use to resolve medical problems. These tools include both biomedical and narrative knowledge.

  6. Conventional and novel stem cell based therapies for androgenic alopecia

    Directory of Open Access Journals (Sweden)

    Talavera-Adame D

    2017-08-01

    Full Text Available Dodanim Talavera-Adame,1 Daniella Newman,2 Nathan Newman1 1American Advanced Medical Corp. (Private Practice, Beverly Hills, CA, 2Western University of Health Sciences, Pomona, CA, USA Abstract: The prevalence of androgenic alopecia (AGA increases with age and it affects both men and women. Patients diagnosed with AGA may experience decreased quality of life, depression, and feel self-conscious. There are a variety of therapeutic options ranging from prescription drugs to non-prescription medications. Currently, AGA involves an annual global market revenue of US$4 billion and a growth rate of 1.8%, indicating a growing consumer market. Although natural and synthetic ingredients can promote hair growth and, therefore, be useful to treat AGA, some of them have important adverse effects and unknown mechanisms of action that limit their use and benefits. Biologic factors that include signaling from stem cells, dermal papilla cells, and platelet-rich plasma are some of the current therapeutic agents being studied for hair restoration with milder side effects. However, most of the mechanisms exerted by these factors in hair restoration are still being researched. In this review, we analyze the therapeutic agents that have been used for AGA and emphasize the potential of new therapies based on advances in stem cell technologies and regenerative medicine. Keywords: stem cells, stem cell therapies, hair follicle, dermal papilla, androgenic alopecia, laser, hair regeneration

  7. Alopecia and its association with coronary heart disease and cardiovascular risk factors: a meta-analysis.

    Science.gov (United States)

    Trieu, Nelson; Eslick, Guy D

    2014-10-20

    Alopecia has been associated with an increased risk of coronary heart disease as well as the following risk factors for cardiovascular disease: hyperinsulinaemia, insulin resistance, metabolic syndrome, dyslipidaemia, and hypertension. We performed a meta-analysis to quantitatively determine the level of risk of coronary heart disease and risk factors in individuals with alopecia. A systematic literature search was conducted using several databases. We calculated pooled odds ratios and 95% confidence intervals using a random effects model. In total, 31 studies comprising 29,254 participants with alopecia were eligible for the meta-analysis and showed that alopecia is associated with an increased risk of coronary heart disease (OR 1.22, 95% CI: 1.07-1.39), hyperinsulinaemia (OR 1.97, 95% CI: 1.20-3.21), insulin resistance (OR 4.88, 95% CI: 2.05-11.64), and metabolic syndrome (OR 4.49, 95% CI: 2.36-8.53). Individuals with alopecia were also shown to be more likely compared to those without alopecia to have higher serum cholesterol levels (OR 1.60, 95% CI: 1.17-2.21), higher serum triglyceride levels (OR 2.07, 95% CI: 1.32-3.25), higher systolic blood pressures (OR 1.73, 95% CI: 1.29-2.33), and higher diastolic blood pressures (OR 1.59, 95% CI: 1.16-2.18). Alopecia is associated with an increased risk of coronary heart disease, and there appears to be a dose-response relationship with degree of baldness whereby the greater the severity of alopecia, the greater the risk of coronary heart disease. Alopecia is also associated with an increased risk of hypertension, hyperinsulinaemia, insulin resistance, metabolic syndrome, and having elevated serum total cholesterol and triglyceride levels. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Narrative and Institutional Economics

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    Vyacheslav V. Volchik

    2017-12-01

    Full Text Available This article addresses a range of questions associated with the occurrence of a new field of study – narrative economics, which is considered in the context of modern institutionalism. Pioneering works of R. Shiller, G. Akerlof and D. Snower spotlighted the importance of analyzing narratives and narrative influence when studying economic processes. In this paper, a qualitative study of narratives is seen through the prism of an answer to the question: «How do prescribed narratives influence institutions and change them? ». Narratives have much in common with institutions since very often, explicitly or implicitly, they contain value judgements about social interactions or normative aspects shaping behavioral patterns. The identification of dominating narratives enables us to understand better how institutions influence economic (social action. Repeated interactions among social actors are structured through understanding and learning the rules. Understanding of social rules comes from the language – we articulate and perceive the rules drawing on common narratives. Narratives and institutions are helpful when actors gain knowledge about various forms of social communication. Digital technologies, mass media and social networking sites facilitate the spread of narratives, values and beliefs; this process is characterized by increasing returns. Studying narratives and institutions is crucial for modern economic theory because it helps to improve qualitative and quantitative methods of analyzing empirical evidence and enables researchers to understand complex economic processes.

  9. Landscape narratives: crossing realms

    Directory of Open Access Journals (Sweden)

    Matthew Potteiger

    1997-03-01

    Full Text Available Landscape narratives are produced across three related realms: 1. the story 2. the context/intertext and 3. the discourse. The story realm is an analysable system of meaning created by the structuring elements within the world of the story. The contextual or intertextual realm describes the role of individual readers and communities in the production of narratives. The third realm of discourse attends to whose story is told, what purposes it serves and what ideologies inhere in the telling. We apply this framework to interpreting the narrative construction of one place, the Crosby Arboretum in Mississippi. To link the practices of making landscapes to narrative practices requires an expanded notion of text, of the role of readers in producing meaning, as well as recognition of landscape as a spatial narrative shaped by ongoing processes and multiple authors. Design practice derived from understanding these conditions forms 'open narratives', as opposed to the current trend for highly scripted and controlled narratives.

  10. Causes of diffuse alopecia in women

    Directory of Open Access Journals (Sweden)

    Rustom Aziza

    1994-01-01

    Full Text Available Fifty female patients ranging in age between 14-45 years, complaining of a diffuse loss of hair for periods varying from 1-22 months were thoroughly interrogated to look for the factors leading to the hair loss. Laboratory investigations undertaken included a routine estimation of haemoglobin, ESR, urinalysis, examination of the stools, and any other test indicated by the history or examination. The hair loss was quantitated by asking the patient to collect all the fallen hairs during a 24 hours period for 7 consecutive days, and pack them into appropriately labelled polythene bags. Each collection was weighed to calculated the average daily loss. Such collections were repeated once a month for a period of 4-5 months to monitor the variations in the hair loss and study the effect for treatment. Ten hairs randomly picked from each collection were examined microscopically to look for any shaft abnormalities in addition to the examination of the root end and the distal end. The probable causes of hair loss in these patients were found to be psychologic stress in 21 cases, fever in 11 cases, child-birth/abortion in 5 cases, and a surgical operation in 3 cases. Some of these cases had more than one factor, while in 15 cases there was no clinical evidence of any of the known causes of hair loss. Routine laboratory investigations however revealed a haemoglobin level of less than 12 gm% in 25 cases, an ESR higher than 20 mm in 18 cases, asymptomatic urinary tract infection in 13 cases and gastro-intestinal parasites in stools in 12 cases. Thus every patient had at least one of the causative factors, while several patients had more than one factor which could be responsible for the hair loss. Almost all the cases in this group seemed to have telogen effluvium. Examination of the root end in most of the hairs showed a club hair, while the hair shaft revealed trichorrhexis in some of the hairs in 10 cases and trichoptilosis in 3 cases. Appropriate

  11. Fatigue, alopecia and stomatitis among patients with breast cancer receiving cyclin-dependent kinase 4 and 6 inhibitors: a systematic review and meta-analysis.

    Science.gov (United States)

    Lasheen, Shaimaa; Shohdy, Kyrillus S; Kassem, Loay; Abdel-Rahman, Omar

    2017-09-01

    Cyclin-dependent kinase (CDK) inhibitors emerge as efficacious agents in hormone positive metastatic breast cancer with more acceptable toxicity profiles than cytotoxic chemotherapy. However, some adverse effects such as fatigue, alopecia and stomatitis, vastly concern patients. The search was conducted in PubMed, American Society of Clinical Oncology meeting library, European Society for Medical Oncology meeting abstract, and the San Antonio meeting abstract databases. We identified phase 2 or 3 trials recruiting patients with breast cancer, randomized to receive hormonal treatment plus either CDK4/6 inhibitors or placebo. We considered studies providing incidence of fatigue, alopecia and stomatitis relevant. One thousand records were screened. 34 studies were considered relevant. Four studies were found to be eligible for meta-analysis with a total of 2007 patients. The relative risk for all grade fatigue was 1.34 [95% CI: 1.17-1.54, p alopecia was 2.14 [95% CI: 1.23-3.73, p = 0.007], and for all grade stomatitis 4.87 [95% CI: 2.11-11.24, p = 0.0002]. In addition, the relative risk for high grade fatigue was 2.40 [95% CI: 1.10-5.26, p = 0.03]. CDK4/6 inhibitors were associated with an increased risk of fatigue, alopecia and stomatitis. Further studies with self-reported questionnaires may elucidate the impact of the increased risk of these selected adverse effects on the patients' quality of life.

  12. Treatment and prevention of chemotherapy-induced alopecia with PTH-CBD, a collagen-targeted parathyroid hormone analog, in a non-depilated mouse model

    Science.gov (United States)

    Katikaneni, Ranjitha; Ponnapakkam, Tulasi; Matsushita, Osamu; Sakon, Joshua; Gensure, Robert

    2014-01-01

    Alopecia is a psychologically devastating complication of chemotherapy for which there is currently no effective therapy. PTH-CBD is a collagen-targeted parathyroid hormone analog that has shown promise as a therapy for alopecia disorders. To compare the efficacy of prophylactic versus therapeutic administration of PTH-CBD in chemotherapy-induced alopecia using a mouse model that mimics the cyclic chemotherapy dosing used clinically. C57BL/6J mice were treated with a single subcutaneous injection of PTH-CBD (320 mcg/kg) or vehicle control before or after hair loss developing from three courses of cyclophosphamide chemotherapy (50–150 mg/kg/week). Mice receiving chemotherapy alone developed hair loss and depigmentation over 6–12 months. Mice pretreated with PTH-CBD did not develop these changes and maintained a normal-appearing coat. Mice treated with PTH-CBD after development of hair loss showed a partial recovery. Observations of hair loss were confirmed quantitatively by gray scale analysis. Histological examination showed that in mice receiving chemotherapy alone, there were small, dystrophic hair follicles mostly in the catagen phase. Mice receiving PTH-CBD before chemotherapy showed a mix of normal-appearing telogen and anagen hair follicles with no evidence of dystrophy. Mice receiving PTH-CBD therapy after chemotherapy showed intermediate histological features. PTH-CBD was effective in both the prevention and the treatment of chemotherapy-induced alopecia in mice, but pretreatment appears to result in a better cosmetic outcome. PTH-CBD shows promise as an agent in the prevention of this complication of chemotherapy and improving the quality of life for cancer patients. PMID:24025564

  13. Treatment and prevention of chemotherapy-induced alopecia with PTH-CBD, a collagen-targeted parathyroid hormone analog, in a non-depilated mouse model.

    Science.gov (United States)

    Katikaneni, Ranjitha; Ponnapakkam, Tulasi; Matsushita, Osamu; Sakon, Joshua; Gensure, Robert

    2014-01-01

    Alopecia is a psychologically devastating complication of chemotherapy for which there is currently no effective therapy. PTH-CBD is a collagen-targeted parathyroid hormone analog that has shown promise as a therapy for alopecia disorders. This study compared the efficacy of prophylactic versus therapeutic administration of PTH-CBD in chemotherapy-induced alopecia using a mouse model that mimics the cyclic chemotherapy dosing used clinically. C57BL/6J mice were treated with a single subcutaneous injection of PTH-CBD (320 mcg/kg) or vehicle control before or after hair loss developing from three courses of cyclophosphamide chemotherapy (50-150 mg/kg/week). Mice receiving chemotherapy alone developed hair loss and depigmentation over 6-12 months. Mice pretreated with PTH-CBD did not develop these changes and maintained a normal-appearing coat. Mice treated with PTH-CBD after development of hair loss showed a partial recovery. Observations of hair loss were confirmed quantitatively by gray scale analysis. Histological examination showed that in mice receiving chemotherapy alone, there were small, dystrophic hair follicles mostly in the catagen phase. Mice receiving PTH-CBD before chemotherapy showed a mix of normal-appearing telogen and anagen hair follicles with no evidence of dystrophy. Mice receiving PTH-CBD therapy after chemotherapy showed intermediate histological features. PTH-CBD was effective in both the prevention and the treatment of chemotherapy-induced alopecia in mice, but pretreatment appears to result in a better cosmetic outcome. PTH-CBD shows promise as an agent in the prevention of this complication of chemotherapy and improving the quality of life for cancer patients.

  14. Estudo do manejo do estresse em pacientes acometidos por alopecia areata Estudio del manejo del estrés en pacientes acometidos por alopecia areata A study of stress management in patients stricken by alopecia areata

    Directory of Open Access Journals (Sweden)

    Simone Maria Godinho

    2009-03-01

    Full Text Available Alopecia Areata é uma dermatose caracterizada pela perda repentina de pêlos em uma única ou em várias áreas, na forma de círculo. Normalmente a perda se inicia no couro cabeludo, podendo também ocorrer em outras partes do corpo. Fatores emocionais traumáticos são referidos como desencadeantes. Um grupo de 12 pacientes acometidos de alopecia areata foi avaliado por meio de entrevista psicológica e do método de Rorschach (Sistema Compreensivo por Exner, com vista a identificar as condições de personalidade dos pacientes no que se refere ao manejo do estresse. Todos os pacientes relataram episódios traumáticos em suas vidas que poderiam ser considerados como desencadeantes da doença, e nove apresentaram nítidas dificuldades no controle e manejo do estresse.Alopecia Areata es una dermatosis caracterizada por la pierda de pelos, de forma rápida y en áreas. La pierda ocurre normalmente en los cabellos, como también en partes del cuerpo. Factores emocionales traumáticos son referidos como desencadenantes. Un grupo de 12 pacientes acometidos de alopecia areata fue evaluado por medio de entrevista psicológica y método de Rorschach (Sistema Comprensivo por Exner, pretendiendo un estudio exploratorio de la dinámica emocional y de la influencia de los factores psicológicos en la etiología de la alopecia areata. Todos los pacientes relataron episodios traumáticos en sus vidas que podrían ser considerados como desencadenantes de la enfermedad, y nueve presentaron nítidas dificultades en el control y manejo del estrés.Alopecia areata is a common dermatological disorder characterized by the rapid loss of hair in single or multiple patches. Hair loss is often on the scalp, but can also occur in other areas of the body. Psychological traumas have often been cited as precipitating factors. An evaluation of a group of twelve patients diagnosed with alopecia areata was undertaken using psychological interviews and the Rorschach Test

  15. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients.

