Air pollution, organic toxicants, seasonal factors, psychological stress, migration, birth order, and nutrition may have a close relationship with the incidence of ASD.
Chronic prostatitis (CP) is one of the most prevalent conditions in urology, yet the most poorly understood. Although there is little controversy regarding the therapy for documented acute bacterial infections, most symptomatic men do not have bacterial prostatitis, for which treatment and management are usually successful. Throughout the past century, the diagnostic entity of CP has been recognised and its clinical characteristics have been well described. However, no hard and fast guidelines have been developed. To date, several surveys of physicians have been undertaken in order to examine their practice characteristics, attitude, diagnostics and treatment modalities applied in patients with CP. These surveys demonstrate that physicians show large deficits in familiarity with and knowledge of CP along with significant uniformity in the medical approach to this condition and confirm the frustration experienced by physicians in the management of this disease. The results of these studies also suggest an important role for continuing education on the diagnosis and treatment of CP. Further study is needed to identify the aetiology and pathogenesis of male chronic pelvic pain and to establish guidelines for its diagnosis and treatment.
One of the most intriguing adverse reactions of TNF-a inhibitors (TNFis) is occurrence of de novo psoriasiform eruptions (TNF-psoriasis). Although well-accepted as a relatively common reaction of this medication class, many aspects of this side effect remain poorly characterized. Specifically, few studies have evaluated histologic features of TNF-psoriasis skin lesions, and most are limited by inclusion of few specimens. We comprehensively evaluated histologic features of 57 TNF-psoriasis biopsies from 50 unique patients seen at a single, tertiary care center dermatology department, and additionally compared histologic features of these biopsies to those of 85 biopsies from control patients with idiopathic psoriasis. The dominant reaction pattern in TNF-psoriasis biopsies was psoriasiform (80.7%), followed by spongiotic and pustular. Papillary plate thinning (p¼0.03574) and neutrophils in the stratum corneum (p¼8.89x10 -7 ) were significantly more likely in histologic sections of idiopathic psoriasis compared to TNF-psoriasis. Alternatively, lack of parakeratosis (p¼0.01983), neutrophils in the epidermis (p¼0.01654), and eosinophils in the dermis (p¼2.23x10 -6 ) were significantly more likely in histologic sections of TNF-psoriasis compared to idiopathic psoriasis. Whereas eosinophils were present in the minority of idiopathic psoriasis specimens (17.6%) and no section had more than 3 eosinophils (n¼1), 52.6% of TNF-psoriasis specimens displayed dermal eosinophils and 21.1% (n¼12) had >3 eosinophils. There was no statistical difference in histological characteristics between the TNF-psoriasis cohort who responded to topicals compared to the cohort requiring more aggressive therapies. We believe consideration of these 5 contrasting histologic features can help dermatologists and pathologists confidently assess biopsies of psoriasiform lesions in patients treated with TNFis, and help drive more appropriate and effective treatment recommendations.
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