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Flowers KC, Shipman KE. Pitfalls in the Diagnosis and Management of Hypercortisolism (Cushing Syndrome) in Humans; A Review of the Laboratory Medicine Perspective. Diagnostics (Basel) 2023; 13:diagnostics13081415. [PMID: 37189516 DOI: 10.3390/diagnostics13081415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Biochemical confirmation of a diagnosis of hypercortisolism (Cushing syndrome) is vital to direct further investigations, especially given the overlap with non-autonomous conditions, such as pseudo-Cushing, and the morbidity associated with missed diagnoses. A limited narrative review was performed focusing on the laboratory perspective of the pitfalls of making a biochemical diagnosis of hypercortisolism in those presenting with presumed Cushing syndrome. Although analytically less specific, immunoassays remain cheap, quick, and reliable in most situations. Understanding cortisol metabolism can help with patient preparation, specimen selection (e.g., consideration of urine or saliva for those with possible elevations of cortisol binding globulin concentration), and method selection (e.g., mass spectrometry if there is a high risk of abnormal metabolites). Although more specific methods may be less sensitive, this can be managed. The reduction in cost and increasing ease of use makes techniques such as urine steroid profiles and salivary cortisone of interest in future pathway development. In conclusion, the limitations of current assays, particularly if well understood, do not impede diagnosis in most cases. However, in complex or borderline cases, there are other techniques to consider to aid in the confirmation of hypercortisolism.
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Affiliation(s)
- Kade C Flowers
- Department of Clinical Chemistry, University Hospitals Sussex NHS Trust, Worthing BN11 2DH, UK
| | - Kate E Shipman
- Department of Clinical Chemistry, University Hospitals Sussex NHS Trust, Worthing BN11 2DH, UK
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Falmer Campus, Brighton BN1 9PX, UK
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2
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Schwartzman GH, Dekker PK, Silverstein AS, Fontecilla NM, Norton SA. Dermatologic Consequences of Substandard, Spurious, Falsely Labeled, Falsified, and Counterfeit Medications. Dermatol Clin 2022; 40:227-236. [DOI: 10.1016/j.det.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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3
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Affiliation(s)
- Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham B18 7QH, UK
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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4
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Kumar D, Singh H, Shrivastav TG. Homologous ELISA for detection of prednisolone in human serum. FOOD AGR IMMUNOL 2017. [DOI: 10.1080/09540105.2017.1376184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Dinesh Kumar
- Immuno, Isotope and Nano-technology Laboratory, Department of Reproductive Biomedicine, The National Institute of Health and Family Welfare (NIHFW), New Delhi, India
- Indian Institute of Technology Delhi (IIT-D), New Delhi, India
- All India Institute of Medical Sciences Delhi (AIIMS-D), New Delhi, India
| | - Harpal Singh
- Indian Institute of Technology Delhi (IIT-D), New Delhi, India
- All India Institute of Medical Sciences Delhi (AIIMS-D), New Delhi, India
| | - T. G. Shrivastav
- Immuno, Isotope and Nano-technology Laboratory, Department of Reproductive Biomedicine, The National Institute of Health and Family Welfare (NIHFW), New Delhi, India
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Savas M, Wester VL, Staufenbiel SM, Koper JW, van den Akker ELT, Visser JA, van der Lely AJ, Penninx BWJH, van Rossum EFC. Systematic Evaluation of Corticosteroid Use in Obese and Non-obese Individuals: A Multi-cohort Study. Int J Med Sci 2017; 14:615-621. [PMID: 28824292 PMCID: PMC5562111 DOI: 10.7150/ijms.19213] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
Abstract
Background: Although the use of corticosteroids has been linked to high incidence of weight gain, no data are available concerning the differences in corticosteroid use between a diverse obese population and non-obese individuals. The main purpose of this study was to systematically explore the use of corticosteroids in obese subjects compared to non-obese controls. In addition, we also explored self-reported marked weight gain within obese subjects. Methods: Two hundred seventy-four obese outpatients (median [range] BMI: 40.1 kg/m2 [30.5-67.0]), and 526 non-obese controls (BMI: 24.1 kg/m2 [18.6-29.9]) from two different Dutch cohort studies were included. Corticosteroid use at the time of clinic or research site visit for up to the preceding three months was recorded in detail. Medical records and clinical data were evaluated with regard to age and body mass index in relation to corticosteroid use, single or multiple type use, and administration forms. Results: Recent corticosteroid use was nearly twice as high for obese subjects than for non-obese controls (27.0% vs. 11.9% and 14.8%, both P<.001). Largest differences were found for use of local corticosteroids, in particular inhaled forms, and simultaneous use of multiple types. Marked weight gain was self-reported during corticosteroid use in 10.5% of the obese users. Conclusion: Corticosteroid use, especially the inhaled agents, is higher in obese than in non-obese individuals. Considering the potential systemic effects of also local corticosteroids, caution is warranted on the increasing use in the general population and on its associations with weight gain.
