BackgroundThere is a lack of evidence to support acyclovir administration in pityriasis
rosea.ObjectiveTo determine the efficacy of acyclovir in patients with typical pityriasis
rosea.MethodsA systematic review and meta-analysis of experimental studies was performed
in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on
acyclovir for pityriasis rosea. Random effect model was used to find the
pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression
of lesions, cessation of lesions, decrease of symptoms and duration of
disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic
treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined
therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment
alone.ResultsSeven papers were analyzed with 324 participants, of which 159 received
acyclovir and 165 were controls. Acyclovir was superior to placebo for
complete regression of lesions at week 1 (Risk Ratio 5.72, CI95%
2.36-13.88). However, combined therapy was not superior to symptomatic
treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies
showed the superiority of acyclovir for the control of symptoms and
pruritus.Study limitationsWe faced differences designs of trials and inconsistency between reports.ConclusionSymptomatic treatment is a reasonable option for pityriasis rosea, and the
addition of acyclovir is justified for the control of symptoms and
pruritus.
Introduction:Little is known about the effects stem cell mobilizers (GCSF) such as neulasta (pegfilgrastim) or neupogen (filgrastim) during pregnancy, and these are often withheld from women undergoing chemotherapy during pregnancy. Materials and Methods: Women receiving chemotherapy during pregnancy were identified from the Cancer and Pregnancy Registry maintained at Cooper University Hospital, Cooper Medical School at Rowan. 176 pregnant women who received chemotherapy were identified. Their oncologists were asked if neupogen or neulasta were "prescribed when necessary;" "were not necessary;" or "were held due to pregnancy." Birth outcomes, white blood count at birth and pediatric health were compared between the group receiving Neupogen/Neulasta (exposed) and a control group (unexposed), i.e. chemotherapy without neupogen/neulasta). Independent T Test or Pearson Chi Square were implemented for statistical comparisons. Results: The mean gestational age at delivery was not significantly different between the exposed (35.4 ± 2.8 weeks) and unexposed groups (35.9 ± 2.8 weeks) p = 0.465. The mean birth weights were not significantly different, 2433 ± 567 g (exposed) compared with 2673 ± 723 g in unexposed group, p = 0.07. Nor was there a difference in congenital malformations: 11.7% versus 4.8%. p = 0.22. The incidence of non-iatrogenic preterm births or complications was not statistically different between groups. Mean WBC count in the exposed group was 13.04 ± 5.0 cells per cubic millimeter of blood and in the unexposed group was 14.6 ± 7.2, p = 0.24. Conclusion: We did not find a statistically significant difference in gestational age at birth, congenital anomalies, or birth weight, incidence of long term medical issues, mean WBC or neutropenia at birth between the newborns exposed to Neupogen/ Neulasta with chemotherapy and newborns exposed to chemotherapy alone.
Bacillary angiomatosis is a rare infection caused by Bartonella henselae or Bartonella quintana, which usually affects patients with the human immunodeficiency virus (HIV) and causes cutaneous and extracutaneous lesions; it is usually benign, but potentially fatal due to systemic involvement. A 49-yearold male, HIV-positive patient was admitted for fever, weight loss, respiratory distress, lymphadenopathy, edema, and multiple widespread angiomatous papules, which began 2 months prior to admission. He had pancytopenia, hypoalbuminemia and hepatosplenomegaly. Skin biopsy showed a well-demarcated nodular lesion with an epidermal collaret that enclosed the dermis, and proliferation of capillaries with hyperplasia and hypertrophy of the endothelial cells. Bacilli were observed with Warthin-Starry stain. He was treated with cotrimoxazole, obtaining resolution of skin lesions and other systemic disorders; however, after stopping therapy, he was readmitted because of recurrence, then he died. This case shows a clinical-pathological correlation of bacillary angiomatosis, which was confirmed by Warthin-Starry stain. In addition, it was associated with systemic findings supported by the therapeutic response to antibiotics, the recurrence of the disease and the exclusion of other differential diagnoses. Despite the reduction of opportunist infections, this unusual disease could be present in some patients and affect skin and other tissues, which increases the probability of death, so physicians should recognize it and start therapy appropriately.
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