    Science.gov (United States)

    Hu, Ruiming; Xu, Feng; Sheng, Youyu; Qi, Sisi; Han, Yumei; Miao, Ying; Rui, Wenlong; Yang, Qinping

    2015-01-01

    Finasteride at 1 mg/day and 5% topical minoxidil are effective in male androgenetic alopecia (MAGA). However, studies describing their effects in Chinese individuals are scarce. 450 Chinese MAGA patients were randomly assigned to receive finasteride (n = 160), minoxidil (n = 130) and combined medication (n = 160) for 12 months. The patients returned to the clinic every 3 months for efficacy evaluation. And efficacy was evaluated in 428 men at treatment end, including 154, 122, and 152 in the finasteride, 5% minoxidil, and combination groups, respectively. All groups showed similar baseline characteristics, including age at enrollment, and duration and severity of alopecia (p > 0.05). At 12 months, 80.5, 59, and 94.1% men treated with finasteride, 5% minoxidil and the combination therapy showed improvement, respectively. Adverse reactions were rare (finasteride, 1.8%; minoxidil, 6.1%), and disappeared right after drug withdrawal. In conclusion, finasteride is superior to 5% minoxidil, while the combined medication showed the best efficacy. © 2015 Wiley Periodicals, Inc.

  16. Recent Advances in the Pathogenesis of Autoimmune Hair Loss Disease Alopecia Areata

    Directory of Open Access Journals (Sweden)

    Taisuke Ito

    2013-01-01

    Full Text Available Alopecia areata is considered to be a cell-mediated autoimmune disease, in which autoreactive cytotoxic T cells recognize melanocyte-associated proteins such as tyrosinase. This review discusses recent advances in the understanding of the pathogenesis of alopecia areata, focusing on immunobiology and hormonal aspects of hair follicles (HFs. The HF is a unique “miniorgan” with its own immune and hormonal microenvironment. The immunosuppressive milieu of the anagen hair bulb modulated by immunosuppressive factors is known as “hair follicle immune privilege.” The collapse of the hair follicle immune privilege leads to autoimmune reactions against hair follicle autoantigens. Alopecia areata is sometimes triggered by viral infections such as influenza that causes excess production of interferons (IFN. IFN-γ is one of the key factors that lead to the collapse of immune privilege. This paper reviews the interactions between the endocrine and immune systems and hair follicles in the pathogenesis of alopecia areata.

  17. Assessing a faculty development workshop in narrative medicine.

    Science.gov (United States)

    Liben, Stephen; Chin, Kevin; Boudreau, J Donald; Boillat, Miriam; Steinert, Yvonne

    2012-01-01

    Narrative medicine is increasingly popular in undergraduate medical curricula. Moreover, although faculty are expected to use narrative approaches in teaching, few faculty development learning activities have been described. In addition, data on the impact of faculty development initiatives designed to teach narrative are limited, and there is a paucity of tools to assess their impact. To assess the impact and outcomes of a faculty development workshop on narrative medicine. Two groups of clinical teachers were studied; one group had already attended a half-day narrative medicine workshop (N = 10) while the other had not yet attended (N = 9). Both groups were interviewed about their uses of narrative in teaching and practice. Additionally, the understanding of a set of narrative skills was assessed by first viewing a video of a narrative-based teaching session followed by completion of an 18-item assessment tool. Both groups reported that they used narrative in both their teaching and clinical practice. Those who had attended the workshop articulated a more nuanced understanding of narrative terms compared to those who had not yet attended. This study is one of the first to describe measureable impacts of a faculty development workshop on narrative medicine.

  18. Calvitron Automated Hair Transplant System in Alopecia Treatment: A Case Report

    OpenAIRE

    Chin-Chiang Yang

    2003-01-01

    The surgical treatment of alopecia is essentially based on minigraft and micrograft techniques in which grafts are inserted into a slit or punch recipient site. To facilitate the transplantation of large numbers of these small grafts, the Calvitron automated hair transplant system has been developed. We report a case of Norwood type V alopecia who received three sessions of hair transplantation (400-500 grafts per session) over 18 months with satisfactory results. During surgery, with one tec...

  19. Cancer-related hair loss: a selective review of the alopecia research literature.

    Science.gov (United States)

    Dua, Priya; Heiland, Mark F; Kracen, Amanda C; Deshields, Teresa L

    2017-04-01

    Alopecia is a common side effect of cancer treatment, affecting approximately 65% of patients. Healthcare providers and allied staff recognize that alopecia is distressing for people with cancer; however, they are often unaware of the extent of distress or the great efforts expended by patients to cope with hair loss. This study reviews the existing literature regarding the psychosocial impact of alopecia on cancer survivors and the coping strategies they use to manage hair loss. We searched for studies examining the psychosocial effects of alopecia on cancer survivors using PubMed and PsycInfo databases and Google Scholar. A total of 36 peer-reviewed articles were deemed relevant to be included in this review. In this review, alopecia was consistently ranked as one of the most distressing side effects of cancer treatment. Survivors report that hair loss disrupts how they experience their bodies, interact with others, and conceptualize their body image beyond treatment. Although upsetting for both genders, the scarce literature that exists suggests that there may be some gender-specific aspects of experiencing cancer-related hair loss. Cancer survivors cope with alopecia in numerous ways and often rely on strategies such as concealment, social support, social avoidance, information seeking, and behavioral rehearsal. Treatment-induced alopecia negatively affects millions of survivors each year in unique and nuanced ways. We hope that survivors' healthcare providers and loved ones may better appreciate the psychosocial challenges they experience related to hair loss, as well as the strategies they use to cope. Further research is much needed to better understand cancer-related alopecia. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Age-dependent associations between androgenetic alopecia and prostate cancer risk.

    Science.gov (United States)

    Muller, David C; Giles, Graham G; Sinclair, Rod; Hopper, John L; English, Dallas R; Severi, Gianluca

    2013-02-01

    Both prostate cancer and androgenetic alopecia are strongly age-related conditions that are considered to be androgen dependent, but studies of the relationship between them have yielded inconsistent results. We aimed to assess whether androgenetic alopecia at ages 20 and 40 years are associated with risk of prostate cancer. At a follow-up of the Melbourne Collaborative Cohort Study, men were asked to assess their hair pattern at ages 20 and 40 years relative to eight categories in showcards. Cases were men notified to the Victorian Cancer Registry with prostate cancer diagnosed between cohort enrollment (1990-1994) and follow-up attendance (2003-2009). Flexible parametric survival models were used to estimate age-varying HRs and predicted cumulative probabilities of prostate cancer by androgenetic alopecia categories. Of 9,448 men that attended follow-up and provided data on androgenetic alopecia, we identified 476 prostate cancer cases during a median follow-up of 11 years four months. Cumulative probability of prostate cancer was greater at all ages up to 76 years, for men with vertex versus no androgenetic alopecia at age of 40 years. At age of 76 years, the estimated probabilities converged to 0.15. Vertex androgenetic alopecia at 40 years was also associated with younger age of diagnosis for prostate cancer cases. Vertex androgenetic alopecia at age of 40 years might be a marker of increased risk of early-onset prostate cancer. If confirmed, these results suggest that the apparently conflicting findings of previous studies might be explained by failure to adequately model the age-varying nature of the association between androgenetic alopecia and prostate cancer.

  1. High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata.

    Science.gov (United States)

    Smith, Alexandra; Trüeb, Ralph M; Theiler, Martin; Hauser, Valérie; Weibel, Lisa

    2015-01-01

    Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days). Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos). IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients. © 2015 Wiley Periodicals, Inc.

  2. Тіе Modern treatment of androgenetic alopecia

    Directory of Open Access Journals (Sweden)

    V. K. Karnaukhov

    2017-01-01

    Full Text Available Androgenetic alopecia (AGA is the most common reason for hair loss. Its frequency in Caucasian population is up to 80% in men and 42% in women. Current gold standard for AGA treatment includes minoxidil and/or finasteride. Both drugs have moderate treatment efficacy and can cause significant side effects. Minoxidil is the only option for treatment of AGA in women since finasteride has no efficacy. This review considers actual concepts of molecular mechanisms of pathogenesis and current treatment options of AGA with their limitations and shortcomings. Current state and perspectives of novel approaches to AGA treatment, potentially more effective and safe than minoxidil and finasteride, are described. The review discusses growth factors and cytokines, topical 5-alpha-reductase inhibitors, androgen receptor antagonists, prostaglandin analogs and antagonists, Wnt signaling activators and platelet-rich plasma injections.

  3. THE ROLE OF ESTROGEN IN WOMEN WITH ANDROGENETIC ALOPECIA

    Directory of Open Access Journals (Sweden)

    Putu Diah Pratiwi

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Hair loss may accured in both male and female population. Hair loss usually accured in Telogenic phase, meanwhile in Anagenic phase hair loss due to chemotherapy or radiation. Female pattern hair loss (FPHL is regarded as hair fall type which is accured in women in common and known as female androgenetic alopecia. Almost 40%, 50 years old female shown hair fall sign, which is developed progressive fibrosing alopecia of central scalp, especially in frontal and parietal area. There are two common treatment for Female pattern Hair Loss are Minoxidil for topical use, and Fenesteride by oral. However, it has long been known that estrogens also profoundly alter hair follicle growth and cycling by binding to locally expressed high-affinity estrogen receptors (ERs, in turn increase anagenic phase and represed telogenic phase. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  4. CD123 immunohistochemistry for plasmacytoid dendritic cells is useful in the diagnosis of scarring alopecia.

    Science.gov (United States)

    Fening, Katherine; Parekh, Vishwas; McKay, Kristopher

    2016-08-01

    Distinguishing types of lymphocytic scarring alopecia is often difficult because of the overlapping features. Recently, the presence of plasmacytoid dendritic cells (PDCs) in cutaneous lupus erythematosus (LE) was demonstrated and further shown to help distinguish lupus from other dermatoses.1-6 This study aims to determine if the presence and distribution of PDCs can aid in the diagnosis of scarring alopecia. Cases of scarring alopecia due to chronic cutaneous lupus erythematosus (CCLE), lichen planopilaris (LPP) and central centrifugal cicatricial alopecia (CCCA) were examined histopathologically. A total of 45 total biopsies were evaluated and CD123 immunohistochemistry was performed on all samples. The relative percentage of PDCs, the presence of clusters and the distribution of CD123+ cells were noted. PDCs comprised a greater percentage of the infiltrate and were arranged in clusters in cases of CCLE vs. LPP or CCCA. In CCLE, the location of PDCs was perivascular, perifollicular, perieccrine and/or at the follicular junction. In LPP and CCCA, PDCs were mainly arranged as single, interstitial cells. Our findings suggest that the presence and arrangement of CD123+ PDCs may assist in the diagnosis of scarring alopecia. We anticipate this will be of value in diagnosing challenging cases of highly inflammatory scarring alopecia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Our experiences on the reconstruction of lateral scalp burn alopecia with tissue expanders.

    Science.gov (United States)

    Guzey, Serbulent; Alhan, Doğan; Şahin, Ismail; Aykan, Andaç; Eski, Muhitdin; Nişancı, Mustafa

    2015-05-01

    Cicatricial alopecia is a form of hair loss that causes both cosmetic and psychological concerns. Although tissue expanders are the common approach to reconstruction, no algorithm exists in the literature for this process. In this study, it was aimed to create an algorithm for the reconstruction of lateral scalp alopecias with the goal to achieve better and standardized results. Lateral scalp alopecias were divided into three groups: total lateral alopecia (type I), temporal and sideburn alopecia (type II), and sideburn alopecia (type III). Tissue expanders were placed at the parieto-occipital area in type I defects, parietal area in type II defects, and the temporal region in type III defects. Tissue expanders were used to create flaps that were advanced with 60° rotation, 90° rotation, and no rotation for type I, II, and III defects, respectively. Fifteen patients were treated with this algorithm. Using this simple approach, we achieved natural, standardized aesthetic results for each patient, all of whom were satisfied with the final results. Although the number of case were limited, the ideal and standardized cosmetic results could be obtained by this approach. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  6. Organizational Remembering as Narrative

    DEFF Research Database (Denmark)

    Musacchio Adorisio, Anna Linda

    2014-01-01

    This article focuses on organizational remembering in banking. To provide an alternative to the repository image of memory in organization, organizational remembering is conceptualized as narrative, where narrative represents a way to organize the selection and interpretation of the past....... The narrative perspective deals with both the experiential and contextual nature of remembering by addressing concerns raised by critiques of organizational memory studies, namely, the subjective experience of remembering and the social and historical context in which remembering takes place. Antenarrative...... and microhistory methods are employed to discuss narrative fragments of remembering that deviate from consolidated narratives and indicate normal exceptions and an ‘ante’ state of affairs. Based on the study of narrative fragments of remembering in two different banking contexts, the article illustrates how...

  7. Narrative self-appropriation

    DEFF Research Database (Denmark)

    Køster, Allan

    2017-01-01

    role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing...... the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern “from behind”. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD......; particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame....

  8. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    Directory of Open Access Journals (Sweden)

    de Vries Martine C

    2011-09-01

    Full Text Available Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1 a narrative review of (primarily qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2 comparison of these experiences with existing theoretical ethical concepts about (pediatric research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist. True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the

  9. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial.

