Melasma: systematic review of the systemic treatments.

Currently available treatment options for melasma include prevention of UV radiation, topical lightening agents, chemical peels, and light-based and laser therapies. However, none have shown effective and sustained results, with incomplete clearance and frequent recurrences. There has been increasing interest recently in oral medications and dietary supplements in improving melasma.

Risk of Malignancy in Dermatomyositis and Polymyositis.

Background: There is variation in the risk of malignancy in dermatomyositis (DM) and polymyositis (PM) in the existing literature.

Objective: To conduct a meta-analysis to estimate the risk of malignancy in DM and PM as compared with the general population.

Methods: Medline and Embase Database abstracts were searched through August 2014 using the search terms myositis, neoplasms, and paraneoplastic syndromes.

Canadian Clinical Practice Guidelines for Rosacea.

Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations.

Hospitalizations for cellulitis in Canada: a database study.

Background: Cellulitis is the skin disease most commonly responsible for emergency department visits and inpatient admissions.

Objective: To determine factors associated with prolonged admissions and mortality in inpatients with cellulitis.

Methods: Data on patients with an admission diagnosis of cellulitis from 2004 to 2008 in the Canadian Discharge Abstract Database were analyzed.

Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options.

Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that has historically been associated with diabetes mellitus. Debate exists regarding the etiology and pathogenesis of NL with a widely accepted theory that microangiopathy plays a significant role. NL typically presents clinically as erythematous papules on the front of the lower extremities that can coalesce to form atrophic telangiectatic plaques.

Lichen planopilaris: update on pathogenesis and treatment.

Lichen planopilaris (LPP) is considered to be a follicular variant of lichen planus. Clinical variants include classic LPP, frontal fibrosing alopecia, and the Graham-Little-Piccardi-Lassueur syndrome. The pathogenesis of LPP remains to be fully elucidated, but like other cicatricial alopecias involves the irreversible destruction of hair follicle stem cells and loss of a hair follicle's capacity to regenerate itself In the early stages of LPP, patients may have scalp pruritus, burning, tenderness, and increased hair shedding.

Mortality from acquired bullous diseases of skin in Canadian adults 2000-2007.

Background: Bullous skin diseases are known to be associated with significant morbidity and mortality. There have been no studies on mortality from severe bullous skin diseases in Canada.

Methods: We used mortality data from the Statistics Canada website from 2000 to 2007 for three major bullous skin diseases: bullous pemphigoid; pemphigus; and toxic epidermal necrolysis (TEN).

Narrowband UVB as an effective substitute for psoralen plus UVA: lessons from a psoralen shortage.

From March to August 2010, there was a shortage of encapsulated liquid 8-methoxypsoralen (8-MOP), the psoralen used for bath psoralen plus UVA (PUVA) in Toronto, Canada. Patients were forced to discontinue bath PUVA treatment and were transitioned to other therapeutic modalities, including narrowband UVB (nbUVB). A retrospective chart review was conducted of all patients who discontinued bath PUVA due to the unavailability of 8-MOP, with a focus on those who were switched to nbUVB.

Prospective registration and outcome-reporting bias in randomized controlled trials of eczema treatments: a systematic review.

We assessed completeness of trial registration and the extent of outcome-reporting bias in published randomized controlled trials (RCTs) of eczema (atopic dermatitis) treatments by surveying all relevant RCTs published from January 2007 to July 2011 located in a database called the Global Resource of Eczema Trials (GREAT). The GREAT database is compiled by searching six bibliographic databases, including EMBASE and MEDLINE. Out of 109 identified RCTs, only 37 (34%) had been registered on an approved trial register.

Use of pioglitazone in patients with lichen planopilaris.

Background: Recent basic science research has revealed a decreased tissue expression of peroxisome proliferator-activated receptor (PPAR) γ in lichen planopilaris (LPP). Therefore, thiazolidinediones, being PPARγ agonists, could be used to treat LPP.

Methods: We followed 24 patients with LPP who were treated with oral pioglitazone hydrochloride.

Techniques to minimize the pain of injected local anesthetic.

The process of injecting local anesthetic still often remains the most uncomfortable part of dermatologic surgery for patients. This review discusses strategies that may be used to reduce this discomfort.

Socioeconomic status, hospital volume, and stroke fatality in Canada.

Background And Purpose: Low socioeconomic status is associated with stroke fatality; however, the mechanism behind this association is uncertain. We sought to determine whether residence in a low-income neighborhood was associated with admission to low-volume facilities and whether this contributed to differences in fatality after stroke.

Methods: All hospitalizations for ischemic stroke from April 2003 to March 2004 were identified from a national administrative database containing patient-level sociodemographic, diagnostic, procedural, and administrative information.