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Affiliation(s)
- Mesut Savas
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent L Wester
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sabine M Staufenbiel
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan W Koper
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aart J van der Lely
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Obesity Center CGG (Centrum Gezond Gewicht), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Lifelines Cohort Study and Biobank, Groningen, The Netherlands
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Golubović JB, Otašević BM, Protić AD, Stanković AM, Zečević ML. Liquid chromatography/tandem mass spectrometry for simultaneous determination of undeclared corticosteroids in cosmetic creams. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2015; 29:2319-2327. [PMID: 26563702 DOI: 10.1002/rcm.7403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/19/2015] [Accepted: 09/20/2015] [Indexed: 06/05/2023]
Abstract
RATIONALE Undeclared corticosteroids in creams intended for frequent use might cause serious side-effects, especially in children. In order to prevent this or find the cause, it was essential to develop a method for quick detection and quantification of low levels of corticosteroids. METHODS Eleven corticosteroids were used in this study: prednisolone, methylprednisolone, prednisolone-21-acetate, fluocinolone acetonide, fluocinolone acetonide-21-acetate, hydrocortisone-21-acetate, dexamethasone, betamethasone, betamethasone dipropionate, clobetasol propionate and triamcinolone. Separation was achieved via liquid chromatography (LC), and mass spectrometric analysis was conducted by electrospray ionization triple-quadrupole mass spectrometry (MS/MS) in the multiple reaction monitoring mode using corticosterone as internal standard. RESULTS Good separation by using a gradient-elution LC/MS/MS method with run time of 25 min enabled the use of a segmented detection method and consecutive decrease in detection limits. The proposed method has been validated in the linearity range of 10-1000 ng/mL with coefficients of determination higher than 0.990. The method has shown to have very low limits of quantification (0.75-3 ng/mL) with satisfactory precision and accuracy for each of the corticosteroids. CONCLUSIONS An LC/MS/MS method for the rapid and simultaneous determination of low levels of eleven topical corticosteroids in creams was developed, optimized and validated. The proposed method can be used for testing of different products indicated for the treatment of atopic dermatitis, including "natural products", and "herbal creams" with "miraculous effects".
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Affiliation(s)
- Jelena B Golubović
- University of Belgrade-Faculty of Pharmacy, Department of Drug Analysis, Vojvode Stepe 450, Belgrade, Serbia
| | - Biljana M Otašević
- University of Belgrade-Faculty of Pharmacy, Department of Drug Analysis, Vojvode Stepe 450, Belgrade, Serbia
| | - Ana D Protić
- University of Belgrade-Faculty of Pharmacy, Department of Drug Analysis, Vojvode Stepe 450, Belgrade, Serbia
| | - Aleksandra M Stanković
- University of Belgrade-Faculty of Pharmacy, Department of Drug Analysis, Vojvode Stepe 450, Belgrade, Serbia
| | - Mira L Zečević
- University of Belgrade-Faculty of Pharmacy, Department of Drug Analysis, Vojvode Stepe 450, Belgrade, Serbia
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Zedan K, Rasheed Z, Farouk Y, Alzolibani AA, Bin Saif G, Ismail HA, Al Robaee AA. Immunoglobulin e, interleukin-18 and interleukin-12 in patients with atopic dermatitis: correlation with disease activity. J Clin Diagn Res 2015; 9:WC01-5. [PMID: 26023628 DOI: 10.7860/jcdr/2015/12261.5742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Immunological/inflammatory reactions are reported to play a role in AD but their role in disease activity has not been fully investigated. This study was done to investigate the role of immunoglobulin E (IgE), interleukin (IL)-18 and IL-12 in AD patients with different disease severities. MATERIALS AND METHODS Sera from 50 AD infants with varying levels of disease activity according to the scoring index of atopic dermatitis (SCORAD) index and 30 age-matched healthy controls were evaluated for serum levels of IgE, IL-18 and IL-12/p40. RESULTS Serum analysis showed higher levels of IgE, IL-18 or IL-12/p40 in AD patients compared with controls. Interestingly, not only was there an increased number of subjects positive for IgE, IL-18 or IL-12/p40, but also the levels of these parameters were higher among AD patients whose SCORAD scores were higher. In addition, a significant correlation was observed between the levels of these parameters and SCORAD scores. CONCLUSION These findings support an association between IgE, IL-18 or IL-12/p40 and AD. The stronger response observed in serum samples from patients with higher SCORAD scores suggest that IgE, IL-18 and IL-12/p40 may be useful in evaluating the progression of AD and in elucidating the mechanisms of disease pathogenesis.
