The association of PPI use and hypomagnesemia is uncommon. Congenital defects in the metabolism of magnesium may be responsible for hypomagnesemia in some patients using this drug class.

No abstract

Decreased pulse pressure (PP) is associated with low cardiac output and increased mortality in heart failure (HF) inpatients. QRS width is a well-known prognostic factor in HF. The study purpose was to explore the mortality effect of combining PP and QRS width in HF outpatients. Initial sphygmomanometrically determined PP and QRS width on the first electrocardiograph in 327 consecutive patients at an HF clinic were recorded. According to PP > or = or <40 mm Hg and QRS width > or = or <120 ms, patients were classified into 4 groups. Study groups were analyzed for their effect on mortality using Cox proportional hazards regression analysis. Patients with PP <40 mm Hg had higher mortality (59% vs 45%; P=.015). QRS width > or =120 ms indicated a trend toward higher mortality (57% vs 48%; P=.067). Actuarial survival curves showed that group 4 (QRS width > or =120 ms and PP <40 mm Hg) had significant increased mortality risk in 3.5 years' mean follow-up. Group 4 had a mean survival time of 1124 days (SD=124) vs 2233 days (SD=285) in group 1 (QRS width <120 ms and PP > or =40 mm Hg) (P=.022). There was a linear association between left ventricular ejection fraction (LVEF) and study groups. PP and QRS width are readily available, inexpensive, and relevant clinical measures to help identify HF outpatients with significantly worse prognosis and decreased LVEF.

No abstract

The association of microphthalmia and linear skin defects was named microphthalmia with linear skin defects syndrome (MLS) or MIDAS syndrome (microphthalmia, dermal aplasia, and sclerocornea), an X-chromosomal disorder manifesting mainly in females. We examined a female newborn with facial linear skin defects following the Blaschko lines. Computer tomography and ophthalmological examination confirmed bilateral microphthalmia. An interstitial microdeletion at Xp22.2, encompassing the entire HCCS gene, was identified. Dermatoscopic examination showed erythematous linear areas with telangectasias and absence of sebaceous glands, which appear as brilliant white dots. Vellus hairs were also absent in the red areas. Dermatoscopy could help to establish the diagnosis of MLS/MIDAS syndrome by confirming the aplastic nature of the lesions.

We performed scanning electron microscopy of an inverted blister roof in a case of pemphigus foliaceus. The loss of intercellular adherence could be easily seen with low magnification. The acantholytic keratinocytes displayed an irregular and sometimes polygonal contour. Round cells, typically seen in light microscopy, were also observed. The examination of a blister roof allows ultrastructural documentation of the acantholytic changes.

No abstract

Background: Little is known about the dermoscopic evaluation of cutaneous adverse drug reactions (CADRs). Objectives: To evaluate the dermoscopic patterns of CADRs and identify those associated with severe cutaneous adverse reactions to drugs (SCARDs). Patients and Methods: Patients included in this study from May 2015 to April 2016 had presented with CADRs. CADR presentation and classification were based on standard criteria. SCARDs included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), overlap SJS/TEN, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). The dermoscopic features of CADRs were described and compared according to the severity of the reactions. Results: Sixty-nine patients were included. Sixteen patients (23.2%) presented SCARDs. The main dermoscopic findings in SJS, overlap SJS/TEN and TEN were black dots or necrotic areas (100%). Erosion [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1 (100%)], necrotic borders [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1, (100%)] and epidermal detachment [respectively, 5/6 (83.3%); 2/3 (66.7%) and 1/1 (100%)] were also common among these reactions. Erythema and purpuric dots were the main dermoscopic findings [respectively, 5/6 (83.3%) and 4/6 (66.7%)] in DRESS. In non-severe reactions, the most prevalent structures were erythema and purpura in exanthema [respectively, 31/33 (93.9%) and 24/33 (72.7%)] and erythema and vascular structures in urticarial reactions [respectively, 6/6 (100%) and 3/6 (50%)]. Black dots or necrotic areas, epidermal detachment, necrotic borders and erosion were highly associated with SCARDs (P < 0.001). Conclusions: Dermoscopy improves clinical recognition of SCARDs.