    Science.gov (United States)

    Panahi, Yunes; Taghizadeh, Mohsen; Marzony, Eisa Tahmasbpour; Sahebkar, Amirhossein

    2015-01-01

    Rosmarinus officinalis L. is a medicinal plant with diverse activities including enhancement microcapillary perfusion. The present study aimed to investigate the clinical efficacy of rosemary oil in the treatment of androgenetic alopecia (AGA) and compare its effects with minoxidil 2%. Patients with AGA were randomly assigned to rosemary oil (n = 50) or minoxidil 2% (n = 50) for a period of 6 months. After a baseline visit, patients returned to the clinic for efficacy and safety evaluations every 3 months. A standardized professional microphotographic assessment of each volunteer was taken at the initial interview and after 3 and 6 months of the trial. No significant change was observed in the mean hair count at the 3-month endpoint, neither in the rosemary nor in the minoxidil group (P > .05). In contrast, both groups experienced a significant increase in hair count at the 6-month endpoint compared with the baseline and 3-month endpoint (P .05). The frequencies of dry hair, greasy hair, and dandruff were not found to be significantly different from baseline at either month 3 or month 6 trial in the groups (P > .05). The frequency of scalp itching at the 3- and 6-month trial points was significantly higher compared with baseline in both groups (P minoxidil group at both assessed endpoints (P < .05). The findings of the present trial provided evidence with respect to the efficacy of rosemary oil in the treatment of AGA.

  10. SERUM-CONCENTRATIONS OF Dehydroepyandrosterone-sulfate IN MEN WITH ANDROGENETIC ALOPECIA

    Directory of Open Access Journals (Sweden)

    Ani Tsvetanova

    2004-10-01

    Full Text Available Androgenetic alopecia (AA is considered as a genetically determinate androgen (DHT-dependent disorder. Theoretically Dehydroepyandrosterone-sulfate (DHEA-S is the first main metabolite in the androgen metabolism. The aim of the study was to determine the serum-levels of DHEA-S (DHEA-S(s in patients with AA and the possible correlation between clinical stage of AA and DHEA-S(s. Forty-four men (37 with male pattern baldness and 7 healthy controls aged 19 to 55 had DHEA-S(s measured. Determination of the hormone was performed by standard radioimmunoassay. Only nine of the men with AA showed high levels of DHEA-S(s. In 3 of the patients were detected a boundary high levels of DHEA-S(s. No correlation between the clinical stage of AA and DHEA-S(s -levels was established. There was relationship only between increase of the age and decrease of the concentrations of DHEA-S(s. In contrast to previous studies, in our investigation, no elevation of DHEA-S(s in men with AA was found. Our results indirect support the current understanding of the importance of some follicular enzymes (STS, 3-beta-HSD, 17-beta-HSD etc. that could increase the amount of the alternative DHT-sources in AA, as well as the theory for the “endocrinology of hair follicle”.

  11. Valuing narrative in the care of older people: a framework of narrative practice for older adult residential care settings.

    Science.gov (United States)

    Buckley, Catherine; McCormack, Brendan; Ryan, Assumpta

    2014-09-01

    To report on the development of a framework of narrative practice, in residential care settings for older people. Residential care settings for older people provide care for people who are no longer able to live in their own home. To date, the impact and structure of nursing practice on care provision in these settings has proved difficult to conceptualise within a specific nursing theory framework. A hermeneutic approach incorporating narrative methods was used. Forty-six narrative interviews with older people in residential care were secondary-analysed for key themes through a three-stage process: by the first author, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Finally, the combined findings were used to derive a single set of themes. The secondary data analysis process led to the development of a framework of narrative practice for the care of older people in residential settings. The framework is influenced by narrative enquiry, person-centred practice and practice development. It has four pillars, prerequisites, care processes, care environment and narrative aspects of care. To operationalise the framework of narrative practice, three narrative elements, narrative knowing, narrative being and narrative doing, need to be considered. Working with the foundational pillars and the narrative elements would enable staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults in residential care. This framework provides nurses with a template that confirms the identity of the older person taking account of their biography. The framework outlines an approach that provides staff with a template on how to provide person-centred care in a narrative way. © 2013 John Wiley & Sons Ltd.

  12. Narrativity in Teaching Materials

    DEFF Research Database (Denmark)

    Poulsen, Jens Aage

    2010-01-01

    Analyse af narrative strukturer i nordiske læremidler om historie- og nordiske læreres forståelse og brug af læremidlerne i undervisningen......Analyse af narrative strukturer i nordiske læremidler om historie- og nordiske læreres forståelse og brug af læremidlerne i undervisningen...

  13. Narrative History and Theory

    Science.gov (United States)

    Tamura, Eileen H.

    2011-01-01

    While narrative history has been the prevailing mode in historical scholarship, its preeminence has not gone unquestioned. In the 1980s, the role of narrative in historical writing was "the subject of extraordinarily intense debate." The historical backdrop of this debate can be traced to the preceding two decades, when four groups of thinkers…

  14. Narrator-in-Chief

    DEFF Research Database (Denmark)

    Herron, Mark A.

    The dissertation Narrator-in-Chief: The Narrative Rhetoric of Barack Obama seeks to show how the concept of “narrative” can be used in rhetorical criticism of presidential speeches, particularly when considering the speeches and the biographical text, Dreams from My Father (1995), of Barack Obama...

  15. More STELLA Narratives.

    Science.gov (United States)

    Doecke, Brenton

    2001-01-01

    Presents six brief (about one page) narratives by primary and secondary teachers arising from STELLA (Standards for Teachers of English Language and Literacy in Australia) workshops and interpretive discussions. Notes that each narrative describes a moment of "good" English/literacy teaching. (SG)

  16. Narrative, history and self

    DEFF Research Database (Denmark)

    Køster, Allan

    There is a strong tradition in psychology and philosophy, claiming that the self is a narrative construction. The paper examines this idea and concludes that the narrative self is not a viable theoretical construct, but that we should opt for an adjacent idea of a historical self. The aim is to e...

  17. Narrative accounting disclosures

    NARCIS (Netherlands)

    Aerts, Walter; Clubb, C.; Imam, S.

    2015-01-01

    Narrative accounting disclosures are an integral part of the corporate financial reporting package. They are deemed to provide a view of the company “through the eyes of management”. The narratives represent management's construal of corporate events and are largely discretionary. Research in

  18. Visual Narrative Structure

    Science.gov (United States)

    Cohn, Neil

    2013-01-01

    Narratives are an integral part of human expression. In the graphic form, they range from cave paintings to Egyptian hieroglyphics, from the Bayeux Tapestry to modern day comic books (Kunzle, 1973; McCloud, 1993). Yet not much research has addressed the structure and comprehension of narrative images, for example, how do people create meaning out…

  19. Narrating Peoplehood amidst Diversity

    DEFF Research Database (Denmark)

    Böss, Michael

    In Narrating Peoplehood amidst Diversity, 16 internationally renowned scholars reflect on the nature and history of peoplehood and discuss how narratives inform national identities, public culture and academic historiography. The book is a timely contribution to the ongoing debate on belonging...

  20. Personal history, beyond narrative

    DEFF Research Database (Denmark)

    Køster, Allan

    2017-01-01

    Narrative theories currently dominate our understanding of how selfhood is constituted and concretely individuated throughout personal history. Despite this success, the narrative perspective has recently been exposed to a range of critiques. Whilst these critiques have been effective in pointing...... out the shortcomings of narrative theories of selfhood, they have been less willing and able to suggest alternative ways of understanding personal history. In this article, I assess the criticisms and argue that an adequate phenomenology of personal history must also go beyond narrative. Drawing...... on a distinction between history and narrative, I outline an account of historical becoming through a process of sedimentation and a rich notion of what I call historical selfhood on an embodied level. Five embodied existentials are suggested, sketching a preliminary understanding of how selves are concretely...

  1. Follicular microhemorrhage: a unique dermoscopic sign for the detection of coexisting trichotillomania in alopecia areata.

    Science.gov (United States)

    Ise, Misaki; Amagai, Masayuki; Ohyama, Manabu

    2014-06-01

    The diagnosis of trichotillomania (TT) is often difficult as it presents similar clinical manifestations with other hair loss diseases, especially alopecia areata (AA). As TT often coexists with AA, the methodology enabling reliable detection of TT in AA needs to be developed. Recently, characteristic dermoscopic findings of TT have been reported, yet, they were most clearly detectable by conventional immersion dermoscopy, not by dry dermoscopy, a technique more easily adoptable in daily practice. In addition, the usefulness of those signs for differentiating TT from AA has not been sufficiently assessed. Through intensive scanning of hair loss lesions by dry dermoscopy in AA patients with TT, we found a sign potentially useful for detecting hidden TT. The sign we named "follicular microhemorrhage" (FMH) represents a red dot corresponding to a follicular ostia capped or stuffed with blood clot and suggests a history of traumatic forced plucking. So far, we have detected FMH in four TT patients with moderate to severe AA. Although further accumulation of cases is necessary, FMH would be beneficial to dissect complicated pathophysiology of hair loss in AA patients with TT. © 2014 Japanese Dermatological Association.

  2. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia.

    Science.gov (United States)

    Gupta, Aditya K; Charrette, Andrew

    2015-01-01

    Topical minoxidil has become a mainstay in the treatment of androgenetic alopecia (AGA). Despite being a longstanding treatment for AGA, relatively few reviews of its efficacy have been published. The current study sought to synthesize the available efficacy data by performing a systematic review of the literature and conducting random-effects pairwise meta-analyses for the outcomes percent increase in hair count from baseline, investigator assessment, and patient self-assessment. Results showed that minoxidil is more effective than placebo in promoting total and nonvellus hair growth (mean difference [MD], 16.68; 95% confidence interval [CI], 9.34-24.03 and MD, 20.90; 95% CI, 9.07-32.74). A significantly higher proportion of participants in the minoxidil group had greater hair growth than participants in the placebo group as judged by both investigators and self-reports (relative risk [RR], 2.28; 95% CI, 1.58-3.31 and RR, 1.56; 95% CI, 1.34-1.80). Despite significant clinical efficacy, cosmetically acceptable results are present in only a subset of patients. Compliance is thought to be a major limiting factor and is being addressed by novel formulations and combinations.

  3. [Penetration and side effects of local estrogen application in alopecia androgenetica].

    Science.gov (United States)

    Orfanos, C E; Wüstner, H

    1975-07-01

    In 30 male patients aged 17-37 with definite androgenetic ("male pattern") alopecia (AA, telogen hair rate greater than 20%) the total urinary estrogen level was estimated before and after topical treatment: In 18 patients estrogen in a alcoholic vehicle (0.05% dienestroldiacetate) was daily applied on the scalp skin; whereas 12 patients were treated with a corresponding preparation without estrogen and served as controls. Before treatment the average estrogen level of all patients with AA was 23.3 mum/24 hrs (individual data ranged from 9.4-45.6 mum/24 hrs) and was thus slightly elevated but still within the normal range. 3 and 6 months after treatment no significant differences of the urinary estrogen level were found between the controlled patients of the two groups and, similarly, no clinical side-effects of the estrogen application (gynecomasty etc.) were recorded. It seems, on the basis of this study, that a long-term topical treatment with estrogen does not involve considerable risks regarding side-effects on male adults, in contrast to children and youngsters. On the assumption that estrogen may be effective in AA, a local mechanism of action on the hair follicle is considered.

  4. The contribution of endogenous and exogenous factors to male alopecia: a study of identical twins.

    Science.gov (United States)

    Gatherwright, James; Liu, Mengyuan T; Amirlak, Bardia; Gliniak, Christy; Totonchi, Ali; Guyuron, Bahman

    2013-05-01

    The purpose of this study was to investigate the potential contribution of environmental factors and testosterone on male alopecia. Ninety-two identical male twins were recruited from 2009 to 2011. A comprehensive questionnaire was completed followed by the acquisition of sputum samples for testosterone analysis and standardized digital photography. Frontal, temporal, and vertex hair loss was assessed from these photographs. Hair loss was then correlated with survey responses and testosterone levels between twin pairs. Two independent, blinded observers also rated the photographs for hair thinning. Increased smoking duration (p money spent on hair loss products (p = 0.050) were all associated with increased temporal hair loss. Daily hat use (p = 0.050), higher body mass index (p = 0.012), and higher testosterone levels (p = 0.040) were associated with decreased temporal hair loss. Factors that were significantly associated with increased vertex hair loss included abstinence from alcohol consumption (p = 0.030), consumption of more than four alcoholic drinks per week (p = 0.004), increased smoking duration (p = 0.047), increased exercise duration (p = 0.050), and increased stress duration (p = 0.010). Lower body mass index, more children, increased caffeine consumption, history of skin disease, and abstinence from alcohol were significantly associated with increased hair thinning scores (p exogenous factors may have a clinically significant impact on hair loss. Risk, III.

  5. Myopericytoma as an unusual cause of scarring alopecia in a child

    Directory of Open Access Journals (Sweden)

    Ying-Fang Lin

    2014-03-01

    Full Text Available Myopericytoma is a benign tumor composed of myoid-appearing oval to spindle-shaped cells arranged in a concentric perivascular pattern of growth. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults, and presents as a well-circumscribed, slow-growing, painless firm tumor. We describe a case of myopericytoma with unusual clinical presentation as scarring alopecia in a 14-year-old girl without any underlying disease, who presented with a 2-month history of a pink patch with hair loss on her frontal scalp. Under the diagnosis of discoid lupus erythematosus, an incisional biopsy was also performed. The biopsy specimen revealed a myopericytoma characterized by a subcutaneous large vein-like structure surrounded by spindled, stellate, and cuboidal cells with multiple small branching vascular spaces. The overlying dermis was fibrotic with dilated vessels and the number of hair follicles was decreased. No features of lupus erythematosus were noted and a lupus band test was negative. Total excision was performed. No recurrence occurred in the following 2 years.