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Affiliation(s)
- Khaled Zedan
- Assistant Professor, Department of Pediatrics, College of Medicine, Qassim University , Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Assistant Professor, Department of Medical Biochemistry, College of Medicine, Qassim University , Buraidah, Saudi Arabia
| | - Yaser Farouk
- Assistant Professor, Department of Pediatrics, College of Medicine, Qassim University , Buraidah, Saudi Arabia
| | - Abdullateef A Alzolibani
- Associate Professor, Department of Dermatology, College of Medicine, Qassim University , Buraidah, Saudi Arabia
| | - Ghada Bin Saif
- Associate Professor, Department of Dermatology, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Hisham A Ismail
- Professor, Department of Pathology, College of Medicine, Qassim University , Buraidah, Saudi Arabia
| | - Ahmad A Al Robaee
- Professor, Department of Dermatology, College of Medicine, Qassim University , Buraidah, Saudi Arabia
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9
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Lorenc A, Crichton N, Robinson N. Traditional and complementary approaches to health for children: Modelling the parental decision-making process using Andersen's Sociobehavioural Model. Complement Ther Med 2013; 21:277-85. [PMID: 23876557 DOI: 10.1016/j.ctim.2013.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/17/2013] [Accepted: 05/22/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Traditional and complementary approaches to health (TCA) are common for children. Andersen's Sociobehavioural Model (SBM) is often used to explain healthcare decision-making. This study aimed to identify the prevalence and determinants of traditional and complementary approaches to health (TCA) in a multi-ethnic child population, and to explore whether the SBM explained TCA health care decision-making in this population. DESIGN Cross-sectional questionnaire survey. NHS ethical approval was given. SETTING GP waiting rooms, Northwest London. MAIN OUTCOME MEASURE AND ANALYSIS All carers/parents (with children under 16), attending GP appointments on specific days, were asked to complete a questionnaire about TCA use; primary outcome 12-month child TCA use. Forward stepwise logistic regression tested appropriateness of the SBM. RESULTS A total of 394 questionnaires were returned, representing 737 children; a quarter White British. Prevalence of 12-month TCA use was 45.4%, mainly food-based herbs/spices for minor illnesses which were used prior to GP consultation. Over half identified that TCA was part of their ethnic/cultural background. Only 29% had discussed TCA with their GP. The strongest predictor of child TCA use in the SBM was carer TCA use, itself influenced by carer gender and ethnicity, and GP advice. Need factors were not influential. CONCLUSIONS Child TCA use was common in this multi-ethnic community, particularly the use of food-based remedies for minor illnesses, and carers' experience and background are central in deciding to use TCA for a child. TCA appears practiced as part of cultural background, with implications for GPs to be aware of their role in guiding patients to ensure safe practice.
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Affiliation(s)
- Ava Lorenc
- Department of Allied Health Sciences, London South Bank University, United Kingdom.
