A rare cause of cutaneous ulceration: Prolidase deficiency Dear Editors, Prolidase deficiency (PD) is a rare hereditary disease characterised by skin lesions including ulcerations, frequent infections, characteristic facies, mental retardation, and splenomegaly. Diagnosis of prolidase activity is made by sequence analysis of the peptidase D (PEPD) gene in erythrocytes, leukocytes, or fibroblasts. 1 Here, we report a case with associating immunological abnormalities and PD.A 20-year-old boy was admitted to the dermatology clinic for severe ulceration on lower extremities, which were persistent for the past 6 months. Family history indicated that his parents were first-degree relatives. On dermatological examination, there were several geographic ulcers on the thighs and soles with irregular borders (Figures 1 and 2). Atrophic depressed scars on the cheeks were also noted. Laboratory studies showed an elevated erythrocyte sedimentation rate (31 mm/h), elevated IgG level (2100 mg/dL; 750-1560 mg/dL), and elevated total IgE level (379 UI/mL; 1.3-165 UI/mL). Antinuclear antibodies (ANA) were positive at a titre of 1:320 (homogenous and granular pattern). Complement components (C3-C4) were within normal levels, and antibodies to double-stranded DNA, cardiolipin, rheumatoid factor, cryoprotein precipitates, and direct Coombs test were negative. Abdominal ultrasonography showed splenomegaly with a 16 cm vertical length of spleen. Multiple skin biopsies from the edge of the ulcers demonstrated thrombus formation, fibrin, and perivascular
Recovery from work is a critical component for employees' proper functioning. While research has documented the beneficial effects of after-work recovery, it has focused far less on the recovery that happens while at work in the form of work breaks. In this review, we systematically review available empirical evidence on the relationship between work breaks and well-being and performance among knowledge workers. Doing so enables us to (a) integrate studies from multiple disciplines, (b) propose a conceptual framework for categorizing work breaks, and (c) provide a future research agenda for studying the role of work breaks in employee well-being and performance. Using Cochrane's guidelines, we review observational and intervention studies (N = 83). Based on the extant research, we propose that work breaks can be described and classified in terms of five features: initiator, duration, frequency, activities, and experiences. The result of our review is an integrative model that comprehensively captures the relationship between work breaks and well-being and performance outcomes, as well as the mechanisms and boundary conditions of these relationships. We conclude by proposing avenues for the future study and practice of work breaks.
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