  6. Quantitative Analysis Using the Phototrichogram Technique of an Italian Population Suffering from Androgenic Alopecia

    Directory of Open Access Journals (Sweden)

    Sara Brancato

    2018-04-01

    Full Text Available In this study, the values of some scalp basal parameters, collected during several clinical studies involving a total of 254 subjects with androgenic alopecia, were analyzed. Subjects’ values were grouped by age and gender, and the differences between groups were examined. The density values (n° of hair/cm2 and the percentages of anagen and telogen hair were considered. Furthermore, the variations recorded at the end of cosmetic treatments (ranging from 12 to 16 weeks aiming to reduce excessive hair loss were analyzed. The basal values regarding the percentage of hair in the anagen phase evidenced a linear decrease with increasing age, with a corresponding increase of the percentage of hair in the telogen phase. As far as the hair density differences between males and females are concerned, females had a mean value significantly higher than males. Moreover, at the end of the intended anti-hair loss treatments, females were more susceptible to improvements of their hair density values.

  7. Alopecia in IL-10-deficient Mouse Pups is c-Kit-Dependent and Can Be Triggered by Iron Deficiency

    Science.gov (United States)

    Vanderford, Deborah A.; Greer, Paula K.; Sharp, Julie M.; Chichlowski, Maciej; Rouse, D. Clayburn; Selim, M. Angelica; Hale, Laura P.

    2012-01-01

    Hair loss (alopecia) can result from a variety of metabolic, endocrine, immunologic, and environmental causes. This investigation was undertaken to determine the mechanisms underlying the sporadic development of alopecia in litters from C57BL/6 interleukin-10-deficient (Il10−/−) mice. All pups in affected litters demonstrated alopecia by postnatal days 17–19, with hair loss from their trunks but not from their head, base of tail, or feet. Histopathology revealed distorted hair follicles containing broken hair shafts and prominent dermal infiltrates containing increased numbers of activated mast cells. Hair re-growth began soon after weaning, suggesting that the alopecia was triggered by factors transmitted during lactation. Milk from Il10−/− dams induced macrophage secretion of pro-inflammatory cytokines in vitro regardless of whether or not their pups developed alopecia. Feeding dams a diet containing 3–6 ppm iron increased the percentage of litters with alopecia to 100% for pups with mast cells, with 0% alopecia in mast cell-deficient pups. When dams were fed diet containing 131 ppm iron, significantly lower hemoglobin and hematocrit values were observed in pups from litters with alopecia (71%; 5 of 7 litters) compared to litters without alopecia. Genetic or pharmacologic inhibition of c-kit that resulted in depletion of mast cells in pups prevented hair loss in at-risk litters. These studies demonstrate that maternal iron-restricted diets enhance the incidence of alopecia in IL-10-deficient mouse pups and suggest mast cells as potential effector cells. Further studies are indicated to further explore the mechanisms involved and to determine how mast cells may contribute to alopecia in humans. PMID:20100190

  8. The role of dimensions of narrative engagement in narrative persuasion

    NARCIS (Netherlands)

    Graaf, A.M.; Hoeken, J.A.L.; Sanders, J.M.; Beentjes, J.W.J.

    2009-01-01

    Several models of narrative persuasion posit that a reader's phenomenological experience of a narrative plays a mediating role in the persuasive effects of the narrative. Because the narrative reading experience is multi-dimensional, this experiment investigates which dimensions of this experience -

  9. The role of dimensions of narrative engagement in narrative persuasion

    NARCIS (Netherlands)

    Graaf, A. de; Hoeken, J.A.L.; Sanders, J.M.; Beentjes, J.W.J.

    2009-01-01

    Several models of narrative persuasion posit that a reader's phenomenological experience of a narrative plays a mediating role in the persuasive effects of the narrative. Because the narrative reading experience is multi-dimensional, this experiment investigates which dimensions of this experience –

  10. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis.

    Science.gov (United States)

    Adil, Areej; Godwin, Marshall

    2017-07-01

    Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, the potent form of testosterone. Currently, minoxidil and finasteride are Food and Drug Administration (FDA)-approved, and HairMax LaserComb, which is FDA-cleared, are the only treatments recognized by the FDA as treatments of androgenetic alopecia. This systematic review and meta-analysis assesses the efficacy of nonsurgical treatments of androgenetic alopecia in comparison to placebo for improving hair density, thickness, growth (defined by an increased anagen:telogen ratio), or subjective global assessments done by patients and investigators. A systematic review of randomized controlled trials was conducted. PubMed, Embase, and Cochrane were searched up to December 2016, with no lower limit on the year. We included only randomized controlled trials of good or fair quality based on the US Preventive Services Task Force quality assessment process. A meta-analysis was conducted separately for 5 groups of studies that tested the following hair loss treatments: low-level laser light therapy in men, 5% minoxidil in men, 2% minoxidil in men, 1 mg finasteride in men, and 2% minoxidil in women. All treatments were superior to placebo (P alopecia and that minoxidil is effective in women with androgenetic alopecia. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Novel insights into the pathways regulating the canine hair cycle and their deregulation in alopecia X.

    Science.gov (United States)

    Brunner, Magdalena A T; Jagannathan, Vidhya; Waluk, Dominik P; Roosje, Petra; Linek, Monika; Panakova, Lucia; Leeb, Tosso; Wiener, Dominique J; Welle, Monika M

    2017-01-01

    Alopecia X is a hair cycle arrest disorder in Pomeranians. Histologically, kenogen and telogen hair follicles predominate, whereas anagen follicles are sparse. The induction of anagen relies on the activation of hair follicle stem cells and their subsequent proliferation and differentiation. Stem cell function depends on finely tuned interactions of signaling molecules and transcription factors, which are not well defined in dogs. We performed transcriptome profiling on skin biopsies to analyze altered molecular pathways in alopecia X. Biopsies from five affected and four non-affected Pomeranians were investigated. Differential gene expression revealed a downregulation of key regulator genes of the Wnt (CTNNB1, LEF1, TCF3, WNT10B) and Shh (SHH, GLI1, SMO, PTCH2) pathways. In mice it has been shown that Wnt and Shh signaling results in stem cell activation and differentiation Thus our findings are in line with the lack of anagen hair follicles in dogs with Alopecia X. We also observed a significant downregulation of the stem cell markers SOX9, LHX2, LGR5, TCF7L1 and GLI1 whereas NFATc1, a quiescence marker, was upregulated in alopecia X. Moreover, genes coding for enzymes directly involved in the sex hormone metabolism (CYP1A1, CYP1B1, HSD17B14) were differentially regulated in alopecia X. These findings are in agreement with the so far proposed but not yet proven deregulation of the sex hormone metabolism in this disease.

  12. Effect of petroleum ether and ethanol fractions of seeds of Abrus precatorius on androgenic alopecia

    Directory of Open Access Journals (Sweden)

    Sukirti Upadhyay

    2011-12-01

    Full Text Available Seeds of Abrus precatorius L., Fabaceae, are commonly used as purgative, emetic, aphrodisiac and in nervous disorder in traditional and folk medicines. In present study petroleum ether and ethanolic extracts of A. precatorius seeds are evaluated for reversal of androgen (testosterone by i.m route induced alopecia in male albino wistar rats and compared to topical administration of standard antiandrogenic drug finasteride for 21 days. The results were reflected from visual observation and histological study of several skin sections via various parameters as anagen to telogen ratio and follicle density/mm area of skin surface. The animal of group 1 who were treated with only testosterone became alopecic on visual observation. Animals of Group 2, 3 and 4 who were treated with finasteride, petroleum ether and ethanolic extract of seed respectively topically along with testosterone (i.m did not developed alopecia. To investigate the mechanism of observed activity, in vitro experiments were performed. Inhibition of 5α-reductase activity by extracts and finasteride suggest that they reversed androgen induced alopecia by inhibiting conversion of testosterone to dihydrotestosterone (potent androgen responsible for androgenic alopecia. So it may be concluded that petroleum ether and ethanolic extract of A. precatorius seed posses anti androgenic alopecia activity due to inhibition of 5α-reductase enzyme.

  13. Effect of petroleum ether and ethanol fractions of seeds of Abrus precatorius on androgenic alopecia

    Directory of Open Access Journals (Sweden)

    Sukirti Upadhyay

    2012-04-01

    Full Text Available Seeds of Abrus precatorius L., Fabaceae, are commonly used as purgative, emetic, aphrodisiac and in nervous disorder in traditional and folk medicines. In present study petroleum ether and ethanolic extracts of A. precatorius seeds are evaluated for reversal of androgen (testosterone by i.m route induced alopecia in male albino wistar rats and compared to topical administration of standard antiandrogenic drug finasteride for 21 days. The results were reflected from visual observation and histological study of several skin sections via various parameters as anagen to telogen ratio and follicle density/mm area of skin surface. The animal of group 1 who were treated with only testosterone became alopecic on visual observation. Animals of Group 2, 3 and 4 who were treated with finasteride, petroleum ether and ethanolic extract of seed respectively topically along with testosterone (i.m did not developed alopecia. To investigate the mechanism of observed activity, in vitro experiments were performed. Inhibition of 5α-reductase activity by extracts and finasteride suggest that they reversed androgen induced alopecia by inhibiting conversion of testosterone to dihydrotestosterone (potent androgen responsible for androgenic alopecia. So it may be concluded that petroleum ether and ethanolic extract of A. precatorius seed posses anti androgenic alopecia activity due to inhibition of 5α-reductase enzyme.

  14. Evaluation of serum homocysteine, high-sensitivity CRP, and RBC folate in patients with alopecia areata

    Directory of Open Access Journals (Sweden)

    Maryam Yousefi

    2014-01-01

    Full Text Available Introduction: Alopecia areata (AA is a common type of hair loss with an autoimmune basis. As the role of homocysteine (Hcys, folate, and CRP has been considered in some autoimmune diseases. Objectives: To evaluate homocysteine, folate and CRP level in AA. Methods: This study was performed on 29 patients who had AA for at least 6 months affecting more than 20% of scalp, and 32 healthy controls. Levels of serum Hcys, blood high-sensitivity CRP, and RBC folate were measured in all subjects. Results: The mean level of RBC folate was significantly lower in the patient group than that in controls (P < 0.001. Also, the level of RBC folate was significantly lower in patients with extensive forms of disease (alopecia totalis/alopecia universalis in comparison with more localized form (patchy hair loss (P < 0.05. Patients with higher "Severity of Alopecia Total" (SALT score had lower RBC folate, as well. Serum Hcys and blood high-sensitivity CRP levels did not show a significant difference in two groups. Conclusion: Patients with alopecia areata have lower level of RBC folate which is in negative correlation with both severity and extension of AA.

  15. Quality of Life in Alopecia Areata: A Sample of Tunisian Patients

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    Jawaher Masmoudi

    2013-01-01

    Full Text Available Background. Alopecia areata (AA has a significant impact on the quality of life and social interaction of those suffering from it. Our aim was to assess the impact of AA on the quality of life. Methods. Fifty patients diagnosed with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, between March 2010 and July 2010, were included. Quality of life was measured by SF 36; severity of AA was measured by SALT. Results. Eighty percent had patchy alopecia with less than 50% involvement, 12% had patchy alopecia with 50–99% involvement, and 8% had alopecia totalis. Compared with the general population, AA patients presented a significantly altered quality of life, found in the global score and in five subscores of the SF-36: mental health, role emotional, social functioning, vitality, and general health. Gender, age, marital status, and severity of alopecia areata had a significant influence on patients’ quality of life. Conclusions. This study indicates that patients with AA experience a poor quality of life, which impacts their overall health. We suggest screening for psychiatric distress. Studies of interventions such as counseling, psychoeducation, and psychotherapeutic interventions to reduce the impact of the disease may be warranted.

  16. Microneedling as a successful treatment for alopecia X in two Pomeranian siblings.

    Science.gov (United States)

    Stoll, Steve; Dietlin, Christian; Nett-Mettler, Claudia S

    2015-10-01

    Alopecia X (hair cycle arrest) is a relatively frequent hair growth disorder in Pomeranians and several other breeds, characterized by symmetrical, noninflammatory alopecia without systemic signs. The cause and pathogenesis remain unknown. Previously reported treatments with various topical and systemic drugs have been variably successful. We hypothesized that superficial mechanical skin trauma applied with a microneedling device would induce long-term hair regrowth at treated sites. Two neutered female Pomeranian siblings with histologically confirmed alopecia X. Previous treatments with deslorelin, melatonin and topical minoxidil had failed to produce significant hair regrowth. The dogs were anaesthetized and the skin was punctured with a microneedling device. Dogs were followed over a period of 12 months. Five weeks after microneedling hair regrowth started, followed by a reduction in hyperpigmentation of affected skin. After 12 weeks there was a 90% improvement in coat coverage at previously alopecic areas. Twelve months after the procedure, coat conditions remained stable. No adverse effects were noted. This is the first report of microneedling to induce hair regrowth in dogs affected by alopecia X. Long-term studies with microneedling in a larger number of dogs with alopecia X will need to be performed to confirm these preliminary results and to further evaluate if hair-regrowth is permanent. © 2015 ESVD and ACVD.

  17. The efficacy and safety of diphenylcyclopropenone solutions in propylene glycol and isopropanol. A comparative study of two formulas used for the treatment of 100 patients with alopecia areata

    Directory of Open Access Journals (Sweden)

    Katarzyna Borowska

    2017-10-01

    Full Text Available Alopecia areata (AA is a T cell-mediated autoimmune disease involving hair follicles characterized by hair loss. 2,3-diphenylcyclopropenone (DCP is a topically administered drug intended for treating AA. The study investigates an efficacy and safety of DCP for the purpose of the treatment of AA. It presents a comparative study of two formulas: DCP in propylene glycol and DCP in isopropanol. While the treatment efficacy in both groups was very simmilar, the tolerance of the DCP in isopropanol was better than DCP in propylene glycol. Authors indicate the potential clinical applications of latter formula.