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Haneef J, Shaharyar M, Husain A, Rashid M, Mishra R, Siddique NA, Pal M. Analytical methods for the detection of undeclared synthetic drugs in traditional herbal medicines as adulterants. Drug Test Anal 2013; 5:607-13. [PMID: 23653249 DOI: 10.1002/dta.1482] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/20/2013] [Accepted: 03/11/2013] [Indexed: 12/20/2022]
Abstract
Traditional herbal medicines (THMs) are gaining popularity worldwide as an alternative approach to prescription drugs for many reasons including a general perception that they are safe. But recently there have been number of reported studies that reveal adulteration of THMs with undeclared synthetic drugs, which may potentially cause serious toxic adverse effects. This paper reviews the various classes of synthetic drugs that were found to be adulterated in THMs worldwide. The main focus is to highlight newer analytical tools used to detect adulteration. Due to the advancement in hyphenated techniques like liquid chromatography tandem mass spectrometry (LC-MS/MS), gas chromatography-tandem mass spectrometry (GC-MS/MS) and other conventional tools, it has become possible to detect synthetic drugs and their structural analogues as adulterants even if they are present in small quantities. This review also gives an overview of health-related risks after consuming such spurious products and challenges for future perspectives to control such type of malpractices.
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Affiliation(s)
- Jamshed Haneef
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi, 110062, India
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Haneef J, Shaharyar M, Husain A, Rashid M, Mishra R, Parveen S, Ahmed N, Pal M, Kumar D. Application of LC-MS/MS for quantitative analysis of glucocorticoids and stimulants in biological fluids. J Pharm Anal 2013; 3:341-348. [PMID: 29403837 PMCID: PMC5760999 DOI: 10.1016/j.jpha.2013.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 03/23/2013] [Indexed: 01/25/2023] Open
Abstract
Liquid chromatography tandem mass chromatography (LC-MS/MS) is an important hyphenated technique for quantitative analysis of drugs in biological fluids. Because of high sensitivity and selectivity, LC-MS/MS has been used for pharmacokinetic studies, metabolites identification in the plasma and urine. This manuscript gives comprehensive analytical review, focusing on chromatographic separation approaches (column packing materials, column length and mobile phase) as well as different acquisition modes (SIM, MRM) for quantitative analysis of glucocorticoids and stimulants. This review is not meant to be exhaustive but rather to provide a general overview for detection and confirmation of target drugs using LC-MS/MS and thus useful in the doping analysis, toxicological studies as well as in pharmaceutical analysis.
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Affiliation(s)
- Jamshed Haneef
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Mohammad Shaharyar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Asif Husain
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Mohd Rashid
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Ravinesh Mishra
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Shama Parveen
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Niyaz Ahmed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Manoj Pal
- Department of Chemistry, Indian Institute of Technology (IIT), Haridwar, Roorkee 247667, Uttarakhand, India
| | - Deepak Kumar
- Research Institute of Natural Sciences, Department of Chemistry, Changwon National University, Changwon 641773, Republic of Korea
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Robinson N, Lorenc A, Falinski A, Banarsee R. The challenges of facilitating primary healthcare discussions on traditional, complementary and alternative medicine for childhood eczema: piloting a computerized template. PATIENT EDUCATION AND COUNSELING 2012; 89:517-524. [PMID: 22465483 DOI: 10.1016/j.pec.2012.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema. METHODS A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs' knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation. RESULTS HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient's choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice. CONCLUSION HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP-patient communication. PRACTICE IMPLICATIONS Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time.
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Hon KLE, Leung TF, Yau HC, Chan T. Paradoxical use of oral and topical steroids in steroid-phobic patients resorting to traditional Chinese medicines. World J Pediatr 2012; 8:263-7. [PMID: 22886202 DOI: 10.1007/s12519-012-0369-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Childhood-onset eczema is a common condition associated with pruritus, sleep disturbance and disrupted quality of life. The mainstay of treatment is usage of emollients and topical corticosteroid (CS). Nevertheless, many steroid-phobic parents are very skeptical about western medicine that may contain CS. Furthermore, complementary and alternative medicine (CAM) is popular among Chinese patients in Asia and many citizens idolize CAM and believe that traditional Chinese medicine and herbs are without any side effects. Pressed by public's quest for efficacious and safe treatment, and lucrative profits, CAM practitioners may take the risks of prescribing steroids and "western medicine" in the name of traditional Chinese herbal medicine. METHODS We report a series of illustrative cases of uninformed systemic and topical corticosteroid usage for eczema by steroid-phobic parents to alert the public of this risk. The drugs were detected by high-performance liquid chromatography with diode-array detection, liquid chromatography-tandem mass spectrometry, gas chromatography mass spectrometry, or liquid chromatography ion trap time-of-flight mass spectrometry. RESULTS Five cases of uninformed corticosteroid usage for moderate-to-severe eczema by steroid-phobic parents were reported. CONCLUSIONS The physician caring for children with skin disease should also be aware that even steroid-phobic parents might indeed be using potent CS without awareness. The patient usually suffers chronic relapsing eczema of moderate-to-severe degree. The steroid-phobic parent is usually non-compliant in following advice on usage of emollient, topical CS, and avoidance of triggers in accordance with western doctors. The CAM practitioner, when confronted by an anxious steroidophobic parent who demands efficacious topical and/or systemic treatment, may knowingly or unknowingly be forced into prescribing potent albeit illegal products containing corticosteroids in the name of traditional Chinese herbal medicine.