A comparison of the cost-effectiveness of in vitro fertilization strategies and stimulated intrauterine insemination in a Canadian health economic model.

Background: In vitro fertilization (IVF) with single embryo transfer (SET) has been proposed as a means of reducing multiple pregnancies associated with infertility treatment. All existing cost-effectiveness studies of IVF-SET have compared it with IVF with multiple embryo transfer but not with intrauterine insemination with gonadotropin stimulation (sIUI).

Methods: We conducted a systematic review of studies of cost-effectiveness of IVF-SET versus IVF with double embryo transfer (DET).

Weekends: a dangerous time for having a stroke?

Background And Purpose: Weekend admissions are associated with higher in-hospital mortality. However, limited information is available concerning the "weekend effect" on stroke mortality. Our aim was to evaluate the impact of weekend admissions on stroke mortality in different settings.

Patient characteristics associated with nocturnal emergency department visits for asthma.

Study Objectives: To identify patient characteristics associated with nocturnal emergency department (ED) visits for asthma.

Methods: Asthmatic patients 18 to 55 years of age who visited Ontario EDs between April 1, 2003 and March 31, 2004, were identified through an administrative clinical database. Patients' time of ED presentation was analyzed for circadian pattern using histogram and polynomial regression.

Is fetal gender associated with emergency department visits for asthma during pregnancy?

Background: To investigate if fetal gender (1) affects the risk of having an emergency department (ED) visit for asthma; and (2) is associated with adverse pregnancy outcomes among women who had at least one visit to the ED for asthma during pregnancy.

Methods: We linked two provincial administrative databases containing records on in-patient deliveries and ED visits. The study sample included women who delivered a live singleton baby between April 2003 and March 2004.

Sex differences in hospital admissions from emergency departments in asthmatic adults: a population-based study.

Background: Women represent the majority of adult patients hospitalized for asthma. Analyzing the course of emergency department (ED) visits before hospital admission can help understanding of the mechanisms behind the excess of hospitalizations in women.

Objective: To investigate sex differences in hospital admission rates in adult patients with asthma visiting EDs in Ontario.

Does a birthday predispose to vascular events?

Objective: To examine the influence of birthdays on the onset and course of vascular events such as stroke, TIA, and acute myocardial infarction (AMI).

Methods: This population-based study included all emergency department (ED) admissions due to ischemic stroke, TIA, or AMI from April 2002 to March 2004 in Ontario, Canada. All cases were identified through the National Ambulatory Care Reporting System.

Missed opportunity: patients who leave emergency departments without being seen.

The rate of patients who visit emergency departments (EDs) but leave before being evaluated and treated is an important indicator of ED performance. This study examines patient- and hospital-level characteristics that may increase the risk of patients leaving EDs before being seen. The data are from the National Ambulatory Care Reporting System, an administrative database, and represent 4.

Effect of gender, age, and severity of asthma attack on patterns of emergency department visits due to asthma by month and day of the week.

Objective: To examine the pattern and strength of seasonal fluctuations in emergency department (ED) visits due to asthma, by month and day of the week, by the patient's age, gender, and severity of asthma attack.

Methods: Time series analysis of ED visits was conducted among patients with asthma aged from 18 to 55 years who visited Ontario EDs between April 1, 2001 and March 31, 2004. Autoregressive regression models with months and days of the week as predictors were fitted for (1) all patients; (2) females and males separately; (3) each combination of gender and age group, and (4) each combination of gender and level of severity.

Are there socio-economic differences in caesarean section rates in Canada?

Caesarean section rates have risen in recent years, sparking renewed debate about the circumstances under which such deliveries are being, and should be, performed. Some commentators suggest that increasing rates may, in part, be explained by women in higher-income brackets requesting elective caesareans (the so-called "too posh to push" hypothesis). After adjusting for maternal age, Canadian data do not support this theory.

Respiratory disease in relation to patient residence near to hazardous waste sites.

We have examined rates of hospitalization for respiratory diseases in relation to residences in zip codes with hazardous waste sites, as well as socio-economic status. Chronic bronchitis and chronic airway obstruction were elevated in persons who live in zip codes containing persistent organic pollutants (POPs) (PCBs and persistent pesticides) as compared to "clean" zip codes without hazardous waste sites or zip codes with hazardous waste sites containing other kinds of wastes, but the differences could be due to socio-economic status and behavioral risk factors since these are also important risk factors for respiratory diseases. Therefore, we investigated rates of hospitalization for individuals living in zip codes along the Hudson River, because here the average per capita income is higher than in the rest of the state, and there is less smoking, better diet and more exercise.