  18. Maternal IL-6 can cause T-cell-mediated juvenile alopecia by non-scarring follicular dystrophy in mice.

    Science.gov (United States)

    Smith, Stephen E P; Maus, Rachel L G; Davis, Tessa R; Sundberg, John P; Gil, Diana; Schrum, Adam G

    2016-03-01

    Aiming to decipher immunological mechanisms of the autoimmune disorder alopecia areata (AA), we hypothesized that interleukin-6 (IL-6) might be associated with juvenile-onset AA, for which there is currently no experimental model. Upon intramuscular transgenesis to overexpress IL-6 in pregnant female C57BL/6 (B6) mice, we found that the offspring displayed an initial normal and complete juvenile hair growth cycle, but developed alopecia around postnatal day 18. This alopecia was patchy and reversible (non-scarring) and was associated with upregulation of Ulbp1 expression, the only mouse homolog of the human AA-associated ULBP3 gene. Alopecia was also associated with inflammatory infiltration of hair follicles by lymphocytes, including alpha-beta T cells, which contributed to surface hair loss. Despite these apparently shared traits with AA, lesions were dominated by follicular dystrophy that was atypical of human AA disease, sharing some traits consistent with B6 alopecia and dermatitis. Additionally, juvenile-onset alopecia was followed by complete, spontaneous recovery of surface hair, without recurrence of hair loss. Prolonging exposure to IL-6 prolonged the time to recovery, but once recovered, repeating high-dose IL-6 exposure de novo did not re-induce alopecia. These data suggest that although substantial molecular and cellular pathways may be shared, functionally similar alopecia disorders can occur via distinct pathological mechanisms. © 2015 The Authors. Experimental Dermatology Published by John Wiley & Sons Ltd.

  19. Lipid nanoparticles for topical and transdermal application for alopecia treatment: development, physicochemical characterization, and in vitro release and penetration studies

    DEFF Research Database (Denmark)

    Gomes, M. J.; Martins, S.; Ferreira, D.

    2014-01-01

    Alopecia is a dermatological disorder, commonly known as hair loss, which affects up to half of the Caucasian male population by middle age, and almost all (95%) Caucasian men by old age. Considering that alopecia affects so many people and that there is currently no scientifically proven treatme...

  20. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men

    NARCIS (Netherlands)

    Blumeyer, Anja; Tosti, Antonella; Messenger, Andrew; Reygagne, Pascal; del Marmol, Veronique; Spuls, Phyllis I.; Trakatelli, Myrto; Finner, Andreas; Kiesewetter, Franklin; Trüeb, Ralph; Rzany, Berthold; Blume-Peytavi, Ulrike

    2011-01-01

    Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 %

  1. Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer

    NARCIS (Netherlands)

    van den Hurk, C.J.; van den Akker-van Marle, E.M.; Breed, W.P.M.; van de Poll-Franse, L.V.; Nortier, J.; Coebergh, J.W.W.

    2013-01-01

    Introduction Cytotoxic therapy for patients with cancer frequently induces reversible, but long-lasting alopecia which might be prevented by scalp cooling. This study evaluates the effectiveness of scalp cooling with respect to the severity of chemotherapy-induced alopecia (CIA) and the purchase and

  2. [Alopecia reconstruction by expansion after a scalp burn injury caused by Taser(®): a case report].

    Science.gov (United States)

    Abada, H; Aktouf, A; Delaunay, F; Lievain, L; Auquit-Auckbur, I

    2014-12-01

    Scarring alopecia resulting from burns may be difficult to treat and involves various plastic surgery techniques such as expanded scalp flaps. Herein, we report the case of a 19-year-old male patient who suffered burning of the scalp with scarring alopecia following an attack with a Taser(®) electrical gun. Given the extent and site of alopecia, we decided to create a prosthesis by means of scalp expansion. The cosmetic result was satisfactory. Several scalp reconstruction techniques have been described for scarring alopecia, with the most widely used being expansion, scalp flaps, repeated excision and hair implants. The present case suggests that scalp expansion offers an effective method for the reconstruction of scarring alopecia following burns with a Taser(®) device. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. The role of narrative medicine in pregnancy after liver transplantation.

    Science.gov (United States)

    Donzelli, Gianpaolo; Paddeu, Erika Maria; D'Alessandro, Francesca; Nanni Costa, Alessandro

    2015-01-01

    Narrative medicine allows professionals from all fields of medical sciences to understand the patient's total experience of illness, and meet his/her needs in an empathetic environment. Narrative medicine helps spread holistic knowledge of a multitude of complex clinical conditions, including transplantation. To underline the role of narrative medicine in women who become pregnant after a liver transplant by using their narrations of this very special experience. We describe our study with narration and listening to the stories of three women expecting their first child after a liver transplant, by analysing the structure and role of narration in the context of relationships between patients and caregivers. The narrations were transcribed verbatim with the main plot analysed in order to address all the aspects of this rare clinical condition and the transition to parenthood. The women narrated this experience in three phases: transplantation, pregnancy and delivery, and post-partum. They described all phases of pregnancy as stressful but satisfying, whereas the fact of becoming a mother was perceived as a victory both as a woman and as a transplant patient. Our results suggest that narrative medicine represents a significant professional tool for caring for transplant patients during pregnancy.

  4. The Role of Vitamin D Receptor Mutations in the Development of Alopecia

    Science.gov (United States)

    Malloy, Peter J.; Feldman, David

    2011-01-01

    Hereditary Vitamin D Resistant Rickets (HVDRR) is a rare disease caused by mutations in the vitamin D receptor (VDR). The consequence of defective VDR is the inability to absorb calcium normally in the intestine. This leads to a constellation of metabolic abnormalities including hypocalcemia, secondary hyperparathyroidism and hypophosphatemia that cause the development of rickets at an early age in affected children. An interesting additional abnormality is the presence of alopecia in some children depending on the nature of the VDR mutation. The data indicate that VDR mutations that cause defects in DNA binding, RXR heterodimerization or absence of the VDR cause alopecia while mutations that alter VDR affinity for 1,25(OH)2D3 or disrupt coactivator interactions do not cause alopecia. The cumulative findings indicate that hair follicle cycling is dependent on unliganded actions of the VDR. Further research is ongoing to elucidate the role of the VDR in hair growth and differentiation. PMID:21693169

  5. Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life.

    Science.gov (United States)

    Martino, Maria Luisa; Freda, Maria Francesca

    2016-11-01

    Previous research has agreed that meaning-making is a key element in the promotion of patients' well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect "the time of illness, the illness of time" demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient's past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment.

  6. Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life

    Directory of Open Access Journals (Sweden)

    Maria Luisa Martino

    2016-11-01

    Full Text Available Previous research has agreed that meaning-making is a key element in the promotion of patients’ well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect “the time of illness, the illness of time” demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient’s past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment.

  7. Embodied selfhood and narrative

    DEFF Research Database (Denmark)

    Køster, Allan

    , it argues for the relevance of attributing the quality of narrativity to embodied affects and responses that otherwise appear as alien in one’s self-experience. The fourth and final article: “Mentalization, embodiment and narrative - critical comments on the social ontology of mentalization theory......” addresses the relation between embodiment and narrative as it manifests in processes of social understanding. Specifically, it takes up this question in a discussion with mentalization theory and argues that while most of our basic understanding of others may play out on an expressive level of interaction......The dissertation, consisting of an introductory essay and four independent articles, provides phenomenological investigations into the relation between embodied selfhood and narrative. More precisely, it investigates this relation in regards to three specifying questions: (1) What is the relation...

  8. Illness narratives in cancer

    DEFF Research Database (Denmark)

    Ulrich, Anita; Evron, Lotte; Ostenfeld-Rosenthal, Ann

    2011-01-01

    Objectives: In this paper,we investigate Danish cancer patients’ narratives on spiritual beliefs and practices and the relationship these practices may have to complementary and alternative medicine (CAM). Design: Narrative inquiry is used to uncover how spiritual beliefs and practices may...... be related to CAM. The analysis is based on empirical findings from a recent PhD project. During a two-year period first author followed 32 cancer patients, family, friends and alternative practitioners through interviews, telephone conversations, treatments and in focus groups. Results: As a general pattern......, religious and spiritual issues were not extensively unfolded in participants’ illness narratives. However, these issues were significantly elaborated on in narratives by four female participants. Conclusion: We propose that for some cancer patients CAM may function, not only or primarily as a treatment...

  9. Algebraic Semantics for Narrative

    Science.gov (United States)

    Kahn, E.

    1974-01-01

    This paper uses discussion of Edmund Spenser's "The Faerie Queene" to present a theoretical framework for explaining the semantics of narrative discourse. The algebraic theory of finite automata is used. (CK)

  10. A genome-wide association study of chemotherapy-induced alopecia in breast cancer patients

    Science.gov (United States)

    2013-01-01

    Introduction Chemotherapy-induced alopecia is one of the most common adverse events caused by conventional cytotoxic chemotherapy, yet there has been very little progress in the prevention or treatment of this side effect. Although this is not a life-threatening event, alopecia is very psychologically difficult for many women to manage. In order to improve the quality of life for these women, it is important to elucidate the molecular mechanisms of chemotherapy-induced alopecia and develop ways to effectively prevent and/or treat it. To identify the genetic risk factors associated with chemotherapy-induced alopecia, we conducted a genome-wide association study (GWAS) using DNA samples from breast cancer patients who were treated with chemotherapy. Methods We performed a case-control association study of 303 individuals who developed grade 2 alopecia, and compared them with 880 breast cancer patients who did not show hair loss after being treated with conventional chemotherapy. In addition, we separately analyzed a subset of patients who received specific combination therapies by GWASs and applied the weighted genetic risk scoring (wGRS) system to investigate the cumulative effects of the associated SNPs. Results We identified an SNP significantly associated with drug-induced grade 2 alopecia (rs3820706 in CACNB4 (calcium channel voltage-dependent subunit beta 4) on 2q23, P = 8.13 × 10-9, OR = 3.71) and detected several SNPs that showed some suggestive associations by subgroup analyses. We also classified patients into four groups on the basis of wGRS analysis and found that patients who classified in the highest risk group showed 443 times higher risk of antimicrotubule agents-induced alopecia than the lowest risk group. Conclusions Our study suggests several associated genes and should shed some light on the molecular mechanism of alopecia in chemotherapy-treated breast cancer patients and hopefully will contribute to development of interventions that will

  11. Androgenic alopecia and dutasteride in hair mesotherapy: A short review

    Directory of Open Access Journals (Sweden)

    Estela B Busanello

    2018-02-01

    Full Text Available Androgenic alopecia (AGA is the most common cause of patterned hair loss in predisposed men and women. AGA is a multifactorial and polygenetic condition, affecting up to 80% of men and 40-50% of women during life. AGA is characterized by a gradual reduction of the anagen and increase in telagen phase, leading to a progressive follicle miniaturization. As a consequence, terminal hairs are converted into vellus hairs decreasing hair density. The pathophysiology of AGA is heterogeneous and highly complex. A diverse combination of genetical factors, endocrine abnormalities, circulating androgens, drugs, diet and microinflammation in hair follicles of each individual are related to this condition. However, it is well known that androgens are the major modulators of male AGA but their specific action on female AGA is still under debate. Circulating testosterone is converted by 5a-reductase in 5a-dihydrotestosterone (DHT in the periphery, a decrease of anagen phase occur, anticipating catagen phase in a complex process involving apoptosis as probably microinflammation. In AGA treatment, mesotherapy is being used with 5a-reductase inhibitors, especially dutasteride, injected directly on scalp. Thus, this updated review summarized the injectable use of dutasteride based on data available on PubMed until March 2017. Dutasteride, a second-generation inhibitor of 5a-reductase is more potent than finasteride due to the capability of inhibit types 1 and 2 of the enzyme. The efficacy and safety of hair mesotherapy with dutasteride were reported by distinct groups and the best results were achieved when this compound was used in combination with other substances, increasing hair growth. This result could be explained by the multifactorial pathophysiology of AGA, involving hair follicle sensitivity to DHT and microinflammation. Therefore, a multi-therapeutic approach seems to be more effective in AGA management. In conclusion, more studies are needed to

  12. An Open-Label Evaluator Blinded Study of the Efficacy and Safety of a New Nutritional Supplement in Androgenetic Alopecia: A Pilot Study.

    Science.gov (United States)

    Nichols, Anna J; Hughes, Olivia Bosshardt; Canazza, Agnese; Zaiac, Martin N

    2017-02-01

    Objective: To evaluate the effectiveness of a novel oral supplement, Forti5 ® , containing green tea extract, omega 3 and 6 fatty acids, cholecalciferol, melatonin, beta-sitosterol, and soy isoflavones, and in the management of subjects with androgenetic alopecia. Design: A prospective case series of 10 subjects. Setting: Open-label, evaluator-blinded, proof-of-concept study. Participants: Ten adult subjects with androgenetic alopecia completed the study. Subjects were not allowed to use oral or topical hair growth products in the 24 weeks preceding the study or during the study. The nutritional supplement was administered at a dosage of two tablets daily for 24 weeks. Measurements: Clinical evaluations were performed at baseline and at 24 weeks. Efficacy was evaluated using hair mass index measured by cross section trichometer, terminal hair count measured with dermoscopy and Investigator Global Photography Assessment. Results: Overall 80 percent of subjects (8/10) were rated as improved after 24 weeks of supplementation (mean change of +1.4 equivalent to slightly-to-moderately increased). Forty percent of subjects (4/10) were rated as moderately improved (2+), and 10 percent (1/10) were rated as greatly improved (3+). There was a significant improvement in terminal hair count (mean increase of 5.9% or 4.2 more terminal hairs in the area examined, p =0.014) and in Hair Mass Index (mean increase of 9.5% or 4.5 higher Hair Mass Index, p =0.003). Conclusion: These preliminary results indicate that Forti5 ® a novel nutritional supplement that contains cholecalciferol, omega 3 and 6 fatty acids, melatonin, antioxidants, and botanical 5-alpha reductase inhibitors, may be a useful adjunct in the treatment of androgenetic alopecia.