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Affiliation(s)
- Kam-Lun E Hon
- Prince of Wales Hospital, Shatin, The Chinese University of Hong Kong, Hong Kong, China.
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Cao G, Li J, Li L, Li H, Wang F, Wang H, Zhang L. Use of nonprescription medicines by patients with COPD: a survey in Chongqing Municipality, China. Chron Respir Dis 2012; 9:77-81. [PMID: 22441338 DOI: 10.1177/1479972312437852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To study the impact of self-administration of nonprescription medicines (NPMs) on patients with chronic obstructive pulmonary disease (COPD), in Chongqing Municipality, China. A total of 85 patients who had used NPM were assigned to the NPM group. Another 83 patients who had only used prescription medicines (PMs) were assigned to the PM group. Their income, educational levels, health status, public health insurance coverage, the expense of drugs during exacerbation, and the numbers of acute exacerbations during the past year were surveyed, and the approved drugs for COPD were evaluated. The contents of corticosterone in various types of NPMs were determined by high-performance liquid chromatography. The proportion of use of NPM in hospitalized patients with COPD was 12.96%. The percentage of illiteracy and low income was significantly higher in COPD patients in the NPM group than those in the PM group. The cost of drugs per day and the quality of life in the NPM group were lower than those in the PM group. Further analysis revealed that 15 of 21 NPMs contained corticosteroids. More importantly, medical advice from doctors and nurses appeared to be effective. Some Chinese patients with COPD living in the Chongqing area of China used NPMs that contained corticosteroids. Health education and advisement can effectively limit the use of NPMs.
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Affiliation(s)
- Guoqiang Cao
- Department of Respiratory Disease, Research Institute of Surgery, Daping Hospital, the Third Military Medical University, Chongqing, China.
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Lewis KM, Robkin N, Gaska K, Njoki LC. Investigating Motivations for Women’s Skin Bleaching in Tanzania. PSYCHOLOGY OF WOMEN QUARTERLY 2011. [DOI: 10.1177/0361684310392356] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Why do many African women continue to use damaging skin-bleaching cosmetics that contain dangerous chemicals (e.g., mercury) that may increase their rates of infertility, skin cancer, and serious skin/brain/kidney disease? To address this question, our study investigated motivations driving the preservation of skin-bleaching practices in Tanzania. We conducted qualitative interviews with 42 urban women in Dar es Salaam who reported engaging in skin-bleaching practices and who were a subset of a larger sample of women from a study investigating the prevalence of skin bleaching in Tanzania. Results yielded six thematic motivations behind the practice of skin bleaching: (a) to remove pimples, rashes, and skin disease; (b) to have soft skin; (c) to be White, “beautiful,” and more European looking; (d) to remove the adverse affects of extended skin bleaching use on the body; (e) to satisfy one’s partner and/or attract male mates; and (f) to satisfy and impress peers. These findings provide empirical support for skin bleaching being linked to self-objectification, colonialism, and Westernization. Skin bleaching is discussed in the context of other potentially harmful body modification practices in which women participate as a result of external and internalized standards of beauty. Implications for future research and potential practice and policy interventions are discussed.
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Affiliation(s)
- Kelly M. Lewis
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Navit Robkin
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Karie Gaska
- Department of Psychology, Georgia State University, Atlanta, USA
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Complementary and Alternative Interventions in Atopic Dermatitis. Immunol Allergy Clin North Am 2010; 30:411-24. [DOI: 10.1016/j.iac.2010.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arýkan D, Sívríkaya SK, Olgun N. Complementary alternative medicine use in children with type 1 diabetes mellitus in Erzurum, Turkey. J Clin Nurs 2008; 18:2136-44. [PMID: 19077023 DOI: 10.1111/j.1365-2702.2008.02464.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM AND OBJECTIVE The aims of this study were: (i) to determine the types of complementary and alternative medicine use among children with type I diabetes mellitus as reported by parents and (ii) to describe sociodemographic and medical factors associated with the use of such treatments in families residing in Eastern Turkey. BACKGROUND Type 1 diabetes mellitus is a tremendously challenging and complex disease for children and families to manage. Therefore, the use of complementary and alternative medicines among children with type 1 diabetes is becoming increasingly popular. DESIGN Survey. METHOD Parents of 100 paediatric patients (who were diagnosed with type 1 diabetes at least 6 months prior to the study) who visited the participating paediatric endocrinology multidisciplinary centres and clinics for diabetes management were included in the study. Data were collected by using a semi-structured questionnaire. Results. Fifty-two per cent of the parents reported the use of one or more complementary alternative medicine therapies. Most such users (59.6%) were using oral herbal preparations; including morus alba (leaves) aloe vera and stinging nettle. CONCLUSION Since we found that 78.6% of those using herbals were satisfied with their results and 69.2% were planning to continue use, it is important for healthcare providers to have relevant knowledge about complementary alternative medicine use and learn about its efficacy and effects (positive and adverse) of these treatments. Relevance to clinical practice. Botanical substitute for insulin seems unlikely, but complementary alternative treatments may provide valuable clues for the development of new oral hypoglycaemic agents and simple dietary agents. It is important for healthcare providers to have up-to-date knowledge about the use and effects of complementary alternative medicines in the outpatient clinical care setting.
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Affiliation(s)
- Duygu Arýkan
- Department of Child Health Nursing, School of Nursing, Atatürk University, Erzurum 25240, Turkey.
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Gill S, Coad J. An exploratory study into nurses' understanding and knowledge of children and young people with eczema. J Res Nurs 2007. [DOI: 10.1177/1744987107079586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This is an exploratory research project that enquires into the capabilities of three different groups of paediatric-trained nurses to meet the needs of children and young people with eczema, one of the commonest of chronic conditions of childhood. Data methodology included vignettes and associated questionnaire, which was used with three groups of nurses working with children and young people: students; qualified children's nurses and school nurses. The findings indicated a low level of dermatology nursing knowledge about basic skin care and that some nurses even appeared to avoid those who were disfigured by skin disease. It also raises some questions about whether the disfiguring nature of skin disorders such as eczema can affect a nurse's decision-making ability.
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Affiliation(s)
- Steve Gill
- Birmingham Children's Hospital, Birmingham
| | - Jane Coad
- The University of West of England, Centre for Child and Adolescent Health, Bristol
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Hughes R, Ward D, Tobin AM, Keegan K, Kirby B. The use of alternative medicine in pediatric patients with atopic dermatitis. Pediatr Dermatol 2007; 24:118-20. [PMID: 17461804 DOI: 10.1111/j.1525-1470.2007.00355.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alternative medicine has been defined as forms of therapy or examination that have no scientific basis and for which no effective or diagnostic reliability has been demonstrated by scientific methods. The use of complementary or alternative medicine is increasing and controlled clinical trials on the subject are few. We performed a questionnaire-based study of 80 pediatric patients with atopic dermatitis. This questionnaire assessed the duration of treatment, the reason(s) for trying alternative therapy, the approximate cost and the success of the treatment, the duration of the childhood eczema, and whether the child had ever required hospital admission for eczema. Of the total, 34 (42.5%) patients had used alternative medicine. Herbal remedies and homeopathy were used most often. Most treatments were reported to show no benefit and in three instances deterioration was reported. This study has prompted us to enquire routinely regarding alternative medicine use. Alternative therapies are subject to minimal regulation and have been associated with serious side effects. We would recommend enquiries regarding alternative medicine use in all pediatric dermatology patients.