  13. Trichoscopic clues for diagnosis of alopecia areata and trichotillomania in Asians.

    Science.gov (United States)

    Khunkhet, Saranya; Vachiramon, Vasanop; Suchonwanit, Poonkiat

    2017-02-01

    Trichoscopy has become a useful diagnostic tool for various hair and scalp diseases, including alopecia areata (AA) and trichotillomania (TTM), which are sometimes difficult to distinguish clinically. To describe trichoscopic findings of AA and TTM in an Asian population and to establish diagnostic clues for these conditions. Trichoscopy was performed with a handheld dermoscope in 52 patients diagnosed with AA and 23 patients diagnosed with TTM. Trichoscopic images were then blindly evaluated. The trichoscopic features more frequently observed in AA than in TTM included exclamation mark hairs (AA 59.6%, TTM 26.1%), tapered hairs (AA 59.6%, TTM 4.3%), yellow dots (AA 46.2%, TTM 21.7%), and angulated hairs (AA 26.9%, TTM 0%) (P < 0.05). On the other hand, broken hairs of different lengths (TTM 100%, AA 3.8%), trichoptilosis (TTM 78.3%, AA 5.8%), V-sign (TTM 43.5%, AA 3.8%), flame hairs (TTM 43.5%, AA 0%), and hair powder (TTM 13%, AA 1.9%) were more commonly demonstrated in TTM than in AA (P < 0.05). Exclamation mark hairs indicate a diagnosis of AA but not pathognomonic. In addition, angulated hairs, fractured hairs forming a sharp angle along the hair shaft, appear to be typical for AA in Asians when differentiating from TTM. It is important to consider various trichoscopic findings together to establish the diagnosis of AA or TTM. © 2017 The International Society of Dermatology.

  14. Alopecia areata - hyperactivity of the hypothalamic-pituitary-adrenal axis is a myth?

    Science.gov (United States)

    Bergler-Czop, B; Miziołek, B; Brzezińska-Wcisło, L

    2017-09-01

    Psychological stress is known to cause exacerbation of different skin pathologies including alopecia areata (AA). A hyperactivity of the hypothalamic-pituitary-adrenal axis (the HPA axis) in patients affected by AA (AA patients) was proposed to be a neuroendocrine response to stress. Still little is known about melanocyte-stimulating hormone (MSH) and cortisol production in AA settings. The aim of the study was to compare trends in a production of MSH and cortisol in patients with AA patients and healthy controls. Plasma concentrations of free cortisol and MSH were measured in 43 AA patients (35.5 ± 10.6 years) and 37 healthy subjects (35.9 ± 10.5 years) selected from the Dermatology Outpatient Clinic at Medical University of Silesia in Katowice, Poland. Results were submitted to statistical analysis with Shapiro-Wilk W-test and subsequently nonparametric (Mann-Whitney U-test) or parametric (Student's t-test) statistics were performed. Mean plasma level of MSH was 5.39 ng/mL in AA patients and 5.71 ng/mL in healthy controls. The difference between groups was non-significant (P = 0.435), but the control group manifested higher values of MSH (Q75 = 13.6 ng/mL vs Q75 = 5.98 ng/mL) and this tendency was especially stronger in females. AA patients had greater mean plasma level of cortisol (157.63 ± 91.16 µg/L) than healthy controls (123.32 ± 71.28 µg/L); however, the difference between them was also non-significant (P = 0.063). No sex-dependent tendency to a greater production of cortisol was found. Expectations of disturbances in production of MSH and cortisol were not fulfilled. Neither MSH nor cortisol plasma levels appear to be clearly changed in AA patients. © 2017 European Academy of Dermatology and Venereology.

  15. Framing Effects in Narrative and Non-Narrative Risk Messages.

    Science.gov (United States)

    Steinhardt, Joseph; Shapiro, Michael A

    2015-08-01

    Narrative messages are increasingly popular in health and risk campaigns, yet gain/loss framing effects have never been tested with such messages. Three experiments examined framing in narrative messages. Experiment 1 found that only the character's decision, not framing, influenced judgments about characters in a narrative derived from a prospect theory context. Experiment 2 found that a framing effect that occurred when presented in a decision format did not occur when the same situation was presented as a narrative. Using a different story/decision context, Experiment 3 found no significant difference in preference for surgery over radiation therapy in a narrative presentation compared to a non-narrative presentation. The results suggest that health and risk campaigns cannot assume that framing effects will be the same in narrative messages and non-narrative messages. Potential reasons for these differences and suggestions for future research are discussed. © 2015 Society for Risk Analysis.

  16. Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica

    NARCIS (Netherlands)

    J. van der Donk (J.); J.A.M. Hunfeld (Joke); J. Passchier (Jan); K.J. Knegt-Junk (K.); C. Nieboer (C.)

    1994-01-01

    textabstractQuality of life and maladjustment related to hair loss were studied by means of a standardized interview in a group of 58 women with alopecia androgenetica who applied for treatment at the Department of Dermatology. The hair loss was found to have a negative influence on the quality of

  17. Prevalence and types of androgenetic alopecia in north Anatolian population: A community-based study.

    Science.gov (United States)

    Bas, Yalcin; Seckin, Havva Yildiz; Kalkan, Göknur; Takci, Zennure; Citil, Riza; Önder, Yalcin; Sahin, Safak; Demir, Ayse Kevser

    2015-08-01

    To determine the prevalence and pattern of androgenetic alopecia in Turkey and to compare the results with different regions. The community-based study was carried out from September 2012 to June 2013 across all the 12 districts of Tokat province of Turkey. Individuals 20-years-old or older were included, and more than two first-degree relatives were excluded. Dermatological examination of all the subjects was performed by dermatologists. The degree of androgenetic alopecia was classified according to the Hamilton-Norwood and Ludwig classifications. Of the 2322 volunteers, 1288(55.46%) were women and 1034(44.53%) were men. Overall mean age was 47.3±15.3 years (range: 20-87 years). Androgenetic alopecia was detected in 740(31.8%) subjects; 247(19.17%) women and 493(47.6%) men. The prevalence of androgenetic alopecia in Turkish society was higher than Asian and African communities; and similar to the rate in European societies hair-loss.

  18. Er:YAG laser-assisted hair transplantation in cicatricial alopecia.

    Science.gov (United States)

    Podda, M; Spieth, K; Kaufmann, R

    2000-11-01

    Autologous hair transplantation and its combination with flap or reduction procedures is a common surgical approach to cover defects in cicatricial alopecias. Due to the poor recipient conditions present in scar tissue, it is crucial to minimize the trauma exerted on implantation holes in order to achieve good transplantation results. We sought to evaluate the "cold"-ablative properties of the Er:YAG laser for the generation of recipient holes in cicatricial alopecia. Patients with cicatricial alopecia of diverse etiology were treated with Er:YAG laser-assisted hair transplantation. Mini- or micrografts were inserted into recipient holes ablated with a pulse energy of 900-1200 mJ and a spot size of 1.0-1.6 mm. A fluence of 80-120 J/cm2 and 8-12 pulses gave an almost ideal combination of minimal thermal damage and tissue ablation down to the subcutis. With an apparent mini- and micrograft survival of 95% we achieved good cosmetic results after two to five transplant sessions in all patients. The Er:YAG laser is a novel effective tool to ablate recipient holes for autologous hair transplantation in cicatricial alopecia.

  19. A bibliometric study of scientific literature in Scopus on botanicals for treatment of androgenetic alopecia.

    Science.gov (United States)

    Rondanelli, Mariangela; Perna, Simone; Peroni, Gabriella; Guido, Davide

    2016-06-01

    In androgenetic alopecia, a number of botanicals are available that can effectively slow or reduce hair loss and inflammation or stimulate partial hair regrowth. The aim of this study was to provide a descriptive overview of the impact and production of literature on botanicals used for androgenetic alopecia and to perform a citation analysis of the related research articles. We searched for "alopecia" OR "androgenetic alopecia" OR "hair loss" AND "Camelia sinensis" OR (and other 15 botanicals) in ARTICLE (Title/Abstract/Keyword) in Scopus database. A total of 29 references, that is, research articles, were retrieved by SCOPUS search, and 93.1% had been published since 2000. The majority (48.3%) describe applications of hair grow stimulants, followed by inhibitors of 5-alpha-reductase applications (27.6%), and studies concerning inhibitors of inflammation (24.1%). The citation analysis revealed a growing interest for this topic and the papers on hair grow stimulants are most cited. Citation trend of inhibition of 5-alpha-reductase articles is growing in the last years. This study has highlighted three important aspects: (1) growing interest for this topic; (2) evidences mainly in hair grow stimulants and recently in the inhibition of 5-alpha-reductase, as demonstrated by article and citation counts across years; (3) in addition, all major studies have been focused on green tea epigallocatechin-3-gallate, Serenoa repens, Citrullus colocynthis and Cuscuta reflexa. © 2015 Wiley Periodicals, Inc.

  20. Acquired generalised neuromyotonia, cutaneous lupus erythematosus and alopecia areata in a patient with myasthenia gravis.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    We describe a patient with the diagnoses of acquired neuromyotonia, cutaneous lupus erythematosus and alopecia areata, occurring many years after a thymectomy for myasthenia gravis associated with a thymoma. We review the current literature on autoimmune conditions associated with myasthenia gravis and thymectomy. To our knowledge, this combination of multiple autoimmune conditions has not been reported previously.

  1. Alopecia areata and vitiligo as primary presentations in a young male with human immunodeficiency virus

    Directory of Open Access Journals (Sweden)

    Li Xuan

    2014-01-01

    Full Text Available A 26-year-old Chinese male consulted with the team regarding his alopecia areata and vitiligo for which previous treatment was ineffective. The patient, a homosexual man, denied having a history of drug abuse and of blood transfusion. No member of his family had vitiligo or alopecia. Laboratory studies revealed that the serum for anti-human immunodeficiency virus (HIV antibody was positive. The patient′s CD4 lymphocyte count and CD4/CD8 ratio were both strikingly low (20 cells/mL and 0.04, but no other complaints or opportunistic infections were reported. One month after antiretroviral therapy, the patient′s alopecia areata dramatically improved, but no evident improvement in his vitiligo was found. This case is a very rare case of alopecia areata and vitiligo associated with HIV infection that might be attributed to the generation and maintenance of self-reactive CD8+ T-cells due to chronic immune activation with progressive immune exhaustion in HIV infection.

  2. Clinicoepidemiological Observational Study of Acquired Alopecias in Females Correlating with Anemia and Thyroid Function

    Directory of Open Access Journals (Sweden)

    Kirti Deo

    2016-01-01

    Full Text Available Alopecia can either be inherited or acquired; the latter, more common, can be diffuse, patterned, and focal, each having cicatricial and noncicatricial forms. This observational study of 135 cases in a semiurban Indian population aimed to detect the prevalence of various forms of acquired alopecia in females and correlate the same with levels of hemoglobin, serum ferritin, triiodothyronine, thyroxin, and thyroid stimulating hormone. The majority (84, 62.2% of our cases of alopecia had telogen effluvium followed by female pattern alopecia (32, 23.7%. Stress (86, 63.7%, topical application of chemicals (72, 53.3%, systemic medications for concurrent illnesses (62, 5%, and pregnancy (14, 10.3% were the common exacerbating factors. Neither low hemoglobin (12 μg/L. Though lack of vitamin B12 testing was a limitation of our study, its deficiency could be the probable cause of iron deficiency as the majority (58, 64.4% of these cases, as indeed majority (89, 65.4% of our study population, were vegetarians. Thyroid disorders (23, 17%, including 9 newly diagnosed were not of significance statistically.

  3. Androgenic alopecia is not useful as an indicator of men at high risk of prostate cancer.

    NARCIS (Netherlands)

    Cremers, R.G.H.M.; Aben, K.K.H.; Vermeulen, S.; Heijer, M. den; Oort, I.M. van; Kiemeney, L.A.L.M.

    2010-01-01

    BACKGROUND: Androgens are assumed to play a central role in the pathophysiology of both prostate cancer (PC) and androgenic alopecia (AA). A correlation between the two phenotypes may be relevant for identification of men at high risk of PC. We evaluated the association between AA at different ages

  4. Intermediate Uveitis and Alopecia Areata : Is There a Relationship? Report of 3 Pediatric Cases

    NARCIS (Netherlands)

    Ayuso, Viera Kalinina; Pott, Jan Willem; de Boer, Joke Helena

    2011-01-01

    Three previously healthy children, aged 5, 8, and 15 years, with idiopathic intermediate uveitis (IU) and alopecia areata (AA) are described. These are the first 3 cases of which we are aware with this coexistence. The results of extensive diagnostic evaluations were negative in all 3 cases. AA

  5. Scalp cooling to prevent alopecia after chemotherapy can be considered safe in patients with breast cancer

    NARCIS (Netherlands)

    van den Hurk, C.J.; van de Poll-Franse, L.V.; Breed, W.P.M.; Coebergh, J.W.W.; Nortier, J.

    2013-01-01

    With modern scalp cooling equipment cytotoxic damage of hair root cells can be prevented in half of the patients with cancer at high risk of alopecia. However, traditionally doubt has existed whether scalp cooling might facilitate hiding and disseminating scalp skin metastases and thus decrease

  6. Alopecia Areata and Discoid Lupus Erythematosus in a Patient with Vitiligo

    Directory of Open Access Journals (Sweden)

    K Pavithran

    1986-01-01

    Full Text Available A 52 year old male who had been having - vitiligo for 20 years, developed alopecia universalis since 4 years and disseminated discoid IUPUS erythematosus since 2 years. The coexistence of these three diseases in the same patient lends credence to the contention that auto′ unity may play a role in the pathogenesis of these diseases.

  7. Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia

    NARCIS (Netherlands)

    van den Hurk, C.J.; van den Akker-van Marle, E.M.; Breed, W.P.M.; van de Poll-Franse, L.V.; Nortier, J.; Coebergh, J.W.W.

    2014-01-01

    Background. Alopecia is a frequently occurring side effect of chemotherapy that often can be prevented by cooling the scalp during the infusion. This study compared effects and costs of scalp cooling with usual general oncological care, i.e. purchasing a wig or head cover. Material and methods.