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Affiliation(s)
- R Hughes
- Department of Dermatology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
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Abstract
Atopic dermatitis is an especially common and frustrating condition, and the prevalence is increasing. The disease can adversely affect the quality of life of patients and caregivers. Significant advances in our understanding of the pathogenesis have led to improvements in therapy. Patient and caregiver education, avoidance of potential triggering factors, optimal skin care, and pharmacotherapy offer the potential for good control for most patients.
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Affiliation(s)
- Alexander K C Leung
- The University of Calgary, The Alberta Children's Hospital, #200, 233-16th Avenue NW, Calgary, AB T2M 0H5, Canada.
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Crawford NW, Cincotta DR, Lim A, Powell CVE. A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales. Altern Ther Health Med 2006; 6:16. [PMID: 16670012 PMCID: PMC1475886 DOI: 10.1186/1472-6882-6-16] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Accepted: 05/02/2006] [Indexed: 11/23/2022]
Abstract
Background A high prevalence of CAM use has been documented worldwide in children and adolescents with chronic illnesses. Only a small number of studies, however, have been conducted in the United Kingdom. The primary aim of this study was to examine the use of CAM by children and adolescents with a wide spectrum of acute and chronic medical problems in a tertiary children's hospital in Wales. Methods Structured personal interviews of 100 inpatients and 400 outpatients were conducted over a 2-month period in 2004. The yearly and monthly prevalence of CAM use were assessed and divided into medicinal and non-medicinal therapies. This use was correlated with socio-demographic factors. Results There were 580 patients approached to attain 500 completed questionnaires. The use of at least one type of CAM in the past year was 41% (95% CI 37–46%) and past month 26% (95% CI 23–30%). The yearly prevalence of medicinal CAM was 38% and non-medicinal 12%. The users were more likely to have parents that were tertiary educated (mother: OR = 2.3, 95%CI 1.6–3.3) and a higher family income (Pearson chi-square for trend = 14.3, p < 0.001). The most common medicinal types of CAM were non-prescribed vitamins and minerals (23%) and herbal therapies (10%). Aromatherapy (5%) and reflexology (3%) were the most prevalent non-medicinal CAMs. None of the inpatient medical records documented CAM use in the past month. Fifty-two percent of medicinal and 38% of non-medicinal CAM users felt their doctor did not need to know about CAM use. Sixty-six percent of CAM users did not disclose the fact to their doctor. Three percent of all participants were using herbs and prescription medicines concurrently. Conclusion There is a high prevalence of CAM use in our study population. Paediatricians need to ensure that they ask parents and older children about their CAM usage and advise caution with regard to potential interactions. CAM is a rapidly expanding industry that requires further evidence-based research to provide more information on the effectiveness and safety of many CAM therapies. Statutory or self-regulation of the different segments of the industry is important. Integration of CAM with allopathic western medicine through education and better communication is slowly progressing.
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Affiliation(s)
- Nigel W Crawford
- Department of General Paediatrics, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Domenic R Cincotta
- Department of General Paediatrics, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Alissa Lim
- Department of General Paediatrics, The Royal Children's Hospital, Melbourne, VIC 3052, Australia
| | - Colin VE Powell
- Department of General Paediatrics, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
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Abstract
Atopic eczema is a significant disease, being the most common skin disorder in children, affecting 12-15% of all school-age children (Emerson et al, 1998). It is an inflammatory skin condition, which is genetic in origin but is triggered by many factors, such as detergents, emotional distress or dust mites (Buxton, 1998) and often starts in the first year of life. It is characterised by dry and itchy skin. This often breaks down and becomes infected, partly as a result of the close relationship of atopic eczema and the organism Staphylococcus aureus, which is found on the skin of most children with atopic eczema (Goodyear, 1993).
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Magin PJ, Adams J, Pond CD, Smith W. Topical and oral CAM in acne: a review of the empirical evidence and a consideration of its context. Complement Ther Med 2005; 14:62-76. [PMID: 16473756 DOI: 10.1016/j.ctim.2005.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Revised: 06/06/2005] [Accepted: 10/18/2005] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Acne is one of the commonest diseases to afflict humanity. Anecdotally, the use of CAM in acne is widespread. In this review the empirical evidence for the efficacy of CAM modalities is examined and the context for their use discussed. METHODS Searches were made of the MEDLINE, EMBASE, AMED (Allied and Complementary Medicines), Cochrane, and DARE databases using the search terms "acne" and "acne vulgaris" together with "alternative" and "complementary". RESULTS The identified studies examined a broad range of CAM modalities but were of generally poor methodological quality. Evidence suggests that many of these therapies are biologically plausible. DISCUSSION AND CONCLUSION Complementary therapies in acne should be viewed in a wider context than that of the very limited empiric evidence base that exists for their use. Further rigorously conducted trials should be conducted to define efficacy and adverse effect profiles of currently used CAM acne therapies.
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Affiliation(s)
- P J Magin
- Discipline of General Practice, Newbolds Building, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
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Abstract
PURPOSE To describe atopic dermatitis (AD) in relation to a case study, the diagnostic criteria, complications, prevalence, future implications, and management for the primary care provider. DATA SOURCES Extensive literature review on the condition, supplemented with an actual case study. CONCLUSIONS Although there are many scientific studies done on AD, the exact pathogenesis and cure for this condition are still to be discovered. It is usually chronic and has some fatal sequelae in those who have been exposed to viral infections. Asthma, allergic rhinitis (AR), and AD are considered the atopic triad. Further studies that may help improve medical providers' understanding of AD are going on and offer hope to those afflicted by this disorder. IMPLICATIONS FOR PRACTICE Children over 5 years old may have outgrown their symptoms, so it is best to diagnose this condition at an early age to provide better management outcomes. Because it is part of an atopic triad, the nurse practitioner must think beyond the presenting skin condition to consider possible respiratory system conditions. AD may herald the onset of asthma and AR.
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Everett LL, Birmingham PK, Williams GD, Brenn BR, Shapiro JH. Herbal and homeopathic medication use in pediatric surgical patients. Paediatr Anaesth 2005; 15:455-60. [PMID: 15910344 DOI: 10.1111/j.1460-9592.2005.01487.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who present for surgery may be using herbal or homeopathic preparations; adverse effects of some of these substances include bleeding, cardiovascular changes, and liver dysfunction. Little information is available on the frequency of use in the pediatric surgical population. METHODS With institutional approval, a survey was conducted to assess the use of vitamins, nutritional supplements, or herbal or homeopathic preparations in children presenting for surgery in five geographically diverse centers in the USA. RESULTS A total of 894 completed surveys showed that overall, 3.5% of pediatric surgical patients had been given herbal or homeopathic medications in the 2 weeks prior to surgery. Most substances were prescribed by parents. The use of these medications did not differ between children with coexisting diseases and those without; use was also not different among ethnic groups or by residence setting (city, suburban, rural). There was a significant difference between the west coast centers in the study compared with the rest of the country (7.5% of patients in Palo Alto, CA; 5.5% of patients in Seattle, WA; 1.5% of patients in Chicago, IL; and 1.9% in Virginia and Delaware used herbal or homeopathic remedies). The most prevalent substance given to children presenting for elective surgery was Echinacea. CONCLUSIONS Herbal and homeopathic medications are used by a small percentage of pediatric patients presenting for elective pediatric surgery patients. Use of these substances should be addressed in the preoperative history.
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Affiliation(s)
- Lucinda L Everett
- Department of Anesthesiology, Children's Hospital and Regional Medical Center, University of Washington, USA.
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Abstract
This article considers briefly how and why complementary and alternative medicine has developed in children's care during the last 10 years. Some of the therapies utilised by children are discussed, similarities and differences to trends in CAM for adults highlighted and a potential role for CAM in children's care in the future, suggested.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, The Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, Pennsylvania, USA
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Abstract
PURPOSE OF REVIEW Atopic dermatitis, one of the most common chronic illnesses of childhood, is encountered routinely by all providers of health care to children. RECENT FINDINGS In recent years there has been a dramatic rise in the prevalence of atopic dermatitis and therefore a rapid increase in the number of studies investigating various aspects of the disease. Consequently, hundreds of publications are released each year, and it is difficult to stay up to date on the latest advances. SUMMARY This review will examine and summarize recent literature on the diagnosis, epidemiology, pathogenesis, treatment, and complications of atopic dermatitis.
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Affiliation(s)
- Stephanie Sturgill
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, USA
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