  8. Narrativity and enaction: the social nature of literary narrative understanding.

    Science.gov (United States)

    Popova, Yanna B

    2014-01-01

    This paper proposes an understanding of literary narrative as a form of social cognition and situates the study of such narratives in relation to the new comprehensive approach to human cognition, enaction. The particular form of enactive cognition that narrative understanding is proposed to depend on is that of participatory sense-making, as developed in the work of Di Paolo and De Jaegher. Currently there is no consensus as to what makes a good literary narrative, how it is understood, and why it plays such an irreplaceable role in human experience. The proposal thus identifies a gap in the existing research on narrative by describing narrative as a form of intersubjective process of sense-making between two agents, a teller and a reader. It argues that making sense of narrative literature is an interactional process of co-constructing a story-world with a narrator. Such an understanding of narrative makes a decisive break with both text-centered approaches that have dominated both structuralist and early cognitivist study of narrative, as well as pragmatic communicative ones that view narrative as a form of linguistic implicature. The interactive experience that narrative affords and necessitates at the same time, I argue, serves to highlight the active yet cooperative and communal nature of human sociality, expressed in the many forms than human beings interact in, including literary ones.

  9. What are narratives good for?

    Science.gov (United States)

    Beatty, John

    2016-08-01

    Narratives may be easy to come by, but not everything is worth narrating. What merits a narrative? Here, I follow the lead of narratologists and literary theorists, and focus on one particular proposal concerning the elements of a story that make it narrative-worthy. These elements correspond to features of the natural world addressed by the historical sciences, where narratives figure so prominently. What matters is contingency. Narratives are especially good for representing contingency and accounting for contingent outcomes. This will be squared with a common view that narratives leave no room for chance. On the contrary, I will argue, tracing one path through a maze of alternative possibilities, and alluding to those possibilities along the way, is what a narrative does particularly well. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Who speaks? Who looks? Who feels? Point of view in autobiographical narratives.

    Science.gov (United States)

    Habermas, Tilmann

    2006-04-01

    In this paper, the author aims to substantiate Freud's claim that neurotic illness creates gaps in autobiographical narratives in terms of the narrator's stating and inducing perspectives. He sketches out the role of narrative perspective and the joint taking of a shared perspective by analyst and patient in psychoanalytic therapy. He introduces four ways of representing perspectives in narratives. Three degrees of narrative distortion are exemplified by three excerpts from life narratives and explored in terms of narrative perspective representation. The most comprehensive perspective representation is achieved in the first example by explicitly stating the present perspective of the narrator as well as the past perspective of the story's protagonist by use of mental verbs. In the second narrative, exclusive use of linguistic forms for inducing the protagonist's perspective both overwhelms the narrator and gives the listener an incomplete picture of what happened. Inconsistent motives, denial of responsibility and omission of detail render the third narrative even more difficult to follow. The author discusses the clinical significance of this exploratory analysis of perspectives in narratives in terms of claiming responsibility for one's past action and of level of defence mechanisms, and by highlighting the emotional impact on listeners, which the author suggests is the stronger the more perspectives are left out. He discusses analogies to countertransference. The analysis of narrative perspectives offers an approach for systematic research in psychoanalytic practice.

  11. Engaging Personas and Narrative Scenarios

    DEFF Research Database (Denmark)

    Nielsen, Lene

    2004-01-01

    design ideas. The concept of engaging personas and narrative scenario explores personas in the light of what what it is to identify with and have empathy with a character. The concept of narrative scenarios views the narrative as aid for exploration of design ideas. Both concepts incorporate...... a distinktion between creating, writing and reading. Keywords: personas, scenarios, user-centered design, HCI...

  12. Utilização de seis fontes alimentares para cabritos em crescimento: 1. Avaliação de alopecia e diarréia Use of six feed sources for growing kids: 1. Evaluation of alopecia and diarrhea

    Directory of Open Access Journals (Sweden)

    Fernando Iván Londoño Hernández

    1999-01-01

    Full Text Available Este experimento foi realizado para avaliar o efeito de diferentes fontes alimentares sobre o aparecimento de diarréia e de alopecia em cabritos em crescimento. Foi usado delineamento inteiramente casualizado com seis dietas (1 - leite, 2 - leite + zeranol, 3 - colostro, 4 - colostro + óleo, 5 - colostro + zeranol e 6 - colostro + óleo + zeranol e cinco repetições. Escores fecais foram medidos diariamente. Os maiores escores fecais foram observados nas dietas 4 (1,655 e 6 (1,786. A maior incidência de diarréia foi observada nas dietas 4 e 6. As dietas 3, 4 e 6 aumentaram a presença de alopecia. A alopecia foi reversível e persistente para os diferentes períodos de duração do experimento. Os compostos fenólicos e os ácidos graxos foram responsáveis pela diarréia e alopecia.This experiment was carried out to evaluate the effects of different feed sources that can cause diarrhea and of alopecia in growing kids. A completely randomized design with six diets (1 - milk, 2 - milk + zeranol, 3 - colostrum, 4 - colostrum + soybean oil, 5 - colostrum + zeranol and 6 - colostrum + soybean oil + zeranol and five replicates was used. Fecal scores were daily measured. The highest fecal scores were observed on diets 4 (1.655 and 6 (1.786. The highest incidence diarrhea was observed on diets 4 and 6. The diets 3, 4 and 6 increased the alopecia incidence. The alopecia was reversible and persistant for different experimental periods. The phenolic compounds and fatty acids were responsible for diarrhea and alopecia.

  13. An Exoteric Narrative

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 3; Issue 1. Special Relativity – An Exoteric Narrative ! S R Madhu Rao. Classroom Volume 3 Issue 1 January 1998 pp 61-66. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/003/01/0061-0066 ...

  14. Critical Narrative Inquiry

    DEFF Research Database (Denmark)

    While organizations have become central for thinking and structuring contemporary social action, existing perspectives on what they are and how to deal with them are still rooted in modern ideas about the foundations of society. The chapters in this volume take critical narrative inquiry — inspired...

  15. Against narrative medicine.

    Science.gov (United States)

    O'Mahony, Seamus

    2013-01-01

    This essay aims to provoke debate on how and what the medical humanities should teach. It argues that the field has been dominated (to its detriment) by two misguided movements, postmodernism and narrative medicine, and that it should be redirected from utilitarian aims towards the goal of exposing medical students to a climate of thought and reflection.

  16. Reconsidering the unreliable narrator

    DEFF Research Database (Denmark)

    Hansen, Per Krogh

    2007-01-01

    to the position of A. Nünning. In the final section, a four-category taxonomy for the different textual strategies that establishes unreliable narration is suggested. The headlines for the taxonomy are intranarrational unreliability, internarrational unreliability, intertextual unreliability, and extratextual...

  17. Pseudo Alopecia Areata Caused by Skull-caps with Metal Pin Fasteners used by Orthodox Jews in Israel

    Directory of Open Access Journals (Sweden)

    Chaim Yosefy

    2003-01-01

    Full Text Available Background: Alopecia Areata (AA is a disease characterized by hair loss that is widely believed to be autoimmune in origin. Thus treatment is generally aimed in this direction using immune inhibitors such as steroids and PUVA.

  18. The Function of Narrative: Toward a Narrative Psychology of Meaning

    Directory of Open Access Journals (Sweden)

    Brian Schiff

    2012-11-01

    Full Text Available In this paper, I argue that the most salient aspect of narrative is not the arrangement of speech elements into a particular order but the kinds of actions that can be accomplished with narratives. Narrative is best thought of as a verb, “to narrate,” or the derived form, “narrating.” It is an expressive action, something that persons do. I argue that one of the primary functions of narrating is to “make present” life experience and interpretations of life in a particular time and space. Narrating brings experience and interpretations into play, into a field of action, in a specific here and now.

  19. MARKETING RESEARCHES OF MEDICINAL AND COSMETIC REMEDIES INTENDED FOR APPLYING IN VARIOUS FORMS OF ALOPECIA

    Directory of Open Access Journals (Sweden)

    I. O. Yarema

    2014-12-01

    Full Text Available Pathological hair loss – alopecia – is an urgent problem that takes one of the leading places in the pathology of skin structure. There are different types of alopecia, the most common forms are androgen and telogen (symptomatic alopecia. Androgenic alopecia (AA isa progressive alopecia caused by androgens action on hair follicle in patients with hereditary predisposition, which is often manifested not only with excessive hair loss, but also with the appearance of dandruff. Uncontrolled use of cosmetic products for combating hair loss is increased in view of high prevalence among young people, and as advertising in the media. Therefore, an important task of modern pharmacy is to create a medicinal remedy that contribute efficient and controlled correction of AA and provide the pharmaceutical market of Ukraine with available economical means. The significant range of cosmetics and medicinal products to eliminate dandruff and hair loss correctionare implementedin Ukraine pharmacy network today. However, the amount of medicinal remedy decreases every year. Most of them, after re-registration movetothe category of cosmeceuticals.This cause the significant increase in the value. For example, the number of medicinal remedy registered in Ukraine for local and systemic treatment of alopecia compared with 2012 decreased approximately on 36%, and drugs to treat dandruff - 17%. Today the amount of native medicines for the treatment of alopecia and dandruff is limited and is only 23%, compared with foreign firms. Leading positions in the import medicines of this group are occupied by India, Germany and France, and the share of foreign drugs is 77% from the total. Cosmetic hair loss remedies are presented significantly numerous, compared to medicinal remedy, an arsenal of forms production, including shampoos, masks, lotions, oil, balms, solutions for rubbing into the scalp, capsules for internal use and so on. The main components of active cosmeceuticals

  20. From method to hermeneutics: which epistemological framework for narrative medicine?

    Science.gov (United States)

    Abettan, Camille

    2017-06-01

    The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine's self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer's work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient's lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice.

  1. Alopecia in association with lamotrigine use: an analysis of individual case safety reports in a global database.

    Science.gov (United States)

    Tengstrand, Maria; Star, Kristina; van Puijenbroek, Eugène P; Hill, Richard

    2010-08-01

    The WHO Programme for International Drug Monitoring, maintained by the Uppsala Monitoring Centre (UMC), has more than 90 member countries contributing individual case safety reports (ICSRs) from their existing national pharmacovigilance systems; these reports are stored in the WHO global ICSR database, VigiBase. A continuous increase of ICSRs of alopecia in suspected connection to lamotrigine use has been observed in VigiBase; however, only limited information has been published on this topic. To examine in greater detail the association between lamotrigine and alopecia by outlining the characteristics of the accumulated reports in VigiBase. An analysis of all reports in VigiBase, up to 1 April 2009, where lamotrigine was suspected of having caused alopecia. Lamotrigine was suspected of being involved in the development of alopecia in 337 patients, reported from 19 countries. The age of the patients ranged between 5 months and 84 years (mean 36 years), with a predominance (58%) of patients <40 years of age. 272 patients were female. In 291 reports, lamotrigine was the only drug suspected by the reporter, and in 112 reports, lamotrigine was the sole reported drug. Commonly co-reported drugs were other antiepileptic drugs. For 217 patients, alopecia was reported as the single event. In 11 patients, the reaction abated on cessation of lamotrigine. One patient was reported to have had a recurrence of alopecia on re-administration of lamotrigine. The UMC continues to receive reports of alopecia associated with the use of lamotrigine. Although alopecia may not be regarded as serious from a regulatory perspective, this adverse reaction has the potential to affect compliance, resulting in decreased efficacy of the treatment regimen and detrimental effects on patient health outcomes.

  2. Formulate, Formalize and Run! How Narrative Theories shape and are shaped by Interactive Digital Narrative

    OpenAIRE

    Szilas, Nicolas

    2016-01-01

    What are the links between narrative theories and computing? Narrative works are countless in the digital world: narrative hypertext and hypermedia, interactive fiction, video games, blogs, location-based narrative, etc. They not only form new analytical objects for narrative theories, but also may extend existing narrative theories. One specific type of digital narratives, AI-based Interactive Digital Narrative (IDN), plays a special role in this landscape because it makes use of narrative t...

  3. BMI and levels of zinc, copper in hair, serum and urine of Turkish male patients with androgenetic alopecia.

    Science.gov (United States)

    Ozturk, Perihan; Kurutas, Ergul; Ataseven, Arzu; Dokur, Neslihan; Gumusalan, Yakup; Gorur, Ayşegul; Tamer, Lulufer; Inaloz, Serhat

    2014-07-01

    Male pattern androgenetic alopecia is characterized by progressive hair loss from the scalp. It is known that imbalances of some trace elements play a role in the pathomechanism of many forms of alopecia. The aim of this study was to evaluate the levels of zinc and copper in hair, serum and urine samples of Turkish males with male pattern androgenetic alopecia and to compare with healthy controls. 116 males with male pattern androgenetic alopecia and 100 controls were involved in this study. Levels of zinc and copper in hair were decreased significantly in the patients (p0.05). Body mass index of patients were higher than control group. In addition, in the group with body mass index of 25 and lower zinc level in hair and urine, copper level in serum were significantly higher (palopecia. In addition, obesity by making changes in the balance of the trace elements in hair, serum and urine may play a role in male pattern androgenetic alopecia. Hence, assessing the levels of trace elements in hair of male pattern androgenetic alopecia patients may be more valuable compared to serum and urine for treatment planning. Copyright © 2014 Elsevier GmbH. All rights reserved.

  4. Forensic historiography: narratives and science.

    Science.gov (United States)

    Drukteinis, Albert M

    2014-01-01

    Psychiatrists function, in part, as historians who rely on patient narratives to help them understand presenting mental disorders and explain their causes. Forensic psychiatrists have been skeptical of using narratives, raising concerns about their lack of objectivity and potential for bias. They also have criticized narratives as being more performative than scientific. Recent authors, however, have pointed out that narratives may be helpful in forming forensic opinions and supporting oral testimony, while stressing that their use must be consistent with the ethics espoused by forensic psychiatry. This article reviews the role of narratives in understanding human events and the ubiquitous presence of narratives in the judicial process. It delves into the inescapability of using explicit or implicit narratives in the course of forensic practice, as well as how they may be meaningfully incorporated into evaluations and find expression alongside scientific principles. © 2014 American Academy of Psychiatry and the Law.

  5. Narrative Aversion: Challenges for the Illness Narrative Advocate.

    Science.gov (United States)

    Behrendt, Kathy

    2017-02-01

    Engaging in self-narrative is often touted as a powerful antidote to the bad effects of illness. However, there are various examples of what may broadly be termed "aversion" to illness narrative. I group these into three kinds: aversion to certain types of illness narrative; aversion to illness narrative as a whole; and aversion to illness narrative as an essentially therapeutic endeavor. These aversions can throw into doubt the advantages claimed for the illness narrator, including the key benefits of repair to the damage illness does to identity and life-trajectory. Underlying these alleged benefits are two key presuppositions: that it is the whole of one's life that is narratively unified, and that one's identity is inextricably bound up with narrative. By letting go of these assumptions, illness narrative advocates can respond to the challenges of narrative aversions. © The Author 2016. Published by Oxford University Press, on behalf of The Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Profiling oral narrative ability in young school-aged children.

    Science.gov (United States)

    Westerveld, Marleen F; Gillon, Gail T

    2010-06-01

    This study aimed to determine if oral narrative comprehension and production measures derived in a fictional story retelling task could be used to create a profile of strengths and weaknesses in oral narrative ability (Profile of Oral Narrative Ability: PONA) in young school-aged children. The story retelling task was field-tested with 169 typically developing children, aged between 5;0 and 7;6 years. Children listened twice to an unfamiliar story while looking at the pictures in a book. Comprehension questions were asked after the first exposure. Following the second exposure, children were asked to retell the story without the use of the pictures. Story retellings were analysed on measures of semantics, morphosyntax, verbal productivity, and narrative quality. Results indicated sensitivity for age on measures of comprehension, narrative quality, semantics, and verbal productivity, but not for morphosyntactic measures. Factor analysis indicated that oral narrative performance comprised three factors, explaining more than 80% of the variance. Two clinical case examples are presented, which show the potential of the PONA to reveal different patterns of strengths and weaknesses across the oral narrative measures. Although early evidence suggests the potential usefulness of the PONA, further research is now needed to test the validity, reliability and clinical application of this tool.

  7. Student narratives of faculty incivility.

    Science.gov (United States)

    Lasiter, Sue; Marchiondo, Lisa; Marchiondo, Kathleen

    2012-01-01

    Academic incivility remains a problem on college campuses. Nursing research has refocused from student impropriety to aberrant faculty behaviors. Our original study using the Nursing Education Environment Survey showed that 133 of 152 student participants experienced uncivil treatment. Latent, inductive content analysis was undertaken to analyze narratives about their "worst experience" of negative faculty behavior. Four categories were identified: "In front of someone," "Talked to others about me," "Made me feel stupid," and "I felt belittled." Incivility had a profound effect on students and is problematic because it increases already significant academic pressure; it interferes with learning and safe clinical performance; it is contrary to caring, a central nursing concept; and it decreases program satisfaction and retention. Few nursing schools have civility policies for faculty behavior. Formal procedures that promote professional interaction should be crafted and implemented. Equally important is creating ways for nursing students to document incivility without fear of retaliation. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Den narrative tilgang

    DEFF Research Database (Denmark)

    Bo, Inger Glavind

    2016-01-01

    I kapitlet gennemgås en socialkonstruktivistisk forståelse af narrativer. I kapitlet vil jeg gennemgå centrale teoretiske pointer, der samlet set er grundlæggende for en social konstruktivistisk forståelse af narrativer for herved at udfolde forståelsen af den narrative tilgang og desuden...... tydeliggøre, hvordan tilgangen er forbundet med en særlig forståelse af identitetsskabelse. Der er tale om pointer der almindeligvis forbindes med ”små fortællinger” i form af længere identitetsfortællinger og narrative interviews. Kapitlet gennemgår således centrale inspirationskilder og teoretiske pointer...

  9. Immersion in narrative games

    Directory of Open Access Journals (Sweden)

    Suely Fragoso

    2014-12-01

    Full Text Available This paper discusses the expressions used to refer to the experience of immersive in narrative games. The starting point is a review of the meanings associated with the suspension of disbelief in literature, cinema and television, challenging the myth of the naïve audience that cannot distinguish between representation and reality. Two characteristics of interactive media narratives – the possibility of agency and the disparities between hardware and software interfaces – reveal the active nature of the audience’s involvement with media representations. It is proposed that, in the case of games, this ability, which allows for simultaneous actions in the world of games and in the real world, is better described as a performance of belief.

  10. Narrative Visual Methodologies

    DEFF Research Database (Denmark)

    Frølunde, Lisbeth

    2017-01-01

    a memory work approach. The multiplicity regards the dialogic concept of heteroglossia introduced by Bakhtin (1981) and the multiple variations of languages and perspectives within languages and ways of ordering the linguistic interplay, for instance, of the comic novel. Heteroglossia has accompanying...... and embodied experience of particular persons. Theoretically and methodologically, I draw on dialogic, relational approaches to storytelling and multimodal narrative that grapple with conveying the complexities of cultural, linguistic and historical contexts of memory....

  11. Child's Play: Therapist's Narrative

    OpenAIRE

    Reddy, Rajakumari P.; Hirisave, Uma

    2014-01-01

    Play has been recognized as an essential component to children′s healthy development. Schools of play therapy differ philosophically and technically, but they all embrace the therapeutic and developmental properties of play. This case report is an illustration of how a 6-year-old child with emotional disorder was facilitated to express concerns in child-centered play therapy. The paper discusses the therapist′s narration of the child′s play.

  12. Understanding patient experiences with scarring alopecia: a qualitative study with management implications.

    Science.gov (United States)

    Haskin, Alessandra; Aguh, Crystal; Okoye, Ginette A

    2017-06-01

    Alopecia can have a significant negative impact on patient's lives. The objective of this study is to describe some of the emotional and psychological challenges that affect women with scarring alopecia (SA). A qualitative study design was used with open-ended, individual interviews with 10 women with biopsy-proven SA. Interviews were audio-taped, transcribed verbatim and analyzed thematically using ATLAS.ti analysis software. Four overarching major themes (with several subthemes) emerged including the following: the negative emotional impact of SA, difficulties with concealing hair loss, negative experiences with diagnosis/management, and the importance of support from others. Patients reported that many of these issues were under-emphasized during doctor visits. Analysis of patient responses indicated that patients with SA contend with significant emotional and psychological sequelae of their diagnosis.

  13. Narrative means to manage responsibility in life narratives across adolescence.

    Science.gov (United States)

    De Silveira, Cybèle; Habermas, Tilmann

    2011-01-01

    Adolescence is a passage from dependence to adult responsibility. Alongside identity development, social-cognitive development, and the ability to construct a life story, adolescents become increasingly aware of both their potential responsibility in an expanded sphere of life and of complex, contextual influences on their lives. This was partially tested in a cross-sectional study, both in terms of linguistic means and content expressed in life narratives. Indicators were defined for narrative agency, grading of responsibility, serendipity, and turning points, and tested for age differences in relative frequencies in 102 life narratives from age groups of 8, 12, 16, and 20 years, balanced for gender. Narrative grading of responsibility, serendipity, and turning points increased throughout adolescence. The relative frequency of narrative agency, in contrast, remained constant across age groups. Results are interpreted in the context of adolescent development of narrative identity.

  14. Why might you use narrative methodology? A story about narrative

    Directory of Open Access Journals (Sweden)

    Lynn McAlpine

    2016-04-01

    Full Text Available Narrative is one of many qualitative methodologies that can be brought to bear in collecting and analysing data and reporting results, though it is not as frequently used as say in case studies. This article provides a window into its use, from the perspective of a researcher who has used it consistently over the past decade to examine early career researcher experience – doctoral students, and those who have completed their degrees and are advancing their careers. This experience has contributed to a robust understanding of the potential of narrative, as well as its limitations. This paper first lays out the broad landscape of narrative research and then makes transparent the thinking, processes and procedures involved in the ten-year narrative study including the potential for creativity that narrative invites. The goal is to engage other researchers to consider exploring the use of narrative – if it aligns with their epistemological stance.

  15. Are specific emotions narrated differently?

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    Habermas, Tilmann; Meier, Michaela; Mukhtar, Barbara

    2009-12-01

    Two studies test the assertion that anger, sadness, fear, pride, and happiness are typically narrated in different ways. Everyday events eliciting these 5 emotions were narrated by young women (Study 1) and 5- and 8-year-old girls (Study 2). Negative narratives were expected to engender more effort to process the event, be longer, more grammatically complex, more often have a complication section, and use more specific emotion labels than global evaluations. Narratives of Hogan's (2003) juncture emotions anger and fear were expected to focus more on action and to contain more core narrative sections of orientation, complication, and resolution than narratives of the outcome emotions sadness and happiness. Hypotheses were confirmed for adults except for syntactic complexity, whereas children showed only some of these differences. Hogan's theory that juncture emotions are restricted to the complication section was not confirmed. Finally, in adults, indirect speech was more frequent in anger narratives and internal monologue in fear narratives. It is concluded that different emotions should be studied in how they are narrated, and that narratives should be analyzed according to qualitatively different emotions.

  16. CRF Receptor Antagonist Astressin-B Reverses and Prevents Alopecia in CRF Over-Expressing Mice

    Science.gov (United States)

    Rivier, Jean; Rivier, Catherine; Craft, Noah; Stenzel-Poore, Mary P.; Taché, Yvette

    2011-01-01

    Corticotropin-releasing factor (CRF) signaling pathways are involved in the stress response, and there is growing evidence supporting hair growth inhibition of murine hair follicle in vivo upon stress exposure. We investigated whether the blockade of CRF receptors influences the development of hair loss in CRF over-expressing (OE)-mice that display phenotypes of Cushing's syndrome and chronic stress, including alopecia. The non-selective CRF receptors antagonist, astressin-B (5 µg/mouse) injected peripherally once a day for 5 days in 4–9 months old CRF-OE alopecic mice induced pigmentation and hair re-growth that was largely retained for over 4 months. In young CRF-OE mice, astressin-B prevented the development of alopecia that occurred in saline-treated mice. Histological examination indicated that alopecic CRF-OE mice had hair follicle atrophy and that astressin-B revived the hair follicle from the telogen to anagen phase. However, astressin-B did not show any effect on the elevated plasma corticosterone levels and the increased weights of adrenal glands and visceral fat in CRF-OE mice. The selective CRF2 receptor antagonist, astressin2-B had moderate effect on pigmentation, but not on hair re-growth. The commercial drug for alopecia, minoxidil only showed partial effect on hair re-growth. These data support the existence of a key molecular switching mechanism triggered by blocking peripheral CRF receptors with an antagonist to reset hair growth in a mouse model of alopecia associated with chronic stress. PMID:21359208

  17. CRF receptor antagonist astressin-B reverses and prevents alopecia in CRF over-expressing mice.

    Directory of Open Access Journals (Sweden)

    Lixin Wang

    2011-02-01

    Full Text Available Corticotropin-releasing factor (CRF signaling pathways are involved in the stress response, and there is growing evidence supporting hair growth inhibition of murine hair follicle in vivo upon stress exposure. We investigated whether the blockade of CRF receptors influences the development of hair loss in CRF over-expressing (OE-mice that display phenotypes of Cushing's syndrome and chronic stress, including alopecia. The non-selective CRF receptors antagonist, astressin-B (5 µg/mouse injected peripherally once a day for 5 days in 4-9 months old CRF-OE alopecic mice induced pigmentation and hair re-growth that was largely retained for over 4 months. In young CRF-OE mice, astressin-B prevented the development of alopecia that occurred in saline-treated mice. Histological examination indicated that alopecic CRF-OE mice had hair follicle atrophy and that astressin-B revived the hair follicle from the telogen to anagen phase. However, astressin-B did not show any effect on the elevated plasma corticosterone levels and the increased weights of adrenal glands and visceral fat in CRF-OE mice. The selective CRF₂ receptor antagonist, astressin₂-B had moderate effect on pigmentation, but not on hair re-growth. The commercial drug for alopecia, minoxidil only showed partial effect on hair re-growth. These data support the existence of a key molecular switching mechanism triggered by blocking peripheral CRF receptors with an antagonist to reset hair growth in a mouse model of alopecia associated with chronic stress.

  18. The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia

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    Ids H Boersma

    2014-01-01

    Full Text Available Background: The effectiveness of finasteride and dutasteride in women with androgenetic alopecia has been the subject of debate. Aim: To evaluate the effectiveness of finasteride and dutasteride on hair loss in women with androgenetic alopecia over a period of 3 years. Methods: From a database containing systematically retrieved data on 3500 women treated for androgenetic alopecia between 2002 and 2012 with finasteride 1.25 mg or dutasteride 0.15 mg, a random sample stratified for age and type of medication was taken to yield 30 women in two age categories: below and above 50 years, and for both medications. Hair thickness of the three thinnest hairs was measured from standardized microscopic images at three sites of the scalp at the start of the treatment and after 3 years of continuous medication intake. The macroscopic images were evaluated independently by three European dermatologists/hair experts. The diagnostic task was to identify the image displaying superior density of the hair. Results: Both age categories showed a statistically significant increase in hair thickness from baseline over the 3-year period for finasteride and dutasteride (signed rank test, P = 0.02. Hair thickness increase was observed in 49 (81.7% women in the finasteride group and in 50 (83.3% women in the dutasteride group. On average, the number of post-treatment images rated as displaying superior density was 124 (68.9% in the finasteride group, and 118 (65.6% in the dutasteride group. Dutasteride performed statistically significantly better than finasteride in the age category below 50 years at the central and vertex sites of the scalp. Conclusions: Finasteride 1.25 mg and dutasteride 0.15 mg given daily for 3 years effectively increased hair thickness and arrested further deterioration in women with androgenetic alopecia.

  19. You Must Change Your Life: A Narrative and Theological Inquiry into the Experiences of Transformative Learning in Clinical Pastoral Education Students

    Science.gov (United States)

    Jones, Logan Carroll

    2010-01-01

    The purpose of this qualitative research study is to explore and describe the experiences of transformative learning in seminary students and clergy who have participated in a Clinical Pastoral Education (CPE) residency program while providing pastoral care to patients in an acute care hospital setting. This research focuses on the affective…

  20. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences